The head of Britain's health and social care watchdog resigned yesterday from her £200,000-a-year post, casting the future regulation of the NHS into doubt.
Cynthia Bower, chief executive of the Care Quality Commission, announced it was "time to move on" as the Department of Health announced a review of the rules governing the organisation she heads, which has been beset by low morale, lack of funds and board level disputes.
A spokesperson for the department said the review would examine how the CQC operates and ensure that regulation minimises risks.
Criticism of Ms Bower's stewardship has been bubbling for months and there was speculation yesterday that she had chosen to go while she could "hold her head up high". The health department is preparing to publish results of inquiries into failures of regulation at the Winterbourne View care home and allegations by a member of the CQC board of a "dysfunctional" regime at the organisation in the next few weeks.
The report of the Mid Staffordshire NHS Foundation Trust inquiry, the worst NHS scandal of the last decade where hundreds of patients are alleged to have died due to poor care, is also expected to make uncomfortable reading for Ms Bower when it is published in the summer. She was chief executive of the strategic health authority overseeing the trust when the scandal occurred.
Her departure creates a headache for the embattled Health Secretary, Andrew Lansley, and new uncertainty for the CQC at a time when regulatory oversight of the NHS will become increasingly critical as it struggles to find £20bn in savings without compromising the quality or safety of care.
Colleagues said Ms Bower had an "impossible" job running the organisation with a £170m budget, almost a third less than that of the three organisations it replaced. Ruth Carnall, head of NHS London, said: "Cynthia has handled unbelievable pressure... very few of us could do so with such resilience."
Her departure is the culmination of a series of events that had undermined confidence in the commission. The scandal at Winterbourne View, a privately run home for people with learning disabilities in Bristol, was revealed by the BBC Panorama programme, not the regulator, and it showed the CQC had ignored warnings from a whistleblower.
Last autumn, the organisation found it was itself the target of whistleblowers – one of them a board member of the CQC, Kay Sheldon – who made a series of allegations to the Mid Staffordshire inquiry, about a "bullying culture" which was target-driven, suffered from low morale and lacked strategic vision.
Reports from the National Audit Office and the Commons Health Select Committee highlighting the low number of inspections carried out and the failure of the CQC to recruit sufficient staff added to the pressure.
Yesterday, a performance review of the CQC praised its "considerable achievements" since it was established in 2009 but highlighted a failure to demonstrate its "effectiveness in reducing risks".
Cynthia Bower: A life in health care
1976-95 Social services posts with Birmingham City Council.
1995-2006 Birmingham Health Authority and primary care trust.
2006-8 Chief executive West Midlands Strategic health Authority.
2008 Appointed chief executive of the Care Quality Commission.
March 2009 Health Care Commission publishes report into Mid Staffordshire Trust.
April 2009 CQC replaces Healthcare Commission.
May 2011 "Panorama" exposes Winterbourne View home scandal.
Dec 2011 National Audit Office criticises CQC.
Feb 2012 Cynthia Bower resigns.