Thursday 18 October 2018
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CQC insiders spill the beans

The Mid Staffs Enquiry continues to reveal the hypocrisy at the top of the NHS and the health and social care regulator, CQC.

Top managers in the NHS attempted to halt the Health Care Commission’s investigation into the cruel and neglectful regime at Mid Staffs Foundation Trust because, as layer upon layer of cover-up and denial were stripped away, the true nature of senior managers’ callous incompetence was revealed.

It is no surprise that the last government, the Department of Health and CQC blocked the current enquiry <> into how the appalling care at Mid Staffs could have either escaped their notice or, while known, was ignored in pursuit of targets, performance measures and the so-called “delivery” of political goals.

While it is estimated that as many as 1200 patients died needlessly, and many others suffered dreadful pain and indignity, Cynthia Bower, as the most senior regional DH manager, was encouraging and supporting the hospital to apply for “Foundation” status. Hundreds of complaints were binned or ignored. The Health Care Commission’s investigation was hampered by a lack of cooperation and behind-the-scenes denigration of those who were conducting it.

However, last week, some of the staff who led the investigation were called to the enquiry to give evidence, and damning evidence it was.

In this time of “super-injunctions” being used to prevent the public embarrassment of the rich and powerful, The Care Quality Commission has used a parallel process of “compromise agreements” to prevent former members of staff spilling the beans about what has really been going on in our regulation quango. People are paid to keep quiet, but they can’t stop them speaking the truth at a public enquiry; indeed, they are required by law to do so.

And so it was, last week, that we learned of the attempts that were made to prevent the truth emerging about Mid Staffs hospital. It’s particularly worrying that people who are still in positions of great power and influence (not least the Chief Executive of CQC) were complicit in trying to hush up the scandal and dodge their own responsibility for it.

As soon as CQC took over control of the Health Care Commission (HCC) and of The Commission for Social Care Inspection (CSCI), Cynthia Bower disbanded the Investigations Team (who had worked on the Mid Staffs investigation) and sidelined them. CQC referred to the investigation and its report as “a blunt instrument” and decreed that in future no reports would contain specific instances of bad practice, abuse and neglect. The investigators had no future with the new regime and left, gagged, frustrated and vilified for telling the truth in their report.

Two obvious questions come to mind:
1. Why was Cynthia Bower appointed to lead CQC when she was responsible for not only washing her hands of the tragedy at Mid Staffs, but for attempting to prevent the truth from being revealed?
2. What makes government think that a regulator led by Cynthia Bower could possibly prevent or even detect such a tragedy recurring whether in a hospital or a care home? During the current enquiry, several senior figures (including the former head of Mid Staffs) have voiced their doubts about the competence or capacity of CQC to do its job.

CQC is clearly not fit for purpose. The mystery is why it still exists in its present form and under its current leadership. If the Government’s “listening exercise” means anything, surely the increasing outcry about CQC’s failures and incompetence must be heard.

“Good care home managers want to have good care verified and confirmed by independent outsiders who are trusted by the public. The reputation of CQC could not be lower. This is not good for residents of care homes.”

The Association of Care Managers calls for a new approach to regulation and inspection of adult social care:
Prioritise the quality of care and the rights and safety of the people who use the services – this is the primary purpose of inspection just as it is the primary task of care home managers
Inspect services as often as necessary but at least once a year
Inspectors should aim to prevent bad practice rather than to condemn it after it has occurred and after residents have suffered
Inspectors should be locally based and known – and accessible - to the public and users of the services
Inspection reports should be written for the public
Inspectors should work directly with residents and relatives, staff and managers of individual homes, NOT with the provider groups and organisations
Inspectors should respond to and investigate complaints, and be willing and available to visit the service without notice and at any time
Inspectors should understand how the services work and be willing and able (when appropriate) to help services to improve
People who use services should have a formal and influential voice in the assessment of care.

We believe all of this can be achieved without increasing inspection fees or passing new legislation. However, it will mean a total reorganisation of the CQC, dismantling the centralised bureaucracy and grandiose management structure, and setting up local Healthwatch inspection teams employing independent inspectors who will be judged by - and paid by - results.

For more information about ACM, please contact
Kate Hawkins
Tel: 020 7720 2108 ext 201
Fax: 020 7498 3023

John Burton, Head of the Association of Care Managers, May 2011