Sam Smith makes the case for sacking Jo Williams immediately, withdrawing her DBE and ostracising her from society.

It has been said that for evil to triumph all that is necessary is for good men to do nothing. That grim maxim could easily serve as the motto for troubled Labour-founded quango the ‘Care Quality Commission’.

In the three years since it was founded, the CQC has been hit by a series of catastrophic scandals – most infamously its failure to act when warned of abuse at Winterbourne View, an institution run by Castle Beck. The site was eventually closed after filming by the BBC revealed institutional abuse of residents by staff.

Damningly, the CQC had been expressly warned of the scandal by a whistleblower and failed to act, one of many failings that eventually led to the resignation of CQC Chief Executive Cynthia Bower.

The CQC was not merely supine, however. New evidence has emerged that not only were concerns raised about the CQC’s management but that CQC Chairwoman Jo Williams was determined to silence critics and hide problems. Quite astonishingly the Independent has reported that Jo Williams obtained a psychiatric assessment of a member of the CQC’s Board, Kay Sheldon, and attempted to procure her dismissal.

The ‘expert’ – a hired gun such as those who have been so stridently criticised for the poor quality of their evidence in the Family Courts, lost no time in forming the ridiculous opinion that Kay Sheldon was possibly suffering from ‘Paranoid Schizophrenia’. This doctor was not a psychiatrist and had never met Ms Sheldon. At the time no one else, including any of her family, friends or colleagues had expressed concerns about her mental health.

Mrs Sheldon had done no more than give evidence to the public inquiry on Mid Staffordshire – an inquiry into serious concerns about events that cost between 400 and 1200 lives. She was not alone in her concerns – she was backed at the inquiry by another whistleblower.

The CQC is one of Labour’s greatest scandals. It is an organisation charged notionally with protecting the vulnerable from poor care. However in fact it was set up to fail from the beginning. The first Chief Executive of the CQC, Cynthia Bower had been the Chief Executive of the NHS’s West Midlands strategic health authority when concerns first arose about Stafford hospital. In 2010 she abolished the CQC’s successful Central NHS Team that had taken part in that investigation and which had criticised the authority she had led.

The CQC was formed from the merger of the Commission for Social Care Inspection, the Healthcare Commission and the Mental Health Act Commission but has a lower budget than its three predecessors. A procession of resignations has followed poor care scandals. In fact the leadership of the CQC, lacking the resources to properly regulate the many organisations it is responsible for has consistently favoured light touch regulation.

I personally favour extremely heavy handed regulation. In this I am joined by many of those who feel, sometimes as a result of personal experiences, that the current state of accountability in health and social care is lamentable. However in this context it would be extremely simplistic to scapegoat Jo Williams merely because the CQC had been ineffective. It is an organisation that was always doomed and some might even suspect that Labour Ministers and Civil Servants were unenthusiastic about NHS problems being exposed.

No, the reason that Jo Williams should be sacked, stripped of her gong and made persona non-grata is in the Care Quality Commission’s attacks on whistleblowers and its attempts to gag them along with her direct attempts to secure the dismissal of Mrs Sheldon.

A report by the Commons Public Accounts Committee found that “2.  The Commission has been poorly governed and led” and that “The Commission is regarded as overly focused on reputation management and has included gagging clauses in its severance deals with staff. Such clauses discourage people from speaking out and making public information that would help drive improvement and hold the Commission to account. The errors in the Commission’s annual report to Parliament also raise questions about the effectiveness of governance and internal control.”

Whatever the undoubted challenges faced by the Care Quality Commission and with the blame firmly pinned on the Labour Government for the creation, perhaps intentionally, of a monstrously inadequate regulatory organisation it is still the case that this woman has to go. It is one thing and quite understandable to put a brave face on a difficult situation. It is another for one of the country’s most important regulators to be gagging staff and for Jo Williams personally to be questioning the mental health of internal critics.

What the Care Quality Commission needs is a larger budget, more teeth and a focus on investigating patient and carer complaints. It needs serious sanctions and legislation, fining private companies and jailing people – not lowly care workers but managers whether in the NHS or the private sector. People need to fear the regulator. Offences of strict liability need to be created to ensure that denying knowledge does not get managers of the hook.

