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THE CARE CERTIFICATE A new induction path
Nurse revalidation
What does it mean for our nurses?
Whistleblowing
Drafting a comprehensive policy
Five Year Forward View
A role for social care
Includes 4-page Skills Academy insert: Making the Endorsement Framework work for adult social care
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In this issue 05
Is it just me…? 07 Robert Chamberlain considers the implications of the new regulation of top-ups. CMM News
08
Business Clinic The panel explores Malhotra Group’s ambitious plans for the future.
24
REGULARS
From the Editor
A View from the Top 33 Barry Sweetbaum, Chief Executive of SweetTree Home Care Services. Conference review 44 A summary of the recent CMM Insight conference exploring current developments and future opportunities in the learning disability sector. What’s On? A round-up of forthcoming events plus details of CMM Insight’s regional conferences.
49
20
Straight Talk 50 George McNamara asks whether the Prime Minister’s new Challenge on Dementia 2020 will go far enough.
FEATURES
47
39
34
20
The Care Certificate Sharon Allen answers a reader’s question about the new Care Certificate and what providers need to know.
27
Revalidation for nurses Dr David Foster and Professor John Clark explore what the introduction of revalidation for nurses will mean for the sector.
34
Whistleblowing Benjamin Roberts summarises the law around whistleblowing and how to draft a comprehensive whistleblowing policy.
39
The Five Year Forward View – it’s not just for the NHS Debbie Sorkin shows how social care providers can play a central role in implementing the Five Year Forward View.
47
Care Home Open Day: The Business Case for Engaging With Care Home Open Day in its third year, Martin Green explores the business benefits of participating. CMM April 2015 3
CONTRIBUTORS
EDITORIAL editor@caremanagementmatters.co.uk Editor in Chief: Robert Chamberlain Editor: Emma Morriss News Editor: Des Kelly Assistant Editor: Emma Cooper
CONTRIBUTORS
PRODUCTION Lead Designer: Holly Cornell Director of Creative Operations: Lisa Werthmann Assistant Production Manager: Jamie Harvey Creative Artworker: Gemma Cook
ADVERTISING sales@caremanagementmatters.co.uk 01223 207770 Advertising Manager: Daniel Carpenter daniel.carpenter@carechoices.co.uk Director of Sales: David Werthmann david.werthmann@carechoices.co.uk National Sales Manager: Paul Leahy paul.leahy@carechoices.co.uk
Sharon Allen Chief Executive, Skills for Care
Paul Birley Head of Public Sector and Healthcare, Barclays
Clare Connell Managing Director, Connell Consulting
Tom Harrison Associate, Carterwood
Dr David Foster Deputy Director of Nursing and Midwifery Advisor, Department of Health
Professor John Clark Director of Education and Quality, Health Education England – South
Barry Sweetbaum Chief Executive, SweetTree Home Care Services
Benjamin Roberts Solicitor and Care Services Manager, Abbey Legal Services
Debbie Sorkin National Director of Systems Leadership, Leadership Centre
Professor Martin Green Chief Executive, Care England
George McNamara Head of Policy and Public Affairs, Alzheimer’s Society
SUBSCRIPTIONS Non-care and support providers may be required to pay £50 per year. info@caremanagementmatters.co.uk 01223 207770 www.caremanagementmatters.co.uk Care Management Matters is published by Care Choices Ltd who cannot be held responsible for views expressed by contributors. Care Management Matters © Care Choices Ltd 2015 ISBN: 978-1-910362-40-2 CCL REF NO: CMM 12.2
CMM magazine is officially part of the membership entitlement of:
ABC certified (Jan 2013-Dec 2013) Total average net circulation per issue 15,991
4 CMM April 2015
FROM THE EDITOR
From the Editor Editor, Emma Morriss asks whether the looming changes will be another Y2K. As I write this, the sector is facing significant change – are you ready?
INCOMING CHANGES April 2015 is the beginning of a new phase for social care, those commissioning it, delivering it and receiving it. The biggest change has to be part one of the Care Act. It’s been much reported, debated, discussed and explored but it brings together and modernises many aspects of adult social care law. In the 11 months since the Act received Royal Assent it’s been all systems go to understand, prepare for and communicate the changes with local authorities, the sector and the general public. As with everything, how well that has happened most likely varies across the country and Robert Chamberlain in his column on page 7 explores the uncertainties around changes to top-ups. This is only part one of the Care
Act, whilst everyone is getting to grips with these changes, part two, the cap on care costs and extension of means-tested support, is looming and the Government is currently consulting on the draft guidance and regulations to implement the care cap costs. By the time this issue of CMM hits your desk, it may be too late to contribute to the consultation, but those of you subscribed to our website or following our twitter feed should have seen the news story. If the Care Act isn’t enough to keep you occupied, there are also changes from the Care Quality Commission (CQC). These include a requirement for providers to display their CQC rating clearly visible to the public. The CQC has just published its guidance on this. However we are still awaiting publication of the CQC’s final special measures policy. The remaining CQC fundamental standards will also come into force
including the duty of candour and the fit and proper requirement for directors which came into force for the NHS in November. The fundamental standards will replace the existing essential standards of quality and safety. Added to that are changes to induction training with the Care Certificate – explored in more detail by Skills for Care’s Chief Executive, Sharon Allen on page 20.
Y2K? There isn’t enough space to cover everything here and it feels like the
tip of the iceberg, but also a little like the Millennium bug or Y2K as it was known. One faction sat waiting for total technological meltdown at midnight on the 1st of January 2000. Whereas others just carried on, celebrating the start of a new millennium and getting on with life. Whatever happens I don’t think the sector will go into meltdown on the 1st of April; local authorities will find a way to meet their obligations, providers will keep supporting clients and vulnerable people will continue to receive the care and support they need. However, I’m sat here writing this in March…
Email: editor@caremanagementmatters.co.uk Twitter: @CMM_Magazine Web: www.caremanagementmatters.co.uk
We buy and sell care businesses and land. We provide consultancy and valuation advice. We don’t do anything else. Dedicated to the healthcare sector – dedicated to you. For more information about Carterwood or to find out how we can help you please telephone 08458 690777 info@carterwood.co.uk
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CMM April 2015 5
IS IT JUST ME...?
Is it just me...?
current council fee levels, the number of residential providers willing or able to operate without top-ups is surely decreasing. There are certain areas of the country where top-ups are almost commonplace due to the disparity between state funding and providers’ operating costs and necessary margins. Where is the extra funding going to come from in circumstances when a council has to pay the going rate?
Editor in Chief, Robert Chamberlain, considers the implications of the new regulation of care fee top-ups from 1st April 2015 and questions if the sector is ready.
DÉJÀ VU
A matter of days after this edition of CMM lands on your desk, the arrangement and charging of care fee top-ups is set to change. From this date, it appears that providers will be in breach of regulations if they arrange top-ups directly with a potential resident’s family or benefactor ie without prior local authority approval.
ALL CHANGE? Technically, the rules around top-ups will remain the same as they are now - in LAC(2004)20 - though our readers advise that these rules are rarely applied. The change is that commissioners’ responsibilities will now move into regulations and they will be accountable for the management of top-up arrangements. Applications must be made to a council for approval of third party payments prior to commencement of care. The third party contribution will be paid directly to the council that
has a responsibility to notify the provider of delays or non-payments. The Implementation Toolkit commissioned by the Department of Health, the Association of Directors of Adult Social Services and the Local Government Association has been produced to explain the top-up process and includes a draft Third Party Contributions Agreement Letter to apply for local authority consent to the charges. The toolkit is available at http://lscp.uk/top-upfees-implementation-toolkit But are councils ready to implement this process and, if not, what are providers meant to do about top-ups in the interim? Having spoken to a number of care home operators across the country I find it concerning to hear that there has been little or no guidance on this issue with just days to go before the changes. If a local authority’s systems are not in place and care providers continue to arrange their own topups, surely both they and the council will be in breach of regulations. Does
this make such top-ups illegal and, therefore, leave providers vulnerable to legal challenges in the future?
BIG ASK Beyond the overseeing of top-up payments, local authorities now also have the statutory duty to ensure that care seekers are given a choice of providers, including at least one
Will we see history repeating itself in the commissioning of poorer quality homes to make the budgets work? I don’t yet have the statistics relating to Care Quality Commission (CQC) ratings but I suspect there will be a correlation between homes relying on council fee levels and lower ratings. This was certainly the case during the time of the Commission for Social Care Inspection star ratings when there was a clear pattern that showed ‘one star’ and ‘zero star’ homes were receiving the bulk of council placements. It is a pity that the new regulations did not stipulate the commissioning of homes rated
‘Will we see history repeating itself in the commissioning of poorer quality homes to make the budgets work?’ that is affordable on council rates. If this is not possible, the council will have to bear the full cost of the available options. Again, this is no different to what should have been happening already but local authorities are now compelled to do so by the Care Act. It is difficult to see how this process changes overnight. On
by the CQC as a minimum of ‘good’ at the time of placement. I fear the ‘requires improvement’ band will be where commissioners purchase in the main. I’d be interested to hear from you about what’s happening in your council region after the 1st of April. It’s certainly a topic that we’d like to investigate further.
Do you agree with Robert? Join the debate on the CMM website www.caremanagementmatters.co.uk CMM April 2015 7
APPOINTMENTS FOUR SEASONS HEALTH CARE Four Seasons Health Care has appointed former regional Managing Director Pauline Lawrance to the newly-created position of Care Services and Quality Director. She will be responsible for development of dementia and nursing care services and raising care quality. Caroline Baker, Director of Dementia Care, will be leaving the business.
CAREMARK Caremark has recruited another experienced business professional to join its regional support team. The regional team comprises six regional managers, headed up by Liz Bosley-Sharpe. Nuria Martinez takes over the Midlands region, previously managed by Liz Bosley-Sharpe who was promoted to National Support Manager at the end of 2014.
CHOICE CARE GROUP Specialist care provider Choice Care Group has recruited three people to its team. Mecky Mudyariwa is a Personnel Assistant who has joined after undertaking a part time role as a social care worker with the company whilst studying at Aberystwyth University. Jack Parker is a Service Manager with Excel Support Services and joined after serving as an Assistant Service Manager with Dimensions. Elaine Pidgeon became a Referrals Manager at the start of the year after working as a Service Manager with Dimensions. 8 CMM April 2015
NEWS Greater Manchester to control NHS budget The £6bn health and social care budget for Greater Manchester will be taken over by regional councils under devolved NHS powers. The surprise announcement represents a quarter of the region’s public spending budget and is being hailed as the latest wave of devolution. It is
intended that by integrating services pressure on hospitals will be eased. The proposal will see NHS England hand over decision-making for spending on hospitals, GPs surgeries and drop-in centres to local politicians with the plan coming into force from April 2016.
No voice unheard, no right ignored The Government has published a consultation paper No voice unheard, no right ignored – a consultation for people with learning disabilities, autism and mental health conditions. Care Services Minister, Norman Lamb MP, said in a written statement, ‘A lot of work has been done over the last two and a half years to improve the lives of people with mental health needs, learning disability and autism and to realise the vision of everyone being treated with dignity and respect by health and care services and enjoying the same rights as anyone else.’ However the scale and pace of change has not yet happened as hoped. He continued, ‘Above all, we want to see four things: • People in charge, supported by family and friends – not as passive patients or “prisoners” of a system, as they so often feel they are; • Inclusion and independence in the community – people should not routinely be sent away from
their homes and communities or to institutions which restrict access to their community or to inappropriate care; • The right care in the right place – there should be real person-centred planning with the individual themselves at the heart; and • Very clear accountability and responsibility throughout the system – there can be no excuses for a lack of clarity over responsibility or for people falling through the gaps between services. • The consultation sets out a series of proposals on how changes might be made. We hope that this will mark a step change – and help to secure the rights that everyone deserves. We also hope that this strengthens further the drive for parity of esteem for all those with mental health needs. The consultation seeks to explore views on a range of proposals intended to strengthen or build upon existing policies.
First integrated funding sites announced NHS England and the Local Government Association have named the first eight sites that will, for the first time, blend comprehensive health and social care funding for individuals and allow them to take control of how it is used. The first wave of the Integrated Personal Commissioning (IPC) programme will go live on 1st April 2015, providing some 10,000 people with complex needs with greater power to decide how their own combined health and social care budget is spent. The start of the programme is a key first stage in the delivery of the NHS Five Year Forward View that was set out in October 2014. Four groups of high need individuals – older people with long-term conditions, children with disabilities and their families, people with learning disabilities, and people living with serious mental illness – will be able to take control of their budget to deliver an agreed care plan. As part of the programme, local voluntary organisations will help patients with personal care planning and advocacy. Successful demonstrator sites are Barnsley, Cheshire West and Cheshire, Luton, Stockton on Tees, Tower Hamlets, Hampshire, Portsmouth and South West Consortium. They are now working on refining their project plans ahead of the launch in April. Further demonstrator sites will be identified later this year.
