Publication of the Commission for Health Improvement's first two reports was always going to represent a test of CHI itself as much as of the organisations under its investigation. NHS managers have engaged in intense debate about what would constitute an appropriate modus operandi for CHI - and about what its style is likely to be. Naming and shaming, in the mould of outgoing Ofsted chief Chris Woodhead, never flinching from the fiercest criticism? Or constructive and supportive with the emphasis firmly on recovery, in what those acquainted with CHI director Peter Homa sense is more his natural mode?
Now they know what they can expect, with the release of reports on North Lakeland Healthcare trust in Cumbria and Carmarthenshire trust in Wales. The answer is a subtle blend of the two models. If CHI does not quite name and shame - individuals are identified by job title - neither does it shy from detailing the inadequacies of those involved. The public would hardly be satisfied with anything less, let alone ministers, widely suspected of political bloodlust in cases such as these. But while CHI may point the finger with one hand, with the other it emphatically signals the way forward for these two wretched organisations.
Here, and in the many reports from around the service which will inevitably follow down the years, CHI has to aim for a delicate balance between not appearing to let the culpable off the hook while avoiding a festival of scapegoating. The public's instinct, perhaps understandably in emotive and tragic instances such as these, is always to seek the embarrassment and humiliation of those it deems responsible. But that in itself rarely solves anything. CHI is right to assert the importance of providing 'a very clear route map back' to recovery for the organisation rather than stoop to playing the avenging angel.
As HSJ goes to press, it remains to be seen how the public will greet CHI's first two reports. The one on North Lakeland is the harder hitting; CHI's brief in Carmarthenshire was restricted for legal reasons, though it is confident that its recommendations if fully implemented would restore confidence in the trust nonetheless. It is inescapably dispiriting to read the catalogue of cruel practices perpetrated on mentally ill patients in Cumbria, so many decades after Ely. What may make the difference this time is CHI's influence and high profile, and its closeness to ministers' hearts. The public mood, too, is far less tolerant of NHS atrocities than once it was. Above all, the overarching framework of clinical governance - still under construction - should ensure that situations like these will eventually never occur again. But nothing is certain without determination locally to effect a transformation.