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Show me the Money! – CQC and Your Financial Viability
When I was in my early 20s I worked for an insurance company. I think my strangest encounter was a gentleman phoning in for a car quotation. He was very happy with it, and I certainly needed the sale, but to get it, he wanted me to stand on my chair and shout down the phone ‘show me the money!!!!’.
Perhaps I have gained a level of professionalism and dignity since those Halcion days, but I can tell you, I did it. I shouted loud and clear standing on my swivel chair (please don’t call health and safety!). SHOW ME THE MONEY!!!!! Answers on a postcard please as to the film that line came from…
I can speculate that CQC will not be standing on a swivel chair shouting in an American accent…’SHOW ME THE MONEY’, but I can guarantee you one thing, if they are worth their salt, they will be checking your information at registration, and when the need arises.
The Regulation…in a Nutshell
The Care Quality Commission (Registration) Regulations 2009: Regulation 13 states the service provider must take all reasonable steps to carry on the regulated activity in such a manner as to ensure the financial viability of the carrying on of that activity for the purposes of—achieving the aims and objectives set out in the statement of purpose; and
meeting the registration requirements prescribed pursuant to section 20 of the Act.
In short – you need to have things in place to ensure the financial resilience of your service.
As an inspector, I came across a number of small domiciliary services very eager to show me new uniforms with impressive logo’s. I have absolutely no doubt that this is an important part of an image, and an easy way for people to identify a member of staff and bring security. I am sad to say, that in some of these cases when I asked to see a business plan, one could not be shown, or the only line was the receipts for the uniform and charges they would wish to make. Little was known about the funding needed to survive or to grow.
All style and no substance - as the saying goes, if the outer layers are there, but there is no substance underneath, this does not convince the regulator of a sound sustainable service.
New Powers – ‘Hard to Replace Providers’
Under the Care Act 2014, Local Authorities are required to provide continuity of care when providers fail. Prior to this, there was no consistent check as to how providers were managing financially. This meant there was no ‘early warning’ to help stop or find other solutions to such collapse. The failing of Southern Cross in 2011 who ran 750 care homes was a turning point which led to new legislation.
CQC have a strategic role in monitoring hard to replace providers, usually because of their size, or expertise. Their Market Oversight team monitor and calculate the risk of such financial collapse and give an early warning to local authorities.
Money in the Pot
My grandmother used to say ‘If there is no money in the pot there is no money in the pot’ – how stating the obvious can give us a stark reality check at times.
So is there money in the pot? In this day and age there is less of the lavish but more of an emphasis on trying very hard to support people in a very tight economic situation. This is compacted by the rise in workers’ wages and the strength of the pound decreased, this is no place for anyone who is not serious in supporting people.
The state of health care and adult social care in England 2015/16 published this month by CQC mentions finance 59 times throughout its pages. The key facts read that growth has stopped in Nursing home beds with an increase of 33% in those aged 85 and over. It goes on to say efficiencies are stretched with Market oversight emerging picture showing 60% overall costs being staffing for residential and 80% in homecare.
Quality and Finance – Inseparable Bedfellows?
Quality planning can help financial stability. You can limit future concerns by being clear from the start. Not for CQC but for yourself, people you care for and employees.
- Before you start, Business Plan. Plan with enough detail to be confident yourself as to your trajectory and satisfy others. How have you recorded and mitigated risks to the smooth running of your service? SCIE have resource to websites which can help you think through some of these questions.
- Start small – do not bite off more than you can chew. If you are buying an existing venture, what assurances have you that staff will remain? Do you have all of the information to make an informed financial choice?
- Make sure you have the necessary insurances to cover the business.
- Enter a mentoring scheme to help you if finance is not your first love or outsource to a financial institution who understand the health and social care market and can ask you the questions you need to answer.
- Invest in a good manager, a manager who shares your ethos will enforce it.
- Any concerns about your source of income should be addressed. Make sure it is from a reputable source and reliable.
Talking finance is not easy. I try to steer away, but it is a large and looming concern and one that can make or break. I must go as I am being shouted at from the other room – My son wants to go for an ice cream.
‘You got money mum?’ he shouted….’I think so’ I said.
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