Tag Archives: Care Homes

Little value for money at the CQC

 

If, as Oscar Wilde once wrote, a cynic is “a man who knows the price of everything, and the value of nothing,” then the Care Quality Commission is starting to look like the most cynical organisation around.

Late last year, the CQC announced a new contract for the supply of Experts by Experience – or lay inspectors – who assist on its inspections of hospitals, care homes and GPs.

Four months after it came into effect, the contract is in chaos.

Experts are leaving in despair at the unravelling of a role the CQC itself calls “critical to the success of our work” as the regulator of health and social care.

Even the Chief Executive, David Behan, admits his own staff are finding it difficult to do their jobs properly. “The contract isn’t performing at the level we would want it to,” he told the CQC’s most recent board meeting in a remarkable understatement of a debacle that could have been predicted.

Well, actually, it was predicted.

Problems started as soon as Remploy, a private company, took over the contract for recruiting and training Experts by Experience in three out of four English regions. (The charities that previously did this work hung on to one area in the centre of the country and by all accounts continue to do it well.)

Experts by Experience are members of the public who join CQC inspections specifically to talk to residents, patients and their families and friends. They assess care through the eyes of the service users and make sure the views of some of society’s most isolated and vulnerable are represented in judgements and reports.

The first inkling of the value Remploy placed on this crucial role came when it refused to honour existing terms and conditions. Instead, it told Experts they could re-apply for their jobs – at half the pay. Not surprisingly, many (myself included) declined.

Those that did sign up have since reported a catalogue of failures that further de-value their work.

The whole point of the Experts is that they have experience in a particular area of health or social care. It might be because of their own needs, or through looking after a family member.

But Remploy, and the proliferating army of sub-contractors drafted in to administer the programme have consistently asked Experts to take part in inspections for which they’re not suited.

“I was booked in March for a hospital inspection in June,” said one Expert, reporting a common problem. “When I finally got details it was for a psychiatric service, for which I have no experience so I declined.” The sub-contractor took no notice. The Expert went on getting emails about the same inspection.

Several Experts report having to work out for themselves which of a long list of upcoming inspections they’re suited to and, from the first three letters of a postcode, how far away they are. Then they “bid” for the work. So much for the CQC’s requirement that Experts be matched to inspections according to experience and skills. What, many of us wonder, does Remploy actually do then?

Communication certainly isn’t the company’s forte. Emails often go unanswered. An Expert’s agreement to join a team for a specific inspection is not passed on to the inspector. An inspection might be cancelled or rescheduled but the assigned Expert isn’t told. Double bookings are almost routine. Inspectors are told there’s nobody available when willing Experts are sitting at home unused.

“Did an inspection today,” an Expert reported last week. “Yet again the inspector had initially been told there was no Expert available, then they had another contact confirming that I was the Expert, and then yet another saying again no one was available.”

Some Experts have been asked to travel absurd distances (despite the CQC explicitly wanting to save money on travel expenses). One was asked to join an inspection 190 miles away. Another was sent a list of possible inspections and replied saying there were three he was suited for. “I told them one was just two miles away (from my home). But I was given one 65 miles away.”

Those are just a few examples from the eight separate dossiers of complaints a group of us current and former Experts have sent the CQC over the past two months. Others have been passing on their individual concerns from the start. So have the CQC’s own inspectors whose meticulous plans for these complex and highly sensitive inspections are frequently thrown into disarray.

“I am sorry there has been some confusion over this,” wrote one inspector to a befuddled Expert. “I received an email last week saying an Expert by Experience was not available, so rearranged my schedule and postponed this inspection. Then yesterday I received your message and another saying a different expert was available! I have now been advised to cancel the request and re-book it.”

Resigning provides no escape from this Kafkaesque scene. One Expert recently told Radio 4’s You and Yours about the frustration and anger that had led her to quit. Three days after the broadcast, Remploy rang to book her for an inspection. Another got no acknowledgement of his resignation.  Instead, Remploy sent updated time-sheets on which to record his working hours.

