HSJ Insight, Influence Channel: CQC published its response

This month saw one of the least surprising developments in the social care sector in recent years:  the resignation of Cynthia Bower as Chief Executive of the Care Quality Commission.  Her tenure must surely be rated as one of the least successful public appointments in recent history.  She was at the helm when CQC’s inspection functions came to a virtual standstill for 18 months whilst inspectors were engaged in the scandalously pointless task of considering over 12,000 applications for re-registration of which exactly six were refused.

Once registration was complete, CQC tried to replace regular inspections with self-assessment forms, the regulatory equivalent of asking students to mark their own exams.  By 2010, staff morale at CQC was so low that a leaked staff survey revealed that only 8% of staff considered that change was well managed and only 16% had confidence in the management overall.   More recent data is unavailable because staff surveys mysteriously ceased at that point.

Ms Bower was then in charge during the fiasco of registering dentists, a process that was so badly handled that it led to the postponement of the registration of GPs for a year.

She was still in command when the Panorama film on Castlebeck’s Winterborne View exposed the hopelessness of CQC to a rightly outraged public.  At the time, CQC assigned blame to an individual inspector, demonstrating an incredible lack of insight.  The reality was that this was an example of CQC’s ridiculous insistence that it wasn’t empowered to investigate complaints about providers.   CQC’s failures reached new grounds when it appeared to be the last stakeholder to realise that Southern Cross had overstretched itself and couldn’t afford its rents.  CQC told the Staffordshire enquiry that it had no responsibility or powers in relation to financial regulation which demonstrated an astonishing ignorance of the regulatory framework.

The Department of Health has to date escaped the wrath that has fallen upon poor Cynthia’s head. That immunity is thoroughly underserved.  The Health and Social Care Act 2008 was, after all, sponsored by the Department which would have had overall responsibility for the Act’s drafting and implementation.  It was obvious to all sensible observers that the requirement for re-registration would be pointless and wasteful.  The argument that automatic transition of registrations was not possible because the regime’s replacement was not like for like does not hold water.  It would have taken a competent health and social care lawyer barely a day to formulate workable transitional provisions.  However, overall, Cynthia was a bad choice and with that in mind, I propose the following job description for her replacement:

Key Competencies

  • Leadership – We welcome applications from people who can lead pro-actively rather than fire fight and over-react in response to crises.  We are particularly interested in hearing from candidates who take the initiative in determining what resources are required for CQC to carry out its functions effectively and making a strong case for those resources to the Department of Health, rather than cutting costs and compromising on effective regulation.
  • Common sense – do you instinctively know that specialised inspectors for different services is likely to be more effective than generic inspectors who are required to inspect a range of portfolios as diverse as single care homes, dental practices to GP surgeries and large NHS Trusts?  If so, we’d like to hear from you.
  • Listening – does the word ‘listening’ mean launching endless consultations and then proceeding with the initial proposals irrespective of the responses?  If so, this role may not be for you.  We are looking for people who will really absorb the opinions of other stakeholders and use that information to provide effective regulation.


  • Competence in maths – do you know what this means –   z = {x- \mu \over \sigma?  Our quality and risk profiles are based on such stuff.  We think it might have something to do with ensuring that we spend more time inspecting poorer services (see ‘common sense’ above).
  • Promoting the sector – we want CQC and the social care sector to be in the news for the right reasons.  Please apply if you think you can promote successes in the sector and demonstrate how regulation has raised standards.

A generous package, including a final salary pension, awaits the successful candidate.

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