Whistleblowers say there was a “bullying culture” at England’s care services watchdogBMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d7812 (Published 30 November 2011) Cite this as: BMJ 2011;343:d7812
The Care Quality Commission, the inspectorate for hospitals and care homes in England, is led by a chairman and chief executive who are not up to the job, a board member told the Mid Staffordshire public inquiry on Monday.
Kay Sheldon, a non-executive member of the CQC’s board, said that the strategy used by the commission’s chief executive, Cynthia Bower, and chairwoman, Jo Williams, was “reactive, led by reputation management and personal survival.”
Mrs Sheldon, an expert in mental health, is one of two CQC whistleblowers who gave evidence this week. She and Amanda Pollard, a compliance inspector, came forward after first taking their concerns to the National Audit Office and after evidence to the inquiry had closed.
The CQC argued that most of the matters they raised were outside the inquiry’s terms of reference, but the chairman, Robert Francis QC, said that they were properly called whistleblowers and that their evidence should be heard.
The public inquiry was set up to learn wider lessons for the NHS from the failure of regulators to spot poor standards of care at Stafford Hospital. At the time, Ms Bower was chief executive of the West Midlands Strategic Health Authority, whose area included Mid Staffordshire.
In her written statement to the public inquiry Mrs Sheldon said, “I can see parallels in the way the chief executive runs the CQC to the way she operated when she was chief executive of the SHA [strategic health authority]. She is not fully aware of what is happening on the ground.” She also cited “a disjointed rather than joined-up approach and a reactive rather than a proactive approach to challenges.”
The CQC is already the focus of separate inquiries by the Department of Health, the House of Commons Public Accounts Committee, and the National Audit Office, the last of which is expected to report within days. The Mid Staffordshire inquiry’s report is due in March.
Mrs Sheldon told the inquiry that the board was expected to “rubber stamp” decisions. Challenge was discouraged and seen as disloyal. After one board meeting where members had challenged decisions, Dame Jo “said she wasn’t very happy with how the board members were behaving and this was due to their egos,” although Mrs Sheldon thought that they were challenging “quite appropriately.”
She said that there was “a bullying culture” at the CQC and it was clear that the organisation had “over-promised.”
Mr Francis praised Mrs Sheldon and Mrs Pollard for their “great courage” in coming forward. Mrs Pollard, who was an inspector for the CQC’s predecessor, the Healthcare Commission, said that she had contacted the inquiry because she was frustrated that management was making inspectors work “in ways which we feel incredibly uncomfortable about.”
Staff had been taken off inspection work to help with registration of providers. All providers of healthcare and adult social care are required to register with the CQC if they provide any of the 15 activities that it regulates. Mrs Pollard said that she received about an hour’s training for this work, mainly on how to process the information on the computer. Staff would be in tears because management threatened to “name and shame” those who failed to meet their quotas for registration. In her written statement she said: “The message is coming through loud and clear that registration is the number 1 concern/risk for the CQC. But no one’s going to die by not being registered.”
The CQC has admitted failing to respond to a whistleblower’s claims that residents were being mistreated at Winterbourne View care home in Bristol (BMJ 2011;342:d3482, doi:10.1136/bmj.d3482). Ten staff were charged this week with criminal offences against four patients.
Mrs Pollard took issue with Dame Jo’s claim to the inquiry that the CQC would spot another situation like that in Mid Staffordshire. “I don’t think the CQC are able to assure themselves that I, as an inspector, would spot another Mid Staffordshire or Winterbourne View,” she said.
The CQC said in a statement that it had faced “major challenges” in merging three former regulators (for healthcare, social care, and mental healthcare) and in registering so many providers “against aggressive parliamentary deadlines” but that the latest evidence to the inquiry did not represent a true picture of the organisation.
Cite this as: BMJ 2011;343:d7812
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