CMM April 2015 9
10 CMM April 2015
NEWS
DH awareness campaign
Choice in End of Life Care
The Department of Health has launched a campaign to ensure care users, carers and those approaching the point of needing care, understand how the changes to care and support will affect them and are able to take appropriate action. Radio advertising is supported by around 2.5 million leaflets through the post. The roll out of the Care and Support & You campaign began late last year and is initially focused on the April 2015 Care Act reforms including the new national minimum eligibility threshold, universal deferred payments agreements and carers’
A new report by the Choice in End of Life Care Review Board, which was set up by Health Minister, Norman Lamb MP, and chaired by Claire Henry, Chief Executive of the National Council for Palliative Care offers a blueprint for how greater choice in end of life can be achieved. The report, What’s important to me: a review of Choice in End of Life Care calls for a new ‘national choice offer in end of life care’ to be established, backed up by an additional £130m from the next spending review. It also calls for a new right in the NHS Constitution for everyone to be
entitlements. The campaign, delivered in partnership with Public Health England (PHE), consists of adaptable campaign materials provided directly to councils to help them communicate with their local communities. In addition there is a nationally-driven communications campaign which no local authority could afford singly, and which reaches audiences with whom local authorities have no pre-existing relationship such as those who fund their own care. Many of the materials for councils are also available to wider partners in the care sector on the PHE resource centre website.
offered choice in their end of life care, and for these choices and preferences to be recorded in their own personal plan of care. The report argues that despite end of life care having made some great strides forward in recent years, far too many people who are dying continue to receive inadequate care that is ill-suited to their needs and wishes. The report also says that there is an opportunity to transform end of life care, so that people get control back over their lives and can exercise choice on the things that are important to them.
launches Election Hub NICE consultation on homecare JRF Joseph Rowntree Foundation analysis of the parties’ pre-election
The National Institute for Health and Care Excellence (NICE) has published a draft guideline to help homecare services provide the highest level of support. It recommends that care should focus on the needs of the individual. The guidance provisionally states that shorter visits than half an hour can be made, but only if the homecare worker is known to the person, the visit is part of a wider package of support and it allows enough time either to complete a specific, time-limited task or check that someone is safe and well. Other draft recommendations include: • Local authorities and health
commissioners checking that support is delivered through a multidisciplinary team as a way of promoting integrated working. • Home care providers making sure their workers have the knowledge and skills needed to perform their duties safely by providing ongoing training. • Homecare managers to supervise workers in a timely, accessible and flexible way, at least every three months. The draft NICE guideline has now been published for consultation which ends on 16th April 2015. The final guideline is expected to be published later this year.
CareTech to raise funds CareTech has placed an additional 10,000,000 Placing Shares for trading on AIM at a price of 210p per share. It intends to raise £21m (before expenses). It originally intended to raise £15m however the size of fundraising was increased due to strong demand. The company has identified a number of organic growth projects and potential bolt-on acquisitions and it is intended that the Placing proceeds will be deployed within approximately twelve months. Farouq Sheikh, Executive
Chairman, commented, ‘The additional funds will allow us to accelerate our growth strategy through organic initiatives and bolt-on acquisitions. We are particularly excited about extending our geographical coverage in the UK and, through working closely with care commissioners, to further extending our range of services. We remain committed to providing the very highest standards of care and look forward to deploying the proceeds of this fundraising for the benefit of all stakeholders.’
(JRF) has launched a 2015 General Election Hub, a place for those seeking information about the policies underneath the politics, ahead of General Election in May. On the site there is rolling
pledges and useful facts about the Government’s performance around several major policy issues including living standards, work and housing. It is available at www. jrf.org.uk/general-election-hub
Under-funding of homecare United Kingdom Homecare Association (UKHCA) has released the national and regional picture of underfunding of homecare services for older people, using data obtained under freedom of information legislation. The report exposes the level of risk that councils place on a system intended to support older people. Continued constraints on local government funding can only exacerbate an already critical situation. A poll of 206 councils found that only 28 paid at least £15.74 per hour, the amount the UKHCA believes reflects a fair minimum price for homecare. From Freedom of Information requests issued to 211 local councils, the UKHCA found,
from the 206 that responded, that the average UK hourly price was £13.66. England’s average price was £13.77 per hour, Scotland was £13.68 per hour, Wales was £14.28 per hour while Northern Ireland paid homecare agencies the least at £11.35 per hour. The UKHCA’s minimum price of £15.74 has been calculated by using the national minimum and adding on the costs of running domiciliary care services, which includes employee travel costs and pension contributions. Of that minimum price, 47 pence is allocated for profit or surplus. The report makes recommendations for councils, providers and Government in all four UK administrations.
One million Dementia Friends The biggest ever social action movement to change perceptions of dementia has celebrated creating one million Dementia Friends. Just over two years since it
was launched, Alzheimer’s Society’s Dementia Friends programme is now transforming the way the nation thinks, talks and acts about the condition. CMM April 2015 11
NEWS
Skills for Care - Learning through Work
Target Healthcare releases interim results
A series of pocket-sized booklets that develop communication and number skills in the adult social care workplace have been developed by Skills for Care. Designed to deliver bite-sized chunks of learning as part of day-to-day care work, they focus
Target Healthcare has released its interim results for the six months ending 31st December 2014. The company saw sustained growth during the period with gross equity proceeds raised of £22.3m and the debt facility increased by £5m. It acquired ten modern care homes for a total consideration of £52.7m (including acquisition costs) with a forward commitment to acquire a purpose-built care home in Tonbridge, Kent. There was a 63% increase in portfolio value to £135.6m, 2.7% on a like-for-like
on routine, but vital tasks in adult social care. Topics include keeping records and working out medication administration. Learning through Work uses practical examples to help care staff to learn new skills in a way they can easily understand.
Part of Lifestyle Care in administration Lifestyle Care (2011) Plc has gone into administration. Deloitte has been appointed to manage the affairs, business and property of the company. In a statement, Deloitte has said, ‘The Company operates 22 care homes, predominantly across the south of England. It is the Joint Administrators intention that the operations of the care homes will remain unchanged and unaffected
by our appointment as Joint Administrators.’ The statement also makes clear that this administration does not relate to the whole of Lifestyle Care, ‘Life Style Care (2010) Plc and Life Style Care Plc (previously Life Style Care (2005) Plc) share common ownership with the Company, however, they are not in administration and remain under the control of their directors.’
basis and it experienced a 64.1% increase in total annual rent roll to £10.5m. The company states that underlying fundamentals of population demographics and supply/demand imbalance of UK care home stock remain favourable. Beyond the interim results, Target Healthcare acquired a further care home for £4.5 million (including acquisition costs) in January 2015 and it has a strong pipeline of suitable investment opportunities.
Sale of care home in Shropshire DC Care has announced that it has completed the successful sale of a residential care home in Telford, Shropshire. Registered for 33, the home provides care across a spectrum of
specialist care needs. It was owned privately and has now been sold to an experienced operator, who will be adding the home to their existing portfolio of high quality and profitable care businesses.
84% of our projects are for returning customers
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NEWS / POLL
Castleoak wins Cambian Group publishes Retirement audited annual results Villages year. The Company’s maiden Cambian Group has published its final dividend was announced audited results for year ending 31st contracts at 1.8p per share, in line with the December 2014. Under the heading A year of significant progress for Cambian, key highlights include 12% revenue growth and an 18% increase in adjusted EBITDA. Average occupancy of 80%, with 2,145 service users at 31st December 2014, 580 places were added to capacity in the period, including 451 from acquisitions. Total capacity at 31st December 2014 was 2,750 places, an increase of 27% on 31st December 2013. Four acquisitions were completed in the year, including acquisition of Woodleigh Community Care, strengthening Cambian’s position in the adult intellectual disability sector. Net debt was £188.7m (31st December 2013:£215.7m), with strong cash generation in the
commitment outlined at its IPO in April 2014. Saleem Asaria, Chief Executive Officer, commented, ‘These results reflect a good performance in 2014, a year in which we also made significant progress in positioning ourselves for future growth. ‘We are pleased with the acquisitions we made in the period, including that of Woodleigh in December which strengthens our position in the adult intellectual disability sector. ‘The quality of care and value for money we offer continues to be appreciated by our customers, and we are well positioned to deliver on our vision to be the highest quality provider of specialist behavioural health services to children and adults.’
Do you feel confident about your business in 2015? Yes No You can vote via: www.caremanagementmatters.co.uk 9%
YES 69%
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% 31 NO
March’s results Can social care save the NHS?
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NO 31%
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Castleoak has won two design and build contracts worth £15m for Retirement Villages Group. Across two major developments, Castleoak will build 68 one- and two-bed retirement apartments for sale plus a new village centre. The first contract is to deliver 49 retirement living apartments, spread across four separate buildings as phase two of Retirement Villages’ Charters Village in East Grinstead, West Sussex. The second contract is at Elmbridge Village, Surrey, where Castleoak will deliver retirement living apartments and a new village centre. Construction of both developments started in January 2015 and will complete early 2016.
POLL
06/03/2015 15:58
CMM April 2015 13
NEWS / IN FOCUS
In focus Better Outcomes for older people using personal budgets WHAT’S THE STORY? The Think Local Act Personal (TLAP) partnership has published a report which collates the latest information about personal budgets for older people. Drawing on research from across the sector, including data from the Health and Social Care Information Centre and the National Personal Budget Surveys, the report Getting Better Outcomes shows that older people do experience positive benefits from having a personal budget, although these are not as marked as for other groups.
WHAT DID THE REPORT FIND? The report draws on work of the Think Local Act Personal partnership to highlight what does and doesn’t work well for older people using personal budgets. It makes recommendations about what can be done to improve practice and includes case studies from councils across England that are working to improve personal budget delivery.
WHY IS IT IMPORTANT? Older people form the largest proportion of people who use adult social care, incurring a majority of adult social services expenditure. Of the total number of people with a personal budget, older people number the most at 51%, yet only 15% of these people use direct payments (money paid directly to a person 14 CMM April 2015
to arrange their own support). The introduction of the Care Act is likely to herald significant changes to the way that services are commissioned with individuals much more likely to be involved in purchasing decisions and through a range of payment methods including personal budgets and direct payments.
WHAT DOES TLAP RECOMMEND? Better processes for accessing and using personal budgets is strongly associated with better outcomes for people and the report recommends that anything councils can do to improve their personal budgets processes is likely to be of benefit to older people. TLAP Director Sam Bennett said, ‘Getting Better Outcomes provides the clearest picture yet of the progress being made with personal budgets for older people. There has been a very helpful shift in the steer and language from Government away from seeing increased numbers of personal budgets as a simple proxy for choice and control, and towards a stronger focus on outcomes, especially as reported by people and their families. Flexibility, reduced processes, genuine involvement of people and their families at all stages of assessment and support planning, and providing independent support systems should increase the success and effectiveness of a personal budget for older people.’
Fastest ever acquisition for Carterwood Carterwood has identifed a site acquisition within a very tight time frame for Cinnamon Care Capital. The site comprised a vacant former care home in Hextable in Kent. Prior to the home’s closure the owners had obtained a comprehensive and
substantial consent to redevelop the site to provide a new 80-bedroom care home and 47 extra care apartments. The transaction took less than three months from submission of initial offer to legal completion.
Next phase of fight against dementia Britain will expand its efforts to combat dementia over the next five years, the Prime Minister David Cameron said as he set out a new, long-term strategy focused on boosting research, improving care and raising public awareness about the condition. Britain has emerged as the world leader in fighting dementia since 2010 with investment in research doubled, hundreds of thousands of NHS staff given specialist training and
1 million ‘Dementia Friends’ taking part in awareness sessions across the country. The Prime Minister wants to build on that momentum both in the UK and worldwide. The Prime Minister’s Challenge on Dementia 2020 is the next phase in the country’s effort to combat the condition and includes: Over £300m invested in UK research; New global fund on dementia; One million NHS staff trained; Three million more ‘Dementia Friends’; Faster assessments, better care for all.
