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Sorry is not good enough Cynthia

The manager with strategic responsibility for Mid Staffs Hospital said she was “deeply, deeply sorry” for what happened but refused to admit that her failure to intervene when presented with clear signs of neglect and abuse was “serious”.

Not only did Cynthia Bower (subsequently promoted to head CQC) miss or ignore the glaring evidence of breakdown in care, she actively encouraged and supported the hospital in its successful application for “Foundation Trust” status. In order for the hospital to join the “premier league” of Foundation Trusts, it would be essential to mislead the Department of Health and cover up the appalling failings in care.

No matter how many times she was asked, Bower refused to admit that this was a “serious mistake”. She refused to accept responsibility, claiming that she hadn’t been kept fully informed and it was not the SHA’s business to intervene.

While hundreds of patients were needlessly dying, neglected and abused in filthy conditions, Bower was (in her own words at the time) “providing strategic oversight and leadership”, “creating strong commissioning to ensure clinical excellence”, and “leading service improvements for patients”. (Source: Cynthia Bower, NHS West Midlands, 3rd July 2006)

One of the striking features of Bower’s evidence to the enquiry was her failure to see the “big picture”, to link events, incidents and trends and to understand and analyse the whole system for which she was responsible. Meanwhile she instigated and commissioned endless reviews, committees, and new procedures and initiatives that were completely immune to the awful reality of what was actually taking place in the hospital wards. She even hired MORI to give her a survey of public and patients’ views, when there was a deluge of complaints and “serious untoward incident” reports available to her.

"Now, clearly, I know now that Mid Staffordshire should have been where we were focusing more of our attention, and to the extent that we didn't do that I am, of course, deeply sorry, and in my statement I point out the obvious place where I believe we could have done something different (listening to complaints). But at the time we were making judgments about where to intervene. That was based on information that we had, both from the targets that we were looking at, from the priority that patients were saying, both locally and nationally...particularly over things like healthcare-associated infection that we knew were leading to excess deaths and illness in hospital." (Cynthia Bower, Mid Staffs Inquiry 18.4.2011)
"I think the SHA was making every attempt, through the information that it had, to try and make judgments about where things were going wrong that weren't being appropriately dealt with. So I wasn't conscious at the time that there was specific intelligence that we could have put together that would have said there were major failings in care at Stafford Hospital." (Cynthia Bower, Mid Staffs Inquiry 18.4.2011)
"I believe that at the point when...the clinical audit work was undertaken, we should have put in an inspection, or we should have arranged for an inspection to happen, and we should have taken opportunities to listen to patient voices; and I think had we done that we may well have picked up the issues that the Healthcare Commission picked up. So to that extent it was a failing," she told the Mid Staffordshire NHS Foundation Trust Public Inquiry. (Cynthia Bower, Mid Staffs Inquiry 18.4.2011)
On leaving the post of NHS West Midlands’ chief executive, Bower said “I am immensely proud of my time in health and social care services in Birmingham and the West Midlands. We have had some outstanding achievements in the NHS across the West Midlands over the last few years, and I am delighted that I have been able to play my part in that.” (Source: NHS West Midlands, 22nd July 2008)

What outstanding achievements will Cynthia Bower claim when she leaves CQC? Perhaps it will be the outsourcing of inspection to Which? magazine.

It would be a profound mistake to believe that the serious failures at CQC are the responsibility of one person even if she is the chief executive. In the unlikely event of there being an inquiry into how CQC killed off the effective inspection of care homes, let us hope that all those responsible would be examined in the way they are being at the Mid Staffs Inquiry. There are those who have actively played a part in hastening the death of inspection, those who have colluded, and those who have stood by knowing it to be wrong, but have failed to protest.

John Burton
Association of Care Managers www.caremanagers.org.uk
April 2011