The aim of this paper is to set out the role of clinical governance within the new commissioning framework. It starts by considering the historical development of clinical governance and lays out ideas for the new arrangements around the concept of the primary care home and concludes with challenging questions for the future.
The paper draws on the author's role and experience as a senior policy maker in the UK Department of Health.
If we are to fulfil the defined attributes of clinical governance the NHS needs to adopt a more reflective self‐auditing leadership culture. Whether that supposition is accepted or not, a set of questions arises. Why, given for instance the gross failures of care for the frail elderly, have the principles of clinical governance not been systematically embedded? Why, given the NHS can no longer be described as poorly resourced, are clinical outcomes for many conditions lagging behind equivalent international healthcare systems? Why have the improved access and clinical outcomes of recent years been dependent on political rather than NHS leadership? And why in our publicly funded NHS is there frequently a culture of regarding patients as grateful supplicants rather than true partners to whom we should account? Clinical governance for personal, population and system care. Does this represent a coming of age?
This article provides a contribution to the emerging policy debate around clinical governance in the new commissioned NHS, rooted in experience from both the clinical front line and the heart of national health policy making.
