Stephen Tilley is a Senior Lecturer in Nursing Studies at the University of Edinburgh.Roger Watson is a Professor of Nursing in the School of Nursing, Social Work and Applied Health Studies at the University of Hull.

• Contributors xiPreface xiii1 Introduction 1Roger Watson and Stephen TilleyHistorical perspective 1An accountant looks at nursing 1Accountability and clinical governance 2Accountability and the law 2A policy perspective 3An NHS trust perspective 3A manager speaks 4Caring for children 4Learning disabilities 5Midwifery 5Community nursing 6Mental health nursing 7Research 8Conclusion 82 The Development of Nursing as an Accountable Profession 9Susan McGannIntroduction 9Historical perspective 9The British Nurses’ Association 10Mrs Bedford Fenwick 10Professional registration 12Matrons’ Council of Great Britain and Ireland 12Political perspective 14Early registration bill 15The war 16Registration Act 1919 18Conclusions 193 Accountability and Clinical Governance in Nursing: a Critical Overview of the Topic 21Kerry JacobsIntroduction 21Accountability 26Accountability and reform 30Clinical governance 32Conclusion 364 Accountability and Clinical Governance 38Roger WatsonIntroduction 38Clinical governance 39Why do we have clinical governance? 39Poor care 42Short cuts 43Trust 44Conclusion 455 The Legal Accountability of the Nurse 47John TingleIntroduction 47The concept of accountability and the new NHS 47Accountability is not irrelevant 48Labels can obscure meanings 48Ideas behind the label 48This chapter 48Legal accountability 49Interests, rights and duties: the role of the law 49The Ms B. case 49Dispute resolution, compensation and punishment 50Establishing nursing negligence 50Vicarious liability 51The aim of the law: compensation 51Clinical negligence law today: all change? 51Regulation, deterrence and education: the role of the law 52Evidence-based healthcare and the courts 54The scandals of recent years 54The law affects all aspects of nursing 55The various forms of accountability 55Accountable to whom? 56Accountability and sanctions 57The allocation and management of healthcare resources: the nurse’s role 58A conflict of accountability 58The role of the law: legal accountability 59Cases of resource and negligence 59Conclusion 636 Accountability and Clinical Governance: a Policy Perspective 64Tracey HeathIntroduction 64Background: the NHS pre-1997 64The Labour Government’s challenge 66Practising within an era of increasing accountability 68Towards a modern and dependable NHS: the Labour Government’s response 68Accountability and clinical governance 70Organisational accountability 70Reflections on the broader policy context 74Conclusion 767 Accountability in NHS Trusts 77Stephen Knight and Tony HostickIntroduction 77Clinical governance 77Responsibilities of trusts 78Professional self-regulation 82A systematic approach to decision making 84Implications for practice 84Conclusion 868 Accountability and Clinical Governance in Nursing: a Manager’s Perspective 87Linda PollockIntroduction 87Background context 87Clinical governance as a concept 88The meaning of clinical governance 88Our interpretation of clinical governance 89Has clinical governance made a difference? 91Clinical governance and its impact at board level 91Clinical governance structures as a vehicle for change 92Clinical governance and people governance 93Clinical governance and its impact on nursing 95Clinical governance and cultural change 96Sharing good practice 97Evidence-based practice – the reality 989 Working with Children: Accountability and Paediatric Nursing 99Gosia BrykczyñskaIntroduction 99Definition of paediatric nursing 100Ability 101Obligations 103Involving parents 104Autonomy of children 106Authority 107Free will and choice 108Power and political action 109Responsibility 111Responsibilities for treatment 111Consequences of responsibility 113Responsibility of parents and children 114Conclusion 11610 