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.
