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| TX: 01,04.09 - Care Quality Commission 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 The Care Quality Commission starts its work today, taking over as the independent regulator of health and social care in England from three now defunct organisations. They were The Healthcare Commission which looked at the NHS; the Care Quality Commission which covered councils and care for elderly and disabled people and the Mental Health Act Commission which oversaw mental health services. This morning on The Today programme the Care Quality Commission's chair, Baroness Young, said that the economic downturn will make its role even more important. YOUNG (INTERVIEW FROM THE TODAY PROGRAMME) I think the worry about the recession generally across health and social care is that those who pay for it will have less money and therefore care home owners will cut costs and cut corners and quality may suffer. We're going to have to keep a very, very close eye on that. Both self funders of care - people who are paying from their pensions or even from releasing money from their homes - and indeed local authorities are going to be strapped for cash. And the worry also is that if we see cuts in the health service as a result of the financial squeeze that we will also see pressure on healthcare systems, just at a time when generally it is acknowledged that for the most part the provision of healthcare has improved dramatically over the last few years. ROBINSON Baroness Young who chairs the new Care Quality Commission. Well joining me to discuss the advent of this new organisation are Ray Jones, who's professor of social work at Kingston University and Paul Farmer, who's the chief executive of the Mental Health Charity MIND. Paul Farmer, do you welcome the merger of these three inspectorates into one? FARMER Yes MIND's pretty pleased that this new commission's come into force because people's journeys didn't really fit neatly into those three separate regulators. People go in and out of health and social care and on occasion in and out of compulsory care. We're also quite encouraged that the people who are in charge have got a very good understanding of these issues and it's good to see a commissioner with direct experience of mental health problems sitting there as one of the people in charge. ROBINSON In what way does she have direct experience? FARMER This is somebody who spent time in and out of mental health services and has used mental health services extensively, so we believe that's a really important sign that the patient experience will be really well heard. However, we do recognise that there are going to be some significant challenges for this new regulator and there's new mental health legislation which is only four months into its life which is going to need some very careful assessment and analysis to ensure that it isn't misused. And as you heard from Baroness Young there's also some real challenges around the application of the quality of mental health services, not just in a downturn but the last act of the Healthcare Commission was to publish a report which suggested that progress around mental health has been quite limited in the last couple of years. ROBINSON You see there are people, aren't there, who say that mental health is always sidelined and that bringing it into this big new organisation will mean it will be even more sidelined than before. FARMER Well we're absolutely clear that that mustn't be the case and it's really crucial that the commission recognises this as quickly as possible. And as I said we are encouraged by the early signs, including the announcement of a special inquiry into the physical healthcare of people with mental health problems, which we know is an important part of this. But you're quite right - there's always a risk that mental health is sidelined. We want to see the new commission treating mental health as a priority and using its new joined up powers to really improve the quality of the experience of mental health service users. ROBINSON Professor Ray Jones, what are your concerns? JONES Well I'm less happy about the combination of those three inspectorates - the Healthcare Commission; the Commission for Social Care Inspection and the Mental Health Act Commission - into one big inspectorate commission - the Care Quality Commission. And I tell you what my concern is, my concern is that with the responsibility that the new commission has, the CQC has, for healthcare and for inspecting NHS services it could well lose a focus, which has been a very positive focus in the past, on what's happening for people who are disabled and with long term conditions and older people living in the community. So I'm concerned about will proper attention be given to the services for those people and will the organisation itself retain the expertise it needs to be able to do that work? ROBINSON And what does past experience suggest? JONES Well the past experience suggests that in terms of when for example the Commission for Social Care Inspection lost its responsibilities for children's services, children's social care services including child protection, that went into Ofsted. Ofsted's track record was in terms of inspecting schools and education and it hasn't quite managed to grasp, I think, some of the nuances and some of the issues in some of the children's services, real sharp end services like child protection. And I do have a concern that the Care Quality Commission could trip over itself in terms of a major focus on the NHS and lose the expertise and the attention on some of those social care services. ROBINSON Paul Farmer? FARMER Well there's no doubt that there are some legitimate concerns, particularly in this area of supporting people who are living in the community and social care provision is a key part of making sure that this is got absolutely right. And I suppose in a way the commission has to follow the trend, so people's experiences are increasingly in mental health, we're spending much less time in hospital, much more time in the community, receiving a combination of health and social care. So it makes sense for the regulator to be having an oversight for the way in which these services are provided. ROBINSON But what about this point that when you amalgamate these inspectorates you lose skills and you end up with people inspecting organisations that they don't really understand? FARMER Well I think there's - it's something we've really got to keep a close eye on, there's no doubt that at the moment the skill set of those people who are being transferred over into the new commission is high, we need to make sure that that isn't lost. It's also important to make sure that the skills from the individual previous inspectorates are joined up, so that we make the most of them rather than lose this very specific expertise that they have. ROBINSON Professor Jones, we're told that the big benefit of joining up all these inspectorates is that it will lead to this much more to joined up thinking, that we keep being promised, and that people won't fall through the cracks, whatever that means. You're not convinced by that, that if you have one inspectorate you can make it seamless care? JONES Well that is possible and that is the goal to be achieved and it was achieved to some extent in the past by people having defined areas of expertise and particular responsibilities across three inspectorates and working well together but making sure that what was valued was the different expertise they had. My concern is that within one big organisation and it will be an organisation with a tremendous scope in terms of its responsibility - the Care Quality Commission - that the NHS will come to dominate and within the NHS what often happens is the sharp end issue around what is happening within acute care and within hospitals comes to dominate. And there is a danger - and mental health services do get called a Cinderella service, services for disabled people sometimes I have to say look as though they've missed out being invited to the ball as well - that within that context we could find a lack of focus on real issues about the quality of care for disabled and older people. ROBINSON Professor Ray Jones, Paul Farmer - thank you both. And we're going to be speaking to the Care Quality Commission's chief executive Cynthia Bower next week on You and Yours and we'll put some of the points that have just been raised here to her then. 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