It's been well chronicled that the NHS is facing unprecedented change. This is certainly the case with Kent community health NHS trust (KCHT).
This new trust was formed on 1 April 2011, when Eastern and Coastal Kent community health NHS trust merged with West Kent community health to form one of the largest community healthcare trusts in the country.
With the merger come many challenges – but also opportunties for efficiency.
One critical task is to standardise compliance to governance and risk-management requirements across the integrated organisation. In the NHS, compliance isn't just a process of ticking the right boxes – it's the difference between a patient well being and tragedy.
The job has taken on even greater resonance with the Care Quality Commission's (CQC) new authority to sanction and even close down services if concerns of significant risk to patients are identified. The CQC can and does turn up unannounced at any service within a trust and question staff and patients about key areas within the standards of quality and safety, as set out by the care regulator.
The task of ensuring our enlarged workforce (5,700 staff) and each individual service within the trust comply with the standards is further complicated by the dispersed nature of running a community trust while bridging operational and culture differences between east and west Kent.
One thing we have done is to embed a sophisticated but easy-to-use real-time quality monitoring tool, from Allocate Software, to self-assess, input relevant actions, and ensure correct processes have been checked and assigned to an expert. Through the dashboard technology we have instant access to up-to-date information so we can tell at any point what assurance is available, what gaps in compliance exist, and what is being done about them.
This level of visibility is an absolute prerequisite to running an NHS trust. And yet it's not uncommon to work in a trust that still relies on multiple spreadsheets with outdated information and a poor grasp of what their problem areas are. Not only are these trusts woefully ill-equipped to cope with the changing compliance landscape, they're also impeded by an unhelpful compliance culture.
In reality the healthcare sector should welcome the extra stringency being exercised by the CQC. It is now equipped to help drive quality performance and safeguard patient care – a goal we should all strive to achieve. Equally as long as good governance is implicit in everything we do, we needn't fear its new powers.
For too long trusts have exhausted their resources and attention by seeking to back up everything they do with documentary evidence of good practice rather than focusing on practising compliance on a day-to-day basis, in the field, where it matters. To date too few trusts have placed adequate emphasis on taking a bottom-up approach to compliance.
It's time to shift the spotlight from creating paper trails and searching for proof of protocol, to each member of staff taking personal responsibility for their actions. The proof will then follow. This approach requires a level of education for all frontline staff and involves keeping CQC standards in the front of their minds in everything they do.
Integrity in compliance is paramount. Frontline staff need to be reminded that compliance is not about form-filling or chasing evidence for abstract standards, it is in fact about practising the basic standards of care every day. Anything short of this will be exposed, and rightfully so.
Jane Burgess is the standards assurance manager, Kent community health NHS trust
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