Care Management Matters May 2015

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MAY 2015 £4.00


Recent history and future plans

Winning strategies

Successful business approaches


The benefits of physical activity

Business Clinic

Dimensions’ housing brokerage in Essex

Resource Finder

Property professionals

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In this issue From the Editor


Is it just me…? 07 Robert Chamberlain considers the need for the general public to understand how social care is funded. CMM News


Business Clinic Dimensions’ new housing brokerage service with Essex County Council.



A View from the Top 33 Dr Alison Rose-Quirie, Chief Executive Officer of Swanton Care & Community. Resource Finder CMM profiles specialist property professionals.


Event review CMM summarises the Surrey and Sussex Social Care Showcase 2015 and The Care Show Bournemouth.


What’s On?


Straight Talk Simon Duffy discusses the recent Citizen Jury and the rights of people with learning disabilities to be true citizens.








Politics and social care Richard Humphries summarises the treatment of social care under the Coalition Government and examines the different political parties’ plans for the sector.


Winning strategies for a successful business Many successful operators have common approaches to the way they operate. Greg Palfrey explores these winning strategies.


Deprivation of Liberty Safeguards – an update The current situation with Deprivation of Liberty Safeguards and how to make an application are explained by Helen Freely.


Physical activity and dementia Sylvie Silver shares her experience of the benefits of physical activity for people with dementia and the organisations that support them.

CMM May 2015 3

EDITORIAL Editor in Chief: Robert Chamberlain Editor: Emma Morriss News Editor: Des Kelly Assistant Editor: Emma Cooper


PRODUCTION Lead Designer: Holly Cornell Director of Creative Operations: Lisa Werthmann Assistant Production Manager: Jamie Harvey Creative Artworker: Gemma Barker

ADVERTISING 01223 207770 Advertising Manager: Daniel Carpenter Director of Sales: David Werthmann National Sales Manager: Paul Leahy

Richard Humphries Assistant Director – Policy, The King’s Fund

Jeremy Porteus Secretariat, ADASS Housing Policy Network / Director, Housing LIN

Kathy Roberts Chief Executive, Mental Health Providers Forum

Sam Bennett Director, Think Local Act Personal

Greg Palfrey Partner, Smith & Williamson

Dr Alison RoseQuirie Chief Executive Officer, Swanton Care & Community

Helen Freely Partner – Private Client Department, Druces LLP

Sylvie Silver Director, National Activity Providers Association

SUBSCRIPTIONS Non-care and support providers may be required to pay £50 per year. 01223 207770 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: 978-1-910362-42-6 CCL REF NO: CMM 12.3

CMM magazine is officially part of the membership entitlement of:

ABC certified (Jan 2013-Dec 2013) Total average net circulation per issue 15,991

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Dr Simon Duffy Director, The Centre for Welfare Reform

From the Editor Editor, Emma Morriss considers the General Election 2015 and what this means for social care. Politics is one of those subjects that divides people. It creates debate and raises passions. However, we can’t get away from it with the General Election 2015 happening whilst this issue of CMM is in circulation. As I write this all Government agencies are in ‘purdah’, the pre-election period when civil servants have specific restrictions on their activity. It can make it difficult to get comment when you’re trying to put together a magazine but it hasn’t affected our ability to bring you the news and best practice you expect from CMM. Given the current political situation, a reader wanted to know how the sector has fared under the Coalition Government and what the parties are proposing post-election. Richard Humphries of the King’s Fund has summarised the Coalition Government’s performance for social care. You can read what he has to say on page 20 along with details of what some of the main political parties

propose for the future of the sector, should they be elected.

RISEN THROUGH THE RANKS Social care has certainly risen through the ranks under the last Government. Having sat in the shadows for so long, it was welcoming to see a change in attitude and the sector debated and discussed. The launch of the Dilnot Commission in July 2010 was a couple of months after the Coalition Government was formed. With its detailed review of the funding system for care and support it felt like there were some real opportunities to move the sector forward. When these were actually incorporated into the Care Bill it crystallised the Government’s commitment to reforming social care. We all watched the Care Bill as it worked its way through

Parliament to receive Royal Assent last year, with the first phase of implementation this year. However there’s still so much to do. Bringing together so many pieces of legislation under one Act is fantastic but it doesn’t solve the pressures facing the sector. It doesn’t address the chronic underfunding of local authorities and the impact on fees. It doesn’t resolve the ongoing issues providers face when trying to support people with higher needs on less money. Also, with part two of the Care Act, the implementation of the funding reforms, not due until April 2016,

the sector isn’t yet able to relax.

WHAT WILL THE FUTURE BRING? Now with a General Election looming and the potential for a change of Government, what will that mean? Will we see social care funding receiving parity with the NHS? Will we see the sector receive the respect it deserves from the media? Will politicians see the impact that good, well-funded, personalised social care services can have on the NHS, on the wellbeing of the population and the wider economy? Only time will tell.

Email: Twitter: @CMM_Magazine Web:

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Is it just me...?

only marginally improve on the current system of funding. The care fees ‘cap’ of £72,000 is certainly misleading. It is only the part of the care fee equivalent to what the council would pay,that counts towards the ‘meter’. Does this mean individuals should deny themselves care until they reach the national eligibility criteria so that they can then purchase care at the same rate as the council, until the cap is reached? Also, the alternatives to traditional care services that are being championed, which are (arguably) lower cost, are not developing swiftly enough to keep pace with growing demand.

Editor in Chief, Robert Chamberlain considers the social care funding crisis set to continue after the General Election.

I’ve deliberately avoided discussing the General Election in my column this month as this is already being covered in depth in this edition of CMM. Still on a political theme, I would like to comment on the ongoing situation with social care funding – regardless of whoever is in post after the General Election. I was prompted to cover this topic following the recent Daily Mail headline, Loving daughter faces having to sell her family home to fund her mother’s care bills after landmark court ruling which could affect thousands of families. The news story covered the Court of Appeal ruling that theatre director, Glen Walford, will have to sell her mother’s house to pay for care fees. The case was of particular interest as Ms Walford resides in the house and has invested £40,000 of her own money on improving the property.

CULTURE OF EXPECTATION While I can empathise with Ms

Walford’s situation I can’t help but feel that there is a prevalent culture of expectation amongst the general public, regarding social care costs, that needs addressing. Social care, unlike heath care, is not provided for by the State unless an individual’s assets fall beneath the current threshold of £23,250. Our ageing population needs to plan for these costs in the same way that retirement funds are considered. The Government’s actions to get private pensions in place for individuals was on the back of a strong message not to rely on State pensions in later years. A similar message regarding care fees planning is needed to challenge public perceptions on State reliance. Unfortunately the respective political parties are instead using the issue as a ‘political football’, which I feel compounds the problem.

THE REALITY Let’s face some facts. There is currently too little money in the

system to fund (at a market rate) the social care of those who qualify for financial assistance. Constrained budgets have led to local authorities raising care needs eligibility criteria, inappropriately short homecare visits and also impacted on the quality of care provided due to underfunded placements. The care sector relies heavily on staff willing to work for a minimum wage

MANAGING EXPECTATIONS Isn’t it about time that the general public were told how it is going to be, in terms of social care funding? There is too little Government money being made available now, or in the foreseeable future, to adequately address the care fees crisis, except for the poorest in society. Even for those that qualify for financial assistance, the rate

‘Isn’t it about time that the general public were told how it is going to be, in terms of social care funding?’ and operating costs are growing at a higher rate than council fee increases. The funding reforms due in 2016 are widely considered to be of far less benefit to care seekers than as presented. With the exception of increasing the threshold for State assistance to £118,000, analysis has shown that the reforms will

at which this care is funded could result in minimal care packages and the requirement of third party top-ups. It’s best not to rely on the State for your social care needs and to start planning for the potential future costs in the same way as one would a pension. But when will this filter through to the general public?

Do you agree with Robert? Join the debate on the CMM website CMM May 2015 7

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APPOINTMENTS CASTLEOAK Castleoak has appointed Roger Davies, former Chief Executive of Methodist Homes, to the new part-time position of Assisted Living Director.

Learn from good and outstanding care says CQC Good and outstanding care has a focus on the individual, has clear and visible leadership and has processes and staff that constantly explore ways to improve. This is what the Care Quality Commission (CQC) has found from its revamped inspections so far, which are providing a clear picture of the quality and safety of care in England. The regulator is calling for providers of these services to learn from what they are doing well so that everyone can get the safe, high-quality and compassionate care that they deserve. Last year, the CQC formally rolled out its new way of inspecting health and adult social care across the country, which assesses whether services are safe, caring, effective, responsive to people’s needs, and well-led.

Most inspections then lead to the CQC awarding ratings of ‘Outstanding’, ‘Good’, ‘Requires Improvement’ or ‘Inadequate’. The CQC has rated over 1,650 providers and services as either ‘Good’ or ‘Outstanding’ – that’s over 75% of its ratings of NHS trusts, primary medical services and adult social care services rated to date. Based on a sample of these, the CQC has found three emerging themes that good and outstanding services share. 1. They provide care that is personcentred – designed around the individual and with their involvement. 2. They have a clear ‘line-of-sight’ from senior leadership to the frontline staff and services. 3. They check how well they are doing and seek ways to improve.

NHS funded nursing care The NHS contribution towards the costs of a place in a care home with nursing has increased by 1% for 2015 to 2016. Since 1st April 2015, the rates for eligible care home residents assessed to require the help of a registered nurse are: • Standard rate will be increased to £112.00 per week. • Higher rate will be increased to £154.14 per week.

CQC fees rise Following a public consultation last year and approval from the Secretary of State for Health, the Care Quality Commission has revised the inspection fees that providers will have to pay from April. The increase for 2015/16 is 9%.

Comprehensive workforce survey Skills for Care has published its State of the Adult Social Care Sector and Workforce in England report – the most comprehensive yet. The report uses data from the National Minimum Data Set for Social Care (NMDS-SC) to explore characteristics of the adult social care sector, including the size and structure of the sector and workforce, demographic information, recruitment and retention issues, pay rates, and qualifications and training information. It also includes recent research that has been conducted, the economic contribution of the sector and a review of how policy

changes may affect it. Due to advances in participation and coverage rates of the sector in the NMDS-SC, Skills for Care is able to use this data and provide estimates of the whole of the adult social care sector. Increased volumes and improved quality of data held by the NMDS-SC means these estimates are the most detailed and reliable to date. The main findings include: • There are an estimated 17,300 organisations involved in the delivery and organisation of adult social care – these organisations are made up of approximately 39,000

establishments. • Overall Skills for Care estimates there to be 1.52m jobs involved in the adult social care sector being carried out by 1.45m workers. • The overall turnover rate of the adult social care workforce was 25.4% (equating to around 300,000 workers leaving their role each year). • Over 80% of the adult social care workforce is female and a fifth are aged 55 or over. • The mean hourly pay rate of a care worker was £7.32, just over £1 more than the National Minimum Wage.

BARCHESTER Barchester Healthcare has appointed John Coleman as its new Chairman, replacing Baroness Ford of Cunningham.

BRUNELCARE Paula Kennedy has been announced as Brunelcare’s new Chief Executive to take over from Helen Joy who is retiring in June.

BARCHESTER Barchester Healthcare has appointed Caroline Baker as Director of Dementia Services. Caroline was formerly Director of Dementia Care at Four Seasons Healthcare.

CARE ENGLAND Care England has appointed two honorary nursing advisors – Professor Trish MorrisThompson, Director of Quality and Clinical Governance at Barchester Healthcare and independent consultant Deborah Sturdy – as part of its strategy to tackle the shortage of nurses in the sector.

ALTERNATIVE FUTURES GROUP Karen Wilson has been appointed as Managing Director at Alternative Futures Group.

OSJCT The Orders of St John Care Trust (OSJCT) has announced that Lt-General Louis Lillywhite, CB, MBE, OStJ, MFOM, FRCP(Glas), FRCGP, has agreed to become its new Patron.

