You've been CHI'd: Clinical Governance and Quality in the Post‐modernisation (post‐CHI) NHS
| DOI | https://doi.org/10.1108/13619322200400024 |
| Published date | 01 September 2004 |
| Date | 01 September 2004 |
| Pages | 6-12 |
| Author | Dominic Ford,Dawn Wakeling |
| Subject Matter | Health & social care |
You’ve been CHI’d: Clinical
Governance and Quality in the
Post-modernisation (post-CHI) NHS
Dominic Ford
Mental Health Operations Development
Manager, Healthcare Commission
Dawn Wakeling
Associate Director, Performance
Development Team, NHS Modernisation
Agency
Framework Feature
n 1 April 2004, the Healthcare
Commission took over the mantle of quality
inspections for the NHS from the Commission for
Health Improvement, which had led a programme of
clinical governance reviews in mental health trusts. In
this article we review the development of clinical
governance in mental health services, assess its
impact, consider the future for inspection in mental
health trusts, and identify what we have learned about
mental health service quality through the process of
clinical governance.
CHI
The establishment of the Commission for Health
Improvement (CHI) on 1 April 2000 was part of the
wider quality improvement agenda in the NHS. CHI
sat alongside other ‘new regulators’ such as the
National Institute for Clinical Excellence (NICE), the
National Patient Safety Agency (NPSA), the National
Clinical Assessment Authority (NCAA) and quality
programmes such as the national service frameworks.
Compared with its successor, CHI’s original functions
and powers were limited, but the creation of CHI
extended systematic inspection in the NHS some
time after inspection had been common in other parts
of the public sector. From its inception CHI
deliberately positioned itself as being different in its
approach from other inspectorates, particularly Ofsted,
stating early on that it aimed to be ‘supportive and
developmental’. Yet at the same time it was designed
Oto raise public confidence in the NHS following a
series of high-profile service failures.
In its short life CHI acquired additional
responsibilities. The NHS Plan led to the creation of an
Office for Information on Healthcare Performance,
charged with collating and publishing data on NHS
performance. CHI also became responsible for
national clinical audits, patient and staff surveys and
the publication of performance indicators and star
ratings.
NHS trusts’ primary experience of CHI has been
through its clinical governance reviews. Clinical
governance is defined as ‘a framework through which
NHS organisations are accountable for continuously
improving the quality of their services and
safeguarding high standards of care by creating an
environment in which excellence in clinical care will
flourish’ (Department of Health, 1998).
Clinical governance and mental health
At first clinical governance appeared an alien concept
to many in mental health services. It seemed to be
based on the medical model and mental health trusts
were slower to embrace it than the acute sector. A
report from CHI on its findings from early mental
health service reviews (Commission for Health
Improvement, 2003) stated that a focus on other policy
initiatives such as social care integration and NSF
implementation had led to delays in implementing
clinical governance. Trust mergers also had an impact.
Research showed that mergers and restructuring set
back progress in NHS organisations by up to two years
6The Mental Health Review Volume 9 Issue 3 September 2004 ©Pavilion Publishing (Brighton) 2004
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