'Groundhog day'

Quality and safety are defined and measured in different ways by academics, commentators and agencies, while the relationships between them are viewed in different ways. Raleigh and Foot write that while the definitions of quality vary in different settings, some themes – safety, effectiveness and patient experience – are common to most quality frameworks and are regarded as the three pillars of quality in healthcare. This chapter examines these three pillars, and, after a brief review of earlier periods, it focuses on reforms in England under the Coalition government. It then explores the impact of reforms on quality and safety, providing a wider comparative perspective.