Care Management Matters May 2014

CMM CAREMANAGEMENTMATTERS

MAY 2014 £4.00

EXIT STRATEGIES Maximise your return

Evermore A revolution in housing with care?

Who’s who…

Property professionals

Straight Talk Safeguarding ‘blame game’

Includes 4-page Skills Academy insert: Focus on Leadership and Graduates: measuring the impact and expanding the reach

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The Social Care Commitment Sign up online www.thesocialcarecommitment.org.uk

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

It involves signing up to seven statements and tasks which focus on issues that are important to all care providers including induction, recruitment and retention and equality and diversity.

“Go online and make the Social Care Commitment. Make the difference.�

Norman Lamb MP, Minister for Care and Support

in this issue

IN THIS ISSUE regulars 05

editor s welcome

Is it just me...?

Editor in Chief Robert Chamberlain considers Public Accounts Committee evidence around workforce wages.

07

News

12

Property News

14

Local Authority and Planning News

16

Corporate News

25

60 seconds with...

22

Melville Knight, Group Chief Executive of Castleoak.

26

Business Clinic A new approach to housing with care is looking to break into the market. We ask the panel whether it ll transform the sector.

37

Who s who...Property Professionals

42

features 18

CMM profiles the lead individuals of care sector property organisations.

44

With the Care Act almost here Jamie Balbes analyses the positives, negatives and missed opportunities of this significant legislation.

Conference reviews CMM reviews the Surrey and Sussex Care Showcase 2014 and the Skills for Care Accolades.

45

What s On?

46

Straight Talk

The Care Act ‒ the good, the bad and the missed opportunities

22

Selling your business ‒ maximising value and retaining more cash Andy Brookes shares his vast experience of preparing businesses for exit to enable you to maximise return.

Fidelma Tinneny opens up about the safeguarding blame game .

29

Demographic Dip: implications for providers and policymakers Irving Stackpole explores demographic changes and whether we really are experiencing a baby boom or a population dip.

29

34

An eleventh-hour settlement in Interest Rate Swaps Keith Lewin considers a significant development in bank Interest Rate Swaps.

42

34

Domiciliary care providers ‒ manage your risks With increasing pressure on domiciliary care providers, David Waters looks at the risks they face and advises the best approaches to address them.

Every time I ve sat to write this welcome in 2014 I ve thought, is the Care Bill going to receive Royal Assent whilst you re reading this issue? Every month it hasn t. We were anticipating it on 1st April ‒ although I hope that doesn t mean the Act is an April Fool. Right now, we are expecting it in mid-May as it needs to go to, the wonderfully titled, Ping Pong between the Houses of Lords and Commons. However, in preparation for it, finally, receiving Royal Assent we bring you an in-depth look at the Care Bill, its positives, negatives and missed opportunities. Jamie Balbes summarises everything for you on page 18.

In an interesting counter to the Care Bill and the demographic drivers that are affecting the sector and its need for change, Irving Stackpole takes an analytical view of demographic trends on page 29. We re all acutely aware of the demographic time bomb but Irving s analysis and conclusions may highlight something different.

If you ve reached a point in your business that you are looking to sell up and move on to pastures new, Andy Brookes shares his experience of preparing businesses for exit and how to ensure your house is in order to maximise your return. His feature starts on page 22.

With safeguarding being such a hot topic, our Straight Talk this month is delivered by Fidelma Tinneny.

Fidelma argues that good providers find themselves in difficult positions due to pressures of safeguarding and sensible conversations are needed by all involved. Do you agree? Read her piece on page 46.

Emma Morriss Editor

Follow CMM on Twitter @cmm_magazine

CMM MAY 2014 ¦ 3

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contributors

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, Care England

Partner, Deloitte

Andrew Sidwell,

Paul Ridout,

Partner, GVA

Partner, Ridouts LLP

Andrew Barnsley,

Zoe Farrell,

Managing Partner, Nexus Corporate Finance LLP

Training Development Director, Catalyst for Care

May 2014

EDITORIAL AND PRODUCTION editor@caremanagementmatters.co.uk Editor in Chief: Robert Chamberlain Editor: Emma Morriss News Editor: Des Kelly Deputy Editor: Heather Day Design and Production: Lisa Werthmann, Jamie Harvey, Nick Cade & Holly Cornell ADVERTISING sales@caremanagementmatters.co.uk 01223 207770 Advertisement Manager: Tracey Diplock tracey.diplock@carechoices.co.uk National Sales 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 © Care Choices Ltd 2014 ISBN: 978-1-909048-96-6 CCL REF NO: CMM 11.3

contributors Andy Brookes, Partner, Hazlewoods LLP Ben Hartley, Director, Carterwood David Waters, Managing Director, PrimeCare Insurance Fidelma Tinneny, Director, Founding Member, Berkshire Care Association Irving L. Stackpole RRT, Med, President, Stackpole & Associates Inc

Publications

CMM magazine is officially part of the membership entitlement of:

Jamie Balbes, Policy Officer, Care England Keith M Lewin, Senior Partner, Brunswicks LLP Melville Knight, Group Chief Executive, Castleoak Michael Voges, Executive Director, Associated Retirement Community Operators (ARCO)

ABC certified (Jan 2012 - Dec 2012) Total average net circulation per issue 15,991

Paul Birley, Head of Public Sector and Healthcare, Barclays

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is it just me...?

Is it just me...?

Editor in Chief, Robert Chamberlain, considers whether the Public Accounts Committee’s evidence session calling sub-minimum wages for care workers ‘unacceptable’ is, in fact, that ‘clear cut’.

The National Audit Office (NAO) published Adult Social Care in England: Overview in March. The report is the first in a series on adult social care and highlights the main risks and challenges for the adult social care system in its current guise and as it changes. I would recommend that you take the time to read the full report but for the purposes of this column I have concentrated on one particular aspect – care workforce pay which the Public Accounts Committee responded to in an evidence session.

MINIMUM WAGE Part two of the report provides statistics for the remuneration of domiciliary care workers. Section 2.20 states, ‘Care workers’ median pay was £7.90 per hour in 2012. Some are not paid in full due to deductions for uniforms or due to travel time between visits. An estimated 160,000 to 220,000 direct care workers in the UK are paid below the National Minimum Wage. HM Revenue & Customs (HMRC) report that non-compliance with the National Minimum Wage in the adult social care sector was higher in 2011-12 and 2012-13 than in any year since 2008’.

The report continues in section 2.21, ‘An estimated three in ten care workers are on zero-contract hours, rising to 61 per cent for homecare workers.’

SHOCKING AND UNLAWFUL The Public Accounts Committee held an evidence session on 26th March 2014 as part of their inquiry into adult social care.

The Chair, Margaret Hodge, described the NAO statistics as ‘pretty shocking’.

Sir Bob Kerslake, Permanent Secretary, Department for Communities and Local Government (DCLG) was questioned as a witness and responded, ‘It is unacceptable for providers to pay below minimum wage.

It is against the law. If local authorities find that this is the case, they should challenge them and ask whether they should still be providers for them. They should certainly be referred to HMRC. This is absolutely clear-cut’.

Commendable as this notion may be, I feel that this statement belies a lack of understanding regarding the realities of local authority commissioning practices for homecare services. It infers that providers are choosing to pay below minimum wage, perhaps ignoring the fact that many council contracts are set at value that cannot afford such remuneration.

The recent study by BBC’s File on 4 found that most councils in England are paying less than the industry recommended minimum for homecare. Only four of the 101 councils surveyed under the Freedom of Information Act met or exceeded the United Kingdom Home Care Association’s £15.19 per hour recommended minimum to cover wages, training, travel and

overheads. The research also identified councils paying as little as £10 per hour.

Surely Sir Bob, it should be against the law to knowingly commission providers at a rate that cannot possibly provide care staff with the minimum wage?

VICIOUS CYCLE The NAO report (section 2.21) states, ‘In a 2012 survey of 655 organisations providing homecare in England, 78 per cent reported they were paid through a spot contract or framework agreement with a local authority. These contracts give providers no guarantee that their services will be taken up, which may inhibit long-term planning and investment in staff. Over three-quarters (76 per cent) of providers felt authorities prioritise low price over service quality. Turnover among care workers is high at 22 per cent annually, which further reduces employers’ incentive to invest in staff skills’.

It seems clear that that the monetary value and nature of such contracts are undermining the development of a stable workforce that is well-trained and suitably remunerated. There needs to be an acknowledgement of this fact during the inquiry because, without extra money in the commissioning pot, these issues will unfortunately prevail.

If you would like to comment please email robert.chamberlain@caremanagementmatters.co.uk

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CMM MAY 2014 ¦ 5

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news

NEWS

APPOINTMENTS APPOINTMENTS

• Planning • Local authority • Corporate News editor - Des Kelly SfC and NSA to merge Skills for Care (SfC) and the National Skills Academy for Social Care (NSA) have agreed, in principle and subject to contract, to merge their organisations. Both parties anticipate that the merger will take place by the end of May 2014.

The merged organisation

will combine the expertise of both teams to create an offer for employers in the sector covering the leadership, learning and development needs of the sector’s 1.5 million workers at all levels, from front line staff to senior leaders. Existing members of the NSA will retain their membership within the

new organisation. Sharon Allen, current Chief Executive of SFC, will stay on as Chief Executive of the merged organisation.

Debbie Sorkin, current Chief Executive of NSA, is moving to become National Director of Systems Leadership, at the Leadership Centre based at the Local Government Association.

New settlement needed for health and social care The health and social care systems are no longer fit for purpose, an independent commission established by The King’s Fund has concluded.

The time has come, it says, for ‘a new settlement’ to meet the needs of 21st century patients and service users.

The interim report from the five-strong commission, chaired by Kate Barker, says that England should move towards a single, ring-fenced budget for health and social

care, with services singly commissioned and entitlements more closely aligned. With the NHS and social care now under significant financial strain, the report presents hard choices about how to pay for fairer entitlements and ensure adequate funding to meet future needs.

In its interim report, the commission concludes that the current settlement is failing to respond to the needs of the increasing number of people

with long-term conditions, young as well as old. It argues that a lack of alignment in entitlements, funding and organisation between the two systems results in unfairness, poorly co-ordinated services and confusion for patients, service users and their families.

The commission will undertake further work on costings, before it publishes its final report in the autumn. The interim report is available form www.kingsfund.org.uk.

‘Urgently review institution placements’ – Mencap and CBF Learning disability charities have called for an urgent review of all decisions to keep people placed in assessment and treatment units rather than in the community. The call, by Mencap and the Challenging Behaviour Foundation, came after NHS England figures

revealed that out of 2,577 people with a learning disability and behaviour that challenges living in assessment and treatment units, only 260 have a moving date, of which only 172 are before 1st June.

NHS England’s figures also revealed that in more than

1,000 cases, the reason given for why people do not have a planned transfer date is a clinical decision. This can include people with very complex needs, those who are too ill to move, or are possibly a danger to themselves or the public, according to NHS England.

NEW CENTURY CARE New Century Care has appointed Ted Smith as NonExecutive Chairman with immediate effect. Ted Smith has been Chief Executive Officer of European Care Group and Chief Executive Officer of Craegmoor.

BRENDONCARE Carole Sawyers has been appointed as Chief Executive Officer of Brendoncare, a charity providing care for older people, based in Winchester. She will be leaving The Fremantle Trust in early June. Carole has been with Fremantle since 1992 and been Chief Executive Officer since 2002.

GREENSLEEVES HOMES TRUST Greensleeves Home Trust has appointed Chris Shaw and Liz Marsh to the Board of Trustees.

The new Trustees bring a wealth of experience from the property sector.

CYGNET HEALTH CARE Cygnet Health Care has announced the appointment of David Cole as its new Chief Executive Officer. David is a trained mental health nurse with 20 years experience in health and social care. He has been Chief Executive Officer of Castlebeck and Chairman up until mid-2008. David was formerly Chairman of Choice Care Group.

CMG CREATES NEW ROLE In order to bring families closer to the heart of the organisation, CMG has appointed Helen Woods as its first Relative Liaison Office. Helen will maintain close contact with families and emphasises the vital role they play in effective care provision.

CAREMARK SUPPORT MANAGERS Caremark Ltd has appointed two new regional support managers, Monique Laurens, for the south and eastern region and Liz Bosley-Sharpe for its expanding Midlands region of franchisees.

KNIGHT FRANK The Knight Frank healthcare team has appointed Tiana Spence as associate.

CMM MAY 2014 ¦ 7

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Adult social care risks and challenges In the first of a series of reports on the adult care system, the National Audit Office (NAO) has highlighted the main risks and challenges as the system changes radically. The report points out that the Government does not know if the limits of the capacity of the care system to continue to absorb pressures are being approached. It warns that major changes to the system to improve outcomes and reduce costs will be challenging to achieve.

The report details increasing pressures on the system: adults with long-term and multiple health conditions and disabilities are living longer; demand for services is rising while public spending falls; and there is unmet need for care.

It says that while the need for care continues to rise, local

authorities’ spending on adult social care fell by 8% in real terms. The trend of reducing the amount of care provided has continued, but NAO analysis shows that local authorities have also improved their ability to control their costs in delivering core services since 2010-11 Local authorities are making efficiency savings by changing contractual agreements, paying lower fees and negotiating bulk purchasing discounts.

Paying lower fees to independent sector providers can put pressure on providers’ financial sustainability, with some reporting problems meeting all but users’ basic needs and investing in training for their staff. The full report is available to read from www.nao. org.uk/report/adult-social-careengland-overview.

Handbook for relatives arranging care Leading social care publisher, Care Choices, has launched the new edition of its popular Care Select handbook with a foreword

by Esther Rantzen CBE. The only publication on the market aimed at relatives arranging care for an ageing family member, the handbook guides readers through the emotional and practical aspects of the journey.

Starting with identifying whether assistance may be needed and going through the different levels of support and care available, the handbook also explores the typical issues families face at such a difficult time. Care Select features editorial from leading organisations including the Alzheimer’s Society, Dying Matters and an introductory piece from The Silver Line founder Esther Rantzen CBE. In her foreword Esther says, ‘it’s a crucial decision for older

people and their families, and the aim of this handbook is to assist them, to find the right care and support including well-run homes when they need them, and projects with caring committed staff.’

The high quality handbook is free to anyone searching for care, features quality editorial and advertising, and is mainly aimed at the selffunding market where families often find themselves plunged into the world of social care without any idea of where to start. An accompanying website will also be launched which will enhance the book and link through to Care Choices’ fully-searchable database of care provision in England and Wales.

Care Choices also runs an informative helpline which can help people find the right care and support for themselves or their family member.

Reducing restrictive interventions The Department of Health has published Positive and Proactive Care: reducing restrictive interventions which provides a framework for adult health and social care services to develop a culture where restrictive interventions are only ever used as a last resort.

Restrictive interventions include a range of different approaches that limit an individual’s movement,

liberty and/or freedom to act independently. The report identifies actions that will improve people’s quality of life which should then reduce the need for restrictive interventions. It sets out ways to know who is responsible for making these improvements, including effective governance, transparency and monitoring. The policy paper can be downloaded from www.gov.uk.

CQC announces changes in regulatory fees The Care Quality Commission (CQC) has published details of the fees to be paid by providers from 1st April 2014.

Changes include a 1.5% increase for providers of adult social care services and 2.5% for all other types of providers;

adjusting the fee bandings for providers of care home services to more evenly distribute fee charges. The CQC will carry out another public consultation in the autumn, which will consider the next set of changes to the fees scheme for 2015/16.

Dying Matters: You Only Die Once This year marks the fifth anniversary of the Dying Matters Coalition, set up by the National Council for Palliative Care to break society’s taboo about talking about dying and to encourage more people to make their end of life wishes known.

