Care Management Matters September 2015

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SEPTEMBER 2015 £4.00

Time to change the law

Collaboration is crucial

Commissioners and providers

An ever-changing sector

Support to manage

Resource Finder

Care sector training

Includes 4-page Skills for Care insert: Core values – The key to better quality social care

Helping to recruit a quality workforce. “This is an absolutely fantastic service which is going to make a real difference to the care industry.”

It can cost around £3,500 to recruit and retain new care staff, which is why it’s crucial that organisations attract the right candidates. A great way to find out about what it’s really like to work in care is to talk to or hear from someone who is already a care worker.

I Care...Ambassadors are a team of enthusiastic frontline care staff who visit schools, colleges, job centres and other employment agencies to inspire others to work in adult social care. We are inviting adult social care employers and their staff to become part of this national team, which supports the whole sector to find a high quality workforce which will stay in post for longer. For more information go to businessbenefits

By registering as an I Care...Ambassdor service and nominating your staff as ambassadors, you will be able to:

showcase the great care and support you provide raise the profile of your organisation change negative perceptions attract better-informed candidates.

As well as supporting recruitment and retention, this initiative is a great learning and development opportunity for staff, which helps to grow their confidence. Feedback we have gathered from those who have already signed up suggests that, 71% of staff feel more motivated, having become an I Care...Ambassador.

In this issue 05

Is it just me…? Editor in Chief, Robert Chamberlain, reflects on how our broken care system is being left to decline.


CMM News


Business Clinic A new vision for health and social care is debated.


A View from the Top Helen Baker, Chair of Dimensions is the subject of our monthly interview.


Resource Finder CMM presents a number of care sector training organisations.


Event review CMM reviews the CMM Insight Derbyshire and Nottinghamshire Care Conference.


What’s On?


Straight Talk Martin Green pulls no punches with his opinion on the postponement of the care cap.





The 3rd Sector Care Awards


From the Editor



Collaborate for a sustainable social care Ray James explores the roles of commissioners and providers in ensuring sector sustainability.


Managing change in an ever-changing sector New resources have been developed to help providers manage change effectively. Robin Miller explains more.


The benefits of good interior design Specialist interior designers can add value to refurbishment and development projects. Alexandra Ledger summarises the benefits.


Deprivation of Liberty – your chance to change the law Stuart Marchant and Emma Timmons review proposals to change the deprivation of liberty safeguard system.

Nominations for 2015 are now open see page 45 for more information. CMM September 2015 3

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





Ray James President, Association of Directors of Adult Social Services

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

Debbie Sorkin National Director of Systems Leadership, The Leadership Centre

Patrick Hall Practice Development Manager (Policy), Social Care Institute for Excellence



Helen Baker Chair, Dimensions

Robin Miller Senior Fellow, Health Services Management Centre, University of Birmingham

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: 978-1-910362-61-7 CCL REF NO: CMM 12.6 Photograph credits: Bright Bay Design Ltd

CMM magazine is officially part of the membership entitlement of:

ABC certified (Jan 2014-Dec 2014) Total average net circulation per issue 16,010

4 CMM September 2015



Emma Timmons Solicitor, Bevan Brittan LLP

Professor Martin Green Chief Executive, Care England


Alexandra Ledger Managing Director, Bright Bay Design

Stuart Marchant Partner, Bevan Brittan LLP

Are you getting the benefit of the CMM website? Sign up today to start getting more from CMM. It’s free for care providers. @CMM_Magazine

From the Editor Editor, Emma Morriss shares her anxieties about the pressures facing the sector given recent Government announcements. I’m anxious. What was meant to be a relaxing summer break from CMM has been far from it. Since we published the last issue it feels like pressure on the sector has increased exponentially.

GOVERNMENT ANNOUNCEMENTS In the Budget, the Chancellor announced that the National Minimum Wage will be replaced by the Living Wage. It will be compulsory from April 2016 and will be set at £7.20 an hour for over 25s, increasing to £9 by 2020. This caused ripples throughout the sector. Without extra funding to achieve the commitment, which is broadly welcomed, how are providers meant to meet this obligation? The Government then postponed the implementation of Part two of the Care Act to April 2020, which is just before the next General

Election. The delay has been seen as necessary by many, though some now doubt the funding reforms will happen at all. Given local authorities are already strapped for cash, the cost of implementing Part two was likely to be too much to bear. However, money has already been spent in preparing for it. James Lloyd, Director of the Strategic Society Centre wrote in Public Finance that he estimated the implementation cost to the taxpayer to date is between £50m and £100m. What could have been done with that money? What about the money that remains? Could it now be used to pay for frontline services? As yet, there has been no confirmation from the Department of Health.

PRESSURE These are just two new announcements putting pressure

on an already creaking system. While my concerns about the sector are manifesting themselves as anxiety, Martin Green is angry in Straight Talk on page 50. It’s definitely worth a read.

WHAT DO YOU THINK? What about you? I’d like to know what you think about the financial climate in which you’re operating. What are your thoughts on the state of the sector? Are you able to overcome the challenges? It’s time to push for a resolution for the sake of those who use the services you

provide. The easiest way to join the debate is on the CMM website.

INSIDE CMM This issue of CMM reflects the issues in the sector, it is full of news on what’s happening, plus features on how to collaborate to survive, manage the changes, and even a proposal on how to transform health and social care so it’s fit for the future. But it’s all going to take time, and money, and buy-in from all stakeholders. Is that too much to hope for?

Email: Twitter: @CMM_Magazine Web:

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12/06/2015 13:09

Is it just me...? Editor in Chief, Robert Chamberlain, reflects on how our broken care system is being left to decline.

Much has occurred in the world of social care during our summer break that does not spell good news for those needing care or those providing it. I won’t labour the issue of the care funding reform U-turn, as Martin Green has written a strong piece on this topic on page 50, but I must say this whole shambolic exercise has

pretend that I haven’t been an outspoken critic of the proposed reform based on diluted Dilnot recommendations. I hold that the ‘care cap’ is inadequate to address the funding considerations affecting our ageing population. It was, however, a move in the right direction. This U-turn sends a very clear message to the man on the street that the

“Concerns that may previously have been deemed as care providers bleating on about their profit margins are now being echoed in the strongest terms by those responsible for commissioning and quality standards.” been incredibly damaging. How on earth can a government state its acknowledgement of a broken system that is unstainable and unfair, spend £100 million to develop a solution and then shelve it for four years (if not abandon it!)? It beggars belief. I’m no hypocrite and won’t

plight of older people in need of social care, though recognised by the Government, is not important enough an issue. They seem happy to turn their backs on the problem. The Budget also took place with implications for our cash-strapped care operators such as the National

Living Wage and the announcement of further cuts to social care budgets.

UNITED FRONT Respective care associations have worked hard over many years to highlight the social care crisis with limited success in Government circles. However, this message is now being reinforced by influential organisations including the Association of Directors of Adult Social Services (ADASS) and the Care Quality Commission (CQC). As ADASS published its latest research, warning of the impact of the continued funding crisis, President Ray James, stated, ‘Short-changing social care is short-sighted and shortterm. It must also be short-lived if we are going to avoid further damage to the lives of older and vulnerable people who often will have no-one else but social care to turn to. ‘What is at stake is the continuing capacity of adult social care to sustain services to those in greatest need. In virtually all our authorities, the

number in need is growing, while the complexity of their needs is increasing.’ he added. CQC’s Chief Inspector of Adult Social Care, Andrea Sutcliffe warned of the impact of the funding crisis on care quality in an interview with The Observer (8th August 2015). She stated that much of the good work in social care was going on ‘despite the system’ and care staff feel ‘undervalued’ and ‘demoralised’. She called for the Government to act in recognition of the value of social care and its true costs. ‘The social care sector is certainly under stress and strain. And that is a combination of all sorts of factors – the increased numbers of people who need care and support, the increased complexity of their needs. But the other thing I would pick up on with the stresses and strain on the system, and the impact on quality, is the role of the commissioners and the funders. ‘There is an important responsibility in the role of those funding care – local authorities or clinical commissioning groups – to really understand what the true cost of care is, what true quality looks like and to make sure they are commissioning services that meet those standards and providers are given the appropriate funding to enable them to do that.’

DEAF EARS? Surely these stark warnings cannot go unheard by our politicians for much longer. Concerns that may previously have been deemed as care providers bleating on about their profit margins are now being echoed in the strongest terms by those responsible for commissioning and quality standards. The missing piece of this jigsaw to lend weight is a public outcry. Let’s hope that will happen.

Do you agree with Robert? Join the debate. Twitter: @CMM_Magazine Web: CMM September 2015 7

8 CMM September 2015

APPOINTMENTS SOMERSET CARE Dr Jane Townson has joined Somerset Care as Chief Executive.

CENTRE FOR AGEING BETTER The Centre for Ageing Better has appointed Anna Dixon as its Chief Executive.

National Living Wage shock George Osborne’s Budget Statement introduced a plan for a National Living Wage (NLW). It was the centrepiece of the budget announcing proposals for the minimum rate, to be set at £7.20 from April 2016 and rising to £9 per hour by 2020 (for over-25s). Although full details of the plan will not be revealed until the Autumn Spending Review, analysis by the Resolution Foundation shows that care providers were already needing to find £1bn to pay for increases in the National Minimum Wage over the next five years.

The additional bill from the NLW will require another £1.3bn by 2020. Given that the care sector is so dependent on people funded by local authorities it means further pressure on the market and the public sector. In homecare, where local authorities purchase 70% of services, there will be particular pressures. The United Kingdom Homecare Association (UKHCA) estimates that to address the existing under-funding of homecare and implement the NLW will require an increase of at least £753m from councils and the NHS in the first

year alone. UKHCA cites a recent Freedom of Information Act request which found that councils paid an average of £13.66 per hour for older people’s homecare. After accounting for Government’s proposed changes to National Insurance Contributions and Corporation Tax, UKHCA estimates that the new NLW will require councils to pay at least £16.70 per hour, including care workers’ travel time and all other costs. It issued an open letter to the Chancellor to request a commitment to proper funding of care services.

CQC strategy development The Care Quality Commission (CQC) is developing a new five year strategy to be launched in spring 2016. It will set out the CQC’s vision for health and social care quality regulation in the future. The development of the new strategy is taking place within an ever-changing environment

in which people are living longer lives, expectations on the quality of health and social care are changing, the population is growing and technology is advancing. The CQC will be consulting with all its audiences on its future strategy in an open and

collaborative way to ensure it is making the right decisions. It has set up a web survey as an informal way to help it develop its new strategy. In early 2016 the CQC will run a formal consultation on its proposed approach, before publishing a finalised strategy later in the year.

Market shaping toolkit The Institute for Public Care has published a Market Shaping Toolkit to support both smaller care providers and local authorities to engage in market shaping and develop innovative practice to meet local needs together. This toolkit has been designed to highlight good practice in the way that local authorities and smaller care and support providers

collaborate and provide innovative services. It offers a series of checklists and materials to encourage good quality market shaping activities. For local authorities, the toolkit will give some new ideas and suggestions about who to engage with, why and how, in local care markets. For providers, the toolkit offers a stimulus and encouragement to ask local

authorities ‘Why are we not doing this?’ The toolkit has five distinct sections and an annotated bibliography which provides quick and easy links to further useful information. Some of the sections will be more useful to providers and some to local authorities; the toolkit is colour coded to help make this clear.

VODG Steve Scown has become the Interim Chair of the Voluntary Organisations Disability Group.

NHS ENGLAND Professor Sir Malcolm Grant has been re-appointed as Chair of NHS England for three years.

CASTLEOAK Castleoak has appointed Lex Cumber as Business Development Director and James Player as Construction Director.

ABBEYFIELD The Abbeyfield Society has welcomed April Dobson as its new Head of Dementia Innovation. Also, Ian Plaistowe has taken up his Chairmanship of the Society.

CARE AND SUPPORT ALLIANCE The Care and Support Alliance has appointed Vicky McDermott as its new Chair.

CARE ENGLAND Swanton Care and Community Chief Executive, Dr Alison RoseQuirie, has been appointed to the Care England Board.

DIMENSIONS Richard Crompton, current Chairman of the Somerset Safeguarding Adults Board and Plymouth Hospitals Trust, has become Dimensions’ Independent Safeguarding Chair.

