Care Management Matters October 2015

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OCTOBER 2015 ÂŁ4.00

The importance of asking opinions

Dementia care

International perspectives

Care insurance

Getting value for money

Business Clinic

Self-governing homecare

Includes 4-page Skills for Care insert: Social care and cultural representation

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In this issue 05

Is it just me…? Des Kelly explores the recent call to encourage more men to work in the care sector.


CMM News


A View from the Top This month, CMM interviews David Williams, Chief Executive of St Monica Trust.


Business Clinic CMM explores Buurtzorg, a Netherlandsbased approach to self-governing homecare.


Event preview A preview of the forthcoming CMM Insight Berkshire Care Conference 2015 on the future of care and commissioning.


What’s On?


Straight Talk Dr Matthew Norton gives his thoughts on two recent reports into the future prevalence of dementia.






From the Editor



Dementia care – an international perspective Professor June Andrews looks at international approaches to dementia care.


What do you think of it so far? How do you gain valuable feedback on your service from clients and their families? Les Bright shares his experience.


Bringing residents together through old and new approaches to activity Combining traditional activities and modern technology can benefit everyone. Ben Allen and James Tweddle explain how.


Putting innovation into practice Victoria Elliot explores innovative ways to improve quality care.


Care insurance: getting value for money David Waters offers guidance for providers to get good value for money from their care insurance. CMM October 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 Studio Manager: Jamie Harvey Creative Artworker: Gemma Barker

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





Des Kelly Executive Director, National Care Forum

Prof June Andrews Director of the Dementia Services Development Centre, University of Stirling

David Williams Chief Executive, St Monica Trust

Colin Angel Policy and Campaigns Director, United Kingdom Homecare Association



Raina Summerson Chief Executive, Agincare Group

David Foster Head of the Nursing, Midwifery and Allied Health Professions Policy Unit, DH

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: 978-1-910362-65-5 CCL REF NO: CMM 12.7

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 October 2015


Les Bright Independent Consultant, BCD Care Consultants



James Tweddle Sales Director, Sky Business

Victoria Elliot Principal Care Consultant (Research and Innovation), OSJCT

Ben Allen Founder, Oomph! Wellness Ltd

David Waters Howden Care (CHIS and PrimeCare insurance)

Dr Matthew Norton Head of Policy, Alzheimer’s Research UK

From the Editor Editor, Emma Morriss summarises some of this month’s features to help you carry on with ‘business as usual’. As the politicians return from their summer break, the news in the sector has slowed and it feels like people are getting on with business as usual.

GOVERNMENT SPENDING REVIEW But in the background we are waiting for the Government’s Spending Review in November, which sets out how much government departments can spend. This will mean that government departments, once again, need to save money from their budgets, but with the National Living Wage to be implemented and ongoing pressures on local authorities, is it possible to do more with even less? If you’re not completely certain of what the Spending Review is and what it could mean for you, turn to In Focus on page 13.

BUSINESS AS USUAL To help you get on with business as usual, this issue of CMM is full of ideas, innovation and best practice. If you’re looking for innovative ways to deliver quality care, Victoria Elliot’s article on page 35 has some great ideas and easily actionable points. In a similar approach, the article from Ben Allen and James Tweddle on page 32 looks at how traditional and new approaches to activity can come together to enhance the quality of life for people in care homes and raise social capital. We also look at how you can get value for money from your insurance. Not only are there practical approaches you can take, there is also a direct correlation with your quality rating from CQC. It’s an interesting article to consider when looking for care insurance and is on page 38. Finally, Business Clinic this month

has explored the Buurtzorg approach to homecare. This Netherlandsbased homecare company delivers care and support by self-governing nurse teams. With no bureaucracy or management structure and a fullysupportive team, is it the solution to homecare’s troubles? We ask our experts on page 26.

3RD SECTOR CARE AWARDS I’d also like to thank those of you who have submitted a nomination for the 3rd Sector Care Awards.

The first round of judging is under way and we’re excited to see the great examples of care and support in the not-for-profit sector. If you didn’t get a chance to nominate, there’s still time to attend, with tickets and sponsorship opportunities still available. More information can be found on the Awards’ website I’m looking forward to hearing about all the wonderful examples of quality care and support at the Awards’ ceremony in London on 9th December.

Email: Twitter: @CMM_Magazine Web:

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Is it just me...?

years in post. The worst of it is we don’t know where they are going – let alone why. Even allowing for the fact that a proportion will be leaving for positive reasons such as promotion or professional development, this must represent a huge amount of waste by the care sector. A waste of money, time and potential.

Des Kelly reflects on the call for more men to work in social care.


Who would have guessed that a comment on the lack of men working in social care would attract such attention? Given the muted interest following the summer announcement about the delay in implementing funding reforms or ongoing concerns about the growing crisis in care and serious worries about long-term sustainability, it is curious that it was this item that peaked awareness of the care sector workforce. Now that the dust has begun to settle on this debate I’m interested to revisit the issue.

STAFFING TIME-BOMB It appears that the storm started with a report published by the International Longevity Centre-UK (ILC-UK) and Anchor that called for more men to be recruited into the care sector to tackle a ‘staffing time-bomb’ caused by a predicted rise in older people likely to require social care in the future. Of course ‘storms’ and ‘time-bombs’ and the

like alway attract media interest. The report warned that if current trends continue, England could face a shortfall of 718,000 care workers by 2025. The report claimed the gap in the number of care workers needed could be filled by men and older workers, who might not previously have considered working in care as a career. The argument was also run that, as an increasing number of men are living longer, more men will be needed in the future to assist in meeting their personal care. Government statistics show 84% of carers in England are women, and just 16% are men – apparently this figure has remained static since 2012. Interestingly, however, Carers UK estimates that the proportion of informal carers that are male is 42.3% which highlights that many men are, in fact, already involved in providing care and support.

WORKFORCE SURVEY There can be little doubt that there

are major issues faced by the care sector relating to the workforce. At the NCF, we have undertaken a survey for each of the last 12 years and have been tracking the age profile, qualification rates and turnover of staff. We have consistently found that the workforce in the care sector is ageing and our data from June 2015 found 50.3% of staff are aged 45 or over. There are corresponding concerns at the other end of the age range, as only 11.5% of the workforce is under 25 years of age. In my view, the most pressing priority is the recruitment of young people to the care sector – both men and women. The turnover rates in the care sector are scary – 21% for those working in care homes, 25% in domiciliary care and rising to 27.5% for nurses working in adult social care. However, the data on ‘churn’ generates even more alarming numbers, with around 30% of workers leaving within a year of recruitment and 58% after three

What is clear is that we need to recruit more people to work in care, including more young people; and we need to do all we can to encourage them to stay longer than they currently do. That has to be about the ethos we create, stimulation, training, development, teamwork, motivation and support – all matters for leaders and managers. There is clearly a role for schools and career agencies to have a good understanding of the career development opportunities that exist within social care. This should include details of career paths, learning and development, as well as promotion prospects. We should be emphasising the stability of a position working in care along with the potential to progress. I believe that the care sector is best served by a workforce that truly reflects the people it seeks to support. It, therefore, needs to be diverse, with women and men, different ages, a broad ethnic mix and so on. Most of all, we need people who have the right values and attitudes to ensure that, whatever the setting, people receiving care and support are treated as individuals with dignity and respect and that the services are properly personalised to meet their needs.

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

APPOINTMENTS EXTRACARE CHARITABLE TRUST The ExtraCare Charitable Trust has announced that Mick Laverty has been appointed as its new Chief Executive. He will take up his new role from January 2016.

HERITAGE CARE Mark Milton has been appointed as the new Chief Executive of Heritage Care to succeed Kim Foo who retires. Mark is currently Chief Operating Officer with the National Autistic Society.

OSJCT The Orders of St John Care Trust has announced that Chief Executive, Andrew Cheesbrough, has decided to step down. Dan Hayes, currently Operations Director, has been appointed Acting Chief Executive. His role as Operations Director will be filled by Kevin Hall, currently Assistant Operations Director for the Gloucestershire region.

GLEN CARE Glen Care has appointed Veronica Moss as Business Development Manager for its operations throughout the South and South West of England.

CARE QUALITY COMMISSION CQC has recruited nine national advisers to provide advice and leadership on how it inspects and regulates mental health and learning disability services. They are Dr Anne York, Dr Margaret Murphy, Dr Paul Gilluley, Dr James Warner, Professor Helen Killaspy, Dr Theresa Joyce, Dr John Devapriam, Vanessa Ford and Professor Jonathan Warren.

8 CMM October 2015

Living Wage could see ‘catastrophic collapse’ In a letter to the Chancellor, the UK’s five largest care providers have warned the introduction of the National Living Wage could lead to a major provider collapsing in the next 12 to 24 months. Four Seasons Health Care, Bupa UK, HC-One, Care UK, Barchester

and Care England wrote to the Chancellor in response to the announcement of the National Living Wage in July’s Spending Review. Early estimates show the additional impact of the National Living Wage on the sector could reach £1bn by 2020, with staff costs

End GP retainers

Legal action over unpaid travel

Care England has called a halt to the ‘unethical practice of GP retainers’, saying many care homes have to pay GPs to visit residents, which is clearly at odds with a health service for all. Professor Martin Green, Chief Executive of Care England said that, ‘One of our members is paying £70,000 per month and this is unacceptable’. Care England argues that clarification is needed about what differentiates basic and enhanced services from a GP and that, as it stands, the definition of a basic service offered in the General Medical Services contract is far too vague to enable negotiations to take place.

A homecare worker is taking legal action against her ex-employer after she was not paid for the time she spent travelling to and from appointments. Caroline Barlow worked as a homecare worker for MiHomecare. It is estimated that MiHomecare employs around 6,000 homecare workers, many of whom, lawyers believe, may also have a claim. Ms Barlow worked for the company from October 2014 to February 2015 attending an average of eight appointments per day at various locations in the South-West of England. She would travel to these appointments in her own car, often spending several hours a day driving to get to see people in their own homes. Leigh Day, the law firm

representing over 60% of the costs of care – although for more complex care this can rise to 80%. Whilst the care sector welcomes the National Living Wage, they are calling on the Government to provide adequate funding to ensure that the rise in care costs can be met.

representing Ms Barlow, has launched a legal action in the Employment Tribunal, which challenges MiHomecare’s practice of not paying care workers for the time they spend travelling to and from appointments. It is estimated that 883,000 people receive homecare in the UK with over 500,000 people employed in the sector. According to lawyers at Leigh Day, the number of claims could run into thousands, costing care providers millions in unpaid wages for staff. According to the investigative organisation, Corporate Watch, a leaked internal MiHomecare document calculated it could owe workers from just one of its branches as much as £80,000 for not paying travel time.

Anchor’s acquisitions Anchor has completed two acquisitions in a quick succession. Firstly, it purchased 24 care homes from LNT Group, in a deal worth more than £100m. Anchor takes on 24 of the homes previously run by LNT Group subsidiary Ideal Carehomes. The homes, in the north and midlands,

provide a total of 1,317 en-suite rooms for older people, including older people with dementia. Anchor has further expanded its care home portfolio with the subsequent acquisition of the Cavendish Healthcare Group. The five residential care homes in Essex

and Suffolk, provides a total of 307 additional rooms. With the Ideal Carehomes acquisition, this brings the total number of homes operated by Anchor to 119. Carterwood acted on behalf of Anchor in the Cavendish acquisition. It is the agency’s biggest deal to date.