Since it was set up Dying Matters has gone from strength to strength, with membership currently standing at around 30,000 including funeral directors, care homes, hospices, charities, community groups and members of the legal and financial sectors.

However, there’s still a long way to go. For many people talking about dying and facing up to their own mortality remains the final taboo, something either to be ignored completely or postponed indefinitely for a day

that many still refuse to believe will ever come.

This year’s Dying Matters Awareness Week (12th to 18th May) has a theme of Dying Matters: You Only Die Once (#YODO). The organisation is encouraging people across the country not to leave it too late to write a will and register it, record their funeral wishes, plan their future care and support, consider registering as an organ donor and telling their loved ones their wishes.

To help prepare for Dying Matters Awareness Week 2014, the Dying Matters Coalition has developed leaflets, posters and ideas on how to get involved. www.dyingmatters.org. The conversation is also happening on Twitter @DyingMatters #YODO.

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property news

New Directions sale DC Care has successfully brokered the sale of New Directions, a group of five care homes plus supported living provision located in St Leonards, Hastings and Robertsbridge. New Directions was established in 1998 and developed into a highly respected provider of care for those with Prader-Willi Syndrome.

Founder owner Gayle Benet grew the group from its first home Bishops Croft, to its current

registration of 34 with a further two residents housed in supported living accommodation. The group was acquired by Craegmoor, part of the Priory Group of Companies for an undisclosed price.

Sarah Hughes, Managing Director of Craegmoor said, ‘We are delighted that New Directions will become part of the Priory Group of Companies complementing and further expanding our Craegmoor

services. The specialist PraderWilli Syndrome services provided fit perfectly with our existing specialist services and New Directions will benefit from the experience and expertise of a larger organisation.’

RBS funds new care home Leamington Spa care home operator Edenplace has announced the opening of a new care facility with a funding package from The Royal Bank of Scotland (RBS). The new home Ashley House is based just outside Leamington Spa and brings new jobs to the local area.

Edenplace specialises in providing care for individuals

recovering from or living with long-term mental illness. As well as the main nursing home, the organisation also currently operates two existing ‘satellite’ houses, designed for more independent residents who only require support from staff during the day.

Edenplace received a loan facility from RBS to fund the acquisition and re-development

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of Ashley House, which offers 13 single rooms and specialist residential care. The new home has also brought 15 new jobs to the local area including the Home’s Manager Dawn Bicknell who works alongside Joe Cutler, the overall manager for Edenplace’s portfolio of homes.

Edenplace Director Patrick Riley, said, ‘Ashley House is

an exciting addition to our organisation and we are busy welcoming new residents with the home’s recent opening.

There is a growing demand in the region for residential care for individuals living with mental illness and by opening this latest home I am certain that we can further improve the provision for the local community.’

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property news

New Care Projects completes £1.6 million development New Care Projects LLP, the operator of the Manorhey Care Centre in Urmston, Greater Manchester, has completed a £1.6 million project at the home with the addition of new accommodation.

Now complete, Manorhey

Community Integrated Care and LNT

boasts an additional 20 beds, taking the home from 63 beds to 83 beds.

Furthermore, a £200,000 refurbishment within the original building is 60% complete, ensuring the highest quality environment is maintained throughout Manorhey Care Centre.

Torquay care homes sold Two residential care homes located in Torquay have been sold to a local operator, Beechcroft Care Homes. The homes, Choice and Southbourne both situated in the Babbacombe area of Torquay, provide care within the categories of old age and dementia and are registered for 24 and 21 respectively.

The selling agents DC Care, instructed on behalf of the Joint Administrator Begbies-Traynor, were pleased to find a suitable purchaser who has already commenced a programme of

refurbishment that will see the homes dramatically upgraded and modernised.

Community Integrated Care has announced proposals to develop a new £4.8 million specialist dementia care service in Blackburn, which is set to open for late summer 2015.

The service, which will be named EachStep Blackburn, will apply the charity’s unique EachStep model of integrated dementia care, which aims to support people from diagnosis until the end of their lives. It will provide domiciliary care

in the Blackburn community, as well as respite, residential, nursing and palliative care for 64 people within the new service.

The proposed development will be overseen by LNT Construction, who have submitted a planning application for the project.

Their proposal aims to support local regeneration plans for the Ewood area of Blackburn, where the service will be built.

Bingley Wingfield Care Home Bingley Wingfield Care Home, a care home with nursing, registered for 48 has been acquired by Bingley Wingfield Care Ltd - and becomes the third care home purchased

by Karen and Mike Reynolds through specialist property adviser Christie + Co in the West Yorkshire region. The home was

acquired from Dr Ghoneim off an asking price of £1.25 million.

The care home was converted from a Victorian residential building by Dr Ghoneim, who also added a purpose-built wing to house single en-suite accommodation. Funding for the purchase was provided by Lloyds Banking Group.

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local authority and planning news

MHA and Castleoak Castleoak, the leading developer and construction partner to the care sector, has welcomed long-term returning customer Methodist Homes (MHA) with a contract to design and build two assisted living schemes.

In Swindon, Castleoak has started work on a scheme comprising 33 one- and twobed apartments and four care suites to deliver MHA’s new assisted living offering.

The new development is next to Fitzwarren House, a care home with nursing, and Stanton Lodge retirement living with care apartments, which Castleoak built in 2005.

In Peterborough, Castleoak’s development team has achieved planning permission for 37 one- and two-bed assisted living apartments and 13 care suites, having previously identified and acquired the site.

Construction started in March.

The innovative care suites in both new developments offer more space and independence than a nursing bedroom. They also have a lower price point than a onebed apartment, providing greater choice for older people.

MHA’s new assisted living offering provides an ‘all inclusive’ package designed specifically to provide help and support for older people.

Planning permission for mcch Work has begun on The Pines, Tunbridge Wells after Cowan Architects secured planning permission on its state-of-the-art 16 unit supported living facility for client mcch. The Pines will provide a home to adults with physical and learning disabilities.

The philosophy behind the design of the scheme is to encourage freedom for residents though the provision of their own space and more

independent living. Working alongside mcch and the care provider, The Avenues Trust, the scheme provides each resident with their own self-contained, one-bedroom accessible flat which benefits from 24hr onsite care assistance should it be needed. Each flat has been designed to provide lifetime flexibility incorporating aspects such as knock-out walls to allow for the future installation of hoist

systems, sufficient storage for equipment such as wheelchairs and generous rooms and circulation to allow for easy use by wheelchairs.

Following consultation with Tunbridge Wells Borough Council and neighbouring residents, a final scheme was agreed and submitted. It was unanimously approved by the Committee. The target completion date is mid 2014.

Southend supported living Work on a new supported living scheme in Southend-on-Sea is now starting. Leading housing and care provider Sanctuary Group is developing 33 apartments at the Sutton Road site in a £4.8 million scheme supported by investment from the Homes and Communities

Agency (HCA).

The development is being built by Sanctuary Group’s contractors UK Construction Ltd and on completion, will replace Chalkwell Lodge, an existing supported living scheme in Westcliff-on-Sea. National mental health charity

Richmond Fellowship currently runs Chalkwell Lodge and will also manage the new scheme in Sutton Road, which will have more specialised facilities, as well as one wheelchair standard apartment, communal areas for residents, office space and staff accommodation.

Nottinghamshire home opens Nottingham Care Home provider, Eastgate Care has opened Canal Vue in Ilkeston.

The company developed the site of the Old Bridge Inn, to provide Canal Vue, a 70-bed

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nursing home overlooking the scenic Erewash Canal in Nottinghamshire.

Homecare Plus Nottingham Homecare Plus has been officially launched in Nottingham. Homecare Plus is the new name for one of Nottinghamshire’s leading and original home care agencies, Time Out Care Services, which has celebrated its 21st anniversary. Founded in 1993 the charitable organisation initially provided respite care services for predominantly black and minority ethnic customers. Homecare Plus will build on Time Out Care Services’ reputation for delivering consistently high levels of care.

Sanctuary Group in Telford Sanctuary Group has started construction at its Sutton Hill development in Telford. Sanctuary is working with construction specialist Seddon to build a total of 49 new homes on five sites near to the Sutton Hill Local Centre as part of the wider regeneration of the area. This will include a mix of apartments, houses, and two bungalows for affordable rent as well as one two-bedroom house and four three-bedroom houses available to buy on a shared ownership basis.

The scheme, which will cost around £5.5 million, has received investment through the Government’s Homes and Communities Agency (HCA) and is due to be completed in Spring 2015.

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14 ¦ CMM MAY 2014

News.indd 14

10/04/2014 16:50

Care Conference

Supported and organised by Care Management Matters

FOR YOUR 2014 MARKETING SCHEDULE! Focusing on the future of care and commissioning

Save the dates!

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4 June 2014

THE FUTURE OF CARE & COMMISSIONING 18 September 2014

16 October 2014

In association with the Lancashire Care Association

What to expect from these events

Delegate proямБle

s 4HE DAY WILL INCLUDE PRESENTATIONS FROM HIGH LEVEL SECTOR REPRESENTATIVES

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s !N AGENDA THAT HAS BEEN PUT TOGETHER IN PARTNERSHIP WITH THE RELEVANT LOCAL CARE ASSOCIATIONS PROVIDERS AND OPINION LEADERS IN THE REGION MEANING THAT IT TOTALLY REmECTS THEIR NEEDS s .ETWORKING OPPORTUNITIES WITH HIGH LEVEL DECISION MAKERS AND LIKE MINDED COLLEAGUES FROM WITHIN THE INDEPENDENT SECTOR

s OF DELEGATES SAID THE EVENT HAD FULlLLED THEIR NEEDS AND EXPECTATIONS s OF DELEGATES SAID THEY WOULD BE RETURNING TO NEXT YEAR S EVENT s OF DELEGATES SCORED THE SPEAKER PRESENTATIONS AS @GOOD OR EXCELLENT

For exhibitor enquiries please call Paul or Tracey on 01223 206965 For delegate enquiries please call Denise Woodhatch on 01293 854401 News.indd 15

10/04/2014 16:50

corporate news

Ashley House profit announcement Ashley House, the health and community care property partner, has issued a trading update ahead of its financial year ending 30th April with an announcement that it will not make a profit in the current financial year.

Its previous updates have stated that in order to reach market expectations for profits in the financial year ending 30th April 2014, the company would need to achieve planning and exchange legal contracts on four out of six extra care schemes.

Planning remains likely to be achieved in the required timescale. However, completing legal agreements with prospective tenants and purchasers is proving slower than anticipated. Whilst it remains confident that all six schemes will successfully close, it is no longer confident that, without compromising its commercial position in order to accelerate completions, they will do so before the financial

Mimosa enters administration

year end. It is, therefore, likely that the company will not make a profit in the current financial year. The profits attributable to schemes that do not close prior to year end, are accordingly likely to contribute to profitability in 2014/15.

The Board wants to take time to achieve strong commercial agreements with the right structure rather than press for completion at the expense of longer term shareholder value.

Over the last few months the company has opened discussions with a number of institutional funders looking to provide long-term capital. This has led to receipt of indicative project funding proposals.

Separately, the Company has agreed to drawdown a further £1.5m development finance from a facility managed by Rockpool Investments LLP in support of Ashley House’s development strategy.

Mimosa Health Care Group has entered administration and is looking for a buyer.

The company is hoping to run in administration until a buyer can be found. Kerry Bailey and Sarah Rayment of BDO LLP have been appointed

as joint administrators whose aim is to find a buyer with minimal disturbance to residents and staff.

The company operates 22 care homes mainly across the North of England, plus the West Midlands and Somerset.

Housing 21 changes name to Housing & Care 21 Housing 21 has announced that it is to change its name to Housing & Care 21.

Bruce Moore, Chief Executive, said, ‘There was a strong feeling that the current name did not adequately reflect our position as a substantial care provider as well as continuing to be a respected housing organisation.’

He went on to emphasise that the change has been designed to be evolutionary, and builds on the many positive associations with the existing name.

However, it was important

to acknowledge that Housing 21 provides a wide range of care services and that the name supports the promotion of these services.

Therefore the Board took the decision to change the organisation’s name to ‘Housing & Care 21’ and to use the same typeface and typography as the existing visual identity.

Housing & Care 21 is the UK’s largest non-profit care provider and a national leader in providing innovative, affordable housing for older people.

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16 ¦ CMM MAY 2014

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corporate news

The Complete Group The Complete Group has secured a new contract, developing the services it provides in the West Country.

Complete has been successful in its application to become a provider of home-based complex care services in

North Somerset to adults with a physical and/or sensory disability. The contract, which will last for up to five years, has been jointly commissioned

by North Somerset Council and North Somerset Clinical Commissioning Group.

Four Seasons acquires homes Four Seasons Health Care has acquired seven homes from Majesticare, a privately-owned care group with a portfolio of 16 premium homes that primarily serve self-funded clients. The seven homes that Four Seasons has acquired have a total of 358 beds and employ 410 staff.

Four Seasons recently announced a strategy to develop a private care division that will provide high quality elderly care, together with hotel standard services and activities programmes designed primarily, but not exclusively, for self-funded customers who see the option of

a care home as a life-enhancing choice.

This is the third significant strategic addition to Four Seasons since it came under the ownership in 2012 of Terra Firma, one of Europe’s leading private equity firms. Last year it acquired Optimum Care, which operates 17 care homes serving the private market under the Avery brand name, as well as four care homes in Bristol from Mimosa Health Care Holdings Ltd. The transaction will not result in any noticeable change to the dayto-day operations of the homes, or for their residents or staff.

Bupa 2013 preliminary results Bupa has released its 2013 preliminary results. The company has seen good growth in customers, revenue and underlying profit driven by expansion in existing and new geographies and segments.

The main highlights include: • Revenues up 8% to £9.1bn.

• Underlying profit before taxation up 5% to £638.5m; over ten years of unbroken growth.

• Statutory profit before taxation down 12% to £514.4m.

• Significant investment, £1.3bn in acquisitions and £329.4m in other capital investment (2012: £265.8m).

• Customer numbers up 57% to 22m, including 5.4m (39%) added through major acquisitions.

• Cash flow from operations at £467.6m (2012: £742.9m).

• Leverage increased to 29% (2012: 19%) as we funded acquisitions.

Regarding its UK care services,

revenue and occupancy remained flat in a competitive trading environment. While the overall number of residents remained stable, it saw an increase in the number of residents funded by local authorities and the NHS, in particular more short stay placements.

Profitability declined significantly as margins were eroded by a combination of below inflation fee increases and rising running costs. Strong competition for self-pay customers also added pressure. However Bupa maintained good resident satisfaction, with 94% of residents rating quality of care as ‘excellent’ or ‘very good’. It invested in training and measures to improve quality.

Bupa invested £59m in its care home portfolio, opening new homes in Glasgow, Brighton and Farnham. The acquisition of Richmond Care Villages marked an expansion with more than 660 residents in total, the transaction added five operating care villages.

HEALTHCARE PROPERTY CONSULTANTS

Sale after sale, day after day Specialists in sales and acquisitions of care homes throughout the UK Tel: 01904 529110 enquiries@healthcarepc.co.uk www.healthcarepc.co.uk

CMM MAY 2014 ¦ 17

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14/04/2014 10:48

THE THE

The Care Act GOOD, BAD

AND

THE

MISSED OPPORTUNITIES

The Care Act is due within weeks, though a recent delay means the anticipated date of 1st April, at time of print, has moved to mid-May. However, due to the transparency of the legislative process what is currently in the Bill to become Law is in the public domain, bar any last minute amendments. Jamie Balbes analyses the positive and negative implications of the Act for providers and what could have been achieved but wasn’t.

The Care Bill is, in many ways, a welcome piece of legislation for adult social care.

From including a duty for local authorities to promote an individual’s wellbeing, to making it a statutory duty for local authorities to examine all the needs of people who undergo assessments, the passage of this Bill, expected in May 2014, will bring a number of benefits to individuals who use social care services.