Social Care Improvement: ‘no cause for complacency’ A major report into the quality and safety of adult social care services in England shows that sector-led improvement – the means by which local authorities review each other’s performance – is working well. However social care leaders have warned that ‘there are no grounds for complacency for either central or local government’ in the report’s findings. The National Progress Report, published jointly by the Local Government Association and the Association of Directors of Social Services, shows that: • Social care-related quality of life is improving; • The proportion of people who say they have control over their daily life increased between 2011/12 and 2013/14; • The proportion of people using social care who receive self-directed
support and those who receive direct payments is increasing. However, reflecting the austerity of the age, the number of people receiving care is reducing year on year. • The proportion of adults with learning disabilities who live in their own home or with their family and those in contact with secondary mental health services who live independently is improving. • Some 44.5% of people who used services reported that they had as much social contact as they would like. However, the report also highlights areas where more work is required, including working with local employers to help more adults with learning disabilities and those in contact with secondary mental health services to gain paid employment.
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Provide outdoor cover for staff and residents with Canopies UK With the Care Quality Commission inspecting care homes throughout the country its no wonder care homes are looking to improve their facilities and make a good impression. A canopy can help protect against the worst of the weather, helping to provide a safe and dry area underfoot, free from frost and slippery surfaces, eliminating potential hazards. They are great in the summer months too, helping to extend your living space and allow your residents outside to enjoy the fresh air.
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To arrange a free survey call Karen:
01254 865 612 Ext: 221 CMM April 2015 15
NEWS
‘Protect social care funding’ the NHS whilst forcing councils Social care funding must be to cut their already chronically protected in the same way that it is for the NHS in the next Budget or underfunded social care budgets is a false economy. It risks leaving another crisis such as the one seen this winter will be unavoidable, local councils unable to alleviate the pressure on the NHS and the most government leaders are warning. The Local Government Association is vulnerable people in danger of losing calling on the Chancellor to use the vital community care. Whilst councils have consistently Budget to protect social care funding to enable councils to support the been protecting spending on adult social care as far as possible, growing NHS and prepare for reforms starting as soon as this April. demand, escalating costs and a 40% cut to local government budgets Without adequate funding, across this parliament mean that elderly and disabled people could be left without the social care councils are being forced to make impossible decisions about which services which help them to remain independent, and stay out of services they provide. If protection for social care hospital and in their own homes for funding is not addressed in a similar longer. Instead thousands could see way as it has been for the NHS, the their elderly relatives, neighbours and friends risk being left without the situation will get worse over the next two years and put at risk the vital care they need to live independently services that the most vulnerable as well as simple every day support people rely upon as well as putting in such as washing, dressing and meals jeopardy the much needed changes on wheels. Council leaders and health to the care system which aim to make care more16:34:20 available to more experts are Hygenex warning thatAdcontinuing Range [186X1110mm] v1.pdf 1 28/01/2015 people that need it. to protect and invest money in
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New Mental Capacity Act directory A new directory of MCA resources has been published by the Social Care Institute for Excellence (SCIE). It is an online collection of up-todate MCA materials. Examples of good practice, and other useful content, have been submitted by professionals across all the sectors that use the MCA. All the materials that are included in the directory have been quality-assured by a
panel of experts, coordinated by SCIE. The MCA Directory also helps to raise awareness about MCA issues, including the Deprivation of Liberty Safeguards. It includes useful information and tools to help understand or implement it. There are links to leading blogs in this area, as well as to the Social Care Online database of research and journals.
New care home in Hampshire In July 2015, Choice Care Group will be opening a brand new care home in Hampshire. Designated Otterbourne House and located near Winchester, the property has been designed specifically for people with learning disabilities, autism and complex needs such as personality disorders, schizophrenia, bipolar disorder and a history of risk to themselves or others.
The single-storey purpose-built care home will have a lounge, quiet lounge and dining room and also feature another new building consisting of a further two bedrooms annexes; each with its own lounge and kitchenette. Building work started in November 2014 and the property is due to open in July 2015, subject to Care Quality Commission registration.
NEWS
The impact of the market on workforce aspects of homecare Think Local Act Personal’s (TLAP) National Market Development Forum commissioned Skills for Care to research, with homecare providers, the impact of contract arrangements on workforce measures like vacancies, turnover, sickness and pay rates. This information was considered alongside Skills for Care’s workforce metrics collected through the National Minimum Dataset for Social Care. The research covered homecare providers’ contract arrangements
including contracted hours, fees and delivery; hourly rates of pay; and prevalent management cultures around practice, training and development. The research did not find a clear correlation between any of the contract arrangements and workforce measures. However, it did identify that: • Increased fees are the main desired change identified by homecare providers, driven by a desire to increase staff wages and invest in training and development rather
than a focus on bottom-line profit. • Local authorities as the main commissioner of homecare services in England tend to pay lower hourly fees and are less likely to have differential rates across the week compared to other commissioning groups. • Individual employers now account for a sizable amount of the hours of homecare services commissioned and tend to pay higher hourly fees and differential rates at the weekend.
Sensory loss in care homes group Action on Hearing Loss, Alzheimer’s Society, Care England, International Longevity Centre-UK, Thomas Pocklington Trust, RNIB, Sense and Federation of Ophthalmic and Dispensing Opticians are working to raise awareness about the issues for people with sensory loss in care homes and care settings.
This group aims to raise the profile of the issue of sight and hearing issues in care home residents; to raise awareness of the issue among residents, families, staff and other professionals; and provide information about the many ways that health and quality of life can be improved for these individuals, often
with low cost adjustments to the care environment. The group is calling on the Care Quality Commission to use themed inspections in care homes and is developing a series of resources and guidance for care home staff, families and health and social care professionals.
• Providers working with individual employers were found to use a higher proportion of fees to fund training and development activities for staff, compared to those received from other commissioners. The report recommends that commissioners and providers use TLAP’s Stronger Partnerships for Better Outcomes: a protocol for market relations to improve commissioning. practice. Resources are available on the TLAP website.
DC Care sells Welsh home DC Care has sold Llangollen Fechan Care Home in North Wales. The home has been sold on behalf of Mr & Mrs Short who have retired. The new owners are experienced operators in both the domiciliary and residential care markets.
The One Stop Shop for all your care home management needs Caresys from Advanced Health & Care is the most complete care home management solution and provides over 3,000 care homes with all the essential tools needed to run an efficient care home business. To find out more about Caresys, the One Stop Shop for all your care home management needs, please contact us on 01233 722670 or visit advcs.co/Caresys
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EV SI EL TE O P SO M LD EN T
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TW O B H U O AC SIN M Q ES E C U IR SE AR ED S E
H TW O O M ES CA SO RE LD
D SI EV TE E L AC OP Q ME U IR NT ED
“Look what we’ve been up to...”
Kent
London
Berkshire and Surrey
Oxfordshire
Fast acquisition – three months from offer to legal completion
Exceeded client expectations on competitive bids received
Discreet targeting achieved acquisition goals
Secured sale of land for a national charity
If you are considering selling an established business, a development site or turnkey proposal then please telephone either Amanda Nurse or Tom Hartley on 08458 690777 or email amanda.nurse@carterwood.co.uk or tom.hartley@carterwood.co.uk. www.carterwood.co.uk
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NEWS
New social care regulation and inspection law - Wales Care home owners will become more accountable for their services under a new law to strengthen the protection of children and adults and improve the quality of care and support in Wales, the Welsh Government has announced. The Regulation and Inspection of Social Care (Wales) Bill will put delivering success at the heart of a revised and streamlined legal framework for the regulation and
inspection of care and support in Wales. It will also ensure no service escapes the regulatory regime. The Bill rebalances accountability in the social care system, away from just those working on the frontline to ensure employers and company owners and directors also share the responsibilities in law. It will also introduce a new model of regulation, which will allow
regulators to press for improvement across one care setting site or across a provider’s entire range of services if deemed necessary. It will make it easier for the regulator to act where care is considered beyond repair and, if necessary, cancel the registration of those providers, services and settings which fail to implement improvements. It also includes stronger penalties for certain offences.
The Bill is part of the Welsh Government’s Sustainable Social Services for Wales: A Framework for Action programme to transform the provision of care and support for the citizens of Wales. It complements the Social Services and Well-being (Wales) Act 2014, which focuses on a model of care and support which has the citizen at its heart and is based on the concept of wellbeing and improved outcomes for people.
Malhotra achieves PLC
Minimum wage underpayment
Following on from a three year rationalisation process across all of its business interests Newcastlebased Malhotra Group has achieved PLC status. The Group, which operates in the leisure, property and care home sectors, brought together its 26 companies and partnerships and consolidated them within one group. The Group, originally established in 1991, has become a North East
There is increasing recognition that a better deal for the workforce will be essential to the quality and sustainability of social care provision in the UK, but so far there has been scant evidence as to the scale of investment needed according to research by the Resolution Foundation. The think-tank is currently undertaking a major investigation into the costs of improving care
success story with a turnover that has seen growth year on year, from £19.5m in 2013 to £22m in 2014 and to a predicted £25m this year. Currently employing around 1000 people, the Malhotra Group has already embarked upon a major five year expansion plan which should see staff numbers double by 2020. For more information on the Malhotra Group, see Business Clinic on page 24.
‘Make older people’s care a key election issue’ The British Geriatrics Society has called on political parties to focus on six key issues in older people’s care, both in the upcoming General Election and as part of a postelection Government. A new BGS policy document identifies six key decisions around health and social care for older people, explaining why politicians
and political parties must urgently address each of them, and highlighting the risks of inaction. The document also outlines how positive decision-making, supported by the insight and expertise of BGS members and healthcare professionals, can provide solutions to some of the most complex and urgent challenges facing the NHS.
The six policy decisions include: • ending the divide between health and social care; • building capacity in Intermediate Care; and • providing national strategic direction on older people living with frailty, dementia, complex needs and multiple long-term conditions.
Funding to support changes to Wales’ social services
Sheffcare’s dementia study
A £14m package of support will be made available to help local government implement major reforms to Wales’ social care system, Health and Social Services Minister Mark Drakeford has announced. The Social Services and Wellbeing (Wales) Act 2014 will transform the way social services are delivered, promoting people’s independence to
Sheffcare and the University of Sheffield have been successful in securing funding for a major European research project into how people with dementia could be supported with technology. Sheffcare has been awarded a grant of €180,000 which will be released over a three-year period as the research project continues.
give them a stronger voice and more control over the services they need. It will also encourage a renewed focus on prevention and early intervention. Speaking at a meeting of the WLGA council in Cardiff, the Minister announced a multi-million pound package over the next two years to support the implementation of the Act.
worker conditions such as paying the living wage and enhancing pension contributions as well as considering the wider savings that would result, for example, through lower tax credit spending as wages rise. Its previous research highlighted that a significant number of frontline care workers are not receiving the statutory National Minimum Wage.
Carterwood sale Carterwood acted on behalf of Paragon and Quintus Housing Trust in the sale of Lyle House and Marling Court, two high quality purpose-built elderly care homes in South West London with a total of 82 registered beds. Carterwood generated strong interest in the homes and received a high number of bids from a variety of different providers. A further round of bids followed and after careful consideration, County Court Care were selected as the preferred party.
Newlands Hall DC Care has sold Newlands Hall, in West Yorkshire. The home is registered for 30 and has been a care home for over 30 years, managed by Orchard Care on behalf of Silverline Care. Newlands Hall has been sold to Regency Healthcare with plans to continue the ongoing improvements already undertaken. CMM April 2015 19
CMM is offering readers the opportunity to put their questions to senior decision-makers. Is there something affecting your business that you’d like an answer to? Are you facing specific pressures you’d like to know how to tackle? Send your questions to CMM.
THE
Care Certificate
Q
I understand the new Care Certificate is to be launched soon. What do I need to know come 1st April? With so many other changes happening around my business this year, how can I be prepared?
A
Sharon Allen, Chief Executive, Skills for Care responds.
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In a time of great change for the sector, 1st April is a landmark date as the Care Act comes into force and the Care Certificate is introduced to support workers in social care and health. With so many pressures on the sector at this time, we have set out to explore everything providers need to know to begin working towards the new Care Certificate from the 1st of April. The Care Certificate is a part of the wider
induction for new staff which replaces the current Common Induction Standards. It was a key recommendation of the Cavendish Commission. Camilla Cavendish was appointed after the Francis Inquiry into the Mid-Staffordshire NHS Foundation Trust to undertake an independent review of social care support workers and health care assistants across both the social care and health sectors.
