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If regulators use data, then problems are bound to take some time to be identified. One death, however regrettable, is not a pattern and only over time can a problem be seen in any statistical analysis. Even then there are difficulties, as the report notes, and further work is needed on the methods of estimating patient deaths in hospital. Inspection is clearly able to spot problems on the day, especially if unannounced, but to inspect every part of the NHS would take a lot of resources. The Healthcare Commission was not, in my view, as an insider for three years, an effective manager of its own resources, and so current and future regulators might be able to do more even with a limited budget. But the professional and ancillary staff of a hospital are there every day and have the means to raise issues internally and externally. For me, the prime questions are around how bad things were on the ward and A&E and, if as bad as has been painted, why were staff not taking action to have the difficulties addressed? If they were stifled by the board, they still had recourse to other means of drawing attention to their concerns. Were they used? When I worked for a private sector company, it introduced a quality control system to manage our very diverse consulting project work. One partner said to me that, in the end, he thought it was a paperchase. "What drives quality in this company", he said, "is the pride in their work that should be taken by every member of staff." Surely we have to rely on the staff who are in a hospital 24/7 to maintain standards rather than inspectors who can only call in, even with much bigger teams than current regulators have at their disposal.