Robert Francis should be the next CQC chair
On 1 August HSJ asked Care Quality Commission chair Dame Jo Williams to consider her position.
We argued her failed attempt to get Andrew Lansley to unseat non-executive director Kay Sheldon had holed her position below the waterline and – following a series of high profile failures – her continued presence threatened the new start the appointment of chief executive David Behan promised.
Last Friday, Dame Jo – having outlasted Mr Lansley by three days – announced her resignation. Her poor performance at today’s House of Commons Health Committee underlined that it was a decision which came not a moment too soon.
Her resignation came in the same week the CQC launched a consultation on its new strategy. In his first interview Mr Behan confirmed the welcome return to a risk based approach to inspection and also pleased many by announcing his ambition to revive the practice of NHS leaders spending time as commission inspectors.
In his characteristically diplomatic manner, the CQC chief also gently lobbed a shot across the new health secretary’s bows by warning there is “a real risk” growing financial pressure may lead to quality being “impacted”. He said the regulator would not hesitate to speak out if that happened.
His predecessor Cynthia Bower has admitted she was brought low by failing to resist political pressure to take on new responsibilities. Mr Behan’s signalling of a more robust relationship with the Department of Health is a good sign.
Many will also appreciate Mr Behan’s direct linking of financial constraint and quality. This week we have seen that most high profile of failing NHS organisations – Mid Staffordshire Foundation Trust – be censured for the quality of its ‘breast cancer surgery’ and potentially become the first FT subject to Monitor’s new financial failure regime.
As the local quality, innovation, productivity and prevention plans revealed in last week’s HSJ begin to bite, the need to keep a careful eye on service quality will increase exponentially.
But who will partner Mr Behan in his efforts to regenerate the fortunes of the CQC?
Here history offers us a guide. In 2002 Sir Ian Kennedy was appointed chair of the Commission for Healthcare Audit and Inspection – which morphed into CQC predecessor the Healthcare Commission. Sir Ian’s tenure was not without problems – it is not that kind of job. However, the appointment of the chair of the seminal Inquiry into children’s heart surgery at Bristol Royal Infirmary was widely welcomed as giving the regulator the ethical substance it needed. The inquiry also made a number of significant recommendations about how the NHS should be governed and it was therefore appropriate for Sir Ian to have his chance to put his proposals into action.
Also serving on the Bristol inquiry was another man who would go on to further develop a prestigious legal career in the world of medical ethics and to chair a major public inquiry into NHS regulation. Robert Francis may, of course, still produce a dog’s dinner of a report into the care failings at Mid Staffs. But let us assume that will not be the case.
HSJ has no idea whether Mr Francis would seek or accept the position of CQC chair. But if he is reluctant then Mr Hunt should exercise his famous charm and seek to change his mind. For exactly the same reason Sir Ian’s appointment was the right one in 2002, selecting Mr Francis as the next CQC chair would give the regulator an even greater sense of independence and integrity.
It might also help – as Mr Francis puts the finishing touches to his report - to know that he would be largely responsible for making many of the recommendations work.