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Government’s first 100 days After 100 days in office, the new Government’s plans for health and social care are beginning to take shape. The King’s Fund has outlined the measures announced so far. Social care – The decision to delay the implementation of the cap on care costs proposed by the Dilnot Commission breaks a Conservative manifesto pledge. Mental health and learning disabilities – Ministers have confirmed commitments made by the previous government, although there has so far been little evidence of new mental health policy initiatives.

Quality and safety – The Government has continued to emphasise quality and safety, aiming to foster a culture of continuous improvement and use ‘intelligent transparency’ to drive up standards. Patient engagement – The Secretary of State has stressed the role of patients, calling for a new ‘social contract’ between the public and health and care services. The NHS Five Year Forward View – The Government has signalled strong support for the NHS Five Year Forward View as new service models are being rolled out across the country.

Public health – Ministers and service leaders have emphasised the importance of prevention but a £200m cut in the public health budget sends a worrying signal. Financial control and productivity – A number of measures are being implemented to control provider spending, while pressure is increasing on the NHS to identify efficiency savings. Devolution – Devolution has emerged as one of the new Government’s defining policy agendas, although questions remain about its implications for the NHS.

ADASS Care Act stock take ‘Everywhere we look there are concerns about financial sustainability,’ said Association of Directors of Adult Social Services’ (ADASS) President, Ray James, as it published its fourth stock take on Care Act implementation. The survey, covering May and June 2015, reveals

increasing concerns about some areas of implementation, although councils’ confidence apparently remains high. The percentage of councils who say they are very confident increased from 35% to 57%. 85 % of councils were also confident about


implementing the April 2016 funding reforms (now delayed). Initial findings highlight market sustainability, arrangements for self-funder assessments, provision of information and advice and advocacy as key areas where potential support needs are greatest for 2015/16.

Zion Care Group loan facility The Royal Bank of Scotland (RBS) has provided a multi-million pound loan facility to support the acquisition of St Joseph’s Nursing Home (St Joseph’s) in Stafford by the Zion Care Group. This is to support Zion Care Group to continue the growth which it started in 2005. The purchased care home, St Joseph’s has been previously run as a convent nursing home managed by the Sisters of St Joseph’s of Cluny. Zion Care Group has acquired the 41-bed nursing home with plans to retain its existing staff, increase its number of beds and, in turn, create new jobs in the future. Zion Care Group operates a number of care homes across the UK and has recently acquired Beechwood Place in York.

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Further acquisitions for Partnerships in Care Partnerships in Care’s (PiC) portfolio has reached over 2,000 beds, following the 2nd September announcement of a further three acquisitions, including new child and adolescent mental health services (CAMHS), mental health, learning disability and acquired brain injury services.

2015 has been a year of significant growth for PiC and the growth continues with the three new acquisitions adding 149 beds across six facilities, making PiC the largest provider of specialist mental health services in the UK. The most recent acquisitions include: Hops Hill Farm Hospital

and School (formerly Oakview London) in Orpington; Ellingham Farm Hospital and School (formerly Oakview East Anglia) in Norfolk; Manor Hall, the Centre for Trauma in Stirling; Vancouver House, Liverpool; Oak Vale Gardens, Liverpool; Knightsbridge House and Carard Cottage in Fareham.

Care and treatment reviews to be embedded across health and social care NHS England has set out how it intends reviews of care and treatment arrangements for people with learning disabilities to be embedded across the health and care system. Care and Treatment Reviews (CTRs) were developed as part of NHS England’s commitment to improving the care of people with learning disabilities or autism. They aim to reduce unnecessary

admissions and lengthy stays in specialist hospitals, and have been rolling out since October 2014. Over 1,400 people had their care reviewed up to March this year, with hundreds more since. CTRs bring those responsible for the care of people who are in, or at risk of being admitted to, specialist hospitals around the table with the individual themselves and their families, as

well as independent clinicians and experts by experience. The aim is to ensure that the care needs of that individual are being met. Care and Treatment Review: Policy and Guidance has been produced by building on the learning from the reviews which have taken place so far, including extensive engagement with people with learning disabilities, their representatives and their families.


Have you received your CQC quality rating? Yes No You can vote via:

September’s results Do you believe social care will receive the funding it needs from Government? NO 93%

YES 9%

Source: Figures correct at time of print.

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In focus

Why the Comprehensive Spending Review matters WHAT’S THE STORY? The Comprehensive Spending Review (CSR) is the process used by the Government to set firm expenditure limits on public spending. The brainchild of former Chancellor, Gordon Brown, spending reviews are used to set out the maximum amount government departments can spend over a set period of time. The CSR focuses on each government department’s spending requirements and is carried out by the Treasury. When he delivered the summer Budget Statement, the Chancellor, George Osborne told government departments to plan ways to cut up to 40% from their budgets by 2019-20 in a bid to find an additional £20bn of savings in public spending. Government must ‘take a step back and think about the shape of the State’, finding ways to ‘deliver more with less’, the Chancellor said. Every department that does not have ring-fenced funding, has been asked to model two scenarios of 25% and 40% of real-terms savings by 2019-20.

WHY IS THIS SIGNIFICANT? ‘The Government will use the Spending Review to set out plans for eliminating the deficit and safeguarding Britain’s long-term economic security. But it will also take the opportunity to invest in its priorities, and deliver ambitious reforms to modernise and localise public services to achieve better

outcomes for citizens.’ This was the concluding paragraph in the document, published in July 2015, setting out the Government’s intentions. Of course, it follows five years of austerity, which have seen significant reductions in funding to local authorities. As the care sector remains reliant on public sector investment, it has a bearing on the rates local authorities set for care services. The announcement, also made in the Budget, of a new ‘National Living Wage’ starting at £7.20 per hour from April 2016 and rising to £9.00 by 2020 is an additional factor relevant to the care sector.

WHAT ELSE DO WE KNOW? Back in 2010, the Coalition Government set out to close the deficit within a single Parliament. This target was not achieved. It is hardly surprising, for in Canada, whose fiscal consolidation is frequently cited as an exemplar for the UK, it took 15 years and three electoral cycles to close their budget deficit by the 1990s. The primary reason that the UK did not close the deficit over the last Parliament has been the slow recovery of Government revenues.

WHAT’S THE REACTION TO THE PROPOSED CUTS? The Spending Review must be about ‘spending smarter, not only about spending less’ in order to balance the nation’s books while improving

public services and local economies, said the Local Government Association (LGA) in launching its submission to the CSR. Councils will face almost £10bn of cost pressures by 2020, comprehensive new LGA analysis has revealed. As part of its detailed submission to the Treasury ahead of the CSR, the LGA has calculated that government policies to be implemented over the next five years will cost councils £6.3bn by

“The Spending Review must be about ‘spending smarter, not only about spending less’ in order to balance the nation’s books while improving public services and local economies.” 2020. It projects this is on top of the extra £3.6bn of ‘business as usual’ pressures to maintain services at their current level. The LGA is warning the Chancellor that failing to fully consider unfunded cost burdens in the CSR could result in important local services being scaled back or lost. The LGA believes the CSR should: 1. Enable wider integration of social care and health services to deliver savings and improve outcomes. 2. Promote growth and productivity by accepting the case for further devolution of powers and funding.

3. Help councils to adequately resource and deliver high quality public services by transforming the business rate mechanism and providing a four year local government finance settlement. Although NHS funding is protected, the impact of rising demand and costs means that health services will not be immune to the effects of the public sector settlement.

WHAT HAPPENS NEXT? The CSR decisions will be published on 25th November. CMM October 2015 13


DoLS caseloads reach record level Deprivation of Liberty Safeguards (DoLS) case numbers reached record levels from April to June 2015, according to official figures. The statistics from the Health and Social Care Information Centre also illustrate the extent to which councils are breaching legal timescales for completing DoLS

cases. In response to the figures, the Association of Directors of Adult Social Services (ADASS) said the Government needed to step-in to provide councils with more funding and extend statutory timescales. The Department of Health provided one-off funding of £25m for 2015 to 16 to help councils

manage the pressures on DoLS. This falls short of the £97m that ADASS estimated councils need to manage the increased number of cases. Any decision on future funding of DoLS will be taken as part of the Government’s Spending Review, due to report on 25th November.

New study explores learning disability and psychotropic drug use A new study to explore the use of psychotropic drugs for people with learning disabilities or mental illness and challenging behaviour in primary care has been published in the BMJ. Using GP data, the study found that the rate of new antipsychotic prescribing was significantly higher in people with challenging behaviour and a learning disability. Autism,

dementia, and older age were also independently associated with antipsychotic use in people with a learning disability. It concluded that the proportion of people with a learning disability who have been treated with psychotropic drugs far exceeds the proportion with recorded mental illness. Antipsychotics are often prescribed to people without

recorded severe mental illness but who have a record of challenging behaviour. The findings suggest that changes are needed in the prescribing of psychotropics for people with a learning disability. More evidence is needed of the efficacy and safety of psychotropic drugs in this group, particularly when they are used for challenging behaviour.

New Lasting Power of Attorney process removes safeguards The new Lasting Power of Attorney (LPA) process, provided by the Office of the Public Guardian, removes certain safeguards that could lead to abuse of the system, warns solicitors Moore Blatch. The new process is intended to increase take-up of LPAs, which is woefully low, with only around 15% of people aged over 75 having one. However, because of the simplification, critical consumer safeguards have been lost.

Of greatest concern is the fact a certification page exists where a third party certificate provider signs to say that the donor understands what is being signed and that no one has pressurised them into signing it. However, there is now no way of checking whether the person who is signing this part of the form has the relevant qualifications to do so. Second, is the removal of the need to notify third parties

of the fact that a LPA has been registered, thus removing a safety net whereby coercion or fraud may be identified. According to Moore Blatch, there are a number of reasons why the take-up of LPAs remains low, including a general lack of awareness of LPAs, a lack of willingness to accept that one might need a LPA, and the perceived and actual complexity of putting one in place.

‘Remarkable Lives’ Lilian Faithfull Homes in Cheltenham has launched a series of events and histories around its residents and their ‘Remarkable Lives’. Over the coming weeks and months it plans to look at many of its residents, giving a brief glimpse into some of the amazing people living in their care homes.

Research to shape future of dementia care A study, which will shape the future of education and training around dementia within the NHS, has been launched by health researchers at three Yorkshire universities. The research team, led by Claire Surr, Professor of Dementia Studies at Leeds Beckett University, alongside collaborators from the University of Bradford and the University of Leeds, will investigate the most effective approaches to training health and social care staff about dementia. Results from the study will help ensure that money is invested in effective training that supports better care for people with dementia. The study, the What Works? Evaluation, is funded by the Department of Health’s Policy Research Programme on behalf of Health Education England and is due to be completed in July 2017.

Change attitudes to learning disability

Bristol care home sold

New analysis for the first time looks at research into public attitudes towards people with a learning disability. Changing attitudes to learning disability: A review of the evidence, published by Mencap, finds that there are many methods that have been successful in improving attitudes towards people in society. These methods should be

A purpose built care home on one of Bristol’s busiest roads has been sold to a specialist provider. Brunel House in Bristol is a purpose-built home with 40 en-suite bedrooms. The home was built in 1996 and comprehensively refurbished in 2010. HPC acted jointly with Savills in the sale of the property to specialist care provider Cambian Group.

