Just like film star Meryl Streep, able to adapt to many different roles, and carry them off with aplomb. That's the model for the Commission for Health Improvement. Kaye McIntosh reports

It's the old 'good cop, bad cop' routine. The latest NHS watchdog will be all cuddly and fluffy at first.

One step out of line, however, and it will develop fangs and a healthy appetite.

But people shouldn't fear the Commission for Health Improvement knocking at their door. At least not if director Peter Homa is to be believed. Instead CHI - pro - nounced variously Chee, Chy or even Kye depending on whether you are into feng shui, trendy Indian tea or mathematics - 'will work collaboratively' with the NHS.

Delegates at a London conference on CHI organised by Birmingham University's health services management centre last week were a little suspicious.

HSMC senior research fellow Dr Kieran Walshe had his own way of putting it. 'CHI must move along the continuum from policeman to friend, when talking to different organisations or different parts of the same organisation. It can't be John Wayne, playing the same part in every movie. It must be more like Meryl Streep.'

A blushing Dr Homa turned down the opportunity to demonstrate his Meryl Streep impersonation, bad accents not being his strong point. But he did take the point. 'CHI must combine the ability to provide scrutiny of clinical governance with the capacity to help and develop.'

This is something which other - infamous - regulators have failed to achieve, according to one speaker.

Professor Carol Fitz-Gibbon of Durham University's education department could obviously think of a few choice words for schools inspectorate Ofsted. But she was far too polite to use them on a conference platform.

That didn't stop her tearing into Chris Woodhead's lot. 'The methodology of Ofsted visits is deeply flawed.' There had only been one study to assess the inspectorate's methods. It was set up by someone with 'no experience in research or in education'.

Its findings were platitudes: 'Good schools have a safe environment! I don't know anyone who is campaigning for an unsafe environment, ' Profressor Fitz-Gibbon commented.

Kate Tompkins, director of nursing and operations at Wiltshire and Swindon Health Care trust, tried to bring things back to a less emotional level. 'Many of us in healthcare are not used to being inspected and looked at. Is one of the lessons to start simple and get people used to a very different way of life in the future?'

Professor Fitz-Gibbon was having none of it.

Inspection was expensive and of doubtful validity.

'No, we don't need to get used to it. Just stop it.'

Just as forthright, but from the opposite point of view, was Denise Platt, head of the Social Services Inspectorate. She didn't approve of coaching for visits. 'We have just been into an authority that spent£100,000 preparing for our visit and they have failed, ' she told delegates.

'Because you can't stitch up the public.'

Ms Platt wasn't pulling her punches. 'It is not my job to defend organisations or social services. It is my job to defend carers and users.'

In the days immediately after Harold Shipman was convicted of murdering 15 patients, it was a timely reminder.

But managers at the conference wanted CHI to avoid aping other government regulatory bodies.

Dr Syamala Thomas, medical director of Mayday Healthcare trust in Croydon, south London, told H S J: 'The way the Social Services Inspectorate works seems very judgmental. If CHI was like that we might feel very threatened.'

While a strong hand was needed to crack down on malpractice, David Cain, chief executive of Trafford Healthcare trust in Manchester, made a plea for flexibility. He wondered how CHI would deal with the constant re-arranging of the furniture that seemed to go on in the health service.

Would it prove a strait - jacket, unable to cope with fluid arrangements between organisations?

He told H S J that his own 'whole-district' trust was working with a primary care group that might become an independent trust in the near future, and with a local authority keen to pool its budgets with the NHS to free resources.

'What we don't want is a regulatory framework that prevents these opportunities being taken.' But he was 'reassured' by the approach of Dr Homa, who soothed delegates by depicting CHI as a positive force, supporting and encouraging all those managers, doctors, nurses and health workers who wanted to do better.

It would be evidencebased and - eventually - an 'international repository' of information on clinical governance.

Its commissioners are in place, along with about 24 staff, many of them on secondment from the NHS or civil service. And that is the pattern for future development. CHI's employees should be able to move in and out of grassroots NHS management and clinical work, to avoid the 'predictable half-life' syndrome where assessors rapidly lose touch with the day-to-day reality of those they inspect. 'I want staff to find their work with us among the most stimulating and enjoyable of their careers, ' Dr Homa said.

It looks as if Dr Homa is already enjoying the vision. Whether those he 'supports' or 'inspects' will be as keen is another question. But a number of trusts and PCGs have risked being labelled swots and volunteered to be among the first 25 visited when CHI starts work in April. Whether they live to regret it or not, it is bound to be an interesting experience.

Tips for the top: the experts' advice for CHI

Dr Caron Grainger, consultant in public health medicine, West Midlands region: 'Don't inspect, develop. It is about leadership at the highest level.'

Dr Kieran Walshe, HSMC: 'Be willing to break the mould of past models.'

Dr Oliver James, politics department, Exeter University: 'There is a tension between the policing and the consultation roles. Give the consultation roles to different organisations.'

Professor Carol Fitz-Gibbon, Durham University school of education: 'When do we evaluate the evaluators to get the cost-benefit for what we do?'