CQC Stops Care Provider Increasing Provision For People With Learning Disabilities

A tribunal has ruled in favour of the Care Quality Commission’s (CQC) decision to refuse an application submitted by Care Management Group Limited (CMG) to vary a condition of its registration and increase the number of people with a learning disability at one of its services.

CMG – a care provider running a large number of specialist support provisions across the country for people with learning disabilities and/or autism and behaviour that is challenging – applied to CQC in April 2017 to increase the maximum number of people at its Cherry Tree service in Essex from 7 to 10.

Situated on a congregate and campus site known as Lilliputs, the setting also includes two other CQC registered services, a children’s home registered by Ofsted and a day centre. Altogether, CMG may accommodate up to 26 people across those services on the site.

The CQC refused CMG’s application on the basis it did not demonstrate it would comply with CQC’s policy ‘Registering the Right Support’ – as well as the underpinning national guidance – that states new services and variations to registrations within a campus and congregate setting should not be developed due to this model of care not being in the best interests of people with a learning disability.

Prior to CMG’s application, the CQC was also not assured that appropriate consultation had taken place with those who used the Lilliputs site, their families and advocates, or with local commissioners to identify local need.

Tribunal Judge, Siobhan Goodrich, said “We have found that the decision was plainly in accordance with the law, including the regulations.

“We also consider that the decision was necessary in pursuit of a legitimate public interest, namely, the protection and promotion of the health and well-being of future service users, who, if this provision were to be extended would be placed there despite the national recognition that this model of care, in a campus and congregate setting, is not the appropriate model in terms of according adequate respect for the rights of those with autism to live as ordinary a life as any other citizen."

Welcoming the decision, Andrea Sutcliffe CBE, Chief Inspector of Adult Social Care at CQC said
“I am proud of CQC, and in particular the registration, advisory and legal teams who worked on this application, for standing up for the rights of people who use services and I am determined that we will continue to do so.”

Resolution Foundation Calls for SME Entrepreneur Relief to be Scrapped

Entrepreneurs’ Relief is expensive, ineffective, and regressive – and the government should scrap it as it looks for ways to fund its £20bn NHS pledge, according to new analysis published by the Resolution Foundation.

Entrepreneurs’ Relief allows people selling companies to pay half the normal rate of capital gains tax (10 rather than the current top rate of 20 per cent) on up to £10m. Successive governments argued the relief would encourage entrepreneurship, bringing wider benefits to society.

The Foundation’s analysis of Entrepreneurs’ Relief finds that it has a good claim to being the worst of Britain’s main tax reliefs, which collectively cost around £155bn a year. They argue that it is:

• Expensive: Actual spending on the relief had ballooned ten times to over £2bn by 2011-12 and HMRC estimates that last year it cost £2.7bn. This is more than the entire Budget for our intelligence services and enough to give £100 to each and every household in the country annually.
• Regressive: The benefit of Entrepreneurs’ Relief’s high cost is highly concentrated amongst a few very wealthy individuals. In 2015-16 52,000 people claimed the relief, benefitting by an average of £75,000. 6,000 people made claims on gains of over £1 million, but this small group (12 per cent of beneficiaries) accounted for 69 per cent of the gains, benefitting by an average of nearly half a million pounds (£450,000) of tax relief each. 
• Ineffective: Despite only being introduced in 2008 to diffuse a political row, Entrepreneurs’ Relief has been hugely extended and run up a cumulative cost in a decade of £22bn without a serious evaluation of its effectiveness. There is no evidence that it has led to any substantial increase in genuine entrepreneurship, with the number of self-employed people that have employees falling during the financial crisis and remaining at or below 600,000 since 2010.

The Foundation is calling for the tax relief to be scrapped as part of Treasury plans to raise taxes to meet some of the costs of the £20bn spending increase planned for the NHS. It says that too often tax reliefs, even when very expensive and poorly designed, go unexamined when decisions are taken on ways to raise tax revenues.

