Mystery shoppers: snooping on the NHS
The covert monitoring of public-sector staff will damage morale, and do little to provide decent public services.
Margaret Haywood, a 58-year-old British nurse with 20 years’ experience, made headlines last month when she was struck off the UK nursing register. Haywood had secretly filmed the neglect and mistreatment of elderly patients in Brighton’s Royal Sussex County Hospital for an edition of the BBC current affairs TV programme Panorama. The decision to prevent her from working as a nurse, taken by the Nursing and Midwifery Council (NMC) on the grounds of patient confidentiality, caused an outcry and an appeal is planned (1).
But it’s not just whistleblowers like Haywood who are watching us at work. Less high profile, but every bit as insidious, is the NHS’s own practice of covert monitoring of staff at work in the form of ‘mystery shopping’ – that is, using someone to pretend to be a client or customer in order to see how staff behave. This is justified in the interests of the organisation and/or good customer care. While it is pretty normal to phone up your bank or utility company and be told that your call may be recorded for ‘staff training purposes’, such monitoring is used much more widely in workplaces today.
What may come as a surprise to many is the spread of this practice to the public sector. Major changes have been introduced in the public sector recently that have alienated many who work in it and contributed to the collapse of its central ethos: delivering services for the public good despite the relative lack of financial rewards that one might receive in the private sector. Where once this sense of vocation among staff was assumed to motivate employees to do a good job, public sector work has more recently come to be driven by meeting targets and quantifiable measures of performance.
In health and social care, for example, patients and service users have been reclassified as customers. This approach has led to private-sector practices creeping into the public sector, and now ‘mystery shopping’ is all the rage. Elements of customer service like face-to-face encounters, emails, telephone calls and letters are measured. There are even protocols on the subject, with best practice stipulating that staff groups and their trade unions should be notified when ‘unobtrusive testing’, as it’s euphemistically termed, is to take place (2).
I believe that this covert monitoring is deceitful and wrong. It also reflects a crisis in public-sector management today, which seems unwilling to manage in a meaningful or inspiring way and which clearly no longer trusts its staff. It does, however, see the customer as king – just as in the private sector.
The kind of issues being addressed in mystery shopping reflect current government preoccupations. In the National Health Service (NHS), for example, general practitioners are considered one of the obstacles to many of the measures the Department of Health wants to implement in the interest of advancing its patient choice agenda. Commissioners, therefore, have to bring GPs to heel: so they are waging a campaign to stop doctors’ practices from closing at lunchtime or for half-days. In addition to issuing contractual threats, there have been mystery shopping investigations to ensure compliance with closing hours: staff call surgeries after 5pm to check that they are still open (3).
In social care, staff practices are also under scrutiny. Staff have to be seen to be passing information to their service users to support them in making decisions. When mystery shoppers were deployed to telephone council departments requesting simple information about services available in a particular area, however, they found that professionals failed to provide their clients with information systematically. Among the several suggestions for improvements, there was the idea that we need specific staff – information co-ordinators – to access information for clients (4).
Service providers don’t appear to be embarrassed about having been ‘mystery shopped’; some even proudly talk about it. A Scottish sexual health service was given a clean bill of health in a national mystery shopping exercise for two years in a row. The genito-urinary medicine clinic in Edinburgh was among 21 NHS clinics to be mystery-shopped. A lead clinician said: ‘Long waits for help could be hazardous where sexually-transmitted infections are involved and it is good to see that our service has done well in this test.’ (5)
In London, mystery shoppers comprising staff and patients have been used to ensure that customer care standards are embedded in services. An NHS manager reported: ‘Visiting the doctor or nurse can be a scary experience and patients can feel lonely and frightened, so being treated in a kind and compassionate way by staff is important… We’re delighted with the success of the “mystery shopper” scheme and we’re going to continue to use it to improve patient care and find out how our patients view us.’ (6)
A veritable industry exists to recruit mystery shoppers. One organisation boasts a staggering 70,000 on its books (7). The industry sells techniques to organisations which help them ‘strive for excellence’. Mystery shopping is also promoted as a way of identifying weaknesses in service chains which might indicate a need for performance management or staff training.
Patients, too, are specifically invited to become mystery shoppers. One NHS organisation offers ‘mystery shopping’ as the first of the 27 options for involving patients and the public in its work, alongside becoming an expert patient champion and joining staff interview panels (8).
Given the way that covert monitoring could be used to crank up staff workloads, or as the basis for disciplinary action, you might assume that organisations whose aim is to promote and defend the interest of workers would be opposed to mystery shopping. In fact, it is very difficult to find any mention of this practice on trade union websites in the UK.
There are precedents for a backlash. In Australia in 2003, for example, Commonwealth Bank staff and their union took action against mystery shopping by distributing information to customers outside the bank, advising that mystery shopping ‘belittles and insults staff, and irritates customers facing a litany of questions each time they enter their branch’. It argued that the bank should instead give branches enough staff and the resources to deliver the level of service excellence their customers deserve (9).
The notion that the ‘customer is king’ might well be a laudable aspiration in sectors such as retail. In the target-ridden public sector, however, ‘customer choice’ is illusory. The UK government insists, nevertheless, that choice is offered to patients, despite the lack of popular demand for it. Consequently, organisations have to prove, through a variety of assurance processes, that they are offering choice and meeting targets. Their survival is dependent on it. Checking and reporting on aspects such as the quality of customer care is therefore commonplace, and if ‘independent’ evidence from mystery shoppers is offered, so much the better. Mystery shopping can therefore be used to whip staff into shape as targets are implemented and monitored.
This constant monitoring of staff reflects managers’ lack of trust, and their abdication of responsibility for doing what they are employed to do: directing and motivating staff, addressing shortfalls in performance and communicating with workers to resolve the problem. Instead, outside evidence is acquired in an underhand manner by which workers can be confronted with their shortcomings. While there has always been friction between management and staff, the public sector could once point to an overriding common purpose of achieving some public good; but that purpose is undermined by covert monitoring and the targets culture that it springs from.
Margaret Haywood paid a heavy personal price for not having addressed the problem of poor patient care differently, and that’s a personal tragedy for her. If hospital managers had dealt with the situation more effectively, she wouldn’t have had to resort to secret filming and would still be able to practice as a nurse. What we don’t need, however, are more whistleblowers, mystery shoppers and covert snooping. We need the reinvigoration of a sense of purpose in the public sector, the restoration of faith in staff, and a government prepared to take responsibility for the running of excellent public services.
Brid Hehir is a nurse and works to promote patient and public involvement in the NHS. She writes in a personal capacity.
Dr Michael Fitzpatrick criticised the squalor of contemporary UK healthcare. argued that Darzi’s interim report on the NHS profoundly misunderstood Britain’s ‘health crisis’. He also criticised the way Tony Blair alienated patients and degraded doctors. Brendan O’Neill declared we don’t need any more patient choice. Or read more at spiked issue NHS.
(1) Nurse struck off register for confidentiality breach, Nursing and Midwifery Council, 17 April 2009
(2) Protocol to cover the use of unobtrusive testing of service delivery, Leicestershire County Council
(3) PCTs get tough on GPs’ in-hours closing, Pulse, 25 March 2009
(4) Mystery shopper finds information hard to come by, Community Care, 14 June 2007
(5) Second ‘mystery shopper’ survey confirms ease of access to Lothian sexual health services, NHS Lothian, 26 August 2008
(6) ‘Mystery Shopper’ scheme anniversary, Wandsworth NHS
(9) ‘Mystery Shoppers’ impede customer service says FSU, HRM Guide
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