However, the shortcomings of this Bill are also numerous.

The cap on the amount a person can spend on their care, set at a far higher level than that recommended by Andrew Dilnot, combined with the duty that local authorities will now have to arrange a selffunder’s care if asked to do so, will mean that the Care Act 2014, as it will become, has the potential to severely impact upon the finances of both providers and individuals who use services.

Subsequently, this wellintentioned piece of legislation may not fulfil the expectations pinned upon it by those in Government and is likely to have both positive and negative implications for providers.

Initiatives that could have mitigated some of these negative implications, which

were discussed and then rejected, demonstrate what the Care Act 2014 could have achieved.

WELLBEING Firstly, it is admirable that this Bill places wellbeing at the centre of care. Ensuring that parity of esteem, protection from abuse and neglect, and a duty of candour are codified into law is a positive development.

Anyone who uses services will now know that they are using them under the protection of an increasingly stringent regulatory system; that their mental health will be treated as seriously as their physical health; and that those in charge of their care will have a duty to be completely open and honest with them.

Such assurances are incredibly important in allowing individuals to use services with confidence – a confidence that is continually shaken by the negative representation of the social care sector in the media.

Additionally, this Bill is refreshing in the sense that it also recognises the wellbeing of another important group, carers. Under this new legislation, local authorities will

have a duty to assess the needs of a carer should they feel that they may be in need of support.

This is important, not only because it recognises the vital contribution of this group, but because providing support for carers will enable individuals to receive informal care at home for as long as possible.

Only 0.03 per cent of care is delivered by a professional and the informal care sector is estimated by the National Audit Office to be worth between £55 billion and £97 billion per year. The selflessness of this group of informal carers is an essential mechanism in allowing individuals with care needs to remain

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the care act - the good, the bad and the missed opportunities

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independent in their homes for as long as they can and wish – contributing enormously to their sense of wellbeing.

This is important in a provider sense, both across health and social care, as it means that although many of these services, especially mental health services, are working alarmingly close to, or at, full capacity, the majority have been able to avoid reaching crisis levels as a consequence of the duties performed by carers.

All of this means that the sustainability of the services that carers provide to their friends and loved ones is essential, and legislating to offer support – that complements existing formal support services such as respite care – for those who give up on average around 20 hours of their time per week, will go a long way towards ensuring continuity of informal care.

Therefore, in many ways, the Care Bill should achieve its primary aim of ensuring the wellbeing of the individual.

SUSTAINABILITY The Care Bill’s enactment will lead to more rigorous appraisals of a provider’s sustainability. Since Southern Cross’ collapse in 2011, the Department of Health has been monitoring the five biggest providers in the sector and oversight in this area will switch to the Care Quality Commission (CQC), who will begin to monitor the finances of all providers.

The House of Commons’ Health Select Committee contested the CQC being given this responsibility and instead suggested that it should go to Monitor, who already have the skills necessary in-house, but this suggestion has since been rejected.

Under the new law, if CQC was to determine that there was a significant risk to the

financial sustainability of a provider’s business, they could do one of two things. Firstly, they could ask the provider to develop a plan for how to mitigate or eliminate the risk identified, or secondly, they could arrange for or get the provider to arrange for, a person with appropriate professional expertise, to carry out an independent review.

Although monitoring sustainability is important in order to avoid another Southern Cross, by placing a duty on local authorities to arrange care for self-funders when asked to do so as previously mentioned, the Care Bill immediately jeopardises a provider’s financial sustainability, as it is well-known that many local authorities regularly use their monopsony power to commission care at rates that do not reflect the true cost of services delivered.

Consequently, this Bill could require CQC’s new financial monitoring powers to be used to an extent that will concern anyone connected with the care sector – most notably serviceusers. We should, therefore, be putting more effort into ensuring services are funded correctly, rather than creating over burdensome monitoring arrangements, and the fact that the Care Bill gravitates towards the latter over the former is a disappointment.

FEES In order to assuage concerns regarding local authorities using their purchasing power to jeopardise the financial sustainability of providers, many in the sector were hoping that the Bill would include a formula by which the fees that local authorities pay for care, could be objectively determined.

They have been disappointed.

During the course of the committee debates, the former

Minister for Care and Support, The Rt Hon Paul Burstow MP raised the issue of local authorities not paying the true cost of care. He used Care England’s evidence to argue that, ‘local authorities are using their monopsony power to force prices down regardless of quality considerations or prevailing economic conditions’.

In addition to this, the rejection of Mr Burstow’s arbitration clause, which would have legislated for independent arbitration in the event of a fees dispute between local authorities and providers, means that the only means of redress open to providers is judicial review. As he noted, this is flawed in the sense that, ‘It cannot be right - it makes no sense - that litigation effectively becomes the only route by which meaningful dialogue and negotiation takes place. That is not a measure of a healthy market; it is a measure of a dysfunctional one.’

The absence of a methodology for setting fee levels combined with the fact that local authority oversight now relies upon the ministerial sign-off of the Secretaries of State from the Department of Health and Department of Communities and Local Government, effectively means that oversight in this area does not exist in practice and local authorities are consequently permitted to set fee levels arbitrarily.

The only option, therefore, is judicial review, but the cost in terms of both expense and time incurred by judicial review proceedings makes this option impractical for the vast majority of providers. This leaves providers dangerously exposed by the law, and the impact that this has on their financial sustainability enshrouds the future of the individuals who use services in uncertainty – the very thing that this Bill sought to avoid.

HOPE FOR THE FUTURE? Although the Bill has many shortcomings, one of these could provide hope for providers in the future. Despite an eligibility framework, which will now only require those needs estimated to be substantial to be met, new regulations regarding assessment will mean that local authorities will be forced to assess all of the needs of a person and disclose any discretionary needs that are not met; whether a local authority meets these needs will then become subject to continual review.

This is encouraging for providers as when the Care Bill comes into law, both met and unmet need will become a matter of public record. With the support that the Protect Care, Pay Fair campaign received from MPs such as Paul Burstow and Andrew George, the work that the Care and Support Alliance has done on fees, and the campaign that Care England has launched to raise the level of fees paid to providers of learning disability services, one can see that stakeholders from across the sector are working towards the goal of securing the increased funding essential for the survival and prosperity of social care in a unified and cohesive manner.

The new eligibility framework will, therefore, provide the basis upon which future campaigns on fees can be framed, and if the sector can demonstrate the unity that it has shown in recent times, then we might finally achieve positive results in this area.

Now we know what’s likely to be included it’s a waiting game until the Bill receives Royal Assent to become an Act. CMM

Jamie Balbes is Policy Officer at Care England.

JBalbes@careengland.org.uk

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Canopies UK the leading supplier and manufacturer of outdoor canopy systems for the healthcare market.

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CMM MAY 2014 ¦ 21

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Selling your business -

Maximising value &retaining more cash

22 ÂŚ CMM MAY 2014

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If you’re looking to sell your business and exit the market, Andy Brookes shares his knowledge of the best way to do so in order to maximise the return.

When you come to sell your care business, there are a number of things that can impact the net cash proceeds that you will receive as the owner. There are many factors that should be taken into account with a business sale.

THE ACCOUNTS When an investor (buyer) is considering buying a business, one of the key pieces of information they need will be the accounts, both statutory and management. These often reflect the financial health of an organisation. Profitability in the health and social care sector is often measured by EBITDA (Earnings before Interest, Tax, Depreciation and Amortisation). EBITDA, to which a multiple is typically applied to arrive at a valuation, is seen as a strong guide to the level of ‘free cash’ generated by the business.

When selling your business, it is worth looking at your accounts and comparing them to similar businesses. If there are areas where your costs seem much higher, consider whether there is excess expenditure that you do not need to keep your business trading at its current level. By eliminating unnecessary costs you will be able to show a potential investor a stronger track record of profitability. Remember, though, the business needs to be able to trade at its current level, so aggressive ‘window-dressing’ of your accounts is not a good idea and can lead to problems further into the transaction process. It is a good idea to speak to specialists in the sector to gauge what will and what won’t be accepted by a buyer in this regard.

Care businesses are valued typically as: EBITDA x ‘Multiple’ It is clear to see that any increase in EBITDA will have an exaggerated impact on the business value. The multiples applied by investors in valuing a business can vary significantly across businesses and

the various types of care sector. They could range from as much as 3 to 8 times EBITDA. • The ’multiple’ part of the formula is derived from a number of subjective considerations: • The market - different sub sectors of social care attract different multiples.

• Size of business - multiples often increase with the size of a business, as the larger businesses are seen as having ‘critical mass’ and being more robust, amongst other things.

• Quality of the business - Care Quality Commission (CQC)/ Ofsted, general reputation, a good website with testimonials, few vacancies and low staff turnover are some indicators of ‘quality’.

• Growth potential demonstrating ability to grow with fresh impetus and capital will enhance the value of the underlying business.

It is a good idea to keep detailed records of the number of units of care that you are providing. A record of care hours provided, if you are a domiciliary care provider, or weekly fees and service user numbers if you provide residential care is key.

A potential buyer will always want to see how the business is trading compared to previous periods and this information is important to any such assessment. The more records (financial and operational) that you keep, the easier it will be for a potential buyer to assess the company during their due diligence process – the financial vetting.

TAX Unfortunately, HMRC will, generally, take a proportion of any profit that you make on selling the shares in your business. However, there are some reliefs and allowances that you can take advantage of.

Entrepreneur’s Relief allows business owners to pay an

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selling your business – maximising value and retaining more cash

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effective rate of Capital Gains Tax of 10 per cent instead of 28 per cent on the capital gain, if the owners meet the qualifying conditions. Such conditions include personally owning the shares for twelve months prior to the disposal, or selling all or part of the business if it is not incorporated (ie not owned in a company structure). There is a lifetime limit on the amount of Entrepreneur’s Relief that can be claimed by each individual on gains, which has been £10 million since 6th April 2011.

Any capital gain is also subject to a tax free annual allowance amount, which is currently £10,900. This single amount will apply to all capital gains you make in a single tax year.

How the deal is structured and when you receive your consideration will determine when tax needs to be paid, and so it is worth considering the best option for you.

Sometimes historical business structuring and shareholdings, whilst correct at the time, mean that the entitlement to Entrepreneur’s Relief can be lost. This can be an expensive mistake. Examples of situations where Entrepreneur’s Relief can be lost include the property being held separately from a trading company and having a large inherent gain (taxable at 28 per cent not 10 per cent), or certain shareholdings not being above 5 per cent or in the voting capital of the company. These issues can often be fixed, and again it is worth taking advice about the structure of the business before you embark on the sale process.

In the run up to sale, it is also worth considering the way you are remunerated. There are big differences between income tax at 20 per cent/40 per cent/45 per cent and capital gains tax at 10 per cent.

DEBT AND WORKING CAPITAL Normalised Working Capital is a term that is frequently seen in transactions.

It is something that can be quite alien to operators and advisers and there are some different views on how it should be calculated or assessed. This is almost always a source of debate throughout a sale process.

However, the two main characteristics of working capital are:

• Buyers generally require a ‘normalised’ level of working capital to remain in the business at completion. This is because it is essentially one of the ‘tools’ needed to operate. They are essentially paying for this ‘tool’ in their EBITDA based valuation, so will not pay a further amount for the working capital. This often comes as a surprise to sellers, as they may believe they will be paid for their trade debtors, or other assets, on top of the headline value.

• The principle of working capital is that a buyer does not expect to have to put any further cash into a business to allow it to operate (ie to pay the staff or trade creditors) and continue to generate the profit/cash stream they are buying.

If your business has debt or cash, which is not considered to be working capital (bank loans, hire purchase, cash balances, overdrafts, corporation tax liabilities or the like), the net amount of debt will reduce the cash that you receive on sale.

If your business has surplus cash, on the other hand, the amount of consideration that you will receive for the business will be increased by any surplus.

The amount of cash, debt or working capital is normally calculated by reference to a set of accounts drawn up following completion and it is important to make sure that you get the wording in the legal documents correct. It is usual for an accountant to help the lawyer on this aspect.

CHOICE OF ACQUIRERS As the market for healthcare transactions is so active, many sellers benefit from having the choice of more than one potential buyer. When faced with such a decision, it is very important to consider what you think is the best choice for your business.

If one potential buyer is operationally a better fit than another, it is more likely that they will be able to develop the business in the way that you may hope. Companies can have a very different ethos and as a result finding one with a similar attitude to the quality of care provided, for

example, or how they look after their staff can make the transition following a sale much easier.

ADVISERS It makes sense to choose advisers with a track record in the sector and good contacts with potential acquirers. The right agent or adviser should be able to give advice on the optimisation of profits, the most appropriate tax structure or issues, how the cash free/ debt free with normalised working capital mechanism will impact and who the potential buyers are.

Your choice of legal team is also significant to the sale process. A great deal of time and effort is required during the due diligence process and legal process. Having a legal team behind you which is used to advising on sales and the intricacies of social care and CQC or Ofsted regulations is extremely valuable. There have been occasions where buyers have made it a condition of purchase that the sellers instruct more experienced legal advisers.

An experienced corporate finance adviser will spend a great deal of time assessing and preparing the business for sale from a financial and tax point of view. They will manage the sale process in a confidential, controlled manner all the way through to completion of the transaction.

Buyers will usually welcome the presence of an experienced independent corporate finance adviser as it should make their acquisition process more efficient.

EARLY PREPARATION IS ESSENTIAL Even in a more buoyant market there is a great deal of preparation and work ‘behind the scenes’ to ensure the sale proceeds are maximised – both in terms of headline price, and the cash you actually take away from the deal after tax.

It really does pay to take independent, often no obligation, advice about exit planning at least twelve months before you anticipate any actual sale.

CMM Andy Brookes is Partner at Hazlewoods LLP. Andy.brookes@hazlewoods.co.uk

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Focus on Leadership and Graduates: measuring the impact and expanding the reach Welcome to the National Skills Academy for Social Care’s Leadership Section Welcome to our latest issue. In 2012, the Social Care White Paper Caring for our future talked about harnessing “a pipeline of talent, capable of inspiring the workforce of the future.1” The Skills Academy’s Graduate Management Training Scheme, the only national scheme of its kind in adult social care, aims to do just that, getting the right people into graduate-entry roles and placing them with host organisations where they can make a significant impact, even over the course of twelve months. This is especially the case with smaller hosts.

The programme has been running for four years now, and has gone from strength to strength. In 2013, 22 trainees were selected from almost 1,000 applicants, and we had submissions from far more host organisations than we could organise trainees for.

Partly in response to this, we set up the first Graduate Internship programme last summer. This was a paid Internship, aimed at making graduate resources available to as wide a range of organisations as possible and at giving graduates a specific six-week project within a host organisation where they could make a real contribution to outcomes.

This year, we will build on the success achieved so far. We have a retention rate of 95% for our trainees, well above that for Teach First or the Graduate Programme for Local Government, and comparing well with the NHS Graduate Scheme. Many of the graduates from 2010 and 2011 have already been promoted to Deputy Manager posts within Residential and Home Care settings, showing that the Graduate Scheme can be used as a fast track to management and to identify the leaders of the future in social care.

And we can demonstrate the value that the trainees bring to the sector and to service users during their placements. Most recently, we have evaluated impact by

NSA_4page May.indd 1

Debbie Sorkin, Chief Executive of the National Skills Academy for Social Care, reports on the return on investment of the latest cohort of the Academy’s National Graduate Scheme, and on plans for expanding the programme this year. focusing on a specific piece of work that each graduate had undertaken, looking at outcomes in terms of both financial savings and impact on service quality. Some of these projects are described in more detailed overleaf, where graduates, interns and hosts all reflect on their experience.