In mid-April, a CQC official told me they’d met senior Remploy staff to inform them that the company was “non-compliant” in almost a dozen areas. These included communication, travel and failing to match Experts to inspections. There were concerns too about recruitment, training, data protection and performance management. Remploy was told to come up with a response. Further, high-level meetings would be held.

But since then, very little has changed.

The CQC says formal contract monitoring meetings take place on a monthly basis “to monitor progress against agreed targets.” But my specific questions about the extent to which those targets are being met, and what happens when they aren’t, went unanswered.

Chief Executive David Behan recently wrote to Experts by Experience apologising for a “difficult” few months. “The experience of transferring to the new contracts for many of you was not a good one,” he said.

Another understatement and one that fails to acknowledge that it wasn’t just the transfer that was difficult. It’s the shambles that Experts and inspectors are still trying to deal with every day that needs sorting out.

As Mr Behan points out in his letter, more money’s been committed in the new contract in order to get even more Experts involved in inspections. He says, “the need to deliver the best value for the public money we spend has never been more important.” With the new contract he goes on, “securing best value” has been achieved.

Really? Best price perhaps. But as any Expert by Experience, inspector or care home resident could tell the CQC, that’s not the same thing as best value at all.

Little Care, Little Quality and some Terrible Commissioning

(Part 2 of my story about the chaos that’s followed the awarding of a key public service contract to a private company and the impact that’s having on vulnerable people. You can read Part 1 here).

 

It’s about time Facebook designed a “jaw drop” button.

We Experts by Experience badly needed one when we watched the Care Quality Commission’s recent board meeting online.

We’d just been told that our jobs inspecting health and social care facilities were being transferred from a charity to Remploy, a private company majority-owned by a big US-based business. None of our previous terms and conditions would be honoured. We would be invited to re-apply for our roles – at around half the pay.

Bruised and confused, we tuned in to see what the CQC, which is responsible for the contracts, had to say.

“I think,” declared Chief Executive David Behan, “there’s been a very, very good piece of procurement activity undertaken.”

Thud. That’s when our collective jaws hit the ground.

This particular “piece of procurement activity,”  took two and a half years to complete.

As I predicted last week, it has resulted in a shortage of Experts capable of doing the job, and in a contractor that is clearly overwhelmed.

So much so that the charities which lost the contract for supplying Experts by Experience have now been called back in by the CQC to stop the scheme going off the rails.

Here’s why:

Remploy won the Experts by Experience contract in three out of four English regions. (In a curious fragmentation of the programme, Central England remains with the charities Choice Support and AgeUK who, incidentally, will continue paying a decent wage).

That was announced in early December 2015. Those of us affected (the majority of Experts) were told we would be transferred seamlessly to Remploy. It would likely be done under TUPE, a process designed to protect workers when the business that employs them changes hands.

But Remploy had other ideas. And on January 13th we were told there would be no TUPE transfer after all. Instead, we could all apply to the new contractor for the same Expert jobs – with a 51% pay cut.

Two days later, in response to my query, Remploy confirmed the new terms and conditions in a list of FAQs. Under the new contract, they would be paying us £8.25 per hour (£9.40 in London). Unpleasant, but perfectly clear.IMG_0133[1]

But then came that CQC board meeting.

“This contract is still in the process of being finalised,” said Chief Executive David Behan. “Detailed workings” would be discussed later that week he said. There were “issues that do need to be settled.” What’s more, there had been “inaccuracies” in what we had been told by AgeUK. He was clearly implying that we Experts had been misled.

We scooped our jaws off the floor and began scratching our heads.

The new contract was due to start in less than two weeks. Remploy had sent us their detailed terms and conditions – yet the CQC was still negotiating?

Two possibilities: Either they’d been unaware that Remploy intended to slash the wages of its Experts in half. Or the CQC had naively assumed we would simply accept the pay cut, ignore the implicit insult to the people we represent in care homes, and meekly hop aboard the private sector bandwagon charging through public services.