CMM May 2015 9


New NICE quality standards

CQC guidance published

Two new quality standards on The quality standard also says that managing medicines in care homes residents who wish to self-administer and preventing falls will help to their own medicines should be improve the quality of care. supported to do so as long as it does The new quality standard, not put them or others at risk. Managing medicines in care homes The second quality standard Falls from the National Institute for in older people, for assessing older Health and Care Excellence (NICE), people after a fall and preventing lists actions that should be taken to further falls, aims to support ensure that all necessary health and hospitals and community services social care practitioners are aware of to help improve the quality of life of residents’ needs and can administer older people and reduce the number the right medicines to the right person of fall-related injuries occurring in at the right time. This includes: people aged 65 and older. • Health or social care providers The standard advises that sending a discharge summary, older people who are living in the community and have a known with details of the person’s current medicines, with a person who history of recurrent falls are referred for strength and balance transfers to or from a care home. • Prescribers who are responsible training. It also says that healthcare professionals should carry out a for people who live in care risk assessment for any pensioner homes providing comprehensive who visits hospital because of a fall. instructions for using and Those who need to stay in hospital monitoring all newly prescribed medicines. should be offered a ‘home hazard assessment’ and any necessary help • A multidisciplinary team to prevent further 12:13:32 incidences before undertaking reviews Caremedication Management Matters Adfor - Feb 2015.pdf 1 04/02/2015 they leave. people who live in care homes.

Following the recent consultation CQC has published its final guidance for providers on meeting the new requirement to display CQC ratings. CQC has also published the final and complete guidance on regulations (the fundamental standards). If you have been awarded a rating from the CQC, you must display it in each and every premises where a regulated activity is being delivered, in your main place of business, and on your website(s), where people will be sure to see it. This is a legal requirement from 1st April 2015. Your ratings must be displayed at the premises where your service is being provided unless you are

delivering care to someone in their own home. The CQC will assess whether or not your ratings are displayed legibly and conspicuously when they inspect. Posters for physical display of your rating are available to download from the CQC’s website. You have a maximum of 21 calendar days to display your ratings from the date your inspection report is published on the CQC website. The CQC will carry out a review of the impact of the posters and online display and make iterative improvements based on feedback from the public, providers and other stakeholders.

Recruitment of nurses A report on the recent symposium on the recruitment and retention of nurses in adult social care is now available with an overview of the feedback provided and commentary on the likely next steps. The

Department of Health will shortly be establishing a social care nursing taskforce with the intention to prioritise the recommendations and prepare an implementation plan by July.

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New Care Certificate materials Materials to support employers in preparing for the Care Certificate, including revised standards and guidance, self-assessment and frequently asked questions are now available from Skills for Care.

The materials are intended as a first step for employers, to prepare for the Care Certificate – to help employers become familiar with the fifteen new Standards and how to assess members of staff completing

Commissioner-provider relationships improved Commissioner-provider relationships improved by Finding Common Purpose. Finding Common Purpose is a joint initiative between the Care Provider Alliance and the Association of Directors of Adult Social Services. It is tasked with providing practical solutions to the barriers in strategic commissioning. The Finding Common Purpose steering group has drafted a Pledge to Work Together. The Pledge is intended as a protocol to cover commissioning, procurement and

safeguarding processes in social services. Leadership in strategic commissioning needs to come from the Association of Directors of Adult Social Services and NHS England, as well as local clinical commissioning groups (CCGs). It should also be based on the results of joint strategic needs assessments, market position statements and, crucially, the full participation of both the local care providers and the people using the services.

POLL the Care Certificate. A free training workbook has also been released. The Care Certificate replaces both the Common Induction Standards and the National Minimum Training Standards.

Care Act resources from SCIE The Care Act 2014 came into force on 1st April and the Social Care Institute for Excellence (SCIE) has produced a wide range of resources to help those people working hard to implement the changes, which include new statutory duties. SCIE has held a series of learning events and has produced guides, films and other resources on issues such as assessment, advocacy and safeguarding.

Are you involved in working towards integration? Yes No You can vote via:

April’s results Do you feel confident about your business in 2015? YES 67% NO 33% 0








Source: Figures correct at time of print.


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In focus Distinctive, Valued, Personal Why Social Care Matters: the next five years WHAT’S THE STORY?

The Association of Directors of Adult Social Services (ADASS) published this discussion paper on the eve of the Coalition Government’s last Budget. It is a document with two titles (above) reflecting two crucial messages about the value of social care and the bleak funding outlook over the next five years – the duration of the next parliament.


A recent YouGov poll indicated that one in three people either receive, or are in touch with, social care. It is, therefore, as important as the NHS. People are living longer. Care and health services need to be more joined-up. But social care has been under-funded for many years. The ADASS report quotes a funding gap of £4.3bn by 2020.


The ADASS discussion paper outlines the developmental steps needed to be taken immediately after the General Election in order to ensure a safe, secure and personalised care and health system for older and disabled people. ‘Adult social care is at a crossroads. As a country we need to be ambitious for care and recognise that protecting the NHS means protecting adult social care, too,’ said David Pearson, President of ADASS. ‘There are choices. And there are consequences of those choices. There is a danger that in some parts of the country sustaining social care services as we have known them will become almost impossible.’ 12 CMM May 2015


ADASS recommends that we must ensure that newly-designed social and health care services concentrate on: 1. Providing good information and advice to enable us to look after ourselves and each other, and to get the right help at the right time as our needs change. 2. Recognising that we are all interdependent and need to build supportive relationships and resilient communities. 3. Developing services that help us get back on track after illness and help disabled people to be independent. 4. Addressing our mental, physical and other forms of wellbeing. Services should be much better joined-up around our individual needs and those of our carers. Personal budgets are central to this approach.


ADASS say that we can achieve these aims by introducing a single shared outcome framework for healthcare, public health and social care; funding the gap facing social care by 2020 alongside that facing the NHS and using the next spending review to work towards a single funding settlement for social care and the NHS; addressing immediate pressures and the double-running costs of developing alternatives through a transformation fund in which investment is conditional on reform.

ADASS welcomes Care Act but adds realism Directors of adult social services have celebrated the coming into force of the Care Act 2014 as marking probably the most significant development in services for older and disabled people since the implementation of the Beveridge Report in 1948. According to the Association of Directors of Adult Social Services’ President, David Pearson ‘…it is nothing less than tremendous that progress on a number of fronts has led to older people living longer and living better. Inevitably, legislation had to change in order to reflect these momentous times. Think Tanks and other agencies began focusing our minds on the strategic shift from welfare services to services organised around wellbeing and personalisation, and began to make

serious improvement in our wider understanding of good practice. The Care Act at last promises to bring social services and social care firmly into the twenty-first century. It is a modern Act for a modern service.’ He went on to detail the new responsibilities and approaches for social care services including general responsibilities for wellbeing and prevention; provisions for assessment; carers; safeguarding; new requirements for information and advice and a new basis for the relationship with care providers to developing a sustainable, diverse and improving social care market with providers. In a year’s time the same legislation will introduce new thresholds and payment caps for people receiving social care services at home or in care homes.

Government clarifies Care Act questions The Government has clarified certain matters related to the statutory guidance for the Care Act. Amongst other elements, it covers people’s transition to the new framework under the Care Act. It explains that those people currently receiving councilarranged care in England will continue to receive such support and services under the old law until the local authority completes a review of that person’s case, at

which point the new law will apply in respect of that person. However, it is expected that everyone should have a review prior to 1st April 2016. If not, the guidance says that the Care Act will apply as of this date and anyone who has not been reviewed will be treated as having their eligible needs met under the Care Act until the local authority completes a review and reaches a decision in accordance with the Care Act.

TLAP launches Quality Initiatives Map Think Local, Act Personal (TLAP) has launched a Quality Initiatives Map which covers the organisations responsible for quality as well as key initiatives and tools. The tools and initiatives contained in the map are not intended to be

exhaustive due to the evolving quality landscape and the volume of available resources. They have been selected because providers need to know about them or TLAP partners have found them helpful to support personalisation.

CMM May 2015 13


Adult autism strategy statutory guidance

Buckinghamshire’s £40m reprovisioning

The Government has published new Adult Autism Strategy statutory guidance for NHS organisations and local authorities. The statutory guidance updates original guidance issued under the Autism Act 2009 and the subsequent Adult Autism Strategy. It accounts for progress and updates to the Strategy made since 2010, and recent legislation like the

Castleoak has completed a £40m care home reprovisioning programme for Housing Solutions, working in partnership with The Fremantle Trust and Buckinghamshire County Council. The programme, known as Project Care, was launched to improve the quality of accommodation

Care Act 2014 and the Children and Families Act 2014. The Adult Autism Strategy statutory guidance sets out requirements for local authorities and NHS organisations – reminding them to work together and with partners, for example, in the criminal justice system or helping people with autism into employment.

Fortis Living extra care delivered ahead of schedule Castleoak, the specialist construction and development partner for care and retirement living, has handed over a £7m extra care development of 57 apartments in Worcester to Fortis Living four weeks ahead of the construction

programme. Meadow Court offers one- and two-bedroom apartments to rent or purchase through shared ownership. Meadow Court is supported by the Homes and Communities Agency (HCA).

Shape of caring The Shape of Caring review, has been published by Health Education England (HEE). It aims to ensure that, throughout their careers, nurses and care assistants receive consistent, high-quality education and training which will support high-quality care over the next 15 years. Bringing together findings and expertise from recent major reports, the review intends to promote good practice from across the country and

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for older people and people with learning disabilities across Buckinghamshire. This included the reprovision of seven old care homes and the addition of a further care home. Castleoak designed and built 600 new bed spaces in eight care homes, each ranging from 60 to 90 beds.

provoke wide debate on a number of high profile issues relating to the education and training of care assistants and nurses. The review has been led by an independent Chair, Lord Willis of Knaresborough and overseen by a sponsoring board. The Chair has been assisted by, and received expert advice from, the HEE Nursing and Midwifery Advisory Group and HEE Patient’s Advisory Forum.


More supported housing needed More supported housing is needed for people with mental health conditions to help prevent relapses and returning to hospital, according to Professor Sir Simon Wessely, President of the Royal College of Psychiatrists and Dr Sri Kalidindi, Chair of the Faculty of Social and Rehabilitation Psychiatry. Specialist supported housing for those with mental health conditions includes nursing and residential care

homes, group homes, hostels, blocks of individual or shared tenancies with staff on site and independent tenancies with outreach support from staff. Professor Wessely stated, ‘There are huge benefits to mental health, social inclusion and reduced usage of health, social and criminal justice services from having stable accommodation. ‘With a local supported

accommodation pathway in place, two thirds of people with very complex mental health needs can be successfully discharged from inpatient rehabilitation units without readmission or placement breakdown. Over five years, two thirds move on to more independent accommodation and one in ten achieve completely independent accommodation.’

Octopus Healthcare On behalf of Octopus Healthcare, JLL’s Healthcare team has successfully completed the acquisition of a 90-bed care home in Stoke Mandeville, Buckinghamshire and agreed a forward commitment of a 60-bed care home in Diss, Norfolk. The acquisition of the two assets out of the CarePlaces Fund, a specialist healthcare property fund managed by Bridges Ventures in partnership with care home

developer Castleoak, was secured for a total consideration of £20.5 million. Opened in March 2014, Fremantle Court in Stoke Mandeville is a care facility let to Freemantle Trust. Upon practical completion in August 2015, De Lucy House in Diss will be let to Greensleeves Homes Trust. The properties will be let on 35-year leases, with annual RPI increases. JLL’s Healthcare team has also secured an investment grade tenant

and sourced funding from Octopus Healthcare for a proposed new 75bed care facility in Ferndown, Dorset. Care UK will occupy the property, which will form part of a larger high end residential development scheme currently under construction by Pennyfarthing Homes, from post completion in mid-2016 for a term of 35 years. The investor will benefit from annual fixed uplifts linked to RPI.

CQC publishes more inspection reports The Care Quality Commission (CQC) has published more inspection reports for different regions. These follow inspections under the CQC’s new programme. It published 35 reports on the quality of care provided by adult social care services across the South of England. 14 services were rated as ‘Good’, 17 as ‘Requires Improvement’ and four as ‘Inadequate’. In the North it published 41 reports. 20 services were rated as ‘Good’, 12 as ‘Requires Improvement’ and nine as ‘Inadequate’. In London, 16 providers have been rated ‘Good’, 12 as ‘Requires Improvement’ and two have been rated ‘Inadequate’. Finally, across the Central region, the CQC has rated 18 of these care homes and home care agencies as ‘Good’, 12 as ‘Requires Improvement’ and two have been rated ‘Inadequate’.

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CMM May 2015 15


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This year’s regional events focusing on the future of care and commissioning Derbyshire & Nottinghamshire Care Conference The Nottingham Belfry, 15th July 2015

Lancashire Care Conference Mercure Blackburn Dunkenhalgh, 23rd September 2015

Berkshire Care Conference The Hilton Reading, 15th October 2015

Book your place



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Commission on urgent care for older people

Esther Rantzen confirmed for 3rd Sector Care Awards

An independent commission to drive improvements in urgent and emergency care for older people in and outside of hospitals has been established by the NHS Confederation. The Commission on Improving Urgent Care for Older People is a joint initiative of the Confederation’s three forums, the Community Health Services Forum, the Hospitals Forum and the Urgent and Emergency Care Forum. It aims to find workable and patient-centred solutions to address the challenges of caring for this group.

