Care Quality Commission

[tammyins]

Afternoon All! How many of you are going to fall foul of these new regulations (to come in April 2011)? If you're a lone operator, or part of a partnership (like myself and my husband), make sure you know where you stand because you're about to be bankrupted out of business!

Anyone working in (most) areas of healthcare will have to be regulated by the CQC from April and it won't be cheap. It's going to cost £1500.00 just to register, then you have to pay for a manager to be registered, then you have to pay annual fees.

I'm actually an Emergency Nurse Practitioner with an EMT certificate and qualifications in advanced care so I approached the Nursing and Midwifery Council for help and clarification - their advice was of no help at all so I spent all day yesterday reading the guidelines. One REALLY useful piece of advice (a bit of irony there) says that we shouldn't take the guidelines as gospel but should refer back to the legislation. I started reading said legislation this morning and after 4 hours, I'm still only 10 pages into it http://www.legislation.gov.uk/uksi/2010/781/introduction/made

Most of my work is event and sporting medical cover and, if I read the guidelines correctly - and follow the advice given by some representative who gave a (useless) talk to the Association of First Aiders last weekend, then if I wish to continue to carry out advanced care I have to be registered and regulated (bang goes £1500.00 in registration). However, if I practice only as a first aider, using only the equipment available in an HSE first aid kit, I don't have to register. I'd also not be allowed to give medical advice, since this is a regulated activity. Therein lies a dilemma. If I only practice as a first aider, I could be considered to be in breach of our Code of Professional Conduct. The CQC representative admitted that St John and Red Cross have been given an easy ride over this regulation, in particular to the background checks and verifications, so why are small businesses (like my partnership business with my husband - no other employees) and lone operators going to be hit so hard. We're going to be bankrupted out of business. I'm now on the point of giving up a 30 year career because I just can't cope with all this crud.

Granted, regulation is desperately needed in some areas. It's ludicrous that someone can buy a vehicle, convert it and call themselves an ambulance service but come on! Why penalise the people in the industry who work hard and try to do things right?

[zippyRN]

Afternoon All! How many of you are going to fall foul of these new regulations (to come in April 2011)? If you're a lone operator, or part of a partnership (like myself and my husband), make sure you know where you stand because you're about to be bankrupted out of business!

Anyone working in (most) areas of healthcare will have to be regulated by the CQC from April and it won't be cheap. It's going to cost £1500.00 just to register, then you have to pay for a manager to be registered, then you have to pay annual fees.

ah diddums get used to it, the fact is that ambulance operations in the Uk are vastly under regulated leading to all sorts of muppets and fantasists running Ambulances with all kinds of made up role titles and claiming to be able to do all kinds of things

I'm actually an Emergency Nurse Practitioner with an EMT certificate and qualifications in advanced care so I approached the Nursing and Midwifery Council for help and clarification - their advice was of no help at all so I spent all day yesterday reading the guidelines. One REALLY useful piece of advice (a bit of irony there) says that we shouldn't take the guidelines as gospel but should refer back to the legislation. I started reading said legislation this morning and after 4 hours, I'm still only 10 pages into it http://www.legislation.gov.uk/uksi/2010/781/introduction/made

Most of my work is event and sporting medical cover and, if I read the guidelines correctly - and follow the advice given by some representative who gave a (useless) talk to the Association of First Aiders last weekend, then if I wish to continue to carry out advanced care I have to be registered and regulated (bang goes £1500.00 in registration). However, if I practice only as a first aider, using only the equipment available in an HSE first aid kit, I don't have to register.

which would immediately cause a problem wit the fact you cannot 'turn off' your registration, and although not yet tested with the NMC, HPC 'case law' has seen a Paramedic struck off for not having 'essential' equipment

I'd also not be allowed to give medical advice, since this is a regulated activity. Therein lies a dilemma. If I only practice as a first aider, I could be considered to be in breach of our Code of Professional Conduct.

see above

The CQC representative admitted that St John and Red Cross have been given an easy ride over this regulation, in particular to the background checks and verifications,

really? care to dig yourself further in the mire with these kinds of accusations, which may be determined to be libellous.

as for background checks and verification , All SJA operational members, Youth leaders and CTD employees in the Priory of England and the Islands (POEI), who may be required to teach children, young people (16-18) or vulnerable adults are enhanced CRB checked and this is renewed on change of appointment or every three years, SJA(POEI) members are also required to make a declaration every year when verifying their membership details and service with regard to any convictions, cautions etc.

Every SJA (POEI county has a Safeguarding Officer and SJA(POEI) has a long standing relationship with the NSPCC over it;s safeguarding procedures and training.

