Clinical governance and the central role of clinical audit Clinical governance is the programme of work through which the NHS is committed to improving clinical quality. The initiative was launched in 1998 as part of a major reform of the health service following Labour's return to power in 1997. Its purpose was 'to ensure that clinical standards are met, and that processes are in place to ensure continuous improve ment in quality' (Department of Health, 1998). For the first time a statutory duty was proposed for trusts concerned with the quality of their services. The chief executive was to be charged not only with the responsibility of ensuring that there was continuous improvement in clinical quality, but also with the duty to report to the board on the state of clinical quality. Trusts were to be given a new statutory duty for the quality of clinical services. Unlike the clinical audit programme that preceded it, clinical quality was no longer solely a professional responsibility that managers could leave to clinicians.