Dame Esther Rantzen will return as the host of the 3rd Sector Care Awards 2015. Following the success of the inaugural 3rd Sector Care Awards, Dame Esther has confirmed that once again she will host this fantastic event celebrating the best of the not-for-profit care and support sector. The 3rd Sector Care Awards were launched in 2014 to celebrate and showcase the innovation and care excellence of the not-forprofit care and support sector. The Awards aim to reward examples of outstanding achievement and

It will bring together leaders from hospitals, community services and local government, specialist clinicians, older people’s advocates and commissioners. It will be chaired by former trust chief executive, Dr Mark Newbold. The Commission will hold evidence sessions, consider best practice examples and produce interim findings before publishing final recommendations by the end of the year. Workshops will also take place to help providers and commissioners implement the Commission’s findings.

AXA Real Estate acquisition On behalf of AXA Real Estate, Knight Frank specialist property team have acquired freehold interest of Manor Lodge care home, Chelmsford, from Aprirose REI for £17.6m at a yield

of 4.75%. The 112-room care home building is let to Care UK Community Partnerships Limited (guaranteed by Care UK Ltd) at £890,788 per annum on a term of 25 years.

Porthaven in Chipping Norton Porthaven Care Homes has commenced construction of a new care home in Chipping Norton. The 58-bed home will be built to Porthaven’s award-winning specification, and will provide 24hour residential and nursing care for the elderly, including residents living with Alzheimer’s and other forms of dementia. John Storey, Chief Executive and

Founder of Porthaven commented, ‘We are very excited about this new home which will open in Spring 2016. Not only will we be providing a much needed service for the people of Chipping Norton and the surrounding Cotswolds, but the home will also directly employ over 70 local people as well as, we anticipate, become a valuable part of the local community.’

Construction starts in Somerset Notaro Care Homes is set to start construction of its 12th care home on a five acre site in Bridgwater, Somerset. The much anticipated care home was given planning approval by Sedgemoor District Council over a year ago to help facilitate the growing need for more beds in the region for those living with nursing dementia needs.

The home will be built by locally based Midas Construction, a familiar name to Notaro Care Homes. Midas has previously been involved in two other projects for Notaro Care Homes and is familiar with the company’s high standards and attention to detail. Nunzio Notaro, Managing Director said that the home will be opening its doors in October 2016.

performance in this dynamic sector and are supported by: National Care Forum, Voluntary Organisations Disability Group, Mental Health Providers Forum, and Housing and Support Alliance. The Awards are open to any UK business operating in the not-forprofit care and support sector. The judging process includes ‘Experts by Experience’ and impartial judges from across the sector. Nominations for 2015, including some new categories, will open shortly and more information is available at

Cambian Group acquires By the Bridge The Cambian Group has acquired By the Bridge, an independent fostering provider who deliver therapeutic fostering for children with high severity need in the South of England, the Midlands, Yorkshire and the North West. The acquisition will enable Cambian to align its current

fostering services with its specialist residential care offerings. Cambian will take ownership of over 20 fostering framework contracts across more than 120 local authorities that will support Cambian providing a continuum of care alongside their other specialist children’s services.

Care homes unable to meet Stroke needs Stroke survivors entering care homes are missing out on crucial rehabilitation and being ‘written off’, the Stroke Association and Chartered Society of Physiotherapy (CSP) have warned. A survey for the two organisations found that three in five care homes are not following National Institute for Health and Care Excellence (NICE) guidelines that the needs of a stroke survivor must be assessed by a specialist within 72 hours of admission. Around 8,000 people are discharged from hospital to a care home after a stroke every year. Without specialist assessments

many of them will not get access to the therapies they need. A report from the Centre for Policy on Ageing says that stroke is the second most common neurological condition among residents, after dementia. The survey found that four out of five care home representatives agreed that services like physiotherapy improve stroke survivors’ ability to regain and maintain a good quality of life. However, the CSP and Stroke Association say even a short delay in therapy can quickly reverse the improvements made whilst in hospital and functions deteriorate. CMM May 2015 17


Richmond Villages in Derbyshire

Manorcourt Homecare opens new service

Bouygues UK’s Midlands regional business, Thomas Vale, has been awarded a contract to deliver a brand new £30 million retirement village in South Derbyshire, on behalf of Richmond Care Villages, part of Bupa. Due to open in 2016, Richmond Aston-on-Trent is situated in Astonon-Trent in South Derbyshire. The

Manorcourt Homecare, the homecare services division of Healthcare Homes, has announced the opening of a brand new homecare branch located in Baystrait House in Biggleswade, Bedfordshire. As part of its launch,

village will provide three forms of accommodation. Large one and two-bedroom Village apartments offering an independent lifestyle; Village suites which come with a ‘hotel style’ package to help with the daily chores; and 24-hour nursing and dementia care within the care home.

Carterwood assists Signature Surrey Heath Borough Council has granted full planning approval for the demolition of the existing Pembroke House office building in Camberley and the construction of a 92-bed care home, which will comprise private apartments that vary from studios to onebedroom suites. The scheme will incorporate 20 specialist

dementia suites. Carterwood was asked by Signature Senior Lifestyle to prepare a needs assessment in support of the planning application. Construction is due to commence in the first quarter of 2016 and it is anticipated that the care home will open its doors to residents during winter 2016.

LNT Carehome Developments LNT Group has today announced the launch of its new brand, LNT Carehome Developments. Bringing together its offering to the care home market under one brand identity, LNT Carehome Developments consolidates the success of LNT’s Turn of Key and Turn of Key Plus products.

Having secured a £30m committed facility from Omni Capital, the new finance is enabling LNT Carehome Developments to ramp up activity. They are actively looking for sites across the UK with the intention to be building on up to 20 sites per year.

the branch is also introducing a brand new bespoke care service called My Way, which is a private-pay initiative that enables individuals to choose the level of care they want to receive in their own homes.

New vision for Suffolk NorthStar, in conjunction with the Castlemeadow Group, have been selected as the preferred care provider and developer of a cutting edge elderly health care vision in Suffolk. Working in partnership as the lead consultants with Halesworth Health and various voluntary and sporting groups, NorthStar will

design and project manage the replacement of existing elderly healthcare provision to develop a rejuvenated care complex which will provide a sheltered housing scheme of 64 extra care apartments offering dementia care services, intermediate care, carer support initiatives, and an advice centre for people with life-limiting conditions.

Porthaven loan facility Porthaven Care Homes has entered into a new five year £100m senior debt facility with HSBC to refinance six operational homes and develop up to nine further new homes. HSBC previously financed the construction of Thirlestaine Park Care Home in Cheltenham for Porthaven which opened in 2014, and is funding existing developments at Chalfont St Peter, Marlborough and Chipping Norton.

John Storey, Chief Executive and Founder of Porthaven commented, ‘It is a testament to the efforts and achievements of the team at Porthaven that HSBC has recognised, and is supporting, the growth of Porthaven.’ ‘Securing such a facility in what still remains a challenging debt environment is something we are proud of, and we look forward to developing our relationship with HSBC even further.’

Sevacare acquires Basing Care Sevacare, one of the UK’s leading providers of home care, has announced the acquisition of Basing Care. The acquisition of Basing Care complements Sevacare’s continued expansion in the South of England. Following successful contract wins in Southampton and Portsmouth, Basing Care, which is based in Basingstoke, Hampshire, will link Sevacare’s London and 18 CMM May 2015

South Coast operations as well as maximise on the work currently being delivered in Hampshire. This acquisition increases Sevacare’s experience of providing high-quality care for people who want to be cared for at home. Basing Care, with 65 employees, delivers services across Basingstoke to around 135 people funded privately or by the local authority or NHS. Darren Stapelberg, Sevacare’s

Chief Operating Officer, said, ‘Fundamentally, the acquisition provides Sevacare with an excellent geographical fit and a platform to provide services to private funded clients and build on the existing contract Sevacare has with Hampshire County Council. ‘We look forward to welcoming the Basing Care employees into the group as we continue to build the range of broader health and social care services for our clients.’

Ravi Bains, Chief Executive Officer, added, ‘This is our first acquisition for more than two years and will be the first of many we are hoping to do in the next few months. We’re grateful for the ongoing support from HSBC. ‘This acquisition complements our organic growth which has always been our strategy, however greater focus will also be given to acquiring high quality businesses such as this.’

CMM May 2015 19


With an imminent General Election, how has social care fared under the Coalition Government and what do the different parties propose for the future of the sector?


Richard Humphries, Assistant Director, Policy – The King’s Fund responds.

Social care wasn’t a big issue in the 2010 election campaign; cross-party talks about how to pay for it ended in an acrimonious political row about the Conservative’s ‘death tax’ poster. But the sense that something had to be done about social care returned after the election with some specific pledges in the Coalition’s programme of Government. The centrepiece was a commitment to establish an independent commission to consider how to pay for care. Nearly five years on, how has social care fared? Arguably, the Coalition has made more progress in five years than the previous Government did in 13. The independent commission, chaired by Andrew Dilnot, reported within a year. To the surprise of many, his central recommendations were not only accepted but also embodied in legislation that will be implemented from April 2016. To make any headway at all on an issue that has eluded all previous attempts at reform – and in the toughest fiscal climate in living memory – is a big achievement. It establishes a symbolic milestone in social care policy – that the State places a limit on how much the individual should pay for care and extends to care and support needs, the protection from catastrophic costs that we have always enjoyed for health care needs. The Coalition should receive credit too for the most comprehensive and ambitious overhaul of social care legislation since 1948. The way that the Government has engaged with the sector and its stakeholders to ensure the passage of the new Care Act is a model of good practice in policy development that contrasts sharply with the experience of the Health and Social Care Act. To consign the 1948 National Assistance Act to the history books is an achievement of which any modern Government could be proud. 20 CMM May 2015

UNDERMINED BY SPENDING CUTS However, the Coalition has undermined much of the good it has done by deciding in the 2010 Spending Review to protect NHS spending from real-terms cuts but leave social care exposed to the impact of a 40 per cent real-terms fall in financial support to local government. The transfer of some NHS funds has helped a bit, but not enough to prevent a 17 per cent fall in spending on social care for older people (see figure 1 overleaf). The sharpest service reductions have been in communitybased services, like home care, that are vital to supporting people at home and avoiding admissions to hospital and long-term care. Since 2009, 25 per cent fewer people are getting publicly-funded social care. Cuts on this scale to most other public services would elicit political and public outrage. It seems ironic that, although the Government has given priority to protecting universal benefits for older people (such as winter fuel allowances) irrespective of need or wealth, it is older people who arguably are least well-served by the sharp deterioration in access to essential care and support. Public spending on older people is not coherent. As the financial ratchet on local government tightens, doubts grow that the Care Act will be adequately funded. The funding reforms will be complex to administer and hard for people to understand. In the absence of accompanying action to address the underlying funding position, relatively few people will benefit from the changes. As the gap between demography and resources continues to widen – to an estimated £4.3bn by 2020 – the National Audit Office is right to warn that no-one knows how much longer services can carry on absorbing these pressures. In the meantime, the deepening fault-line between universal NHS care that is free at the point of need and social care that is rationed to people with the highest needs and lowest means is not sustainable. That is why we, at the King’s Fund, endorse the recommendations of the Commission on the Future of Health and Social Care in England for a new settlement in which there is a single ring-fenced budget for social care as well as health.

THE ELECTION AND PARTY POLICIES As the election draws closer, the NHS may attract the loudest political noise but recent pressures in emergency care have highlighted the crucial inter-dependency of social care and the NHS. The coalition has done well to pass the Care Act, but bigger change is now needed. In an ageing society social care has become too important to play second fiddle to the NHS. As the election is very near, the main political parties have announced policies relating to health and social care. Although specific manifestos haven’t been published at the time of writing, a brief roundup of the main parties’ policies is below.

CONSERVATIVE PARTY POLICIES • Continue to ring-fence the NHS budget, with a real-terms increase in health spending from 2015 to 2020. • All patients to have access to comprehensive care, including to a GP from 8am to 8pm, seven days a week by 2020.


