Care Quality Commission report details full extent of bullying culture Report was commissioned by new CQC chief executive, David Behan, to determine scale of the problems
The full extent of the bullying culture within the Care Quality Commission has been revealed in an internal report, which talks of fear and harassment, often in a drive to reach targets.
Allegations of a bullying culture at the CQC were first made during the inquiry into poor care at Mid-Staffordshire NHS hospital trust. Low staff morale and fear of criticism were thought to have contributed to the CQC's series of disasters, including overlooking problems at the Winterbourne View care home and the row over an report into inspections at Morecambe Bay where several babies died, which was said to have been suppressed.
Friday's report was commissioned by David Behan, the new CQC chief executive, to give staff a chance to air their grievances and determine the scale and seriousness of the problems. It showed "there are worrying levels of perceived bullying at all levels in the culture of the CQC". The inquiry, by the independent consultancy People Opportunities, did not interview a cross-section of staff but asked those who wanted to discuss bullying to come forward, so those who spoke to the team were self-selecting.
But more than a tenth took up the invitation – 236 out of 2,148 permanent staff (whole-time equivalents), of which 955 are frontline inspectors – and 90% of those felt they had been subjected to bullying or harassment. "Though many of the contributors asked for complete anonymity and were not prepared to indicate their region or function, it is clear that this problem exists across the whole organisation," said the report, which was to be published on the CQC website.
Kay Sheldon, the whistleblowing CQC board member who tried to raise the issue of bullying internally from 2011 and was subjected to serious harassment after she gave evidence of it to the Mid Staffordshire public inquiry, said that the mammoth task of trying to merge three organisations to create the CQC caused many of the problems. "There was huge pressure. I think the organisation never really got over that," she said. "But for whatever reason, the organisation and the Department of Health were not really willing to face up to the fact that the CQC was struggling quite badly." The board took the wrong approach, she said. "When I was raising these issues about our performance, capability and capacity and whether we were fulfilling our statutory duties, the culture was that we had to be overly supportive. Any criticism was frowned upon and seen as disloyal.
"It was a failure of leadership. The executive team and board did not have the capability to turn it around. We had a board that was overly sympathetic and advising rather than governing and an executive team that was struggling. Their response was to try to get to grip with the situation. That led to a culture that many staff felt was oppressive and there were many reports of bullying, related to when staff raised concerns about workload and their ability to do the job. They were effectively told if you can't take the heat, get out of the kitchen."
Sheldon, who was excluded from many CQC activities and isolated, complained to an employment tribunal and was recently awarded £60,000 compensation.
She has also had an assurance that her appointment to the board will be renewed in the autumn. She says she now thinks things are changing. "There is certainly more of a sense of optimism," she said. The staff are glad that past problems have been acknowledged and there is a new transparency but there are also anxieties about change — David Behan, chief executive, said the old model is not fit for purpose and new specialist inspectors will be appointed.
The authors of the report said the bullying culture was "systemic and largely the result of the number of reorganisations that the CQC has gone through whilst being expected to deliver an increasing workload". Line managers and staff felt they had been bullied. Many staff were initially afraid to talk to the team. "Individuals frequently asked to be reassured that they would not be identified and many described their 'fear' of repercussions," said the report.
"We were struck by how determined people were to tell their stories despite many becoming very distressed during the interview. Many commented on the relief they felt at having someone to talk to about their experience."
Almost everyone accepted the need for targets, but said these were badly communicated and managed. People said they were ridiculed in team meetings because they were not working at the same pace as others. Some told of long hours and becoming ill because of the lack of support over balancing inspections and enforcement action.
Most of the stories involved a breakdown in relations between a staff member and line manager. "My report was sitting there [in the team meeting] covered in red pen – I was terrified," said one employee.
"My reports get changed and changed – I've tracked the changes and she is changing her changes. When I mentioned it she says I'm 'useless' at writing reports. She keeps my reports so long I miss all the deadlines," said another.
Some told of having been humiliated in front of the team. "In the team meeting she shouted at the top of her voice 'You never, ever leave anything'," said one. "My manager shouted at me, right in my face, in front of the team. After the meeting she apologised. I was off sick for six weeks."
"In front of the team he suggested I went to the gym or bought a bike so I could lose weight. I was deeply shocked and humiliated," said another. People told of being sworn at and of receiving no replies when they emailed line managers asking for help.
There was clear pressure to get through the work faster. "I wanted to shadow a visit but she told me to get on with it. Then she picked my report to pieces in front of the team. I'm stressed and distressed – I've never had my competence questioned before. I feel deliberately undermined," said one interviewee.
"I'd only just come thorough induction and she kept asking me how many inspections I would do in a week. I was crying at work and at home – my team members were appalled at my treatment," said another. Another said: "No one ever praises us. The regional manager shouted at us all and told us we were rubbish; I'll never forget that."
People were fearful of making mistakes and there was a culture of blame, said the report. Hospitals and care homes that did not like their inspection findings sometimes challenged the inspector using freedom of information requests to the CQC. "They are just laughing at the CQC, but it's the inspectors who carry the flack," said one.
People who had held very senior positions in health and social care before joining the CQC talked of being "broken" by their manager's behaviour. "Those we spoke to frequently described long periods of stress-related sickness, feeling hurt, threatened, shaking, being diagnosed with post-traumatic stress and other related symptoms," said the report. Managers, on the other hand, said it was hard to deal with poor performers.
Staff told of impossible workloads and having to cut corners. "I work more hours because I am absolutely terrified of falling behind and being seen as failing. People cry in the workplace all the time – it's abysmal," said one. "I know it's been a good week because I haven't cried this week," said another.
The report said there were strengths to build on, particularly the "passionate commitment" of all staff to the CQC and confidence in Behan, who replaced the much-criticised Cynthia Bower, among those who had worked for him before.
"The behaviour of the leadership is absolutely critical to increasing staff confidence that bullying will not be tolerated," said the report. "It is clear that if there are to be real improvements in the culture that they need to be visible, authentic leaders who role-model the values, beliefs and behaviours that support a healthy organisation.
"David Behan, and his executive team will be under intense scrutiny from all levels of the organisation with a particular focus on how well their behaviour matches their rhetoric."
Behan said he had commissioned the report after a staff survey last year showed some members of staff had experienced bullying, which was "shocking and unacceptable". He thanked the staff who had spoken to the interviewers for their "honesty and courage".
"We are committed to building a future organisation to be proud of in every way," he said in a statement. "We know that we are at the start of this journey and that we need to take the time to build and maintain good relationships, which are based on trust.
"Our focus is on accountability and improvement through what we do and how we do it. We will take lessons from this report into our thinking when making decisions about change and the pace of change needed."
Guardian
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