One trainee, for example, saved her host £140,000 through developing a new organisational Health and Wellbeing Plan. Another effectively undertook the management and development of the Activities Team – in a large organisation – from an early stage, with better teamwork and an expanded activities programme amongst the results. An third led on a new IT mentoring scheme for young volunteers, enhancing skills and activities amongst care home residents, building links with local communities and leading to an influx of young volunteers to Abbeyfield, greatly diversifying the existing volunteer base. And one intern, working in a national mental health charity, set up virtual panels to explore issues around growing older and mental health, which the organisation is now using as part of its strategic planning process.

So it’s clear that the graduate and internship schemes add value to organisations and to the sector as a whole.

In recognition of this value, we aim to be running two internship programmes this year, along with a graduate trainee scheme. This will be with a view to expanding the programme further from 2015 onwards. So have a read of the stories overleaf and of what people have to say about their experience. We’d love to hear from you if you’d be interested in being a part of this. It’s part of how we’re working together to embed leadership from the ground up in social care.

For more information about the Graduate Scheme, please contact harriet.phillips@nsasocialcare.co.uk.

1: Caring for our future: reforming care and support. Department of Health, July 2012

15/04/2014 08:57

Investing in the future, embedding strong leadership values Harriet Phillips, Graduate Scheme Manager, National Skills Academy for Social Care

We are increasingly hearing reports that the graduate market is showing signs of recovery, and perhaps more significantly, of expansion. For me, there has never been a more important time for social care to demonstrate its legitimacy as a career choice for talented and ambitious graduates.

As the sector continues to grow, there is huge potential for the Skills Academy Graduate Scheme to consolidate its identity and maintain its small but significant stake in the graduate market alongside the larger corporate schemes.

Our trainees have been praised for their passion and the ‘unjaundiced eye’ that they bring, in return they are offered a unique insight into social care built on real responsibilities.

The Graduate Scheme continues to attract overwhelming support from across the sector. Now that we have confirmation of funding for Cohort 5, an opportunity has presented itself to reflect on the success of the scheme to date, to celebrate its alumni and to look ahead to the future.

Since its inception in 2009, the Skills Academy Graduate Scheme has produced 88 alumni, in addition to 11 interns who completed 6 week placements last summer. A huge proportion of those graduates continue to work in and around social care, demonstrating a long term return on the investment made in them. The Skills Academy is confident that alumni will continue to progress through management

positions across the sector, as well as becoming inspiring mentors, guest speakers and hosts for future cohorts.

Enquiries about the programme continue to flood in on a daily basis, often citing the unique opportunity that we are offering graduates in social care. I could not agree more; during my time on the scheme the progress I witnessed in myself and my fellow graduates was immense. The year as a whole was a steep learning curve – hard work, highly rewarding, with an invaluable support network in place from day one.

In February I made the transition from alumna to Graduate Scheme Manager. I am committed to ensuring the sustainability of the scheme for future trainees, and to protecting the legacy built by the first four cohorts and the host organisations who supported them. We are also looking ahead to expanding the scheme over time in line with its potential, reaching a greater number of organisations and their service users.

The Graduate Management Training Scheme continues to be an invaluable part of the Skills Academy portfolio, investing in the future by embedding strong leadership values across the rapidly expanding sector. We are looking forward to welcoming a 5th cohort of graduates to our growing network of future leaders and managers in social care.

The impact of the Training Scheme 1: a passion for the sector Sophie Whitehead, Transformation Project Manager, King’s College Hospital (Cohort 1)

The National Skills Academy Graduate Scheme gave me a great starting block for my career. If I’m honest, I didn’t know a huge amount about the realities of social care before I started, but meeting the people who run the Scheme and the board who support it has given me a passion for working in this sector that I don’t think will ever go away. I spent 6 months working in a care provider getting some essential hands on experience, followed by 6 months with the local authority that commissioned that care provider. I had the opportunity to see the relationship from both sides (provider and commissioner) and experience the pressures for each, which taught me some invaluable lessons.

The aspect of the scheme that had the greatest impact for me was the professional coaching sessions. As a graduate working in local government for the first time, I felt that coaching really helped me to develop confidence in my abilities and decisions, and enabled me to take on more responsibility, faster.

After the scheme ended, I was lucky enough to secure a fixed term post as Personalisation Project Officer at the local authority. The role included responsibility for all things related to person centred support; working alongside the Programme Manager to roll out Personalisation across

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the department. This incorporated communications, policy work, research and project management, providing opportunities to try my hand at a variety of disciplines and gain a good range of experience. After 18 months in this post, I spent some time working in the Adult Social Care Commissioning team, before successfully applying for a Project Manager post in the department. For the last year I have worked on some exciting and challenging projects in and around commissioning, procurement and service redesign.

I have recently secured a post as a Project Manager in an acute trust so will be leaving local government, for the time being, to work in the NHS. As integration increasingly becomes the major priority in social care, I hope that this move will offer me a better understanding of the whole health and social care economy and provide a good grounding to continue my career in the health and social care sector. I certainly don’t see it as a permanent departure from Social Care. Our ageing population is one of the greatest challenges, not just to the NHS and local government, but to the economy as a whole. I hope that during my career I will be able to contribute in some small way to finding a viable solution, that enables people to lead happy, healthy, and meaningful lives in their later years.

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The impact of the Training Scheme 2: making a real difference to people’s lives Phil Darby, Deputy Care Home Manager, Methodist Homes Association (MHA) (Cohort 3)

I always wanted to have a job where I could make a real difference to people’s lives. On graduating from University, I spent months applying for graduate schemes, focusing on those which offered the potential to move up to management level. During my search I noticed an advertisement for the Skills Academy’s Graduate Management Training Scheme. I clicked on the link, and it was a real light bulb moment – this seemed like the perfect opportunity for me. I’d spent 5 years volunteering for my local Leonard Cheshire care home, but never really knew how to get in to the sector; this scheme provided the perfect opportunity. When I joined Cohort 3, I was placed with MHA, a charitable organisation which provides care and support to thousands of elderly people across the UK. My experience over the course of the year was life changing. Having the opportunity to earn a management qualification while working at the same time enabled me to learn the right balance of theoretical and practical skills required to manage effectively in the sector. I was based at a residential and dementia care home in Leicester, where I performed every possible role in the home, starting off as a domestic assistant and ending up assisting the home manager. By performing each role I gained a much greater appreciation for my colleagues, which allowed me

to empathise and therefore manage more effectively. The management qualification, an ILM level 4, gave me the knowledge and skills I was lacking and helped give me the confidence to use these skills in my placement.

Perhaps the most important legacy of the scheme is the support networks the scheme cultivates. The Skills Academy members, the Insight Management tutors, my host organisation and my peers on the scheme were invaluable throughout the year, offering advice, support and encouragement. This support has continued beyond the scheme, which has been hugely beneficial for myself and the other alumni.

After finishing the scheme in January 2013 I was offered a position with MHA. I spent 6 months travelling across the country as a medication systems implementer, training staff on medication policy and how to use a new medication administration system. In July last year, I became the deputy manager of a 44 bed residential and dementia care home in Bognor Regis. I could never imagine working in another career; it’s a real privilege being able to provide care and support for an amazing group of people. Getting to work alongside some inspirational people makes me aspire to be the best that I can be. I hope to manage my own care home in the near future and progress as far as I can in my career.

A new Internship Scheme: the perfect way to start a career in social care Steph Mitchell, 2013 Intern and Prospective Graduate Management Trainee Steph was one of 11 participants on the Skills Academy’s 2013 Internship scheme. The programme was introduced last year to provide a challenging 6 week taster into management in social care as well as an alternative route for exceptional interns into the Graduate Scheme.

I had recently finished my degree in Psychology when the opportunity to apply for the social care internship arose. It immediately appealed to me as a chance to explore a potential career in a sector where your work has a direct benefit to people’s lives. In what felt like no time, I had been placed with Sanctuary and I was meeting my placement supervisor for the first time, feeling nervous about what she was about to tell me I would be doing for the next 6 weeks. These nerves were short lived as I was told I would be undertaking training and shadowing before mystery shopping a number of care homes. Rather than being nervous, I found I was actually quite excited and keen to get started!

I found that Sanctuary Care was an excellent company to work for. They, along with the National Skills Academy for Social Care, kept in close contact ensuring I felt well supported throughout the duration of my internship. I was confident that had a problem arisen, it would have been

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dealt with efficiently and that people genuinely cared about my experience. My placement involved writing up a report and recommendations on my findings from mystery shopping. This gave me something tangible to work towards and felt like what I was doing was important to the company. I was later told that the report had been discussed at a meeting involving the General Director and that they would be implementing changes throughout the company as a result of my research.

Since completing the internship I have been working on my MSc in Psychological Research Methods. I think this has made me better prepared to start a career in social care. The opportunity to work in a sector whereby you can have an impact on people’s well-being is more appealing to me than ever. I am very keen for the opportunity to join the Graduate Scheme with the NSA as I am confident that I would feel the same support and also be able to fully immerse myself within the sector straight away. I hope to make a real contribution to the area of work, using the skills of communication I have learnt while on my Masters. I see the NSA Graduate Scheme as the perfect way for someone in my position to start their career.

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A new direction and making a difference Hannah Morgan, Regional Care Coordinator, The Good Care Group (Cohort 4) I graduated with a degree in French and Politics from the University of Manchester in 2011 and felt directionless.

When I moved to London my Grandmother was having 15 minute home care visits to prompt her medications and giving her something to eat during the day when I was at work. I provided the remainder of her care. This was my first experience of the social care sector and it was at this stage I knew I wanted a job that could make a real difference to someone’s wellbeing and quality of life. A matter of days later, I received an email to say that the Skills Academy was recruiting for the next cohort of management trainees.

I was allocated a placement with The Good Care Group for my year on the Scheme. From day one I was supported by a team of extremely enthusiastic, passionate, interesting and dedicated people from all walks of life whose motivation was always the wellbeing of the client. The leadership at The Good Care Group focuses on getting the best out of everyone and they were highly committed to helping me develop in my new role, in what was a new sector for me.

Having been appointed into the position of a Regional Care Coordinator, I was thrown into a management role from day one. I was given the task of supporting the day-to-day care management of a portfolio of around 30 clients and

60 carers, which included completing assessments and care planning, ensuring that the best suited carer was chosen for each client, and providing on-going support to carers, clients and their families.

The graduates came together regularly to complete our ILM management training, in the form of workshops, development days and action learning sessions. We developed together, sharing experiences, concerns, growing as a team and making memories. Without the Graduate Scheme I would not have had the opportunity to manage a team of people in social care and carry such a high level of responsibility.

The future is looking bright; I was offered a permanent position at The Good Care Group in a management role, and there will be an abundance of opportunities coming up over the next few months. The Good Care Group is committed to the continuous professional development of their teams and to ensuring that their staff becomes the best that they can.

I would encourage young leaders to consider social care as a viable and exciting career path, with plenty of prospects in a wide range of roles. We are facing an increasing ageing population that needs young leaders to provide the energy and creativity to steer it in the right direction, now and into the future.

The Host Perspective: Focusing on promoting high quality leadership Judy Downey, Chair of the Relatives & Residents Association (2013 host)

Last year, The Relatives & Residents Association (R&RA) was selected by the National Skills Academy to host both a yearlong Graduate Trainee, Cathy Hickey, and a Summer Intern, Hannah Brada.

We speak up and speak out on behalf of older people in care homes for a better quality of life. We are the only national charity for older people which concentrates entirely on residential care. We offer immediate, accurate information, comfort and support to the many family and friends who find themselves facing a move into a care home or raising concerns about care. We also work to influence policy and practice by reflecting the experience of our members and callers, as well as in the research, training and publications we produce and the policies we advocate.

Cathy quickly became a valued member of our team, involved in all aspects of our work, from basic administration to discrete projects. Eventually she was capable of coping competently with regulatory questions from both our clients and CQC. She actively took part in meetings with the Department of Health, with CQC on our joint project with them, and others. She attended workshops and conferences with us or on our behalf and made contact and interacted with a wide range of service providers. Under supervision, she also reorganised our filing and retrieval system.

Cathy helped expand our resources, including taking the

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lead on three publications, including updating and restyling our “Questions to Ask” as well as being included in our Keys to Care and Keynotes projects, attractive new aide-memoires for health and care workers.

Last summer, Hannah worked diligently on the background discussion paper we shall be issuing later this year on the pros and cons of using CCTV in care homes, examining existing law, research and practice in the sector and beyond. She also learned about R&RA’s work and took an active role in discussions and debates.

Both Cathy and Hannah have left a lasting impact on the charity with their achievements and we are delighted that they remain in touch with us. These additional resources allowed us to achieve goals that would not otherwise have been possible. This is a credit not just to our graduates but to the powerful and imaginative impact of the scheme itself.

The system of graduate selection was exceptionally high and the NSA offered superb support and additional training to both the graduates and host organisation throughout.

This clear focus on promoting high quality leadership, compared with the resources devoted to it in other sectors like medicine, nursing and teaching, needs to be expanded and developed to achieve something near parity not only for the sector, but for the individuals and families we all represent.

15/04/2014 08:57

60 seconds with...

60

SECONDS WITH...

M E LV I L L E K N I G H T Melville Knight is Group Chief Executive of Castleoak, the care sector construction organisation.

WHAT IS CASTLEOAK? WHAT DO YOU DO?

WHAT PRESSURES DO YOU FACE?

Castleoak is a developer and construction partner working exclusively in the care sector.

Established for 30 years, we work with private, social and not-for-profit customers on all types of care accommodation throughout the UK. Castleoak s customers range from start-ups to national organisations, including Barchester Healthcare, Bupa, Care UK, Methodist Homes, Avante Partnership, Saxon Weald Housing Association and Anchor Trust.

Castleoak has delivered over 180 care homes, including specialist dementia care facilities and over 3,000 apartments in extra care schemes and care villages across the UK.

Land supply is limited so we face fierce buying competition from residential developers.

The construction sector is also very cyclical and as we move from bust to boom we have to manage both prices and costs very carefully.

HOW HAVE YOU SEEN THE MARKET EVOLVE OVER THE YEARS? In care homes, the market has moved to much larger bedrooms with en-suite shower rooms, arranged in clusters to promote group living.

A wider range of communal facilities is provided and the quality of specification and fit out has improved considerably.

The range of accommodation has also widened. There are now various models of housing with care and care villages.

Resident care is much more personalised and there is a greater focus on quality of life and meaningful activity.

CASTLEOAK WINS REGULAR AWARDS AND IS SEEN AS A BEST COMPANY TO WORK FOR . WHAT S YOUR SECRET? We have a clear set of company values that have remained constant over the years. These include honesty, working in partnership, striving for excellence in everything we do and treating everyone with respect.

I think colleagues relate to these values. Combined with, what I hope is, authentic leadership and a good company reputation, I think they help to make Castleoak a great place to work.

HOW DO YOU ENJOY YOUR SPARE TIME WHEN NOT WORKING? My wife has recently launched a ladies fine Italian shoe boutique.

Much of my spare time is spent helping with that, including lots of buying trips to Italy!

Otherwise, I enjoy growing vegetables, keeping chickens, spending time with my two children who live and work in London, helping to lead a church as well as sampling great restaurants.

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EVERMORE - A REVOLUTION IN HOUSING WITH CARE? A new approach to retirement living is emerging from the US. Based on communal living in small settings, will it transform the market?

On face value, Evermore could be another retirement village, independent living with mixed tenure. But on closer inspection, its small scale and approach differs.

THE EVERMORE APPROACH The Evermore approach is based on the successful US Green House model, designed to satisfy both personal preferences and current social policy priorities. It enables home ownership, through mixed tenure, combined with quality and personalised care and autonomy. The US model is designed to be affordable and available to all. However, what sets it apart from existing housing with care is its novel staffing model and bespoke way in which care is delivered.