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introduced for people with a learning disability. The report analyses what attitudes exist towards people with a learning disability; how negative attitudes are having a harmful effect on people’s lives; and key actions that can be taken to improve how society treats people with a learning disability. Mencap recommends

an increase in direct contact with people with a learning disability and greater indirect contact via the positive media portrayals of learning disability. They are also fighting for the rights of people with a learning disability to have equal participation in education, employment, social and leisure pursuits.

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Clifton court care home in Doncaster sold

Extra care can reduce loneliness

DC Care has completed the sale of Clifton Court Care Home, near Doncaster. The home, which was an asset of Mirus Care Limited (in liquidation), was originally registered for 33 elderly clients and closed late last year. The home has been sold to

A new report from the International Longevity Centre (ILC-UK) has found that extra care can have a major impact in promoting residents’ quality of life and reducing feelings of loneliness and isolation. The report, funded by Audley Retirement and Bupa, surveyed residents of retirement villages on quality of life and used a statistical technique to compare the results with a group of people who were living in the community. The research revealed that retirement village living can promote greater independence and provide greater choice in planning for later life than would otherwise be available. The research shows that the communal environment within a retirement village has the potential to reduce social isolation, particularly for residents who move

Community Places Ltd, which is a specialist care provider. They are carrying out substantial alterations to the building, so that they can develop and deliver a bespoke service, working closely with commissioners.

New report on the myth of the baby boomer A report seeks to bust the widely touted myth that there is a uniform group of older people in the UK – so called ‘baby boomers’ – who have benefitted at the expense of younger age groups. The report by the Ready for Ageing Alliance presents compelling evidence that baby boomers (in this report defined as between the ages of 55 to 70) are

in fact a diverse group of people in virtually every aspect of their lives. The report argues that, in reality, one of the few things this group shares is chronological age. The Ready for Ageing Alliance argues that the term ‘baby boomer’ has become an overused and potentially dangerous shorthand to inaccurately describe everybody in a single age group.

from more rural or remote homes. The average person living in a retirement village experiences half the amount of loneliness (12.17%) when compared to those in the community (22.83%). Nearly two thirds of respondents living in retirement villages (64.2%) could be classified as not at all lonely, and over four out of five (81.7%) said they hardly ever or never felt isolated. Over half (54.7%) often felt in tune with those around them, and nearly four in five (79.1%) hardly ever or never felt left out. People living in this type of accommodation also reported a strong sense of control over their daily lives, nearly 10% higher than those living in the community. They also felt secure in their homes, with 97% of respondents agreeing that they felt safe where they lived.

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New BAME mental health support service

‘Learning through Work’ from Skills for Care

Metropolitan has launched a new support service in Nottingham to promote mental health awareness and wellbeing among the city’s black, Asian and minority ethnic (BAME) communities. The free Support Towards Empowering People Service (STEPS), offers one-to-one and group support to people with mental health needs.

Learning through Work is a series of pocket-sized booklets from Skills for Care that develop communication and number skills in the adult social care workplace. The booklets, of which there are

By helping to identify these needs and addressing them through personalised support plans, the programme is aimed at enabling greater independence. Working closely with local voluntary and statutory bodies in Nottingham, STEPS outreach workers can also refer customers to other appropriate health services in the area.

Porthaven planning consents Porthaven Care Homes has successfully obtained planning consent for two new care homes to open in spring 2017. The first is in Farnham, Surrey on the site of the former Brethren’s Meeting Hall on West Street. The 64-bed home will provide 24-hour residential and nursing care for older people, including residents living with

Alzheimer’s and other forms of dementia. The second new care home is in Kidlington, Oxfordshire. The home, on Banbury Road, will comprise 70 bedrooms and also provide 24-hour residential and nursing care for the elderly, including residents living with Alzheimer’s and other forms of dementia.

seven, are a practical resource that focus not only on routine, but vital tasks in adult social care, such as keeping records, monitoring fluid balance and working out medication administration.

Vanguard support package The NHS Five Year Forward View partners have published an initial support package for the new models of care vanguards which were launched in March 2015. The 29 vanguards, local NHS and care consortiums which are leading on developing new and better ways of providing care to act as blueprints for the NHS in England, were selected following a rigorous process involving patients, clinicians and peer review. They will initially improve the care provided to more than five

million people. Building on the best practice already being displayed, the support package is designed to be led by vanguard leaders alongside national experts. It aims to help the vanguards be as successful as possible in making the changes they are planning. It is also intended to maximise sharing of learning and practice across the vanguards and, importantly, with the wider NHS and care system – a key element of the vanguards’ work.

CMM October 2015 17


Carterwood acquire Cavendish Healthcare (UK) Ltd on behalf of Anchor Group of five residential care homes in Essex and Suffolk Over 300 registered beds with 100% en-suite facilities Acquisition completed in just over six months

T: 08458 690777 E: W: 18 CMM October 2015


New Care Projects

North Wales group sold

Development-led care home operator, New Care Projects, has concluded the sale of part of its portfolio of homes for an undisclosed sum to HCP, a specialist California-based health care investment REIT. The operation of the two homes, Allingham House Care Centre in Timperley and Manorhey Care Centre in Urmston, has been taken over by Maria Mallaband Care Group with immediate effect. The transaction offered New Care the opportunity to dispose of the mature trading assets, which

Acting on behalf of AlixPartners Services UK LLP, joint administrators Care at Home (Wales) Limited has been sold. The group comprises three care homes – Plas y Bryn, Plas Isaf and St Michael’s – in Rhos-on-Sea. All

were new build in nature and located in the Borough of Trafford. In addition, their bias towards private fee pay, excellent clinical reputation and consistently high levels of occupancy at above 96%, heightened the appetite for the homes. The multi-million pound deal allows New Care to exit with surplus funds to fuel their ambitious expansion plans; designing, constructing and operating ‘new generation’ purpose-built care homes across the UK.

New assisted living for MHA Castleoak has delivered two assisted living schemes for MHA as part of an £8.5m contract. The Maples, in Peterborough, offers 37 one and two bedroom, high specification apartments for rent and 13 care studios. Fitzwarren Court, in Swindon, comprises 33 one and two bedroom luxurious assisted living apartments, and four studio apartments for extra care. The new developments add to MHA’s portfolio and now mean that the organisation provides

accommodation, support and care services to 16,000 older people across Karl Hallows, Development Director at MHA, commented, ‘These assisted living developments are real assets to MHA’s portfolio, offering a flexible alternative to residential care. We have a long-standing relationship with Castleoak and are very glad that together we can continue creating high quality retirement living with care for older people.’

iPads can improve quality of life for older people Interest in the use of touchscreen technology to improve the quality of life for older people, and in particular those living with dementia, is growing. But, according to researchers at the Association for Dementia Studies at the University of Worcester, until now there has been a dearth of systematic approaches to introducing and using touchscreen technology in care settings, as well as a lack of evidence based analysis of the benefits. The researchers have published the findings of an eight-month study conducted in partnership with Anchor, entitled How iPads can support people with dementia

living in care homes. In the largest systematic roll-out of iPads in care homes in England, Anchor has introduced tablets to 75% of its care homes (currently 63 homes across the country). The introduction is part of the Anchor Inspires model to deliver the highest quality and standards of dementia care. Researchers have used a range of methods to evaluate the approach and benefits of the roll-out. The findings reveal that, if managed correctly, iPads have significant potential to enhance the quality of life of older people and particularly those living with dementia.

three care homes provide care for the elderly. The Administrators instructed Bespoke Care and Eddisons to jointly market the assets for sale. The homes were sold to Rosewood Healthcare Group.

Supporting nursing assistants There’s a national shortage of nurses across the country and that’s having a big impact on the NHS. Care provider HC-One is addressing this by supporting nursing assistants to take on some of the roles that nurses have predominately done. Social Care Institute for Excellence (SCIE) is supporting this initiative by conducting an independent evaluation of the Care Assistant Development Programme, which it will report early next year. The lack of nurses in social care means that the use of agency nurses is high and that can have an effect on someone’s continuity of

care. HC-One wants to change the structure of nursing in their homes, by aiming to provide better quality of care. HC-One’s plan is to develop senior carers into nursing assistants, trained up to assist with medication, care planning, wound care and catheter care. Nursing assistants will get an increased hourly rate and a nurse mentor to support them. To join the programme, senior carers have to show a strong commitment to learning, complete tough competencybased written tests and complete a comprehensive workbook.

Reshaping mental health More than 20,000 people have given their views on the top priorities for reshaping mental health services as part of a drive to develop a five year national NHS strategy. Better access to high quality services, a wider choice of treatments, more focus on prevention, more funding and less stigma were the top five calls for change by 2020. The results of the Mental Health Taskforce: Engagement Report have been published. Carried out by Mind and Rethink Mental Illness on behalf of the Five Year Forward View national Mental Health Taskforce, the views of patients, carers, the public and health professionals were collected. This included a conference held for more than 120 secure care mental health patients and led by a former secure care patient. The report will be used to inform the work of the Taskforce, which explores the variation in the availability of mental health services across England, looks at the

outcomes for people who are using services, and identifies key priorities for improvement. Since April, feedback has been received from 20,473 people via an online survey; 250 people with lived experience and carers attended events, 60 people detained in secure mental health services were supported to send in written responses and 26 organisations also wrote in submissions. Three clear themes emerged from the findings: prevention, access and quality. 52% of people said access was in their top three priorities for change, 33% said needing a choice of treatment and 25% said prevention. Funding was important with 21% rating it in their top three and stigma was cited by 19%. Other areas included treating mental health equally with physical health, more joined up NHS services, attitudes of NHS professionals, improved training and recruiting staff with particular skills. CMM October 2015 19







Network with, and learn from international dementia experts Identify future trends that your organisation needs to prepare to tackle Source new suppliers and innovations that can help improve dementia care Find out about the latest developments in dementia care that could help you better care for yourself, family, clients or patients

Learn about dementia care best practice from leading international speakers which include:

Professor June Andrews Director Dementia Services Development Centre University of Stirling

Dame Joan Bakewell Baroness House of Lords

Professor Alistair Burns National Clinical Director for Dementia NHS England Professor of Old Age Psychiatry University of Manchester

Professor Sridhar Vaitheswaran Consultant Psychiatrist Aita-Menni Hospital, Psychiatric Research Institute

Professor Tara Cortes Executive Director The Hartford Institute for Geriatric Nursing New York University College of Nursing

Professor Timothy Kwok Director Jockey Club Centre for Positive Ageing Department of Medicine & Therapeutics The Chinese University of Hong Kong

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3 Source new products and services from leading healthcare providers 3 FREE education programme designed to address your key challenges including staffing, funding and more... 3 Live examples and practical advice on creating dementia friendly spaces

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CMM October 2015 21


CMM is offering readers the opportunity to put their questions to senior decision-makers. Is there something affecting your business that you’d like an answer to? Are you facing specific pressures you’d like to know how to tackle? Send your questions to CMM.

Dementia Care



Is the UK leading the way in dementia services? With the number of people with dementia rising around the world, what is happening internationally and can it help to identify or improve best practice here?


Professor June Andrews FRCN, Director, Dementia Services Development, University of Stirling.

