Discussion. ‘Do no harm’ is an enduring principle of medicine, yet people continue to be harmed in the process of being ‘cared for’. Before the 1990s, there was very little understanding that poor quality might be inherent in the structures and processes of the healthcare system.1 Now, as a result of considerable research investment, a great deal is known about, for example, hospital-acquired infection, surgical error, medication error, and the systems and processes that predispose practitioners towards error. Nevertheless, what it means to ‘care’ and how this might carry threats to safety has recently been exemplified by events at Mid Staffordshire NHS Foundation Trust in the UK. Here, there were consistently higher than average mortality rates and poor standards of care in which patients’ most basic needs were routinely overlooked; personal hygiene, nutrition and hydration were not maintained, and patients were treated without compassion or respect for their dignity...... To read the full article, log in using your NHS OpenAthens details.