MARCH 2019
www.caremanagementmatters.co.uk
NHS LONG TERM PLAN What about social care?
Staying neutral
Reducing your carbon footprint
A new social care
Going back to the drawing board
Radar technology
Changing fall detection
DRIVING
OUTSTA
NDING C
ARE
Person Centred Software has been extremely responsive to my needs and the software is very intuitive and closely aligned to our care homes’ needs. We’ve achieved an excellent return on investment and I wouldn’t hesitate in recommending the software. It’s worth every penny and then some. RISHI SODHA, CARE DIRECTOR, HANDSALE CARE HOMES
Person Centred Software interviews Rishi Sodha, Care Director at Handsale Care Homes. Rishi Sodha is the Care Director at Handsale Care Homes, a group of eight care homes that have implemented Mobile Care Monitoring (MCM), Person Centred Software’s electronic care system. Rishi explains that when one of Handsale’s homes, Treelands Care Home in Oldham, Lancashire, went fully paperless, it made an immediate difference to staff morale and efficiency for the care home, “At the time, a nurse pulled me into her clinic room and told me it was the first time she’d stepped foot inside there since her morning meds round and she felt it was the first full day of nursing she’d done in 10 years,” says Rishi. “She also showed me her office which contained just one shelf of paperwork replacing what she described as being a paper mountain rather than an office.” Rishi points to time saving as a major benefit. “Our nurses are saving up to 4 hours a day and the care staff between 45 minutes to an hour. I hear many homes complain about lack of staff but if a nurse can save four hours, it’s like having another staff member for a third of a shift.”
Book a demo of MCM with us: Call 01483 604108 or email hello@personcentredsoftware.com
“Initially at board level, we saw Mobile Care Monitoring as a way to save time, but it has given us insight into things we just didn’t know. For example, we discovered that one resident was missing a sleeping care plan, and we were able to rectify it immediately.” “At a corporate level, we can now sleep calmly at night. And our home managers can go on holiday, confident that the right care is being given to everyone.” And since implementing Mobile Care Monitoring, Rishi confirms that no risk assessments have expired. “Person Centred Software has been extremely responsive to my needs and the software is very intuitive and closely aligned to our care homes’ needs. We’ve achieved an excellent return on investment and I wouldn’t hesitate in recommending the software. It’s worth every penny and then some. I know all home managers wouldn’t go back. And if I ever threatened to remove Person Centred Software, I think I’d have a riot on my hands.”
Read the full interview with Rishi at www.personcentredsoftware.com/handsale
In this issue 05
Inside CQC Head of Inspection at the Care Quality Commission, Alison Murray shares the work happening around dementia.
07
CMM News
09
Business Clinic Our panel discusses the potential impact of a new fall detection technology being trialled at a Tanglewood care home.
30
Rising Stars 2018 Samantha Stuart is Registered Manager at Fairfield care home in Bedworth.
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Celebrating excellence Halas Homes won an award at the Markel 3rd Sector Care Awards in December 2018. Read about their commitment to supporting people into employment.
46
Event Review A review of Westminster Health Forum’s Next steps for adult social care in England conference.
48
What’s On?
49
Straight Talk Mind’s Specialist Policy Adviser, Alison Cobb examines the Review of the Mental Health Act.
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36
FEATURES 25
REGULARS
From the Editor
41
20
Where does social care fit in the NHS Long Term Plan? David Foster OBE sets out how social care will gain from the NHS Long Term Plan, how it will not, and what needs to be done to ensure its successful implementation.
25
Reducing the carbon footprint of the care sector Care providers must become more sustainable – both environmentally and financially. Katie Elmer from Carbon Footprint Ltd shares the best energy-saving solutions with the biggest impact for operators.
36
Past the tipping point: Reimagining social care John Kennedy, Social Care Consultant, puts forward his ideas for radical change to fix our broken social care system.
41
Maintaining momentum: Music and dementia An update on the latest developments in using music to support people with dementia, with Grace Meadows from Music for Dementia 2020 sharing tips for implementing best practice. CMM March 2019
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EDITORIAL editor@caremanagementmatters.co.uk Editor in Chief: Robert Chamberlain Editor: Angharad Burnham Content Editor: Emma Cooper
CONTRIBUTORS
PRODUCTION Lead Designer: Holly Cornell Director of Creative Operations: Lisa Werthmann Studio Manager: Jamie Harvey Creative Artworker: Ruth Clarry
ADVERTISING sales@caremanagementmatters.co.uk 01223 207770 Advertising Manager: Daniel Carpenter daniel.carpenter@carechoices.co.uk Director of Sales: David Werthmann david.werthmann@carechoices.co.uk Senior Sales Executive: Aaron Barber aaron.barber@carechoices.co.uk
@CQCProf
@DrDavidFoster
@CarbonAcademy
@RichAdams_RN
Alison Murray Head of Inspection, Care Quality Commission
Dr David Foster OBE Chairman, Foundation of Nursing Studies
Katie Elmer Senior Sustainability Consultant, Carbon Footprint Ltd
Richard Adams Chief Executive Officer, Sears Healthcare Ltd
@SlaterGordonUK
@MiraRehab
James Farrell Solicitor, Slater and Gordon
Alina Călin Co-founder and CRO, Mira Rehab Ltd UK
Samantha Stuart Registered Manager, Fairfield care home – WCS Care
@Grace_Meadows_
@HalasHomes
@MindCharity
Grace Meadows Programme Director, Music for Dementia 2020
Alison Sayer Chief Executive Officer, Halas Homes
Alison Cobb Specialist Policy Adviser, Mind
SUBSCRIPTIONS Non-care and support providers may be required to pay £50 per year. info@caremanagementmatters.co.uk 01223 207770 www.caremanagementmatters.co.uk Care Management Matters is published by Care Choices Ltd who cannot be held responsible for views expressed by contributors. Care Management Matters © Care Choices Ltd 2019 CCL REF NO: CMM 16.1
@johnnycosmos
CMM magazine is officially part of the membership entitlement of:
ABC certified (Jan 2017-Dec 2017) Total average net circulation per issue 16,336
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CMM March 2019
John Kennedy Independent Social Care Consultant and Commentator
From the Editor Editor, Angharad Burnham summarises this month’s features, with the theme of social care’s future. This month, we are focusing on how we can work with health partners and what we could reform to improve the system. We are also looking at what technology is paving the way for social care’s future.
SYSTEM CHANGE Leading the charge on the future of our sector is the NHS Long Term Plan. In this issue, Dr David Foster OBE provides a summary of the impact he expects this to have on social care, exploring the detail of the Plan as it relates to our sector and the steps we must take to ensure its implementation. The Long Term Plan is a good starting point for a shake-up in how social care is delivered, however, in his article, John Kennedy puts forward a different proposal. He asks, what would we do if we were to start from scratch with the social care system – what would be the best solution? His view is laid out on page 36.
Following last month’s Business Clinic on body cameras in social care settings, our panel is looking at a different type of monitoring. The latest in falls detection technology has begun trials in a Tanglewood care home and doesn’t record residents with either cameras or microphones. Read the article on page 30 to find out how the technology works and see if you agree with the panel’s thoughts.
THE POWER OF MUSIC Our Inside CQC column this month sees Head of Inspection, Alison Murray discuss the differences in dementia care now compared to how it has been in the past. In it, Alison emphasises the need for good quality support going hand-in-hand with a better understanding of the condition. She mentions the work happening with music to support people with dementia, and to help you implement best practice, we
have a feature on just this. Music for Dementia 2020 have shared the latest updates on the work happening in this field, with tips for linking-up with local organisations and ideas for different ways you can bring music to the lives of the people you support – whether they are living with dementia or not.
SUSTAINING YOUR BUSINESS We all know it’s important to do what we can to protect the environment, but how sustainable is your business and what can be done to improve your carbon footprint (and your finances)?
We asked Senior Sustainability Consultant, Katie Elmer what providers can be doing to ensure they’re not only sustainable environmentally, but also how this can help financially. See what she suggests on page 25. Finally, don’t forget that you can become a member on the CMM website for free. Membership comes with a host of benefits, including updates on the latest sector news, discounts to CMM Insight events and access to the site’s member-only areas. You can also use the site to provide feedback on all of the features in this edition by using the comments sections at the end of articles.
Email: editor@caremanagementmatters.co.uk Twitter: @CMM_Magazine Web: www.caremanagementmatters.co.uk
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If, like me, you have spent your career in the health and social care sector, you will have witnessed the change in our understanding of dementia. Thanks to brilliant researchers and people and their families sharing their first-hand experience, today we are more able than ever to support people to live well with dementia. At CQC, to ensure we are making informed judgements about care quality, we’re committed to supporting our own staff to remain informed of evolving best practice and innovation in dementia care. Regular readers of ‘Inside CQC’ may remember my colleague Sue Howard’s column from November 2018. Sue shared that we have introduced ‘areas of interest’ groups. These represent the services and activities that we regulate and are designed to help inspectors develop their knowledge and then be equipped to share this with colleagues in their local areas. One of these areas of interest focuses on dementia, bringing together over 90 inspectors and inspection managers who are passionate about the issue. I sponsor the group as a Head of Inspection. We’re already seeing the impact the group is having; we’ve been developing learning materials and creating spaces for reflective conversations and joint learning about inspecting services supporting people with dementia. This has built confidence and enabled inspectors to advise others in their local areas with queries and inspections. In January, we held a conference for the group to bring together all our learning from the past year and to hear from the people campaigning and innovating for better dementia care. We kicked things off by listening to Jan, an Expert by Experience, talk about her experience of caring for her mother who lived with dementia. It’s a story we’re all too familiar with: Jan’s mother, in her late 80s, was living a happy life with dementia but following a fall her health and quality of life deteriorated quickly. Jan talked about the challenges of caring for someone with dementia: the patience required to support someone whose behaviour changes; the impact on her family, social and working life; and the interactions with hospital staff treating her mum’s physical injuries, who did not always have a good understanding of dementia. These are real challenges faced by people living with dementia and their families and adult social care has a powerful role to play in supporting people through them. There
Inside CQC A L I S O N
M U R R A Y
Alison Murray, Head of Inspection at the Care Quality Commission (CQC) discusses the regulator’s recent work around dementia and what’s coming next.
are some great examples of small changes providers can make that have a big impact on the people they support and their staff’s confidence to do their job. For example, Alzheimer’s Society has developed and trialled ‘Lift the Lid’ workshopsin-a-box to help staff challenge perceptions around sex and intimate relationships for people living with dementia. As a country,
“There’s also exciting work happening to promote using music to support people living with dementia.” we’re not very good at talking about sex and intimacy in any setting, never mind care homes. It’s great to see initiatives like this one that help providers feel confident supporting people to maintain romance, sex and relationships – with dementia or not. We have just published our own guidance on relationships and sexuality in care settings, answering the frequently asked
questions providers have about meeting the sexuality-related needs of people who receive support and helping to understand the risks (you can find this in the Guidance for Providers section of our website). There’s also exciting work happening to promote using music to support people living with dementia. Research shows that music helps to reduce distressing symptoms of dementia, including anxiety and agitation. Music for Dementia 2020 aims to make music available to everyone living with dementia by 2020 and has a host of resources on its website to help providers and carers make music part of life. Their feature on page 41 explores more about what they are doing. Technology is making this easier to put into practice. The BBC Music Memories website makes it simple to find songs and music that people living with dementia can reconnect with. Just pick a genre and decade and start listening. I hope that’s given you a taste of what we’re seeing. We’re always keen to hear about what services are doing themselves, so please get in touch with @CareQualityComm to share examples on Twitter.
Alison Murray is Head of Inspection at the Care Quality Commission. Share your thoughts and feedback on Alison’s column on the CMM website www.caremanagementmatters.co.uk Not a member? Sign up today. CMM March 2019
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National recruitment campaign launched The Department of Health and Social Care (DHSC) has launched its national recruitment campaign to attract more workers to the adult social care sector and is calling for providers to get involved. Following two pilot recruitment campaigns, DHSC has begun a national communications campaign to address the estimated 110,000 vacancies in adult social care in England. Running throughout February and March, the national campaign aims to: • Increase interest in adult social care as a career choice. • Increase understanding of the variety of roles in social care. • Equip smaller and medium-sized
providers with tools to support the campaign. The campaign will comprise social media, digital and local radio advertising, events and media relations across England. Care providers are being encouraged to get involved with the campaign by providing case studies, advertising their vacancies and promoting social quizzes and content from a dedicated Facebook page. DHSC is asking providers to submit real life case studies and stories from their own organisations, which will be used across the campaign. Interested providers can email casestudies@ morecarejobs.co.uk to get more information.
