All change for inspections?

The seven-year itch is not just a phenomenon of marriage. Joint
reviews have had their ups and downs since the first was published
in 1997 and it seems the government is now ready for a younger
model to spice up social care inspection. Welcome to the Commission
for Social Care Inspection, writes Natalie
Valios.

The commission’s duties are set out in the Health and
Social Care (Community Health and Standards) Act 2003, which
applies to England and Wales. From April, the regulatory body will
take on the work of the Social Services Inspectorate, including its
joint reviews team operated with the Audit Commission, and the
social care responsibilities of the National Care Standards
Commission (NCSC).

Although the work of the SSI has rarely been called into
question, the same cannot be said of joint reviews and the NCSC.
The issue is whether the commission will learn from the past. In a
promising move, it is researching what joint reviews have achieved.
The results are expected in March.

But critics are not so sure the commission will improve
anything. John Burton, a former local authority inspector and now
independent social care consultant, says inspection is just a small
but important part of providing good social care. But it
“sits smugly at the top of the heap, pronouncing on things it
knows little about and has forgotten how to do”.

Burton’s main concern is that the commission will join up
the worst bits of inspection. “The trouble was that joint
reviews were based on a fairly superficial idea of quality control
and they failed to look at what organisations were
doing.”

Verdict blown apart

It is hard to forget the biggest blunder made by a joint review
team. In November 1999, Haringey social services’ review
stated that child care practice was “safe,” and
“the systems appear sound”. Just three months later,
the death of Victoria Climbié blew apart that verdict.

In an online Community Care poll in July 2002, 94 per cent of
respondents believed that joint reviews should be overhauled
following criticism of the Haringey review at the Victoria
Climbié inquiry.

Burton says: “The joint review team was looking at the
wrong things. They were looking at systems instead of practice,
which was symptomatic of what was wrong with how the SSI and joint
reviews worked. You should look at outcomes and what actually
happens to people and trace it back to the system. But the style
was to look at systems and procedures and paperwork, and see
whether everything was in place and think ‘this looks
good’.”

But it seems there was a misconception about what joint reviews
were meant to examine.

Former director of joint reviews John Bolton says their
fundamental role was to look at resources and managing performance
while promoting best practice where possible. “There were
times, and I will put my hands up to this, when they were trying to
be all things to all people. At times we were probably too
ambitious.”

Bolton feels that joint reviews had a huge impact in looking at
the role of social services within local authorities. They also
predated performance assessments and contributed to how data about
social services performance were used.

He worries whether the emphasis on resources in joint reviews
will be adopted by the commission. “My one wish is that they
will retain the links between the use of resources and the delivery
of social care and continue to explore the interconnection between
services and inspect individual service areas.”

Not everyone agrees

But not everyone agrees. Some concur with the opinion expressed
in Community Care in 2002 that an obsession with cost was stifling
social care provision. The author blamed joint reviews, stating:
“Reviews have focused on cost rather than quality as the
defining issue. Progress has been judged largely by the extent of
commissioning in the private and independent sector and dedication
to the relentless pursuit of cheaper service
delivery.”¹

Despite the criticisms, Bolton believes that joint reviews have
been a success. “Some were not as good as others. But far
more people will talk to me about their value – perhaps they
are being polite. New directors have said that the joint review, if
it was fairly recent, was a useful report and reflected what they
found when they arrived in the department.”

One of the first things Bolton did on becoming Coventry’s
director of social services and housing just over a year ago was to
look at its joint review. Published in 1998, it found the social
services department was not serving people well and questioned its
ability to improve.

“There were still things that hadn’t been addressed
and I thought they were important to do, so I have benefited from a
joint review myself,” says Bolton.

He has a high opinion of the SSI, which, he says, worked to
clear standards. Joint reviews complemented that by completing a
holistic picture including consideration of resources and
value-for-money issues. He says the performance assessment
framework does not do this enough and hopes that the holistic
approach of joint reviews will be maintained by the commission. He
is pleased that some staff from the joint reviews team will join
the commission.

Some credibility

Heading these staff will be Paul Snell, who joins in April as
national business director of inspection, regulation and review.
Currently social services director of Nottingham, he is used to
being on the receiving end of inspections. Snell hopes his
experience “will add some credibility to the management of
the commission”.

His directorate will manage all inspectors in nine regional
offices, accounting for more than 2,000 staff. “No single
organisation has been able to bring all this intelligence about the
quality and quantity and commissioning of social care to one place
before. It is an opportunity for us to improve the way the market
works.

“We will not be saying that value for money isn’t
important, but we will also want to look at users’
experiences, the quality of services and their adequacy.”

Bolton will no doubt be pleased to hear that Snell’s
intentions are for business as usual, at least for the first year.
“That’s deliberate because we want some stability. But
through the year we will look at whether there are ways in which
some of those mechanisms can be improved.”

The problem lies with inspectors saddled with conventional
thinking and old ideas, says Burton. “If they can change,
fair enough. But if they can’t, or won’t, they should
go and we should bring in enthusiasts with ideas and
commitment.”

Time will tell whether this new model keeps the
government’s heart racing or whether it is dumped as quickly
as the NCSC.

1 Donal Mullally, Viewpoint, Community Care,
28 March 2002

The SSI and joint reviews

The Social Services Inspectorate examines the quality of
services that users and carers receive and assesses how well social
services departments deliver services.

It decides what to inspect in each social services department
and when to do so, based on the department’s inspection
history, performance and star rating, and in consultation with the
councils themselves. All SSI inspections use lay people as
assessors.

Joint reviews consider how well a council meets individual
needs, shapes services, manages performance and manages resources,
including finances. A joint review team judges how well a council
serves local people, whether it provides value for money and how
well placed it is to improve services.

The final reviews will be published in March. They are Swansea,
Wrexham, Wigan, Leeds, Luton and South Tyneside.