For many years the relative informality of approach to governance has been one of the attractions of pilgrimage medicine, with clinicians feeling they can concentrate more on quality of care rather than red tape. Nevertheless transparent clinical governance is a modern day reality, and our sick pilgrims deserve to receive the same or better standard of care during a pilgrimage than they would receive at home. The future viability of pilgrimages including sick pilgrims is therefore interconnected with good clinical governance.
The seven pillars of clinical governance are—clinical effectiveness, risk management, patient experience and involvement, communication, resource effectiveness, strategic effectiveness, and learning effectiveness.
This is best provided by having good pilgrimage structures in place to ensure that excellent clinical practice is applied to the care of pilgrims, that the pilgrimage as an organisation has robust processes and procedures in place to identify and learn from clinical issues, and that they can demonstrate that learning. All of this is within the ability of any pilgrimage assisted by up to date clinical leadership, whether doctor, nurse or both. There is more information about what is recommended in "Guidance for arranging Pilgrimages involving children, young people and adults at risk" published in 2018 by NCSC and CSAS.
The clinical team is made up largely of nurses and doctors, as well as some allied health professionals such as physiotherapists, occupational therapists, etc. It is important that clinical staff are in good professional standing with their relevant professional organisations, and that their activities are covered by insurance. Nursing insurance is generally provided through the pilgrimages insurance, however, this does not cover the activities of doctors, who need to make contact with their individual indemnity organisations. Several years ago, there was a concern about this cover, arising from the decision (later reversed) by one medical indemnity firm to discontinue cover for doctors accompanying pilgrims to Lourdes. The background to this decision was that EU law stated doctors had to have insurance, and all UK medical indemnity firms provide assurance (not unlimited resources) rather than insurance. Currently all large indemnity organisations will provide cover for "humanitarian work" in Lourdes.
However, pilgrimages may wish to consider separate insurance to provide cover to the pilgrimage for overarching activities undertaken by doctors, such as assessment, training, etc., as this is not covered in the Catholic Insurance Services policy, which many pilgrimages use. This form of insurance was originally developed in conjunction with Seirbhis for use by Irish pilgrimages, but it is now more widely used in mainland Britain.