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NHS watchdog chief Cynthia Bower resigns NHS watchdog chief Cynthia Bower resigns
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The head of the NHS regulator for England, who has been the subject of mounting criticism over the watchdog's failure to adequately police hospitals and care homes, has resigned. The head of England's NHS regulator, Cynthia Bower, has resigned after growing criticism that the watchdog was not fit for purpose.
Cynthia Bower announced on Thursday that she was resigning from her £195,000-a-year role as chief executive of the Care Quality Commission, which she has held since 2008. Bower, chief executive of the Care Quality Commission (CQC), announced that she is quitting her £195,000-a-year post after four increasingly difficult and controversial years at the helm.
Although she insisted it was "time to move on" after four years helping set up and lead the regulator, it comes after growing public and private pressure for her to quit. Concern over the watchdog grew in the Department of Health last year after organisations including care home operators and the NHS Confederation, which represents hospitals, voiced their fears that their establishments were not being policed properly by the CQC.
When the CQC started up in April 2009, Andrew Lansley, the then shadow health secretary, questioned the appointment of Bower, given that in her previous role as chief executive of the NHS's West Midlands strategic health authority she had failed to properly investigate the scandal at Stafford hospital, where hundreds of patients died owing to appalling care. A Whitehall sources said: "Ministers had been assured that the CQC's house was in order. But each time they opened a door, skeletons fell out."
In recent months the Commons health select committee and the National Audit Office have issued highly critical reports about the CQC. They were prompted in part by serious concerns raised by key organisations in the health and social care fields, such as the unions representing NHS staff, the NHS Confederation, which speaks for hospitals, and campaign groups such as Action on Elder Abuse and Action against Medical Accidents. Paul Burstow, the social care minister, is said to have become uneasy after repeatedly hearing complaints from care home providers, residents and relatives that the CQC was not enforcing basic inspection standards.
It has been criticised for adopting a "light-touch" regulatory regime, despite evidence of poor standards of care in some NHS hospitals, particularly of older patients, and whistleblowers have claimed that the CQC has a bullying culture, low morale and a lack of strategic direction. Unions representing NHS staff and patient charities such as Action on Elder Abuse and Action against Medical Accidents also voiced grave reservations about the body's effectiveness.
"After almost four years leading CQC, I feel that it is now time to move on," Bower said. "The process of setting up an entirely new system of regulation has been intensely challenging – but we have accomplished an enormous amount. We have merged three organisations, registered 40,000 provider locations and brought virtually the entire health and social care network under one set of standards, which focus on the needs of people who use the service." Andrew Lansley, the health secretary, and his ministers were so worried by the CQC's apparent failings that they brought forward its performance and capability review, planned for later in this parliament, to investigate the concerns as a matter of urgency.
She welcomed the publication on Thursday of the findings of an unprecedented performance and capability review of the CQC by the Department of Health's permanent secretary, Una O'Brien. That report, published on Thursday, contained some praise but also confirmed key failings in the CQC's performance, such as some managers' inadequate training.
Bower said it "recognises the scale of what has been achieved – and in particular the significant improvements made over the last nine months. I'm confident that CQC will continue to build on the progress already made, delivering increasing benefits to people who use services by shining a light on poor care – and I am proud to have played a part in this." Bower's departure was portrayed as a personal, voluntary decision because she felt it was "time to move on", and Whitehall sources said she "was not pushed".
Sources said Bower would stay in her post until this autumn as part of "an orderly transition". But her eventual departure may coincide with a government shakeup of NHS regulation after the publication, expected in early summer, of the result of a public inquiry into how NHS regulatory failure let the Stafford scandal happen. But she is thought to have decided to quit before, as expected, she personally and the CQC in general are criticised in three forthcoming reports.
The chair of CQC, Dame Jo Williams, said: "I am very sorry that Cynthia has decided to move on, but I understand her desire to take on new challenges. I would like to take this opportunity to thank her for the enormous contribution she has made to the setting up and running of CQC. "This is Cynthia Bower's calculation of the best time to get out, given what's coming down the track," said one official. "She decided to walk. She's gone before pressure would have forced her out."
"She has shown tireless commitment to this organisation, and she leaves it in a strong position to carry out our essential role in tackling poor care. This is confirmed by today's performance review from the Department of Health, which recognises CQC's 'considerable achievements' in setting the essential platform from which tougher regulatory action can be taken." The assessment of the CQC by the Commons public accounts committee (PAC) will be "damning", with MPs on the panel discussing whether to call for Bower's resignation in it, sources said.
The Department of Health also plans to review how the CQC handled the scandal of Winterbourne View, a private hospital near Bristol for people with learning disabilities. The CQC admitted that it ignored a whistleblower, former charge nurse Terry Bryan. He then went to the BBC, whose Panorama programme revealed sickening abuse of patients, leading to an outcry, 10 arrests and the home's closure last June.
But the most serious criticism of Bower is likely to come from the year-long public inquiry into how NHS bodies failed to prevent between 400 and 1,200 patient deaths due to poor care at Stafford hospital.
In 2009 Lansley, then shadow health secretary, questioned Bower's suitability to lead the newly-created CQC because critics claimed she had done too little to investigate relatives' claims of appalling treatment when she ran the NHS's West Midlands strategic health authority.