The integrated approach to housing, health and social care revolves around companionship that aims to not only enhance quality of life, but

also health and general functioning. Research suggests that this could result in appreciable cost savings across public services especially to the NHS; by putting control back into older people’s hands while ensuring they always have access to the right care.

INTENTIONAL COMMUNITY Evermore’s ‘intentional community’ will be aimed initially at self-funders who will be able to buy a one-bedroom, self-contained apartment in a household consisting around 10 to 12 people. Each household will form part of a small village of around 60 people.

Individuals will buy a lifestyle proposition from Evermore that consists of an architecturally designed living space with the conviviality of a family home and a support network when they need it. The apartments will feature a separate living room,

kitchenette, double bedroom with walk-in wardrobe and wet room. Each apartment will have a balcony to access outdoor space, plus will open onto a communal living area and hearth, open plan kitchen and a large dining table. Villagers will be encouraged to share mealtimes together at the communal table.

Individuals purchase or rent a one-bed apartment with a service charge to cover utilities and building maintenance. He or she then pays a monthly fee for housekeeping and hospitality; care packages are available for purchase according to need.

The communities are designed like a domestic family home. In addition to the living space and garden areas, there will be a communal space available for the local community to utilise. This can also be used as a central hub by health and wellbeing professionals such as GPs and physiotherapists. Each village community will

A welcome addition but has challenges

Shared living will divide opinion

Michael Voges Executive Director Associated Retirement Community Operators (ARCO)

Ben Hartley Director Carterwood

Evermore are clearly working very hard to bring this type of offer to the UK market, and I applaud their enthusiasm for their model. In my view, they face two main challenges.

Firstly, it combines innovative ideas such as the Mulinellos with elements that are more akin to the co-housing model. I have no doubt that there are older people who are looking for the type of companionship to be found in this type of intentional community .

However, I believe that a considerable number of older people (more likely to be younger older people, and/or couples) would need some persuasion before opting to live so close to 10 to 12 others, and share facilities with them. I m sure many will have questions such as Will they share my interests?

What happens if we don t get on?

In a larger scheme, residents have more choice over where and with whom they socialise.

Secondly, the small scale nature

of the model and the high staffing ratios mean that this will not be cheap and thus affordability becomes an issue. I would assume that ‒ as with the intentional community ‒ this is therefore more likely to appeal to the older older person who may have higher support and probably care needs.

After all ‒ why pay a hefty service charge if I don t yet need the services?

Therefore, I would see Evermore s model as being similar (with innovative twists) to the Assisted Living products already offered by a number of providers in the market today. As such, it is more of a response to existing residential care homes, rather than a revolution of the housing with care model.

Nevertheless, Evermore is a highly welcome addition to our sector as it expands the still limited housing options for older people, and I wish Evermore every success at making their model work.

Given that the UK is obsessed with home ownership it is truly surprising that there are so few genuine housing alternatives in the sector, which try to bridge the gap between traditional sheltered housing and residential care.

Demand for extra care will inevitably rise. We anticipate that the market will respond through the emergence of a large variety of different housing models and options that will provide greater choice for older people. However, such a range of options is, currently, sadly lacking.

The Evermore approach is seeking to provide a housing option but in a more integrated manner than that compared to most other new developments. The acceptance of a shared living concept will, of course, be down to personal choice ‒ one which will inevitably divide opinion.

However, the extra care market is all about personal choice, not just need, and a proportion of the market

will choose something along these lines.

The concept of the Mulinellos is an interesting one but not new - it just hasn t been so clearly defined.

In the last extra care scheme Carterwoood mystery shopped, the support worker (note not care assistant) commented that she did everything from changing light blubs to assisting to domestic tasks and escorting someone to the shops. We do, however, like the separation of the support function away from any connotation of direct care provision as this will be a useful marketing tool.

Economy of scale is not always needed to generate a viable model but size does help spread the costs.

The difficulty in maintaining service charges at manageable levels is the provision of 24 hour care and support, particularly at night.

It will be interesting to see how the Mulinellos approach to care provision overcomes this challenge

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business clinic

have an average footprint of 1.3 acres and will be located on the edge of towns and suburban centres, within easy walking distance of shops, cafes, transport links and leisure facilities.

MULINELLOS Traditional care worker roles will be replaced

by Mulinellos. Mulinellos are universal workers who will support residents in their domestic life and there is an option of access to care when needed. The name means ‘whirlwind’ in Italian and describes the multifaceted role they will play, which involves everything from cooking to cleaning, managing the household budget, to providing personal care and support. They are based on a staff-resident ratio of one to five or, maximum, one to six.

As well as looking after the practicalities of running the household, they are advocates for homeowners ensuring other services, for example doctors and district nurses, can be called upon when necessary. Mulinellos will work as a team with the same level of accountability within the household, there is no top-down hierarchy. Mulinellos will have the time to get to know and develop relationships with the residents. They will be

recruited from customer service and retail backgrounds. The aim is to break down professional barriers between staff and residents and, most importantly, to nurture and maintain a community. Salaries and contact hours with residents will be higher than is typical for the sector. However, the company feels that the introduction of a new staffing model allows costs to be kept within the necessary limits.

WHY DEVELOP A NEW MODEL? Older people have a variety of needs and wishes for their housing and care. Models like extra care, provide a flexible menu of services but the team behind Evermore feels that there is an urgent need to keep evolving practice and to learn from affordable and effective solutions.

The company believes that new models are needed that ensure people retain their sense of personhood and independence as much as possible. The creation of an intentional community, which combats loneliness, helplessness and ensures that people are well-nourished psychologically and physically, is at the heart of Evermore.

Moreover, Evermore feels a sense of

family is crucial which is why. Small groups of unrelated individuals will live in the same building and share each other’s lives.

PROGRESS SO FAR Evermore is ready to launch and currently in the final stages of capital fundraising. Three sites have been identified in the north-west and they are in the process of finalising planning permission to open the first site in late 2015.

The company intends to build more than 20 communities by 2020.

Alongside developing its own sites, Evermore has launched the Evermore Academy which aims to help existing providers to change the CMM way they are currently delivering care.

Over to the experts...

Will this approach transfer sufficiently well to the UK market? How easy will it be to create an intentional community of different people with differing needs, wants and preferences? With many operators opting for larger developments to make shared facilities viable, will this work on a small scale? What would service charges need to be to cover multi-skilled, professional staff?

What do our experts think?

Evolution not revolution Paul Birley Head of Public Sector and Healthcare Barclays Evermore has pulled together a number of attractive features to produce their community model although their plans strike me as more evolution than revolution.

The care home market continues to evolve and Evermore s solution looks to continue this trend. As the population ages, we will require more care provision and Evermore will offer another choice.

Their focus on companionship is a big positive. Research suggests loneliness has a material impact on health, the equivalent impact as smoking 20 cigarettes a day!

Abbeyfield was founded on combating loneliness so this is not particularly new. Evermore s solution also looks to build on a number of trends that I ve seen - self-contained suites and universal workers. I have seen a number of care homes with suites and a few operators adopting universal workers .

The idea of universal workers is a sensible development and should

help deliver that community feel Evermore is looking to create.

Although this clearly won t be a solution for everyone, it does provide further choice. However, there are a couple of key challenges that come to mind.

Firstly, I wonder if Evermore will be able to find enough sites to build their communities in the south where land prices are higher and where good access to facilities might not be so readily available. Also, when it comes to finance, there is a possibility that these schemes might be seen as speculative residential developments and therefore not necessarily attractive to funders.

That said, having a mixed tenure solution could also be an attractive offering, although again not unique, and any solution that helps reduce costs in the NHS must also be encouraged.

Overall, this is certainly a solution that I hope will succeed.

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

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

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DEMOGRAPHIC DIP:

Implications for Providers and Policymakers

Irving Stac kpole looks at changes and explor in demogra es whethe p r we are re baby boom ally experie hics or a popula ncing a tion dip. If it is a popu dip, are we lation ready for a boom?

S

o much has been written about the ageing of our population and the impending retirement of the ‘baby boom’ generation that you would think we were awash in elderly. You may have seen headlines like, ‘The Grey Tsunami’. The economic principles of supply and demand state that if there are lots of older people (demand) then care homes, nursing homes and domiciliary care agencies (supply) should be operating at capacity and even expanding to meet the growing demand.

Yet, some operators and managers still report poor occupancy, voids in available capacity to take on extra clients.

As we will see, these anecdotal reports are borne out in the facts that care home, nursing home and housing

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demographic dip: implications for providers and policymakers

g

with care supply has been shrinking.

This paradox begs a simple question. If there are so many older people, why isn’t the demand greater? Why aren’t care homes, nursing homes and other care provision full, with more capacity being added every day?

Many operators and managers point to the influence (even interference) of intermediaries such as regulators and local authorities to explain why they aren’t full and why they need to close homes or remove capacity from the system.

While the impact of these intermediaries is undeniable, this explanation isn’t at all complete.

Live Births (thousands) 1000 957,782

DEMOGRAPHIC FACTS 800

The demographics of ageing are not as simple as has been portrayed in the popular press, by advocacy groups in the sector or by policymakers. The population is growing gradually older, however those accessing care services has been shrinking.

The ‘market’ (the number of older people requiring care and support) is declining.

In a declining market, the supply (the capacity of services for this market) also declines.

600

400 1900 05 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 00 05 2010

FIGURE 1: Live Births: UK & Wales 1900 - 2010 Source: ONS

DEMOGRAPHIC DIP If we look more closely at the live births in England and Wales we can see this ‘demographic dip’ in Figure 1.

The live births peaked at approximately 960,000 in 1920. Those born in 1920 who survived would reach 75 in 1996, and 85 in 2006. The birthrate then went on a steep decline until approximately 1942. Of course this ‘demographic dip’ corresponds with periods of war, great economic and geopolitical instability. The next ‘peak’ in birth rates is in 1946 at approximately 850,000 births, and then there is another decline and trough (corresponding with the postwar recession) until 1955. Of course, these peaks and troughs must be reflected as the population ages.

Demand for care services and housing with care is greatest when people reach 75 to 85. There is certainly demand among the younger population and some demand after 85, but the average age of relocation to care settings, and the height of service use occurs between the ages of 84 and 87.

This means that in 2014, those accessing care services were born between 1926 and 1929 (see Figure 2.).

Live Births (thousands) 1000 957,782 75 YOA in 2014 800 85 YOA in 2014 600

400 1900 05 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 00 05 2010

FIGURE 2: Age-qualified market trends - 2014 Source: ONS

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demographic dip: implications for providers and policymakers

100%

80%

60%

40%

20%

0% 65-69

70-74

75-79

80-84

85+

FIGURE 3: Rate of change of older people in England 2010 to 2030 by age (Dilnot) Source: 2008-based population projections, Office for National Statistics

Year

1990

1995

2000

2005

2100

Residential

140000

151000

163000

161000

171000

Nursing

104000

174000

164000

146000

151000

Residential

36000

52000

50000

49000

45000

Nursing

10000

17000

16000

14000

16000

NHS

68000

43000

24000

19000

14000

Local Authority

114000

71000

51000

32000

22000

Total

472000

508000

469000

421000

418000

Private

Voluntary

FIGURE 4: Residential and nursing placements 1990 to 2010 (LaingBuisson)

As can be seen in Figure 2, the population of those likely to require care services has been declining, will continue to decline and will not rebound until 2025.

These demographics will have a deep, protracted impact on the demand for services. It is this ‘demographic dip’ in combination with symptoms of the recent ‘great contraction’ (think recession on steroids) which are depressing demand.

There has been an extraordinary array of reports and projections about a rapid growth in the number of older people.

These make great bylines in the popular press. Most of these reports rely upon the ‘rate of change’ rather than the more granular number of people, and often project the change from 2010 to 2030 or even 2050. For infrastructure and strategic planning purposes such projections are extraordinarily important, but if you’re trying to run a care home in Yorkshire, or domiciliary care agency in Surrey, if your market is shrinking today, next year and the year after, you may not survive to 2030.

Figure 3 from the Dilnot Report1 shows the rate of growth amongst older people, however, in the actual report this was incorrectly labelled as ‘the number’.

This chart depicts a dramatic change, and one can find many of these in many reports and documents. The truly important thing today, and in the near term, isn’t the percentage difference in older people from 2010 to 2030 as much as the numeric change between now and 2030. The estimated total 85+ population will grow from approximately 1.8 million to 3.6 million from 2010 to 2035. This is a dramatic rate of growth over this period of time, but the overall number is relatively small, and in the near term, from 2014 to 2020, we are faced with a flat or declining market.

THE SUPPLY This demographic dip and resulting decline in demand is reflected in the number of available residential and nursing care beds reported by LaingBuisson and others, depicted in Figure 4.

The decline in total utilisation from 472,000 in 1990 to 418,000 on 2010 (decrease of 11.5 per cent) represents the type of contraction in supply to be expected in a declining market. The decline in the available supply cannot be explained merely as the result of

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demographic dip: implications for providers and policymakers

g

policy changes or intermediaries; this is supply and demand at work in the nursing and care sector.

WHAT ABOUT LIFESPAN? Having presented this challenging, contrarian scenario in several national and international conferences, some of the arguments against the downward drag of the demographic dip on the care market have been offered up.

WHAT ABOUT ACCEPTANCE? One way to compensate for a declining market demand is to increase the acceptance or penetration of the product or service. It is a fundamental truth, however, that in our societies, care home and nursing home use can be seen as negative. Negative press, ageing stock and public squabbles have further tarnished the perception of care services. Try as we might, this will be hard to change.

‘From a public policy and budgeting point of view, it makes little sense, in my opinion, to demand more resources now, when the market is declining.’

Many would argue that the increasing life expectancy and declining mortality since 1920 would offset the effects of declining birth rates. The arithmetic of this, however, simply doesn’t work because of the scale of the decline; live births declined by over 360,000 between 1920 and 1935. Life expectancy would have to have increase by a factor of 2.5 to 3 (more than double) among those 80 years of age or older to achieve survival rates that would compensate for the decline in live births.2 Increased life expectancy and decreased mortality, while offsetting this decline, cannot adjust for the size of the demographic dip.

WHAT ABOUT CHRONIC DISEASES? With a society which is gradually ageing and enjoying improved survival and lower mortality, some argue that the chronic diseases of ageing (orthopedic, neurological and cardiovascular) will compensate for the demographic dip by increasing the demand for services among the declining older population.

Prevalence of Alzheimer’s disease and related conditions among the population seems to be increasing. However because these illnesses and diseases are primarily late onset, the incidence results in burden, therefore demand, mostly as the population ages.

WHAT TO DO? In a free and open market system, supply would contract to meet the available demand. Furthermore, as the consumers’ needs and desires change, the suppliers would adapt and modify the product or service. It is unlikely that this will occur easily and without some significant convulsions. After all, entering the care market as a provider is not, nor should it be, easy so market exits will be difficult and potentially traumatic.

From a public policy and budgeting point of view, it makes little sense, in my opinion, to demand more resources now, when the market is declining. Preparation must be made for the inevitable increase in demand that will result when the oldest baby boomers reach the age of high consumption around 85. This is in approximately 15 years’ time. In a collaborative environment, this should offer sufficient time to consider the most beneficial and least costly options. For example, assistive technology to improve the safety and surveillance of the health of any population. The baby boom population and those who come later will expect care providers to have technological sophistication.

For operators and managers, the goal is to survive the next decade or so. There are four demonstrated strategies to survive a declining market.

1

Improve customer/consumer loyalty.

In a declining market, increased market share comes at a very high cost, therefore, retaining existing customers and consumers is imperative.

Loyalty depends upon effective service error recovery and most managers are not accustomed to applying these principles in their daily operations.