CMM September 2015 9


APPOINTMENTS COMMUNITY INTEGRATED CARE Community Integrated Care has appointed Andrew Sleigh as Chief Finance Officer and Karen Sheridan as Managing Director for Scotland.

Care Cap delayed until 2020

Care Home Open Day success The number of homes taking part in Care Home Open Day (CHOD) this year increased by 834 compared to 2014, with approximately 3,860 UK homes participating. The number is approximate as there were homes taking part which did not register on the CHOD website. Also, it does not yet include the figures for the care homes that took part in Australia and other parts of the world.


Care and Support Minister Alistair Burt has announced that the implementation of the cap on care costs will be delayed until April 2020. For more information, see In Focus on page 15.

Barchester’s Charitable Foundation, has announced the names of four new trustees.

ExtraCare makes a difference

These are Ann Mackay MBE, Director of Policy at Care England; Barchester’s Caroline Baker, Director of Dementia Care; Kate Mansfield-Loynes, Head of Clinical Learning and Development; and Malcolm McDonald, Maintenance Manager at White Lodge Care Home.

GLEN CARE Glen Care’s appointed Darasana Karki as the new Director of Nursing and Hospital Director at Glenhurst Lodge in Maidstone.

MILLSTREAM MANAGEMENT SERVICES Simon Crewe has been appointed Managing Director of Millstream Management Services. Millstream is a wholly owned subsidiary of Churchill Retirement Living.

BILFINGER GVA Bilfinger GVA has appointed Kate Deakin and Charlotte Brierley to its specialist health division.

CBRE James Laidler has joined CBRE as Healthcare Valuer within its Specialist Markets team in Leeds.

OCTOPUS HEALTHCARE Sheila Hendy has joined Octopus Healthcare as Clinical Assurance Director.

10 CMM September 2015

The social media engagement this year was phenomenal – with the hashtag #CHOD2015 trending twice on the day (and reaching a high of third place). It trended again on both Saturday and Sunday. The number of visitors and members of the public who got involved also seems to have increased. A big ‘thank you’ to all the care homes and staff who took part.

The latest research findings from Aston University’s three year longitudinal study of the approach used by The ExtraCare Charitable Trust shows the model makes a real difference - improving the quality of life for residents whilst relieving pressure on the NHS and reducing

costs for the public purse. The main findings were: NHS costs reduce by 38%; unplanned hospital stays reduced from 8 to 14 days to 1 to 2 days; a 46% reduction in routine and regular GP visits; and significant cost savings on social care. The research compared the cost

CQC safeguarding

Care homes reduce isolation

The Care Quality Commission (CQC) has updated its information on how it works with partners to make sure people are protected from abuse, neglect and maltreatment. The statement from CQC sets out its role and responsibilities for safeguarding and how its carries them out. It has been written following the Care Act 2014, which for the first time provides a legal framework for safeguarding adults. Also, the statement reflects the new CQC inspection regime.

A survey recently conducted by Hallmark Care Homes suggests that residents feel less isolated and happier after moving into a care home, compared to where they were living previously. In the survey, the Essex-based provider asked relatives with a loved one in one of Hallmark’s care homes to rate their happiness and level of activity prior to and after they had moved into the care home. 74% of those who responded said that their loved ones were happier or just as happy after making the move into residential care and it

of care provided at The ExtraCare Charitable Trust to the cost of care provided in people’s homes in the wider community. It showed that ExtraCare’s model is likely to offer significant potential savings in the cost of social care for local authority commissioners.

was identified that the level of social activity enjoyed by residents had a direct and positive impact on their overall levels of happiness. Some 89% of residents now take part in social activities at least once a week compared to just 63% prior to joining a Hallmark community. When asked what the residents’ living situation was prior to moving in, just 23% of people surveyed reported that their loved one lived with a partner before they moved into a care home. A staggering 59% had been living alone for over five years prior to their move.

3rd Sector Care Awards – nominations open Nominations are now open for the 3rd Sector Care Awards 2015. The Awards are open to any individual, team or organisation that excels at supporting people in the notfor-profit sector. Employees of all levels are invited to share their experiences and contribution. The innovative judging process will once again involve Experts by Experience. 2014’s event was a fantastic celebration of the hard work and

dedication of third sector providers. 2015 builds on those amazing contributions and has also added new categories, meaning more people can get involved. The 12 categories for 2015 are Compassion, Innovative Quality Outcomes, Creative Arts, Community Engagement, Citizenship, Leadership, Collaboration (Integration), Contribution to Sector

Development, Making a Difference, Beyond Governance, End of Life, and Technology. It is easy to nominate online at Just click on the relevant category to read criteria and submit your nomination. The event will, once again, be hosted by Dame Esther Rantzen DBE and nominations close on Friday 4th September.

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Winterbourne View progress report – Time is Running Out Sir Stephen Bubb, Chief Executive of charity leaders’ organisation ACEVO, has published a six month review of the progress being made by the Transforming Care programme to act on the recommendations of Winterbourne View – Time for Change. In Winterbourne View: Time is Running Out he has given a reserved welcome to the progress being made in the implementation of the recommendations in the report. Sir Stephen accepts that there is

much to commend in the approach taken so far by NHS England and its partners. But he adds that there is an alarming absence of any tangible progress on the ground. While the NHS has finally accepted the need to close Winterbourne-style institutions they can’t do that unless there are sufficient community facilities primed and ready to go to. Six months after the report was delivered Sir Stephen celebrates the Care Act and the Department of Health Green Paper on the rights

of people with learning disabilities and/or autism. He also welcomes the commitment made by Simon Stevens, Chief Executive of NHS England, to publish a full transition programme in the autumn. Despite this pledge, however, there currently appears to be no dialogue between NHS England and those on whom they will rely, such as third sector providers, to help deliver the transition. He says it is unacceptable to wait months more before this dialogue commences.

Transforming services for people with learning disabilities NHS England has established five fast-track sites that will test new approaches to re-shaping services for people with learning disabilities and/or autism, to ensure

more services are provided in the community and closer to home. The five sites will bring together organisations across health and care that will benefit from extra

technical support from NHS England. The sites will be able to access a £10m transformation fund to kick-start implementation from autumn 2015.

Councils could lose £3.3bn Councils in England could face a £3.3bn reduction in central government funding for local services in 2016/17, new analysis by the Local Government Association (LGA) reveals. The LGA’s annual Future funding outlook report warns councils will need to make further significant savings next year, equivalent to 12% of their total budgets. Using the most recent Office for Budget Responsibility forecasts, LGA analysis predicts councils will see funding for local services reduced by a further 11% in 2017/18 and 4% in 2018/19 before increasing by 7% in 2019/20. It predicts this will leave councils facing a funding gap of £9.5bn by the end of the decade. This will be caused by a combination of reduced government funding and rising demand being placed on adult social care services by our ageing population and will add pressure on vital services.

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Infection Code of Practice

Fit for Frailty - a BGS campaign

This revised Code of Practice from the Department of Health applies to NHS bodies and providers of independent healthcare and adult social care in England. The code now reflects the changes required to meet the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the role of infection prevention (including cleanliness) in optimising antimicrobial use and reducing antimicrobial resistance. The law states that the Code must

The British Geriatrics Society (BGS) has launched the first of two-part guidance on the recognition and management of older patients with frailty in community and outpatient settings. Called Fit for Frailty, it has been produced in association with the Royal College of General Practitioners (RCGP) and Age UK, and aims to be an invaluable tool for social workers, ambulance crews, carers, GPs, nurses and

be taken into account by the Care Quality Commission when it makes decisions about registration and that providers must have regard to the Code when deciding how they will meet the regulations. However, the Code is not mandatory, so registered providers do not, by law, have to comply with it. A registered provider may be able to demonstrate that it meets the regulations in a different way (equivalent or better) from that described in this document.

others working with older people in the community. The guidance will help them to recognise the condition of frailty and to increase understanding of the strategies available for managing it. In the guidelines, the BGS calls for all those working with older people to be aware of, and assess for frailty. It dispels the myth that all older people are frail and that frailty is an inevitable part of age.

The reality of the financial climate The National Care Association has released results of a survey of its members on the reality of operating in the current financial climate. The NCA remains extremely concerned about the impact of the substantial funding gaps for providers delivering care to vulnerable members of society across the country. This is a direct result of the

downward pressure on fees received from funding authorities and compounded by the increases in operation costs, which include: a 9% increase in fees paid to the Care Quality Commission; fluctuating energy costs; increase in the National Minimum/Living Wage; pension auto-enrolment cost; and expected increase in interest rates before the end of the year.

A survey carried out by the National Care Association shows that: 9% of respondents are deeply ‘concerned’ about their business; 3% felt that the wage increase would have a ‘significant’ impact on their businesses; 72% were very concerned about their ability to continue in business; and the majority of people responding to the survey did not feel able to

pay their staff the Living Wage of £9.00 per hour by 2020 without a ‘substantial’ increase from commissioners. Additionally, 24% of respondents indicated that they would consider exiting the market if their local authorities did not make a significant move to increase the fees they pay over the next five years.

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Chocolate factory to care village Planning consent for a £60m redevelopment of the former Cadbury’s Factory in Keynsham has been obtained from Bath and North East Somerset Council by Freeman Retirement Living and Taylor Wimpey. The landmark buildings have been secured for development by Bristolbased charity, the St Monica Trust.

The Trust plans to convert the iconic red-brick buildings into a state-of-theart retirement community, featuring 120 assisted living apartments and a 105-bed care home offering a range of specialist care. The St Monica Trust is celebrating its 90th anniversary this year and the Keynsham site will be its fifth retirement village.

Greensleeves acquisition Greensleeves Homes Trust has acquired Gloucester House, a 54bed care home in Sevenoaks, Kent.

This acquisition brings the total number of care homes managed by the Trust to 18.

CMM Insight is CPD Accredited Attendance at CMM Insight conferences now counts towards Continuing Professional Development (CPD). CPD is a commitment to lifelong learning, a skill that is invaluable to all people across every segment of society. According to the Care Quality Commission, ‘CPD offers an assurance that the worker is maintaining and developing their skills and knowledge in order to support people who use services. ‘As well as being an indicator

of quality, there is a wide range of business benefits associated with the consistent achievement of relevant qualifications within the workforce… qualifications and CPD are of crucial importance to providers and managers alike.’ The CMM Insight Lancashire Care Conference is on 23rd September and the Berkshire Care Conference is on 15th October. CMM website subscribers receive a discount to CMM Insight events.

Immigration rules will cause nursing chaos The Royal College of Nursing (RCN) has released new research revealing that changes to immigration rules will risk intensifying the severe shortage of nurses in the UK, compromising patient safety, as well as costing the health service millions. Under the new rules, people from outside the European Economic Area (EEA) must be earning £35,000 or more before they are allowed to stay in the UK after six years. These rules will force many nurses to return to their home countries, leaving employers with nothing to show for the millions of pounds spent on recruiting them. The effects of the new rules will start being felt in 2017. The RCN has calculated that up to 3,365 nurses currently working in the UK will potentially be affected

and estimates that it will have cost the NHS alone £20.19m to recruit them – money which will have been wasted if they are forced to leave the UK. The figures for future years are even more worrying, particularly if overseas recruitment continues to rise as a result of a shortage of homegrown nurses and a crackdown on agency nurse spending. If international recruitment stays the same as it is now, by 2020 the number of nurses affected by the threshold will be 6,620, employed at a cost of £39.7m. If workforce pressures force a higher rate of international recruitment, the number of nurses affected could be 29,755, costing over £178.5m to recruit.

In focus Phase 2 of the Care Act delayed WHAT’S THE STORY?

In response to concerns expressed by the Local Government Association and many other stakeholders about the timetable for implementing the cap on care costs in April 2016 (Phase 2 of the Care Act), the Government has announced a decision to delay its implementation until April 2020.


In March, the Government consulted on its proposals to implement the recommendations of the Commission on Funding of Care and Support, chaired by Andrew Dilnot. The formal consultation closed in the preelection period and was not published. The announcement of the delay allows time to be taken to ensure that everyone is ready to introduce the new system and to look at what more can be done to support people with the costs of care. There were substantial implications for local authorities and a fear that implementing the cap in April 2016 could destabilise an already fragile care market.


