Recent changes to the way care is regulated in England may impact on access to insurance for providers in the public, private and voluntary sectors. Since some insurers use the CQC assessments (which are public documents) to gauge the levels of risk they are being asked to cover, some care providers may find it difficult to get insurance, or could see premiums rise substantially.

And since care can be a risky business, insurance is one area where you really can’t afford to get caught out.
The background is that on 1 April 2009, the Care Quality Commission (CQC) took over from the Commission for Social Care Inspection in regulating social care services provided in England by care homes, domiciliary care agencies, and care homes with nursing. It also took over regulating hospital services from the Healthcare Commission, and regulating mental health service providers from the Mental Health Act Commission.

The changes will affect an increasing number of organisations for some time to come. From April 2010, it will also be a legal requirement for all independent providers, foundation trusts and NHS providers to register with the CQC, and from 2011 this may include NHS primary care providers, including GPs (previously exempt from regulatory control).

One of the roles of the new CQC is to undertake independent assessments of care facilities, awarding star ratings in seven key areas. These are the choice of home; health and personal care; daily life and social activities; complaints and protection; environment; management and administration; and any statutory requirements that are identified.

Since these reports are made publicly available, insurers are able to assess their exposure to risk when it comes to quoting for individual providers. On one hand, they may be reassured by evidence of high-quality management, resident wellbeing and staff health and safety training. On the other, however, any weaknesses or failings, or any requirements for improvements to be made, could diminish insurer confidence.

Facilities that receive low ratings from the CQC-or that have not achieved the required improvements within the allotted timescale-may find themselves unable to obtain insurance cover, or may have to pay a much higher premium.

Of course, not every aspect of the star ratings will affect an insurer’s consideration of the risk (for example, if one of the CQC’s recommendations is for a more diverse range of service user activities to be offered). But it’s essential that care providers understand how the assessments may affect their insurance status-even if it’s as simple as ensuring and evidencing that improvements are made within the required timeframe.

According to Paul Eden, a director of the charity and care division at Giles Insurance Brokers Ltd, providers could be caught out by thinking this only applies when their insurance is due for renewal-but that’s not the case: “The requirement to disclose ‘material facts’ to your insurer is ongoing-that means those facts which might affect your underwriters consideration of the risk,” he says. “So if the CQC highlight a problem that is also relevant to your insurer but isn’t disclosed to them it could compromise or even invalidate your insurance.”

Eden suggests that if you’re concerned, one of the ways to set your mind at rest is to ask your broker for an insurance risk assessment. “At Giles, we offer care providers a free, no-obligation and impartial review of their existing cover, which includes looking at any issues which might leave them and their business exposed.” 

A standard insurance review will check whether you have missing or inadequate cover; whether there are any areas where you might be over-spending on insurance; and whether your total premiums are competitive. It will verify whether there is any scope for you to increase levels of self insurance, and determine whether you would benefit from additional health and safety advice. It will also explore the claims service levels from your existing broker and insurer, and whether your competitors may be getting better cover elsewhere.

“For care providers we are well placed to provide the extra scrutiny,” says Eden. “We’ll look at your facility from the point of view of where you might risk breaching your policy conditions: such breaches could compromise a claim or even mean that insurers repudiate a claim entirely. We’ll also look at your CQC assessment to see how you can work with your insurer to ensure the best possible level of cover at the most appropriate premium.”

Independent experts can check the situation over for you. And when the insurance review is free, it’s difficult to justify not taking up the offer. So to maintain all the protection you need for yourself and your staff, property, reputation and income, why not ensure your own peace of mind-by asking for an independent review from your broker?

Howard Wright Care Home Insurance
Tel: 0121 200 4920
E: info@howard-wright.co.uk
W: www.howard-wright.co.uk