We can read the recent events at the Care Quality Commission as a failure of leadership − and we have been encouraged to do so from some quarters − or we can ask questions about the role of senior civil servants and ministers.

‘They will not have needed to be reminded that these services were being provided to some of the most vulnerable people in society’

Who was it who wanted to combine three separate inspection services covering hospitals, local authority adult social services and private sector nursing and residential care? Was the motivation to improve standards or save money? Who increased the remit to include domicilary care but not the resources? Who imposed a timetable for registering and initial inspections of hospitals for people with learning disabilities? Who instructed the the new inspection regime should have a light touch?

What was the response from the minister to advice that combining three different organisations and reducing staffing would distract senior management at a time when there was increasing concern about the quality of care services? How did the minister react to the news that the restructuring was resulting in a loss of experience and expertise as older staff took the early retirement deals?

A valuable lesson

What was the minister’s response when the Department of Health’s own risk assessment alerted them to the inadequacies of a “light touch” inspection approach when combined with inexperience staff and new areas of service to inspect? They will not have needed to be reminded that these services were being provided to some of the most vulnerable people in society.

‘What senior managers have leant is that if things go wrong it won’t be the unseen senior civil servant or the minister who is hung out to dry’

What was the role of senior civil servants was it to ensure the minister was fully aware of the risks, was it to provide support and guidance to the chair and chief executive of the CQC or was it simply to pass on the ministers instruction “get on with it”?

We could learn a lot from the story of the CQC. We could learn what happens when you combine health and social care organisations with very different management cultures. We could learn about reducing the risk of loss of expertise through restructuring and down seizing at the same time.

We could learn about protecting specialist knowledge and skills when moving into a more generic structure. But what senior managers have leant is that if things go wrong it won’t be the unseen senior civil servant or the minister who is hung out to dry.

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