Adam Corlett, Senior Economic Analyst at the Resolution Foundation, said "The UK’s £2.7bn Entrepreneurs’ Relief is hugely expensive and overwhelmingly benefits a small number of wealthy individuals. There has also been no serious evaluation of the relief, despite it costing £22bn over the past decade.

“As the Treasury wrestles with how to raise revenues to fund the Prime Minister’s pledge of £20bn for the NHS, they should start by scrapping this expensive, regressive and ineffective tax relief”.

Electronic Prescribing System to be Expanded at GPs and Pharmacies

The Department of Health and Social Care has announced plans to change existing regulations relating to the use of paper prescription to allow a greater number of medicines to be prescribed electronically.

Health and Social Care Secretary Matt Hancock has said he will support the hundreds of GPs and pharmacies still to make the move to electronic prescribing.

As well as financial savings for the NHS of up to £300 million by 2021, switching to electronic prescribing has benefits for patients including:

• less time spent waiting in pharmacies and GP practices
• repeat prescriptions can be collected from the pharmacy instead of having to visit the GP first
• removing the worry about losing paper prescriptions

There has already been growth in the use and availability of electronic prescribing by a majority of GP surgeries, from less than 1% in June 2010 to 63% in June 2018. More than 6,000 GPs are already able to upload prescriptions electronically, which can be downloaded by a pharmacist, saving time for staff and patients.

But thousands of paper prescriptions are still issued each year – due to current regulations limiting the circumstances in which electronic prescriptions can be issued.

Changes to these regulations will be made later this year, to expand electronic prescribing for nearly all prescriptions.

Health and Social Care Secretary, Matt Hancock, said "We need to harness technology across the NHS to improve care, save time for patients and make the lives of hardworking staff easier. In an NHS where thousands of GP surgeries already enjoy the benefits of electronic prescriptions, it can’t be right that there are occasions when archaic paper prescriptions still have to be used.

As part of our long-term plan, I want the NHS to become the most advanced healthcare system in the world. Electronic prescribing both saves GPs’ time and helps to give patients a better, more seamless experience and ensures every pound of taxpayers’ money is spent effectively."

Poor Record Keeping and Non-Existent Risk Assessments Contributed to CQC Cancelling Care Service Registration

Satellite Consortium Limited (SCL), a domiciliary care service, in the London borough of Haringey, has had its registration cancelled by the Care Quality Commission - effectively closing it down.

SCL was a domiciliary care service registered to provide personal care to people in their own homes. The service provided care and support for older people, people with physical and learning disabilities and sensory impairment and people living with dementia. At the time of inspection, the service was providing personal care to 68 people.

The CQC moved to cancel the provider’s registration following an inspection in October 2017 – but it has taken until now to complete the legal processes involved.

Key Issues

• Satellite Consortium Limited did not have a registered manager in post, which impacted on the leadership and governance at the service. 
• The provider lacked robust and effective systems to assess, monitor and evaluate the safety and quality of the service and did not carry out regular internal audits to identify areas of concern and improvements.
• People using the service did not get the care they needed as sometimes staff failed to turn up and when care was delivered it was frequently late. 
• The quality of care was also not good enough, people were put at risk by poor care practice which failed to meet their needs.
• The CQC reviewed 13 people's care plans and found that none of the care plans had risk assessments instructing staff on the risks involved in supporting them and how to safely manage those risks. For example, one person had high mobility needs, was at risk of pressure ulcers as they spent the majority of their time in bed and used a hoist and bed rails for safety. This person had not been identified as being at high risk of pressure ulcers and there were no risk assessments in place to ensure their mobility and care needs were safely met or to instruct staff how to minimise risks involved in supporting the person. This placed the person at high levels of risk of avoidable harm.
• People deemed to lack capacity, did not have their capacity assessed. Staff were not trained in the Mental Capacity Act and were not provided with information on how to encourage people to make decisions.
• SCL did not follow safe and appropriate staff recruitment practices and did not effectively monitor staff punctuality and timekeeping with missed and late visits not being recorded. 
• The provider did not notify CQC of two safeguarding cases. Not all staff received safeguarding training and staff lacked understanding of how to identify and report abuse. Safeguarding records did not give details on the investigation outcomes.

