ABSTRACT

The term clinical guidelines had already been applied to developments in the NHS before 1997.4 It was the incoming Labour government of that year, however, which began to consolidate the role and function of CGs within a framework for a new system of NHS governance.5 The National Institute of Clinical Excellence (NICE) was established as part of the new system and it formally began work in April 1999.6

Clinical governance for the NHS has been described as a framework requiring a systematic set of mechanisms, for supporting an organisational environment in which excellent and improving quality of clinical services will flourish.7 Governance in this case can also be regarded as a set of social institutions (patterns of ways of doing things, perhaps partly governed by rules), involving distinctive processes with supporting organisational structures. The NICE was envisaged as a supporting structure largely to provide information, with other elements of governance being used to supply the incentives for individuals and organisations to pursue consistently excellent quality of service. For example, the Commission for Health Improvement, or CHI (informally soon known as ‘nasty’ in contrast with NICE), was set up as a central organisational structure to investigate evidence of unsatisfactory local clinical performance, to recommend changes if necessary, and to press for improvement.