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

Dr Boland suggests that structural change in Mid-Staffordshire was not recommended in the Francis report on the same day that the interim administrator has done. But his suggestion that it is the clinical staff who uphold standards of quality and safety rings hollow. My experience has been the opposite. Although I was able to use the privilege of age to speak out, knowing I could up sticks and leave for NHS retirement, I found in the end that banging my head against a brick wall was a waste of effort. My own attempts to maintain specialty standards were undermined by (medical) managers intent on fixing the budget; my notifications of adverse events were (bar one of a dozen) ignored. I asked to meet with the CQC on a visit, but my request was conveniently forgotten by the hospital's managers, no doubt because they wanted to keep me quiet (I had already been threatened with disciplinary action for speaking to the press and purveying a "non party" line). And my more junior colleagues, fearful of retribution, which was indeed threatened to a few, simply put their heads down and shut up.

Compared with the culture of fear within hospitals any culture of fear within the CQC is nothing. It will only change when clinical drivers supersede financial ones.