For the past two decades, the National Health Service (NHS) in the UK, particularly in England, has worn its corporate heart on its sleeve when it comes to discussions about clinical quality. Since the middle 1990s, there has rarely been a time without intense public debate about scandals affecting individual clinical practice, whole services and even whole organisations. Our response has been to put massive effort into building and implementing what NHS leaders described — nationally and internationally — as a ground-breaking framework of reform to governance across system and individual practice, and across regulation, employment and commissioning health care. And if the facts are examined, it is difficult to avoid the conclusion that it has not worked. We are as mired in widely debated health care scandals as we were 20 years ago.
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