NHS

A Critical Analysis of NHS Targets in Accident and Emergency Departments



A Critical Analysis of NHS Targets in Accident and Emergency Departments

Clinical Governance

At best, the National Health Service (NHS) is the envy of the world. At worst, there are unacceptable variations in service performance and practice that are wasteful and unfair (NHS Executive, 1998a). To rectify these inequalities, the present Government recently spelled out its commitment to health care quality. Of the Government policy documents, The New NHS: Modern, Dependable (Department of Health, 1997) required Trusts to establish clinical governance and more recently, A First Class Service - Quality in the New NHS (Department of Health, 1998), explained how clinical governance sits within trusts' quality assurance strategies. Clinical governance, an attempt to improve quality standards, efficiency, openness and accountability is defined as:

The means by which organisations ensure the provision of quality clinical care by making individuals accountable for setting, maintaining and monitoring performance standards (NHS Executive, 1998b). After a number of incidents in the British NHS (in which questionable clinical practices continued unchecked) clinical governance attempts to control clinical practice by strengthening professional development, the aim being to assure quality locally (Chambers, 1998). Clinical governance is also designed to bring clarification to areas of uncertainty, and consolidate segmented, health-care policy and practice.

Scally and Donaldson (1998) believe that a commitment to deliver high quality care should be at the heart of everyday clinical practice. It is therefore the responsibility of the government of the day to provide the necessary resources and infrastructure to facilitate efficient service delivery and quality treatment. At a local level it is the responsibility of general practitioners and trusts to use available resources to their maximum capacity to ensure this, and at a regional and national level the onus falls on the shoulders of the NHS managers and clinicians.

The Government has recently launched a new directive The NHS Plan (DOH, 2000a) which highlights investment in and reform of the NHS. It states that:

The document states that the public wanted to see:

More and better paid staff using new ways of working

Reduced waiting times and high quality care centred on patients

Improvements in local hospitals and surgeries.

The NHS Plan goes on to say that the, NHS is a 1940s system operating in a 21st century. It has:

A lack of national standards

Old-fashioned demarcations between staff and barriers between services

A lack of clear incentives and levers to improve performance

Over-centralisation and disempowered patients.

The challenge for the NHS is clear. In order to respond to and anticipate the needs of an ever-changing nation, healthcare services need to be:

Well-defined (i.e. clear strategic objectives and goals);

Co-ordinated (i.e. correct personnel for the job);

Realistic to needs (i.e. local and regional)

Efficient and cost-effective;

Supported by core systems and procedures;

Publicly accountable;

Progressive and innovative;

Reliable and available; and

Standardised (i.e. same treatment available everywhere).

In July 1998 the Government published the White Paper A First Class Service: Quality in the New NHS (DOH, 1998). This document outlined how trusts were expected to approach and implement quality initiatives in order to improve overall service ...