Accountability and Clinical Governance in Learning Disability Nursing 117Bob Gates, Mick Wolverson and Jane WrayIntroduction 117Clinical governance in learning disability nursing and guidelines for practice 118Consent 120Interdisciplinary working 120Evidence-based practice 121Advocacy 121Autonomy 121Relationships 122Confidentiality 122Risk assessment and management 122The challenges of effectively implementing clinical governance in services for people with learning disabilities 123Fragmented partnership working 125User and carer involvement 125The spectrum of need 126Quality of life 126Solutions to the barriers associated with implementing clinical governance in learning disability services 127Conclusion 13111 Where does the Buck Stop? Accountability in Midwifery 132Rosemary ManderIntroduction 132What is meant by accountability? 133To whom is the midwife accountable? 134Institutional accountability 135Accountability to the woman 136Personal accountability 136Professional accountability 137Hierarchy of accountability 138Accountability and autonomy 139What are the prerequisites for accountable midwifery practice? 140What are the implications of the midwife being accountable? 141Conclusion 14112 Accountability in Community Nursing 143Sarah Baggaley with Alison BryansIntroduction 143Organisational and policy issues affecting the accountability of community nursing 143Current issues in community nursing 145Resource allocation and skill mix 145Delegation and skill mix 145Legal and professional issues in community nursing 147Clinical governance 148Clinical effectiveness and evidence-based practice 149Role developments 150Nurse prescribing 152Primary healthcare and public health nursing 153Conclusion 15613 Clinical Governance, Accountability and Mental Health Nursing: an Emergent Story 157Stephen TilleyIntroduction 157Review of themes from Tilley (1995) 158The centrality of the topic 158Accounts 160Accounting 161Accountability 162Accountability and clinical governance 164The role of the mental health nurse in clinical governance 16714 Accountability in Nursing Research 170Alison Tierney and Roger WatsonIntroduction 170Research as a responsibility of an accountable profession 170Accountability in nursing research 171Nurse researchers as nurses 172The importance of accountability in research 172To whom are nurse researchers accountable? 173Accountability to the sponsor 174Accountability to research ethics committees 176Accountability to research participants 178Accountability to research ‘gatekeepers’ 182Accountability to (and of) the profession 185Accountability to the wider public 186Tensions of multiple accountability 187Conclusion 189Appendix Code of Professional Conduct 190(Reproduced with permission of the Nursing and Midwifery Council)References 198Index 216

‘This interesting book would be an ideal reference source particularly for students and post graduate/ registration nurses undertaking professional studies in nursing.’ Journal of Neonatal Nursing 'This book is enjoyable and thought provoking and would be of use to alI nurses, particularly those with an interest in clinical governance or those who are wishing to expand their clinical roles.' Nursing Standard ''If you are looking for a book with opinions on accountability, this book is for you... A great reference for the library.' Journal of Advanced Nursing "This book has attempted successfully to address the whole issue of accountability and clinical governance in a truly holistic way... It is a book that is neither simple nor abstruse but succeeds in placing all the threads together in order to clarify the truth behing accountability and clinical governance." Journal of Psychiatric and Mental Health Nursing

Stephen Tilley is a Senior Lecturer in Nursing Studies at the University of Edinburgh.Roger Watson is a Professor of Nursing in the School of Nursing, Social Work and Applied Health Studies at the University of Hull.