2

Increase efficiency. This does not mean cutting staff, as is commonly understood. Higher levels of output for the current inputs is the principal of achieving higher efficiency. The principles of continuous quality improvement, LEAN and Six Sigma management techniques must be imported to the sector.

3

Innovation. Capital investment in innovations, such as technology, which have a measurable impact on improving efficiency, as well as increasing customer loyalty will allow some operators to survive – others will be left behind.

4

Differentiate. Novel programmes, such as innovative ways of caring for people with dementia, new technologies which allow staff to spend more time with residents and families, will offer providers marketing and public relations opportunities to demonstrate to potential clients how they differ from their competitors.

SURVIVAL Surviving the demographic dip will be a challenge for the sector. Being realistic about the imminent changes and responding effectively will allow certain providers to survive and continue serving older people, as well as their families. CMM Irving L. Stackpole RRT, MEd is President of Stackpole & Associates Inc. istackpole@StackpoleAssociates.com REFERENCES 1Fairer Care Funding: the Report of the Commission on Funding of Care and Support. July 2011 2 Leeson, G. W. The Demographics and Economics of UK Health and Social Care for Older Adults: Working Paper Number WP304. Oxford Institute of Ageing Working Papers, May 2004

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SPEAKER

SPEAKER

SPEAKER

SPEAKER

Catherine Murray-Howard, Deputy Chief Executive, Community Integrated Care

Joe McGilligan, Chair of East Surrey CCG & Co Chair of Surrey’s Health and Wellbeing Board

Trevor Brocklebank, CEO and Co-Founder, Home Instead Senior Care

Andrew Azzopardi, Managing Director, Sunnyside House.

SPEAKER Directors of Children and Families services

Dr Toyin Ogboye, Public Health Specialist, Specialised Commissioning NHS England

Health+Care is the only national event where health meets social care Health+Care returns on the 25- 26 June 2014 at London ExCel. More than 7,000 professionals will gather from all over the country for 14 theatres of world class conference programmes, with dedicated ‘Home and Residential Care’ theatres, delivered by expert speakers and policy makers.

Your complimentary delegate pass will allow you to: > Get advice on how to influence your CCG and local authority to ensure its strategy works for your organisation > Source practical cost saving ideas for driving efficiencies > Prepare for new-style CQC inspections

In addition to the 14 theatres of content, there will be a new Care Commissioning and Public Health conference, a centralised hub for technology – Technology First, and new features for 2014 for you to follow your own specialist learning needs.

> Discuss updates on policy and liability developments and political thinking

Health+Care is the only event to bring together the entire health and social care sector on a major scale, making the event your best shared learning and networking opportunity. Plus the 400 exhibitors will enable you to source and compare the latest innovations.

> Gain insight into new opportunities and threats in the reformed health and social care system

In just two packed days, you can update your knowledge and meet more people than you could from months of research in your office.

> Debate the role of regulation in improving quality

> Debate issues surrounding the Better Care Fund > Meet the people that can award you budget available from the Step Down Care initiative

> Learn economy of scale to compete for new contracts > See new innovative pricing mechanisms and ways of setting contracts Plus much more! Attend the show - save time + save money

Passes are usually £695+VAT* but senior social care and care provider professionals can get complimentary passes that are available.

Register at www.healthpluscare.co.uk *Commercial companies will not qualify for complimentary passes

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14/04/2014 18:00 14:45 17/03/2014

34 ¦ CMM MAY 2014

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An eleventh-hour settlement in Interest Rate Swaps Keith Lewin brings an update on Barclays’ settlement of Guardian Care Home’s bank Interest Rate Swap.

To recap, and for those who haven’t read the previous articles, a bank Interest Rate Swap Agreement (‘Swap’) is a complex financial instrument, a bet, otherwise referred to as a ‘derivative contract’, through which a business could effectively cap the amount of interest that it would pay if, after having borrowed a capital sum, say, £1,000,000, interest rates rose above a specified level. The products are sometimes referred to as a ‘hedge’ against interest rates rising.

The flipside of such a deal was that if interest rates fell below a certain level, the customer would pay a larger amount to the lender.

Undeniably, interest rates are at an historically low level, with Bank of England’s Base Rate just 0.5 per cent.

The bet was one which – from a customer’s point of view – was against interest rates rising. Few realised, and the banks didn’t explain, that if interest rates fell, the customer would pick up a large bill.

For a customer to get out of the arrangement/contract, banks charge or seek to charge large penalties, which most customers cannot afford – for some businesses of modest means with relatively modest loans are liable for millions of pounds to buy themselves out of the Swap.

The Swaps were sold to customers with a substantial asset base, typically real estate. Many sectors were targeted, not just care homes: hotels, restaurants, public houses – anyone with a chargeable capital asset.

There have been a number of High Court cases in which the Swap deal has been a central feature, some of those claims failed.

The banks have also been reviewing many of the Swap agreements and have made some payments to customers - where the bank concerned has decided that the customer had been mis-sold the Swap product. In many cases, the banks have taken the view that large companies can ‘look after themselves’ and, so far as I know, payments have so far been made only to small and medium-sized enterprises.

ELEVENTH-HOUR DEVELOPMENT However, one case before the courts, and which I have been following with a keen eye, is one in which the stakes were very high, namely, Graiseley Properties Limited (and 14 others) v Barclays Bank Plc (and another) which concerned the selling of a number of Swap contracts to a group of associated companies which most people in the care sector would recognise as Guardian Care Homes.

In this case, the companies bringing the claim sought a declaration from the court that the Swaps contracts entered into with Barclays were void and, alternatively, that the Swaps be rescinded. The companies also sought some £12,000,000 plus interest and costs. The companies in the case included claims about the rigging of the Libor rate – and this was pleaded even before Barclays was ‘outed’ and subsequently fined some £209 million for the misconduct of some of its staff in regard to improperly manipulating the Libor rate.

There have been a number of skirmishes in this court case

as it has been progressed through the High Court, for example, Guardian was able to force Barclays to release a large number of embarrassing emails. The trial which was due to commence in April 2014, and Guardian was intending to force some very senior people from Barclays to appear at the trial and put them in the witness box.

People like Bob Diamond who formerly led the team within which the Libor manipulation took place and who subsequently became Chief Executive of Barclays before resigning in the wake of the Libor-rigging scandal.

Readers will recognise that the stakes in such a trial were very high and could be expected to be widely covered by the press and media, not just in the health and social care sector, not only in the specialist financial columns, but, front page news.

Perhaps it is, therefore, not surprising that, at the eleventh hour, Barclays settled the claims brought by Guardian and, as a result, Barclays will renegotiate the £70 million of debt with the 15 Guardian Care companies – I assume that Barclays has also agreed to meet the costs of the claim brought against it, costs which will be very large. This is a massive climb-down by Barclays.

A Barclays spokesperson, said, ‘In response to discussions with Graiseley (Guardian Care), in order to support the ongoing viability of Graiseley’s care home business, the parties have agreed to a commercial restructuring of Graiseley’s debt.’

WHAT DOES IT MEAN? That statement raised lots of unanswered questions.

From the care sector’s point of view, this case has put care providers in a better place in terms of negotiating with banks.

That said, many care providers who might wish to challenge, in the courts, the Swap agreements with which they are burdened, may have already lost their chance to challenge them – all claims based upon contracts must be commenced in the courts within six years of the alleged breach.

WILL THIS BE MY FINAL ARTICLE ON THE ISSUE OF INTEREST RATE SWAP AGREEMENTS? That depends; it depends upon how the banks behave collectively in their reviews of all of the potentially mis-sold Swaps. They were forced into a position by the banking regulators to conduct a review of all potentially mis-sold Swaps and when I last looked at the statistics, the banks were clearly dragging their collective feet – probably to make as many contracts as possible fall outside of the period when court proceedings could be commenced.

As ever, time will tell.

CMM For Keith’s previous articles on Interest Rate Swaps see CMM December 2013, CMM March 2013 and CMM July 2012.

Keith M Lewin is Senior Partner at Brunswicks LLP Keith.Lewin@brunswicks.eu

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Who’s who…

PROPERTY PROFESSIONALS Buying or selling a care business takes specialist knowledge, finding a property agent experienced in the sector is a must. With all the latest information on valuations and the best strategic advice, the right agent can have a huge impact on the success of transactions whether you’re considering acquiring or disposing of a care business. This month CMM looks at the lead partner, head of healthcare or director of specialist care sector property professionals.

BESPOKE CARE

Bespoke Care has been established by industry expert, Anita Allen. With over 30 years’ experience within banking, finance brokerage, management and agency, all specifically in the long-term healthcare sector, Anita provides good quality advice to vendors seeking a discreet sale.

Throughout the whole sales process a ‘holistic’ professional service is delivered in a consultative manner. Bespoke Care, tailor its healthcare property advisory services so that vendors and purchasers receive a personal, client-focused service.

Managing sales throughout the UK and in all care sectors including specialist, children’s services, domiciliary businesses and elderly care, the firm ensures vendors obtain the best outcomes with as little disruption to the care business as possible.

ANITA ALLEN Director

Bespoke Care is not a 9 to 5 firm – but is tenacious, thorough, with a work smart ethic – working alongside other care specific professional firms to maximise the financial ‘net’ outcome for vendors. Bespoke Care also assists corporate care operators, sourcing sites for new developments and providing consultancy services for purchasers investing in their first care facility.

Telephone: 07963 562617 / 0114 236 9532 • Email: aallen@bespoke-care.com • www.bespoke-care.com

BURFORD CARE HOMES

Burford Care Homes specialises in the sale and acquisition of healthcare businesses within the UK marketplace.

Backed by over 27 years’ proven UK experience, Burford Care Homes is rich with industry contacts. Director, Paul Burford is highly-regarded and renowned for his confidential and seamless handling of every conceivable detail of a successful care home sale.

Paul’s attention to service is what makes him stand out in a highly competitive marketplace and his clients over the years have ranged from owners of single care homes through to multi operators and large corporates.

PAUL BURFORD

As you will see from the testimonials section on the Burford Care Homes website, Paul is held in high regard by some of the most prominent names in the care industry and would be delighted to discuss, with no obligation, how he can be of assistance to home owners seeking to sell their home in a highly confidential manner.

Director Telephone: 07808 764748 • Email: paul@burfordcarehomes.co.uk • www.burfordcarehomes.co.uk

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BUTTERWICKS HBS LTD

Peter has held prominent positions within the healthcare valuation industry for over 25 years and has been involved in numerous valuation projects along with the sale and acquisition of many nursing, residential and specialist care establishments. In a long career, he has worked as a healthcare specialist for two of the country’s leading independent business surveyors and was co-founder of an innovative healthcare sales agency with many corporate clients.

Now with his own company, which specialises in the discreet marketing of all types of care establishments from children’s homes and specialist care units through to proposed care villages, he is able to draw on his vast experience and many industry contacts. Always approachable, Peter welcomes open and frank discussion of clients’ requirements and objectives.

PETER BUTTERWICK Managing Director Telephone: 01908 565516 • Email: info@butterwicks.co.uk • www.butterwicks.co.uk

CARTERWOOD - WWW.CARTERWOOD.CO.UK

Amanda Nurse is a director of Carterwood along with her business partner, Ben Hartley. Her career to date has been exclusively within the long-term care sector. Carterwood is a chartered surveying practice specialising in the adult social care market, offering a bespoke service for clients in direct counterpoint to some of their larger competitors.

AMANDA NURSE Director

She says, ‘Our clients are from both the private and not-for-profit sectors of the industry, and range from individuals to the largest corporates in the sector. The diversity of the work we carry out is exciting, challenging and innovative.’

‘Particularly close to my heart is the development of our agency business.

However, this is only possible because of the deep understanding of the market that comes from operating a sophisticated consultancy division.

One informs the other. Together they enable us to give a comprehensive offering to our clients, no matter what their requirement may be.’

Telephone: 08458 690777 • Email: amanda.nurse@carterwood.co.uk • www.carterwood.co.uk Tom works on behalf of both private and not for profit operators.

Tom has been a member of the Carterwood agency team for over Tom is currently handling the acquisition and disposal of a number of three years and in that time has been involved in a range of sale and development sites in the south of England. acquisition projects, with particular focus on the market within the South West and on the South coast.

Telephone: 08458 690777 • Email: tom.hartley@carterwood.co.uk • www.carterwood.co.uk The Carterwood Agency • Is involved in numerous disposals of operational care homes throughout the country, with specific experience of dealing with sales on behalf of housing associations.

Agent • Previously sold development sites for proposed care use on behalf of private individuals and developers – on a conditional and unconditional basis.

• Is currently leading the acquisition of a number of development sites in the south of England.

• Is currently involved in the disposal of two care home groups in the elderly and specialist care sectors with a value in excess of £20 million.

• Is currently instructed in the sale of a number of development sites at different stages on the sales process – e.g. about to come to market/on the market/under offer/nearing completion on a nationwide basis.

• Acts for a range of clients including – private equity houses, investment funds, not-for-profits, small and medium size operators.

• Has specialist knowledge of demand and supply/demographics on the development side of the sector.

• Has detailed knowledge of a wide range of buyers, and specifically of which geographical areas organisations are looking to target over the next 12 months.

• Has in the past year tripled the size of its Agency Division.

TOM HARTLEY

Based in Bristol, the Carterwood team brings together an extraordinary blend of skills and experience. Growing a business is never easy, and it is core to Carterwood’s philosophy that they maintain quality as they expand. Amanda says: ‘These are exciting times for the Carterwood Agency. As we continue to expand we are dedicated to providing the very best and most personal service for all our clients no matter how large or small.’

CHRISTIE + CO

Richard Lunn is Christie + Co’s Director and Head of Healthcare, leading a team across the company’s network of 14 UK offices. Richard joined Christie + Co in 1989 from a major retirement housing developer. He has specialised in healthcare throughout his career and has worked throughout the company’s network, with periods managing the Winchester, Bristol and Birmingham Offices.

Richard was made an Associate Director in 1996 and a Director in 1998, becoming responsible for the care sector in 1999. Working with our local agency teams, Richard has developed relationships with the top corporate healthcare operators and financiers, regularly selling over 50 per cent of all individually transacted care homes in the UK for each year.

Founded in 1935, Christie + Co is a leading care agent and adviser - advising on the sale, acquisition and valuation of care homes since 1984’s

RICHARD LUNN Registered Homes Act. Christie + Co has 200 highly experienced business agents, chartered surveyors and consultants, over 30 of whom work specifically in its Care Team, based in 14 offices around the UK. Director and Head of Healthcare Telephone: 0207 227 0700 • Email: richard.lunn@christie.com • www.christie.com

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who’s who…property professionals

DC CARE - WWW.DCCARE.CO.UK

Operating from head office premises near to Wetherby in West Yorkshire and a satellite office in Peterborough, Cambridgeshire, DC Care provides a specialist agency service to the healthcare sector throughout the whole of the UK. Established in 2002, DC Care has grown to become one of the most respected agents in the industry, with a reputation for providing an ethical, discreet and professional service to both vendors and purchasers.

ALISON TAYLOR

With a decade of specialist healthcare experience, Alison joined DC Care four years ago and in that time, has concluded sales of a range of businesses, from closed care homes, homes in administration, to wellperforming larger operational groups. Her extensive financial analysis and

Regional Director (North)

relationship management experience gained in other industries, enables her to quickly grasp the often very individual facets of any sale. Alison provides a number of lenders with marketing reports, enabling decisions to be made on the future of businesses showing early signs of distress.

Telephone: 07825 353748 • Email: ataylor@dccare.co.uk • www.dccare.co.uk Andrew has a wealth of experience in business transfer having been in the industry since 1998. Prior to this, a background in internal auditing provided the relevant accounting experience required in order to give care home owners an accurate appraisal of their business. Since joining DC Care in January 2010, Andrew has built an excellent network of

contacts in all aspects of care. A real hands-on and personal approach to the entire selling process has resulted in DC Care significantly increasing its presence in the South, making the company one of the most active specialist agents in the healthcare sector.

