Clinical governance-from rhetoric to reality?

Although clinical governance now has a strong structural base in the National Health Service (NHS), its actual application in terms of service delivery is more inconsistent. Cross-agency and boundary working are still underdeveloped, and true patient involvement remains the province of a minority of enthusiasts. Despite this there have been some significant moves forward in that quality is now intrinsically linked to service delivery, and managers and clinicians are more explicitly accountable for the care they provide. This article examines the introduction of clinical governance to the NHS and discusses what practical applications have been made. Case studies drawn from those who are working at the frontline are used to illustrate the impact that clinical governance components have had on service delivery and patient experience.