I have read in the papers that following the scandals in Mid Staffordshire NHS Foundation Trust the government is planning tough new measures of inspection with fiercer inspectors: the same approach but more stick. This piece is suggesting that the philosophy of regulation needs a fundamental change and that the government is charging along ever faster in the wrong direction if it wants to achieve real quality.This Comment may have been triggered by criticisms of nursing, but it applies to social care, social work, education and other fields. The common factor is that effective work relies upon the quality of relationships between the individual members of the client groups and the individual professionals. It is the relationships which enable change.
This applies to the therapist working with a disturbed child, a foster carer settling a child removed from home, or a teacher getting over a new idea to a student. The nature of the relationships will vary from person to person – both child and professional – and upon the nature of the task, and there can be no precise rules to follow for success.
The professional needs the right equipment, resources, knowledge, skills and other attributes to achieve success, but a key factor often taken for granted is the right motivation. Furthermore, real success is only achieved when the child chooses to respond. The professional might do a brilliant job, but unless the child wants to learn or hear or participate, the performance will have been wasted. Developing the child’s motivation is therefore perhaps the main key to success.
Developing this motivation depends upon being aware of the child’s thoughts and feelings, understanding where they are, listening to them and respecting them as individuals. This is as true when they are being antisocial, obtuse and irritating as when they are being positive, attentive and charming company.
The next piece of logic is that if professionals are meant to be relating effectively with the children for whom they are providing services, they should work in a context which fosters these values. They should not have to defend themselves against bullying bosses if they are expected to be caring and warm to the children, for example. Jim Anglin wrote about the importance of congruence within children’s home staff teams, but the same is true of other groups such as army platoons and social work teams and hospital wards. Like the stick of Blackpool rock, the same values need to permeate the whole organisation. The values put over by the managers flavour the way that the organisation works. By corollary, if you are wanting caring services, concerned about children’s needs, that has to be reflected in management’s attitudes.
The smaller staff teams work within larger organisations, and the same goes for them. Without spelling out the detail of all the hierarchies affected, the buck rests with the Minister. The values a Minister holds will permeate the whole Department and in due course, the service. This means that if the Minister wants a quick impact for political reasons, the long-term commitment of the workforce risks being undermined. If there are frequent reorganisations, staff feel unappreciated, and they will be reduced to doing whatever good practice they can while having to look after their own interests as well.
To come to inspection, the type of system set up will affect the response of those being inspected. A degree of tension when under the pressure of inspection is not always a bad thing, but a continuous threat of downgrading and exposure saps morale. People spend their time building defences, rather than on the tasks of working with the children. A tick-box system will encourage workers to get the boxes filled, even if their clients suffer. Similarly if systems are too complex and time-consuming they eat into the workforce’s available time and detract from the care or education which the workers should be offering.
There is a finite amount of time that can be spent on inspection; the country has limits to its budget. The time therefore needs to be spent productively, to have maximum impact. This applies partly to the numbers of inspectors and the hours they have available, but it also applies to the thousands of frontline workers, administrators and managers who spend time preparing for inspections, enabling them and then responding to them. Because this time is concealed in various budgets it is hard to estimate how much of the services’ budgets are spent on the process.
One aim of inspection is obviously to root out unacceptable practice. The problem is that formal inspections rarely do uncover anything new. I am not denying an occasional serious find. The typical way that bad practice is identified is by listening to the complaints of disaffected staff, relatives and service users – if they are taken seriously. Furthermore, spending one’s career solely policing the bottom line must be soul-destroying for professionals.
A more useful aim of inspection is to encourage everyone to improve. If so, the process can be more collaborative and less confrontational. Most practice is above the line, and the experience of the inspectors who know the job can be of real help to managers and practitioners, helping to make good practice better.
What I am advocating, therefore, is a more supportive, warm, concerned approach to inspection. We need to make sure that inspectors are expert in the fields which they are inspecting. And it is time to return responsibility to the local authorities. This could, incidentally, cut out some of the duplicate work required by commissioners of services and inspectors, but the main point is that local people know their areas, the people served by the services. They want good local services themselves and often the inspectors need to be based locally if possible complainants are to trust them.
The reason why many services have come under massive centralised inspecting bodies has been to assert common standards. That can still be done from a local base, and having a centralised organisation does not prevent individual inspectors having different views in interpreting the rules.
I am not naïve enough to think that a sloppy warm approach will solve all problems. What I am arguing for is a shift in the fundamental values and attitudes to an approach which values people, rather than spends its time fault-finding.
We will still need to do a lot of the standard checking and so on. And there will still be times when things go wrong. A parent bringing up a child with love and affection may still need to lay the law down and say no. Similarly there will be times when a supportive localised inspectorate needs to be firm.
I suspect that a well trained sheep-dog probably gets real job satisfaction at getting the sheep in the right place, without hurting them. Because some sheep have wandered it does not mean that the government should hire Rottweilers.