The registration process for care does not promote good quality personalised support
Author: Dawn Cassius
I am a qualified, dedicated and experienced carer and have been for 13 years. Prior to this, my career was in retail management.
During the autumn of 2019, I had been working as a personal care assistant for a self-funding service user, who had been doing well on her recovery journey from brain surgery. The family hired me on recommendation after the local authority provided my details on their list of approved and accredited PA’s and, although I was only able to provide a maximum of 4.5 hours per day due to my other commitments, they still decided to keep me on.
After eight months of working for the service user, the family needed to increase the care package due to a decline in health. Unfortunately, the service user refused to use an agency and asked me to find a team to support her. It was at this time that I reached out to fellow approved and accredited PA’s that were on the same local authority approved list and asked for their help.
The service user explained that there were many reasons for refusing agency cover and told me how she was fed up of no shows, seeing different faces every visit and having the exhausting task of having to talk staff through what to do because the care plan was so detailed, and that they would always be in a rush, looking at their watches, because they were running overtime.
I was stuck in a situation where the family did not want to employ me, pay holiday or have the hassle of paperwork but they were happy that I was registered self-employed and would invoice them for my hours.
As PAs, we were encouraged to buddy with other approved and accredited PAs so that we would have support and the ability to job share when holidays, breaks or sickness cover was required. PAs would often become acquainted during training days, frequent training sessions and after their experience of working together.
My dilemma was I was in need of hip replacement surgery due to my osteoarthritis and, as my service user began to decline in health, I informed her and her representatives and family that she may need to replace me, as I only had two other ‘PA Buddies’ who were local authority approved that could step in.
I was unaware that the situation for my service user was changing rapidly as we went into the second stage of lockdown.
It became apparent that new equipment was needed that required two people, as well as extra support from the local authority, but the service user insisted on her own team of carer staff. The situation changed very quickly, and this was when I was contacted by the regulator who was aware that the business name I used for invoicing was not currently registered with them.
Having journeyed through the intense and very stressful CQC registration process, after being told by email that I was in breach of section 10 of the social care act, I responded to their message by email, later followed up by telephone, explained my accreditation with local authority, that I work in partnership with adult social services and that I was hired privately. However, the person on the phone insisted that it would be up to them to let me know if I require registration and, before they did, I would first have to complete the registration process.
There were over 150 policies that were required, business insurance quotes, and other legalities which were all based around the employment of large numbers of workers. I kept thinking:
“… but this isn’t my vision”
I didn’t want to start an agency, and I certainly didn’t intend to sit in an office box-ticking paperwork and being taken away from the work that I had an immense passion for.
By the time I submitted all my care-related qualifications, certificates, Enhanced DBS, ICO, and a mountain of other documents, I just about made it through to the second stage. At the end of the interview, I was told that I would hear back from them within 10 days, and when an inspector contacted me, they said that they were concerned and wanted to know how I would cope with 35 clients on my books.
I responded by explaining that I wouldn't have more than my existing clients, and I would not be carrying out any regulated activity. I was not an agency and never intended to be one; I just wanted to be able to have some time off to have a surgical procedure and my current client insisted on picking her own care team to continue her care, as her health began to rapidly deteriorate.
The penny finally dropped, followed by silence, after which CQC closed my application process.
From my own experience and research, people continue to express the same concerns regarding large providers and the sometimes-poor quality of service, from lack of engagement with the cared-for from the carer, and the lack of regular communication from the office staff with family or representatives.
Service users/representatives explained to me that they do not wish to use care agencies because of the high turnover of and lack of consistency due to their heavy workload. They complained that some agency staff are always in a rush, they are ‘in and out’ in less than 30 minutes and make no time to chat, provide a listening ear or even notice the sudden changes a service users’ needs and well-being. When one care worker from the six-week enablement team was asked to wash up the dishes, they replied, “No, we don’t do that!”
I have come to learn that the regulators current process doesn’t recognise or accommodate accredited and privately hired care workers who are working into retirement and do not want to start an agency or employ large numbers of staff.
It would be good for the CQC to recognise that there are dedicated people who are qualified and passionate about providing help to those who wish to stay living independently in their homes for as long as possible. Perhaps if the regulator had a more inclusive approach to its registration processes, recognising smaller teams of 2 to 3 workers, we wouldn’t have to suggest residential care just because we are restricted to non-regulated activities.
The publisher is Citizen Network. One Size Does Not Fit All © Dawn Cassius 2025.
Deinstitutionalisation, Personalised Support, regulation, Self-Directed Support, social care, England, Article
