Chief of health authorities and trusts were urged in a health service circular to respond to the quality consultation document A First Class Service. The main elements are:

clear national standards for services and treatments through national service frameworks and a National Institute for Clinical Excellence;

local delivery of high quality healthcare, through clinical governance underpinned by modernised professional

self-regulation and life-long learning;

monitoring progress through a Commission for Health Improvement, a framework for assessing performance and a national survey of patient and service user experience.