Bristol lays out the parameters of NHS failure, but it could happen again That Bristol has entered the lexicon of the entire nation, not just the NHS, as a synonym for health service failure says much about the awful scale of that failure in the public mind. Bristol has come to epitomise not just the inadequacies of one hospital unit but all that has been wrong with the health service for decades.

It doesn't end this week with the publication of the long-awaited report. With the report's firm conclusions and recommendations, now is the time for everyone working in the NHS to put up a mirror to themselves. It is also a time for honesty - and that means not kidding anyone by claiming it couldn't happen again. It is fair to say that much has been done since the inquiry was set up to prevent a repeat of the failures at the infirmary: the development of clinical governance, the establishment of the Commission for Health Improvement and the National Clinical Assessment Authority, the reform of the professional regulatory bodies and the whole performance monitoring system will go a long way to improve patient safety and confidence.

But we can't assume that because things are better than they were they are yet good enough. There are many enlightened trusts, supportive of audit and training and clinical governance, attempting to end the blame culture. But no one can deny that behind closed doors even now, there are managers and clinicians who are seeking to minimise or disguise problems with their services. It would be folly to pretend there are not GPs who do all they can not to refer their patients to particular surgeons, nor health authorities that are not aware of the dire reputations of one or two local practices. The complexity of a whole local health economy, the vested interests and the dominant personalities are not exclusive to Bristol. And change is slow.

It may be true that the scrutiny and regulation of paediatric cardiac surgery can ensure there will not be a repeat of the failures in that specialty, but we can't pretend it couldn't happen elsewhere. We cannot draw a line under Bristol now we have the report - it is only the beginning.