Clinical Governance

Clinical Governance Structure

At St Peter's Hospice we are committed to making sure our patients, their families and carers receive a continually high standard of safe and compassionate care. We aspire to excellence in all we do.

To make sure we are providing excellent care, we use the NHS framework. This incorporates seven areas of working practice known as the 'seven pillars' of clinical governance.

The seven pillars do not stand alone – they are brought together to ensure and maintain quality and safety of care. More detail about each pillar is below.

Clinical governance pillars

Process of Governance

1. Risk Management – we have put robust processes in place to understand, monitor and minimise the risks to patients and staff. These are based on national tools including risk assessments and live risk registers, as well as oversight from senior staff, regular meetings and reports.

2. Clinical Audit - to ensure that clinical practice is continuously monitored and improved, we have a regular programme of clinical audit based on local and national standards. Our staff take part in this through our Clinical Audit and Practice Improvement Group.

3. Education, Training and Continuing Personal and Professional Development – our education department leads the provision of up-to-date education, competency assessment and continuing professional development. We have a digital platform that allows easy assessment of attendance and compliance.

4. Clinical Effectiveness – our clinical governance processes are designed to use data, feedback and reflection to ensure we deliver the best evidence-based and patient-centred care.

5. Information – we are transparent with patients about how we use their data in order to deliver the best possible clinical care. We submit quarterly and yearly reports to the commissioners and trustees, and our quality account is published on NHS Choices and our website.

6. Client and Carer Experience and Involvement - we proactively ask for feedback from our patients, their families and carers using compliments, comments, concerns and complaints. Where needed, we make changes to improve the care and support we provide.

7. Staffing and Staff Management – our human resources department works with our clinical teams to support quality and efficiency in the recruitment, induction, retention and management of staff.



The Quality Account is submitted to the NHS on an annual basis. The aim of this report is to give clear information about the quality of our services so that our patients can feel safe and well cared for, their families and friends are reassured that all of our services are of a very high standard and that the NHS is receiving very good value for money. We also undertake PLACE (Patient-led assessments of the care environment). Each year, St Peter’s Hospice reports to the Care Quality Commission (CQC). The CQC is an independent regulator of health and adult social care in England with an aim to improve and maintain better standards of care.

How to give feedback

We greatly value the feedback that patients and families give to us. We want to learn from your experience, hear what we are doing well, and importantly how we might be able to improve both now and in the future.

Give your feedback