Providers can advertise their vacancies on DWP Find a Job, where the campaign and website will direct those looking for work. Campaign materials will also be available to equip providers with information and assets to help them support the campaign locally. Providers will also be crucial in driving traffic to the Facebook page by liking and sharing posts, sharing their own content to the page, encouraging employees to refer friends to the sector with the campaign's hashtag, '#shareifyoucare', and sharing a quiz that encourages potential applicants to see if a role in adult social care could be the right fit for them.
Call for reform of social care Age UK is calling on Government to publish its social care green paper, saying that the funding and reform of social care is urgently needed. This comes as the charity reports that more than 50,000 older people have now died while waiting for care during the 700 days after the Government first said it would publish a social care green paper. The figure comes from NHS Digital data showing the number of people who died before social care services could be provided. Age UK is also stating that, over the same period, more than
600,000 older people had their requests for social care refused by their council, and over 7,000 older people had run down all their savings because of their care bills, leaving them reliant on the State to fund their care. In addition, over 1.2 million older people developed an unmet need in the same 700 days. This equates to 1,805 people developing an unmet need every day. Caroline Abrahams, Charity Director of Age UK said, 'These tragic new figures demonstrate just how many older people are now suffering from the Government’s failure to act decisively on social
care. No-one can say whether some of those who have died might have lived longer had they received care, but at the very least their final weeks and months might have been more comfortable and their families’ lives made easier, had they been given more support... 'As it is, more than 50,000 older people and their families have been let down when many of them needed help the most. Sadly, it seems inevitable that more will join them unless and until the Government grips this issue and gets on with the process of reforming social care and giving it the funding it needs.'
Kate Terroni has been named new Chief Inspector of Adult Social Care by the Care Quality Commission (CQC). Kate will start in May, and takes over from Interim Chief Inspector, Debbie Westhead. Kate is currently Director of Adult Social Care at Oxfordshire County Council. Mark Sutton has also been announced as Chief Digital Officer, a new role at CQC. Mark will join CQC’s Board and Executive Team in April this year.
SKILLS FOR CARE Andy Tilden has been appointed Interim Chief Executive of Skills for Care, following the announcement of Sharon Allen’s departure. Andy will have a handover period with Sharon before she leaves in April.
UKHCA The Board of United Kingdom Homecare Association (UKHCA) has confirmed the appointment of the new Chief Executive, Roger Berry, who will succeed Bridget Warr CBE. Roger was the chair of the Health Select Committee for Wiltshire Council from 2014 and has a strong appreciation of social care from a statutory sector perspective.
CHRISTCHURCH GROUP Christchurch Group has announced the appointment of Donald Muir as Non-Executive Chairman. Prior to his appointment at Christchurch Group, Donald was NonExecutive Director of Cambian plc, a leader in the provision of children’s care services and autism schools. CMM March 2019
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NEWS
Care providers get access to NHSmail Care providers can now access NHSmail, a free email service to enable easier sharing of data between health and social care organisations, by completing the entry level of the online Data Security and Protection Toolkit (DSPT). NHSmail is a secure and efficient way of sharing clinical and care
information with health and care providers. It can be accessed from mobile devices as well as desktops and includes a full directory of all users. The DSPT is an online selfassessment tool for data security, supporting organisations to ensure they have the right processes and practices in place to manage and
hold data safely. It is mandatory for those who provide care through an NHS contract, though all providers are encouraged to complete it if they hold, process and share data. Developed in collaboration with the Care Provider Alliance (CPA), the entry level of the DSPT has been specifically designed for care providers. It is time-limited and
is a stepping stone for providers towards completing the full toolkit, showing how they comply with data protection legislation and best practice. Completing the toolkit will support care providers to take steps towards complying with nationally recognised standards of data security. Guides for the DSPT are available on the CPA website.
Care England study into council fees A Care England study into council fees has shown that local authorities are failing to keep pace with rising costs, causing many care homes to have to make difficult decisions about whether to close their service or refuse council placements. This is despite increasing numbers of people requiring support. One in five councils have given no increase in fees they pay for 2018/19, even though cost and
wage bills have risen by up to 5%, according to the Care England study. Where providers are having to turn away council placements, this in turn is increasing the pressure on the NHS. Care England contacted every council across England with a Freedom of Information request, asking them to provide details on their base rates for older people's care home and care home with nursing placements in 2018/19. Of the councils who did reply
to the request, 20% made no increase in the baseline rate for care home with nursing beds; 18% of councils reported that they gave no increase for nursing with dementia beds; and 22% of councils reported no increase for residential care home beds, including residential care beds for older people with dementia. Examples where councils made offers that fell short include: • Staffordshire, which offered a 1% increase for existing
placements only. • Haringey, with no automatic uplift in fees. • Bath and North East Somerset, which only offered a 1% uplift. The analysis involved in putting together the Care England study also showed a projected 7.5% jump in the number of older people in care homes by 2020. This would require an extra 33,000 staff at a cost of an additional £581m.
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CMM March 2019
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INVOICING
HOME LEDGER
NEWS
Guide to new ways of working The Care Provider Alliance (CPA) has published a short guide to new ways of working across the independent and voluntary adult social care sector. It captures a wide range of new ideas and approaches, including: • New types of service based on more informal support. • Ways for services to work together locally.
• The new ways in which technology is being used in care services. The ideas cover how health and care services can work together to keep people out of hospital and how all of the options can support and enhance care services. There are brief details in the guide on each topic, along with links to
many sources of more detailed information and specific local examples. Bridget Warr CBE, Chair of the Care Provider Alliance’s Programme Board, said, 'In this guide we have drawn together some of the many new ideas and approaches from across our vibrant, innovative and forwardlooking sector…
'To help with future work, we are keen to receive further ideas and thoughts on this topic from across the sector, and the guide ends with a series of questions through which we hope as many people as possible will give us their feedback via the Care Provider Alliance website.' The guide is available on the Care Provider Alliance website.
UKHCA minimum price for homecare The United Kingdom Homecare Association (UKHCA) has published its minimum price for homecare services for 2019. The publication aims to inform people of the various minimum costs that homecare providers face and offers a suggestion of a minimum hourly rate which should be paid. The rate that UKHCA is proposing is £18.93 per hour, starting from April 2019. The
Association says that this allows full compliance with the National Minimum Wage as well as the delivery of sustainable homecare services to local authorities and the NHS. Calculations have also been made for the voluntary UK Living Wage, the Scottish Living Wage and the London Living Wage between November 2018 and October 2019. These are:
• UK Living Wage: £20.75 p/h • Scottish Living Wage: £20.75 p/h • London Living Wage: £23.97 p/h Policy Director at the national homecare association, Colin Angel, said, 'It is essential that a viable regulated homecare sector is available to support the care of older and disabled people who choose to remain at home. 'The prices councils pay for care must cover the costs of
the workforce, including – as a minimum – full compliance with statutory minimum wage levels and the costs of running a regulated care service. 'UKHCA’s Minimum Price for Homecare provides a thorough rationale for the costs of statefunded care and is highlighted in Government’s Care and Support Statutory Guidance (for England) as an approach which can be adopted by councils.'
CMM March 2019
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NEWS
Report highlights social care postcode lottery A new report from Key, equity release advisers, highlights the social care postcode lottery across the UK, urging people to consider options for funding their care early. The report shows that people in some areas of the UK are up to four times more likely to be fullyfunded, with those in the East of England far more likely to have their care fully-funded than people
in Wales and the East Midlands. Cracking the Care Code is based on a Freedom of Information request to 205 local authorities, which found that councils provide support for 568,867 over-65s. Of these, over 175,000 (31%) are fully-funded and just over 300,000 (53%) are partially funded. 19 councils were unable to provide information on the level of funding for 93,324
people (16%). Key’s Freedom of Information request also established that 6,882 retired homeowners are currently using Deferred Payment Agreements to pay for their care. Deferred Payment Agreements were most likely to be used in the West Midlands and East of England where each local authority has on average 72 and 71 in place respectively while London
(11) and Scotland (16) have the lowest on average. Research for Key’s report found that just 21% of over-55s say they have made any provision for care. Around 44% say they would use savings and investments to fund some or all of their care, while 40% believe their pension income will be enough. Around 19% say they would need to use property wealth.
Health and Care of People with Learning Disabilities
Graduate Management programme
Annual figures on the health and care of people with learning disabilities have been released in a report from NHS Digital. The Health and Care of People with Learning Disabilities, 2017-18 consists of data collected from 57% of GP practices in England on key health issues for people with learning disabilities. A total of 47% of patients registered in England were included in this publication, a decrease since 2014-15 (52%). The report, published this week, found that the life expectancy of females with a learning disability is 18 years lower than the general population. Males had a life expectancy of 14 years less than that of the general population. Looking at annual health checks, the research found that 55% of patients with a learning disability received an annual
Skills for Care is seeking people who have graduated from university in the last seven years to apply for a place on the Graduate Management programme. Candidates can apply until 1st April 2019. The programme lasts one year and will begin in October 2019. Skills for Care is also interested in hearing from providers who would like to be involved as a 'host' for the Graduate Management programme. More details are available on the dedicated webpage. The course has been developed in partnership with the NHS Leadership Academy, the Department of Health and Social Care and employers. The Graduate Management programme matches graduates with forward-thinking employers, offering experience in social care and health. It fast-tracks graduates into leadership roles, teaching them the skills and knowledge to support them to become an effective leader and make a real impact on the lives of others. Skills for Care Chief Executive,
learning disability health check in 2017-18, which is up 12% from 201415's Health and Care of People with Learning Disabilities. Almost 45% of people with a learning disability received a flu vaccine, including 83% of those aged 75 or over with a learning disability. The report found an increase in the proportion of patients with learning disabilities receiving palliative care, from 0.5% in 2014-15 to 0.8% in 2017-18. There were more patients with learning disabilities receiving palliative care than patients without learning disabilities at all age bands. The report also gives figures on the prevalence of various health conditions, such as epilepsy and heart disease, noting that coronary heart disease was 1.7 times less prevalent in those with learning disabilities than those without.
Care England and Busy Bees Care England and Busy Bees have come together to develop a solution to help people fund their long-term care. Busy Bees developed the successful salary sacrifice scheme for childcare and is proposing to use this system to solve the issues surrounding adult social care funding. Care England and Busy Bees both share a passion for crafting solutions to the long-term funding of social care and agree on the 12
CMM March 2019
need for societal solutions rather than political ones in order to bring about change. John Woodward OBE, Founder President of Busy Bees says, 'Our relationship with Care England will help open up options for intergenerational care. Faced with the demographic time bomb we need to have more money going into the system and a salary sacrifice scheme is one means of bringing innovation and promoting opening dialogue.'
Sharon Allen said, 'Our graduates are identified through our valuesbased recruitment and selection process to ensure they have what it takes to succeed. Previous graduates have gone on to enjoy permanent roles in our sector, and I’m confident our new programme will produce some influential future leaders.' Over the course of the year, graduates will contribute to the leadership and management of quality care across the sector and will achieve two fully-funded qualifications. They will acquire the right tools to progress into strategic leadership roles. The programme is open to graduates from any degree subject. They must: • Have graduated in the last seven years. • Have/will have at least a 2:2 degree by September 2019. • Have the right values and ambitions for a career in care. Anyone who would like to apply or find out more about the course can visit the Skills for Care website where more details are available.
Belmont Healthcare Belmont Healthcare has completed the acquisition of Haslington Lodge Care Home in Greenhithe, Kent, worth over £2m. The semi-purpose-built home has 46 bedrooms, many of which are en-suite.
Belmont Healthcare was advised by law firm, Shakespeare Martineau on all legal aspects of the acquisition, including undertaking due diligence, negotiating acquisition documents and liaising with funders.
Graduate Management Programme Could you host the next generation of leaders? Our successful Graduate Management programme is seeking forward-thinking health and social care employers to host like-minded graduates. Developed in partnership with Skills for Care and the NHS Leadership Academy, our one year programme fast-tracks graduates towards leadership roles within the sector. Our graduates complete a rigorous values-based selection process and are then carefully matched with organisations. Hosting a graduate within your organisation can provide many benefits including: a full-time team member who can offer fresh thinking and inject new ideas an enthusiastic, innovative and ambitious graduate with the right attitude and values for a career in health and social care they bring transferable skills and knowledge and can often be a great catalyst for change and improvement.
