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| TX: 22.12.08 - Cynthia Bower PRESENTER: WINIFRED ROBINSON |
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| Downloaded from www.bbc.co.uk/radio4 THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY. ROBINSON Three different inspection bodies currently monitor healthcare, social care and mental health services. The Healthcare Commission examines the NHS. The Commission for Social Care Inspection or the CSCI regulates care homes and care-at-home agencies and the Mental Health Act Commission looks out for people detained in mental health units. Well next April these three bodies will be replaced by one super inspectorate called the Care Quality Commission. Well last week this CQC, as it's already being called, announced proposals for assessing the performance of organisations providing health or social care. Well earlier Peter spoke to Cynthia Bower, the chief executive of this new commission, in her first broadcast interview. And he began by asking her what this new organisation's going to be able to do that its three predecessors couldn't? BOWER I think the real advantages are the fact that for most people who use health and social care services a really good service is one where services join up and work together. It's very rare that somebody just uses health or just uses social care, we need health and social care to work together. And also we know when things go wrong they often go wrong in the cracks that open up between services. So you're going to have a regulator that can automatically look across the entire care pathway, the entire piece, and say is it working properly for people who use services. WHITE But in this particular case all three of these commissions had pretty good reputations, you know we've had reputations certainly on behalf of the Mental Health Act Commission and you know what's often said is they were specialists - they knew very specifically what they were looking for. BOWER Well in the case of the Mental Health Act Commission, for example, we're going to do our best to preserve the professional expertise of the staff, the staff will transfer into work for me and I've already put a mental health professional in to lead the service. So what we're intending to do is preserve the best of the old commissions and at the same time have this added advantage of being able to look across different services and take the whole perspective. WHITE You have got a huge remit - hospital standards, the fight against infections, social care and protecting people receiving mental health service - so what are your priorities out of that lot? BOWER All of those different providers, the independent sector, social care, the NHS are going to have to be registered in a year's time, or just over a year's time, against a new set of requirements - there's a new set of legal standards coming in for all of those providers. And in the case of the NHS it's the first time they've been registered in this way. So my biggest priority is to get a debate going with people who use services and people who provide services about what those standards should look like and what safe levels of care should be, as well, of course, as getting the organisation and up and running. WHITE There are sometimes fears that there are big brothers and small brothers in this kind of area, I mean health is always seen as a big beast, social care perhaps has always felt maybe that it plays second fiddle and that in a big organisation, the worry is that might just get more pronounced. BOWER Well we shall certainly work our very hardest to make sure that's not the case. We've got commissioners on our board who've come from a social care background, who'll be watching us like a hawk. I have to say the bulk of the staff who are transferring into the new organisation will come from the Social Care Inspection, so the majority of staff are from that background. So there's an enormous opportunity for us to put a huge emphasis on social care. I've got a social care background myself, I'm not going to let it disappear under the weight of interest in the NHS. WHITE But of course there are also big concerns about health at the moment and in October the Health Care Commission said trusts are struggling to meet hygiene standards and that systems aren't yet in place to ensure effective infection control, only 40% of acute of specialist trusts comply with the three infection related standards and meet the MRSA targets. There are big problems in hospital with infection isn't there. BOWER There are indeed certainly a lot of issues around health - healthcare associated infections and that's one of the reasons why the government decided that in advance of registering all providers against a new set of standards, which is what we'll be required to do, we are going to look first and foremost at NHS providers and healthcare associated infections. So on the 1st April 2009, so 12 months ahead of everything else, we will look at how NHS providers are doing in meeting a new legal requirement to protect patients, staff and the public from the risks of acquiring infections. So we're beginning our work by looking at that very hot topic. WHITE But you do have new powers to fine providers, are you going to use those - you can shut down hospitals if they don't? BOWER We do indeed have a whole range of new enforcement powers which we're consulting on at the moment. And that includes the power to shut down a provider of health and social care. I have to say in order to take that decision there would have to be a catastrophic risk to people who use those services to their health and their well being and there would have to be no other action that you could take in order to secure the safety of people who use that service. So it would be - it's a fairly drastic action to take, it's the sort of - for want of a better expression - the nuclear option and it would be an