The Commission for Health Improvement has published the report of its fourth pilot clinical governance review, which looks at North West Wales trust.The report raises a 'significant concern'about 'lack of provision of co-ordinated cardiac services'over the trust's two main sites, and suggests that its human resources strategy should be updated.The trust has 'made progress' in developing clinical governance in the short term, but needs to develop its long-term plans, structures and leadership further, the review team found.The reviewers also noted that the trust has developed care pathways, including one on 'care for the dying' on which it leads an all-Wales project. CHI chief executive Dr Peter Homa said the trust had produced an action plan following the review. 'We do not just say what We have found, we help the health service to develop plans for improvement. And in four years we will be back to see how they have done.'