The problems of ineffective regulation are not new nor unknown to mankind. In the Sententiae of Publilius Syrus, a Roman writer from the first century BC, it is said, “Invitat culpam qui peccatum praeterit” which translates as “Pardon one offence and you encourage the commission of many”. It was also said that, “Iudex damnatur ubi nocens absolvitur” or “The judge is condemned when the guilty is absolved”.

Put in modern terms a weak regulator of care is an enabler of all those it is supposed to stop – paedophiles, gerontophiles, financial abusers, murderers, the incompetent and those who simply find it profitable to provide poor care. 400 – 1200 people died in Staffordshire. The CQC’s wide remit covers the protection of people from all walks of life. The old, the young, the sick, the disabled and the mad – we all at some time or another will need the CQC for ourselves or our families and it is failing.

Jo Williams is not the author of all the CQC’s problems. It would be facile and wrong to engage in scapegoating which will obscure real issues. She is however a despicable woman and one whose OBE for “services to people with learning disabilities” now has a ring of bitter irony. She has presided over a service which again and again has been alleged to be failing, to be overstating its achievements and oppressing whistleblowers. She has taken ownership of some of that wrongdoing of her own volition and must bear the responsibility.

If the CQC by its incompetence has made it harder to detect abuse and in so doing enabled the abusers then that is in part the doing of its leadership. That leadership needs to pay the price and it must be a heavy one.

GildasTheMonk
August 25, 2012 at 14:42

Anna, if you read this can you contact me please? G the M

Edna Fletcher
August 24, 2012 at 10:36

Having discussed the process of ‘investigating’ care agencies with a CQC
inspector/ researcher, when making a complaint about an organisation with
form, to the extent that it had been part of an investigative journalism piece
in a national paper which it kept well hidden, I was rather astonished to find
that the reason for the ‘light touch approach’ taken to organisations with
known records or histories is due to the fact that there would be no ‘care
services’ left if they were all criticised heavily or closed down!!!!
An
endorsement of neglecting and abusing care organisations resulting for bad or
even fraudluent management practices?

rogerh August 24, 2012 at 07:11

Oh dear, Oh dear, I think you missed the point. The CQC has done and will
continue to do exactly what it is designed to do – to see that care homes are
run on the cheap and that private and public operators will not be troubled by
any real controls. Whistleblowers must and will be punished ‘pour encourager
les autres’, no deviation from the (phony) narrative that ‘We Care’ can be
allowed.

The usual trick worked for the CQC – set up a regulator and make thoroughly
sure it did nothing and claimed ‘lack of resources’ when the inevitable
disasters happened. Bowers and Williams are mere footsoldiers in this scam –
they went along fully knowing what the game was all about – the controlling
minds were of course much further up the pile and well insulated from getting
the sack.

Expect a temporary show of enthusiasm from the CQC, expect this enthusiasm
to be wound down and a return to business-as-usual – any residual enthusiasts
will be reminded firmly of the real agenda – toe the line or be sacked.

Zanshin August 23, 2012 at 17:39

Actually sent a detailed email to this foul woman, listing all the reasons
why she should resign immediately, following the care home scandal.
Still
no reply – not that I expected one .

Tatty August 23, 2012 at 14:50

Beats me why “regulators” were ever thought to be a great idea here when we
already had a Police Force. How on earth have people been persuaded that when
you witness a crime that the best thing to do in the first instance is to
write a letter to a Third Party and wait weeks, months or even years for a
pertinent reply ? Just count up how many Authorities, businesses and public
sector organisation have so-called “Complaints procedures” these days. It just
beggars belief.

We can rant and rave and demand and recommend but the genie is well and
truly out of the bottle now. There is no justice or punishment or “care” for
anyone in this country because far too many people are paid far too much money
to prevent it being pushed even half-way back in again. It’s going to take a
revolution and may the gods help us all in the fallout.

I suspect…given the profileration of evidence…that’s what TPTB were aiming
for all along.

