“I’m not here just to kick your tyres.” I had never heard this expression before. The context in which it was used was a US college scout doing a home visit with a view to offering a scholarship.

‘My experience of inspections of health and care services is they are superficial’

The expression was used towards the end of the interview to indicate it wasn’t just about the college deciding whether to make an offer, it was also about the student deciding whether this was the college for them. The image of someone inspecting a second-hand car by going around and kicking the tyres reminded me of inspections the department had be subjected to.

Inspecting hospitals, schools, care homes and a whole range of public services has been newsworthy recently, either because of scandals’ in the quality of services or claims by professionals about the unfair nature and intolerable pressure inspections can create.

Judging a car by walking around it and kicking the tyres would seem rather superficial and ineffective, made only marginally less so by checking the documentation, current MOT certificate of road worthiness and service history as an indication of how well it’s been looked after. Yet my experience of inspections of health and care services is they are superficial, overreliant on documentation provided and are not much more than a walk around with optional tyre kicking.

Potential for improvement

This has not always been the case. At one time inspectors spent far more time on site but, as resources have been cut, staffing reduced and more demanding targets introduced, two weeks on site has become 2-3 days.

‘Don’t make the mistake of being overly candid in your attempts to win the sympathy or understanding of the inspector’

The inspectors require a detailed but succinct positional statement in advance of their arrival, backed up with reference to supporting documentation and performance statistics. This is a crucial document since it is your opportunity to describe your services strengths and weaknesses. It would be a big mistake to gloss over the weaknesses as this will be reflected back as lacking insight and awareness and therefore reducing the potential for improvement!

Whatever the assessment of your service, your future probably depends on the verdict for the “potential for improvement”.

Early on in the inspection there is an interview with the person with overall responsibility for the service which will be followed up with interviews of a cross-section of managers, staff and service users. Despite the informality of this one-to-one, the head is expected to impress and show they are in touch with the issues, even though this may only be a small area of their responsibilities, and to be convincing as an effective leader.

Of course, it is tempting to see this as a charm offensive to get the inspector on side. They may talk about the difficult budget position, starting from a low base but there has been tremendous improvement over the last 18 months with very encouraging feedback from patients. Is this reflected in the evidence submitted?

Too much information

Don’t make the mistake of being overly candid in your attempts to win the sympathy or understanding of the inspector. A former boss got carried away in listing the challenges that a director faced in the current climate and concluded by saying: “To be frank this service isn’t in my top three, probably even my top 10 priorities.”  Big mistake.  What they meant was they didn’t have any worries about this service but that’s not how they came across.

The draft report slammed the department. We were allowed to ask for “factual errors” to be corrected but there was no scope for changing the tone of the report, the comments or conclusions. The report started from the view point that the organisation did not see the service area as a priority and this was reflected in the leadership provided by the senior management team. Despite our additional evidence, assurances from partner agencies that they had been positive and repeated reassurance from senior managers that the service was a priority, the report stood.

What was most damaging was the assessment that our prospects for improvement were poor. Why? Because the senior management team did not view the service as a priority.

We had out tyres well and truly kicked.