Written evidence from Experts by Experience (CQC0011)
Executive Summary
Experts by Experience are skilled workers who have personal experience of using health and social care services. They support CQC inspections by gathering evidence on the views and experiences of patients, service users, residents and their relatives. This submission concerns the CQC’s Experts by Experience contract, which commenced in February 2016. The two successful suppliers were Remploy (a for-profit organisation) for three of the regions and Choice Support (a charity) for one region. The new contracts were expected to increase the number of Experts and provide a quality, value for money service. This submission provides evidence from the experiences of current and former Experts that the Remploy contract is failing to retain experienced Experts, recruit suitable new Experts, provide a high quality service or provide value for money. It is exacerbating problems of CQC staff morale, sickness and turnover as well as reduced productivity in the inspection programme. The CQC is not fulfilling its contractual responsibilities to manage the failing Remploy contract effectively, so is wasting taxpayer’s money, jeopardising the quality and integrity of the CQC inspection programme and putting vulnerable service users at risk of not having their views and experiences recorded effectively.
2.1 The CQC acknowledges that there are problems with the Remploy contract and has admitted Remploy is non-compliant in eleven contractual obligations. Remploy has been served with a Remedial Action Notice and is subject to a Performance Improvement Plan. The latest Q2 CQC performance report reveals that the Remploy contract is the highest risk contract for CQC, the only contract to attract a red RAG rating. The Choice Support contract has no identified risks and has a green RAG rating. The serious contractual failings for Remploy in attracting, recruiting, training, managing and deploying appropriate Experts warrant a termination of contract. But instead, the CQC is adopting a sticking plaster approach, continuing to commit scarce resources to discuss improvement plans.
2.2 The CQC acknowledges mistakes were made in the procurement process and conducted a “Lessons Learned” exercise, published in July. The main focus of the exercise was procurement timetables, with an acknowledgement that the process was rushed. There was no attempt to examine the grounds for awarding the service to two contractors, or awarding three out of four regions to a business with no experience of running a programme of this nature. The CQC say Remploy won not only on price but on quality evaluation, but give no information on what the quality evaluation criteria were.
2.3 As a group of current and former Experts, we submit regular lists of current issues concerning Remploy, and its various sub-contractors, to the CQC Engagement team, so CQC is well aware of the many problems still encountered. We have seen little improvement.
2.4 The CQC has admitted it needs to improve its contractual obligations to provide “fill rates” (requests for Experts for inspections) for Remploy to work on. From our experience, we believe inspectors are not requesting Experts as often as they should (targets of 90% inspections to include Experts have been set) and we believe the recruitment quality issues and problematic fulfilment process with Remploy have been major contributory factors in this.
2.5 We have tried to obtain information through Freedom of Information requests about how Remploy is performing on Key Performance Indicators, compared to Choice Support. Our requests have received refusal notices.
3.1 Current and former Experts share many continuing concerns as a result of the Remploy contract. Remploy has assigned a number of sub-contractors to run the Experts by Experience programme. Some of these have already terminated their contracts. The sub-contractors, like Remploy, have no experience or understanding of the inspection programme or Experts’ work, so the problems persist. Administrative processes are poor. Inspections can be allocated inappropriately outside Experts’ areas of experience. Available Experts may not be assigned to requested inspections. New Experts can be sent on inspections without security checks, induction or contracts. Experts who have resigned are approached about possible inspections. Personal data is sent to other sub-contractors without permission. Experts can be asked to travel over 50 miles to an inspection when other Experts are available more locally. Experts are having to complete unpaid administrative tasks that Remploy should be doing in order to be allocated to inspections. Experts receive either no payment for training or a small payment only after completion of an inspection, within a time limit, which may not be allocated. Experienced Experts are forced to attend mandatory training that does not enhance their own learning, but they provide valuable information for new recruits and, indeed, the trainers who know little about the CQC and even less about Experts. Remploy lose details of inspections to the point where Experts may not be paid for their work as there is no record of the work allocation. Experts receive no support after difficult inspections or having raised issues about inspectors not following CQC guidance. Experts report being either overpaid or underpaid with limited follow up when they raise these problems. A staff satisfaction survey sent out by Remploy in August was designed for new recruits, but sent to all Experts (sometimes twice), with no assurances of anonymity or independent analysis. Experts who raise concerns with Remploy are asked to consider resigning. None of these difficulties are encountered by Experts in the Choice Support contract.
