Clown jewels
Care Quality Commission , Issue 1630 AS THE Care Quality Commission (CQC) scrambles to address multiple serious failings exposed in last month's blistering interim report from the Dash Inquiry, someone who won't be around to answer questions is the chief architect of this national scandal, former chief executive Ian Trenholm.

When appointed in 2018, Trenholm was heralded for having delivered "technological innovation at scale to improve people's lives". But his recent departure is the third time in 10 years he has left an institution after overseeing monumental IT flops, costing taxpayers millions and leaving mayhem in his wake.

Parting gesture
Giving only a few days' notice, he signed off cheerily in June from the CQC, which regulates healthcare and adult social care in England, celebrating a £199,000-per-year job well done.

"This month saw the delivery of the last big milestone in a complex and challenging programme of work," he reflected. For complex and challenging, read huge, unmitigated balls-up. "The conclusion of this stage of the transformation feels like a good time to move on," he continued.

Just six weeks earlier Trenholm had "welcomed" the wide-ranging Department of Health review into CQC's effectiveness overseen by public health doctor Penny Dash. Her brief included looking into the disaster zone of his new system.

"We recognise how important scrutiny of regulation is," he assured stakeholders, shortly before legging it.

Digital disaster
If only he'd moved on before launching his new IT-led framework, aimed at reducing costly life-saving in-person inspections. This put the onus on healthcare providers to self-assess via a new digital portal that didn't work. It left them unable to report such trifling matters as, er, the death of a detained mental health patient, allegations of abuse or events that stop a service running properly or efficiently.

Messages via the old system (the one that did work), were only accepted in exceptional circumstances. New provider registrations have been held up, sometimes for months, putting more pressure on social care capacity (and thus hospital beds) and threatening to put new providers out of business before they can even start.

Managers struggling with the new IT system were reportedly told they were the only ones having issues. Sound familiar?

History lesson
Trenholm also tried to cut workloads by not doing the job properly. His new system looks afresh at only a fraction of the inspection categories, often remotely, and relies on historical reports for the rest, blending the scores to create an average that has no bearing on the service being offered today.

On Trenholm's six-year watch, real-life inspections fell by two-thirds. During Covid, routine inspections were stopped, putting lives at risk and compounding the backlog, while new registrations slowed. The Dash report found one in five healthcare settings had never been rated. Meanwhile, staff surveys consistently revealed alarming levels of bullying, fear and lack of faith in the leadership.

Guessing game
Trenholm also thought it would be a good idea to remove expertise from the inspection process. Instead of being assigned specific sectors such as adult social care or hospitals, etc, he introduced a free-for-all.

"We used to have dedicated and experienced staff who knew their area inside-out," one insider told the Eye. "Suddenly, people were being sent into new settings with no experience, no expertise, no idea what they were doing. It put people in extremely difficult situations, potentially making life or death decisions based on guesswork. There was an exodus of the old guard and all their knowledge."

Providers, meanwhile, said care workers and managers were often left in tears by inspectors who didn't have a clue what they were doing.

Ex-copper with previous
With Trenholm gone, interim chief executive Kate Terroni has been left to apologise and grovel. But the CQC can't say Trenholm's less than illustrious IT track record was a surprise. An ex-copper, he was earning a £175,000 salary as chief executive of NHS Blood and Transplant (NHSBT) when he introduced another doomed IT system that was eventually written off at a cost to the NHS of £26m.

He had already transplanted himself to the CQC when a PwC inquiry into the NHSBT failures blamed a "lack of consistent programme leadership", a "limited experience of large technology transformation programmes" and Trenholm's refusal to listen. At NHSBT he also ended walk-in donations, creating national shortages that led to cancelled operations.

Prior to that, Trenholm had jumped ship from Defra, where he had helped oversee another IT shitshow. The botched £215m common agricultural policy system created so many issues around miscalculated farm subsidies that it led to £180m in EU fines. His colleagues were left to face the wrath of MPs, who branded leadership of the project "dysfunctional" and "immature".

His CQC legacy seems hardly more impressive.