CMM May 2015 21



• A ‘truly seven-day’ NHS including expansion of hospital services at weekends. • Committed to implementing the NHS Five Year Forward View ‘in full’. • 5,000 more GPs to be trained by 2020. • Spend an extra £1.25bn on mental health services in England over five years, to treat more than 100,000 young people by 2020. • Cap redundancy payments to NHS and other public sector staff at £95,000, except for those earning less than £27,000 a year.

Figure 1: Growth in population and changes in spending on adult social care, 1997/98 to 2012/13

LABOUR PARTY POLICIES • A national health and care service based on ‘whole person care’ which brings together physical health, mental health and social care, with health and wellbeing boards overseeing commissioning and Monitor given a new role to drive integrated care. • Repeal key aspects of the Health Social Care Act and make the NHS the preferred provider of services, with a statutory exemption for the NHS from EU procurement and competition law. • A cap on profits made by private companies providing NHS services in England. • Introduce an annual £2.5bn Time to Care fund to pay for 20,000 nurses, 8,000 GPs, 5,000 care workers and 3,000 midwives. • Guaranteed appointments with a GP within 48 hours and a maximum one-week wait for cancer tests and results. • Set maximum limits on levels of fat, salt and sugar in food marketed to children.

LIBERAL DEMOCRAT PARTY POLICIES • Increase NHS spending by £8bn a year by 2020/21, in three stages. • A Manifesto for the mind promise to spend £3.5bn more on mental health care in England over the next parliament. This represents an additional £2.25bn on top of the £1.25bn pledged over five years in the 2015 Budget to improve access to talking therapies and reduce waiting times. • Promote integrated care by pooling health and social care budgets and giving a stronger role to health and wellbeing boards. • NHS mergers no longer to come under the jurisdiction of the Competition and Markets Authority and commissioners not to have to put all services out to tender. • Introduce an annual £250 bonus for carers looking after someone for at least 35 hours a week over a 12-month period.

UKIP POLICIES • Increase frontline NHS spending by £3bn a year, with social care funding for older people increased by £1bn a year. • Make NHS-approved private medical insurance compulsory for all visitors to the UK and for migrants who have been resident Richard Humphries is Assistant Director, Policy at the King’s Fund. 22 CMM May 2015

for fewer than five years. • Replace Monitor and the Care Quality Commission with ‘county health boards’ made up of locally-elected health professionals. • Introduce a statutory ‘licence to manage’ for NHS managers, overseen by a professional regulator on the same footing as the General Medical Council. • End hospital car parking charges in England.

GREEN PARTY POLICIES • Repeal the Health and Social Care Act and ensure ‘a public NHS’. • Introduce an ‘NHS tax’ to increase funding to the approximate EU average, abolish prescription and other user charges, and expand free NHS dentistry. • Abolish foundation hospital status, reducing the amount of income that these trusts can earn from treating private patients. • All promotion of tobacco and alcohol products, including sponsorship, to be banned. • Introduce free social care for all people over 65 years of age.

NATIONAL HEALTH ACTION PARTY POLICIES • Introduce an NHS Reinstatement Bill to abolish competition in the NHS, end the purchaser-provider split and restore the Health Secretary’s duties to provide universal and comprehensive health care in England. • Guarantee a minimum four per cent annual rise in NHS spending, increasing it to at least 10 per cent of GDP, with the money to pay for this coming from general taxation, including a 1p rise in income tax until cost savings could be realised elsewhere. • Abolish prescription charges for NHS services. • Impose a moratorium on accident and emergency and hospital closures and reconfigurations where these do not have the support of the local population and affected staff. For more information on the King’s Fund’s General Election 2015 CMM content, visit

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HOUSING INNOVATION IN ESSEX Housing and support provider Dimensions has entered into an innovative housing agreement with Essex County Council to help more vulnerable people to find suitable housing, to address issues with the county’s housing market and support people in the most appropriate way whilst also saving money. Dimensions is a specialist provider of a wide range of services for people with learning disabilities and autism. As a not-for-profit organisation it supports around 3,500 people and their families throughout England and Wales. The organisation enables people to be part of their community and make their own choices and decisions about their lives. It has recently entered into an exclusive contract with Essex County Council (ECC) to provide housing brokerage to people with a wide range of needs. The process started in 2011 when the council decided to pilot a Housing Brokerage Service to test out a new way of supporting people with learning disabilities to access a range of housing options and increase the number of people moving onto independent living. The aim was to identify different housing options, have someone dedicated to sourcing the available options for individuals based on their needs and preferences and then support individuals to see plans through to reality. ECC, sponsored by the National Development Team for Inclusion (NDTi) and the Department of Health, set out to pilot the Housing Brokerage Service in 2011. This was to address significant issues the county had in identifying and securing suitable properties for people with disabilities – the county has a deficit of social rented housing along with a very competitive private rental market. It was felt that the best approach to supporting people with disabilities to find suitable housing would be through using specialist brokers (rather than social workers) who understood how local authority housing worked and who could also develop relationships with estate 24 CMM May 2015

agents and private landlords. It was at this stage that discussions started with Dimensions. They hadn’t undertaken housing brokerage, however they were wellversed in personalised approaches to housing and services for people with learning disabilities. Dimensions already operated in Essex but did not hold significant amounts of housing stock so there were no conflicts in the working partnership.

MAKING IT WORK There were many aspects to consider in making the brokerage work, including the organisation of housing and support delivery in the county. The pilot stage helped to identify and solve issues as they arose. Social care support is arranged by ECC, however housing responsibility lies with the district and borough councils. This means that there are different departments, teams and budgets to consider when supporting people to move. There needs to be a high level of communication and efficiency to ensure all aspects come together to meet an individual’s needs within the timescales required by landlords – housing vacancies can move very quickly. The service acts as an intermediary, offering a named person who supports individuals, landlords, social workers and commissioners through the entire process. The housing brokers identify requirements, find suitable properties and bring all parties together offering expert guidance and reassurance at every stage, including ongoing support. Although the brokers work to a contract, they are independent of the council, meaning that they

are not bound by local authority rules and regulations. They have flexibility in the way they operate, so they can bring together private landlords, social landlords, housing associations, the county and borough councils and estate agents. The brokers work to ensure they are the first point of contact for any opportunities to ensure there is a steady stream of housing available for people when they may need it. The brokers give landlords and estate agents advice and guidance on letting to people with disabilities including resolving any issues or concerns around tenants with housing benefit. They also support the individuals by helping them to complete the necessary paperwork or ensuring that their support is set up for when they move in. When the pilot was evaluated, the report by the NDTi stated that there was an ‘impressive’ range of housing options made available to people looking for housing. These include shared supported living, private rented, local authority, shared ownership, choice based lettings, management transfers, extra care and shared lives.

REAL SAVINGS In its first year, the service paid for itself seven times over before considering ongoing lifetime cost savings. For example, one young couple, who formed a relationship while in residential care costing £4,000 per week, wanted to move in together. The broker identified a private landlord, negotiated the rent to an affordable level, worked with the social worker to identify a support provider and liaised with all of them to support a successful

move. The saving to ECC is over £150,000 per year. ‘Part of the problem is that whilst ECC has the duty of care, it is the twelve borough councils in Essex that have the duty of housing,’ explained Sanna Westwood, the former commissioner who launched the pilot, ‘and although the young couple’s housing costs were significant, from the borough council’s perspective they were suitably housed. By introducing a range of housing options our housing brokers are basically the oil that makes the system work more efficiently.’ Once the pilot was evaluated it could be seen that the new approach offered great financial and social outcomes. This led to the mental health and substance misuse teams in the county deciding to pilot similar services. ECC then contracted with Dimensions to take on all three services from April 2015, offering a single brokerage service to support vulnerable people to build their independence and live in their own homes. Dimensions feels that it could easily be replicated in other areas and for other vulnerable groups with housing needs. It just needs local authorities to fund a post that isn’t traditionally funded by social care, however Dimensions believe the results speak for themselves. CMM

OVER TO THE EXPERTS... As personalisation is integral to care and support services, is it logical to personalise housing too? Is this individualised approach replicable? Will other local authorities follow suit? What opportunities does it offer traditional providers? How will it shape the market?

PROVIDES AN ADDED DIMENSION TO HOUSING CHOICES Why personalise care if we don’t also personalise housing? Everyone’s housing choices are constrained by personal circumstances; age, financial and physical factors, geography, family circumstances and availability of affordable housing choices. Even with these constraints, they should not stop us exercising choice in where and how we live and with whom. A fundamental component of the Care Act is the ‘suitability of accommodation’ in meeting people’s at-home care and support needs. This article gives an excellent overview of the innovative new housing brokerage service. It demonstrates that access to such a service provides an added dimension to the way information and advice is delivered, and offers people more voice and greater housing choices. There are a number of ingredients that need to be in place to make housing choice tangible


and deliverable. These include individuals being supported by family, Mental Capacity Act and Court of Protection activity; timely social care or other input as people transition from thinking about moving to actually moving; understanding what can be afforded and then having affordable housing available at the right time; support agencies, social care and local housing authorities understanding the available housing and how to access it; everything to make the move; and ensuring that the property is part of a person constructing a meaningful life and relationships, rather than an end in itself. All these ingredients flow from effective commissioning practice, focused on outcomes with people at the heart whilst ensuring that decisions are based on good information. As such, this new service has real potential.

Jeremy Porteus Secretariat, ADASS Housing Policy Network, Director, Housing LIN

THIS IS A GREAT EXAMPLE Personalisation should mean a system that is flexible and responsive to people’s whole life needs, which enables people to make choices and take control and which works to enhance wellbeing as well as physical health. Housing services can play a vital role in this, providing and maintaining secure accommodation for people of all ages to live full and active lives. But while personalisation is well-established in social care and gathering momentum in health, housing has less often been the focus of innovation in this area. This is set to change. The Care Act embeds many of the principles of personalisation in statute and is explicit about the importance of suitable accommodation in meeting people’s needs and promoting wellbeing. Delivering on this ambition will take a coordinated approach to shape future housing services and different thinking about how people can be empowered to make choices about the housing

and support that is right for them. Dimensions and Essex’s work is a great example of this. Identifying housing to meet the needs and preferences of people with disabilities can be challenging, but the service shows that by combining expertise of working with people with disabilities alongside the ability to build relationships and navigate the system from outside statutory services, much can be achieved to build the right support. TLAP is working with housing partners to develop and share our understanding of how personalisation fits with housing and support, in particular how we make Individual Service Funds work in this context. This is another innovation that Dimensions (and other providers) know plenty about and whose time has come with the prominence it is given in the statutory guidance for the Act.

Housing is a fundamental need for all. Access to secure and appropriate housing contributes significantly to health and wellbeing. The fabric of a building, alongside personalised care and support, is essential for better, recovery-focused pathways. Suitable housing can prevent inappropriate placements and admissions. Within self-directed services, choice, control, ownership and accountability are central; they are tailored to the individual and housing should be too. The voluntary sector has a role in providing brokerage services and facilitating the relationships required to secure individualised housing. Brokerage across a range of services is being explored elsewhere and providers, on the whole, are welcoming it as long as processes are transparent and meet individuals’ needs. Delegating brokerage can enhance the function of local authorities and offer more bespoke choices and long-term sustainability. This, alongside the financial case

made in Essex, should encourage local authorities to consider how to support people to access suitable housing. There can, however, be barriers. Understanding personalisation depends on individuals, and requires willingness from local authorities to learn and change. There are issues around choice, social rented housing and the private rental market. Effective communication is key, plus time to build relationships. Partnerships may initially work best where the brokering organisation has a strong relationship with the local authority. Brokerage offers innovative partnership working between housing and related services. It offers a valuable, informed level of support to self-directed services, facilitating integrated services and identification of the best solution. It also ensures that needs are discussed earlier and aid a cohesive, comprehensive recovery pathway.

Kathy Roberts Chief Executive, Mental Health Providers Forum

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As with the UK health care industry generally, care home provision is experiencing significant difficulties. Growing regulatory requirements, rising payroll costs, public funding restrictions, expectation of improved physical facilities and increasing establishment costs are all causing a gloomy view of the care home arena. However, for care home providers it is not all bad news. With the UK population aged over 65 set to increase by 15% over the next seven years according to the Office of National Statistics, the already significant demand for care homes will continue to grow. There has been, and continues to be, consolidation within the sector and there is an improving appetite from funders, such as banks and equity houses, for the right



for a successful business

In a tough market there are always likely to be winners and losers. Running a successful and profitable business involves having clear strategies. Successful operators have common approaches and behaviours to the way they operate which Greg Palfrey explores. CMM May 2015 27



business model. Although many operators and investors only want to acquire modern, purpose-built homes there is still a future for the more traditional, smaller care homes. The key question many providers face is how to deliver a profitable business model that can satisfy the demand, balancing affordable fee levels with appropriate cost control.

operation of the business. Successful operators have a practical and targeted staff development programme. Although this may cost more in the short-term (both financially and in terms of time) it delivers substantial long-term financial benefits coupled with an increasingly motivated, efficient and technically astute workforce.


