On the day the inquiry into the Bristol heart scandal began, the Department of Health published guidance on clinical governance.

The Bristol case - in which at least 29 children died after substandard heart operations - highlighted the fact that hospitals around the country may have widely different standards of clinical care.

Health campaigners say that, for many conditions, patients are faced with a lottery of care, with some areas offering better standards than others.

Equal access

Launching the new guidance, Health Secretary Frank Dobson said: "Patients have the right to expect that the same high standards of care should be in place across the whole country.

"We want to tackle the unacceptable variations of service across the country, assuring quality and improving equity of access."

The clinical guidance is divided into four key steps which all NHS bodies are expected to follow. They are:

• Setting up a clinical governance committee as part of their board, which will represent a balance of skills and interests
• Carrying out an assessment of the trust's ability to implement clinical governance
• Formulating and agreeing a plan for developing clinical governance and improving standards of clinical care
• Setting out in board and annual reports the clinical governance arrangements.

Professor Liam Donaldson, the government's Chief Medical Officer, said: "Clinical Governance aims to produce within every health organisation in the country an environment in which clinical excellence will flourish.

"The guidance acknowledges that many organisations do already deliver high standards of care.

"This initiative will ensure that all organisations will level up to the best that is provided across the country."

But Suzanne Tyler, deputy director of the Institute of Health Services Management, which represents NHS managers, said: "Here we have a little more detail about what is expected of managers, but the question remains how managers can be held responsible for clinical governance when they have very little power to influence clinical behaviour."

Professor Donaldson: the aim is to ensure that all NHS bodies are up to the best

The guidance is just one step in the government's efforts to boost standards across the country.

In April, the National Institute for Clinical Excellence will be set up.

It will oversee the setting of clear national standards, which will be laid down in National Service Frameworks.