Her review The Cavendish Review: An Independent Review into Healthcare Assistants and Support Workers in the NHS and Social Care Settings suggested that the preparation of social care support workers and health care assistants for their roles within care settings was inconsistent. As a result, the creation of a Fundamental Certificate of Care or ‘Care Certificate’ was recommended.
Since then Skills for Care, Health Education England and Skills for Health have been working in partnership to consult with the sector about what the Care Certificate might look like. This partnership has been integral to developing the Care Certificate, which will launch from 1st of April, because this is the first time that there will be a common approach to induction across the social care and health sectors.
WHAT IS THE CARE CERTIFICATE? The Care Certificate fits into a whole approach to leadership, learning and development in social care and health. It is not something happening in isolation but feeds into wider leadership, learning and development across all services. The Care Certificate is designed to be the start of the career journey for social care and
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CMM April 2015 21
Are you ready for the new changes? From April 2015 social care providers are required to implement the new Care Certificate framework to ensure employees delivering care are compassionate, caring and provide quality care. Care Certificate will replace both the National Minimum Training Standards and the Common Induction Standards. CQC have also introduced new ratings and KLOE inspection guidelines to encourage care providers to improve.
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THE CARE CERTIFICATE
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health workers offering direct care. However, it is only one element of the training and education that will make them ready to practice within their specific sector. Although the Care Certificate is designed for staff new to care and offers this group their first step on their career ladder, it also offers opportunities for existing staff to refresh and improve their knowledge in line with the new Standards. The Care Certificate builds on and replaces the Common Induction Standards and respectively National Minimum Training Standards for all new staff from the 1st of April. It sets out explicitly the learning outcomes, competences and standards of care that will be expected in health and social care, ensuring that the combined workforce is caring, compassionate and delivers quality care and support. It also means that wherever direct care is delivered, those delivering it will have the same induction training. There are 15 Care Certificate standards, which were published at the end of January. These are: Understand Your Role. Your Personal Development. Duty of Care. Equality and Diversity. Work in a Person-Centred Way. Communication. Privacy and Dignity. Fluids and Nutrition. Awareness of Mental Health, Dementia and Learning Disabilities. 10. Safeguarding Adults. 11. Safeguarding Children. 12. Basic Life Support. 13. Health and Safety. 14. Handling Information. 15. Infection Prevention and Control. 1. 2. 3. 4. 5. 6. 7. 8. 9.
The content of the Care Certificate standards is similar to the Common Induction Standards because its development has been based around building on those standards, including a greater emphasis on not just knowledge based learning but observing how that is then put into practice. The Care Certificate is the start of the career journey for new staff groups and is only one element of the learning and development that will make them ready to practice within their workplace. Each adult social care worker starting in a new role offering direct care is already expected to have learning and development and assessment as part of their induction. This will usually take place over the first 12 weeks of employment. The Care Certificate does not replace employer induction specific to their workplace, nor will it focus on the specific skills and knowledge
needed for a specific setting. However, the Care Certificate is a key component of the overall induction which an employer is required to provide in order to meet the essential standards set out by the Care Quality Commission.
1ST APRIL 2015 From the 1st of April 2015, employers will be expected to ensure that all new care staff begin training towards their Care Certificate. However it’s highly likely that some staff will be in the process of completing their Common Induction Standards which they commenced prior to the 1st of April. There will be some overlap and Skills for Care has been working closely with the Care Quality Commission (CQC) to ensure that this is taken into consideration during inspections that take place in this transitional period. The CQC has been a close partner in this and has agreed to take a proportional approach to inspection in the transitional period. Inspectors will understand that the 1st April is not a cliff-edge and those starting the Common Induction Standards prior to the cutoff will not need to abandon that training in favour of the Care Certificate. However, the CQC will want to see that all new staff employed from the 1st of April are working towards their Care Certificate. Providers will need to evidence that they are moving to the Care Certificate and the CQC will be looking for evidence of that.
EVIDENCING LEARNING There are templates and workbooks available for staff and organisations to evidence the work staff undertake towards the Care Certificate. These are similar to those used for the Common Induction Standards and staff will be able to use these to evidence their learning. It will be the role of management to assess this learning and evidence to share with the CQC and other stakeholders. For those organisations that have in-house learning departments or use external learning providers, their materials can also be used as long as they meet all of the Care Certificate Standards. Managers will be responsible for ensuring that their staff are trained in the standards however, this role doesn’t have to fall to the Registered Manager directly, it can be another member of staff or an external organisation as long as the
manager is confident in the assessment and understanding of the staff. In order to achieve the Care Certificate, ALL 15 standards need to be completed. Once an employee has completed their learning and the manager is confident of the evidence and their understanding of the individual standards, the official Care Certificate can be downloaded from the Skills for Care website and there is guidance on the website on how to do this including how to add the employer’s logo.
A POSITIVE MOVE FOR THE SECTOR One of the key strengths of the Care Certificate is that this is the first time an agreed set of standards defines the minimum expectations of what care should look like across the social care and health sectors. The implementation of the Care Certificate will impact on a substantial proportion of the social care and health work-force of millions of employees across the country. This is also the first time that mental health has been formalised within induction standards across health and social care. This group of staff have more contact with people than any other group and this gives them the minimum competences to ensure that this is delivered to an agreed set of standards. For organisations that have ancillary staff that don’t deliver direct care but do have contact with the individuals who use the service, they may benefit from having an understanding of aspects of the Care Certificate. It is possible to draw out relevant parts of the standards and offer that learning to those ancillary staff. The Care Certificate is a really positive move, not only for people receiving social care but for those engaging with health and mental health services too. It is the first time there will be consistent standards across the board and individuals can have the confidence that all new staff are trained in the same way to deliver the very best care. Skills for Care is proud to have played such a pivotal role in the development of the Care Certificate and its standards as well as the partnership working alongside Health Education England and Skills for Health. For more information and to access the supporting materials visit www.skillsforcare.org.uk/care-certificate CMM
Sharon Allen is Chief Executive of Skills for Care. Are you ready for the Care Certificate? What are your thoughts on this change to induction training? Join the debate at www.caremanagementmatters.co.uk. If you would like to put your question to senior decision-makers, email editor@caremanagementmatters.co.uk CMM April 2015 23
AMBITIOUS PLANS FOR MALHOTRA Not solely a care provider, the Malhotra Group has a diverse and interesting portfolio. Based in the North East, bringing together corporate ethics and family values, it operates across care, leisure and property and has just become a public limited company with a strong future vision. Founded by Meenu Malhotra, The Malhotra Group was set up in 1991 in the North East. The care division – operating under the banner of Prestwick Care – was established in 1986. The Group now includes a second generation family member on the Board and is part of Malhotra Family Holdings which has interests in both the UK and in India.
DIVERSE AND INTERESTING The company grew from a modest start, with the current Managing Director, Meenu Malhotra first setting up a number of drapery shops in the region before embarking on a rapid programme of growth. The Newcastle-based Group’s portfolio is made up of 26 care, leisure and property companies and partnerships which have recently been brought together as one. The Group acquired its first care home in 1991 as the second business it acquired - it also acquired an old department store in Newcastle turning the upper floors into student accommodation in 1996. Aside from the department store, the core of the business from the outset was North East-based care homes. It acquired its second home in 1996, followed by another in 1998 and then developed a purpose-built home in 1999. From 1999 to 2005, the company diversified its portfolio in the region. It moved into property and leisure acquiring commercial properties, including prestigious properties in Newcastle city centre, developing arcades, a backpackers’ hostel and purchasing a public house. 24 CMM April 2015
Bunty Malhotra, Chief Executive Officer of Prestwick Care, explained the company’s original vision; ‘Although the Malhotra Group has a diverse range of business interests, the ethos of all of them is very similar – to provide the very best services and attention to detail for their clients and customers. This is particularly true in the awardwinning care division where the commitment has always been the comfort, safety and wellbeing of residents whilst preserving their dignity.’
PRESTWICK CARE The Malhotra Group, under the Prestwick Care brand, acquired its first care home 29 years ago, which was a small, 16-bed unit in Newcastle. The company soon recognised that this was a side of the business that could be developed alongside the company’s other interests and it has grown over the decades, although the company has had to adapt its offering to meet the changing demands of its clients. Bunty continued, ‘Prestwick Care’s mission is to provide excellent, dedicated care with the help of a professional team to ensure the highest standards are maintained for our residents’ lives, all provided with a caring attitude and supported by our continuous effort to improve. ‘When the Malhotra Group first became involved in the care home industry it was to cater to a very different market than the one that exists today.’ With the growing acuity of individuals coming to its care
homes Prestwick Care has evolved to provide a mix of both nursing and residential care. Bunty added, ‘Our speciality has become offering first class accommodation and the highest standard of living to people with a wide range of often extremely complex needs. This is all provided while having to constantly maintain the highest standards in the face of continuing cuts to care budgets by local authorities.’ The Prestwick Care homes have a broad remit, covering all registered care categories across both residential and nursing care. The long-term plan is to develop more homes with a goal of ultimately providing 2,000 beds across the North East. Future plans include the development of two new homes, one at Melton Park, Gosforth, Newcastle which is due to open in August 2015 with 67 beds and an 88 bed care facility on the site of the former Alnwick Bus Depot in Northumberland.
RECENT BUSINESS DEVELOPMENTS The Group has seen turnover grow year-on-year, recent figures saw turnover increase from £19.5m in 2013 to £22m in 2014 and it is forecast to reach £25m in 2015. The Group currently employs around 1,000 people. However given the diversity of its portfolio the company decided to undertake a rationalisation process three years ago. This process has culminated in it becoming a public limited company (PLC) in February 2015. This consolidation of the business
and re-registration as a PLC is part of the Group’s major five year expansion plan which should see staff numbers double by 2020. Although there are no immediate plans to float the company, the aim is for shares to be offered to the public in the future. Bunty explained, ‘The Malhotra Group had 26 different companies and partnerships and it was agreed that it made sound commercial sense to rationalise these and bring them under one umbrella company. Becoming a PLC puts the company in a strong position going forward for future development. There are plans for the company to grow across all divisions, with the launch this year of a five year plan which should see it double in size and then be in a position to be floated on the stock market.’ CMM
OVER TO THE EXPERTS... The Malhotra Group has grown to a substantial size since 1991, becoming a key player in the North East. It now has ambitious plans for the future. Is there market appetite for Malhotra’s care offering with Prestwick Care to meet its ambitious growth plans? With plans to double in size in five years, with a view to floating on the stock market, could this be the beginning of another slew of listed social care companies similar to those seen in the mid-2000s with CareTech and Southern Cross? Or is the mixed portfolio the crucial aspect of Malhotra’s public offering plans? Will we see the Group become one of the sector’s major providers?
ESSENTIAL THAT CARE DIVISION IS MANAGED SEPARATELY Success in the elderly care sector requires a tireless focus on quality and attention to detail. The margin pressures, recruitment challenges and high expectations of the Care Quality Commission regulator make the elderly care sector challenging for operators. With the experience of Southern Cross fresh in people’s memories, I am not convinced that elderly care home groups should be publicly listed. The greater reporting requirements of public companies results in a focus on short-term financial results rather than longterm investment in high quality services and caring staff. I am also not convinced of the synergies between the diverse range of different businesses that form part of the Malhotra portfolio ranging from hostels to pubs. It is, therefore, essential that the care business is managed as a separate entity from the rest of the group.
I would also be extremely reticent about expanding any elderly care home business in the North East. The market is over-supplied with residential care homes which results in poor occupancy even in new-build services. The only sector where I think there is demand, is for specialist dementia services as there is a growing need for these services and it isn’t possible to care for people with advanced dementia at home without 24-hour care. The care of those with dementia has attracted much media attention of late, and it is widely assumed that this market is ripe with new opportunities. Demand for dementia services also tends to be higher in less affluent parts of the country where greater levels of smoking and poor diet can result in more cases.
Clare Connell Managing Director, Connell Consulting
The Group has built up a variety of successful businesses, based on providing the very best services and attention to detail for their clients and customers. In the care homes they have focused on maintaining the highest standards. The combination of quality care and attention to detail are characteristics of a number of successful care home operators. The market over the next couple of years will throw up a number of challenges and uncertainties for operators including staffing, the new inspection regime, the Care Act, further austerity measures plus the prospect of changes in central policy following the upcoming election. Importantly, however, I also expect that operators who deliver quality care with an attention to detail and who don’t over-stretch their resources, will benefit over time, as quality care facilities will be needed in the future. Therefore Mahotra’s growth strategy seems sensible and logical in light of current market conditions.