Every SJA county in the Priory of England and the Islands is inspected and audited annually by NHQ both in terms of clinical and corporate governance , also with regard to specific standards and targets relating to fleet, clinical audit, records handling etc. during this audit the asset register and servicing records for all durable equipment is checked to ensure that it is serviced in accordance with the manufacturers requirements .

I can't answer for BRC in this respect but I have no reason to suspect that their practices will be much different.

perhaps that's why there is an alledged 'easy ride' for SJA and BRC becasue oif their all ready in place systems of audit and improvement notices ...

so why are small businesses (like my partnership business with my husband - no other employees) and lone operators going to be hit so hard. We're going to be bankrupted out of business. I'm now on the point of giving up a 30 year career because I just can't cope with all this crud.

Granted, regulation is desperately needed in some areas. It's ludicrous that someone can buy a vehicle, convert it and call themselves an ambulance service but come on! Why penalise the people in the industry who work hard and try to do things right?

you are not being 'penalised' uou are being expected to adhere to the same standards as everyone else in the field , the NHS has come to dislike small provider units after occurences such as Shipman so it's unsuprising that that the CQC is following suit, given the actual and anecdotal evidence of the standards or lack thereof in some providers it's perhaps unsuprising that there will be consolidation in the market and unfortunately for some providers it will mean merge or give up and we may see the price of cover rise to sustainable levels to meet the requirements now placed on providers.

[tammyins]

Where do I start? I don't have a problem with regulation at all - it's the extortionate fees they're going to charge that will be crippling, especially as we're not operating from a level playing field. It was the representative of the CQC who told us that the voluntary associations would be given an easy ride - not a statement I merely plucked out of thin air.

As a Registered Nurse, I'm already bound by the rules and regulations of the NMC, I adhere to those rules and to my Code of Professional Conduct and I'm proud of my practice. One of the reasons I left St John was because they were restricting my practice (being told not to touch any cardiac patients at a major event but to, instead, wait for the Drama, sorry, Trauma Squad to arrive was in clear breach of my Code of Conduct. I'm trained in ALS, PLS and ACLS, but was not allowed by St John to use those skills, even though I volunteered to come off duty in order to treat a patient. I couldn't have my professional hands tied behind my back like that. Really, I suppose though, I should be very grateful to St John. Despite being a charity, it charges for its services and we've picked up a lot of work when St John have cancelled duties at short notice because volunteers decided they couldn't work on the day.

As far as CRB checks are concerned, I renew mine regularly but it's getting increasingly difficult. My husband applied to do some agency/bank work in a local A & E because we have 2 kids at uni and the extra money would have been helpful. His CRB request was submitted on 4 August. It's now 20 November and it STILL hasn't been done - he's not alone with this problem. There are many people who are losing out on potential jobs because the CRB aren't doing THEIR jobs.

Think yourself very lucky you have the support of a voluntary organisation. If you come out into the real world and try to work in the private sector you'll find life much harder. Many of us have wanted regulation for many years - it's ludicrous that anyone can buy an old ice cream van, put a few stickers and a couple of lights on it and call themselves an ambulance service. Thankfully, we don't run ambulances any more, that's one less thing to worry about, especially as we don't receive them free from people like the Masons - unlike our local St John.

St John can obviously afford the extortionate fees but for small, independent partnerships like ours (and there ARE good services out there) it will be difficult. £1500.00 just to register is way above what many will be able to afford, on top of the annual fee they're going to charge. Have regulation by all means, but make it fair and make it affordable and STOP moving the goal posts - we received a letter from the CQC this week to say we now have to register in December, rather than in April. Although the regulations only specify that records should be kept securely (I HAVE read the regulations), the CQC are insisting that we can no longer work from home because they don't want records stored in private houses so, instead of having records securely locked away at home, where there is almost always someone present, we now have to find premises (with all the attendant costs) where we will only be present for a few hours a day and where we'll still be using the same, secure storage units. Perhaps the CQC should look at some of their interpretations.

I certainly wasn't looking for sympathy when I posted this subject. I wanted the opinions of other who will be affected by these regulations and fees, especially those who may be driven out of business by them because there are some of us who want to put a case to the CQC for reducing the registration fees to a more affordable level. I also want to know if anyone else is getting confusing signals - the CQC agent who spoke to people at the AofA said that CQC rules and regulations superceded those of the NMC - a point which I have had clarified by the NMC as being incorrect.

So, if there are any others out there adversely affected by this much needed but ill-thought out regulation, please let us know.