When we didn’t, a frantic backpedalling got underway.

Two days after the board meeting, the CQC announced that existing Experts who applied to Remploy would get £15.00 per hour for the first six months after they transferred.
An email from Remploy confirmed that temporary rate, helpfully adding that any decision to join them was entirely up to me.

I clearly wasn’t the only person un-wooed by the six month bribe.  At which point CQC backpedalling turned into blind panic.

Last Thursday, just four days before Remploy was due to take over the Experts by Experience programme, the CQC announced a further change.

If we signed up with Remploy we’d get £15.00 per hour for the first six months, and £12.50 per hour for the six months after that, with no decision yet on what the final level of pay would be. (I think we can guess. After all, new recruits are getting £8.25).

And still Remploy was struggling to get the programme fully up and running by the February 1st start date.

Some Experts by Experience who did express an interest in joining the private company have had no response. Others were immediately passed on to sub-contractors whose contact has been equally patchy.

A few were asked to do inspections . They were told to send in scanned copies of their criminal record checks. (Not the normal practice.) None were offered a contract, asked for their bank or National Insurance details, or given the reporting template needed to do the job properly. None have yet been issued with formal ID. I could go on…

Meanwhile a sub-contractor which ran an Experts by Experience recruitment day in January, has pulled out of the scheme. A spokesman wouldn’t say why, just that “the partnership [with Remploy] has ended.”

Not surprisingly then, the CQC desperately needs help. And who better to turn to than the charities that successfully ran the programme for years. The CQC has now asked Choice Support and AgeUK to supply Experts for inspections for the next two weeks – presumably at the Commission’s (that is, the taxpayers’) expense. The charities are by all accounts doing their best to oblige.

And after that? Who knows what’ll happen. The terms of the contract, and details of its execution and delivery have been changing almost by the day.

No, Mr Behan, this was not “a very very good piece of procurement activity,” at all.  

Calling time on my zero-hours job

I’m about to lose the zero-hours job I love.

Maybe “lose” isn’t the right word. But the contract under which I work has been taken from the charitable sector and awarded to a private company. The new bosses at the multi-million pound business taking over refuse to honour existing terms and conditions. They won’t even discuss them.

Instead, they’re offering exactly the same work with a 44 per cent cut in pay. (51 per cent for those living outside London).

So thanks, but no thanks. There’s austerity, and then there’s just plain insulting.

Let me explain. For the past two years I have worked as an “Expert by Experience” for the Care Quality Commission. I accompany CQC inspectors on unannounced visits to care homes for the elderly where I talk to residents and their relatives about their care. I visit people in their rooms, observe activities and meal times, assess the environment – from the state of the carpets to any bad smells – and then write a detailed report.

We’re called Experts by Experience because we’ve all had direct and extensive contact with health or social care services, usually as a result of caring for a family member. So we’re there to make sure the people using these services – and their families – are listened to.*

That requires patience, attention to detail, skilled interviewing and accurate note taking – sometimes in very difficult circumstances.

People in homes for the elderly typically have high levels of need. It could be serious physical ill health; it could be dementia – often both.

Conversations can be repetitive, fragmentary or non-existent. While the CQC inspectors wade through the minutiae of care plans and staff training files, check regulations and interview managers and carers, we sit and chat and observe how the residents actually live.

We wait patiently while they struggle to find their words. We watch interactions between staff and residents, listening for signs of disrespect and noting the many examples of genuinely warm and affectionate care.

Sometimes we pause, put the investigative work on one side and simply listen to life stories. A widow still grieving for a young husband lost in the war. A relative wracked with guilt because they can’t look after their loved ones in their own homes anymore.

Conversations can be unbearably intimate. Elderly women will tell you about the children they wished they’d had. Recovering alcoholics describe the families that fell apart in their drinking years.

