Outgoing Commission for Social Care Inspection chair Denise Platt has signed off with a warning about the ability of its successor body to be an effective social care regulator.
The Care Quality Commission started work today, absorbing the CSCI’s social care functions, the Healthcare Commission’s role in health regulation and the Mental Health Act Commission’s responsibility for protecting the interests of detained patients.
In an interview with Community Care, Platt again expressed her concerns about the CQC’s ability to scrutinise social care services and represent users.
Public focus on health
She said there was no doubt about the commitment of the chair Barbara Young and chief executive Cynthia Bower to social care, but warned that the CQC would struggle to balance its health and social care responsibilities “because of the focus of public attention” on health.
Adult social care failings were unlikely to have the same public impact as those in health, she said, citing the recent Healthcare Commission report on emergency care at Mid-Staffordshire NHS Foundation Trust, which caused a media storm and sparked two government inquiries.
Loss of expertise
The CQC lacked people with social care expertise at senior level, with Bower, who left social care management in 1995 to pursue a career in the NHS, being the only person with a background in the sector at executive board level, Platt said.
Many CSCI managers have not transferred to the CQC. She said that Lord Laming noted in his recent child protection report that there was a loss of expertise when the CSCI transferred responsibility for children’s social care inspection and regulation to Ofsted in April 2007. “The CQC needs to be aware of that,” she added.
Impact on policy questioned
Platt also questioned the ability of the CQC to have the impact on social care policy that the CSCI has had, primarily through its annual State of Social Care reports. For example, the 2008 report focused on the poor experiences of people who did not qualify for publicly funded social care and led to the DH promising to update guidance on eligibility criteria.
“The focus on social care policy may be diluted in a body that’s set up to look at both health and social care,” Platt said.
She also suggested that the CQC would be less independent from the DH than the CSCI.
The CSCI’s greatest achievements had been its impact on social care policy and its focus on involving users in all aspects of its work, she said, adding that CQC needed to take this further.
She also said the introduction of quality ratings last year for social care providers was a significant CSCI reform. A report on the ratings published last week found they had made a strong impact on councils’ commissioning decisions with more than four out of five using them in the purchase of care home places.
Doubts over personalisation
With the government’s three-year personalisation programme reaching the end of its first year yesterday, Platt also warned that while there was much “goodwill and activity” from councils on making care person-centred, “activity doesn’t equate to better services”.
She added: “That’s what the CQC needs to look at – whether activity is delivering better services. Until we start to see a difference for individuals, we are still at the start of a long road.”
The Care Quality Commission