The proposals to cap care costs and create a supporting private insurance market were expected to add £6bn to public sector spending over the next five years. But there are no indications the private insurance market will develop as expected. The Government had stated that it will continue with other efforts to support social care, in particular through the Better Care Fund, which will drive the integration of

social care and the NHS. Separately, Health Secretary Jeremy Hunt MP has written to Dr Sarah Wollaston in her capacity as Chair of the Health Committee explaining the decision, emphasising the intention to use the delay to ensure that there is better planning and to work with the financial sector. The letter certainly appears to suggest that a lack of preparedness by local authorities was the main reason for the delay (although it also cites the impact of the new national living wage).


The introduction of the cap on care costs system is probably the biggest reform to how care is paid for since 1948 and, therefore, it is vital to ensure that the new system is ready to work as intended from the first day. The National Audit Office had also highlighted particular concerns about the timetable for delivery. The Government statement announcing the delay also said, ‘We will work hard to use this additional time to ensure that everyone is ready to introduce the new system. It will also provide an opportunity for us to continue to work together to consider what else we might do to support people to prepare for later life, including the risk of needing care and support. For example, the new pension flexibilities that were introduced in April create a real opportunity for us to work with the financial sector to look at what new products may be developed, thereby creating even more choice.’ So, four and a half years to resolve the situation and satisfy a series of competing demands. CMM September 2015 15


Housing and Health Exchange The Housing LIN has been working with Public Health England to get a web-based programme of knowledge and information exchange up and running to support peer-to-peer learning and discussion. This free online resource for

practitioners working across housing, adult social care, public health and primary care practitioners lists relevant policy and showcases examples of practice that have either helped to transform people’s lives and/or improve local service delivery.

New HIV guidance

Health Care REIT and Avery

The National AIDS Trust has developed new guidance for care workers on how to support older people living with HIV. The guide can be downloaded from its website free of charge.

Health Care REIT has acquired a 9.9% equity stake in the Avery, and provided a substantial working capital commitment to support further developments. Avery has assisted living facilities under development in Aldridge and Northampton, together with care home developments in Derby, Bristol, Clevedon, Bracknell, Stafford and Greater London. Health Care REIT had already acquired a total of 14 care homes operated by Avery in July 2013. It was this initial transaction that formed the basis of a commercial relationship that has continued to develop. Health Care REIT Inc. of Toledo, U.S. is the largest healthcarefocused real estate investment trust in the U.S., and is listed on the New York Stock Exchange with a market capitalisation of circa $40bn.

Financial sustainability in social care Survive or Thrive: securing financial sustainability in social care – the provider perspective a paper from the National Care Forum (NCF) has introduced a programme of activity focusing on the issue of sustainability in social care (and health care) services. It builds on work already being undertaken on workforce, which will be published shortly, and a continuing consideration of the impact of regulatory developments. Des Kelly OBE, NCF Executive Director, said, ‘We need a clear vision of new models of care and new ways of working that recognise

the vital role of social care to support the NHS. This needs to be combined with a willingness for providers to work collaboratively with key partners to ensure adequate resources for social care. Let’s ramp up the dialogue with commissioners and others. ‘The Market Position Statements at a local level are an important opportunity for providers to ensure that commissioners understand that sustainability and quality improvement are of equal importance. The NCF supports the view that all providers, including

not-for-profit organisations, must continue to play their part in raising quality, increasing efficiency and reducing demand and dependency through preventative measures. Nevertheless, authoritative sources point to the likelihood of a substantial funding gap in both health and care which will impact adversely on both people and providers unless it is urgently addressed. NCF will be working with other members of the Care Provider Alliance to engage the Association of Directors of Adult Social Services and others to make clear our concerns.’

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Heathcoates expansion plans Heathcotes Group has agreed a £20 million expansion plan which will double the size of its business. The support from Yorkshire Bank, a combination of debt funding and working capital, has been agreed on behalf of the Group by Mitchells Chartered Accountants and Business Advisers. With more than 30 care homes and around 800 full-time staff, Heathcotes already has a strong presence in Leicestershire, Nottinghamshire, Derbyshire, Staffordshire, Lancashire, Cheshire and Yorkshire, but is now targeting cities such as Manchester and Birmingham for further growth. The Group plans to add a further eight care homes to its expanding portfolio in 2015 alone, with more scheduled in 2016 and 2017.

NICE consultation The National Institute for Health and Care Excellence (NICE) and the Department of Health (DH) are running a joint consultation to seek views on which social care topics NICE should produce quality guidelines and standards. The Health and Social Care Act 2012 set out a responsibility for NICE to develop quality standards and guidelines for social care in England. In 2013, the DH ran a consultation to identify social care topics suitable for developing into NICE guidelines


and quality standards. An initial set of topics has been referred by the DH and Department for Education. In order to develop the longer term social care work programme, the DH and NICE have provided a list of proposed social care topics for comment and are asking if there are any others topics that are missing from the list. More information on the consultation can be found on the NICE website. The consultation closes on 9th October 2015.

Care Act reform report The Department of Health (DH) has implemented the first phase of the 2014 Care Act well, according to the National Audit Office. 99% of local authorities were confident that they would able to carry out the Act reforms from April 2015. This report, Care Act firstphase reforms, finds that the DH consulted carefully on the Act, to

understand the main risks and respond to sector concerns, and there is wide support for the Act. Other departments implementing programmes could learn from this approach. Local authorities identified two big risks: cost and, secondly, uncertain additional demand from self-funders and carers.

Do you believe social care will receive the funding it needs from Government? Yes No You can vote via:

July’s results Are your clients: Local authority funded 11% Self-funded 19% Both 70% 0








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Significant nursing challenges The National Care Forum (NCF) workforce survey has highlighted significant challenges for employers of nursing staff in adult social care. The recruitment and retention of nursing staff is clearly a significant issue for care providers. The National Care Forum Personnel Statistics Survey Report 2015 details the workforce of 60 organisations and over 64,000 employees. The survey this year includes detailed information on nursing in adult social care for organisations providing over 6,000 residential nursing care places and additional nursing support within homecare services. There has been considerable attention directed at staffing levels in the NHS within the last 12

months and, in turn, this appears to have impacted on both recruitment and retention of nurses to the adult social care sector. Turnover of nursing staff in the survey ranged hugely – from zero to an astonishing 83%. The reasons given for nurses taking up employment elsewhere were particularly resonant across organisations, including: returning overseas; expectations very different from previous roles; other employers paying more; and increase in NHS nursing opportunities. The report includes further detailed information including staffing age groups, qualifications, turnover, leavers, sickness absence and agency use across all care services.

New guide on ISFs There is new, comprehensive advice to help councils and providers meet Care Act 2014 guidance on Individual Service Funds (ISFs). ISFs help people with care needs to have flexible, personalised support, tailored to individual preferences without having to manage the responsibility of cash direct payments. It means people and families can choose to live in their own homes, with their own support and using their own budgets, while the councils that commission those services work differently with community organisations and providers of services to improve

outcomes for people they serve and reduce costs. ISFs also work well in residential care settings and have been used as a model for improving the flexibility of homecare delivery. The Guide, Individual Service Funds (ISFs) and Contracting for Flexible Support, developed by Think Local, Act Personal and Housing and Support Alliance, is aimed at council commissioners and providers, and sets out how councils can contract flexibly with a service provider to meet a person’s needs, and contract in a way that gives the person more control over their own support.

Northumberland development A former cattle auction site has been transformed into a luxury assisted living scheme which will provide a home to 73 residents and employment for up to 100 people. Construction on the £7m scheme at Ponteland in Northumberland is almost complete and operators Crown Care are now recruiting nursing staff ahead of its opening in the autumn, paying above the living wage of £7.25 an hour. 18 CMM September 2015

The Royal Hampton is a 73-bed home providing residential, nursing and dementia care; two three-bed bungalows and four three-bed town houses with associated car parking, service amenities and garden area. Crown Care engaged Newcastle-based architects Alston Murphy Associates to design the development to the highest specifications alongside the building contractors, Chester-leStreet’s Meldrum Construction.

Living with dementia – survey A new survey has been developed to understand the experiences of people with dementia and their loved ones. Care Choices is conducting the survey of people’s experiences of living with, or caring for, someone with dementia. The team would like to hear real-life experiences from people living with dementia or caring for someone with dementia – sharing practical advice, hints and tips.

What worked for one person, and what didn’t, can help others to build up their knowledge of dementia and how to manage the symptoms on a day-to-day basis. It’s the knowledge of Experts by Experience that is so valuable. Professionals are encouraged to share their experiences too. The short survey is available online at dementiaexperiences

Stanage Lodge DC Care has sold Stanage Lodge, a former care home in Grimsby, to Pathways Care Group. The home, which is purpose-

built, was part of a series of strategic disposals by HICA, as they move into specialist dementia care provision.

Devon care home acquired Southlands Care Home in Newton Abbot, has been acquired by new owners with funding provided by The Royal Bank of Scotland. Decorum Care & Support Services Ltd, which is owned by

Andrew Bone, has acquired the 28-bed elderly care facility after it was put up for sale by its previous owners who were retiring. RBS has supported the acquisition with a fee-free loan.

Brookdale Care acquired by Tracscare Tracscare has acquired Brookdale Care. A long-established care provider, Brookdale is renowned for its specialism in delivering outstanding care and support for people with autism and its leading Milton Park Therapeutic Campus. The campus provides an innovative care pathway, with specialist services for psychiatric intensive care, intensive behavioural support, transition and registered residential needs.

Tracscare and Brookdale share a commitment to delivering bespoke, person-centred care and support that enables people to meet their true potential. The two providers both work in partnership with commissioners to deliver responsive, flexible, specialist care and support through market-leading training of dedicated, experienced clinical teams and care staff.

Care UK in Suffolk and Norfolk July saw a trio of new, state-ofthe-art homes added to Care UK’s portfolio of care homes in East Anglia. The first residents arrived at Cavell Court – a new home in Norwich which, when full, will provide comfortable, high quality care for up to 80 older people. In

addition, two more homes, Cleves Place in Haverhill, and Cedrus House in Stowmarket, built as part of a contract with Suffolk County Council, held ceremonies with residents and local dignitaries to mark their official openings of the homes.

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With significant pressures in the sector, how can providers collaborate with commissioners to ensure social care is sustainable for the future?


Ray James, President, Association of Directors of Adult Social Services.

The Association of Directors of Adult Social Services (ADASS), and its predecessor the Association of Directors of Social Services (ADSS), have both had long histories in contributing substantially to the growing wisdom lying behind commissioning. This, not just on our own, but alongside a wide-ranging number of stakeholders and partners. A good example of the breadth of interest and involvement is the commendable initiative the Care Quality Commission (CQC) has taken of organising an event on the sustainability of the sector. This will bring together commissioners,

20 CMM September 2015

providers, representative bodies, government officials and - probably for the first time - banks and lenders too. Everyone at a recent CQC symposium on the topic was made very much aware of the moral imperative we all share to improve the sustainability of the sector. My own contribution was to stress the commissioner’s role as bringing people together to co-produce a transparent and shared understanding of the outcomes desired and the issues and risks associated with that. Everything from a fair and true cost of care through to our importance of social care to the wider economy.

