Archived: Health Tech Services Group Limited

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this service. This key question has been rated Inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulation in relation to governance at the service.

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

The service did not have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and our communities.

Staff knew and understood the provider’s expectations for the service. The senior leadership team did not demonstrate values to their frontline staff in this service. Staff did not have the opportunity to contribute to discussions about the future of their service, especially where the service was changing due to losing its sponsorship licence. During the inspection, we found staff were unsupported and were asked not to approach senior leaders with concerns around their employment. Staff were uncertain about their futures and were given misleading information about the security of their roles.

Of the 25 staff within the company 23 were employed under international sponsorship arrangements. The business model and workflow did not demonstrate the company had enough work for 23 staff. Home Office information identified companies should employ a mixture of both UK based and overseas staff and not be wholly reliant on a workforce employed through sponsorship. We found the 2 staff who were not employed under sponsorship were based in Wales, and both had designated office jobs which were not health and social care related. This meant the company was entirely reliant on sponsorship staff for carrying out regulated activities, and those staff did not have sufficient work and payment available. The company and its senior leaders had an ineffective business model; they had not scoped demand and matched that with appropriate staff numbers. Staff had no recourse to public funds, and we were told by staff they were unable to have alternative employment. It was the responsibility of the sponsor to ensure that there was sufficient income within their business model to meet the annual salaries of sponsored workers. If companies were unable to remunerate sponsored workers appropriately then they should not have assigned certificates of sponsorship.

Leaders had not been open and honest with staff. We saw in team meeting minutes discussions with staff about their futures were misleading regarding the revocation of the sponsor licence. Leaders communicated to staff that the revocation of their licence was malicious. Staff were led to believe that the company had submitted all required documentation. We saw the Home Office response which was clear; the provider had failed to supply all the requested documentation, and there was evidence already supplied that workers were not paid in line with sponsorship guidance.

Staff told us and we saw recorded in team meeting minute notes, that staff may continue to work for Health Tech Services Group Limited and could transfer to another company under the same directors, and under a new sponsorship agreement. This gave staff inaccurate information that if the company folded, they would be transferred to a “new” employer under the United Kingdom's Transfer of Undertakings Protection of Employment regulations also known as TUPED. The new company under the same directors would then apply for a new sponsorship licence. This is not compliant information under sponsorship guidance.

The company website was advertising services online under a different service name. The CQC rating banner had been placed across all services, although only 1 service group had been inspected, for homecare. This website was found to be misleading to the public and other partners because it looked as if all services had been rated as “Good” with a banner rating good for each individual service.

The service did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience, and credibility to lead effectively, and they did not do so with integrity, openness, and honesty.

Managers did not make notifications to external bodies as required. Managers had failed to complete required notifications of incidents that may affect the health safety or welfare to people who use the service. Care Quality Commission under Regulation 18 Health and Social Care Act 2008 (Care Quality Commission Registration) Regulations 2009 (Part 4). Managers had failed to formally notify CQC through the statutory notification process that their Home Office Licence for sponsored employment had been revoked, or about the arrest of one of its staff. The service had failed to provide required information to the Home Office and as a result the Home Office Sponsorship licence had been revoked. A copy of the licence revocation letter was required to be submitted to CQC along with any contingency plans to enable the service to continue, but this did not happen.

The service had also made enquiries about changing its name and were advised they would need to register this company with CQC. The application was never made but a different trading named was in use. We found the ambulance, office stationery and website had used the other trading name and branding and not Health Tech Services Group. This meant people using the service could not identify the provider and would find it difficult to associate the regulated service alongside the unregulated name in use. Digital searches show the other trading name as being CQC regulated when it was not.

We saw 2 conversations, which were recorded as supervisions, both of which had been used to address performance issues. Supervision should be used as an ongoing supportive dialogue to monitor wellbeing, unblock challenges, and guide professional growth. There were no annual appraisals or performance reviews to evaluate achievements, align goals, and plan career milestones. Staff were employed for a position within the company, but we saw that their roles were changed without any recorded conversations. We saw evidence where staff had been transferred from homecare services to ambulance drivers

Staff team meeting minutes stated not to approach senior leaders about sponsorship concerns which left staff feeling vulnerable and ill informed. This meant leaders were not approachable and available to staff when they needed support. Staff had contracts of employment although these were not being adhered to. We saw examples where staff had not been paid, part paid, and having unauthorised deductions made. We observed and were told by staff that hours of employment were consistently not met, and the hourly rate was not in line with the stated guidance.

