Care Management Matters February 2014

CMM CAREMANAGEMENTMATTERS

FEBRUARY 2014 £4.00

TO THE RESCUE

Can social care save the NHS?

Private pay extra care Will it take off in 2014?

Francis Report Impact of Government response on our sector

Who’s who…

Specialist solicitors

Includes 4-page Skills Academy insert: Focus on Leadership and Governance: developing leadership at Board level

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in this issue

IN THIS ISSUE regulars 05

editor s welcome

Is it just me...?

Editor in Chief, Robert Chamberlain reflects on the shortcomings of the funding reforms.

06

News

11

In Focus

12

Corporate News

14

Property News

16

Local Authority and Planning News

28

60 seconds with...

26

Business Clinic

22

Amanda Scott, Sunrise s new Managing Director.

Our panel considers rumours around the sale of HC-One and possible acquisition

by Four Seasons.

37 Who s Who...

features 18

Profiles of a number of solicitors specialising in social care.

44

18

Ben Hartley examines the private extra care market.

Conference preview

A preview of the upcoming CMM Insight ‒ The Future of Learning Disability Care conference.

45

What s On?

46

Straight Talk

Will the private extra care market take off in 2014?

Rhidian Hughes argues why we need to seize the opportunities in forthcoming legislation to build the workforce.

22

How can social care save the NHS?

Can social care save the NHS? Should it?

Does the NHS even need saving? CMM asks the questions.

25

A Plan for Life

29

What the Mid-Staffordshire scandal means for social care

CMM summarises FitzRoy s study into short-termism by local authorities when planning care for adults with learning disabilities.

Rachel Warren explains the impact on social care of Mid-Staffordshire Hospital s failings.

29

32

REACH: Support for living an ordinary life These fully revised standards are explored by Sally Warren.

Welcome to the first issue of CMM for 2014.

Traditionally a new year is seen as a fresh start and an opportunity to move forward with renewed vigour for what s to come. With that in mind, on page 18, Ben Hartley of Carterwood looks at what 2014 holds for the private pay extra care market.

Although it s a new year, there are still the same pressures on the system. Towards the end of 2013 there was much talk about pressure on the NHS and how integrated health and social care may be able to alleviate it. Considering that, we asked whether social care can save the NHS. Our three respondents gave very interesting and mixed responses. The feature starts on page 22.

In this month s Business Clinic we ve asked our panel what they think about a potential sale of HC-One. The rumour mill was connecting Four Seasons with the sale but is the sector ready for such a potentially huge operator so soon after the demise of Southern Cross? See the panel s thoughts on page 26.

Finally, if you specialise in learning disability care, you can t afford to miss our CMM Insight conference on 25th February in Manchester.

With confirmed speakers from the Care Quality Commission, Association of Directors of Adult Social Services, the author of the Winterbourne View Serious Case Review and many more it will be a very interesting day. Turn to page 44 for more information and details of how to book, plus a special offer for CMM readers.

Emma Morriss Editor

35 Professionalising older people s care - a career pathway for the workforce 35

Justine Cawley details the need for a professional career pathway in social care.

Follow CMM on Twitter @cmm_magazine

CMM FEBRUARY 2014 ÂŚ 3

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contributors

CMM CAREMANAGEMENTMATTERS February 2014

Editorial and Production editor@caremanagementmatters.co.uk Editor in chief: Robert Chamberlain Editor: Emma Morriss news Editor: Des Kelly design and Production: Lisa Werthmann, Jamie Harvey, Nick Cade & Holly Cornell Editorial assistant: Rebecca Northfield adVErtiSinG sales@caremanagementmatters.co.uk 01223 207770 advertisement Manager: Tracey Diplock tracey.diplock@carechoices.co.uk Business development Manager: Paul Leahy paul.leahy@carechoices.co.uk SuBScriPtionS info@caremanagementmatters.co.uk To request your free copy of CMM call 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 Š Care Choices Ltd 2014 iSBn: 978-1-909048-87-4 ccl rEF no: CMM 11

Publications

CMM magazine is officially part of the membership entitlement of:

editorial panel Des Kelly OBE,

Mike Padgham,

Executive Director, National Care Forum

Chair, UKHCA

Professor Martin Green OBE,

David L Jones,

Chief Executive, Care England

Partner, Deloitte

Andrew Sidwell,

Paul Ridout,

Partner, GVA

Partner, Ridouts LLP

Andrew Barnsley,

Zoe Farrell,

Managing Partner, Nexus Corporate Finance LLP

Training Development Director, Catalyst for Care

contributors Alison Taylor, Specialist Business Appraiser, DC Care Amanda Scott, Managing Director, Sunrise Senior Living Ben Hartley, Director, Carterwood Justine Cawley, Director of Business Development Elizabeth Care, 360 Forward.

Mark D Ellis ACIB, Head Of Property and Social Care Banking Services, Lloyds Bank Commercial Banking Paul Saper, Managing Director, LCS International Consulting Ltd Rachel Warren, Solicitor and Senior Associate, Charles Russell LLP Rhidian Hughes, Visiting Professor, Buckinghamshire New University Sally Warren, Managing Director, Paradigm

ABC certified (Jan 2012 - Dec 2012) Total average net circulation per issue 16,302

Sandie Keene, President, Association of Directors of Adult Social Services Steve Hughes, Chief Executive, Lilian Faithfull Homes

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is it just me...?

Is it just me...?

Editor in Chief, Robert Chamberlain, reflects on the shortcomings of the Government’s social care funding reforms and welcomes Norman Lamb’s acknowledgement that more needs to be done.

The Care Bill received its second reading shortly before the Christmas break and is currently at Committee Stage in the House of Commons as we go to press. The incorporated social care funding reforms, although welcomed as a step in the right direction, have sparked concerns from sector institutions and providers alike.

Practicalities Among the list of concerns is the ability of local authorities to identify, assess and track the progress of self-funders towards the care ‘cap’ through ‘care accounts’ amid budget cuts and workforce reductions.

Even if adequate Government funding is provided to councils, which is questionable, the tasks they face are seismic and the timeframes set may well be unrealistic.

The new legal duty on councils to actively prevent ill health, being introduced in the Bill, will also add to the pressure on council resources.

UnderfUnding

surrounding the reforms addressing the misconceptions very clearly. You can find the document at www.ageuk.org.uk.

On my list of concerns is the fact that the current underfunding of care fees paid by councils is being ignored. With a significant increase in those eligible to receive funding, I worry that this situation may deteriorate further.

LaingBuisson’s latest edition of Fair Price for Care claims that ‘average council fees remain between £31 and £130 per week below the minimum level that the Fair Price model calculates is necessary to offer operators a reasonable return. As a result, most care homes depend for their commercial viability on private payers who heavily subsidise publicly-paid residents’.

If this situation goes unaddressed, the increase in local authority purchasing will present a further headache to care providers who rely on the income from self-funders to make ends meet.

needs assessment

The Care Bill proposes to bring an end to The increase in the upper financial the ‘postcode lottery’ of eligibility criteria threshold to qualify for local authority with the introduction of a standardised support from £23,250 to £118,000 will assessment of whether an individual’s result in an estimated 100,000 additional needs qualify them for support. Currently, older people qualifying for funding. This eligibility varies from council to council change, along with the notion of a ‘cap’ with the majority providing support on care costs, will be welcome news to for ‘substantial’ or ‘critical’ needs only. the general public, although my guess There are fears that the new ‘bar’ will is few understand the full implications. be set too high, potentially resulting in Banner 1 07/10/2013 16:09 Page 2 over 130,000 people currently receiving Age UKad_Layout has dispelled a list of ‘myths’

council-funded support being left to fend for themselves. The obvious question is whether a lowering of the threshold, as recommended by the Dilnot Commission, could be afforded in the current climate.

In an interview with The Telegraph (8 January 2014) Norman Lamb acknowledged this concern and stated that new plans were being considered to provide ‘some state-funding’ for those assessed as not being ‘sick enough’ to qualify under the new system.

Mr Lamb recognised that the funding reforms ‘do not go far enough and risk leaving thousands of vulnerable elderly and disabled people without the help they need’. Further changes are planned to address this issue and Department of Health officials have been given the task of devising a ‘more sophisticated’ approach. He went on record to say ‘I don’t ultimately want a system which says you are not sick enough go away and get sicker and then we might help you.’

fUtUre Unclear On the one hand the reforms may increase the numbers receiving state-funded care while on the other, eligibility of needs may be set so high that it reduces this figure by a similar amount. Whatever the outcome, without sufficient financial backing the system will continue to creak. if you would like to comment please email robert.chamberlain@caremanagementmatters.co.uk

We buy and sell care businesses and land.

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Dedicated to the healthcare sector – dedicated to you.

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Appointments Appointments pete CAlveley Former Chief Executive of Four Seasons Healthcare, Pete Calveley, has been appointed Chief Executive of Barchester Healthcare. He will take up his role in mid-2014.

Pete will take over from Willie MacDiarmid who is currently acting as interim Chief Executive Officer.

DouglAs Quinn Douglas Quinn (former Chief Executive of Voyage) has been appointed Chairman of the rebranded Baywater Healthcare, a management buyout of Air Products UK homecare division. osJCt ChAirmAn AppointeD Don Wood has been appointed Chairman of The Orders of St John Care Trust (OSJCT). His term of office is for six years. new Ceo for mhA Adrian Bagg has been appointed Chief Executive of MHA. He joins MHA from his role at Papworth Trust in March.

CAre uK Appoints DementiA expert Dr Nori Graham, Vice President and former Chairman of the Alzheimer’s Society of England and Alzheimer’s Disease International, has become a non-executive director of Care UK. new mAnAging DireCtor At sunrise Amanda Scott has been promoted to Managing Director of Sunrise Senior Living.

Read our 60 Seconds with Amanda on page 25. hAnover’s new Chief exeCutive Dame Clare Tickell DBE has taken up her new post as Chief Executive of Hanover Housing Association.

News

• Corporate • Local authority • Planning News editor - Des Kelly CQC State of Social Care The CQC published its State of Social Care report late in 2013. Findings from more than 35,000 inspections underpin the fourth annual State of Care report, which considers how care is delivered in hospitals, care homes, dental surgeries and in the community.

Key findings included: • More than half a million people aged 65 and over were admitted as an emergency to hospital with ‘avoidable’ conditions in the last year – including almost one in ten aged 75 and over (396,000 people).

• People with dementia continue to have poorer outcomes in hospital.

• Although CQC has seen some improvements in care across sectors, where inspectors find poor care it is serious and having a disproportionately large impact on people’s health and wellbeing.

• One in five inspections at nursing homes revealed safety concerns such as failing to give out medicines safely or not carrying out risk assessments when starting to care for someone, and ongoing staffing pressures.

• There is a link between high staff turnover in residential homes and numbers of death notifications, which may suggest that too much staff

churn results in gaps in care.

• More than 10 of inspections of residential homes uncovered problems with either safeguarding and safety, staffing, or the care and support received by residents – for example, people not being helped to eat and drink enough.

• More than 10% of home care agencies did not meet standards in staffing or monitoring quality.

• Common quality issues at home care agencies include late or missed calls.

The full report can be read at www.cqc.org.uk

CQC to review dementia care The Care Quality Commission (CQC) is to carry out focused inspections of some 150 care homes and acute hospitals to review how people with dementia are cared for in england. CQC will explore the care and support that these services provide for people with dementia and in doing so,

draw common themes on what works well and what needs to improve on a national level. specifically, the inspections will focus on how people living with dementia are supported to maintain their physical and mental wellbeing; how effective care can reduce admissions to hospital from care homes and

avoid unnecessarily lengthy stays, and; how care services can work together when there is a need for people to move between services.

All of CQC’s inspections will be unannounced. For every service inspected, CQC will publish a report, as well as a national report in May.

Better commissioning of LD services Leadership, reduced bureaucracy and sharing risk are among the key ingredients to successful commissioning, according to a new report.

The challenges and potential solutions to productive strategic commissioning are explored in a publication issued jointly by the Association of Directors of Adult social

services (ADAss) and the Care Provider Alliance.

Finding Common Purpose, developing strategic commissioning relationships to support people with learning disabilities, is based on a recent workshop held by the two organisations.

It is an important insight into issues either side of

the commissioning fence.

The report argues for an approach to commissioning which safeguards the best of current approaches and avoids the ‘short-term, adversarial relationships that can harm valuable services – and the people who depend on them’.

ADAss will be presenting this at CMM Insight, see page 44.

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New website for care seekers Impact of short-term to. The fully-searchable site also A new website for care seekers planning has links to useful editorial and has been launched by Care Choices. The fully searchable website can be accessed on all devices from smart phones to tablets and desktop, meaning people can search for care in any part of the country wherever they are, whenever they need

care services Directories for more than 30 regions, direct care standards information from CQC including links to inspection reports plus a brochure request facility. www.carechoices.co.uk

Respect and Protect report Respect and Protect, a new report funded by Comic Relief and the Department of Health (DH) has been published. It draws together the findings of a major programme of research looking at the experiences of older people in care homes and hospitals in England and Wales.

Comic Relief first brought the mistreatment of older people to public attention in 2005 with the TV drama Dad, watched by over 5 million people. Following this, Comic Relief partnered with the DH to study the prevalence of abuse and mistreatment of older people. The new research recommends practical steps which can be taken to help prevent the mistreatment of residents and patients as well

as staff. Creating a culture of care and respect is central to preventing the mistreatment of older people in care homes and hospitals.

Care homes and hospitals must support and value their staff, as well as the people they care for. This involves a range of different approaches that listen to the voices of the people being cared for and has their wellbeing at the centre of the care planning process.

Comic Relief also announced the launch of a £100,000 challenge fund to help develop some of the ideas further with the promise of further funding to implement the best ideas.

The report can be read here www.panicoa.org.uk.

TLAP to launch Quality Forum The Think Local Act Personal (TLAP) partnership is to launch a Quality Forum. It has three initial priorities.

1. It will map national quality initiatives in adult care, setting out who does what. Linked with help for individuals to navigate unregulated care services.

2. Shape the sector’s response to the Francis Inquiry to: • review local quality assurance and improvement

models, • influence the work of the Department of Health Quality Board, • advise on other’s priorities, e.g. influence DH funding and work programme, • develop a common purpose across health and social care.

3. Influence quality aspects of the Department of Health’s care reform and CQC’s development of quality ratings.

Local authorities are being forced to make short-term decisions for adults with learning disabilities – often deciding social care packages based on a one-year ahead view of their lives – according to A Plan for Life, a new study amongst senior local authority decision-makers by learning disability charity, FitzRoy. The report also reveals that

local authorities are ill-prepared for the wellbeing provisions in the draft Care and Support Bill.

FitzRoy is calling on the Government to publish Guidelines alongside the Act to help local authorities understand and measure wellbeing, and to ensure its consistent application. More information can be found on page 28.

Government response to the Francis Report The Government plans to make the NHS more open, accountable and focused on safety and compassion. Hard Truths: The Journey to Putting Patients First sets out the Government’s response to the 290 recommendations made

by Robert Francis, following the public inquiry in to the failings at Mid-Staffordshire NHS Foundation Trust. This follows the Government’s initial response, which included the introduction of a new hospital inspection regime and legislation for a duty of candour on NHS organisations so they have to be open with families and patients when things go wrong.

Amongst the actions on safety and openness are proposals for a transparent, monthly reporting of ward-by-ward staffing levels and other safety measures;

quarterly reporting of complaints data and lessons learned by trusts along with better reporting of safety incidents; a statutory duty of candour on providers and professional duty of candour on individuals, through changes to professional codes.

Other actions include a new criminal offence for wilful neglect, with an intention to legislate so that those responsible for the worst failures in care are held accountable; a new fit and proper person test to act as a barring scheme for senior managers; and a new care certificate to ensure that healthcare assistants and social care support workers have the right fundamental training and skills.

For information on how the response may impact on your business, see page 29.