SUSTAINABLE COMMISSIONING Increasingly, our role is to create the conditions within which others (citizens) make their purchasing decisions and transactions. We can

increase the focus on outcomes, on securing value chains and encouraging transparent and openbook approaches to cost. Further evidence of our involvement comes from Sandie Keene’s initiative, during her ADASS presidency, to produce the Top Ten Tips for Commissioners. It’s surely no accident that we have recently instituted a specialised commissioning network, chaired by Calderdale’s Bev Maybury, to join its other key policy areas. More recently, alongside Department of Health, Local Government Association (LGA) and Think Local Act Personal (TLAP), we co-sponsored the seminal Commissioning for Better Outcomes from the Health Services Management Centre in the University of Birmingham. Both initiatives have stressed the importance of sustainability. This latter document was launched last autumn and is already being piloted and tested within the LGA’s Peer Challenge initiative. Its essential task


Collaborate for a sustainable social care has been to lay down 12 vital standards of good commissioning, and to provide commissioners with the means to test themselves against the demands they make. It will be a long time before the last word is written on the topic; but it’s well worth reminding ourselves of just what those 12 key standards are, representing as they do current state-of-the-art thinking on the issues. Good commissioning: • Focuses on ensuring diversity, sustainability and quality of the market. • Is person-centred and focuses on outcomes. • Promotes health and wellbeing for all – including physical, mental, emotional, social and economic wellbeing. • Delivers social value – for the whole community not just the individual, their carers, the commissioner or the provider. • Is co-produced with people, their carers and their

communities. • Promotes positive engagement with providers. • Promotes equality of opportunity. • Is well-led by local authorities. • Demonstrates a whole system approach. • Uses evidence about what works. • Provides value for money. • Develops the commissioning and provider workforce. The key point running throughout these standards is co-productivity – an essential stress on the fact that commissioning is not an isolated task carried out behind the walls of a single local authority bastion. It is one that is essentially outward-looking, wedded to the wider needs of communities, individuals and providers and one which acknowledges the skills and qualities that everyone engaged in the process can bring to the table. In an age where integration of services is going to

be the sine qua non of all our care services, those principles cannot be ignored, overlooked or mislaid.

THE CURRENT PICTURE Well, that’s the ideal. How far away from it are we? How far are we down the road of creating an ideal paradigm in which local authority commissioners and their providers are achieving their fullest potential in pursuing the interests and wellbeing of people who need and use our services? As Bev Maybury put it at a recent joint ADASS and Social Care Institute for Excellence seminar, ‘Have we got the right commissioning skillset or are we still dealing with the same old emperor just dressed up in a set of new clothes? And in process terms, do we have the right systems and tools to be agile enough to respond to future demand and variance in quality? ‘Are Market Position Statements (MPSs)


CMM September 2015 21



providing the basis to shape our markets differently? Or are they merely aspirational? We all need, all the time, to consider tighter investment in our business relationship capacity to help move us away from reliance on traditional commissioning, procurement and contracting roles.’

COMMON PURPOSE We undoubtedly have a common purpose, and one which is heavily underlined by legislation bringing together a jigsaw of social care legislation, regulation and guidance. What are its core principles? They are for us ‘to prevent, postpone and minimise people’s need for formal care and support...built around the simple notion of promoting people’s independence and wellbeing… people should be in control of their own care and support.’ The independence and wellbeing we promote must: • Be personalised: people who use our services must have choice and control over what really matters to the quality of their lives. • Increase the voice and influence of citizens and carers over their own lives and their communities. • Build individual and community capital/ resilience. • Create a safe, sustainable system or market with a diverse range of choices of good quality affordable care and/or support. The Care Act, too, is symptomatic of an unprecedented degree of co-operation which has emerged within the sector during the past five years. Yes, there are still fault lines, but the old adversarialism is long gone, a thing of the past long put into a box from which we hope it will not easily spring again. The Commissioning for Better Outcomes publication is one example of that and there are many more. However, it is within the development of the Care Act that we have seen taken forward a vision for social care long championed by local government. This sustained engagement of the entire sector – including providers – has been pivotal in shaping the legislation and underpinned the preparation for implementation of Phase One. There is no doubt that adult social care, despite being some £4.3bn adrift of the total cash it has required over the past near-five years, engaged in, welcomed and provided substantial input to the Act. As far as Phase Two is concerned? We know

that the delay until April 2020 will have some major impacts on the lives of our citizens and on the markets within which we all operate. We know that, by then, profound and irrevocable changes will have been made to the landscape in which all care – health and social, voluntary, private and independent, family and community – is delivered. Despite this, we have welcomed that delay because of the possibilities – I stress ‘possibilities’ – it provides of having additional funding to attend to current services which are in urgent need of further, pretty well immediate, investment.

SUSTAINABLE MARKET Despite the welcome co-operation I’ve spoken of, there are still outstanding ‘stress points’ – key issues which commissioners and providers equally share and need to resolve. MPSs, for example, should underpin active dialogue with providers and the delivery of innovative, person-centred, quality care and support services. What does your supply and demand picture look like? Have you established with your colleagues an appropriate market balance? Has that been calculated and addressed within a strong relationship with your Clinical Commissioning Group? Crucially, what about the overall financial profile in your locality, your joint appreciation of the importance of local land and property values, and your assessment of labour market and labour supply issues? This latter point will be pivotal in the growing, keenly felt competition there will be – very keen in some parts of the country – for labour. Commissioners and providers are obliged to work together to secure a sufficient, properly remunerated and trained workforce. We know there are acute problems arising from the Government’s commitment to a National Living Wage by 2020. There are obvious connections with the current state of social care funding, the position of the training agencies and the exposed position any negotiations prior to a referendum on membership of the European Union could have on the movement of labour within the Union. As with negotiations over fair prices for care, it is absolutely vital that commissioning is seen as the joint pursuit of a common interest in the wellbeing of our service users. We really do need a golden thread of national policy and funding so that if the Chancellor

backs up his encouraging words about raising the minimum wage to £9, with a transparent and agreed sum of money to do so, that money ends up in the wage packets of those frontline social care workers who make a difference to the lives of over a million people in our country, every minute of every day. Frankly, a failure to remunerate and recruit, train and retain a confident and secure workforce is tantamount to a failure to care properly for the people we expect them to care for. Diversity and sustainability in the market is a shared endeavour built on an agreed fair cost of care. No opportunity should be lost to emphasise this point to people who have to make decisions concerning social care funding – particularly in the light of the forthcoming four-year Spending Review. Equally frankly, the close collaboration between commissioner and provider will never be more important – and perhaps tested – when it comes to fulfilling our statutory duties with regard to potential or actual market failure.

REDEFINING SOCIAL CARE Scoping what sometimes appears to be a menacing, if not hostile, horizon there are some major shifts which again are forcing social care to redefine itself. As CQC Chief Executive David Behan might put it, those old tectonic plates are shifting again, and if they crunch up against each other they will make a very unpleasant noise indeed. Precisely what proposal for deeper integration of health and social care might emerge from the Spending Review is anyone’s guess. But emerge they shall, and it will be in the joint interests of commissioners and providers to keep a weather eye on developments there. They will not be entirely divorced from constitutional alignments which will take shape around devolution – Cornwall-style or Manchester-style (DevoManc). These changes, and the sorts of ‘tri-borough’ experiment seen in London and elsewhere, will continue as part of the convulsions set in motion by the wider economic turbulence in which we have been placed these past five years or so. It will make providing more complicated. It will make commissioning more complicated. All the more reason, then, for both providers and commissioners to seize the new opportunities that are arising and help keep social care at least on top, and even at the cutting edge, of a seemingly never-ending chapter of public sector reform. CMM

Ray James is President of the Association of Directors of Adult Social Services. Twitter: @RayJJames @1ADASS Is your commissioner open to collaboration? Comment on this article on the CMM website Web subscribers can also access additional content. 22 CMM September 2015

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A VISION FOR HEALTH AND SOCIAL CARE REFORM The Government’s announcement that it is postponing the implementation of the 2016 Care Act changes, reiterated its support of integrating health and social care. It is now imperative that the two sectors come together and reform their ways of working to protect the whole system. With that in mind, two leading names in social care and health have published their proposals for reform. Is this the solution? Anyone operating in social care is aware of the importance of integrating health and social care. We have a perfect storm of an ageing population, increased numbers of people living with long-term conditions, squeezed local authority budgets, discrepancies between the fees paid by private clients and councils, high staff turnover, increased operating costs and that’s just social care. The NHS is at breaking point, accident and emergency departments can’t function through the winter, there are insufficient beds to meet demand, older people are admitted to hospital and then struggling to get back out again leading to bed-blocking, amongst other things. It’s obvious something needs to change. When it comes to funding, the NHS budget is protected, with the Government committing in the recent Budget to increase spending by £10bn per year in real terms by 2020/21. Although some of this money has to go towards service transformation including integrating with social care, the social care budget via local authorities is continually being squeezed. However, they work hand in hand, if health and social care came together costs could be saved, lives could be improved and pressures on all services could be reduced.

VICIOUS CIRCLE A new report by Ian and Stephen Smith sets out plans to reform the systems and address the ‘vicious circle of a broken down health and social care system’. 24 CMM September 2015

Ian R Smith is a leading name in social care. He is the Chair of Four Seasons Health Care and has held a number of high profile positions in business including Chief Executive of General Healthcare Group which owned and operated private hospitals. Professor Stephen K Smith is a Professor of Medicine who set up the first academic health and science centre at the Imperial College Healthcare NHS Trust. Together they have published, in a personal capacity, their proposals for the reform of the health and social care systems. Originally published in the Health Service Journal, Away from the past and to a sustainable future. How the UK’s health and social care systems can be reformed to better align with the needs of today’s society, sets out their vision. This includes a new type of integrated care organisation keeping people out of hospitals. Hospitals themselves will become academic health science centres consolidating clinical practice and research to deliver personalised medicine to improve health outcomes. They argue that the existing structure of specialist facilities currently in local hospitals isn’t the best way to meet patient needs.

INTEGRATED CARE ORGANISATIONS The integrated care organisations that they propose will remove the boundaries between health and social care, acute and chronic medicine, generalist and specialist skills, primary and secondary settings, episodic and preventative

interventions and physical and mental health. The model would enable health and social care providers to work together to deliver care focusing on the individual that manages their needs, whether physical, social or mental. It would bring together GPs with social workers, mental health experts, pharmacists and diagnostic technology in large health centres. The model would support personal, lifetime care pathways rather than individual episodes of care (such as from home, to intermediate care facilities, to hospital and back home), with each patient having a ‘case manager’ who will navigate them through the system. This would be made possible by a rapid introduction of electronic patient records in a connected digital network. Clinicians would be separated into generalists who would consider the ‘whole person’ in their social setting and specialists based within hospitals, advancing medical science and practice. While the integrated care organisation would need to draw on a balance of specialists and generalists, they say that there is a strong case to consolidate the specialist expertise, for example, in cardiology or cancer into centres of excellence. This will mean fewer but larger clinical units.

MOVING FORWARD WITH REFORM Ian and Stephen agree that there needs to be a strategy for reform to integration – something that is echoed throughout Government, think tanks and wider sector

leaders. However, they are realistic to the barriers, including constant reorganisations affecting the system, complex management structures, an under-supported workforce, fragmented regulation, funding constraints and, of course, politics. Ian Smith explained, ‘We do not under-estimate the enormous political challenge involved. This is in no small part because for more than half a century the NHS has been an election campaigning issue, with the major parties vying to persuade voters they can be trusted to ensure its future. This has created the public expectation that the ultimate goal should be to preserve the status quo. But perpetuating that myth does our society a great disservice and in the long-term it is unsustainable. There is a compelling case for change to put the UK again at the leading edge of health and social care outcomes, just as the establishment of the NHS and social care systems did in 1948. The integrated care model that we propose is realistic and achievable, but we recognise that others may have thoughts on how health and social care could be developed.’ CMM

OVER TO THE EXPERTS... There are many thoughts and strategies for reforming health and social care. If it is universally agreed that integration is the best way to ensure sustainable services, fit for the future, are the integrated care organisations proposed here the solution? Also, how do we get the reformed system that is so desperately needed?

WILL TAKE YEARS OF SUSTAINED EFFORT Ian and Stephen are absolutely right to identify the need to develop integrated models of care in response to demography and changing patterns of needs. This has been a goal of successive governments for over 40 years but achievements have been limited. This should warn us that achieving integrated care at pace and scale is difficult and complex. But our work on hospitals that have begun to develop integrated models and integrated care organisations in other countries offers some helpful pointers. In most of these places it has taken years of sustained effort. Building up trust and effective relationships has been more important than organisational change alone. There are no short cuts. Whole system governance arrangements that engage the resources and expertise of other agencies are vital – especially winning the support and commitment of primary care. Establishing integrated care


organisations would almost certainly require parallel changes in commissioning, with a shift towards population-based capitated budgets that incentivise care outside of hospitals. With England’s current complex commissioning landscape, doing this without structural reorganisation would be tricky. A different regulatory model would also be needed, geared to monitoring the performance of the whole system, not separate organisations, in achieving joinedup care. If this was hard to do when the economic sun was shining, how much harder it is in the toughest financial climate in living memory? But the alternative, to persist with fragmented, unco-ordinated services, will not be sustainable. Examples from UK and abroad show what can be achieved with the right vision, leadership and realism about how long it will take.

