ABSTRACT
Recent governmental interest in audit dates from the publication of a 1989 White Paper on the NHS (Department of Health, 1989). Commitment to audit was reiterated in 1998 in the latest White Paper produced by the incoming Labour government (Department of Health, 1997). Trust Chief Executives now have responsibility for the effectiveness of the services they provide (Black, 1998). Despite this, almost a decade after its formal introduction, few of the anticipated benefits of audit have been realized and critics are questioning its value and continued government investment (Fulton, 1996; Maynard, 1991; Mooney and Ryan, 1992). The majority of audit activity remains haphazard and unfocused with few obvious benefits to patient care (Miles et al., 1996; Walshe and Coles, 1995). In addition, there is still substantial dissent among clinicians about its usefulness (Thomson and Barton, 1994) and much confusion as to how to carry it out (Nolan and Scott, 1993; Miles et al., 1996).
