Details of two new quangos to be superimposed on the NHS in England--one to set clinical standards, the other to enforce them--are given in a government green paper, A First Class Service: Quality in the New NHS, issued last week for consultation.

With the promise of more money in the pipeline, the government is setting conditions in terms of supervising professional standards and restoring its own and the public's confidence after recent, well publicised clinical failures. The tone is one of collaboration, but with an element of compulsion and the threat of stronger measures.

The green paper is epitomised by ministerial enthusiasm for a new post of director of health improvement. The director is intended to be a high profile inspector general of the NHS conducting spot checks and with the power to act against failing hospitals or individual doctors. The proposals are in line with last December's white paper, The New NHS (BMJ 1997;315:1561), but they acquire fresh impact in the aftermath of the recent paediatric surgery scandal in …