The CQC has come in for more criticism recently a chief executive thinks they were unduly harsh in placing his trust in special measures having judged two areas of service failing yet recognised excellent work in many other areas of the trust. A journalist writes an article on nursing homes inspected and deemed to be performing well only for staff to be prosecuted for abuse! Doctors claim inspections are unhelpful and a time consuming distraction from the real business. Nurses and social workers hate them because of the additional work and stress involved and the snaps judgments made based on so little direct observation. So is there a better way?

Is there a better way?

I think inspection serve a useful service. It is easy to coast and to think you have a better service than you do. It is tempting to shrug your shoulders and say this is the best we can do with the limited resources we have.

Two things, inspections need to be led by people with experience at a senior level so they understand how health and social care is delivered within a  political context and so inspectors don't have the wool pulled over their eyes by senior managers who know how to play the game. A lot of experience inspectors left following the restructuring and merger of health and social care inspection services to be replaced by relatively inexperienced staff. And secondly they need time to do a thorough job, at one time it was 2 weeks on site now it can be 2 or 3 days.
Some times it just bad luck that your inspection visit comes when it does. The fact that other trusts and other local authorities with in the region are also struggling with increased demand and budget cuts, that as a result their performance has dipped even more alarmingly than yours and the fact that their care standards have also drawn criticism from patent groups and local MPs is irrelevant its your services that are under the microscope not theirs.
You get to see the final report for factual accuracy and some of the errors are so basic they undermine your confidence in the report's findings. Then the report is published and its tone, if not its content,has completely changed. What happens between the final draft report and its publication? Politics. No one will ever admit that senior civil servants on behalf of their minister influence reports but they don't have to senior managers in CQC didn't get to be senior managers without know what is expected. 

Often it's not the report but how it's reported on by the media that causes you problems. The inspection report describes some excellent and innovative work by competent and caring staff but the media focuses on a couple of minor criticisms and a concern about low take up by ethnic minorities or growing use of agency staff. And then the local MP takes the opportunity to  stick the boot in because he is from a different party to the one controlling the council!

We still operate in an unhelpful blame culture which seeks to find the individuals responsible rather than acknowledging the faults in the system.

Blair McPherson www.blairmcpherson.co.uk 


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