The Inspectors Call (but are they listening?)

happyhorse21On Wednesday evening last week, when I should have been shovelling fish fingers into my offspring, I cycled in the pouring rain to a “Listening Event” run by the Care Quality Commission who were about to begin a two day, new style inspection of  the Homerton Hospital in my home borough of Hackney.  I have complained here before about public meetings held in rooms where the biscuits outnumber the people by a ratio of approximately 50 to 1 and although there were definitely too many biscuits in this particular room, the ratio was a bit better than usual. In fact I was pretty impressed by the numbers: probably around sixty or so.  Some new faces, some black faces, some young faces.  All good to see, but my enthusiasm was slightly eroded when most of these turned out to be members of the CQC team rather than members of the Hackney public.   These twenty or so “listeners” were a subset of what we were told was a team of 30 inspectors who would be descending on the hospital the next morning.  Now that must have cost a pretty penny.

Introductions matter

The Lead Inspector said hello to everyone:  “My name is Dr Mumble and I am a Consultant from Mumble” he mumbled at top speed.  Then he made sure there were plenty of CQC people on each table and that was it. We like working on tables these days (we like it so much we seldom seem to get to do things any other way) but it is still nice to feel part of something and to be given a little idea of what is expected of you.  It took three attempts by the redoubtable Malcolm Alexander to get the Eminent Consultant from Mumble to introduce himself and his colleagues.  With a bit more pushing someone else was persuaded to describe the inspection process but it had clearly already been decided that no time was to be spent on such niceties as they were here to listen not to talk.   At least it meant that We, the Story-Tellers, were saved death by Powerpoint and They, the Listeners, were saved the declamatory grandstanding from the floor that can sometimes take over these sorts of events before they ever get going.

Desperately seeking real voices

My table of eight was made up of three (yes three) members of the CQC team, me, one member of the local Healthwatch Board, a member of Healthwatch staff, a governor from the hospital and one Member of the Public.   Looking around the room I saw enough familiar faces to suggest that the other tables had a pretty similar profile.   It soon became clear that what the Listeners really wanted were real life, first hand stories straight from the horse’s mouth but unfortunately there was a bit of a shortage of bona fide horses present.  The only absolutely real life person on our table launched our precious fifty minute session with a twenty minute tale of dissatisfaction with a service that, it gradually became apparent, was not actually covered by the inspection.  Somehow, despite repeated efforts, we all failed to head her off at the pass.   Nevertheless, the inspectors took an awful lot of notes.

When she finally ran out of steam, the Healthwatch staff member took up the baton and tried to summarise the findings of their recent local insight-gathering exercise about the hospital. Unsurprisingly however, she was unable to do it justice in her five minute allotted span and it seemed this was not really what the men from the CQC were looking for.  It seemed obvious that a report like this should be required reading for the inspection team and she had sent it to them in advance but in the absence of any clarification as to whether anyone had actually heard of it, let alone read it, I can understand why she felt she should make the most of her 300 seconds to promote it.

One size does not fit all

It is good to see the CQC put its money where its mouth is and actively seek to hear what people are saying about the services they are inspecting.  What is needed here however is a much clearer distinction in the minds and processes of the inspection teams between different sorts of user intelligence and how they should be garnered. If the intention of this event was, as gradually became clear, to hear the voices of grassroots service users rather than to hear from organisations and their representative who have already absorbed, digested and processed the views and experiences of their members and others who approach them, then this should have been made explicit in the publicity materials for the event.  The people who represented or worked for local organisations and groups should have been asked to stay away and provided with a different opportunity to feed into the process.  When we were commissioned by Hackney Council to interview over twenty key organisations before the launch of Healthwatch, we found a huge number of well-informed and committed people with views on health who would certainly have lots to say about the Homerton. Maybe it would have been a better use of the thirty strong CQC team that evening to have put each one in a booth for an hour with the CEO of a local charity, a tape recorder and a structured online questionnaire.

Go to the people – they won’t come to you

If this event was not really the right place for professional (or amateur) health campaigners and advocates, was it the right way for the CQC to find out what Real People in Hackney think of their local hospital?  Almost certainly not.  The weakness of this type of event in achieving this particular goal was brought home to me at the weekend when I spoke to a friend whose partner has been in the Homerton since Christmas. Both of them are going through a very difficult time but I was surprised by the passion with which she spoke about the Hospital.  She said she could not fault them and that they had looked after her and her partner so well she could hardly express it.  Caught up in an exhausting and relentless cycle of hospital visiting, childcare and work she would never have made it to an event like this one and consequently her story, and the stories of people like her, will remain unheard.

If organisations like CQC want to hear unfiltered, genuine responses from ordinary people about their experiences, then this is not the way to do it.  How about visiting the primary school gate at 9 in the morning or at 3.30, or popping into the older people’s day centre, or talking to people at the bus stop outside the hospital or in the park cafe or the queue at the pharmacist?  You could even offer them a biscuit or two to encourage them to talk.  Years ago we had a lot of fun hauling people out of the rain at Stamford Hill Library and other public buildings and bribing them with cups of tea (and biscuits) to talk about the reconfiguration of primary care in the borough.  This sort of thing gives you the kind of insight you will almost never get at a public meeting, even one with tables – and, in my experience, a much more balanced perspective.  A depressing reflection of human nature it may be, but if you call a public meeting on a wet February evening, the vast majority of people who turn up will be there to complain rather than to tell you about their good experiences (unless of course you want to close something down in which case the inverse principle applies).

Missed opportunities to test the Hoxton nightlife

As I left the plates of softening biscuits behind at eight o’clock and wiped down my bicycle saddle, I was amused to note the Apprentice style fleet of black people-carriers waiting to whisk our inspectors away to their hotel.  I have no idea which of the achingly stylish new East London hotels they were heading for but I could not help wondering why they did not send their wheelie suitcases ahead of them in the taxis and walk instead. It might have afforded them a the opportunity to soak up the atmosphere of the place and run up against some of our colourful local streetlife, which includes many regular users of the local hospital services. On the plus side though I am sure the taxi drivers would have had plenty to tell them about the Homerton.  I wonder if they asked.



  1. Colin Adamson says

    Oscar Wilde said apparently that socialism would never happen because there are not enough evenings in the week. He has a point because few are prepared to cycle through the rain – and the public are not the ones who get the taxis laid on to take them home. Philip Collins writing in the Times (14/02/2014 paywall) dug out the Wilde quote to head up a good piece on how to make citizens voices count. He identifies the “illusion that what we most lack in our lives is the opportunity to sit on the consultation panel of the Clinical Commissioning Group.” He adds “I think I might be washing my hair that night”. What is real power? For all the talk of citizen and patient power, are our rulers scared of it? Why is individualism always “rampant”?

  2. peter short says

    It’s said that in the old days the Tsarist police would send three people to interview ‘suspects’ – one to ask the questions, one to write down the answers and the third to keep an eye on the two dangerous intellectuals….

    As for managing table top conversations – use resources to deploy and/or train group leaders who have the facilitation skills required. Otherwise get on the streets and go to where the people go.

  3. Alan Simpson says

    Very interesting blog. I live and work in Hackney and my partner and. I have had consistently positive experiences at the Homerton Hospital but did not know about this CQC consultation and as you suggest would probably not have gone at end of a busy day. It’s a big challenge to find constructive ways of engaging with the voices of real local people. I attended a local health watch event and left very unsure there had been much point to it and I am even less clear whether anything that was said there has been fed into anything at all.

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