• Contributors xiPreface xiii1 Introduction 1Roger Watson and Stephen TilleyHistorical perspective 1An accountant looks at nursing 1Accountability and clinical governance 2Accountability and the law 2A policy perspective 3An NHS trust perspective 3A manager speaks 4Caring for children 4Learning disabilities 5Midwifery 5Community nursing 6Mental health nursing 7Research 8Conclusion 82 The Development of Nursing as an Accountable Profession 9Susan McGannIntroduction 9Historical perspective 9The British Nurses’ Association 10Mrs Bedford Fenwick 10Professional registration 12Matrons’ Council of Great Britain and Ireland 12Political perspective 14Early registration bill 15The war 16Registration Act 1919 18Conclusions 193 Accountability and Clinical Governance in Nursing: a Critical Overview of the Topic 21Kerry JacobsIntroduction 21Accountability 26Accountability and reform 30Clinical governance 32Conclusion 364 Accountability and Clinical Governance 38Roger WatsonIntroduction 38Clinical governance 39Why do we have clinical governance? 39Poor care 42Short cuts 43Trust 44Conclusion 455 The Legal Accountability of the Nurse 47John TingleIntroduction 47The concept of accountability and the new NHS 47Accountability is not irrelevant 48Labels can obscure meanings 48Ideas behind the label 48This chapter 48Legal accountability 49Interests, rights and duties: the role of the law 49The Ms B. case 49Dispute resolution, compensation and punishment 50Establishing nursing negligence 50Vicarious liability 51The aim of the law: compensation 51Clinical negligence law today: all change? 51Regulation, deterrence and education: the role of the law 52Evidence-based healthcare and the courts 54The scandals of recent years 54The law affects all aspects of nursing 55The various forms of accountability 55Accountable to whom? 56Accountability and sanctions 57The allocation and management of healthcare resources: the nurse’s role 58A conflict of accountability 58The role of the law: legal accountability 59Cases of resource and negligence 59Conclusion 636 Accountability and Clinical Governance: a Policy Perspective 64Tracey HeathIntroduction 64Background: the NHS pre-1997 64The Labour Government’s challenge 66Practising within an era of increasing accountability 68Towards a modern and dependable NHS: the Labour Government’s response 68Accountability and clinical governance 70Organisational accountability 70Reflections on the broader policy context 74Conclusion 767 Accountability in NHS Trusts 77Stephen Knight and Tony HostickIntroduction 77Clinical governance 77Responsibilities of trusts 78Professional self-regulation 82A systematic approach to decision making 84Implications for practice 84Conclusion 868 Accountability and Clinical Governance in Nursing: a Manager’s Perspective 87Linda PollockIntroduction 87Background context 87Clinical governance as a concept 88The meaning of clinical governance 88Our interpretation of clinical governance 89Has clinical governance made a difference? 91Clinical governance and its impact at board level 91Clinical governance structures as a vehicle for change 92Clinical governance and people governance 93Clinical governance and its impact on nursing 95Clinical governance and cultural change 96Sharing good practice 97Evidence-based practice – the reality 989 Working with Children: Accountability and Paediatric Nursing 99Gosia BrykczyñskaIntroduction 99Definition of paediatric nursing 100Ability 101Obligations 103Involving parents 104Autonomy of children 106Authority 107Free will and choice 108Power and political action 109Responsibility 111Responsibilities for treatment 111Consequences of responsibility 113Responsibility of parents and children 114Conclusion 11610 Accountability and Clinical Governance in Learning Disability Nursing 117Bob Gates, Mick Wolverson and Jane WrayIntroduction 117Clinical governance in learning disability nursing and guidelines for practice 118Consent 120Interdisciplinary working 120Evidence-based practice 121Advocacy 121Autonomy 121Relationships 122Confidentiality 122Risk assessment and management 122The challenges of effectively implementing clinical governance in services for people with learning disabilities 123Fragmented partnership working 125User and carer involvement 125The spectrum of need 126Quality of life 126Solutions to the barriers associated with implementing clinical governance in learning disability services 127Conclusion 13111 Where does the Buck Stop? Accountability in Midwifery 132Rosemary ManderIntroduction 132What is meant by accountability? 133To whom is the midwife accountable? 134Institutional accountability 135Accountability to the woman 136Personal accountability 136Professional accountability 137Hierarchy of accountability 138Accountability and autonomy 139What are the prerequisites for accountable midwifery practice? 140What are the implications of the midwife being accountable? 