Care England Care England has officially launched. This sees a merger between leading care associations, the English Community Care Association and the National Care Association. Care England

will work on behalf of small, medium and large providers and speaks with a single unified voice for both members and the whole care sector. www.careengland.org.uk

Care is all we do. www.castleoak.co.uk

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news

Skills for Care’s Accolades finalists Skills for Care has announced its finalists for the 2013/14 Accolades.

Best employer of under 250 staff • Nina Clegg for Half Acre House, • Amber Trust, • Cherish Care for You and Your Home Ltd.

Best provider of learning and development • DH Associates Ltd, • St Lukes Hospice, Plymouth, • Tyne and Wear Care Alliance.

Best employer of over 250 staff • Cornwall Care, • Choices Housing Association, • Local Solutions.

Best employer support for Apprenticeships • Hertfordshire County Council -Workforce Development Team, • Oxfordshire County Council - Health and Social Care Apprenticeship Scheme, • St Mungo’s.

Best individual employer who employs their own staff • Mr Edwin Dalby, • Lisa Arger, • Mark Chipperfield ‘on behalf of Jean Team’, • Vale Longmore.

Best employer support for Assessed and Supported Year in Employment • Southampton, Hampshire, Isle of Wight, Portsmouth (SHIP) Social Work Education Network (SWEN),

• Creative Support Ltd, • Hertfordshire County Council – Workforce Development Team.

Best recruitments initiatives • Extracare Charitable Trust, • Greensleeves Homes Trust – Mount Ephraim House, • The Westminster Society for people with learning disabilities.

Most effective new approach to service delivery • Making Space dementia Services, • The Abbeyfield Society, Browns Field House, • MacIntyre.

The winners will be announced at a gala event on 27th March in Birmingham.

New housing and support standards To celebrate 20 years of work in helping the care and support sector to develop and provide excellent services, Centre for Housing and Support (CHS) has relaunched its Service Excellence Standards, updating and rebranding its Code of Practice. The Service

Excellence Standards changes the emphasis from evaluating the quality of the inputs used in service delivery to assessing the quality of the service by its impact or outcomes on its customers. The outcomes were developed out of the research and in response to the specific

requirements of legislation and regulation in both support and social care. CHS undertook wide scale consultation on the Standards across provider, regulator and commissioner groups.

For more information visit www.chs.ac.uk.

Care homes survey HPC is conducting a survey of thousands of care home owners across the UK to invite them to make their views known on the key issues affecting the sector, including fees, inspections, quality ratings and banks.

There are 21 multiple choice questions which will take only a few minutes to complete and also the opportunity for owners to expand on any points raised in their own words if they wish to. HPC will be publishing the

key results of the survey in the specialist and national press and will also send a copy of the full report to any contributor who requests one. www.healthcarepc.co.uk/ survey

New Reach Standards for living an ordinary life Reach: Support for Living an ordinary life has been launched by the Housing and Support Alliance in partnership with Paradigm. Support for Living is about getting the support (paid and unpaid) you need to live the life you want.

First launched by Paradigm in 2002, it was originally developed to ensure that there were clear standards for supported living.

Read about the Reach Standards in more detail on page 33.

Violence against care staff A new report from Skills for Care explores research into the extent of the problem of violence against staff working in the care sector.

Three key issues were examined, the trends and current prevalence of violence against social care and support staff; guidance and monitoring procedures employers are using to record violence incidents, and what the sector can learn from the NHS in response to violence against staff.

It can be downloaded from www.skillsforcare.org.uk.

ADASS issues advice on commissioning home care In response to increasing attention on the quality of home care, the Association of Directors of Adult Social Services (ADASS) has produced a Top Tips for Directors Commissioning and Arranging Home Care Services paper on commissioning and arranging home care services.

The top tips include: Assure yourself people who use services are at the heart of all activities; Consider political engagement and domiciliary care; Assure yourself care management processes are robust; Assure yourself of the contracting process, employment terms and

conditions and the status of the domiciliary business in your area.

In addition, Norman Lamb MP, the Care Services Minister, has announced that he has asked the Care Quality Commission (CQC) to consider the impact of commissioning practices when CQC inspect home care

providers from April 2014.

With the assistance of some funding from the Department of Health, ADASS are in the process of developing a framework for improved commissioning and are anticipating that this will be available in the spring. www.adass.org.uk

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in focus / corporate news

In Focus: Red Tape Challenge removes unnecessary regulation What’s the story?

Over two-thirds of regulations on healthy living and social care have been scrapped or improved as part of a plan to reduce ‘red tape’. A review by the Department of Health found that 128 of the 555 regulations covering public health, quality of care, mental health, NHS and professional standards were not necessary. It also found that another 252 could be improved.

What Was done?

The review was carried out as part of the Government’s Red Tape Challenge, which looked at regulations across Whitehall, with the aim of removing them unless there was a very good case for them to remain.

Dame Denise Platt represented care providers (on behalf of the Care Provider Alliance) and acted as the social care sector ‘Red Tape Champion’.

Between November 2012 and January 2013, the 555 healthy living and social care regulations underwent public consultation through the Red Tape Challenge website and comments were received from a wide variety of organisations and individuals on a number of areas of Department of Health regulation. These were examined to decide which suggestions could be taken forward.

What Was proposed?

Following the review, the Department of Health will take forward proposals including: • simplifying a large number of professional standards regulations, • working with the Department for Communities and Local Government to reduce duplication of care home inspections by the Care Quality Commission and local authorities, • reviewing the Deprivation of Liberty forms used by hospitals and care homes where authorisation is required to deprive a person of their liberty when they lack the mental capacity to consent to treatment or care, in response to comments received about their number and complexity.

What happens next?

Many of the Department of Health’s regulations are considered essential to make sure patients/service users and the public are properly protected, and that high standards are maintained The Department of Health has, however, looked at where regulatory reform is appropriate and should be made to reduce unnecessary burdens.

Where can i read more?

A full list of the regulations to be scrapped or improved is set out in the review document Proposals for the regulations in the Healthy Living and Social Care Red Tape Challenge theme. It is available on the Red Tape Challenge website www.redtapechallenge.cabinetoffice.gov.uk.

August Equity completes investment and closes fund August Equity LLP has completed a further investment from in its fund, August Equity Partners III. The investment comprises the acquisition of Essex based The Old Deanery Care Village, which has two care homes, The Old Deanery and St. Mary’s Court, on its 10 acre site.

The Old Deanery is a 93 bed home and focuses on residential care for older people with dementia and physical

disabilities. St. Mary’s is a 90-bed home with a focus on more specialised care services including young onset dementia.

The care homes offer high standards of care for residents, have a strong positions in the local market and a significant focus on private pay service users.

The fund has now closed having reached its hard cap of £200 million.

Voyage acquires Ingleby Care to strengthen Midlands’ presence Voyage Care, the UK’s largest provider of support for people with learning disabilities, has further accelerated its strategic growth plans with the acquisition of Warwickshirebased specialist care provider Ingleby Care.

Offering a mixture of residential, supported living and domiciliary services, Ingleby Care provides high quality support to adults with learning disabilities and additional complex needs, as

well as home-based care for over 65s.

The acquisition, which strengthens Voyage Care’s existing presence in the Midlands, was funded using existing cash resources.

Hazlewoods Corporate Finance led by Corporate Finance Partner David Main, assisted by Corporate Finance Manager Richard Pitt advised on the acquisition. Legal services were provided by Harrison Clark Rickerbys.

Hallmark opens care home in Brighton Hallmark Care Homes recently opened a new care home in Brighton.

Maycroft Manor is a 99bed home designed around the group’s ‘relationshipcentred’ care and dementia strategies. Facilities include the ‘Corner Shop’ and the various ‘Residents’ Laundry’ rooms, a cinema and therapy room.

Plus two large cafés, numerous lounges and dining rooms.

The specialist dementia environment has its own café, hair salon and laundry

room. Memory-prompting design features are arranged throughout.

Outside space is easily accessible; with outdoor terraces on each floor plus a spacious rooftop garden complete with raised planters and greenhouse.

The home has also achieved a BREAM excellent rating for its outstanding environmental credentials.

Maycroft Manor is Hallmark’s 18th home. It intends to open homes in Surrey and Warwickshire in 2014. cmm february 2014 | 11

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corporate news

Fremantle Trust opens Fremantle Court The Fremantle Trust’s new state-of-the-art, flagship care home, Fremantle Court, is due to open. Fremantle Court, on Risborough Road, Stoke Mandeville, Aylesbury, is an innovatively designed 90-place

care home, being built by Castleoak Care Partnership, a renowned care home building specialist. The home will provide general residential care, in addition to nursing and specialist dementia care.

Avante opens Puddingstone Grange Avante Care and Support has opened Puddingstone Grange in Greenwich. It will offer dementia specialist care and support for the frail and elderly requiring dementia care or dementia care with nursing.

The new care centre has been designed around a central core area, aimed at making the whole living environment more communal

and inclusive; whilst still maintaining privacy, dignity and independence to further stimulate and retain the life skills of the residents.

Within the home are 62 en-suite bedrooms, with each with a 24-hour carer call system, walk-in chair assisted shower room, a relaxation therapy room, hair and beauty salon and landscaped gardens.

GB Building Solutions’ contract with Care UK GB Building Solutions is to build an 80-bed care home for Care UK, in the grounds of Abney Hall Park in Cheadle, Cheshire.

The £5million contract is the second care home project awarded to GB Building Solutions by Care UK. The development site is located within the walled gardens of the grade 2 listed Abney Hall and involves the

demolition of an existing office block and the construction of an attractive contemporary building, specifically designed for the care of older people.

The building will provide 80 en-suite bedrooms with communal areas and additional facilities to include: a ground floor ‘village walk’, cinema, hairdresser, spa, library, internet study, café and restaurant.

Sanctuary Care secures services in Cornwall Sanctuary Care has announced the transfer of care services at St Mary’s Haven Care Home, a residential care home in Penzance, Cornwall.

This agreement will see the organisation take responsibility

for the delivery of care and support to residents in the care home.

St Mary’s Haven is a purpose-built home providing residential and respite care to the elderly.

The Social Care Commitment www.thesocialcarecommitment.org.uk The sector’s promise to provide people who need care and support with high quality services.

Signing up to the commitment is easy to do and can be done by employers and employees in working in care.

It proves your commitment and dedication to improving care and support and promotes your organisation publicly, as a provider of quality services. @carecommitment #qualitypeoplequalitycare

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corporate news

Oak Retirement and Markey Markey Group has started work on a £15 million retirement apartment complex in Cheltenham. Known as Honeybourne Gate, the luxury scheme is being developed by Gloucester-based Markey with the backing of private investment company Parallel Capital. It will be managed by Oak Retirement.

Gloucestershire Local enterprise Partnership, GFirst LeP is supporting

this prestigious development by providing a loan funding award from the Gloucestershire Infrastructure Investment Fund (GIIF). The scheme will consist of 54 one- and two-bedroom apartments as well as a range of communal facilities. Residents will also be able to access ‘extra care’ services including on-site emergency support at any time, domestic help and assistance with personal care.

Royal star & Garter Home opens in surbiton The Royal star & Garter Homes welcomed the President of the Charity, Her Royal Highness Princess Alexandra, to the official opening of its new, state-of-theart home in surbiton, surrey. surbiton is the second home to be built as part of the Charity’s modernisation plan, with

63 specially equipped en-suite rooms. Of these, 26 form a specialist dementia unit, named after Tom Lister, one of the founders of The Royal British Legion, in recognition of its generous donation of £2.05 million in support of the dementia care wing.

Community Integrated Care rebrands to CIC Group Community Integrated Care has rebranded moving from representing itself as ‘CIC Group’, to return to its full name of Community Integrated Care.

Community Integrated Care is one of the UK’s largest charities and in 2013 celebrated its 25th anniversary. It supports almost 3,000 people across england and scotland, who have learning disabilities, mental health

concerns, autism and agerelated needs such as dementia.

It employs over 5,000 staff and in 2012 had a turnover of £93 million. The rebrand follows the charity’s new five year strategy. The change in branding aims to give the charity a more distinct and recognisable visual identity, as well as showcase the ambitious nature of the organisation.

Four seasons eyes HC-One It has been reported that Four seasons Health Care is among the bidders for the company created from the collapse of southern Cross. Four seasons is apparently planning a firstround bid for the business, made up of units of HC-One and NHP. HC-One was formed as a management company

to run homes managed by southern Cross.The business is a partnership between NHP, which owns the freeholds and leaseholds of the properties, and Court Cavendish. NHP is also up for sale as part of this deal, but it is controlled by its bondholders, which could complicate the sale.

For more see page 26.

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property news

PrimeLife sale and leaseback deal Knight Frank has announced the sale and leaseback of 10 care homes on behalf of PrimeLife Limited.

The portfolio of care homes, predominantly located in the East Midlands, comprised a total 511 care beds in eight future-proof purpose-built facilities and two older homes which may suit long term redevelopment.

Established in 1982, PrimeLife Ltd is a family business which has grown substantially to now operate

approximately 60 care facilities providing circa 1,800 care beds. It is now the UK’s 27th largest care provider and 11th largest provider of mental health and learning disability care in a residential setting.

The portfolio was acquired by 90 North, an independent investment advisory firm.

This is the investor’s first venture into the healthcare sector and shows the increasing appetite for alternative sector investments from a wide range of purchasers.

DC Care sells three former Southern Cross homes DC Care has recently sold three care facilities. Broome End Care Home, in Essex, Haunton Hall in Staffordshire and Revelstoke Lodge in Devon are all former Southern Cross care homes.

Tim Perkin, of CBRE, was appointed Joint Fixed Charge Receiver and a management company was instructed to oversee the day to day operations at the care homes until new buyers were found.

DC Care marketed the care homes individually rather than as a group, given the very

individual style of buildings and the diverse geographical locations.

NatWest/RBS storm fund NatWest and RBS have launched a £250 million UK Storm Business Fund to provide shortterm, interest-free financing to speed recovery for businesses affected by recent floods and gales. Loans can cover the cost

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property news

RBs funds expansion Construction work to extend one of Flintshire’s leading care homes has started with support of a development loan from The Royal Bank of scotland (RBs). Based in Bagilt, Flintshire, Pen y Bryn eMI Care Home currently provides accommodation and specialist dementia care for 16 individuals, but with funding secured from RBs, under the banks’ Government backed

Funding for Lending Scheme (FLS), work to extend the facility to 30 bedroom capacity can now commence.

The new extension will go some way to help solve the problem of a lack of dementia care facilities in the region. The plans will see the creation of 18 high quality rooms. All of the new rooms will be minimum 14m2 in size plus en-suite wet rooms.

Castleoak pushes ahead seven care homes for Care UK seven of the ten new care homes in Care UK’s £45 million suffolk re-provisioning programme are now on site with Castleoak. The programme will replace suffolk County Council’s former care homes and wellbeing centres by 2016. The first two care homes to get underway, Asterbury

Place in Ipswich and Mildenhall Lodge in Mildenhall, have recently celebrated with topping out ceremonies.

Both are due to open in the summer. Castleoak identified and purchased two of the care home sites and is providing extensive planning consultancy on all ten.

expansion at Inwood House work has commenced at Inwood House Care Home in Horbury, wakefield to construct a 20-bed extension and refurbishment of the existing home. The home has been owned and run by husband and wife team Richard and wendy Barraclough since 1983 and currently is home to 35 clients. Funding to support the development work has been

provided by The Royal Bank of scotland (RBs).

Inwood House has earned a reputation over 30 years for providing quality care for the elderly, elderly who may have dementia and elderly who may have other physical disabilities.

It is a family run business and the only home that Richard and wendy own.

suffolk care home acquired After 19 years of ownership, Hector and Mary Jackson have sold their suffolk care home in order to retire. Manor Farm Care Home in Kessingland, near to Lowestoft, has built up an enviable reputation under the ownership of the Jacksons and now forms the platform for the new owners – London based care group KRG Care Homes – who plan to expand further into the eastern region.

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on as before, caring for 25 elderly residents in the comfort of this manor house building, which stands in grounds of some two acres.

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local authority & planning news

Springfield Healthcare opens Leeds care village Springfield Healthcare Group, one of the largest independent providers of domiciliary care in Yorkshire and Humberside, has opened a new £5 million care village in Leeds.