[zippyRN]

As a Registered Nurse, I'm already bound by the rules and regulations of the NMC, I adhere to those rules and to my Code of Professional Conduct and I'm proud of my practice. One of the reasons I left St John was because they were restricting my practice (being told not to touch any cardiac patients at a major event but to, instead, wait for the Drama, sorry, Trauma Squad to arrive was in clear breach of my Code of Conduct. I'm trained in ALS, PLS and ACLS, but was not allowed by St John to use those skills, even though I volunteered to come off duty in order to treat a patient. I couldn't have my professional hands tied behind my back like that. Really, I suppose though, I should be very grateful to St John. Despite being a charity, it charges for its services and we've picked up a lot of work when St John have cancelled duties at short notice because volunteers decided they couldn't work on the day.

I don't recognise any of that from the last 10 - 15 years in SJA which represents my adult service with the organisation and my involvement with operational and clinical management activities, the only concern I have from a professional practice point of view with SJA has been a reluctance to explore routes of making more medications available to suitably skilled RNs and ODPs, despite the apparent hypocrisy it has displayed over medicines legislations and IHCD technicians .... however this is down to the hard work of volunteers and paid staff in the counties I routinely work with and whom NHS and Private Sector event medical management teams are happy to contract work to.

As for "despite being a charity it charges for it's services" I think your understanding of Charity law is a little lacking, AS giving money, goods or services to another charity is not a charitable aim of SJA as lodged with the charity commissioners it is required to charge 'at cost' services it provides to another charity , although this can be offset by an exchange of services. A charity cannot enter a loss making arrangement with a for-profit organisation , therefore charges to 'for profit' organisations must be at or above 'at cost' where a not for profit organisation is not a registered charity and where the charitable aims of the organisation can be demonstrated to be met then work can be done for less than cost praice.

<snip>

Think yourself very lucky you have the support of a voluntary organisation. If you come out into the real world and try to work in the private sector you'll find life much harder. Many of us have wanted regulation for many years - it's ludicrous that anyone can buy an old ice cream van, put a few stickers and a couple of lights on it and call themselves an ambulance service. Thankfully, we don't run ambulances any more, that's one less thing to worry about, especially as we don't receive them free from people like the Masons - unlike our local St John.

To be honest the biggest block to regulation was the NHS ambulance service in the closed shop days, as they simply did not acknowledge the existance of providers other than themselves and the VASes

Do I see a little green eye d monster peeking out here ? the fact Organisations who have as their charitable objectives raising money for the benefit of Charities choose to donate to SJA, the major (national) donation by the Mark Master Masons was over 10 years ago, if lodges or localities have donated since that is a lodge / locality decision and not a national one.

In some cases grants or being the subject of a fundraising campaign is down to effective relationship building and not necessarily down to the names involved, i'm aware of an independent event cover organisation who recieved the donation of a fully equipped ambulance from an NHS Acute Trust which had used it for critical care transfers and had purchased an new vehicle for that role....

St John can obviously afford the extortionate fees but for small, independent partnerships like ours (and there ARE good services out there) it will be difficult. £1500.00 just to register is way above what many will be able to afford, on top of the annual fee they're going to charge.

The fact is the regulatory need is the same and reading the CQC guidance SJA will be registering on at least a county basis and in some cases may be registering on an area basis depending on county structure, so that will be 30 something lots ( excluding the none England 'counties' in PoE+I ) and should similar legislation come in covering Wales SJCW will be registering on a regional basis rather than nationally i suspect.

Have regulation by all means, but make it fair and make it affordable and STOP moving the goal posts - we received a letter from the CQC this week to say we now have to register in December, rather than in April.

the registration has from the outset been BY April 2011 i.e. all organisations would be registered before

Although the regulations only specify that records should be kept securely (I HAVE read the regulations), the CQC are insisting that we can no longer work from home because they don't want records stored in private houses so, instead of having records securely locked away at home, where there is almost always someone present, we now have to find premises (with all the attendant costs) where we will only be present for a few hours a day and where we'll still be using the same, secure storage units. Perhaps the CQC should look at some of their interpretations.

perhaps they should, or perhaps it needs to be queried as there are other registerable activities which could concievably be run from home or in an office attached to a home

[mikemedic999]

Check the rules again......

[Kiwiology]

...leading to all sorts of muppets .... running Ambulances with all kinds of made up role titles and claiming to be able to do all kinds of things

Red base, November 100 located.

Yes hello my name is Kiwi, this is my partner Kermit, I am the Grand Wizard of Emergentology and a State Registered Paramedic State Rejected Paraalmost, oh shit that looks like the LAS fast response car pulling up out front, best leg it Kermit, I am sick of getting nicked by the HPC, but you know what, the GMC hasn't found me yet!

Thames, Medevac, mile and a half north of Tower Bridge, special VFR please, returning to Barts, apparently we're not welcome at the London any more!

Sorry blokes, I couldn't resist taking the piss on this one