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Clinical trials are valuable in both advancing the scientific knowledge of surgical oncology and defining the very best care for patients afflicted by malignancies. As an obligation to both the scientific community and the general public, the cooperative audit programs and the CTMB collaborate to ensure that the conduct of clinical trials are meticulous and the data are validated. However, audit programs should be viewed not merely as a surveillance mechanism. It serves as a stimulus for performance improvement by providing opportunities for peer-review and education.

A comprehensive system of performance measurement for all UK central government departments was introduced in 1998. Each department now has ‘high level and focused commitments’ or Public Service Agreements (PSAs) with the Treasury plus detailed departmental targets (Service Delivery Agreements or SDAs). Each PSA includes statements of central government departmental aims and objectives, allocated resources, key performance targets and details of how departments propose to increase the productivity of their operations (see Cm 4181 1998).

It was with great pleasure that I accepted the invitation to present the opening address at this conference. My credentials as a mayor of various municipalities between 1963 and 1996 — the last being The Hague, our seat of government — and my membership of the Netherlands Court of Audit since 1996 have placed me in a position which allows me to offer a few introductory observations from the Dutch perspective on the theme of this conference: ‘The similarities and differences between central government accounting and local government accounting within or between countries’. My change of appointment also brought about a change in my position with regard to reporting: as a mayor I was responsible every year for drawing up and presenting the municipal accounts on time to the municipal council. My role as a member of the Board of the Netherlands Court of Audit is to independently audit the accounts of central government ministries.

How well am I doing in managing my warehouse? How well are each of the managers who report to me doing in managing their warehouse operations? Which of our warehouses is doing the best job, and what changes would bring the others up to that standard? How well are each of my foremen doing? How effective is my warehouse crew, and what can I do to upgrade the performance of these people?

Once the quality assurance program is in place and up and running it is necessary to periodically review and examine the system to be sure that the program is continually being implemented. Such reviews and examinations are called audits, and there are several different types. These are described below.