However, I haven’t seen too many successful care home operators who run other businesses in their portfolio unless they are completely separate and run independently of the care home group. Too often, the other businesses can become a distraction stretching management to cover all the different companies which can result in a loss of focus. I also wonder about a market listing for a care home group. There are only a couple of specialist care operators on the market and I still have doubts as to whether investors understand the dynamics of the elderly care sector which has been more ‘steady as she goes’ than fast expansion. It is also a sector that isn’t particularly well covered by the market analysts plus its track record over the last few years hasn’t been great looking back there were many more quoted companies than there are today.
Paul Birley Head of Public Sector and Healthcare, Barclays
CARE STRATEGY WILL STRENGTHEN ITS POSITION It is extremely impressive how Meenu Malhotra has driven the business from its small beginnings in 1991 to a group with a £22m turnover today. In reference to Prestwick Care, the care home market has seen an increase in transactional activity over the last 18 or so months, with a number of new entrants to the market, particularly investment from USA REITs. This has had a positive impact on the market, which has been good for existing operators, who are benefiting from the more acquisitive market. Prestwick Care comprises a number of high quality purpose-built homes that meet the market’s ever-increasing expectations for quality accommodation, and appear to be well-placed in this regard. The only caveat is that the majority of overseas investment has been primarily in southern England; however, investors are starting to look outside the South East. The Malhotra Group has plans to float on the stock market after
SENSIBLE AND LOGICAL GROWTH IN CURRENT MARKET
the next phase of its five-year strategy. CareTech and more recently Cambian, both operating in specialist care, are good examples of successfully floated companies in the sector. The success of the Cambian flotation highlights that there is interest in the specialist market from investors; however, Cambian is one of the UK’s largest mental health providers and it remains to be seen whether a company of Malhotra’s size and business interests would be attractive to the market. Going forward, Prestwick Care has a strategy of focusing on the development of high quality care homes, with the development of a new 67-bed care home at Melton Park, Gosport underway. If the Malhotra Group continues with its focus on new care home developments, this can only help to strengthen its position as a key provider in the North East.
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Training and Consultancy
Revalidation for nurses From December 2015, all nurses who are due to reregister will start using revalidation. Dr David Foster and Professor John Clark explore what this means for nurses in the care sector. Revalidation is not in the Oxford dictionary (at least not the 1995 version within reach) so it must be jargon. But it is one of the most important words associated with nursing at the moment – disregard it at your peril. Jargon or not, it is a big deal for nurses and the care sector. Since valid means to substantiate, confirm, be legally acceptable or describe something that has not yet reached its expiry date, it is reasonable to assume that to revalidate must mean to declare valid again. And so it is the word that the Nursing and Midwifery Council (NMC) is using to describe the new process by which all nurses will declare and demonstrate that, on a three yearly cycle, they remain fit to practise throughout their careers.
FIT TO PRACTISE OVERHAUL The NMC is having to overhaul the system it uses to make sure nurses are fit to practise and that nurses consistently exhibit high degrees of professionalism and good practice. However, nationally some poor practice has been
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REVALIDATION FOR NURSES
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exposed, for example by the report into Winterbourne View and the investigation conducted by Sir Robert Francis QC into the standards of care at Mid-Staffordshire. As a consequence of his investigation Sir Robert recommended: ‘… that the Nursing and Midwifery Council introduces a system of revalidation similar to that of the General Medical Council, as a means of reinforcing the status and competence of registered nurses, as well as providing additional protection to the public’. The NMC accepted this recommendation and recognised that it needed to do more to inspire greater public confidence in nurses. It is essential for public safety that nurses are competent and safe practitioners and the public should rightly expect nurses to show that they are up-to-date in their practice. This will apply to all nurses: not just NHS nurses, not just those in clinical practice giving hands-on care, but also those in managerial and leadership roles, in education, research, public health and policy jobs who need to be registered nurses. Revalidation applies to any sphere of nursing practice and to anyone who wishes to continue practising and remain registered as nurse with the NMC. The NMC has 670,000 nurses on the UK register and with 310,000 nurses working within the NHS in England around 60% of its nursing registrants work outside the NHS. There is, therefore, a considerable number affected by this change in the independent sector, in care homes with nursing, in domiciliary care and elsewhere. They might be giving hands-on care and might also be Registered Managers or in other roles where nurse registration is legitimately required. Revalidation is approaching fast and is a process that needs to be widely understood to be implemented effectively.
REVALIDATION IN PRACTICE From December 2015, all nurses who are due to re-register (that is those who are at the end of the three yearly cycle where they have to renew their registration with the NMC) will start using revalidation. This means that by December 2018 everyone on the register will have undergone revalidation. This process of renewal every three years is not new. Nurses have to pay an annual fee to remain registered and every third year have had to declare themselves to the NMC as being up-to-date and fit to practise. Until now this
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three yearly renewal has been based on the PREP (post-registration education and practice) standards. PREP required nurses to make a self-declaration to the NMC that they had undertaken 450 hours of practice and 35 hours of continuing professional development (CPD) in the preceding three years. Those nurses who took PREP seriously will find that revalidation presents only modest changes. But PREP has been much criticised and, although all nurses have had to declare compliance with these standards, it has never been audited and so fitness to practise assurances through PREP could not be substantiated. The new system has to address this with a view to increasing public confidence in nurses whilst helping to improve standards of care and generating a culture of continuous improvement. The requirements for revalidation differ from PREP in that, although there is still a need to undertake 450 hours of practice in three years, the hours needed for CPD go up by 5 hours to 40 hours in three years. Also the nature of the CPD will be slightly different in that 20 of the 40 hours will need to be participatory. This is to ensure that there is interactive learning in participation with other nurses and to guard against all CPD being done in isolation in front of a computer as e-learning. Participatory learning can take many forms; it could be formal classroom, on the job training, structured courses or activities such as mentoring, coaching or shadowing. The important feature being that the learning is relevant to the scope of practice and that there is evidence of what has been done with supporting evidence of learning through reflection. Another new component part of revalidation is feedback. Not just feedback for its own sake, but being responsive to it and using it to change personal practice as a consequence. This feedback is, however, causing some anxiety about who might provide it, how it might be collected and how to deal with negative feedback. In reality, nurses are likely to use a range of sources. Feedback could come from patients, their families and carers, colleagues, mentors or through the appraisal system – but it must never be acquired by coercion. Indeed, using complaints could be very valuable. They might feel like a negative source of information, but they are important stimuli for learning. That highlights an important feature of revalidation: it is about a nurse’s continuing fitness to practise and not about managing performance. The NMC will not be interested in seeing the original feedback, which will remain confidential to the nurse, but it will be interested in a
‘Revalidation applies to any sphere of nursing practice and to anyone who wishes to continue practising and remain registered as nurse with the NMC.’
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reflective account on the feedback which demonstrates what has been learnt and how it has changed practice for the better or that it has reinforced good practice. Revalidation will also require five reflective accounts over the three year period on how CPD or feedback has changed or improved practice and how it is relevant to the Code. Nurses will then have a discussion with another nurse about their reflections on the Code, CPD and feedback. In meeting these new requirements nurses will not just declare that they have met the standards, they will also have to seek third party confirmation that this is the case. This will need a professional development discussion with another NMC registrant covering reflections on the Code, CPD and practice-related feedback. The NMC provisional policy on this point says that confirmation will be provided by the nurse’s line manager. The preferred, and indeed ideal, confirmer is a line manager who is also an NMC registrant. There will be instances where the confirmer may not be a registrant and so the confirmation discussions will need to be held with a registrant who is not the line manager. For self-employed nurses, the NMC will provide guidance on how to access confirmation at a later date.
PILOT STAGE More details will emerge over the course of the year because the NMC is currently piloting and testing the new system. It is anticipated that the final standards and guidance on revalidation will be approved in October 2015. As part of the pilots the NMC will also decide how best to audit nurses’ portfolios of evidence and how many it will audit in any one year to satisfy itself that the process is effectively protecting the public. The pilots will be evaluated and revalidation itself will start in December 2015 for those renewing their registration at that time. There will also be an evaluation of the effectiveness of revalidation starting 2016. There is a reasonable emphasis on the role of employers to support the system of revalidation. No good employer would want to employ a nurse who cannot revalidate and many will have sufficient CPD opportunities on offer to meet the NMC’s criteria and have effective appraisal systems to contribute to the process. However, some nurses might not have one employer
consistently. They might be self-employed or work on a casual basis through a bank or agency, so they will have to think carefully about how to construct their revalidation. After all, it is ultimately the responsibility of the nurse to maintain their fitness to practise, keep up-to-date and have evidence to revalidate. It is a profoundly important aspect of professional practice to take this responsibility seriously as an individual.
NEW CODE There is one other new and crucial element to revalidation and that is the revised NMC Code. The Code, published in January comes into effect on 31st March. It contains the professional standards that registered nurses must uphold whether they are providing direct care to individuals, groups or communities or bringing their professional knowledge to bear on nursing practice in other roles, such as leadership, education or research. It also aims to promote a culture of professionalism and accountability and states that employers should support their staff in upholding its standards as part of providing the quality and safety expected by service users and regulators. The Code is absolutely central to the revalidation process as a focus for professional reflection – and it’s a really important feature of this process to recognise that nurses will revalidate against the standards in the Code and not their job description. Revalidation might still sound like jargon, but it is vitally important to every single nurse who wants to continue practising. It is also crucial that providers of care understand what revalidation means as a process and as a good employer. The NMC, quite rightly, wants all nurses to practise with a high degree of professionalism, ability and accountability in whatever setting they work. In the care sector especially, nurses give hands on care to some of the most vulnerable people in society: they need to trust their nurses and know that they are in safe hands. Revalidation might not mean anything much to them but they need to be confident that every nurse deserves his or her place on the register and that revalidation is an effective process to ensure that. Acknowledgement: Thanks go to Dr Katerina Kolyva, Director of Continued Practice at the NMC for reviewing the contents of this article on behalf of the NMC. CMM
Dr David Foster is Head of the Nursing, Midwifery and Allied Health Professions Policy Unit at the Department of Health. Professor John Clark is Director of Education and Quality at Health Education England – South. 30 CMM April 2015
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A VIEW FROM THE TOP
BARRY SWEETBAUM Barry Sweetbaum is Chief Executive of SweetTree Home Care Services.
REFLECTIONS ON THE LAST DECADE Anyone looking at the sector today would have to say it is in complete crisis, verging on meltdown. This is not a crisis caused by a lack of capability, because that we have in abundance, but a crisis caused by a lack of capacity, clarity and transparency. I am a true believer that the vast majority of those working on the ground wake up each day wanting to make a positive difference however we have a system that keeps getting in the way. The lack of trust and confidence in the sector means no-one knows where to turn. Clients and care professionals feel vulnerable engaging with services they don’t trust but also can’t walk away from. When Nicki Bones and I set up SweetTree in 2002 we didn’t know anything about domiciliary care other than it could be done better. We wanted the team to make a positive difference in the lives of clients each and every visit, this remains the goal today. SweetTree is now a leading provider of high quality domiciliary care with dedicated specialist services. We ensure each service is run by a specialist manager and supported by a dedicated team of specially trained carers. This is in sharp contrast to the generic support model most providers operate however reflects our view of what quality care is all about. PROJECTIONS FOR THE NEXT DECADE Observing current sector events is like
watching footballers play without boots or a referee - there is no traction or structure on the pitch. The opportunity exists to create an exciting, vibrant, life-changing world for all. However we seem to be failing all but the lucky few. The solution has to be twofold, 1) creating a best practice based, high quality community care model with highly trained and motivated care teams at its heart and 2) a societal understanding that in care, like life, you get what you pay for. People can’t expect a first class, professional sector to come from nothing. Whether paid through taxes or direct contributions, sacrifices are needed, quickly. Trying to squeeze the system more is damaging it further and soon it will be beyond repair. Moving forward we will be remaining true to our model and expanding into new markets. We are opening our second office and more will follow. However we must maintain high standards, our training focus and continue to make a positive difference each and every day.
benefits customers and makes commercial sense for the public purse.
