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 private 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.