CQC chief executive Cynthia Bower: I'm not self-serving
The chief executive of the Care Quality Commission has said she underestimated the “turmoil” that would be involved in setting up the regulator. She admitted she should have decided to “wave a flag” calling for outside help rather than carrying on trying to do an “impossible job”.
Cynthia Bower also hit back at critics for failing to take into account how “challenging” the CQC’s creation had been. Responding to attacks on her leadership, she said she did not “mind people thinking I’m incompetent”, but objected to claims she was “only interested in a large pension”.
Ms Bower’s comments came at HSJ’s Leadership Forum last week during a frank discussion about the very public, often personal, criticism she has faced as head of the regulator during the past year.
Asked what she thought were fair and unfair criticisms, Ms Bower said the response to the CQC’s failure to act on a tip-off about the abuse of residents at Winterbourne View care home was the “most fair” because “we did miss something”.
She added: “It was slightly galling that other people had missed it as well, including the commissioners and the provider themselves, and we caught it in the neck. But you know when the public have an expectation that we were there following up information and we didn’t [do so], well then that’s fair.
Turning to media criticism of the CQC, she said: “Why should the press be interested in how hard it’s been to set [the CQC] up? They shouldn’t, but it’s that failure to see the context and how challenging it is that’s really hard to take.”
The CQC was set up in 2009 as a merger of the Healthcare Commission, the Commission for Social Care Improvement and the Mental Health Commission. It was made responsible for licensing and monitoring every health and social care provider in England as being safe to operate and for ensuring they remain safe.
Ms Bower said: “Setting up new organisations and the turmoil it involves and the time it takes to get it back into the right place is one of the easiest things to underestimate and I think that I underestimated it when I took this job.
“We had to bring together three organisations and take out considerable cost because funding was significantly less even though the job was bigger.”
She said the hardest criticism to cope with was inaccurate media coverage, such as reports this week claiming the regulator was being urgently investigated when it was actually subject to a Department of Health performance and capability review that has been in the pipeline for at least the last two months.
Addressing the personal attacks she received, Ms Bower said: “I don’t mind people thinking I’m incompetent, although I don’t want them to; I do hate being thought of as self-serving and out for what I can get and only interested in a large pension.”
Asked about the Commons health committee’s criticisms – that the CQC’s leadership should have stood up to the DH in the face of unrealistic expectations to register 9,000 GP practices by April 2012 while maintaining inspection levels – Ms Bower said that was not unreasonable. However, she questioned what it would have achieved.
“What I don’t think would have happened is the DH would have said ‘good gracious, here’s some more money’. They would have said ‘here’s a lot of other people who are also trying to do an impossible job with less money and fewer resources’. It’s not as if I was being asked to do something no one else was being asked to do,” she said.
“The big lesson I’ve learned from it is we get so used to managing risk that we forget to wave a flag and say actually ‘this is a risk we need help [with] from outside the organisation’. That’s a lesson both from the health select committee and Mid Staffs.”
Asked how she coped with the threat of the sack Ms Bower said she worked closely with those who had the power to dismiss her – the health secretary and her board – and stakeholders who could influence them.
When questioned over whether she thought she had the support of stakeholders, Ms Bower said it was a “constant dialogue”.
But she added: “I thought I had the support of the Association of Directors of Social Services until I read The Guardian this morning.”
She was keen to point out the regulator had also seen good publicity over the last 12 months.
“It’s not been an unequivocal disaster… I set a tone for the things I wanted to achieve and the sort of organisation I wanted us to be and I still believe very firmly in that. When I look back over the last year we have made enormous progress to that end.”
CQC loses IT expert
The Care Quality Commission is losing two of its most senior information experts at a time when the way it shares and uses data is under heavy scrutiny. CQC chief executive Cynthia Bower told a board meeting last Wednesday that its head of ICT had “recently left” and its director of intelligence was leaving in “early December”.
The CQC recently commissioned a review of its information management processes.
In September the Commons health committee criticised the “frustrating” delays in development of “provider profiles” which will make public the data held by the CQC on NHS and social care organisations.