Quality, safety and clinical governance in NHS and independent hospitals: lessons from the interface

AIMS AND OBJECTIVES The overall aim of this research is to provide evidence on the quality and safety of patient care in NHS and independent hospitals and the effectiveness and impact of shared arrangements for clinical governance. BACKGROUND The quality and safety of acute care in both NHS and independent hospitals, and its oversight through clinical governance, have been the subject of a number of public inquiries and other reports and there are longstanding concerns among policymakers and leaders in both the NHS and independent healthcare sectors. Empirical evidence on the quality and safety of care has been limited by the lack of comparable routine data across both NHS and independent hospitals, but that is now changing. The importance of clinical governance has been recognised and we know that some important reforms have been initiated but not how well they are working, particularly to address the way clinical governance works across the interface and between organisations. RESEARCH QUESTIONS 1. What are the characteristics of the patient population and the care provision in NHS and independent hospitals in England, and what differences are observed by funding type (NHS or private), care setting (NHS or independent), specialty, procedure, geography and over time? 2. Can we map and measure the overall scope of practice of doctors providing care in both NHS and independent hospitals, and explore how well those organisations understand and oversee that scope of practice through the separate and shared arrangements for clinical governance that they have in place? 3. How does the quality and safety of care provided in NHS and independent hospitals differ, and what hospital, consultant, or other characteristics are associated with such variations? 4. How have the practice and working arrangements between NHS and independent hospitals changed during and after the COVID19 pandemic, and what effects have those changes had on clinical governance and the quality and safety of care? METHODS This is a mixed methods study, combining the use of a survey of clinical governance leads in NHS and independent hospitals; in-depth qualitative research in case study clusters of linked NHS and independent hospitals; quantitative analysis of existing and newly available routine data sets on inpatient care; and qualitative work with patients with experience of both NHS and independent hospital care. A detailed project plan and timetable are set out in the accompanying Gantt chart. DISSEMINATION AND IMPACT We have focused from the outset on how this project can help to improve quality and safety and tackle the problems highlighted by the Paterson inquiry and other reports, and the development of this proposal has had close involvement and support from our PPI group and colleagues in a range of stakeholder organisations (the Independent Healthcare Provider Network, the Care Quality Commission, NHS Digital, the Private Healthcare Information Network, the General Medical Council) who are key to dissemination and uptake of its findings. Our Project Advisory Group will include representatives of all these organisations and others. We set out clear plans for the research to produce actionable research findings of real value to NHS organisations, independent healthcare providers, and the various stakeholder organisations outlined above in improving quality, safety and clinical governance, and for a programme of focused dissemination events and forums.