Senior figures in healthcare were quick to respond to health secretary Frank Dobson's proposals on quality.

Institute of Health Services Management director Karen Caines said the correct 'tone and pace' were essential. 'Naming and shaming will be fatal. An 'off with their heads' approach will just lead to defensiveness and resentment when we need a willingness to open up to the public,' she added. The 'institutionalised warfare' between Ofsted and schools must be avoided, which would take 'immense sensitivity and understanding' by the Commission for Health Improvement.

Clinical governance as set out in the consultation document was 'strong for hospitals but weaker in primary care', said NHS Confederation chief executive Stephen Thornton. He welcomed the proposals, adding: 'We look to NICE to provide guidance for management, not just clinicians - it must help us make tough choices.' But raising standards would mean 'spending more on management'.

Delivering the quality programme would 'require significant effort and resources, for example in providing sufficient time for doctors to take part in the new governance arrangements', said British Medical Association chair Sir Alexander Macara. He also welcomed the proposals, adding: 'Naturally, matters of detail about how these mechanisms will work remain to be addressed.'

NICE and CHI 'will have our full support', promised Joint Consultants Committee chair Sir Norman Browse. 'This programme will take 10 years to fully implement, but doctors are already frustrated that some of these proposals, which they have been discussing with the government for over a year, will not begin until 1999-2000.' Managers 'cannot be directly responsible for the clinical care a doctor gives a patient, he added.

Measures to improve quality 'will not remove the need to tackle tough choices in rationing', King's Fund chief executive Julia Neuberger said. 'NICE will have to provide information of a high quality on which local clinicians and managers can rely. CHI will have to balance spot checks and troubleshooting with education and development to help NHS trusts bring their standards up to national levels of good practice.'

Rabbi Neuberger welcomed plans for a national service framework for mental health, warning that it would need proper resources 'as the considerable demands on funding for the national cancer framework have shown'.

The UK Central Council for Nursing, Midwifery and Health Visiting 'strongly supports the call for modernisation of professional self-regulation', said UKCC president Alison Norman. It 'looks forward to an early response from the government to the report by the consultants examining the regulatory framework of the three professions', which is expected to be with ministers this month.

'We need to be given more details of what powers this new watchdog will have to interfere with doctors and clinical governance in our hospitals,' said shadow health secretary Ann Widdecombe. 'The government must be very careful that in the effort to improve standards, which we welcome, they do not start to interfere even more with clinical decisions within the health service,' she said.

See Open Space, page 18.