A director of a national home care provider has voiced anger over the “poor service” provided by the Care Quality Commission (CQC) following a dramatic increase in fees.
Michelle Fenwick (pictured far right), director of Heritage Healthcare Franchising, said that while the CQC has acknowledged a lack of funding for domiciliary services from the government, home care providers are forced to pay “a fortune” to register with the regulator.
The CQC said at its recent State of Care Conference that a lack of long-term funding for domiciliary services and increased challenges around the workforce is having a knock on effect on GP services and the acute sector.
Responding to this statement in an exclusive interview with Home Care Insight, Fenwick said: “My opinion is that while it’s great that the CQC stood up and acknowledged that, the regulator is very good at taking a lot of those funds to fund themselves. We pay an absolute fortune to the CQC for a really poor service.
“Our fees to them a few years ago would have been about £770 to be registered for the year, but we’re now coming up to over £2,000.”
The CQC proposed a 60% increase in home care providers’ fees from April 2017. This meant that the fee for a single location provider increased from £1,369 to £2,192.
This year, the regulator brought in a new way of charging providers, based on the number of service users they support – a change Fenwick sees as unfair.
“They wanted to target companies who had lots of clients, not on the basis that we’ve done very well, recruited very well and grown their clients list. We were now going to be penalised,” she said.
Fenwick believes this new way of charging has been dropped, but the CQC was unable to confirm or deny this when contacted by Home Care Insight.
The Heritage Healthcare director added that although the CQC has increased its fees, the service it provides has “worsened”, with some home care business owners having to wait months to hear from the regulator about registering their services.
“There are areas in the country that are desperate for care services – we hear all the time about people being stuck in hospital waiting for care,” she said.
“We are a growing brand desperate to get our services registered so that we can provide employment and services to the clients, but one of our branches took 19 weeks for somebody at the Care Quality Commission to speak to us.
“I think some people are a bit frightened to talk about this, but I absolutely stand by that. They charge an absolute fortune.”
Fenwick also accused some CQC inspectors of being too subjective.
“Every single inspector has a different opinion or interpretation of the regulations, so this then has an effect on the outcome of the inspection,” she explained.
“We didn’t realise this was the case when we didn’t have as many branches, but now we do – and this is something we often talk about as franchisors in the care sector – we can clearly see that one inspector will rate and view the same branch completely differently to another.
“So they bring their own interpretation into it, and their own feelings and opinions, and that really shouldn’t be the case.”
Reacting to this allegation, Kate Terroni, the CQC chief inspector of Adult Social Care said: “Our inspection methodology provides a clear framework that allows our inspectors to take a consistent approach to inspection, whilst also allowing them to exercise their professional judgement. Inspections cover the full breadth of the health and social care services we regulate and the diverse needs of the people who use services.”
“No two services are alike, therefore we always provide clear reasons from the evidence we have gathered to show why we have applied the regulations in the manner we have. Our provider guidance provides further information on how to comply with regulations.”
This is not the first time the CQC has come under scrutiny; at a recent Tech for Care conference in Manchester, care providers accused the organisation, and other regulators, of creating a barrier to innovation and preventing a shift to digital.
Directors from the Local Government Association (LGA) and Digital Social Care said care providers often tell them that inspectors prefer to see paper care records over electronic ones.
Mark Golledge, programme manager at LGA said: “This has actually come up in quite a few forums, where providers say that inspectors will come out to them and say that they need to be seeing paper records, but actually that is preventing the shift to digital.”
Fenwick said that some Heritage Healthcare franchises have also had inspectors demand to see paper records, accusing the CQC of being “behind the times” when it comes to understanding digital care solutions.
“We are three quarters of the way through with implementing electronic document systems, call monitoring systems and electronic MAR charts into our branches. Lone working now is not the issue it was a few years ago because we can physically see where our staff are and that they are safe and have attended calls,” she said.
“These systems are very expensive, and we are all funding this to keep ahead of each other, but we are way ahead of the CQC.
“We’ve had inspections recently where [inspectors] don’t know how to use the systems and, because they don’t understand them, they instantly don’t like them, and they want to see evidence on paper, but that’s not how we run now,” Fenwick continued.
“We are not doing anything wrong – the regulations say we don’t have to present documents on paper – but that’s what’s expected and if you don’t deliver that then you can be given a poor rating.
“And if you receive a poor rating then you are stuck with that poor rating for at least 12 to 18 months, and the damage that can do to your business is scary.
“The thousands of pounds that we pay to [the CQC] every year should be enough money for [inspectors] to be able to understand these systems. But some inspectors may only have a few years left in the role and don’t see why they should go and learn something new.”
Responding to these comments, Terroni said:“We don’t require a provider to have records in a specific format but they do need to be secure and available to those who need to see them. Records must be in line with the accessible communication standards and date protection requirements.”