Rescare Editorial: The following article appeared in the latest (May 2012) edition of Rescare’s magazine, and appears here with the kind consent of its author.
CQC is a joke… But it’s no laughing matter!
Two Care Quality Commission whistleblowers dramatically and independently came forward at the eleventh hour to give evidence to the Mid Staffordshire Inquiry chaired by Robert Francis QC. The thrust of their evidence was to challenge the evidence given months earlier to the Inquiry by Cynthia Bowers, CQC’s chief executive, Baroness Barbara Young, former chair, and Dame Jo Williams, the current chair of CQC.
The first remarkable thing is that one of the witnesses, Kay Sheldon, is a current Board member of CQC who was sufficiently frustrated in terms of trying to get information and to ensure that the Board was engaged in strategic decision-taking that she concluded that she had no choice other than to ‘go public’; a decision which was not taken lightly, as is clear from her witness statement which is some 33 pages long–
It can be read on the Inquiry website at: http://www.midstaffspublicinquiry.com/sites/default/files/evidence/Kay_Sheldon_-_witness_statement_and_exhibits.pdf
In her written evidence Mrs Sheldon says that in the early days of CQC “…very little consideration was given to the capacity of the organisation to deliver the strategy.” And that the Board “…did not have a full discussion about [the] budget, [and] what we could afford to do or how to allocate our budget.”
Just 18 months after CQC had published its five year plan the ‘Executive’ (which I take to be Cynthia Bower and Baroness Young, who was Chair at the time in question) reportedly announced, presumably to the Board, that they wanted to reduce the strategic priorities from the five announced in CQC’s ‘Our Strategy for 2010-2015’ from five to just two, namely:
Acting swiftly to help eliminate poor care; and
Making sure that care is centred on people’s needs and protecting their rights
Mrs. Sheldon also expressed the view that CQC’s approach to strategy is “reactive and led by reputation management” something which readers may consider is reflected in their own experiences of CQC and observations of its various pronouncements.
Mrs Sheldon said in terms “There is a culture of bullying within some parts of the CQC.” Which she puts down to “…the need [of CQC] to push through changes as quickly as possible and to achieve positive results.”
Something which will chill the blood of many is that, in Mrs Sheldon’s view, CQC lacks a “…coherent and embedded approach to risk.” For those who follow such matters, may be aware that I and others have been writing articles which were highly critical of CQC’s then expressed intention to harvest intelligence on care establishments by using computer software developed for the intelligence community (the MI 5’s and MI 6’s of this world – I kid you not!) to ‘crawl’ through the internet looking at the postings on various social networking sites, such as Facebook, to ‘sniff out’ the informal and casual exchanges between work-mates and others to see what they say about where they work.
This, according to CQC would be a risk-based, intelligence-led approach to managing the sector and, in particular, an approach to address CQC’s aim of making sure that care is centred on people’s needs and protecting their rights.
Most people would expect CQC to take a look at the care!
My response was that I was OUTRAGED!
Of course, these not-quite-harebrained-schemes were being promulgated at a time when CQC was parting company from very large numbers of inspectors and also at a time when it was facing a real crunch. I speak, of course, about the process by which all social care providers in England were required to register anew with CQC.
A process which was quite, quite bonkers.
The scheme of re-registration of all existing care providers was created by politicians – so the politicians must shoulder some of the blame – but they will have been acting on advice from CQC, then in shadow-form, and with input from CSCI – the Commission for Social Care Inspection. At the time the legislative provision was enacted I had thought that it had been done in an attempt to side-step the cancellation process whereby poor care providers had their registration cancelled – however, (there was, and still is, an appeals process which if correctly handled by lawyers and the care provider rarely worked and which came at a huge cost to the regulator in terms of manpower and other resources, such as cash) if it was to have been used to clean up the care providers – it failed. CQC refused to re-register just five care providers.
So, all in all, an utter waste of time and resources.
To remind you, at the time of the demise of CSCI there were thought to be some 600 care homes which were very ‘poor’ and, having failed over the previous five or six years, to improve to a point where they were meeting the legal requirements there was a belief that they should be closed. Cancellation only really worked where an urgent application was made because service users safety was immediately imperilled.
So, what better way to sweep aside so many poor and failing establishments than simply refusing to register them?
That would have required careful planning – what would become of all of the people living in the 600 care homes which would not be re-registered? To where would they be moved? How would the logistics work? What would be the timing? Those and 101 other planning questions arise. Perhaps it was put in the ‘Too difficult box’.
Whether that was the original plan or not, Mrs Sheldon’s evidence doesn’t shed a single ray of light onto it. However, if it had been the original plan it was quite clear that the organisation that was/is CQC is not capable of meeting such a challenge.
The evidence of Amanda Pollard, the second CQC whistleblower, and currently a CQC inspector tells a story of ‘dumbing-down’ of expertise within CQC, a lack of planning, pulling personnel off vital tasks such as inspection and putting them to work processing some of the 24,000 or so applications for registration with so little training (in her experience, just 3 hours) that it became a matter of simply “rubber-stamping” each provider’s self assessment of compliance!
These two women gave their evidence on 28.11.2011; remarkably, one is a Care Quality Commission Board member – the very top of the organisation, the other, a compliance inspector.
They portrayed a dysfunctional organisation lacking in strategic leadership with scant understanding of the relative roles of a Board and the executive officers of the organisation.
The evidence portrays constantly changing goals dictated, it seems, by external comment and criticism; with almost all inspections ceasing when CQC needed to register some 24,000 social care providers when inspectors were switched from inspection to registration which itself was clearly a rubber-stamping exercise.
Of course, there have been a number of inquiries and investigations into CQC and its apparent failings, not least its abject failure to respond appropriately or at all to whistleblower reports of events at Winterbourne View.
CQC is not fit for purpose. Currently it is recruiting hundreds of additional inspectors and is advertising that it wishes to strengthen its Board by the appointment of two more Board members.
Keith M Lewin, Senior Partner, Brunswicks LLP
mailto:keith.lewin@brunswicks.eu
Telephone No.08455 190695
Address: Suite 3, 56 Hamilton Square, Birkenhead CH41 5AS
= = = = = =
Supplementary Information:
On June 8th 2012, following the resignation of Cynthia Bower, David Behan was appointed the new chief executive of the CQC.
In an article entitled ‘New CQC boss eyes unsafe services’, published in The Guardian’s Society Section on 13th June, the Public Services Editor, David Brindle, explained David Behan’s background and described the task he faces.
The online version (‘New head of Care Quality Commission takes aim at unsafe services’) is available here: http://www.guardian.co.uk/society/2012/jun/12/care-quality-commission-chief-executive-behan
Rescare wishes David Behan well in the challenge he faces: to improve the CQC’s regulation of registered care-providers; and to restore our trust in the CQC.