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The Care Quality Commission re: Project Ambrose

1.1 On 1 April 2009, the Care Quality Commission (CQC) became the independent regulator for all registered health and social care services in England. CQC replaced three earlier commissions: the Healthcare Commission (HCC), the Commission for Social Care Inspection (CSCI) and the Mental Health Act Commission (MHAC). CQC carries out its functions by a process of registration, inspection, monitoring and, if necessary, enforcement, using civil and criminal powers afforded under the Health and Social Care Act 2008 (HSCA).

1.2 Following the establishment of CQC it was set the challenge of developing systems to register over 22,000 health and adult social care providers, spanning some 40,000 services, under the new HSCA. Of these 22,000 providers, CQC had to register 378 NHS trusts by April 2010.

1.3 During the period relevant to our review, CQC, as an independent regulator, co-existed alongside other entities with responsibility for, or an interest in, patient healthcare, including NHS Strategic Health Authorities (SHAs), which were structured across ten regions, containing various NHS health trusts; these included NHS Primary Care Trusts (PCTs), which took responsibility for managing or commissioning local NHS services. Monitor is the regulator of NHS Foundation Trusts. These, along with other entities with an interest in patient healthcare, feature in this report.

1.4 Until April 2012, CQC was structured around seven regions: East, East and West Midlands, London, North East and Yorkshire and Humber, North West, South East, and South West. CQC's North West regional team was responsible for registering and regulating healthcare providers including University Hospitals Morecambe Bay (UHMB), which achieved Foundation Trust Authorisation in October 2010. UHMB provides a comprehensive range of acute and support hospital services for around 350,000 people across North Lancashire and South Cumbria. It largely operates from three main hospital sites: Furness General Hospital (FGH), Royal Lancaster Infirmary (RLI) and Westmorland General Hospital (WGH).

1.5 This report concerns our investigation into CQC's regulatory oversight of UHMB through its inspection and monitoring regime, both pre- and post- HSCA registration (in April 2010), in response to a complaint filed by a member of the public (the Complainant). Our report also addresses what we shall refer to as the "11 questions" and an allegation of a "cover-up", submitted by a Whistleblower at CQC. The series of events significant to this investigation span a time period of some four years beginning in autumn 2008.

1.6 The nature of the allegations made are very serious, with certain events (which include the deaths of a number of UHMB patients) currently being investigated by the Police. Our investigation has therefore been, of necessity, highly detailed. It has also focused on the allegations raised; however, as a consequence of conducting our investigation, we make limited reference to broader aspects of regulation in the public healthcare arena, which we consider relevant to how CQC fulfils its role.