Published: 06/02/2003, Volume II3, No. 5841 Page 25

Jonathan Shapiro's article (Walking tall, page 18, 23 January) is surprising. Is he arguing that the Commission for Health Improvement got it wrong, and that his trust does not deserve the favourable report on its clinical governance arrangements? No, instead he reveals his discomfort with rigorous, fair and objective external scrutiny.

Our developmental approach was never meant to be misinterpreted as soft or apologetic. The purpose of a clinical governance review is to assess the progress NHS organisations are making with clinical governance. We set out to be challenging - not to produce a negative reaction, but to secure necessary changes in attitude and behaviour to benefit the service and patients. This has not stopped us from building constructive relationships with individuals and organisations committed to the same goals.

I am disappointed that Dr Shapiro has little if anything to say on the value to the trust of the review process as a whole. The evidence on the benefits of healthcare regulation internationally shows that being assessed by an external body can help organisations to focus on long-term priorities, can act as a lever for change, help individuals to overcome institutional and/or professional resistance to change and can act as a catalyst for improvement. In general, the feedback we have received from trusts that have been reviewed, some solicited and some volunteered, confirms the evidence and indicates that the CHI review process generally achieves the positive benefits of regulation.

That is not to say CHI itself is incapable of improvement.We value feedback on our process and the individuals who carry it out, and incorporate it into appraisal processes for our methodologies, CHI staff and our reviewers, many of whom usually work elsewhere in the NHS.

The review Dr Shapiro refers to was able to highlight a great deal of good practice that the rest of the NHS could learn from. It was also able to highlight some areas where further improvement could be made - which will ultimately feed into better patient care.

That more than justifies any discomfort Dr Shapiro may feel with the notion and practice of independent external scrutiny.

Dr Peter Homa Chief executive CHI