9th January 2012 / Posted in: Care Quality Commission (CQC), Management, Operational management

Are the Care Quality Commission’s failings at Castlebeck just the tip of the iceberg?

At the beginning of October Panorama revealed that over 150,000 social care workers are paid less than the minimum wage.  The care industry employs over 2m people in the UK. It’s physically and mentally tough work, those receiving care are dependent on carers for many of their basic needs yet it’s poorly paid.  Many are paid the minimum wage, many little more, and a significant number are paid less as their employers exploit loop holes.

In November the media announced that Dr Foster had published a report which revealed that the death rates in NHS hospitals in England are higher at the weekend. Their report showed a correlation between highest mortality rates and the fewest senior doctors available.

Last month concerns were voiced as to whether the Government should do more to monitor the finances of companies operating in the care home sector needs following the collapse of Southern Cross earlier this year.

The regulatory body in England - the Care Quality Commission (CQC) has developed a document - the Essential Standards of Quality and Safety - which is used to evaluate whether registered health and social care providers in England are compliant with section 20 of the Health and Social Care Act 2008.

Standards against which providers are evaluated include:

• staffing - there are sufficient numbers of suitably qualified, skilled and experienced persons, at all times, employed for carrying out the regulated activity
• financial position - the service provider must take all reasonable steps to provide the regulated activity in such a manner as to ensure the financial viability of delivering the service as defined  in their statement of purpose.

According to their website the CQC state that their job is ‘to check whether hospitals, care homes and care services are meeting government standards.’ Comparing these standards with the events reported in the press suggest that the CQC aren’t doing their job, and the failings at Castlebeck hospital in relation to mistreatment of residents have resulted in an investigation by officials at the Department of Health and NHS Management. 

Whilst the regulated health and social care providers have exacting standards they are required to meet, how does the CQC demonstrate it meets standards required by a regulator? Previous healthcare regulators of the independent healthcare sector - the Healthcare Commission and National Care Standards Commission struggled with service standards and inconsistency between inspectors.  Is Castlebeck just the tip of the iceberg and has anything be learned by the mistakes of the CQC’s predecessors?

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3rd January 2012 / Posted in: Business efficiency, Management, Planning and preparation, Priorities, Time management, Top tips

3 top tips for client meetings

When we're busy we often don't allocate enough time to prepare for meetings with our clients or follow up after the meeting.  Every meeting, or significant telephone conversation, presents an opportunity to sow seeds which may develop and grow the business with that particular client.

These three tips may help you make the most of these opportunities: 

► Send a summary of what was discussed and agreed within 48 hours of the meeting. If you don’t already send minutes or action plans Minutes.io is a useful tool.  A summary is useful ground work for future meeting agendas.

► Take time to reflect on the meeting and whether any additional information, or clarification, is needed to progress any work

► Plan the actions required by the client remembering to schedule time in your diary. As well as making sure actions don’t get overlooked, scheduling helps keep track of the time actually spent on each client/project

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19th December 2011 / Posted in: Financial management, Management, Operational management

Profit or Cash - which is more important?

‘Turnover is vanity, profit is sanity but cash is reality.’  This neat saying, known as the ‘Banker's Mantra,’ is everything a business needs to remember about financial control.


Here’s why. I’ll start with profit - the sanity.  The reason for being in business is to make money, and profit is the measure of a business’s ability to make money .... or loss if it isn’t doing well.  

Nothing in this life is ‘free’ so the Inland Revenue tax your sanity which is why some  businesses may want to keep their reported profits to a minimum. However for the  the purpose of this short blog I’m only focusing on operating profit, that is the  profit earned from a business’s core business operations.  It’s also known as EBIT - earnings before interest and tax. 

As I’m blogging about profit and cash I’ll only mention vanity in so much as it’s all the revenue a business generates from its operations. As it’s the largest number in the profit and loss account it’s what companies can boast about.

A business can’t focus on just profit and turnover alone because the process of generating revenue needs cash because

• creating the products or services it sells
• getting these to market
• employing staff
• office facilities, office overheads
• purchasing assets such as computers

all need cash.