INSIGHT Having spent my life working in the sector, firstly in the NHS and then in secondary and community care, I just cannot understand why it’s all so bloody difficult. Rarely do you get such a high level of commonality in the aspirations of the customer and those supporting them as in the care sector. Ensuring high quality, user-focused services
ADVICE Jane Ashcroft from Anchor once said care professionals must ‘listen to the voices in their head’ and I could not agree more. Whether a carer directly supporting clients or an investor helping to make the wheels go around, you must always reflect on what impact your decisions will have and the effects that they will have on others. CMM
INFLUENCES Apart from the obvious influence of my family and friends, one of my greatest influences has been a carer named Margie who looked after my mother when nearing her end of life with cancer. Margie showed me what high quality, compassionate care can be and how important it is to get it right. I knew Margie only briefly 25 years ago but remember her as if she is in the room today. This highlights that our teams’ work reaches the core of who we are as a society and that everyone working in this sector should be treated with the huge respect they deserve. LESSONS I had a boss named Kingsley Manning early in my career who taught me ‘it’s never the screw up that gets you but rather the coverup’. If you are open, honest and transparent about how you deal with things, good and bad, people trust and respect it.
An extended version of this interview can be found at www.caremanagementmatters.co.uk CMM April 2015 33
Do you have robust whistleblowing policies? Given the ongoing high profile whistleblowing affecting the sector, Benjamin Roberts shares his expertise on the law around whistleblowing and how to draft a comprehensive whistleblowing policy. Whistleblowing keeps hitting the headlines in relation to the health and social care sectors. The appalling practices exposed at Winterbourne View and the Old Deanery (highlighted in the BBC’s Panorama programmes) brought the issue to the forefront in 2011 and again in 2014. In both cases the perpetrators of abuse were exposed, along with staff who had failed to report the abuse they had witnessed. It was galling that only by using hidden cameras was the abuse brought to light and action taken to protect the victims. It has long been established that sharing of information is vital for the protection of vulnerable groups in our care. Moreover, withholding information to the detriment of service users is potentially an act of abuse.
WHISTLEBLOWING LAW The law governing whistleblowing, known in legal terms as ‘making a protected disclosure’, was set out in the Public Interest Disclosure Act 1998 (PIDA) and incorporated into the Employment Rights Act 1996 (ERA) in sections 43A-43L. A protected disclosure is defined as any disclosure of information which, in the reasonable belief of the worker making the disclosure, is made in the public interest and tends to show one or more of the following (the full grounds have been edited to reflect those most applicable to the care sector): • a criminal offence; • the breach of a legal obligation; • a danger to the health and safety 34 CMM April 2015
of any individual; or • the deliberate concealment of information tending to show any of the above matters. It is easy to think of examples that might fall within the definition above. For example, a breach of the Mental Capacity Act 2005, failure to correctly hoist a service user or incorrectly signing a medicine administration record (MAR) chart. A worker who reported any of these events could be making a potential disclosure. However, for it to be whistleblowing, additional criteria must be met. The ERA goes further, it also requires that the worker must: • not act for personal gain; and • reasonably believe the information disclosed, and any allegations it contains, are substantially true. Next, the worker must either: • have reported this to their employer; or • reasonably believe that they would suffer detriment (or that the evidence would be destroyed or concealed) if they did so. Finally, it must be reasonable in all the circumstances of the case for the worker to make the disclosure. In making that final judgment the courts will consider: • who the disclosure was made to and why (a report to the Care Quality Commission would qualify); • how serious the issue being reported was; • if the issue is ongoing or likely
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to reoccur; • if the worker followed any internal procedures; and • if the disclosure breached service user confidentiality.
WHISTLEBLOWING IN PRACTICE Applying the above in practice, the worker should have reported the issues to their employer unless, for example, their employer was the perpetrator, in which case they should have reported it to the Care Quality Commission, as opposed to the press, a friend, or on a social network. However, that is not to say that a potential act of whistleblowing should not be treated as such if, at first glance, one of the criteria above does not appear to have been met – only careful investigation can reveal the full facts and caution should always be exercised. Workers can whistleblow at any point, so it may well be that a worker whistleblows when they, themselves, are being investigated for misconduct. It is vital that employers faced with that situation address the two issues separately, fairly and objectively. The Court of Appeal case Fecitt and others and Public Concern at Work v NHS Manchester [2012] IRLR 64 CA made it clear that if there are employment issues in relation to an employee who whistleblows (or purports to whistleblow), the employer is not prevented from addressing these, as long as it is clear that any treatment of the employee that could be perceived as negative is not in relation to their whistleblowing. If an employer proposes to investigate disciplinary issues (or take disciplinary action) with a purported whistleblower, it is likely that will be a very fine line to tread. Employers may be understandably upset if a worker reveals confidential information
about staff or service users to third parties when purporting to whistleblow. However, it is worth bearing in mind, not only the protections of PIDA, but also the exemptions in the Data Protection Act 1998. The exemption in s.29 says that the protection of data under the Act does not apply where a disclosure of personal data is for the purpose of prevention or detection of a crime. Other exemptions may well apply, depending on the facts and circumstances. What is abundantly clear is that employers must never infringe on a worker’s right to whistleblow and within reason must encourage them to do so in good faith, preferably internally. As an employer, you must not (nor be seen to) attempt to curtail your staff’s absolute right to whistleblow externally without first reporting issues to you. However, through a well-drafted policy, clear systems for reporting and training, you may be able to encourage your staff to both whistleblow more and to you in the first instance. This also needs to be balanced with the potential abuse of the whistleblowing system by staff making malicious allegations against each other or seeking to unfairly undermine their managers.
WHISTLEBLOWING POLICY A best practice, whistleblowing policy should: • ensure that all staff have read (and signed to say that they have read, understood and will abide by) the policy; • make it clear that any concerns or complaints about or relating to their own contracts of employment should be raised via the grievance procedure; • explain that staff have a duty of care towards service users; • explain that staff have an obligation to report bad practice
or abuse and failure to do so, or concealing this, could be a serious disciplinary matter; • explain that issues should be reported promptly to aid investigation and safeguard those who may be at risk; and • highlight and give examples of potential issues that may be reportable and that they need only have a ‘reasonable belief’ that what they are reporting is correct. Explain how to whistleblow: • verbally and/or in writing; • to the appropriate manager (including when they wish to report their usual manager and where to find the relevant contact details); • about third party organisations or individuals; • draw strict lines in terms of what staff may or may not do in order to establish whether or not their concerns have a factual basis (eg forbidding staff to take documents or photographs or set up their own surveillance, but advising on how to protect information at risk of destruction); • explain that managers have been fully trained in how to record, report and act upon allegations made – all issues reported will be taken seriously and treated confidentially; • explain that whistleblowers will be protected from any potential victimisation and how to report any incidents of victimisation resulting from whistleblowing; • explain that staff are encouraged to put their names to reports, but can have their anonymity protected if they wish; • explain that staff have the right, if they wish, to report concerns directly to the Safeguarding board, Care Quality Commission or the Police, but explaining that they should only do so if they reasonably believe that they would suffer detriment (or that
the evidence would be destroyed or concealed) if they reported internally; • explain that any bullying, harassment or any other detrimental treatment of whistleblowers in or out of the workplace could constitute gross misconduct; • explain that malicious allegations (eg where the allegations are known to be false, where there is no factual basis to make the allegations and/or no reasonable basis for a belief that the allegations could be true) could constitute gross misconduct. Domiciliary care providers in particular should bear in mind that their staff might be required to whistleblow about third party care providers (eg if the care is shared between two providers) or about family members of the service user. Domiciliary care providers must, therefore, train staff to recognise potential signs of abuse or neglect and how to report concerns.
TAKE ALL REASONABLE STEPS What is abundantly clear is that encouraging whistleblowing and supporting whistleblowers is increasingly important for care providers. Moreover, with concealed cameras becoming more widely available and affordable, concerned members of the public or staff may resort to this means of ensuring that there is no maltreatment taking place. This can obviously place providers in a difficult position, where third parties are more aware of what is taking place when care is provided for service users than they are themselves. The key to preventing this and potential abuse is to take all reasonable steps to ensure that staff are monitoring care and reporting any concerns CMM immediately.
Benjamin Roberts is Solicitor and Care Services Manager at Abbey Legal Services. carehomes@abbeylegal.com For more information, to read Benjamin’s top tips for providers and read a whistleblowing case study, visit www.caremanagementmatters.co.uk 36 CMM April 2015
Just confirmed This year’s regional events focusing on the future of care and commissioning Derbyshire & Nottinghamshire Care Conference Nottingham 15th July 2015
North West Care Conference Clayton-le-Moors, Blackburn 23rd September 2015
Berkshire Care Conference Reading 15th October 2015
For exhibitor and delegate enquiries contact Paul Leahy:
Organised by
T: 01223 207770 E: paul.leahy@carechoices.co.uk CMM April 2015 37
38 CMM April 2015
Debbie Sorkin shows how social care providers can play a central role in implementing the Five Year Forward View, to improve people’s wellbeing and quality of life. When the NHS was founded in 1948, it confronted a very different set of priorities to those it currently faces. Average life expectancy was 66 for men and 71 for women, and the emphasis was on ‘care and repair’ and the treatment of infectious diseases. Today, thanks to medical and technological advances, and rising standards of living, the landscape has utterly changed. Average life expectancy has rocketed; infectious diseases like Tuberculosis are a relative rarity; and outcomes for heart conditions and cancers have improved out of all recognition. As Andrew Dilnot stated at the start of his 2012 review of the Funding of Care and Support, ‘It is a matter for celebration that people are living longer.’ However, these advances come at a price. People are living longer, but with long-
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The Five Year Forward View – it’s not just for the NHS CMM April 2015 39
INTEGRATED CARE COMMISSIONING HOME CARE RESIDENTIAL CARE CARE COMMISSIONING PUBLIC HEALTH TECHNOLOGY FIRST
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A lot is changing at Health+Care 2015 The largest national event for health and social care returns to Excel, London on 24-25 June 2015. Join us and enjoy a more personalised experience, new feature areas, more expert speakers, learning zones and a more streamlined programme tailored to your needs. The conference programme will ensure your business is provided with 25 streams that will give you everything you need to run an efficient and profitable business. Don’t miss out on sessions focused on new approaches to commissioning, early intervention, integrated care, the future of social care, health and wellbeing boards, plus so much more. Health+Care will feature the latest ministerial speakers post-election, so you can be the first to hear how the latest legislation will affect the care sector. Delegates will also get access to the largest sourcing floor in the UK plus a dedicated cost savings hub and telecare area showcasing cutting-edge developments to help you provide better care services. Step out of the artificial boundaries between the care sector and the rest health and social care departments at Health+Care.
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40 CMM April 2015
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THE FIVE YEAR FORWARD VIEW – IT’S NOT JUST FOR THE NHS
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term conditions, and this is putting pressure on health and social care systems. In the case of social care, these strains have been exacerbated by the serious cuts in local authority budgets in recent years – the Association of Directors of Adult Social Services estimates that over £3.5bn has been removed since 2010. The NHS estimates that it faces a potential funding gap of £30bn by 2020 if nothing is done to alleviate the situation.
FIVE YEAR FORWARD VIEW The NHS Five Year Forward View, produced in collaboration with Public Health England and other national health and care organisations, and published last October, is an attempt to bring the NHS face-to-face with these realities and to set out how, by integrating its services much more
and by placing more emphasis on prevention, it can continue to provide a universal health service. At the same time, it wants to improve the service that patients and service users experience. As the Five Year Forward View notes; ‘Even people with long-term conditions, who tend to be heavy users of the health service, are likely to spend less than 1% of their time in contact with health professionals.’ By definition, then, this means placing the emphasis much more on what happens during the other 99% of the time. And this means both better integration – between GPs and hospitals; between physical and mental health; and between health and social care – and social care playing a more central role in people’s health and wellbeing.
Although social care is actually not mentioned very much in the Five Year Forward View – I counted roughly a dozen mentions - and few examples are given, I would advocate that social care providers – whether in the private or in the not-for-profit sectors; whether in home care or residential care; and whatever their client group – see this as an open invitation to get involved, and take it.
GETTING INVOLVED There are a few ways to get involved. Firstly, by getting involved in the new models of care that the NHS is proposing. These care models are designed to follow a basic blueprint, and then to be adapted in different areas to put in place services that
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‘NHS England will be looking for these new places to start implementation this year. So there is every reason for social care providers to get involved, either in this initiative or in similar programmes (for example, via the Pioneers or the Better Care Fund).’