Creating one hundred jobs, it is currently the only healthcare project in the country to attract finance from BGF (Business Growth Fund), the independent company established to provide growth capital to the UK’s growing businesses. The £1.9

million investment in the Grange forms part of BGF’s overall £4.4m investment in Seacroft Grange owners, Springfield Healthcare Group and recognises both the company’s potential for growth, as well as its quality as a well-managed business.

The opening follows a five and a half year project to transform a dilapidated historic Grade 2 listed building overlooking an ancient village green into an

innovative new care complex for a wide range of age groups, with the aim of being at the heart of the local community and meeting new standards of care.

Seacroft Grange Care Village has been designed to adapt to a person’s changing care needs and will offer a full range of services including aspirational day care, residential and nursing care, as well as private independent living apartments for a wide range of age groups.

Sanctuary Care’s Derby extra care A new scheme by Sanctuary Care has been officially opened by the Mayor of Derby Councillor Fareed Hussain. It has 98 one and two

bedroom apartments, an onsite restaurant, coffee bar, lounge, health suite and cinema room.

It has been designed for rent or buy through shared ownership.

The scheme is being run by Sanctuary Care and offers a 24-hour on-site care team as well as a 24-hour emergency response service.

New extra care in Stoke-on-Trent The Eric Wright Group has been appointed to build 390 extra care apartments in the biggest scheme of its kind in Stokeon-Trent. Stoke-on-Trent City Council has named Sapphire - a consortium of construction, housing, facilities management, property development and architect professionals - to build the apartments over the next three years.

The villages will be created

at three sites across the city and will be fully-occupied by 2017.

The site are Holdcroft Fields, Abbey Hulton, the former Brookwood Home and Blurton Farm Depot, Blurton, and the former Westcliffe Hospital, Chell.

Sapphire has been selected to deliver the villages based on a Private Finance Initiative (PFI) procurement process which started in November 2011

with the issue of the Official Journal of the European Union notice. Sapphire was one of four bidders to be shortlisted in March 2012. Sapphire will build, finance and operate the retirement villages over a 25year period in partnership with the Council. The consortium comprises Eric Wright Group, Your Housing Group, Kajima Partnerships Limited and Seddon Construction.

Choice Care Group in Hampshire Specialist care provider Choice Care Group is expanding its services in Hampshire by opening a new care home in Tadley. The property, Red Roofs, is currently under

development and on course to open its doors in April 2014.

It will be situated next door to another Choice property, Fairview.

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residential care for six people with learning disabilities, autism and complex behavioural needs, with a further two selfcontained annexes also being built at the site.

Doncaster selects Care UK Care UK has taken over responsibility for a learning disability service commissioned

by Doncaster Council which supports over 130 people. The service supports adults living in more than 40 houses across Doncaster. The contract is initially for three years with an option for a further two years.

Approval in Mid-Suffolk Mid-Suffolk District Council has approved Care UK’s proposals for a 60-bed care home in Eye. It will be developed by Castleoak and work is due to commence in April with opening scheduled for spring 2015.

Ideal in Blackburn Ideal Care Homes has submitted plans to build a 64 bed care home on the site of the former Blackburn Royal Infirmary.

Littleport home expansion Plans have been submitted to add 20 bedrooms to the Old Vicarage Residential Home in Littleport.

East Cambridgeshire District Council is expected to make a decision in the coming month.

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Will the private extra care market take off in 2014?

Ben Hartley looks at the prospects for the private extra care sector over the coming year.

People are living longer lives, but how can they have a good quality of life well into old age? One part of the answer to that question centres on the provision of housing and care choices that are appropriate to the wishes and needs of those people as they get older.

Demographic projections predict that the scale of social care need will be so great in 25 years time that plans to meet it must inevitably involve a radical shift in the way adult social care is delivered in the UK. Whilst there is still a need for the traditional institutional model of care provision, it no longer dominates thinking in the way it once did. Additionally, contributing to this need for change has been the consistent voice of an ageing population that expressly wishes to stay independent for as long as possible. Becoming elderly does not remove the need for social inclusion and engagement in society.

Private extra care housing Partly servicing this desire has been the growth of private ‘extra care’ housing models, offering property for sale or market rent.

This is not to be confused with social rented extra care housing; the market for which is subject to different dynamics and demand/supply characteristics. The private extra care market is currently in its infancy in the UK, which is surprising when you consider the key underlying drivers of ‘demand’ for the product.

• An ageing demographic.

• The underlying strength of the housing market in the UK (although admittedly cyclical), particularly in the South East and London.

• The British obsession with home ownership. This shows no sign of stopping as people reach 65, although there is

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generally a downsizing decision from the larger family home to be made at some stage.

• There is a massive shortage of extra care (or assisted living as its usually referred to in other countries) units compared to other English-speaking first world nations such as Australia, New Zealand and the USA, where the supply of extra care assisted living housing is many times as great as that of the UK. As an example, within the M25 there are fewer than 10 existing private extra care developments, which is staggering given the size of the demographic that needs to be serviced.

•

•

Barriers to develoPment What’s the problem and why aren’t schemes popping up all over the place, in every town, to meet what would seem to be an almost ridiculously high level of latent demand? One issue may be product definition. There is currently no clear definition of extra care. It is often referred to as a concept rather than a type of housing and the term covers a range of different housing models.

This serves to confuse both the marketplace and those who might invest in it. Some sort of definition might help, but fundamentally central to the philosophy of extra care is that the housing element of the scheme is not registered by the CQC, with any care required by the residents being provided by a separately registered domiciliary care agency. Extra care schemes also provide a range of communal and ancillary facilities which underpin the additional services offered to purchasers. It is these that differentiate extra care from traditional sheltered housing.

But the lack of a clearly delineated product doesn’t explain the relatively slow growth for the sector compared to that overseas.

There are, of course, some exceptions to this. Consider the future sheltered housing pipeline.

• The following are quotes in the national press in respect of three major retirement housing developers who provide (predominately, although not exclusively) the more traditional sheltered housing product – ie predominately warden controlled with limited on-site communal facilities.

• ‘Churchill Retirement Living plots £500 million site expansion drive’ (August 2013).

• ‘Pegasus Life buys 11 sites for £500 million development’ (November 2013).

• ‘McCarthy & Stone chief outlines £1.5 billion development plans’ (June 2013).

• In excess of £2.5 billion of new private sheltered housing development, by these three developers alone, planned for the next few years. We must presume they have looked at key underlying demand drivers and thought ‘let’s build a lot more schemes’. Why isn’t everyone building private extra care in the same way? It might be useful to consider the following areas, which provide some understanding of the perceived risks and uncertainties.

• Extra care involves significant upfront capital investment due to the provision of communal services and facilities on site this increases funding pressure and upfront development costs.

• The ‘extra care’ premium achievable on schemes as a result of providing these additional communal services can be highly variable - from zero to upwards of 60+ per cent over traditional sheltered housing stock in top-end care villages.

Lack of direct comparables in the local market make it difficult for developers/agents/valuers to accurately price extra care

•

•

•

schemes without a much wider understanding of the product and the issues relating to both successful (and unsuccessful) schemes in other parts of the country.

Churchill and McCarthy & Stone are developers first and foremost – they are not operators and once the development has been completed a management company takes over. With extra care schemes, the provision of care and other services is often tied to the lease, and therefore the developer/operator divide is often blurred, which can put off prospective investors due to a perceived skill gap.

The target market (typically between 70 to 80 years, although this can vary significantly) is highly risk averse, and generally takes longer to make a buying decision, with the added complication of influence from family and friends as decisionmaker drivers. This factor has some significant implications, ie longer sales periods, which can then also transcend into a market perception that the scheme is struggling – even if the budgeted fill rate is on target.

High service charge costs act as a barrier to sale, and traditional estate agents struggle to market individual units effectively through not fully understanding the ‘lifestyle choice’ nature of some extra care models.

Service charges are necessarily high in order to provide 24-hour on-site care and support (to meet the extra care definition), as 24/7 staffing over 365 days a year has enormous cost implications. This, of course, is the raison d’être of traditional residential care facilities. These charges can be as much as £5,000 to £7,000 per annum compared to around £1,000 per annum for a traditional sheltered housing scheme, and may put people off – particularly when non-emergency care and support needs are then charged on top.

Banks are risk averse and funding is currently tough to come by. Extra care developments often fall into the ‘property development’ lending category, with a high risk profile, rather than ‘healthcare’, which is perceived as being a much lower risk for lenders.

Ways to mitigate risks Is the sector in the UK likely to stay the poor relation to its counterparts overseas? Well, I believe there are ways for companies to mitigate the risks and problems outlined above.

Developers might consider the following: • Limit the provision of communal facilities to generously proportioned but sensible levels and contain to ground floor only. The extra care purchaser will have already bought their own (often generously sized) apartment/cottage – why build three new communal lounges when one will, in all likelihood, be sufficient to satisfy usage demand?

• Carry out the necessary due diligence work in relation to pricing and sales rates in order to ensure that schemes are built in the right locations. Conducting robust market research is essential given the scale of capital investment involved in most schemes.

• Ensure both the ‘development’ and ‘operational’ skills base are covered – if necessary find an operations partner, or vice versa if a developer.

• Address the issue of a risk averse buying public head on.

Widespread marketing of the product benefits and its point of difference from other housing models is needed in order to

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will the private extra care market take off in 2014?

justify the price tag. Often extra care is a lifestyle choice rather than a need-driven decision, and this should be reflected in the selection of marketing style/approach. It is crucial that the ‘product value’ is clearly communicated.

• Develop in affluent locations, where a high service charge is not a huge barrier to buyers. If this is not possible then assess ways of minimising service charges by reducing the on-site offering or possibly outsourcing emergency out-of-hours cover.

• Funders will be more amenable through the provision of appropriate due diligence reporting, combined with strong site location and prudent sales rate assumptions.

Is the future brIght?

What, then, are the prospects for the sector in 2014? Mixed, would seem to be the answer. We have noticed some positive signs in that approximately 20 per cent of all our due diligence and market survey work over the past year has had some element of extra care, in the form of full care villages, standalone schemes or smaller close care-style developments. This, as a percentage of our work, has increased significantly over the past five years.

Conversely, it is our belief that the market will continue to be polarised and that significant growth in the private extra care market is unlikely. At the top end, we have been fortunate enough to advise a number of pioneering operators recently as part of their development programmes. Not-for-profit sector providers Anchor Trust, Brendoncare Foundation, Sanctuary Care and Extra Care Charitable Trust are actively developing new schemes, as well as private operators Retirement Villages, LifeCare Residences, Audley and English Care Village Partnership. Many of these will be flagship schemes for the next decade and set a high bar in terms of sector quality. However, we anticipate that the overall penetration of this end of the market will stay relatively small, and will be limited to select developments in mostly affluent areas.

One innovation that is worthy of mention is LifeCare Residencies Battersea Place development next to Battersea Park.

For central London this is a true ‘market-making’ scheme. We understand that reservations have been taken on over twothirds of the scheme. The project is not only different in terms of economics, but will be the only true high rise central London care village that we have seen in the UK. Given its initial apparent success, it may not be the last.

The private extra care market will continue to struggle with negative factors that, for some, will outweigh the positive benefits, and we see the leading edge companies ploughing a relatively lonely furrow for the foreseeable future. Retirement living developers such as McCarthy & Stone and Churchill will continue to offer a viable alternative to the ‘lifestyle choice’ care village model, albeit involving a different economic and facility model.

These operators, as we have commented above, are vigorously pursuing development opportunities and are likely to continue to do so.

Given the pace of development at the lower end of the market, it may be that some operators will refocus on producing a model to rival those successfully providing retirement living models; only time will tell. cmm ben hartley is Director of Carterwood. ben.hartley@carterwood.co.uk

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O

ur health and social care sectors are facing enormous pressures but with recurring issues in the NHS around unnecessary Accident and Emergency admissions, pressure on all services and struggles to get older people out of hospital once they’ve been admitted, people are starting to acknowledge that there is a role for social care in relieving some of this pressure. CMM posed the question ‘how can social care save the NHS?’and brings you three interesting responses.

The care secTor is already helping The nhs steve hughes chief executive lilian Faithfull homes The CQC’s State of Care Report is direct and to the point. ‘Must do better and quickly’ is the clear message. It is based on evidence and expert analysis and states what many social care professionals have known for years; far too many hospital admissions are avoidable and people with dementia continue to have poorer outcomes in hospital.

The care sector is already helping the NHS. The care sector’s ability has improved in response to changing needs at admission. Social care now has fantastic specialist dementia knowledge and as a result the quality of life for many people, often with co-morbidities and possibly a dementia, is far better today than even five years ago.

The question is not ‘How can social care save the NHS?’ but ‘What is the problem that we are trying to solve?’

For many of us in social care, it seems that the problems that we have been asked to solve are saving costs and freeing up bed space for an overwhelmed NHS. The result is a lack of mutuality and little change.

Take beds; every week we are asked to take people at very short notice; the notion that we might say ‘no’ because the person is unsuitable or because we cannot subsidise any more placements seems to come as a surprise. I believe that person-centred care starts with person-centred placement. We are placing individuals into their next home and building a community not counting down numbers on a spreadsheet.

As for costs; current dialogue with our local authority over a new structure for care fees suggests that the proposed reductions are all about saving money rather than joint working.

Social care can assist the NHS if the two work together with mutuality and respect. The NHS could listen to social care problems rather than only wanting to solve their own. Social care problems might be to avoid placements that don’t work and to play to strengths and specialisms which vary from home to home.

Progress might be as simple as the NHS listing their top twenty problems and asking local care organisations what they could do to help. Care organisations could then list the help they in turn need or articulate what stops them assisting the NHS. Our organisation could offer specialist training or reablement beds if the pricing structure was right and even an on-call dementia response team to people at home in an emergency if we believed the change in CQC registration was worth the investment and change to our service.

A local care home started to solve one problem to ‘reduce calls to emergency services’. However, their care team can’t always lift heavy people who fall so they purchased a specialist inflatable lifting chair for £2,000 and believe it will halve the calls to the ambulance team. How many more simple ideas could make a difference if only we made time to think and invested modest seed funds?

I’m optimistic, joint-working, local initiatives and mutuality wins.

g

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how can social care save the nhs? g cmm february 2014 | 23

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how can social care save the NHS?

NHS NEEDS REFORM, RETHINKING AND REDIRECTION

A STEP CHANGE IN PRODUCTIVITY IS NEEDED

Sandie Keene President Association of Directors of Adult Social Services

Paul Saper Managing Director LCS International Consulting Ltd

How can social care save the NHS? An intriguing question, and one which tempts more answers than discretion permits. But the simplest answer is, it can’t, because the NHS doesn’t need saving. Like all other public services in the face of acute financial pressures and cultural changes, it needs reform, rethinking and redirecting. But I don’t think anyone in the health services can be unaware that it is getting a fair measure of all three forms of attention, and has been for several years now.

In the run-up to Christmas last year there were great tidings of comfort and joy – the UK economy is on the turn, the level of Government borrowing is actually set to fall and the icing on the cake was Simon Stevens accepting the post of new CEO of NHS England from 1st April 2014. On 16th December, the House of Commons had its second reading of the Care and Support Bill, and the Government introduced clauses to implement the major findings of the Dilnot Commission Report from 2016/17.

Anyone, though, who believes, and works to, the maxim that social care services should be available to save health services is playing the wrong tune in the wrong orchestra with absolutely the wrong instrument! We are not dealing with services in distress: we are dealing with people in distress, and the challenge is not to save services, but to make them more fit for that purpose.

On the face of it, pretty exciting stuff, but there are some in Westminster who are more sceptical. When it comes to the NHS and social care budgets, both sides of the political divide seem to be in some sort of denial that a funding gap yawns on the other side of the 2015 election. Various think tanks give us a truer picture. Politicians like Dr Liam Fox and Vince Cable might well question whether it is realistic to protect services such as health from further rounds of cuts but the facts are that there will still be is a funding gap in health and social care budgets of £28 billion per annum in 2021/22, even if budgets increase in real terms 2.4% per annum in line with the Government’s GDP growth projections, rather than the 0.1% rise currently in their figures.