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

to admit patients: the more they admit, especially ‘cheap patients’ not requiring complex care, the more money they make. This doesn’t help to advance the community care advocated in the FYFV. Part of the answer is more integrated working; sharing of roles and resources. The New Models of Care, especially the primary and acute systems outlined in the FYFV, will come close to the Integrated Care Organisations. Getting organisations to focus on this locally can work, so the devolution models will be interesting to watch. In the USA Accountable Care Organisations are enabling significant cost savings. This takes time. What happens if the need for short-term financial savings trumps longer-term goals? The Vanguard sites are showing what can be done through new approaches; it would be a tragedy if that were squandered.

Debbie Sorkin National Director of Systems Leadership, The Leadership Centre

THIS DESERVES TO BE EXPLORED The sector was half expecting the announcement to delay the implementation Care Act’s financial reforms. The National Audit Office report into Phase One’s implementation, although more positive than reported, rightly pointed toward the significant and growing gap between the Act’s aspirations and the funding available. Add this to the additional costs of raising the minimum wage and the lack of progress on developing private financial products for long-term care; and the reforms have looked progressively less likely. The inequity these reforms intended to address will not disappear. The sector will have to engage proactively in the new Government’s priorities, specifically over the adopted FYFV and devolution and integration. The sector must then use them as a platform to build a more sustainable future. The Government’s commitment to £8bn extra funding for the NHS underlines the necessity of this approach.

It’s not only in the long-term that the system is unsustainable. £18bn in local authority (LA) budget cuts have left 150,000 older people without homecare, and cuts in fees have led to providers cutting back services, or leaving LA contracts. The growing split between self-funded and publicly-funded care is just as apparent in residential care, with the new minimum wage likely to put more pressure on staffing numbers. Despite relative protection, the NHS budget is also creaking. NHS trusts were in the red by £822m in 2014/15. A recent King’s Fund survey found 89% of Finance Directors planning for even bigger deficits this year, possibly up to £2bn. This is before the £22bn in savings promised in the NHS Five Year Forward View (FYFV). Wherever they operate, people are under pressure to make more income or savings, without considering the impact on the wider system. Trusts, for example, have every incentive

This paper is an interesting addition to the FYFV’s New Models of Care. It makes a compelling case for separating clinicians, with generalists leading an integrated community service in larger centres. Specialists would be freed up to work in fewer ‘centres of excellence’. This deserves to be explored alongside others. However, reorienting local health systems toward care at home and marrying health and care, with such fundamentally different structures, is a huge challenge, not least given (often politically motivated) hostility toward reshaping acute services. As recognised, the ‘how’, shared IT systems, constructive conversations with local communities at their centre and the building of something approximating consensus, is often as difficult as the ‘what’. Overcoming these challenges has never been more pressing to improve people’s experiences and outcomes.

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Core values The key to better quality social care If there is one thing I have learned as a leader in social care it is that establishing and maintaining core values is central to quality care and support services. Embedding those values at all levels of an organisation means we can offer person centred care, where people are supported to live the lives they want. That’s why we focus so diligently on developing programmes that bring the right people into social care and then help them throughout their careers. These programmes also provide us with the opportunity to focus on the values of the organisation these people lead, the values of the people they manage and how to keep those people.

Sharon Allen

I recently spent some time with our latest group of graduates, who are about nine months into their year-long programme. I spoke with them about the importance of strong and effective leadership and management for quality care and support and what we see happen when it is absent. I gave them three tips to focus on throughout their careers: always to focus on values and to model this as they lead teams; to invest in workforce and leadership development; and encouraged them to have, and at the appropriate point become, a mentor. I ended by encouraging them to be ambassadors for adult social care and that’s what I think every one of the hundreds of people who have completed our leadership and management programmes have become: leaders and managers who are always working to improve their organisations’ cultures so they embed core values into every member of their teams.

Turn over to read how Skills for Care is improving leadership and management in the sector

Bringing the right people into the industry Skills for Care, home of the National Skills Academy for Social Care (NSA), recognises the need to bring the right people with the right values into the social care sector and the National Graduate Management Training Scheme was developed to do just that. Harriet Phillips, Programme Manager for Leadership and Management, says the scheme attracts those with the right core values into host organisations which then nurture their development. “Any graduate of any course can apply for the National Graduate Management Training Scheme, as long as they have the right core values. Graduates are subjected to a rigorous recruitment process and then matched with a host organisation that can help them develop within the social care sector. From there, we hope that the graduates will make an impact whilst completing their placement, then progress within the sector, hopefully eventually to the most senior positions within social care.” For graduates, the scheme is a unique opportunity to enter a growing sector, with managerial responsibility straight out of university. For hosts, the graduate scheme offers an individual with strong core values and a desire to work in social care. Annette Bennett, Group Supported Living Manager at Clearwater Care, was a placement supervisor of a graduate in this year’s 2014 and 2015 programme. “Personally, I was privileged to work with Sophie. Not only has she contributed significantly to the achievements of services but we have learnt so much from the process of working with her on her leadership about how we need to invest in developing leaders in the future.”

For more information, please email or visit

Enhancing the skills of those in senior management Most senior social care leaders have worked their way to the top based on strong core values. Once there, they have the opportunity to drive change, both locally within their own organisations and nationally. In order to encourage these changes, it is important that they are supported to develop their leadership and management skills and given the space to collaborate with other leaders in the sector.

enhancing the leadership and management skills of senior leaders and directors will help improve the social care offer.

to build up their peer networks across sectors, and actively work towards integrated solutions to the challenges facing social care.�

“There is a need for real change across adult social care. Once we have the right leaders and managers in place, those who really want to drive change forward, it is important that we give them everything they need to do this.

The New Directors programme covers key issues faced by directors of adult social care services, including political governance and the need to show leadership across a wide range of networks.

Through our Top Leaders and New Directors programmes - the latter of which was developed with the Association of Directors of Adult Social Services (ADASS) - Skills for Care equips those with the right core values and the desire to make a change with everything they need “That is what the Top Leaders and New Directors programmes to positively influence the sector. were developed to do, to embed the essential leadership and Patrick Carroll, Programme management skills into these roles Manager for Leadership and and to support senior leaders Management, is clear that

Top Leaders was developed to help those working in the most senior positions across health and social care understand their role in the wider context of the rapidly changing social care sector, as well as improving skills and confidence.

Both programmes are due to start in October 2015. For more information, please contact

Graduate Management Training Scheme For more information on this scheme, please visit, or email

Top Leaders and New Directors If you are interested in developing your skills as a senior leader or new director in social care, please email New Directors ÂŁ799 (exc VAT) Top Leaders ÂŁ1,950 (exc VAT)

Will you be a winner? The Skills for Care Accolades reward the best of the best employers who are committed to delivering high quality care and developing their workforce. Entering the Accolades gives you the chance to recognise the great work you do and also to share best practice across the sector.

Enter our awards now!

This year entry forms have been simplified and there are nine categories for you to choose from, including best employer of over and under 250 staff, best provider of learning and development and most effective approach to leadership and management. The closing date for entries is Thursday 24 September 2015.




Helen Baker is Chair of Dimensions.

REFLECTIONS ON THE LAST DECADE From my perspective there have been two big shifts in the sector. Firstly, the level and pace of outsourcing of social care services from the statutory to the private and, in particular, the not-for-profit sectors. Secondly, the rising expectation that the people using services should have a greater voice about what is delivered and how; that we start by assuming capacity rather than looking for what the individual cannot do. Dimensions is a great example of a number of organisations joining up to deliver better together over the last decade. It is now a substantial national player committed to changing the lives of people with learning disabilities and autism. The rapid growth of Dimensions has meant that we have had to invest considerable time and capacity in building strong controls to ensure efficiency and quality. We can now use that sound base to take positive risks and work with staff, the people we support and families to research new ideas and models. I have moved to an entirely nonexecutive portfolio working with boards across the not-for-profit sector, NHS and central government. My passion for good governance is about creating secure space for innovation. Working across different bodies and sectors has opened

up opportunities for me to do what I really thrive on - making connections between people, organisations and ideas to transform what social care can achieve. PROJECTIONS FOR THE NEXT DECADE In the sector, investment in preventative services will continue to be outgunned by critical and acute health demands, in particular, despite efforts to shift this. Paid services will increasingly focus on those with the highest level/most complex needs. There will be a renewed energy in building informal community-led support built around networks as much as traditional organisational models. At Dimensions, we will work more through partnerships and alliances based on shared purpose and values. We will leverage our size to enable the people we support and their families to have a more powerful voice to influence what really matters to them, including what we deliver. We will also add value to the sector by researching new models of support evaluated against the outcomes chosen by the people we support. Regarding my career, I am already enormously enjoying the kinds of non-executive roles which define most people’s opportunities post paidemployment so I hope to be able to sustain this for some years to come.

INSIGHT Without strong, proportionate governance organisations waste energy and capacity on chasing the demands of commissioners, regulators and public expectation. A well-governed organisation can focus all this energy and capacity on working with the people it supports to transform what is possible. INFLUENCES My family, the exceptional colleagues I have worked with at all levels of the organisations I have been a part of, but in particular, what the people we have supported have been able to achieve when their capacity, rights and choices have been properly valued. LESSONS The biggest lessons I have learnt are that the most significant opportunities to drive the changes I have really cared about have often been in the gaps between organisations. Also, investing in leadership at all levels is transformational. ADVICE Be brave and push the boundaries. Actively look for opportunities which push you outside your comfort zone if you want to continue to grow professionally and achieve more than your younger self would have believed possible. CMM

An extended version of this interview can be found at CMM September 2015 27


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I have to admit it, I felt slightly out of my comfort zone. Which is ironic because I was about to take part in a Twitter event on organisational change for social care managers. Steve, from the communications team at the Social Care Institute for Excellence (SCIE), one of our partners in a new venture in this area, said that a good way to get

discussions going on issues like this is to join a pre-arranged Twitter group. As I sat there at five o’clock, I wasn’t sure if anyone would join us. I needn’t have worried. The ‘event’ was very successful and it turns out there’s a great appetite to learn about organisational change. Care and support is changing all the time. I think it’s important


Managing change in an ever-changing sector Robin Miller explores new research and resources to aid change management in an ever-changing social care.

CMM September 2015 29



to respond to this developing world by looking at the way that organisations are managed. It’s exciting because this sees the introduction of new policies and resources taking on the views of local people and communities, and also sees people embracing technological change. There’s never been a better time to look at organisational change in social care. Until now, there haven’t been many resources to support organisational change. At the University of Birmingham, we’ve produced a resource, Managing organisational change in adult social care, in partnership with SCIE and the University of Middlesex. The original research on which the resource is based was funded by the National Institute for Health Research’s School for Social Care Research.

A TWO-WAY STREET Organisational change must be a two-way street and a social media meeting was a good way to introduce it, because with ‘change management’ you don’t want to preach to people. Take the case of Bharat who is the subject of a case study within the new resource. Bharat is responsible for overseeing a radical change in practice which will support and enable service users and their families to rely more on their own resources, and to use direct payments to supplement those resources. To remove barriers between caring specialisms and to take out some management costs, a new generic social care team has started up, managed by Bharat. It sees three teams come together, with all the cultural issues that brings with it. Through his case study we learn that Bharat was challenged by a colleague when he selected the ‘Lean’ process for organisational change. Lean is drawn from the automobile industry and, therefore, the colleague suggested it’s not appropriate for social care. As a result of this challenge Bharat ran a workshop that enabled them all to modify the Lean approach to work more effectively within the social care setting they operate. Lean looks at an organisation’s ability to do more work with fewer resources. All the way through we hear Bharat’s reflections on how it’s going. He says, ‘While you can’t build a new culture in a day, we’ve made a good start. When we collected stakeholder perspectives this year, there were fewer differences between groups.’

