A north-south divide is emerging in the NHS, with hospitals in the north and the Midlands performing better than those in the south, according to the Commission for Health Improvement.

A summary of the commission's 175 inspections since its inception two years ago shows that trusts in the north and the Midlands have fewer areas of concern and stronger clinical governance arrangements than those in the south.

Peter Homa, the commission's chief executive, did not blame a lack of resources but said that difficulty recruiting staff and a "difference in culture and attitude" could be to blame.

The commission's report said that many trusts had poor workforce planning and that "yet more creative ways of recruiting and retaining staff" were needed. The report warned that staff were working longer hours than recommended and found poor management of locum staff and widespread failure to check professional registration.

The report highlighted areas of good practice in both the north and south of England. It praised Dewsbury Healthcare NHS Trust, Yorkshire, for the installation of a telephone system for reporting serious incidents, and also singled out Bromley Hospitals NHS Trust, in Kent, which has developed a rapid access clinic for patients with cardiac problems.

The commission came to its conclusions by analysing inspection scores. A trust gets a score of one point when it makes little or no progress, two points for making "worthwhile" progress, three for "good strategic grasp and substantial implementation," and four for excellence.

Twice as many hospitals in the south than in the north and the Midlands got bottom marks. The report also said that the commission had been called in to investigate serious service failures in four organisations in London and the south, compared with just two in the Midlands and the North.

The first clinical guideline produced entirely by NICE has just been released. It tackles the treatment and management of patients with schizophrenia. Previous NICE guidelines were produced by other organisations and taken into the NICE fold.

It says that people with schizophrenia in England and Wales should be involved in all decisions on their care and should be offered psychological as well as drug treatment. These are two of the recommendations in guidelines published by the National Institute for Clinical Excellence (NICE) this week.

The guidelines outline what was judged to be best practice for health professionals caring for individuals with schizophrenia, after review of available evidence by a group of health professionals and people with schizophrenia.

The first recommendation "health professionals should work in partnership with service users and carers, offering help, treatment and care in an atmosphere of hope and optimism "emphasises the need for shared decision making and informed consent in all aspects of schizophrenia care.

The chairman of the guidelines committee, Tim Kendall, who is also joint director of the National Collaborative Centre for Mental Health and medical director of community health, Sheffield, commented: "The very collaborative process used in developing the guideline has resulted in a strong recommendation for the humanity we need to bring to the care of people with schizophrenia."

The guidelines recognise that the nature of schizophrenia can make it difficult for people to make informed decisions about their treatment, but they advise health professionals to make all efforts necessary to ensure that a service user can give meaningful and properly informed consent before treatment is started. The guidelines recommend that any medicine used in treatment should be chosen jointly by the person with schizophrenia and the clinician.

The guidelines recommend greater use of psychological treatments and more appropriate use of drugs for schizophrenia. Oral atypical antipsychotic drugs, at the lower end of the standard dose range, should be considered in the choice of first line treatments for individuals with newly diagnosed schizophrenia.

The use of moderate doses of antipsychotic medicines was recommended, with the aim of avoiding the use of high doses and loading doses that are sometimes used at the moment. People with schizophrenia should take only one antipsychotic drug at a time, except in rare cases. Dr Kendall pointed out that nearly half of people being treated with neuroleptics are currently taking more than one drug. There is no evidence that this is beneficial for most people, he warned.

Psychological treatments particularly cognitive behaviour therapy and family interventions were recommended as an indispensable part of the treatment for people with schizophrenia and their families. The guidelines recommend that anyone with psychotic symptoms should be offered at least 10 sessions of cognitive behaviour therapy.

A BMJ article by Fritshe et al. asked if short courses in evidence based medicine improve knowledge and skills.

This was based on a before and after study of courses in evidence based medicine. They attempted to develop and validate an instrument for measuring knowledge and skills in evidence based medicine and to investigate whether short courses in evidence based medicine lead to a meaningful increase in knowledge and skills.

They carried this out in various postgraduate short courses in evidence based medicine in Germany and validated the instrument using with experts in evidence based medicine, postgraduate doctors, and medical students.

They studied intensive 3 day courses in evidence based medicine delivered through tutor facilitated small groups. They found that the questionnaire distinguished reliably between groups with different expertise in evidence based medicine.

Experts attained a threefold higher average score than students. Postgraduates who had not attended a course performed better than students but significantly worse than experts. Knowledge and skills in evidence based medicine increased after the course by 57%. No difference was found among experts or students in absence of an intervention.

They conclude that the instrument reliably assessed knowledge and skills in evidence based medicine and that an intensive 3 day course in evidence based medicine led to a significant increase in knowledge and skills.