CHI is currently evolving into the Commission for Healthcare Audit and Information (CHAI).

Members may be forgiven for suspecting that the new arrangements mean more tea and less action, and may wonder where we go from here - maybe CHAIN (we once had cogwheel), CHAIR (more committee and less action) or even a euro version CHAIS. Some details of CHI/CHAI and the importance for clinicians are outlined below.

Introduction
CHI was established to improve the quality of patient care in the NHS. It does this by reviewing the care provided by the NHS in England and Wales (Scotland has its own regulatory body, the Clinical Standards Board). CHI aims to address unacceptable variations in NHS patient care by identifying both notable practice, and areas where care could be improved. It has six operating principles that underpin all of its work:, namely:

• The patient’s experience is at the heart of CHI’s work
• CHI will be independent, rigorous and fair
• CHI’s approach is developmental and will support the NHS to continuously improve
• CHI’s work will be based on the best available evidence and focus on improvement
• CHI will be open and accessible
• CHI will apply the same standards of continuous improvement itself, that it expects of others

Statutory functions of CHI
CHI currently has four statutory functions:

• Clinical governance reviews (see the CHI website for more details: www.chi.nhs.uk)
• Studies
  The first CHI national study report into Cancer Care in England and Wales was published in December 200l. The next study, which will look at implementation of the NSF for coronary heart disease, will be published in 2004.
• Investigations
  CHI investigates serious service failures in the NHS. It will only investigate issues if there are lessons to be learned across the NHS.
• Leadership
  CHI leads, reviews and assists NHS healthcare improvement and aims to collect and share notable practice in the NHS.

How is CHI’s work changing?
At the request of the Secretary of State for Health, CHI has been asked to set up an Office of Information on Healthcare Performance. CHI will become CHAI (Commission for Healthcare Audit and Information). This will become a leading source of information regarding the performance of NHS organisations, both at local and national level. This specialised department will be responsible for publishing NHS performance ratings and carrying out national surveys of patients and staff. It will also conduct national clinical audits. This will mean that CHI will review all aspects of patient care and will publish a wide range of information about the NHS.

These new arrangements are being presented to Parliament with a view to coming into force in April 2004. Professor Sir Ian Kennedy has been appointed as the Shadow Chairman of the Commission until he takes up the substantive role. He chaired the Bristol enquiry. His appointment indicates the determination of the Government to implement the lessons learnt from Bristol and in particular their determination to obtain information on which performance can be judged.

NICE
Although arrangements are not yet confirmed, changes may well include taking over the currently proposed NICE portfolio of audit – including the National Stroke Audit, the Myocardial Infarction National Audit Project (MINAP) and the proposed National Continence Audit. CHAI may well also subsume the National Health Service Information Agency (NHSIA) and the National Clinical Audit Support Programme (NCASP).

Such changes are important for clinicians, as there will be growing pressures to obtain data on performance which will be open to public scrutiny. It is essential, therefore, that the profession contributes to these developments to ensure that the data generated reasonably reflects practice.

How independent is CHI?
“CHI works closely with the Department of Health (DoH), but operates independently from it.” CHI commissioners, appointed by the Secretary of State for Health in England and NAW, ensure that CHI operates independently. The National Audit Office is CHI’s external auditor.

BGS members can draw their own conclusions as to the likely independence of a body of commissioners appointed by theSecretary of State for Health. Recent newspaper reports have highlighted that the Government is concerned about its ability to control potentially damaging reports regarding the state of the NHS. There appear to be moves to reduce the guarantees of independence for the newly emerging Commission for Healthcare Audit and Inspection.

JM Potter
Chairman
Clinical Practice Evaluation Group