The international economic climate is one driver for the expected reductions in healthcare costs and concurrent improvement in quality of care. As the NHS in England enters a new phase of commissioning based on reducing costs and improving safety and quality, programmes to improve care and reduce avoidable harm to patients will be key for providers of clinical services. Rather than a comparison with other, usually very different critical care units, our approach
involves monitoring a range of measures that have recently become the basis for a service specification for commissioning
critical care services across a clinical network of critical care units in the North Trent area of England. A process of incremental practice change and evaluation over a period of time has helped to steer improvements in clinical care such
as that reported here.