Retain a balanced client mix

Many successful operators share the following common attributes.

A key issue for all operators is understanding the optimum mix of self-funded versus local authority-funded residents. A nationwide care home business needs to consider what services to provide as well as the geographical location of its operations, as local authority weekly fees vary considerably across the country. A successful care home operator assesses and continually monitors the volume of potential residents able to fully self-fund. The higher volume of wealthier individuals able to self-fund in the South East means that many leading operators are beginning to only invest there. Given the constraints on the level of local authority fees, care homes routinely need to be cross-subsidised by charging self-funders more.

Consistently achieve good or outstanding Care Quality Commission (CQC) reports This is achieved by implementing and regularly reviewing operational controls for personal care, medicines, hygiene etc. It may be beneficial to seek the opinion of a specialist regulatory adviser to not only keep you apprised of changing regulations but also to act as a devil’s advocate. As a minimum, non-compliance with regulations will result in additional staff time/ resource being required to instigate corrective action. Further, as CQC reports are public, adverse reports may cause families to look elsewhere when placing relatives, or local authorities to cease placing new residents with the business. Continued failure to address concerns raised by CQC (in either a ‘requires improvement’ or ‘inadequate’ inspection rating) may result in an embargo being placed on the business preventing it from taking new residents or ultimately, an order for the closure of the care home. Develop and retain staff Wage costs can often constitute circa 50% to 60% of care home revenue. Rising payroll costs have had a significant impact in recent years with increases in the National Minimum Wage, pension auto-enrolment, additional staff training and increasing use of agency staff having caused a dramatic rise in overall expenditure. High staff turnover is not only expensive, due to related agency and training costs, but also disruptive and therefore, detrimental to the 28 CMM May 2015

A living and relevant business plan Successful operators have a clear business plan both for the short-term (often 12 months) and longer-term (three to five years). This will be a formalised plan which is regularly reviewed (by owners and management), questioned and amended in the context of changing market conditions and trends. There should be no ‘sacred cows’ but rigorous questioning of the business model as to whether it is still relevant, with changes being made based upon a realistic and objective strengths, weaknesses, opportunities and threats (SWOT) analysis. When drafting a business plan, key questions to consider include: • What are my unique selling points (USPs)? • Who are my key competitors? • What does the care sector look like now? • How is it likely to change? • Is my management and staffing structure appropriate to my current and future needs? • Should my operation be solely elderly


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30 CMM May 2015



care or specific to physical disability or dementia services? • What services can my business provide from its existing property? • Based on my existing care home operation would it be feasible to develop a domiciliary care operation? • Does the business need to make property changes or invest in new equipment? • Should I be considering an acquisition, merger or sale? • What funding options are available? Strong financial control Successful operators monitor financial key performance indicators (KPIs) on a regular basis to enable timely action to be taken to identify and rectify problems or to maximise returns where improved results are highlighted. KPIs will often include occupancy rates, fee rates, debt ageing and collection, income and costs compared with revenue and cost forecasts, as well as margins by separate business streams. Good business practice that is carried out formally and consistently by successful providers would include preparing and monitoring: • A rolling 12-week cash flow forecast. • An annual forecast consisting of monthly linked profit and loss account, cash flow and balance sheet forecasts, together with a written summary of the key assumptions upon which they are based. • Monthly management accounts comparing actual monthly and cumulative results with the forecast, explaining material variances. • Action plans to address material adverse variances or to maximise the benefits that can be achieved from, say, positive sales or margin variances. Names and timescales should be allocated to each action and monitored to ensure achievement. Review purchasing strategies To have a good handle on the business’ performance, successful providers regularly and vigorously review purchasing strategies

for material costs, such as energy, food and transport to ensure cost efficiency. For example, when examining energy costs reviews they would not only look at the use of purchasing groups and longer-term supply agreements, but also energy saving measures such as insulation and any available grants. Similarly, reviews of food costs encompass looking at the quality and prices from a range of suppliers together with seeking to reduce waste. Actively manage the relationship with their funder The provision of reliable financial and management information gives current or potential funders confidence. A successful operator’s forecasting system enables them to predict funding shortfalls in advance and approach their funder not only with the problem but also a suggested solution. Similarly, well thought-out, forward-planned capital expenditure and payback analyses are more likely to receive full consideration from funders. Funders do not like surprises. Early identification of issues provides both the business and the funders with greater options and is likely to result in a better solution for all concerned.

STRATEGIES TO SUCCESS Whilst care businesses increasingly appear within our financial warning criteria, there is still a very successful care sector operating across the country. Success in the care sector can typically be achieved by implementing the strategies and disciplines as summarised above. There is a multitude of issues that care home operators must deal with on a daily basis. This often makes it difficult to take the necessary time out to review their business model afresh and implement appropriate changes. However, taking the time and even having external sources to assist with this is a key strategy to success. ‘It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.’ CMM

Greg Palfrey is Partner at Smith & Williamson CMM May 2015 31

CARE COMMISSIONING Facebook: Health+Care
















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The official Health+Care 2015 programme is now live! Senior social care and public sector professionals are invited to the third annual Health+Care conference on the 24-25 June 2015 at Excel London, where they can utilise the expert led 25 stream programme. Hear from our faculty of unparalleled speakers, presenting important sessions and case-studies on: improving the quality of social care through regulation, working across health and social care to safeguard children, the importance of early intervention, The Care Act a new deal for social workers in adult social care - plus so much more. View the full programme online:

Register for your complimentary tickets at

Don't miss out on 25 streams of world-class content designed to support you tackle the increasing financial pressures your organisation faces, whilst providing you with the unique opportunity to start creating key partnerships with your peers, commissioners, care providers, clinicians and public health leaders.

2015 Speakers Include:

Organised By:

Lyn Romeo Chief Social Worker for Adults, Department for Health

32 CMM May 2015

Des Kelly OBE,

Dr Jeremy Cox

Executive Director, National Care Forum

Named GP for Safeguarding Children in Hertfordshire

Mark Lobban

Alison O’Sullivan

Director of Strategic Commissioning, Director of Children’s Services Kirklees Council and ADCS Families and Social Care, Kent president-elect County Council










INFLUENCES alternative. The Manchester devolution of REFLECTIONS ON THE LAST DECADE One of my earliest influences was the late healthcare spending is exciting and I hope I haven’t worked in social care for the Googie Withers, who played a strong but demonstrates the benefits of integration. whole of the last decade, having come kind-hearted prison governor in Within Swanton has an exciting future having from mental health and before that These Walls. The mixture of compassion criminal justice, yes I was a prison governor. separated from Barchester Healthcare. and professionalism in a challenging Barchester focused on elderly care so, During my time at Swanton, Care UK and role stuck with me and was a genuine understandably, Swanton didn’t get the Priory, I’ve seen increasing cost pressures; inspiration in my early career choice. focus it needed or achieve its potential. devaluation of the sector amongst some Now fully independent, we can focus more sections of the media and politicians, LESSONS on supporting people with severe learning evidenced by downward fee rate pressure; You need to know your services and the disabilities, autism, mental and physical and a drive to create bespoke services. people within them. Every week I visit sites disabilities, and very complex behaviours. Devaluing the sector makes recruiting and speak to service users, family and staff. The sector has previously assumed it is incredibly difficult. Cuts mean staff are paid It’s vital that I’m approachable and available providing homes for life and that people far less than they should be. The media is so I can find out about and respond to with this level of complexity aren’t capable constantly critical – it isn’t conducive to of progressing to greater independence. Our challenges and learn about innovative ideas attracting the best people. that can be rolled out. It’s about ensuring role is to support people to form dreams My own career has been through a everyone feels valued for their contribution and aspirations, to be as independent as significant transition too. Ten years ago I to supporting people to progress. This must possible. This has to be the future. was a managing director in the criminal include service users and families. justice sector. This, together with years of INSIGHT operational responsibility for prisons and ADVICE We want to provide consistently highimmigration removal centres, gave real One of the most important pieces of advice insight into how those with mental illnesses quality care. Not all services are where they have need to be but we are working tirelessly are treated within the prison system. It led !evil won si emmargorp 5102 eraIC +hreceived tlaeH islathat icifas foyou ehmove T up the hierarchy you need to ‘do less’ and ‘think to address this. I am confident that we me to want to join an organisation where eraC+htlaeH launna driht eht ot detivni era slanoisseforp rotces cilbup dna erac laicos roineS I could make a real, positive difference. I 5can 2 deachieve l trepxe eour ht esvision. ilitu nacWe yehtare erefocused hw ,nodnoL lecxE tamore’; 5102 enthis uJ 5isn’t 2-42 easy eht noas ecI’m nerean fnooperator c .emgreater margorpfocus maertson the at heart. A much worked for two mental health providers and on increasing independence and helping business’ strategic direction is needed, individuals and their families to recognise learned so much about the sector and its dna snoisses tnatropmi gnitneserp ,srekaeps delellarapnu fo ytlucaf ruo morf raeH their financing. The funding relationship is vastly htlaehand ssorcachieve a gnikrow ,noipotential. taluger hguNot orhtjust erac laicos fo ytilrather auq ehthan t gnivogetting rpmi :nocaught seiduts-up esain c operational different to the prison sector; for one thing, I - tmeeting cA eraC eimmediate hT ,noitnevreneeds, tni ylraebut fo eplanning cnatropmi eht ,nedetail. rdlihc dYou raugneed efas oa t egood rac laiteam cos dnto a allow you lluf eht weiV .people erom hcto umdevelop os sulp - the erac laicos tlud a nifreedom. srekrow laI’ve icosbeen rof laefortunate d wen a enough this and supporting never had to worry about occupancy! ku.oc.eracsulphtlaeh.www :enilno emmargorp to build a very experienced new senior right level of independence for them. We’re share remodelling PROJECTIONS FOR THE NEXT DECADE elkcat uour oy ttraining roppus otto deensure ngised tnpeople etnoc ssalc-dlmanagement row fo smaerts 5team 2 no tuwho o ssim t'noDmy passion t htiw uoy and gnidicompetence vorp tslihw ,secto af ndo oitathis, sinagitro ruand oy seare russup erp to laicthe nanchallenge if gnisaercnito ehmake t our haveehthe skills With regards to the future, integration ,srenoissimmoc ,sreep ruoy htiw spihsrentrap yek gnitaerc trats ot ytinutroppo euqinu vision a reality. CMM is an exciting journey. is key – it’s non-negotiable, there’s no .sredael htlaeh cilbup dna snaicinilc ,sredivorp erac





S Rose-Quirie is Chief Dr Alison Executive Officer of Swanton Care & Community.









An extended version of this interview can be found at

:edulcnI srekaepS 5102 CMM May 2015 33

For Sale

On behalf of A Berry and D Butters of Deloitte LLP, Court Appointed Receivers of: The Pines Nursing Home, Appleby in Westmorland, Cumbria CA16 6HN • Located in a popular Cumbrian market town. • Nursing home registered for 27. • 25 single bedrooms, 1 shared bedroom, all en-suite. • All bedrooms are located within high quality purpose-built, single-storey extensions.

• Average fee of £607.23 per week (March 2015). • Significant business growth potential. • Sale includes two self-contained purpose-built apartments. • Further development potential on large site

Offers Invited For further information please contact: Cirion Plant MRICS 0161 956 4493 Bela Chauhan 0121 609 8316

34 CMM May 2015 08449 02 03 04

As the market is picking up and confidence is growing in the sector, you may be thinking about the future. If you’re looking to grow, or even exit, the skills of a specialist property professional can make all the difference. Whether you’re looking for a new site or wanting to know the best location for fee rates and self-funding clients, a specialist property professional can help. With many years’ experience, a true understanding of the market, a network of prospective buyers or sellers and the ability to be discreet in the process, the specialist property professionals here have a wealth of experience to meet your specific business needs.

Resource Finder:

Property professionals

Dobson Grey Tel: 01789 298006 Email: Website:

Burford Care Homes


Tel: 07898 764748 Email: Website:



• Care homes; • Care homes with nursing; • Dementia services; • Learning disabilities; • Physical disabilities; • Specialist care.

• Sales; • Acquisitions.

