NEWS FOCUS: One of CHI's first reviews deals with the bodies-in-the-chapel 'scandal'. The man who paid the price, Ken Williams, talked exclusively to Laura Donnelly

I just do not accept it. ' Ken Williams (left) has more reason than most to resist critical findings made in the Commission for Health Improvement's first set of reviews.

But the rejection, from the man who stood down as chief executive over the bodies-in-the-chapel furore at Bedford Hospital trust in January, mirrors comments made by all three trusts under the microscope this week.

Their reactions to what should have been a 'developmental' process are opening a wider debate - about how an organisation like CHI can fairly judge amorphous issues such as quality, 'the patient experience' and staff relations, and how far concerns raised by individuals can be balanced against more general evidence.

CHI released three clinical governance reviews this week, examining Bedford Hospital trust, Poole Hospital trust and the Countess of Chester Hospital trust. None of their conclusions were damning;

all three trusts received a mixture of praise and criticism.

Yet both Mr Williams - now seconded to run the west division of Eastern region's workforce confederation - and the chief executive of Poole Hospital trust seem bruised by the CHI experience.

The report on Bedford vindicates comments made by many in the service who came to the support of Mr Williams when the media story on overflow mortuary facilities broke. The review of the trust was brought forward because of concerns over the issue.

'Despite the apparent lack of respect and dignity shown to the dead by the published photographs in the national press, CHI found no evidence to suggest a general lack of respect for individuals at the hospital.

'Every member of staff interviewed about how they treated the deceased gave a moving and thoughtful account of the care they personally gave. '

But the report gives credence to suggestions that the very existence of the photographs reflected a different problem altogether - poor relations between managers at the trust and certain groups of staff.

'The trust has a 'them and us' culture. Many staff indicated that they were afraid to report incidents for fear of being branded troublemakers.

'Despite having a whistle-blowing policy for staff who want to raise concerns, CHI found that staff either did not know about the policy or would not feel safe using it.

'There was a strong feeling that staff raising serious concerns would not be supported by the trust. Recent high-profile events had reinforced this. '

Mr Williams feels that too much weight has been given to anonymous opinions voiced to CHI, at the expense of quantitative accounts, such as staff attitudes surveys carried out by the trust.

He also points to 892 signatures in a petition supporting him, and the fact that 'the whole of the medical staff voted for my reinstatement'.

Speaking exclusively to HSJ, he says: 'What is a little bit difficult to understand is why they looked at these concerns raised by some individuals but didn't look at any further evidence.

'It doesn't sit well with the groundswell of support that I felt, nor does it sit with the staff attitudes' surveys - of which we now have two. '

He says Bedford's first survey reached a 35 per cent 'favourability' rating, compared to a 30 per cent average among the NHS syndicate to which Bedford belongs.

'I am concerned about the methods used by CHI. . . There is not much benchmarking - It is just not very objective. '

As this piece went to press, Bedford Hospital trust was not available for comment.

Despite an overall feeling that the report on the Countess of Chester paints an accurate picture, medical director Dr William Kenyon agrees to 'anxieties about the use of anecdotal evidence and the presentation of it'.

Such concerns are echoed more strongly by Lloyd Adams, chief executive of Poole Hospital trust.

The trust received praise for its stroke unit and the methods used to select day cases. But it said patients were 'frequently moved between wards, often at night, and that many patients are not based on the ward where their consultant works . . . The workload for the trust's operating theatre is extremely high which means that operating lists are being undertaken late into the night'.

HSJ asked Mr Adams whether the report reflected the trust as he sees it.

'I suppose it would be churlish to say no, but there is a feeling that it tends to focus on the negative.

'Most elements of it are factually correct, but there are some that appear to be based purely on anecdotal evidence, whether from staff or patients.

'The nature of this sort of experience is that it lends itself to people who want to complain. '

Mr Adams says the final report was actually less critical than earlier drafts shared with senior staff at the trust, and far less damning than initial verbal feedback they got from CHI.

'That was demoralising for our staff and left me with a huge leadership job, ' he says, resignedly.

Talk back: CHI's response CHI chief executive Dr Peter Homa says: 'Inevitably a review will expose areas that are uncomfortable for some people working within organisations. '

But he insists CHI seeks to balance a 'combination of qualitative and quantitative evidence'and 'triangulate'them to 'tease out the real issues'. He says CHI has already wised up to the difficulties of examining broad areas such as staff satisfaction and the 'fragmented'way in which such issues are currently evaluated, and is in the process of creating a standard staff survey for trusts to complete.