Recent press stories about low standards in some NHS hospitals, where up to 12 hospitals have been judged inadequate by the semi-autonomous body Dr Foster’s, have once again raised questions about targets, inspection and standards. We have been treating similar themes in this blog (see below The Tyranny of Targets and Performance Measures). The discussion has become much more animated in a context where standards of hygiene and care have more than just nominal implications, but can make the difference between life and death for patients. The debate seems to swing between two poles: on the one hand, the argument goes, it is no longer enough to rely on self-assessment, since some of the failing hospitals judged themselves excellent. Therefore the right approach must be more stringent, on-the-spot inspections. This is an argument for adding to the bureaucracy of inspection. The more free-market argument is to encourage the public to vote with their feet, and to stop using hospitals that fail to meet basic standards. As consumers we are encouraged to exercise our right to ‘exit’ the service. Neither approach seems to ask what kinds of work practices allow highly trained professional staff to ignore what must be very obvious to them in terms of low standards. To what extent does the practice of government ‘naming and shaming’ and the anxiety that this evokes in top NHS managers encourage them to prevent staff pointing out the obvious for fear of jeopardising the hospital’s reputation? How possible is it to speak out in hospitals even if what one has to say is unpalatable? Neither inspection nor consumer exit deals with the ethical responsibility of staff in situ, both managers and health professionals to find ways of talking about and dealing with the difficult situations they find themselves in together.
I was working with some teachers in a school the other day when the conversation turned to inspection and evidence. The new UK school inspection regime is based much more clearly on teachers’ and managers’ assessments of how they think they are doing – they have to fill in what is called a SEF, or self-evaluation form – which is then offered to incoming inspectors as the primary basis for their inspection. According to the Department for Education, evidence has to be rigorous, has to be written down and has to demonstrate ‘impact’. The inspectors then judge not just the quality of teaching and learning in school, but also the quality of the SEF. The idea is that the inspection becomes an assessment of teachers’ ability to assess themselves in the given form of the SEF.
Since I have taken a long-term interest in encouraging reflection and reflexivity in the posts in this blog , I was interested to note my own resistance not to the idea of self-evaluation but to the way it was being put forward and the ideology of relentless improvement and scrutiny that it implies. Continue reading