• Care and nursing homes; • Supported living; • Assisted living; • Old age; • Learning disabilities; • Mental health; • Charities; • Not-for-profit; • Local authorities; • Primary Care Trusts.

SERVICES • Acquisition and disposal advice;

• Development and project management; • Property and site finding; • Market research; • Profit maximisation; • Economic viability appraisals; • Investment and brokerage; • Land assembly; • Lease, contract negotiations; • Section 106 negotiations; • Development appraisals and analysis; • Planning lobbying support; • Identifying and securing occupiers/purchasers.

CMM May 2015 35


Carterwood Ltd

Cooper Healthcare Ltd

Tel: 08458 690777 Email: Website:

Tel: 07837 335545 Email: Website:

SECTORS • Elderly care; • Dementia services; • Mental health; • Learning disabilities; • Physical disabilities; • Drug and alcohol dependence; • Extra care; • Assisted living; • Care villages; • Sheltered housing; • Close care; • Acquired brain injury; • Domiciliary care; • Supported living; • Independent hospitals; • Acute hospitals; • Children’s nurseries; • Children’s homes; • Residential special schools.

SERVICES • Agency; • Valuation; • Consultancy.

LEAD INDIVIDUALS Ben and Amanda formed Carterwood in 2008 and have both worked exclusively within the longterm care sector since qualifying as Chartered Surveyors, Amanda in 1992 and Ben latterly in 2001. Although Amanda has Director responsibility, her main focus is Carterwood’s agency division. Her in-depth knowledge of the market and her skill and experience in handling detailed negotiations have ensured steady

growth and a growing reputation for the agency. Ben’s experience and focus on the specialist consultancy and valuation work that Carterwood undertakes has helped the company to become one of the leading providers of advice in relation to the care home, extra care and care village sectors. Ben is often asked to act as an expert witness in relation to planning appeals, where his depth of technical knowledge provides particular insight.

COMPANY INFORMATION The company prides itself on having an individual style and personality. This is driven by the approach of Amanda and Ben, who run a business that reflects their personal and professional values. They are supported by a highly skilled and proficient team who share these values and work over the three sectors of the operation. Tom Harrison was the company’s first appointment at Associate level and his experience includes valuation, consultancy, sale and acquisition advice, as well as specialist work for banks and insolvency practitioners. The company’s client list reads like a who’s who of the sector and Carterwood is now firmly established as a serious player within the social care arena, with a very strong record in consultancy, sale and acquisition.

Amanda Nurse Director Tel: 0845 869 0777 Email: Ben Hartley Director Tel: 0845 869 0777 Email:

36 CMM May 2015

SECTORS • Elderly care; • Specialist mental health facilities; • Children’s homes; • Turnkey development opportunities; • Learning disability homes; • Foster care agencies.

SERVICES • Acquisition; • Disposal; • Consultancy; • Analysis.

LEAD INDIVIDUALS Samantha Cooper, Managing Director, has over 25 years’ industry experience as a commercial and residential agent, specialising in the acquisition and disposal of care businesses throughout the UK including elderly care, specialist mental health facilities, children’s homes, turnkey development opportunities, learning disability homes and foster care agencies. With Samantha as your consultant you have direct access to her knowledge and extensive expertise, and can be completely assured that she will manage the whole sale process from inception to completion. Samantha is recognised for her passion, energy and knowledge assisting operators and purchasers throughout all the stages of the transaction. Ian Catterall recently joined Cooper Healthcare to strengthen

the company’s presence locally and nationally and to assist his sister in growing the family business, boasting over 15 years’ successful industry experience. Ian specialises in personal account relationships from sole traders to large corporate companies. Previous employment includes, a leading group of estate agents, specialising in the disposal of residential properties in the North West where Ian prided himself on giving a personal touch which made him a top achiever in target sales. Ian has exceptional knowledge, expertise and focus for client relations which will greatly benefit Cooper Healthcare as they continue to grow.

COMPANY INFORMATION Cooper Healthcare is an established, nationwide property consultancy offering a more personalised and consultative approach to the healthcare sector. We pride ourselves on working with operators to achieve the best outcome from their business, providing a personal, discreet and client focussed service. Our prestigious sales brochure sets ourselves ahead of our competition because of its thorough detail and granular analysis, enabling vendors to promote their home(s) without any disruption to their day to day business. If you are considering selling, now or in the future and would like a discreet, confidential consultation and a free financial analysis of your business, please contact us.

Samantha Cooper Managing Director Tel: 07837 335545 Email: Ian Catterall Tel: 07912 696218 Email:

New training courses from Alzheimer’s Society Step Inside – building skills and confidence to support people with dementia This introductory skills based course will enable participants to understand the unique ways that dementia affects people. Made up of four different modules, participants will learn how to apply evidence based practical tools to help people with dementia to live well.

We put people with dementia at the heart of everything we do. Our outcome based solutions enable compassionate and high quality support to be delivered to people living with dementia, which increases staff confidence and realises their potential. Courses can be delivered within the workplace or as part of our open course schedule. Alzheimer’s Society operates in England, Wales and Northern Ireland. Registered charity number 296645.

Level 2 Award in Understanding Dementia Alzheimer’s Society and the Royal Society for Public Health (RSPH) have joined forces to create a new qualification to help people understand more about dementia. The Level 2 Award in Understanding Dementia has been designed to raise standards in dementia care using a person centred approach which places compassionate care at the heart of the training. Meaningful Occupation – supporting people with dementia to retain their independence This course equips participants with the skills to use a person centred communication and risk management approach to support people with dementia to retain their independence.

Training and Consultancy Responsive Behaviour – compassionate practice to support people living with dementia This course focuses on behaviour as a form of communication. It enables participants to embrace new approaches to support people with dementia with complex needs, based on delivering respect, compassion and empathy. Improving pain assessment and management for people with dementia This course will help participants recognise when a person with dementia is in pain and understand how to provide appropriate care and support. For more details about the courses and how to book, please contact us by phone or email, quoting this reference CMM/MAY15 T: 01904 567 909 E: Or visit our website

The perfect lift for all occasions The A6000 has all of the benefits of a platform lift but with the style and feel of a traditional passenger lift due to the traditional lift landing doors and fully enclose cabin but without all of the additional builders work.

 0844 241 5030



We can offer a 1000kg rated vertical platform lift to serve different floor levels to facilitate the movement of a full size bed and its occupant with comfort and ease.

CMM May 2015 37


DC Care


Tel: 01937 849 268 Email: Website:

Tel: 01904 529110 Email: Website:

SECTORS • Elderly care and nursing home; • Children’s homes; • Learning disabilities; • Physical disabilities; • Mental health; • Vacant care homes; • Care home groups; • Care home sites; • Care homes in administration or receivership; • Charities and not-for-profit; • Local authorities.

the industry since 1998. Prior to this, a background in internal auditing provided the relevant accounting experience required in order to give care home owners an accurate appraisal of their business. Since joining in January 2010, Andrew has built an excellent network of contacts in all aspects of care. A real hands-on and personal approach to the entire selling process has resulted in DC Care significantly increasing its presence in the south, making it one of the most active specialist agents in the sector.



• Sales and acquisitions; • Care home appraisals; • Marketing reports.

DC Care has concluded over 380 transactions, with a total value of approximately half a billion pounds. Our goal is to maximise the outcome for every one of our clients. The team is focused on service and acts for either vendors or purchasers in relation to buying and selling companies and operational care businesses, empty units for redevelopment and the sale and acquisition of development sites. We provide assistance on exit strategy planning, portfolio realignment, targeted acquisitions and administrations, liaising closely with carefully chosen professional partners to build a due diligence team where appropriate. Each member of the team has hands-on, specialist experience, gained over many years. This expertise, coupled with the wider commercial experience of the principals, means we are able to offer practical, relevant and commercial advice to our clients. DC Care is the trading name of The Franklyn (Developments) Limited.

LEAD INDIVIDUALS With over a decade of specialist healthcare experience, Alison joined DC Care in 2010 and in that time has concluded sales of a range of businesses, from closed care homes, homes in administration, to wellperforming larger operational groups. Her extensive transactional, appraisal and relationship management experience gained in this and other specialised industries enables her to quickly grasp the often very individual facets of any sale. Alison provides a number of lenders with marketing reports, enabling decisions to be made on the future of businesses showing early signs of distress and also advises clients and investors on portfolio development matters. Andrew has a wealth of experience in business transfer having been in

Alison Taylor BA (Hons) BIM Regional Director (North) Tel: 07825 353748 Email: Andrew Sandel Regional Director (South) Tel: 07825 206777 Email:

38 CMM May 2015



• Specialists in social care; • Care and nursing homes; • Independent hospitals; • Old age; • Learning disabilities; • Mental health; • Assisted/independent living developments; • Investments.

• Sales and acquisitions; • Site feasibility reports; • Care home trading assessments; • Care needs assessments (for planning applications); • Formal valuation advice; • Expert witness evidence; • Strategic advice to group operators; • Social care research.

Swordfish Property Enterprises Ltd Tel: 0208 455 5929 Email: Website:

SECTORS • Care home; • Elderly care; • Dementia services; • Learning disabilities; • Physical disabilities; • Acquired brain injury; • Mental health;

• Drug and alcohol dependence; • Care villages; • Health centres/doctors’ surgeries.

SERVICES • Development opportunities; • Land sourcing.



Knight Frank LLP

Tel: 0207 087 5858 Email: Website:

Tel: 0207 861 1153 Email: Website:



• Retirement housing and housing with care; • Care homes; • GP practises and pharmacies; • Day centres and nurseries; • Education; • Dentists; • Hospitals; • Learning disability and mental health.

his wide-ranging experience and expertise, his advice is particularly sought on strategic issues including acquisitions of operational businesses, loan restructurings and business reviews. Whilst predominantly UKbased, his work extends to include projects in Russia, Italy, Spain, Turkey, China and India. Clients find his insight into international healthcare trends and capital flows particularly relevant in today’s increasingly global market.




• Research; • Transactional; • Funding and financial restructuring; • Valuation; • Operational consultancy; • Strategic planning.

JLL is a financial and professional services firm specialising in real estate services and investment management. The JLL Healthcare team is part of our newly created Alternatives division. For over 30 years JLL has been leading the way in the Alternatives market, building strong sector teams that offer a wealth of knowledge and experience to our clients. Our Alternatives division draws these teams under one umbrella, allowing us to provide our clients with a streamlined approach to maximising their investments across the portfolio of ‘Alternative’ sectors. Our dedicated Healthcare experts are based out of London, Bristol, Leeds and Edinburgh. Our global reach makes us a partner of choice and our transactional work is increasingly global. Our holistic approach enables us to respond to increasing client demands and makes us unique in the current marketplace for advising clients on healthcare transactions. In 2014, we advised on over £4bn of healthcare transactions with a further £375m currently under instruction.

• Strategic consultancy; • Development consultancy; • Sales and acquisitions; • Valuation; • Portfolio consultancy; • Research and feasibility studies; • Building consultancy and surveys; • Planning consultancy; • Lease advisory; • Property asset management.

LEAD INDIVIDUALS James is the Lead Director and is a recognised national specialist in the sector with over 20 years’ experience. In that time he has advised healthcare operators, social care companies, landlords and investors and has a deep understanding of how private sector businesses can create value and work collaboratively with the public sector. James’s work covers corporate strategy, agency, commercial due diligence, valuation, funding and development. He is a Member of the Royal Institution of Chartered Surveyors and sits on the British Property Federation Healthcare Committee. Phil Hall is Chairman of JLL’s Healthcare team and has over 25 years’ experience in the sector, advising operators, banks and investors. Given

James Hanson Lead Director of Healthcare Tel: 07779 225392 Email: Phil Hall Chairman of Healthcare Tel: 0207 852 4622 Email:

• Care homes; • Learning disability and mental disorder units; • Physical disability and ABI units; • Mental health and secure units; • Day centres and nurseries; • Hospitals and surgeries; • Pharmacies and dental practices; • Assisted living and retirement villages; • Development sites.

LEAD INDIVIDUALS Christopher Wishart is a partner in the healthcare department. Overseeing the acquisition and disposal of care facilities throughout the UK, Christopher has over 15 years’ experience advising a broad range of clients as to the most beneficial and appropriate strategy for achieving a successful sale. Christopher advises clients ranging from owner operators looking to retire, through to banks and corporate advisers who are acting on the disposal of distressed assets. Christopher commented, ‘No two care homes are the same, so getting

under the skin of the business prior to taking it to the market is a key factor, focusing on key transaction points which vendors and purchasers will need to consider. Trust, discretion, market knowledge and taking the time to learn about the objectives of each of my clients are key fundamentals to a successful sale.’ Julian Evans’ experience has primarily concerned acting for corporate and private operators, banks, institutions and funds in the valuation, acquisition and disposal of trading care homes, specialist (acute) care homes, hospitals, day centres, medical surgeries and fixed income throughout the UK and Europe. He is Head of Healthcare.