Mudplugger
August 23, 2012 at 20:46

Ever tried reporting a crime to the Police force ? Here’s an
experiment……

Go along to your local Plod-shop and report that someone has committed an
offence of Fraud, involving the theft of money via your credit or debit
card. Will it be investigated ? Will you get a Crime Number ? Will they ever
bring the fraudster to justice ? That’s three big fat “No” answers.

Nice Mr Plod will simply tell you to report it to your bank – your bank
will do some rudimentary checking and, in the vast majority of cases, your
‘stolen’ money will be refunded by the bank. You will go away happy. Case
closed. But a crime has still been committed, it’s just not been reported,
counted, investigated, solved or prosecuted.

So, if that’s what they do to avoid investigatory work on a simple,
demonstrable, measurable case, what makes you think the Police would ever be
interested in a case involving something as subjective as the quality of
care ? They’re far too busy persecuting motorists and guarding the odd South
American embassy building…..

LJAR August 23, 2012 at 14:16

The question I have is where are these people’s children and grandchildren
when they were being abused in the care home?

This wont be solved by more or better regulation – it will be solved by
people actually caring about what happens to their elderly relatives and at
the moment they act as though they couldn’t give a damn.

Edna Fletcher
August 24, 2012 at 10:41

You may find that the complaining relatives are removed from further
contact with the ‘care home’ and their loved one by the Court of Protection
judges, at the institution of social Services who clearly financially gain
from the arrangement on many levels.

Don’t believe me? Have a look through many blogs by carers trying to
raise concerns with the social services department regarding standards of
care..

Bunny August 24, 2012 at 11:07

There was a case in Warrington which I remember well, an elderly woman
died in her flat, which was a council property but not care. Three weeks
later the council sent out someone to check on her because her neighbours
also elderly had not seen her for a while. The poor woman had been dead for
three weeks, her fifteen grandschildren who all lived locally complained
that the council should have done more. Some give a damn but others just
package them off, oh look it has a care mark, aren’t we looking after
granny.

On the other hand a friend of my father’s died, he had never married and
lived in his parent’s house. He was in his 90′s when he passed away, he died
peacefully in his sleep, for the last years of his life he was nearly blind
and deaf and was house bound. His next door neighbour used to call in every
day, bring the milk in and did the shopping for him, he found him after the
morning after he had passed away. Now that was care.

Edna Fletcher
August 24, 2012 at 21:11

I agree, there are many families who think care means ‘care home’ and
true a lot do not visit much once they are in. I do know of someone with
severe / profound learning difficulties and physical difficulties who was
looked after at home by her parents until aged 40 and I know they
struggled with getting help from the local authority- but did get some.
The child had siblings too. I was surprised not that she was put into
residential care in the end, as ageing parents might consider their
ability to care long term, but that the parents looked so ‘free and happy’
after this decision with no sibling actually offering to help.
One
cannot judge properly all situations where families show little care for
an elder / disabled because we have no knowledge of the relationship
history. I know of parents who literally wanted no relationship with their
surprisingly well balanced adult children / grandchildren, being ‘more
into each other’ than family life. This to the extent they did not attend
the weddings of their children either. Would you visit such parents once
they are in a care home?

ivan August 23, 2012 at 01:05

Mudplugger, the simple answer to that is make everyone on any committee, a
quango or a multi-disciplinary task force etc. individually responsible for
any decision made by said committee, a quango or a multi-disciplinary task
force etc. so that no matter how hard they try to wriggle out of it they all
suffer the same consequences

As for the ‘process’ that these people follow, again make each and everyone
that relies on that ‘process’ responsible for not only the outcome but the
spirit of the outcome.

That being said, the best way of dealing with all these committees, quangos
etc. is to disband them and make all members and hangers on redundant without
any more than the statuary redundancy payments. .

Mudplugger August 22, 2012 at 22:03

Jo Williams is not the problem, rather she is a symptom of a problem which
afflicts all types of public service. Put simply, it is the avoidance of
personal accountability.

This is simply achieved by establishing a group, be that called a
committee, a quango or a multi-disciplinary task force etc – they all have one
major purpose, that being to avoid the blame for any event being directly
attributable to any individual. “It was the committee wot done it, guv.”