According to Alzheimer’s Disease International, there are 9.9 million new cases of dementia worldwide every year. The number is increasing fastest in low to middle income countries. This is because people there are living longer, as their health and social care systems improve. There was a time in some countries when almost no-one lived long enough to develop dementia. Now they do.

CURRENT UK SITUATION This rise in dementia brings with it innovative ways of supporting people with the condition. This means the UK can learn from the approaches of other countries, although the situation in the UK is improving in many ways. Here, there is clear recognition of the human rights of people with dementia, and research is being applied into the design of environments, staff education, nutrition, hydration, exercise and reduction of stress that can reduce dementia symptoms. This, in turn, makes life easier for staff, families and the person with dementia. Earlier diagnosis is making it easier for individuals and families to make preparations for the future and increased public awareness is important.

HUMAN RIGHTS Some other parts of the world are not so far forward in human rights, although many have interesting dementia care ideas from which we can learn. People with dementia, in the past, have been denied the rights and freedoms available to others. In many countries, physical and chemical restraints are still used extensively in care facilities for older people and in acute care hospitals, even

when regulations are in place to uphold the rights of people to freedom and choice. In Hong Kong, for example, there is still use of physical restraint for people with dementia. On one visit, we saw a distressed older person in a straight-jacket strapped to the bed in an acute hospital. Significant improvements have been made by enlightened nursing staff, although more work needs to be done. Each country is starting from a different point. Dementia advocacy organisations, such as the Alzheimer’s Society, know this also still happens here, and it shows up to the wider public in adverse news reports. However, if it does sometimes happen, it is regarded with horror or embarrassment when it is uncovered. It, hopefully, happens more often out of ignorance of alternatives and poor supervision, than being truly the first line of management of a practical problem.

DRAWING INTERNATIONAL COMPARISONS This year, the Dementia Services Development Centre (DSDC) at the University of Stirling is celebrating 25 years, with a Festival of Ideas and an international dementia conference. In the last 12 months, my colleagues and I have visited and worked in Hong Kong, Singapore, New Zealand, Australia, Washington, Canada, Saudi Arabia, Europe and the UK. In addition, about 1,000 visitors every month come to the DSDC in Stirling, from every part of the globe, sharing ideas. This knowledgesharing has given us fresh insights into services in a range of other countries which give an indicator of where the UK could be heading.

FUNDING CARE The funding of care in the UK is complex and the systems are fragmented and different between the four countries. It is equally complex in many other places. In Canada, much of the care is funded through the Government insurance system. Remarkably, in Singapore there is a legal requirement for children to fund the care of their parents. When we consider the concerns in the UK about top-ups,


CMM October 2015 23



the depletion of savings and selling of the family home to pay for care, is this radical Singaporean solution the future for us? Someone will have to pay, and, if not the taxpayer, it’s likely to be our children in years to come. Singapore has an established dependence on foreign domestic workers to support people at home by providing live-in dementia care. However, as countries become richer and grow economically, foreign workers are increasingly reluctant to migrate for work.

RESIDENTIAL CARE In the UK some people with dementia never have to go into a residential facility. They are able to stay at home with support from family, friends, health services, social services and charities. Internationally it is accepted that being able to stay at home is the best outcome. There are two reasons for this. Firstly, it is what people with dementia say they want. Secondly, the residential care model is becoming increasingly challenging to deliver, with difficulties such as rising costs and impending workforce shortages. However, a good care home is an absolute necessity for some people, particularly at the end of life. Although, in some countries residential care is never an option, even at the end of life, because the services required have not been developed. In the UK, we are seeing the average length of care home stay dropping. This pattern is mirrored in Canada, where, like the UK, there is a mixed economy of private, public and charitable sector care providers. In India there are few residential care facilities. Home-based care provided by relatives is the norm. However, this is changing; as family dynamics change, more women join the workforce and their families get smaller.

CHINA When looking at China, there is a tradition of keeping people at home. High net-worth individuals are able to buy in better care than they could get in a care home, often

at lower cost, and as a consequence take this alternative. Changing demographics as result of the one child policy and the increased physical health of China’s ageing population means there is likely to be an increasing need for care homes. However, central government regulation of facilities is underdeveloped. There are, however, nursing homes that have been set up by the Government and there are several private facilities in cities such as Beijing and Shanghai. The country needs trained nursing staff, but work is also required on how to impart the kind of values-based training that translates very well between the UK and other similar health systems like Malta, Australia, Canada and New Zealand with shared histories and language. Chinese cultures face an issue around people dying in a facility. Because of this, the dying person may be moved to the local hospital at the very end of life. This is a situation that UK operators will recognise, but it happens here for different reasons. In any case, it is distressing for the person with dementia and an expensive move for either the family or the authorities.

OTHER INTERNATIONAL APPROACHES In Germany, about 40% of moderate to severe cases of people with dementia are institutionalised, and the majority of patients in nursing homes do not receive special care programmes. In Poland, the cost of care homes is high and they currently lack effective scrutiny. In Hungary, many older people still live close to their relatives and are not dependent on cars, meaning the family unit is close by to offer care and support. Until recently people with severe dementia symptoms were housed in psychiatric hospitals but new legislation shifted this to nursing homes, though most of them have waiting lists. Saudi Arabia also has a tradition of family care, but changing families and the ageing population make this virtually impossible in modern times. In the

“Elsewhere in the world, there are examples to envy. Australia has a fantastic funding system, New Zealand has a wellestablished care village concept and the Netherlands has a system of medical care home specialist doctors. ” absence of a care home tradition, older people spend longer times in hospital. Internationally, names that are given to residential facilities reflect a different cultural approach in each country. In the USA, a nursing home is also called a ‘skilled nursing facility’, ‘long-term care facility’, or ‘custodial care’. In the UK, the term ‘custodial care’ is mainly used for prisoners. In the US it relates to those who need assistance with personal care and daily living tasks, not nursing care, and is mainly for those with dementia.

PLACES TO ENVY Some of these differences are unique to each country, but others offer us learning. Elsewhere in the world, there are examples to envy. Australia has a fantastic funding system, New Zealand has a wellestablished care village concept and the Netherlands has a system of medical care home specialist doctors. Where I would like to have dementia? Increasingly, I think of the highlydeveloped care services for people with dementia in Japan. Through long-term care insurance or health insurance, people can access residential care services, in specialist centres. Otherwise, right here at home. CMM

Professor June Andrews FRCN is Director of the Dementia Services Development Centre at the University of Stirling. Twitter: @ProfJuneAndrews For more information on the International Dementia Conference and other resources, visit Subscription required. 24 CMM October 2015

Social care and cultural representation People from black, Asian and minority ethnic (BAME) backgrounds are often under-represented within leadership positions in social care. In Britain, 12% of people come from these backgrounds, but in the social care sector only 2.5% of directors are from BAME communities. The reasons for this under-representation are not always clear, but not having a workforce representative of the communities they work in can impact on how person-centred care is being delivered.

Symone Stuart

Our country is full of rich and diverse cultures and that means people who need care and support will have a range of different customs and cultural requirements. A diverse workforce is crucial so services meet every individual’s needs, and that means culturally too. It is the responsibility of everyone to ensure that their organisation has a diverse workforce. The best way to make sure the social care sector is able to provide this type of person-centred care is to offer practical support that will make sure the sector is representative of the population it serves. It is an important issue within social care, and one that Skills for Care and the National Skills Academy for Social Care are looking to tackle, by offering learning development and networking opportunities for those from BAME backgrounds already working in the sector who are already leaders or aspire to be. If we get it right then people from diverse cultures and backgrounds will see the clear career paths that means they are able to progress into leadership roles in organisations and the communities they serve. Symone Stuart, Programme Manager, National Skills Academy for Social Care

Turn over to read how Skills for Care is giving BAME social care leaders the skills they need to progress

Moving Up – BAME leaders programme Skills for Care, home of the National Skills Academy for Social Care, will this year launch the fifth cohort of Moving Up – BAME, a programme aimed at giving social care leaders from black, Asian and minority ethnic (BAME) backgrounds the skills they need to progress to top leadership positions. Through mentoring, coaching, networking and one to one support, the programme aims to equip learners with the skills they need to progress in social care. Learners from previous years have had positive things to say about the impact the programme has had on their careers. A 2014 cohort learner said: “My understanding of my work has changed and people have a better understanding of what I am capable of. Following the course, I was given responsibility for a new project with the council. It was my first time taking a strategic lead and the programme gave me the confidence to take that step.” The programme was developed to increase the diversity of social care leaders. Currently, only 2.5% of social care directors are

from black, Asian and minority ethnic communities, whilst people from these backgrounds represent 12% of society. This means that those from BAME backgrounds receiving care and support are, more often than not, receiving care from groups of people who are not always familiar with their cultural needs. “The programme aims to equip learners with how to deal with the barriers they may face as social care leaders,” said Louisa Imanene, programme support officer for Skills for Care. “It develops their potential as a social care professional, extends their capabilities to lead in a complex and changing environment, increases their confidence and develops their ability to network at all levels. It also teaches learners how to utilise both formal and informal support.”

If you are interested in participating in the Moving Up BAME programme, please visit

My view Alexis Keir is Director at Elfrida Rathbone Camden. The charity works to achieve independence, empowerment and personal development for disabled people, children and young people, parents and families. Here, he gives his views on the importance of a representative sector to those who need care and support. The diversity and complexity of provision in the care sector is increasingly reflecting the diversity of our towns and cities. It is important that the social care workforce has the ability to work with people from different backgrounds. And yet it’s also good for people who need care and support to see their faces and experiences reflected in that workforce – because it gives a reassurance that a service values diversity, both in recruitment and in service provision, and is genuine in its commitment to inclusion, whether that be around sexuality, race, gender or disability. A service that looks to engage with and address its own equality issues is one that is likely to pay attention to quality issues across the board.

Alexis Keir

My advice on progressing your career Go out of your comfort zone to find new experiences to broaden your perspectives and professional experience. There will be plenty of people ready enough to pigeonhole you in one way or another – don’t do that to yourself. For me, my career changing experience was to travel and work in New Zealand for 15 months. Being away gave me a whole set of new ideas to bring into my UK practice, including incidentally working for a BME-specific organisation because I was inspired by the engagement with Maori-led service providers in New Zealand.

Join our Moving Up - BAME Leaders Programme We are now accepting expressions of interest from black, Asian and minority ethnic (BAME) social care leaders looking to enhance their leadership and management skills.

To apply for the newest cohort of the Moving Up – BAME programme, which begins in October 2015, visit

This comprehensive training programme costs £500 (plus VAT) for National Skills Academy for Social Care members and £600 (plus VAT) for non-members.

Management support People performance management matters and how well you do it has a huge impact on the quality of care that people who need care and support receive. Your leadership will set the tone and help to create conditions for a positive workplace culture that is focused on delivering highquality care. Good leaders create a positive environment for employees so that they feel engaged and are focused on caring for others. Skills for Care, home of the National Skills

Academy for Social Care, has produced an online toolkit to support managers with their responsibilities for people performance management.















