As Cynthia Bower resigns from the Care Quality Commission, speculation turns to who will be next to take the position
So who wants the job from hell? There is unlikely to be a long queue of applicants to replace Cynthia Bower as chief executive of the much (some say rightly) maligned Care Quality Commission (CQC). Still, there will be those who relish a challenge.
The only mildly surprising thing about Bower's resignation is its timing. Pretty well everyone knew it was coming, but many expected hers to be the most prominent head to roll when the Francis inquiry into care failings at hospitals in mid-Staffordshire is published in a few months. As regional NHS chief executive at the time of the scandal, she is likely to be heavily implicated.
As it is, she has been forced to go now by the conclusions of the Department of Health's performance and capability review of the CQC – an unprecedented or routine exercise depending on whom you believe – that while the combined health and social care regulator was improving its game on an exceptionally tricky wicket, it needed to do more to regain public confidence.
Few will shed tears at Bower's departure. "Good news ... high time … shambles ... atrocious" were among the choicer epithets in reactions from within the care sectors. Indeed, some voices called for further defenestrations at the CQC's headquarters in the City of London. But there will be sympathy, too, for someone asked to do what often looked like the impossible.
Whatever the wisdom of combining the three regulators for health, mental health and social care in 2009, the requirement placed on the newly formed CQC to register every care provider, from hospitals to dentists and nursing homes to care agencies, meant something had to give. And that something was routine inspections.
Between the second half of 2009-10 and the same period of 2010-11, inspection activity plunged 70%. Then came the Winterbourne View fiasco, in which the BBC's Panorama exposed the CQC failure to follow up a whistleblower's concerns about abuse of people with learning disabilities at a residential hospital near Bristol, and the die was cast.
Una O'Brien, permanent secretary at the Department of Health, has acknowledged some responsibility for asking too much of the CQC. In evidence to the Commons public accounts committee (PAC) in January, sitting alongside Bower, she said: "It turns out that we all underestimated the scale of the task and we must learn from that." She repeated that near-apology in her letter to Bower and Dame Jo Williams, the CQC's chair, summarising the conclusions of the performance review, saying that "in hindsight, the scale of the task facing CQC was underestimated".
Williams, highly regarded in the care sectors, seems unlikely to follow Bower through the exit: in her formal reply to O'Brien, she talks of wanting to respond positively to the review and of intending to provide a draft action plan in coming weeks.
Indeed, ministers appear to have little appetite for further upheaval beyond refashioning the CQC's governing board, which has been left looking dysfunctional by outspoken public comments by Kay Sheldon, its "service user engagement and involvement champion", who chose to give evidence to the Francis inquiry. O'Brien has told Williams that the board will be expanded and made unitary in composition – that is, bringing in the chief executIve and other senior managers.
When she gave evidence to the PAC, Bowers was able to say that as she was not a board member, she took no responsibility for its decisions on prioritising the CQC's activity – even though, she eventually admitted under questioning, she might have recommended them.
Other than a new chief executive and revamped board, then, the CQC is expected to be allowed to get on with its mandate. That will suit even the organisation's toughest critics, who accept that another structural reform of regulation is the last thing that is needed. But the CQC will undoubtedly be on probation. O'Brien told the PAC: "I think it will take five years from when the whole thing was set up to know if it is working." That would take us through to 2014.
When the headhunters start ringing round likely candidates to replace Bowers, they will therefore be able at least to hold out the prospect of two years' stability. In the current state of the NHS and the social care sector, that may look good.
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Read the complete post at http://www.guardian.co.uk/social-care-network/2012/feb/24/leading-cqc-mission-impossible
Feb 24 2012, 07:18 AM
Healthcare Network | guardian.co.uk