<p>Successive publications and consultation documents from the government have placed quality related issues firmly on the agenda. The New NHS: Modern Dependable focuses on the efficiency and quality of the NHS (DoH 1997). Another government publication, Making a Difference, dedicated section seven to ‘enhancing the quality of care’ (DoH 1999). This White Paper recognised the significance and potential of nursing involvement in the process. The momentum has increased further through the publication of NHS performance ratings (DoH 2001a), and although designed not to focus on quality of clinical care, the inference in the press exists.</p>