The last major piece of the government's quality drive jigsaw has fallen into place with the announcement of the chair and director of the Commission for Health Improvement.
Dame Deirdre Hine, who retired as chief medical officer for Wales in 1997, and co-chaired the advisory group that led to the Calman-Hine report on cancer services, will chair CHI part-time for£20,950 a year.
The director of health improvement will be Dr Peter Homa, who has been leading the government's waiting-list drive since May 1998 when he was seconded from his job as chief executive of Leicester Royal Infirmary trust. His salary will be 'up to£100,000'.
Managers' leaders have welcomed their appointments. Nigel Edwards, policy director of the NHS Confederation, says: 'They are two excellent people who will be a powerful force for change.'
He is also happy that the 24-strong advisory group contains many confederation nominations and provides a good balance of different experience and skills (see box, left).
The commission will start work in November and expects to begin the first 'inspections' of trusts in the spring.
Health secretary Frank Dobson thought the appointments sufficiently important to announce them himself. He expressed delight at finding two people committed to making 'the best use of clinicians and managers to deliver better and quicker services'.
He said that Dame Deirdre's track record, which includes having been director of Breast Test Wales, spoke for itself, and pointed to a fall in waiting lists of more than 220,000 since Dr Homa took over the task.
Dame Deirdre is also president-elect of the Royal Society of Medicine and has long experience in medicine and public health. This does not quite square with the promise that CHI's chair would be 'a lay person' not employed by the NHS.
In fact, she did not initially apply for the chair's job, but for the position of Welsh member of the commission. But her performance at interview was 'so outstanding' that she was asked to consider going for it.
The breadth of her experience was 'unrivalled by any of the other candidates', according to sources at the Department of Health.
Dame Deirdre comments: 'I am medically qualified, but I would not be regarded by my clinical colleagues as one of them.'
She points out that she gave up clinical work 25 years ago, since when she has been involved in management and policy. And she says: 'As I get older, I am more and more interested in the patient point of view that has always dominated my thinking.'
She was interviewed twice, including by a panel with a representative from the Commission for Public Appointments, before being appointed.
She says the chair's role will be to 'establish the style of the organisation' which will have to be carefully worked out because of the 'complex work that is necessary to deliver clinical care to patients'.
That style will not be 'over-confrontational' and will be very far from the image of a powerful inspectorate trampling over managers and clinicians that the popular press has suggested.
Dame Deirdre wants to contribute to an NHS 'in which skills are applied in a patient-friendly way in an environment that is conducive to excellence'.
She adds: 'We will develop the appropriate critical faculty. We would be of no use to the service if we didn't.'
But she says her experience tells her that the best way to encourage improvements is to hold up a mirror. The reflection of an inadequate performance is a powerful incentive to change, she says.
She adds that it would be totally counter-productive if CHI were to be seen as a kind of 'Ofdoc' or 'Ofsick', creating similar tensions in the service as Ofsted has with teachers.
Dame Deirdre was one of a team of doctors from the Welsh Office who visited Bristol Royal Infirmary in the mid-1980s to look into concerns about its child heart surgeons. Then, she says, there was insufficient evidence available to enable action to be taken.
While she is reluctant to draw lessons while the Bristol inquiry continues, Dame Deirdre believes that CHI will identify problems much earlier.
She says it will have better sources of information, and she points to the development of better information systems.
The commission will have a multidisciplinary staff of 40 to 50 people to carry out reviews of clinical governance at every trust over a period of four years. Reviewers will be drawn from the service, but will not become permanent members of staff.
That, says Dame Deirdre, will be a very effective way of getting the message across because the reviewers will return to the service.
Dr Homa says the commission will not turn up unannounced at unsuspecting trusts, but will take a 'rigorous, evidence-based, developmental approach to its responsibilities'.
One of its 'very early tasks' will be to design review mechanisms and work out how to enlist the multidisciplinary personnel who will be needed to ensure that the reviews are expert.
'We will be working with the health service to help them deliver,' Dr Homa says.
The object, says Mr Dobson, is 'not to go round identifying wrongdoing but to improve standards'.
But if things do go seriously wrong and there is an inadequate response to the commission's advice, he has 'the necessary powers to take action'.
In practice, the commission will report first to health minister John Denham in England and to health and social services minister Jane Hutt in Wales. Only the most serious or intractable cases will reach the health secretary's desk.
The commission intends to liaise with organisations with an interest in quality in the NHS, from the General Medical Council and the UK Central Council for Nursing, Midwifery and Health Visiting, to royal colleges and accreditation bodies.
Hosital trusts will be the first to be reviewed, and a relationship will be developed with primary care groups pending the development of primary care trusts.
CHI's advisory group will meet in September for the first time. Its 24 members include:
Richard Higgins, chief executive, Parkside Health trust, west London.
Clare Dodgson, chief executive, Sunderland health authority.
Judy Wilson, director of the Long-term Medical Conditions Alliance.
Professor Trevor Sheldon of York University.
Isabel Nisbet, director of fitness to practice, General Medical Council.
Dr Jonathan Boyce, director of health studies, Audit Commission.
Professor Rod Griffiths, West Midlands director of public health and policy.
Tessa Brooks, leader of the NHS chief executives' development programme.
Dr Sheila Adam, deputy chief medical officer.
CHI's key tasks
To visit every trust and primary care trust in England and Wales to review quality arrangements;
to identify and tackle serious or persistent clinical problems at an early stage;
to investigate such problems;
to conduct national and local reviews on the implementation of NICE guidelines and national service frameworks.