Afterwards, we sift through it all, pulling out the important details. Our reports are woven into the inspectors’ final judgements of the standards of care, and include many direct quotes.

It’s interesting and rewarding work and, CQC colleagues tell us repeatedly, we are “unique and valuable” members of the inspection teams.

But evidently not valuable enough.

The CQC contracts out the Experts by Experience programme. It’s run by a number of “support organisations,” including AgeUK for whom I have worked on a zero-hours basis.

Now, after a protracted procurement process, AgeUK and a number of other charities have lost their contracts in three out of four English regions.

From February 1st, the programme will be run instead by Remploy – once a government agency, now a private company majority-owned by US health and human services business Maximus.

Remploy/Maximus have promised to deliver hundreds more Experts by Experience for the CQC. But the budget is tight and presumably they also have to deliver profits for their shareholders. Hence the big cut in our pay.

From £17.00 per hour, to £9.40 in London and £8.25 elsewhere.

In other words, people with considerable expertise and years of experience, selected through a rigorous interview process and then given specialist training, are being offered the Living Wage.

Less than my student nephew gets for a match-day shift at the pub.

True, few of us became Experts for the money. And we’ve always put in extra hours for free.

But some Experts are retired and living on modest pensions. Others have caring responsibilities or disabilities that make this kind of flexible work a lifeline. For them, the pay cut (announced just three weeks before the new contract was due to start) is a real blow.

But more than that, regardless of personal circumstances, the terms of the new contract are insulting. Not just to us but to the elderly and vulnerable people we’re there to represent. From next week, it seems, their opinions and feelings will be worth roughly half as much as they are now.

So not surprisingly, we’re protesting. Or at least trying to.

It’s not easy communicating with other Experts. Though we have Contracts of Employment, we’re not apparently employees. We’re merely “workers” and as few of us are members of the recognised work-place union, it has declined to get involved. Welcome to the zero-hours world.

But bit by bit we’re connecting with each other and discovering that very few of us are prepared to work for a private contractor for such low pay. (Oh, did I mention they’re shaving an hour off the already short time paid for report writing and a few pennies off the mileage allowance too? The shareholders will be pleased.)

The CQC says it’s aware of our concerns but that the new contract is a good one because there’ll be many more Experts by Experience over-all. But who will they get for such low pay? And when are they going to be recruited and trained?

Calls to Remploy go unanswered. (The receptionist has no extension for the Experts by Experience programme). It has therefore been difficult to discover more about the contract discussions that the CQC says are continuing. So far, our protests have produced what the CQC clearly thinks is a sweetener: existing Experts who join Remploy will get “up to” £15.00 per hour for the first six months of the new regime.

A small pay cut to help a big company get its new business up and running so that it can then take an even bigger slice of our pay?

No thanks.

Unlike the vast majority of people on zero-hours contracts (cleaners, carers, food industry workers… admittedly a growing list), I’m a well educated stroppy middle class professional and I can afford to just walk away.

But I’m sad that an inspection this week was my last. Sad also that there are unlikely to be many (if any) experienced and qualified Experts available for inspections come February 1st.    

And mostly I’m sad – and angry – that the same free market, get-the-rock-bottom-price-whatever ideology that encourages faceless corporations to squeeze money out of public services has now swallowed up a socially valuable job I loved.

Once again, it’s the powerless and vulnerable who’ll suffer as a result.

(UPDATE: Thirty-six hours after this blog was published, the CQC acknowledged the concerns of Experts by Experience and announced an update on its contract negotiations with Remploy. Now, in addition to the offer of six months work at £15.00 per hour, there’ll be an additional six months at £12.50. After that, pay will be set at an as yet undecided rate. (That’s despite Remploy having sent us all details of the very much decided £9.40/£8.25 pay). A sliding scale of insult and uncertainty then. They can still count me out.)

(*While I do mostly elderly care, other Experts focus on homes for people with mental health problems or learning disabilities. We also join inspections of hospitals, GP surgeries and domiciliary care. All are affected by the change in contract)