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Clinical engagement has supplemented clinical governance in healthcare to strengthen the contribution of medical professionals to the assessment of clinical outcomes for patients. Assessments of clinical engagement have, until now, been qualitative; this case study in the journal Australian Health Review introduces the concept of quantitative assessment of clinical engagement by measuring the number of patients managed according to specialist society guidelines. Such an assessment engages all staff (medical, nursing, allied health and pharmacy) involved in patients receiving treatment according to such guidelines and provides an assessment of individual and organisational compliance with those guidelines. Clinical engagement is then quantified as the percentage of patients that have been documented to receive specialist society- or college-approved guideline-compliant treatment, relative to the total number who could receive such treatment, in any healthcare organisation.

This Health Service Journal (HSJ) article explores how executive leaders can drive improvement by focusing on developing an organisational culture, building up staff in an open, just, and empowering environment, thereby enabling organisations to meet the challenges of the new and uncertain healthcare environment.

A careful planning for a pandemic, like COVID-19, is critical to protecting the health and welfare of entire humanity. Hospitals play a very critical role within the health system in providing essential medical care to the community, particularly during the crisis. But hospitals are complicated and vulnerable institutions, dependent on crucial external support and supply lines. During the current outbreak, an interruption of these critical support services and supplies would potentially disrupt the provision of acute health care by an unprepared health-care facility. Any shortage of critical equipment and supplies could limit access to the needed care and have a direct impact on healthcare delivery and panic could potentially jeopardise established working routines. In such scenario, even a modest rise in admission volume can overwhelm a hospital beyond its functional reserve. Even for a well-prepared hospital, coping with the health consequences of a COVID-19 outbreak would be a complex challenge for sure.   WHO hospital readiness checklist shows the key actions to take in the context of a continuous hospital emergency preparedness process. This document is also attached for download.

In July 2018, the then Minister of State for Health, Stephen Barclay MP, commissioned Tom Kark QC to write a report and to make recommendations in relation to the fit and proper person test (FPPT) as it applied under Regulation 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Tom Kark QC review of the fit and proper person test (the Kark review) was published in February 2019 and made seven recommendations on how to improve the operation and effectiveness of Regulation 5. 2022 update The approved proposals which now form the basis of the current implementation work overseen by the newly established Kark Implementation Steering Group (the 2022/2023 Steering Group), are as follows: All Directors (executive, non-executive and interim) should meet specified standards of competence to sit on the board of any health providing organisation. Where necessary, training should be available. That a central database of directors should be created to hold relevant information about qualifications and history. A mandatory reference requirement for each director should be introduced. The FPPT should be extended to all commissioners and other appropriate arms-length bodies. The ministerial position is that Kark recommendation 5 (‘the power to disbar for serious misconduct’) is not being progressed at this time. Ministerial support was received for recommendation 6, and this will be taken forward as an action by the Department of Health Social Care (DHSC) and the Care Quality Commission (CQC): Remove the words “been privy to” from regulation 5. The final Kark recommendation related to extending the FPPT to social services. This is outwith the scope of the current NHS England work and will not progress as part of this programme of work.

An independent review of how effectively the test prevents unsuitable staff from being redeployed or re-employed in health and social care settings. The review was led by Tom Kark QC. It sets out 7 recommendations, including: developing competencies for directors making a central database of directors’ qualifications, training and appraisals expanding the definition of serious misconduct. The current fit and proper persons test is designed to ensure that senior staff who are responsible for quality and safety of care are fit and proper to be in their roles. The test applies to directors in the NHS, the independent healthcare sector and the adult social care sector.