Telephone: 07825 206777 • Email: asandal@dccare.co.uk • www.dccare.co.uk

ANDREW SANDEL

DC Care Specialist Property Agents has concluded over 300 transactions, with a total value close to half a billion pounds. Over the years, our goal has remained the same: to maximise the outcome for every one of our clients.

The team is focused on service and acts for either vendors or purchasers in relation to the buying and selling of companies and operational care businesses, empty units for redevelopment and the sale and acquisition of development sites. We provide assistance on exit strategy planning, portfolio realignment, targeted acquisitions and administrations, liaising closely with carefully chosen professional partners to build a due diligence team where appropriate.

Each member of the DC Care team has hands-on, specialist experience, gained over many years. This expertise coupled with the wider commercial experience of the principals, means we are able to offer practical, relevant and commercial advice to our clients.

DC Care is the trading name of the Franklyn (Developments) Limited.

Regional Director (South)

GVA HEALTH WWW.GVA.CO.UK

Iain is a Chartered Surveyor with 33 years’ experience, 25 of which have been spent specialising in the healthcare, hotels and leisure property sectors. He is Head of Independent Healthcare for GVA. He is an experienced agent and valuer in the sale and valuation of all interests in healthcare property, including land, vacant property, turnkey

developments, going concerns, investments and development. He also has experience in joint venture agreements, land options, operator searches and lease and management contract structuring. Iain is a RICS Registered Valuer. He has a particular specialisation in the assisted living and retirement village markets and the private hospital sector.

Telephone: 0207 911 2603 or 0844 902 0304 • Email: iain.lock@gva.co.uk • www.gva.co.uk

IAIN LOCK, BA MRICS Director, Head of Independent Healthcare

The GVA Independent Healthcare team is one of the largest and most respected in the sector having been led for 20 years by the vastly experienced Andrew Sidwell who remains part of the team. Advice is now led from London with significant and experienced presence in Birmingham, Manchester and Bristol.

The team covers the full gambit of agency, valuation and consultancy advice in the elderly, specialist, hospital and assisted living markets and acts for the majority of the main operators, investors, developers and lenders in the sector.

High profile instructions include:

The sale of seven care homes comprising 358 beds and two development projects with planning consent for 150 beds on behalf of Majesticare Luxury Care Homes. The sale to Four Seasons Health Care, completed in March 2014 for an undisclosed sum and involved the provision of consultancy and transactional services to Majesticare.

The acquisition of Spire Hospitals Edinburgh, Washington and Hove. In three separate transactions GVA acted on behalf of LaSalle Investments on the acquisition of Spire Edinburgh and Washington and for Scottish Widows (SWIP) on Spire Hove. All three transactions involved high quality purpose-built or newly converted buildings let to Spire Hospitals.

Valuation and strategic consultancy advice to a pension fund in respect of a group of care homes comprising c500 beds. GVA subsequently instructed to provide disposal and rent review advice.

Instructions from administrators on a portfolio of 17 care homes with in excess of 650 beds. GVA was initially Instructed to provide valuation advice with a mandate to deliver strategic marketing advice and then to dispose of the portfolio on behalf of a leading lender. The marketing campaign attracting offers both for the whole portfolio and for break-up. The group is under offer.

Independent Healthcare is part of GVA Health which incorporates over 60 health property specialists across service lines including rating, planning, building surveying, environment, lease consultancy and property management in addition to the Independent Healthcare team activities. GVA Health is a leader in the field of health property in both the private and public sectors in the UK.

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who’s who…property professionals

HPC - WWW.HEALTHCAREPC.CO.UK

HPC’s two principal directors form one of the most experienced teams in the care property sector, with over 45 years’ combined experience.

Ian has over 25 years’ experience in commercial property and has specialised in healthcare since 1990. He has worked throughout the UK including four years in London heading a busy national healthcare department. Ian has been lead adviser on some of the largest social care IAN WILKIE transactions in the UK and also acts for and retains many Director private clients. He has been a Director at Christie + Co and was Managing Director of GLP Taylors, prior to leaving in 2008 to establish HPC. Assignments over recent years include:

•

•

•

•

• Lead adviser in the sale of two investment properties tenanted by Orchard Care Homes to Target Healthcare REIT at deal value of £11.5 million.

• Lead adviser on the sale of Pindar Oaks Independent Hospital, an award-winning

mental health unit sold on behalf of HgCapital and Voyage to Cambian Group.

Commercial due diligence on behalf of a non-UK investment fund in relation to major UK care home portfolios.

Lead adviser on the sale of Burnside Care Ltd, an independent hospital providing care, rehabilitation and treatment to people with learning disability and mental illness, to Craegmoor.

Lead agency adviser on the sale of Healthlinc Individual Care, an independent hospitals group specialising in mental health, to Lighthouse at a deal value in excess of £40 million.

Lead agency adviser in the sale of Ermine Care, an independent hospitals group specialising in learning disability and mental health, to 3i at a deal vale of £13.5 million as part of their £90 million MBO of Care Principles.

Telephone: 01904 529111 • Email: icw@healthcarepc.co.uk • www.healthcarepc.co.uk

NIGEL NEWTON TAYLOR Director

• Externalisation of local authority care homes into the private sector.

Nigel is a Chartered Surveyor with 25 years’ experience providing • Expert witness evidence provision in legal and planning processes. commercial property advice in both the public and private sectors.

• Joint consultancy with PricewaterhouseCoopers in implementation of Specialising in care, he has provided a mix of consultancy, valuation Fair Price for Care exercises. and transactional advice to clients including local authorities, lending • Valuation advice to group operators for accounting or dispute institutions, not-for-profit organisations and corporate healthcare resolution purposes. operators. Having commenced his career within a government agency, • Rent review representation.

Nigel switched to the private sector in 1997, since when he has held • Care sector research, facilitating optimum client growth strategy. the positions of Director at Christie + Co and Director at GLP Taylors • Strategic development advice. (managing the transactional business). Typical instructions in recent years include: Telephone: 01904 529112 • Email:nnt@healthcarepc.co.uk • www.healthcarepc.co.uk

JONES LANG LASALLE LTD - WWW.JLL.CO.UK

As a leading global real estate services company, Jones Lang LaSalle (JLL) is at the centre of market shaping trends and movements in capital through its global network of offices.

Our specialist team operates across the UK and is unrivalled in its professional capacity combining a wealth of expertise that includes: • Valuation. • Agency.• Corporate finance. • Corporate/debt re-structuring. • Operations. • Development advisory.

• Professional advisory/consultancy. • Renewable energy/technology. • Building surveying (project and development services). • Planning.

PHIL HALL National Director and Chairman, Healthcare

The UK healthcare business is Chaired by Phil Hall and headquartered in London with regional representatives operating out of offices in Bristol, Leeds and Edinburgh.

Phil has been at the forefront of the industry for many years, providing healthcare advice to operators, investors and lending institutions across many cycles in the market.

With a consistent and in-depth understanding of a wide range of healthcare organisations and the way real estate is used to deliver business and service objectives, JLL is unenviably placed to deliver real value and tangible benefits to its clients through creating and delivering sustainable and bespoke solutions.

Track Record – recent examples of more prominent mandates demonstrate our capabilities better than anything else.

• Sale of Richmond Village, UK Retirement Village Operator.

• Restructuring of Caring Homes, one of the UK’s largest elderly care companies.

• Purchase of a specialist learning disability business, St Luke’s Healthcare, from the administrator to Lloyds Bank.

• Corporate restructure and wind down of the listed core business of Southern Cross Healthcare.

• Acquisition of Castlebeck Hospitals with debts of over £400 million.

• Acquisition advice for Dunelm Limited.

• Purchase advice to bidders on the potential acquisition of Four Seasons Health Care.

• Advice and arrangement of development facility for the construction of a hospital pre let to Circle Reading (UK).

Telephone: 0207 852 4622 • Email: phil.hall@eu.jll.com • www.jll.co.uk/healthcare

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who’s who…property professionals

SAVILLS - WWW.SAVILLS.COM/HEALTHCARE

Craig Woollam is a Director of Savills and leads its Healthcare division, one of the most active transactional and valuation teams in the UK operating from seven regional locations.

Over his career in the healthcare market spanning some 26 years, Craig has worked with a number of notable private sector, charitable, local authority and NHS clients, dealing with transfer of care provision and C2 CRAIG WOOLLAM properties/portfolios. Clients have included Craegmoor, Director & Head Priory, Anchor, Quintain Estates, Aviva, Hanover, Home of Healthcare Group, Viridian, L&Q, the Civil Service Benevolent Fund, Kent, Hampshire, Hertfordshire, Cambridgeshire and Northamptonshire County Councils and as well as and numerous NHS Trusts and hundreds of private clients.

His expertise covers the acquisition, disposal and valuation of businesses as going concerns, C2 property/development land and corporate recovery within the care and specialist care sectors.

Recent projects include: • Quintain Estates, marketing and sale of 21 care homes across the north of England and Wales.

• Sale of Viridian’s London and Midlands care home portfolio with circa 300 beds.

• Stargate Group and Adderley House Limited in administration seven care homes in the South and Midlands.

• Property disposal for Advinia Healthcare Partners in the South West. Savills is a global real estate service listed on the London Stock Exchange, and has been named the UK’s number one property services firm for the tenth consecutive year.

Telephone: 01202 856805 • Email: 01202 856805 • www.savills.com/healthcare

Neil Farquhar founded the Capital Allowances Consultancy at Savills in 1996 which has developed into one of the largest, leading national practices in this specialist field covering all areas of the UK. Our specialist twelve strong team comprises both specialist surveyors and

tax advisers, with over 80 years combined experience together with a well-established working relationship with both HMRC and the Valuation Office based on a fully-disclosed, forensic approach.

Telephone: 01904 529112 • Email:nnt@healthcarepc.co.uk • www.healthcarepc.co.uk

NEIL FARQUHAR National Director, Head of Capital Allowances

Our services include: • All aspects of general capital allowances consultancy and compliance. • Due diligence and valuation on property acquisition and disposals.

• Valuation on all aspects of capital expenditure projects (new build, extension, refurbishment and fit out).

• Capital allowances structuring and planning. • All aspects of HMRC/Valuation Office negotiations.

The major changes to capital allowances from April 2014 have increased awareness in this specialist field, as capital allowances become an integral part of all commercial property transactions. We advise a wide range of healthcare clients including care homes, specialist centres, clinics and treatment centres and have a proven track record in this sector of establishing maximum value leading to greater tax savings.

KNIGHT FRANK LLP - WWW.KNIGHTFRANK.CO.UK/

Christopher Wishart is a partner in the healthcare department at leading property adviser Knight Frank.

Overseeing the acquisition and disposal of care facilities throughout the UK, Christopher has over 15 years’ experience advising a broad range of clients as to the most beneficial and appropriate strategy for achieving a successful sale.

CHRISTOPHER WISHART Partner Healthcare

Christopher has latterly advised clients ranging from owner/operators looking to retire, through to banks and corporate advisers who are acting on the disposal of distressed assets. Christopher commented, ‘No two care homes are the same, so getting under the skin of the business prior to taking it to the market is a key factor, focusing on key transaction points which vendors and purchasers will need to consider. Trust, discretion, market knowledge and taking the time to learn about the objectives of each of my clients are key fundamentals to a successful sale.’

Telephone: 0207 861 1076 • Email: chris.wishart@knightfrank.com • www.knightfrank.co.uk/healthcare Julian Evans’ experience has primarily concerned acting for corporate and private operators, banks, institutions and funds in the valuation, acquisition and disposal of trading care homes, specialist (acute) care

homes, hospitals, day centres, medical surgeries and fixed income throughout the UK and Europe. In 2013, he advised on £1.5 billion of sale and leaseback. He is Head of Healthcare.

Telephone: 01904 529112 • Email:nnt@healthcarepc.co.uk • www.healthcarepc.co.uk Founded in 1896 and a Limited Liability Partnership since 2003, Knight Frank is the world’s leading independent global residential and commercial property consultancy. The group turnover is in excess of £300 million per annum.

JULIAN EVANS Head of Healthcare

Headquartered in London with 330 offices, employing more than 12,500 professionals and spanning five continents, Knight Frank provides the highest standards of quality and integrity in global residential and commercial property advisory services. Our reputation for uncompromising professionalism in everything we do is earned by serving our clients and earning their trust.

Knight Frank advises on the full spectrum of healthcare property with a dedicated healthcare consultancy team of ten surveyors, utilising 59 UK offices to source land and healthcare businesses to complement our clients’ portfolios. The team advises on more than £8 billion of healthcare property assets per annum inspecting circa 3,000 care facilities throughout the UK and Europe.

The healthcare team currently has approximately £400 million of live sales including individual care homes through to investment portfolios. Having a strong residential arm enables Knight Frank to also recognise properties with potentially Higher Alternative Use Values and work with large residential developers to identify sites which could include healthcare facilities.

Understanding the nuances of healthcare businesses and recognising the future of the industry through the identification of new sites and land for development has been highlighted in the Knight Frank Healthcare research reports. Released quarterly, these focus on different sections of the market and give operators, investors, developers and funders an insight as to the market.

Knight Frank’s key services include sales and acquisitions, strategic consultancy, development consultancy, valuation, portfolio consultancy, research and feasibility studies, building consultancy and surveys, planning consultancy, lease advisory, Property.

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352027( <285 %86,1(66 72 7+286$1'6 2) &$5( 6((.(56 $&5266 7+( &28175< Care Choices, the leading publisher of care information, has launched a brand new website for people searching for care.

Are you looking to attract more self-funding clients?

Do you have vacant rooms?

Why use www.carechoices.co.uk?

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

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

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Health Living breathing property To find out more, contact:

GVA Health is a national team of property specialists uniquely focused on working with clients operating in the independent, public and primary healthcare sectors.

We harness market intelligence, commercial acumen and creativity to produce tailored solutions for operators, banks, investors and developers.

Whether you need expert advice and skills ranging from agency, valuation and development to planning and project management, we have experts near you.

Adam Burchell 020 7911 2514 adam.burchell@gva.co.uk Cirion Plant 0161 956 4493 cirion.plant@gva.co.uk Iain Lock 020 7911 2603 Iain.lock@gva.co.uk

gva.co.uk/health 08449 02 03 04

CMM MAY 2014 ¦ 41

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DOMICILIARY CARE PROVIDERS MANAGE YOUR RISKS The time is critical for domiciliary care providers to implement rigorous risk management policies. The care insurance market is hardening after an explosion in the number of claims predominantly in the care home market, but this will undoubtedly place pressure on insurers involved with domiciliary care businesses too. Insurers are also seeking to lessen their exposure to risk, including minimising cover for abuse claims. Consequently, they are increasingly assessing domiciliary care providers on an individual basis.

In the past 10 years or so, care businesses have enjoyed low and declining insurance premiums. There was always a cheaper insurer around the corner, which meant domiciliary care agency owners felt little financial pressure to worry about how many claims they made. These days are over; insurers are now scrutinising domiciliary care providers’ risk management programmes and assessing how they: • manage and minimise the risks they face, such as those relating to staff, customers and visitors; • review aspects of these risks and how regularly these reviews are done; • develop risk management programmes following claims that occur and through learning of the experience of others; • implement and develop staff training programmes.

In addition, this is an austere age and the population is ageing.

Funding is scarce and local authorities offering contracts are putting huge pressure on domiciliary care providers to underfund care services and meet budget expectations.

This was recently highlighted by Radio 4’s File on Four programme.

There is very little margin for error financially, so if something goes wrong, finding the resources to fix it, or settling potential lawsuits, can have a significant impact on the business. Good management, especially good risk management, helps domiciliary care providers protect themselves and minimises the chances of problems occurring.

