Published: 08/12/2005 Volume 115 No. 5985 Page 37

Clinical governance is, or should be, the thread through that runs through the tapestry of the whole organisation.

The role is an overall title for strands of work such as risk management, complaints handling, clinical audit, training and health and safety.

In essence, clinical governance is the framework that holds NHS organisations to account in safeguarding standards of care and improving service quality.

The concept was first described in the 1997 white paper The New NHS: modern, dependable, and further developed in the 1998 white paper A First Class Service: quality in the new NHS. It was finally enshrined in trusts' responsibilities in the 1999 Health Act.

But at the time the required systems and standards were not in place to coordinate that work, a gap that was filled by the Clinical Governance Association.

Clinical governance is working. Over the years it has made a difference for patients. But the momentum has to be maintained. We are working with the clinical governance support team to develop best-practice master classes.

The current changes in the NHS create a whole new ball game and clinical governance is key to helping provide answers on how organisations can commission for quality. Clinical governance is all about patient care. It is part of performance management; making sure that organisations provide care with quality, or buy care with the appropriate quality indicators built in.

We have an ideal opportunity to get clinical governance embedded in commissioning, contributing to the indicators we will look for when we buy services from acute or specialist hospitals. Should we buy care from an organisation that is not compliant with patient safety? We have never asked the question before; the priority has been ensuring that targets are met.

For some in clinical governance the issue is simply how to get the profile raised at board level when organisations are so target-driven. It is easy to focus on four-hour accident and emergency targets, but not so clear how make the board accountable for quality. If you get clinical governance right, it should fall together like the pieces of a jigsaw.

Audrey Fitzpatrick is chair of the Clinical Governance Association and clinical governance lead for East Cheshire primary care trust.