Quality in Optometry Wales Introduction

Clinical Governance is all about maximising quality of care, patient safety and service delivery on an on-going basis. It covers many aspects of practice from Health and Safety to clinical interactions. It is not new to optometry since many aspects of clinical governance are enshrined in legislation or regulation as well as in the College of Optometrists' code of Ethics and Guidance on Professional Conduct and in other guidance documents. In some ways it might be analogous to the quality control exerted by a major supermarket chain on its suppliers, or by airlines and railways to ensure passenger safety, all of which most people would regard as good things. Although originating within the NHS, clinical governance is a quality framework and, as such, is clearly applicable to both NHS and private practice. Given the current trends for litigation and fraud investigation, operating an effective clinical governance framework can provide a safer working environment for the practice owner and staff as well as the patient. The concept of clinical governance in the NHS began in 1998 with the publication by the Department of Health of the document "A First Class Service: Quality in the NHS" which provided the following and now widely used definition of clinical governance:

"A framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish."

Initially clinical governance in Wales was seen to consist of a series of five themes for improving quality and ensuring that professionals were accountable for their practice. These themes were patient experience; quality improvement; staff focus; use of information; and leadership, strategy and planning.

The focus of clinical governance has since changed significantly in the light of reports such as the Kennedy report on the Bristol Children's Hospital (2001) and "Building a Safer NHS for Patients" (2001). These reports and the launch of the National Patient Safety Agency in September 2001 mapped out the quality agenda in terms of the objective of creating world-class health and social care for Wales in the twenty-first century mapped out in "Design for Life" (2005).

Thus, from the perspective of the National Assembly for Wales and local health boards, the focus on standards has moved on from the clinical governance themes approach and is now detailed by more recent thinking in "Healthcare Standards for Wales" (2005). (There is a similar document for England.) Local health boards are required to engage in clinical governance with, amongst others, all their contractors and they are monitored on their performance by the Healthcare Inspectorate Wales.

The standards cover the following areas, known as 'domains':

• Patient experience
• Clinical outcomes
• Healthcare governance
• Public health

The standards within the domains have been organised so that they can be directly mapped across to existing clinical governance guidance in Wales as illustrated in the table below:

When commissioning new services, LHBs expect service providers to meet or be working towards the standards outlined in "Healthcare Standards for Wales." It is likely that this requirement will extend to any new additional services provided by optometrists in the future.

In September 2002 the Welsh Assembly Government published "The Future of Optometric Services in Primary Care in Wales" outlining its vision for the future role of optometry in the provision of eye care. "Quality in Optometry in Wales" now shows the quality optometric practices can offer when providing these future services. Indeed quality in optometry is very high: Optometrists and dispensing opticians are very highly trained; practices respond to the market environment by offering high quality services; and LHBs already know that there are very few patient complaints about optometry services.

In this clinical governance toolkit we have worked down the list of standards and identified where and how they apply to optometry. As stated above, this covers many aspects of practice. Many of these relate to activities that are either a legal requirement or are simply good clinical practice. This means that most practices should be compliant with many aspects of clinical governance without any new effort.