These costs occur in advance of the product being produced and sold so cash is an essential ingredient.   It doesn’t matter where the cash comes from - whether it’s generated by the business or provided by investors or borrowed from the bank, but without cash a business cannot survive.

Some business owners and managers think that if they are in profit they should have cash and can’t understand when they don’t.  It’s sometimes caused by them focusing on the P&L, which doesn’t show cash movement, rather than looking at the balance sheet and cash flow forecasts.

The reason that profit and cash aren’t the same thing is timing.  There are two aspects to this.  Firstly cash is needed to produce and sell a product or service, and secondly accounting conventions use the tax date of an invoice as the moment the profit is recorded, not the payment of the invoice.  For the majority of businesses the cash received for payment of an invoice is not on the day it is raised.  Consequently there needs to be a buffer of cash to carry on the business.

Taking this a stage further a company can be highly profitable on paper but because of the disparity between paying the cost of sales and overheads and receiving payment for invoices mean the company has no cash. If the cash outgoings are greater than the cash coming in the company may go into receivership. It’s called overtrading.

Profitability is a function of the company’s ability to maximise revenues from their cost base - namely their direct and indirect costs and assets. Having sufficient cash in the bank to continue the operations that generate profits is the proof of management’s ability to:

• minimise the amount of cash tied up in stock
• cost control
• minimise the time it takes for invoices to be paid - the debtors
• generate a greater margin than depositing the same money in the bank

So - to answer the question - 'profit or cash - which is more important?' - cash is the most important as the business cannot continue to carry on day to day operations in the current market without cash in the bank and you cannot rely on banks to provide an on-going overdraft facility.

However the end game for any business is both - as profits are the purpose of being in business and these can only be enjoyed by the business owners if there is sufficient cash to distribute the profits.

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23rd November 2011 / Posted in: Care Quality Commission (CQC)

GPs can’t avoid the requirements of the Health & Social Care Act 2008

Since April 2010 the provision of health and social care in England and Wales has been governed by the Health & Social Care Act 2008 - in other words it is, to all intents and purposes, already in effect, even although the appointed regulator, the Care Quality Commission (CQC), has allowed NHS GP practices until April 2013 to formally register as providers. This delay doesn’t in any way absolve GP practices from their responsibilities under the Act. 

It is remarkable therefore that delaying the registration by 12 months from April 2012 has seen a number of GP practices bury their heads in the sand and put off preparing for registration. The penny hasn’t dropped that registration with the CQC doesn’t mark the point at which they have to comply with the legislation - they should have been doing it since it came into force in April 2010.

The Act applies to all providers of health and social care in England and Wales and its purpose in it’s simplest terms is to provide one set of standards that applies to all providers of health and social care thereby enabling the end user to compare services from NHS and independent providers and to ensure they receive a consistent standard of care.

Like any Act of Parliament once it receives Royal Assent anyone to whom it applies has to abide by the legislation, even although they are not required to register until April 2013.   As an example, some people think the Official Secrets Act applies to those who are required to sign it. But in fact it applies to everyone, whether you have signed it or not, in the same way that we are all required by the Road Traffic Act of 1988 to wear seat belts, even although we have not signed that Act.

In the same way Health & Social Care Act, NHS GP practices have been required to provide services in line with the requirements of the Health & Social Care Act 2008 since its introduction in April 2010.  

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22nd November 2011 / Posted in:

A big ‘thank you’ to Will Donald at Amex

Last Thursday we took the overnight ferry from Portsmouth to Caen - looking forward to a weekend in Honfleur to celebrate our 10th wedding anniversary. Shortly after we joined the A13 motorway our car lost power and refused to accelerate leaving us no alternative but to pull over on the hard shoulder.

A call to the RAC revealed we didn't have European cover and they couldn't help. Nor could the AA or our insurers and the local Land Rover dealer in Caen weren't licenced to recover vehicles from the motoway. Our relaxing weekend looked doomed until we spoke to Will Donald at Amex.  He got everything back on track and here's the thank you my husband sent Raymond Joabar, CEO of Amex. Sorry that it has come out a bit small.

When was the last time you had exceptional customer service ....... and took the time to find out the name of the CEO to write and thank them?

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