The inquiry heard severe criticism of how she responded to the emerging evidence about Stafford hospital's care, especially in its A&E unit.
Although the CQC said Bower will be staying on until the autumn, there is a belief in Whitehall that either the PAC report, due in the next few weeks, or the Stafford report, expected in April or May, could make that untenable.
The CQC said: "Cynthia Bower will continue to collect a salary until she leaves the CQC, commensurate with the fact that she continues to perform a full time role up to that point, but there will be no final 'lump sum' payment."
Ministers welcomed Bower's decision as a chance to refocus a body that has been beset by infighting, poor morale and claims of bullying, and has been severely criticised by the health select committee and National Audit Office. The committee highlighted the CQC's "significant distortion of priorities" for putting registration of care providers above inspections. The NAO castigated it for "significant failures that put patient care at risk".
Bower has admitted that the CQC's initial "light-touch" regime did not work or command confidence. It switched to a much more robust approach last year, including unannounced inspections, after Lansley made clear his concerns.
In a brief statement, Lansley said: "I would like to thank Cynthia for her work and leadership and wish her the best of luck for the future. Over the last year, we have seen CQC make improvements and respond to the need for enhanced scrutiny and enforcement of standards."In a brief statement, Lansley said: "I would like to thank Cynthia for her work and leadership and wish her the best of luck for the future. Over the last year, we have seen CQC make improvements and respond to the need for enhanced scrutiny and enforcement of standards."
The NHS's chief executive, Sir David Nicholson, thanked Bower for her commitment to the job. "Building a new regulator involves great vision, leadership and resilience. This is always a complex task and one under constant scrutiny. It is great credit to Cynthia's leadership to have achieved this," he said. David Stout, the NHS Confederation deputy chief executive, said the performance and capability review of the CQC showed that the government "has listened carefully to the points we have been putting forward".
O'Brien said Bower had "provided energetic leadership to the CQC from its very outset". "An effective regulator needs to work with and earn the confidence of the organisations it regulates. We have made the point that the inspectors are not always earning the confidence of the organisations they visit because their knowledge is too generic."
Pressure for a shakeup of the CQC intensified last November after two internal whistleblowers gave extraordinary evidence about its failings in the Stafford hospital inquiry.Pressure for a shakeup of the CQC intensified last November after two internal whistleblowers gave extraordinary evidence about its failings in the Stafford hospital inquiry.
Kay Sheldon, a CQC board member, and Amanda Pollard, a CQC inspector from Kent, claimed that patients' lives could be at risk because the regulator was performing so badly it might not spot another scandal.Kay Sheldon, a CQC board member, and Amanda Pollard, a CQC inspector from Kent, claimed that patients' lives could be at risk because the regulator was performing so badly it might not spot another scandal.
They claimed some staff were not properly trained for their jobs, the CQC had a culture of bullying, was beset by low morale and lacked a clear view of what it should be doing. Sheldon said Bower and Williams put "reputation management and personal survival" above patients' interests. They claimed some staff were not properly trained for their jobs, the CQC had a culture of bullying, was beset by low morale and lacked a clear view of what it should be doing. Sheldon said Bower and the chair of CQC, Dame Jo Williams, had put "reputation management and personal survival" above patients' interests.
Sheldon said Bower's departure was necessary and overdue. "This is the right decision for CQC and for the future of regulation," she told the Guardian.Sheldon said Bower's departure was necessary and overdue. "This is the right decision for CQC and for the future of regulation," she told the Guardian.
"People will not be surprised to learn that I believe Cynthia Bower should have left before now given the serious and ongoing problems the organisation has faced. Today's capability review report raises significant questions about senior level competence in the organisation as well as the functioning of the board. "People will not be surprised to learn that I believe Cynthia Bower should have left before now given the serious and ongoing problems the organisation has faced.
"It is an inescapable fact that the board has not provided the necessary leadership and scrutiny. The persistent failure to address, and at times acknowledge, the problems needs to be tackled if we are to achieve an effective and sustainable regulator that functions in the interest of patients and the public.""It is an inescapable fact that the board has not provided the necessary leadership and scrutiny. The persistent failure to address, and at times acknowledge, the problems needs to be tackled if we are to achieve an effective and sustainable regulator that functions in the interest of patients and the public."
Health and social care organisations were divided about Bower's departure. Williams should leave too, in order to restore the CQC's credibility, added Sheldon.
Jeremy Taylor, chief executive of National Voices, an umbrella group representing 130 charities such as Asthma UK and Macmillan Cancer Support, doubted that Bower needed to go.
"It's not clear that this resignation was necessary but it does offer the opportunity for the CQC to move on and recover public confidence after a rocky period. The last thing CQC needs is a hiatus in leadership, so the plan for Cynthia Bower to stay on until the autumn seems very sensible. The recruitment of her successor needs to begin immediately, not 'shortly', as in the chair's statement," Taylor said.
"The CQC needs to be the firm, independent champion of the patient and service user, acting without fear or favour."
He said the watchdog needed adequate funding and a sensible remit from the government. "The CQC has been hampered by being asked to do too many things that have little relevance to patient safety and quality." He cited the example of registering all GPs and dentists when they are already regulated by other bodies.
Taylor identified three priorities for the regulator: "assessing quality and risk from a patient and service user experience, developing smart intelligence, and developing a high quality inspectorate".