I have what I consider to be a healthy scepticism regarding new assessment instruments. Many of these are announced with great enthusiasm but fairly rapidly disappear or are used mainly by those who have developed them and by their associates.

Although the tone of the paper by Gowers et al. (2000) seems rather strong on enthusiasm and perhaps a little lacking in its critical view, I do have great respect for colleagues associated with development of HoNOSCA and other respected colleagues talk well of it. Clearly, it deserves careful scrutiny. For me relevant questions include: ‘Is it easy to use?’, ‘Is it useful in terms of describing a patient population?’ and ‘Is it useful in looking at outcome?’