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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.

Readers' comments (20)

  • Martin Rathfelder

    A woman with an impossible job.

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  • If anyone has a very high profile job and presides over an organisation that makes one very significant error after another, then they should expect to leave ... or otherwise to be pushed.

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  • Establishing an organisation as complex as CQC takes time and if we want to attract and retain the best people into leading such organisations, we have to recognise this and give time before calling for heads. It is all too easy to sling the mud.
    We should all remember that it is the people in these care homes and trusts who are responsible for the poor care they deliver, not the CQC itself. We need to support the CQC in its tasks and stop this distracting and dangerous sideshow.

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  • James Slater

    New job? High-risk? Accountable? Very well paid? Got a past that might not stand up too well under scrutiny?

    Spot the connection & get used to it ...

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  • David Poynton

    It is refreshing to see someone at the top of their profession saying how hard it is. It is very easy for people sitting on the sidelines making judgements. Even easier for MPs trying to get a soundbite. I have worked with Cynthia and know her to be passionate about both the public she serves and the people she works with. I think that she has managed the challenge well and has not shirked from accepting responsibility for things when they have wrong and it should have been spotted. You can't say that about a number of high profile issues over the last few months.

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  • Before pleading for time, remember the consequences to others. They will carry the scars, most likely for a lifetime. And it's not just while with the CQC. It is always within our power to resign, either in anticipating the failure and being denied resources to prevent it, or after it. Not doing either does perhaps support a view that one is self-seving.

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  • It was never any secret how difficult it was going to be to merge three very different organisations- at least the staff and the trade unions were aware of it. Seems that top management thought that the "merger fairy" would make it all right. Front line staff did protest that they could not cope with change after change in how they had to do things, that inspection was taking a back seat to registration and rash staff cuts meant that there were fewer inspectors to do the key job of safeguarding the health and wellbeing of people who use services. Their concerns were dismissed as irrelevant. Cynthia has to take some of the blame- the people directly reporting to her must have hidden the truth from her. Or if they did not, she ignored it. That is when the "mistakes" have happened. Don't blame CQC staff as a whole..they are not to blame.

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  • A complex organisation working in a complex and highly politically charged system like health is bound to expereince problems. Hanging a chief executive out to dry when things don't work out every time is a crazy mentality. So long as such post holders have not deliberately deceived and they demonstrate the capacity to learn from less-than-prefect preformance, we should encourage people to keep these jobs. There are many good and capable people out there who won't go near this sort of role so we had better be careful or we'll run out. I'm not a chief exec and I don't know CB but I have some experience of working at a senior level in a regulating body and it felt like a virtually impossible job.

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  • Clearly this was -and still is - a very challenging job for anyone, and surely the "parent" and "grandparent" must have recognised this. Where was the increased support and mentoring needed for someone in this position?

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  • Mr Lansley take note - you were warned about the turmoil caused by re-organisation, the consequences of the latest changes are down to you.

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  • Structural change is seldom the panacea that our leaders hope. I'm concerned that we are breeding a generation of managers who know nothing but change and think re-structuring is an end in itself.

    We have a lot of very hard working, very well meaning, very intelligent people who are wasting their time moving the deckchairs rather than addressing the underlying problems.

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  • A complex organisation working in a complex and highly politically charged system like health is bound to expereince problems. Hanging a chief executive out to dry when things don't work out every time is a crazy mentality. So long as such post holders have not deliberately deceived and they demonstrate the capacity to learn from less-than-prefect preformance, we should encourage people to keep these jobs. There are many good and capable people out there who won't go near this sort of role so we had better be careful or we'll run out. I'm not a chief exec and I don't know CB but I have some experience of working at a senior level in a regulating body and it felt like a virtually impossible job.

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  • But self-serving is exactly how many people see you. Not listening to staff who could see the flaws in the early CQC rhetoric, arrogant about knowing best, setting up a deeply flawed system which has been exposed, insisting generalists can do everything, being appallingly hierarchical and not speaking or listening to anyone except an inner circle, presiding over a closed culture where staff have learnt to keep quiet, getting rid of and gagging others, now rushing in the opposite direction re inspections etc to save your skin, but still with poor methodology. Self serving describes it pretty well.

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  • I was present at a patient/user representative conference recently and heard and saw Cynthia Bower speak for the first time. Following a life-long career in the NHS I was very underwhelmed by Ms Bower's presentation. For someone in such a senior and key position I was very disappointed and not impressed. Whatever her positive qualities are, communication skills do not appear to me to be one of her strengths. I would have thought that such skills are essential to her role and the lack of such skills and the diminished confidence of stakeholders is likely to be the outcome and is disappointing.

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  • I've been involved in previous systems for regulating care homes. It's a tough job because costs are trimmed to the bone and some home owners made it even harder with threatening and belligerant attitudes, even explicit threats to my personal safety. But you can't let it be about yourself because the task is to safeguard some of the most vulnerable people in our society. And I know from experience that this requires a lot more than a 'light touch' of regulation and inspection. Failing care homes need frequent monitoring, but also support to change if they lack the expertise or will to become safe and effective carers.

    If Ms Bower cannot move on from this and get a real grip on ensuring that standards are maintained, she should consider her position and the Department should consider the fitness for purpose of the Commission itself.

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  • 'The big lesson is.......we get used to managing risk'
    But risk to what and whom? This piece makes it clear it was about personal risk to career and not appearing less able than others. The risk that should have been managed was to patients, and, as we know, this was a matter of life and death.

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  • I agree strongly with the view that CEOs are dispensed with far too early so that very few get to learn how to manage improvement. In this case though, the failures with the CQC's performance mean that lots of other CEOs and other staff come under threat to their careers and the public lose confidence in their providers because of the use of the media, the quality of inspectors and the shoddy governance arrangements. Perhaps she should be given a list of every weakness in the CQC, given 28 days to come up with action plans and if they are not all fixed within 3 months call for her head?

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  • Ms. Bowers says she managed her risk of dismissal by keeping close to the SoS, her board and stakeholders who could influence them. Perhaps a little self serving?

    No mention of those who bore the consequences. This tells one all one needs to know about governance priorities and whose interest the process is meant to safeguard.

    How we need the patients' experience to be become as a centre of influence!

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  • How strange that a CEO in her position should say she doesn't mind if people think she is incompetent. If people think she is incompetent, she should go.

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  • It is interesting that the reasons she gives for failour are so often the same ones other organisations and senior managers have been eliminated for by her organisation.

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