Improvement through inspection? The development of the new Commission for Health Improvement in England and Wales.

Introduction Inspection and external review are increasingly used in healthcare systems throughout the world, in various forms, in pursuit of quality assurance and improvement. Although the experience of systems such as accreditation in those countries which have used them for decades is decidedly mixed, we are nevertheless witnessing what has been described as an explosion in external audit, regulation, review, and inspection—not just in health care, but across the public and private sector. But little evidence exists to show that regulation and inspection improve quality, and some would argue that they conflict with a modern understanding of eVective quality improvement. This article explores the contribution that external review and inspection can make to quality improvement in the context of the National Health Service (NHS) in England and Wales, where a new national statutory healthcare inspectorate is about to be established.