Social care never sits still. Over the course of their careers, senior social care professionals, including, managers will have built up a set of practice-based skills and experiences about what has worked in the past. This knowledge can be applied to future ‘change situations’. However, there’s more. I think that we need to expect (and support) frontline social care practitioners to act as practice leaders, akin to clinical leaders in the health sector. Bharat’s colleague may have a valid point when raising their eyes to the ceiling and suggesting that some attempts at change management are, ‘just another restructure.’ Restructuring can have a role to play, but only as a support to changing culture and practice, and not as in the end in itself. No-one is saying that this isn’t complex. Although some issues can be resolved quickly and easily in the right circumstances. A tweet came in during the event I mentioned above from social care blogger Rich Watts (@rich_w). He said, ‘Sometimes an hour over coffee can be the source of many positive effects.’ However, although social care providers and managers often have the skills to lead change, they sometimes don’t also have a language or the practice frameworks to help them communicate and reflect on what they do. In the resource’s accompanying film, Tony Waterfield, Senior Practitioner at Solihull Metropolitan Borough Council, said, ‘People can really benefit from online learning like this. They can remind themselves about how change can feel and they can find out how managers can be supported to adjust to change, and to recognise the vast wealth of skills they and their workforce possess.’

SLOWLY (AND COLLABORATIVELY) DOES IT Another point that staff make about organisational change is that it’s done at breakneck speed, as if someone on high wants it all happening five minutes ago. Richard Humphries, Assistant Director of Policy at the King’s Fund (@ RichardatKF) joined in the Twitter event and said, ‘Sustainable change takes much longer than electoral/financial cycles.’ I couldn’t agree more. Policy initiatives can be helpful but they can often disrupt too. We need stability and funding certainty. The people we serve, along with their carers and frontline staff, are at the centre of social care and need to be at the centre of change.



Bharat’s is just one example from the resource, which provides a set of tools and approaches to access when undergoing a change process. During the research stage, SCIE and the two universities spoke widely to managers and people who use services. As a result we’ve created four, particularly useful, case study scenarios of managers in different social care contexts, together with a compilation of change approaches. There is also an accompanying film, embedded on the site. The other scenarios look at Alex, the manager of a care home for older people, owned by a housing association; Carl, the manager of a new recovery hub within an NHS mental health trust; Denise, the manager of a residential care home for people with learning disabilities, which is closing down.

SCIE’s Ewan King warned in a Guardian article recently that the worst case scenarios he was tasked with looking at as a researcher 18 years ago are now the norm. So, I think it’s only right to say that it’s time we got on with this. There I go, trying to get it done overnight. The final word to wise comes from Ian James, Director for Communities and Adult Social Care at Solihull Metropolitan Borough Council. Ian said, ‘Often we make the job more difficult for ourselves by failing to recognise the human instinct to resist change and by focusing on the process of change rather than the experience.’ This new resource is designed to help people overcome some of the barriers to starting the process of organisational change. I shouldn’t have been concerned about attendance at the Twitter event. Its success only went to reassure me, as our research for the resource did, that there is a great willingness out there to embrace organisational change in social care. CMM

THE REALITY OF THE SITUATION Managing change is a day-to-day reality for most social care professionals.

Robin Miller is Senior Fellow at the University of Birmingham’s Health Services Management Centre. @RobinHSMC Comment on this article on the CMM website Web subscribers can also access additional content. 30 CMM September 2015

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INTERIOR DESIGN Alexandra Ledger explains why a good interior designer isn’t an additional cost to a project but an essential professional to maximise profitability and quality of life. 32 CMM September 2015

Fuelled by both media coverage and Government policy changes, the significant rise in public interest in the care home sector in recent years has resulted in a population that has become more informed, more demanding, and more knowledgeable about what is available. One outcome of this has been the rise of an increasingly competitive private market, in which interior design has grown to become an important focus for residents and their relatives when choosing a home.

IMPORTANCE OF DESIGN The measure of a successful care home is taken in a number of different ways. The wellbeing of residents, commercial success and the quality of management and staff all play important contributing roles. However, it is not often that design is extolled as a key factor. Yet in 2002, the Joseph Rowntree Trust’s report on designing and managing care homes for people with dementia stated that, ‘good and pertinent design will provide the platform on which these other success factors can be based.’ Similarly, successful care home design is, in itself, the bringing together of many different elements. It involves collaboration between people offering a wide range of expert skills, with a home’s interior design having equal standing to the exterior appeal. A good interior designer can play a key role in the successful completion of what can be a difficult process, making it important for clients to take this into account at the outset of what will inevitably be a complicated, collaborative effort.

ENGAGE THE RIGHT DESIGNER If you are considering undertaking a new development or refurbishment it is essential to establish what particular services you need from an interior designer. The term ‘interior designer’ is, unhelpfully, an ambiguous, catch-all phrase that encompasses professionals working for both the domestic and commercial markets and fails to recognise the very different sectors and levels of services available. Given the complex and rigorous demands placed on interiors within care environments it is key to ensure you engage a designer with the knowledge and experience to provide appropriate solutions; this helps to maximise the return on your investment. You want to be secure in the knowledge that the finished product will not only appeal to potential residents and give the best opportunity to improve their health and wellbeing, but also be fit-for-purpose and thus

maintain these benefits into the future, giving a home long-term viability. Due to the unfamiliarity with the services an interior designer can provide, there can be the perception that the role is not essential and, therefore, an additional and unnecessary cost. However, a knowledgeable and experienced designer (especially when brought on-board early in a scheme) can add real value to a project. A recent example of this was where we identified the unnecessary over-provision of assisted bathrooms on planning drawings for a proposed care home and were able to reconfigure the interior layouts to gain an additional bedroom on each floor. This added income potential to the home. Financial acumen not only applies to the ability to see the bottom line implications of design; budgetary control is also of crucial importance. Good designers have the knowledge and resources to make a limited budget go further. Different interior designers will offer different levels of service. For example, some will provide a purely furniture, furnishings and equipment (FF&E) based service – put simplistically this covers anything that would fall out if you tipped the building upside down. Other designers offer a more holistic service, which, in addition to the above, provides a more in-depth and architectural interior design solution. You would expect to receive much more input on how a space is to be used and how different areas of a home might affect different residents and their wellbeing. This type of service might typically include involvement in the layout and design of internal spaces at early planning stages, ceiling and lighting layouts and the co-ordination of services. Providing this level of input is traditionally how designers work within the hotel and leisure sectors and, generally, achieves a more comprehensive finish overall.

BENEFITS OF EXPERIENCE There are risks involved if you don’t employ a specialist for your interior design. These can include: • Lack of programming and management of the design process can lead to critical dates being missed in the contract programme, causing delays and potentially added costs. • Potential for compliance failures, with finishes and materials not meeting regulatory issues such as Building Regulations, Fire Regulations and British Standards. • The aesthetic ‘promise’ of the exterior of the building ends up not being matched by the interior. • The design doesn’t consider specialist best


CMM September 2015 33


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practice such as design for dementia. • Not getting the best finishes, furniture and furnishings solutions to suit your budget. • Ill-considered furniture and fittings provision increases the likelihood that interiors become ‘institutional’ in style. • You may lose the opportunity to increase the health and wellbeing of residents through good design.

WHAT TO EXPECT A good commercial, interior designer, specialising in care environments and experienced in providing services for new build and refurbishment contracts, will be able to work seamlessly with your consultant team. They will provide a structured, managed process for the interior design phase. This will tie in with the main contract programme and critical dates for the project, ensuring requests for information from your consultants and contractor are met and avoiding site delays and their costs. The starting point of any design project is the brief, which is an essential first step. If one does not already exist then your designer will help you develop this to provide a clear and robust framework around which the interior design is formed. They will have an extensive resource and design library. This will contain the latest finishes and materials available for the contract market. You should also expect your designer to be up-to-date with the latest materials that are most suitable or specifically designed for care environments. They should also be able to advise on interiors matters relating to current Building Regulations, British Standards and Care Quality Commission requirements. Timing is important. Commissioning an interior designer early on in a project to plan interior spaces properly can bring to light design issues which might not have been considered. For example, we were brought in late on a project to provide decorative interior design services. On examination of the plans we highlighted that the first thing people coming into the building would see were the double doors of the plant room facing the entrance. Unfortunately at that late stage it would have been too costly and disruptive to reconfigure the access but an earlier involvement would have led to a better and more aesthetic solution. Key traits in a good design company are flexibility of approach, an ability to provide a

breadth of service to suit each individual project and, as necessary, the ability to see a project from the earliest planning stages through to completion and beyond. Whether it be planning stage interior architecture, detailing bespoke joinery (eg. reception desks and bars) or providing the essential finishing touches and accessories to complete your ‘home’, your designer should be able to collaborate with your team to provide a holistic and seamless package covering all your requirements and aspirations.

GOOD DESIGN IN DEMENTIA CARE Nowhere is a collaborative and holistic approach more important than when designing homes for people with dementia. There is increasing evidence that poorly-designed care environments can have a significant and detrimental effect on patients with cognitive problems and dementia, leading to additional distress and confusion. The Government recognised this in autumn 2012 when the Health Secretary, Jeremy Hunt MP announced £50m of capital funding for improvements to dementia care environments in hospitals and care homes. Designing for dementia is a complex, often confusing and sometimes contradictory discipline, covering an immense range of issues. The challenge is to provide a service that, as its end result, maximises quality of life for residents whilst simultaneously reducing the burden and cost of care delivery. This may appear counterintuitive but good designers are used to handling seemingly contradictory objectives. It is well-recognised that specialist dementia design, based on understanding the impact of

physical environments on people with dementia, can help to: • Reduce falls. • Reduce incidents of behaviours that challenge among service users. • Increase carer involvement. • Foster the personal and professional development of team members, with improvements in staff retention, recruitment, sickness and absence. • Increase productivity and reduced waste by using spaces more effectively. With these goals in mind, an experienced designer can talk you through established best practice and offer bespoke solutions to best suit your needs and those of your particular residents. Cognitive decline introduces a wide variety of difficulties for designers. Whilst doctors research medical advances to combat the condition, designers have a role to help mitigate some of the everyday effects. It is clear that taking steps to ensure environments are appropriately designed enables residents to maintain a measure of independence, allowing them to enjoy some of the skills of daily living. As designers and developers, we have a responsibility to ensure we provide the very best environments to maximise independence and dignity. Designing for the care sector is complicated and challenging. However, if you choose to combine professional design with ambitious development or refurbishment, then there is every opportunity to have real impact on people, giving them greater quality of life and developing a lasting asset for the local community. CMM

Alexandra Ledger is Managing Director at Bright Bay Design. Have you ever used an interior designer? Share your experiences on the CMM website CMM September 2015 35

The deprivation of liberty safeguards (DoLS) were established with the purpose of protecting people who are lacking in mental capacity and need to be deprived of liberty in order to receive appropriate care and treatment in hospitals and care homes. In practice, the DoLS provide an administrative process via the Court of Protection for authorising deprivations of liberty. Since it came into force in 2009, the DoLS system has been heavily criticised for its technical and cumbersome nature, itsonesize-fits-all approach and was even described by the House of Lords committee as not ‘fit-for-purpose’. In 2014, the definition of deprivation of liberty was widened in the Supreme Court decision of P v Cheshire West and Chester Council and P v Surrey County Council [2014]. This has placed an increased burden on local authorities and health and social care practitioners; it has resulted in an influx of cases to the Court of Protection and has been criticised as being a huge drain on resources. Given the complex nature of this area, it is reported that care providers are reliant on their local authority to identify potential deprivations of liberty amongst residents and it is likely that many current care arrangements across England and Wales equate to invalid deprivations of liberty. This July, following a request from the Government, the Law Commission has released its consultation paper proposing to replace DoLS with a system called ‘Protective Care’. The Law Commission states that it seeks to achieve better, more appropriate outcomes for people with care and support needs and reduce unnecessary burdens on local councils and the NHS. The Commission is seeking the views of care providers, lawyers and any person with experience of the current system on this proposal. It is truly recommended that all readers take this opportunity to consider the proposals and respond to the Law Commission with any comments, recommendations or criticisms so as to ensure that the draft legislation 36 CMM September 2015

Deprivation of Liberty your chance to change the law

On 7th July 2015 the Law Commission published its Consultation Paper on Mental Capacity and Deprivation of Liberty which will lead to a scrapping of the current deprivation of liberty safeguards (DoLS) system. Stuart Marchant and Emma Timmons explain the key proposals put forward and how you can influence the changing law.

put to Parliament in 2017 is fair and effective.

