This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.

Following serious concerns about clinical and organisational failures in the NHS during the 1990s (such as Alder Hey, the Bristol Royal Infirmary and Shipman), the Government identified the need for a more systematic approach to improving quality and safety in healthcare. The Department of Health introduced clinical governance, a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care. Primary Care Trusts (PCTs) are responsible for providing primary care services and commissioning services on behalf of their local health economy. This report examines the Department's progress in implementing clinical governance in primary care; the lessons learned; and the risks that will need to be managed if quality and safety are to be embedded in the new PCTs. that clinical governance is not as well established in primary care as in secondary care, largely because of the complexity of PCTs role in both commissioning and providing care; and the independence of contractors delivering healthcare, particularly General Practitioners (GPs). Primary care has also been slower in adopting a structured approach to quality and safety, evident for example in the lack of compliance with national systems reporting of clinical incidents. There is a lack of clarity between PCTs and their contractors as regards accountability for ensuring quality and safety, and scope for greater involvement of patients and the public in ensuring that primary care services are safe and of high quality.

Clinical Governance is integral to healthcare and all doctors must have an understanding of both basic principles, and how to apply them in daily practice. Within the Clinical Governance framework, patient safety is the top priority for all healthcare organisations, with the prevention of avoidable harm a key goal. Traditionally medical training has concentrated on the acquisition of knowledge and skills related to diagnostic intervention and therapeutic procedures. The need to focus on non-technical aspects of clinical practice, including communication and team working, is now evident; ensuring tomorrow's staff are competent to function effectively in any healthcare facility. This book provides a guide to how healthcare systems work; their structure, regulation and inspection, and key areas including risk management, resource effectiveness and wider aspects of knowledge management. Changing curricula at undergraduate level reflect this, but post-graduate training is lagging behind and does not always equip trainees appropriately for a hectic clinical environment. An Introduction to Clinical Governance and Patient Safety presents a simple overview of clinical governance in context, highlighting important principles required to function effectively in a pressurised healthcare environment. It is presented in short sections based on the original seven pillars of clinical governance. These have been expanded to include the fundamental principles of systems, team working, leadership, accountability, and ownership in healthcare, with examples from everyday practice. This format is designed to facilitate use as a 'pocket guide' which can be dipped into during the working day, as well as for general reading. Examples from all branches of medicine are presented to facilitate understanding. Contributors are taken from a broad base - from junior doctors to internationally recognised experts - ensuring issues are addressed from all perspectives.

Primary Care Trusts (PCTs) are responsible at the local NHS level for the statutory "duty of care", largely through implementing clinical governance. The concept of clinical governance aims to improve continuously the overall standard of clinical care; reduce variations in outcomes of, and access to, services; and ensure that local decisions are based on the most up to date evidence of what is known to be effective. The key principles of clinical governance are: a coherent approach to quality improvement, clear lines of accountability for clinical quality systems and effective processes for identifying and managing risk and addressing poor performance. Clinical governance, implemented effectively, can provide PCT Chief Executives with assurance that healthcare, whether provided directly or commissioned from other providers, is both safe and of good quality. This report finds that the organisational structures and processes for clinical governance have largely been put in place at PCT level. But progress in implementing the different components of clinical governance varies both within and between PCTs. More needs to be done to provide assurance about the performance of General Practitioners and the systems which protect the safety of patients. Key features of those PCTs that can demonstrate consistent improvements in quality include effective clinical leadership, maintaining the capacity to deliver services, ensuring the quality of the patient experience and improving services based on lessons from complaints and patient safety incidents. The higher performing PCTs are characterised by: availability and accessibility of information to support evidence-based medicine; all staff appraised against an agreed work and development programme; service users involved in service development; clear action plans developed in response to clinical risks; and underperformance by clinical staff addressed by clear management procedures.

Dementia is a term for a range of progressive, terminal organic brain diseases, including Alzheimer's. Some 560,000 people in England are estimated to have dementia, with a steeply rising trend over the coming years. Some 476,000 people are unpaid carers of people with dementia. Direct costs to the NHS and social care are currently at least £3.3 billion a year, but the overall annual economic burden is estimated at £14.3 billion. This report examines what health and social care services are available for people with dementia and their unpaid carers in England and whether they are providing effective and good quality support. Until 2005 the Department of Health attached little priority to dementia, and progress was hampered by a lack of good quality data, by stigma, and by the low level of political and national focus on older people's mental health. The NAO conclude that services are not currently delivering value for money to taxpayers or people with dementia and their families. Whilst health and social care services are spending significantly on dementia, spending is late - too few people are being diagnosed or being diagnosed early enough. Early interventions that are known to be cost-effective, and which would improve quality of life, are not being made widely available. Services in the community, care homes and at the end of life are not delivering consistently or cost-effectively against the objective of supporting people to live independently as long as possible in the place of their choosing. The rapid ageing of the population means costs will rise and services are likely to become increasingly inconsistent and unsustainable without redesign. Recommendations cover: improving diagnosis and early intervention; improving management of services; gearing the system to respond to the major challenges of dementia in the future.

For many years, stroke was viewed as an inevitable consequence of getting old. For stroke patients there seemed little to be done, except making them more comfortable.Things have begun to change, moving towards better treatment and care for stroke through specialist services and key interventions, such as stroke units, immediate scanning, thrombolysis and Early Supported Discharge.The publication of the NAO report 'Reducing Brain Damage: Faster Access to Better Stroke Care (HC 452)' in November 2005 highlighted how these developments can improve the efficiency and effectiveness of stroke care. As a result, the Department of Health is working to develop a comprehensive national stroke strategy, crossing prevention, urgent care, hospital care, community support and social care.This publication 'Joining Forces to Deliver Improved Stroke Care' sets out recommendations from expert project groups for a new national stroke care strategy, while also examining key messages and examples of good practice arising from the October 2006 'Joining Forces to Deliver Improved Stroke Care' conference hosted by the NAO

Health Protection: Principles and practice is a practical guide for practitioners working at all levels in public health and health protection, including those with a non-specialist background. It is the first textbook in health protection to address all three domains within the field (communicable disease control; emergency preparedness, resilience and response (EPRR); and environmental public health) in a comprehensive and integrated manner. Written by leading practitioners in the field, the book is rooted in a practice-led, all-hazards approach, which allows for easy real-world application of the topics discussed. The chapters are arranged in six sections, which begin with an in-depth introduction to the principles of health protection and go on to illuminate the three key elements of the field by providing: case studies and scenarios to describe common and important issues in the practice of health protection; health protection tools, which span epidemiology and statistics, infection control, immunisation, disease surveillance, and audit and service improvement; and evidence about new and emerging health protection issues. It includes more than 100 health protection checklists (SIMCARDs), covering infections from anthrax to yellow fever, non-infectious diseases emergencies and environmental hazards. Written from first-hand experience of managing communicable diseases these provide practical, stand-alone quick reference guides for in-practice use. Both the topical content of Health Protection: Principles and practice, and the clearly described health protection principles the book provides, makes it a highly relevant resource for wider public health and health protection professionals in this continually evolving field.