Find out more at www.skillsforcare.org.uk/hostagraduate Email graduates@skillsforcare.org.uk Telephone 0113 241 1275
Leadership Academy
NEWS
VODG backs focus on restraint training Voluntary Organisations Disability Group (VODG) is backing a renewed focus on restraint training by the Restraint Reduction Network (RRN), which has led the development of the national training standards. There has been a lack of quality assurance for restraint training and too often training focuses on restrictive interventions, without sufficient focus on prevention or de-escalation, says VODG. There is growing recognition among professional bodies and government departments (and arm’s length bodies) that whilst the use of any kind of restraint may on rare occasions be necessary to keep people safe, it is also traumatic and
must be minimised in therapeutic settings, says RRN. The standards provide a national and international benchmark for training in supporting people who are distressed in education, health and social care settings. These standards will ensure that training is directly related and proportional to people's needs. They will also ensure that training is delivered by competent and experienced training professionals who can evidence knowledge and skills that go far beyond the application of physical restraint or other restrictive interventions. The standards aim to promote
culture change, not just technical skills. They will: • Protect people’s fundamental human rights and promote person-centred, best-interest and therapeutic approaches to supporting people when they are distressed. • Reduce reliance on restrictive practices by promoting positive culture and practice that focuses on prevention, de-escalation and reflective practice to minimise use of restrictive practices. • Increase focus on prevention, understanding of the root causes of behaviour and recognition that many behaviours are the result of distress due to failing to meet
needs. • Improve staff skills and confidence in how to keep people safe in crisis and to better understand how to meet people’s needs in order to prevent crisis situations. • Improve the quality of life and protect the fundamental human rights of people at risk of being restrained and those supporting them. • Where required, focus on the safe use of restrictive interventions including physical restraint. RRN has worked with Health Education England to produce the standards.
New Chief Inspector of Adult Social Care A new Chief Inspector of Adult Social Care has been appointed at the Care Quality Commission (CQC). Kate Terroni will begin in her new role in May, taking over from
Debbie Westhead who has been interim Chief Inspector of Adult Social Care since Andrea Sutcliffe CBE’s departure in December last year. Kate, a registered social worker,
is currently Director of Adult Social Care at Oxfordshire County Council, where she has embedded co-production in adult social care throughout the county and provided leadership across the
health and care system. Kate is also co-chair of the ADASS workforce network and was previously Deputy Director of Commissioning at Oxfordshire County Council.
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CMM March 2019
NEWS
Improving employment rights for carers
New UKHCA Chief Executive announced
Carers UK is calling for better employment rights for carers, as research finds more than 600 people a day are forced to quit work to care for older and disabled relatives. This new research reveals that 2.6m people have quit their job to care for a loved one who is older, disabled or seriously ill, with nearly half a million leaving their job in the last two years alone. The findings also show that more people are caring than previously thought. Almost 5m workers are balancing their paid job with caring – compared with Census 2011 figures of 3m. The research emphasises the need for better employment rights for carers so that the increasing number of staff with caring responsibilities is able to stay in the workforce. It comes as Employers for Carers, a group of more than 115 employers committed to
Roger Berry will succeed Bridget Warr CBE as United Kingdom Homecare Association (UKHCA) Chief Executive. He has first-hand experience of dealing with local government and of lobbying national government. Roger was also Chair of the Health Select Committee for Wiltshire Council from 2014. Commenting on the new Chief Executive, UKHCA’s Chair, Trevor Brocklebank said, 'Roger proved to be an extremely strong candidate amongst applicants of a high calibre. His key skills include business strategy, management and strategic planning. He is passionate about our sector and I know he is determined to make a massive contribution for our members and the people we all support. 'He will join UKHCA at an exciting time. Government policy increasingly recognises home-
supporting carers in the workplace and supported by Carers UK, launches Carer Confident, the first UK-wide employer benchmarking scheme of its kind. This scheme recognises and accredits UK employers who have built carerfriendly and inclusive workplaces. Carers UK states that, when asked what support from their employer would be most important if combining their job with unpaid care for a loved one, 89% of UK adults said a supportive line manager/employer, 88% said the option to work flexibly, and 80% said five to 10 days’ paid care leave. Asked what supportive employment policies are currently available for carers in their workplace, 38% of UK employees said their employer had flexible working but only 12% said they had additional paid care leave. A third said that there were no policies listed to support carers.
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specialist healthcare business agents We are delighted to announce the recent successful sale of Dr Anderson Lodge, a substantial purpose built care home located in Doncaster, South Yorkshire registered for 60 service users within the categories of elderly nursing and dementia care. The business has been sold on behalf of Mr Lakhan Kandola, who now seeks to focus on his other business interests in Southern England. The business has been acquired by Mr Jayanti Varsani, an existing operator in the East Midlands, with this latest acquisition expanding his existing care business portfolio.
based care as the preferred option and the sector is supporting more people who fund their own care. Roger will be able to build on the Association’s strong performance to date and have a positive impact on social care policy and support for our member organisations’ services.' Roger will join UKHCA on 4th March 2019 for a one-month handover with Bridget, who moves on from the Association in April. Trevor Brocklebank continued, 'Bridget has been an amazing ambassador of UKHCA for the last eight years and I would like to thank her for her contribution, both to the Association’s members and the wider health and care sector. Together with the passionate team she has built, she has been instrumental in ensuring UKHCA’s standing as a widely recognised, knowledgeable, factbased, representative association.'
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NEWS / IN FOCUS
Palliative care for people with dementia Researchers have been awarded a grant to improve palliative care for people with dementia. The £4.7m grant has been awarded to researchers at the Marie Curie Palliative Care Research Department, UCL, and the Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London. The Empowering Better End of Life Dementia Care Programme (EMBED-Care) aims to create new ways of supporting patients with advanced dementia, including where they live and how they receive care. The research will build understanding on the current and future needs for
dementia palliative care, how people with dementia move through the health and social care system and will develop new ways to deliver these services. The research is one of four collaborative projects being funded by the ESRC-NIHR Dementia Research Initiative 2018, which aims to improve the lives of people living with dementia across the UK. This research aims to inform a better quality of care and ensure that people living with dementia receive the support and guidance they need to plan for their future care while they still have the capacity.
VODG warns against rushing mental capacity law reforms The Voluntary Organisations Disability Group (VODG) has warned that rushing mental capacity law reforms will result in a failure to protect human rights. Government must resolve confusing and troubling aspects of its mental capacity law reforms if it wants to strengthen people’s human rights, says VODG. The draft legislation for England and Wales seeks to replace the current Deprivation of Liberty Safeguards (DoLs) system and aims to change the legal safeguards for people who lack capacity to consent to their care or treatment. These changes will be vital to strengthen and streamline the current under-funded system, but VODG states that the draft legislation in its current form is complicated and difficult for providers to deliver. Amendments in the House of Lords have allayed some fears about conflicts of interest, oversight and new responsibilities for providers relating to the reforms, but significant concerns remain. These include: • A lack of government consultation with providers,
families and people using services (there is as yet no response to a freedom of information request about details of the consultation process, says VODG). • The lack of any easy read or accessible version of the draft Bill. • A lack of any draft code of practice to ensure clarity and consistency in the new system. • Doubts over how the new system will be regulated and what independent oversight will be introduced. • Doubts over the wording and complicated language used in the statutory definition of ‘deprivation of liberty’. • The need for an impact assessment relating to the new responsibilities created by the bill, such as staff training and implementation (MPs have previously called for a costed impact assessment). Analysis of the impact of mental capacity law reforms is vital, given the Government’s statement that the changes will save an estimated £200m a year.
IN FOCUS Financial sustainability of the NHS WHAT’S THE STORY?
The National Audit Office (NAO) has reported that the NHS system is not financially sustainable in its current state. The NAO’s annual report on the financial sustainability of the NHS, states that this is down to substantial deficits in some areas, offset by surpluses elsewhere, alongside growing waiting lists and increases in waiting times. While the NHS Long Term Plan sets out a sensible approach to achieving the priorities and tests set by the government in return for its long-term funding settlement, NAO has found that risks remain to its delivery.
WHAT ARE THE RISKS?
The long-term funding settlement for the NHS only applies to the NHS England budget, and not to the Department’s entire budget. NAO reports that it therefore does not cover key areas, such as education, public health and capital investment that could affect the NHS’s ability to deliver the priorities of the Long Term Plan. In addition, NAO states that without a long-term funding settlement for social care, local NHS bodies are concerned that it will be very difficult to make the NHS sustainable. NAO work also highlights that previous funding boosts have been spent on dealing with immediate, short-term pressures, with less devoted to the changes required for longterm sustainability. It says there is a risk that the extra funding will not be used effectively as more money may be used to pay agency staff or will go unspent as healthcare providers may not
be able to recruit the staff to cover the additional activity. The NAO states that current funding flows in the NHS are complicated and do not support partnership working, integration and the better management of demand. Trusts also told the NAO that Sustainability and Transformation Fund payments made by NHS England have encouraged trusts to prioritise short-term gains over longterm sustainability, which also resulted in reduced collaboration with other local bodies. However, this funding has helped most (210 of 232) trusts improve their reported performance, although, overall, the trust sector failed to achieve its target deficit position again in 2017-18. Partnership working, which NAO suggests could form the basis for a more strategic approach to meeting demand, is vulnerable, given that partnerships are not statutory bodies and face significant challenges. Three-quarters of partnerships have a deficit when the finances of their constituent trusts and CCGs are added together.
WHAT DOES NAO RECOMMEND?
The NAO has made a number of recommendations to the Department, NHS England and NHS Improvement to ensure additional funding is spent wisely. This includes: • Testing whether local plans to manage demand are realistic. • Ensuring key risks to delivery of the Long Term Plan are identified. • Developing a sustainable longterm plan to support trusts in severe financial difficulty. CMM March 2019
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NEWS
Wellbeing of ‘sandwich carers’ Research into the wellbeing of 'sandwich carers' has found that more than one in four report symptoms of mental ill-health. The Office for National Statistics (ONS) reports that almost 27% of sandwich carers show symptoms of mental ill-health while caring for their own children as well as their older relatives. A sandwich carer, according to ONS, is more likely to report symptoms of mental ill-health, feel less satisfied with life, and struggle financially compared with the general population. With life expectancy increasing and women having their first child at an older age, around 3% of the UK general population, equivalent to more than 1.3 million people, now have this twin responsibility. The mental wellbeing of sandwich carers worsens with the
amount of care given, according to the data. More than 33% of those providing at least 20 hours of adult care per week reported symptoms of mental ill-health, compared with 23% of those providing fewer than five hours each week. People providing fewer than five hours of adult care each week reported slightly higher levels of life and health satisfaction, relative to the general population. Those providing between 10 and 19 hours of adult care per week were least satisfied, even compared with those giving at least 20 hours each week. ONS suggests this could be because 69% of carers in the 10- to 19-hour category are in work (either employed or self-employed), compared with 41% of those providing at least 20 hours a week. Similarly, many sandwich carers are not satisfied with the amount
of leisure time they have. Those looking after their relative in their own home – half of whom provide at least 20 hours of adult care per week – are least satisfied. Overall, around 61% of the general population are happy with the amount of leisure time they get, compared with 47% of sandwich carers looking after their relative outside the home and 38% of those providing care within their own home. As well as reporting a lack of leisure time, 41% of sandwich carers looking after a relative within their home say they’re unable to work at all or as much as they’d like. Women sandwich carers – who account for 68% of those providing at least 20 hours of adult care per week – are more likely to feel restricted than men. Around 46% of women feel unable to work at all or
as much as they’d like, compared with 35% of men. Women sandwich carers are also much more likely to be economically inactive than men – 28% are not part of the labour market, compared with just 10% of men in the same situation. However, ONS says that the majority of sandwich carers are able to balance their job with caring responsibilities. More than 59% of those providing care at home say this does not prevent paid employment. One in three sandwich carers say they are 'just about getting by' financially, while one in ten are 'finding it difficult' or 'very difficult' to cope. Meanwhile, only 17% say they are 'living comfortably', compared with 32% of the general population. The full data set can be downloaded on the ONS website.
