5 Governance
Internal culture
89. At previous accountability hearings we have taken
evidence on the workplace culture within the CQC. In the committee's
last report we outlined worrying practices related to the excessive
workloads of inspectors. The committee's report of the 2012 accountability
hearing reported that:
the average inspector's caseload has increased
from approximately 50 locations per compliance inspector as at
1 April 2010 to 62 locations per inspector on 1 April 2011.[120]
The Committee also reported evidence from the RCN
that inspectors were being forced to manage excessive caseloads
partly as a result of having to provide cover for absent colleagues.[121]
90. The CQC's written evidence demonstrated that
CQC management accepts that there has been a chronic problem with
the CQC's workplace culture. The CQC provided evidence regarding
the outcomes of their staff surveys which stated that:
Bullying, harassment and discrimination were
areas identified in the 2012 survey as giving cause for concern.
As a result, Sarah Hunter, an independent consultant, was appointed
to lead an independent review of bullying and harassment within
CQC. Her report, published in June 2013, found that there was
a worrying level of perceived bullying and harassment and made
recommendations to address the issues identified.[122]
The independent report confirmed the concerns expressed
by the RCN and concluded that:
manifestations of bullying are systemic and largely
the result of the number of reorganisations that the CQC has gone
through whilst being expected to deliver an increasing workload.[123]
The report found that:
Many people we spoke to talked about workload
in the context of institutional bullying. "This is a long
hours culture - they wring the blood out of you." [...]
A number of those who had experienced bullying
by their line manager connected it to their desire to make more
thorough inspections than their line manager felt was necessary.[124]
91. The CQC's written evidence outlined the new mechanism
for members of staff to report concerns about workplace practices
to a senior board member:
Michael Mire, one of the newly appointed non-executive
directors, has been appointed as the Senior Independent Member
to whom members of the Commission and members of staff can raise
their concerns where they feel that they cannot do so through
their line management or through HR.[125]
In oral evidence David Behan added that staff surveys
would be conducted twice yearly by an independent organisation.
He reported the outcome of their most recent survey, which had
found that:
82% said that they were positive about the CQC
changing for the better. Staff satisfaction went up to 61% and
they calculated an engagement index at 63. The public sector average
is 56.[126]
Mr Behan, however, qualified the positive outcomes
of the staff survey and said:
I am not happy to be average and I am certainly
not happy just to beat the best of the public sector. [...] Our
lowest scores in the survey—it is not appropriate just to
look at the high scores—were about whether people feel valued
in the CQC, whether their morale is high, and whether they have
confidence that the senior leadership will effectively make the
changes that we have to make.[127]
92. The Committee welcomes the CQC management's
commitment to this process of culture change within the organisation
and, in particular, their commitment to monitor progress in delivering
this objective.
93. Creating a mechanism for staff to report bullying
and harassment to a director at a very senior level will help
the executive team and the Board maintain a realistic understanding
of the experiences of the CQC's frontline workforce. Whilst this
is an important step that delivers necessary senior oversight,
this system, in itself, is not enough to eliminate the culture
that has produced bullying and harassment.
94. Concern has been expressed to the Committee
about the impact of individual workload on the culture of the
organisation. Management of workload is an important part of business
planning. At our next accountability hearing the Committee will
seek assurances that workforce planning associated with the new
regulatory model has not repeated the mistakes of the past and
that inspectors are be able to complete their work thoroughly
(including weekend and out-of-hours inspections) without being
required to manage unreasonable workloads.
Funding
95. In 2012-13 the CQC's expenditure was £166
million, £17 million more than the £149 million spent
in 2011-12.[128] The
CQC's net expenditure is funded by grant-in-aid from the Department
of Health. This amounted to £60 million in 2012-13, up £15
million from the previous year.[129]
96. The CQC attributes the greater expenditure and
funding requirement to the recruitment of additional staff. Of
the £17 million increase in expenditure, £16 million
was attributable to staff costs. In 2013-14 the CQC's revenue
budget is expected to reach £180 million of which £80
million will be grant-in-aid.[130]
The inclusion of £17 million in capital expenditure costs
takes the CQC's total proposed expenditure for 2013-14 to £197
million.[131]
97. In 2012, the CQC said in its evidence to the
Committee that in 2013/2014 it proposed generating £100 million
from fees and reducing the grant-in-aid contribution from 24 per
cent to 19 per cent of its overall costs. This was as part of
a proposal to phase out grant-in-aid funding by 2015-16.[132]
98. The CQC's budget has risen rapidly in the last
year and is likely to rise further. Mr Prior told the Committee
that "Her Majesty's Government have wished us to become an
effective strong regulator, and there is a cost attached to that."[133]
He confirmed that it was no longer the CQC's objective phase
out grant-in-aid funding. He explained the rationale behind this
change in policy:
At the moment we spend about £153 million[134],
of which £100 million comes from fees. In three years' time
we will be spending between £200 million and £210 million.
