Clinical governance was the centrepiece of an NHS white paper introduced soon after the Labour government came into office in the late 1990s.1 The white paper provides the framework to support local NHS organisations as they implement the statutory duty of quality, which was placed on them through the 1990 NHS act.2 Clinical governance provides the opportunity to understand and learn to develop the fundamental components required to facilitate the delivery of quality care—a no blame, questioning, learning culture, excellent leadership, and an ethos where staff are valued and supported as they form partnerships with patients. These elements have perhaps previously been regarded as too intangible to take seriously or attempt to improve. Clinical governance demands the re-examination of traditional roles and boundaries—between health professions, between doctor and patient, and between managers and clinicians—and provides the means to show the public that the NHS will not tolerate less than best practice.

In 1998 Scally and Donaldson set out the vision of clinical governance: “A framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.”3 In this paper we take the story forward. Two years on, how is clinical governance faring in the NHS, and, with the advent of the national plan for the NHS,4 how is it being developed in practical terms?