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More dialogue, more learning, more action
  1. James Mountford1,
  2. Martin Marshall2
  1. 1UCLPartners, London, UK
  2. 2UCLPartners, Lead, Improvement Science London, London, UK
  1. Correspondence to
    Dr James Mountford, UCLPartners, 3rd floor, 170 Tottenham Court Road, London W1T 7HA, UK; james.mountford{at}

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2013 has not been an easy year for England's National Health Service (NHS). A feeding frenzy led by the popular press exposing deficiencies in care on an almost daily basis, alongside thoughtful challenges from commentators on the 65th birthday (the traditional retirement age in the UK) of what many believe to be ‘a national treasure’ has led to some serious questions about whether the NHS in its current form is sustainable.1 ,2 The question is not new, but the intensity of public interest in the quality and safety of care provided by the NHS is breaking new ground, and happening at a time of rising public expectations and decreasing deference across all walks of life.

The publication of a number of seminal reports in 2013 on safety and quality has contributed to this high level of interest. First, in February, a report was published into the tragedy of failings in care at Mid Staffordshire Hospital by Robert Francis, a distinguished barrister.3 In its many pages were stories of harrowing gaps in care and compassion, and failure at seemingly every level of the system. Crucially, Francis framed Mid Staffordshire as an extreme example of shortcomings encountered in some form throughout the system. His view was that ‘a fundamental culture change is needed’, and he made 290 recommendations for how to bring this about. This was followed in July by the publication of a report by Sir Bruce Keogh, the Medical Director of NHS England, into 14 hospitals with the highest mortality rates.4 Most recently, August saw the publication of a review into patient safety in the NHS led by Professor Don Berwick, former Centers for Medicare & Medicaid Services (CMS) administrator and founder of the Boston based Institute for Health Care Improvement, initiated at the personal request …

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  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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