Managers pleaded with the shadow chair of new inspectorate CHAI to keep his pledge to reduce the burden of scrutiny

Published: 03/07/2003, Volume II3, No. 5862 Page 103, 104

Managers ground down by relentless inspection visits have begged the shadow chair of the Commission for Healthcare Audit and Inspection to stick to his guns in reducing the audit burden on the service.

In his first major address since his appointment to the role, Professor Sir Ian Kennedy made clear his determination that CHAI, as the leading inspectorate, ensures a reduction in the audit burden placed on trusts that are now subject to scrutiny by a range of bodies.

'We will seek, as the leading inspectorate, to ensure that visits are co-ordinated and so structured that you are not always overladen with people trekking through to find this or that, ' he said.

Sir Ian said his body would examine the quality of patient care, the quality of patient experience and the quality of the organisation which delivers it, and would rely on 'intelligent information' which was well-interpreted. And he said he could 'not stress too strongly' that the new approach would be introduced 'over time'.

Sir Ian said that if CHAI had a motto it would be 'improvement, improvement, improvement', and that it was possible to create a system of more rigorous audit while reducing the burden for managers.

But managers were sceptical of whether the body, which goes live next April, would be able to keep the promise. South Essex Partnership trust chief executive Patrick Geoghegan made a plea:

'In an organisation like mine It is fiinspection, inspection, inspectionfl. We have the Commission for Health Improvement, we have the Social Services Inspectorate and everyone else stopping at our door...we spend so much time going through the inspection process we do not have time to roll out the actions and make the improvements that we would all like to make.'

London Ambulance Service trust chair Sigurd Reinton said he was 'hugely encouraged' by the approach Sir Ian had laid out. But he told fellow delegates: 'I remember how [Dr] Peter Homa also sounded very encouraging when he set out.'

He said accounts from trusts that had undergone CHI visits had left him 'full of foreboding'.

And he urged Sir Ian 'to make greater haste in changing that approach than I think you implied in your presentation that you are planning to do'.

But the shadow chair of CHAI said: 'The pace of change will be driven by one thing alone...how quickly we can solve the question of having data which is translatable into information which is translatable into knowledge which is translatable into wisdom.

'If we can't crack that - and the NHS has a diabolically poor record...we are going to have a system where my colleagues and I will have to do periodic inspections of 3,000 organisations.'

Earlier, Sir Ian urged the government to publish its standards, against which CHAI will measure services, as well as against National Institute of Clinical Excellence guidance and national service frameworks, as soon as possible.

And while outlining the range of 'targeted and proportionate' visits which will replace the clinical governance review regime in the long run, he challenged senior managers to volunteer to join inspection teams.

'If we are to carry out visits I offer you a challenge. There has been some comment in the past that in some cases reviews carried out are not always viewed as being to the standards that some of you would wish. The answer lies in your own hands.'

In the debate session which followed, Audit Commission head of health Peter Wilkinson, currently seconded to CHAI on a part-time basis, warned against confusing measurement with accountability.

'Measurement should be seen as one of the tools of inspection. We must keep away from presuming every measurement is a measurement of accountability - that if you do not achieve it you will get shot.'

See comment, page 17; feature, pages 26-28.