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The CQC cover-up (2)

cynthiaBower

C4 News has an account on youtube, but the critical video of Jon Snow’s interview with Cynthia Bower has not been put up there. It is temporarily on the main C4 site.

The interview is 6m11s. I had to listen to it three times. Jon Snow was at his best. He starts by pointing out that Cynthia Bower and the CQC had been given an absurd task. Under the legislation they had to register 41,000 institutions within 2 years. Any unregistered institutions would be automatically closed.

She in turn spelt out some of the difficulties involved. The CQC had to simultaneously train staff, set up computer systems etc etc.

Snow then turned to the “deletion” of the report. The explosive allegation in the Grant Thornton report was that there had been a meeting of Cynthia Bower (CEO of CQC), Jill Finney (deputy CEO), Anna Jefferson (“media manager”) and Louise Dineley (some kind of compliance type, current title Head of Regulatory Risk & Quality). The only written record of the meeting was a private note by Dineley. She alleged that she had been instructed by Jill Finney to “delete” an internal CQC report entitled “Summary of the internal review of the regulatory decisions and activity at UHMB” (ie the trust that owned Furness General Hospital, which had the dodgy maternity unit).

Bower started by complaining about the precise word “delete”:

CB: The fact remains that this report was never deleted, and the person who was accused, Jill Finney, of issuing the instruction to delete it

JS: [interrupting] Non-deletion doesn’t prove the point, does it? The point is, whether it was deleted or not, there was a desire in the room that this report should go not further. That’s true?

CB: No. There was no desire that this report [slight pause]

JS: You weren’t happy with it.

CB: I wasn’t happy with it. That’s not the same as saying the report should be gone. You know. The report wasn’t fit for the purpose that I had intended it.

JS: Because you wouldn’t blow the whistle on the politicians, on the ministers, the people who set this up, you decided you would render compliant a hospital which had effectively killed 16 babies.

CB: That’s not an accurate description. What we did when we registered Morecambe Bay without conditions, we did it in good faith. We might have taken inappropriate assurance from other agencies, including the hospital. The hospital itself had to declare that it was compliant with the law in order to apply to be registered and it did that. It is clear that the hospital didn’t tell us everything that they already, reports they had been given, particularly the Fielding report about maternity services. So there were things they could have told us at the point of registration that they didn’t.

That needs a little thought. In effect Bower is claiming that she was merely incompetent and ineffective, not guilty of wilfully allowing Furness to carry on killing babies through poor standards.

The stuff about the “assurance from … the hospital” is absurd. The whole point about a regulator such as CQC is that one cannot rely totally on the regulated body. Yes, incompetence and deaths at Furness Hospital was primarily the fault of the hospital and the trust. But the idea of a regulator is to pick up failings in the bodies it regulates, not simply to ask them to confirm that all is tickety-boo.

Its job in fact is a form of auditing. Auditors cannot check everything, they have to do a mixture of test-checking and judgmental checking (picking on the most important things, or the things most likely to have gone wrong). Then the golden rule is that if you are “put on enquiry” by the results of that checking, you have to probe further.

In this case, the CQC failed to handle the original review properly. In a later internal review that failure was picked up by senior management, who promptly decided to bury it for “FoI reasons”. In other words, their priority was not to rush over to the hospital to see what needed fixing, but to make sure there was nothing sitting around in the CQC files that could be discovered by a future Freedom of Information request, thus embarrassing the same senior management.

Unsurprisingly, there is now some dispute about exactly what was said at the unminuted meeting. But it is clear that nothing much was done about fixing the problem at Furness.

Now if you were suddenly put in charge of a largish organisation charged with reviewing 41,000 institutions including several hundred major hospitals all within 500 working days, a timescale which was set in stone, you might feel you had an unreasonably challenging task and inadequate resources to complete it. You might also feel that you were stuck with the practical consequences of some ministers rushing into an ill-thought out scheme in order to look good.

But life is tough at the top. The fact is that no one will thank you for botching the job. You either have to figure out how to carry it out competently on time and on budget, or you have to lobby forcefully for more resources and more time. If necessary, you have to resign, noisily, to give your successor a fighting chance of getting the job done.

On the current evidence Bower was incompetent. She failed at her previous job (at the strategic health authority responsible for the Staffordshire mess) and she failed at this one.

I also found the rest of the interview fairly unappealing. We had a classic non-apology – she was deeply sorry for the child deaths at Furness, but apparently felt that she was not personally responsible in any way. Then we got a good deal of whingeing about how although she had a nice pension pot, she was going to find it difficult to take the retirement jobs she had hoped to take.

It is hard to say about Jill Finney. She has not appeared in an interview of any depth. It sounds to me as though she did mention FoI as a reason for concern, which hardly sounds like a proper sense of priorities. On the other hand, who knows what Bower was like as a boss. Maybe Finney had little choice but to defer to her. As for Anna Jefferson, it was presumably her job to fuss about the CQC’s press. It is hard to complain about her pointing out, if she did, that the internal report would cause the CQC grief if it got into the public domain.

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