Care Quality Commission’s leaders ‘lack the necessary skills’

Board member tells public inquiry into Mid Staffordshire trust scandal that NHS watchdog is ‘badly led with no clear strategy’

The NHS watchdog is facing fresh claims about its competence after a board member told a public inquiry that the regulator’s chief executive and chair lacked the necessary skills to lead it.

The Care Quality Commission is already under scrutiny in the shape of separate inquiries by the Department of Health, National Audit Office and Commons Public Accounts Committee – prompted by a series of criticisms of the organisation’s ability to do its job.

On Monday CQC board member Kay Sheldon raised new doubts when she called for the replacement of the watchdog’s chief executive, Cynthia Bower, voiced serious concern about its chair, Dame Jo Williams, and said that it is hamstrung by a culture of “bullying”.

In a statement to the public inquiry into the Mid Staffordshire hospital trust scandal – which is investigating how failures of NHS regulation meant hundreds of avoidable patient deaths were not identified or prevented – Sheldon said: “My main concern is that the organisation is badly led with no clear strategy. The chair and chief executive do not have the leadership or strategic capabilities required.”

She added that they were running an organisation where staff concerned at its direction felt too afraid to speak out, that the board was expected to rubberstamp rather than shape the executive team’s decisions, and that some CQC inspectors felt ill-qualified for their key roles.

“I do not see how the organisation can move forward in a robust, coherent or useful way without better leadership. We need a chief executive that can manage the organisation and currently we do not have that”, Sheldon said. She was questioned by the inquiry for almost three hours after deciding to go public in order to raise her longstanding concerns.

Sheldon, a mental health expert, has been a CQC board member since it was created in 2009. She is also an adviser to the Department of Health, tribunal member of the Ministry of Justice’s social entitlement chamber, and an associate lecturer at the University of East Anglia.

Robert Francis QC, the inquiry’s chairman, praised what he called the “great courage” shown by Sheldon and CQC inspector Amanda Pollard, who also gave critical testimony. Francis said both should be seen as whistleblowers because of their statements at the hearings.

Sheldon said some of the five other non-executive board members of England’s NHS and social care regulator also had concerns about Bower. The chief executive’s previous stewardship of the NHS’s West Midlands strategic health authority has already been examined by the inquiry after claims by patient groups such as Cure the NHS that she could have done more when she held that post to realise the extent of the poor care some patients were receiving at Stafford Hospital between 2005 and 2008. None of her fellow directors was prepared to call for a vote of no confidence in Bower, said Sheldon.

In her statement she also 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. She is not fully aware of what is happening the ground. A disjointed rather than joined-up approach and a reactive rather than proactive approach to challenges are not working effectively with the board.”

Sheldon told the inquiry how she recently relayed her concerns to Williams – anxieties which she stressed were motivated by a desire to see the CQC do its job well and were not a personal grudge.

“What I have done is raised it informally with the chair and the reaction was ‘Stick with me’. I did raise it recently in a pre-board meeting and the reaction was that the chair said ‘Look, I’ve decided to back her and as an organisation we don’t need a high-profile sacking at this point’,” added Sheldon.

The CQC came under fire earlier this year for not acting on concerns raised by a whistleblower about abuse of patients at Winterbourne View, a hospital near Bristol for people with learning disabilities. In findings endorsed by David Cameron, the Commons health select committee recently condemned the CQC for spending too little time investigating providers of health and social care because it was too consumed with the administrative task of registering providers in order that they could receive their licences to operate.

Sheldon’s intervention comes just before the National Audit Office, the official public spending watchdog, is expected to criticise the regulator for offering poor value for money in a report due out this Friday.

In evidence Sheldon painted a picture of the CQC as a seriously under-performing organisation with no clear strategy about what it was trying to achieve, with dedicated staff afraid to challenge its priorities or the leadership’s views. “Very good people have left the organisation. And I think some of the culture is bullying”, she told Francis.

Bower and Williams face an uncomfortable few months. Apart from the imminent NAO report and ongoing DH and PAC probes, there is also the outcome – expected in early 2012 – of the Mid Staffs inquiry itself, which has spent the last year taking evidence and which concludes on Thursday.