Public Services Management: Spotlight turns on residential homes: New rules of inspection are opening previously closed doors, writes Liza Donaldson

ANYONE having to choose a home for an elderly relative, or, at the other end of the age spectrum, a nursery, child-minder or playgroup, will soon be able to consult reports from a little- known army of inspectors.

The inspectors, numbering more than 1,000 and located in council social services departments, are helping to spearhead a countrywide move towards publishing reports that people can scrutinise to make informed choices about the services their loved ones receive. While this may help people to select the right home or nursery, publication of these reports is having other important spin- offs. Inspectors claim they are helping to educate the public, owners of residential homes and service providers as well as enhancing standards.

Despite the Citizen's Charter promise of more openness, the situation across the country is patchy, as only a few pioneers publish such reports. However, a long-awaited Department of Health circular has given a fillip to the pro-publishing inspectors. The circular stresses that councils must have 'fully operational open reporting' (ie, publishing) by 31 August for all adult and children's homes. Although it excludes making public reports on boarding schools, nurseries, playgroups and child- minders for the time being, there is a promise of action. The circular pledges that 'the Government intends to take separate action to apply Citizen's Charter principles to inspections of boarding schools and day-care services'. No timetable has been set for boarding schools, but proposals for publication of reports on nurseries, child-minders and playgroups should be out, according to the Department of Health, by the end of the summer.

A number of councils are already blazing a trail by publishing some or all inspection reports. Sunderland City Council, for example, was among the first to publish reports of inspections into 51 public and private residential homes. It has done so since inspection units were set up in 1991 - as required under the NHS and Community Care Act 1990. The full inspection reports go to social services committees and are therefore available from agendas in libraries and some council offices. Reports on the area's nine nurseries are available from individual nurseries, but the results of inspection of 300 child-minders are still private.

More publicity is planned. At Gateshead Metropolitan Authority in Tyne and Wear, reports on 63, mainly private, residential homes have been made public since March last year in the central library and selected social services offices. The policy 'aims to strike a balance between economy and very ready access'.

Dave Eason, chief inspector for the Gateshead authority, believes that since moves towards more openness, there have been fewer scandals nationally of abuse of adult residents. The focus has shifted to children's services, prompted by such events as the 'pin-down' scandal in Staffordshire homes and the case of Jason Dabbs, a trainee nursery nurse in Newcastle, jailed in January for indecently assaulting his charges.

'Open reporting has strengthened inspectors' hands,' Mr Eason said. 'When people mess you about and do not come up to standard, then they know the report will be published. What is said can affect whether or not people use the home.'

This 'carrot' to impose the standards required is achieving quicker results than the long- winded stick of deregistration, the ultimate sanction. Gateshead, a smallish authority, has helped to increase public knowledge about the reports by writing to all relatives of people in the homes with a questionnaire on aspects such as the quality of care, food, laundry, and cleanliness. The letter explains that the report will be published and where it can be found.

'The people of the North have had a hard life in an economically vulnerable area of mining and shipbuilding. Often their expectations as a customer are very low. The inspection units feel they are educating the customer, and public reporting is part of that,' Mr Eason said.

As customer expectations rise, so in time do standards. 'We can see a big rise in standards over the last three years (since inspection units were launched),' he said. 'I think that expectation has played a big role in that.' He admits that owners of homes and the inspectors have also faced a steep learning curve.

Essex County Council is probably the first large local authority going the whole hog with open reports. It has already published reports on 475 public and independent homes for adults in the county over the past year. From this month, it will publish reports on 42 residential homes for children, 99 day nurseries, and 601 playgroups. It is not publishing but is advising 2,058 child- minders to make inspectors' reports available on request in their own homes.

Leo Bishop, head of inspection and customer care for Essex, said: 'The child-minder reports are not being published in libraries because we don't want to let some pervert know there is a woman alone during the day and to put children at risk. You have to balance the benefits against the risks.'

Essex has drawn up a document on the standards that those registering services for adults and children must statutorily meet, and ones they should ideally attain. Essex, in addition to inspection, writes to a sample of relatives, consults GPs, and asks views, where appropriate, of the users of the service.

'I take the view that inspection is a snapshot from a visit on one or two days. But the people who really know are the relatives and staff or nurses who go in on a regular basis,' Mr Bishop said. 'Our key job is to network and draw together the information on what the service is like.' He believes that publishing also encourages inspectors to write in plain, jargon- free English, and makes them more accountable to the public. He contends that the quality of services inspected has improved as a result of scrutiny, with the drive for higher standards continuing. He argues that criticisms, such as those from the Working Mothers Association that publishing costs may spread already thin resources for child care even thinner, are not justified.

Highlighting some of the inadequacies - for example, the poor state of some buildings used for playgroups - is likely to attract attention and resources, he says.

A campaign to alert the public to the existence of the reports is underway. Users of the services themselves have given almost universal support to greater openness in inspection reports. Groups as diverse as Counsel and Care, advising those seeking homes for elderly people, the Pre-school Playgroups Association and the National Children's Bureau are in favour. The change is seen, not as a cure-all, but as a healthy step in the right direction. As Gateshead's Mr Eason put it, 'Sunlight is the best disinfectant.'

(Photograph omitted)