The decision to revoke the sponsorship licence meant sponsored workers had no income and no recourse to public funds and were consequently reliant on their salary. By failing to pay the correct salary, they risk becoming destitute. The salary thresholds existed to provide essential safeguards and ensure that sponsored workers were not exposed to financial hardship.

People did not feel they could speak up and that their voice would be heard.

The registered manager told us they were the point of contact for the Freedom to Speak up role. Freedom to Speak Up (FTSU) encourages a positive culture where people feel they can speak up, their voices heard, and their concerns acted upon. Whilst the requirement is for NHS organisations its important similar systems are available to support people in all health and social care services to raise concerns in a safe and appropriate way. However, in a small organisation where staff were reliant both on employment and a right to remain in the UK staff told us they did not feel comfortable to raise concerns.

There was no independent system or person staff could speak to if they had any concerns. Staff were frightened to raise concerns due to threats by the leaders about continued employment and a right to reside in the United Kingdom. We saw information following an employment tribunal identified the staff member had their work stopped after they had raised concerns following a directive, they moved locations from the North of the UK to the South, without any financial support and unpaid salary. Staff told us they had never been paid their agreed salary, were due salary for hours they had worked and were frequently paid either later than the agreed date and in instalments.

Some staff told us there had been other requirements on their employment such as additional costs for training and a service level agreement which required them to meet all training requirements until this was completed, they would remain unpaid. We saw other records which showed staff were expected to pay for repairs to an ambulance following an accident when they were driving and for which the vehicle insured for.

The provider did not value diversity in their workforce. They did not work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Leaders did not ensure there are effective and proactive ways to engage with and involve staff, with a focus on hearing the voices of staff with protected equality characteristics and those who are excluded or marginalised, or who may be least heard within their service. Staff did not feel empowered or confident that their concerns resulted in positive change to shape services and create a more equitable and inclusive organisation.

Leaders did not take steps to remove bias from practices to ensure equality of opportunity and experience for the workforce within their place of work, and throughout their employment. Where staff had shared concerns around individual circumstances, we are unable to give examples of this due to the information being identifiable to a person and staff concerns around reprisal. When we asked about flexible working arrangements, the only flexibility was weighed toward the employer and not the employee. An example of this was staff were only paid the hours the employer assigned work to then, not their contracted hours but were expected to be available for the whole day. We asked how working hours got divided amongst staff fairly but there was no system to ensure this happened.

On inspection we reviewed the company policies and procedures and found the equality, diversity and inclusion policy out of date and not specific to the company. However, when we next visited the policies and procedures had been updated but were not embedded.

Leaders did not take active steps to ensure staff and leaders are representative of the population of people using the service. The regulated services were 100 % consisted of sponsored workers, so not representative of the local population. When asked there was no evidence the provider had undertaken equality monitoring of staff within the service to ensure it was diverse in its make-up and representative of the patient group.

Leaders did not take action to prevent and address bullying and harassment for all staff and did not allow staff to find alternative employment or take leave they had requested. One employee took the service to an employment agency advice service which could not be heard as the employee fell outside the criteria of working for the company for less than 2 years.

We could not be supplied with any examples of where managers had put reasonable adjustments in place for staff members to help them carry out their role.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The evidence showed significant shortfalls. The service did not have clear responsibilities, roles, systems of accountability, and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The service did not ensure they operated a robust recruitment procedure, including undertaking any relevant checks to ensure all staff employed were “fit and proper”. The service did not have robust procedures in place for ongoing monitoring of staff to make sure they remained able to meet the requirements. This also included ensuring staff risk assessments were undertaken where work references were not sought, and when unknown referees were providing character references. The impact of this may mean unsuitable staff are employed placing patients at risk of harm.

The position of the registered manager who was also employed under sponsorship was acknowledged by the Secretary of State for the Home Department (SSHD). The SSHD identified “this was a byproduct of the individual being placed in the role”. The role of the registered manager was not advertised in the UK before going overseas for a sponsored worker. Without a registered manager, the service would not be compliant with CQC regulations. We requested a comprehensive contingency plan, the senior leadership said they had but this was not received. A job advert on a digital platform was sent to us.

The company was operating under a different trading name which was not registered to provide regulated activity with CQC. Leaders had approached CQC regarding the name change and were advised to complete a new registration should they wish to continue regulated activity under a different company name. This was not actioned although we had been advised by the registered manager that CQC said it was okay to do. We later found this comment to be incorrect and CQC had advised on a new registration.

There were ineffective systems in place to manage risk, issues and performance. Information highlighted by the SSHD showed the service had ineffective business management systems. The service had recruited staff without the availability of sufficient work. Without regular work staff did not obtain regular experience to deliver patient care and develop their skills and knowledge.