Octopus Healthcare Fund
Palliative care course
Octopus Healthcare has announced that it has raised a further £133.5m for its Octopus Healthcare Fund and has also agreed to acquire seven care homes. This latest fundraising, from new and existing institutional investors, takes the total equity raised for the Fund to £320m since its launch in August 2017. Octopus Healthcare Fund has agreed to acquire the portfolio of purpose-built care homes let
Lancaster University will be running a Massive Open Online Course (MOOC) on improving palliative care in care homes for older people in April 2019 for three weeks. The MOOC will offer participants an opportunity to learn about palliative care in care homes and how it can be improved using the PACE Steps to Success programme. It has been developed as part of an
on long leases to Care UK for approximately £110m. Care UK was represented by CBRE Group throughout the transaction. In addition, the Octopus Healthcare Fund has agreed to forward-fund the development of a new elderly care home in the Midlands to be leased to a national operator. These acquisitions will take the Fund’s total portfolio to 26 care homes.
Planning permission granted for Beeston care village Broxtowe Borough Council has approved the development of a £15m care village by Charterpoint Senior Living, Peveril Securities and Belong. Featuring a 75-bedroom care facility, 30 supported living apartments and village centre amenities, including a bistro, which will be open to the public, a hair salon, exercise studio and function rooms, the development 18
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will be on part of the former Myford works site on Chilwell Road. The council has previously approved plans for 32 houses, 15 apartments and a convenience food store for a separate section of the site. The care community will be run by Belong and intends to create a home for life with specialist nursing and dementia care as provided in other Belong villages.
EU funded study called PACE and the intervention tested in a clinical trial across seven countries. The free online course will be suitable for staff working in palliative care in care homes, as well as others with an interest in palliative care. More information is available on the website, www. futurelearn.com/courses/palliativecare-in-care-homes
Digital innovation programme Projects that support innovative uses of digital technology in the design and delivery of adult social care are set to share in over £1m funding, provided by NHS Digital and managed by the Local Government Association. Ten authorities will receive up to £30,000 to design a digital solution to address a specific issue with their service, with eight receiving up to a further £90,000 to support its implementation. The funding will run over two years. Bids should focus on one of the following three themes: • Efficiency and strengths-based
approaches. • Managing marketing and commission. • Sustainable and integrated social care and health systems. Previous projects which have been funded by the SCDIP include the introduction of Amazon Alexa into people’s homes in Hampshire to combat isolation. The SCDIP encourages the adult social care sector to use technology to respond to challenges in their local area. It is intended to support direct practice, improve information sharing and enable integration.
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WHERE DOES SOCIAL CARE FIT IN THE
NHS Long Term Plan? January saw the publication of the NHS Long Term Plan, but what does it say and what are the consequences for social care? Here, David Foster OBE from the Foundation of Nursing Studies sets out the detail of the plan and explores its wider impact. The NHS Long Term Plan (LTP) outlines what the NHS in England intends to deliver over the next ten years. It gives cause for both optimism and opportunity, but it also raises concerns and could represent a missed opportunity for the social care sector. Both the structural changes to the system and the workforce issues detailed in the LTP will affect the sector. Its genesis recognises concerns around funding, staffing, increasing inequalities and pressures from a growing and ageing population. All these factors herald a need to accelerate redesign across the whole health and care system so that it is properly joined-up and care is given at the right time and place.
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INTEGRATION While it’s important to note that the Department of Health and Social Care (DHSC) does not own the plan, its publication represents a great opportunity for DHSC to act as the driver of integrated health and social care. The LTP contains statements of genuine intention to integrate the sectors. GPs will be funded to collaborate with community health and social care staff – to deal with pressures in primary care and extend the range of local services – and NHS and social care budgets will be blended ‘where councils and CCGs agree this makes sense’. It also promises to ‘boost “outof-hospital care” and finally dissolve the historic divide between primary and community health services,’ which could be interpreted to include the care sector, but might not. It must be said that some of the statements in the LTP, such as this one, give the feeling that the NHS will take the upper hand with the care sector rather than truly collaborate with it. The rising acuity of care is recognised, with the LTP stating, ‘Sicker patients are being successfully looked after without hospitalisation by GPs, community health and social care services,
none of which have seen their expenditure grow at the same rate as acute services.’ The recognition that acute care can be given in the community effectively and efficiently is positive, but there needs to be greater recognition that acute and complex care is already being given in the community, at home and in care homes with nursing, and this recognition must include the need for this care to be funded. Integrated Care Systems Given this context of complexity and a desire to give care closer to home, the system of planning and commissioning needs to change. This will be the remit of Integrated Care Systems (ICSs), which will be created across all of England by April 2021. ICSs will plan and optimise care and provide more person-centred support by bringing together ‘local organisations in a pragmatic and practical way to deliver the
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WHERE DOES SOCIAL CARE FIT IN THE NHS LONG TERM PLAN?
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“triple integration” of primary and specialist care, physical and mental health services, and health with social care.’ ICSs will have partnership boards, but it is not clear from the LTP if these will include members from social care. ICSs should be able to routinely identify gaps in care pathways and commission services to fill those gaps. Greater transparency of health and social care data will also be enabled. This could be an important and useful development for integration, bringing about a flow of data for mutual benefit, but it will be reliant on IT and the right attitudes.
COMMITMENTS TO THE CARE SECTOR? There are some commitments in the LTP which affect the care sector directly, but they read as though they are NHS solutions rather than being co-produced. The LTP recognises that, ‘One in seven people aged 85 or over permanently live in a care home. People resident in care homes account for 185,000 emergency admissions each year and 1.46 million emergency bed days, with 35-40% of emergency admissions potentially avoidable. Evidence suggests that many people living in care homes are not having their needs assessed and addressed as well as they could be, often resulting in unnecessary, unplanned and avoidable admissions to hospital and suboptimal medication regimes.’ It also states that 70% of people in care homes have dementia or severe memory issues. It goes on to suggest that enhanced community multidisciplinary teams and the application of the NHS Comprehensive Model of Personal Care might help to reduce the number of people living in care homes, by providing more frequent assessments and making them more available to those in the community. This investment in needs
assessment in the sector would be welcome; it is a complex and timeconsuming area and needs extra resources if it is to be conducted effectively. A Clinical Assessment Service (CAS) is also proposed, which will support the public to navigate the best care pathway for them. The CAS will also support care home staff (amongst others) to make the best decisions about supporting patients closer to home and avoiding unnecessary trips to A&E. This service should include professionals familiar with the care sector to ensure its success. The LTP also confirms a laudable aim to continue to improve performance in terms of delayed transfers of care. NHS England’s Enhanced Health in Care Homes Vanguards have shown that collaboration can reduce A&E attendances and admissions and the hope is that these will continue and be replicated. There is also the promise of ‘extra recovery, reablement and rehabilitation support to wrap around care services and support people with the highest need’, which intends to prevent unnecessary admissions to hospital and residential care. Hopefully, this will be a coordinated enterprise with input from both sides of the sector. Significantly, there will be ‘guaranteed NHS support to people living in care homes’ which needs an ‘upgrade’. This implies NHS support to care home residents is not currently guaranteed or of the necessary standard. Improvement is welcome, although it is not stated how this will be achieved or measured. Another promise is that of an NHS Assembly, which will be established early in 2019 and will bring together organisations and individuals to advise the NHS as part of the ‘guiding coalition’ to implement the LTP. This is an opportunity for the care sector to be represented, by organisations like Care England, the National Care Forum and Skills for Care.
WORKFORCE Workforce issues are acknowledged in the LTP as being of profound concern. There are major worries about the supply of nurses, some allied health professionals and doctors. Health Education England (HEE) has a strong role to play in the LTP’s workforce ambitions, and it recognises that workforce planning has been too disjointed, stating that HEE will become more accountable to both health and social care employers. The LTP also admits that NHS workforce growth has not kept up with need and makes the frank admission that staff are feeling the strain. This is undoubtedly true, and some of that strain is because health and social care are still far from integrated. Care staff are also under strain, but the LTP fails to mention the 42,000 registered nurses in the social care sector. Nursing is bigger than the NHS, and this must be recognised in any actions to remedy nursing shortages. A national recruitment campaign is proposed and it would be short-sighted for this to be solely for the NHS. Having one campaign for the NHS and one for social care really underlines that, despite the rhetoric, integration is not a reality. Positively, the LTP does confirm that international recruitment of nurses will continue and steps will be taken to ensure the post-Brexit migration system provides the necessary certainty for health and social care employers. Workforce planning is complex and the LTP commits to its workforce efforts being ‘attentive to both the detail and the wider context’. And there is reason to be optimistic that this will consider social care. There will be a new cross-sector National Workforce Group to include the new Chief Nursing Officer (CNO) for England, and a national workforce plan will be published in 2019. I am confident the CNO
recognises that nursing is bigger than the NHS and that her leadership remit is for the whole profession across all sectors. To enable the education of more nurses, DHSC is planning a 25% increase in nurse undergraduate places, and an extra 5,000 clinical placements will be funded from 2019/20. The Teaching Care Homes initiative has demonstrated that the sector is an excellent learning environment, and a proportion of these placements must be in social care. Also detailed in the LTP is a new post-qualification employment guarantee which seems only to apply to the NHS. However, it’s important that, as clinical placements are expanded, the employment guarantee should keep the clinician within their profession regardless of sector. There is an additional intention to make training more accessible and build on the success of nursing apprenticeships. An online nursing degree for the NHS will be established. Although this has not received universal support from the profession, if it does gain approval, it should be a source of registered nurses for all sectors and parts of the country.
IMPLEMENTATION As a policy document, the LTP is clear about what needs to change but not how it will be done. To explain this, a national five-year implementation programme will be published by Autumn 2019. Local implementation plans are due in April 2019, and the LTP offers assurances that Government is committed to adult social care being funded so as not to impose additional pressure on the NHS. There are some clear positives and opportunities to take away from the LTP, but without proper consideration of how health and social care can be brought together, some of the promises made may be doomed to fail. CMM
Dr David Foster OBE is Chairman of the Foundation of Nursing Studies. Twitter: @DrDavidFoster What do you think of the NHS Long Term Plan? Is it doable or does it ask too much without providing the support needed? Share your feedback on this article and give your opinion of the Long Term Plan on the CMM website www.caremanagementmatters.co.uk 22
CMM March 2019
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Reducing the carbon footprint of the care sector
There is an urgent need for care providers in the UK to become more sustainable – both environmentally and financially. With new legislation coming into force, Katie Elmer from Carbon Footprint Ltd, investigates pragmatic energy-saving solutions that can ensure sustainable change and provide year-on-year savings for operators.
Energy is one of the largest overheads for care home operators, and the cost will only continue to increase with forecasts of rising utility bills. Care homes place high demand on energy, using lighting, heating for both space and water, kitchen appliances, laundry and technology to meet residents’ often demanding and varying needs. Use of company vehicles has additional carbon impacts and the homecare sector faces the issue of staff getting to clients. These can all have
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The PASSsystem enables data about an individual and their care delivery to be captured and monitored in real time – from a full care assessment captured on a tablet device to the collection of care notes and MAR sheet reporting.
In the office Staff in the office monitor the delivery of care delivered by care assistants in the field. Information about the tasks carried out during visits, including the administering of medications, are sent securely from the care assistant’s mobile device back to the office in real time. If a task is not carried out or a visit does not take place, the PASSsystem alerts the office and action is taken to investigate.
On smartphone Care Assistants record a wealth of information easily and efficiently during and after a visit. This forms a permanent record of care delivered, helps to improve on-going care quality for the individual and is always as up-to-date as possible because changes made on the PASSsystem to a customer’s care plan are updated across the system whenever information is modified.
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REDUCING THE CARBON FOOTPRINT OF THE CARE SECTOR
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substantial financial consequences. In addition, there are market pressures, as potential residents and their families increasingly expect to see more environmentally-friendly accommodation. Furthermore, care homes present something of a dilemma to the energy manager. Whilst identifying sources of high energy use (and high carbon emissions) is quite easy, reducing consumption is fraught with potential risks to the wellbeing of residents.