141Conclusion 14112 Accountability in Community Nursing 143Sarah Baggaley with Alison BryansIntroduction 143Organisational and policy issues affecting the accountability of community nursing 143Current issues in community nursing 145Resource allocation and skill mix 145Delegation and skill mix 145Legal and professional issues in community nursing 147Clinical governance 148Clinical effectiveness and evidence-based practice 149Role developments 150Nurse prescribing 152Primary healthcare and public health nursing 153Conclusion 15613 Clinical Governance, Accountability and Mental Health Nursing: an Emergent Story 157Stephen TilleyIntroduction 157Review of themes from Tilley (1995) 158The centrality of the topic 158Accounts 160Accounting 161Accountability 162Accountability and clinical governance 164The role of the mental health nurse in clinical governance 16714 Accountability in Nursing Research 170Alison Tierney and Roger WatsonIntroduction 170Research as a responsibility of an accountable profession 170Accountability in nursing research 171Nurse researchers as nurses 172The importance of accountability in research 172To whom are nurse researchers accountable? 173Accountability to the sponsor 174Accountability to research ethics committees 176Accountability to research participants 178Accountability to research ‘gatekeepers’ 182Accountability to (and of) the profession 185Accountability to the wider public 186Tensions of multiple accountability 187Conclusion 189Appendix Code of Professional Conduct 190(Reproduced with permission of the Nursing and Midwifery Council)References 198Index 216

‘This interesting book would be an ideal reference source particularly for students and post graduate/ registration nurses undertaking professional studies in nursing.’ Journal of Neonatal Nursing 'This book is enjoyable and thought provoking and would be of use to alI nurses, particularly those with an interest in clinical governance or those who are wishing to expand their clinical roles.' Nursing Standard ''If you are looking for a book with opinions on accountability, this book is for you... A great reference for the library.' Journal of Advanced Nursing "This book has attempted successfully to address the whole issue of accountability and clinical governance in a truly holistic way... It is a book that is neither simple nor abstruse but succeeds in placing all the threads together in order to clarify the truth behing accountability and clinical governance." Journal of Psychiatric and Mental Health Nursing

Stephen Tilley is a Senior Lecturer in Nursing Studies at the University of Edinburgh.Roger Watson is a Professor of Nursing in the School of Nursing, Social Work and Applied Health Studies at the University of Hull.

• Contributors xiPreface xiii1 Introduction 1Roger Watson and Stephen TilleyHistorical perspective 1An accountant looks at nursing 1Accountability and clinical governance 2Accountability and the law 2A policy perspective 3An NHS trust perspective 3A manager speaks 4Caring for children 4Learning disabilities 5Midwifery 5Community nursing 6Mental health nursing 7Research 8Conclusion 82 The Development of Nursing as an Accountable Profession 9Susan McGannIntroduction 9Historical perspective 9The British Nurses’ Association 10Mrs Bedford Fenwick 10Professional registration 12Matrons’ Council of Great Britain and Ireland 12Political perspective 14Early registration bill 15The war 16Registration Act 1919 18Conclusions 193 Accountability and Clinical Governance in Nursing: a Critical Overview of the Topic 21Kerry JacobsIntroduction 21Accountability 26Accountability and reform 30Clinical governance 32Conclusion 364 Accountability and Clinical Governance 38Roger WatsonIntroduction 38Clinical governance 39Why do we have clinical governance? 39Poor care 42Short cuts 43Trust 44Conclusion 455 The Legal Accountability of the Nurse 47John TingleIntroduction 47The concept of accountability and the new NHS 47Accountability is not irrelevant 48Labels can obscure meanings 48Ideas behind the label 48This chapter 48Legal accountability 49Interests, rights and duties: the role of the law 49The Ms B. case 49Dispute resolution, compensation and punishment 50Establishing nursing negligence 50Vicarious liability 51The aim of the law: compensation 51Clinical negligence law today: all change? 51Regulation, deterrence and education: the role of the law 52Evidence-based healthcare and the courts 54The scandals of recent years 54The law affects all aspects of nursing 55The various forms of accountability 55Accountable to whom? 56Accountability and sanctions 57The allocation and management of healthcare resources: the nurse’s role 58A conflict of accountability 58The role of the law: legal accountability 59Cases of resource and negligence 59Conclusion 636 Accountability and Clinical Governance: a Policy Perspective 64Tracey HeathIntroduction 64Background: the NHS pre-1997 64The Labour Government’s challenge 66Practising within an era of increasing accountability 68Towards a modern and dependable NHS: the Labour Government’s response 68Accountability and clinical governance 70Organisational accountability 70Reflections on the broader policy context 74Conclusion 767 Accountability in NHS Trusts 77Stephen Knight and Tony HostickIntroduction 77Clinical governance 77Responsibilities of trusts 78Professional self-regulation 82A systematic approach to decision making 84Implications for practice 84Conclusion 868 Accountability and Clinical Governance in Nursing: a Manager’s Perspective 87Linda PollockIntroduction 87Background context 87Clinical governance as a concept 88The meaning of clinical governance 88Our interpretation of clinical governance 89Has clinical governance made a difference? 