3.2 Remploy Experts are operating in a fragmented, confusing, bewildering and energy-sapping environment. Communication is poor. Experts are not sure if they should apply to another sub-contractor to receive work. They do not know the rationale for Remploy distributing work to sub-contractors. They can receive duplicate paperwork. Communications can be conflicting. Emails requesting information on disabled access to training venues have not been answered. Remploy circulates, confusingly, two different newsletters, but in some months the monthly newsletter has not been sent. The newsletters focus on good news stories and have included erroneous information and guidance on report writing. Some sub-contractors offer erroneous advice, conflicting with the CQC guidance. The high turnover of administrative staff leads to a lack of support and inefficiency. Experts are contacted about inspections they have already said they cannot do, or for days they are already booked. Some Experts are allocated minimal work, whilst others are overloaded with requests, in the same geographical area. Remploy and sub-contractors offer Experts different reasons for the recent dramatic fall in numbers of inspection requests.
3.3 Inspectors are reporting the unsuitability of some new Remploy recruits. Remploy’s core business is getting disabled people into paid work, which is laudable. But recruitment into the skilled Expert by Experience role should entail rigorous person specification criteria, induction, support and quality training, as offered by Choice Support.
3.4 New recruits are offered the living wage only, and experienced Remploy Experts now face the first pay cut since the contract commenced. National media and social media outrage in February forced the CQC (or, more exactly, tax payers), to temporarily top up the pay rate offered by Remploy (£8.40 per hour) to the same pay rate as Choice Support Experts in Central region (£15 per hour), but for a limited period only. In Central region there is no intention from Choice Support to cut pay rates of £15 per hour for all Experts.
3.5 The CQC continues to claim that it has no influence over the pay rates offered by the two contractors, although we received evidence that the CQC Executive made the decision to cut the pay rate to the living wage level. The low wage offered by Remploy reflects a lack of understanding of the responsibility and skill level required, including the CQC ambassadorial role. It also does little to help fulfil the contractual obligations to recruit more Experts. The CQC supports an unjust, divisive and inequitable payment system. This is particularly galling when all Experts have their pay for each inspection capped and, in order to provide high quality support, they work many hours unpaid. We note that specialist advisers who work on inspections are all paid the same fee for inspections across the country and so do not have to endure an unfair and divisive payment system.
3.6 Disparity of pay, terms and conditions; low pay; administrative inefficiency; poor communication; lack of understanding of the role of Experts; lack of support and training and continued frustrations all add up to test even the most dedicated Expert to the limit. It is unfair and unjust that Experts should have to deal with these problems simply because they live in one of the three regions where Remploy is contracted. In the Central region Experts contracted to Choice Support do not face these frustrations, injustices and inefficiencies. Choice Support understands the CQC inspection programme and the Experts’ role in supporting it. It is completely unacceptable for such disparities across regions to be supported and encouraged by the CQC, the regulatory body whose lynch pin is universal standards of quality and human rights.
3.7 Many Remploy Experts have resigned or are intending to resign as the promised improvements from Remploy are not forthcoming and their pay rates fall to unskilled levels.
4.1 Inspectors are exasperated by the struggle to negotiate their way through Remploy’s allocation systems to find Experts for their inspections. Some inspectors try to circumvent the Remploy allocation system through sheer frustration, contacting experienced Experts directly to assess their availability. We know that, in many cases, their requests for Experts are not fulfilled, or Experts are allocated without them being informed, or allocated at the last minute. We also know that Experts are often available, but not contacted by Remploy or its sub-contractors due to inadequate administrative systems. We know that some newly recruited Experts have not provided the quality service inspectors need and that there have been complaints from inspectors and providers.
