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Do we need inspection to judge the performance of health trusts?

How can I realistically judge the acute health trust serving my area?

Last week I went along to their annual members’ meeting. Although the presentations were mostly pretty lacklustre compared to the PR-infused one I attended two years ago, the organisation sounded pretty competent and caring. Two days later, in a different role, I had a quick tour of the main hospital and it seemed clean and efficient. Much of the comment on NHS Choices is positive and it gets four out of five stars. But it’s below average on the Friends and Families test.

That’s quite a lot of information to collect, particularly for anyone who doesn’t have much time, and it gives at best a patchy idea how good the trust is.

However they’ve recently had a CQC inspection. That told me that they ‘require improvement’ overall (with a score of ‘Good’ in two areas and ‘Requires Improvement’ in three). That inspection would have been expensive and would have been a burden on the trust, but it does give me a pretty simple and straightforward judgement (backed up by detail). Inspections may miss things (as with a number of high profile failures which were preceded by positive inspections) and they inevitably average out a wide variety of performance. A large part of my local government career involved working towards reducing inspection on local government so I do recognise that those being inspected didn’t always find them beneficial (whereas they are more likely to welcome voluntary peer reviews), although they did see them as an important driver of improvement. But despite all that they can be helpful in alerting local people to problems or good practice.

Just as the Government lifted all the ‘burden’ and ‘red tape’ of inspection from local government, they decided to impose it on health. No doubt a future government will release health from the ‘stranglehold’ (or whatever they choose to call it at the time) in years to come.

So, my conclusion is that I do like the element of independent, systematic judgement. But it is important too to work hard at reducing the burden on those inspected, such as by using readily available information and spacing inspections on a risk basis. Which, paradoxically is the way the Audit Commission was going when it was unceremoniously abolished.

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