COMPANY INFORMATION Knight Frank is the world’s leading independent global residential and commercial property consultancy. Knight Frank advises on the full spectrum of healthcare property with a dedicated healthcare consultancy team. Having a strong residential arm enables Knight Frank to also recognise properties with potentially higher alternative use values and work with large residential developers to identify sites which could include healthcare. Understanding the nuances of healthcare businesses and recognising the future of the industry through the identification of new sites and land for development has been highlighted in the Knight Frank Healthcare research reports. Released quarterly, these focus on different sections of the market and give insight into the market.

Christopher Wishart Partner – Healthcare Tel: 0207 861 1076 Email: Julian Evans Partner – Head of Healthcare Tel: 0207 861 1147 Email:

CMM May 2015 39

Deprivation of Liberty Safeguards – an update Helen Freely looks at the current situation with Deprivation of Liberty Safeguards (DoLS) which are part of broader legislation brought in to protect the rights of adults who lack mental capacity. 40 CMM May 2015

For those of you that don’t already know, the Mental Health Act 2007 was introduced to address what was referred to as the Bournewood Gap identified by the European Court of Human Rights (ECHR) in HL v UK [2004]. In short, in this case, the ECHR found that our law did not give adequate protection to people who lacked mental capacity to consent to care or treatment and who needed limits on their liberty to keep them safe. Article 5 of the ECHR requires that no one should be deprived of their liberty except in certain circumstances and there must be an appropriate legally-based procedure in place to protect the individual’s rights. If due process is not followed, an exercise of physical restraint can, at worst, amount to assault, a criminal offence, or compensation may be payable, or for care homes or hospitals it may amount in failing to meet Care Quality Commission required outcomes or standards.

RECENT DEVELOPMENTS In March 2014, there were two cases before the Supreme Court called P v Cheshire West and Chester Council, and P and Q v Surrey County Council. The Supreme Court found that there is a deprivation of liberty for the purposes of Article 5 of the ECHR when a person is under continuous supervision and control, is not free to leave and lacks capacity to consent to these arrangements. The Court held that the following factors are irrelevant: • a person’s compliance or lack of objection to their care arrangements; • the purpose of the deprivation of liberty; • the extent to which it enables them to live a relatively normal

life; and • the normality of the placement given the needs of the patient. Since these judgements, local authorities have increased the number of applications for DoLS significantly. Care homes and hospitals need to be particularly aware of these requirements. There is a new Practice Direction from the Court of Protection and also new Court of Protection court forms. The one to use is the COP DOL10 for an Application to authorise a deprivation of liberty under section 4A(3) and 162(a) of the Mental Capacity Act 2005. For urgent applications, you should use the COP DLA form. In a real emergency application, you can telephone the Court of Protection security office and explain the nature of the case and get the judge to be contacted via a Family Division Duty Officer. The Court will not entertain hybrid applications which deal partly with deprivation of liberty safeguards and partly with other welfare issues. So, the application must be specific to that issue. One thing that the Practice Direction requires is early contact with the specialist team set up at the Court of Protection to deal with these applications. They want to know your thinking about making an application and want you to talk it through with them.

WHAT IS A DEPRIVATION OF LIBERTY? There is no clear definition of deprivation of liberty, in that it depends on the particular circumstances of each case. The Code of Practice includes a list of factors that have been taken into account by the UK courts and the ECHR when deciding what


CMM May 2015 41



amounts to deprivation of liberty. They include the following: • Restraint being used, including sedation, to admit a person to an institution where that person is resisting admission. • Staff exercising complete and effective control over the care and movement of a person for a significant period. • Staff exercising control over assessments, treatment, contacts and residence. • An institution taking a decision that a patient will not be released into the care of others, or permitted to live elsewhere, unless the staff in the institution consider it appropriate. • Refusing a request by carers for a person to be discharged to their care. • A person being unable to maintain social contacts because of restrictions being placed on their access to other people. • A person losing autonomy because they are under continuous supervision and control.

authorities or any interested person can make a DoLS application. Even if there is no dispute, there is a requirement for periodic review of Standard Authorisations registered by local authorities. In a case known as Re X and others (Deprivation of Liberty) 2014 and RE X and others (Deprivation of Liberty) (Number 2) 2014 Sir James Munby, the President of the Court of Protection expressed the view that this should be at least annually and that such reviews could not be delegated to a court office, but would need to be reviewed by a judge.



On receiving a request for authorisation, there will be a series of assessments as follows: • An age assessment – to confirm the person is over 18. • A no refusals assessment – to confirm that an authorisation does not conflict with a valid advance decision (a living will), the decision of an attorney under a Lasting Power of Attorney or the decision of a court appointed deputy. • A mental capacity assessment – to confirm that they lack the ability to make the decision themselves. • A mental health assessment – to confirm that they suffer from a mental disorder. • An eligibility assessment – to confirm that they have not been detained under the Mental Health Act. • A best interests assessment – taking into account the person’s best interests to keep them from harm.

Care homes and hospitals, local

The assessments are usually

The fact that the doors in a care home or hospital are locked would not necessarily be enough on its own to amount to a deprivation of liberty. Equally a person could be deprived of their liberty without locked doors if staff exercised total control over their movements. Every situation needs to be looked at on a case by case basis. If you think that any of the patients under your care may be being deprived of their liberty, you must apply for DoLS and have it authorised by the Court of Protection.

completed within 21 days of the application being received, but you can apply for urgent authorisation which could be turned around in a matter of days. If authorisation is given, it will state how long it will last, up to a maximum of 12 months and a Relevant Person’s Representative will be appointed to represent the interests of the person whose liberty is being deprived. If an application is refused, any continuing deprivation of liberty will be unlawful. In this case, the providers should immediately take steps to put in place a care plan which does not involve a deprivation of liberty, in fact release the patient, e.g. returning someone to their family home if possible. Alternatively, it is possible to challenge a decision, but you must be prepared for the possibility that it will be refused again and, in the meantime, you should re-assess the care plan.

IMPORTANT THINGS TO NOTE It is important to note that you may require permission from the Court of Protection to apply for DoLS, but this can all be prepared in the same bundle of paperwork and it can be considered at the same time. Early contact with the Deprivation of Liberty team at the Court of Protection is recommended. You need to use special Deprivation of Liberty forms and the judge gives early directions for the process of the application and monitors progress. You are encouraged to attach a draft order to your application and consultation between the applicant and the Court is an integral part of the process. There will also be an application fee of £400 payable.

Deprivation of Liberty is an important aspect of care provision that needs to be followed correctly. Where there is any confusion or uncertainty, it is important to seek advice. There are a number of useful resources available online to help too. CMM

DOLS FACTS AND FIGURES In January 2015, the Care Quality Commission published its fifth annual monitoring report on the implementation of the deprivation of liberty safeguards. The report Monitoring the Use of the Mental Capacity Act Deprivation of Liberty Safeguards in 2013/14 examines the first five years of implementation of DoLS. Some of the key findings include: • Since 2014, the number of applications have soared from 13,000 a year to around 55,000 a year. • Since 2009, the rate of applications for people over the age of 85 has nearly doubled. • In 2013/14, 69% of applications were by residential or nursing home care providers. The rest were in respect of mental health or acute/community hospitals. • Last year, 85% of local authorities said that care homes’ and hospitals’ poor understanding of their role and function was a barrier to good practice.

Helen Freely is Partner – Private Client Department at Druces LLP and a Member of Solicitors for the Elderly To read the CQC report Monitoring the Use of the Mental Capacity Act Deprivation of Liberty Safeguards in 2013/14 and see the CQC’s related infographic visit 42 CMM May 2015

... delivering through experience

specialist healthcare business agents

DC Care Sells Newlands Hall


Newlands Hall, Heckmondwike - Reg 30

DC Care has completed the sale of Newlands Hall, a long established care home in Heckmondwike, 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. Alison Taylor, Specialist Business Appraiser, managed the sale and said "I first saw Newlands Hall over 10 years ago and was delighted to have been able to play a part in its continued operation and I wish Regency Healthcare every success with their plans."

When industry knowledge and wisdom are needed, when a discreet sale is desired, our clients choose DC Care to sell their care business.


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Physical activity dementia

Sylvie Silver explores the benefits of physical activity for those with dementia and shares some examples of best practice. Has your New Year resolution to exercise more already faded away or have you discovered the benefits of being a bit fitter? The prospect of increased physical activity can make some people groan as visions of the gym loom large but we are often told now that just increasing the amount we walk can make a difference to both health and wellbeing. These principles are just as pertinent to those living with dementia. For many, physical activity is a vital contributor to their well being and mental health, for others, encouragement and motivation are needed to simply keep limbs moving and maintain as much independence as possible. The Alzheimer’s Society website has an excellent section on the importance of physical activity. It details not only the health conditions that can be relieved, like reducing the risk of strokes, but also other benefits like improving sleep patterns. Recent studies have shown that exercise may improve memory and slow down mental decline too. Within the care sector a lot of work has been done on falls prevention and physical activity has been shown to improve strength and balance and help to counteract the fear of falling. We also have guidance on what types of exercise are appropriate, and the benefits of each, at the different stages of living with dementia.

THE CORRECT LEVEL OF ACTIVITY What is the right amount of activity in the early to midstages of dementia? • People who are not currently active should be doing about

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30 minutes of activity at least five days a week. • This can be broken up into shorter sessions throughout the day, i.e. a 15 minute walk to the local shops or round the grounds and then housework or gardening tasks in the afternoon. • Regular physical activity is recommended to maximise benefits. What is the right amount of activity in the later stages of dementia? • People in the later stages of dementia should be encouraged to move about regularly. • There should be opportunities to sit unsupported (as far as possible) with supervision on a daily basis. • A daily routine involving moving around the home can help to maintain muscle strength and joint flexibility. • Exercise can range from changing position from sitting to standing, walking a short distance into another room or moving to sit in a different chair at each mealtime throughout the day. I guess that the majority of care providers know most of this already but I doubt if many carry out an audit of physical activity with their residents. I wonder how many care plans identify how physical activity and exercise needs will be met.

BEST PRACTICE I spend quite a lot of time working in care homes with care teams. We talk a lot in our training sessions about the


CMM May 2015 45



impact on wellbeing of physical activity, and many care staff recognise the importance but struggle to see how they could meet these recommendations. I get them to identify the routine day-to-day work that is carried out in a home. Things like table laying and sorting laundry always feature early on the list. Eventually we might include delivering the post or newspapers, collecting prescriptions or putting away deliveries. I then encourage them to think about how residents could be motivated to join in with these things. Could they think of a regular ‘job’ for every single resident? Many residents enjoy the responsibility of sharing a job with a carer. It can raise self-esteem, build relationships, and offer social interaction in addition to meeting physical activity needs. I have heard many great examples of good practice – here are just a few. • A lady cared for in her room puts cut flowers into small vases for the dining room twice a week. This encourages upper body movement and fine finger control. • A gentleman, accompanied by a carer, delivers the daily menus to every room every day maintaining his mobility and self-esteem. • An energetic resident who enjoys walking helps the laundry lady push a clothes rail of clean items around the home every day. The physical effort seems to help her sleep better. Some care homes have a very structured approach to physical exercise. I was pleasantly surprised when visiting Queen Elizabeth House in Bromley to suddenly be surrounded in the

‘Getting out, even into the garden, is now seen by inspectors as more important than it ever has been in the past.’ lounge by both residents and staff – it felt a bit like a flash-mob but they had all descended for the daily 10 o’clock exercise session. It lasted 15 minutes, used four familiar pieces of music and was led in part by a resident who was at one time a League of Health and Beauty instructor. The catering assistant said it really helped with her stiff shoulder and a resident said she wouldn’t miss it for the world. I am particularly impressed by Avondale Care Home in Aylesbury where they have developed a well-equipped gym and every resident has set their own goal. At least one resident wants to build up his strength to aid transferring and limit the use of a hoist. Jordan Collins, their Leisure and Wellness CoOrdinator, told me, ‘We spoke to each resident about setting

their goals, we then made suitable action plans. These plans will be used to focus work on specific areas to improve them to help them get closer to their goals.’ Ashley House Residential Care Home in Borden has installed extra doors to easily access the gardens, this has encouraged residents to walk outdoors more which helps to maintain their physical fitness and their wellbeing. They also have a vegetable patch for added interest outdoors and to encourage meaningful activity. All of these homes have a large cohort of residents living with dementia who benefit greatly from physical activity.

