COMMENT: Problem trust is opportunity for NHS to show its 'modern' credentials

The report from the Commission for Health Improvement on Epsom and St Helier trust makes sobering reading - a trust, it seems, untouched by modernisation. The catalogue of problems it faces covers almost every area: clinical standards, workforce shortages, the physical environment, leadership and morale.

It is a trust which has become infamous for its failures, a trust running hospitals in which the local population and local GPs have no faith and in which staff do not wish to work. The rot set in at St Helier many years ago and has been allowed to continue - by regional office and the health authority as well as the trust's own management team. Problems accumulated over a long period with, until recently, limited efforts to find solutions or ensure accountability. It seems the trust had simply come to be viewed as a troubled one - 'Epsom and St Helier - oh, It is had problems for years. . .'

Were it not for CHI, it is quite possible that little would have changed. Now the NHS has mechanisms for bringing problems to the fore - never more starkly than in the shaming review report on Epsom and St Helier, with a list of action points running to two pages.

The action plan set out to haul the trust into the 21st century is robust and commendable - but that in itself may not be enough. A new chief executive and a lengthy 'to do' list can not be expected to achieve the kind of radical change the trust needs. The importance of maintaining a tight grip on the process of change at Epsom and St Helier must not be overlooked. But the service is once again entering a period of sustained upheaval, with the transition from region to strategic health authorities making support and monitoring in the short term very difficult.

In time, a case such as Epsom and St Helier might seem ripe for an experiment in 'franchising'. For now, newly appointed trust chief executive John de Braux may have to rely on all the support the Modernisation Agency can muster. It must take a leading role in triggering change throughout the organisation. If the new management team, with help from regional office and the agency, can turn round the trust within a year, the 'modern' NHS will have demonstrated real capacity for change. Health secretary Alan Milburn still has the option of implementing the recommendations of the report of the Bristol inquiry and extending CHI's role to validation of services.

It may come too late for Epsom and St Helier, but CHI needs to have teeth. As things stand, its reviewers will simply return in four years.

If the Department of Health truly wants to show its commitment to delivery it can take action that will ensure Epsom and St Helier and other trusts like it have the support they need, and in the process make clinical governance a reality.