4.2 Without an Expert, inspectors are faced with adding extra (expensive!) inspector days to inspections if they want to effectively capture the views and experiences of service users. This extra pressure comes at a time when inspectors are being asked to complete more inspections and, in Adult Social Care services, are no longer allowed to use Bank Inspectors to assist them.
4.3 From a Freedom of Information request we know that the number of all CQC inspections increased on average around 54% across the four Regions over the period May 2015 to July 2016. Numbers of Experts by Experience deployed on inspections during that period also increased, particularly in the Central and London Regions, but not in line with the huge increase in the number of inspections. Also, the percentage deployment of Experts by Experience in relation to the number of inspections varied across Regions. In the North and South (Remploy) regions the percentage deployment of Experts actually fell between 8% and 21%. In the Central (Choice Support) region Experts were deployed 5% to 11% more. This lack of assistance will be adding an enormous strain to inspectors’ workload, and will be seriously compromising their ability to capture the views and experiences of vulnerable service users.
4.4 This extra pressure will have a negative impact on inspector’s productivity and morale. The CQC’s latest performance report (Q2 to September 2016) shows report timeliness is still below target and sickness rates for inspectors are high. Most worrying are the very high inspector turnover rates of 11.8%, with 60% of this turnover attributed to inspectors with two years or less experience. So the recent effort put into recruiting new inspectors has not achieved the desired outcomes.
4.5 We are concerned about Remploy’s quality assurance as some sub-contractors do not even want to see Experts’ reports. It is not clear how Experts are being supported and managed, or how their performance is managed.
4.6 The CQC inspection programme is struggling to meet its targets and morale amongst key staff is low. Yet the CQC allows a contract to continue that is exacerbating the problem and their “active monitoring” of the contract with Remploy is costing money, but ineffective.
5.1 The CQC has not commissioned work to capture the views of service providers on the differing approaches to the Experts by Experience programme across the regions. Service providers could question the quality and equity of the service and register dissatisfaction as a result.
6.1 Problems with the Remploy contract have been well documented across national media, trade press and social media. CQC remains resolute in its defence of the contract. This is having a negative impact on the reputation of the CQC.
7.1 The real victims in this sad saga are the most vulnerable people in society. In three of the regions, service users are not receiving the service they deserve and their views are not consistently captured.
8.1 In public statements the CQC is always supportive of the Experts by Experience contribution to the inspection programme, but it is equally defensive about the Remploy contract. Despite public and media outcry, the CQC insist on “actively managing” the failing contract.
8.2 We have explained the problems and written to the CQC many times. We have requested information through the Freedom of Information Act, but these requests have mostly received refusal notices due to “commercial sensitivity”. We are contesting these outcomes as the information we are requesting is in the public interest and appears to be available.
8.3 We would welcome more scrutiny regarding the Remploy contract, particularly around comparisons with the Choice Support contract; key performance indicators; percentages of inspections that include Experts; feedback from inspectors on the quality of Experts; the impact of the reduction in percentages of inspections involving Experts; why inspectors are not requesting Experts; what resources are being deployed to actively manage the contract; the contract quality criteria and evidence that the contract is value for money.
8.4 The CQC continue to be optimistic and upbeat about the future success of the inspection programme, including the Remploy contract.
8.5 We do not share the CQC’s optimism. Amongst inspectors, morale is low, sickness rates are high, turnover is very high and productivity is still low. Experts in three regions are under-valued, treated unfairly and struggling with a failing contract. The views and experiences of vulnerable service users in three regions are not being effectively recorded. The CQC are defensive about the Remploy contract and unwilling to share information about performance and value for money that is in the public interest. The time has come for the CQC to admit mistakes, swallow pride and take positive action to terminate the Remploy contract.
8.6 The CQC is accountable to the general public, but more specifically, to vulnerable service users. Our group of current and former Experts by Experience believe therefore that the whole procurement process; the decision to award the contract to Remploy; Remploy’s inability to operate the contract; the CQC’s apparent failure to enforce compliance with the contract and comparisons with the Choice Support contract are worthy of further scrutiny by the Health Select Committee or an appointed body.
Recommendations for the Health Select Committee
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