Care Quality Commission chief executive Cynthia Bower showed a “cynicism” that may not have helped the organisation get off to a good start, counsel to the Mid Staffordshire Public Inquiry has suggested in closing submissions.

Ms Bower said in evidence that it was “unclear” whether the CQC’s predecessor the Healthcare Commission had intended to use the timing of the publication of its report into failings at the trust “as a means of making a statement about itself prior to being abolished.”

The closing submission, prepared by the inquiry’s legal team, said this seemed to “reflect a cynicism by the new chief executive which may not have been particularly conducive to the smooth transition from one organisation to the next.”

The document, which has 36 chapters and runs to more than 1,800 pages, was summed up by Tom Kark QC in his closing statement to the inquiry at the beginning of December.

Published just before Christmas it provides evidence from the inquiry to support the criticisms made by Mr Kark of almost all of those involved with the trust between 2005 and 2009. It has some particularly significant suggested recommendations for the CQC.

Although sympathetic to the regulator’s plea the inquiry does not recommend it be reorganised, the submission recommends the chairman does not take the view that the “status quo is satisfactory”.

It recommends the CQC takes on responsibility for monitoring compliance with the National Patient Safety Agency alerts and sets out minimum staffing levels for accident and emergency and wards for the elderly to assist inspectors in making a judgement about whether service is safe.

The submission called for the inquiry to consider “urgent recommendations” that the CQC “revise its policy of using generic inspectors or at least to revise its training programme for inspectors”.

It is critical of the lack of audit of decisions made by inspectors to see if they are consistent and also suggests a defined standard for clinical governance, possibly drawn up by the National Institute for Health and Clinical Excellence, would be helpful for inspectors.