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TX: 01.04.04 – INTERVIEW WITH HEAD OF NEW SOCIAL 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
The drive to raise standards in care homes for the elderly has been blamed for a big contraction in the business. More than 70,000 places have been lost over the past few years. This struggle to provide enough good quality care at an affordable price is being played out, not only in relation to older people but right across the care sector in services for adults and children with disability and for children in care. Today a new organisation comes into being, taking over the inspection, regulation and audit of care services. The Commission for Social Care Inspection will do work previously done by three existing bodies - the Social Services Inspectorate, the Audit Commission and the National Care Standards Commission. It will have some additional political clout, reporting annually to Parliament on the state of the care market in England and advising on how policy should be shaped.

David Behan is the chief inspector for the new commission and he is here. You're being asked to regulate a system which is widely regarded as failing at the moment. If we could start with care homes for the elderly, what do you think of the situation that you have inherited?

BEHAN
Well good morning and thank you for the invitation. We are a new organisation and for the first time we'll have a single body in this country that brings together a range of functions. And as such we'll be able to have an integrated approach to inspecting and regulating care services. Our central function is to drive improvements in care services in this country. And at all times we will put people who use services at the centre of what we do, so we're going to listen to what they tell us about how they experience care. We know we've got some big challenges, services for children and care for older people, and what we know from the evidence from one of our predecessor bodies that the way that care homes are meeting standards has improved year on year. And that's the evidence that shows that regulation is working. Some of our ambitions in this work is to move towards a more proportionate approach to regulation and what we mean by this is where people are operating above the national minimum standards that we reward that by a lighter touch in our regulatory activity. We also want to look at where regulation gets in the way of good practice and an example of this would be if somebody is in a residential care home and they're beginning to suffer from Alzheimer's dementia then very often what will happen to that individual is they will have to move home because a home won't be registered to provide dementia care. But what we know about good practice for people with dementia is that continuity of care is important and not changing their care. So they're the kind of things that we want to look at and see if we can deliver some improved approach to regulation and inspection.

ROBINSON
Well we've heard on this programme from lots of home owners who claim that the push towards higher standards, which you say has improved the provision that is available overall, and at the same time this push for lower costs is in fact driving them out of business.

CLIP
CATHERINE
Here in Lancashire we have the higher rate and the lower rate. The higher rate as it is now is about £286 if somebody comes who's very dependent.

SMITH
Roughly what would you say would be a realistic price?

CATHERINE
I would say £370. It sounds a lot of money but when you've added in too the 168 [indistinct word] it's only a few pounds.

SMITH
So you're saying that at the moment you're being paid £286 for a resident when in fact you should be paid nearly a hundred pounds more?

CATHERINE
Yes. So really we are absorbing all those costs ourselves.

ROBINSON
Eddie Catherine from Lancashire talking to Charlotte Smith back in January last year and since then he has sold his home. How on earth can you square this circle, this business of home owners saying that they cannot afford to provide services at the prices that local authorities are offering?

BEHAN
Well one of our key functions is to feed back to government about how policies are being delivered on the ground and the impact that they're having on people. We did a survey yesterday, a Mori Survey, to launch and one of the things that people said to us in that is people clearly want a range and choice of services, they do want to stay at home, three quarters of the people in the survey wanted to stay in their own homes. And there's an important debate to be had about the amount of money that's in the system and then an important debate to be had about how that money is being spent. And one of the challenges from our survey yesterday was about whether that money is being available to deliver a range of choice - some people wanted direct payments to make arrangements for their own care and certainly a choice of services at home. We do have a function to look at value for money in social care services, this is a new function we've been given and we look to discharge that. And one of the things we will look at is regional variations in cost, these variations between Lancashire say and variations in the South East of England. And through our activity we will gather evidence around the impact on people of these variations in charges. But we're a regulator and the view that we need to take is about charges which are fair and the equity and transparency of those charges and look at this gap between cost and the quality of services.

ROBINSON
Well why we're on this subject about wide variation in charges levied by local authorities for care services let's look at the care provided at home. In January a study by the Coalition on Charging suggested that these charges are rising very sharply and this is Kate McMullan.

