ABSTRACT
In the early years of the NHS, there were no formal comprehensive processes by which to evaluate health care. It was naturally and perhaps simplistically thought that every health care practitioner would work to the highest professional standard and provide a uniform level of high-quality care to the benefit of their patients (Donaldson & Scally 2009). This, plus the complex nature of defining and measuring quality in health care, left the NHS without a formal and rigorous evaluation framework for most of its existence.