THE DOMICILIARY CARE MARKET IS COMING UNDER INCREASING PRESSURE TO LOOK AT ITS RISK MANAGEMENT POLICIES. DAVID WATERS EXAMINES THE RISKS PROVIDERS FACE AND WHAT THEY SHOULD DO TO ADDRESS THEM.

TOP 10 RISKS To protect your business and your clients there are 10 main risks facing domiciliary care providers which need to be understood and addressed.

1. Employers’ liability – remove the risk of injury to staff The risk of staff injuries can be minimised by training and making sure everyone is fully conversant with the tasks they have to perform. It is also vital to encourage staff to be alert to risks and inform others about them, as each property they visit will be different. A prime example is that of aggressive clients; if all staff members are aware of the potential dangers, steps can be taken to avoid anyone coming to harm. As domiciliary care workers often work alone, protect them by keeping records to demonstrate they provide the best service they can at all times. Torches and spare batteries are a good idea, as an example.

2. Buildings and contents – planning for an emergency While buildings and contents are not usually a major concern for domiciliary care businesses, it is important to plan for emergencies. If a fire guts a domiciliary care provider’s office, it needs a facility it can move into straight away to continue operating. In most towns there are ‘hot start’ offices equipped and ready for operation that usually support approximately 20 businesses. Adequate insurance cover is also essential.

3. Regulatory issues - demonstrate compliance and safety of your clients

It is imperative that domiciliary care providers mitigate any risk of losing their Care Quality Commission (CQC), or national regulator’s, registration. The care regulators throughout the UK, especially CQC in England, have

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become much more rigorous and are increasing the frequency of audits conducted relating to a domiciliary care business’ methodology, working practices and documentation. This is something which cannot readily be insured. Establish a system for evidencing compliance and client safety or risk losing your registration.

4. Liability to others – put common sense into practice Risks such as those relating to client medication or damage to their property (eg breaking a piece of furniture or burning the carpet while ironing) are manageable through common sense. Ensure care staff are fully briefed when it comes to medication and operate a managed system where field supervisors accompany care workers on some visits. Care workers will appreciate the attention and clients will be safer for it.

5. Claims of theft – reduce risk of claims against employees

Recently we have seen a swathe of claims for theft where domiciliary care staff, people of trust, have stolen money and/or jewellery belonging to a client. The legal view now seems to be that the employer is responsible when a client makes a claim for money or belongings being stolen or allegedly stolen by an employee. The law does place increasing responsibility on the shoulders of the employer when such situations arise. This makes it vital that robust measures are in place requiring all your staff to advise you of any ‘gifts’ they may receive from clients and to make sure you also know if any personal sensitive information, such as PIN numbers, are divulged. It would be prudent to rotate your staff in their caring duties for each client as a matter of course. It is the responsibility of the domiciliary care providers to make sure that they have a high standard of quality staff that can provide the same high level quality of care to all customers. While relationships between care worker and cared-for person are very important, there has to be a need for holiday and sickness cover too, so excellent individual management is also required to make sure clients sensitive to change know why rotation is necessary.

Of course, continuity of care must be taken into account, and the individual clients’ needs must be treated on a case by case basis. Regular in-situ supervision should also be provided to all staff on an irregular and unannounced basis.

6. Business interruption (records) – manage ongoing risks

Business records are essential to the normal operation of any domiciliary care provider and it is important to plan for IT glitches that may cause some or all of these to be erased.

Invest in a backup system that updates automatically and

daily. Also, ensure business interruption insurance includes a provision for reconstituting missing data, this should cover a minimum of £25,000.

7. Employment practices – get up to speed on employment law

Make sure contracts of employment are up to date and reflect the current legal position. Whenever there is a risk of having to take disciplinary action with any employee, take advice – most domiciliary care provider insurance policies include a legal advisory service, so use it. This may save the time, effort and expense of having to attend and respond to employment tribunals.

8. Vehicles – check care workers are covered All too often domiciliary care providers do not consider the risks presented by motor vehicles, yet require carer staff to drive from appointment to appointment in their own cars. These insurance policies may only cover the driver for social, domestic and pleasure purposes. Check they are covered for business use.

9. Loaned equipment – is it safe?

Many domiciliary care businesses lend equipment to clients, such as wheelchairs and hoists. Check when items were last inspected, if they are fit for purpose and if the client is insured to use them. Domiciliary care providers that take chances leave themselves vulnerable to potential claims, not just from the equipment going missing, but from the client being injured while using an item.

10. Goods in transit – insure them Many domiciliary care workers take company equipment with them on visits, which can amount to thousands of pounds in value. Check this is insured in employees’ vehicles, especially when a vehicle belongs to the care worker rather than the business.

TAKE RESPONSIBILITY Domiciliary care providers must take responsibility for managing and minimising risks to their businesses. Good, risk conscious providers, which implement and continually review risk management programmes, will be rewarded with better businesses, consistent quality staff and a growing demand.

Those that do not will struggle to maintain their businesses, let alone find insurance cover.

CMM David Waters is Managing Director at PrimeCare Insurance. david@primecareinsurance.net

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conference reviews

SURREY AND SUSSEX CARE SHOWCASE 2014 Improving the quality of local adult social care provision was high on the agenda for over the 600 care providers who attended the Surrey and Sussex Care Showcase, at Brighton Racecourse.

The theme of Driving up the Quality of Social Care was the Showcase’s free seminar programme and the main draw for many care providers. Andrea Sutcliffe, the Chief Inspector of Adult Social Care at the Care Quality Commission (CQC), gave the keynote speech exploring the changes to CQC inspections and how care home owners and managers can get involved in shaping CQC’s new approach.

Paul Richardson from the Department of Health gave delegates an update on the passage of the Care Bill through Parliament and outlined the Government’s plans to implement

wide-ranging reforms to the care and support system. David Pearson, Vice President of Association of Directors of Adult Social Services looked at the issues facing providers trying to improve quality in challenging times. Other top level speakers included Debbie Sorkin from National Skills Academy; Professor Andrew Kerslake from the Institute of Public Care; Elaine Cass from Social Care Institute for Excellence and Dame Philippa Russell DBE from the Standing Commission on Carers.

A wide range of exhibitors offering legal, financial and other business services, training opportunities, products and services for the care sector took part.

Erica Lockhart, Chief Executive of employers’ representative body Surrey Care Association and one of the Showcase organisers said, ‘Care Showcase plays an important role in helping us highlight and share all the good practice that goes on day by day, year by year within the adult social care sector in Surrey and Sussex.’

Care Choices Ltd and Care Management Matters were media partners of the event which was sponsored by Lloyds Bank and supported by Brighton and Hove Council, Surrey Care Association, East and West Sussex County Councils.

SKILLS FOR CARE ACCOLADES 2013/14 The annual Skills for Care Accolades once again paid homage to organisations and individuals achieving the highest standards of workforce development within social care. As well as celebrating best practice, the Accolades provided an excellent platform in which to showcase best practice to the wider sector.

The night of celebrations at the Hilton Metropole Hotel in Birmingham, was hosted by Helen Skelton, the World Recordbreaking, BBC1 TV presenter.

With eight main categories and a Winner of Winners award there was much excitement and nervous energy throughout the evening.

CMM was proud to sponsor the category for Best Employer of under 250 staff, which went to Amber Trust, a charity that provides professional support services across Derbyshire.

Although there was only one winner of each category, every nominee showed fantastic best practice, innovation or dedication to its workforce in order to be nominated.

The other winners on the night were: Best employer of over 250 staff Cornwall Care Limited Best individual employer who employs their own staff Lisa-Marie Eastwood

11th March 2014, Brighton

27th March, Birmingham

Best provider of learning and development Tyne and Wear Care Alliance Best employer support for Apprenticeships Oxfordshire County Council Health and Social Care Apprenticeship Scheme Best employer support for the Assessed and Support Year in Employment Southampton, Hampshire, Isle of Wight & Portsmouth (SHIP) Social Work Education Network (SWEN) Best recruitment initiatives The Westminster Society for people with learning disabilities Most effective new approach to service delivery – MacIntyre Finally, the coveted Winners of Winners award went to The Westminster Society for people with learning disabilities. Skills for Care CEO, Sharon Allen said, ‘This is a well-deserved award for the Westminster Society for people with learning disabilities who, not only won their category in the face of very fierce completion, but then convinced a panel of expert judges they deserved the top prize.

‘The Accolades celebrate the outstanding achievements of employers from across our growing sector but they are all united by an absolute commitment to invest in learning and development opportunities for their workers.’

Congratulations to all nominees, winners and highly-commended.

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what’s on?

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WHAT S ON? Event: Date/Location: Contact:

Next steps for mental health policy: integration, access and public mental health 29th April 2014, Central London Westminster Health Forum, Tel: 01344 864796

Event: Date/Location: Contact:

Learning Disability Sheffield 1st May, Sheffield Pavilion, Tel: 01273 43 49 43

Event: Date/Location: Contact:

Improving elderly care services: funding, integration and personalisation 8th May 2014, Central London Westminster Health Forum, Tel: 01344 864796

Event: Date/Location: Contact:

The Alzheimer s Show 16-17 May 2014, London Draw Events Limited, Tel: 01892 723 195

Event: Date/Location: Contact:

Tackling Long-Term Conditions: Coordinating Care, Delivering Improvements 29th May, London Open Forum Events Limited, Tel: 0161 376 9007

Event: Date/Location: Contact:

Healthcare Buildings Forum 19th/20th June, Warwickshire Stable Events, Web: www.hb-forum.co.uk

Event: Date/Location: Contact:

5th Eden Alternative UK Conference 24th June, Heathrow Eden UK, Tel: 01225 309238

Event: Date/Location: Contact:

Health+Care 2014 25th/26th June 2014, London Closer Still Media, Web: www.healthpluscare.co.uk

Event: Date/Location: Contact:

The Autism Show 27th/28th June 2014, Manchester Tel: 01538 755623

Colton House • Princes Avenue • Finchley • London • N3 2DB

CMM EVENTS Event: Date/Location: Contact:

The Transition Event 22 May 2014, Birmingham Care Choices, Tel: 01223 207770

Event: Date/Location: Contact:

Derbyshire and Nottinghamshire Care Conference 2014 4th June, Nottingham McCullough Moore, Tel: 01293 854401

Event: Date/Location: Contact:

North West Care Conference 2014 18th September, Clayton-le-Moors McCullough Moore, Tel: 01293 854401

Event: Date/Location: Contact:

Berkshire Care Conference 2014 16th October, Reading McCullough Moore, Tel: 01293 854401

Please mention CMM when booking your place.

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straight talk

straight talk Fidelma Tinneny gives an honest account of the safeguarding blame game .

FIDELMA TINNENY FOUNDING MEMBER BERKSHIRE CARE ASSOCIATION I had a phone call the other day from a domiciliary care manager asking for help with a safeguarding investigation. A married couple s notes had been kept in the same file. Not the best practice, but hardly safeguarding ‒ where is the abuse or neglect? It appears that pressing the big red safeguarding button is the first choice for all agencies to deal with any or all the ills of the care world. In my voluntary role with Berkshire Care Association I regularly receive calls from providers brave enough to question a local authority s (LA) safeguarding team. They are usually at the end of their tether.

Fears of retribution and blacklisting are common and the list of what is regarded as safeguarding grows ever longer.

• • • • •

People who fall and do not go to hospital, Those who go to hospital directly, Paracetamol not given within 5 minutes of request, A person not wearing their footwear, Staff reporting a service user throwing a hair brush at another service user, • Staff not reporting events of similar magnitude.

Another care home manager, prepared to challenge shared their thoughts, We are asked to take people with behavioural problems because they know we can meet their needs. When they display the expected behaviour and we inform the LA, there is an investigation. If we don t inform there is an investigation. There are significant extra demands made on our team to behave as and how the LA wishes. We have to attend meetings at short notice with no agenda or minutes, with people we do not know who or why they are there. There are reams written we never see ‒ even on request. Our entire team feel like they are in purgatory and we are never told what we could or should have done differently. When we have lost half the team and had a nervous breakdown there is a request to take another person with similar or worse behaviour.

When we say no, we go back to the investigation stage and deeper into purgatory.

Media exposure of abuse and neglect has horrified us all. It has sensitised us all to be vigilant in ensuring only the highest standards of care. No argument there, but of the 176,000 safeguarding alerts in 2012/13 only 20% were either substantiated or partially substantiated. This means in the other 80% providers, police, safeguarding teams and more knows who else were mobilised to investigate what turned out to be not a safeguarding incident. It is noteworthy that in the serious case review conducted

by South Gloucestershire Council into Castlebeck Ltd, the owners of Winterbourne View, they concluded that, On paper the policy,

procedures, operational practices and clinical governance of Castlebeck Ltd were impressive. So how or why did it not work?

And why did the exposers not step in when they witnessed such obvious horrors?

Trust is at the core of all care work. The service user and their families have trust, belief or faith in the delivery of their care, regardless of staff designation or location. Staff in turn need to trust each other. When trust is diminished, there is no confidence in the delivery of appropriate care, leading to suspicion, doubt and blame.

The downside to what feels like a never-ending media barrage of negativity, is that it creates suspicion of care staff - including other professionals - resulting in a frequently over-zealous, detrimental approach to a guise called safeguarding.

Care, the Cinderella service, frequently feels like a place of distrust with colleagues in other parts of the system. Partnership, transparency, equality, professional recognition and respect, and other documented mantra for sharing and unity , rightly expected of every professional, become irrelevant to the now dirty word of care when it comes to safeguarding. Staff and the organisation are guilty until proven innocent for every minor complaint or naturally occurring and sometimes predictable event like falls. There has been a significant increase in hospital admissions from care settings ‒ a culture has developed where staff believe if the hospital has checked, the organisation cannot be accused of abuse or neglect. Is this really in service users best interests?

Providers feel victimised and bullied by safeguarding teams, many of whom have little or no experience of the environment, swarming without any information sharing, outcomes, learning or change ‒ despite it often being told to the media. Insistence is frequently made on staff being suspended without reasons given, against every principle of good leadership let alone employment law, leading to further anxieties for employers and staff. The entire system has become risk averse. It is clogged with safeguarding, that is driving poor care underground. Transparency? This is blindness.

Safeguarding, is the principal exertion and belief of everyone working in health and social care. The joy of making a difference to lives is the pinnacle of Maslow s hierarchy of needs.

It is time for care to stand up for itself and stop this abysmal atmosphere and affliction on good care. We need to stop losing good staff because of the pressure of safeguarding. We need to work together in all parts of the system to have clear guidance on what is and is not abuse and neglect. We need to talk...big time.

DO YOU AGREE WITH FIDELMA? PLEASE EMAIL YOUR THOUGHTS TO EDITOR@CAREMANAGEMENTMATTERS.CO.UK 46 ¦ CMM MAY 2014

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Following the success of 2013 ’s event, where over 600 people attended and benefited from the conference, we’re once again bringing you…

In association with

Becoming an adult

- building the best future for young people with additional needs

Thursday 22nd May 2014 at the National Motorcycle Museum in Birmingham.

(Coventry Road, Bickenhill, Solihull B92 0EJ)

To register your interest in attending, book your place or sponsor this event please contact us on 01223 207 770 or email info@progressmagazine.co.uk.

The Transition Event is the one-day forum for young people with additional needs, their parents and professionals to explore the move to adulthood.

Incorporating a series of main presentations, workshops, interactive sessions and an exhibition of service providers.

www.progressmagazine.co.uk/events.html

Supported by

SoLO Life Opportunities Principal sponsor

Associate sponsor

Sponsor

Sponsor

Please visit www.progressmagazine.co.uk/events.html for more information or contact us on 01223 207 770

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