I USED to complain there was no patient voice in Scotland.

Lots of charities did a fantastic job representing groups of people with specific medical conditions, but nobody looked at the whole service and said in a language everyone could understand: "This could be better."

Then the SNP formed a minority Government and started its NHS Better Together programme, which was about using feedback to improve the service and came with talk about ensuring a patient-centred approach. It was fluffy but we also got hospital cleanliness inspectors who were not afraid to point out when things were dirty and checks on the way older people were being cared for in hospitals. These inspection regimes are carried out by a branch of the NHS, NHS Healthcare Improvement Scotland (NHS HIS), so they aren't truly independent, but they have been a breath of fresh air. They carry out surprise inspections, so health boards cannot window dress on a given day. They have published many reports which have been critical of hospitals or departments and are rigorous at following-up recommendations to see if changes have been made.

Getting health boards, often judged by sympathetic peers, used to this more objective assessment without alienating staff must have required careful diplomacy. NHS HIS deserve credit for triggering change rather than the construction of defensive walls.

It was perhaps inevitable there would a clash eventually and it happened at NHS Tayside. Following an older person's inspection at Ninewells Hospital in Dundee, staff were shown a draft of the HIS report and disagreed with comments about the acute medicine unit. A meeting involving Gerry Marr, who is chief executive of NHS Tayside and a member of the NHS HIS board, followed and the original report was delayed. A new version was published some time later following a second inspection. In the fall-out NHS HIS inspectors and a lay partner decided to quit. An independent review of what happened was also ordered.

This review, published last week, worries me. It is the least patient-centred document I have read for some time and not just because it buries meaning in words such as "axiomatic" and "iterative".

The questions I believe most patients would think are raised by the Tayside incident are hardly discussed: should boards see a draft of reports before they are published and should chief executives, subject to inspections, be allowed to sit on the NHS HIS board?

One thrust of the document is about NHS HIS having more of a "sharing approach" with NHS boards under inspection. It mentions the original Ninewells inspection team including "public partners" sensing their independence was being compromised, but it gives them little sympathy. It notes, in a slightly patronising tone, that the public partners "felt their key loyalty was to the 'public interest' rather than other stakeholders or HIS".

Surely not only the public partners but NHS HIS were brought into existence to put the public interest first?

I hope NHS HIS will go from strength to strength, but I am concerned the review weakens its authority and independence. As it looks at its processes in the wake of findings, someone should scrawl across the office wall: Patient-centred.