Despite cynicism from some doctors, 'more were inspired than usual' about the chance to 'get the culture right', chief medical officer Professor Liam Donaldson told delegates.

Admitting that the health service was 'not very good at responding to quality failures', Professor Donaldson said the lack of sustained action to prevent the recurrence of problems was one of the key areas to tackle.

He said responses to quality failures inevitably ended in the simultaneous publication of 'a report of 59 recommendations and a press release from the trust which said 58 of them had already been implemented'.

Professor Donaldson stressed the importance of identifying the criteria which distinguished a culture in which clinical governance was successful.

'Systems that rely on error-free performance are doomed to failure,' he claimed. But he said the 'sea change' following the Bristol case could make life easier for the generation of managers that followed it. 'You won't have the uphill battle that we had in getting your staff and organisations involved in clinical governance.'