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THE FIVE YEAR FORWARD VIEW – IT’S NOT JUST FOR THE NHS
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are fit for the needs of local populations. They are explicitly designed to break down the barriers between social care and health, and between primary and secondary care. The first model is the ‘Multispecialty Community Provider’ (MCP). This allows groups of GPs to combine with other services, including mental health and social care, to create integrated out-of-hospital support. The second, related model, which takes things a stage further, is a vertically integrated hospital and primary care provider, or ‘Primary and Acute Care System’ (PACS), similar to the Accountable Care Organisations now being developed in the USA and in other European countries. These PACS will also be able to provide community services. Some GPs are already developing proposals to become Multispecialty Providers. For example, the Whitstable Medical Practice in Kent has plans to join up with two other practices in order to become a federation covering 53,000 patients, and to run services including a nursing home (which it would build) and an extra care facility for frail elderly local people. In Wessex, seven GP practices are teaming up with a small community hospital to set up an extended service for around 70,000 local residents, including mental health services for older people. In the North West, GPs in Rochdale and Bury are looking at the interface between primary and secondary care, particularly in relation to early discharge schemes to get people out of hospital sooner. Finally, in the West Midlands, NHS Dudley Clinical Commissioning Group is planning an MCP of integrated services across health and social care, serving 60,000 people, as part of a wider ‘network of care’.
NEW MODELS OF CARE If you provide mental health services, there are plans in the Five Year Forward View to organise the system better, including through more effective integration of crisis services and more appropriate use of community settings. For providers of residential care for older people, NHS England has pledged better support for people with dementia, alongside more work with social care to develop new shared models of support, to reduce hospital bed use and increase quality of life. The criteria for these models are set out in the box above.
CRITERIA FOR NEW SHARED MODELS OF CARE Enhanced services in care homes should demonstrate: • Strong and inventive partnerships, including with the community and voluntary sector. • A focus on residents’ capabilities (ie an asset-based model). • In-reach services provided in partnership. • Use of new technologies and telemedicine. • Innovative approaches to local assets, including intermediate and respite care beds. • Multiagency and multi-disciplinary teams. • Flexible workforce models. • Redesigned hospital discharge processes. • Training and support for staff and families around end-of-life care.
To support these new models of care, many places around the country, including the health and social care integration Pioneers, are introducing integrated workforce teams. In the London Borough of Islington, for example, there are joint community ageing and psychiatric liaison and assessment teams in place. Kent is aiming to deliver fully integrated health and social care teams and 24/7 community-based care during the course of this year. Birtley House in Surrey is piloting the Elizabeth Nurse accredited qualification for its care staff, to support staff to work in integrated settings. This trend will continue through the Five Year Forward View, with Health Education England charged with working with partners to commission and expand new health and care roles, in order to ensure a flexible workforce. We already have great examples of social care providers working in partnership with CCGs and acute NHS Trusts, whether it’s Nightingale residential care home in London being funded through its CCG to provide on-site medical care, thereby reducing hospital admissions; Marches Care and Coverage Care in Shropshire working with healthcare providers on shared assessments in order to facilitate timely hospital discharge; Community Integrated Care’s arrangements with Pennine Trust North Manchester to offer short-term intensive care and support to older people recuperating or recovering from illness or injury; or the Royal Masonic Benevolent Institution using telemedicine, especially video links, to connect
residents in care homes with consultants in hospitals. You may already have similar experiences in your own organisation, or want to explore what partnerships might be possible. Now is the time to do so. In January, NHS England received more than 260 applications from groups around the country hoping to be chosen as ‘Vanguard’ sites to implement new models of care, and the shortlisted places were announced at the beginning of March. NHS England will be looking for these new places to start implementation this year. So there is every reason for social care providers to get involved, either in this initiative or in similar programmes (for example, via the Pioneers or the Better Care Fund).
INVISIBLE RIVER If your local CCG or acute trust hasn’t yet been in contact with you, be proactive: get in touch with them and show them how you can help. And persevere. I sometimes describe social care as the ‘invisible river’ running underneath, and supporting, healthcare, and there’s something of this in the glimpses of social care in the Five Year Forward View. But it doesn’t have to be this way: actually, it can’t if we’re to have a care service that works in accordance with what people want and need. The Five Year Forward View is an open door, and social care should be storming through it with all the force it can muster. CMM
Debbie Sorkin is National Director of Systems Leadership at the Leadership Centre. Debbie.sorkin@localleadership.gov.uk Twitter: @DebbieSorkin2 42 CMM April 2015
CMM April 2015 43
CMM INSIGHT CONFERENCE AND EXHIBITION 2015 26th February, Manchester
Many of the leading care and support providers in the learning disability sector came together in Manchester to discuss current developments and future opportunities in this rapidly-changing sector. Organised by CMM, the event brought together delegates, speakers, sponsors and exhibitors from across the country to move forward the debate around learning disability services.
A DAY OF TWO HALVES It was a day of two halves with speakers sharing current developments and then moving on to explore the opportunities. The keynote speaker, Rosy Pope, Joint Lead of the Association of Directors of Adult Social Services’ Learning Disability Network explored the forthcoming Care
44 CMM April 2015
Act changes and implications for commissioning and providers. She explained how it’s ‘an Act of two halves but is here to stay’. She shared that relationships between commissioners, the regulator and providers are very important to make the best services for people but the ‘single biggest challenge’ will be the workforce. Deborah Westhead, Deputy Chief Inspector of Adult Social Care at the Care Quality Commission (CQC) was the next, eagerly-anticipated speaker. Deborah updated delegates on the CQC’s approach to regulating adult social care, ‘getting under the skin of services’. On the matter of regulating supported living, Deborah explained that the CQC is exploring approaches to regulation. She also encouraged providers to read the inspection reports of ‘Outstanding’ providers. Deborah was followed by Luke Joy-Smith,
Regional Managing Director – West at Dimensions, who put into context how policy and practice can transform the lives of individuals. Luke shared individual stories of people that Dimensions supports and how simple changes can make huge differences to lives, increasing independence and quality of life whilst reducing support needs. He gave good examples of how the right environment can instantly change someone’s life. After an interesting Q&A session which saw Deborah Westhead fielding the majority of the delegates’ questions, the presentations moved from policy to operational considerations. Amanda Nurse, Director of Carterwood delivered an interesting Property Mastermind which saw her answer questions on the market and share her expertise on the nature of the market and the
EVENT REVIEW
organisations that are flourishing. She explained how there is still a role for residential care in the sector but the most successful groups offer residential care and supported living as a care pathway. Roger Harcourt, Partner at Shakespeares followed with a thorough market analysis. He explored the economic and political climate in which providers operate, summarised the current market and then went on to explore where there are opportunities for providers. Opportunities that Roger highlighted included diversifying through care pathways or collaboration, expansion with the right funding, consolidation of this fragmented market, or exit. The afternoon session began with a series of workshops: exploring appropriate outcomes to measure quality of life, delivered by Simon
Papworth of Person-Centred Outcomes; Whistleblowing, presented by Liz Mulvaney of Freeths LLP and Managing risk and medicines adherence delivered by Sarah Beattie of Biodose. Delegates then reconvened for the final presentations of the afternoon. Robin Miller of Birmingham University shared his expertise in culture change. He told delegates, an organisation’s culture can be summarised as ‘the way we do things round here’. He shared practical examples of how culture can be changed in an organisation.
Neil Matthewman, Chief Executive of Community Integrated Care concluded the main stage presentations by drawing together practical and strategic approaches to transforming an organisation. Neil put into context many of the previous speakers’ points to show how they can make a different to people’s lives and an organisation. The day concluded with a live version of CMM’s Business Clinic. Overall feedback from the day was positive, with many delegates taking away actionable ideas to help improve their businesses.
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CMM April 2015 45
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Ablution Revolution? BESPOKE EDITORIAL, NEWS, OPINION AND BEST PRACTICE INFORMATION
LNT’S INSTITUTIONAL INVESTOR THE FUTURE OF FINANCE?
Business Clinic
LNT GROUP
The LNT Group, chaired by British entrepreneur Lawrence Tomlinson, includes a number of different, and far-reaching companies including the care sector focused Ideal Carehomes, LNT Construction and LNT Software, plus LNT Solutions and Ginetta Cars. Ideal Carehomes is a care home operator, offering high quality services for older people without any third party top ups. Its homes are mainly across the UK and are designed and developed to be future-proof. LNT Construction designs and builds care homes, not only for Ideal Carehomes but for third parties too including Anchor, Avery, Sanctuary and Nugent Care. Having built 52 care homes since 2009, with 36 being run by Ideal Carehomes, it offers providers turnkey solutions and is currently working on developments in the south and Home Counties. The third care-focused company in
the Group is LNT Software, an integral care sector software package.
REFINANCING
In April 2013, the Group finalised a £100 million refinancing, though the process was not straight forward. At the time, Lawrence Tomlinson was quoted as saying the deal had taken two to three years to come together, involved four different banks and had ‘issues’. He named Santander and Yorkshire and Clydesdale Banks in the process, plus it’s reported that RBS and Bank Leumi were also involved. Mr Tomlinson went on to say that the amount of paperwork involved was ‘phenomenal’ and that the whole process was ‘complicated’. He has, however, given very positive feedback about several of the banking partners involved in the 2013 refinance. He told CMM, ‘Whilst there were complexities in the 2013 refinance which were costly, and at times challenging, it met our finance needs for 2013 to 14. I found Santander and Yorkshire Bank particularly helpful throughout the past year, and Leumi continue to be a key partner in enabling our care home developments.’ After all this, the deal would have needed to have been renegotiated in September 2014. With renegotiation on the horizon, LNT Group has just announced a £51 million debt refinancing with L&G Capital. L&G Capital is a new business line created by Legal and General to provide five key functions: direct investments; implementing the investment strategy across the balance sheet; managing the Group’s Shareholder Funds investments and managing the Group’s debt and liquidity. One of the drivers behind
the business is the slowdown of bank lending which is leading to a shortage of investment capital. This has led the organisation to focus on replacing bank and Government capital with long-term institutional debt or equity funding, as it has done with LNT.
L&G DEAL
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Does a new 10-year deal between L&G Capital and LNT Group, owner of Ideal Carehomes, signal a change in care sector financing? The LNT Group’s Founding Chairman, Lawrence Tomlinson, has been a vocal advocate for the need for sensible financing in business since the credit crunch. As one of two Entrepreneurs in Residence at the Department for Business, Innovation and Skills, he published an independent report in November 2013 which looked into bank lending practices and how certain banks deal with businesses in distress. In April 2013, the Group had negotiated a £100 million refinancing of the business with a collective of banks. With that up for renewal in September 2014, the Group has announced a £51 million debt facility with L&G Capital. As the insurer looks to increase its involvement in the care sector, is this the future of financing?
The deal between LNT Group and L&G Capital, which was announced in mid- TARGET HEALTHCARE REIT May, is a £51 million debt facility, over On the same day as the L&G ten years, to LNT Group incorporating Capital announcement, Target all its subsidiaries. It is secured Healthcare REIT Ltd announced that against the Group’s portfolio of care it had acquired a portfolio of three homes and will give the company homes from Ideal Carehomes for the ability to move forward with approximately £13.9 million. These building a sustainable and growing have been leased back to the operator build pipeline of new care homes. for 35 years. The announcement Mr Tomlinson explained the drivers comes just a month after Target behind the deal with L&G Capital, ‘Our Healthcare REIT acquired two decision to take a debt facility from other Ideal Carehomes, the first for Legal and General was largely driven £3.8 million and another, due for by the offer of long-term finance and completion in summer 2014, for £5.1 their understanding of our business million. In 2013, Target Healthcare model which we believe paves the REIT also acquired homes from Ideal way for a fruitful partnership for the Carehomes in September for £4 future.’ million and £18 million for four homes Alex Gipson, Lending Manager at in March. CMM Legal and General, said, ‘Organisations OVER TO THE EXPERTS... that hold enduring business models and that, therefore, operate and Given the tough nature of the bank plan over medium- to long-term finance market, highlighted by the horizons are clearly better matched ‘issues’ faced by LNT in 2013, do to external capital that operates over these new financing options mark similar long-term durations. For this the future for care sector financing? reason, the financing needs of LNT’s Are more providers going to have to Ideal Carehome business provides a look farther afield than the traditional very natural fit with Legal & General’s banks to access finance? Will we long-dated pension and annuity see more organisations such as liabilities and we expect increasing L&G begin to meet the needs of the opportunities in sectors such as market, not necessarily being met the care home market, supporting by the traditional banks? Is this the organisations committed to delivery changing face of care sector finance? of long term solutions to meet What does our panel think? increasing demand.’
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It’s not L&G’s first investment in the care home sector. It acquired 13 care homes from MHA for just over £70 million in December 2013 and it forward funded and purchased five care homes in Suffolk with Care UK for £31 million. These were funded on behalf of Legal and General Property’s Managed Property Fund.
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Ablution Revolution?
