CQC goes under the spotlight

This article has been taken from the guardian.co.uk website

The watchdog responsible for overseeing NHS hospitals and care homes is being urgently investigated by the Department of Health over a series of alleged failures that could have risked patient care.

DoH officials and NHS bosses have acted after mounting concerns about the Care Quality Commission (CQC).

The CQC's chief executive, Cynthia Bower, spent last Thursday morning being questioned by Una O'Brien, the health department's permanent secretary, before a team of Whitehall officials descended on the watchdog's headquarters in the City that afternoon.

The inquiry coincides with investigations by the National Audit Office and the Commons public accounts committee.

In September the prime minister endorsed a damning report by the health select committee on the CQC, which accused the regulator of neglecting its core duty of scrutinising patient care in favour of bureaucratic "registration" of care providers. Within the NHS many have serious doubts [as to] whether the CQC is now fit for purpose.

The CQC's alleged shortcomings have forced the health secretary, Andrew Lansley, to consider yet another overhaul of NHS regulation. The CQC, set up by Labour in 2009, regulates the NHS, social care and mental health, with a mandate to oversee 20,000 hospitals, care homes and treatment clinics.

Bower, who is paid more than £195,000 a year, was formerly chief executive of the NHS West Midlands' strategic health authority, where she was responsible for supervising the performance of Stafford hospital. A critical report is expected early next year from a public inquiry into a scandal at the hospital, where poor care led to hundreds of needless patient deaths between 2005 and 2008, and how it went undetected for so long.

The Guardian has established that:

• The CQC misled parliament in its annual report, overstating the number of inspections and reviews of the NHS, independent healthcare and adult social care sectors it carried out. Rather than the 15,220 "inspections and reviews" it claimed to have undertaken in the year ending March 2011, it has now admitted to the DoH that the correct figure is 7,368.

• There has been rising disquiet over the CQC's "light touch" regulation. Until May 2011, when BBC's Panorama exposed the scandal of abuse at Winterbourne View, a private hospital for people with learning disabilities, the CQC had launched just one investigation. By contrast, its predecessor, the Healthcare Commission, completed 16 investigations in five years. After the BBC's story the regulator launched two investigations into NHS hospital trusts.

• One of the first acts under Bower's leadership was to disband the investigations team – because, in the words of the then chair Barbara Young, it was being used to "bayonet the wounded on the battlefield". The decision caused consternation among NHS bosses, who feared that failing to expose and publicise examples of poor care would encourage complacency.

• Senior CQC staff who disagreed with the board say they felt marginalised and complained of a culture of fear, underlined by the "language of witch hunt". There has been an exodus of staff who have been gagged to prevent them from speaking about the CQC. In 2009, employees wrote to senior managers complaining about what they saw as a "bullying culture", following which a senior executive left. The letter warned of the "potential impact of the proposed reduction in inspection frequency for … adult social care services".

In 2010 an internal staff survey showed just 16% of staff felt the regulator was well managed, only 14% had confidence in the decisions made by the executive board, and 8% felt change was well managed. One analyst, Rona Bryce, told the Mid Staffs inquiry that she was told she could have been "suspended" after she analysed the evidence provided under oath by her boss at the CQC, Richard Hamblin.

Heather Wood, who led the inquiry into hundreds of deaths at Stafford hospital, left the CQC last year and had been gagged from speaking out about her time there. However, under subpoena to the Mid Staffs inquiry, Wood warned that under the current regulatory set-up "the investigation [into Stafford hospital] would almost certainly not have taken place".

Officially, the DoH inquiry into the CQC is a "pilot of a new annual performance and capability review" of its many quangos. In reality, ministers have been greatly concerned that the regulator is not seen as a toothless watchdog after a series of damning reports saw patient care become a key issue for the public.

The DoH said it was "essential that the ... CQC is performing to the highest possible standards. We are currently carrying out a review to ensure that it is doing the best it can to protect patients. The findings of the review will be made public in the new year."

Ministers became alarmed in June when Panorama exposed the scandal of abuse at Winterbourne View. After the disturbing footage was aired it emerged that the regulator had failed to investigate claims made by a whistleblower, Terry Bryan, who was apparently so exasperated by the CQC's inaction – he was told when he rang up that the inspector was on holiday – that he took the matter to the BBC.

The regulator has argued that it is not adequately funded. The three previous regulators it replaced had over 3,000 posts, whereas the CQC began life with just under 2,100 in 2009, a cut of 30% in the workforce.

The CQC has asked the government for £15m to fund a new regime, including a 15% jump to in boost to its 800-strong inspection workforce.

A spokeswoman for the CQC said: "The review has been openly discussed with CQC stakeholders and staff and we have found it an extremely helpful process."