Commission for Health Improvement (CHI)

The Commission for Health Improvement has a vast task ahead of it. Patrick Butler explains

Patrick Butler
guardian.co.uk

Wednesday November 15, 2000

What is the Commission for Health Improvement?
An "arms length" health services inspection body, set up in April 2000, with the aim of driving up standards of care across the NHS in England, Wales, and (by invitation only) Northern Ireland. Scotland has its own body, the Clinical Standards Board. CHI carries out investigations into "major system failures" (known in journalese as "failing hospitals") and, separately, it plans to inspect every NHS trust, Health authority and primary care group (known as local health groups in Wales) by 2004 as part of its programme of clinical governance reviews. Clinical governance reviews measure, in each inspected body: the quality of patient care; whether clinical staff are up to date in their professional practice; and that safeguards are in place to prevent clinical errors.

Does CHI see itself as a bit like Ofsted, the education inspectorate?
No. They are both inspection bodies that aim to raise standards at the organisations they inspect. However, CHI resents its reputation as 'the Ofsted of the NHS' feeling that this gives it an unwarranted reputation as an aggressive, intimidatory 'hit squad' out to punish recalcitrant NHS organisations. It wants to be known as an 'assessor' rather than an 'inspector' and sees its role as developmental and collaborative. It says its methods are "very different" from those of Ofsted.

Does the NHS believe CHI is a bit like Ofsted?
Yes, so far. A recent survey by the Health Quality Service and trade magazine Health Service Journal discovered that most trust NHS chief executives and senior quality managers were "fearful of inspection". They worry it will adopt an Ofsted-style "name and shame" approach, that staff will be made public scapegoats, and that CHI investigators will "relish… wielding a big stick." Like school teachers with Ofsted, NHS managers believe CHI inspections will be costly, stressful, and will distract attention from day-to-day work.

Does it have the power to close failing hospitals or remove the management?
No. But it "will report serious findings" to the health secretary or the Welsh Assembly (who may take action). According to health secretary Alan Milburn: "(CHI)…is uniquely placed to respond quickly to and investigate thoroughly, with extensive powers to gather information and interview individuals. Using these it will identify the source of problems, and develop fast and effective solutions. It will not take over the provision or management of services."

Is it independent of government?
Technically, yes. Its aim is to publish the truth as it sees fit, regardless of how uncomfortable this may be to government, NHS bodies or to the public. There is some cynicism among NHS staff as to how independent it will be. An internal CHI report in October 2000 admitted: "We need to convince the NHS that we are the developmental body we claim to be… The NHS audience is reasonably aware of what we aspire to be, but is cynical that we will be allowed to be."

Who decides which NHS organisation will be investigated by CHI?
It will investigate individual health services "when required to do so" by the secretary of state for health. In addition, "anyone within or outside the NHS" can ask it to conduct an investigation, although in these cases it is a matter for CHI to decide whether or not to proceed.

Who runs CHI?
It is chaired by Dame Deidre Hine, former chief medical officer for Wales and co-author with ex-chief medical officer for England, Kenneth Calman of the seminal Calman-Hine report into UK cancer services. The chief executive is Peter Homa, a former trust chief executive and head of the NHS waiting list task force. Board members include two prominent Labour Party-supporting doctors, cancer specialist Professor David Kerr and London GP Sam Everington.

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Useful links
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