The Clinical Standards Board for Scotland’s quality assurance system in secondary prevention following acute myocardial infarction

The Clinical Standards Board for Scotland (CSBS) was established in 1999 to develop a national system of quality assurance and accreditation of clinical services with the aim of promoting public confidence in the NHS in Scotland (NHSS). The coronary heart disease pathfinder project assessed services to patients following myocardial infarction. The quality assurance system involves comparison of performance against written standards developed by a multidisciplinary project group which included lay members. Six nationally applicable standards were the subject of comprehensive open consultation with both the public and the professions. All acute trusts in Scotland were issued with a self-assessment tool followed by a visit from a multidisciplinary external review team comprising of lay representatives and health service professionals who produced a verbal and written report. There was a pool of over 100 reviewers and each team numbered on average eight reviewers, two of whom were lay members. A national report of Scotland’s performance was published by CSBS in October 2001.
The main areas of concern in Scotland’s national performance were that few sites were able to meet the standard relating to thrombolysis times and there was an overall lack of robust audit material. It was noted, however, that the major strength of Scotland’s delivery of healthcare lay with the staff providing services.
The process of accreditation in Scotland differs from that of other countries and one of its strengths lies in the involvement of the public, patients and health professionals as peers in all stages. The process itself encouraged dissemination of good practice and highlighted areas of concern.