Letter to the editor.

"Inside the word emerging is emerge, from an emergency new things come forth. The old certainties are crumbling first, but danger and possibility are sisters."

Inspection as a driver for quality improvement.

Following publication in 2013 of the report by Robert Francis QC into care at the Mid Staffordshire Foundation Trust, the Care Quality Commission (CQC) has introduced a new and radically different approach to hospital inspection. This involves much larger teams (typically 30 or more people) including clinicians, experts by experience and CQC staff. Eight core services are assessed against five key questions (domains): Are services safe? Effective? Caring? Responsive to patients' needs? Well led? Each domain of each core service is rated on a four point scale: Outstanding, Good, Requires Improvement or Inadequate. To date 65 (40%) of the 160 acute trusts in England have been inspected, the aim being to inspect all trusts by December 2015. The most important single finding is the huge variation in quality of care that the inspection teams have identified within the NHS. Informal feedback suggests that the new approach to inspection represents a significant improvement on previous CQC inspections, though further improvement is imperative.