The essentials

how well we is important and management (PPM) who use our People performance on the quality of care that people do it has a big impact managing an services receive. for leading and they deliver. you are responsible quality of the service will make a As a line manager of people and the your employees individual or team the supervise and develop ability to work to The way you recruit, feel about their job and their they difference to how for a right standard. create conditions tone and help to care. will also set the on delivering high-quality Your leadership culture that is focused for employees so that they positive workplace a positive environment Good leaders create focused on caring for others. are has feel engaged and Management School s at Lancaster University determine the effectivenes that Prof Michael West into the factors blog Cultures of undertaken research and organisations at work. His of care. teams of individuals, high-quality cultures the creation of Engagement explores

The toolkit aims to increase managers’ knowledge and understanding about what good people management is and to help them better understand their managerial responsibilities. about: Find out more

PPM Importance of

Doing PPM well

Developing positive workplace culture events Monday 19 October / Tuesday 20 October 2015, London

Following the success of earlier seminars, we are holding two further events to help organisational leaders and managers and learning and development leads to develop and maintain positive workplace cultures.


from the manage your employees them and to the people How you lead and difference to can make a big join your team, with care and support. they are providing

The toolkit is freely available at:

Positive workforce cultures can have a profound effect on the way staff feel about their work, how they behave, what they achieve and how long they stay in their post.





The interactive and experiential learning event will provide a better understanding of organisational culture and its significant impact on performance. Places will be charged at ÂŁ130 (plus VAT). For more information and to book your place, visit

Keeping conversations open and honest

PPM Making time for




DAVIDWILLIAMS David Williams is the Chief Executive of St Monica Trust.

REFLECTIONS ON THE LAST DECADE Over the last decade we’ve witnessed a dramatic increase in customer expectations and our customers are now far better informed about the care they would like delivered to them. We’ve also seen an increase in regulation over the sector and a decrease in funding into health and social care. There’s been a lot of talk about health and social care integration, but we have seen very little materialise in terms of services on the ground. PROJECTIONS FOR THE NEXT DECADE Starting to produce products that are tailor-made to produce excellent outcomes in terms of wellbeing and celebrating the fact that older people are living longer, means that it’s going to be a very exciting decade. However, we’re facing four significant challenges. We have a market which is affected by the increase in the number of older people within the UK population as a whole. We shall see an increase in competition among providers for a limited staffing group due to larger employment within the country. There will be an increase in the expectation around services older people want to receive and to encourage them to downsize from their homes to live in a retirement community. We’ve also got increased regulation. To understand customer expectations and how we develop the services that

people want, we need to go out and find out how those services need to be constructed. We also need to be fishing upstream and convince young people that health and social care is a good career to go into. This will involve actively going out into schools, embracing apprenticeship schemes and selling health and social care as a really fulfilling career.

depersonalised service, where people were treated as objects rather than individuals. There was a factory-line mentality with the focus on what made things easier for staff. People’s own needs were being ignored. These are things that I have dedicated my life to changing and have driven me to work in a career that focuses on older people’s housing, health and social care needs.

INSIGHT What I’ve really enjoyed in my first few months with the Trust is meeting and talking directly with over 900 staff and 1,000 residents. Engaging in these conversations is vital in order to learn richness of the organisation and how we should be moving forward together. It’s really important to me that a chief executive isn’t hidden away in an office. We need to be visible, walking around and feeling the culture that’s being developed. I want to create an environment where people feel they can contribute to strategy and to use that as a framework to develop the organisation into the future.

LESSONS It’s important to be open and honest in your dealings with people. Also, if you say you’re going do something, then you should deliver it. Always be prepared to accept criticism and acknowledge that you are not always going to be right. When you are wrong, accept it and then do something about it. Equally, it’s important to learn from your mistakes and not repeat them. In terms of being a chief executive, it’s important not to think that you own the business. The role of a chief executive should be as a trustee of that organisation. The time when think you own it is the time to leave.

INFLUENCES My greatest influence, in terms of how I consider the world, was working as nursing assistant in a psychiatric hospital after I graduated from university. The treatment of older people that I witnessed within that ward has had profound effect on my life. My experience in that ward was of a completely

ADVICE You can always learn new things and try to take advantage of coaching and mentoring opportunities as they arise. Try to absorb as much information as you can as you progress, but don’t be afraid of discarding any information that doesn’t fit. Finally, surround yourself with good people. CMM

An extended version of this interview can be found at Subscription required. CMM October 2015 25

HOMECARE – LEARNING FROM THE NETHERLANDS Last month’s CMM featured news about homecare teetering on the brink of collapse. The system is feeling pressure from all sides and something has to give. Is this Dutch approach the answer? The pressures facing the homecare sector are well-known. It is a system that is already struggling to meet competing demands of more clients with higher needs, tightening local authority budgets and legal challenges over the payment of national minimum wage. Providers are becoming increasingly unable to meet the needs of the people under local authority contracts. Added to this, the sector is now facing the new National Living Wage, which the United Kingdom Homecare Association has warned will bring ‘serious risk of catastrophic failure’ to homecare if it isn’t fully-funded by the Government. This could lead to the continued supply of state-funded homecare becoming unviable at a time when the Government needs social care services to support the NHS; particularly helping people to leave hospital promptly.

DUTCH HOMECARE SECTOR Buurtzorg means ‘neighbourhood care’ and is a Netherlands-based, not-for-profit homecare provider. Developed in 2007 by Jos de Blok, a community nurse who had studied economics, its approach to homecare is delivered via selfgoverning teams of nurses. At the time it was set up, the country’s homecare sector was becoming fragmented. Jos de Blok explained how the market worked in a recent TEDx Geneva talk. He explored how a Government policy to professionalise the industry had seen an increase in managers, a large number of different service offerings and an accompanying 26 CMM October 2015

increased amount of bureaucracy. As a result, nurses had to decide the type of care to deliver to each individual with many different levels of service to choose from. However, the clients’ needs hadn’t changed, just the system. This led to increased administration and staff feeling under pressure to account for every aspect of their day, from care delivered to travel times. The resulting effect was that it added to workloads and detracted from the role of delivering care. The professionalisation of the sector, Jos explained, actually led to it becoming fragmented, quality dropped and costs increased. Also, there was little continuity of care, with a number of different care workers visiting clients, plus a predicted shortage of nurses on the horizon. This all sounds familiar.

BUURTZORG APPROACH To counteract this, Jos de Blok set up Buurtzorg. Developed to strip out the bureaucracy, small teams of nurses work together autonomously in defined neighbourhoods. There’s no management or hierarchy, only administrative support at a small head office with Jos and his wife at the helm. The nurse teams support each other and their clients, building community links and helping to meet the needs of their clients locally by working together to solve problems. Teams of up to 12 nurses support 40 to 50 clients in small neighbourhoods, where they can build relationships and get to know everyone in the community. The nurse teams know their clients well, support them and tend to both their health and social care needs.

The nurses have shared values and openly support each other. They work together to organise their days, manage their clients, pass on important information, solve problems, lead their own training and work within the wider community too. The nurses are central to integrating the local services around the individual, including working closely with health colleagues and family carers to ensure care is co-ordinated, tailored and works. Clients include those with long-term conditions, disabilities and dementia, those in need of end of life care, older people with co-morbidities and anyone needing reablement following a hospital stay. Although the clients are the same as those supported by homecare here, by being autonomous teams, they are not caught up with bureaucracy or paperwork. IT solutions have been introduced to reduce paperwork and administration and the back office administrative staff undertake any paperwork that needs to be completed. This leaves the nurses to get on with what they do best: care for people. The company grew quickly from the outset, with more nurses hearing about the Buurtzorg approach and wanting to be involved. As the teams are self-managing, this didn’t have a huge impact on the company and the growth was sustainable. In 2015, Buurtzorg has 8,000 nurses working across 800 teams. It boasts the highest customer satisfaction of any homecare provider in the Netherlands, costs are 40% lower even though nurses are highly educated, with 70% being registered nurses and 40% holding a

Batchelor’s Degree. And it has been voted the best company to work for three times.

GROWING INTEREST Although developed in the Netherlands, the approach has picked up a lot of overseas interest. It has been discussed in in Sweden, Australia and Japan. There is Buurtzorg USA which was established last year, and Jos de Blok has spoken around the world about how even the most complex of homecare structures can be simplified to become autonomous nursing teams. In the UK it has been looked into by the Royal College of Nursing, The King’s Fund, the Scottish Government and the Chair of Public Health Wales. Public World Consulting organised a recent event with the Royal College of Nursing and the United Kingdom Homecare Association to explore the model. Public World Consulting is also working with Guy’s and St Thomas’s NHS Foundation Trust and Buurtzorg to test the model. CMM

OVER TO THE EXPERTS... We have a very complex, but also very fragile homecare market. Could the Buurtzorg approach to autonomous homecare work here? Could it be the answer to England’s homecare situation? Would our levels of regulation and compulsory training impact on its success? Is such a drastic change to the system possible to implement? Or is it worth trying as the sector is facing ‘catastrophic collapse’?

AN ATTITUDE SHIFT IS NEEDED Buurtzorg offers a fascinating model for joined-up health and social care. There are certainly lessons from this model which could be implemented here. Buurtzorg boasts impressively low operating costs, with minimal bureaucracy and excellent use of IT. Its success also seems to come from the use of small-scale teams of non-hierarchical, self-directing registered nurses, whose professional development is well-supported. The shrinking pool of registered nurses is well-documented, and increasingly a well-trained homecare workforce could be future district nurses. There has been lots of interest in Buurtzorg in the UK, but few attempts to put it into practice. I think there are three interlinked issues to overcome: money, training and trust. The costs of developing homecare workers with similar training and skills afforded by up to three years of nurse training are unlikely to be met by the State in a grossly underfunded system. Nurse education also equips people


to become accountable individuals, recognised through a professional register. A move which Government (in England) has repeatedly ruled-out for social care workers on grounds of cost. The vast majority of cash-strapped councils continue to commission homecare prescriptively, with care purchased in minutes at extremely low prices. This is where trust comes in. Employers must equip staff to take on significant autonomy, while councils must learn to trust their providers to deliver reabling services and allow flexibility for the right care to be delivered for individuals, whose needs change regularly. An attitude shift is needed to deliver this model successfully. It might even be unrealistic to look to underfunded councils or CCGs to drive this model. It may well come from providers to the self-funded market, where prices allow greater risk-taking and innovation.

Colin Angel Policy and Campaigns Director, UKHCA

seamless integrated services and a widely accepted fair price for care. But our society is fragmented, our system has a diminishing workforce with little support to professionalise, not enough nurses to deliver essential clinical care, a lack of investment and continuing absence of robust private insurance models to support this type of service. Most importantly, we have dangerously undermined that vital bond between the frontline staff and the person receiving care. It is unsurprising that the model is so successful, it seems simple: co-operation between essential service elements to give holistic care with autonomy and trust given to the frontline professionals. Would it work here? There are glimmers of similarity in the development of some clinically-led social care teams and with nods towards proper outcome-based commissioning but we have some way to go.

