Monitor publishes lessons learnt from Mid Staffordshire….and (re)defines clinical governance

Following the significant failings in quality of care at Mid Staffordshire NHS Foundation Trust, Monitor commissioned KPMG, its internal auditors, to consider how the way Monitor operates and works with others could be improved. The KPMG report and Monitor’s response has been published by Monitor (See below).

The KPMG report makes fourteen recommendations; all of these have been accepted by Monitor and, says Monitor, agood progress has already been made against many of these. There are two main themes:

1. The need for better sharing of information across the healthcare system. Monitor has already taken action in this area. We have agreed arrangements with the Care Quality Commission (CQC) to ensure that we are informed about concerns that they might have about the quality of care delivered by applicants to be foundation trusts and that these concerns are resolved before a decision is taken to authorise the applicant. Arrangements have also been agreed to share information about under-performing foundation trusts and to coordinate any action. These agreements are part of the Memorandum of Understanding which Monitor and the CQC have now signed and can be downloaded below.

2. The need for Monitor to focus on developing an approach to assuring itself that appropriate clinical governance is in place in applicant or existing foundation trusts. Monotor has (re)defined clinical governance as “the combination of structures and arrangements in place at, and immediately below, the Board level to manage and monitor clinical performance, plan and manage continuous improvement, identify performance that may be below standard or out of line, investigate it and take management action.”

Healthcare Governance Review feels the definition of clinical governance does nothing to bring clarity to the governance versus management debate.  The Monitor definition is a confusing ‘jumble’ of governance and management statements. Indeed, the majority of Monitor’s definition speaks to management rather than governance concerns. Monitor would have been better to adopt the Scottish definition of clinical governance, which is “Corporate accountability for clinical performance.”

Download the KPMG report, Monitor’s response and the Monitor/CQC Memorandum of Understanding here.

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