UNLOCKING INVESTMENT Time to boost growth in retirement communities
Challenges on the horizon
Predictions for 2016
Getting safeguarding right
Leadership, communication and joint-working
Community engagement How to reap the rewards
Includes 4-page Skills for Care insert: Celebrating leaders and managers
FEBRUARY 2016 ÂŁ4.00
In this issue From the Editor
Is it just me…? 07 Editor in Chief, Robert Chamberlain, considers the continued plight facing adult social care providers and wonders if the sector is a victim of its own success. CMM News 09 Including a summary of 2015’s poll results.
Business Clinic 28 The panel comments on whether smaller scale sale and leaseback is a new model for financing care. A View from the Top 35 Anna Galliford, Chief Executive of FitzRoy is the subject of this month’s interview. 3rd Sector Care Awards Find out who won at the 3rd Sector Care Awards and how the day was celebrated.
What’s On? 45
Straight Talk 46 Adam Carter shares ways to improve the sector’s recruitment and retention situation in 2016.
Trying to make out the writing on the wall Des Kelly OBE predicts what 2016 will hold for social care.
Engage with your community and reap the rewards Tom Owen and Jess Watson look outside the care home to consider how strengthening links locally can improve your business outcomes.
Getting safeguarding right Ewan King shares best practice in safeguarding.
From exit to event – Unlocking investment in retirement communities Michael Voges explores the benefits of retirement communities and how a change to their funding structure can encourage investment and boost the market.
Driving up quality by ongoing self-assessment Sarah Maguire and Peter Kinsey discuss ongoing self-assessment as an important factor in driving up quality. CMM February 2016 3
firstname.lastname@example.org 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 email@example.com 01223 207770 Advertising Manager: Daniel Carpenter firstname.lastname@example.org Director of Sales: David Werthmann email@example.com National Sales Manager: Paul Leahy firstname.lastname@example.org
Des Kelly OBE Executive Director, National Care Forum
Tom Owen Co-Director, My Home Life England
Jess Watson Social Action Lead, My Home Life England
Paul Birley Head of Public Sector and Healthcare, Barclays
Jessamy Venables Senior Agent, Carterwood
Paul Simic Chief Executive, Lancashire Care Association
Ewan King Director of Business Development and Delivery, SCIE
Anna Galliford Chief Executive, FitzRoy
Sarah Maguire Director of Quality and Safeguarding, Choice Support
Adam Carter Managing Director, Carter Schwartz
SUBSCRIPTIONS Non-care and support providers may be required to pay £50 per year. email@example.com 01223 207770 www.caremanagementmatters.co.uk Care Management Matters is published by Care Choices Ltd who cannot be held responsible for views expressed by contributors. Care Management Matters © Care Choices Ltd 2016 ISBN: 978-1-910362-79-2 CCL REF NO: CMM 13.0
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4 CMM February 2016
Michael Voges Peter Kinsey Executive Director, Chief Executive, Associated CMG Ltd Retirement Community Operators
From the Editor Emma Morriss discusses how CMM can help you to kick-start 2016. Happy New Year. In my first column of 2016 I want to be forward-looking. A New Year brings about talk of improvements, progress, change and opportunity - personally and professionally. The more I think about the year ahead, I have a growing sense of expectation. Whether that’s positive or negative, I’m yet to work through it, but it feels like the sector is on the verge of something. Beyond my thoughts, Des Kelly looks at what he thinks 2016 will bring social care in his article starting on page 22. This issue of CMM comes to you as there are calls for a crossparty commission on the future of health and social care. We’ve been here before, many times, and I’m not one to think that the years of underfunding will be immediately resolved by a group of politicians sitting in a room, talking through the issues. But, if the commission happens, at least it’s a move in the
right direction. In his column on page 7, Robert looks at whether the sector has become a victim of its own success in the face of adversity.
KICK-START 2016 CMM aims to be a constant in your daily work life, and for that reason we try to keep true to our ethos of promoting best practice. This issue, we kick-start the year with a feature on safeguarding and the role of good leaders, communication and collaborative working. We also return to the driving up quality code and how assessing your company’s performance can bring great improvements. We also bring you the final article in our series from My Home Life. The feature explores the role of community engagement in improving people’s lives and business outcomes. All of these improvements involve taking a
step back, trying new things and engaging with others. They take resources which are difficult to spare when staff are stretched. However, there are rewards to reap and each of these approaches can go towards achieving an ‘Outstanding’ rating from CQC, which, in itself, can pay dividends.