COMPLIANCE REQUIREMENTS Coupled with the increasing financial burden of energy consumption, there are growing legislative and regulatory demands to reduce the carbon footprint of the care sector, and providers may find themselves needing to meet two relatively new pieces of legislation. First, there is the Energy Savings Opportunity Scheme (ESOS). This requires large entities (those with more than 250 staff in the UK or who satisfy financial criteria) to audit their significant energy streams and provide achievable recommendations for cost savings opportunities (or face fines from the Environment Agency of circa £50,000). New for April 2019, most of these large entities will also be impacted by Streamlined Energy and Carbon Reporting (SECR). This means they will need to report their annual carbon footprint and energy consumption and, going forward, demonstrate that they are actively reducing this. To help with these requirements, Carbon Footprint has found that implementing a mix of behavioural and technological measures can yield energy and carbon savings of up to 20%, with return on investment in less than three years.
GETTING TO GRIPS WITH ENERGY COST Demand for energy in care environments means that cutting consumption/utilising renewable technologies is the only way carbon emissions can be significantly reduced. However, this obviously needs to be done with care, to ensure there is no loss of comfort or service, and that risks to residents’ wellbeing aren’t increased. Switching energy suppliers and using brokering services can alleviate some cost hikes in the shorter term; however, reducing consumption at source is the most sustainable means of tackling this – particularly in light of issues such as security of supply and affordability of care. There are large operational savings that can be made in reducing your carbon footprint and this can be passed onto residents, to help minimise fees and assure people that their residence is as sustainable as possible.
HEATING UP Heating, ventilation and air conditioning (HVAC) are vitally important and any changes to these systems must be carefully considered to avoid any increased risk of infections in the home. Heating of both water and rooms can total around 40% of a care home’s energy consumption. This is often
down to the requirements of residents in terms of bathing and rooms being warm, as well as the amount of laundry that needs to be done. However, there are various free and low-cost solutions that can reduce both energy costs and carbon footprint. Consider the following and make changes if needed: Free/low-cost • Are the minimum set temperatures too high? • What would the optimum temperature be, and can this be seasonally adjusted? Some care homes have a Building Management System (BMS) that can be programmed to do this automatically. • Do you have thermostatic radiator valves? These can be used to adjust the temperature by controlling the flow of hot water to the radiator. Make sure these are set at appropriate levels, i.e. put radiators on the ‘frost’ setting in spaces that don’t need to be heated at all times. • Ensure residents do not have access to HVAC controls (and that staff are trained on their use). • Are appliances being used efficiently, e.g. are tumble dryers being used for full-loads? Medium/higher cost • Ensure all heating equipment is serviced at least annually, and that boilers and piping are insulated effectively. • The age of the boiler has a significant impact on energy consumption. While boiler replacement can be costly, the paybacks can be worthwhile. • Consider an alternative heating system. Biomass heating systems create energy by burning organic materials and can provide significant cost and carbon reductions. Ground source heat pumps are another alternative; these harness natural heat from underground. • Is your building effectively insulated? Focus on windows (look at their glazing and how well they are fitted), loft hatches and loft insulation, poorly fitting doors, electrical fittings on ceilings and walls and ceiling-towall joists. You should also consider draught-proofing. • Could you install a BMS if you don’t have one already?
LIGHTING Lighting is another critical part of a care home’s energy consumption profile. Again, there are some easy solutions to reducing the use of lights and some that require a little more expenditure but should give you a quick return on investment. The following measures should help to reduce the lighting load: Free/low-cost • Maximise natural daylight; this is called daylight harvesting. Make sure windows and skylights are cleaned regularly to allow the most light in and ensure walls are bright and clean. • Where artificial lighting is necessary, ensure it is cleaned regularly. • Consider using ‘switch off’ stickers next to light switches to encourage people to turn lights off when they are not required.
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REDUCING THE CARBON FOOTPRINT OF THE CARE SECTOR
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Medium/higher cost • Switch all lighting to LED. This can consume up to 90% less energy than traditional lighting. LED lights are also brighter, which means fewer lights are required. Return on investment for switching like-for-like lamps is usually a maximum of three years. • Conduct a lighting survey that considers budget (will a phased approach be best?), the different requirements in different spaces, and potential disruption to residents. • Automatic lighting controls, such as passive infra-red, should be considered in areas of low or intermittent occupancy. Daylight sensors should be used externally to avoid having security lights on when it is bright outside.
ELECTRICAL EQUIPMENT Consideration should be given to the energy rating of all electrical equipment before it is purchased. Energy performance is clearly labelled on appliances and choosing equipment with better energy ratings will make a difference to your carbon footprint. Computers, monitors and printers should be shut down when they aren’t being used, instead of being left on standby.
GETTING ON THE ROAD Energy consumption from transport can be a considerable cost and significantly affect your overall carbon footprint. Operational maintenance teams, minibuses, and field-based care workers all contribute to this. It is worth developing a travel policy that provides environmental guidance. This should give employees tips on how to reduce fuel consumption, such as journey planning, vehicle maintenance, efficient driving techniques, and vehicle technology. This could also be supplemented with driver training. The policy should encourage, where possible, alternatives to traditional car use, like having meetings over Skype, car sharing and using public transport.
IMPLEMENTING YOUR STRATEGY To make sustainable, long-lasting change, communication and staff awareness are key. It’s a good idea to make sustainability and energy part of staff development and any training programmes you run to ensure staff consider sustainability part of their role. You can also monitor and measure your energy and read your meters to get a more accurate picture of your energy consumption. Use sub-metering or install halfhourly meters where appropriate, which can be analysed
over a day and can help to identify unexplained energy consumption. Once you have collected this data, you can annually assess your carbon footprint. Publicise the results and put together an action plan to reduce your footprint. This should be communicated fully to all staff and residents and you should make them aware of how they can participate. Set up steering groups to help affect change, with clearly defined roles and responsibility and top-level commitment and presence. You could also use incentive schemes for energy reduction suggestions, set up league
“To make sustainable, long-lasting change, communication and staff awareness are key.” tables between different sites and consult the people using your services, and their families, for ideas. This is likely to get more people on board with your plans and help them to see the significance of small changes. You could also consider an Environmental Management System like ISO 14001; this manages all your environmental impacts in one place. ISO 50001, an Energy Management System, could also be considered, which can be a route to ESOS compliance for larger organisations.
ACTION STATIONS Getting to grips with the energy strategy of a care home might seem an onerous task; however, the key is to start something, even if it isn’t as all-encompassing as you might wish it to become. You must do what legislation requires of you – but also use this as an opportunity to improve your site and the environment for your residents. Small steps and achievements on the way, such as energy brokering to reduce tariffs and switching to LED lighting, will quickly show that cost-saving results can be readily achieved with little to no capital outlay. As well as your management team, you should involve your residents – you may be very pleasantly surprised at their interest and knowledge, and this can help to create a community that is collectively committed to low carbon. CMM
Katie Elmer is Senior Sustainability Consultant at Carbon Footprint Ltd. Email: katie.elmer@carbonfootprint.com Twitter: @CarbonAcademy Are you making changes to your service to become more environmentally-friendly? What more can be done to reduce the sector’s carbon footprint? Share your thoughts and provide feedback on this feature on the CMM website. www.caremanagementmatters.co.uk 28
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Z606 Archers CMM Mag 1/4 page.indd 1
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RADAR FALL DETECTION: A NEW WAY TO INCREASE SAFETY AND REDUCE RISKS? There are many different technologies designed to detect falls and each has its drawbacks. However, new radar technology is being trialled to provide an alternative to these methods and potentially change the way falls monitoring is carried out. Tanglewood Care Homes has partnered up with healthcare technology start-up, FrontDoor to become the first care home provider in Europe to test a new fall detection system at its flagship care home, Cedar Falls. The partnership aims to enhance residents’ safety and improve the quality of care in Tanglewood’s care communities.
THE TECHNICAL DETAIL FrontDoor’s fall detection technology uses impulse-radio ultra-wide (IR-UWB) radar signals. This is effectively a very highresolution version of the sort of radar that is used on ships. The radar system is attached to the ceiling of a bedroom, from where it sends out millions of lowenergy pulses in waves. These waves bounce off objects in the room and the data is gathered and analysed by the equipment. This allows the technology to detect any kind of movement in the room, from someone moving around, down to movements on the skin’s surface. From this, the technology can detect both falls and the state of a person’s breathing rate and heart rate. When detecting a fall, the system assesses both the speed of the fall and the distance of the person’s heart rate from the ground. This means it can detect both accidental slips or trips resulting 30
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in a fall and falls resulting from heart attacks or muscle issues, which may be a slower type of fall. Once a fall or another issue is detected, the system communicates this via a mobile app to the care workers. The system will also keep monitoring the resident, so that it can tell if the person has got up or if they aren’t moving at all, and it will send their respiration rate to the monitoring software in real time.
DEVELOPING THE SOFTWARE IR-UWB radar technology is still a relatively new concept, so testing is important. Tanglewood has agreed to use the system in one of its rooms to help develop the product and ensure its accuracy and the trial is providing valuable feedback. One issue that is often faced by people creating fall detection solutions is avoiding false alarms. As a person can fall in myriad different ways, teaching the system what is and what isn’t a fall can be challenging. However, the trial with Tanglewood allows for real-life scenarios to be fed-back to the developers in a bid to overcome this. Another challenge being faced by developers is making the technology accessible to the care workers who will be using it. Tom Shelbourn, Founder of FrontDoor said, ‘There’s a lot
of great technology out there, but it’s no good if you need to be a rocket scientist to use it… we are developing user-friendly apps to show care workers the information they need, and nothing more.’ As with other monitoring technologies, privacy must also be a consideration. FrontDoor is hoping that due to the nature of the detection software, there are fewer privacy issues with this system than others. IR-UWB radar technology does not ‘see’ or ‘hear’ the resident and therefore aims to negate any concerns around invasion of privacy from that point of view.
AN AMBITIOUS FUTURE In terms of the benefits of application, the technology is designed to free-up care workers’ time so that they can spend more time caring. Tom continued, ‘Technologies such as this will enable us to shift care culture to be more proactive rather than reactive, so that resources can be allocated to where they are needed most.’ Part of this is ensuring that staff don’t need to check on residents as frequently. This includes checking on residents at night or when they are sleeping; care workers won’t need to disturb the resident by opening the door, as they will be alerted if that resident is out of bed or has had a fall as soon as it happens.
The system also reduces the risk that a resident will have a fall and remain lying on a floor until they are checked on.
ADDITIONAL APPLICATIONS The organisation is also hopeful that the system, in the future, will be able to diagnose health issues. It is hoped that with daily passive monitoring of a person’s heart rate, any potential irregularities that might otherwise go undetected will be raised by the system before any major event, such as a heart attack, takes place. There’s also scope to monitor blood pressure with the technology, too. Outside of care homes, it is hoped that the technology might have applications in health services and in the community. Tom went on, ‘There is an increasing number of elderly people living in the community, and domiciliary care resources are spread incredibly thin…It’s been shown that wearable technologies are not reliable, as people can forget or simply do not like to wear them.’ CMM
OVER TO THE EXPERTS... Does radar technology provide a real alternative to current fall monitoring systems? How could it be improved? What might be the concerns and drawbacks of using it?
A STEP FORWARD The use of technology to help monitor and prevent falls has long been discussed. However, the potential for this technology to assist has always been countered by concerns about individuals’ privacy being protected, the use of technology to reduce staffing rather than enhance care and often the tech solution itself not being robust enough to do the job as promised. If these challenges can be overcome, then I believe that this technology has a role to play in care delivery. The idea of the technology linking to an app is, I think, a step forward from some of the original systems which involved banks of screens at care stations, and the need for care staff to be watching the screens rather than the residents. This always felt like a step away from a person-centred approach to care. The challenge of incorporating the use of the app into a person-centred care plan
POTENTIAL FOR FUTURE DEVELOPMENT should not be underestimated. There is also the potential for staff to become reliant on the technology to tell them when something is not right, rather than using clinical knowledge and experience to assess for risks and produce preventative care plans to reduce falls risk. These systems should always aim to enhance care provision and not replace elements of it. The fact this system is aimed at fall detection rather than falls prevention also demonstrates that the use of technology to prevent falls is still some way off. But with the smart use of the biometric data, we are perhaps finally heading in that direction. Until then, only time and testing will determine if technology offers more benefits than current best practice in falls management.
