Janus: the two faces of the Commission for Health Improvement

A complex, competing and paradoxical array of roles is ascribed to the Commission for Health Improvement (CHI). This contrast in roles is perhaps best epitomised by descriptions of its role as to support and aid development of trusts and health authorities, whilst at the same time being the reviewer and investigator. Is it possible to accommodate these competing roles in one organisation? How has it been done? And how real is its much‐trumpeted prized independence? This paper provides a brief contemporary history of CHI in its first two years, and a commentary on this first generation organisational regulator prior to its transformation to CHAI, the second generation manifestation.