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Through a literature review, this paper demonstrates that there is a lack of knowledge about quality management within the mental health services. Ideas about quality from the wider services sector are then discussed, and a case study of a mental health scenario is provided. It is argued that health services generally, and mental health services in particular, have much to gain from becoming more closely aligned with the wider field of knowledge of quality management. Concludes that the wider techniques of managing service quality may prove useful, particularly in mental health services, due to the nature of such services and their inherent variability.

Discusses the audit processes in health care from the existing perspectives and argues the need to extend the current uni‐dimensional approaches which include medical, clinical and managerial quality. Argues that one way of expanding these approaches is to develop an audit instrument based on the views of service users. The implementation of audit has been a process with regional variations, which have created centres of excellence and centres where there is very little happening. Considers elements that are involved in devising an audit tool which is based on customers′ perceptions of service quality, and reports on an empirical study which is still in progress and which aims to develop a tool which is effective, efficient and based on patients′ views.

Hidden camera television documentaries filmed in care home settings have shown evidence of the abuse of vulnerable adults, been widely discussed in the mass media and have brought the attention of the mass population to the importance of these issues. Governmental documents have also emphasised the need to protect vulnerable adults. It is therefore known that vulnerable adults exist and require protection from abuse in any shape or form. However, this paper aims to argue that protecting vulnerable adults and the current mechanisms for encouraging such individuals to make their views known to services are not mutually compatible. The main technique vulnerable adults may use, the complaints procedure, currently may not be sufficient to enable vulnerable adults to express themselves and their anxieties adequately.

The paper provides a case study which clearly demonstrates the nature of the problems, and then recognises and describes a number of levels which could be explored to learn more about these issues.

Potential solutions are explored by the authors, who draw conclusions about the need for further research into this area.

This paper defines a gap between adult protection and complaints procedures, questioning both their efficacy and abilities to meet their stated aims. The paper also highlights that the nature of these may not sufficiently enable complaining vulnerable adults to express their views of services.

Reports the findings of a qualitative piece of research that was undertaken with professionals in the health field. There are numerous professionals working in the health/social services fields. Those who were the respondents in the research included chiropodists, nurses, doctors, psychologists and art psychotherapists. The sample was taken mainly from Essex, with input from a wider environment which included Newcastle, Southend, Manchester and Burnley. The researchers gave a brief scenario prior to asking open‐ended, qualitative questions about professionals' perceptions of: the physical appearance of managers; the roles of managers in the NHS. The comments made by the respondents indicate a disturbing degree of hostility towards and misapprehension about managers in the reformed NHS.

Over the past 30 years there has been a growing interest in fiction by Native American authors. An increasingly diverse crop of Indian writers have produced innovative and sometimes controversial works, but often critics, readers and the book publishing community have concentrated their attention on older, more established writers. This article identifies younger and up‐and‐coming Native American authors, many of whom are producing major literary works, but have not received the attention they deserve. The article also discusses ways researchers and those involved in collection development can track down information on rising Indian authors and their novels.

The National Health Service (NHS) has many different kinds of professionals and managers working underneath its large umbrella: non‐clinical managers administer the work of health‐care professionals, who in turn are concerned with the management of patients’ treatments. Delivery of health‐care services involves the managers and professionals working together to achieve a service that is good for, and acceptable to, patients. A change in the philosophy of the NHS is indicated by the growing acceptance, by both managers and professionals, of the necessity to elicit the views of patients (i.e. the expectations and perceptions of service users) and to incorporate these views into the planning and implementation of services. Discusses one such attempt to elicit the perceptions of service users, and reports on the preliminary findings of a patient‐centred audit which has been undertaken in Southend Community Care Services NHS Trust. Discusses the effects that the audit has had on the chiropody services in Southend, for both non‐clinical managers and health‐care professionals, in order to highlight the usefulness of the approach.

The immediate, common sense answer to the question, “Who is the NHS for?” would obviously be, “The patients who use it”. This may well be the fundamental purpose of the NHS, yet it would appear that differing views of how this is to be achieved contribute to a misreading between stakeholders of each others′ remit. The different positions taken by the two most important NHS stakeholders, the professional clinicians and the administrative managers, affect their definitions of, and therefore their attitudes to their own contribution to the purpose of the NHS. Suggests that before priorities in health care can be considered and discussed, let alone be set, consensual agreement needs to be reached concerning the views of professional clinicians and managers of ways of achieving their vision of who the NHS is for.

In the UK healthcare field, audit is currently employed not only in medical and clinical areas, but has also been introduced into the managerial and professional areas. A new approach to audit has been developed as a result of research and is based on a newly‐developed audit instrument which is able to elicit users’ perceptions subsequent to an encounter with a community health service. The paper describes the research process and the development of the instrument now employed in auditing patients’ perceptions of quality. The authors describe the adaptation processes used in order to place the Parasuraman Servqual instrument into the health setting in the UK. The new instrument is currently being operationalised, and the findings of both audits that have been completed thus far are described. The instrument has measured health outcomes from the users’ perspective, and has also highlighted gaps between what the service offers in terms of quality and users’ perceptions of what is actually being delivered.

This article aims to describe the research process, and the development of the instrument now employed in auditing patients' perceptions of quality improvement in a community health care trust in a coastal town in Essex, England.

The new instrument is currently being implemented and the findings thus far are described.

The instrument has measured health outcomes in terms of quality improvement from the users' perspective, and has also highlighted gaps between what the service offers in terms of quality and users' perceptions of what is delivered. The study demonstrates the importance of the professional role in quality improvement.

Patient‐centred quality improvement audit should be undertaken regularly so that both non‐clinical managers and health care professionals can establish whether or not they are providing services that are patient‐friendly and effective from the user's viewpoint. In the course of their work, professionals and managers discuss patients and speak on their behalf in various forums, and knowing what patients actually expect and perceive before speaking on their behalf may be of great benefit in such instances.