BUSINESS AS USUAL I hope you can take a lot away from this issue to help you carry on with business as usual in the light of
increasing pressure. Don’t forget that the CMM website has an archive of our past articles, a daily news update and exclusive conference discounts. Subscription is free, you just need your CQC registration number. Please take a look, and share your thoughts. For those of you operating learning disability services, don’t miss out on the chance to hear about opportunities and best practice in the sector. CMM Insight conferences can help you to move forward in 2016. For more information on the event, visit www.caremanagementmatters.co.uk
Email: firstname.lastname@example.org Twitter: @CMM_Magazine Web: www.caremanagementmatters.co.uk
We buy and sell care businesses and land. We provide consultancy and valuation advice. We don’t do anything else. Dedicated to the healthcare sector – dedicated to you. For more information about Carterwood or to find out how we can help you please telephone 08458 690777 email@example.com
CMM February 2016 5
6 CMM February 2016
Is it just me...? Editor in Chief, Robert Chamberlain, considers the continued plight facing adult social care providers and wonders if the sector is a victim of its own success.
I am confident that the majority of people realise the importance of adult social care’s role in society. This belief is regardless of the widelyheld poor (and misguided) public perception of care providers. It is also regardless of the pitiful funding situation and the way that our sector is a constant poor relation to health, despite the rhetoric. A world without social care would be a very dark place for the hundreds of thousands
OVERCOMING ADVERSITY I have worked in this industry for 18 years and things have changed dramatically during this period. However, the one constant is that, whatever is thrown at it, the sector always finds a way to continue and, in many cases, improve its care delivery. Back when I began at Care Choices, the average care home
“The health and social care wheels will fall off at some point and this is becoming increasingly evident as time goes by.” of people in need of its support and a devastating blow to health services. It leads me to ask, if society recognises the key role that social care plays, why has so little been done to invest appropriately and fix the system? Are we victims of our own success?
resident was in their late 70s and their needs were far less complex than today. When I now visit care homes, their clientele resemble those who would have resided in yesteryear’s nursing homes. However, the increased dependency of clients and the costs of meeting these needs
has certainly not been reflected in fee increases over the years. Yet, somehow, the sector survives and finds a way to meet the needs of those it cares for. This resilience and tenacity is integral to the character of social care, as is the need to provide the best quality of life for society’s most vulnerable. The Care Quality Commission’s statistics on the performance of the sector speak for themselves. Despite the most stringent inspection regime to date, at a time when costs are rising and fees are flat-lining, more than 60% of services inspected have been rated ‘Good’ or ‘Outstanding’. We should take great pride in this achievement, but imagine what could be achieved with an appropriate funding system in place.
NEW HOPE? It is encouraging to hear that Liberal Democrat MP, Norman Lamb, has proposed a cross-party commission
to review the future of NHS and social care. The proposal, put to Parliament as we go to press, is backed by exhealth secretaries Alan Milburn and Stephen Dorrell (who is the current chair of the NHS Confederation). Norman Lamb has gone on record to say, ‘The reality is that we will either see the system effectively crash or we confront the existential crisis now. This transcends party politics.’ He also issued a stark warning regarding councils’ funding of social care, that he described as ‘on the brink’, with an expectation that a number of providers may exit the market if the future funding is not addressed. The health and social care crisis must come to a head. It can no longer be brushed under the carpet. The respective systems are struggling to cope with existing demand, and the predicted future increases in demand cannot be contemplated as things currently stand. This issue does, indeed, transcend political divides. I hope that Parliament listens and takes the opportunity to tackle this ticking time bomb.
DÉJÀ VU I know that we have been here many times before, with the Royal Commission on Long-Term Care for the Elderly and the Dilnot Commission on Funding Care and Support - all with disappointing outcomes. However, this problem can’t be ignored forever. The health and social care wheels will fall off at some point and this is becoming increasingly evident as time goes by. The social care sector may have proven itself to be survivalist, but there can no longer be justification for not addressing the need for adequate funding.
Do you agree with Robert? Join the debate. Twitter: @CMM_Magazine Web: www.caremanagementmatters.co.uk CMM February 2016 7
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APPOINTMENTS VODG Steve Scown, Chief Executive of Dimensions UK has been elected as Chair of the Voluntary Organisations Disability Group (VODG).