Debbie Ivanova, CQC’s Deputy Chief Inspector of Adult Social Care, said "Every client of Satellite Consortium Limited was entitled to receive a good standard of care. Unfortunately that was not the case and on this occasion we have had to use our enforcement powers to cancel the provider’s registration.”

CMA Raises Concerns Over Effects of University Laundry Merger on Student Finances

The Competition and Markets Authority has provisionally found that JLA’s purchase of Washstation is likely to lead to higher prices or lower quality in student laundry services.

The 2 firms provide a range of managed laundry services to higher education customers such as universities, colleges and providers of student accommodation. These services include supplying and maintaining washing machines and tumble dryers, refurbishing laundry rooms and providing cashless payment services and apps to monitor machines remotely.

When JLA New Equity Co Limited (JLA) acquired Washstation Limited (Washstation) in May 2017, the transaction represented a merger between the 2 leading providers of managed laundry services to the higher education sector.

After receiving a complaint about the completed merger, the Competition and Markets Authority (CMA) opened an initial Phase 1 investigation into the takeover in February 2018. It found significant competition concerns, namely that JLA’s purchase of its nearest competitor would give the merged company a market share of more than 90%.

As a result, the case was referred to a group of independent panel members at the CMA for an in-depth, Phase 2, investigation.

After considering a wide range of evidence, the CMA has issued provisional findings. It is concerned that the merger is likely to result in customers paying more for laundry services or receiving a lower quality service, which might ultimately impact students.

The CMA found that, following the merger, JLA now faces only limited competition. Other providers of managed laundry services in the higher education sector are not currently in a position to compete strongly with JLA / Washstation, and it is unlikely that any future expansion by these firms would be sufficient or quick enough to offset the loss of competition caused by the merger.

The investigation has also shown that companies providing laundry services in other sectors – for customers such as hospitals, care homes or leisure centres - would find it difficult to enter the higher education market and create enough competition to act as rivals for the merged company.

The CMA is now inviting comments on its provisional findings until 31 August. It will also seek comments up until 21 August on its remedies notice, which outlines measures the CMA could take if it finally decides that there has been a substantial lessening of competition.

GP Practice Suspended by CQC

A Haringey GP practice was suspended for six months by the Care Quality Commission following an inspection in May 2018 which highlighted significant concerns about patient care.

The practice was rated Inadequate in all areas.

Patients are still able to receive care at The Staunton Group Practice in Wood Green, north London because it is currently being run by another provider. This will continue until October 2018, when it will be decided if the suspension can be lifted and the original provider can return.

At the inspection, the original provider was found not to have effective systems in place for the management of:

• risks to patients and staff with regards to safeguarding practices.
• high-risk prescribing - medicines reviews for patients on high-risk medicines were not being carried out.
• blank prescription forms and pads.
• Infection prevention and control practices.
• Emergency drugs and equipment - which were stored in unlocked rooms, accessible to patients and visitors.

In addition records of over 600 patients who were previously registered at other practices had not been consolidated with their records at the practice, meaning their medical histories were incomplete.

The practice had not planned its services to meet the needs of the practice population. Patients continued to find telephone access difficult. Routine appointments were not available for three-to-four weeks.

In order to be able to have the suspension lifted the provider must now:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. 

Professor Ursula Gallagher, CQC Deputy Chief Inspector of GP Practices, said “It is a matter of extreme concern when a practice falls below a certain standard of care - and the care we found The Staunton Group Practice was so concerning that we had no choice but to prevent them working.

“Presently patients are being cared for by a new leadership regime and we will need to see vast improvements at the practice before we will consider lifting the suspension.”

