A more open, transparent organisational culture is needed for non-executive directors to be able to hold their boards to account
When I approached the Mid Staffordshire public inquiry as a whistleblower about my serious concerns regarding the leadership, management and culture of the Care Quality Commission (CQC) I knew it was an extreme step to take, not least because I am a board member of the CQC.
Non-executive directors (NEDs) have a fundamental role in ensuring the interests of the public are at the forefront of an organisation's mind. We bring independent judgment and scrutiny on issues of strategy, performance, key appointments (such as the CEO) and accountability. The barriers and challenges I faced – and continue to face – in attempting to fulfil my role as a public appointee have been substantial. The more I tried, the greater the resistance.
The failures and omissions of the CQC have been widely reported. From where I was sitting on the board, I was unable to hold the executive team to account for the organisation's performance. Nor was I able to assume accountability as a non-executive director in setting strategic direction and ensuring appropriate governance. There were frequent deviations from the agreed strategy and business plan as well as a lack of accurate information about the organisation's performance and financial situation. The board is predominantly passive, often being asked to simply "endorse" key strategic decisions. And debate and challenge are seen as disloyal or unreasonable.
There have been repeated failures of delivery, governance and effective leadership. And the public information available through board meetings and on the CQC website was inadequate. This does not sit easily with the government's stance that public scrutiny and accountability of organisations will be served through the publication of accessible information. One of my main concerns about the CQC was the lack of coherent strategy. The response to this was that we had "reduced our strategic priorities", but this was never articulated clearly or consulted on. Recently, it has been decided that the organisation will be undertaking a "full strategic review". However, many decisions have already been made without a coherent sense of direction or feasibility.
The CQC has a duty to involve people who use health and social care services, but we are not discharging this responsibility effectively. What I have seen is an increasing emphasis on "influential" stakeholders and a risk-averse approach to patient and public involvement.
Eventually, I reached a point where I felt obliged to raise my concerns elsewhere. This was not straightforward. Approaching the Department of Health or even the health secretary did not seem viable as the lines of accountability and responsibility are so inter-dependent. Any NED from an arm's length body who has serious concerns about an organisation would face the same dilemma, as there is no mechanism for raising them in an objective way.
I approached the public inquiry after much soul-searching, weighing up the ramifications of "rocking the boat" with the potential longer-term gains of a more robust and sustainable regulator.
I have had to risk my reputation, income and health. My endeavours to provide robust scrutiny and challenge led to my professionalism being questioned. Doubt was cast on my mental health and my performance, whereas previously I had received overwhelmingly positive feedback. Many whistleblowers say they have been vilified and this inhibits others coming forward.
Now, another review of the CQC is taking place, this time ordered by the health secretary, Andrew Lansley, looking at how the regulator responded to the concerns I raised. However, I remain to be convinced that the issues will be fully investigated.
For NEDs of public bodies to serve the public in the best way possible, independence and an open culture are essential. There also needs to be transparent, objective and safe mechanisms for NEDs to raise serious concerns about the organisations they serve. Otherwise the "public interest" ethos will wither and die.
Kay Sheldon is a board member of the CQC. She is writing in a personal capacity.
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