ABSTRACT
All three UK White Papers7 discuss appropriateness of care and how this must become a major focus of quality and clinical governance. None of the papers gives a clear definition of appropriateness of care, but it really means the optimum point of balance between liability and quality which is in line with having the best defensibility in terms of processes and systems if things do go wrong. It also entails quality assurance standards which demonstrate a controlled environment of care. Appropriateness (see Figure 1.2) is dependent on having the best quality improvement systems to guarantee high standards (clinical guidelines), must take into account both patient and staff perceptions in meeting these and must have adequate performance measurements to enable demonstration of the clinical governance criteria. This must be achieved in line with clinical and cost effectiveness to ensure scarce resources are used responsibly.
