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Rather than emulate Ofsted’s culture of fear, the UK care regulator must engage clinicians to improve standards

BMJ 2013; 347 doi: (Published 18 July 2013) Cite this as: BMJ 2013;347:f4611
  1. Billy Boland, consultant psychiatrist and lead doctor in safeguarding adults, Hertfordshire Partnership NHS Foundation Trust, St Albans AL3 5TL, UK
  1. billy.boland{at}

The Care Quality Commission should listen to Robert Francis, says Billy Boland. Cultural, not structural, change is needed, and to improve quality and safety the regulator must engage with doctors and nurses, who identify most cases of abuse and neglect

On 21 June the health secretary Jeremy Hunt announced a further £40m (€46m; $26m) for the Care Quality Commission (CQC) after revelations of an internal cover-up of its failure to monitor poor performance in Morecambe Bay Hospital.1 Hunt said on BBC Radio 4’s Today programme that it was “beyond belief” that the regulator that was supposed to “speak out” about bad practice had behaved in such a way. The additional money is intended to improve the quality of inspection and to give Ofsted style assurance to patients and the public, Hunt said.

The Office for Standards in Education, Children’s Services and Skills (Ofsted), established in 1992, carried out over 30 000 inspections in 2011-2 and has an annual budget of £165m.2 In contrast the CQC …

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