Improving the quality of health care and services is a priority for the NHS, and for commissioners, managers, practitioners and service users. However, to improve we must first know what already exists. The primary way to do this is to measure what is being provided by evaluating current services. At its inception, the National Health Service (NHS) was originally designed to give priority to collective needs rather than individual wants. Patient choice was not on the policy agenda within the NHS until the market oriented reforms in the 1990s. Even then it was not vigorously pursued and was...