‘Shock and awe’ may not be the best approach to inspection

Posted on July 20th, by geoff in CT blog. 2 comments

By Caring Times editor Geoff Hodgson

Stories about up to eight CQC personnel descending on a care home to carry out a routine inspection are becoming commonplace and I do wonder if this is the best methodology the regulator could adopt.

It smacks of a raid rather than an inspection and nothing could be more effective at putting the staff, from the manager to the handyman, off their stride. If an inspection aims to assess how a care home functions under pressure, then this modus operandi surely achieves that goal. But if an inspection is being carried out to evaluate the quality of care delivery and the competency of staff, to assess outcomes and to get an idea of how the community operates on a day-to-day basis, then I think this approach is ill-conceived.

Let’s assume we have eight inspectors spending six hours for an inspection. That makes 48 inspector-hours or three working days for two inspectors. After the first day (some of which might be spent largely in the office ticking the mandatory boxes) the residents and staff would be used to having the two of them around. The next two days could be spent in unobtrusive observation of the care home community, noting its strengths and weaknesses. There would be time for chats with residents, relatives and staff at appropriate times without disrupting service delivery. Crucially, the pair would have time to explore fully any practices which, on first blush, appear questionable but which, after consultation with residents/relatives/staff, might be shown to be entirely appropriate. There would be less ‘jumping to judgment’.

All these benefits, and with no deployment of extra resources. Of course I am assuming that the inspectors have been appropriately trained and know how to do their job – a fair assumption as the Care Quality Commission assures us that this is the case.

  • The CT Blog is written in a personal capacity – comments and opinions expressed are not necessarily endorsed or supported by Caring Times.

2 responses to “‘Shock and awe’ may not be the best approach to inspection”

  1. Tony Stein says:

    As someone who’s just enjoyed an 8 person inspection team visiting one of our services I had to smile reading this.
    I think that you make a good point about the end result and if we believe that the “Hawthorn effect” of changing behaviours under observation has any merit, then I can’t think of any worse way of inspecting than to adopt the ‘mob handed’ approach.

    In general I’m strong supporter of the CQC and prepared to accept that not only will there be variability among inspectors and inspection teams but that this will be worse at a time when new methodologies are being introduced. What is starting to grate however is the arrogance and carelessness of the fact that those inspections that are not proportionate or reasonable in their outcomes are unable to be appealed on anything but grounds of factual accuracy. This has to change.

    Whilst Andrea Sutcliffe may feel that the “mum test” is a proper basis for inspection I’m frankly getting fed up trying to second guess what exactly her mum wants. The CQC is trying to be everything to everyone. If they want to objectively test compliance against an understood set of rules and regulation that’s fine by me. If they want to make a subjective judgement as to the quality of a service according to what Mrs Sutcliffe senior might or might not find suitable, then they need to introduce an appeals process.

  2. John Burton says:

    This is extraordinary. I assume that these “mob handed” inspections are taking place at the larger care homes, but even so I question what eight inspectors think they will see that one experienced and knowledgeable inspector knowing what to look for wouldn’t see in a day.
    Tony Stein puts his finger on the problem: CQC don’t really know what their core task is. They are so terrified of getting it wrong and displeasing their capricious paymasters (government) that they have lost touch with underlying principles. Andrea Sutcliffe’s “mum’s test” is a good principle but it means that you’ve got to ask mum and mustn’t assume that your mum is the same as my dad – that what suits her will suit him. This means that you cannot maintain the mum’s test alongside the foolish notion that there can ever be fair and consistent “quality ratings” across thousands of different care homes with hundreds of different inspectors, and hundreds of thousands of different mums and dads, and different relatives, neighbours, volunteers, staff . . . No, the inspector’s job is to check that care homes are good enough for mum, dad, aunt, uncle, friend, partner, neighbour, and to keep in touch with what is going on all year round. That takes one inspector who takes personal responsibility and professional pride in the job, not raids by CQC SWAT teams.

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