Over the last couple of years or so a number of prospective clients (service managers and providers) have asked me if I do ‘mock inspections’. In other words, for me to come along to their service and ‘replicate’ a real-life CQC inspection, and even to give a ‘mock rating’. Up until recently I’ve tended to say no because I’ve been sceptical regarding their value. However, having given the matter some more thought I think that if they are carefully managed they may indeed have some benefit. But before going on to explore such benefits I think it might be helpful to share my original reservations.
As an ex-CQC inspector I am well aware of the logistical challenges in carrying out a ‘full-blown’ inspection, which essentially resolves around gathering evidence for each of the 25 key lines of enquiry (KLOEs) which together form the basis of the five domains (Safe, Effective, Caring, Responsive, Well-led). Depending on the size and nature of the service, an actual CQC inspection may take two or even three days to complete, and may be carried out by two or more individuals, which will include the lead inspector, possibly a second inspector, and an expert by experience.
With regards to how the CQC inspection team proceeds with its work when it arrives at a particular service, there are a number of factors to be taken into consideration, some of which probably make sense to managers and providers, and some less so. To start with, if a service had an ‘Inadequate’ or ‘Requires Improvement’ rating at its last inspection then the inspection team are going to be particularly interested to see how things have improved in the areas where problems had been identified. And if they have been alerted prior to the inspection, perhaps by a whistleblower or by a safeguarding alert, regarding a particular issue, then this will certainly be something they will want to look at.
However, it may also be the case that one or more of the inspection team has their own ‘agenda’ or axe to grind, so to speak, which means they are going to be on the lookout for specific problems. Clearly, this is not how inspections should be conducted but as many providers and managers will tell you, this is exactly what does happen.
Taking all these factors into consideration, it means that it is virtually impossible for a third party (for example, an external consultant) to ‘replicate’ an actual CQC inspection with any degree of realism. Furthermore, even if the ‘inspector’ (the external consultant) arrives unannounced, as is the case with a ‘real’ inspection, the manager and the staff will know instantly this is not the ‘real thing’ because the ‘inspector’ will not be able to produce a valid CQC ID. This means the dynamics of the ‘inspection’ will be very different from the ‘real thing’, however much the ‘inspector’ tries to make it so.
And finally, when it comes to the question of giving a ‘mock rating’, which is probably what the provider or manager is particularly interested in, once again this is highly problematic. The CQC inspection team arrives at its final rating through a series of discussions both between themselves and with their team manager. In other words, the ratings are arrived at by a process of negotiation, rather than by applying some form of ‘algorithm’ or ‘formula’. As with the inspection itself, this is something that is very difficult if not impossible to replicate.
So there would appear to be plenty of reasons for managers and providers to steer clear of ‘mock inspections’. However, and as I indicated earlier, it is possible to carry out a form of ‘mock inspection’ which avoids all these potential pitfalls whilst providing useful information and feedback to the service.
The first thing to bear in mind is that simply having a third party, a ‘fresh pair of eyes’, coming in to look at the service can be extremely valuable. ‘Outsiders’ see things that those on the ‘inside’ cannot or will not see. Furthermore, and this has certainly been my experience, managers and providers often find it very helpful simply to spend time talking with the ‘inspector’ (the external consultant or someone in a similar role) and explaining how their service operates, where it does well, and where there could be room for improvement. And this is an even more helpful exercise if the ‘inspector’ asks enquiring questions about the service, which helps the manager or provider think more deeply and critically about their service.
In terms of looking for evidence that the service is safe, effective, caring, responsive and well-led, which should be the focus of any review or inspection, regardless of who carries it out, this is certainly something that a ‘third party’ can do. Although in reality they will most likely find different evidence for each of the KLOEs than a CQC inspection team would, such evidence is still perfectly valid and useful. It is important to remember that there is no ‘right’ or ‘wrong’ evidence, although some evidence is ‘stronger’ and more relevant than other evidence. The critical point here is that the ‘inspector’ fully understands the inspection process, what the KLOEs actually mean, and what kind of information would be good evidence for each KLOE.
And finally, the ‘inspector’ does not need to offer a ‘mock rating’ for the service; the evidence (or lack of it) for each KLOE will give a very good indication regarding the state of the service and whether it is in fact safe, effective, caring, responsive and well-led. Again, the key point here is that the ‘inspector’ is able to accurately interpret the evidence for each of the KLOEs and what it says about the quality of the service.
So, in conclusion, ‘mock inspections’ (or you might prefer the term ‘whole service reviews’) can be very helpful if they are conducted on their own terms by suitably experienced and qualified individuals. In other words, the aim should not be to try and ‘replicate’ an actual CQC inspection, but rather to focus on gathering evidence of quality across the whole service and then to give an accurate interpretation of such evidence to the provider and/or manager.