Richard Adams Chief Executive Officer, Sears Healthcare Ltd
I believe it is extremely good that this technology has reached the real-life testing scenarios. Extensive lab research has been performed in the area of detecting falls, but very few devices have reached the consumer, with the main drawbacks being the reallife context and understanding the main players involved: who is involved in monitoring, who is involved in action or intervention, how do you implement a universal protocol of intervention? A care home is a well-defined environment, so a good place to begin. But if we were to address older people living independently at home, with family carers being away at work during the day, there could be a lot of questions regarding the services that could intervene. This would require, I believe, the active involvement of several health and care services, and maybe even the creation of new structures, to be successful.
The IR-UWB radar technology has the potential, as well as other motion sensors (like depth cameras), to simply be installed in a room without interfering with the everyday life of the user. This is, of course, of vital importance, as it does not require anything from the user – no wearables or button, which could hinder the user or generate misuse. However, leaving all the work to the computer does present major challenges. It would require cutting edge AI to be able to accurately assess the seriousness and urgency of situations and avoid false alarms to be a reliable support. Nevertheless, the technology could be enhanced to perform movement analysis and assess the risk of falling and the impact of preventive solutions. The potential for future development is huge.
Alina Călin Chief Research Officer, Mira Rehab Ltd UK
NEEDS ROBUST POLICIES AND SAFEGUARDS The use of technology in the care industry is growing and the IR-UWB radar that FrontDoor is using has been adopted successfully in other industries. It is important that available technology is utilised in the care industry and it will be very interesting to see the results of the trials. The challenge for any company deploying a technological aid into the care home environment is to satisfy the regulators it will benefit residents. Whilst the system is promoted as freeing-up care workers’ time so they can spend more time caring, regulators do not want to be left with the impression that the adoption of such systems are simply staff costsaving measures. Residents, and in some cases relatives, should also be made aware of the use of such technology. Whilst the technology cannot see or hear a resident, they will be identifiable and their
movements within their own private space observed. As with all technology, there should be safeguards to ensure the staff operating the systems are properly trained and fully aware of any limitations to its capabilities. So often, there can be an over-reliance on the capabilities of technology and an assumption that it will never fail. There will need to be a very clear indication to staff if the system is not working at any stage and robust policies in place to inform staff of the failure and the alternative checking and record keeping procedures. The efficiency savings of technology can be substantial and can also improve the standards of care, but it is people that are held accountable when things go wrong and the human factor should never be taken out of the equation.
James Farrell Solicitor, Slater and Gordon CMM March 2019
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RISING STARS
CAREER HISTORY I first became a care worker in a care home when I was 18. Originally, I wanted to train to be a nurse and I started a degree to pursue that, but my circumstances changed after becoming pregnant, so I took a step back from my course to focus on raising my son while continuing my career in care. I changed jobs to do more flexible domiciliary care where I became a team leader and then a care co-ordinator. After a while in domiciliary care, I moved back to working in a care home before I had my second child and worked nights, which fitted my personal circumstances well. I moved back to home care again and became a branch manager which I really enjoyed before an opportunity came up to manage a WCS Care home in 2017, which was something I really wanted to do.
ORGANISATION
Samantha Stuart is Registered Manager at Fairfield care home in Bedworth.
The care home I run has 36 beds for both socially-funded and privately-funded residents. We also run a day care centre. The home is really welcoming and I loved it from the second I walked in. The staff are genuinely lovely and we have wonderful residents and families, too. When I applied for the position, I realised that Christine Asbury (our Chief Executive), Ed Russell (Director of Innovation and Development) and Shirley Randle (Service Manager) – the senior management team who interviewed me for the role – shared many of the same views that I have about what a care home should be like. In our home, there’s always something going on. We go for trips out to local attractions at least once a week using our Oomph! Out & About service, and visit some of our other care homes in the area, so that residents can carry on doing what they’ve always enjoyed doing. During one of the visits to our neighbours, we realised that two ladies from two different homes knew each other and had a lovely time catching up – something we wouldn’t have known if it weren’t for trips like this. It’s inspiring to work with Christine, our Chief Executive. She lives and breathes our values and was instrumental in bringing them to the organisation. The whole senior management team regularly pop in and see us and sit with the residents. Our senior management team is really supportive and there’s a great learning culture across the organisation. We’re encouraged to try new things and if they don’t work first time, we learn from them and move on until they do work. They’re great at encouraging us with our own personal development and many of our staff have progressed through the organisation to become managers or senior managers.
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RISING STARS
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CURRENT ROLE
The culture at WCS Care is very different to other organisations I’ve been to – people are encouraged to live their life how they want to and aren’t being told what to do or when to do it; it’s completely up to them. We support people to maintain their independence for as long as they’re able to, so if someone wants to butter their own toast, pour their own milk or make a cup of tea, then that’s absolutely encouraged. Our home also has the policy that family can come and go as they please, which is particularly important during end of life care. Recently, the relatives of one of our residents receiving end of life care stayed at the home for a week to be with their loved one in the final days – it was a privilege to be able to give that time to them and know that we had done everything we could to support them during this difficult time. And it shouldn’t be any other way. We work in our residents’ home, not the other way around – and our staff respect that in everything they do. From delivering care to ordering furniture, we ask the residents what they want. Recently, we ordered carpets and asked each resident to pick their favourite, just like they would in their own homes. Residents get choices on everything as it’s their life. As a manager, I’m very hands-on. I do spend time in my office doing paperwork, but I also go out onto the floor regularly to see what’s happening, talk to staff and residents. If my staff need support, I down my pen and help them out. I expected the job to be difficult and it is, but the support from my team makes it so much easier. I get a lot of joy out of my job. Not many people can say that they love coming to work, but I do. I get to help my staff develop and climb the ladder if they want to, and helping the residents and their families to live a happier life is also really special. You get to make a difference to so many people’s lives. We’re a tight-knit family at the home and there are obviously times that are harder than others, particularly when supporting relatives and staff through times of grief – it’s important to just be there, be compassionate and be respectful, while helping people focus on the happy memories of that resident and the realisation of the positive impact you’ve had on their life.
RISING STARS I first found out about the Rising Stars programme when our Chief Executive, Christine told me she had nominated me to take part. I had only just started at the company and it was a real privilege to be recognised as a ‘Rising Star’ in the organisation. I’ve learnt so much since being on the programme.
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My mentor, Rory O’Connor from the Royal Air Force, has been brilliant. Being able to have someone to speak to outside of the company has been great for bouncing ideas off, and the NCF staff are all amazing too. We get sent reports and policies and all sorts of documents that help us gain knowledge which really helps with our personal development. The programme has opened up doors for me that I never thought I’d be able to even knock at. My confidence has improved hugely through the Rising Stars programme. I think it’s to do with the knowledgebuilding. I’m so grateful that I’ve had this opportunity for self-improvement. I didn’t expect the impact that Rising Stars has had on my career in such a short time.
FUTURE CAREER I’m more than happy being a care home manager but Rising Stars and WCS Care have given me the confidence to think about my future goals. While I’m truly happy where I am and not planning on changing any time soon, I can see a world of opportunities to aim for such as Service Manager or maybe Director eventually – I’d be happy to stay here forever. I think if it happens, it happens. I used to think that I’d need to go to University to further my career but Rising Stars has shown me that it’s about more than that – having the passion to succeed is a big part of it. Yes, you need the practical knowledge, but it’s about how you apply that knowledge too. Until now, I didn’t feel I had the confidence to climb any further up the career ladder, but now I do and I’m looking forward to taking the next step.
ADVICE My advice is to never forget why you’re in this sector, doing the job you do. No-one works in social care because of the money – it’s because you care about people and that’s what matters most. Always remember that you are a carer – share your passion with others and be supportive. When you’re making a difference to people’s lives, everyone is important and should be valued, whatever their role is. We all need to help staff to feel this. CMM Samantha is part of the second cohort of Rising Stars. This innovative programme, developed by National Care Forum and supported by Carterwood and apetito, is designed to identify leading lights within organisations who will shape and form the care sector in the future. More information about the programme, the candidates and future opportunities can be found at www.nationalcareforum.org.uk
Membership has its benefits Join our growing community of registered managers Are you a registered manager of a care service? Join Skills for Care and keep up-to-date with the latest developments, access peer support and exclusive benefits that enhance your learning, development and wellbeing. Skills for Care is the membership organisation for registered managers in England. Our members are raising the profile of your profession that sits at the heart of our sector – championing the values for delivering compassionate, person-centred care. Membership benefits include:
■ ‘Social care manager’s handbook’; the go-to resource for registered managers
■ monthly online newsletter, packed with relevant information for your role
■ discounts on Skills for Care’s products, resources, leadership programmes, CQC seminars and access to HR support
■ mentoring or the chance to become a mentor ■ exclusive members-only Facebook group for peer support ■ annual renewal resource; eg ‘Guide to improvement: workbook edition for 2019’.
Are you an organisation looking to invest in your registered managers?
Join today for only £35 for 12 months
Membership adds value and demonstrates a commitment to investing in your managers. Buy 10 or more memberships and receive a 10% discount.
Find out more and join today at www.skillsforcare.org.uk/membership
While reform has been promised to social care for decades, we are still operating in a system that is outdated and which fails to keep up with changing demand. John Kennedy, Social Care Consultant, tells us where we are going wrong and puts forward ideas for radical change. 36
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The awaited Green Paper has failed to materialise again. We’ve been talking about reform in adult social care all my working life, and, while things have been tough in the past, it now seems like we really are staring into the abyss. Social care seems never important enough to be high on the political agenda. There are approximately 1.4 million people in England today
over the age of 85 and, by my 85th birthday in 2051, there may well be 4.5 million of us. It’s unprecedented and a game-changer. Looking more broadly at adult social care, it’s estimated that 1.4 million people are now excluded from receiving the care they need and that they used to get. The NHS is under relentless overwhelming pressure, partly because of a
PAST THE
TIPPING POINT REIMAGINING SOCIAL CARE
poorly-imagined social care system failing to respond to the failure demand embedded in the current approach. The recent State of Care report, published by the Care Quality Commission (CQC), paints a grim view of the state of adult social care. We have passed the ‘tipping point’ and it’s official: social care is collapsing in slow motion. But all
this has been known for years – the collapse was wholly predictable.
HURDLES FOR INNOVATION AND CHANGE The public’s expectations about the kind of care they should, and want to, receive, not to mention its quality, are also changing. We’ve
changed immeasurably as a society and will continue to. Older people are no longer ‘Victorians’, as they were when I started off 35 years ago. They are now the pioneers of a consumer society. They’ve given us good coffee and en-suite hotel rooms, they’ve exercised their consumer power and created new markets, products and opportunities. So why is the way
we care so poorly envisioned? Why, I reflect, have we been left behind while other sectors have moved on? The bleeper I had in the 1980s has evolved into a smartphone – if you’d given me a smartphone when I was a kid, I’d have thought I was an extra in Star Wars. Why isn’t our care system equally as unrecognisable? Instead of responding to
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A CQC inspection is never going to be a normal day at work At Gordons Solicitors, we offer training and legal advice to providers and their teams aimed at getting the best possible outcome from their inspections. Please give us a call. We will be delighted to share our specialist knowledge and expertise to help you on the road to Outstanding.
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Staff can change their behaviour when they are watched by inspectors. Even CQC has acknowledged the Hawthorne Effect applies when carrying out its Short Observational Framework for Inspection. However, supporting your staff will help in putting them at ease so they can do themselves justice during the inspection. Equally, providers and managers may need assistance in managing the inspection process, from receipt of the PIR down to publication of the final report.
PAST THE TIPPING POINT: REIMAGINING SOCIAL CARE
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changing demand, we’re simply entrenching what we don’t desire. No-one wants domiciliary care that operates to a ‘pizza delivery’ model. The current system focuses more on ‘time slots’ and ‘logistics’ than creating the right conditions that allow empathy and kindness to grow. No-one wants ever-bigger care homes or industrial models of care, but we are being pushed in this direction. Before I get trolled for dissing social care, I’m not. I know of fabulous places and fabulous people doing incredible things. But it’s not consistent or common. Far more want to be fabulous, and far more could be if the engineering of the system were improved and nurtured. CQC is right to say that good care is everyone’s responsibility; no-one should expect a regulator to be the sole agent of quality. However, slightly ironically, its approach has led to CQC shouldering all the responsibility for the quality of social care services in the eyes of not only the public, but also Government and, to a significant degree, providers, whose activities are dominated by the ever-changing ‘angels on pinheads’ requirements. This shouldering of responsibility has made CQC the most powerful and influential agent in social care. It has the power to create the right environment for progress, and it has the power to fetter. But CQC is also trapped in the circular firing squad of blame, fearful of encouraging anything outside of the norm. This fear of upsetting the balance and trying something new dominates the culture in social care. The vast majority of providers want to do a good job every day and the vast majority of care workers want to be kind. But in the current system, even some of the very best remain worried to try new things, boxed in by an apparently rigid and unyielding system.
