I don't work in the NHS, and I would agree there have been great improvements over the last decade. HOWEVER, I would argue strongly that these are nothing to do with PIs, and I suspect if you ask most staff, from consultant, to secretary, to hospital porter, they would tell you that PIs have been a hinderence. I work across social care and education, and I admit, I can be a right lazy git at times. However, I have worked with lots and lots of very hard working, and dedicated people, from OTs, to Social Workers, to managers, to teachers, top nursery nurses, and I can assure you, the vast majority of them would tell you what I am telling you when it comes to Performance Indicators.