Clinical governance was intended to ensure clinical quality in the National Health Service. Its first full description, in the British Medical Journal in 1998, seemed to some to be more rhetoric than substance. Now, 3 years on, its proponents believe it is starting to achieve its purpose. The British Medical Journal has again published a paper, this time subtitled 'turning vision into reality'. Expectations might have been that this paper would present evidence of how clinical governance is changing practice to ensure quality, but analysis of the paper shows that it does little more than repeat the rhetoric of the earlier description. It describes how clinical governance might be organized and what it might do, but not what it has done. Its authors repeat the idea that everyone can be 'the best' and achieve 'exellence', which is not reality at all. Anyone introducing a new method of managing the National Health System has the same obligation as those who introduce new treatments to provide evidence that the method works, and that the financial and non-financial costs are not too high. The new paper fails to provide that evidence.