THE LINK WITH QUALITY It’s not working either – quality is not being improved commonly and consistently. Quarter on quarter, inspections report approximately 50% of care homes are below expected standards, and we aren’t resolving this, we are just playing whack-a-mole. A recent report from The King’s Fund on the impact of regulation highlighted that a focus on inspection and ratings wasn’t having the anticipated impact on systemic quality in social care. Strikingly, the researchers did note the positive impact of a good relationship between inspector and inspected, but we now understand that this more nurturing approach is evident in the health sector, and is more or less non-existent in social care.
IT WILL GET WORSE The ‘crisis’ is officially upon us. But without radical reimagining it’s only going to get worse. Providers are increasingly struggling to find people to fill permanent senior roles, particularly registered manager positions. These roles are proven to be the most crucial factor in the quality of a care service. Increasingly, people are unwilling to shoulder the significant legal and reputational risk that these roles bring with them. Burn-out and mental distress are also endemic and, for women, the highest occupational risk for suicide is care work. Good, long-term and responsible investment is being discouraged. Investors are reluctant to have line of sight from their boards to registered care provision, for fear of litigation and reputational damage. This increases the risk that any investment that is forthcoming is aggressive, short-term and profitdriven. There is a very high turnover
rate for new entrants to the care sector and a particular increase in difficulty recruiting and retaining younger people. The needs of the next generation of care workers could be very different – will they accept the dissonant value base of the sector? We must recognise that tomorrow’s workforce might not want ‘the work’ as it stands. Do we need a workforce recruitment drive? Or do we need
regulation so that it has ‘skin in the game’. CQC could work to support innovation, sharing the risk with providers to permit, enable, encourage and breed confidence, so that providers know they won’t be penalised for trying something new. Integral to this will be to have at least one person on the CQC board who has contemporary experience of working in adult social care.
“The ‘crisis’ is officially upon us. But without radical reimagining it’s only going to get worse.” to imagine a different kind of ‘work’? The care system is failing everyone: citizens, workers and society. Yes, more money would help, but it won’t solve our problems in itself. We need to shift the power so that consumers are in charge, not commissioners. Our language needs to shift – let’s stop thinking of ‘services’ and ‘service users’ and start calling it what it is – community and neighbourhood, friends, neighbours and people. Informal carers, the bedrock of social care, must be supported and valued, where they are often ignored and disempowered. And our workforce needs to be professional, well-paid and wellvalued. But until the system allows change, we will be stuck in a Victorian world.
FIXING A BROKEN SYSTEM In the absence of Government taking responsibility, someone needs to step-up and lead, and I can’t think of any other agency, with the resources and power able to do that, than the regulator. Perhaps we could reimagine
Data and evidence could be used to expose the impact of poor commissioning. Only by proving the direct correlation between poor quality and shoestring commissioning will change be brought about. We also need to forensically and inquisitively examine and evaluate the bureaucracy – ensure that what is demanded of all care workers is effective and actively helps quality. It mustn’t unnecessarily take away the time to care. What if we moved to a SMART and evidence-based regulatory model? Could we bring a stop to the pettifogging culture?
STAYING ALIVE The sector needs to speak truth to power, loudly and courageously. CQC is one of the only agents in the space with a voice that can be heard across both providers and Government and that has the ability to bring about change on a fundamental level, but it must change itself first. Like it or not, CQC could in many ways be our Obi Wan. In other words, our only hope. We must reimagine – the alternative is to fail while waiting for reform and watch the sector collapse. CMM
John Kennedy is Independent Social Care Consultant and Commentator. Email: jpkennedy366@gmail.com Twitter: @johnnycosmos What are your thoughts on the future of social care? Could CQC change the way we operate? Share your thoughts on John’s proposals and feed-back on the feature on the CMM website. www.caremanagementmatters.co.uk CMM March 2019
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THE RAINY DAY FUND FOR EVERYDAY HEROES. The Care Workers Charity supports people who are, or who have been, engaged in the care sector by relieving poverty and sickness through hardship grants. There are over 1.5 million care workers in the UK, contribu�ng to one of Britain's largest workforces, and caring for some of the most vulnerable people in our society. For Britain's care workers, early starts, long hours and mentally draining work are part and parcel of the job. As a result, it's all too easy for illness, or other unforeseen circumstances, to push them beyond their financial limits. The good people of the care sector make a massive contribu�on to our everyday lives. The Care Workers Charity is here to help current, former and re�red workers on their rainy day. Charity No. 1132286 and SC048051
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Social Care Showcase 2019
‘Stepping up to the Challenge’ Wednesday 6th March 2019, 9:00am – 4:00pm Brighton Racecourse, Freshfield Road, Brighton East Sussex BN2 9XZ In its thirteenth year, the region’s top business advice, training and workforce development event for adult social care providers, The Surrey and Sussex Social Care Showcase, takes place at Brighton Racecourse on Wednesday 6 March 2019. Free*conference and exhibition for adult social care owners, chief executives, managers, senior staff and professionals across Sussex, Surrey, Brighton and Hove. * Free Event to those providing care and health services in East Sussex, West Sussex, Brighton & Hove and Surrey. Others are welcome to attend however will incur a £60 delegate charge.
Exhibitors include: § National Organisations supporting Health & Social Care § Professional Services § Workforce Development Specialists § Lawyers § Business Development Services § Training Providers § Care Associations § Suppliers to Care Industry § Technology Providers Over 20 Seminars available:
§ Sharon Allen, Skills for Care § Deborah Ivanova, CQC § Vic Rayner, National Care Forum § Keith Strahan, NHS Digital § Rob Persey, ADASS & Brighton & Hove City Council § Neil Eastwood, Care Friends & Sticky People § plus Legislation Updates, Business Advice Seminars, plus many more !
For full details visit www.careshowcase.org.uk For details on exhibiting please email showcase@surreycare.org.uk Thanks to the support of our partners:
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Media Support:
M A I N TAINI NG M O M E N TUM
M U S I C AN D DEMENTIA A year ago, The Utley Foundation asked, ‘What would life be?’ for people living with dementia if music, in all its rich variety of forms, was properly utilised. Here, Grace Meadows from Music for Dementia 2020 provides an update on progress and shares tips for implementing best practice.
In 2017, the International Longevity Centre (ILC-UK) was commissioned to research the power of music on dementia, with the aim of producing a clear set of recommendations about what needed to be done in this space. This included looking at the ecosystem – what was happening, where and how, where the gaps in provision were – and the evidence base. Experts in dementia, music, health and care,
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and, importantly, people who were living with dementia, presented findings at the House of Lords in January 2018. The recommendation: the creation of a centralised and interactive website to provide information and expertise on how music is essential for people living with dementia and their carers. Until recently, the growing opportunities and power that music brings to the support of people living with dementia were not being recognised or contained. Research, evidence and musical expertise all over the country was disparate and fragmented. Music for Dementia 2020 is mobilising and bringing together the spectrum of different musical activities available, to help people find the right music for them, at the right time and in the right ways. Music-based interventions for people with dementia can range widely, including communitybased music groups, live music in care homes, listening to the radio or recorded music, playing an instrument, music therapy, or using personalised playlists. These should all be considered by providers as ways of supporting people with dementia.
KEY DEVELOPMENTS SINCE 2018 The recommendations in the ILC-UK report were a muchneeded call to action. Since the report, The Utley Foundation has begun creating a national taskforce of stakeholders across the music, dementia, health and social care sectors, from people living with dementia through to MPs. The aim is to help improve the quality of life for people living with dementia through music. To achieve this, Music for Dementia 2020 has a clear vision to: • Develop cross-sector support to make music readily available and accessible for people living with dementia. • Create a collective understanding across society
that music is a necessity for people living with dementia and they need access to it now. There is some excellent work happening across the UK to ensure that people living with dementia do have access to music across a range of settings. There is a lot of music-making that happens in people’s homes, communities, concert halls, care settings and acute settings, such as hospitals and hospices. But
“The use of music to support people with dementia needs to be ingrained in the culture of care to ensure widespread uptake.” there are many places where there is little or no activity and this is where efforts are being concentrated to encourage the introduction of music as part of everyday life. Organisations are also working to make their music offer sustainable so that it doesn’t just last for the duration of its funding – they are looking at moving to models where the value and quality of their offer is driving investment and long-term commitment and support from commissioners.
WHAT STILL NEEDS TO BE DONE? Sadly, we know that this work is not happening in all areas across the UK and that provision is patchy. This could be down to a lack of awareness or budgetary constraints, but the use of music to support people with dementia needs to be ingrained in the culture of care to ensure widespread uptake. We want to scale-up the excellent work that is already happening, so that it can be accessed by more people more widely, for example, expanding programmes
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MAINTAINING MOMENTUM: MUSIC AND DEMENTIA
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such as Live Music Now, Playlist for Life, Music in Mind and Together in Sound. We are also aiming to help introduce music where it isn’t already being utilised to support people with dementia. Ultimately, we want people living with dementia and those caring for them to be able to access a range of musical activities, from playlists and performances, to interactive, participatory music-making and music therapy. All of these are already available, but practitioners and services need to be supported to grow and spread across the UK so that everyone living with dementia has access to the musical experiences that they want to participate in. There is growing understanding and awareness of the positive role music has to play in supporting people living with dementia; the future will see music, and the arts more generally, being valued and recognised as essential for people living with dementia. This will mean that access to, and quality of, the music offer is the same across the country regardless of postcode. We will see a future where quality of life for people living with dementia is at the heart of their care and music will be the channel for making this happen.
IMPLEMENTING BEST PRACTICE Making music available means promoting and supporting the whole spectrum of music activities to be available for people living with dementia. The care sector is encouraging availability of choice across the UK as a way to provide personcentred care, and music is not to be excluded from this. In order to ensure that people are having a truly personalised experience
with music, people should be able to make choices about what types of musical activities they want to participate in – if they’d rather listen to music than join in with singing, this option should be available to them. This is very much aligned to the personalised care agenda recently announced as part of the Long Term Plan. Music, care and health organisations are all supporting the Music for Dementia 2020
and look at where you could add more music and what kind of musical offerings are already available. Develop more group activity or music therapy, create personalised playlists and invest in devices so that everyone has access to their own music. It is also important to look at training for care staff, so they feel confident and comfortable leading music sessions and incorporating music into care routines.
“On a local level, we would like to see care providers linking more with local music practitioners and organisations, developing ways of working together that are sustainable and meaningful.” campaign through involvement with The Utley Foundation’s taskforce. The Music for Dementia 2020 team are encouraging organisations to share the messaging – helping to increase awareness and understanding, and increase delivery of their musical offers. This is happening through collaboration at both local and national levels. At a national level, conversations are being had with the care and health sectors to bring about greater awareness and understanding of the role of music in the care of people living with dementia. At Music for Dementia 2020, we are currently working with the NHS and Social Prescribing Network to embed music into social prescribing, supporting health practitioners to understand the benefits of music. We encourage providers to talk to us and their local music services – work with music practitioners to map the needs
On a local level, we would like to see care providers linking more with local music practitioners and organisations, developing ways of working together that are sustainable and meaningful. This could be creating a link with a local orchestra, community music group, local music and arts venue, music therapy service or school. The Music for Dementia 2020 website could help with facilitating these links.
INCREASING AWARENESS The benefits of music for people living with dementia are well-publicised, with huge potential. We must push for more awareness of what providers can do to use music in their services and encourage uptake of different types of activity to ensure we are all providing the best person-centred support for people who need it most. CMM
Grace Meadows is Programme Director at Music for Dementia 2020. Email: grace@m4d2020.com Twitter: @Grace_Meadows_ @music4dem2020 What are you doing to encourage music activities in your service? How can musical offerings for people with dementia be improved? Share your ideas and feed-back on this article on the CMM website. www.caremanagementmatters.co.uk 44
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Celebrating excellence Markel 3rd Sector Care Awards
Halas Homes won the Community Engagement Award at the 3rd Sector Care Awards in December 2018 for their commitment to supporting people with disabilities into employment. In health and social care, we are all working in unprecedented times – resources are scarce, but people’s individual requirements are high. As the saying goes, the whole is greater than the sum of its parts and we have found that by engaging with communities, thinking creatively and sharing ideas and opportunities, we have been able to change people’s lives.