I do not think our fees are going to go up by very much, but we
will see.[135]
Mr Prior added that that CQC's funding for the next
three years had been "substantially agreed with the Department
of Health"[136]
but he was less sure "how far they have agreed it with
the Treasury."[137]
99. David Behan explained that the three-year registration
and inspection strategy required a financial plan to support it.[138]
David Prior told the Committee that uncertainty still exists regarding
funding after 2013-14, he said "for the next two years, the
details are still being nailed down, but in principle we have
full support from the Department."[139]
100. The Committee welcomes the commitment that
has been given to ensure adequate funding for the CQC. In the
longer term, however, the independence of the CQC will be substantially
reinforced when arrangements are in place to ensure that the cost
of regulation is met by the registrant community.
The case of Anna Jefferson
101. On 3 October 2013 it was announced that the
CQC's Head of Media, Anna Jefferson, had been cleared of any wrongdoing
by an internal inquiry examining allegations that a critical internal
report related to University Hospitals of Morecambe Bay NHS Foundation
Trust (UHMBFT) had been suppressed by senior CQC staff. The Grant
Thornton report alleged that Ms Jefferson had been involved with
the decision to cover up the report, claiming that she said "this
can never be in the public domain nor subject to FoI."[140]
102. Ms Jefferson, who was a media manager at that
time, contested ever having made the remarks, arguing that her
concern was that the internal report was not of a good enough
standard and that an external party should review the registration
of UHMBFT. In written evidence submitted to the Committee in June
2013 she said that Grant Thornton had never put the quote to her
in interview despite saying otherwise.[141]
103. The CQC statement which followed the review
conducted in line with the CQC's disciplinary procedures concluded
that:
Anna Jefferson had not supported any instruction
to delete an internal report prepared by a colleague - Louise
Dineley - or otherwise acted inappropriately in that regard.[142]
It added:
The CQC regrets any distress Anna Jefferson has
suffered as a consequence of this matter and is pleased to welcome
Anna back to the organisation following a period of maternity
leave. She is currently undertaking a course of postgraduate study
with CQC's support.[143]
104. Commenting on the implications of this sequence
of events, David Prior told the committee that the CQC's internal
findings had not challenged the overall conclusions of the Grant
Thornton report. Mr Prior said:
They (Grant Thornton) raised issues about the
behaviour of certain individuals, which we looked at very carefully.
They raised issues but did not come to a conclusion that anyone
was guilty of this, that or the other. They raised issues. We
checked those issues out very thoroughly through a disciplinary
process and found that, in the case of Anna Jefferson, the allegations
raised were not valid.[144]
105. The Committee does not find this argument convincing.
The Grant Thornton report concluded that any attempt to withhold
the internal report, even on the grounds that it was not of sufficient
quality, could not be justified.[145]
As a result Grant Thornton concluded that there may have been
an attempt to 'cover up' the internal report and that the evidence
was persuasive.[146]
The Grant Thornton report, therefore, did more than simply raise
issues: it sought to form conclusions based on the behaviour and
actions of CQC staff.
106. Mr Prior said that the case of Anna Jefferson
and the outcome of the disciplinary investigation:
does not in any way undermine the major thrust
of the Grant Thornton report, which was that the whole organisation,
and the regulatory system that we were implementing, was completely
unfit for purpose.[147]
107. The Committee agrees with this statement. Mr
Behan noted that there was no "contemporaneous evidence in
relation to the allegation against her" [Anna Jefferson].
In the light of this observation the Committee regards it as
regrettable that the Grant Thornton report appeared to lend weight
to the allegation.
120 HC 592, para 45 Back
121
Ibid. Back
122
CQC (ACQ 02), para 37 Back
123
People Opportunities Limited, Exploring Bullying and Harassment in the CQC,
June 2013, p 3 Back
124
Ibid, p 16 Back
125
CQC (ACQ 02), para 37 Back
126
Q130 Back
127
Ibid. Back
128
HC 374, p 81 Back
129
Ibid, p 83 Back
130
CQC (ACQ 02), para 27 Back
131
Care Quality Commission, Business Plan 2013-14, p 19 Back
132
HC 592, Ev 50 Back
133
Q126 Back
134
The CQC's recurring budget in 2012-13 Back
135
Q125 Back
136
Q127 Back
137
Q127 (Mr Prior) Back
138
Q127 (Mr Behan) Back
139
Q128 Back
140
Grant Thornton, The Care Quality Commission re: Project Ambrose,
June 2013, p 265 Back
141
HC 526-i, 3 July 2013, Ev 27 Back
142
http://www.cqc.org.uk/public/news/statement-regarding-anna-jefferson Back
143
Ibid. Back
144
Q32 Back
145
Grant Thornton, June 2013, para 6.248 - 6.249. Back
146
Ibid, paras 6.252 Back
147
Q32 Back
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