Raina Summerson Chief Executive, Agincare Group

I BELIEVE IT IS WORTH TRYING Buurtzorg: the concept and the way it works is undoubtedly fascinating. It immediately reminds me of Nurse Fleet on her bicycle in the village where I grew up, where she was the district nurse, midwife and health visitor. By being highly-trained, accessible and resourceful she was able to be completely flexible in the work she did, solving complex problems for all age groups and varying her routine to accommodate changing demands on her time. But Buurtzorg is not a case for turning the clock back to a nostalgically constructed community. It is a contemporary and vibrant model recognising diversity of need and, importantly, seems well supported by IT. Reducing bureaucracy is important for nurses, but they still need to keep good records to satisfy the adage that ‘if it’s not written down, it hasn’t been done’. There is something to learn from Buurtzorg which doesn’t have the administrative demands of a system based on commissioning and

This model is clearly an effective combination of elements which deliver successful outcomes for both the workforce and those receiving services. However, there are some fundamental barriers when considering its transfer to the UK. Our regulatory, commissioning and funding framework provides a very different backdrop. Developments in integration, co-location, professional training and more trusting partnerships amongst services would be required. Trust issues and funding fears drive barriers between central and local governments, the NHS and providers. We only have to look at the Better Care Fund rollout to see the challenges. Buurtzorg relies on essential components: informal networks of neighbourhood resources, high staff ratios of qualified (and professionalised) staff, integration of medical and support services and flat rate ‘per hour’ payments. Mainly, things we want to achieve here are involvement of family and community,

inspection regimes. A personal approach to care is very attractive and one that is based on meaningful relationships sounds very satisfying for both the client and the nurse. And, crucially, such relationships are based on trust. This is key to Jos de Blok’s creation of Buurtzorg, in which the nurses work with no management structures and are self-organised. In this model, nurses can exercise a great deal of autonomy and many of our current district nurses already do: they are co-ordinators of care, they won’t say ‘it’s not my job’ – they might not do the job, but they readily get it done by someone appropriate – and many are prescribers. So there are no impediments when it comes to nurse regulation or nurse training, in fact the freedoms nurses have craved for years are now available to support this model. And I believe it is worth trying.

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CMM October 2015 27

12/02/2015 10:50


Reflecting on why and how we ask people for their opinions on services, Les Bright draws on his personal and professional experience to suggest that we are likely to learn more by asking for opinions, not answers.

28 CMM October 2015

Many of us invite people using our services to comment on their experiences, regardless of whether a regulator requires us to do so. But few are so bold as to invite an outsider to conduct the work. Information gathered in this way can often be revealing, insightful and more credible than presenting some unsurprising facts from routine in-house surveys conducted by our own staff.

LEARNING FROM OTHER TRADES Every time I take my car to the garage for a service I get called a few days later by someone enquiring about my ‘customer experience’. They ask me the same old questions every time, ‘Was the member of staff who dealt with you polite? Did s/he explain the work that had been done? On a scale of 1 to 5, where 5 is the highest/best and 1 is the worst/ least acceptable, how did we do...?’ I’ve never been asked whether I considered the service to be good value for the money spent, and I always try to introduce that into the call. The interviewer makes it clear, courteously, that

what matters to me is of no interest to them, or, perhaps more pertinently, to the company on whose behalf they are asking me to comment. After a recent visit for an annual service and MoT, rearranged twice at their request, I turned up an hour after the time I had been told my car would be ready for collection only to be informed that it would be another half hour. I accepted this, while making it clear that I expected the agreed price to be reduced as a result of their failure to complete the job within a reasonable time. Once again I was called within 48 hours, but instead of wading through the predictable set of questions and then asking whether they would like my opinion on other matters, I asked at the outset if any of the ‘survey’ would cover value for money or price. I volunteered the view that, on the basis of my most recent visit, I appreciated their flexibility around price, only to be told that there was no space for this on the schedule of questions, and in any event I had opted out of giving my views by not agreeing to answer their standard questions.


CMM October 2015 29



I suppose I ought to be pleased that they persist in calling me every time, but so long as they continue to ask me about the things that matter to them and ask for my scores, the term ‘customer experience’ seems to be a misnomer, or just a case of going through the motions. And, on this occasion, they missed out on the chance of some unsolicited positive feedback from which they could have learned.

THE HEALTHY APPROACH Now, as well as being someone with a long career in social care, managing services, acting as an advocate, researching and campaigning, I am also the son of a 94 year old lady who moved into a care home a few months ago after around five weeks in hospital. The hospital displayed graphs depicting the ward’s performance, as measured by patients’ families’ comments, and piles of questionnaires were strategically placed around the public areas. But nobody ever asked me for my opinion nor, more importantly, was able to answer my simple questions, ‘...I don’t really know, I think you’ll have to ask someone who was on duty earlier...’ However, as these people were on duty earlier, they tended not to be around when I visited. I was pleased to be consulted about the plans for Mum to be transferred to the care home we had chosen, with an ambulance arranged for 2pm the next day, suiting the home, the hospital and me. However, the next morning at around 10.30am, as I was driving to the home with bits and pieces to personalise her room, I was called by the manager to check when I would be arriving, as Mum had just been delivered there by patient transport. At this point I wondered where I might find a copy of the questionnaire asking me ‘How are we doing?’. However, I put this to the back of my mind as I focused on ensuring the smoothest possible transition for Mum.

WHAT DO RESIDENTS AND RELATIVES THINK? This leads me to ask, can care providers learn from a garage or a hospital ward in their attempts to uncover meaningful feedback from residents and their families? Care homes are built on multiple relationships of varying degrees of intimacy, offering differing perspectives on how well the home is doing in

providing a fulfilling life, appropriate care and a personal service to people being looked after there. Capturing the opinions of all parties may be too demanding, require elaborate systems, take staff away from other tasks and may not deliver the hoped-for insights. It is, therefore, crucial to prioritise listening to, and learning about, concerns of residents and their families, to record these as accurately as possible and to demonstrate, wherever necessary, that you have heard and acted on the comments made. Experience of casually asking residents their opinion on the home they live in is that many will frequently offer feedback such as ‘...all the girls are wonderful...’ or ‘...mustn’t grumble...’ or ‘...the food is very good...’ – good to hear, but not very illuminating or helpful in adjusting staff practices. While there may be a wider range of opinions offered by residents’ families, such comments may not be absorbed into a wider look at how the home is doing.

UNCOVERING SECRETS However, if it is possible, set aside time to listen. By using a schedule of prompts that starts from the premise that what matters to the resident or their closest family matters to you, you will learn things you didn’t already know. You may spot patterns that lead you to reconsider how you organise tasks or routines. I have followed this approach in almost 20 homes where the registered owners have decided that the best bet for securing more, different and fuller information on what people think is to ask an outsider to come in to meet residents and relatives. I’ve always come away thinking that this approach uncovers new and different perspectives on what works – and why, and what doesn’t work – and what might be done to improve the situation, although I suppose I’m bound to say that! The ‘secrets’ uncovered in this way include incredibly heartening stories of staff ‘going the extra mile’, as well as people being relieved at finding a way of relating something that worries them, but not sufficiently to risk damaging established relationships with staff or other residents. People are often surprised when I open our conversation – it’s not an interview – by telling them that I do not have a questionnaire that I am working my way through, and that I will not be

ticking a series of boxes, adding up the scores and declaring the home to be good, bad or indifferent. I invariably tell them that nothing is ‘out of bounds’ and that I am interested in hearing what matters to them. I tell them that there are topics or areas of interest that I hope we will cover, but their issues take precedence over mine. I make no unsustainable claims – that problems will be solved, or the need for agency staff will disappear, or fees will be reduced. I also make sure that they appreciate that, although I am not an employee of the organisation running the home, I am nevertheless working for them and will be reporting back my findings. Generally, I spend up to an hour with each person I meet so that, in a day, I will meet a minority of residents, but what the approach lacks in numbers is more than made up for by the in-depth reporting of conversations and the concerns – and compliments – which people express. In common with other similar encounters people may casually throw out a comment of great significance with the words ‘’s only a little thing...’, to which I invariably respond by telling them that nothing is too small to be considered, and that ‘small things make a big difference’ when it comes to offering a personal service.

COMMITTING TO FEEDBACK Collecting people’s opinions and experiences, and then producing a report, is only useful if the organisation owns the activity to the extent of committing to feed back the findings to residents and relatives. This is critical to my belief that I am doing something worthwhile. Some relatives use talking to an independent person as a therapeutic activity. They can work through their feelings of loss and disappointment at no longer being able to care for a loved one in a domestic setting and express worries ‘safely’, that is, without compromising their relationship with managers, carers or other members of their family. The risks of possibly learning things that cause concern is far outweighed by the confidence that the process can convey to those who choose to share their opinions. Indeed, those who don’t choose to speak usually welcome the fact that the provider is prepared to engage the services of an outsider to comment on service quality, as a result of listening to other lay-people. CMM

Les Bright is an Independent Consultant at BCD Care Consultants. How do you monitor feedback from residents and families? Log onto the CMM website at to comment. You can also access a provider checklist and case study. Subscription required. 30 CMM October 2015




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Bringing residents

together through old and new approaches to activity

Improving the wellbeing of care home residents is top of the agenda in the corridors of regulators, commissioners and thought-leaders up and down the country. However, achieving this can be a challenge for even the most efficient and motivated care providers and teams, due to the varying capabilities and needs of residents. Beyond the tailored day-to-day support and care that each resident requires, finding new and exciting ways to engage individuals living with a wide range of conditions is the key to unlocking an outstanding service. Nowadays, much focus is rightly given to personalised activity provision: ensuring all activities are tailored to the needs, interests and goals of individual residents. This is only part of the journey to individual wellbeing. Care homes are unique environments where large groups of individuals – residents, staff, friends and family – live, work, play and interact under one roof. In a group environment like a care home, wellbeing is contagious. To help to spread the good and stop the bad, shared experiences can be very beneficial. Creating shared experiences not only helps to overcome any isolation that may be experienced by older people living in care homes, but goes further by cementing group dynamics – and building social capital – by 32 CMM October 2015

Wellbeing is contagious. Bringing residents together for shared experiences spreads happiness throughout the home. Stimulating activity and meaningful engagement are essential to building social capital. Ben Allen and James Tweddle explain how to combine traditional activities with modern technology to benefit everyone.

bringing people together, sparking conversation and strengthening relationships. As a result, it increases the wellbeing of everyone in the environment, from residents to staff and beyond. And it doesn’t have to cost the earth either. New and emerging technologies can be a vital resource for staff when thinking creatively about an imaginative and comprehensive group activities programme. Television is one such technology that can be used to enhance a wider, personalised, activities programme.

THE POWER OF ENTERTAINMENT Top quality entertainment has always

had the power to unite people and to form friendships around shared passions. With modern technology, it’s never been easier to bring entertainment into a care home environment. The challenge is to take this further, to leverage this content into wider activities and wellbeing, and to build much needed social capital. The use of technology can bring a range of stimulating activities to care homes. To be truly personalised, these can be co-designed with service users and built around entertainment content such as sport, movies and the arts. Television and technology can engage people collectively and notably increase wellbeing. Television in particular

can have a powerful effect. With an increase in available channels, and therefore variety of content, there is an opportunity for frontline staff to develop innovative new ideas on a wide range of fun and creative activities. These can be built around residents’ specific interests such as classic movies, entertainment, sports, arts and natural history content. Whether it’s a sing-a-long to a classic Elvis musical, setting up a game of chair tennis after a Billie Jean King retrospective, or arts and crafts sessions inspired by the latest David Attenborough documentary, there’s entertainment to engage, inspire and stimulate every resident. A traditional seated exercise



class can be transformed by having Singing in the Rain on the television, a room full of umbrellas and a group of happy residents re-enacting the famous routines. By expanding on the offering of the traditional television, you are stimulating not just their bodies, but also their minds and their hearts. Crucially, you’re also much more likely to get regular participation and engagement and, by association, increase wellbeing and social capital within the home. You may find a member of staff has a

talent for singing or a real interest in football that can be drawn out.

