The Commission for Health Improvement's first review of mental health services has revealed serious problems as a consequence of staff shortages, as well as substantial variation in the experiences of service users.

The CHI report on Wrightington, Wigan and Leigh trust found it was in transition following a major reorganisation and commended its 'effective leadership and notable capacity for learning and improvement at all levels'.

But it said 'the trust has an urgent need to recruit psychiatrists' and called for more collection of data on quality and outcomes and for the trust to 'ensure that its many plans are seen through to fruition', in particular regaining accreditation to train junior doctors.

An action plan drawn up by the trust on completion of the review has highlighted significant progress since the CHI team left, including the appointment of a consultant psychiatrist, provision of single-sex accommodation and the integration of health and social care provision.

With the rolling programme of CHI reviews now established across NHS organisations, the commission has published several other reports in the past week, including two trust reviews which identified 'a gap between vision and reality'.

The review of Gloucester Royal trust found 'extreme' pressures on space, equipment and staff, compounded by too many patients being ready for discharge but with nowhere to go.

Delayed discharge was also a problem at Redbridge Health Care trust, as were waiting times and weaknesses in middle management. But both trusts also won praise in areas such as staff training and development.

The first CHI review of a health authority has also been published.

The report on Norfolk HA and its primary care groups concluded that lack of time and money to implement clinical governance was a key issue, but praised overall performance in delivering public health services, commissioning and development of audit.

Areas in which a greater need for consistency was identified included patient involvement, use of electronic data to support patient care and risk management.