Appointment of the Chair of the Care Quality Commission

I am writing about your hearing on Thursday (details of which were put on the Committee's website yesterday). I thought it might be helpful to you in briefing your Committee to have an input from someone like me.

I am a former Under Secretary who, in various posts in the Cabinet Office, Department of Transport, Department of Employment and DTI, was responsible for public appointments. I have had dealings with the CQC and its predecessors as a "customer" in relation to problems with family members' dealings with care homes and various parts of the NHS.

Currently, I spend some time working as a volunteer in the constituency office of Roger Gale (though I am writing this in a personal capacity) which means that I am aware of much of his casework. I have also been a non-executive director of Nationwide Building Society where, amongst other positions, I was a member of the senior appointments committee, selecting board members and senior management.

I hope that your Committee will probe this appointment with great care because I have profound misgivings about whether the candidate is best placed to meet all the challenges that face the CQC.

I might add that it would be helpful to us all if you had been provided with information from the Department of Health as to the way they went about their selection process. Where was it advertised? Who carried out the initial sift? Who formed the final selection panel? And so on.

These are highly relevant questions since the impression one gets is that expediency might have ruled in this case. The Department were faced with a vacancy at short notice and the easiest thing in the world is to promote the Deputy.

According to the CQC press notice issued when Barbara Young stepped down, "Dame Jo Williams CBE has been a non executive member of the CQC's board since its inception in shadow form in October 2008" and she has been temporary Chair since the previous Chair's resignation.

As the top person, who has been in an influential board position for the whole of the life of the organisation, its faults and weaknesses in performance can be laid at her door.

My experience of this organisation is that it is a pretty hopeless regulator (and I have dealt with plenty of different regulators in my time). Just as with the Audit Commission and Ofsted, the CQC has adopted a pretty mindless, mechanistic approach to assessment. "Mechanistic" is a polite word for "box-ticking".

One has learned to read their reports with an extremely sceptical eye. All too often one can see that there are problems touched upon but discreetly pushed to one side, when any reasonable, competent inspector would have highlighted them as issues to be addressed.

Worse still, if one talks to inspectors when their guard has been let down they reveal that they are unhappy with the methodology and - even worse still - the pressures they can be put under to moderate their criticisms. This is a problem which goes back to the time when inspections were carried out by County Councils themselves so that they ended up inspecting themselves: sadly the attitude still persists.

Leaving aside inspection reports, dealing with the CQC - for example on Freedom of Information cases - is a classic case of marching through treacle with a costive, unhelpful bunch of bureaucrats, poorly supervised and badly managed.

Whatever her strengths, Dame Jo Williams has presided over this organisation.

The Department of Health, of course, do not have a clear idea of how poorly the organisation is performing. In my experience "sponsor" departments are pretty hopeless at knowing how to obtain an accurate picture of the organisations they are meant to be keeping an eye on.

So one can see why officials would have recommended to their ministers that continuity and a "safe pair of hands" were desirable features of this candidate. I think it regrettable that ministers fell for this one. In my considered opinion what the CQC needs is a new, fresh, strong leader without the "baggage" of recent history in the organisation and the earlier experience in the field offered by Dame Jo.

I would contrast the Department of Health's decision on this appointment with the radical approach of Eric Pickles to the future of the Audit Commission.

I would not suggest that we should do away with the CQC but there does need to be a fundamental review of the way it operates. It follows that it needs someone who can lead the organisation into a new approach to regulation.

I hope that your Committee will not be diverted into a long discussion of whether we should or should not keep the "star ranking" system. I happen to think that this is a useful, customer friendly approach. But the issues are much more fundamental than that.

In the questioning of the candidate I hope that your Committee will ask her:

i) to what extent do you feel that you are responsible for the weaknesses in the CQC's performance?

ii) what aspects of the CQC's work has caused you most concern?

iii) what lessons have you learned from your involvement in the CQC since the time you joined the "shadow" board

iv) how would you characterise the CQC's relationship with the Department and how do you see it changing?

v) what steps do you take to supplement the board management information provided to you with other forms of monitoring such as meetings with user groups?.

vi) do you feel that the CQC board needs further strengthening - and, if so, in which areas?

vii) how would you characterise your relationship with the Chief Executive and her senior management team?

These may be rather more pointed questions than your Committee are used to putting - though I must say that they seem to be a pretty robust group of Members! - but given the state of affairs that I observe at the CQC I believe that they are appropriate.

I hope you find this contribution helpful.

P H TWYMAN, MScEcon FRSA

7 September 2010