Dame Denise Platt - CSCI

ePolitix.com speaks to Dame Denise Platt, chair of the Commission for Social Care Inspection, about the Health and Social Care Bill

Question: Congratulations first of all on winning the title of Public Servant of the Year at the Women in Public Life Awards 2008. What does this award mean to you?

Dame Denise Platt: It means a lot, it was very unexpected and I was surprised at how pleased I was. I was pleased because it raises the profile of social care and helps to make sure that the voices of the people who use social care are heard in the national policy agenda and this is really what the commission is about.

So to receive an award that recognises what we have tried to do as a commission was important. It was also important that it was an award for women in public life. There are a lot of issues around women in social care, the majority of the workforce are women and they often work in low-paid jobs, perceived as low status jobs. To the people who rely on these women, the jobs have a very high status because without the work that they do their lives would be very different.

An awful lot of informal carers are women, there are increasingly more men in caring roles but the majority are still women who often do not have their rights as citizens recognised.

If you look at older people's services, the vast majority of people receiving the services are women and if things are not well run, these women will very often have their achievements and their identities completely overlooked. People do not see that they are women who have done things with their lives. So it was really important that it was an award in recognition of women in public life.

Question: You were given the award in recognition of your work to raise the profile of social care as a national policy issue; are you still concerned that social care is not being given the same attention as health care by government?

Dame Denise Platt: There is increasing acknowledgment that social care needs to have more recognition and understanding. This is definitely one of the regrets I have about the fact that the Commission for Social Care Inspection is going off the stage at this moment in time.

We are an organisation that is about social care and we have consciously tried to raise the issues that everyone involved in social care worries about and has concerns about. We have then tried to amplify those concerns and just as we are getting these issues heard we have to disappear.

Even though social care will be a large part of the new Care Quality Commission, you can see that any chief executive appointed will spend most of their time worrying about the health service because that is what politicians worry about. So, yes, I think getting social care listened to and heard about has been one of the achievements of the CSCI.

I think what we need to see is the green paper we have been promised. We were promised a process to develop the green paper around the new settlement between individual family and state and who should be responsible for what in the provision of social care.

This is an issue we raised in our second State of Social Care report. Now we need to see the paper, we need to know what the process is going to be, and we need people to stop talking about it and to actually have the process in place.

I will know that social care has really landed on the policy agenda properly if the new settlement is given serious political attention from all the parties and not just the government.

Question: The Health and Social Care Bill contains plans to create the Care Quality Commission, how exactly would this change the face of social care regulation?

Dame Denise Platt: It introduces for the first time one set of registration requirements for health services and social care services. The government has now issued the consultation document proposing what the registration criteria should be and there is such a level of generality that it is difficult to know how they will operate in practice.

The Bill does bring in changes of this uncertain nature. It is difficult to see, for example, how the registration criteria for an acute hospital and domiciliary care services, delivered to people in their own home, can be common without over-regulating some parts of the sector and under-regulating others.

It is also the case that social care services sustain people in the way that they want to live their lives. If you are a person with learning disabilities, you may rely on social care services to help you get up and get ready for work. One of our experts by experience in the Commission is a carer, he is looking after his partner and social care services help him as a person with learning disabilities to look after his partner.

So these are services that are alongside you while you carry out your daily life and achieve what you want to achieve. Whereas a lot of the health services, such as GP services, are episodic in nature they are not the way you live your life, you do not live in the clinic.

There are distinct differences between health and social care and by trying to bridge them together these differences can be missed; you can force health services to operate in ways which are not appropriate for health services and vice versa.

There are times in people's experiences, such as when they leave hospital or if they have a major incident, such as a stroke, where health and social care services have to work very closely together or it can be distinctly difficult for the patient. Quite often after they have worked together, social care is the service that remains with the person.

My worries about the new commission are that it actually looks backwards to an institutional way of regulating services, rather than looking at where the policy is taking social care. I am thinking particularly here of the personalisation of individual budgets and people saying what the mix of their own care services should be.

These services may, of course, not be in an institutionalised setting, which means that old ways of looking at how services should work together may not be appropriate in the future. If people are given an individual budget, they will integrate health and social care services in ways that we have not yet thought about, and so in many ways it feels as if the Bill is backward-looking.

Also, because the Bill specifies common registration criteria and then lots of compliance criteria, what appears to be a simplification of the agenda could actually result in something really bureaucratic, where there are lots of compliance standards depending on labels attached to the services. And so social care regulation will be changed in that way.

I think the major concern that we have about the changes is that the Health and Social Care Bill, currently going through Parliament, does not have enough emphasis on user involvement in the activities of the new commission. That has been a big issue for us; we have involved people who use the services in everything that we do. The Bill just says the commission must 'take account of' service users, which is not strong enough.

Question: CSCI has warned government they think these changes to social care regulatory bodies are premature, why is this?

Dame Denise Platt: I think the change at this time is premature because the policy around social care is at a state of flux and people who use services must be considered when looking at policy changes, such as the personalisation agenda and how regulation can best support that agenda.

I do regret the changes because we were set up to do very particular things. We were set up to reform the way in which care homes and domiciliary care services are regulated. We were set up to introduce systems that differentiate between how the public can tell the difference in quality of different services.

However, we have not completed that process and it feels as if we are handing over a piece of work that is unfinished.

The personal regret for me is that I know what we could have achieved and it is frustrating not to be able to see it through.

Question: The creation of the Care Quality Commission will be the third proposed change to the regulation of social care services since 2002, how has this affected service users and the workforce in the sector?

