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TX: 10.02.10 - Quality Care Commission

PRESENTER: WINIFRED ROBINSON
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
There's been more criticism today in the Commons of the government's promise to provide free care at home for the most needy. In today's Times 70 councillors across England have called the idea ill conceived and unaffordable. Also today the inspection body - the Care Quality Commission - has produced its first report on the quality of this kind of care. It's the help with basic tasks of everyday living - getting up, getting washed and dressed, cooking a meal. The commission wants local council social services departments and NHS trusts to work more closely together. One place that's tried to do it is Herefordshire, it's one of only two places in England. Chris Ball is the chief executive of both the council there and the primary care trust.

BALL
Obviously we still have the situation where services are paid for in different ways but in a sense that shouldn't be the problem that the user focuses on, what the user should focus on is their own needs and we should focus on how we work with them to meet those needs. What we shouldn't be doing, it seems to me, is handing the problem of the relationships between different bits of the system to the user, that's our problem that we need to solve.

ROBINSON
So you act as chief executive to the two bodies, so you are in effect doing what was once two jobs and other managers similarly then now work for both the PCT and the local authority?

BALL
We've got a single management team for the two organisations, so how I often describe it to people simply is that we're two organisations being supported by a single management structure. We have managers that are responsible for both healthcare and social care services, as well as other council services and what that does is it creates a culture within which professional staff can work together.

ROBINSON
You must still be rationing scarce resources, do you believe that you're getting more for your money?

BALL
I wouldn't pretend for a minute that we've solved all of the problems but that is the objective. The objective is to get the best value we can for local people's money. And actually it's also to make the service better because duplication is both expensive but it's also - it doesn't feel good from the point of view of the user. So this is both about quality and cost.

ROBINSON
When you talk about duplication was it duplication in management roles or do you think that some services were duplicated, were people - I don't know - for example perhaps being assessed by more than one set of professionals?

BALL
I think that's probably more of a point, I don't think it's so much that the direct services themselves are duplicated, though I'll come back to that. Where we need to get to is a place where we have the fewest possible number of people involved in the assessments process, so that people aren't telling their story to numerous different professionals and that a single assessment is able to kind of crossover into a range of different service needs that people have. But I think there is also some potential to think about how we can develop skills across different bits of the workforce, so that we can ensure that some fairly simple things can be delivered by different kinds of workers, whether community nurses or social workers or therapists or whoever, so that, for example, if somebody needs some fairly basic benefits advice that that could be delivered by the worker who happens to be with them rather than them needing to be referred elsewhere.

ROBINSON
Do you believe that you are rationing what you have more fairly than before?

BALL
Yes fairness clearly has to be an issue. But that doesn't take away the reality which is that in any system where public resources are limited we have to make choices, that we have to be clear that we make those choices based on good transparent and understandable criteria and that we communicate well with people around making those choices.

ROBINSON
The feeling for a lot of people on the receiving end of these systems - and we get a lot of e-mails from people here at You and Yours - is that it really - they really are systems that respond to those who shout loudest and the feeling is that there must be a great pool of people who are not good advocates for themselves and have not other advocates who simply get left out.

BALL
Well the health and social care system is a system which is designed to deal with people who are vulnerable and people who often cannot be their own advocates and I think it's really important that we recognise the role of different people - people such as GPs, part of their role is to make sure that vulnerable people who may not be strong advocates for themselves still get access to services whether they're health services or social care services. So I actually think we have a responsibility to make sure that we don't run a system designed to meet the needs of those who shout loudest and that we do make sure that it's a system which is based on choices based around need rather than choices based around the level of someone's noise.

ROBINSON
That was Chris Ball. What's your experience of trying to get help at home with basic are? You can call us 0800 044 044 or e-mail bbc.co.uk/radio4/youandyours. There'll be more on the government's promise to provide free personal care to the most needy on the World at One and they'll be talking to the Health Secretary Andy Burnham.

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