To be an accredited registered manager with CQC, it is a requirement in a regulated service to have NVQ Level 5 in Leadership and Management or at least to be working toward the qualification. We requested to see the registered manager had been officially enrolled in appropriate training, but this was not supplied. Therefore, we had no assurance the registered manager had the required skills and knowledge to fulfil this role.

We were provided with 2 risk registers: The first, Environmental Aspects Programme & Risk Register with impact ratings. This was last reviewed on 1/4/2025. The second, Risk Register Ambulance, identified information about risks, their impacts, mitigation strategies and risk owners, with highest risks identified around medical conditions, consent and fuel check. There was no date for review identified. Neither risk register identified the considerable risk to the organisation of the loss of the Home Office Sponsorship licence for employment of international staff or the impact of the delay in assessment and rating by the Care Quality Commission. No information was available to identify mitigation of these risks.

We saw notes of 5 team meetings, under a different trading name, but relating to Health Tech Services Group between September 2025 and March 2026. Information provided identified it was an employment requirement for all staff to attend these meetings; staff were unclear if they were paid to attend. Meeting notes identified key issues were discussed and during the March meeting the revocation of the Home Office license was discussed, however incorrect information was supplied to staff.

The provider did not understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not share information and learning with partners or collaborate for improvement.

Leaders were not open and transparent, when they communicated with all relevant external stakeholders and agencies. We saw evidence of recent inspection ratings miscommunicated to partners, we saw examples of this within company meeting minutes and emails to external providers. We also found the company website was misleading to the public, partnerships and community. Upon trying to review the service we unable to find any reviews of the service. This was because the feedback on the service had been captured under a different trading name, this would not make it easy for partnerships or communities to access independent reviews or complain about the service.

Managers had liaised with local councils and organisation to highlight the services it could offer, but otherwise had minimal liaison in the communities it worked within the Midlands Region. However, the service had worked in partnership with a council outside the Midlands and had been invited to participate in several community events as a partner organisation. It was difficult to ascertain if these events had been attended because the company did not have any records of this activity. The registered manager told us they had organised free blood testing awareness activities in local parks and outside shopping centres to support community health awareness initiatives.

A manager had contacted the Care Quality Commission about changing the name of the registered company. The manager had been advised they would need to complete a new registration. We found despite this advice no registration had been completed, and the registered company was operating under a different name. The service’s staff worked under sponsorship arrangements. However, a failure of the business model and lack of insight in the local community requirements had resulted in the revoking of the Home Office license. Home Office communication was presented to staff as deceitful and not their failure to operate to requirements by not submitting documents they had maintained they had. We saw evidence and discussed with a manager why senior leaders had decreased sponsorship employees' hours as soon as sponsor had come into the UK meaning the employee did not get registered with His Majesty’s Revenue and Customs because the employer did not have work available for staff.

Character references were used in place of employment references, and no direct observation was put in place for these staff who were not known to the service. Leaders had not supervised or planned for double up cover to mitigate not having the correct references in place until they were confident, they knew staff. We found staff to be doing references for other staff.

We saw evidence of staff being tied into a 12-month service level agreement (SLA) for basic mandatory training. All new staff were only being offered this route under the condition of being offered sponsorship if signing up to this contract. Senior leaders were charging for this training when suitable alternatives were offered free on care websites. Staff were disadvantaged and could not complete this training as currently all required training was not available. One staff file we inspected found a member of staff to be working from 31/7/2024 but their contract read July 2025. There was no earlier contract to review, and we were told this was because the SLA replaced the contract. Staff files seen showed hourly rates applied as part of their job offer letter under sponsorship guidelines, it was confirmed staff did not receive this rate of pay.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research. We saw innovation planned but not implemented for the diagnostics and tech side of the service but not for the patient transport services.

We did not see embedded examples of processes to ensure that learning happened when things went wrong, such as feedback to staff and reflective learning. Leaders did not encourage reflection and collective problem-solving; from the evidence we saw a blame culture was apportioned and staff informed of how they were to pay the company back for mistakes and incidents.

We asked for examples or meeting minutes between staff and leaders to look at how staff contributed to continuous learning, we saw leaders did not encourage staff to speak up with ideas for improvement and innovation and actively invest time to listen and engage. Staff feedback identified there was not a strong sense of trust between leadership and staff.

No appraisals took place for staff or personal development goals set, so there were no recorded conversations allowing staff to prioritise time to develop their skills around improvement and innovation. There was no clear strategy or policy for how to develop these capabilities and staff were not consistently encouraged to contribute to improvement initiatives.