THE NEW PROCESS – PROTECTIVE CARE The Law Commission has proposed a new system, known as Protective Care, which will have a wider scope than DoLS. The overarching system of Protective Care will comprise three different schemes specifically tailored to different care settings and the level of care/treatment being received. The consultation paper proposes that the nature of the safeguards provided should differ according to the setting. 1. Supportive Care The proposed Supportive Care scheme will apply to persons living in care homes, supported living and shared lives accomodation who lack capacity to consent to their living arrangements. It is intended to act as a preventative safeguard for persons who are not yet subject to restrictive or intrusive care but might require such care in the future. Under Supportive Care, local authorities will be required to keep individuals under review and to include records of capacity and best interests assessments within care plans. Providers will also be required to be clearer about the basis on which decisions about care and treatment are made. Where it appears to a local authority that a person may be eligible for supportive care, the local authority would be required to ensure that an appropriate assessment has taken place. The Consultation proposes that required safeguards under Supportive Care should not place too onerous a burden on providers or local authorities as in most cases, the local authority will just need to link existing reviews (under the new Care Act) and incorporate capacity assessments within the existing assessment process. 2. Restrictive Care The proposed Restrictive Care system is intended to be the direct replacement for the current DoLS


CMM September 2015 37



system. However, instead of focusing on whether a person has been, or is likely, to be deprived of their liberty, it will focus on the level of care being proposed or delivered. In order to be eligible for Restrictive Care, a person must: • Be receiving, or be likely to receive, restrictive or intrusive care in a nonhospital setting; and • The person must be lacking capacity to consent to such treatment (as a result of an impairment of, or a disturbance in the functioning of, the mind or brain). The consultation proposes restrictive care and treatment be identified by a non-exhaustive list which includes any of the following: • Continuous or complete supervision and control. • The person is not free to leave. • The person is either not allowed, unaccompanied, to leave the premises in which placed or is unable by reason of physical impairment to leave those premises. • The person’s actions are controlled by physical force, use of restraints or administering of medication. • Any care and treatment that the person objects to. • Significant restrictions over the person’s diet, clothing or contact with, or access to, the community and relatives, carers or friends. The Law Commission has proposed the creation of an Approved Mental Capacity Professional (AMCP). Under the Law Commission’s proposals, AMCPs would be able to authorise individual care plans and place conditions on the provision of care and treatment. Like Approved Mental Health Professionals under the Mental Health Act 1983, AMCPs will act as independent decision-makers on behalf of the local authority and will possess overarching responsibility for assessments but will have the option to assign restrictive care and treatment

assessments to a professional already involved with the case. At present, it is proposed that ‘serious medical treatment’ cases should still be decided by the Court of Protection but the consultation seeks views on whether decisions regarding ‘significant welfare issues’ where there is a major disagreement should also be required to be decided by the Court of Protection. The Law Commission is also proposing that appeals should no longer be heard centrally by the Court of Protection but locally, by a specialist tribunal, which includes medical and mental health practitioners, as well as ‘lay representation’, which could include service users. 3. Hospital Care The Hospital Care system is intended to provide protection to those persons lacking capacity that are receiving treatment for physical disorders in a hospital setting, where the treatment amounts to, or may amount to, a deprivation of liberty in the next 28 days. It is proposed that a registered medical practitioner will need to certify that the proposed treatment, amounting to a deprivation of liberty, is in the patient’s best interests and is proportionate to any risk of harm. The hospital will appoint a responsible clinician to oversee and manage the patient’s care plan. A patient could only be deprived of their liberty for up to 28 days. After 28 days, an AMCP will be required to make an assessment. They can authorise a further deprivation of liberty for up to 12 months. This is a potentially significant burden placed upon medical practitioners and training will be required to enable them to fulfil this responsibility effectively. The approval process will need to be carefully designed and monitored by the NHS body to ensure that this responsibility is discharged effectively, which is likely

to increase the burden upon acute trusts even further, when previously the responsibility lay with the local authority.

MENTAL HEALTH ACT INTERFACE It is proposed that the Protective Care scheme will not be used to authorise the detention of persons lacking capacity that require treatment for a mental disorder. Instead, the Mental Health Act will be amended to deal with such situations. Incapacitated, compliant patients in circumstances amounting to a deprivation of liberty will fall within a new mechanism under the Mental Health Act, designed to deal with such circumstances. Incapacitated, non-compliant patients requiring treatment for a mental disorder will continue to fall within the existing provisions of the Mental Health Act. This legislative assertion of the primacy of the Mental Health Act over the Mental Capacity Act will greatly simplify this notoriously complex area of law.

PROTECTIVE LEGAL FRAMEWORK The consultation introduces several suggestions for protective legal framework to adjudicate the Protective Care scheme, key of which is the establishment of a First Tier Tribunal to review cases under the Restrictive Care and treatment scheme. In our view, the establishment of a First Tier Tribunal to deal with this new scheme is a welcome change and would hopefully alleviate some of the delays in the Court of Protection and increase capacity for it to deal with more complex cases.

OPINION There’s no doubt that DoLS is a system that is not fit-for-purpose and needs to be replaced. The introduction of the

Law Society’s guidance on Identifying a deprivation of liberty: a practical guide provides some help and is required-reading under the present system. The Law Commission’s new proposals expand considerably on the DoLS. On the positive side of the balance, by removing the bureaucracy of the DoLS assessment and approval process and making the system work across all care settings, including supported living and extra care, the system should be simplified and universal. If implemented well, this could achieve the correct balance between the rights of individual service users in line with the Care Act 2014 and a streamlined approach for care providers and local authorities. However, by introducing a new regulatory framework which further formalises the care of all people lacking mental capacity, the system will bring greater monitoring by the local authority and regulatory oversight by the Care Quality Commission which could result, if not implemented carefully, in a significant additional burden on care providers. The practical interface for providers, with individual social workers with increased powers of approval and monitoring, may cause some who have existing challenging relationships with social work professionals to have cause for concern; is this too much power for an individual?

HOW TO INFLUENCE THE NEW LAW Those who have felt the impact of DoLS should make the most of this opportunity to feed into the Law Commission consultation. The consultation runs until 2nd November 2015 with plans to publish recommendations in 2016. It is urged that you read the consultation document and respond directly with your views to tim.spencer-lane@ CMM

Stuart Marchant is a Partner and Emma Timmons is a Solicitor at Bevan Brittan LLP. @BevanBrittanLLP Read the consultation documents or share your thoughts on DoLS on the CMM website 38 CMM September 2015


Lancashire Care Conference

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we provide are available in three categories. Entry - Designed for those new to the industry or interested in starting a career in social care. Occupational competence Level 2 and 3 Diplomas in Health and Social Care. These are options to take a generic pathway or a specialist dementia or learning disability pathway. The Level 5 Diploma in Leadership for Health and Social Care and Children and Young People’s Services gives you the opportunity to build both your managerial and care skills, allowing you to help more people. It also fulfils the regulatory requirement for those looking to become managers of children’s homes or adult residential and domiciliary services. Continuing professional development - These are awards and certificates that allow you to tailor your learning to your job role. The Level 4 Diploma in Adult Care enables experienced staff to develop their skills and specialisms. Our industry experienced trainers and assessors offer a bespoke approach, providing tailored learning and development solutions, including comprehensive apprenticeship programmes. We have emerged as one of the leading providers of health and social care qualifications in the UK with a core focus of supporting our learners throughout their careers, from start to finish.

Resource Finder

Training With the introduction of the Care Certificate in April, induction training for all health and care workers changed. This reiterates the importance of good quality training in the sector. Trained, competent staff improve the wellbeing and quality of life of those they support. Training can be offered in a wide range of subjects from the Care Certificate to dementia care, learning disability support, health and safety, and fire training. Training is also very flexible and can be delivered on- or off-site, via DVD, e-learning, through external providers, face-to-face and more. To help you ensure your staff are delivering the best quality care to the people you support, CMM brings you its Resource Finder on care sector training.

CMM September 2015 41

42 CMM September 2015


Age UK Training Tel: 0808 168 1225 Email: Website:

SECTORS • Health and care professionals, • Care homes, • Hospital, • Home care, • Supported living • Day centre setting, • Residential homes, • Nursing homes, • Carers, • Care home managers, • Commercial business.

DELIVERY • Face-to-face, • E-learning, • Online, • Short courses, • Tailored training.

COMPANY PROFILE Age UK Training inspires greater understanding in dementia care. There are over 800,000 people living with dementia in the UK and this is predicted to hit one million by 2020. As the training arm of the country’s leading charity for older people, Age UK Training knows that these growing numbers bring with them new challenges, particularly when it comes to care. Recognising the need for better support for both those living with dementia and those caring for them, Age UK Training recently launched a new dementia focused training programme,

Remember Me. Designed to encourage better understanding amongst care practitioners supporting older people living with dementia, Remember Me places participants in the shoes of a person living with dementia, providing insight into the challenges faced and offering first-hand experience to help understand what it feels like to live with the condition. Using real case studies and practical learning methods, Remember Me is delivered by Age UK’s expert trainers. Taught via five Foundation modules, topics cover effective communication, emotional wellbeing and daily assistance, to offer an understanding of the situations that might arise when caring for someone with dementia and how professionals can best support them. Modules can be personalised to suit the needs of different care professionals and can be spread over time. Training can also be tailored to include Age UK’s Sense of Ageing, a unique course designed to help care workers understand the way physical ageing impacts on everyday life. National training provider, Age UK Training, has offered training and consultancy across the UK for over 60 years with a range of training topics that reflect Age UK’s expertise, innovation, creativity and vision for those in later life.

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CMM September 2015 43


Redcrier Training Solutions Tel: 01823 332200 Email: Website:

SECTORS • Residential homes, • Nursing homes, • Home care.

DELIVERY • Face-to-face taught courses, • eLearning, • Silver Box distance learning.

COMPANY PROFILE Redcrier has been established since 1998 as an independent training provider. During this time it has evolved with the care industry to become one of the most well-regarded specialists for staff training. It offers compliance tools, improvements in staff performance and retention as well as cost reductions. Redcrier creates training packages around you, your staff and your training matrix. It currently supplies a blended approach to staff training for over 1,600 care organisations. Redcrier offers 40 different

health and social care courses through three unique delivery styles: The Silver Box distance learning system, face-to-face courses and eLearning. Training can be built around your specific needs, taking into account budget, staff numbers, location and knowledge base. From large groups to small independent care providers, Redcrier can tailor a training package around your bespoke needs. Its ethos is to help you achieve your company goals by assisting you with compliance and building on your person-centred approach. Redcrier will work with you to design and build the correct training package to help you improve staff performance. In order that Redcrier can better understand your goals and requirements, it offers free training consultations throughout England and Wales so that it can tailor your training, help you to become more efficient and assist you in offering the best possible care. Talk to the team today to see how we can help you.

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• Care homes, • Residential care, • Special schools, • Hospitals, • Hospices, • NHS Trusts, • Community Equipment Stores.

• Video conferencing, • iPhone, • iPad, • PC, • Tablet, • e-Assessments, • External demonstrations.

44 CMM September 2015


Celebrating over 20 years in business, regis has earned its reputation as a recognised national learning solutions provider. All resources are produced to a high standard with its DVDs attracting purchases by hundreds of satisfied customers, including some major players in the industry. All DVD training packs come with a very comprehensive CD where training notes, activities and questionnaires

can be freely downloaded, together with a certificate. Face-to face-training can be delivered in the workplace or an alternative venue and covers subjects such as: Fire, Moving and Positioning, First Aid, Health and Safety, Safeguarding and much more. The newly available Care Certificate set is a sure winner for regis with glowing compliments received from many customers. The set, in a rigid presentation box, contains a workbook and a DVD covering all 15 standards, together with a delivery resource CD with full guidance on observation methods. This has proved to be invaluable for those people delivering or assessing the Care Certificate. A marking facility for the workbooks is also available. QCF diplomas at levels 2, 3 and 5 are also delivered by regis throughout the country and in some cases funding may be available.