WELLBEING AND DEMENTIA For those residents living with dementia, cognitive and psychosocial therapies are proven to be highly effective intervention methods. For example, recent research has suggested that exercise therapy, music therapy and cognitive stimulation therapy can all be

Leading care home provider, Hallmark, has teamed up with Sky and Oomph! to implement a wellness programme in several care homes across the country. Activity sessions link gentle exercise and mental stimulation with content from popular television shows or movies directly via Sky.

Whether it’s a sing-a-long to a classic musical, setting up a game of chair football to get residents in the mood for the next live Premier League match, or having a story-telling session inspired by a favourite movie or television series, there’s entertainment to suit every individual’s taste and interests. Activities are sure to get residents motivated and active. By using Sky’s content, sessions are designed to help residents build relationships with one another, increase their mobility and enhance mental stimulation. Regular exercise improves cardiorespiratory and muscular fitness, bone and functional health and reduces the risk of unhappiness and cognitive decline. Hallmark is already noticing a difference to residents’ quality of life, with classes showing a proven increase in levels of social interaction and mental stimulation among those taking part. The use of Sky content during Oomph! classes has helped Hallmark’s residents lead an active and engaged life, and has had a positive effect on their health and happiness.

valuable interventions which lead to the improvement of the memory and quality of life of people living with dementia. On a care and support level, enhancing residents’ wellbeing is about meeting them where they are. Activities focusing on reminiscence are, therefore, a crucial part of the mix. It’s the job of the activity co-ordinators to create immersive, sensory experiences and facilitate group discussion that stimulates residents physically, mentally and emotionally.

Reminiscence should focus on the individual and their experiences, but classic scenes – Morecambe and Wise, Louis Armstrong, Jesse Owens, the Royal Wedding or the moon landing – open doors that are often otherwise closed. The benefits of personalised, meaningful activity to care home residents are well-documented. Creativity is required, but by using existing resources, technology and traditional activities, it’s possible to enhance the lives of everyone. CMM

Ben Allen is Founder of Oomph! Wellness Ltd. Twitter: @OomphWellness James Tweddle is Sales Director at Sky Business. To find out more about Sky and its connection with Oomph!, plus the impact these can have on the wellbeing of residents and staff in a care environment, visit Subscription required. CMM October 2015 33

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PUTTING INNOVATION INTO PRACTICE Victoria Elliot gives an overview of why it’s important to utilise innovative techniques in care homes, in addition to outlining ways other care providers could enhance the quality of care they offer through innovation.

According to the Office for National Statistics, over 290,000 older people in the UK live in care homes – a number expected to rise as the number of over-65s continues to grow. Recent studies also show that the number of people living with dementia in the UK will increase from 800,000 to 1.7 million in the next 40 years. As a result of this, it is becoming increasingly important for care providers across the


CMM October 2015 35



country to adopt a culture of innovation that includes developing and trialling new approaches and techniques. It is also crucial to take an integrated approach, encompassing all aspects of wellbeing, including environmental, physical, social and psychological. This will mean that, when the number of those living in care homes and the number of those living with dementia rises, the industry is providing the highest quality, person-centred care possible. As part of a Trust-wide initiative to improve care quality, increase research and innovation, and heighten the lived experience of care teams and residents, the Orders of St John Care Trust (OSJCT) has developed and implemented a number of initiatives over recent years to better support those working and living in its care homes. These have the potential to be adapted by other providers to ensure those receiving services have the best quality care and experience.

COGNITIVE STIMULATION THERAPY One approach that has been used successfully is Cognitive Stimulation Therapy (CST), – a psychosocial treatment that uses a series of 14 structured group therapy sessions to provide peer support to people living with memory loss. The use of CST has led to a number of positive effects on residents with dementia, including improved confidence levels and bonding amongst group members. Most participants not only identified improvements in their view of friendships, but some also felt their memory had improved as a result of the therapy.

EMPLOYING SPECIALIST DEMENTIA NURSES Employing specialist dementia nurses such as Admiral Nurses is another innovative way of improving the quality of dementia care delivered within a care environment. These specialist dementia nurses are tasked with providing skilled assessments of dementia care practice, as well as offering practical advice and support to families and carers of those with the condition. There are approximately 100 Admiral Nurses currently working throughout the UK; however, the majority of them work in the NHS, with only a few working in the care sector today. Following an in-depth look at the role specialist dementia nurses such as Admiral Nurses

play, OSJCT found that they have a direct positive impact on the care provided to residents within its homes. This is by improving quality of life and helping to resolve specific issues. For example, Admiral Nurses assisted care teams to reduce residents’ pain, increase residents’ independence and meaningful engagement, and also generally improve upon the wellbeing and physical health of residents. The study also found that Admiral Nurses have a positive impact on care home employees, by helping to expand their knowledge and skills, whilst also making them feel more supported and confident in doing their jobs.

GROUND-BREAKING HOUSEHOLD DESIGNS It is possible to aid those with dementia by refining the design and layout of care homes – although this is simplest when undertaking a new build. The quality of life for people with dementia is influenced significantly by the environment in which they live. Following months of research, OSJCT developed a layout for future specialist dementia care facilities, incorporating a number of features proven to suit those living with the condition. For example, the new layout utilises a design resembling a small, home-like environment, instead of including features like long, doubleloaded corridors and large multi-function rooms. Features like these were very common in facilities designed and built a decade ago as a way of catering to those who were physically, not cognitively, disabled. However, many people with dementia live in homes with these features today, despite them not being the most appropriate to meet residents’ needs. People with dementia may also encounter difficulties retrieving a mental image of a place they cannot see, so another feature that has been used in designing a dementia-friendly facility is ‘total visual access’ – which allows residents to see all of the places relevant to them. For example, the dining room and lounge are designed with a combination of solid walls, half-height walls and timber-screening, providing maximum visual access into the rooms while ensuring both privacy and the mitigation of noise transfer. The small-scale environment laid out in a dementia-specific care home design, combined with the inclusion of themed areas and variances in décor, not only encourages residents with

limited mobility to walk and maintain independence, but also assists with way-finding and orientation.

EMPOWERING RESIDENTS THROUGH ART AND CHOICE Another way of implementing innovation into a care setting is through meaningful activities and projects that engage residents. Thanks to funding from The Baring Foundation’s Late Style Programme, OSJCT has recently taken part in a project, designed and supported by New Brewery Arts. It involved the creation of a piece of artwork designed to explore ageing through art, with input provided from older people. As part of the project, Robert Race, a 70-year old Wiltshire artist, was commissioned to create an automaton based on the theme of ageing, with an important part of the project being to engage with older people during its development. Another key criterion for developing the work of art was to ensure that the final result would be something that was highly-interactive and accessible to all ages, including those with varying levels of cognitive impairment. Over six months, Robert inspired and assisted residents to print, cut, fold and craft their own small automata, making something new each week. He then used this experience, and his own thoughts on ageing, to shape and inspire his final work of art. Now complete, the automaton, called Getting On, will go on tour to 16 OSJCT care homes across Gloucestershire, Wiltshire, Oxfordshire and Lincolnshire, providing access to a large number of residents – a group that have historically had limited access to high quality art exhibitions and displays. It will also be exhibited at Gloucester Cathedral, New Brewery Arts Centre in Cirencester and at the UK Dementia Congress.

EMBRACE INNOVATION There is no requirement for care providers to develop, trial and evaluate innovative approaches. However, any organisation that embraces a culture where innovation is encouraged and that strives to continually improve the lived experience of residents and staff will be in a prime position to meet the growing and changing needs and expectations of the workforce, residents and families. CMM

Victoria Elliot is Principal Care Consultant (Research and Innovation) at The Orders of St John Care Trust. Twitter: @OSJCT Would you implement some of these techniques? Comment on this article on the CMM website Subscription required. 36 CMM October 2015

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CARE INSURANCE: Getting value for money

Funding issues and an explosion in claims have caused a rise in care insurance premiums. These rises can range from as little as a few hundred pounds for small care homes or homecare providers to upwards of half a million pounds for groups of care homes. However, providers can, and should, get good value for money from their insurance if they are prepared to shop around. David Waters explains how. 38 CMM October 2015

Historically, the care sector chases premiums down, with providers simply switching to the cheapest insurer. While most sectors do this, care does it to unprecedented levels. However, this has led to companies purporting to offer cheap cover, only to cease trading after losing underwriting support or being closed down by authorities such as the Financial Conduct Authority (FCA) or Prudential Regulation Authority (PRA). When this happens providers are left high and dry with no other option than to purchase insurance elsewhere, often leaving them thousands of pounds out of pocket. Those unlucky enough to have claims outstanding could be in a ruinous position financially if they have to cover the costs of claims and client redress themselves. There remains a number of insurers registered in offshore territories and invariably beyond the control of the FCA or PRA. Providers using these must understand the commercial risks involved. It’s obvious that providers want to look at cost, but that must be combined with the financial security of the insurer, the covers being proposed, the service and the care sector knowledge of the broker. In many cases, anything which appears to be too good to be true is exactly that. Providers should seek a stable, reputable, mainstream insurer that is both authorised and regulated by the FCA or PRA. One that offers a comprehensive level of cover that is good value for money. As a result of decreasing profit margins two large insurers, Ecclesiastical and Hiscox, have both exited care insurance. Those remaining are scrutinising care businesses carefully before offering cover and setting premiums at realistic levels, but providers can still get good value for money by bearing in mind the following.

CLAIMS HISTORY Aside from obvious variables, such as location, how many people they support and employ, and how many premises they operate from, providers’ claims histories will impact premiums and affect a policy’s value for money.


CMM October 2015 39

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Insurers need to stay profitable just as care businesses do, so it is unsurprising that providers making lots of claims (eg for small things they could fix relatively easily and inexpensively themselves) will experience premium increases at renewal. In fact, these increases could ultimately cost more than any claims payments made, meaning they end up out of pocket. ‘Serial claimants’, those making a number of claims in any one insurance year, may also struggle to find cover in the future. Of course, providers are entitled to

businesses. If any claim is made, care businesses should document clearly the measures they have put in place to prevent reccurrence. This goes on record and can positively affect premiums, leading to value for money at policy renewal. Providers that claim strategically when there is a genuine need can get excellent value for money from their insurance policies via a combination of support from insurers, expertise in managing repairs and helping to keep their premiums low. When it comes to claiming, providers

“The main issue for insurers of care businesses, generally, is the increasing number of liability claims – predominantly arising from injuries to staff and care of clients. ” make a claim if damages sustained are covered under the terms of their policy. However, assess the financial impact this can have on premiums before doing so. Making lots of claims can be detrimental to a provider’s relationship with insurers, which, if well-built and maintained, can be highly rewarding in the long run.