MCMULLAN
The Coalition on Charges charge in this report shows that this happening to a number of disabled and older people. They're experiencing a few hundred per cent rise in their charge. For instance a man in the report who's 73 years old, recently retired, worked all his life, needs 14 hours care a week but he'd paid £12 up until last year and under the new guidance is now paying £112 a week for these essential services which we're talking about - getting out of bed, getting a bath, going to the shops. So these are really essential services that non-disabled people take for granted.

ROBINSON
Kate McMullan. What seems to be happening is that after ministers promised that prices would be standardised to a certain extent across the country local authorities seemed to use that as an excuse to push charges up in some cases. Shouldn't there just be a standard charge if it's the same service, regardless of where you live?

BEHAN
I think one of the issues that we've found over the past 12 months is that those people who are living on very low incomes have been removed from the charging and clearly …

ROBINSON
So that's obviously a good thing but let's talk about the rest.

BEHAN
That's a good thing and one of the issues that your clip has raised again is this issue about regional variations. Now there is guidance for all local authorities to operate on and one of our tasks is to look at where these regional variations occur and through the evidence of our inspection and regulatory activity draw together these messages and feed these back to local councils and to central government about the impact of policies on individuals.

ROBINSON
So in layman's terms you'll be able to tap a local authority leader on the shoulder and say this is not right, these charges are too high?

BEHAN
One of the issues - one of the roles we need to play is to challenge local authorities to ensure that they're providing the best quality services for all their residents in their area.

ROBINSON
Well as you said at the beginning there are huge shortcomings in services for children, recently exposed in the Victoria Climbie case and there's legislation going through Parliament at the moment in response to that. It was one of those cases where it seemed no one took very much time to speak to the child herself and in February on this programme we examined the stigma that still surrounds being in care for children in this country. Sarah Jane told Peter White about her experience on Call You and Yours.

SARAH JANE
It was scary because it was a really big house, there were 14 bedrooms and then two flats attached on to the side, just like four or five staff all the time.

WHITE
Now what about when you had to leave, explain to me what happened and how you were told what was going to happen.

SARAH JANE
Just one day I were told that I was going to be moving out and into an hostel, I weren't given no choice.

WHITE
How old were you then?

SARAH JANE
I was nearly 17.

WHITE
And how long did you have support for when you came out of the home?

SARAH JANE
I didn't, I didn't have a social worker after I'd moved out of the children's home.

WHITE
So really you were very much, you were left to sort of fend for yourself and get on as best you could?

SARAH JANE
Yeah.

ROBINSON
SarahJane talking to PeterWhite. That shouldn't be happening now, there was a promise many years ago by this government, almost one of its first promises, that children leaving care would not be left unsupported. Is it still going on?

BEHAN
It's a very powerful anecdote and one of the important senior positions we've got in the commission is a children's rights director. And that person, Roger Morgan, is responsible for ensuring that the rights of children, children looked after as the one in your clip, their rights are protected in everything that we do. His job is to meet with children that are looked after, listen to them, so that we can respond to their claims. And a good example of this is recently where a number of looked after children had been making representations to Roger that they couldn't stay with friends overnight because the friends needed to have checks done on them and this was a barrier and my children have stayed with their friends overnight and this was obviously preventing them engaging in normal activities for children. So one of the things that Roger has done is make representations to the Department of Health and a couple of weeks ago those regulations were changed. So now children can stay overnight. And that's a really good example, I think, of where we've listened to children and actually taken action to change the regulations, so we are responding more to what they tell us.

ROBINSON
But this very big issue where targets have been set for local authorities to make sure that children who leave care have the sort of support that a child in a regular family would have - is that being delivered on the ground?

BEHAN
The position nationally is variable and in some places you'll hear children speaking well and positively of the support that they've received from social workers and then in other places you'll get clips like the one that you've played. Our job is to challenge local authorities to make sure that we're all working, they're all working to the standard of those best authorities and clips like you've just played become consigned to history because children will be talking about the support that they've received to move forward and I think the BBC series recently featured some good examples of some really positive work and raising some of the really difficult issues that people are working within to deliver good quality services to children.

ROBINSON
If we ask you to come back on this programme in a year's time what will you have achieved?

BEHAN
Well we hope that we'll have made some significant progress and we're determined to do this and actually removing those regulations which get in the way of good practice. So the examples that I use about the child and individuals with dementia we've got solutions to those and we can be talking about moving on to remove other barriers to good practice so we can deliver improved services to people in this country.

ROBINSON
David Behan, head of the new Commission for Social Care Inspection, thank you.





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