So Goodbye then Cynthia Bower, who quit one day after the piece in the Eye’s last edition questioning when she would Bower out. Cynthia Bower was originally exposed in Private Eye’s special investigation, Shooting the Messenger, for conducting a lame piece of research to question the validity of mortality statistics and therefore the problems at Mid Staffs. She had claimed in Board papers that “there was no systematic relationship between quality of care and hospital standardised mortality figures”. Mid Staffs had put that view under severe strain, but Cynthia had already been promoted to top wonk at the Care Quality Commission before the damning report on Mid Staffs was published by the brave Dr Heather Wood.
So Cynthia began work at the CQC initiating £20 million worth of redundancies and getting rid of the investigations team and Dr Heather Wood. A highly placed source in the CQC told MedicalHarm he “had never before or since seen the number of people signing gagging orders” as they left the organisation. It is unclear whether Cynthia’s departure will allow some of those gagged people, including Dr Heather Wood, to speak up.
Faced by a barrage of hostile questioning from the Public Accounts Committee, Cynthia Bower of the Care Quality Commission made two stark claims – “I would never behave in a vindictive way” and “we don’t make any attempt to gag”.
So what did Cynthia want to hide? From 2002 to 2009 the inspections team had done 19 inspections, responding to whistle-blower concerns. Under Cynthia’s reign no NHS inspections had been done for two years, and the inspection team had been moved on. In place of actually getting into the hospital, Cynthia proposed a new fangled “field force model” with “expertise at the intersection of the axes”. Inspections would be replaced with compliance, and regional wonks working from home on laptops looking at self-assessed forms. This would be a “responsive model” with emphasis on “horizon scanning”. The new operatives would be able to “proactively test intelligence”. But not a medical qualification in sight. Trebles all round for NHS trusts!
When the Public Accounts Committee questioned Cynthia Bower on who was responsible for this new idea and new model, she claimed it was the “Board”. But she refused to release the Board minutes until the Public Accounts Committee questioned her aggressively. Those minutes now show that the Chair of the CQC, Barbara Young, had very serious reservations about this new model. Barbara Young cited the “the likely inadequate frequency of interaction” and the lack of “a level of seniority of interaction and knowledge required”. She asked “for it to be recorded that she took not part in the decision”.
Meanwhile, the new model of compliance operatives has failed several times, with notices issued to hospitals ending up in expensive legal challenges. Even the top mandarin at the Department of Health, Una O’Brien, admitted to the Public Accounts Committee that they had convened a “major lessons learned seminar” and claimed “optimism bias had got in the way”, followed by the fact that the “journey of improvement they are seeing” needed a “clearer time horizon”.
It might have been better not to pay off and silence those with medical knowledge who uncovered Mid Staffs. MedicalHarm asked Cynthia Bower under freedom of information for the number of people in the new era CQC with any with medical qualifications. The case went to the Information Commissioner and Cynthia claimed it would take a full “20 minutes to ask each staff member about their qualifications”. So, she argued, it would be far too expensive to tell Private Eye what qualifications CQC staff had. We presume the answer is not staff with any medical qualifications.
But Cynthia was prepared to release a spreadsheet of job adverts for the last year. “Deputy Director of Operations” needs the following qualifications: “none required”. What about a “Registration Assessor”, judging the quality of care in the all important test? Qualifications: “none required”. As for a “Senior Analyst”, another important position, yes, “none required”.
Looks like Cynthia’s “field force model” of “horizon scanning” by assessors with laptops working from home, with little or no medical qualifications, may take some time to shift.