New Online Hub For Aspiring Writers Goes Live

The Sunday Times Peters Fraser + Dunlop Young Writer of the Year Award, in association with the University of Warwick, has established an online hub for emerging and aspiring writers, featuring contributions from high-profile authors and literary experts.

The hub, found at youngwriteraward.com, offers:

• Monthly ‘How To’ guides. These accessible, essay-format pieces promise writers a DIY online writing course. The series will be written by a different writer each year; starting in 2018 with AL Kennedy, Associate Professor at the University of Warwick.
• Monthly ‘What I Wish I Had Known When I Started Writing’ articles. Well-known writers will reminisce on their early careers. The series starts with Paul Beatty, Anne Enright, Ian Rankin and Nick Hornby. Paul Beatty’s piece will launch the new programme on Wednesday 8 August.
• Regular ‘Top Tips’ posts by experts, including staff at Peters Fraser + Dunlop, staff and students at the University of Warwick and journalists from The Sunday Times, as well as guest posts from experts from the literary world, such as the British Council, publishers and writers.

Talking about the launch, Andrew Holgate, Literary Editor of The Sunday Times, said ‘Bringing together well-known writers, experts in the field, and a network of partners, together with an exceptional list of alumni – from Max Porter to Sarah Howe, from Zadie Smith to Robert Macfarlane, from Sarah Waters to Naomi Alderman – the Sunday Times/Peters Fraser and Dunlop Young Writer of the Year Award, in association with Warwick University, is a unique support and champion for emerging and aspiring writers, providing those starting out with an increasing range of expertise, encouragement, and support.’

More About the Young Writer of the Year Award...

Sponsored by the literary agency Peters Fraser + Dunlop, the Young Writer of the Year Award, in association with the University of Warwick, rewards the best work of fiction, non-fiction or poetry by a British or Irish author aged between 18 and 35. Last year Sally Rooney won the prize for her debut novel Conversations with Friends.

The British Council is the international partner of the prize, opening doors for shortlisted authors abroad and providing opportunities for cross-border collaborations and exposure beyond the UK and Ireland. The University of Warwick is offering a bespoke 10-week residency to the winner.

The 2018 shortlist will be announced on 4 November, and the winner will be revealed at a ceremony at the London Library on 6 December.

Strong Leadership, Detailed Care Plans and Great Communication Results in Outstanding CQC Rating

The Care Quality Commission has found the care being provided at Oakwell, a care home for people with mental health needs, to be Outstanding following an inspection in April this year.

Oakwell provides accommodation, personal and nursing care for up to 13 people with mental health needs in Bensham, Gateshead. At the time of the inspection, there were eight people using the service.

Some of the findings from the inspection included:

• Time was taken to build relationships with clients, staff and other agencies involved in the care of clients.
• The provider inspired life-long learning, supporting staff to obtain higher education qualifications, as well as running apprenticeship schemes and enabling training to become a registered nurse.
• The culture of the service promotes continuous learning for all staff, reviewing what went well and what didn't and spreading the learning.
• The service recognised the risks of social isolation, and staff worked to ensure people kept their personal relationships, and remained active in their social groups.
• People were supported to enter into employment and engage locally with healthcare professionals and services.
• The management team promoted an open and honest culture throughout the service at all levels.

Debbie Westhead, Deputy Chief Inspector of Adult Social Care said:  “It is fantastic to find a service that fully supports both the people receiving care and the staff delivering it. The registered manager had formed very close working relationships with local healthcare professionals. Everyone we spoke to describe the service as being of significant benefit to people’s lives.

“We found a real focus on helping people recover and safely live their lives in the most independent way possible. Staff were very knowledgeable and took the time to get to know people. The care records, and people’s feedback, reflected the length the service went to in ensuring they developed and delivered the best possible care.

“The management team were clearly supportive and enabled staff to be innovative in managing people’s care needs and developing best practice. They led the way and weren’t afraid to constructively critique their performance.”