LIABILITY CLAIMS The main issue for insurers of care businesses, generally, is the increasing number of liability claims – predominantly arising from injuries to staff and care of clients. In 2001, the average care business had one liability claim every 16 years and the average cost of a liability claim was less than £7,000. In 2015, the average care business is making one liability claim every seven years and the average cost is now skewed to an average close to £25,000 (more than a 200% increase in numbers of claims and a 350% increase in costs over 14 years). The net effect is insurers’ costs have increased substantially in a short period of time. The only way they can return a profit and maintain their presence in the market is by increasing premiums. It is projected that the volume of claims will increase and this, in large part, is why both Ecclesiastical and Hiscox have pulled away from underwriting care

can also get good value for money by choosing a policy on a ‘claims occurring’ basis. This means it meets claims when the event causing the loss occurs during the policy period irrespective of when the claim is made. This is opposed to a ‘claims made’ policy, which only meets claims when the claim and the event are reported during the policy period. This gives providers residual cover after policy lapses or is cancelled and has little effect on premiums; something for nothing almost.

QUALITY STANDARDS Quality standards, or risk management, is vital in today’s market. A good risk management strategy helps prevent things going wrong, reducing the chance of having to make a claim and lessening the risk for insurers. This can ensure good value for money for providers when it comes to premiums. Insurers now carefully assess the way in which businesses: • Manage and minimise risks, such as those relating to service users, staff and visitors. • Review aspects of these risks through risk assessments and how regularly these are carried out. • Develop risk management programmes and implement additional measures

should claims occur. • Implement staff training programmes. Interestingly, a recent survey of our care clients highlighted that those which were Investors in People (IiP) accredited had fewer liability claims. Claims made by businesses with IiP accreditation tend to be settled quicker and at a lower cost than those originating from businesses without it.

IDENTIFYING RISKS Care providers should start by carrying out a risk assessment to identify potential hazards, then set about implementing measures to mitigate these hazards. These include policies, procedures, management changes or structural modifications to premises. Providers can minimise their own business risk profile by considering: • Employers’ liability (risk of injury to staff): Protect staff by ensuring all are well trained, alert to the risks they face and are able to inform management and others about them. • Buildings maintenance: A scheduled maintenance programme will help mitigate damage to buildings and prevent deterioration, which could lead to damage or injury. • Regulatory issues: Comply with the Care Quality Commission (CQC), or your national regulator, ensuring all standards are met and procedures followed. Evidence this through meticulous documentation. If a regulatory issue does occur, be sure to carefully design and action a response to the issues raised, usually referred to as an action plan, and meet all deadlines. Share this information with insurers, don’t wait for them to ask for everything – don’t forget CQC information is in the public domain. Are all staff up-to-date with the latest news from the appropriate regulator, familiar with the duty of candour and CPR trained? Have the implications of the Care Certificate been considered? Do customers (residents) have Do Not Resuscitate orders, if so where are they? Do night and weekend staff know of the orders’ existence? • Liability to others: Manage risks to


CMM October 2015 41



others with common sense, whether it be using two members of staff to dispense medicine or displaying a ‘wet floor’ sign to prevent slips and falls or similar. Common sense goes a long way and the logic of common sense can be followed by the Courts. • Contents: Insure all contents on a ‘newfor-old’ basis, make sure values reflect this – a carpet that cost £1,000 ten years ago would probably cost closer to £2,000 today. Store valuable items securely and carry out regular electrical testing to keep things safe. • Theft: Reduce the risk of allegations of theft claims against employees by ensuring they report any ‘gifts’ from service users or whether they are in possession of sensitive personal information (eg PINs). Rotate care staff between residents or customers as a matter of course. • Business interruption: Be sure to manage ongoing risks so if something does happen the impact on the normal running of the business is minimised. Always try to have alternatives, a backup electrical supply is a good one. Is electricity supplied down a single set of wires? If so, is there a backup option or would it be wise to consider an emergency generator? • Employment practices: Ensure employment contracts are upto-date and always take advice, especially before taking disciplinary action, as employment law is fraught with complexities. Create an open culture where management and staff communicate freely to mitigate the risk of tribunals. • Water damage: Minimise the risk of leaks by having roofs and pipes inspected regularly and, in the case of care homes, use cut off (push down) taps to prevent residents leaving taps running and not only wasting water, but potentially causing damage. • Vehicles: Ensure staff and any equipment they take with them on visits are appropriately insured. This is especially true where vehicles are used for transporting service users

CQC RATING In England, the CQC rates care businesses as ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’. The rating attained is clearly an indication of how well-run the regulator perceives a business to be. Insurers use this as part of their underwriting matrix when weighing up their exposure to risk and setting premiums. Outstanding providers are more likely to find insurers supportive with premiums and covers than those rated inadequate. So apart from the obvious benefits of attaining a good rating from the CQC, providers can use this to get good value from insurance. An effective quality standards (or risk management) strategy will go a long way to securing the coveted ‘outstanding’ CQC rating, but the tips from Claire Ferrari of Pro Risk Care Consultancy on the CMM website give more information.

(this would constitute as ‘business use’ in insurance terms). Ensure company vehicles have a valid MoT, are taxed and portray the business and its quality of service positively. By identifying risks, documenting measures implemented to mitigate these risks and communicating these effectively with brokers and insurers, providers can get good value from their insurance policies by keeping premiums as low as possible. Those struggling with risk assessments and risk management would be advised to appoint a professional risk consultancy. This article is an introduction to the thought-processes needed to make

businesses better. Something we all need to strive for and can achieve. Don’t be defensive – all too often I hear the words ‘we really tried’ or ‘I never thought this could happen’ followed up with ‘I don’t see how we could have done anything else’. If this reflects your views ask others – friends, family and professional advisers – you may find they have had similar experiences. When it comes to insurance premiums, there are variables over which care providers have little control, but sound risk management, well-trained and engaged staff and well-run businesses will lead to higher CQC ratings and, in turn, insurance that is both comprehensive and excellent value. CMM

David Waters, Chair, Howden Care (CHIS and PrimeCare insurance). Web: or How do you manage your insurance premiums? Add your view on the CMM website at Subscribers will also have access to Claire Ferrari’s tips for improving your quality rating. 42 CMM October 2015

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CMM October 2015 43



CONFERENCES • EXHIBITIONS Berkshire Care Conference • 15 October 2015

15th October 2015 Following the great success of last year’s event, the CMM team has been working closely with Berkshire Care Association to once again shape the order of the day of this national level conference. After careful consideration, CMM is pleased to confirm that the agenda is set and the day looks to be extremely interesting and informative, particularly in light of the recent changes to the social care landscape. With Phase One of the Care Act now in place, but other issues on the horizon, the current pressures to those delivering care and support have never felt more palpable. With a thoughtful and considered line-up of speakers to reflect this, the Berkshire Care Conference aims to address these points and more. It will acknowledge the specific needs of the local care market and allow a unique opportunity for delegates to network with like-minded providers who will, almost certainly, be facing the same issues. There will also be interactive workshops allowing attendees to delve into subjects further and expand the scope for more understanding of operating in the current market. These include how to provide quality care in a turbulent homecare market. With an exhibition of carefully selected services and products, the conference will explore the future of care and commissioning and how the market may evolve in the months to come.

Main stage presentations will include: Social Care Reform and Providers: Past, Present and Future Patrick Hall, Practice Development Manager (Policy) – Social Care Institute for Excellence. Outstanding Care or Perfect Paperwork? Adrian Hughes, Deputy Chief Inspector, Adult Social Care – Care Quality Commission. The Reality of Implementing the Care Certificate Rachel Reid, Locality Manager – Skills for Care. These leading sector representatives, along with the other speakers, will offer their expert opinion and insight into the current social care environment. There will also be an invaluable panel discussion, which allows delegates to raise their own questions. With a relevant and topical agenda, those attending the Berkshire Care Conference can be assured that the event will once again prove successful at raising and resolving, as best as possible, the issues that matter most to local providers wanting to deliver the highest standards of care. For more information on the agenda, speakers and how to book or sponsor the event, visit

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Please mention CMM when booking your place. CMM October 2015 45

D R M AT T H E W N O R T O N • H E A D O F P O L I C Y • A L Z H E I M E R ’ S R E S E A R C H U K

Dr Matthew Norton explores recent reports into the prevalence of dementia now and in the future.

Changes in the estimated prevalence of people with dementia have hit the headlines more than once lately. But while the figures are vast and projected to increase still further, there is some encouraging news. First, the bad news – news that demands attention – is that both the numbers of people with dementia, and the cost of the condition, are still on the rise. The World Alzheimer Report, published last month, estimates that today over 46 million people worldwide are living with dementia, and that the condition is now costing the global economy an eye-watering US$818bn a year, a figure that has soared by 35% in the last five years alone. The majority of this, around 80%, is attributed to the cost of social care and the cost of informal, unpaid care, highlighting the enormous strain this lifeshattering condition places on our care

system and on families who look after their loved ones. The outlook for the future shows a worsening picture: the report estimates that by 2030, the number of people with dementia will have reached over 74 million, with the figures set to top 131 million by 2050. Its projections show that in just three years’ time, the condition will cost the global economy more than US$1tn a year. Huge figures like these can be difficult to comprehend, but each tells a story of more and more families hit hard by Alzheimer’s disease and other dementias; diseases that tear lives apart and which currently cannot be stopped or slowed. They are a renewed call to action, and should rally us in our determination to tackle these diseases. Yet hidden in the detail is a possible silver lining. The report outlines the potential for dementia prevalence to reduce if certain risk factors can be addressed – factors such as low education, smoking, high blood pressure and diabetes. While the figures project that the biggest rise in dementia prevalence will be in low income countries as life expectancy increases, a second report suggests that in some Western European countries, prevalence among people over 65 may even be stabilising. The review, published in The Lancet Neurology, analysed five studies, most of which suggested that there had been no increase in the proportion of older people with the condition in the last decade or more. In one study reviewed, the estimated number of over-65s with dementia in the UK in 2011 was in fact lower than had been predicted two decades earlier. This suggests that, in the UK, the generation of people who are reaching old age today may have a lower risk of dementia than their parents or grandparents did. One potential reason could be that people from this generation have generally been healthier: they have had better living standards, access to better education and

healthcare, and have lived through an era that has seen real advances in public health. Better cardiovascular health, evidenced by a drop in the numbers of people with vascular disease, may have helped drive a fall in the proportion of older people developing dementia. If this interpretation is correct, this is encouraging news. It tells us that dementia risk is not static – that we can, as individuals and as a society, work to change our risk. But it should also serve as a warning. Public understanding of the risk factors for dementia is still low. The UK currently has rising levels of obesity and diabetes, both risk factors for the condition, and if measures are not taken now to help people become healthier from mid-life, we could see this apparent fall in dementia prevalence reversed in future. We also should not underestimate the challenge we currently face, even if dementia prevalence stays the same in the coming years. The proportion of older people with the condition may not be rising, but our population is ageing fast, with the first of the baby boomer generation having now reached retirement. With age the biggest risk factor, we can still expect to see the overall number of people with dementia increase – in the UK, that figure is projected to reach 1 million by 2025. With no treatments capable of tackling the diseases that cause it, the potential impact on our care sector is immense. That’s why research into new treatments, as well as preventions, is still vital. In the meantime, efforts to improve public health must continue, with much more work needed to help people understand the steps they can take to reduce their risk of dementia. Of course, these aren’t sure-fire preventions, and we can’t stop every case of dementia, but if we can create a healthier society now, we could have a real impact on the number of people living with dementia in the future. CMM

Do you agree with Matthew? Join the debate at Twitter: @CMM_Magazine 46 CMM October 2015

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