Described as one of the biggest reforms to the NHS since its creation in 1948, the Commission for Health Improvement - or CHImp - has been officially launched.

As watchdog for the health service in England and Wales, its role is similar to that of Ofsted, the education standards body. As such, some commentators have re-labelled it Ofsick. Headed by Peter Homa, and chaired by Dame Dierdre Hine, CHImp will tour hospitals, GP practices and other NHS centres to judge whether or not standards of treatment are up to scratch.

These standards will be set by the National Institute for Clinical Excellence, or NICE. It will recruit a staff of 400 doctors, nurses, and other health care professionals. The staff will monitor the performance of every aspect of the NHS in both England and Wales in a four-year rolling programme of inspection visits, starting, they hope, in April 2000.

During these, it will check the hospital's own performance figures, and examine whether managers and senior doctors are doing enough to improve standards through training and education. In cases where performance is extremely poor, it will have the power to send in hit squads to take over the failing hospital.

If whistleblowers alert CHImp to serious problems at a particular hospital, it has the power to undertake a spot check, and, with the agreement of the health secretary, remove an entire hospital trust management board if the service is clearly failing.

One of its first targets is expected to be to enforce high standards in cancer care across the NHS. The government hopes it will raise standards and stop scandals occurring - former Health Secretary Frank Dobson emphasised this role following the Bristol heart babies affair in 1998.

And in enforcing NICE rulings, it also hoped the commission will speed up an end to postcode variations in care, where the quality of treatment varies depending on where the patient lives. Critics say that given the size of the job, inspections risk either being too superficial or over bureaucratic.

Robert Naylor, an NHS trust manager, told the BBC: "I hope it does not become too inspectorial. I hope it will be an organisation that will help us to continue to improve and to facilitate that process rather than be an organisation which is continually critical." Current Health Secretary Alan Milburn was responsible for the development of CHIMP in his former role as a minister under Frank Dobson at the Department of Health. At the time, he promised a tough commission.

Death rates from Britain's second biggest killer cancer have plummeted thanks to earlier detection and better treatment. A study shows a 36% fall in bowel cancer mortality among women in England and Wales between 1971 and 1998, and a 20% fall for men over the same period.

Experts believe the reductions are partly due to patients overcoming their shyness to report embarrassing symptoms to GPs. It is also due to advances in treatment, such as chemotherapy using combinations of drugs, which have improved survival and quality of life. However the disease still kills around 17,000 people a year in the UK, claiming more lives than any other cancer apart from lung cancer.

Dr Lesley Walker, is head of scientific information at the Cancer Research Campaign, which published the report. He said: "We're delighted that more lives are being saved from bowel cancer, thanks to better reporting and treatment of the disease. "But UK survival rates are still lagging far behind those in the US and this shameful situation can only be changed with greater investment in our health service.

"We also need to investigate why death rates are falling for women more than for men. This may be because women are more likely to go to their doctor with early symptoms." In the United States, 60% of people with bowel cancer survive for five years or more, compared with 40% in Britain.

A recent BMJ article discussed this important topic.

Leaflets and other information packages (video and audio tapes, computer programs, and websites) have long been seen as integral to educational strategies designed to promote health, persuade people to adopt healthy lifestyles, and increase uptake of screening.

They have also been developed to educate patients in self care of chronic conditions and how to take medicines correctly. There is now growing interest in providing information to support patients' participation in choosing treatments and deciding on strategies for managing their health problems.

If patients are to be active participants in decisions about their care the information they are given must accord with available evidence and be presented in a form that is acceptable and useful. Information materials are no substitute for good verbal discussions, but consultations are usually short and plenty of evidence exists that patients do not receive the information they want and need.

Few of the patient information materials currently in use meet these standards. Benefits of interventions are emphasised, risks and side effects glossed over, and scientific controversies hardly ever mentioned. In too many cases the information contained in patient information leaflets is inaccurate or misleading.

Various checklists have been proposed to enhance the quality of health information. These cover issues such as accessibility, acceptability, readability and comprehensibility; style and attractiveness of presentation; accuracy and reliability of content; coverage and comprehensiveness; currency, and arrangements for review and updating; reference to sources and strength of evidence; reference to sources of further information; credibility of authors, publishers, and sponsors; relevance; and utility.

In general far more attention has been paid to presentation and readability than to content. Ironically the insistence on aiming for readability may have contributed to the poor quality. But accuracy. of the content is arguably, even more important, and there is no excuse for palming patients off with unscientific clinical opinion which does not conform to the standards required for evidence based medicine.