ABSTRACT
Good medical practice has always depended on learning from experience and thoughtful reflection. In recent years evidence-based practice has come to rely increasingly on solid scientific methodologies. Health policy tends to be based on a different kind of evidence to that which informs the practice of medicine. Safety is a key element of quality and risk reduction is one way of ensuring safety. Doctors tend to focus on clinical risk management. Governance takes an overview, ensuring that senior managers are aware of all kinds of risk the organisation faces and that organisational policies and procedures are in place to minimise risk. The political theory behind the changes proposed in Equity and Excellence for the English part of the British National Health Service (NHS) is a particular version of capitalism. When people have a potentially life-threatening illness, timeliness becomes of utmost importance.