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Are you ready for the new changes? From April 2015 social care providers are required to implement the new Care Certificate framework to ensure employees delivering care are compassionate, caring and provide quality care. Care Certificate will replace both the National Minimum Training Standards and the Common Induction Standards. CQC have also introduced new ratings and KLOE inspection guidelines to encourage care providers to improve.

Radar Healthcare Quality Management Software is the smart solution. Radar Healthcare’s training and induction module provides an intuitive easy to use framework to deliver the Care Certificate and also ensure all training and induction requirements are met for CQC regulatory compliance. Our system provides the tools to self-assess against the new Key Lines of Enquiry (KLOE’s) helping to deliver continuous improvements and efficiencies whilst saving you time and money.

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SECTORS • Adult social care, • Care homes, • Nursing homes, • Domiciliary care, • Supported living, • Housing with care, • Children’s services, • Families’ services.

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COMPANY PROFILE Whatever stage you are at on your improvement journey SCIE can provide you with expert support to become a better-led, effective, safer and more responsive caring organisation. SCIE is the UK’s leading improvement agency for social care. Using its unique knowledge around what works, SCIE supports care providers, local authorities, housing, health and the voluntary sector to improve the way that they deliver services. SCIE has developed a range of innovative programmes to support you in the implementation of key social care policy and practice areas:

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• Expert guidance on implementing policy, • Support in developing and cascading learning methodologies through your organisation, • Opportunities to explore what works and best practice from around the country, • Clear understanding of roles and responsibilities within your organisation, • Access to a broad range of evidence-based resources, • Consultancy and improvement support. To deliver better care and support you need a highly-skilled, confident and knowledgeable workforce. SCIE offers tailored in-house training on improvement support, Care Act implementation, safeguarding, the Mental Capacity Act and DoLS, dementia awareness and co-production training. Commission SCIE to help you plan, commission, evaluate and deliver better care and support to people who use services. SCIE’s research, information and evaluation services will support you with the evidence to make better decisions, review performance and evaluate impact. Please visit the SCIE site to access our full range of resources including e-Learning, SCTV films, guides and briefings.

• Adult social care, • Care homes, • Nursing homes, • Domiciliary care, • Supported living, • Housing with care, • Local authorities.

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COMPANY PROFILE Skills for Care, home of the National Skills Academy for Social Care, is the employer-led workforce development body for adult social care in England. We work with employers across the country to make sure their people have the right skills and values to deliver high quality care. We offer workforce learning and development support and practical resources from entry level right through to those in leadership and management roles. We’ve developed a selection of free materials to help you implement the Care Certificate in your workplace. These include: • A workbook that covers what learners need to know and understand for each standard in the Care Certificate. • A guidance document. • the framework assessor document. • A self-assessment tool.

• A mapping document that sets out how the Care Certificate maps across to other resources that are used within the sector. The resources and more information can be found at www.skillsforcare. We run excellent leadership and management learning programmes, including: • The Moving Up programme for black, Asian and minority ethnic social care managers and leaders. • The Top Leaders programme, aimed at leaders within the most senior positions in health and social care. • The New Directors programme, designed in partnership with the Association of Directors of Adult Social Services. • The National Graduate Management Training Scheme, where we match specifically selected graduates with host organisations for a 12 month placement. More information on all of our programmes can be found at www. As part of our commitment to help employers identify high quality learning and development providers we’ve introduced our Endorsement Framework. From September, you’ll be able to search for the learning providers endorsed by us, and relevant courses, on our website at endorsement

CMM September 2015 47



CONFERENCES • EXHIBITIONS Derbyshire & Nottinghamshire Care Conference 15 July 2015

15th July, Nottingham The Derbyshire and Nottinghamshire Care Conference, in association with Derbyshire Care Providers Association and Nottinghamshire Care Association, took place for the third year running at the Nottingham Belfry. The conference, supported and organised by Care Management Matters, boasted a topical and reflective agenda, one which you would expect to see in the current climate of the care sector. Acknowledging the challenges and issues facing the sector now and in the near future, Derbyshire Care Providers Association Vice Chairman, Pierre Falleth introduced the conference with the clear message that, ‘We need to stop seeing each other as competitors and really work together in these tough times.’ Also there to welcome delegates was Alan Pearce, Chairman of Nottinghamshire Care Association.

and not just to enforce.’ Leading on from these presentations, Editor-in-Chief of Care Management Matters, Robert Chamberlain opened the floor to a panel discussion giving delegates an opportunity to ask questions and hear directly from their local authority representative. The attendees took full advantage of this. A focused outlook for the local care market was delivered by Roger Harcourt of Shakespeare Martineau. Looking at the specifics of the market in the Derbyshire and Nottinghamshire regions, Roger provoked some food-for-thought as he asked whether the current care sector is a burning platform or an opportunity to create a new and integrated social care system.


The day was punctuated by a series of interactive workshops. Deal or No Deal, which explored business valuations, was delivered by Amanda Nurse and Tom Hartley from Carterwood. How to market your home effectively to those funding their own care was a very interesting workshop given by Chris Tarry from The Care Marketing Consultancy. The final workshop was delivered by Jess Watson from My Home Life who explored how to create a culture that delivered quality and positive outcomes for businesses.

The 2016 considerations of the Care Act were addressed in the keynote presentation by Patrick Hall, Practice Development Manager (Policy) at the Social Care Institute for Excellence. Patrick’s exploration of the impact and implementation of the Care Act caught everybody’s attention as he discussed how the main points would affect providers whilst still considering that the recently delayed second phase reforms could still come into place later on. Sue Howard, Deputy Chief Inspector (Adult Social Care, Central Region) of The Care Quality Commission discussed the quality ratings and achieving excellence. Sue made it clear that the new regulations were, ‘to inspire improvement In association with


FINAL PRESENTATIONS The penultimate presentation was delivered by David Williams of Skills for Care, who gave an insightful overview of the Care Certificate and

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48 CMM September 2015

ideas about how best to implement it. The day was rounded off by Paul Johnson of Smartgate Solutions, who spoke about how integrating people, process and technology can be used to ensure compliance. It was a busy and informative day which allowed, in some cases, questions to be answered and, in others, to be debated. It would not have been possible without the sponsorship of Hazlewoods, Smartgate Solutions, Royal Bank of Scotland and Shakespeare Martineau. Thanks must also go to the exhibitors. Organised by

WHAT’S ON? Event: Integrated Health and Social Care 2015 Date/Location: 10th September, London Contact: GovKnow, Tel: 0845 647 7000 Event:

Multi-specialty community providers: Implementing new models of care Date/Location: 16th September, London Contact: The King’s Fund, Tel: 0207 307 2596 Event:

Making Choice Happen: Delivering quality end of life care to make choice a reality for everyone Date/Location: 15th October, London Contact: National Council for Palliative Care, Tel: 0207 697 1520 Event: UKHCA England Conference and AGM 2015 Date/Location: 21st October, London Contact: United Kingdom Homecare Association, Tel: 0208 661 8188

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Event: The Future for Social Care in England Date/Location: 26th October, London Contact: Westminster Forum Projects, Tel: 01344 864796 Event:

What’s New? A year of change. Care England 2015 conference and exhibition Date/Location: 12th November, London Care England, Tel: 0207 492 4840 Contact: Event:

Innovative Carpet Solutions Designed for the demands of the healthcare sector, ECONOMIX offers outstanding performance, the latest trend colours and excellent environmental credentials.

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Cloud Breaking – Finding the person behind the symptoms of Dementia Date/Location: 26/27th November 2015 Contact: Dementia Care Seminars, Tel: 01725 553168

CMM EVENTS Event: Date/Location: Contact: Event:

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

Date/Location: Contact:

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

Event: Date/Location: Contact:

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

Event: Date/Location: Contact:

CMM Insight 2016 25th February 2016, Reading Care Choices, Tel: 01223 207770

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The Transition Event 2016 26th May 2016, Birmingham Care Choices, Tel: 01223 207770

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


Martin Green has strong words for the government following the postponement of the care cap.

The Coalition Government heralded the Care Act as a once-in-a-generation opportunity to clarify how we were going to fund social care, and a chance to give citizens clarity about what they would have to contribute. One of the centrepieces of this legislation, was a commitment to capping care costs, and it was hoped that this would then enable the citizen to understand how they were going to plan for their future, but also give the insurance industry some clarity about the risks and costs inherent in insuring people’s long-term care. It was hoped that this would then lead to some insurers developing new products, and a much better engagement by both the insurance industry and the citizen. Of course, by the time the concepts that were outlined by Andrew Dilnot had been through several Parliamentary processes, they were hardly recognisable

from the vision that either the Government claimed it wanted to develop, or indeed the proposals that Andrew Dilnot first put forward. Many of us supported the Care Act, not because we thought it was the best solution, but partly because we thought it was the only solution, and at best, it would deliver a degree of clarity. Throughout the election campaign all parties focused their attention on the NHS, and there was little or no recognition of the important role of social care. It was, in effect, off the agenda. Partly this was due to the mistaken belief that the Care Act had solved the social care problem, and partly it was due to the ignorance, or dishonesty of politicians, who were neither prepared to debate, nor I suspect understood, the issues in social care. The exception to this lack of knowledge, has to be the Chancellor of the Exchequer, who must have known that if he was reappointed, this was one area that he was going to cut back on. Throughout the election campaign, there was not a hint of the subsequent policy, and I suspect this was one of the reasons why, at every opportunity the focus of attention was always on the NHS, where politicians had made their commitments, and had no wriggle room to change the funding levels. I find it both bizarre and inexplicable that at a time when integration is supposed to be the mantra of the moment, there is a total lack of understanding within Government, about the impact of social care cuts on the NHS. The Chancellor must be made to understand that if he cuts social care funding, he will see a consequent spike in NHS expenditure. The level of understanding about social care is very poor, and not only should politicians get better informed, but they should also understand that social care delivers better outcomes for people who use services, and also delivers much more efficient and effective use of resources. Chancellor Osborne, is making productivity gains one of the centrepieces

of the Government’s agenda, but he seems absolutely incapable of understanding how much better the productivity, efficiency and outcomes are in social care. Instead of seeing social care as a Cinderella that he wants to ignore, he should be putting it at the very centre of the Government’s productivity and efficiency agenda. One of the challenges that we often face in social care is from politicians, who tell us social care is not high-profile enough in their inbox, or nobody tells them that social care is important. There are some tough things we need to tell politicians when they give us this humbug. Firstly, politics should be about leadership and they should understand the importance of social care because it is the system that transforms the lives of the vulnerable. Vulnerable people often do not have the energy or capacity to educate politicians, but their need is still great. I also want to ask those same politicians how many letters they got telling them that they should put enormous taxes on airline tickets, when we all fly away for our holidays. I would warrant next to nobody told them to do it, but it didn’t stop them. The myth these people try to create is that they always respond to our wants and wishes. Well, history tells us that they don’t. As for the issue of social care not being a big talking point in the election campaign, my response is that it might have been, if politicians had had the honesty to tell us what they intended to do. However long it is before the care cap is implemented, one thing is for sure; that the Government can no longer push the funding of social care into the long grass. We are now approaching a crisis, made worse by the announcement of the new living wage, which everyone supports, but cannot fund without extra money. If the government doesn’t act to put social care funding on a firm and realistic financial footing, the NHS will find itself unable to cope. CMM

Do you agree with Martin? Join the debate at Twitter: @CMM_Magazine 50 CMM September 2015

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Call 08442 414 660 Westside Story Copyright © All rights reserved. For customers signing up to a Care Home Sky Lounge Package and/or Sky In Room Package: You will be billed monthly. Pricing shown is ex VAT. Sky TV minimum term is 12 months. Installation of equipment is not included, please call for more information. Charge of £50 per box (plus VAT) applies if Sky does not install your equipment. 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 to Sky cost up to 7p per minute plus your provider’s access charge. Oomph! voucher terms & conditions: £500 discount voucher off “Oomph! Training” or “Oomph! Monthly Activity Packs” to care homes purchasing their first Sky Care Home TV Lounge Package. 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 - see Correct at the time of supply 07.08.2015.

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