The NHS watchdog accused of a covering up its failure to investigate a maternity unit where babies died through neglect is still not “fully set up” to properly inspect hospitals, its chairman has admitted.
The Care Quality Commission (CQC) is accused in a report being published today of suppressing an internal review that uncovered critical weaknesses in its inspections, which may have cost the lives of mothers and babies.
Regulators deleted the review of their failure to act on concerns about University Hospitals of Morecambe Bay NHS Trust, where police are investigating the deaths of at least eight mothers and babies.
There have been accusations that midwives colluded to hide errors. The trust, which faces at least 30 civil negligence claims, will also be subject to an independent inquiry in public.
The CQC's chairman, David Prior, said it was a "shocking state of affairs" and told BBC Radio 4's Today programme: "I'm desperately sorry that this happened."
Concerns about the maternity unit at Furness General Hospital in Cumbria came to light in 2008, but the CQC gave the Morecambe Bay trust the all-clear in 2010.
A report has found that the health watchdog bosses were so concerned about how damning the review would be that they ordered it should never be made public and that it should be destroyed.
Mr Prior admitted that despite the failings over Morecambe Bay, the CQC is still not capable of properly investigating hospitals.
“We are not set up, we were not set up then, we’re not fully set up now to investigate hospitals,” he said. “They are hugely complex, difficult organisations. Our job is to inspect hospitals and we were not doing it properly.”
He added: “We went [for] what is called a generalist form of inspection, so we would send people into hospitals who might have a background in social care or in the fire service or the police, who had not worked in hospitals before. I mean how could they go in to maternity services and give a proper inspection.”
Mr Prior, who took up his post with CQC earlier this year, told the programme: "This is a shocking state of affairs and I'm desperately sorry that this happened. It's hard when you look back on it to see how could this have happened?"
He insisted that the CQC is now being reformed and he was scathing about the organisation’s management at the time of the alleged cover-up
"There's an old saying the fish rots from the head,” he said. "The board and the senior executive were totally dysfunctional. That results in bad behaviour further down the line.
"The chairman, the chief executive, the deputy chairman have all gone and that is right, there was no pay-off or anything like that, they have gone."
Mr Prior said he was not aware of the details of the Morecambe Bay case until Friday last week, but he added: "I have known for the last three months that we were not fit for purpose when it came to hospital inspections and that we had to fundamentally change the way we were doing it."
The father of a newborn boy who died at the hospital said claims that the healthcare watchdog covered up a failure to investigate are "shocking".
James Titcombe's baby son Joshua died aged just nine days old in Furness General Hospital in 2008 after staff failed to spot and treat an infection, sparking a police investigation.
Mr Titcombe said that the report showed a "multitude of very serious failures" and was "quite hard to believe".
He said there were wider questions about the NHS, claiming evidence was given to the Francis Inquiry into the Mid Staffordshire scandal that there was "possibly ministerial pressure on the CQC not to cause trouble at that period of time".
"These aspects haven't been looked at in the detail that I believe they need to be looked at," he said.
The CQC has come under fire in recent years for failing to protect patients and prevent a series of scandals, as it relied on “tick-box” systems which let hospitals vouch for their own safety.
It has announced plans for a more rigorous inspection regime and Ofsted-style ratings. None the less, the regulator is expected to become embroiled in a deepening scandal.
The independent report suggests that senior managers were more concerned about protecting CQC’s reputation than about the lives of patients when they ordered the suppression of the review. It concludes: “We think that the information contained in the report was sufficiently important that the deliberate failure to provide it could properly be characterised as a 'cover-up’.”
The report, by management consultants Grant Thornton, was ordered by David Behan, who became chief executive of CQC last summer after his predecessor stood down.
It follows a campaign by Mr Titcombe and other families in Cumbria and Lancashire who lost mothers and babies at the hospital, where there were dysfunctional relationships between doctors and midwives and staff shortages.
Problems with the maternity unit emerged in 2008, but in 2010 the CQC gave the Morecambe Bay trust a clean bill of health.
When issues were brought to its attention in 2011, an internal review was ordered into how the emerging scandal had gone unnoticed. The resulting review was so damning that bosses decided it should never see the light of day.
The report describes a CQC official saying that he was ordered by a senior manager in March last year to destroy his review because it would expose the regulator to public criticism.
In the accounts of discussions between officials about what to do with the findings, one senior manager states: “Are you kidding me? This can never be in a public domain nor subject to FOI [a Freedom of Information request]. Read my lips.”
The official who had written the internal CQC report said to the Grant Thornton review team that he had been told his work must be deleted because it was damaging to CQC. He said he felt he was “being put in a very difficult position” and asked to do something that he felt was “clearly wrong”.
The report says the same senior manager “said that he felt very uncomfortable about the apparent weight that was being given in the meeting to the potential media impact and reputation damage his report findings might cause CQC. His view was that the focus instead should have been on patient safety and the protection of service users.”
The same official said he was then asked to write up a different review removing any references critical of the watchdog. “In effect, he had been asked to omit anything that could be considered damaging for CQC,” the new report says.
The original internal review had been ordered after questions were asked about why CQC had given the NHS trust a clean bill of health in April 2010 – registering it without any “conditions”, helping it to win elite “foundation” status later that year – despite serious concerns about the safety of its maternity services.
The decision was taken despite a number of serious incidents, including the deaths of babies and mothers, and a warning by the CQC’s regional director of “systematic failures” in the hospital maternity services which could lead to further tragedy.
It was not until September 2011 that the trust was finally warned that the failings were so serious that it would be closed down without major changes. By then the trust had the highest mortality rate in the country, with 600 “excess deaths” in the previous four years.
Since being appointed CQC chief executive last summer, Mr Behan has restructured his executive team, replacing all bar one of his six executives.
Tim Farron, the president of the Liberal Democrats, said the report suggested an "appalling failure" by the CQC.
"What the report today demonstrates is that it would appear that there was a deliberate suppression of facts that, had they come to light, could have saved lives," he said.
"That is bordering on criminal and we need to look at whether it was criminal."