It is perfectly true that social care services have much to contribute to these changes in the NHS. We are all pivotally involved in the nonmedical care of a range of people both before and after their hospital stay. And, therefore, safe and carefully planned discharge arrangements for leaving hospital are vitally important in ensuring a smooth transition from institutional to community settings.

Equally, robust, safe and effective processes of ensuring that fewer people are unnecessarily admitted - both to hospital and residential/ nursing care - in the first place are equally in demand. This calls for more than just a re-galvanised adult social care system. It calls for proper, place-based co-ordination of the full range of local authority and NHS services as well as a different, far-seeing engagement with the voluntary sector.

It is there that the twin challenges of demographic and cultural change on the one hand, and the changing attitudes towards public expenditure on the other, will have to be met. In that context, the experience of the integration pioneers is going to be critical, and we have to hope that they will, in their different ways, based on their different traditions, rise to Care Minister Norman Lamb’s invitation to them to `think the unthinkable’.

But if it’s misguided to talk about services saving services, there is one aspect of the difference between health and social services which, perhaps due to ingrained politeness, seldom surfaces. Social care has often pioneered changes in public service. Full engagement with the market and de-institutionalisation over the past 25 years have both been areas where social care values and the interests of the Treasury have been roughly in tandem.

Arguably, the massive trend towards the personalisation of social care services is another. Maybe it won’t be too long before personalisation which is doing so much to reform social care with the person-centred focus it brings with it, will be made more available to enhance the already excellent care that is so widely available in most of our hospitals.

The challenge is not just a few more difficult years, but rather to deliver a step change in productivity in health and in social care services never achieved previously anywhere in the world.

Although the funding gap can be reduced through pay reform, improvements in the management of chronic conditions in the community, and reduction of hospital activity through the Government’s Quality, Innovation, Productivity and Prevention programmes, there will still have to be a level of disruptive change that includes full implementation of integrated care, better management of real estate and radical overhaul of primary care along European lines. But even then this might not be enough.

Social care has its own pressures. The number of older people with moderate and severe disabilities is projected to increase by 32% between 2010 and 2022, under a best case assumption. If so, net public expenditure on social care and continuing healthcare for older people will need to increase from £9.3 billion to £12.7 billion per annum and possibly more, if trends on excess drinking and obesity cannot be quickly reversed. The extra cost of Dilnot will also need funding.

After the General Election in 2015, whoever wins, there will either be tax increases and more Government borrowing or the quality of, and access to public sector provision will simply fall away. Either way, given the pressures on both health and social care, it is hard to see how one can save the other.

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15/01/2014 9:55 am

Focus on Leadership and Governance: developing leadership at Board level Welcome to the National Skills Academy for Social Care’s Leadership Section

Debbie Sorkin, Chief Executive of the National Skills Academy for Social Care, introduces new resources designed to help providers strengthen their governance.

Welcome to our latest issue. Much of the government’s (and the sector’s) response to Winterbourne View and the Francis Report has identified good governance as crucial to effective leadership. So it’s timely to look at how employers can support their Board members to carry out their roles, and at new, affordable resources that are available to help.

quality and safety of their services. The requirements set out in law include...providing leadership in developing the right values and cultures in the organisation [and] having good governance systems in place...”.

But how can providers support Board members to fulfil their role, so that they can feel clear about their role and confident to carry it out? This is especially the case for Boards of smaller providers, or for Board members who might feel isolated from their peers, or who have minimal opportunity for learning and development.

Whether they are in the private or not-for-profit sector, Boards are ultimately responsible for the leadership and management of an organisation. In summary, they are there to set the tone – i.e. the culture – and ultimately they carry the can when things go wrong.

The Skills Academy is looking to bridge the gap in two ways. Firstly, we have introduced governance e-modules At least, that is the theory. In practice, this is not always onto our website, so that Board members – especially new the case. The report into Winterbourne View noted the members - can obtain an understanding of the sector, key lack of effectiveness of the Board, amounting to a de facto trends and their responsibilities to the organisation, the abdication of its responsibilities. And Robert Francis, in people using services and their families, the staff and the his final report into Mid-Staffs NHS Trust, laid the greatest Executive Team. blame squarely on the Board of the hospital, which he said failed to take any accountability and which was Secondly, we are working with the Social Care Institute overly reliant on external reports, rather than acting on for Excellence to develop a Guide for Social Care Directors complaints or concerns raised directly with it or – where and Board Members, drawing out the responsibilities of appropriate – delving into operational issues. the role and illustrating good practice through case studies and signposting to other sources of support. The Guide Moreover, accountability has been difficult to make stick will be out next Spring, and the aim is to encourage and in practice. In the case of Winterbourne View, as the support, and to show the value of Board roles, so that government noted in its initial response to the report1 , current and prospective Board members understand why although front-line staff were prosecuted and jailed, no they are important to people using services and rewarding such option was available for holding Board members to in its performance. account for poor quality or for letting a culture develop that led to neglect and abuse.

Overleaf, you can read about the experience of different organisations in using the e-modules, alongside views Therefore, as part of its response to issues around from CQC and the Department of Health on their leadership and accountability at Winterbourne View and approaches to governance. And if you’d like to be Mid-Staffs, the Department of Health has set processes involved in developing the Guide, please contact me: we’d in train designed to make Board – and Board member be delighted to have you on board.

– accountability absolutely clear, and to strengthen For more information, please contact debbie.sorkin@ the sanctions if Board performance is unsatisfactory. nsasocialcare.co.uk or go to www.nsasocialcare.co.uk.

According to the Department: “Owners, Boards of Directors and senior managers of organisations which 1 Department of Health: Transforming care: A national response to Winterbourne View provide care must take responsibility for ensuring the Hospital, Jan 2013

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Leadership and governance - making boards accountable Dr Glen Mason, Director of People, Communities and Local Government, Department of Health

Good leadership is fundamental to the delivery of high quality care. However there are many different levels of leadership from strategic leaders to front line leaders, and it is important that each of these levels operates to a good standard and leaders are supported and developed in their roles.

Leadership is an issue that has come into the spotlight more recently through the Winterbourne View scandal and the Francis report into Mid Staffordshire NHS Trust. Failures in leadership have been highlighted as significantly contributing to these catastrophic organisational failures.

One specific area of leadership is the importance of effective Board leadership and governance. Yes, it is vital that we strengthen and support front line managers, and we are making good progress in this area, but at the other end of the scale, good Board leadership and governance also makes a significant contribution. It can be argued that good front line leaders cannot be effective unless the Boards of their organisations foster the right values, culture and behaviours and are clear as to what is important by the way they act and prioritise.

Boards set the tone and culture that the whole organisation operates within. The report into Winterbourne View noted the lack of effectiveness of the Board, amounting to a de facto abdication of its responsibilities. Robert Francis, in his final report laid the greatest blame squarely on the Board of the hospital.

The Government’s response to Winterbourne View made it clear that owners, Boards of Directors and senior managers of organisations which provide care must take responsibility for ensuring the quality and safety of their services.

The Government views this as very important and I am pleased that the National Skills Academy for Social Care and the Social Care Institute of Excellence have agreed to take forward work to produce and publish a Guide for Social Care Board Members.

The Guide will identify the responsibilities of the role, what these entail, and make suggestions on how to fulfil these responsibilities. There will also be a section for Board members on how to hold key members of the Executive to account. The Guide will include key principles for Boards in relation to assuring quality and safety, public confidence, hearing the voice of service users as well as outlining requirements in relation to the Charity Commission and Companies House.

I feel this activity will help to bring greater consistency, a better understanding of Board responsibilities, safer services and higher quality standards of service delivery.

Some organisations have already made progress in this area, and I would like to encourage more to take up the challenge so that we can work to make significant improvements in this important aspect of leadership.

Ensuring boards are effective Des Kelly OBE, Executive Director, National Care Forum “Boards tend to be, in fact, incompetent groups of competent individuals”, so says Professor John Carver from the Institute at the University of Georgia School of Social Work. He is not the only management commentator to be critical of the way in which Boards typically operate: “There is one thing all Boards have in common… they do not function” (Drucker, 1974) “Effective governance by a Board of trustees is a relatively rare and unnatural act… trustees are often little more than high-powered, well-intentioned people engaged in low-level activities” (Chait, Holland, and Taylor, 1996).

Is this fair? Governing Boards in various forms have existed for a long time. However despite the long-standing nature of such a structure of governance there has been a failure “to develop a coherent or universally applicable understanding of just what a Board is for”, argues John Carver. He builds this argument on the basis there is a substantial body of literature about management development with an assortment of training and qualifications as well as an acceptance that becoming a manager requires on-going investment in learning and professional development. And yet for governance and Boards, for the most part, there hasn’t been anything like the same attention. As a consequence, the Carver argument runs, Boards do largely what they have always done.

The experience, knowledge and skills that Board members

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bring to their role is not in question, as many come having held senior management positions. The relationship between management and governance is beyond the remit of this short article - although arguably the Board needs to be primarily interested in strategic thinking rather than planning. Ensuring that Boards are effective in the way in which they govern demands that there is an appropriate balance between simply rubber-stamping decisions or micromanaging.

There has been a general acknowledgement, in response to the travesties covered by both the Winterbourne View and Francis reports that an organisational culture which places disproportionate emphasis on regulatory compliance and financial management, perhaps at the expense of high quality, compassionate, person-centred care, led by the particular set of circumstances, causes poor practice. As a consequence there is a likelihood that Boards will be subject to greater regulatory scrutiny and accountability.

At the National Care Forum we have introduced ‘Quality First’ as a QA framework which requires the active commitment of both the Chair (on behalf of the Board) and the Chief Executive because we believe that both are essential to ensure that people receiving care and support are respected and protected. It is only a start but it makes explicit the different sets of responsibilities. There is an important leadership role for the National Skills Academy to developing thinking and practice in this crucial area.

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Effective Board Leadership and Governance in social care from an NHS perspective Dr Nicholas Bradbury, Programme Lead for Nursing and Midwifery at the NHS Leadership Academy The external national and regional context in which Boards are operating is changing drastically and continuously. The primary task of the Board is to keep the organisation faithful to its core purpose whilst also keeping tight oversight of the quality and quantity of its culture, activities, and what characterises and nurtures its human relationships. A defining step change of the times we are in is the shift from getting away with focussing on an organisation as a discrete entity to a focus on the wider perspective of health and social care in every aspect. The task now is, clearly, the quality of the organisation’s effectiveness, balanced with the Board’s skill in building mature, sophisticated partnerships across a multi-faceted local health and social care economy. For example, what is the risk environment? How do national and local performance indicators relate to each other?

Have the financial models been built on a sufficiently long term view of the overall health and social care context?

This is of course a vast subject. But taking some significant examples, in ensuring an effective process for establishing and implementing the strategy, a Board must be satisfied that there has been robust collaborative engagement with partners to shape it in the interests of service users. The co-production model increasingly being used in the NHS is to be commended here.

In ensuring accountability, has the data examined included written intelligence and the realities experienced by staff and

service users, and have these been listened to? What is the Board doing to build a healthy dialogue with the public beyond the organisation?

The same questions apply to a Board’s examination of the culture it is shaping. The evidence is compelling that the quality of the care and compassion experienced by staff affects the quality of patient care and service user experience.

Another example of the fast-evolving context is that Board members now need to appreciate more than in the past how the changing environment is affecting the statutory, accountability and organisational demands of their partner organisations. Is the Board’s market analysis oriented towards integrated care pathways that do justice to the demographic, diversity and equality issues? How well is the Board collaborating with the scrutiny arrangements of local government?

Whether it’s working well with partners or amongst themselves there is no substitute for a Board’s willingness to examine its own processes and underlying relationships. Unresolved conflict is not dead. It’s buried alive. Soon it will scream. Board members must be open to learning, vulnerable, compassionate and able to tolerate uncertainty. With a challenging external context , the internal environment must be steady, warm and wise.

Reference: The Healthy NHS Board 2013: Principles for Good Governance (NHS Leadership Academy) www.leadershipacademy.nhs.uk

Excellent Care Services are led from the top Tracy Wharvell (C Dir) and Dr Jan Sheldon (C Dir) are Directors, Plum Moment Ltd Being a *Director or a Trustee in an adult social care business requires a range of specialist knowledge. The National Skills Academy recognised that there was insufficient information available to support Directors and Trustees and commissioned Plum Moment Ltd., a specialist business consultancy service, to develop a Governance Framework for adult social care.

The Governance Framework has been developed in conjunction with the Leadership Qualities Framework. Leadership can make a difference to the quality of care and support which is delivered; good governance is a critical component to the development of effective leadership.

The Framework has been developed based upon current thinking and best practice in corporate governance and contextualised to reflect what it is like to work in adult social care.

We also undertook an in-depth consultation with key stakeholders and experienced board members which significantly informed the development of the Framework.

We recognise that Directors and Trustees have different skills and experience. The Framework supports both those with little knowledge of adult social care to increase their knowledge, and those with in-depth knowledge but little experience of operating at board level.

The Framework provides support with making decisions about the strategic direction of the business without micromanaging compliance and process. It also encourages the development of structures and systems which promote core values, protect people and create a collegiate and nurturing approach whilst ensuring

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delivery and efficiency.

The Governance Framework has five key principles: • Sound knowledge and understanding of key legislation and social care policy • Sound understanding of the values of social care • Commitment to developing good business practice • Responsibility for ensuring regulatory compliance • Effective use of financial information to improve quality and support growth opportunities.

The principles promote strategic decision making at Board level which reflects the uniqueness of working in adult social care and the importance of the relationships with people who receive care and support.

To support the principles we also developed a programme of flexible e-learning to provide interesting and accessible learning and signposting to meet the needs of participants.

Culture should start at the top of an organisation; the role of the Board is critical to the delivery of excellent care services.

We are proud to have had the opportunity to develop the Governance Framework and e-learning programme. We know, when used effectively, it will make an important contribution to the development and delivery of excellent care services. * ‘Directors’ includes both Executive Directors (those who work in the organisation) and Non Directors (those who sit on the Board of the organisation but do not work in the business on a day to day basis).

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Governance – more than a legal requirement Debbie Price, Chief Officer, Shropshire Partners In Care (S.P.I.C.) Governance is not only a legal requirement - it is an operational necessity. Delivering good care every day demands strong Governance oversight and processes to ensure a safe, competent and compassionate service.

Owners have a responsibility to understand the sector, the standards and the competencies needed to deliver their services, and to set strategic direction, identify the relevant resources and to ensure procedures are in place to deliver their objectives, whilst at the same time actively taking part in a quality assurance system to ensure that standards are being met. Ignorance is no longer an option; providers must have systems in place to satisfy themselves that sufficient information is received in an appropriate format to evidence due diligence.

Owner managers and those who are directly involved need to have some form of internal governance structure such as a Board including an external appointee to challenge them to improve the quality and operation of their business. Good corporate governance mitigates risk by ensuring that the service has the support and resources necessary to deliver positive outcomes for people in need of care.

I believe that care providers want to deliver good and excellent services, but they face unprecedented changes, many directly attributable to financial challenges, reconfiguration of partner organisations and regulators. The introduction of Clinical

Commissioning Groups (CCGs), many of whom are only just beginning to understand the independent sector, has introduced its own challenges and CCGs need to recognise that care providers provide one of the solutions by offering financially viable, responsive health and social care services.

These challenges are in addition to the day to day running of services, which is a demanding and difficult responsibility that relies on having strong positive leadership which is all too often taken for granted. Managers need owners’ support to understand their business objectives and the part that they play in delivering the outcomes, resources and an opportunity to personally develop their skills, and more importantly opportunities to network with other Managers.

Poor leadership will quickly compromise a service and organisations could find themselves with serious safeguarding issues and/or reputational damage. Governance will quickly identify weaknesses and give providers time to put measures in place to reduce any risks and support managers to develop their own skills and experience.

I am proud to work in social care and I know the difference that a care service can make to the lives of the people that they support.

