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This article provides a comparative review of the interpretation and implementation of clinical governance frameworks within the four home countries of the UK - England, Northern Ireland, Scotland and Wales. Clinical governance has become one of most significant and important concepts in modern health care. The article considers the policy background and the many definitions of clinical governance, but specifically compares the various strategic and operational approaches to delivery of clinical governance in different parts of the UK. It is suggested that these variations in approach, by each of the four UK countries, can lead to confusion for healthcare professionals in trying to understand, implement and monitor elements of clinical governance in practice. [ABSTRACT FROM AUTHOR]

Some years ago the Government set out their plans for the regulation of Nurses and other health professionals in The NHS Plan (Department of Health [DH], 2000) and Making a Difference (DH, 1999). This year the government produced a new series of White Papers, aimed at bringing to fruition the earlier plans and the ideology that underpinned them. This article considers two such papers -- neither produced by a nurse, despite their impact on nursing work. High Quality Care for All (DH, 2008a) and A High quality Workforce (DH, 2008b) are discussed considering the power and control of health care delivery that doctors and nurses now enjoy. A conclusion is reached that whereas there is much talk of innovations in nursing ideology and clinical practice, and significant advances in nurse education and training designed to facilitate advanced and autonomous practice within the nursing profession, it is just that. The real positions of power and influence within clinical provision and practice have remained the same: held by civil servants and members of the medical profession. While nurses are represented it is at a lower level of influence and they are missing from the top table. The political level of decision making for Healthcare directly involves members of the medical profession but not nurses. [ABSTRACT FROM AUTHOR]