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FEATURES-LET'S GO TO WORK

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When the Social Services Inspectorate comes to town people's reactions can vary from welcoming to outright hostili...
When the Social Services Inspectorate comes to town people's reactions can vary from welcoming to outright hostility. Suzanne Simmons-Lewis finds out what it's like to be one of the team during an inspection of Wiltshire CC

Four plucky officers from the Social Services Inspectorate courageously agreed to be shadowed during their inspection of Wiltshire CC's mental health services so LGC's readers can appreciate the highs and lows of the inspection process.

LGC followed the team of inspectors around for two hectic days as they visited and interviewed service users, front-line staff, councillors, directors and chief executives - all while reading reams of case files.

Just to make the inspection even more complicated, new structures established in Wiltshire have thrown the inspectors into uncharted territory. The council and Wiltshire Health Authority have set up a joint commissioning board to amalgamate some of the area's mental health services. The result is the Avon & Wiltshire Mental Health Partnership NHS Trust. At the time of the inspection, the trust had been running for just 15 weeks.

'When services merge there should be a lack of duplication and it should be easier for the service user,' explains councillor Judy Seagar (Con), chair of the social services committee. 'There should be a better use of resources and a one-stop shop for commissioning.'

Because of the new arrangements an inspector was requested from the Commission for Health Improvement to assist the inspectorate with the health components of the inspection. Krisha Singh, 41, a clinical psychologist and head of psychology services at Hitchingbrooke Health Care NHS Trust in Huntingdon was seconded for the job.

On the evening of the second day of the process all four inspectors are gathered around a dinner table at a small hotel in Devizes. They are in the middle of a process called 'triangulation'. At the end of every evening, and at numerous times throughout the day, the inspectors discuss and analyse their feelings on how different aspects of the service are operating.

'It's quite important to do triangulation - checking out ideas,' explains Ms Singh, who is on her first inspection. 'The daily programme is usually quite full with people splitting up to go and do various interviews. At mealtimes you can start to put parts of the jigsaw together. It's about teamwork, discussion and communication,' she adds.

For two weeks the inspectors become intimate bedfellows, spending long days together that begin around 8am and can last until midnight. The amount of ground to cover makes the process very intense and the inspectors admit they can become so immersed their sense of time gets distorted, making one day seem like one week.

Chemistry within the group - both personal and professional - is crucial. The inspectors have a variety of expertise and experience between them, each exercising an important function in the process.

The lead inspector, 43-year old David Horne, has worked for the inspectorate for almost a decade and fulfills two roles. He is an analytical inspector - which involves developing policy and methodology to improve the inspection process and help build a national picture of the state of social services - and, to stay close to what is happening on the ground, he also takes part in inspections from time to time. This time it is his responsibility to compile the inspection's report. A qualified social worker with a doctorate in psychiatric care, Mr Horne has lectured in computer studies and social work and crossed the public/private sector divide to do a stint with high rollers in the City.

Graham Woods, 55, is also a qualified social worker. He has spent a good part of his working life with the inspectorate since joining in 1973. As the organisation has developed, so Mr Woods' role has evolved.

'We used to be called the Social Work Service of the Department of Health, and it didn't have such a focus on inspection as it has now,' he recalls. 'In those days it was much more to do with development work and liaison, which the policy arm of the inspectorate now does.'

Jeff Connor, 69, is a retired chartered engineer. He is a lay assessor for the Inspectorate - someone who gives their time voluntarily to look at services from an ordinary person's perspective. This engaging Yorkshireman, who now lives in the scenic climes of Clifton in Derbyshire, has been a parish councillor in Clifton for the past 20 years. Mr Connor first became a lay assessor in1993 after responding to a newspaper advert.

'When I retired I wanted to do more voluntary work and I chose the inspectorate because I wanted to keep in touch with what was going on in the outside world,' says Mr Connor, who has so far chalked up 24 inspections.

'Lay assessors apply lay thinking to a situation, but you do need to have a little bit of understanding about how the thing works,' he says. 'I can say things an inspector can't and I can occasionally spot something obvious from the ordinary person's perspective that the inspectors may have overlooked,' he adds.

