The inspection body charged with reviewing standards of NHS care is to revamp its image in an attempt to distance itself from Ofsted, the controversial education inspectorate run by Chris Woodhead until his resignation last week.
An internal report for the commission for health improvement (CHI) reveals it is "uncomfortable" at being perceived as the health service equivalent of Ofsted, which became notorious for its "name and shame" approach and for its unpopularity among teachers. The commission is worried that it is regarded negatively by NHS bodies as a "hit squad" or as a "namer and shamer" - a reputation that will detract from its attempts to collaborate with hospitals to help them develop better services.
The report reveals internal concerns that the CHI, headed by chief executive Peter Homa, is regarded with cynicism by health service staff, has a negative media image and is virtually unknown to the general public.
The organisation, which will carry out independent inquiries into problem hospitals and review standards of care in local health services, is considering "repositioning" itself to improve its poor image - even though it has yet to publish the results of any of its investigations. "The NHS perceives us as an 'Ofsted for the health service', which we are not comfortable with," the report says. "But an inspectorate for the health service (and one that is developmental and consistent) must be a good thing."
Among other measures, the report recommends that the CHI drops the use of the word "inspect" from its corporate vocabulary because of its "negative connotations". Instead, it suggests, the word "assessment" should be used.
The report was written by Matt Tee, CHI director of communications, who was formerly head of news at the Department of Trade and Industry (DTI). Before that, he was public relations director at the Guy's and St Thomas' hospital trust in London.
The commission, which was set up in April, is a key part of the government's plans to drive up standards of care across the NHS. It is due to publish its first reports within the next couple of weeks. But the report warns that the NHS is "cynical" about its claims to be independent of government, and distrustful of its wider aims and values.
"I believe the NHS has mostly heard our message that we want to be developmental, but is cynical about our ability, let alone desire, to behave differently," writes Tee.
The report hints that the CHI's reputation may have been damaged by the government spin that accompanied its launch, when aggressive terminology such as "hit squad" was bandied around to describe its role. While that spin initially gave it a strong, front page profile, it may have caused long-term damage to its relations with the health service.
A survey in September by health accreditation company Health Quality Services and trade magazine Health Service Journal found most NHS managers "fearful of inspection" by CHI. Many of those surveyed felt inspections would be stressful, costly and punitive and would lead to many committed staff being forced out of the NHS.
The commission report admits that early national media coverage of its role has locked negative perceptions of its work into the mind of the media. "The political journalists think of us purely as Ofsted for the health service and aren't really interested in any other story," it says, "... unless we turn sharply on the government, or the government gives us significant new teeth."
The report urges a charm offensive on the trade and professional media, which, it says, "have a huge influence on how we are seen because they are seen as dispassionate commentators and what they write is respected".
But the report also warns that the CHI must prove it is independent and must be "prepared to say things that will make the government, the NHS and the public uncomfortable at times".