Even when an individual social worker takes apparent responsibility for a
‘case’, that social worker never actually decides anything him/herself – it is
put to a ‘case conference’ and the decision is officially taken by the
‘conference’, not the individual. That way, any come-back will never be
directed to an incompetent individual but rather to an inanimate body: the
group, committee or conference. It is arse-covering on an institutional scale.
What happens to the ‘case’ is not important, covering the arse is the sole
objective.

The second strand in this game is the ‘process’. These organisations are
obsessed with process, again for the sole purpose of anal-coverage. As along
as it can be established that the ‘process’ was followed then, whatever the
outcome for the ‘client’, the official is innocent because he/she can prove
that the process was followed. And this is what leads to the box-ticking
approach used by the CQC and its ilk – whether the ticked boxes actually
reflect care standards is unimportant, they are there to be ticked to prove
that they have been ticked, nothing more, nothing less. As long as they are
ticked, the arse remains covered.

In the world of public service, the day when a official does a job and is
personally answerable for that job is long gone – there is an infrastructure
of defence, carefully erected, to ensure that the official will remain immune
from criticism, regardless of the scale of incompetence. Sir Humphrey would be
proud.

Delphius August
22, 2012 at 19:25

The problem with the care quality commission is that its not an
organisation that is run to monitor the quality of care, but instead to
monitor the care and quality with which boxes are ticked. There is a huge
difference.

Right now I know of instances where care is actually suffering because time
is being diverted away from care to maintain “essential” paperwork.

The framework put in place by CQC is not one that necessarily produces any
better care, its just one that “indicates” care is being maintained.

Its like a lot of organisations put in place by both this and the previous
governments in that the aim of the organisation isn’t to actually deliver the
core function of the organisation, but to be provide the appearance of it.

I was taught from an early age that you are supposed to deliver what you
say you will deliver, and you measure success against those targets. The
deliverables you are measured on have to be tangible and physical. In other
words you’re not measured on saying you are going to do such and such, or even
saying you have done it, but be measured on if the act has actually been done.
As an example any parent will know when you ask a child to tidy their room,
you don’t rely on them telling you the room is tidied because they have a
tendency to tell untruths in order to avoid tidying their room properly or at
all. You actually go and physically check the room and make damn sure the room
is tidy and all the crap isn’t just piled under the bed or in a corner
somewhere.

So it is with CQC: they need to go back to a regime of actually checking
the quality of care by proper physical inspections, if necessary interviewing
those that are supposed to be receiving the care.

Until CQC grasp that fact,

The Meissen
Bison August 22, 2012 at 20:20

Isn’t the whole problem in the word “deliver” which is omnipresent in the
mouths of politicians and functionaries?

Most of the things that are supposedly intended to be delivered are not
susceptible to being delivered in the first place. What constitutes a
desirable outcome for a letter or parcel cannot be applied to all the
amorphous activities which are generally not finite and to which the word is
now applied.

There’s the world of difference between a care-home,say, undertaking to
look after an elderly person as opposed to delivering a care package. In the
former instance competent individuals by implication are personally engaged
in a continuing process tailored to some extent to the specific needs of the
individual being cared for.

The latter is impersonal and describes a defined and static process to
which the elderly person is rigidly subjected willy-nilly.

Delphius August 22, 2012 at 20:43

I agree. I know of the sort of homes that provide such impersonal care,
in effect barely allowing existence.

Keeping someone functionally clean, nourished, etc, isn’t necessarily
“care”. Sure, they are fed, watered and washed, but they don’t have a
life. Many larger care homes work on this principle, where residents are
provided for in conveyor, industrial battery-farm style. Its existence,
but its not a life.

For instance feeding someone the same diet day in day out, is
delivering nourishment, but is hardly beneficial from from a psychological
standpoint. Its borderline abuse, but it happens and it passes inspection.
It must do, as such homes continue to stay open without sanction, year on
year.

Also raising and washing someone at the same time each day, day in day
out, ignoring the fact that the person may want a lie-in on a particular
day, is delivering care, but is hardly caring.

