Central Manchester University Hospitals NHS Foundation Trust, like many Trusts, asked itself a number of searching questions in the wake of the reports into appalling standards of care in a number of UK care settings between 2006 and 2009. In order to seek assurance on the quality of care being provided and to be very clear about where improvements were needed, the Board of Directors commissioned a comprehensive peer review into standards of care provided. The resulting exercise involved over 200 staff being trained in review techniques and participating in a comprehensive Trust wide quality improvement programme. The output of this exercise was a detailed plan to improve quality of care, increased recognition of excellence, shared learning across multiple specialties, and increased staff engagement and expertise. [Abstract]