On April 1, 2004, the U.K. Commission for Health Improvement (CHI) became the Commission for Health Care Audit and Inspection (CHAI) (now known colloquially as the Healthcare Commission). Is this relabeling of any importance or simply a marketing ploy in the ever-changing world of British public sector management? We shall argue that it is an exemplar of a systemic shift in emphasis in British public administration in favor of intense centralized regulation at the expense of trusted localized discretion. It is a change that reflects the tensions of an emphasis on service delivery underpinned by performance targets, yet dependent on professionals and managers whose perspectives on legitimate evaluation and accountability are often based on premises that differ and even conflict with government and each other.