BENEFITS TO BUSINESS Recognising the benefits to residents is the priority but there are many benefits to a care home business too. The most obvious one is that a resident that maintains physical mobility is less dependent on the care team to get about or transfer, needs fewer moving and handling aids and is likely to stay healthier. Caring for lots of physically dependent residents can be exhausting and have a negative impact on staff morale and the budget. The Care Quality Commission has made it quite clear that quality ratings will be based just as much on how residents spend their day as on any other criteria. A home that is positively promoting physical activity for those living with dementia will do far better than one that is not addressing this fundamental element of every resident’s day. Reducing medication has a far greater chance of success when the resident has plenty of meaningful activity to occupy them and this often entails access to the outdoors and the freedom to walk at will. Also, getting residents out and connecting with the local community is the best possible way to promote a positive image of a care setting. It is also far easier to go out with ambulant residents, which requires fewer staff, than those dependent on wheelchairs. Getting out, even into the garden, is now seen by inspectors as more important than it ever has been in the past.

ESSENTIAL TO LIFE Every care home has the ability to use music to encourage dance and movement and many carers are happy to set up a spontaneous dance session. I would like to see these planned a bit more, perhaps on a daily basis – every afternoon before supper seems to work well to encourage more physical activity for everyone. Throw in some playfulness and fun and it can be a very uplifting way to end the day. I struggle to envisage a life without physical activity and I’m hoping that by the time I am in need of care that it will be seen as just as essential as taking CMM me to the toilet.

Sylvie Silver is Director of National Activity Providers Association To read the Alzheimer’s Society’s factsheet on Exercise and physical activity for people with dementia, visit 46 CMM May 2015


SURREY AND SUSSEX SOCIAL CARE SHOWCASE 2015 18th March, Brighton The social care agenda is constantly evolving but, with vital new legislation regarding the Care Act coming into place this year and the forthcoming election, it feels like this has never been truer. This may be why over 700 care employers and staff attended the Surrey and Sussex Social Care Showcase 2015 to receive advice and training from established industry experts and over 70 exhibitors who were offering up-to-date information on the latest products and services available. This year, the showcase had the theme of Challenges and Opportunities of Working Together and the seminar programme featured leading figures within the sector, including Andrea Sutcliffe, Chief Inspector for Adult Social Care at the Care Quality Commission (CQC) and Dr Glen Mason, Director of People, Communities and Local Government at the Department of Health.

CHALLENGES AND ISSUES After an informative opening by Lord Lieutenant of East Sussex, Peter Field, the event covered a wide range of topics and raised the most prominent challenges that adult social care is currently facing. The most pressing issues seemed to be the increasing pressures on fees, costs and recruitment and how care providers can make the most of funding for

training purposes. In a bid to provide possible answers to this, and other issues, there were training providers, workforce development specialists, lawyers, business advisers and nongovernmental organisations available to speak to in the expansive exhibition area. Care providers also seemed particularly keen to hear about the opportunities available for sustaining and growing their businesses and practical business advice that they could put into place after the event. This incorporated how to ensure their services will be rated as the best possible quality in light of the CQC’s new inspection approach.

NETWORKING AND SUPPORT The showcase also, of course, proved a fruitful place to network and let people from different fields gain other perspectives on the journey that the care industry seems to be taking from their point of view. From day centre managers and senior care staff to strategic decision-makers and NVQ assessors, those involved with the care sector shared their own opinions on key issues and their views and visions for the future. As much as the event was about advice and a pro-active approach, it also seemed to be about support. A touch of colourful old-world charm was

also brought to the event courtesy of Worthing’s own town crier, Bob Smytherman, who rang in the day’s announcements some enthusiastic bell-ringing which caught everybody’s attention and ensured that nothing on the substantial programme went unnoticed by those attending. The Surrey and Sussex Social Care Showcase was supported by Surrey Care Association, East Sussex County Council, Brighton & Hove City Council and West Sussex County Council with sponsorship from media partners CMM and Care Choices.

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THE CARE SHOW BOURNEMOUTH 25th/26th March, Bournemouth Each year, the Care Show seems more bustling than the last and this year in particular the Bournemouth International Centre hosted a packed event, with those involved in all aspects of the social care industry attending the two day event.

CMM SEMINARS Most people within the sector are aware of the prominent challenges and changes within the industry and this year’s CMM-organised seminar programme tackled those issues head-on through the carefully selected speakers and presentations. The free-to-attend exhibition and seminars attracted a huge number of attendees. Some of the highlights included Alison Murray, Head of Inspection (South Coast) at the Care Quality Commission discussing, at length, the changes to regulation and the new quality ratings coming into force, which was of keen interest to everybody in attendance. Recruitment and retention and potential funding strategies were also popular presentations and they were discussed by Neil Eastwood of Sticky People and John Lucas of Hazlewoods respectively. They covered a range of solutions for providers to take back to their businesses. Dementia care was also at the forefront of the seminar programme courtesy of Sandie Sims, Joint Dementia Quality Lead Care Homes at Dorset Clinical Commissioning Group. Her informative talk covered best practice for dementia care in the community and provided ideas for how care providers could integrate better within the community. As ever, the large exhibition area filled both halls and gave attendees the opportunity to source new and alternative products from over 150 suppliers offering innovative solutions to issues they may be facing. 48 CMM May 2015

SURVEILLANCE RESEARCH We also learnt some very interesting opinions held by attendees about topical issues concerning the care sector. A poll carried out by Arc Seven over the course of the two days found that almost three-quarters (73%) of the visitors agreed that covert surveillance should be introduced in care homes as a solution to the issues that are currently appearing in the news. Arc Seven Director, Gemma Keogh, said the results of the poll proved that the sector was open to the use of cameras. This is an interesting thought to hold onto as we head into a new chapter for social care following the introduction of the Care Act and new regulatory changes. With such a successful and positive outcome to this year’s event, the organisers, UBM, have already confirmed next year’s dates as the 15th16th March 2016, to be held once again at Bournemouth International Centre.

WHAT’S ON? Event: Safeguarding Adults Date/Location: 28th April, London Contact: Capita Conferences, Tel: 0870 400 1020 Event: Self-Neglect and Adult Safeguarding Date/Location: 6th May, London Contact: Healthcare Conferences UK, Tel: 01932 429933 Event: NICE Annual Conference Date/Location: 12th/13th May, Birmingham Contact: NICE, Tel: 0845 056 8339 Event: Adult Social Care Inspections Date/Location: 19th May, London Contact: Capita Conferences, Tel: 0870 400 1020 Event: All Together Now! Breaking the Boundaries of Care Date/Location: 29 May, London Contact: Care England and Royal College of Nursing, Tel: 0207 492 4840

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Event: Health+Care 2015 Date/Location: 24th/25th June, London Contact: CloserStill Media, Tel: 0207 348 5261 Event:

Enhanced Health in Care Homes: Implementing New Models of Care Date/Location: 2nd July, London The King’s Fund, Tel: 0207 307 2596 Contact:


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Derbyshire and Nottinghamshire Regional Care Conference 2015 15th July, Nottingham Care Choices, Tel: 01223 207770

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Lancashire Regional Care Conference 2015 23rd September, Clayton Le Moors Care Choices, Tel: 01223 207770

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Berkshire Regional Care Conference 2015 15th October, Reading Care Choices, Tel: 01223 207770

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3rd Sector Care Awards 9th December, London Care Choices, Tel: 01223 207770

Please mention CMM when booking your place. CMM May 2015 49

D R S I M O N D U F F Y • D I R E C TO R • T H E C E N T R E F O R W E L FA R E R E F O R M

Dr Simon Duffy discusses the recent Citizen Jury held by the Learning Disability Alliance and how people with learning disabilities have a right to be considered as true citizens.

Learning Disability Alliance (LDA) England will seem a very new organisation to many readers, but it links together both some new and some very wellestablished organisations, in a way that is both ground-breaking and potentially very powerful. It provides a way in which service providers and professionals can come together alongside self-advocates and families: providing them with backup, but not getting in their way. A powerful example of this new way of working is the first LDA Citizen Jury, held in Central London on 2nd April. The jury was made up of people with learning disabilities and family members and the jury heard presentations from each of the five main political parties in England; they asked challenging questions, and then

decided who would best stick up for the rights of people with learning disabilities. However, when it came down to it, one party didn’t actually turn up. The Conservative Party was noticeable by its absence, despite a high profile letter to the Prime Minister and on-going efforts to seek a representative from Conservative Central Party Office. Compare this to the Labour Party, who sent along Kate Green, their disability spokesperson. It is hard not to conclude that the Conservative Party had decided that their track-record on disability is so poor that it would be better not to turn up and to avoid being accountable to people and families. Although the Conservatives did not turn up the Jury did hear a presentation about their record and all parties were marked and given an overall satisfaction score. The Greens won (81%), Labour were second (71%), Liberal Democrats came third (58%), UKIP fourth (36%) and the Conservatives came last (18%). For many in the learning disability sector this approach will seem far too political and direct. We are used to a gentler approach. Many charities, who may have started life as campaign groups, have now become part of the establishment, and they find it difficult to challenge bad policies made by central or local Government. Yet this must change. The severity of our problem in the UK was brought home to me while working in Australia recently. There I met politicians who were astonished by the way in which the UK Government was targeting disabled people and families for cuts. In Australia, such policies would have been political suicide. For, in Australia, the disability movement had brought service providers, self-advocates and families together. Funding for disability support was popular and parties of both Left and Right knew that it needed to be protected. How different to the UK. Here, even the Labour Party has struggled to take a strong line to defend the rights of

Do you agree with Simon? Join the debate at 50 CMM May 2015

people with learning disabilities. I suspect that this is why – despite a strong and personable presentation from Kate Green – Labour still came in second to the Green Party. But it is not the Labour Party who is responsible for the fact that the media and the political elite believe that there are no votes in disability. Service providers, charities and campaigning groups must take the brunt of the responsibility for this problem. Since the Community Care reforms of the early 1990s too many organisations have slipped into the role of being a mere ‘servant’ to the Government. There are now many chief executives with superhigh salaries, and many workers on very low wages. Instead of campaigning for rights and to defend services, too many organisations are simply preparing for the next ‘re-tendering’ exercise either to defend themselves, or take over from some other organisation. The birth of LDA England marks an important stage in reversing this trend. Some charities and community organisations are now taking courage by coming together with self-advocates and families. They do not need to stand alone, they can start to be more honest and to confront some of the real problems we face. The other reason the LDA was created was to start focusing on all the issues that matter to people with learning disabilities. The LDA manifesto is not just about health and social care, it’s about incomes, work, education, family life and community – issues of everyday human rights. As people with learning disabilities step forward, despite all the obstacles put in their way, to claim their rightful place as full citizens they challenge us to look at all aspects of our society. More information about the process and the details for voting can be found on the LDA England website: http:// CMM

Design The Touch Series is a UK manufactured and designed care system, using hospital grade materials that house Intercall technical excellence.

Location RFID technology is used to identify sta, record actions and control user access.

Data logging Data logging records all system events, calls, alerts and responses for reporting and analysis.

Integration Industry standard connectivity via TCP/IP, the Touch Series is a modern nurse call system oering easy communication and management of patient care.

Cloud Intercall Cloud service uses the power of the web to allow secure remote access to your Intercall system anytime, anywhere.

Sky TV packages for heightened well-being



vouchers with your first lounge package†

With the over-65s watching more Sky TV^ than any other age group, our TV packages offer all kinds of ways to keep your residents entertained. Great value in-room packages cost under £10* a week, with lounge packages at less than £70* a week.

To find the right Sky TV package for your care home, call 08442 414 645

Believe in better

^Over 65s Sky TV viewing statistics based on Sky IQ data, April 2014. *Pricing shown is ex VAT. Customers will be billed monthly and installation costs apply. Installation of equipment is not included, please call for more information. Charge of £50 per box (plus VAT) if Sky does not install your equipment. Sky TV minimum term is 12 months. 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. 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 09.04.2015. †Oomph voucher: £500 discount voucher off “Oomph! Training” or “Oomph! Monthly Activity Packs” to care homes purchasing their first Sky Home TV lounge. No cash alternative available. Voucher cannot be used in conjunction with any other offer and expires 6 months after date of issue. Voucher is issued by Oomph Wellness Training Limited. Further terms apply [].

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