Multiple healthcare failings point to an NHS culture where care and compassion are no longer guaranteed. The NHS Constitution and values set out in it should have supported and empowered healthcare professionals to improve their working culture, however these have not been widely adopted. This article describes a framework for all healthcare staff that hinges on principles of ‘observing practice, praising good practice, challenging poor practice, and escalating if standards are compromised’ (OPCE), and which encourages everyone to take responsibility for poor care.