Health Director

The Challenges Ahead

The first year will no doubt be a time of development for the Care Quality Commission. What issues do you feel the organisation will face in the changeover from existing systems of inspection?

I think the transition really covers all of our regulatory work, not just inspection, because we have three different ways of working between the Commission for Social Care Inspection, the Healthcare Commission and the Mental Health Act Commission. We need to think about what the best practice is across all three commissions and bring that together so that we can have the benefit of building on the best that the three organisations have brought to us.

First of all we are going to be introducing a new registration system across all of health and social care starting from next April. Healthcare workers in the NHS will be the first to join in April 2010 and all of social care and the independent healthcare sector will follow in the October; then 2012/13 will see general practice and primary care services, so that GPs and dentists will be the last to join the system.

That will be an opportunity for us to have a single registration system however, obviously we want to play tunes on it for the different care settings because regulating a big complex academic research centre is very different from regulating a small domestic care home.

Practically every single thing we do we will have to look at again to decide what the model is for the CQC. We do want to very much focus on some key flavours; we are about looking across health and social care for the first time and that is the prime benefit of bring the three organisations together. We want to make sure that we focus on quality of care for the individual, on personal care, on bringing the users to the centre of everything we do and making sure we are focused on improvement. We want to be fairly fast moving, we want to pick up issues and deal with them to make sure we are helping make services improve. Rather than focusing on what’s gone wrong, we want to ensure that things go right in the future.

With the remit of the commission now covering all of the former organisations, how does the CQC plan on better meeting the healthcare needs of people in care homes?

While of course it is for the providers of care homes and the local NHS professional and managers to actually deliver the service, our job is to assure the public that people’s needs are being met and organisation are providing quality services. One of the first things we are going to do is our review into the quality of healthcare being provided for people living in care homes. Within that, we will be examining NHS-funded homes, primary care and community healthcare services, general practice services, and the quality of care for those living in care homes by the care home staff themselves.

Questions have to be asked such as are people in care homes able to have a say in their healthcare and the does care delivered to those who live in residential care up hold their human rights and respect the individual, who are a very diverse group of people? So that will be a major issue we will be looking at, however, there are a variety of other ways in which we will be looking at and making sure that services join up between getting healthcare within the social care setting and vice versa.

What sort of positive changes do you feel will be put in place follow the responses from the consultation for proposals for 2009/10 assessments of health and social care?

Of course the annual health check and the annual assessment of social care are very much in transition, because we will be moving to the new registration system and we are going to have to make our minds up about what we do by way of periodic assessment of health and social care as a result of that. I think in social care very little will change for this coming year and in health care we’ll ask the trusts to make the self declarations about their compliance with the national Standards for Better Health.

That’s for the first six months and in the second six months we want them to be very much focusing on the future registration system, because they will be applying to become registered in the autumn in a view to be registered by 1 April. So we want to get them focused on the standards that are going to be within the new system, so it’s a bit of a transition year really.

How does the commission plan on regulating health and adult social care services to ensure quality and safety standards, drive improvement, and stamp out bad practice amidst the challenges of our ageing population?

I think the golden thread running right through everything we do is going to be the belief that our approach has got to be based on basic human rights, equality and dignity. Now that is particularly true for people who get marginalised due to their circumstances; like elderly people, those with dementia, learning difficulties and a whole variety of others. So we really want to take a rights based approach to our work but, apart from that, we want to look at some specific issues that are important for people particularly the elderly. Along with the study into care homes we are carrying out, we are also looking at the stroke care pathway and we will be working with the DH to look at ways in which we can help with the implementation of the dementia strategy. We want a strategy taken forward that puts people right at the centre of dementia care and in the future we may look at the dementia care pathway.

Nutrition is another important issue for older people and we will have this as one of the new registration requirements, so that all providers of care will have to ensure that people are getting palatable, enjoyable food and are encouraged to eat it. We also want to ensure that people are being properly hydrated, that they have appropriate access to water and are encouraged to drink, it’s so important with older people. We’ll also want to make sure we are looking at how providers of services are involving their stakeholders, particularly their elderly stakeholders, and the users of services, helping input how users are feeling about services. We want to look at how providers are respecting dignity and providing care in a safe environment.

So there is a whole variety of ways, through our registration process, our special reviews, our annual assessment and also by putting this information in the public domain so they can make choices and we can help assure people of the quality of care.

Do you think that the governments National Dementia Care strategy and Adult Social Care Green paper go far enough to tackle the complex health and social care issues facing the country?

I think its early days for both of them yet and we haven’t seen what the government’s next stage will be on the green paper in its follow up expected in June. However, it’s one of the biggest public policy issues around at the moment, how to meet the care needs of an increasingly ageing population. It really does give the opportunity for the government laying out a new settlement on social care and to help people understand what they are entitled to, what they are going to have to fund themselves and what the funding mechanisms are.

The dissemination of information and the anguish of not understanding what you are entitled to can have a negative impact on those in need of care. How do you think that can improve?

I think its several fold actually because it’s also about the fact that there are people who are inside the system and there are those who are lost within it, which the Commission for Social Care Inspection (CSCI) pointed out. One of the most recent CSCI reports released mad the point that whatever happens we need a system where everyone is entitled to an assessment of what their care needs are. This is to ensure that everyone has access to help, support and an understanding of what care services might be available for them to meet their needs. From there the discussion can then happen about how this is going to be paid for. At the moment there are some local authorities who will select people out from assessments because they feel they have resources of their own, whereas the need is that everyone gets their own helping hand with the assessment process.

Baroness Barbara Young, chairman, Care Quality Commission spoke to Natalie Quinn, editor