NHS inspectorate shows its teeth

CHI aims to ensure care is the best it can be

The first investigations by the NHS inspectorate, the Commission for Health Improvement, has proved that the fledgling organisation pulls no punches.

CHI's reports into hospitals in Cumbria and Carmarthenshire were comprehensive and damning.

Notably, in the case of North Lakelands NHS Trust the CHI team concluded that it could not be sure that the problems of abuse of patients and failure to act on complaints would not be repeated.

This conclusion followed hard on the heels of an external inquiry and reports from the Mental Health Act Commissioners, both of which were positive about the new unit that had replaced Garlands Hospital where the abuse took place.

The establishment of CHI as part of the government's modernisation of the health service brought a mixed reaction.

Sceptics suggested that, as it was staffed predominantly by people who worked in the NHS, it would not be sufficiently critical when care did not come up to scratch.

And the fact the commission has no powers to discipline staff or shut down services led some to suggest that it was "toothless".

On the other hand some health service staff were alarmed that the new inspectorate would led to "naming and shaming" of hospitals and individuals.

Parallels were drawn with the schools inspectorate Oftsed.

Supporting the NHS

The government has always been adamant that the role of CHI is to support the NHS, while making sure that it protects the public from lapses in standards.

CHI came into being under the 1999 Health Act, assuming its statutory powers in April 2000.

It has four main functions:

• conducting a rolling programme of clinical governance reviews of every hospital, health authority and general practice
• monitoring how national guidelines such as National Service Frameworks and guidance from the National Institute of Clinical Excellence are implemented
• investigating "major system failures" such as those in North Lakelands and Carmarthenshire
• Becoming a focal point for sharing of good practice.

Its overriding purpose is to make sure that health care is the safest and best quality it can be and to iron out the variation in standards across the UK.

The bulk of the commission's work involves the clinical governance reviews, with every NHS organisation receiving a CHI visit every four years.

The CHI team spends about a week in each organisation observing care and collecting information from staff.

CHI director Peter Homa:robust and supportive

These reviews will feed in over time to the planned "traffic light system" for hospitals.

Traffic lights

Hospitals given the green light by CHI will have additional freedoms in how they spend money and develop services; those on an amber light will be monitored to make sure any problem areas are improved; red light hospitals may have management teams removed and a "hit squad" despatched to turn things around.

Although CHI operates as an independent body it is accountable to the Department of Health for the work it does.

With a budget of £12m for the current financial year, many of the people working for the commission are clinical staff and managers on secondment from NHS jobs.

It is headed by Dr Peter Homa, formerly the NHS "waiting list buster" and chief executive at Leicester Royal Infirmary, who has pledged that the commission will be both robust in its criticism and supportive of staff.