Dealing with the health and social care crisis Liberal Democrat Health Spokesperson, Norman Lamb has launched proposals for an unprecedented cross-party commission into health and social care. Norman Lamb, who has received backing from Conservative and Labour former health secretaries, Stephen Dorrell and Alan Milburn, believes that only a full non-partisan
commission will properly deal with the crisis in health and social care. The former care minister believes the commission would be a ‘Beveridge Report’ for the 21st Century, and be the first of its kind since the creation of the NHS and welfare state. Its aim will be to engage with the public, staff in the NHS and care services and civic society on the
massive challenge the NHS and care services face. To mark his call for the commission, Norman Lamb used a 10-minute rule bill in Parliament, and called for an investigation into the crisis being faced by the health and social care sectors. There appears to have been broad support from the care sector to the proposal.
Care Quality Commission concerns The Committee of Public Accounts has raised new concerns over the performance of the Care Quality Commission (CQC) in regulating health and care services. In its report, the Committee recognised that the CQC had made ‘substantial progress’ since the last report in 2012. However, it found that ‘it is behind where it should be, six years after it was
established’ and that it is not yet an ‘effective regulator’. Responding to the report, the CQC acknowledged that it has made ‘substantial progress’ in strengthening the way that it monitors, inspects and regulates services to make sure that people get safe, high-quality and compassionate care. However, it said that there are areas to improve, which
it is already proceeding with. Particular priorities for improvement are the timeliness of its inspection reports, its ongoing recruitment drive, how it responds to information of concern, and how it develops and provides reassurance about its readiness to take on its new responsibility to assess the use of resources within NHS trusts from April.
Insufficient Spending Review settlement The Chancellor set out his spending plans for the remainder of this Parliament. He acknowledged that the sector needs new money to help pay for rising costs. As such, he announced that councils will be allowed to levy 2% on Council Tax, ring-fenced for adult social care. Mr Osborne also announced an increase of £1.5bn in the Better Care Fund by 2019/20 for integration. He said that social care spending will have risen ‘in real terms’ by the end of this Parliament. Other announcements included State Pension increase to £119.30 per week and £600m extra funding for mental health.
Following the announcement, the sector united to call for ‘urgent’ talks with the Government in the face of a mounting care crisis. In a letter to George Osborne (Chancellor), Jeremy Hunt (Department of Health) and Greg Clark (Communities and Local Government); the Association of Directors of Adult Social Services, NHS Confederation, Care Provider Alliance and Care and Support Alliance state bluntly that the Spending Review settlement ‘is not sufficient to resolve the care funding crisis. ‘Ultimately the package put forward for social care will not enable us to fill the current gap in funding,
cover additional costs associated with the introduction of the National Living Wage, nor fully meet future growth in demand due to our ageing population.’ Equally dangerously, they warn that some of the resources are back-loaded – with Better Care Funding not reaching levels of any significance until towards the end of this Parliament. ‘This has significant implications in terms of the vital support needed by older and disabled people and their carers. And it also puts the delivery of the NHS Five Year Forward View – and implementation of the Care Act – at risk.’
AMBITIOUS ABOUT AUTISM Ambitious about Autism has appointed John Trampleasure as its new Director of Fundraising, External Affairs and Strategy.
CONSENSUS Consensus has appointed Belinda Robinson as its new Head of Development and Partnerships (South).
CQC Peter Wyman, Chair of Yeovil District Hospital Foundation Trust, has been appointed Chair of Care Quality Commission (CQC). Dame Eileen Sills has also been appointed as CQC’s National Guardian for the freedom to speak up within the NHS.
ORDERS OF ST JOHN CARE TRUST Orders of St John Care Trust has appointed Sarah Smith as Health and Safety Manager to join its Operations Team.
ECL ECL, formerly known as Essex Cares, has appointed Keir Lynch as its new Chief Executive and Michele Dunn as Head of Care.
CARTERWOOD Robert Belcher FRICS joins Carterwood as a consultant to work with its training and consultancy teams. The company has also promoted four members of its team.