The fieldwork is by no means the beginning of the inspection process. Twelve weeks before the fieldwork begins the authority will be notified. The council will then have to select a senior officer with operational understanding to liaise with the SSI. That person will be responsible for setting up the meetings and activities that need to be covered during the two week's fieldwork.

Ten weeks before fieldwork begins, questionnaires will be sent to 100 of the department's clients. From this, a further sample of 20 is selected for a more in-depth probe. During the fieldwork, the inspectors will go through these case files in fine detail, question the allocated social workers and visit service users.

'We use these cases to get an insight into how the system operates,' Mr Horne says.

A week before fieldwork begins the inspectors gather for a pre-briefing meeting where they discuss initial themes and questions.

Two weeks after fieldwork is completed they will meet the council's chief executive and senior officers for the 'headline feedback' stage of the inspection. Here inspectors will inform the council of their initial findings.

'There is nothing worse than us coming in and taking over your life and not telling you anything for weeks,' says Mr Horne. 'We try to be as transparent as possible and headline feedback is a good chance to find out if our perceptions resonate with the officers and get a real dialogue going.'

When councillors have seen the draft report and highlighted any factual inaccuracies, the final report is published, no later than 12 weeks after the fieldwork is completed.

The inspectorate prides itself on the high standard of its research methods and guidance. These help inspectors apply a broadly uniform approach to their work, and means the findings can be fed back in a statistical, as well as qualitative, way to help identify national trends and develop policy.

Each inspector is armed with a thick manual of guidance on which to benchmark all their activities, although they do not follow the questionnaires slavishly.

'The SSI never used to have standards and some inspectorates still do not work to these tight frameworks,' explains Mr Horne. 'We have to be flexible in our approach to assess how good the service is. There are multiple ways to find this out. A service can be good at the point of delivery, but it can do a itself a disservice if officers don't record it so well,' Mr Horne says.

Council departments have often said their normal work grinds to a halt in the weeks it takes to prepare and host an inspection. Wiltshire is no exception.

When the inspectors meet with a group of six harassed social workers there is obvious resentment. During much of the meeting they are very vocal about the 'demands' placed on them. They complain it takes them away from their case work when they are already operating at half capacity because of staff shortages.

The situation is made worse because the new service is in a state of flux. Just weeks after merging with the health sector, the social workers say they are left bewildered and cynical about whether joint working can be achieved. They complain of a lack of strategic direction for ground-level staff and excessive workloads. All this coupled with the belief they have only 'physically' merged with health - many invisible walls still exist.

It is fair to say these social workers see the inspectors as the enemy. But on many other visits to councillors, directors and service users the dialogue is more positive.

However, the inspectors are frequently told during the visit that they 'couldn't have come at a worse time', and 'we could do without having you here right now'. From the director of the trust to the councillors, no one seems to be taking the inspection particularly seriously. Rather than seeing it as a catalyst for change, it is seen as a necessary evil.

Throughout their visits, the inspectors remain even-tempered. They are always probing, but they listen carefully and do not rush into judgments.

Visiting service users in their homes requires sensitivity and vigilance, particularly in an area like mental health. But at times a sense of humour is very necessary. After visiting one schizophrenic service user, two members of the team came away with a collection of unidentified brown stains on the back of their clothes.

Inspecting a service dominated by women, the SSI's approach has been accused of being too soft - in sharp contrast to the more macho Ofsted inspections under Chris Woodhead. But Mr Horne is quick to defend the facilitative approach to inspection.

'We are actually measuring people against standards,' he says. 'We believe in negotiating with people and adopting a constructive dialogue to reflect this. Ofsted behaves in a more aggressive and confrontational way, but our method allows us to challenge in a meaningful way. There is greater impact on change when you take a facilitative approach.'

He points out: 'We have placed councils on special measures where necessary. Although it's about respect, at the same time we have a duty to inspect, which hopefully affects change and helps them to develop.'

When the SSI recruited their last batch of inspectors there was an endless list of requirements: a commitment to standards; the ability to work as part of a team; leadership skills; the ability to collate, analyse and evaluate complex information; and senior management experience. Tough criteria, but having watched them at work it is easy to see why.

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