Care providers are in desperate need of relief from both the government and the CQC. As the UK reopens the care industry is seeing an alarming shortage in care-workers and increased costs of service due to lack of funding. They key challenge providers will face is their ability to meet the industry standards with such limited resources. Providers will want to take extra care to increase awareness and understanding of how the CQC conducts investigations and what they are looking for at inspections to avoid being shut down or incurring unnecessary costs trying to keep their businesses afloat.
Finding Funding – No Budget, No Business
While the adult social care sector has received an additional £250 million in funding to last until the end of September, they are still lack a long term solution. According to research, adult social care will need £4 billion a year to maintain social care services at current levels. This is despite allowing a 4% increase in council tax (double the inflation rate) to help offset some care costs. Additionally, councils will have spent at least 20% less on public services per resident next year than they did in 2009-10. This is even more concerning as occupancy over the pandemic decreased significantly, putting many homes at risk of failing financially. This becomes a twofold problem: (1) less funding/occupancy means homes need to charge residents more to remain financially viable and, (2) as costs increase the most vulnerable are unable to afford care and homes are losing business. Councils will be relying on council tax and business rates for budgets going forward, but these short term funding solutions are deemed financially unviable moving forward.
Ultimately it will fall on management in care homes to ensure that staffing levels are where they need to be in order to provide adequate care. Currently, the Health and Social Care Act 2008 requires providers to have a registered manager (s.13). As part of the regulations, good governance is also mandated (reg 17). What this does is create a checklist for registered managers to ensure that the care home is running up to par according to the CQC.
Further, when it comes to staffing there are also a number of requirements: (1) Providers must have ‘sufficient numbers of suitably qualified, competent, skilled and experienced persons (Reg 18).’ In a staffing shortage these extra burdens make it that much more difficult to recruit because a large number of people who might be willing to work are immediately screened out. That is not to say that providers should hire anyone they can find, but training and recruitment costs money that providers currently don’t have. (2) Providers must also ensure that ‘fit and proper persons are employed (Reg 19).’ Again, while the premise of these requirements is a good thing, in practice the CQC tends to use these as weapons against providers to find faults in how they are managing and running their businesses.
One of the biggest issues the care industry is seeing is workforce competition, particularly with the hospitality and retail industries. Adult social care is seen as the less attractive option for a number of reasons, with surveys showing 67% of people wouldn’t consider a career in social care because of concerns over low pay (42%) and being emotionally challenging (41%).
There is also the issue of general lack of retention and many vacancies. Surveys show that 37% of staff intend to leave the sector in the next 5 years and a study in 2020 found that the turnover rate was only 30.5%. On top of this there were 112,000 vacancies’ in 2020, looking to be increased by the end of 2021 due to mandatory vaccinations for workers.
Further, unlike the social care industry, the hospitality and retail sectors have seen economic relief packages from the government that have allowed them to fund recruitment efforts and retain staff alongside adapting their business model to an online platform without fear of losing revenue. Adult social care doesn’t have this luxury because their industry is based on providing in person help to those in need. While the sector was pledged £1 billion per annum, significantly lower than what the sector’s predicted need is, over the next 5 years they have yet to see any significant portion of this money. This lack of funding also makes concerns over inadequate wages a reality. This has placed managers in an impossible position – sacrifice quality of care or financial viability.
The issue becomes further compounded by mandatory vaccination measures, which are predicted to make the shortage even worse. In Yorkshire the industry has seen a 70% decrease in applications. Providers have already had to lay off staff and fear that predictions are low-balling the reality of this crisis. This is coupled with 20% of the workforce hesitant to even get the vaccine to begin with and up to 16% nationwide currently unvaccinated. The government predict that as much as 7% if the work force will not be deployable as a result of mandatory vaccinations and 40,000 staff are unlikely to be able to work in care homes in the next 16 weeks. On top of this it is estimated that it will cost £100 million to recruit and train new staff in order to meet demand.
CQC Scrutiny – KLOEs
Staffing problems are buttressed by the fact that the two main complaints the care industry has seen are in leadership and management. As the CQC are doing more targeted risked based assessments this puts managers under a microscope particularly in the categories of well-led, effective, and safe. Where there is already a lack of staff and money, undoubtedly this will reflect badly on the managers. Managers, and the service providers who employ them, will want to take extra care to ensure that they are meeting the requirements set out in the regulations otherwise the homes can be shut down (s.17(1)(c)). Essentially any mishap can prompt ratings that service providers are unhappy with and this ultimately results in contentious legal battles challenging the CQCs actions and decision making – again spending more money.
What can Providers do?
The obvious solution would be to pay workers more, which would lead to increases in applicants and retention. This would then have a knock-n effect of ensuring that there were enough staff, with adequate training providing the correct care and reflect well on management. However the lack of funding is a huge barrier. Additionally, the CQC’s person centred approach with a focus on service user experience inherently biases regulations to undermine providers’ efforts given the lack of resources at their disposal. It also fails to take into account the unprecedented challenges providers have faced over the last 18 months due to the pandemic.
This is why it is imperative for providers to familiarise themselves with the CQCs KLOEs (https://www.cqc.org.uk/sites/default/files/20171020-adult-social-care-kloes-prompts-and-characteristics-showing-changes-final.pdf) to ensure they are prepared for inspections. Undoubtedly the burden which providers and their managers face is enormous when it comes to inspection reports, but pre-emptive action, even as simple as using the KLOEs and regulations as guidelines, will go a long way to ensure that no dime is wasted. Providers also need to be strategic in which battles they choose to fight and proactive in managing their services so they don’t only employ lawyers at the last minute when the costs and stakes are high. At Ridouts we can help by ensuring you are fully prepared when it comes to dealing with regulators, before and after inspections, and can offer robust strategic and legal advice to help best serve your individual needs.