But a good service comes from strong, clear leaders who understand the business objectives and how to achieve them - they must be committed to maintaining a presence in their organisation.

Regulating and inspecting care services – the CQC operating model Alan Rosenbach, Special Policy Lead, Care Quality Commission Leadership in the care sector The Care Quality Commission is committed to registering and inspecting care services against five key questions. These are: • Are they safe? • Are they effective? • Are they well caring?

• Are they responsive? • Are they well led?

It could be argued that if services are well led then the capacity to deliver safe, effective and responsive care will follow as a measure of that.

The CQC approach to: are services well led?

The leadership and governance arrangements for adult care must be understood in the context of the characteristics of the care sector. The social care sector is hugely varied, with a very large number of providers, a strong private and voluntary sector, significant differences in size and types of services and care provided, and a lack of consistent, high-quality data. Social care is generally provided in people’s own homes, either because their home is now a residential or nursing home setting, or because domiciliary care is provided at home. Critically there are large numbers of people who pay for their own care. Personalisation is hugely important in adult social care. This means that people are able to identify their individual needs and are empowered to take control and to make informed choices about the way they live their lives. We need to take this into consideration when assessing how effective services are.

Is this service well-led? In adult social care, this may look different depending on the size of the provider, but we know

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leadership is a key factor whatever the size of the service. We will also want to focus on the Registered Manager, as we know that the way they carry out their role has an important impact on setting the right culture, approach and leading good practice by example.

Developing a ratings system We will need to make a judgement about the level of quality for each of the five key questions we will ask of services. We also think that one overall rating for a service will be easier to understand, so we will develop rules for inspectors to use which would enable them to make this judgement.

What happens next?

We want to work with pace. Between now and spring 2014 we will have: • Wide engagement with internal and external stakeholders on thinking through the detail behind the question of leadership and governance; • First phase of changes introduced, for example inspection reports that provide a narrative against the five questions, a stronger focus on leadership, culture and governance.

Leadership and learning are indispensable to each other, and we will want to understand the way in which leadership takes account of the views and experiences of people who use services and families.

If you want to keep up to date with our proposed changes on this and other on-going work please visit our website at http://www. cqc.org.uk/public/news

15/01/2014 2:53 pm

A Plan for Life

FitzRoy’s new report A Plan for Life highlights short-termism in planning services for adults with learning disabilities.

A survey of 100 chief executives, heads of adult social care and commissioning managers in local authorities has revealed that they are being forced to make short-term decisions for adults with learning disabilities. They often decide social care packages based on a one-year ahead view of their lives, despite admitting that long-term planning will save money.

The report, A Plan for Life also reveals that local authorities aren’t prepared for the wellbeing provisions in the Draft Care and Support Bill.

Learning disability charity FitzRoy, who produced the study, is calling on the Government to publish guidelines alongside the Act to help local authorities understand and measure wellbeing, and to ensure its consistent application.

SURVEY RESULTS The in-depth study finds that short-term planning is endemic in social care for adults with learning disabilities, suggesting a lack of consideration for longer-term needs, long-term costs and the person’s whole quality of life.

Key life stages such as leaving college, entering older people’s services and the death of a parent can have a critical impact on an individual’s health and wellbeing. Yet, 42% of respondents admitted that they look one year ahead or less when making care decisions. 29% don’t recognise the death of a parent as having a significant impact on social care needs, despite grave concern from parents and families about this.

However, the vast majority (94%) of care commissioners recognise the drawbacks of such short-termism, arguing that local government needs more opportunities to make long-term decisions rather than focusing on short-term challenges.

Cost is the overriding consideration when making these decisions, it was deemed influential by 94% of commissioners. 73% admitted that cost is disproportionately influential and 64% said they’re often under pressure to cut costs at the expense of good quality service.

UNSUSTAINABLE COSTS The study highlights an urgent need for change, with short-term planning costing more in the long-

term and commissioners admitting that longterm planning will help to improve quality of life and reduce care costs.

According to the survey, 87% agreed that short-term planning leads to higher care costs, greater care needs (78% agreed), a higher rate of emergency placements (60% agreed) and failure to secure the right care for adults with learning disabilities first time (57% agreed) – all of which places significant strain on resources.

87% also believe long-term planning presents the single greatest opportunity to improve the quality of life for adults with learning disabilities, with 82% saying that too many are currently unable to live happily and independently.

PROMOTING WELLBEING Worryingly, 36% of local authorities are unaware that the Draft Care and Support Bill creates a legal obligation for them to promote individual wellbeing. 25% don’t feel prepared to fulfil this duty, and 44% don’t have a clear strategy in place to promote wellbeing.

While 55% don’t have a formal means of measuring the quality of life of adults with learning disabilities, 74% say a universal measure would improve placement stability and 67% agree it would reduce long-term costs.

HUGE IMPACT, HUGE RESPONSIBILITY Anna Galliford, Chief Executive at FitzRoy, concluded, ‘Adults with learning disabilities and their families need to know that they will be supported to live as independent and fulfilling a life as possible, and appropriately cared for.

Care decisions have an almighty impact on an individual’s ability to manage their disability and how they live their life, for the rest of their lives.

‘Local authorities face a huge responsibility to help adults with learning disabilities and their families find the best care and living arrangements for them. This cannot be determined by cost alone; these are lifetime decisions that must be based on whole life planning – looking beyond the current budget cycle.’

CMM To read the full report visit www.fitzroy.org/a-plan-for-life.

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13/01/2014 3:57 pm

business clinic

RetuRn to the behemoth?

With HC-One on the market and Four Seasons rumoured to be in the running, could we see a return to a behemoth provider like Southern Cross? What does our panel think?

HC-One was formed by care home landlord NHP Group and Dr Chai Patel’s Court Cavendish. It was set up in 2011 to take on the bulk of the Southern Cross homes when it collapsed.

The plan was to combine Dr Patel’s extensive understanding of the sector and experience of turning around care businesses and NHP’s existing investment in a large proportion of the Southern Cross stock.

When HC-One was launched on the 1st November 2011 it pledged an ethos of accountability, involvement and partnership, which is still promotes today.

As a spokesperson told CMM, ‘Our vision remains to run the kindest care homes in the UK through the principles of accountability, involvement and partnership.’ When the company began operating, Dr Patel was reported to have said the deal would be ‘properly funded with a proper future providing high-quality services.’

NHP has now announced a strategic review with the sale of HC-One being the most likely outcome.

Current situation In December, HC-One’s spokesperson gave CMM this exclusive comment about the possible sale. ‘In the two years since HC-One’s inception, the progress that has been made in turning around the business has been really encouraging. With more than £60 million having been invested into HC-One, we now support more residents than in the past, have substantially improved our quality of care and significantly reduced home embargoes.

None of this would have been possible without the outstanding commitment and contribution of our staff teams.

‘This latest development is the next step in the turnaround of HC-One. The strategic review process started by HCOne’s owners continues to assess the

future options for the business, with a sale now emerging as the most likely outcome.

NHP’s support has ensured that HC-One remains debt free and fully-funded for the next three years, however they believe the longer term prospects may be better served by seeking new owners.

‘At this time no final decisions have been made, and we will continue to communicate directly with residents, relatives and staff as this process continues.

We do not expect this process to conclude for several months.’

speCulation Since the strategic review announcement the rumour mill has started as to who may be in the running to buy it. Speculation has naturally fallen on Terra Firma, the private equity group which bought Four Seasons Health Care from RBS and its other lenders. Four Seasons is the largest independent provider of care. When

Too close for comfort to Southern Cross

How may the Government and CQC react?

Alison Taylor Specialist Business Appraiser DC Care

Andrew Cannon, Managing Director, Bupa Care Services UK

There are a number of issues worth discussing when looking at this potential deal. Firstly, the value of the business itself. A recent newspaper article quoted HC-One as having an EBITDAR of £50 million, with (they say) a likely market value of £550 million to £600 million.

The stock consists of both freehold and leasehold properties, is nationwide and of mixed quality.

Whilst undoubtedly a route to a significant proportion of market share, I’m unsure as to whether this value can be achieved. The multiples of EBITDAR that are being seen in the market are significantly lower than this. The sale does potentially include NHP, but there are matters which could complicate this aspect of the transaction as the bondholders control the company.

The second point is how such a transaction would be viewed by the people commissioning the care.

Four Seasons already leads the field, with Bupa the nearest competitor.

The acquisition of HC-One would result in Four Seasons having more than twice as many homes as Bupa.

The topic of long-term residential and nursing care is already a politically sensitive one and the creation of a ‘super-provider’ may receive a lukewarm reception at the very best.

The OpCo/PropCo model does continue to work for a number of investors and operators alike.

However, local authority fees remain challenging and the private fee paying market is not a limitless one; location of the homes is a key factor and this is a mixed bag for HC-One. Lastly, unsurprisingly, CQC will no doubt be looking for robust assurances that the problems which led to the collapse of Southern Cross cannot happen again. It isn’t long since the demise of Southern Cross and this might just be too close for comfort in the eyes of the regulator and the Government.

Regulators and politicians expressed concerns about the potential impact of another large care home provider failing following the collapse of Southern Cross. It remains to be seen how they would react to any new major consolidation in the sector, especially given the CQC’s new responsibilities to examine the finances of larger providers.

Two wider issues face all operators in the sector, whatever their size: the long-term underfunding of aged care and the changing role of care homes.

Central and local government are increasingly encouraging people to stay in their own homes longer.

That, combined with demographic changes, means people are entering care homes older and frailer than ever before with a combination of age-related illnesses and chronic conditions such as dementia or Parkinson’s disease.

To meet this challenge, along with the more sophisticated

demands of older people generally, care homes will need more specialist equipment, even more highly-trained care staff, and more tailored facilities. Being an aged care provider is no longer just about having capacity or bed space, it’s about offering a wider range of support and more tailored options, all of which require investment.

Yet fees paid by local authorities have been below the level needed for some years. In England, there have been real-term cuts of over 5 per cent in council fees in the past three years, following years of static fees. Then we have the effects of the ‘Dilnot cap’. Far from bringing extra resource into the sector it has added a layer of confusion for families and threatens to put further strain on already-stretched public budgets.

Anyone entering the sector has to be able to continue funding the level of investment needed for quality care in the light of these challenges.

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business clinic

Southern Cross was on the verge of collapse, Four Seasons took back the portfolio of properties that Southern Cross had leased from it. The two companies had a number of similarities.

Both struggled with debt and old stock, however where Southern Cross failed, Four Seasons was bought by Terra Firma.

The deal was based on Four Seasons’ strong asset base; it owns around 60 per cent of the facilities it operates, which limits its exposure to the rental costs that hampered Southern Cross. It was this purchase by Terra Firma that gave the company stability to access new capital and build sector share. With the HCOne sale offering both property and the operating business there is an obvious link.

According to the LaingBuisson Long Term Care Providers Directory, Four Seasons is the largest operator of care homes in the UK, with nearly 25,000 beds across 469 care homes. A purchase of HC-One’s 12,000 beds across 235 homes would see the company become a huge provider, larger than Southern Cross at its collapse. It would hold more than 10 per cent of the total care beds across the sector.

Four Seasons announced in November that it had completed its restructuring

‘to focus on developing three distinct businesses in strategic areas.’ Whether it has the finances or appetite to add HC-One to its portfolio will become clearer in the coming months, however HC-One could fit within Four Season’s new ‘national network of homes that will provide personalised dementia and nursing care alongside residential.’

Debt, Debt anD more Debt Debt has plagued the sector ever since 2008 when the banks ran into difficulty.

When money was easy to come by, the debt of the larger providers was serviceable, but since it’s no longer that easy to find, and huge deals require the buy-in of a large number of different lenders, debt is clearly more problematic.

Although the HC-One spokesperson told CMM that the company remains debt-free, that can’t be said for NHP. It has been reported to be struggling to service its debt with credit rating company Fitch downgrading Titan Europe 2007-1 (NHP) Limited last February due to what it described as ‘substantial deterioration in performance, with occupancy falling [and]…significant decline in property values.’

Other big providers have all started to get their finances in order which could impact on available funds for potential purchasers or appetite for acquisition.

Court Cavendish recently refinanced Care Management Group, CareTech refinanced loan facilities, Maria Mallaband agreed a funding deal, Ideal Care Homes (and LNT Group) refinanced and a number of organisations bought into Barchester.

Added to this, the CQC is set to scrutinise the finances of the largest providers which could affect a purchase by another large provider. Or is the CQC scrutiny a contributory factor in the possible sale?

Whatever the speculation, it is clear NHP is looking at all its options with a sale being a strong possibility. It remains to be seen what is driving the decisions and what the outcome will be. cmm

Over to the experts...

With the speculation around Four Seasons and HC-One, is it wise to have another huge provider given the demise of Southern Cross? Will the ageing stock and low local authority fee rates impact on whoever buys the company? What does the panel think?

Quality of care must be the focus Mark D Ellis ACIB Head of Property & Social Care Banking Services Lloyds Bank Commercial Banking The fundamental focus of all care providers is to ensure that their residents receive the highest quality of care, and this should be the same whether they have 35,000 beds under their provision or just a single independent facility.

The structure of care operators is constantly changing, and consolidation in the market is inevitable given the nature of the industry and the increasing overseas investment that is pouring into the sector, particularly from American corporations and the property Real Estate Investments Trusts (REITS).

The sector faces constant change and operators have to adapt to new legislation whilst taking into account a recovering economic background.

Lessons have been learnt

from the collapse of Southern Cross and indeed any business that finds itself in the position where it is monpolising the market must ensure that it has stringent financial procedures in place, as adopting such a large property portfolio will necessitate the requirement for on-going investment to maintain a quality living environment.

The need to take expert guidance on board to protect any investment is the same for any business regardless of the sector it operates in.

Care providers should adopt a cautious approach to growing their operations so that they do not reach a size that they cannot manage, and in doing so they will generate a longterm future for their business and ensure residents continue to receive quality, family care.

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Seeking Care Authors (Freelance – Working From Home)

ABP

Agora Business Publications are seeking experienced, opinionated and informed authors to write articles for Care Quality Matters, Home Care Management Today and Dementia: Care Quality Management.

Care Quality Matters focuses on helping providers pass their CQC inspection. Home Care Management Today is devoted to domiciliary and home care issues. Dementia: Care Quality Management helps dementia care providers give their vulnerable service users the best possible care in this challenging area. All newsletters give practical solutions plus forms and checklists which can be implemented immediately.

We seek experienced writers who have successfully managed adult care services to provide practical, actionable tips and advice on how to improve care quality within care homes, dementia services and domiciliary care services.

If you would like to work from home on a freelance basis, sharing your experience and expertise with providers then we would like to hear from you. In return, we are offering a generous fee rate per page published. Volume of work is dependent upon your skills and experience as well as your other work commitments.

If you are interested then please send your CV plus supporting material to: jobs@agorapublications.co.uk or write to: Niki Haunch, Agora Business Publications, Nesfield House, Skipton, North Yorkshire, BD23 3AN.

amanda scott amanda Scott is the newlyappointed Managing Director at Sunrise.

What’s been your career journey?

I began my career in care at 16 when I worked at a local care home whilst at 6th form. I’d always wanted to be a nurse so when I began training I had an appreciation of good care and how important it was. The Government is now suggesting those intending to be nurses should spend a year as health care assistants before beginning training.

In the mid-1990s I left the NHS to become the Deputy Manager of a local care home. I was inspired by how much had changed.

After seventeen years in the care sector, I came to Sunrise in 2011 as Clinical and Quality Director.

DiD you plan to climb the care sector ranks?

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I never had a clear forward plan.

What I did have was a desire to make a difference and I noticed the more experience I gathered, the bigger difference I could endeavour to make. As a care assistant, I felt I could make a difference to the lives of individuals. When managing a care home I could make a difference to dozens of people, as Clinical and Quality Director I could make a difference to each of Sunrise’s 3,500 residents. As MD I want to contribute to Sunrise as an organisation and to the sector as a whole.

One thing which has made my rise easier is that the leadership team really work together. Each one is pulling in the same direction for the benefit of Sunrise and our residents.

What pressures Do you see facing the sector?

I listened intently to Andrea Sutcliffe’s vision for care and how she plans to take this forward. The idea of care home groups returning to a quality rating system is one of these opportunities, and I am determined that Sunrise can be at the forefront of recognition for excellent care and providing quality of life for seniors.

What are your plans for the company?

I want to build on Guy’s fantastic work and continue to place exceptional levels of care at the forefront of Sunrise’s provision.

With 80% of care home residents living with some form of memory impairment, we will be ensuring our policies and training reflect the needs of those we care for. It will also be important to ensure the product we offer and the environment we provide is perfectly tailored to those we support.

There is also considerable potential for growth at Sunrise – an opportunity I’m thrilled to be part of.

What Do you Do in your free time?

Having completed the 67 mile ‘Cycle the Wight’ challenge to raise money for Alzheimer’s Society last year, with Sunrise colleagues and my husband, we have surprised ourselves by finding a new hobby, and cycle most weekends. Fortunately, my home county of Lincolnshire is much flatter than the Isle of Wight! cmm

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B

What the mid-staffordshire the scandal With Government having published response to the means itsreport into failings mid-staffordshire, for inrachel Warren looks what impact social atrecommendations may have on the care care sector.

etween 2005 and 2008, patients at the main hospital in Stafford were subjected to appalling suffering. Vulnerable patients who needed help to eat were not given that help; water was left out of reach; patients were left in soiled beds; hospital wards were dirty; and, in the Accident and Emergency Department, untrained staff were left to decide in what order patients should be treated.

Yet, at the same time, the NHS Trust which operated the hospital, successfully applied for Foundation Trust status, and none of the organisations which were responsible for regulating and overseeing the provision of healthcare in England acted to protect patients.

The hospital’s failings eventually came to light when, as a result of its high mortality rates

g

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what the mid-staffordshire scandal means for social care and consistent complaints from patients and their relatives, g the Healthcare Commission carried out an investigation. Its highly critical report was published in March 2009.

In response to this, and the following public outcry, the Government commissioned Sir Robert Francis QC to carry out an independent inquiry into the deficiencies at Stafford Hospital and, subsequently, a public inquiry to explore the wider failings. The second inquiry looked at why the problems at Stafford Hospital had not been picked up by other bodies and organisations, including the Department of Health, the local Coroner, local Primary Care Trusts and the Care Quality Commission (CQC). In February 2013 the final Francis report was published. It made 290 recommendations as

‘The impact of the scandal is likely to be far-reaching across the healthcare sector’ to how patients could be protected from low standards of care in the future.

Towards the end of 2013, the Government published its final response to the Francis Report. Many of the recommendations from the Francis Inquiry have been adopted; although not all. However, there are some that will have an impact on social care.

Changes for CQC The Francis Report recognised the demands placed on the CQC, particularly as it becomes responsible for regulating an increasing number of healthcare professionals, such as dentists and GPs. However, CQC was also subject to criticism. For example, it was observed that the CQC had an institutional instinct to attack those who criticised it, which was contrary to how a healthcare regulator should react. Concerns were also expressed regarding the fact that the CQC had changed its emphasis from carrying out regular and planned inspections, to concentrating on inspecting providers where issues had been raised. Such an approach might not have identified problems at Stafford Hospital, or other organisations failing to provide adequate care.

In an attempt to address the issues raised in the Francis Report, the CQC has appointed a number of Chief Inspectors; including one for adult social care. Andrea Sutcliffe took up this post in October 2013. Amongst other things, she will be responsible for reviewing the ratings system for adult social care. The CQC will be consulting on this in spring 2014, together with proposed changes to the way in which it inspects and regulates.

The Government is also proposing some legislative changes which will affect the CQC. These include new regulations to allow the CQC to act immediately in situations where it considers that service users or patients are at risk by prosecuting a provider for failing to comply with fundamental levels of care without first issuing a warning.

In addition, the Government has decided to give the CQC more independence by removing the Secretary of State’s involvement in certain operational matters, such as the requirement for the CQC to seek approval before carrying out an investigation into a care home.

On the face of it, independence may be a good thing; but a reduction in Government oversight seems counter-intuitive in the light of the criticisms which the Francis report makes of the CQC.

WorkforCe Changes Sir Robert recommended that where a service user in a care home is under the care of a doctor or nurse, only a registered healthcare assistant should be able to provide direct physical care to them.

This proposal has been rejected by the Government, mainly on the ground that a system of regulation would be expensive. Instead, following a review by Camilla Cavendish, commissioned in the wake of the Francis Report, concerns regarding untrained staff providing care are to be met by the introduction of care certification. Other recommendations made in the Francis Report, and explored in the Cavendish Review, which the Government has accepted include the creation of a national code of conduct for healthcare support workers, together with a common set of standards for their education and training.

Board memBers test One of the many problems at Stafford Hospital which was identified in the first Francis Report was that the management was deficient.

In an attempt to rectify this, the Government has accepted the recommendation that, for board level appointments, including those in private sector care organisations, a fit and proper person test will apply. This requirement will be regulated by the CQC, and will impose a duty on service providers to ensure that all Directors are suitable for the job.

named CliniCian There has been a considerable amount of emphasis on care for the vulnerable; particular older people. As a consequence, the Government has accepted the proposal that there should be a named accountable clinician who is responsible for patients receiving care outside hospital. This will start with vulnerable older people, and so is likely to have a direct impact on care homes.

adeQuate staffing There has been a lot of discussion about ensuring that providers have adequate staffing levels. Whilst this has mostly been in the context of hospital wards, it is quite possible that social care may also come under scrutiny.

soCial Care Will Be affeCted The recommendations made by Francis Report, and the Government’s response to them, are a reaction to failings in the NHS in a hospital setting. Nevertheless, some of the proposals for change relate directly to social care. The impact of the scandal is likely to be far-reaching across the healthcare sector, and social care will be affected by the changes and by new attitudes to enforcement, not least because social care now shares a regulator with the NHS. cmm rachel Warren is a solicitor and senior associate in the healthcare team at law firm Charles russell llP. rachel.warren@charlesrussell.co.uk

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REACH: support for

living an ordinary life

Paradigm in partnership with the Housing and Support Alliance has launched a fully revised version of the standards Reach: Support for living an ordinary life. Sally Warren explores why this was needed and how the standards can help people with learning disabilities to lead an ordinary life of their choosing.

WHAt iS tHE PuRPoSE of Reach: SuppoRt foR living an oRdinaRy life?

A new version of the standards Reach: Support for living an ordinary life was much needed to reflect the present context of supported living. The core purpose of the new resource is to: • clarify the standards of support for living to ensure that ‘supported living’ doesn’t become a model that people can simply tick as ‘achieved’.

• ensure that in the current climate of dwindling financial resources and tightening budgets, we remain committed to quality support that values the range of resources available to people, for example the community, family, skills exchanges and friends.

• show how Reach can help people with direct payments or personal budgets.

• ensure that we focus on the concepts of ‘ordinary lives’ that adheres to the values codified in Human Rights legislation.

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Supported living first launched by Paradigm and partners in 2002, Reach was designed to encourage supported living. Reach offered a set of voluntary standards; which remain the most widely recognised standards in relation to supported living.

Supported living at its core was about ensuring each person is able to live their life as they choose. it was about living life with the same choice, rights and responsibilities as other citizens. it wasn’t about a model. in 2014, there are many choices for people in relation to housing and support.

Creative housing and support solutions designed with and for individuals, not limited by a model or service model. there are however, providers who have ‘ticked’ the box of de-registering properties to offer supported living but when asked, ‘Did the people supported choose who they live with, who supports them, where they live?’ some still answer, ‘Well, not really.’

Supported living has become a service type, a model, rather than a way of supporting people to have real choice and control over their lives. this needs to change. imagine it’s you and you were made to live in a way you haven’t chosen, with people you haven’t chosen to live with, to have regular personal care carried out by people you haven’t chosen and maybe don’t like? unacceptable for you? unacceptable for everyone.

Why reach: Support for living an ordinary life? it’s not about whether people should have choice and control over their lives. it’s about human rights. Life, for all us, is an everchanging reality. We don’t fix our life at one point in time and accept that as our lot. We try new things, make mistakes, learn from experiences and seek support of friends, family, community and sometimes paid supporters. this helps us make sense of it all and plan for the future.

Reach: Support for living an ordinary life recognises that no two lives should be the same. the focus is on the individual. this enables the support provider and/or the important people in a person’s life to see how well they are doing in creating the circumstances that allow people to live a life of their choosing.

Reach: Support for living an ordinary life

focuses on real conversations not assessment.

Warmly conducted conversations encourage aspirations - choosing where you live, how you live and with whom are the start. it is a conversation that should never end.

Reach is underpinned by the united Nations Convention on the Rights of Persons with a Disability. this states that all people are entitled to: • Self-determination: ‘i can say what matters to me and how i want to live.’

• inclusion: ‘i’m included in my community and benefit from the services everyone uses.’

• personalised support: ‘i get the assistance i need to live as i want.’

What do We Mean by an ‘ordinary life’? the goal of the Ordinary Life movement in the 1980s was to see disabled people ‘in the mainstream of life, living in ordinary houses, in ordinary streets, with the same range of choices as any citizen, and mixing as equals with others, and mostly non-disabled, members of their own community’. there has undoubtedly been progress.

Good person-centred practice has led to people achieving more of their own goals. A greater focus on the variety of resources in people’s lives (eg friends and community) has encouraged everyone to look beyond just paid support. People with personal budgets and the freedom to truly self-direct are living fuller, more meaningful lives.

However, the reality for some is that there is often a lack of input over who supports them, when the support is received and how this attends to what really matters to them as individuals. the care and support industry has been under pressure to place so much importance on meeting minimum standards and ‘professionalising’, the most important aspects of care and support have been lost listening to what people say and then doing something about it.

An ‘ordinary life’ is about having the same opportunities as everyone else; the chance to work, love, have friendships, happy times, sad times, a home, to live with people you want to live with. it’s not complicated, but somehow the systems we have created have made achieving something ordinary difficult.

the reach reSource Reach: Support for living an ordinary

life consists of a series of high-level outcome-based statements in a userfriendly format setting out expectations and rights regarding quality support for living. the eleven standards set out what people should expect from their team or agency offering them support for living an ordinary life as a citizen. the Reach: Support for living an ordinary life pack has two main parts: 1. the it’s My life manual is designed mainly for use by or with people who receive support and their family and friends. it is also useful for organisations to find out how well they are doing in supporting each person. it explains to individuals what rights they should expect from the support they have in their life. this may be paid support, but it also includes the support provided by friends, families and the wider community. it goes on to help individuals figure out if they are getting good support, if they have the home and lifestyle they want and to create a plan of action.

2. the Service review manual will mainly be used by organisations providing support and those responsible for monitoring to find out how a service or organisation is doing overall. it helps organisations to understand what really good quality ‘support for living an ordinary life’ is, and will ensure that they are always working to make sure this is offered to the people they support. it will also assist support providers and commissioners to meet their responsibilities to the people they support and the relevant regulatory bodies. one life, one set of standards, one process.

Reach: Support for living an ordinary life is Not an assessment tool. Reach is a resource and set of standards to encourage people to explore what support for living an ordinary life looks like for a person. used honestly, with integrity, Reach will help people to identify desired changes, create a plan and take action.

Supported living has always been about ensuring ordinary lives. We have lost our way. it is time for all of us to re-think and get back on track. Support for living…one person, one life. cmm Sally Warren is Managing director of paradigm. sallyw@paradigm-uk.org

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Professionalising older people’s care -

A career pathway for the workforce Justine Cawley explains why we need a professional career pathway for the care sector.

As everyone working in the care sector will know, recruitment and retention of care assistants is a big issue, not helped by limited career pathways. Mandatory training is only set at Diploma Levels 2 or 3, so our industry gets tarnished with an unprofessional image of low pay and poorly trained staff.

Problems don’t just apply to the care assistant, as nurses who enter the care home sector from the NHS also haven’t received formal training for working with older people. Movement in the other direction is also a problem, as nurses entering the NHS

from care homes are often seen as coming from an inferior environment.

However, we all know that working in care homes can be one of the most rewarding and also the most challenging careers, both in terms of the complexity of the clients and also the lack of resources compared to the NHS. Staff who choose to work with the elderly are often the most dedicated, yet in many cases are not valued for what they do in terms of perception of their skills.

How can we solve the related problems of recruitment,

g

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professionalising older people’s care - a career pathway for the workforce

g

retention, skills, training, pay levels, career progression and proper care for the elderly?

ElizabEth CarE 360 Forward has recently launched a new practice-led education and development programme called Elizabeth Care™. Initially in conjunction with the University of Surrey, it will provide a solution, a new career pathway designed to bring professionalism to those caring for older people. Elizabeth Care™ will provide a work-based career pathway to develop a specialist older people’s workforce, encouraging caring people into the sector by providing them with long-term prospects and a fulfilling career.

It is based on the 360 Standard Framework™ that defines excellence from an older person’s perspective, integrating health and social care. It was developed by Patricia Duff OBE and Rosemary Hurtley. 360 Forward has spent many years working on a culture change programme that defines and diagnoses person-centred cultures with solutions to transform the caring culture by ensuring that it focuses on dignity and compassionate care. The 360 Standard Framework is highlighted on the NHS Choices website. It is compatible with the Care Quality Commission and its outcomes are tangible and can be measured.

The curriculum is based on this framework. The Elizabeth CareTM programme was conceived out of a real desire to give staff specialist qualifications in the care of older people that focus on the patient and prevent poor quality care.

lEarning pathway The pathway comprises on-the-job learning from Governmentfunded apprenticeships, for specialist carer through to fully qualified Nurse, specialising in the care of older people. The whole pathway has been designed around person-centred care in line with the quality standards framework.

The apprenticeship will be delivered by local colleges and the courses are designed to naturally progress through the levels of qualifications in specialist care of older people (an integrated socio-health model). The pathway is flexible as students and employers who sponsor them have the option whether or not to continue to study for further qualifications after the apprenticeship or intermediate stages.

The specialist care practitioner role and the specialist older person’s nurse will follow similar courses but at different educational levels and this has been designed purposely so that staff teams can learn together and in turn understand each others’ role. CPD modules will be delivered through the University of Surrey in partnership with 360 Forward. There are a selection of modules to meet the needs of the role, including management and leadership, professional and personal development, delivering quality outcomes, compassion in care, research for professional practice, valuing work-based learning, dementia and end of life care, with each module having three to five taught days and the rest being work-based learning.

propErly trainEd staff We know that the financial situation for most care homes is already extremely challenging even without these additional training costs. However, we believe that it is not a matter of

choice. Unless we really invest in training, businesses won’t be able to meet the standards and conditions imposed on them. Nor will care homes be able to hold their own against the NHS when it comes to integration. We have to show professionalism, so having properly trained professional staff is a must.

We also believe that a properly trained workforce with a progressive career path will not only save significant sums in recruitment costs, but will also help to build the business, attracting more clients who are willing to pay what it takes for quality care.

bEnEfits to all We have had a lot of interest from the sector from care homes and domiciliary care agencies across the country. Some employers want to get more young people into the sector, particularly those that want to care. Being able to see prospects and a career pathway makes this possible.

Equally many employers are very interested in the specialist carer for older people role that is likely to see the most expansion. The days have long gone when nursing homes were filled with a plethora of nurses. Instead, the majority of staff are now care workers who are having to deal with more complexity as older people live with a number of long-term conditions and a rapidly growing number of people with dementia needing specialist care.

Care workers want more responsibility and knowledge in order that they can give the best quality care for their clients and the chance to specialise, which in turn will give more job satisfaction. Employers want to give quality care to their clients, so it’s a winner all round.

More importantly, it gives confidence to the general public who have seen our industry hit by a number of scandals and to relatives that their loved ones are in the care of professionally trained staff.

Equally, nurses need to feel valued and equipped to do their job and care home managers want to see excellent quality of care given to their residents. Therefore, employers have also shown a great interest in this aspect of the career pathway – eventually we want to see consultant nurses working in care homes.

Although the links between health and social care may appear weak at the moment, government policy is pushing for more integration, with all the political parties behind it knowing that the current system is untenable. It is not possible to continue to be the Cinderella service. Social care can’t be left behind and we can’t afford not to train and develop the talent that exists within our care homes. The way to do this is by professionalising the sector and making sure those working in it have specialist qualifications to work with older people so they become the experts. It will also enable them to work seamlessly across health and social care, with the needs of the client being at the heart, rather than trying to fit their needs around outdated systems.

As spokesperson on older people, Baroness Joan Bakewell said, ‘I have long believed that the caring profession needs a clear career pathway. Students should be able to study part-time while working and should gain qualifications in line with their progress. I hope this initiative brings it a step closer.’ cmm Justine Cawley is director of business development Elizabeth Care at 360 forward. jca@consultant.com

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Who’s who…

SPECIALIST SOLICITORS With enormous pressures on providers, you never know when you may need a good solicitor. From fighting local authority fees to discussing internal concerns, there are a number of care sector specific solicitors who could help you. CMM brings you a selection of legal firms which represent the sector and details of the lead partner.

If you are looking for legal advice on any aspect of your care business, it’s essential that you find a solicitor and a firm that is well versed in all matters of the law that affect this sector. The people and firms profiled in this article all have vast experience in the sector and a passion to support care providers run efficient and above board businesses.

Running a business in the care sector means dealing with a range of legal issues.

Employment law, immigration concerns, health and safety, rules from the regulator,

contractual arrangements with tenants and landlords…the list of areas where you may require advice is long. But with the right firm supporting you, your business can continue to thrive and embrace new opportunities.

The information provided in this article has been submitted by the individual firms, should you wish to discuss a legal matter please use the telephone and email details provided to contact one of these legal specialists directly.

Please mention CMM when contacting any of these legal experts.

BEVAN BRITTAN LLP - WWW.BEVANBRITTAN.COM

Stuart is a Partner in Bevan Brittan’s health and social care team with extensive experience in assisting all kinds of care provider. He says: ‘Most of my clients are providers of care services, either in the private and not-for profit sectors or the NHS. I work with small and large organisations on quality, compliance, commissioning and strategy issues which are often testing and difficult, and I have fantastic colleagues who provide other types of support for providers.

STUART MARCHANT

‘Personally, I enjoy helping with technical legal issues or on practical and regulatory problems in delivering care services. Importantly, the team’s advice and representation is always centred round our clients’ best interests, being mindful of their legal responsibilities, commercial interests and the value of their reputation. It speaks volumes that our clients genuinely like working with us and I am always happy to speak to care providers who may just need a quick conversation to provide reassurance or guidance.’

Partner Telephone: 0870 194 7712 • Email: stuart.marchant@bevanbrittan.com • www.bevanbrittan.com Offices are located in Bristol, Birmingham and London, with national coverage.

Services include:

As a firm, Bevan Brittan is uniquely set up to advise organisations who work in health and social care because of its broad client base across public service delivery. The firm draws on this experience to help independent sector social care providers on all aspects of their business, from commissioning and procurement issues and challenges to specialist advice and support on care and regulation.

• • • • • • • • •

Serious incidents, safeguarding and health and safety investigations; Commercial dispute resolution; Care support – from capacity and consent to deprivation of liberty; Contracting; Procurement and competition; Regulation; Employment issues; Property and construction; and Commercial structuring and finance.

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who’s who…specialist solicitors

BIRKETT LONG LLP - WWW.BIRKETTLONG.CO.UK

Tracey Dickens heads Birkett Long’s Health and Social Care team, working with clients from across the healthcare sector. Tracey specialises in buying and selling of care homes, companies and businesses, shareholder and joint venture agreements, franchises, company and share restructuring, commercial agreements, and partnerships and LLPs – including agreements for doctors and other health professionals.

Ranked regionally in respected directory, The Legal 500, the team is described as ‘very knowledgeable…acting predominantly for healthcare clients’. Tracey is also highlighted as a notable practitioner in the UK-wide medical partnerships section of the Chambers & Partners directory.

TRACEY DICKENS Partner

In Tracey’s words, ‘Each client has a set of circumstances and needs that is unique. We deal with acquisitive owners of multiple care homes as well as smaller businesses and professional practices. Our approach is always commercial and our aim is to add value to the business or the practice concerned, as well as get the ‘legal necessities’ done efficiently.’

Tracey and her colleagues have particular expertise in relation to care homes, regularly assisting healthcare clients with their legal needs. The team’s knowledge of this sector enables them to properly protect clients’ interests, being aware of business critical issues as well as legal ones.

Telephone: 01206 217326 • Email: tracey.dickens@birkettlong.co.uk • www.birkettlong.co.uk

Birkett Long LLP is a progressive Essex-based firm of solicitors and independent financial advisers with offices in Chelmsford, Colchester and Basildon. With over 150 staff, the firm is one of the largest in the area, offering a wide range of specialist services. Birkett Long LLP prides itself on its ability to provide a service equal to many London firms at competitive local rates. The firm’s team of independent financial advisers gives clients access to a comprehensive service.

Birkett Long LLP is identified as a ‘Regional Heavyweight’ by the Legal 500 directory and is the ‘firm with the highest profile in Essex’. It is accredited with quality marks from the Law Society, Lexcel, and ISO 9001.

Lawyers are specialists who work in dedicated teams offering the diversity of advice often

only found in city practices. The firm is vibrant and dynamic; dedicated to investment in training and development of staff, focused on client care and involved in the local community.

Birkett Long’s specialist team advises on operational aspects of business and assist with business structure, acquisitions and disposals. They provide guidance on employee matters, help with recovering debts and assistance with property arrangements. The firm’s specialist skills in the health and social care sector are increasingly sought after. Tracey Dickens leads a team with a client portfolio representing domiciliary care, care homes, public sector, doctors, dentists, pharmacists and vets.

BRUNSWICKS LLP

Keith leads a team of six lawyers and two support staff; he acts only for care providers and their senior personnel, acting for owner-managed businesses, large national providers, regional groups, charities and not-for-profit organisations. He also undertakes occasional work for overseas governments.

He has worked exclusively in social care and healthcare law since 1999 and has a reputation for steering a calm course through a range of challenges particularly those arising from safeguarding , deaths, regulatory interventions, contract and fees disputes and contract monitoring, inquests and police investigations.

Keith and the team have been instructed on claims arising from interest rate Swaps mis-selling.

KEITH LEWIN Partner

Keith is editor and publisher of the only weekly digest of what is going on in the sector - Brunswicks’ Healthcare Review. He sits on the editorial boards of other publications, regularly writes for a range of industry specific journals. Keith is a sought after presenter on the conference and lecture circuit and his opinions sought by journalists on radio and TV.

Telephone: 08455 190 695 • Email: keith.lewin@brunswicks.eu • www.brunswicks-web.co.uk

CHARLES RUSSELL

Catherine heads Charles Russell’s Care Homes team, working with clients from across the healthcare sector. Catherine, who is described by Legal 500 UK as a ‘first-class lawyer’, is the client partner for a major UK operator of care homes whom she advises on corporate work including acquisitions.

As a multi-disciplinary team, operating across all our UK offices, the Charles Russell Care Homes team provides expertise in all areas including regulatory, property, corporate finance, litigation and dispute resolution, IP/IT, data protection, employment and tax. We have particular expertise in advising clients regarding the buying and selling of care homes and have acted for one of the largest privately owned care home groups in the UK on acquisitions throughout the country.

CATHERINE DREW Partner Telephone: 01483 252530 • Email: catherine.drew@charlesrussell.co.uk • www.charlesrussell.co.uk/care_homesco.uk

DRUCES LLP - WWW.DRUCES.COM

The Druces Care Group is led by corporate partner Christopher, who has over 15 years’ experience in acting for all types of care businesses, and specialises in acquisition and disposal of care business and companies. Druces represents a number of well-known care home operators, as well as institutional investors, landlords and banks in the care sector.

Telephone: 0207 216 5557 • Email: c.axford@druces.com • www.druces.com

CHRISTOPHER AXFORD

The Druces Care Group consists of partners and associates in the corporate, property and litigation departments and was boosted by the arrival of further property and corporate specialists in the last few years.

Partner

Druces’ lawyers have experience in acting throughout the UK and have acted for many years in the health and care sectors, representing a number of banks and financial institutions, corporate and commercial providers, medical charities, pharmaceuticals and bio-tech companies, medical suppliers and manufacturers, owners, investors and insolvency practitioners.

regarding trust, charities and commercial requirements, as well as advising medical suppliers, private medical insurance companies, and companies dealing with medical tourism, employee assistance programmes, stress auditing and counselling, injury management and rehabilitation in relation to a wide range of corporate and commercial agreements.

Alongside its traditional strength in advising operators in the care sector, the team has been involved in a number of significant restructurings within the care sector in the last few years, including the fallout from the collapse of Southern Cross Healthcare, as well as acting for a growing number of overseas investment funds investing into the sector.

The team also has experience in advising hospitals, local authorities and the NHS

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who’s who…specialist solicitors

GELDARDS

Andrew heads up Geldards’ Care Services team and acts for a variety of care home operators ranging from family-owned businesses to large groups.

He has been advising in the care services sector since 2001 and has particular specialism in the buying, selling, restructuring and refinancing of companies and businesses. Andrew has also recently been advising clients on their potential claims arising from interest rate Swaps Mis-selling and continues to do so.

Andrew is ‘lauded by the market for his excellent commercial acumen and deal management skills according to Chambers & Partners 2011.

The wider Geldards’ Care Services team can assist you in day-to-day management including employment, property, planning and construction matters, as well as advise you on regulatory and compliance issues.

ANDREW BORKOWSKI Partner

So, whether you are a large care home group or a single property operator, Geldards will provide you with honest, pragmatic advice, tailored to your situation and the way you do business.

Telephone: 0115 983 3650 • Email: andrew.borkowski@geldards.com • www.geldards.com

HARRISON CLARK RICKERBYS - WWW.HCRLAW.COM

Charlotte joined the firm in 2003 and has acted for health and social care providers across the private sector for the past eight years. She specialises in acquisitions, disposals and corporate restructuring and is a frequent public speaker.

Her portfolio of work includes care homes, children’s homes, home care providers, foster care agencies and educational facilities. Charlotte and her team advise on all stages of transactions, from planning and preparation of sale, due diligence, sale negotiations and deal structuring, through to completion. She is extremely approachable, helpful and knowledgeable - and her practical, commercial and cost-effective approach is behind the long-standing relationships with clients who value her as a trusted business adviser.

CHARLOTTE THORNTON-SMITH

Charlotte has a strong link with the West Midlands Care Association, is a member of the Care and Support Committee of Midland Heart and has been recognised in the Legal 500.

Telephone: 01905 744811 • Email: ctsmith@hcrlaw.com

Partner and Head of Health and Social Care

Harrison Clark Rickerbys’ health and social care team is unique in its offering for the sheer breadth and depth of expertise it provides to a wide range of clients operating in the health and social care sector nationally. They invest the time to understand clients’ culture, business, challenges and requirements, and are an enthusiastic and pro-active team delivering a consistently outstanding level of service.

Always with an ear to the ground for potential opportunities which may be of interest to clients, they are viewed as trusted strategic business advisers as well as lawyers, offering cost-effective and practical advice.

businesses in the health and social care sector.

The team advises healthcare professionals, health and social care providers, medical suppliers and not-for-profit organisations. Charlotte has wide experience of corporate matters and specialises in acquisitions, disposals and corporate restructuring of

The combined team has acted for individual healthcare professionals, such as doctors and dentists, public sector bodies, private operators, institutional lenders and private equity investors.

In April 2013, Harrison Clark and Rickerbys merged their health and social care teams bringing together specialists across the practice. Louise Crook and Derek Jones, both recognised by the Legal 500, now work closely with Charlotte to provide a broad knowledge of the sector. Louise is a board member for Gloucester Care Providers Association, has published articles for the national press and journals and has acted for national groups in the acquisition and disposal of properties within the sector. Derek has over 25 years of experience in regulatory matters, representing providers in resolving problems with CQC, safeguarding and local commissioners.

LESTER ALDRIDGE - WWW.LESTERALDRIDGE.COM

The LA Healthcare Team is headed by Peter Grose. Peter enjoys a national reputation specialising in the law regulating health and social care. He acts for national care home and supported living providers throughout the UK in addition to independent hospital and specialist children’s care and education providers.

Peter negotiates firmly with CQC on behalf of clients facing enforcement action and also with local authorities in relation to contracting disputes. He also specialises in dealing with local authorities in relation to Safeguarding investigations. Peter is a regular lecturer and writer for the care press in relation to current care issues.

PETER GROSE

Peter is appointed solicitor to the Registered Nursing Home Association and the National Care Association.

Partner and Head of Care Team

Telephone: 0120 278 6163 • Email: peter.grose@LA-law.com

LA is one of the leading law firms in the country specialising in the health and social care sector, advising care providers nationally on all legal issues relating to care homes, domiciliary care and supported living. LA also advises independent hospitals, special schools and children’s home providers.

In addition to enforcement action and safeguarding, the Care Team also has a strong reputation in the field of supported living, represents providers at coroner’s inquests, represents providers charged with criminal offences against service users or for breaches of health and safety or environmental health legislation.

The Care Team specialises in dealing with conflict with the regulatory authorities and negotiating with them to achieve the best possible outcome. They have considerable experience in handling more serious cases involving appeals to the First Tier Tribunal and emergency cancellation of registration proceedings before a magistrate.

The Team’s healthcare regulatory practice is particularly strong and they are regularly approached by major equity funds and lenders to undertake regulatory due diligence on acquisitions and disposals of large care groups, having handled most of the sectors biggest transactions during the past three years.

LA is also experienced in dealing with contract disputes with social services and frequently advises on what to do when things go wrong, for example a ban on referrals due to a Safeguarding Adults investigation. The Team also provides on-going assistance and representation through the Safeguarding process, including in respect of any action which may need to be taken against employees as a result of the Safeguarding matters.

The Team also regularly advises on a range of charities-related healthcare issues; for example, they recently advised on setting up a consortia of interested charities to provide healthwatch services, dealing with complex governance issues following the obligation placed on local authorities to appoint a social enterprise to act as a local Healthwatch company in its area to represent patients and other health service users under reforms introduced by the Health and Social Care Act 2012.

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who’s who…specialist solicitors

LYONS DAVIDSON - WWW.LYONSDAVIDSON.CO.UK

Nick is a Partner in Lyons Davidson’s employment law group and works exclusively in employment law, specialising in advising care home sector clients on employment law issues that affect their business.

‘I advise clients across a wide range of care home businesses, from defending difficult employment disputes to managing employment issues on care home acquisitions and disposals. Care homes are a sector I know well, having worked with owners and managers for over 14 years.

NICK JONES

‘Many of our care sector clients take advantage of managing their employment issues through Lyons Davidson’s HR+ employment solutions package.

For an annual fee, care home owners and managers are able to concentrate on running their business and control their employment law associated costs.’

Telephone: 0117 904 5912 • Email: njones@lyonsdavidson.co.uk • www.lyonsdavidson.co.uk

Partner and Head of Health and Social Care

Lyons Davidson Solicitors is a national law firm with offices throughout England, Scotland and Wales. Our 1,100 staff work with businesses, providing tailored commercial advice to industry sectors on a wide range of specialist subject areas.

We have particular strength and expertise in advising clients in the care home sector, and pride ourselves on our ability to provide a comprehensive service to our care home clients. We draw upon the specialist expertise of our lawyers to offer the key services that our care sector clients need, including: • acquisitions and disposals,

• • • • • •

commercial property, corporate finance and banking, regulatory, health and safety, employment and pensions, commercial disputes resolution.

We are committed to delivering high-quality, professional services in a cost-effective and approachable manner. We take a fresh approach to the practice of law and aim to provide innovative thinking, clear advice and effective solutions.

MACLAY, MURRAY & SPENS LLP

Roger Tynan heads up the employment team within the Housing & Care department at Maclay Murray & Spens LLP (MMS). Roger has over 20 years’ experience as an employment lawyer and is assisted by fellow care employment specialists Sarah Myners and Sophie Applewhite in advising care providers on a wide range of issues, including contract and policy reviews and implementation; breach of contract and constructive dismissal claims; multiple high value and complex diversity, equality

and discrimination tribunals; negotiating termination and settlement agreements; TUPE (with particular expertise in outsourcing and service provision change); restructuring, redundancy, discipline and grievance issues. Clients are mainly quasi-public and third sector organisations.

MMS also advises these clients on governance and constitutional matters, care contracts, vetting and safeguarding, pensions and property transactions.

ROGER TYNAN Partner Tel: 0330 222 0087 • Email: roger.tynan@mms.co.uk • www.mms.co.uk

MILLS&REEVE

Julian leads Mills & Reeve’s independent sector health practice. Our 200-strong health sector group is one of the most experienced in the country, helping businesses and NHS and other public bodies with every aspect of their operations. We support our clients on everything from corporate transactions, commercial agreements and procurement to employment, inquests, mental health law, judicial review and disputes, real estate, PFI, IT and data protection.

Julian is a corporate lawyer specialising in transactions, M&A and joint ventures between the independent and public sector. Julian and his team have advised on some of the most innovative deals in the sector in recent years for clients such as Virgin Care, Healthcare at Home, Allied Healthcare, AmSurg and Bupa.

JULIAN SMITH Head of Independent Sector Health Telephone: 0121 456 8392 • Email: julian.smith@mills-reeve.com • www.mills-reeve.com/julian-smith

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Druces LLP - Salisbury House, London Wall, London EC2M 5PS Our team of expert lawyers have experience in providing all kinds of assistance to those engaged in the health and social care sector.

Our team has particular expertise in advising on the acquisition and disposal of healthcare businesses and interests.

Druces LLP offer a complete range of services that includes advice on : • The registration process and other regulatory matters;

Our team can offer advice and representation on all aspects of operating in the sector, from the initial registration process, through to dealing with local authorities and regulatory bodies on a day to day basis.

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Our team act for many leading property investors, developers, landlords, banks, charities and financial institutions within the health and care sector.

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We understand that it is vital to recognise that transactions associated with regulated businesses are not pure commercial property transactions.

• Employment advice, including immigration and work permits;

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who’s who…specialist solicitors

RADCLIFFESLEBRASSEUR - WWW.RLB-LAW.COM

Andrew heads the Care Homes and Mental Health Law team and specialises in all areas of healthcare law. He acts for a large number of private sector healthcare providers and care home operators as well as the NHS. Particular areas of expertise include care homes law, mental health law, public law and judicial review and personal injury matters. He has been involved in many of the most important mental health cases in recent years and is seen as a leading practitioner in this field. Andrew has extensive advocacy experience including attending inquests on behalf of many healthcare clients.

Andrew has significant experience of regulatory matters involving CQC and the HSE/police. He regularly lecturers and contributes articles to the health and legal press and provides an educational programme to clients and others in the health industry, especially relating to mental health, care homes and human rights.

ANDREW PARSONS

Telephone: 020 7227 7282 • Email: andrew.parsons@rlb-law.com • www.rlb-law.com

Head of the Care Homes and Mental Health Law Team

RadcliffesLeBrasseur is one of the leading UK law firms in the care homes sector with offices in London, Leeds and Cardiff. We have many years of experience in advising managers and operators of care homes, both in the private and public sector.

As well as advising on specific issues within the care homes sector, such as CQC registration issues and other regulatory matters, adult safeguarding investigations and Deprivation of Liberty Safeguards, we can also assist with employment, corporate and property matters. As specialists in the field of mental health law, we can also advise psychiatric care providers.

We understand that, in a health care setting, problems can arise at any time. We therefore operate a 24 hour helpline service to provide our clients with advice and support around the clock.

Our care homes team, made up of 13 experts, delivers educational lectures, briefings and seminars to help keep our clients abreast of legal developments. We also offer a free monthly care homes bulletin focusing on the latest news, guidance and legislation affecting the care homes sector.

• CQC Regulatory Issues including enforcement action.

• Dispute resolution, including debt collection.

• Drafting and advising on policy documentation.

• Health and safety matters.

• Local authority or CCG funding disputes.

• Mental Capacity Act issues.

• Mental Health issues.

• NHS law and practice.

• PR issues and press statement.

• Property development and the construction of care homes including property planning issues.

• Regulatory matters.

• Untoward incidents (including staff, resident or visitor injury claims).

Our expertise includes: • Confidentiality and Data Protection issues.

• Corporate transactions and financing.

RHW SOLICITORS

Giles heads up rhw’s Care Sector team. He is a senior commercial solicitor, primarily specialising in commercial property work having for some years worked in central London, gaining most of his experience with a leading City firm.

Giles has worked extensively for care providers since 1995, specialising in advising on business sales and purchases, property matters, CQC issues, safeguarding investigations and other regulatory matters.

‘Our Care Sector clients value the specialist knowledge, thoroughness, integrity and commerciality which underpins our team’s approach. This is reflected in the long standing relationships we have with most of our clients.’

GILES GILLINGHAM Head of Care Providers Legal Team

The rhw Care Sector team deals with a broad spectrum of work such as fees issues on which they have achieved notable success recently, safeguarding investigations, CQC enforcement action, employment issues, commercial funding, shares/assets sales and purchases, property matters and dispute resolution.

Giles and his team regularly publish topical articles in care sector publications.

Telephone: 01483 540534 • Email: giles.gillingham@rhw.co.uk • www.rhw.co.uk

WIREHOUSE

Adam qualified as a solicitor in 2009 after completing his training contract at a leading firm in the South East of England.

for one of largest legal expenses insurers in the UK, a boutique employment law firm and regional heavyweight firm.

He took the decision to specialise in employment law on qualification, and his passion for this area of law stems from the commercial nature of the work and the need for practical and pragmatic resolutions to the issues which arise.

Adam has experience advising care sector clients, from care homes to domiciliary care businesses on a range of matters and when necessary, representing them at Tribunal.

Adam joined Wirehouse in 2011 bringing with him experience working

ADAM HAINES Employment Solicitor

Wirehouse are proud to have a wide range of care providers as clients and a team of advisers with extensive knowledge in this sector.

Telephone: 0844 915 0141 • Email: adamhaines@wirehouse-es.com • www.wirehouse-es.com

Next edition: Spotlight on nutrition If you would like to feature in the next Spotlight please email editor@caremanagementmatters.co.uk or send a tweet to @CMM_Magazine

www.caremanagementmatters.co.uk

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15/01/2014 10:42 am

Extend your residents living space with a canopy from Canopies UK!

canop es uk

Canopies UK is the countrys leading supplier and manufacturer of outdoor canopy systems.

A canopy can help protect against the worst of the weather, helping to provide a safe and dry area underfoot, free from frost and slippery surfaces, eliminating potential hazards.

A canopy also offers benefit in the summer months, helping to extend your living space and allow your residents outside to enjoy the fresh air. Also, our canopies help to block out 90% of the sun’s harmful UV rays, ideal when wanting to retire from the sun and sit in the shade.

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01254 777002 Ext: 221 PROMOTE YOUR BUSINESS TO THOUSANDS OF CARE SEEKERS ACROSS THE COUNTRY Care Choices, the leading publisher of care information, has launched a brand new website for people searching for care.

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• It is promoted in over 350,000 care services directories published by Care Choices • It is supported by the Care Choices Helpline which receives hundreds of calls from care seekers each week • It is featured on many Council websites with direct web links • It is accessible on all devices including smart phones and tablets • It has been designed specifically to increase search engine rankings

Contact us now on 01223 206965 to feature your care service on www.carechoices.co.uk t: 01223 206955 e: enquiries@carechoices.co.uk Follow us @CareChoicesLtd

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15/01/2014 3:10 pm

CMM FEBRUARY 2014 ¦ 43

15/01/2014 3:11 pm

conference preview

Book two places at th e same time and get a 20% discount on the 21st secoOctober, nd ticket pricLondon e!

CONFERENCES

CMM INSIGHT – THE FUTURE OF LEARNING DISABILITY CARE Do you operate in specialist care? Do you offer services for people with a learning disability? If so, you can’t afford to miss CMM’s forthcoming Insight conference.

Now in its 6th year, this national conference will once again bring together the most influential organisations to explore current and future developments in the specialist sector.

The day will include presentations from the Care Quality Commission, Association of Directors of Adult Social Services, leading law firm Mills & Reeve and a number of other leading names in the specialist field.

The main plenary sessions will be accompanied by an exhibition and a choice of workshops.

WHY YOU SHOULD ATTEND The pressure on care services is immense at the moment. Policy, funding and safeguarding issues are all putting pressure on learning disability services. This is where CMM Insight can offer you an informed insight into the sector and the future of learning disability care. You can hear from policy makers, the regulator, other providers and specialists in the sector. As well as giving you an opportunity to network with your peers.

Too many conferences leave delegates with more questions than answers. This is where CMM Insight differs. CMM Insight has built a reputation for insightful presentations that really connect

25TH FEBRUARY 2014, MANCHESTER

with your interests and needs. Our intention is to leave you with actionable ideas to develop your business.

The last event was well-attended by a number of the industry’s key decision-makers from specialist care organisations.

WHAT’S HAPPENING ON THE DAY? Main stage presentations include: • Alan Rosenbach, Special Policy Lead to CEO at Care Quality Commission CQC progress in implementing commitments to transform care for people with learning disabilities • Margaret Flynn, Author of the independent Serious Care Review into Winterbourne View Safeguarding and Adult Provision • Andrea Pope-Smith and Rosy Pope, Joint Leads for the Learning Disabilities Policy Network at The Association of Directors of Adult Social Services The Finding Common Purpose Report There will also be a choice of workshops highlighting specific issues that you may want guidance on including: • Steven Rose and Sarah Maguire, Choice Support The Driving up Quality Code We will also bring you our ‘Live’ Business Clinic. This long-running CMM feature is brought to life on the stage with a panel of experts on hand to answer on specific topics.

For more information on the day or to book a ticket contact CMM on 01223 206953 or email cheryl.yardley@carechoices.co.uk. sponsored by

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what’s on?

Our turn to look after you Helping you maintain a healthy business With over 20 years of health and social care experience, you can rely on Hazlewoods to provide support at all stages of your business lifecycle.

Our dedicated team can provide expert advice on accounting, tax, business strategy and sales across the full spectrum of health and social care.

To find out more, please contact Andrew Brookes Tel: 01242 246670 Email: andrew.brookes@hazlewoods.co.uk Web: www.hazlewoods.co.uk @HazlewoodsCare

WHAT’S ON? Event:

Date/Location: contact:

Event:

Date/Location: contact:

Event: Date/Location: contact:

Palliative and end of Life Care: the Next Steps for funding, Commissioning Services and Provision of Care 4th february 2014, Central London Westminster Health forum, Tel: 01344 864796 Masterclass: Deprivation of Liberty Safeguards 11th february 2014, London Healthcare Conferences uK, Tel: 01932 429933

Event: Date/Location: contact:

Integrating Health and Social Care 26th february, London Capita Conferences, Tel: 0207 202 0593

Event:

Showcase 2014: Driving up the Quality of Social Care 11th March 2014, brighton Surrey Care association, www.careshowcase.org.uk

Date/Location: contact:

KEYS

falls Prevention and Management in Older People 4th february 2014, London Healthcare Conferences uK, Tel: 01932 429933

Event: Date/Location: contact:

Social Care 2014 19th March 2014, London Govtoday, Tel: 0161 6865576

Event: Date/Location: contact:

The Care Show 26th and 27th March 2014, bournemouth ubM, www.careshow.co.uk

Just tell us the number on the lockface and we’ll post the keys to you today!

Event: Date/Location: contact:

reforming Social Care Conference 2014 27th March 2014, Central London GovKnow, Tel: 0845 647 7000

We have a loyal customer base ranging from the largest hospitals to the smallest care home, actually anywhere that has things which need to be kept locked.

Event: Date/Location: contact:

Skills for Care annual Conference 2014 27th March 2014, birmingham Skills for Care, Tel: 0113 241 1295

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cmm EVENTS Event:

The future of Learning Disability Care Conference 2014

Date/Location:

25th february 2014, Manchester

contact:

CMM, Tel: 01223 207770

Please mention cmm when booking your place.

cmm february 2014 | 45

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straight talk

straight talk Rhidian Hughes argues why we need to seize the opportunities in forthcoming legislation to build the workforce rhiDian hughes Visiting Professor Buckinghamshire new uniVersity The well-being principles set out in the Care Bill (the soon to be Care Act) provide the prompt to reconceptualise care and support. That, in turn, leads us to think differently about the workforce. As we deal with increasingly diverse care needs brought about, in part by demographic changes, coupled with social forces and changes in society, we need a diverse care and health market. So too we need an equally diverse workforce with a range of qualities, competencies and capabilities to get care right for people using services.

workforce issues. Later drafts of the Bill saw amendments which strengthened workforce responsibilities. One amendment draws out the workforce responsibilities of local authorities who must have regard to, ‘the importance of fostering a workforce whose members are able to ensure the delivery of high quality services (because, for example, they have relevant skills and appropriate working conditions).’

But we do have workforce troubles. Providers are all too familiar with recruitment and retention problems. It’s easy and convenient even, to conflate poor quality care with the workforce. But it’s more challenging to think about sustainable funding as one of the root causes for the recruitment and retention churn we see in the sector.

The new legislation prompts us to think workforce. For example, direct payments give more choice to people but require us to plan a workforce trained and equipped to deliver bespoke services, sometimes one to one. There will be a much stronger role for information, assessment and advocacy services and we need a trained workforce to deliver that at scale. Local authorities are gearing up for the Act and strong partnerships with providers will be critical to future success.

Suffice to say many of the workforce challenges the sector faces boils down to the low status of care work. And in turn the low status of the workforce. And that takes us back to the low status of social care more generally and, arguably, the low status of people who use social care services.

We need to build on the market development initiatives contained in the Caring for our future White Paper. Those market development statements that support providers to make better informed decisions about workforce capability and capacity, both today and in the future, should be welcomed.

Is the workforce fit for the future? Well, probably not. The Government’s White Paper said, ‘The care and support system in England today is not fit for the 21st Century’. If we look back to services some 10 or 15 years ago we have seen the workforce deliver significant improvements to quality. We need to recognise and celebrate those successes.

Integration is at the heart of the Bill. But the world of integrated care in relation to workforce only goes so far. We count health education by the billions of pounds. Yet in contrast we count social care training and development by the million. Scrutiny of the Draft Care and Support Bill concluded that joint education and training arrangements between health and social care ‘may be a bridge too far for this legislation’. If we are serious about securing the future workforce to deliver services, then we need a more radical transformation in how services and the workforce are aligned and, crucially, funded.

But nothing stays the same, and if it does we will just get less because of the scale of demographic, social and economic forces shaping the care and support sector. As society changes so too services must transition and transform. And we need a workforce that transitions and transforms to align with those changes. Workforce needs to be on the agenda yet it is often found at the margins of discussions about commissioning, service change and transformation. Workforce leadership is sometimes seen as an elite sport undertaken by others.

We need to use the measures in the new legislation to lever positive change in how we build workforce capability and capacity.

Early drafts of the Bill were devoid of explicit reference to

To deliver future legislation involves identifying unique blends in skills, competencies and ways of working in social care, as well as across health and wider welfare services. There are policy opportunities to bring together public services, providers, the third sector and, crucially, people who provide and use services – to plan and identify frontline capability for the future. The lifeblood of care and health, and community services is its people. And it’s critical that we value and get the workforce in the right shape to deliver care and support fit for the future. cmm

Do you agree with rhiDian? Please email your thoughts to eDitor@caremanagementmatters.co.uk

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The Social Care Commitment

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Sign up online The Social Care Commitment is an agreement by employers and employees about improving workforce quality across adult social care.

It will raise public confidence that people who need care and support will always be supported by skilled people who treat them with dignity and respect. “CQC fully supports the Social Care Commitment� David Behan, Chief Executive of the Care Quality Commission.

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