Who inspects the inspectors?

Our health care appears to be in chaos with reports of failing health trusts, hospitals that have disastrously high levels of deaths and medicines sold abroad as poor old Britain can’t afford them.

The hideous tales from Basildon University Hospital last week epitomize how bad things are. An unannounced visit by the Care Quality Commission (CQC) found “Third World” conditions. The death rate at the hospital was one third higher than it should have been.

However, it wasn’t that long before that Basildon got a very good rating from its CQC inspection. Moreover, it is a Foundation Trust hospital – which status you are only meant to gain on being excellent.

We need to really look at inspections!

The same syndrome was seen in the Baby Peter tragedy in Haringey where OFSTED inspected Haringey’s Children’s Services and gave them a three star rating just before the Baby Peter case broke – and then immediately after in the urgent investigation for Ed Balls, Secretary of State for Children and Families gave them a one star rating. As with Basildon, it is only after tragedy has struck and a new inspection carried out that the truth has come out over the real state of affairs.

OFSTED said of their earlier inspection that Haringey Council had misled them by giving them false information. That first inspection was what is called a ‘desk inspection’ I believe – where conclusions are drawn from paperwork and data records and not actual physical inspections or interviews.

I think this symptomatic of three things really.

Firstly, I don’t have real confidence that inspections and evaluations are properly impartial. The regime imposed by the Labour government is one of hoops that have to be jumped through (in many spheres of operation) in order to get gold stars which then lead to autonomy and / or extra funding. There is a huge incentive for all concerned to produce and find results which result in these desirable outcomes.

The second problem seems to be the quality of inspections themselves. For OFSTED to say that Haringey mislead them by not providing accurate information damns OFSTED for not seeing through such a scam just as much as it damns Haringey for trying to get high marks in an inspection through falsifying or not providing proper information.

Interestingly, during the urgent investigation that followed the Baby Peter case, I had information from people working in the departments that people who wanted to speak out were not allowed to talk to the inspectors. Only those chosen by management were allowed to give evidence. Talking to the people the managers don’t want you to meet should be a basic part of any inspection that is meaningful.

Thirdly, there is far too little comeback on the inspectors when they get it wrong. All manner of public services have had searching inquiries and overhauls as a result of tragedies in the last few years. But the inspection bodies have been largely untouched.

It’s a common sign to see a senior service manager in the media under pressure to resign (often rightly so). But you don’t see those responsible for inspections that missed the real story under similar pressure.

The sign of real lessons being learnt from the Basildon tragedy should be seen not just in our hospitals – it should also be seen in our inspections bureaucracies.