Voice of experience

Over the past few decades, the idea that services can improve
through the involvement of the people who use them has become a
part of the social care environment.

This has been extended to putting service users at the heart of
inspection teams – the Social Services Inspectorate has used lay
assessors for several years. But how far has the principle come?
Have service users been given a meaningful role in inspections?
What do they bring to the inspection process, and could the
impending changes to the way services are inspected leave users out
in the cold?

The evidence for the involvement of service users and lay
inspectors is unequivocal. Last month a report from children’s
charity Barnardo’s¹
looked at the experiences of care leavers who took part in SSI
inspections of services in 19 English local authorities. It found
that children in care opened up more in interviews to the care
leavers than to the inspectors.

Tessa Harding, head of policy at the charity Help the Aged, says
older people, too, “talk much more freely with other older people,
who they expect to understand them, than they do to professionals”.
Inspections using lay assessors can paint a truer picture of the
real strengths and faults of a service, she says. Some older people
are wary of criticising their service because of the unknown
repercussions, and lay assessors can find ways to ask the right
questions. They may also be viewed as less frightening than a
professional inspector, and can establish a more direct personal
relationship.

Harding says problems can arise when lay assessors are not treated
as equal participants in the inspection process – they are not
appropriately trained, are not respected as equals or recompensed
for their expenses and time. She wants inspection teams to ask
local senior citizens’ forums for an overview of good or bad
practice in their area. “It’s not a substitute for the direct
involvement of older people, but it could be a useful first step,”
she says.

Norma Raynes, director of the Institute for Health and Social Care
Research at the University of Salford, says lay assessment is a
meaningless activity if the assessors are not involved in setting
the standards. “We just co-opt users into our own defined
processes. The process discourages lay assessors, it’s tokenism and
we are very good at that,” Raynes says.

There are two aspects to inspecting a service, says Brian McGinnis,
special adviser at learning difficulties charity Mencap. First
there are matters that do not need general input. An inspector can
examine paperwork and staff procedures, for example, by consulting
records. Second, and just as important, is the “feeling” of a
place. “If you have to live the rest of your life in a home, how it
feels is just as important as how it looks,” McGinnis says.

This is where the lay assessor can come into their own. By being
able to relate to the user’s disability, illness or age, they can
gauge service quality. “We do have places where the paperwork is
great, but the relationships between staff and users aren’t that
good,” McGinnis says.

Protecting and ensuring quality for users is a key element behind
the National Care Standards Commission, which came into force in
April. The body, set up under the Care Standards Act 2000, took on
responsibility for inspecting public, private and independent care
settings in England for people with a range of needs, including
mental health problems, learning difficulties, disabilities and
drug and alcohol problems.

But putting mechanisms in place to involve such a variety of users
is a challenge. Heather Wing, director of adult services at the
NCSC, says there can be issues about communication because not all
users can communicate their concerns. To address this, the NCSC has
set up a group to develop a range of materials to engage them in
inspections. It has also produced a service user comment card for
users to fill in and return to the inspector.

When the commission took over inspections from local authority
inspectorates, it retained lay assessors who wanted to continue the
role. But the commission has yet to make up its mind on how it will
use lay assessors and is carrying out research into their
effectiveness. “It’s our intent to use them, but we want to see
what will be the best way,” says Wing. “You have to balance how
much a lay assessor can take on board with the fact that they bring
a valuable component to the inspection process because of their
knowledge. I think they are incredibly valuable, but the process
has to be managed as it takes a lot of time and effort. If we want
to do it properly we have to avoid tokenism.”

Joint reviews are known for seeking the opinions of a range of
“stakeholders”. The review team carries out a random survey of
users and carers, as well as selecting a number of individual users
to speak. Reviewers also meet local users’ and carers’ campaigning
groups. “The better organised a council is in involving users, the
better it works in joint reviews,” says Sue Mead, director of joint
reviews.

Users do tire of people asking for their views but then never
hearing from them again, Mead says, so the joint review team has
worked hard to ensure they receive enough feedback. It also
encourages councils to involve them when they are putting together
their action plan so that they become part of the local
solution.

And what of the new inspection and registration body? In an
unexpected move weeks after the launch of the NCSC, the government
announced that its social care functions would be merged into a
Commission for Social Care Inspection, with the inspection
functions of the SSI. Wing admits to being “bothered about yet more
change”. But she hopes that if the user involvement processes can
be embedded in the NCSC’s methodology they will be transferred to
the new commission.

No one is clear about what will happen when the new commission
starts work. And the Department of Health is remaining quiet on the
issue. “There’s nothing definite yet because it has not even been
properly formed or introduced in parliament,” says a spokesperson.

Most would be surprised, though, if user involvement was reduced,
as they feel the principle is now well established. Mead is
convinced that users and carers will be central to any new
arrangements. “It will be an independent body with a new role and
function that equates with modern services. It is clearly going to
devise new approaches and methodology to reflect the ways that
social services are changing.”

Raynes is not convinced: “The new commission is a reflection of the
mess we are in about inspection. I have no idea what the value of
inspection is and we don’t have a handle on the cost.

“On the one hand it’s a rational thing to do, but on the other it’s
madness because the existing commission hasn’t had time to put its
feet under the table. We will have to be optimistic that they have
got it right this time.”

As it is unlikely that the new body will take over its functions
for at least two years, it certainly has time to get it right and
make sure that users are involved from the start.

¹ Barnardo’s, Voices and Choices, 2002