91Clinical governance and its impact at board level 91Clinical governance structures as a vehicle for change 92Clinical governance and people governance 93Clinical governance and its impact on nursing 95Clinical governance and cultural change 96Sharing good practice 97Evidence-based practice – the reality 989 Working with Children: Accountability and Paediatric Nursing 99Gosia BrykczyñskaIntroduction 99Definition of paediatric nursing 100Ability 101Obligations 103Involving parents 104Autonomy of children 106Authority 107Free will and choice 108Power and political action 109Responsibility 111Responsibilities for treatment 111Consequences of responsibility 113Responsibility of parents and children 114Conclusion 11610 Accountability and Clinical Governance in Learning Disability Nursing 117Bob Gates, Mick Wolverson and Jane WrayIntroduction 117Clinical governance in learning disability nursing and guidelines for practice 118Consent 120Interdisciplinary working 120Evidence-based practice 121Advocacy 121Autonomy 121Relationships 122Confidentiality 122Risk assessment and management 122The challenges of effectively implementing clinical governance in services for people with learning disabilities 123Fragmented partnership working 125User and carer involvement 125The spectrum of need 126Quality of life 126Solutions to the barriers associated with implementing clinical governance in learning disability services 127Conclusion 13111 Where does the Buck Stop? Accountability in Midwifery 132Rosemary ManderIntroduction 132What is meant by accountability? 133To whom is the midwife accountable? 134Institutional accountability 135Accountability to the woman 136Personal accountability 136Professional accountability 137Hierarchy of accountability 138Accountability and autonomy 139What are the prerequisites for accountable midwifery practice? 140What are the implications of the midwife being accountable? 141Conclusion 14112 Accountability in Community Nursing 143Sarah Baggaley with Alison BryansIntroduction 143Organisational and policy issues affecting the accountability of community nursing 143Current issues in community nursing 145Resource allocation and skill mix 145Delegation and skill mix 145Legal and professional issues in community nursing 147Clinical governance 148Clinical effectiveness and evidence-based practice 149Role developments 150Nurse prescribing 152Primary healthcare and public health nursing 153Conclusion 15613 Clinical Governance, Accountability and Mental Health Nursing: an Emergent Story 157Stephen TilleyIntroduction 157Review of themes from Tilley (1995) 158The centrality of the topic 158Accounts 160Accounting 161Accountability 162Accountability and clinical governance 164The role of the mental health nurse in clinical governance 16714 Accountability in Nursing Research 170Alison Tierney and Roger WatsonIntroduction 170Research as a responsibility of an accountable profession 170Accountability in nursing research 171Nurse researchers as nurses 172The importance of accountability in research 172To whom are nurse researchers accountable? 173Accountability to the sponsor 174Accountability to research ethics committees 176Accountability to research participants 178Accountability to research ‘gatekeepers’ 182Accountability to (and of) the profession 185Accountability to the wider public 186Tensions of multiple accountability 187Conclusion 189Appendix Code of Professional Conduct 190(Reproduced with permission of the Nursing and Midwifery Council)References 198Index 216

‘This interesting book would be an ideal reference source particularly for students and post graduate/ registration nurses undertaking professional studies in nursing.’ Journal of Neonatal Nursing 'This book is enjoyable and thought provoking and would be of use to alI nurses, particularly those with an interest in clinical governance or those who are wishing to expand their clinical roles.' Nursing Standard ''If you are looking for a book with opinions on accountability, this book is for you... A great reference for the library.' Journal of Advanced Nursing "This book has attempted successfully to address the whole issue of accountability and clinical governance in a truly holistic way... It is a book that is neither simple nor abstruse but succeeds in placing all the threads together in order to clarify the truth behing accountability and clinical governance." Journal of Psychiatric and Mental Health Nursing