extremely unlikely set of circumstances for a hospital I would suggest. WHITE Can I just raise a couple of issues about social care? Now the government's been holding a consultation on the future funding of social care, as the population ages we know demand is going to increase rapidly and the government's going to announce next year its plans. What measures would you like the government to take regarding the funding of social care, how would you deal with what seems to be a shortfall with almost any system that you can come up with? BOWER I mean from my point of view I've welcomed the work that CSCI have done already in considering these issues and it seems to me that the issues that they were raising were absolutely the right ones. And no doubt as CQC comes along we'll be engaging further in debate with government about how those things can be addressed. WHITE I mean, you know, it seems everyone at the moment is standing back and looking at everybody else about how it should be funded, you know whether it should be out of tax, whether it should be some kind of insurance solution. Don't you have to - as the person who's running the whole inspection edifice - you need to have a view on this don't you? BOWER Well I think what - one of the things that we absolutely need to have a view on is the impact on that and people who use services, on the impact on the choices that are available to them, on the impact of the quality of their lives, on the impact of the sorts of services that they are able to choose and that are available to them. Going back to what you were saying a few moments ago, I think this is one of the reasons why social care won't get pushed down the agenda of the Care Quality Commission because the issues around funding, and as you say, the relative responsibilities of the individual and the state, to me are one of the big social issues that we're now having to address. And I'm sure as we gather more information as a regulator, as we understand the impact on those decisions on people's lives we will have our own views to make to government about that. WHITE Now the Social Care Commission and the Mental Health Act Commission they've got quite a reputation for carrying out a large number of inspection visits. Some campaigners have worried that CQC will rely more on institutions self assessing themselves, which they say could mean problems are more likely to stay hidden, will care homes and mental health units will they continue to receive the same number of inspection visits? BOWER Yeah absolutely, I mean at the moment what we're saying is that the staff who currently work in - who are inspectors and assessors in social care and health and the commissioners in the Mental Health Act will come over to work for us and at the moment the last thing I want to do is start interfering in the models of inspection and review that they've been accustomed to doing. WHITE Are you going to have the same staff levels? BOWER We are going to have the same staff levels. But of course what we'll want to do as a regulator is we'll want to look and see what represents the right approach - life moves on, self assessment I'm sure will always be part of the regulatory landscape. What we're going to have to do, like everyone else, is look at the balance between self assessment and inspection. WHITE What are your own personal experiences of the system because it always looks different on the other - when you're on the other side of it doesn't it? BOWER I'm a mother and so when my son was growing up I was a much heavier user of health services than I was when I was a single person. I have - I had an elderly mother who my sister and I cared for until she died fairly recently and at that point we were very heavy users of the health and social care system. WHITE And how good were you when you weren't getting what you wanted, because you hear a lot of people say I'm really good at giving other people advice, when it comes to fighting for myself I find it more difficult, I'd be interested to know how you reacted when you didn't get what you wanted? BOWER Well what I - what I found most interesting when I didn't get what I wanted - and I'm thinking most particularly about when my mother was ill - was how reluctant my mother was to make a fuss, even though there were things about the services she was getting that weren't very good she was reluctant for myself and my sister to make a fuss. And so there becomes almost an embarrassment factor, you know, oh dear if I'm jumping up and down on the ward every five minutes and making a fuss then somehow or other that's unseemly. And it was much - it was much tougher to take a stance than I had - would have anticipated. WHITE And is that why it's often harder to make the changes that you want to make because presumably a lot of people with - the generation that you're talking about - a lot of people are having the same problem, I mean it rings bells with me with my mum? BOWER I think what - what I tried to do, not always successfully, with my mum was try and reassure her that no matter what we said that the care was still going to be available to her and that what we were trying to do was get the best possible care for her. But what you see then is that that improvement system has got to be all around you, it's got to be in how the staff treat you, it's got to be how advocates are available to you, it's got to be how people are treated themselves on wards. So it's what you do realise is that it's a total system that's got to kick in to support someone, otherwise they do feel very isolated. ROBINSON Cynthia Bower talking to Peter White. And the Care Quality Commission's consultation on how it intends to monitor organisations runs until March 12th. That interview is available as a health podcast from our website. Back to the You and Yours homepage The BBC is not responsible for external websites |
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