Sneaky and Naive: The Department of Health’s plan to raise care home inspection fees

Care quality Commission


While MPs were enjoying their Christmas break the Department of Health sneaked out a consultation paper planning a massive increase in compulsory inspection fees for care homes, privately provided ambulance services and hospitals.

As part of the spending settlement the ministry has decided to recoup the present £120m  a year subsidy given to cover compulsory inspections made by the Care Quality Commission. Altogether the ministry want to recoup some £780m over a ten year period. I have written about this in Tribune magazine

There is a subsidy is because the CQC has had to up its game and do more through inspections after the scandals exposed by  the Robert Francis report into Mid-Staffordshire NHS Foundation Trust and the Winterbourne View private home for people with learning difficulties exposed by BBC Panorama.

The Treasury wants to abolish this subsidy on the grounds that it must recover all the costs of inspections rather than part of them.. Superficially this sounds fine as NHS trusts will not to have to pay for the inspection of their own hospitals and ambulance services. Neither will 94 per cent of GP surgeries.

However increasing privatisation and outsourcing of services by local authorities and health trusts to private firms means that the bill for the inspections which already run into thousands of pounds could fall on councils and trusts who commission the services.

The paper reveals that 90 per cent of  care services are already privatised and privatisation is increasing in the NHS with private ambulance providers becoming the norm and mental health provision and other services being outsourced.

To try and justify this civil servants have tried to tell ministers that this could have nil effect on health provision.

This naive view is bolstered by the belief that care homes s will accept a cut in their profits to prevent an adverse health outcome caused by councils and health trusts having to cut the number of people sent there because of the increased cost of inspection fees.

This is contradicted by negotiations for the present year’s fee increases. The paper says:

“There is a risk that any increases in fees could have a destabilising effect on providers, as many providers are facing a tough financial climate, with increased running costs and reductions in income. During the CQC’s consultation into their fee levels for 15/16, 80% of providers opposed the proposed 9% fee increases for this reason. “

This is hardly surprising given that to run a care home on a profit, they already pay staff little more than the minimum wage and cash strapped councils are unlikely to pay them any more for residents. It puts into question whether running a care home  is a suitable business for the private sector. Soon they will soon have to pay the living wage. So would anyone believe they will absorb higher inspection fees into their profit margins.


The paper also discloses that the review will mean they will cut inspection fees for private dentists as they make a profit. It then naively assumes that the dentist will pass on the saving to patients. Does anyone believe that?

Whoever drew up these proposals cannot really live in the real world – no wonder ministers are told what they want to know rather than face reality themselves.


Revealed: Blueprint for Lansley’s bureaucrat free simple NHS (This document is real!)

Can you understand this document reproduced below?

Simplified Map of how the London NHS will look after Lansley has finished with it

No, thought so.Well this is the all singing, dancing model of the remains of the National Health Service after Andrew Lansley has finished with it. It is being distributed by the NHS Commissioning Board and a copy has come my way.Have you seen such a complicated diagram with different arrangements for accountability and funding? Far from creating fewer bodies it seems to create a plethora of new bureaucratic ones who will  have more complicated relationships than a man with 20 mistresses.

Note where the public and the patient – supposedly the focus of David Cameron’s reforms. They are hidden under three levels of bureaucracy at the bottom of this diagram – obviously the least important people around.

 Note all the new bodies, Public Health England, London Health Education, the NHS Commissioning Body, London;The NHS Trust Development Authority, London; Clinical Senates, Clinical Commissioning Groups,  Patch teams ( I think they put sticking plaster on people when it all falls apart) the Care Quality Commission ( the body whose boss has just quit before being pushed and finds it difficult to monitor one home let alone all the rest) and a role for local authorities who being stripped of cash anyway by Eric Pickles, the communities secretary.

There are also Commissioning Support Services – I think this is the bit where the private sector make their millions from the taxpayers before they take over the running of the hospitals.

In my view this document gives a complete lie to the idea that some how  we are going to have a wonderful bureaucrat free NHS with thousands of new doctors and nurses and patients with a sensational choice for everybody in England to go any hospital they want, regardless of cost.

It more looks like a recipe for chaos, fragmentation, confused accountability and irresponsibility with taxpayer’s cash. This diagram illustrates why it is costing £1.3 billion to do this.

Andrew Lansley becomes excited when he see this wonderful NHS blueprint!

There still a little time left before collective madness sets it. If it wasn’t an insult to the thousands of mentally ill people suffering in this country, I would suggest that Mr Lansley ought to be sectioned under the Mental Health Act for all this mayhem he is about to cause. You can off course tell him he is mad yourself. His direct e-mail in the House of Commons is: