Care Management Matters November 2013

CMM CAREMANAGEMENTMATTERS

NOVEMBER 2013 ÂŁ4.00

HAPPY BIRTHDAY CMM! 10 years and counting

How has the market changed?

KPIs through the years

Care retrospective

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Predictions, policy and news

Buildings to meet demand

Private-pay clients How can you attract them?

Includes 4-page Skills Academy insert: Focus on Leadership and Communities: Building Leadership Capacity across Communties

Shaun Shines when it Comes to Care Catering Head Chef Shaun Brennan has been at Juniper Care Home since its opening in 2012. He and his five-strong brigade are responsible for the welfare and nutrition of some 30 residents daily, all with differing needs, catering with a passion and dedication that shows in their food.

“The biggest challenge we face is to ensure consistency across the menus” says Shaun. “Whether it’s quality, nutrition or looks; if I’m not there the food standards can’t drop, so we have to stock quality products to make our food the best it can be every time.”

One such product that Shaun uses regularly throughout his menus to safeguard consistency is Millac Gold. Convenient and highly versatile, Millac Gold is ideal for producing quality dishes in higher volume with minimal waste.

“It’s a great product and so easy to work with. It’s also really versatile – much more so than fresh cream. We use it for lots of desserts, for mousses, cake fillings; we make dauphiniose and Lyonnais potatoes with it, it goes into soups, everything."

Shaun says he is also able to make a marked saving using Millac Gold when compared to fresh cream.

“As it’s ambient it has a good shelf life, it can sit in the store room for a long time. If we were using double cream, we would be paying a lot more money and it only has a limited life. We would have to keep ordering it in but only get 4-5 days usage from it, so it doesn’t make sense commercially.”

Shaun often cooks for those whose diets require extra calories or fortification; he reveals that he has found Millac Gold to be ideal for ensuring those residents nutritionally ‘at risk’ are getting their daily calories.

He adds: “Chefs can tackle the issue of malnutrition by using full fat products like Millac Gold. It adds real depth and a background to dishes and gives our guests the fats that they need. It’s so versatile compared to fresh cream for fortifying food.”

Simon Muschamp, Head of Marketing at Pritchitts, says: “With the National Association of Care Caterers calling the current situation a “nutrition time bomb”, malnutrition is a serious and costly problem in care homes across the nation.

Millac Gold is a tremendously effective weapon in a chefs’ armoury that can help them to fortify their menus and cater more effectively for undernourished residents or those with small appetites.

We know how hard care chefs like Shaun work to cater for the specific needs of residents – Millac Gold is one kitchen partner that can help them deal with some of the many challenges they face and allow them to fortify their menus. We also recognise that budgets are tight and so is time; so instead of having to order multiple varieties of cream, a care chef only needs one product. Use it anywhere or any time where you would like to increase the calorific content in your dishes, and rest assured that it will perform time and time again.”

For more information on Pritchitts and to find care specific recipes from Shaun Brennan visit the brand new website: www.pritchitts.com

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MORE THAN JUST CREAM Millac Gold is the versatile, high performance choice to increase the calorific value of your menu • it is versatile so can be used in all your recipes - savoury or sweet, hot or cold • it is more stable than cream – it doesn’t split or over-whip and can be re-whipped • it whips up to 3 x its volume – giving great value for money • it has a long ambient shelf-life which means reduced wastage *Free sample request offer only valid for sample Millac Gold 1ltr cartons. Open to bona fide care home caterers in UK and Ireland only, available whilst sample stocks last. See www.pritchitts.com for full terms & conditions. Offer ends 31/12/2013.

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IN THIS ISSUE regulars 07

editor s welcome

Is it just me...?

Guest editor, Des Kelly OBE argues that the quest for improved quality has been the one constant of the last decade.

08

News

11

In Focus

12

Property News

14

Local Authority and Planning News

16

Corporate News

24

Business Clinic The LGO has warned local authorities that they re responsible for care homes actions. What does our panel think?

26

60 Seconds with...

Professor Martin Green OBE and Sheila Scott OBE are CEOs of Care England, a merger of the National Care Association (NCA) and the English Community Care Association (ECCA).

37

Spotlight on...

Medication management, pharmacy services and training.

48

32

Conferences

features

CMM previews the forthcoming Care Show Birmingham.

20

49

What s On?

50

Straight Talk

Comparing the KPIs To celebrate our 10th anniversary, CMM asked Colliers International to compare KPIs from its first report in 2004 to the current market.

John Burton explores why there is such a shortfall in registered managers.

27

Attracting self-funders In conjunction with the Care Show Birmingham, CMM brings you advice on how to attract, reach and ensure you meet the needs of self-funding clients.

32

CMM looks at changing predictions, policy and news since our first issue in 2003.

27 44

20 30

Looking back from the future

Welcome to the 10th anniversary issue of CMM. In his welcome to the first ever CMM, our Editor in Chief, Robert Chamberlain said, Currently, there are few business sectors as dynamic as this one. In the aftermath of the Care Standards Act and the now revised Minimum Standards these are stimulating times requiring clear leadership with properly articulated solutions.

I d say that statement still rings true 10 years on. With the Care Bill going through Parliament, times of austerity, pressure on local authority fees, rising demographics and clients with higher acuity; clear leadership and properly articulated solutions are essential to having a successful business.

In celebration of CMM s birthday, we have put together some retrospective features alongside our usual editorial.

Comparing the KPIs looks at Colliers International s first care sector market research, which we published in 2004.

It compares the changes in these important performance indicators up until 2013 and gives a great overarching view of the market on page 20.

We also revisit some of the predictions, news and policy covered

by CMM over the years in Looking Back from the Future on page 32. I found it very interesting to see what has happened over the last decade, I hope you do too.

I d like to take this opportunity to thank you all for your loyalty to the CMM since 2003; we re working hard to keep moving forward. As I sit here wondering what we ll be covering in 2023, I hope you re all still reading to find out.

Meeting the design demands of dementia Kevin Whitehead considers what is needed to move the sector s buildings forward to care for those with dementia.

Follow CMM on Twitter @cmm_magazine

CMM NOVEMBER 2013 ÂŚ 5

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CMM CAREMANAGEMENTMATTERS

editorial panel Des Kelly OBE,

Mike Padgham,

Executive Director, National Care Forum

Chair, UKHCA

Professor Martin Green OBE,

David L Jones,

Chief Executive, English Community Care Association

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

November 2013 EDITORIAL AND PRODUCTION editor@caremanagementmatters.co.uk Editor in Chief: Robert Chamberlain Editor: Emma Morriss Associate Publisher: Matthew Tingey 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 2013 ISBN: 978-1-909048-75-1 CCL REF NO: CMM 10.8

contributors Adam Lenton, Head of Healthcare, Colliers International Claire Patrick, Business and Talent Development Director, Primocare+ David Huckerby, Director, GD PR & Media Ltd Des Kelly OBE, Executive Director, National Care Forum John Burton, Head, Association of Care Managers and Member, Steering Group NSA-SC Registered Managers Programme Judy Downey, Chair, The Relatives and Residents Association

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CMM magazine is officially part of the membership entitlement of:

Katryna Quiggin, Director, Pilgrim Consultancy Ltd Kevin Whitehead, Director, McBains Cooper Professor Martin Green OBE, Chief Executive, English Community Care Association Sarah Pickup, Immediate Past President, Association of Directors of Adult Social Services

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

6 ÂŚ CMM NOVEMBER 2013

Sheila Scott OBE, Chief Executive, National Care Association Tabitha Cave, Partner, Veale Wasbrough Vizards

is it just me...?

Is it just me...?

Guest Editor, Des Kelly OBE argues that the quest for improved quality has been the one constant in the rapidly changing environment of care services of the last decade.

Nothing has changed…and everything has changed. Can this really be true?

A glance through the first edition of Care Management Matters (published early in 2003) makes for interesting reading. In just 10 years the magazine has become a little piece of history with references to things long gone (if not forgotten): CRBs, NVQs, NCSC, TOPSS England, Social Care Register and so-called Care Trusts. So much has happened in 10 years with a succession of Green and White Papers and a plethora of policy reports and exhortations as well as half a dozen Ministers for Care Services. It is interesting to consider how the enthusiasm and optimism for the ‘dynamic’ business environment of the care sector heralded in the very first leader column from the first issue of the CMM has stood the test of time.

*@50*0:4 I read recently that cynicism starts at the age of 44 – honestly! We can all recognise cynicism as a product of the ageing process. Perhaps it’s the inevitable result of experience triumphing over aspiration given constant reminders that things quite often don’t turn out as we hope. I’m guessing some would say it’s the ‘reality check’ - the fact that the theory is so much easier than the practice.

8<,:; -69 8<(30;@ I would argue that the one constant theme across the last decade has been the quest for quality in the provision of care and support services. Quality, as defined by people receiving care and support, has an ever-changing definition. However, a focus on compliance with standards was something of a distraction. Amazingly, 10 years ago neither CSCI nor CQC existed, there was no Southern Cross or Winterbourne View, and nationally recognised quality ratings (for social care) had yet to be developed. For a period of five years during the last 10 we had a regulator in the Commission for Social Care Inspection (CSCI) that used every means to drive quality improvement balancing strong regulatory actions with better information on services and guidance for providers. I find myself getting nostalgic for CSCI! And it puzzles me – CSCI was hardly perfect.

However the organisation had begun to establish a professional authority and credibility. The sector needs a strong regulator who is seen to front the positives of care as much as to criticise providers or commissioners when things go wrong. The history of regulation in social care is rather littered with organisations set up and discarded before they had the chance to be effective.

Arguably we have lost at least four of the last 10 years (along with considerable resources) to interference in the national regulator to the care sector.

What does all this teach us? Despite the best efforts of care providers, committed to driving up quality, we are not there yet.

*/(5., (5+ ;9(5:0;065 I am not, of course, downplaying the significance of pressures on funding or the growth in the proportion of people paying the full cost of their own care, or cross-subsidisation arguments and associated market tensions. Nevertheless there has been a seemingly constant debate about the need to improve safety and standards of care and to improve quality of outcomes. The revelations associated with Winterbourne View and Mid-Staffordshire Hospital Trust cast a shadow well beyond health to social care.

At least half of the last 10 years have been lost to exacting austerity measures and public sector funding was already under pressure. So, across 10 years the context of the business environment for the care sector, aside from efforts to drive up quality will continue to be one of change and transition.

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CMM NOVEMBER 2013 ¦ 7

news

APPOINTMENTS SCIE APPOINTMENTS Tony Hunter, Chief Executive of North East Lincolnshire Council and Senior Vice President of the Society of Local Authority Chief Executives (SOLACE), has been appointed as Chief Executive of the Social Care Institute for Excellence.

Peter Hay CBE has also been appointed to SCIE s board.

Peter is Strategic Director, Adults and Communities at Birmingham City Council and former President of ADASS.

ADASS ELECTS VICEPRESIDENT David Pearson has been elected Vice-President of ADASS ‒ a move which will see him becoming President at the Association s annual general meeting in April 2014.

COLTEN CARE SENIOR APPOINTMENTS Two senior appointments have been announced by Colten Care. Ian Hudson, currently Managing Director, is to become Executive Chairman while Mark Aitchison is to become Chief Executive, in addition to his current role as Group Finance Director. Both appointments take effect from December 1, 2013.

NSA BOARD The Skills Academy is delighted to announce that Clenton Farquharson and Deborah McKenzie have joined the Board of Trustees.

HOUSING 21 CEO Housing 21 has appointed Bruce Moore as Interim Chief Executive.

VOYAGE CARE CEO Voyage Care has appointed Kevin Roberts, its current Chief Operating Officer, to Chief Executive with immediate effect.

8 ¦ CMM NOVEMBER 2013

NEWS • Corporate • Local authority • Planning News editor - Des Kelly CQC’s independence strengthened The Care Quality Commission (CQC) is to be given greater independence so it can act as the nation’s chief whistleblower on health and care. Under the proposals, the Health Secretary will relinquish a range of powers to intervene in the operational

decisions of the CQC. This means that the CQC will no longer need to ask for Secretary of State approval to carry out an investigation into a hospital or care home. In addition, the newly created positions of Chief Inspector of Hospitals,

General Practice and Adult Social Care, will be enshrined in law. This will place the positions on a permanent footing and ensure that individuals who are appointed to the roles are able to speak up for patients without fear of political interference.

LGO reminds councils on top-ups The Local Government Ombudsman (LGO) has reminded councils across England that they are responsible for the actions

of the care homes they commission. The advice follows an LGO investigation into Merton Council in which a contracted private home asked

a family to pay top-up fees – which they had no right to demand.

See Business Clinic on page 24 for more on this story.

‘Build retirement properties’ says Demos A new report from think tank Demos says that building more retirement properties would free up more than 3 million homes, offering a lifeline to families desperate to move up the housing ladder.

Analysis reveals 58% of over60s are interested in moving but feel restricted by a lack of suitable alternative housing or a fear of an unfamiliar environment. Those interested in downsizing are currently sitting on £400bn of housing

wealth. Helping them move would free up over 3 million properties, including 2 million three-bedroom homes. Demos’ polling also shows that threequarters (76%) of those over-60s wanting to move and occupying three, four and five bedroom houses wish to downsize. The research also tops previous estimates of pensioner’s housing wealth, finding over-60s own £1.28 trillion in housing equity in England alone.

The findings have led the Home Builders Federation (HBF) to launch the Campaign for Housing in Later Life, with a range of public and private sector partners, urging government to remove obstacles and improve housing choices for older people. The campaign calls for a commitment from local councils to respond to demographic change and recognise the housing needs of older people when deciding local housing policy.

CQC consults on fees The Care Quality Commission has published a consultation about the fees that it proposes to charge registered providers in 2014/15.

The fees paid by providers ensure that CQC can register and inspect health and adult social care providers to make sure they provide

safe and effective care, monitoring them to make sure they continue to do so, and taking action if they fall below that bar. CQC is committed to making sure that fee charges are fair and proportionate. This year’s consultation includes proposals to increase fees for all providers by

2.5%.

In addition CQC is consulting on changing the bandings for residential care home providers to reduce the ‘cliff edge’ effect of the current model (where a small change to the size of the service can take a provider into a higher fee band).

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news / in focus

Cost of homecare rises With an increasing demand for care services, a Which? investigation finds that some local authorities have been restricting home care and increasing costs above inflation, leading to a widening postcode lottery in care costs. Using Freedom of Information requests over the last five years, Which? asked councils in England and Wales what level of home care they provided each year from 2009 to 2013.

The results show that more than 80% of councils now restrict care to those whose needs are ‘critical’ or

‘substantial’, up from just over 70% in 2009. Of the 26 councils who reported they offered care to people with ‘moderate’ or ‘low’ needs in 2009, only 12 continue to do so. At the same time, of the 100 councils that responded about their care charges in both 2009 and 2013, around a third (36) have increased charges above the rate of inflation. And some local authorities have either scrapped weekly caps that limit how much people have to pay, or raised the level of the cap so they have to pay more.

Personalisation gathers pace An Association of Directors of Adult Social Services (ADASS) survey shows that over the last year local authorities have continued to personalise their services and support for individuals despite facing significant financial pressures. One of the biggest challenges still facing the continued expansion of personalisation is the development of a suitably diverse market to meet individual preferences, says ADASS - only 70% of councils are reporting that there was a

diverse and culturally sensitive market available to meet individual choices and needs.

Only 11 councils reported that fewer than 50% of all eligible adults received personalised services.

A total of £3.3bn was allocated in personal budgets in 2012/13, 30% as Direct Payments and 70% as councilmanaged budgets. 18% of all personal budgets were for less than £1,000 pa, whereas 29% were for more than £10,000 pa and 53% were between these two amounts.

End 15 minute care A Freedom of Information investigation by Leonard Cheshire has revealed over the past five years the proportion of homecare visits of 15 minutes or less has risen by 15%. In extreme cases, some local authorities are commissioning three quarters of all visits in 15 minutes or less.

The report Ending 15 Minute Care reveals that UK adults take on average at least 40 minutes to carry out essential tasks including getting up, washing, dressing and eating breakfast. However, councils are increasingly expecting disabled people to complete these in 15 minutes.

In Focus: Questioning the reform of social care funding Think tank Strategic Society Centre has published a report A Cap that fits: getting reform to care funding right. It is intended to influence the current consultation by the Department of Health Caring for our future: consultation on reforming what and how people pay for their care and support, which covers funding reform as well as access to care and eligibility.

>/(; +6,: ;/, 9,769; :(@& The Government has committed to implementing reform of care funding in England in April 2016. However, according to the Strategic Society Centre, analysis of the ‘capped cost’ reforms suggest they are unlikely to meet the stated objectives: • People’s care costs won’t be capped.

• A market in pre-funded care insurance is unlikely to emerge.

• Annual increases in the ‘cap’ may cause worry and concern.

The report examines issues facing the ‘capped cost model’, identifying options for policymakers to address them.The report concludes by assembling options into an alternative package of measures that could be implemented in April 2016 – what might be considered a ‘capped cost plus’ model.

0: ;/,9, ( )(*2 :;69@& In July, the Government published a consultation Caring for our future: implementing funding reform, seeking views on how changes to the funding system should occur and be implemented. The proposals in the consultation set out the implementation of the Dilnot Commission recommendations. They recommended a cap on how much anyone would be required to pay for their care costs: £35,000. The Government has announced that from 2016 it intends to establish a cap of £75,000. The Dilnot report also recommended that the current means-test threshold be extended from £23,250 to £100,000. The Government has proposed an upper threshold of £123,000.

0: ;/,9, 469, ;6 0; ;/(5 ;/(;& Yes, and part of the difficulty is the complexity of the model and its operation. The cap on care payments does not include the ‘hotel costs’. Therefore, people in residential care will need to pay £7,000 to £10,000 per year in accommodation and living costs.

So they will pay more than £75,000 before the state becomes responsible for payment.

>/(; /(77,5: 5,?;& Some commentators have suggested that the Government is proposing a ‘Dilnot-Lite’ interpretation, which undermines the model and its premise. There will be huge additional demands for assessments by local authorities before a new funding system could be introduced. The outcome of the consultation is therefore crucial and that is the reason for this latest report. This is an important issue that seems likely to continue to challenge politicians for some time to come.

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CMM NOVEMBER 2013 ¦ 11

property news

BCP and Guild Care Worthing charity Guild Care is working with Building Construction Partnership, a specialist provider for the design and construction of nursing and specialist health care buildings. The charity’s new dementia home and dementia wellbeing centre will be built on land to the east of Northbrook College, Durrington and will support older people throughout their dementia journey. The 60-bedroom care home will be affordable, catering for both

state and privately funded residents.

The home exceeds the requirements of the latest regulations for care homes for space requirements on bedrooms by over 66% and living space and facilities by nearly three times. There will be a function room that can be used as a cinema or training room, themed living rooms, a cafeteria, two hairdressing salons, a therapies room and a shop.

Summerfield Nursing acquires Amber Wood A state-of-the-art nursing home in Cheltenham that went into administration in 2012 has been given a new lease of life by new owners Summerfield Nursing.

Summerfield Nursing, an independent family-run

provider of high quality nursing care, has completed the successful acquisition of the former Amber Wood Care Home site in Cheltenham. It took ownership of the newly named Summerfield Nursing Unit in late September.

Guild Care will be able to extend its day respite services for dementia and offer shortterm overnight respite, carer support with information and advice, health checks for people with dementia and their carers, community outreach, dementia home care, and a range of therapies including chiropody, massage and bathing.

The £7million home is being financed by a combination of Guild Care funds, fundraising and bank finance.

Redevelopment at Cranwell Court A recent £1.4 million redevelopment of Cranwell Court has already started to benefit its residents with dementia in Grimsby.

Extensive research was carried out in order to shape the new dementia facilities,

Over a decade of successfully selling care home businesses.

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12 ¦ CMM NOVEMBER 2013

such as the use of colour and technology to help residents as they move around the home and reduce trips and falls. Hand massages and aromatherapy is now offered by staff to aid relaxation in residents.

property news

Malhotra Group plans Malhotra Group is looking to construct a new purpose built 54bed care home at Melton Park, Newcastle using funds attained from their recent £25 million deal from using the Funding for Lending Scheme. The construction of the care home will bring approximately 70 jobs to the area. It will also support the future growth of the care home side of the Group.

Melton Park Care Home will offer a range of specialist care for dementia, the elderly, EMI and CHC care. Planning has been secured and it is due to open its doors in February 2015. It will have luxury spacious rooms – all with en-suite and views of the racecourse – hairdressers, library, cinema, restaurants for residents and their families and a hydrotherapy pool.

The home will also boast landscaped gardens and bespoke interior design.

The Group has grown over the years to become a business with a consolidated turnover of about £40 million across

Eleanor Care’s contract

the various companies and businesses which make up the Group. Now, following a major restructuring operation, involving over 100 properties and numerous businesses, all of the Malhotra holdings have been consolidated into one formal group which in due course will obtain PLC status.

RBS structured the funding using the bank’s Funding for Lending Scheme (FLS) which is a Government backed scheme launched by the Bank of England and HM Treasury last July to provide more accessible funding to support SMEs with growth plans.

The majority of the new funding from RBS is specifically to help the continued growth of its thriving healthcare portfolio, which owns and operates high quality care facilities throughout the North East under the ‘Prestwick Care’ brand.

Care categories include residential, nursing, elderly mentally infirm, continuing health care, young physically disabled, brain injury and dementia.

Eleanor Care, which provides homecare throughout London and Poole, Dorset, has won a tender to provide domiciliary care in the Royal Borough of Kingston upon Thames.

The care company, which has its head office in Lewisham provides a range of dedicated services, tailored to people’s individual needs and preferences.

The contract is for a three

year period with an option to extend for two years at the council’s discretion, and Eleanor Care is now only one of three providers after Kingston Council reduced its number of providers from twenty four.

Following the contract win, Eleanor Care is in the process of setting up a new branch in Kingston, providing a significant boost for the area.

Hospice receives £2 million extension A Chester-based hospice will undergo a £2 million extension in order to improve facilities for patients and staff. Hospice of the Good Shepherd’s planned two-storey construction will provide day care, offices, further clinical and outpatient areas, as well as training facilities for staff. The car park will also be

extended in order to provide further spaces for patients and visitors.

Hospice of the Good Shepherd provides palliative care to patients living with terminal illnesses and staff endeavor to improve patients’ quality of life, whilst supporting their families, friends and carers.

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CMM NOVEMBER 2013 ¦ 13

local authority & planning news

Extension at Bedfordshire care home Park House in Sandy, Bedfordshire has opened a new ÂŁ350,000 extension.

The new wing has created six new bedrooms with en-suite facilities and a quiet day room, all of which are built round

New site purchased by WCS Group

an outdoor courtyard. Safety features, such as level-access showers and easy-access doors, were central to the design. The extension was completed by Hutchinson Builders, based in Potton.

home is the Trustâ&#x20AC;&#x2122;s newest development in Gloucestershire.

It provides dementia and nursing care for 80 residents.

Leicestershire â&#x20AC;&#x201C; doubling the number eligible for public funding. â&#x20AC;˘ The council will have to set up care accounts for all service users â&#x20AC;&#x201C; a substantial new requirement â&#x20AC;˘ Reduced income for the council, as fewer people will pay care charges. â&#x20AC;˘ Extra costs for the council, estimated at up to ÂŁ30 million per year extra in Leicestershire by 2025.

Dave Houseman, Cabinet Member for Adult Social Care at Leicestershire County Council, said: â&#x20AC;&#x2DC;The council is in favour of reforms to care funding but, at a time weâ&#x20AC;&#x2122;re already having to save ÂŁ110 million, weâ&#x20AC;&#x2122;re concerned this could slice even more from our budgets. â&#x20AC;&#x2DC;Itâ&#x20AC;&#x2122;s essential that the Government fully funds these additional responsibilities.â&#x20AC;&#x2122;

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Lancaster Grange, a 60bed care home situated in Fernwood, Newark on Trent, has recently been opened.

Situated on the edge of Newark, the home was designed by

Tangram Architects, and built by Bullock â&#x20AC;&#x201C; a national contractor specialising in quality social housing. Care services are provided by Barchester Healthcare.

Extra care boosts Flintshire economy

LCC predict ÂŁ30m care costs increase Proposed changes to care funding could increase costs to Leicestershire County Council (LCC) by up to ÂŁ30 million per year, a report says.

LCCâ&#x20AC;&#x2122;s cabinet is set to express concern about how local authorities may have to bear extra costs from the Governmentâ&#x20AC;&#x2122;s proposed care reforms.

The Governmentâ&#x20AC;&#x2122;s care bill is proposing that, by April 2016, care costs will be capped, so no-one will pay more than ÂŁ72,000.

People will get their care costs paid for if they have assets of less than ÂŁ118,000, up from ÂŁ23,000 at the moment. They will still have to pay their own hotel costs of staying in a care home, of up to ÂŁ12,000 per year.

A report to LCCâ&#x20AC;&#x2122;s cabinet predicts that this will mean: â&#x20AC;˘ An additional 7,000 to 8,000 people per year requiring care assessments in

already been obtained for the 72 bed specialist care facility in Kenilworth.

WCS is preparing for the building work to commence in 2014.

Nottinghamshire home opens

Cheltenham care centre The Orders of St John Care Trust has officially opened its Windsor Street Care Centre in Cheltenham.

The Windsor Street care

WCS Group has purchased a site in Common Lane, Kenilworth, for a new specialist dementia care home, anticipated to open in 2015.

Outline planning consent has

Anwyl Construction has almost completed a project which would provide a ÂŁ25 million plus boost to the Mold economy. The nearfinished 61-home extra care complex at Llys Jasmine is worth ÂŁ8.3 million and Tom Anywl, Construction Director, said, â&#x20AC;&#x2DC;In all, 80 per cent of that cost will go on wages and with 80 per cent of the workforce involved from within ten miles of Mold, itâ&#x20AC;&#x2122;s a massive boost for the local economy.

He added, â&#x20AC;&#x2DC;The accommodation at Llys

Jasmine is being built to offer independent living with support facilities available to allow residents to adapt to their changing circumstances. There will be numerous shared facilities in the development including a community restaurant, comfortable lounges, multifunction rooms, hairdressing and laundry provision. At the heart of the scheme is a sheltered courtyard garden which provides residents with a variety of safe and attractive outdoor spaces to encourage an active lifestyle.â&#x20AC;&#x2122;

New care centre being built in Wiltshire A new care centre is being built in Devises with the foundation stone having been unveiled.

The centre will provide 80 care beds delivering specialist

dementia and nursing care.

It is due to open towards the end of 2014 and will comprise five wings, over three floors accessible by resident lifts.

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14 ÂŚ CMM NOVEMBER 2013

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corporate news

Healthcare Homes Healthcare Homes, an East Anglian-based residential and domiciliary care provider, has announced the acquisition of South Norfolk Carers Limited.

The specialist domiciliary care organisation is merging with Healthcare Homesâ&#x20AC;&#x2122; domiciliary division, Manorcourt Homecare, and will continue

City & County for sale?

to provide home-based care and supported living services to individuals in and around Norwich, Brooke, Bungay and surrounding areas.

South Norfolk Carers is a family-operated domiciliary care organisation that employs 45 people and operates across the region.

Acquisition by Guinness Care and Support Guinness Care and Support has recently acquired Live Well at Home in Gloucestershire.

The acquisition is part of a wider growth plans for Guiness Care and Support to increase its presence in the domiciliary care market, recognising the importance of being able to provide more people with care in their home, so they can remain independent for longer.

Live Well at Home will keep its current name and become a subsidiary of Guinness Care and Support.

Guinness Care and Support already provides care at home services to customers nationally as well as a range of retirement living options, including sheltered housing extra care and residential care homes.

Sovereign Capital has announced that it is exploring its exit options with regard to its investment in City & County Healthcare Group. City & County, the fourth largest provider of communitybased care and support services, was created in 2009 following Sovereignâ&#x20AC;&#x2122;s acquisition of London Care (which also trades as Custom Care), which has been providing domiciliary care throughout the London area since 1995. Since the acquisition, the Group has made 14 acquisitions including: ISS Healthcare, Sterling Homecare, Guardian Homecare, Quality Care Services and Help at Home.

Sovereign Capital, a buy and build specialist is considering an exit after a number of

approaches for the business.

When invited to comment on the rumours surrounding City & County, Julie Sieger, Marketing and Communications Director at Sovereign Capital told CMM, â&#x20AC;&#x2DC;City & County has grown over the last four years to become the UKâ&#x20AC;&#x2122;s 4th largest provider of care at home. (City & County provide 145,000 hours of care per week, have approaching 7,000 staff and operate from 62 branches across England, Wales and Northern Ireland). We have had a number of approaches for the business from possible buyers and are currently exploring our exit options for the business which include a full exit to a buyer or possibly an IPO.â&#x20AC;&#x2122;

Sheffcare Home Care Sheffcare is launching a home care service. Sheffcare operates a chain of eleven residential

care homes across Sheffield, and is taking its levels of care out into the wider community.

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corporate news

Barclays supports Signature Barclays has supported care home provider Signature Senior Lifestyle, with a £14.8m loan to develop new care nursing facilities in Brentwood. The new care home, The Beeches is situated in London Road, Brentwood and features a variety of 99 private studio and one and two bedroom apartments, and will create 150 new jobs in the local area, with a number of nursing roles available.

The Beeches offers a full spectrum of 24-hour residential and nursing care for individuals

and couples, along with assisted living, giving day-to-day support.

Respite and post-operative convalescence care is available, plus specialised dementia and end-of-life care. The care home has been under construction for eighteen months at a cost of approximately £25m.

Signature Senior Lifestyle is currently investing in establishing a series of care facilities located in select areas of the South East to meet growing demand for high quality and specialist care.

Choice Support’s growth The Roy Kinnear Charitable Foundation has joined Choice Support’s group structure initially as a wholly owned subsidiary. The Foundation manages Roy Kinnear House, in Twickenham, which was established in 2000 to provide a home for life for eight

people with profound and complex learning and physical disabilities who need nursing care, a high degree of personal care and significant social support. Choice Support, established in 1984, is a leading national social care charity.

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Orchard Care Yorkshire-based Orchard Care Homes has won a contract to operate 40 care homes in the south of England and Wales building on its existing strength in the North of England and Scotland. This new deal establishes Orchard as a leading UK player with over 110 homes. Orchard Care

Homes won a contract two years ago to manage 40 of the former Southern Cross homes from landlord London & Regional. The transformation in the quality and performance of these homes has led to London & Regional awarding their southern portfolio to Orchard.

Avante branches out Avante Community Support’s strategic plans to ensure business continuity and service delivery demands can be met, has led to the service moving out of its Faversham offices and setting up two new offices; one office in Turkey Mill Maidstone and the other in Erith.

The move at the end of last year to Turkey Mill, Maidstone, has allowed Avante Community Support

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to meet regularly with care staff who work locally in the area, for inductions, updates and training, as well as develop the business in the local area.

Avante Community Support is part of the Avante Partnership is an established charitable organisation providing home care and support in order for people to remain living independently in their own home environment.

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As CMM celebrates its 10th anniversary, we look at the first ever Colliers’ research into care sector KPIs that we published in autumn 2004; Colliers International summarises how and where the market has changed over the years and what factors have driven those changes.

20 ¦ CMM NOVEMBER 2013

,*65640* :;(;0:;0*:

8

Annual GDP growth

3.2%

0.7%

Quarterly GDP growth to December 2004

0.7%

0.7%

Interest rates

4.85%

0.5%

Unemployment rate

4.8%

7.7%

InďŹ&#x201A;ation (RPI)

3.5%

3.3%

National Minimum Wage

ÂŁ4.75/hr

ÂŁ6.31/hr

UK Average House Prices

ÂŁ158,111

ÂŁ164,098

5<9:05. *(9, 796-0; 4(9.05:

Sources: OďŹ&#x192;ce of National Statistics, Bank of England, Haver Analytics, Land Registry, Experian and The Low Pay Commission Wage

.,5,9(3 4(92,; 6=,9=0,> In 2004, itâ&#x20AC;&#x2122;s safe to say that the economic scene was very different from today. The UK economy had grown by 3.2% in 2004 after accelerating in the last quarter (by 0.7%) and interest rates were around 4.85% at the end of the year. Unemployment was at its lowest (4.77%) since 1980 (Experian). The national minimum wage was ÂŁ4.75 an hour and the rate of inďŹ&#x201A;ation or RPI Retail Pricing Index was 3.5%.

Running forward to 2013, we are just starting to see the beginnings of growth. Purchasing Managersâ&#x20AC;&#x2122; Indexes (PMI) data continues to suggest very strong GDP growth in the third quarter of 2013 and forecasters have upgraded their outlooks substantially, including the Organisation for Economic Co-operation and Development (OECD), whose revised views suggest that the advanced economies will be the engines of growth, rather than the emerging economies.

Despite optimism, ofďŹ cial data shows little evidence of improved UK capital formation and investment, crucial ingredients to a sustained recovery and improved occupier market performance.

International M&A activity has picked up slightly providing increased revenue for City ďŹ rms, but domestic facing M&A is still very low.

Consumer Price Index (CPI) and Retail Price Index (RPI) inďŹ&#x201A;ation remain moderate at 2.7% and 3.3% respectively and rising Government debt costs (10 year gilts at 2.8%) suggest that base rates will remain low despite improving economic sentiment. Early signs also suggest that employment rates will climb slowly as existing excess capacity is absorbed.

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05-3<,5*,: 65 ;/, :,*;69 Since 2004, we have seen a number of White Papers and Government regulations put in place to encourage better care standards for the elderly. In 2008, the Government enacted the Health and Social Care Act 2008, modernising and integrating health and social care. The Act set up the Care Quality Commission which regulates health and adult social care in one regulatory body with tough new powers to ensure safe and high quality services.

Social care services are under growing ďŹ nancial pressure as a result of local authority budget constraints. There is also

J CMM NOVEMBER 2013 ÂŚ 21

comparing the KPIs

J

greater demand for services now more than ever; since 2004 the number of people over 85 has risen by two-thirds and demand outstrips supply.

As a result, councils are rationing services by only offering support to people with very high levels of care needs. Those who can remain and be cared for in their homes are being encouraged to do so. There’s very little investment in preventative services and when people do need to arrange care, it is generally due to a crisis in their circumstances.

The Dilnot Commission was set up in July 2010 by the coalition Government, tasked with making recommendations for changes to the funding of care and support in England. It published its report on 4th July 2011, delivering its recommendations on the future funding of care and support including putting a cap on the lifetime care costs that people face, raising the threshold at which people lose means-tested support and providing universal access to deferred payments for people in residential care. The Government has countered with its plans, to be delivered in the forthcoming Care Bill, but what hasn’t been agreed is how the Government will fund it.

The care industry in 2013 finds itself in the midst of bad press over failing care standards and financial difficulties amongst some of the biggest private operators in the industry. Despite this, the market itself is now more consolidated, with a more streamlined product and targeted delivery of care services for the future.

4(92,; *647(90:65: ;/,5 ;6 56> 7LYZVUHS JHYL A comparison analysis of our KPIs from H1 2004 to H1 2013 clearly shows the difficulties that the sector is facing now. Starting with the personal care sector, occupancy rates have declined from 92.5% in H1 2004 by nearly four percentage points to 88.5% in June 2013.

Not surprisingly, the cost of care has increased substantially since 2004 with personal care average weekly fees increasing by more than 55% in nominal terms and in real terms (with inflation taken into consideration) fees have increased by less than 20%.

Rising wage and non-wage costs put pressure on operators. For example, in the personal care sector, payroll costs have increased by almost two percentage points since 2004; whereas non-payroll costs (including fixed and variable costs) have fallen by nearly

three percentage points over the same period. Despite these cost pressures, profit margins in the personal care sector have fared fairly well by remaining relatively stable, falling by less than one percentage point since 2004.

5\YZPUN JHYL Comparing the nursing care sector KPIs in H1 2013 to H1 2004, economic and Government policy pressures are evident in this sector as well. Occupancy levels have fallen by nearly four percentage points since 2004. Although nominal average weekly fees have increased by more than 40% since 2004 in the nursing sector, in real terms average weekly fees have increased by no more than 10%, which is considerably less than the uplifts in the personal care sector.

Nursing wage and non-wage costs have fallen over the period by less than two percentage points across the board. As a result, nursing sector profit margins have increased since H1 2004 by almost three percentage points; indicating that nursing care operators are managing rising costs and declining occupancy levels better than those in the personal care sector.

:WLJPHSPZ[ JHYL Analysis of our specialist care KPIs over the same period shows that occupancy levels have only fallen by less than three percentage points, which is less than the declines in both personal care and nursing.

Specialist care nominal fees have seen uplifts of more than 40% and in real terms by less than 10% putting pressure on operating margins.

Specialist care home operators have been able to keep wage costs down as our analysis shows that payroll costs have declined by less than three percentage points from H1 2004 to H1 2013. On the other hand, non-payroll costs increased by more than 2.5 percentage points over the same period, indicating that rising food and energy costs are having a greater impact on the sector. Despite the cost pressures, specialist care profit margins have remained relatively stable over the 2004 to 2013 time period.

Economic pressures and Government policy have had a significant impact on the elderly care sector since 2004; with operators having to deliver a more targeted and streamlined approach to elderly care to be successful in the sector.

CMM >P[O [OHURZ [V *VSSPLYZ 0U[LYUH[PVUHS (KHT SLU[VU'JVSSPLYZ JVT

KPIS AT A GLANCE PERSONAL CARE • Occupancy rates declined by nearly four percentage points since H1 2004.

• Cost of care increased substantially ‒ average weekly fees increased by 55% in nominal terms ‒ a real terms increase of less than 20% (inflation taken into consideration).

• Rising wage and non-wage costs ‒ personal care payroll costs increased by almost two percentage points; non-payroll costs have fallen by nearly three percentage points.

• Profit margins remained relatively stable, falling by less than one percentage point.

NURSING CARE • Occupancy levels have fallen by nearly four percentage points.

• Average weekly fees have increased by more than 40% ‒ a real terms increase of no more than 10% (inflation taken into consideration).

• Wage and non-wage costs have fallen over the period by less than two percentage points.

22 ¦ CMM NOVEMBER 2013

• Profit margins have increased by almost three percentage points.

• Nursing care operators are managing rising costs and declining occupancy levels better than those in the personal care sector.

SPECIALIST CARE • Occupancy levels have fallen by less than three percentage points less than the declines in both personal care and nursing.

• Nominal fees have seen uplifts of more than 40% - a real terms increase of less than 10% (inflation taken into consideration) putting pressure on operating margins.

• Wage costs have been kept down. Payroll costs declined by less than three percentage points, non-payroll costs have increased by more than 2.5 percentage points.

• Rising food and energy costs are having a greater impact on the sector.

• Specialist care profit margins have remained relatively stable.

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business clinic

COUNCILS RESPONSIBLE FOR PROVIDERS ACTIONS A recent investigation and report from the Local Government Ombudsman (LGO) has warned Councils that they are ultimately responsible for the actions of the care homes they contract with. The advice to local authorities has been made by the LGO following its investigation into Merton Council and Sutton Court Care Centre. that she should not be paying a top-up fee as The LGO received a complaint regarding the contract for the placement was between a care home in the London Borough of Merton which had asked a family to top-up the Council and the care provider.’ the fees of a local authority funded client straight to them and not the local authority. *6473,? :0;<(;065

;/, *09*<4:;(5*,: According to the LGO report, ‘Mrs B needed residential care when she was discharged from hospital in October 2010. The Council provided her daughter, Mrs A, with a list of care homes which accepted the Council’s funding rates. Mrs A identified a suitable home, Sutton Court Care Centre operated by Hydefall Limited (“Sutton Court”) and the Council arranged a placement.

‘Sutton Court arranged separately with Mrs A to recover the full private cost of the placement. Mrs A was not aware at the time

However the situation wasn’t as simple as that. When Mrs B moved into Sutton Court in October 2010 the Council, Mrs A and Sutton Court signed a contract.

At that time it wasn’t clear what Mrs B’s financial contribution would be to her care fees, although it was agreed later that she was not to self-fund her care, but to make a contribution to the cost. Mrs B had a property, which she jointly owned with Mrs A, and there had been some debate and deliberation over the property, its value and whether it should be included in the financial assessment as it was being rented out.

In January 2011, Mrs A received an invoice from Sutton Court for the difference between the Council’s fee for Mrs B’s care (£585.46 a week) and Sutton Court’s fee for self-funding clients (£700 per week).

When the Council wrote to Mrs B in January 2011 and Mrs A in June 2011 it advised what Mrs B’s contribution to her care would be. At which point Mrs A contacted the Council to tell them she’d already been paying the contribution to Sutton Court.

+,3(@: It wasn’t until March 2012 that the Council contacted Sutton Court to remind them that Mrs B was not self-funding her care and that the fee had been agreed in October 2010 as being £585.46. It also advised Mrs A to stop paying Sutton Court, that the

Highlights the importance of clarity

Exposes providers to greater liability

Sarah Pickup Immediate Past President Association of Directors of Adult Social Services

Tabitha Cave, Partner Veale Wasbrough Vizards

What this case demonstrates is the need for clarity among all parties.

Whether councils are responsible for the actions of providers they contract with depends what the contracts are for, whether they are clear and properly in place and whether the actions of the provider are related to the contract and could and should have been foreseen or monitored by the council.

We should not generalise too far from one ruling - commissioners do have some responsibility for the quality and proper delivery of the care they commission and in order to fulfil this responsibility they must put clear contracts in places together with effective monitoring arrangements. Providers are responsible for delivering in accordance with the contract they have entered into.

The issue above is confusion about whether the person in question was a self-funder and whether or not the contract for on-going care was between the individual and the provider or the council and the provider. These are separate questions as a person may

24 ¦ CMM NOVEMBER 2013

be in a position to fund their care fully, but may still be placed by the council at the rates the council pays and the cost would be recovered by the council. So it is not automatically the case that if someone can fund their own care they should be invoiced directly by the provider.

This should certainly not be the case if the contract is between the provider and the council.

There is, of course, an issue about the underfunding of the social care system and, while some differential between the cost of places commissioned by local authorities as compared to individuals can be justified because of the certainty of income for a high volume of places, it is true that sometimes the differential is inexplicable and sometimes unacceptable. However, for me, this case does not particularly serve to emphasise these issues, but rather highlights the importance of clarity of responsibility, including during a period when the position is uncertain, and of efficient communication and administration.

It may be tempting for providers to take some comfort from the LGO s decision and its reinforcement of local authority obligations when placing residents. However, it is perhaps of greater note that the decision expressly prohibits the charging of unlawful third party top up payments by providers. The decision to hold local authorities to account for these and to require them to reimburse monies received in error actually exposes providers to greater liability (including the risk of litigation and legal costs and the jeopardy of lucrative local authority contracts).

It is perhaps understandable (as a lawyer) that my primary conclusion is that this is a salutary lesson about the imperative of clarity of terms and justifiable invoicing. Many care providers offer a combination of local authority-funded and private places. Notwithstanding residents rights to elect to pay top ups to secure the home of their choosing, providers

must take care when finalising contracts and raising invoices, to ensure legal compliance.

Providers are recommended to encourage the payment of a resident s contribution to care or top ups direct to the placing authority and to press the authority to pay the full amount due.

Regrettably, it is my experience that contracts for care are often complex multi-party arrangements, frequently lacking sufficient clarity. With the introduction of new consumer protection legislation next year (and attendant publicity), such contracts are likely to be subject to increasing scrutiny.

I think it likely that local authorities will review their standard terms in the light of the LGO decision and recommend that providers take the opportunity both to review their own contracts (especially those relating to top ups) and invoicing arrangements, in order to avoid embarrassing and potentially expensive mistakes.

business clinic

Council was funding the placement and as such the agreement between Mrs A and Sutton Court wasn’t valid.

A new agreement was then made between the Council, Sutton Court and Mrs B. The terms and conditions were the same as the original contract of October 2010, setting out that Mrs B would be invoiced by the council for her contribution to her care. It was at this point that Mrs A then complained to the LGO.

;/, -05+05.: The LGO investigated and deemed it to be ‘maladministration causing injustice’ because, as Merton Council had arranged the placement, the contract for Mrs B’s care was between the Council and the care provider. Subsequently, it deemed that according to the law, ‘the actions of the care provider in carrying out these arrangements shall be treated as actions of or on behalf of the Council.’

;/, 9,:765:, The Council responded to the investigation by saying that Mrs B should never have been charged top up fees as the contract for care was always between the Council and Sutton Court. It says the home was not acting on its

behalf as it had acted ‘outside of the scope of the contract and authorisation from the Council.’ ‘In these circumstances it [the Council] cannot be held responsible for refunding monies paid directly to the home.’

However, Sutton Court said, ‘it has not acted wrongly, because, at the time of invoicing, Mrs A was subject to a 12 week disregard. It understood Mrs A had a home to sell and would be a privately funded client. It says the Council “does not accrue the debt arising between the quanta of the Council rate and the private rate and therefore the Home has to bill this direct”.’

The LGO also explained that, ‘The provider has also referred to delay in the Council’s administration, uncertainty over the value of the house and when it might be sold, and maintains that the provider is entitled to charge the full private rate for part of the period covered by the complaint.’

Dr Jane Martin, Local Government Ombudsman, commented, ‘I know from the many complaints that we receive that this is not an isolated case. The law is clear: it says that the actions of the care provider in carrying out these arrangements shall be treated as actions of or on behalf of the Council.

‘Therefore I hold the Council responsible for the actions taken by the care home provider in seeking to extract extra

funding from the family. I hope my report will serve as a warning to other councils that they are responsible for any contracted providers’ activities, whether they have instructed them to act or not.’

;/, 9,:63<;065 Merton Council has agreed to work with Sutton Court to reimburse Mrs A for top-up charges. The LGO recommended that the council make all parties that it contracts to provide care on its behalf aware that they cannot charge extra fees for the same care directly to the service user or their family.

Over to the experts...

This case sets out the many factors involved in funding care and highlights the differences between council and private-pay fees. Clarity is needed between all parties as to who is responsible for paying which aspects, and when there are many different factors it can be difficult to decipher. With the LGO saying that councils are now responsible for the actions of the homes it contracts with, how many more cases are going to come to light? Can care providers take no responsibility in these circumstances?

Highlights the complexities of the system Judy Downey Chair The Relatives & Residents Association This case follows a previous LGO case in 2012 criticising Southampton City Council for similar failings. It also highlights the resistance of many local authorities (LAs) to fully publicise and enforce the legislation on choice of accommodation or intervene in private arrangements with care homes.

The Sutton Court case doesn t come as a surprise, given that last year nearly a quarter of all those who contact our helpline, did so specifically about this issue. Current figures continue this worrying trend.

A caller from Shropshire, again inappropriately charged a top up fee, was advised by us to challenge the council using the information we provided. He eventually took the matter to the LGO who investigated and the county was told to repay these charges and to make changes to its financial assessment process.

The LGO also asked Shropshire County Council to review all similar arrangements it had on record and to make public its problems with this assessment process. However, many of these arrangements are

unofficial, happen by default and not recorded by adult social care departments.

This latest decision could provide extra protection to those receiving LA support, as it makes clear that the responsible LA should no longer ignore these arrangements.

However, the LGO has no powers to enforce its decisions and they don t form the basis for case law.

The case once again highlights the complexities of the care system for the ordinary person and the various different and overlapping complaints procedures.

Neither the LAs nor the LGO have powers to investigate and take action against providers who act in this way. Only CQC, which has the legal power to take enforcement action. Ironically CQC maintains that it does not and cannot investigate individual complaints. Given that it is a regulatory requirement for providers to protect the resident from abuse, which should include financial exploitation, it is not clear whether the LGO or Merton Council also reported the home to the CQC, but one hopes so.

CMM NOVEMBER 2013 ¦ 25

60 seconds with...

60

SECONDS WITH...

PROFESSOR MARTIN GREEN OBE AND SHEILA SCOTT OBE

WHY HAVE YOU DECIDED TO MERGE? We decided to merge because we were increasingly having the same position on policy and we believed that by merging, we could strengthen the voice of the independent care sector.

We also believe that this is a critical time for the health and social care sector and the potential of what our services could do is not well understood by either health or social care commissioners. We believe that by joining forces, we will have a stronger platform to show what current services do and we will be better able to show the potential of care services to deliver on the integration and well-being agenda.

WHAT ARE YOUR HOPES FOR CARE ENGLAND? We believe that Care England will be established as the Premier Representative body for care and because we will represent by far the most significant part of the sector, we will have greater strength and influence.

We believe that our current memberships, when combined, will be even more powerful than we are separately and it is our hope that more people will come forward and join us in the future.

We believe Care England will offer such tangible benefits to care providers that we will attract more support. The more people who join us in our crusade to improve the image and working environment for the care sector, the more successful we will be.

26 ¦ CMM NOVEMBER 2013

Professor Martin Green OBE and Sheila Scott OBE are CEOs of Care England, a merger of the National Care Association (NCA) and the English Community Care Association (ECCA), the two largest social care provider representative bodies.

WHAT DO YOU SEE AS THE MAIN CHALLENGES YOU LL BE DEALING WITH? The main challenges that we will have to deal with will be: • The funding of care.

• How to ensure high-quality and proportionate regulation.

• Challenging local authorities who are very poor commissioners and who underfund care services.

• Developing and enhancing the status and professionalism of the care workforce.

• Ensuring an environment where innovation can develop and flourish.

• Working across the interface of health and social care services.

WHAT IS THE BENEFIT OF THE MERGER FOR YOUR MEMBERS AND THE SECTOR AS A WHOLE? We believe that there will be several benefits for our members as a result of this merger. We will represent a large portion of the sector and this will give us enhanced credibility and a stronger voice. Care England will unify the member benefits of both organisations and make these available to the membership of the new body.

We will have a much more efficient use of resources, enabling us to focus our efforts on membership benefits. We hope that more of the sector will join us and strengthen the voice CMM of Care England.

Attracting self-funders In conjunction with the Care Show, CMM brings you advice on how to attract, reach and ensure you meet the needs of self-funding clients.

When it comes to clients who pay for their own care, self-funders are unique. As Katryna Quiggin, Director of Pilgrim Consultancy Ltd explained, ‘Broadly you could say that they are likely to be looking for quality care, value for money and the right location. Each of these facets will be underpinned by the customer’s individual perceptions and experience – what some consider good quality may not be the same for others. Ultimately the search for a care solution is

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CMM NOVEMBER 2013 ¦ 27

attracting self-funders

J highly personal and subjective.’

It’s a decision that can be made at a difficult time and you need to be aware of that. David Huckerby, Director of GD PR & Media Ltd recommends that you should understand the pressures faced by families finding care for loved one, especially at time of crisis, ‘Unfortunately, there is still a lot of guilt attached to accessing care and support for loved ones, hence people placing relatives want to know that the fundamental areas of life are well catered for – safety, security and engagement.

‘Put yourself in each person’s position and consider what you can do that is going to make their life easier. That may be in the form of information, support or hands-on care provision at short notice. Whatever it is, by making your service easily accessible and straightforward, you will certainly be considered – accessing care is daunting at any time, let alone in a crisis situation, so people tend to have loyalty to those who they feel have bent over backwards to help them.’

6;/,9 05-3<,5*,: There are so many factors that influence decisions and people want to know what they are getting for their fees. This could include company ethos and integrity, the credibility of management and the competence and confidence of staff. Claire Patrick, Business and

Talent Development Director at Primocare+ adds, ‘Above everything else, clients want trust. For example, if someone from the organisation says they are going to do something as simple as return a phone call, they do it; otherwise it erodes trust and undermines other areas.

‘Empathise with and normalise any emotions attached to the decision, after all this is a major life transition for all concerned, family members, friends and the potential resident. Keep in touch with them, ensure they experience a friendly, welcoming environment and make sure that all care staff understand how important the first impressions are. Encourage them to engage and be friendly. If care staff think “it’s not my job” to handle enquiries that’s a sure fire attitude to turn families away and give an irrevocable impression that staff only care about their area of responsibility and not what is ultimately most important, the resident and family.’

/6> ;6 9,(*/ ;/,4 Before you can attract clients you need to know who they are. As David explains, ‘How to reach a client can very much depend on who your actual customer is – many providers are now adopting a dual approach, firstly targeting relatives who may be organising care for their loved one and secondly, the actual recipient of care themselves.

‘A mixed approach can be

beneficial, as where these two groups find information may differ widely (online and offline). It is also important to monitor where you do pick up enquiries, as you will get a feel for what works and where to focus your resources.’

As well as a good website, looking at specialist print publications is a must. Many local authorities produce directories of care services, which are handed out to enquirers and care seekers through local authority customer centres, social care departments, GPs and local charities. Advertising within these will get you straight to the hands of the care seeker and/or their family.

9(0:05. (>(9,5,:: When people begin to look for care it is usually driven by need. It could be a change of circumstances, the death of a partner, an illness or clinical diagnosis; as such, you need to ensure potential customers are aware of you and the service you offer.

‘Remember that people usually look within a 20 mile radius of where the family lives so make sure people know you exist in their community,’ advises Claire.

‘As such, good signage is vital. It ensures that everyone locally knows you exist. Work to make your home the central hub of your community by arranging regular events and sending out PR to get editorial in the local magazine or newspaper.

Network with clinical professionals, a large number of referrals come from social services and hospital discharge teams, but think about getting a good relationship with other centres of influence in your community. Consider whether you are an active part of the community or outside of it.’

:;(5+ 6<; -964 ;/, *96>+ If you operate in an area with a number of different care homes you need to make your service stand out. Claire advises, ‘This isn’t tough – work on your customer experience, train staff to go the

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28 ¦ CMM NOVEMBER 2013

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Get back to what really matters, delivering great care Caresys from Advanced Health & Care is the complete care home management system trusted by over 3,000 care homes across the UK. Come and see how we can help you get back to delivering great care at The Care Show Birmingham Stand F52

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CMM NOVEMBER 2013 ¦ 29

attracting self-funders

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extra mile and above all, do something today. People want to know if the facilities are appropriate to their loved one, if they are clean and welcoming, and how much it costs. Many people making care decisions are struggling with a number of personal emotions. If you help to address those emotions you will stand out. You need to listen and really understand the experience they are going through and what they need.’

A care home is ultimately a home so it needs to be run by real people.

David adds, ‘People like to get to know the real people who will be involved in their loved one’s care and it builds trust with potential

attract clients, without an ability to convert them to customers it is wasted. Ensure every person that answers the phone can speak for the business; be open, honest and informed about the service. It’s important to be empathetic and, when people come to view the home, the person showing them round needs to build a rapport.

Putting people at ease will leave a lasting impression.

Make sure you follow up on all visits, successful or unsuccessful.

Katryna explains, ‘In practice, regularly seeking feedback from current customers about their experiences – both good and bad; building on the good and

¶,I \RX RSHUDWH LQ DQ DUHD ZLWK D QXPEHU RI GLIIHUHQW FDUH KRPHV \RX QHHG WR PDNH \RXU VHUYLFH VWDQG RXW· customers. For far too long, care providers have been afraid to shout about their strengths and tell people their good news, for fear of being exposed if things go wrong. This has left the sector playing catch up after having been painted in a terrible light (due to a small number of isolated negative incidents) in some areas of the media. If you believe in the quality of the service you provide, you should be confident in telling people how good it is.’

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30 ¦ CMM NOVEMBER 2013

recognising the bad – can help lead to improvements in ways of working, conditions, facilities etc.

This will help to sustain or improve your market position.’ Keep in touch with enquirers and allocate that responsibility to someone so you know it is being done. As David shares, ‘This will allow you to see your service through other people’s eyes and to improve your offering’.

‘This is such an important factor for care service providers’, finishes Katryna, ‘The service is so personal that relationships between staff and customers are the key to care provider success. There are just a few touch points with potential

customers – often referred to as “moments of truth”. It is important to plan for these small interactions to ensure that the customer has a positive experience every time they come into contact with you.

‘If you add up their contacts prior to making a decision about where to stay, you’d be surprised at how few there really are – perhaps a handful of phone calls and a face to face visit (where they speak to whoever happens to be there at that time). To make these interactions matter involves everyone in the company. Why not invest in some training to ensure that, not only the receptionist, nurses and managers are friendly, but also the cooks, cleaners and maintenance staff. Offering a welcoming smile, exchanging pleasantries, holding a door open, and staff demonstrating they take pride in their work, will ensure that a positive impression is provided. Make every moment matter – as they are in short supply.’

In a time when local authorities are able to support reducing numbers of people, attracting the self-pay market is essential. Set out your core values and be true to them in all you do. Be consistent in your approach, be open, honest and most of all, be visible in your market through events, advertising, PR and a clear indication of where you are located.

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predictions APRIL 2005 Consolidation and growth Several large deals are under negotiation but pace of acquisitions has to slow down; simply due to the lack of major acquisition targets. Big groups will continue to target medium-sized groups. Big and medium-sized groups will continue to target small groups and individual homes. There will continue to be organic growth for smaller operators.

Building activity High land and building costs will be unlikely to facilitate substantial new building in the short term.

Supply and demand Shortage of long-term care facilities will remain for several years.

Simple economics of demand and supply suggest that returns will remain good at operational level.

Prices paid for established businesses will remain high with competitive bidding for attractive opportunities.

EARLY 2008 PRIOR TO THE FINANCIAL CRISIS There is likely to be a slowdown of the economy. A slowdown or fall in the housing market.

Tighter bank lending criteria. Investors will remain but will be cautious and have one eye on their public image and regulation.

There will be a continued or accelerated quest for purpose-built accommodation with higher specifications.

The pace of development of new care facilities to continue at accelerated level, further boosted by diminishing competition for land from house-builders.

JULY 2010 S PREDICTIONS FOR 2015 No-one in 2010 could ve expected the wide-ranging changes coming into force with the Care Bill in 2015, so what were we predicting in 2010?

Market 2015 will probably be at the beginning of a new period of growth for the sector, with leaner companies gearing up to replace lost bed stock and meet rising demand.

The future of older, underfunded, underinvested care home premises is limited. As the housing market will show signs of sustainable recovery, the exit route from the care sector into conversion for residential use will prove to be the path of least resistance.

Larger care home estates could be broken up into good estates and bad estates due to their ageing property assets.

Pressure on small operators, especially in serving local authority funded residents or in older, converted homes. With difficulty protecting margins against minimal fee increases combined with wage cost and inflation.

More organic growth and consolidation of operators as larger corporates increasingly target growth to achieve central cost-efficiencies to protect margins.

Lending The average cost of funds has risen and the multiple that parties are willing to pay has fallen back to nearer the norm that pertained during most of the last 50 to 60 years.

There will be pain as lenders readjust their books and they, together with investors take a more

32 ¦ CMM NOVEMBER 2013

layout one

looking back future from the

CMM rounds up policy, news and predictions from the last 10 years.

balanced view of risk and reward in health and social care markets.

Banks will take a firmer line on operators whose borrowing in periods of rapid growth has left them in a position where their gearing is unsustainable at current values.

Funding The coalition Government, tasked with making significant inroads into the national debt, will put a squeeze on funding and fee rates.

Substantial squeezes on local authority funding of residential care.

Increasing eligibility criteria, with homecare as model of choice.

100% block-contracting and partnering with local authority/planning bodies around availability of land.

An increase in financial products enabling aspects such as equity release.

Models of care Budget models for homecare and care homes (Travelodge-style).

Two-tier system ‒ budget care home accommodation/homecare services for pure local authority payments, and differentiated quality services for those able to subsidise care with top-up payments/pure private pay.

Private homecare and assisted living growth.

Regulation Regulation could return to local authorities.

Regulatory change coupled with pressure on fee levels could see a sustained period of bed loss.

Increasing regulation in homecare and supported living.

Specialist care The level of acuity in supported living will continue to increase.

A greater proportion of service users will continue to be funded by supported living budgets rather than residential care budgets.

The number of people with learning disabilities living outside the family home will continue to increase as their family carers age.

CMM NOVEMBER 2013 ¦ 33

looking back from the future

news - some things never change…

FEBRUARY 2003 Research reveals that the Government s allocation for older people s services for next year is £797m less than the £5.69bn amount for 2002/2003. This means that local authorities should anticipate cuts to their funding for older people s services next year.

A new report by the National Audit Office reveals that more than 4,000 people over 75 are fit enough to leave hospital but are unable to do so, thus blocking hospital beds whilst appropriate care is found for them.

then to now How have the Registered Nursing Care Contribution and National Minimum Wage risen over the last decade?

April 2003 NHS Nursing Contribution rises from: Low - £35 per week to £40 per week Moderate - £70 per week to £75 per week High - £110 per week to £120 per week April 2013 Registered Nursing Care Contribution is £109.79 per week.

October 2003 National Minimum Wage rises from £4.20 per hour to £4.50 per hour.

October 2013 National Minimum Wage rises from £6.19 per hour to £6.31 per hour.

34 ¦ CMM NOVEMBER 2013

looking back from the future

Here today, gone tomorrow Regulator roundabout April 2002 ‒ National Care Standards Commission came into being two years after it was established in the Care Standards Act 2000.

17 days later it was announced that it was to be abolished under the Health and Social Care Act 2003. Legislation was introduced in March 2003 to establish the Commission for Social Care Inspection.

April 2004 ‒ Commission for Social Care Inspection took over regulation of the sector.

April 2009 ‒ Care Quality Commission came to being after a merger between Commission for Social Care Inspection, Healthcare Commission and Mental Health Act Commission as announced under the Health and Social Care Act 2008.

Star ratings Star ratings were proposed by the CSCI in 2006 to be implemented from June 2007, however, it wasn t until May 2008 that they started to be awarded. The ratings which graded homes from poor to excellent received mixed reviews from the sector. It was hoped they d give the public clear and easily understandable information about the quality of care, as judged by CSCI. However they didn t last long and stopped running them June 2010.

There is an intention to reintroduce a quality rating system in the future.

Eligibility criteria April 2003 Fair Access to Care Services introduced a non-negotiable framework of eligibility for bands of need . Its aim was to ensure local authorities treated individuals consistently and since then needs have been assessed as critical, substantial, moderate and low with most local authorities now only supporting those in with critical or substantial needs.

July 2012 the White Paper Caring for our future: reforming care and support committed to introduce a new national approach to eligibility, with national minimum threshold for eligibility that applies in all areas of England. This is to be introduced in April 2015 subject to the passage of the Care Bill through Parliament.

FOR BETTER OR WORSE Care Standards Act revisions and exclusions Care Standards Act 2000 set up the National Minimum Standards for care homes in England and Wales. Although a good minimum standard for care they faced numerous revisions between 2002 and mid-2003. Some environmental standards, which forced providers out of the market or to make costly changes to their homes, were then amended to exclude any homes built before April 2002.

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CMM NOVEMBER 2013 ¦ 35

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SPOTLIGHT ONâ&#x20AC;Ś medication management, pharmacy services and training CMM turns its spotlight onto care sector medication management, pharmacy services and training to help you ensure that you meet the medication needs of your clients.

CMM NOVEMBER 2013 ÂŚ 37

spotlight on… medication management, pharmacy services and training

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ACC provides training, learning and development solutions for those who care for older people. Awarded Centre of Excellence status by the National Skills Academy, we believe that we offer the most powerful training available to care companies in the UK today.

Our approach is to use high definition films and the power of storytelling to convey key messages that will engage, inform and inspire care staff to deliver high quality care for older people.

based on real events and the programme examines a range of common challenges in the administration of medication and the monitoring of people who are taking medications.

Designed for viewing in a facilitated group session or as an individual learning solution through our online platform, the ACC programme on medication management provides care workers with high quality training to ensure the safety of vulnerable older people.

Our programme on medication management was filmed through three scenarios

Telephone: 01908 802808 • Email: sascott@acctv.co • www.agedcarechannel.co.uk

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We have over 70 years’ experience of care in the community and now have 14 pharmacies across Gloucestershire. The main elements of our free services are:

• Nine delivery vans able to collect and deliver prescription medication, same day service guaranteed.

• Ordering, collecting and delivery systems for client prescriptions.

• Free supply of medication trolleys and fridges to care homes.

• Dedicated technician to support each home.

• Complete package which includes the supply of all incontinence, stoma and catheter products.

• An extensive range of mobility products and aids for the disabled at the most competitive prices.

• Lightweight, biodegradable storage systems designed to accommodate all solid dosage forms of medication.

• Free nationally accredited training modules.

• Seven day service, 24 hours a day.

Telephone: 01242 676 569 • Email: pss.badham@badhampharmacy.co.uk • www.badhampharmacy.co.uk

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The Biodose monitored dosage system is the world’s only medication management platform to accommodate liquid medicines alongside tablets and capsules. Engineered to increase dramatically medication adherence, Biodose also reduces the risk of medication errors as all medication is pre-measured, dispensed and sealed before it leaves the Biodose pharmacy.

Biodose enables homes to boost their efficiency, cutting round times by 20%*. Rated by 85% of pharmacies** as ‘better’ or ‘much better’ than any other medication management device, Biodose remains the ‘best in class’ monitored dosage system available. Biodose combines a superior, photographic medication administration record with ingenious personalised packaging and the expertise of your local independent pharmacist. Altogether, a smarter solution to issues of adherence in care. * Case study of Dolphin Manor, near Leeds, home to 35 residents. ** Survey of 189 UK pharmacies using Biodose, May 2013

Telephone: 01260 292840 • Email: info@biodose.co.uk • www.biodose.co.uk

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Boots can offer your care home: • Free access to our e-learning website, with an evergrowing resource of information and training, including: - Diabetes, to help carers and nurses build an understanding of residents’ condition and their needs and to give great care to residents with diabetes.

- Care of Medicines foundation and advanced level courses, accredited by the Royal Pharmaceutical Society.

- Domiciliary care.

- Medicines handling systems training:

• • • • •

Pharmacist advice visits, including antipsychotic medication audits where appropriate.

Expert support and advice from your dedicated care services team.

Dedicated, purpose-built, care service rooms in our stores.

28 day delivery of medication.

Daily delivery of medication with two cut off times to meet emergency and mid-month medication requirements; we can supply the majority of our customers on a Saturday.

• Advice and support seven days a week.

• Free prescription management from collection to delivery.

Telephone: 0115 949 4047 • Email: care@boots.co.uk • www.boots.com/carehomeservices

38 ¦ CMM NOVEMBER 2013

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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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The Future of Learning Disability Care 4HE 2ENAISSANCE (OTEL -ANCHESTER - %1 s TH &EBRUARY

Now in its 6th year, this national conference is once again bringing together the most influential organisations to explore current and future developments in this specialist sector. #/.&)2-%$ 30%!+%23 Alan Rosenbach, Care Quality Commission Margaret Flynn, Safeguarding Lancashire Sally Warren, Paradigm

Lisa Hopkins, Dimensions Steven Rose, Choice Support Sarah Maguire, Choice Support

PROGRAMME WILL INCLUDE: • CQC s progress in transforming care for people with learning disabilities • Overview of the market and provider opportunities • Positive behaviour support

WHO SHOULD ATTEND? • Local authorities • Property consultants • Major providers • Solicitors • Independent specialist providers • Major lenders • Suppliers to the sector • Insurers • Providers of supported living

To find out more, call 01223 207770 or email info@caremanagementmatters.co.uk www.caremanagementmatters.co.uk/events.asp

Book two places at the same time and receive A DISCOUNT ON THE second ticket price.

Please mention CMM when booking your place.

sponsors include:

SPONSORSHIP AND EXHIBITING OPPORTUNITIES AVAILABLE CMM NOVEMBER 2013 ¦ 39

spotlight on… medication management, pharmacy services and training

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Addressing the crucial area of medication, this DVD covers the key elements staff should be aware of when dealing with medication. Mapped to Common Induction Standards, NVQ learning points and the new Skills for Care Knowledge Set, this will prove to be an invaluable training resource.

This DVD covers, in clear language, good practice as well as legislative and technical information. It can be used for basic awareness or for full training in the administration

of medication. All BVS DVDs are CPD accredited and are accompanied by further training resources, such as lesson plans, hand-outs, Q and A sheets and certificates.

Some of the key subjects covered include: an introduction to legislation • roles, responsibilities and boundaries • types of medicine • ways medicines are administered • safe practice • storing medication safely • monitored dosage systems • maintaining medication records

Telephone: 0845 644 2866 • info@bvs.co.uk • www.bvs.co.uk

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Care Homes are coming under more pressure to deliver higher and higher levels of care to residents, therefore needing systems that are accurate and easy to use.

We have developed a system that will help a care home provide better medication management in their homes.

Our system is simple and just requires for a carer to scan a unique barcode each time they give a medication administration.

Resident’s picture and care plan details are shown on screen with a picture of every medication to be taken at that administration time. This then allows the carer to easily register if a resident has taken their medication at that administration time.

All details of each administration are stored for viewing at a later date, detailing each action taken for the complete round.

This system reduces errors, speeds up administration rounds and provides detailed reports for the management team.

Telephone: 0845 094 7963 • Email: enquiries@medmanagement.co.uk • www.medmanagement.co.uk

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This new trolley to the Norseman range will hold up to 12 hangers with further shelf space for laptops, pens and dispensing.

The strength of this trolley is in its versatility – simply remove the shelves and you can add sectioned trays that can be used for original pack medication or add hanging brackets to hold blister packs hanging from the back of the trolley.

There is a door on each end (both operated with the same key) and each half of the trolley can be set up independently of each other, ideal for separating permanent residents from short stay. The biggest advantage of this trolley is the capacity and value, at only £450 (+VAT) they are much cheaper than buying two larger trolleys that take up far more space. For further information, please quote trolley code 12NHT when you phone.

Telephone: 01132 566556 or 07561 102104 • Email: phoughton@norsemandirect.com • www.medstrolleys.com

40 ¦ CMM NOVEMBER 2013

spotlight on… medication management, pharmacy services and training

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For those on a complex pill regime, taking prescribed medication at the right dose and at the right time can be confusing and difficult.

Not taking medication as prescribed can have major consequences, particularly if the person is elderly or vulnerable.

A key benefit of Pivotell automatic pill dispensers is that they make the correct dose, and only the correct dose, available at the correct time. All other pills are safely locked in

the dispenser out of sight, helping prevent an incorrect dose or an overdose being taken.

Pivotell dispensers have been continuously developed over many years - there are now four models to suit different individual’s needs. The newest Pivotell Advance GSM dispenser includes a GSM module and will send e-mail and text alerts to family members or carers if, for example, medication is not taken on time. This enables an early response to be made which might prevent an adverse event occurring.

Telephone: 01799 550979 • Email: office@pivotell.co.uk • www.pivotell.co.uk

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A new guide to medicines management and older people is now available from Rosemont Pharmaceuticals.

Called Medicines Management and Older People – a Guide for Healthcare Professionals, the booklet includes sections about how medication works, the ageing process and medicines, common adverse drug reactions, definitions of compliance and concordance, as well as an overview of some of the legal

aspects of medicines management.

The content of the guide is based on current best practice and contains the most up-to-date evidence about medication management. The focus is on the care of older people, who have a higher prevalence of illness and take around 50% of all prescribed medicines.

Telephone: 0113 244 1999 • Email: marketing@rosemontpharma.com • www.rosemontpharma.com

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At Superdrug, we recognise that medicines management in a care home can sometimes be a little confusing and a bit of a chore. We have developed a pharmacy service that supports you in managing medicines in the right way, making things easier for you, as well as meeting all the regulator requirements.

We also have a network of in-store nurses. Our pharmacists know about medicines and our in-store nurses know all about what’s important when providing care. As a team, we have time for you, to offer professional and expert help, as well as friendly and approachable service – no other pharmacy chain can give you that. If you are looking for an e-medication administration record solution to support with medication ordering, checking in and administration, we can help with that too. To find out more, pop into one of your local Superdrug stores with a pharmacy or contact our central team.

CMM OCTOBER 2013 ¦ 42 Telephone: 0208 683 5415 • carehomes.superdrug@uk.aswatson.com • www.superdrug.com

CMM

COMING UP IN 2014 WE WILL BE BRINGING YOU:

CAREMANAGEMENTMATTERS

DECEMBER - Spotlight on…training providers FEBRUARY - Who’s who…legal services MARCH - Spotlight on…nutrition APRIL - Spotlight on…nurse call systems and assistive technology MAY - Who’s who…construction JUNE - Spotlight on…software JULY - Who’s who…property Do you offer one of these services? Do your products fit within these categories? Find out how you can feature in a future issue of CMM. Call Tracey on 01223 206956 or email tracey.diplock@carechoices.co.uk ^^^ JHYLTHUHNLTLU[TH[[LYZ JV \R

42 ¦ CMM NOVEMBER 2013

CareFirst

from

LloydsPharmacy Morning...

Noon...

...and Night

Improve patient care

Get time back to spend with patients

Improve bed occupancy

Helping you put residents first As part of the our new CareFirst service, eMAR is designed to integrate with your electronic care planning systems, to help you manage your residents’ often complex medicine regimes, which can be a time-intensive, complicated problem.

Morning, noon or night, eMAR is an easy to use, paper-free medicines management system that puts carers in complete control.

As an Electronic Medicines Administration Records system, eMAR makes resident records, schedules and treatments available on a tablet computer at the touch of a screen.

The medicine round becomes a quicker and simpler task, with reduced risk – offering managers a detailed oversight of all activity, while giving carers back more quality time to spend with residents.

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At the same time, it dramatically improves your operational performance, helping to achieve your occupancy targets through strict compliance with CQC’s Outcome 9 and Scotland’s Care Commission requirements.

Specifically designed to help you save time and money, eMAR radically simplifies medicines management – so you can focus on the wellbeing of residents, and the growth of your business.

To find out more, call for a FREE eMAR assessment on 02476 432117 Or visit lloydspharmacyservices.co.uk/putcarefirst

-EETING THE DESIGN DEMANDS OF DEMENTIA

44 ¦ CMM NOVEMBER 2013

#ARE STANDARDS ARE CHANGING AND WITH THESE THE DELIVERY OF CARE AND THE FACILITIES TO DO SO EFFECTIVELY MUST CHANGE TOO +EVIN 7HITEHEAD CONSIDERS WHAT IS NEEDED TO MOVE THE SECTORjS BUILDINGS FORWARD TO CARE FOR THOSE WITH DEMENTIA The bulk of the UKâ&#x20AC;&#x2122;s care homes are operating from old buildings.

The majority are either period conversions or local authority stock that has been sold into the private sector. These homes were designed to meet previously deďŹ ned standards and perceived need, based on good practice and the residents who used them.

These facilities focused on the care of older people, without speciďŹ c conditions beyond general old age and frailty. However, this type of â&#x20AC;&#x2DC;retirement homeâ&#x20AC;&#x2122; is becoming a thing of the past as specialist care requirements outpace general needs care. Older people are, more often than not, being admitted into care settings with some form of dementia. This, along with, an indisputably ageing population, lack of hospital beds and our developing understanding of dementia as an age-related condition, have all combined to focus our increasing demand for a very different type of care facility. One that is able to enhance the lives of residents with dementia, not inhibit it.

Older facilities, wherever possible, must now be redesigned and reinvented, according to the new agenda for care provision in the UK. In the Royal College of Art report Design for Dementia, it is recognised that, â&#x20AC;&#x2DC;The vast majority of care home residents in the UK have a form of dementia. More than a third of these residents are not staying in facilities speciďŹ cally designed for their needs.

Many homes have been adapting existing environments that are not up to date with current thinking in the ďŹ eld.â&#x20AC;&#x2122; As the focus shifts ďŹ rmly towards a spiralling demand for dementia care, standards are set to change.

;/, .96>;/ 6- +,4,5;0( *(9, Dementia care itself has seen considerable growth over the last 20 years. The condition currently affects around 700,000 people in the UK and costs the health service more than cancer, heart disease and stroke put together. Around 25 per cent of people in hospital beds at the moment have dementia. The scale of the problem has emerged in direct correlation to advances in medical science, which are enabling longer life.

With such a broad range of indicators and severity of the condition, there is a need for facilities that can support residents at either end of the spectrum and anywhere in between.

The majority of people living with dementia remain in their own homes, accessing healthcare facilities and other buildings on a regular basis. The cost of dementia care means there is a drive by central government and local authorities to keep people in their own homes. Here the condition can be managed effectively with support from day clinics, clubs and social community events. These provide both support and a degree of respite care. Therefore, dementia friendly design in non-dementia speciďŹ c buildings is also an important consideration.

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CMM NOVEMBER 2013 ÂŚ 45

meeting the design demands of dementia

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Those who suffer a greater degree of cognitive disruption may respond better in the care of a dedicated care home. Dementia presents an extremely complex set of impairments, from memory loss and the ability to learn, problems with perception and reasoning, as well as high levels of stress and anxiety. These are compounded by the usual problems associated with ageing, such as sight, hearing and physical impairment. Research shows that cognitive impairment affecting people with dementia can be aggravated by building design. New and existing buildings, wherever possible, need to incorporate design that minimises some of the adverse effects.

According to the Kings Fund’s Developing Supportive Design for People with Dementia project, ‘Appropriately designed environments have the potential to reduce the incidence of agitation and challenging behaviour and the prescription of antipsychotic medication, promote independence, improve nutrition and hydration, increase engagement in meaningful activities, encourage greater carer involvement as well as improving staff morale, recruitment and retention all of which contribute to a reduction in overall service costs.’ From the point of view of the person with dementia and the business, these are outcomes that can benefit everyone.

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Guidance on the optimum environment for dementia sufferers is currently being drawn up. The draft document, presented by Emeritus Professor Mary Marshall from the University of Stirling at the Design in Mental Health Conference and Exhibition in May 2013 calls for simple spaces and interior environments with noise reduction panels and soft furnishings. For example, floor coverings need to be consistent in nature. A person may have developed problems with depth perception and other visual processing issues, making any pattern on the floor appear to be a trip hazard. Such momentary confusion can lead to trips and falls.

Whilst the sector awaits new guidance from the University of Stirling, there are some existing tried and tested design approaches for the care environments of people with dementia.

>(:/9664 (=(03()030;@ (5+ ,(:, 6- <:, Continence issues can also be supported through improved design. Plenty of washroom facilities that are easy to find, access and use will help to reduce unnecessary dependence on staff.

Likewise, ease of movement around a building will ensure people can reach the washroom when they need to. Therefore, the design of rooms and corridors needs to consider wheelchair users, as well as those walking with a frame or stick.

(**,:: ;6 6<;:0+, :7(*, Research has also found that access to outside space plays an important role in the palliative care of dementia sufferers. Both new and existing buildings should incorporate easy transition from inside to outside, including level walkways and handles that are simple to use.

Sunlight has its own benefits, such as vitamin D, while exercise

46 ¦ CMM NOVEMBER 2013

can reduce some of the effects of dementia. The need for gentle exercise can be supported internally through building design too.

There has been a growing trend for ‘racetrack’ corridors in recent years. These enable people to walk continuously without facing an obstacle such as wall or fire exit.

However, care professionals are now finding they encourage aimless walking that elevates stress and causes dehydration.

The preference is for incorporating things to do and see within corridors – such as pleasant views and vistas, fish tanks and areas to sit.

-66+ (5+ ,(;05. (: ( *<3;<9(3 ),5,-0; As our understanding of dementia grows, food is considered an important cultural experience, as well as a nutritional requirement. While there is typically a very low expectation of mass catering, this must be reversed in the specialist dementia care environment. People with dementia can often take longer to eat, have trouble with co-ordination and, in some cases, have difficulty swallowing. Mealtimes, therefore, place stress and a high demand on care workers’ time. Design that incorporates the infrastructure to enable residents to participate in food preparation can provide a more vibrant, inclusive and beneficial culture for both residents and staff.

-05(5*05. 9,-<9)0:/4,5; (5+ 5,> *65:;9<*;065 There is clearly a need for more, better and specialised care, but who will pay? In the future, a reduced working population will have to bear the pressure of the financial burden. The right consultation on what must be done for existing buildings, as well as the design and construction of new buildings can ensure longer term sustainability or future-proofing of care homes.

>/(; 796=0+,9: *(5 +6 The Kings Fund’s Is your care home dementia friendly? EHE Environmental Assessment Tool is useful for enabling you to look at your service from the point of view of dementia residents and assess where you could make small differences to benefit those you care for. It looks at operational as well as design approaches including keeping the home free from clutter, ensuring there is adequate signage to the toilets that can be seen from all areas. For those who are unable to take on large-scale renovation or design works, these easy to implement changes can be achieved quickly with minimal financial outlay compared to full renovation works.

Essentially, we face a demographic and dementia time bomb.

This growing pressure has focused attention on the provision of care and the facilities currently available to deliver this. Existing facilities must be in a position to meet higher standards and improved understanding of good dementia care. Meanwhile, more facilities must be built, with the right level of investment, design consultation and medical knowledge to deliver better care in the longer term. This will, not only benefit residents and the quality of care they receive, but it will benefit your business too.

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the Berkshire Care Conference

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Coming soon...

7th November 2013 The Hilton Hotel, Reading www.mcculloughmoore.co.uk/berkshirecare

Sponsored by

Interested in exhibiting?

Organised in partnership with the Berkshire Care Association, this event represents the perfect opportunity to get your business in front of the key decision-makers and purchasers in Berkshire. You will also benefit from an array of additional promotional benefits with Care Management Matters.

Interested in attending?

Presentations will include: s Rebuilding public and provider confidence in the care sector Alan Rosenbach – Special Policy Lead, Care Quality Commission (CQC) s Interpretation of the Care Bill Des Kelly OBE – Executive Director, National Care Forum s Sharing sector experiences John Lucas – Partner, Hazlewoods s Understanding the local care market John Roddy – Consultant, Shakespeares

Workshops will include: s Better leadership: better care. How to strengthen leadership at every level Debbie Sorkin – Chief Executive, National Skills Academy for Social Care s Berkshire supply and demand analysis – what’s happening in practice that will affect your business future Amanda Nurse – Director and Ben Hartley – Director, Carterwood s How to market your care home – 3 simple steps to full beds Simon Beck – Founder, Care Home Marketing Expert s Dementia architecture Karen Ross – Inclusive Design Consultant, robinson lloyd architecture Ltd (in association with jhai ltd)

PRIZE DRAW!

All delegates w the chance toill have a three cours WIN e din for two and ner month’s healt a membership h club at Hilton Readin the g

Supported and organised by Care Management Matters

For exhibitor enquiries please call Paul Leahy on 01223 206965 For delegate enquiries please call Denise Woodhatch on 01293 854401

conference preview

CARE SHOW BIRMINGHAM AND DEMENTIA CARE SHOW 2013

Hall 11, NEC Birmingham 12-13 November 2013

The Care Show Birmingham returns to the NEC in November to provide education, products and services for everyone involved in the social care sector. The event is aimed at owners and operators of care homes, care homes with nursing, domiciliary care agencies, sheltered accommodation, learning disability homes, local authorities, specialist care units, private hospitals and construction companies.

For 2013, visitors will receive free access to both Care Show Birmingham and the brand new Dementia Care Show.

To further learning, sharing best practice and moving forward your business, there is a packed seminar programme.

CARE SHOW Keynote Seminar Theatre Featuring: • Industry commentators such as Alan Rosenbach, Special Policy Lead at CQC, Avnish Goyal, Owner and Managing Director, Hallmark Healthcare, and Professor Gillian Leng, Director of Health and Social Care, National Institute for Health and Care Excellence.

• Leading care sector organisations such as Housing 21, National Institute for Health and Care Excellence (NICE), Association of Directors of Adult Social Services (ADASS), Hallmark Healthcare, Colliers International and Knight Frank.

Topics covered include: • The latest on regulation.

• Business outlooks for the short- and long-term • Tips on improving your business’ success through winning public sector contracts and marketing yourselves to self-funders.

Wellbeing Zone Within the Care Show Wellbeing Zone, visitors will be able to have a massage, a manicure and enjoy a coffee.

Meaningful activities such as this can make all the difference to a care home – whether that is improving the wellbeing of residents or complying with industry standards.

DEMENTIA CARE SHOW Dementia Care Seminar Theatre Featuring industry commentators such as: • Professor Graham Stokes, Director of Dementia Care, Bupa Care Services UK • Professor Mary Marshall, Emeritus Professor, University of Stirling • Barbara Hobbs, Owner, BHC • Nadra Ahmed, Chairman, National Care Association.

Topics covered include: • Dementia care in the community.

• Inspirational dementia care projects.

• Dementia and the physical environment.

There are also a number of panel discussions and presentations.

Access is free of charge.

Featuring at the Dementia Care Show is the Dementia Design Academy in association with Dementia Services Development Centre (DSDC), University of Stirling where you can see a full size dementia care bedroom, en-suite bathroom, kitchen, dining area and garden, purpose-built to benefit people with Alzheimer’s. The bedroom, which is built at the Dementia Care Show, can help you to make your care home dementia-friendly. DSDC University of Stirling will be available to answer any queries you may have on how to make your care environment a more dementia-friendly place.

COME ALONG AND SEE HOW IT WORKS. Dementia Sensory Theatre in association with 4D Creative For the first time, visitors to the Dementia Care Show will be able to experience an immersive sensory theatre, designed to be of benefit to people with dementia. Through a combination of light, sound and projection the sensory theatre will create a unique environment for the care and treatment for those with dementia.

This year, there are over 150 UK care sector exhibitors at Care Show Birmingham and Dementia Care Show.

To register for Care Show Birmingham visit: https://care2013. registerbynet.com/ See CMM’s Attracting Self-Funders feature on p 27 for an insight into one of the show’s seminars.

48 ¦ CMM NOVEMBER 2013

whatâ&#x20AC;&#x2122;s on?

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WHAT S ON? Date/Location: Contact:

Safe and Sound - ECCA 2013 Conference and Exhibition 6th November, London ECCA, Tel: 020 7492 4846

Event: Date/Location: Contact:

Care Show Birmingham 12th-13th November, Birmingham UBM, Tel: 0207 921 8343

Event: Date/Location: Contact:

The King s Fund Annual Conference 2013 Achieving transformational change 13th November, London The Kings Fund, Tel: 020 7307 2400

Event: Date/Location: Contact:

Deprivation of Liberty Safeguards 20th November, Central London LexisNexis, Tel: 0207 347 3576

Event:

Managing Complexity in Older People in the Community 20th November, Harrogate British Geriatric Society, Tel: 020 7608 1369

Event:

Date/Location: Contact: Event:

Tel: 020 8343 2943 Fax: 020 8343 2994 Email: sales@keysplease.co.uk Colton House â&#x20AC;˘ Princes Avenue â&#x20AC;˘ Finchley â&#x20AC;˘ London â&#x20AC;˘ N3 2DB

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, IVVR 5V^ (]HPSHISL 6USPUL Website also contains... â&#x20AC;˘ Catalogue of back articles â&#x20AC;˘ Readersâ&#x20AC;&#x2122; letters â&#x20AC;˘ Whatâ&#x20AC;&#x2122;s on?

CMM CAREMANAGEMENTMATTERS

JULY 2013 ÂŁ4.00

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Date/Location: Contact:

Next steps for dementia care - commissioning, the Dementia Challenge and the Care Bill 26th November, Central London Westminster Health Forum, Tel: 01344 864796

Event: Date/Location: Contact:

Care Managers Networking Breakfast 27th November, East Midlands Care Training East Midlands, Tel: 0115 9599 544

Event: Date/Location: Contact:

Supported Housing 2nd December, Central London Capita Conferences, Tel: 0870 400 1020

Event: Date/Location: Contact:

ALTENPFLEGE 2014 25-27 March 2014, Hannover, Germany Sector Marketing, Tel: 01275 33591

CMM EVENTS Event:

Berkshire Regional Care Conference

Date/Location:

7th November, Reading

Contact:

McCullough Moore Ltd, Tel: 01293 854401

Event:

The Future of Learning Disability Care Conference 2014

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Date/Location:

25th February 2014, Manchester

Contact:

CMM, Tel: 01223 207770

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Includes 4-page Skills Academy insert: Focus on Leadership in the Front line: The Front Line Leaders Programme

www.caremanagementmatters.co.uk

Please mention CMM when booking your place.

CMM NOVEMBER 2013 ÂŚ 49

straight talk

straight talk Why do so many homes lack a registered manager? John Burton explores reasons behind more than 3,000 services being without one.

JOHN BURTON HEAD ASSOCIATION OF CARE MANAGERS MEMBER OF STEERING GROUP NSA-SC REGISTERED MANAGERS PROGRAMME To a new CQC board member - and perhaps to the general public - it is shocking that more than 3,000 (out of 24,000) social care services, most of which are care homes, lack a registered manager (as revealed at the last CQC board meeting and making inaccurate headlines in the press). A further 1,000 health services did not have a registered manager, so 4,000, or one eighth, of the overall total of 32,000 locations that must have a registered manager don t have one. And CQC says it is going to get tough with them and may fine them up to £4,000.

CQC has a dismal record of highlighting faults in the services it regulates in order to draw the attention of MPs and the public away from its own failings. However, the new, reformed - or trying hard to reform - CQC has promised transparency, and I m inclined to give it the benefit of the doubt, partly because it is still at the stage of admitting its past failings to give it a low base from which to improve.

So, let us accept the figures, but ask why there s such a shortfall, is registration needed and working, or is there a better way to do it?

CQC takes more than eight weeks to process one in four applications. It aims to get this down to one in ten but even if it processed 100% of applications within eight weeks, there would, of course, always be some homes where a new manager has not yet been recruited or a newly appointed manager is not yet registered.

There are not enough managers to go around. We all know that care home providers have difficulty recruiting suitable people for this most demanding ‒ and potentially fulfilling ‒ role. Even when their efforts to improve are genuine, a home or provider that has a poor record may be recruiting for months, sometimes years, before finding someone willing to take on the job. Good managers are understandably reluctant to risk their careers by taking on a failing home. It is not particularly uncommon for a home to have two or three new managers within a year.

David Behan explained to the CQC board meeting that not having a registered manager is often a sign of a failing home.

That is true, but converting a failing home into a good one

needs an exceptional manager who could probably get a better paid and easier job in a highly-regarded home.

Currently a manager must apply for the job, then a DBS (Disclosure and Barring Service) check, and then for registration with CQC. All the information that CQC requires for its form should have already been supplied on the other application forms. While CQC is at pains to point out that its registration process isn t a job interview, it can ‒ and occasionally does ‒ reject an applicant who is then likely to be dismissed or demoted by their employer. Some of these decisions have subsequently been overturned at tribunal.

Managers experiences of the CQC interview are mixed. There is nearly always considerable anxiety about the process and many managers are relieved to find that their interviewer is friendly and reasonable, and that they don t feel the intention is to catch them out. All that is required is that the manager anticipates the likely questions (safeguarding is a certainty) and rehearses the correct answers. However, there are also negative reports including long delays and interviews conducted by CQC staff who start by saying they know nothing about the job, and simply go through the motions, the result being a chat , wasted time, and an automatic stamp of approval arriving several weeks later.

As with all other regulatory activities, I would like to see a much more localised, whole home approach. Inspectors need to know their homes and be able to respond quickly to events or complaints. An inspector must know when a manager is leaving and will ask the provider what progress they are making with appointing a replacement. As soon as someone is appointed and in post, the inspector should go to the home to meet them, find out about them, examine their application, references and DBS check. During the visit, the inspector should discuss the home and the new manager s plans for it. This would be a much more effective and comprehensive process of registration than the dreaded interview. A follow-up visit (inspection) six months later would then be genuinely helpful to the home and manager, and would encourage a manager who is leading changes in a previously failing service.

Like heads of homes, inspectors must be allowed to manage their own work like true professionals.

DO YOU AGREE WITH JOHN? PLEASE EMAIL YOUR THOUGHTS TO EDITOR@CAREMANAGEMENTMATTERS.CO.UK.

50 ¦ CMM NOVEMBER 2013

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