Chief executives will be 'expected to leave the NHS' if they fail to deliver the government's clinical governance programme, health secretary Frank Dobson warned this week.

Speaking on the day the Bristol Royal Infirmary inquiry started taking evidence, Mr Dobson said chief executives were 'sometimes expected to leave the NHS because they have failed' to balance the books. 'In future, clinical governance will be part of that assessment,' he said.

Trust boards that ignored warnings about poor performance could be 'in the firing line', along with other staff 'right down the line', Mr Dobson added.

He said the drive to improve standards was not designed to 'identify and punish wrongdoers', but to 'help clinicians and managers deliver to a higher standard'.

Mr Dobson was launching guidance setting out a timetable for health authorities, trusts and primary care groups to put clinical governance programmes in place.

Managers in HAs and trusts will have to carry out a 'searching and honest assessment' of their organisation's performance on quality by September as part of a 'baseline assessment' to identify 'particularly problematic services' and 'areas needing to be developed'.

NHS organisations will have to draw up development plans, including 'clear milestones' for bringing services up to standard, developing information technology, management, communications and training.

HAs, trusts and PCGs will have to publish annual reports on clinical governance, starting next year. These should be 'accessible to lay readers' and include 'meaningful indicators of progress'.

Regional offices will monitor trusts and HAs, and the Commission for Health Improvement will visit each 'local health system' every three years to check on clinical governance systems.

Funding for quality projects with 'significant resource consequences' will have to be agreed through health improvement plans, the guidance states.

Decisions 'will have to be made about which improvements are feasible and at what pace'.

Tim Jones, NHS Confederation policy manager, said 'it would be useful' to have development money to start the process. 'There has to be some money spent to win the hearts and minds of clinical staff,' he said, adding that investment in IT, staff development and human resources 'represented substantial costs' that should be funded centrally.

Doctors' leaders welcomed the guidance. Dr Mac Armstrong, secretary of the British Medical Association, said the Department of Health had set out a 'cautious' timetable recognising clinical governance 'cannot be achieved overnight'. He welcomed the change in management culture from a focus on the bottom line to a 'recognition that trust boards are responsible for quality'.

Chief medical officer Professor Liam Donaldson said the NHS had not been 'particularly good at learning from mistakes or replicating good practice'.

Clinical governance had to address the causes of 'fairly spectacular disasters', such as the Bristol case, and poor performance that included 'an element of organisational failure'.

Clinical Governance: quality in the new NHS.