The cynic in me wonders if its because most such institutions seem to
have nursing wings, that its a ploy to break down a resident in order to
eventually shuffle them off to more expensive (and therefore profitable)
nursing care before they eventually kick the bucket.

However, these practices go on, such homes pass CQC inspections as all
the required boxes are ticked. I’d rather be shot than live in such a
place.

JimS August 22, 2012 at 21:03

So did some quango check the quality of your new car, TV, can of baked
beans or whatever?

Of course not. We don’t need any of these highly paid ‘front’ men and
women to pretend that everything is hunky dory. Instead of creating a
culture of quality we have a culture of appearance where failure MUST be
covered up or spun into something different.

Failure is more valuable than success, it shows where the weak points
are. Success is an unknown failure waiting to happen. Fake success does no
one any good except for the bonus-seeking quango head.

Disenfranchised of Buckingham August 22, 2012 at 18:17

While not wanting to seem misogynist I can’t help but notice the number of
useless women running things. Another one was highlighted on Dispatches last
week running the Job Centres.

There has to be case of imposing women on organisations either because, or
despite of, their incompetence.

Furor Teutonicus
August 22, 2012 at 14:20

XX It has been said that for evil to triumph all that is necessary is for
good men to do nothing.XX

Sam Smith. You make one fundemental error of logic. No GOOD man would be
seen dead within twenty miles of a quango.

JuliaM August 22,
2012 at 11:18

“This doctor was not a psychiatrist and had never met Ms
Sheldon.”

Shades of David Southall ..? And he’s still practising too.

Brass Monkey
August 22, 2012 at 10:48

Scary article. Very Scary. Did not the U.S.S.R. have a history of
consigning dissenters to psychiatric hospitals, and does this not still go on
in other communist countries? It is so nice to know that attempts to carry out
this practice are alive and well in U.K. Not!
I applaud you Sam, but alas
this woman will probably continue unscathed because no one has the balls to
dismiss her. When another useless head of department (Sharon Shoesmith) was
sacked she eventually got rewarded with a big payout for not doing her job
properly, so I guess no-one will want to do anything about Jo Williams.

GildasTheMonk
August 22, 2012 at 11:09

Quite. In the public sector Parallel Universe there is no responsibility
or consequence. Only pay offs!

The Meissen Bison
August 22, 2012 at 10:46

Good piece.

However, your Latin’s a bit slack with:
“Invitat culpam qui peccatum
praeterit” which translates as “Pardon one offence and you encourage the
commission of many”.

It’s more like ‘He who overlooks an offence invites censure’ which is of
course equally to the point. Apologies for my pedantry.

JimS August 22, 2012 at 10:34

Get rid of the regulators! You don’t solve problems by creating a parallel
organisation with its own empire-creating and self-survival tendencies.

Quality has to be embedded in an organisation and you do that with
motivated competent staff at all levels who spot problems before they are
problems and are able to do something about it, rather than by being directed
by ever complicated ‘procedures’ or ‘regulations’.

It’s the old Japanese quality mantra; drain the river and reveal the rocks,
don’t flood the river and hide them.

Bunny August 24, 2012 at 10:54

Agreed on the introducing a mantra of quality into these organisations.
We seem to be on a hamster wheel to hell with social issues at the moment
and this is just one of them.

GildasTheMonk
August 22, 2012 at 10:33

What a great piece Sam Smith. That is spot on. At first I thought the CQC
was doing a good job, and then later on I began to realise that they were
almost hopeless. The care of the eldery (or lack thereof) is a national
scandal, and I think this piece is a fine call to arms!

Woman on a
Raft August 22, 2012 at 15:00

+1

Ancient + Tattered
Airman August 22, 2012 at 18:50

Agreed. A shocking indictment.

wiggiatlarge
August 22, 2012 at 10:01

That’s as good an article as any i’ve seen on the CQC, I did a small piece
myself on the Cynthia Bower affair awhile back and the gagging orders on
whistle blowers was well trailed even then, to see this outfit still limping
on in the same fashion after all that has gone before is a total disgrace, not
fit for purpose is the least it should be called.