Participants in this discussion concentrated on three related questions. Their debate answered the questions posed as well as raising further issues for consideration

Paper by Anne Dean. This paper poses the question 'Does quality assurance place too great an emphasis upon policies and procedures and too little on directly assessing and enhancing the impact of services on end-users?'

"Much of quality assessment is to do with how systems operate with an emphasis on what the organisation does, procedures and paper trials, complaints, appointment procedures and so on. There could be an inbuilt danger that quality assessment tilts too far towards looking at organisational systems and practice at the expense of enquiry into the benefits to service users." This discussion explores the benefits standards bring to clients.

How do you know when you've done a good job, are evaluation and impact analysis the same thing? This paper explores how theories of evaluation might help in the design of impact analysis measures for guidance.