Ablution Revolution? A Comprehensive Research Study into Wetroom Provision in UK Care Homes
Integration in practice
Ben Hartley analyses the provision of ensuites and wetrooms in UK care homes and draws some interesting conclusions.
Notes
It is said that, apart from death and taxes, the only certainty in life is change - a truism, for sure, but one that warrants some reflection when we consider how society thinks about the way we care for our older people, and particularly in relation to residential settings.
Maps
iTunes
Before launching into the research I’d like to draw comparisons with the hotel and guesthouse sector. It’s not that long ago that ensuite bathrooms in hotels and guesthouses were a dream for the future. Today, it’s as standard as the beds in the room. Residential care for older people though might not be keeping up with the ablution revolution, which was our starting point in deciding that there needed to be some in-depth work to establish the current position.
30 CMM February 2015
We embarked upon a thorough and extensive research project, carrying out a comprehensive survey over six months involving more than 6,000 telephone interviews. It reveals a very interesting picture. The research includes data from the whole of the UK and comprises information from private, not-for-profit, local authority and some NHS care homes.
Right to work
Where we were unable to contact a care home directly, we made a number of assumptions based on data from other sources including the A-Z Care Homes Guide and the Care Quality Commission. The principles of what we did and why are relatively easy to convey. The detail, however, is trickier and, unless you are a stats lover, a little less inspiring.
A view from the top
Definitions
Safari
For the purpose of this research, we describe an ensuite bedroom as one where there is at least a WC and wash hand basin. Such a room may also provide, though this is not a requirement for the purposes of our definition, a shower cubicle, bath or wetroom.
Weather
By contrast, our definition of a bedroom with an ensuite wetroom is one where there is a full wetroom, i.e. a walk-in shower complete with level access as well as the WC and wash hand basin. In effect, this is a subset of the ensuite bedroom provision – simply characterised by a higher level of facility.
Headline results We know that care homes aren’t keeping pace with the rate of change witnessed in hotel stock, however, although we knew that provision was more limited, the findings have shown an even bigger gap in provision than anticipated.
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Care Home Open Day: The Business Case for Engaging
Care Home Open Day is now in its third year but there is more to it than a lovely day for residents. Martin Green explores the business case for taking part in the event. The Care Home Open Day is now in its third year and we have received a really good groundswell of support from the care sector. The rationale behind the day, is to make sure that care services are seen to be at the centre of their local communities and discussions about the benefits of the day, have quite rightly, tended to focus on the benefits to residents, their families and staff. There is however, a clear business reason to engage in this initiative and I think there are some important benefits that can be seen in relation to the business case.
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CMM April 2015 47
CARE HOME OPEN DAY: THE BUSINESS CASE FOR ENGAGING
>
OPPORTUNITIES
One of the most important things about the open day is it gives you a really good opportunity to showcase your services and to identify the differentiators between your care and other competitors in the market. There is an opportunity for people in your locality to come to your services and to get to know what is available. This is particularly important in the care home sector, where our markets are traditionally local and the engagement with local people will ultimately translate into higher occupancy levels, as people begin to see what your services can deliver and they then identify how your services could support their relatives, or friends. There are also great publicity opportunities associated with Care Home Open Day. The event gives you a reason to invite key stakeholders into your service, and their attendance will also spark interest from the local media. As every care home operator knows, it is sometimes difficult and expensive to get exposure in your local press. The fact that it is a UK-wide event, which is receiving so much support from the top of Government, makes it instantly newsworthy and if you have a celebrity or dignitary attending your open day, this is a golden opportunity for the local press to feature your care services. There is no better advert for your care services than the people who currently live in them and their families. All too often, we struggle to find opportunities for residents and their relatives to give a view on the impact the care services have on their lives. The positive nature of Care Home Open Day enables you to begin a conversation with your service users and their families, and get their voices heard by the wider community. There is nothing that the media likes better than a human interest story and care homes are full of such stories and Care Home Open Day is a reason to champion them and get them to a wider audience. The local print media is a very good source of publicity, but we should not forget the important role the local radio plays in getting messages across to communities. It is my view that engaging with your local radio station could be another important way of raising your profile and getting your services better understood and used by local people.
ENGAGE WITH CQC The regulator has now started to differentiate services with their quality ratings, and one of the definers of excellence will be how much engagement there is between care services and the local community. Being involved in Care Home Open Day really shows commitment to community engagement and you can also use the day as an opportunity to talk to your residents and families and to get feedback on the current view of your services
and new ideas for improvement and development. Some businesses spend a lot of money trying to initiate responses from the general public and here is a way that you can do exactly that, but in a very cost-effective manner. The involvement of the Care Quality Commission (CQC) in the open day is also an opportunity for you to gain better understanding and stronger relationships with your regulatory body. Of course, the CQC will make judgements about your service, but the more that inspectors understand about the sector and what it achieves, the deeper their knowledge will be, and this can only translate into better quality relationships between provider and regulator.
RECRUITMENT AND RETENTION Recruitment and retention of staff is one of the major challenges for care providers and the open day can also give you an opportunity to encourage people who may be considering working in the sector to come into your services and find out more about what the job involves. Care homes need to have a local workforce because they require people to be available for different shifts and be flexible about how they work. Reducing travel times by developing a locally skilled and trained workforce, is one way in which care homes can achieve the goal of a more stable workforce. Also, the goodwill and enthusiasm for the open day can motivate existing staff, rejuvenating them with ideas and the opportunity to get involved in something different. The care home sector is little understood by the general public and this has led to quite a lot of negativity. I hope that in developing Care Home Open Day, we have given care providers an opportunity to be proactive and to face the public on the front foot, extolling the virtues of our services, the commitment of our staff, and the outcomes to our residents and their families. The contribution care makes is vital to the individuals who receive it, but it is also vital to the UK economy, both because care is a large employer, which enables people to have resources and to spend money in their local communities, and because we contribute to the reduction in stress and absenteeism of relatives. Families and friends are able to be much more productive when they know that the people they love are being cared for and supported.
MORE THAN JUST AN OPEN DAY The Care Home Open Day is so much more than just opening care homes to the public, in doing so, it is also a mechanism to redefine peoples’ views of the care sector, and to enable people to understand that we are part of a vital and much-needed public resource. CMM
Professor Martin Green OBE is Chief Executive of Care England. www.nationalcarehomeopenday.org.uk 48 CMM April 2015
WHAT’S ON? Event: Care Show Bournemouth Date/Location: 25th/26th March, Bournemouth Contact: The Care Show, Web: www.careshow.co.uk/bournemouth
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Event: Improving Dementia Care Date/Location: 26th March, London Contact: Capita Conferences, Tel: 0870 400 1020 Event:
The Gold Standards Framework Centre ‘Celebrating Best Practice’ Conference and Awards Ceremony Date/Location: 27th March, London Contact: Gold Standards Framework Central Team, Tel: 01743 291892 Event: Care and Support West Spring Conference Date/Location: 30th April, Bristol Contact: Care and Support West, www.careandsupportwest.co.uk Event: NICE Annual Conference Date/Location: 12th/13th May, Birmingham Contact: NICE, Tel: 0845 056 8339 Event: All Together Now! Breaking the Boundaries of Care Date/Location: 29th May, London Contact: Care England and Royal College of Nursing, Tel: 0207 492 4840
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Health+Care 2015 Event: Date/Location: 24th/25th June, London CloserStill Media, Tel: 0207 348 5261 Contact:
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Derbyshire and Nottinghamshire Regional Care Conference 2015 15th July, Nottingham Care Choices, Tel: 01223 207770
Event: Date/Location: Contact:
Lancashire Regional Care Conference 2015 23rd September, Clayton Le Moors Care Choices, Tel: 01223 207770
Event: Date/Location: Contact:
Berkshire Regional Care Conference 2015 15th October, Reading Care Choices, Tel: 01223 207770
Event: Date/Location: Contact:
3rd Sector Care Awards 9th December, London Care Choices, Tel: 01223 207770
Please mention CMM when booking your place. CMM April 2015 49
GEORGE MCNAMARA • HEAD OF POLICY AND PUBLIC AFFAIRS • ALZHEIMER’S SOCIETY
in 2012, sets out an ambition to make England: • the best in the world for dementia care and support, and for people with dementia, their carers and families to live; and • the best place in the world to undertake research into dementia and other neurodegenerative diseases.
George McNamara asks whether the Prime Minister’s new Challenge on Dementia 2020 will go far enough.
Where next for dementia? There is no doubt that the profile of dementia has reached unprecedented heights - but what difference has this made? And more importantly, are people with dementia now able to access the tailored care and support they need and expect? The publication of the Prime Minister’s Challenge on Dementia 2020 outlines a blueprint for the next phase of this country’s effort to combat dementia and improve the lives of people with the condition. Its publication sends a clear signal that while good progress has been made, there is still a lot more to do. The report, which rightly builds on the first Dementia Challenge published
These are certainly bold and commendable ambitions and the report goes a long way in laying out how this can be achieved. Rightly, the 2020 document focuses on the importance of diagnosis and postdiagnosis support. The success of many Clinical Commissioning Groups towards increasing diagnosis rates in their area has to be applauded and maintaining this focus going forward will be crucial. Alongside this, we need to ensure adequate post-diagnosis support is available. Alzheimer’s Society has long campaigned for this commitment to providing meaningful care to all, postdiagnosis. The report doesn’t go as far as we’d like in ensuring everyone has access to a Dementia Adviser or equivalent (a named contact trained to provide expert information, advice and support), but in saying that there should be a minimum provision of care, provides a real opportunity for all of us to contribute to what this means in practice. We should see an end to situations where people are left to fend for themselves during one of the toughest moments of their lives. Awareness and tackling stigma is another priority area. Alzheimer’s Society also announced that it has created one million dementia friends - people with an improved understanding of the condition who have committed to a social action. This initiative, borne from the experiences of people with dementia who all too frequently lose friends and experience loneliness, really is transforming the way the nation thinks,
Do you agree with George? Join the debate at www.caremanagementmatters.co.uk 50 CMM April 2015
talks and acts about the condition. As we bypass the one million mark it becomes the biggest ever social movement for any disease. We have now committed to creating a further three million dementia friends by 2020. Research too is an important area of focus. This strong commitment to support medical research, including a new international dementia research institute and global fund dedicated to dementia, will help to put us in the best possible position to identify treatments that can stop the progression of dementia by 2025. One key area that was mentioned, but will urgently need to be addressed in the implementation is the importance of accessible social are. At the moment, our chronically underfunded social care system means that people with dementia are struggling to cope with no support from care services; being admitted to hospital unnecessarily and moving into care homes too early when family carers buckle under the massive strain of caring alone. The report, published in the heat of election campaigning, must soon be followed with an implementation plan and additional resources if it has any chance of becoming a reality. Without this, it will be a well-meaning document that gathers dust as opposed to driving change. We need to see a sensible funding settlement for social care within the Spending Review. We will be holding the Government to account on this. The importance of this document, and crucially how it is implemented, cannot be underestimated. If our health and social care settings are not delivering dementia friendly care and support, then we will be significantly failing to address one of the major challenges we face with an ageing population. We should not forget: if we get it right for dementia, it is often right for those living with other long-term conditions. CMM
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Believe in better *Pricing shown is ex VAT, for the Sky in-room package. Customers will be billed monthly and installation costs apply. **Over 65s Sky TV viewing statistics based on Sky IQ data, April 2014. ^Sky Box only free where Sky installs your equipment. Charge of £50 per box (plus VAT) if Sky does not install your equipment. Installation of equipment is not included, please call for more information. Free box offers not available if you have previously had such offers. 12 month minimum term for Sky TV and WiFi. Both in room and lounge packages available. Channels available dependant on chosen package and scheduling may be subject to change. Some content/channels unavailable in communal areas. As at the date of print, channels not available in communal areas are: Alibi, G.O.L.D., Watch, Star Gold, Star Life OK and Star Plus. #WiFi availability subject to location. WiFi pricing subject to survey. Set up fee applies. †Free £500 voucher for Oomph! is available as part of the Sky Lounge package. Further terms apply. See voucher for details. Calls cost 5.1p per minute (plus 15.97p connection fee) for BT customers. Calls from other providers may vary. Correct at the time of supply 10 March 2015. The Grand Budapest Hotel © 2014 TGBH LLC, Twentieth Century Fox Film Corporation and TSG Entertainment Finance LLC. All rights reserved. Artwork © 2014 Twentieth Century Fox Film Corporation. All rights reserved.
Care Management Matters 210mm x 254mm_100315.indd 1
10/03/2015 14:40
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