The Inquiry into the failings in the Mid-Staffordshire NHS Foundation Trust has been going on for a while now but yesterday there was some hefty evidence from two CQC (Care Quality Commission) ‘insiders’ which blasted open the so-called regulator and lifted the lid on the poor practice that some of us have suspected for a while.
I would urge anyone in health and social care who serves are regulated by this body, take a look at some of the evidence presented yesterday. I did and I hate to say that I wasn’t surprised but let’s just say it confirmed some of my suspicions.
The two witnesses who provided the evidence were Amanda Pollard – an inspector with the CQC and Kay Sheldon – a non-executive director at the CQC.
I want to look at some of the statements that they made in the hope that these issues are picked up on by a wider audience. Both Amanda Pollard and Kay Sheldon are ‘whistleblowers’ in the finest tradition and should be heartily applauded for the stance they have taken.
Amanda Pollard gave evidence first. She started by saying (emphasis added is mine)
Can I just make clear that I do believe that the CQC is making a difference to people’s care. Unannounced on-site inspections are the way ahead. The CQC has inspectors well motivated to making that difference but we are doing that despite the lack of clear direction and support mechanisms not because of them.
Last Friday, the chair, Jo Williams, posted a letter to all staff on the CQC intranet, making it plain that she saw my and the board members’ appearances today as highly damaging and would weaken the work carried out by inspectors on a day-to-day basis.
She was of the view that airing personal opinions in the media will negatively impact on the care received by people as our effectiveness would be reduced. I have not aired my views to the media. I took my concerns to Public Concern at Work, who felt the issues I raised were pertinent to this inquiry.
I was told I had to attend today. Whilst I was not expecting to be thanked for my actions, if the CQC was serious about hearing the staff’s views, even when they’re negative, they would have heard mine and I would not be sitting here. The CQC must support the whistle-blowers who come to us and maybe that should start at home
As someone who has always felt that unannounced inspections are the ONLY way ahead, I feel vindicated but the worrying comment about the management and the way the organisation has been run create many questions that the government needs to be asking of this body. It is particularly worrying that whistleblowers within the organisation which is supposed to act on such information themselves are so poorly served. Good for Amanda Pollard, I say.
Pollard was an inspector with the Healthcare Commission before it was merged into the CQC and she goes on to explain how she was trained and how inspections were conducted by specialists with people coming from different backgrounds.
Pollard was asked to work in a different way and concentrate on registration of bodies rather than the inspections of infection control which were her specialist area – so she wrote to Cynthia Bower and told her she was concerned this would increase risk – indeed, a part of her letter read
“We have just been told that the PCT inspections are now stopping, and we are all to work on registrations. The message is coming through loud and clear that registration is the number 1 concern/risk for the CQC.But no one’s going to die by not being registered.”
This explains her worries about the focus of the CQC and the implication of being pushed to different systems of work which were less meticulous and more focused on government driven targets.
But one of the saddest parts for me to read as a committed social care professional who has been working in this field for way too long was this part where Pollard explains how she was ‘trained’ to do social care inspections.
“I was given no training for undertaking the registration process. I was told I didn’t need to attend the training as I would be carrying outinspections during this period.”
“In the main I registered care homes, nursing homes and ancillary services. We were told that there was no clinical or specialist skill required to complete the registration, and the process seemed nothing more than a tick-box exercise, certainly for me the process was just a rubber-stamping exercise.”
And that sums up the way this ‘regulation’ system regards social care regulation. This is why we had whistleblowers at Castlebeck and Winterbourne recieving no response from the CQC. I lay no blame whatsoever at hard-working inspectors with no training and low morale but every kind of blame possible at a government and management that allowed this to happen. Pollard talks of a culture of ‘naming and shaming’ inspectors who do not meet their ‘quotas’ thus having to cut corners on inspections. Inspectors no longer knew the services they were inspecting. Pollard was inspecting residential and nursing care homes after a few days of shadowing and was expected to write up reports with no specific training about involving or talking to adults with mental health needs or dementias although some inspectors did try to less formally share their knowledge amongst themselves.
She also explains how ‘desk-based inspections’ were promoted and encouraged due to time and targets that needed to be met. The evidence is fascinating and worth working through for anyone involved in the sector but I want to move on to Kay Sheldon’s evidence, briefly.
Kay Sheldon’s background came from Mind and the Mental Health Act Commission before that too, was merged into the CQC. Like Pollard, she raised concerns internally thus leading to her giving evidence at this inquiry. She is a non-executive director of the CQC. She paints a picture of poor governance all round. A board which is barely listened to and doesn’t actually make decisions and where dissent or difference of opinion is seen as ‘disloyalty’. She stated
More often than not it would be the views of the chief exec and the exec thatwould go forward. And I remember there was one board meeting when there was actually other board members thatwere quite challenging and the chair said — I could seethe chair was upset and I said, “Are you okay?” And she said she wasn’t very happy with how the board members were behaving and this was due to their egos. And I think they were actually challenging quit appropriately. So actually challenge is discouraged, because it’s seen as disloyal. And as I — I’ve been challenging quite a lot recently because I felt I had to, and that’s been very difficult
Sheldon emphasises a lack of overall strategy in the CQC or at least a strategy that was failing and wasn’t meeting the purpose. Sheldon refers to the CQC ‘overpromising’ – something I’d suspected for a while – and notes that the new government made different demands but the strategy was not adjusted and inspectors frustrated by not being able to do the job they think is needed or that they want to be doing.
One of the more interesting nuggets (to me) also came when she spoke about the emphasis in the CQC on ‘reputation management’ and have some upcoming workshops on this topic. Seems ironic when if they just actually did their job better and provided a good function, their reputation would increase.
In fact the speed in which the CQC issued a highly defensive statement attacking Kay Sheldon’s evidence indicates that ‘reputation management’ is indeed high on their agenda.
We have to demand more from a body which is clearly failing. We have to demand quality and realistic promises. If the CQC can’t deliver quality regulation, it should petition the government and the result WILL be more Winterbourne Views – unless BBC Panorama is commissioned to go into every care home and hospital in the country.
Is it too much to demand professional, well-trained, knowledgeable and respected inspectors who are able to work to their own professional strengths rather than by an organisation which clearly can’t run itself and more and more looks like a headless chicken of a body which is not fit for purpose?
I await the CQC’s choreographed response to Amanda Pollard’s statement with interest.
– Thanks and acknowledgements to @shaunlintern who has been providing excellent coverage of the entire inquiry and to @sjcalkin and @chrisinstafford for keeping me informed of the evidence via Twitter.