NHS East of England chief executive Sir Neil McKay has been brought in to “challenge” the Care Quality Commission as it prepares to register every trust by 1 April.

The move has been interpreted as a “vote of no confidence” in the CQC and coincides with managers telling HSJ about the “chaotic” registration process.

Neil McKay doesn’t strike me as a ‘helper outer’

The CQC says it invited Sir Neil, who is close to NHS chief executive Sir David Nicholson, to help it engage with the NHS.

But an NHS insider said: “It sounds a bit like Napoleon inviting the Duke of Wellington.

“The scale of the task is the issue. I think the regulator is feeling it’s in some difficulties in terms of delivering what it’s being asked to deliver.”

Another senior NHS figure said: “Neil McKay doesn’t strike me as a ‘helper outer’.

“To bring in somebody so high profile is a vote of no confidence in the management of the CQC. Frankly that’s how it’ll be interpreted immediately by the service.”

Sir Neil started his unpaid role this week and will be working at the CQC for around one day a week until the end of March.

CQC chief executive Cynthia Bower said: “We invited him to come and join us. The reason we did so was because we’ve been engaged in working in co-production with the NHS.

“We asked Neil if he would help us… on how we were working with the NHS as an additional challenge to our thinking. It was absolutely our idea.”

She chose Sir Neil because “he’s the most experienced NHS manager in the country” and formerly ran an acute trust.

She said: “We’re doing something that’s completely new and we’ve had to do it in a very short period of time.”

NHS trusts have until 29 January to submit their registration applications to the CQC. They face restrictions on the services they can operate, fines and even closure if standards are not up to scratch.

Managers have told HSJ the commission appears to be struggling to cope with the huge demands of implementing the new system.

Sussex Partnership Foundation Trust chief executive Lisa Rodrigues said: “Even the commission would probably admit it hasn’t been the smoothest of processes.”

Some aspects, such as the information trusts were expected to provide, had been “significantly changed” at the last minute, she said. Local CQC leads had expressed concern about their workload.

Cumbria Partnership Foundation Trust chief executive Stephen Dalton said: “Capacity wise they must be really struggling. It looks fairly chaotic to me. It’s been a very ambitious programme; it’s a bit of a shifting sand.”

Before the commission was officially launched last April there were concerns it was taking on a huge task on a much smaller budget than that of the three regulators it replaced.

The registration process will be highly politically sensitive, coming in the run-up to the general election.

As revealed by HSJ, former CQC chair Barbara Young handed in her notice after rows with the Department of Health in the wake of the Basildon and Thurrock University Hospitals Foundation Trust scandal.

A senior government source stressed this week that the DH was “at arm’s length from the registration process”.

But the source added: “It’s going to be high stakes. We see this [registration] as the first big test of the CQC. “It’s the crux of their remit as a tougher safety regulator.

“We are continually being very clear with the CQC that they need a rigorous process that does not let anybody off the hook.”

Chris Ham, who will succeed Niall Dickson as King’s Fund chief executive in April, said there was still no consensus that registration was the best regulatory system.

Professor Ham said: “There’s a feeling that there’s regulation overload, not just from the CQC, but from all the regulators, and that’s creating a lot of work at all levels of management and registration has been overlaid on top of that.”

Sir Neil said it was “preposterous” to suggest the DH had been involved in his move.

He said: “I am delighted to have been asked by the CQC to support them in ensuring the new registration scheme for the NHS is robust and challenging but also appropriate and not over-burdensome.”

It was a good example of the CQC “seeking support and advice from those they regulate, as all good regulators should”.


  • 1 April 2009: Official launch of CQC. Acute trusts register under hygiene code standards
  • 14 October 2009: Basildon and Thurrock University Hospitals Foundation Trust receives “good” quality of services score
  • 26 November 2009: CQC’s damning report on Basildon and Thurrock is leaked. CQC chair Barbara Young resigns
  • 27 November 2009: Barbara Young criticises the annual health check and calls registration “a much more sophisticated system”
  • 29 November 2009: Dr Foster’s 2009 Hospital Guide is published, naming Basildon and Thurrock as having the highest death rates in the country
  • 30 November 2009: Health secretary Andy Burnham asks the CQC to speed up the implementation of the registration system
  • 29 January 2010: Deadline for trusts to submit registration applications

CQC SOS: high stakes mean it is essential registration succeeds