The NHS Executive has pulled back from compelling health authorities and trusts to sign a public assurance that all their clinical and non- clinical risks are assessed and properly managed by the year 2000.
The current system of controls assurance will be extended to cover key areas of non-clinical risk, such as health and safety, buildings and infection control, said NHS director of performance and finance, Colin Reeves, at a conference last week.
But health boards won't yet be required to give a public guarantee that controls for maintaining clinical standards are in place and working.
This appears to go back on guidance released last year, which proposed that 'a more comprehensive controls assurance statement will become mandatory in the NHS in 1999-2000, embracing all internal control.' This was interpreted as including clinical standards.
The retraction is thought to be due to fears of a high rate of non-compliance by trusts and health authorities, and the danger of clinical governance becoming bogged down in a bureaucratic quagmire.
Controls assurance has been described by Mr Reeves as 'the final part of the corporate governance jigsaw'.
At the conference, he stressed that 'controls assurance statements covering clinical, organisation and financial systems are the goal'.
But he wanted to avoid imposing a bureaucratic structure that would 'put clinicians off' and 'undermine' the 'delicate flower' of clinical governance.
The aim was 'to develop controls assurance so that it covers the complete totality of systems without impinging on or subsuming clinical governance', he said.
His model would make control of clinical risk a shared responsibility between clinicians and the board, but would not immediately be brought under the umbrella of controls assurance. It would, however, provide a clear link between clinical governance and corporate governance, which would be allowed to develop separately, but 'hand in hand'.
Organisational control standards relating to management of the environment of care have been drafted for inclusion into controls assurance in 1999- 2000, Mr Reeves said. Guidance will be published next month.
Managers welcomed the revised approach. Sonia Mills, who became chief executive of Swindon and Marlborough trust after it was prosecuted by the Health and Safety Executive in a landmark case last year,described the proposals as 'heartening'.
'In many trusts getting the full programme running would have involved a great a deal of work,' she said.
Addenbrooke's trust administrative director Keith Day described it as a 'good, practical development of the controls assurance initiative', which would 'enable true clinical governance to continue without inhibition'. The new standards were 'a good,
commonsense list of things that trusts should have in good shape anyway'.