Key changes that will make hospital doctors in England publicly accountable for their clinical performance have been signalled by the government in the wake of the Bristol case in which 29 children died after cardiac surgery.

The changes go further than the mortality league tables announced earlier this month (13 June, p 1767). Doctors will be obliged to take part in far more sophisticated systems of clinical audit.

The moves supplement, and in some respects breach, previous reliance on professional self regulation. For instance, participation in the four national audits known as standing confidential inquiries will be compulsory rather than voluntary. In some NHS regions over a third of surgeons and anaesthetists do not take part in the …