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Published: 26/02/2004, Volume II2, No. 5894 Page 24 25

As chair of the Commission for Social Care Inspection, Denise Platt will oversee a newly created body, bringing together the inspection of both public and private social care services.How does she see her role at the heart of a new world of integrated care, on which so much political effort is being focused?

The social care fraternity voiced doubts last July about the suitability of Denise Platt's appointment as chair of the new Commission for Social Care Inspection. Would Ms Platt - fresh from a policy-setting role heading the Department of Health's directorate for children, older people and social care services - have enough distance from the centre to lead a supposedly independent commission?

The rumblings of discontent may have inspired Ms Platt to mark her new appointment with strongly worded criticisms of the government's children's services green paper, Every Child Matters.

And, unlike her opposite number at the Commission for Healthcare Audit and Inspection, Professor Sir Ian Kennedy, she chose to demonstrate a seemingly handsoff approach to the nitty-gritty of operational inspection and review.

CSCI, launched in shadow form in January, is gearing up for its official 'birth' in April ('Following the rules will not get the job done' is the slogan on its motivational sign at its temporary office in London's Charing Cross).

Spawned in 2002 by the Delivering the NHS plan strategy, which also led to the creation of CHAI, the commission brings together the inspection of both public and private social care services. It replaces the Social Services Inspectorate, where Ms Platt was once a chief inspector, and the social care functions of the short-lived National Care Standards Commission.

The commission will employ nurses and pharmacists as part of its 2,000-plus workforce, reflecting its duties to inspect and review nursing homes and domiciliary care and, significantly, medicine management in these settings.

With a seemingly insatiable ministerial appetite for integrated delivery of health and social care services, particularly for vulnerable groups, and with joint posts, pooled budgets and assimilated trusts proliferating, how will CSCI police such integration?

Perhaps not wanting to upstage chief executive-in-the-wings David Behan, Ms Platt shies away from detailing anything she deems 'too operational'.

'[CSCI and CHAI] are locking our relationship together with a memorandum of understanding, ' says Ms Platt. 'We have a duty to work together, and We are looking at various methodologies to do with the national service frameworks, which we will be reviewing and inspecting together.'

CSCI's constitution document is more illuminating, establishing that it will work with both CHAI and strategic health authorities 'during this transitional year'. This should ensure CSCI is in 'a position to validate a council's description of interface performance [with the NHS] and assist with grasping any problems'.

Those involved in promoting best practice in integrated working question how two separate organisations inspecting different parts of service delivery will retain a patient/service user perspective and avoid an overly systemic focus. Many argue that embryonic integrated services such as children's trusts need joint targets and performance reviews.

Ms Platt agrees that the systems for inspecting, reporting and - crucially - advising on how joint health and social care services can be improved will require a look at joint indicators. But she warns against seeing them as a standalone solution: 'Both [CHAI's] Ian Kennedy and myself are keen to look at the services from the perspective of people using them, and then looking at how you can measure outcomes. This means looking at some indicators perhaps in a different way.

'However, neither he nor I want to operate in ways that leave people high and dry. We will want to work in a way that says: 'This is what we think is going on in your service, and we think you can put some energy and effort in this direction to improve'. You really need to know the health service's contribution to the performance of an indicator and the social services' contribution to actually get any improvement.'

Amid the joined-up fervour, and the suggestions that internal DoH restructuring over the past year has sidelined social care expertise, Ms Platt sounds a note of caution about retaining distinctions. 'Our transition teams meet regularly.We are comparing where we are, and working out where it is sensible to work together because of how people use services at the endpoint.

'But CSCI's compass is the whole of the social care industry, and sometimes when people say 'and social care', I do not think they have the faintest clue what it means.

'It means a million people working in social care services; it means 30,000 different units that deliver social care, the majority of which are in the private and voluntary sector.

'So the regulatory responsibility of CSCI is substantial. Last year the Care Standards Commission - whose responsibilities we will inherit - carried out 50,000 inspections of services like nursing homes, domiciliary care, foster services, children's homes, in order to give them a licence to trade. So There is a substantial regulatory responsibility, as well as our responsibility to assess performance of local councils' social care services. That is where much of the interface on commissioning of health services will happen; That is where all the issues of delayed discharges get sorted out, but our scope is wider.'

Ms Platt seems noticeably more relaxed when exercising her newfound freedom to 'inform policy'.

In its response to Every Child Matters - the commission's first public statement - it highlighted the government's failure to recognise the health input in the development of the children's national service framework.

So is Ms Platt reassured by noises coming from children's minister Margaret Hodge, which appear to signal a greater statutory role for health in the Children's Bill, which is expected next month?

'I hope so. The NSF will be as important as the green paper when It is finished because it will follow the child's journey through health services, social care, education services.

'It will track children through the system from the children's perspective, rather than looking at a structural arrangement.

'One of my main concerns about the green paper was the absence of any mention of the children's NSF, and the absence of any mention of health, ' Ms Platt continues.

She argues that the NHS 'universal' role in children's lives - from maternity services through to child and adolescent mental health services - means it makes just as important a contribution to a child's welfare as social services, education and the criminal justice system.

'I just felt the green paper was silent on the health contribution to children's services in the way that the original children's trust proposals haven't been, ' she says.

'Some local authorities are working very strongly with primary care trusts trying to get integrated services, particularly for disabled children and in mental health services. It just feels a lost opportunity, because It is about Every Child Matters, and yet the health contribution was played down.'

Ms Platt also becomes animated on the subject of vulnerable groups at the other end of life. She is, in particular, a fan of the rapid growth of intermediate care services (which CSCI will be responsible for examining). This is partly as a result of reimbursement grants given to social services departments to reduce delayed discharges at acute hospitals.

However, she adds her voice to growing disquiet about the services supporting older people with mental health problems. This follows September's damning Commission for Health Improvement report on 'neglect' of elderly people at Manchester's Withington Hospital.

'It is an issue we have raised with the department... which I would hope will be making some representations in the spending review to focus on older people with mental health problems and support for their carers in the community.

'In my view, there is not enough capacity in those services. The community services to support carers and people with Alzheimer's and dementia in the community are particularly poorly developed, and in some places are non-existent. And the mental health services for older people that have a functional mental health problem like depression very often get overlooked as well, ' she adds.

Ms Platt believe the problems at Withington Hospital - part of the integrated Manchester Mental Health and Social Care trust - also serves as a warning to trusts and local authorities, and perhaps over-zealous ministers, on the dangers of a top-down approach to integration.

'The issue really is that just because you have an integrated structure does not mean, of itself, that you are going to deliver better care, ' she says. 'You really have to work at better care, and how the integrated structure is going to deliver it.'

A sound piece of advice for health and social care organisations... and perhaps their new inspectors, too.