Published: 08/12/2005 Volume 115 No. 5985 Page 36

A director of clinical governance needs to be many things - leader, inspirer and energiser. Alexis Nolan asks Dr Ian Spencer how he does it.

'The role is one of leadership, providing inspiration - and It is unlikely we will be doing ourselves out of a job because we can always climb another rung on the quality ladder.' So says Dr Ian Spencer, director of clinical governance for Northumberland, Tyne and Wear strategic health authority.

'One aspect is about building aspiration in the system and in delivery, ' he says. 'I keep telling the troops they'll never be finished. There is always a step you can take to do something a bit better.' Clinical governance is what Ian describes as 'a fairly new beastie', but It is a role with bite, and vital in engaging the whole healthcare workforce to improve performance. It encompasses areas such as patient safety, risk management, and incident and accident reporting.

The people in clinical governance roles come from a variety of backgrounds; there is no typical career path. In Ian's case, he progressed from his medical degree and subsequent house jobs in the acute sector to a career in general practice in Durham.

'I was put onto the local medical committee and it opened up opportunities to join the family practitioner committee, one of the precursors to health authorities, ' explains Ian. 'And I hooked up to one of the management boards in the local hospital, and then I started to get sucked into projects around public health and emergency planning.' The publication of the Acheson public health report in 1988 was critical to Ian's career. 'It talked about this thing called a public health director; I remember sitting in bed thinking 'I am going there'.

'I squandered the security of general practice and went into the public health training programme in the northern region, without a guarantee of a job. Then I did my master's degree in public health.

In 1993, I was recruited in Newcastle to carry out a joint role between the family health services authority, where I went in as clinical policy director, and locum consultant in public health at Newcastle health authority.

'The portfolio at that time was the medical adviser-driven agenda of developing prescribing, starting to develop clinical policy but working across the boundaries of two health authority regimes. We then started a set of mergers that has taken me down a route of a series of primary care roles in Newcastle, developing the quality agenda and ending up where I am now.' On the SHA's creation in 2002, Ian's experience as clinical governance reviewer for the Commission for Health Improvement helped him get his new job.

What he has done to help NHS organisations in the region develop clinical governance was recognised only last month by the National Audit Office in its report A Safer Place for Patients:

learning to improve patient safety.

The NAO highlights the SHA's establishment of a clinical governance forum and associated network. Ian put these in place after an intensive threemonth period of visits to all clinical governance leads in the SHA's acute, mental health, ambulance and primary care trusts.

The purpose was to find out how he could help the trusts achieve what they wanted in clinical governance.

'I had this vision of developing a network meeting and wanted to get an idea of how they would want to work and what they could get out of it, ' says Ian.

The forum brings the clinical governance leads together every quarter to explore issues such as organisational culture and structure, clinical governance topics, trusts' priorities, good practice and networking.

It is also attended by representatives from the National Patient Safety Agency, the local government office, public health, dental leads, midwives, academics and others. 'It is an inclusive environment, ' says Ian. It has also been opened to include representatives from the independent sector, and Ian wants to ensure that patient representation is in place in the future.

The forum is supported by a network of around 15 feeder groups, covering areas such as senior nurses, dentistry and litigation leads.

'Our local mantra is that clinical governance is everybody's business, ' says Ian. 'It is not just the domain of the clinical governance lead - it actually covers the breadth of healthcare. Everybody's got a part to play. It is not just the boards and chief executives; It is not just the clinical; It is not just the doctors and nurses. It is porters, reception staff - everybody.' The SHA has also helped trusts include local priorities in the framework of clinical governance plans in areas such as healthcare-acquired infections, suicide and child protection Ian says that there is sometimes a tension in his role as both facilitator and inspector. 'I have to be firm but fair, ' he says. 'I have to support, but if something goes wrong I have to critically review it.' 'The job is partly about cheerleading, about inspiration, winding people up and keeping them energised, ' adds Ian. 'You have to be dogged, because you need to stick with it and have a thick skin. You have to be pushy.'

Dr Ian Spencer CV

2002 - director of clinical governance for Northumberland, Tyne and Wear SHA

2001-2002 - director of primary care for Newcastle and North Tyneside health authority

1994-2001 - head of primary care development for Newcastle and North Tyneside HA

1993-1994 - clinical policy director for Newcastle family health services authority and locum consultant in public health medicine 1992-1993 - senior registrar in public health medicine at South West Durham HA

1990-1992 - registrar in public health medicine at Newcastle HA

1976-1990 - principal in general practice in Ferryhill and Chilton, County Durham