Whatever the consequences of the Health and Social Care Act turn out to be, the inescapable conundrum facing the UK health system, among many others, is the imperative at the very least to maintain, and preferably to improve, standards of care and patient outcomes in a chilly financial climate. Within this ‘quality agenda’ are a number of still-unanswered questions about, among other things, inequities in the provision of and access to primary care, standards of nursing care and patient safety in hospitals, population health inequalities related to deprivation and exclusion, the morale and commitment of the NHS workforce, and the future of professional education and training. This is, then, no time to freeze in the headlights of reform and to give in to planning blight as the bureaucracy is overhauled yet again. There is, as Captain Jack Aubrey would undoubtedly have said were he in a senior management role, no time to lose: ‘This ship, is England. So it's every hand to his rope or gun, quick's the word and sharp's the action’.1
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