This document has been produced in response to the enormous growth in activity around and interest relating to the subject of quality in healthcare. As well as the introduction of clinical governance, two new national organisations, the National Institute for Clinical Excellence (N.I.C.E.) and the Commission for Health Improvement (CHImp), are being set up. As NHS trusts were showing increased interest in the whole field of quality and accreditation, the Health Quality Service decided to conduct a survey on attitudes to quality in NHS trust management, and the results are discussed in this report. The authors conclude that the results of the survey paint a picture of a service lacking in good quality information and boards bereft of confidence they are supposed to be running, making the case for a strong national system of clinical governance.