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Editorial Tuesday 25 June 2013: Cynthia Bower & Jill Finney involved in major, unevidenced changes to CQC 'Take Care Now' report

Among the people probably feeling vindicated by the ongoing fall-out from regulation is former Healthcare Commission and CQC inspector Dr Heather Wood.

Her second statement to the Francis Public Inquiry into Mid-Staffs is well worth reading.

Wood's additional evidence was in response to having being asked questions about how West Midlands SHA (run by Cynthia Bower during most of the period under investigation) had responded to the 'Take Care Now' killing of a patient through overdose by Dr Daniel Ubani.

Dr Wood writes that her evidence "shows the CQC to have watered down criticism of the SHA in the final investigation report without any logical justification. It suggests that the explanation for diluting strongly evidenced findings is that the CQC leadership was reluctant to criticise West Midlands SHA since the chief executive of the CQC had been chief executive of the SHA for much of the time period covered by the investigation ... it was the relationship between the CQC and West Midlands SHA that was of concern, and is the subject of much of this statement".

Investigating the SHA's involvement in out-of-hours (which 'Take Care Now' provided), Dr Wood's investigation concluded that the SHA had shown "a lack of strategy, leadership and monitoring of out-of-hours services during the main period covered by this investigation ... this finding was not adequately reflected in the final report".

Dr Wood's evidence describes her being phoned by Imelda Richardson, deputy director of operations at CQC, who expressed concern that "we were going beyond the terms of reference of the investigation". Richardson's phone call was, according to Dr Wood, "instructing me to cancel scheduled interviews with West Midlands SHA senior staff the following week".

Unsurprisingly, Dr Wood notes that "no-one in Investigations had ever encountered such a situation before".

Fortunately, Dr Wood sent emails and kept contemporaneous notes that fully endorse her statement.

Dr Wood's statement later records that "Ms Richardson said that she needed to consider whether the investigative work with the SHAs could proceed and would get back to us. When I followed this up, she said she had to 'discuss it with Cynthia' (Bower, chief executive of the CQC). I was concerned about the propriety of this, and CQC's governance, since Ms Bower had been chief executive of the SHA for much of the time period covered by the investigation".

The statement later says "My concern was and remains that the matters raised by the SHA at the time were handled without due process by the CQC and with the involvement of lour chief executive, who had been chief executive of the SHA for much of the time period covered by the investigation. There was an assumption by the CQC that the SHA was correct and that its own Investigations staff - particularly me - were at fault".

Dr Wood later records that she and her fellow investigators and analysts had serious concerns over amendments to the report on clinical, financial and organisational matters. She describes the team's view of these changes as "a significant watering-down of the findings, particularly the criticisms of the commissioning by PCTs and of the oversight of this function, and of out-of-hours in general, by SHAs'.

They queried the changes, providing reasons for this challenge. Full notes were kept.

Then the summary document was sent to Jill Finney and Cynthia Bower on 1 July 2010 (yes, the Cynthia Bower who was the SHA chief executive during most of the period under investigation).

Dr Wood's statement records that Jill Finney's email says that the summary "contained 'sweeping statements relating to PCTs and SHAs' which she (Finney) thought were very subjective and might not be supported , although she (Finney) had not seen, nor asked to see, any of the original evidence ... as mentioned in my (Dr Wood's) second statement to the inquiry, the comment on sweeping statements appeared to be an example of CQC's dislike of clear unambiguous language".

The changes were again challenged; notes were again kept.

Dr Wood received a version with further revisions to the section on SHAs. The Investigations team were most concerned about "the removal of the criticism about SHAs not having a strategic vision of framework for out-of-hours and not monitoring PCTs' performance in terms of those services ... all the changes involved the SHAs and many were a watering-down of criticism or potential criticism. Our finding thavtherewas a lack of strategy and leadership from the SHAs in respect of out-of-hours had been turned into a statement that 'the strategic focus for out of hours services was not part of the wider context of integrated urgent care'."

Although a subsequent meeting apparently agreed to reverse the changes, and Dr Wood and colleagues produced a table of the agreed alterations, these changes were not reversed in the published version of the report.

The CQC's chief executive was Cynthia Bower, whose tenure at the West Midlands SHA had been under investigation in this matter.

The usual procedure of holding a press conference for the launch of a major national report was not followed. Dr Wood understands "that staff in Communications who had experience of publishing such reports recommended a press conference, but were over-ruled by the Head of Communications".

The Head of Communications of CQC was Jill Finney.

Dr Wood concludes "it appeared to me that the CQC's decision not to have a press conference was taken in order to reduce the publicity and attention given to the report, and to reduce the risk of criticism of its Chief Executive. And in this, the CQC was successful. As a consequence, some important lessons about out-of-hours were lost".

The Care Quality Commission was intended to be the NHS's quality regulator.