On reflection

Peter Homa, one-time CHI chief executive and - briefly - CHAI chief inspector, has returned to the south London trust where he worked at the beginning of his career. In his first interview since his dramatic departure from the inspectorate, he tells Alastair McLellan that he has much to look forward to

When HSJ interviewed Peter Homa high up in the central London headquarters of the Commission for Health Improvement in November last year, the CHI chief executive enjoyed a sweeping, panoramic view of the capital - and Mr Homa's future seemed just as impressive.Most observers agreed that he was a shoo-in for the post of chief inspector at CHI's successor, the Commission for Healthcare Audit and Inspection, a job that Mr Homa agreed would make him as powerful as NHS chief executive Sir Nigel Crisp (The HSJ Interview, pages 18-19, 21 November 2002).

A year later and Mr Homa is ensconced at St George's Healthcare trust in south London, having recently been appointed chief executive of the troubled trust.His new office 'enjoys' a view of the hospital roof and a distant row of terraced houses.

It is now a matter of record that Mr Homa did get the CHAI job, only to fall out dramatically with chair Professor Sir Ian Kennedy over how closely the new inspectorate should follow the path taken by CHI. Then in July this year it was announced that Mr Homa was returning to St George's, a hospital in which he served as an administrator in the 1980s.

Mr Homa has kept his counsel since losing the CHAI job.He has agreed to give HSJ the first interview since entering this selfinflicted purdah, but even now he speaks cautiously and has to be cajoled into discussing both CHI and CHAI.

Asked what legacy the original inspectorate will leave CHAI, he speaks warmly of the CHI staff and their 'wealth of experience in how to inspect NHS services', as well as commending 'some very powerful analytical tools' they helped to develop.

But Mr Homa says that CHI's greatest achievement was that 'within a very short period of time, it broke the ice on NHS regulation'.He believes that in general most in the service thinks CHI is 'a force for good'.

This opinion has not changed since returning to the front line.

However, he has been reminded of the need to simplify and streamline regulation of the NHS.He has also, he admits, been surprised by 'an assumption on some colleagues' part that CHI's judgements were very heavily influenced by the Department of Health'.

Mr Homa believes that CHAI would be wise to follow its predecessor's lead in making sure there is movement between the inspectorate and the NHS.

'If there is not the exchange of staff and experience, then the inspectorate is not aware of the heat and burden of delivering healthcare. And if those delivering healthcare, both clinical and managerial, are not aware of the inspectorate's responsibilities that means the whole process [of inspection] will not be as effective as it could be.'

One of the most telling criticisms of CHI's review teams was that not enough senior people were prepared to serve as reviewers. So would Mr Homa be prepared to serve as a CHAI reviewer?

'Once I've established myself at St George's I would be delighted to put myself forward', he says - with only the tiniest of hesitations.

Does that mean that Mr Homa is satisfied with the nature and clarity of CHAI's approach?

'Yes, ' he replies, before expanding: 'I am satisfied with the approach as I understand it. I realise how complex and difficult it is. I anticipate that it will be a migration from one regime to another, which will extend over a period of time. It may well be frustrating for some in that it will be seen as too slow in some areas.'

With that, Mr Homa moves the subject on quickly to his new job and the challenges that brings.

St George's is a nationally renowned tertiary centre with a respected and innovative medical school.Mr Homa points out that it provides 'among the most comprehensive range of clinical services in the land'.

But the latest star-rating analysis highlighted problems with accident and emergency and outpatient waits.An ongoing industrial tribunal case with former finance director Ian Perkins has seen accusations of waiting-list manipulation scattered across the national media.

No wonder, then, that Mr Homa feels that there are myriad calls on his time: 'The trust has found that a good deal of its attention has been deflected onto a small number of highprofile issues.'

He talks of 'rediscovering a sense of direction and selfconfidence - all backed up by solid delivery in a way that is meaningful to staff and patients'.

Work has already begun on a five-year plan, which will 'be informed by those we work with - including primary care and patients'.

He adds that for major tertiary centres like St George's, the local aspect can be 'enriched and complemented by some of the national perspectives'.

Asked for his vision of a modern acute trust, he replies: 'There must be much greater emphasis on clinical networks - where the roles and responsibilities of secondary and tertiary centres in relation to primary care are even more clearly defined.'

Mr Homa says that he wants St George's to be regarded 'as one of the premier hospitals in the country'. The view from Dr Homa's window may not be what it was - but his ambition remains just as far-sighted.