FEATURE
Are You Rated By Your Region?
Roger Harcourt, Partner and Head of Healthcare at law firm Shakespeare Martineau, examines the correlation between the economic position of local areas and CQC ratings.
The latest data about the performance of care homes seems to indicate that higher profits lead to better CQC ratings, at least most of the time. But, aſter closer examination of the findings, it appears that there are some anomalies, which could point to inspector subjectivity.
Research published recently by Independent Age shows the percentage of care homes in England receiving ‘inadequate’ or ‘requires improvement’ ratings by region and by local authority area. As we might expect, care homes in the London area, where property prices are significantly higher than the rest of the country and a lot of residents have a high net worth, has the lowest percentage of lower rated homes. The North West, on the other hand, where property values and earnings are more modest, has a much higher percentage of lower-rated homes.
A cross-comparison of the data with research by Knight Frank Healthcare, which shows the financial performance of care homes regionally, according to their EBITDARM as a percentage of income, provides further evidence of a
link between higher fees / profits and better care ratings.
None of this is particularly surprising. Affluent communities, where households have a high disposable income and high-value assets, such as property, find it easier than others to meet the cost of residential care for their elderly relatives. This will generally increase the percentage of self-funding residents in such locations, producing higher average fees and profits which can be invested into the care provided and the systems to demonstrate compliance.
However, the research highlights some anomalies which deserve closer scrutiny. When we delve further into the research to see how care homes in local authority areas measure up, some of the results are not what we would expect to see. Despite being in London, for example, Kensington & Chelsea and Westminster have a higher percentage of lower-rated homes than other parts of the capital. Equally, while the North West is the worst-performing region overall in terms of its CQC ratings, Blackburn with Darwen appears to be
bucking the trend. It is rated the 12th best-performing local authority in England despite being no more or less affluent than its neighbours.
With such wide differences between local authority areas with similar wealth/fee profiles, it seems likely that there are more factors at play. Could it be that the differences are due to the way the CQC organises its inspection teams?
Whilst individual inspectors used to rotate their portfolios, it is believed that they are now more likely to be assigned to individual areas on a more permanent basis. This move may be intended to reduce travel time, assist with gathering local knowledge and help inspectors to get to know their local authority counterparts under the Care Act 2014. However, does such localism leave care home operators well served in their area if they repeatedly have the same inspection teams?
The marked differences in the ratings given to care homes in neighbouring local authority areas, as shown in this data comparison, could be evidence of
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