Dame Denise Platt: This is true, it was announced that one of our predecessor organisations was going to be abolished 17 days after it started work. Therefore, when we were created there was a lot of cynicism, and indeed, we did not get to the end of our first year before the changes were announced.

People were very angry, I was very angry, the people working at the commission were very angry. We adopted the policy that we were going to carry on and try to do the things we were set up to do until we were told to stop and I suspect that this year, four years on, is where we are being told to stop.

We refuse to be defeated in a way, and we have gone about our work trying to do things differently. We have tried to involve people who use services differently and to give people a different experience of regulation.

In particular, we have tried to focus on the public’s need for information. Very particularly too, we have tried to focus on the needs of those people who are buying their own care, the self funders, and draw attention to them. We have also tried to give our experts by experience more of a say in the way that we operate as a commission.

As our work transfers to a new body, which will do things slightly differently, we hope that some of our focus and ways of working will be transferred. We will try to help our staff to transfer with a set of values that they think are really important to delivering social care.

Amazingly, as far as our workforce is concerned, staff turnover is not great, people are not leaving us in droves. I suspect the next critical point for our staff will be when the next chair and chief executive are chosen.

As far as people who use services are concerned they are more worried than the people that we regulate, I think there is more nervousness because people who use services feel that they may lose what they had gained, they may lose the involvement, and they may lose the voice. I think they will be worried about being over medicalised in a health-dominated environment. So people who use services are more fearful.

Providers themselves will be concerned about what the new registration system will mean in terms of bureaucracy and relationships. There was a feeling at the inaugural stages of the CSCI that, if we kept our heads down, another reorganisation would be along in a minute. So there will be speculation that the Care Quality Commission may not bring the reorganisation of the regulator to a complete stop.

Question: There are still lots of concerns about the levels of elder abuse in care homes, what can be done to ensure older people who use social care services are better protected?

Dame Denise Platt: I don't think we know enough about the prevalence of elder abuse but we do know there are increased levels of concern around elder abuse for people who live in their own homes, or in family situations. In care homes, serious abuse in many ways is easier to tackle because you can see it. The abuse elder people find draining consists of casual comments and behaviour, inconsiderate treatment and staff ignoring individual personalities.

I have quite often visited residential care homes where staff are very busy going about their business and doing things very well. However, the people that live there can be like shadows in the background, watching the staff do their work. That is not how it should be, what we need to look at is how our services can really respect people as individuals.

There is a quote that when you have met one person with Alzheimer's disease, you have met one person with Alzheimer's disease - you don't know what all people with Alzheimer's disease are like because you have met just one of them. If you have met one older person, you have met one older person, all older people are not the same and yet we talk as if they are, whether they are 60 or 90. We would not talk about babies and 30-year-olds as if they are the same.

When providing social care, we need to relate to the person and we need a system of care that recognises what people have achieved, what they still want to do, who they are, what their concerns are, and what they value. We must support the positives in people, rather than the discriminatory attitude which can see old people as a nuisance, invisible, who have nothing left to contribute.

For example, if it wasn't for older people living in our communities, a lot of the voluntary sector would fall apart. I sat in a room full of people who had been called together by a very well meaning person in a primary care trust to look at active ageing.

The people in the room were all about 70 or 80 and it was absolutely clear that they thought she was talking about other people, they didn't think she was talking about them. They thought she was asking for their help with some other group.

Equally, when I went on holiday to Syria a couple of years ago on a trip, the most agile person on this trip who was leaping about over archaeological sites like a mountain goat was 86. You could not have written her off because of her age.

The abusive attitude develops when people are no longer seen as people and they become objects or commodities, either in the community or in residential institutions.  Care homes are closed institutions, the doors may be open and people can come in and go out but they can feel very closed and claustrophobic environments and behaviour, which in other environments will be completely unacceptable, becomes the norm. This is why an external inspection process is really important if we want to challenge these patterns of behaviour.

Question: There are a large number of people who care for their own family members, how can we do more to support these carers?

Dame Denise Platt: I think one of the problems is that carers are often only given support in their caring role and not necessarily given support to be citizens in their own right. Clearly there has been legislation that has supported carers rights. Still, when we inspect, we find that they are only offered support in order to carry out their caring role, and often offered inappropriate support at that.

I have met lots of carers who have told me they are perfectly happy caring for a relative because they are close to the person and feel comfortable doing it and enjoy doing it.

However, what they want is someone to do the cleaning, shopping and cooking while they do the personal care work, but social services say these are low level services and can't be provided anymore.

That is complete nonsense and these ideas need to be turned on their head. Carers should be given the caring support they think will be helpful to them in their situation. This may mean another carer comes in to be with the person they are looking after while they go to work.

It could mean someone to do the cooking or cleaning while they are doing the personal care. The care should be on the carer's terms and not based on what other people think is the right thing for them. Carers do benefit from respite care but that is not enough.

Question: Do you think that there are other eligibility questions in social care context that perhaps needs to be changed?

Dame Denise Platt: As you know, we have been asked by ministers to do a further review of eligibility criteria as a result of our findings about people really struggling to get assistance.

It is difficult for me to anticipate the outcome of this review but we have had a listening event already where we brought together people who use services, careers, local politicians, commissioners and service providers just to listen to what people think about eligibility criteria. The situation really is a mess and we look forward to throwing some light on it.

Question: Do you have any final comments for ePolitix.com readers?

Dame Denise Platt: I would like parliamentarians to be vigilant when CSCI no longer exists, and to continue to ask important questions about social care services.

I would like them to continue to scrutinise at the work of the new commission through a human rights lens and to ensure that people who rely on social care are encouraged to participate as much as they can.