comment: The service can only gain from implementing all the Bristol findings

Many of the conclusions reached by Professor Ian Kennedy at the end of the Bristol inquiry came as no surprise to those working in the NHS. Arguably, given the circumstances at BRI during the 1980s and 1990s, there was a disaster waiting to happen - and few would deny that it could be repeated even now. Many of the contributing factors - split-site working, lack of equipment, severe shortages of experienced staff and 'silo' management techniques - are to be found in the NHS of the 21st century, But there are now mechanisms in place which go some way towards avoiding a repeat of events at Bristol, and there is a real chance that those mechanisms could be made a great deal more robust if Professor Kennedy's recommendations are implemented by the government.

Those 200-odd recommendations have at their core the development of a truly patientcentred health service in which users are genuinely partners in care.

The rhetoric is all too familiar, but by combining implementation of these recommendations with the modernisation agenda that has emerged from the NHS plan we have the possibility of an NHS that actually delivers on that rhetoric.

The expanded and independent roles proposed for the Commission for Health Improvement and the National Institute for Clinical Excellence are crucial to future improvements.

CHI's early clinical governance reviews - which might not be taking place were it not for events at Bristol - show clear promise. Trusts, health authorities and practices have emerged from the review process genuinely enthused.

Good performance has been noted, and where performance falls short the outcome is an action plan for change. The report and action plan are useful starting points for improvement in any NHS organisation, but it is vital that the energy and desire for change following a review is sustained.

Were CHI also to have the power to collate performance data and to validate and even suspend services, it would ensure that those reports and action plans are considerably more than bits of paper.

One other key recommendation from the inquiry - that managers should be subject to regulation or revalidation in the same way as other health professionals - has been broadly welcomed. The professional organisations can make an important contribution to the form of regulation that might emerge, but here there is also a clear role for the Leadership Centre.

Until now there has been no single forum with the potential to co-ordinate and support the development of high-quality managers - post-Bristol there is an opportunity for the centre, now in its infancy, to come into its own. The programmes being developed, combined with the work the Institute of Healthcare Management in formulating a code of ethics, are the beginnings of a framework for setting clear standards for health managers.

But the prospect of managers who do not come up to scratch being struck off may be too much for some to stomach at this stage. In the same week as the publication of the Bristol report, NHS chief executives had an opportunity to meet together for the first time ever and to do some straight talking with the policy makers.

By all accounts the health secretary was left in little doubt how the most senior tier of NHS managers feel about what is currently expected of them. Supportive of the direction in which health secretary Alan Milburn is moving, they made it clear that they need support, too, in terms of resources, freedom and personal development.

It is not 'all motherhood and apple pie', as one put it.

The burden on chief executives is huge, the expectations of them have never been greater.

And post-plan, post-Bristol they retain the will to deliver.

But the service needs to see the centre set an example. When Parliament is recalled, Mr Milburn must take his courage in both hands and implement the recommendations of the Bristol inquiry.