The use of large up-front fees and disproportionate deposits has already resulted in significant cost consequences for one care provider.
Care providers vary significantly in their approach to involving boards in setting up systems to ensure the delivery of high quality care.
Surprisingly, the quality of the service is rarely a routine element of board meetings with the scrutiny of the operational team often getting much less time than finance or business development. In our experience the following issues are likely to require consideration in any routine review of quality:
- is quality of care overseen by a dedicated committee with appropriate and up to date terms of reference?;
- is there a plan, approved by the board, for the constant improvement of care quality across the organisation?;
- how are concerns about care quality reported to the board, is the information presented in a manner (such as KPIs/traffic lights) that is easily understood by the board;
- does the board have the opportunity to meet key employees so that they can be appropriately challenged on the information given to the board, for example, if the board is given figures for complaints from service-users how can they challenge staff on the reasons for those complaints and how they were resolved;
- what systems are in place for internal auditing of the quality of care. are outcomes and trends reported to the board and recommendations implemented;
- does the board receive any external reassurance in the form of an independent review of the organisation’s arrangements for governing care quality
- are arrangements for involving service-users and families in the governance of the organisation effective;
- do larger providers with federal structures review the relationship between member bodies to ensure care quality is consistent, given the impact of local failure on the organisation as a whole?
The impact of a new CQC enforcement regime is already being felt and the pressure a CQC to be performing is only going to see this increase.
Charitable providers should ensure that the board of trustees are aware of the new regulatory approach taken by the Charity Commission, as well as the new CQC regime. The willingness of the Charity Commission to ‘show its teeth’ as a regulator has been demonstrated by the number of recent statutory inquiries it has opened. Even where other regulators are involved, the Commission has shown a willingness to get involved to assess whether the charity trustees fulfilled their duties. It has, for example, recently opened an inquiry into St Paul’s School to ‘investigate the charity trustees’ approach to safeguarding and handling of allegations of a sexual nature’. Funding restrictions inevitably impact on the quality of care. As funding constraints become ever more apparent, the board may want to consider alternative ways of monitoring the profitability of particular services and consider whether resources should be focused on more sustainable services. Quality comes at a cost and the damage done by bad publicity arising from a safeguarding event can easily outweigh the cost of not pursuing a contract.
Care providers continue to adapt to the changing environment by developing new skills and services, exploring commercial partnerships and engaging more closely with service commissioners. As they do so, their activities become more varied and often more complex. It is essential that standards of governance and especially those that impact on the quality of care, keep pace.
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