This is the account of an inspector who worked in different organisations for many years and experienced what she describes as a dramatic and deeply insidious cultural change. The writer, who is now retired, wishes to remain anonymous.
When I started work as an inspector with social services I felt lucky. I had a relevant professional background and a wealth of experience. I had worked in senior positions in homes for people with learning difficulties and had been privileged to have worked for two years in one that was acknowledged to be way ahead of its time. I was confident about what I should be looking for and I felt the role gave me the opportunity to offer providers a balance between professional advice and support and, where necessary, a more formal approach.
I was largely welcomed when I visited homes. Most people were caring and wanted to put good ideals into practice. Others were excited to learn modern approaches which encouraged service users to lead their own lives. Mistakes could be serious so people welcomed advice.
Flicking jelly babies
Concepts of ‘risk management’, ‘informed choice’ and ‘normalisation’ were not always properly understood leading, for example, to Julie being left to fend for herself in a dirty chaotic room as a ‘consequence’ of failing to follow her cleaning rota; or Tom who had joined a cult because they were apparently showing a personal interest in him (and his benefits) whilst those who were supposed to be supporting him were ‘leaving it to him’. Or quiet Paul, who always complied with organised activities he had no interest in and whose challenging behaviours had progressed from flicking jelly babies at other service users on the minibus to greater disruption!
People were keen to hear progressive ideas and hungry for help. Cynics might say they had no choice but to listen since I was the inspector but in those days inspectors each had a caseload of homes to be visited a minimum of six times a year and people came to know and value you. I was supported by a thoughtful ‘boss’ who had a social work background and years of experience. She enabled us to fulfill a role which was more advisory than enforcement (although I should stress that we would always address bad practice through the formal process when there was no hope of changing things any other way).
For a few years I was an inspector in an authority specialising in provision for people with learning difficulties so I saw a wide range of approaches to care which enabled me to keep in touch and my professional knowledge up to date. This specialisation was lost when inspection became ‘generic’. I still feel strongly that knowledge and experience of a client group, and the experience of practice, is essential when inspecting for quality of care, and for spotting potential abuses. When change came, I remember how many of the experienced inspectors fought to keep the specialist approach, but sadly this did not happen. Organisational change was imminent. My ‘boss’ was given early retirement.
Then came the computers, reams of paperwork and new buzz words. Laws and Standards were rewritten with the formal measurement of care seen as of paramount importance. I often felt I was being asked to measure the homes’ management and delivery of care in a quasi-scientific way and that this handicapped me from using my professional judgement to evaluate the service users’ quality of life, rights, freedoms and choices and protection from abuse.
Inspect and enforce
Priority seemed now to be given to the publication of reports and all that this entailed. Scores and ratings were the order of the day. Inspectors were told that their duty was to inspect and enforce and that homes should buy in their own advice from trainers and consultancies since giving extra guidance was not the inspector’s role. Access to information by the public, albeit to highly edited information, had become our raison d’être.
Thus the process of inspection itself fundamentally changed. Where once I felt I had been employed for my knowledge, experience and judgement I now felt I was someone who ticked boxes for evidence. How each service user was actually faring in the home was looked at less as inspectors became overwhelmed with timeconsuming standardised procedures and inspecting systems.
In this new world processes were too restrictive. For example, the process for inspection included in depth ‘case tracking’ of a few individuals. We had to cross reference their records against interviews with the service user and staff and an inspection of their room. This focus on the whole experience of a few individuals rather than on an overview of issues for many I believe led to tunnel vision about the running of the home, particularly in large homes where random chance played a role in choosing which residents were ‘case tracked’. Not all residents or rooms were even seen.
A consequence of this was that in some poorly-run homes difficult residents were taken out on the day of the announced inspection so that inspectors would find it difficult to ‘case track’ them. Once, while ‘case tracking’ I observed another resident, who was not being ‘case tracked’, being infantilised by a staff member. I acted on it in this instance but it became a challenge to find time to deal with other issues. I worked many extra hours for no pay.
I look back now and wonder if things could have been different.
Huge backward step
The overall effect of the changes seemed like a huge backward step. Although there was no question that some changes had been needed, including for example better ‘business management’, I believe most social services were not able to employ sufficient inspectors. One of the effects of change in the new organisational structure, with its separation from social services, was that the local ‘inspectorate’ increased its number of personnel by about 400 per cent while cutting by about two thirds, and later more, the number of visits made to homes.
Office space, IT equipment, glossy brochures, publicity and public relations blossomed. I often wondered what would have happened if only these sorts of resources had been given to social services to manage effectively?
As homes deteriorated, inspectors were busy enforcing regulations or closures. Due to a lack of legal expertise such action was hugely time consuming. Many inspectors became demoralised.
Procedures which had been virtually non-existent, often passed on by word of mouth in social services, had now become rampant. Many inspectors raised their heads above the parapet to voice the anxiety that our input was no longer enough to protect the service users, or to properly advocate for their rights. Many good inspectors left. Many more felt crushed. Worst of all, there was often no one left to speak for Julie or Tom or Paul.
I ‘TUPE’-ed through the years to the National Care Standards Commission (NCSC) and the Commission for Social Care Inspection (CSCI). I left as the organisation changed yet again to the Care Quality Commission (CQC).
But none of the changes, in my view, were as dramatic as that first transition into the ‘new world’. Each subsequent change seemed to be more of the same, with slight adjustments, greater workloads and different headed notepaper!
By the time I left, far less of my time was spent in homes. My role had become a policing one, I was not always welcome and didn’t get the same openness and cooperation from people. Sometimes staff and even residents had been primed NOT to talk to me. The effects of the cultural change were both dramatically obvious and deeply insidious. Providers often resented paying for a process that no longer offered them the same benefits.
Enlightening
On one memorable occasion I was warned that it was ‘too dangerous’ for me to enter a unit. I already had misgivings about the home and after discussion with staff I chose to enter at my own risk. The resident, who was acting out, calmed down and agreed to explain as best he could how he felt and why. It was enlightening. Would I have done this without any background experience?
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- Caring professionals (on ‘both sides of the fence’) finding
- out how impossible it was to withstand the rip-tide of huge change.
- How stress and anxiety and a blame culture numbs people’s feelings and alters their focus.
- How numbness closes down sensitivity and forestalls empathy.
- The most vulnerable people in society take the brunt of these changes.
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- Remember that most people respond better to the sun than the wind!
- Focus, on people and their rights to lead their own unthreatened lives.
- Recognise what those threats are.
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