COLLABORATING WITH THE COMMUNITY Over the past five years, our day services have grown extensively; we have gone from creating performing arts groups for people with learning disabilities, to those groups being booked to perform at local care homes and community shopping malls, Birmingham Symphony Hall and Town Hall. The groups are also booked to perform at educational events, including university events. The groups engage and perform with local schoolchildren and choirs 46
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and the reaction they receive is so positive. We get feedback from parents too, who are moved by their child’s ability to connect with audiences whilst performing. We also run a gardening club group, whose attendees have learnt new skills and are often in the local community planting, weeding and watering. After initially joining the local allotment association, we became involved with Halesowen in Bloom, helping to plant bulbs and install bird boxes in the local town for the Royal Horticultural contest. Over the last three years, this has developed considerably, and we now tend our own plot in front of one of the local churches. We regularly collaborate with a group of local primary school children, meeting to clear, plant and develop the area. People tell us they love seeing us in the town and we felt honoured to help the town gain a Gold Award in the Royal Horticultural contest this year. We have also developed small garden areas outside local community services, including the GP surgery, and have provided watering cans for people to use to encourage engagement. Recently, a local group within the community have taken over the ownership and running of an ex-council building and renamed it Hasbury Community Hub to develop for the local community. Our staff and the people who use our services are now a part of this project and the gardening group have planted trees and will be helping to develop a war memorial garden.
SUPPORTING EMPLOYMENT In 2011, we opened a social enterprise community coffee shop in a residential area to enable us to provide work-based opportunities for people with learning disabilities. There are three staff who support and develop the skills of people with learning disabilities at the coffee shop. By teaming together, our employment project staff have supported our coffee shop staff to develop catering and customer care skills and to gain a realistic approach to work. Early in 2017, we successfully obtained funding to run a three-year supported employment project to help adults with learning disabilities in the Halesowen area find and sustain employment.
Through networking with local organisations, the employment project promotes and celebrates the benefits of employing a diverse workforce where all skills are valued. Sean The project soon received a number of referrals and our staff began to work with these individuals to help them identify the type of work they would like to do, complete job applications/CVs, attend interviews and learn to travel independently. We are very proud to say that we currently support four young people who have been successful in obtaining permanent paid employment, one in an apprenticeship, two in voluntary work experience placements and several others who are just starting out on their journey into employment. One of the most resilient young people we work with is Sean who, after trying anything we threw his way, was finally rewarded with a much-deserved paid job at Sainsbury’s. We believe that the secret of our success (aside from the commitment, enthusiasm, hard work and determination of the wonderful young people referred to us) is that we are able to offer a very person-centred service which acknowledges the individuality and value of each job seeker and works closely, openly and flexibly with them, their families and employers. The provision of a job coach to support all parties through the induction period and beyond is vital to ensure that employment is not just obtained but is also sustained.
3RD SECTOR CARE AWARDS Winning the 3rd Sector Care Award was a much-appreciated recognition of the success of our job seekers and we hope will help to secure the continuation of our service. It’s not often you get to be amongst so many inspirational, empathetic, positive and creative-minded individuals in one room, which is exactly what happens at the 3rd Sector Care Awards. The event in December was full of upbeat people from fantastic and forwardthinking organisations who shared how they work and design innovative models of care. To learn that the hard work of all who work for Halas Homes had been recognised by winning the Community Engagement Award was such an incredible boost to us. Without the enthusiasm and flexibility of such a wonderful staff group who truly want to make a difference to people’s lives, we clearly would not be able to achieve this extent of community engagement and make such an impact on individuals’ lives.
LOOKING FORWARD As far as the future is concerned, we hope to be able to continue to support people with learning disabilities into work as it is universally known that without support it is difficult for people with learning disabilities to sustain employment. As the performing arts groups are increasingly sought after, the gardening club is growing and jobs are deservedly being offered and retained, it is inevitable that engagement will naturally increase. But most powerful of all is that, in turn, this creates greater awareness of what a valuable asset people with a learning disability are in their community. If the whole is greater than the sum of its parts, community engagement must be a positive and powerful force in improving everyone’s lives. CMM
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3RD SECTOR CARE AWARDS
Alison Sayer is Chief Executive Officer at Halas Homes. Email: alison.sayer@halashomes.co.uk Twitter: @HalasHomes
The Markel 3rd Sector Care Awards is run specifically for the voluntary care and support sector. Visit www. caremanagementmatters.co.uk/3rdsector-care-awards to see 2018’s winners and find out more about this year’s event. Sponsorship opportunities are available. With thanks to our supporters: National Care Forum, Learning Disability England, The Care Provider Alliance, Association of Mental Health Providers and VODG. This award was sponsored by
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EVENT REVIEW
WESTMINSTER HEALTH FORUM: Next steps for adult social care in England – funding, service redesign and policy 15th January 2019
Westminster Health Forum’s Keynote Seminar on the future of social care in England promised an interesting morning of discussion and updates from leaders in the sector. As delegates arrived in the Whitehall venue and took their seats, the Chair for the first session, Anne Marie Morris MP gave her opening remarks, welcoming attendees, addressing the issues we are facing in the sector, and inviting Ed Moses, Director for Care and Transformation at the Department of Health and Social Care (DHSC) to the stage. Ed’s presentation on the next steps for policy outlined key areas for improvement and development, exploring the three key areas of funding reform, system reform and baseline funding. He explained that, although these often get put together as one, it’s vital that they are taken as individual elements and examined on their own to ensure successful change.
COLLABORATION Touching on the publication of the NHS Long Term Plan, Ed noted that its aims to give people more choice and control should ultimately make it simpler for people to transition between health and social care services, with a more joined-up approach to the system. Continuing with the theme of collaboration, Niall Dickson, Chief Executive of the NHS Confederation then took to the floor. He reviewed the various reports, green papers and white papers social care has received over the last 20 years, suggesting a few for worthwhile reading and noting that radical social care reform, where it has been successful elsewhere, has taken time and effort to implement. Niall emphasised the need to deliver parity of esteem for the NHS and social care 48
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in order to raise the public profile of social care. He suggested that the NHS should take on this responsibility to ensure the public are informed of the differences between heath and social care – using its own influence and status to change the public’s opinion of the sector.
PANEL DISCUSSION Questions were then invited from the floor, with various delegates posing interesting topics for debate, before we moved on to a panel discussion on priorities for the green paper. The panel consisted of Professor Martin Green, Chief Executive of Care England; Michael Voges, Executive Director of Associated Retirement Community Operators; Professor David Grayson, Chair of Carers UK and Professor at Cranfield University; Professor John Howarth of University of Central Lancaster; and Aileen Murphy, Director for the Ministry of Housing, Communities and Local Government and Local Government Value for Money at the National Audit Office. Each panel member was given five minutes to highlight their three most sought-after inclusions in the forthcoming green paper. Questions were again taken from the floor with lively engagement and pertinent points of discussion, before the Chair gave her closing remarks and thanked the speakers for their insightful presentations.
SECOND SESSION After refreshments and an opportunity to discuss the morning’s presentations, delegates returned to the conference hall, where Dame Moira Gibb from Skills for Care welcomed them to the second part of the seminar. Attendees heard from Dr Ossie Stuart from
Social Care Institute for Excellence on how important it is to ensure providers can offer personalised and flexible care, drawing on his own experiences of receiving support to make valid suggestions and convey the clear need for this type of offering. John Ivers, Chief Operating Officer of CareTech then spoke on the possibilities of using technology in care settings to support people to live more independent lifestyles. He gave examples of how technology is making a difference in CareTech’s services before the room moved onto questions for both speakers. A short presentation from Martin Knapp from NIHR and London School of Economics and Political Science followed, covering the key issues for long-term funding of adult social care. Martin used recent research to demonstrate the appetite for different types of funding before handing over to David James, Head of Social Care Policy at the Care Quality Commission to discuss how we can improve standards. Sharon Allen from Skills for Care then provided delegates with an engaging and motivating presentation discussing recruitment. She advised that a key part of retaining staff is ensuring you develop them once they are in your organisation. Sharon also spoke of the need for clear and consistent guidance on what is expected of employers in terms of staff training.
CLEAR ACTION POINTS After another round of questions from the floor, Dame Moira gave her closing remarks, noting the amount of information gleaned from the series of short presentations. Delegates left the morning seminar with much to take away and a clear picture of the actions needed to improve the chances of social care reform in England. CMM
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drafting legislation. However, it has already accepted two recommendations: • Choice for people over which friend or relative has a role in decisions about their sectioning and care, replacing the current ‘nearest relative’ role with a ‘nominated person’. • Advance choice documents to enable people to set out their wishes about their future care and treatment under the Mental Health Act and to give these legal weight.
The year-long independent Review of the Mental Health Act was published in December. Here, Alison Cobb discusses the priorities.
The Mental Health Act dictates the circumstances under which someone might be detained in hospital for their mental health against their wishes. Although detentions under the Act are specific to hospital settings, many providers will be supporting people who may be affected. The Prime Minister commissioned the Review of the Mental Health Act to address problems with how the current Act is used; we are seeing rising detentions, racial disparity and concerns about dignity and human rights. The Review highlights the need to restore people’s dignity and proposes changes under four principles that would be in the Act itself, not just the Code of Practice. These are: choice and autonomy, the use of least restriction, therapeutic benefit, and the person as an individual. The Government has announced a new Mental Health Bill and says it will formally respond to the Review before
Other key changes are also proposed: Criteria for detention – The Review recommends that the Act should only apply to people who object to being admitted to hospital. People who lack capacity to agree to being admitted, but do not object to it, would be treated under the Mental Capacity Act. Before sectioning someone, the threshold for the severity of the situation would be increased to, ‘a substantial likelihood of significant harm to the health, safety or welfare of the person, or the safety of any other person, without treatment.’ There would need to be evidence of these risks, in keeping with the aim to have stronger, clearer reasons for detaining someone. Race equality – One of the main recommendations is to improve how local mental health services respond to the needs of their population’s ethnic and cultural backgrounds. Using an Organisational Competence Framework and Patient and Carer Experience Tool would help to make improvements and support organisations meet their duties under the Equality Act 2010. Other recommendations include culturally-appropriate advocates, enabling people to follow religious and spiritual practices while in hospital, and encouraging greater representation of African and Caribbean people in mental health professions. Care in hospital – The Review recommends improving people’s experience while they are detained. It suggests changes to social and physical environments; ending unjustified restrictions; and improving the way
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complaints are handled. It urges the Care Quality Commission to develop new criteria for monitoring the social environments of wards. Staffing levels would also need to be sufficient for daily one-to-ones with patients. As far as possible, shared decisionmaking and planning care collaboratively should be the basis for all care and treatment decisions made under the Act. Statutory care and treatment plans – A new, legally-required plan would be developed within days of a person being detained, setting out the aims of care and treatment and how the person’s wishes had influenced the plan. This would be developed during the person’s stay and would include planning for when they come out of hospital. It would also be scrutinised by a tribunal whenever it considered an appeal for discharge. Advocacy – All mental health inpatients, whether detained or in hospital voluntarily, would be entitled to an Independent Mental Health Advocate without having to ask for one. Second opinions – People who have been sectioned would be able get second opinions on their treatment earlier and make an appeal if they still disagreed with it. The Review also includes a proposed Statutory Care Plan for people in contact with mental health and/or social care services, changes to the frequency and powers of tribunals, and the need for more accessible and responsive services. There are also calls to restrict the use of community treatment orders (CTOs) which are meant to reduce the risk of readmission after leaving hospital but are both intrusive and ineffective. Mind wants to see more fundamental shifts in the law and the scrapping of CTOs altogether, but the Review’s recommendations have the potential to make vast improvements to people’s rights and experiences when in crisis. Mind is calling on Government to accept and implement the recommendations, and for concerted commitment and action to reduce racial inequalities in the use of the Act. CMM
Alison Cobb is a Specialist Policy Adviser at Mind. Email: media@mind.org.uk Twitter: @MindCharity 50
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