CMM February 2016 9
Severe cuts threaten services
Impact of migration workforce
A new report published by the TUC warns that severe spending cuts are already undermining public service quality and that if the Chancellor doesn’t rethink his plans to cut spending further, public service outcomes are set to plummet. The report, Making the case for public spending, which was commissioned from the Fabian Society by the TUC, shows how public spending cuts have led to strained public services, less provision and
Despite evidence of rising care needs, adult social care in England is facing significant challenges in recruiting, paying for and retaining its staff. It faces a gap of 200,000 care workers by the end of this Parliament because of restrictions on immigration and a failure to attract British workers. Longer term, the sector could face a shortfall of 1 million workers in the next twenty years according to research from Independent Age and the
longer waiting times for key services. The report details how funding cuts to adult care resulted in local authorities being unable to support more than half a million fewer adults (29%) in 2013 than in 2009. Making the case for public spending warns that if spending cuts continue as planned, there will be major recruitment and retention problems in the public sector, more inequality and poverty, and a negative impact on UK growth.
GP care for residents with dementia - survey Care England, in partnership with Alzheimer’s Society, is conducting research into GP care for care home residents living with dementia. They would like care home providers and managers to complete a short survey exploring how the health service meets the physical and mental health needs of people with
dementia living in care homes, how GP practices provide primary care services to care homes and if GP practices charge care homes for these services. The survey is available online at https://survs. com/survey/fa2sm0lsz and will take less than five minutes. All responses will be treated anonymously.
International Longevity Centre-UK (ILC-UK). Moved to Care maps the size, shape and scope of the care workforce in England and warns of the impact of recent restrictions on migration and a continued failure to attract more UK born workers to social care. It also sets out new estimates on the workforce gaps that could emerge if we continue to place restrictions on migration and under-fund social care.
Funded Nursing Care review The Department of Health has commissioned an independent review across England to consider the costs of providing registered nursing care in a nursing home. This review will consider whether the rate currently paid for NHS-funded nursing care is reflective of the cost of providing this service. It will also look at other relevant factors affecting costs such as regional variation and
care home specialism. The Department of Health has appointed Mazars to undertake this project which is planned to take place over the period from November 2015 to February 2016. The Mazars team will work with the Department of Health and a range of stakeholders, including representation from the NHS, local authorities and care sector providers.
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NEWS / POLL
The end of formal adult social care? Detailed analysis of the social care funding measures outlined in the Spending Review reveals a bleak future for older people needing care. The new research published by the International Longevity Centre - UK (ILC-UK), Centre for Later Life Funding and supported by Age UK, reveals: • Approximately 1.86 million people over the age of 50 in England (1 in 10) have unmet care needs – an increase of 120,000 people (or 7%) since 2008/9. • Data from 326 local authorities shows that the councils with the
highest concentration of older people and unpaid carers will be the ones that will bring in the least amount of money from the 2% council tax precept. • There are approximately 4.3 million people aged 50 and over in England who are living alone (that’s roughly 1 in 5 middle aged and older people living on their own). ILC-UK points out that even if the Spending Review announcements bring £3.5bn into adult social care, a scenario they describe as ‘highly
Health Charter refreshed The Voluntary Organisations Disability Group, the National Care Forum and the National Development Team for Inclusion have launched a new free report describing how providers use the health charter in practice. The report also includes refreshed guidance.
Well over 100 organisations have now signed up to the health charter. The practical guide is based on the learning of 20 organisations who have been actively using the charter to improve the support provided to people with learning disabilities and to directly address health inequalities.
unlikely’, this will still only mean that spending on care returns to 2015 levels by the end of the Parliament. This level of funding would imply an overall fall in expenditure on care as a proportion of GDP putting us firmly towards the bottom end of the OECD league table. The think tank argues that the low level of funding offered is likely to result in a polarisation of care – private formal care for those that can afford it, rising reliance on informal carers and increasing unmet needs for those that can’t.
Cambian acquisition Cambian Group has acquired Spring Hill School – a specialist day and residential school near Ripon, North Yorkshire – increasing its network of specialist autism education services. The school has been renamed Cambian Spring Hill.
If given the goahead, will another commission on the future of health and social care bring about the solutions needed? Yes No Don’t know You can vote via: www.caremanagementmatters.co.uk
See page 18 for a summary of 2015’s poll results.
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New nursing associate role Health Minister Ben Gummer has announced a plan to create a new nursing support role. Provisionally called nursing associates, they will work alongside healthcare support workers and fully qualified nurses focusing on patient care. The role, which could also be a new route for those wishing to become a registered nurse, has been recommended by nursing leaders and other healthcare professionals. The new addition to the care workforce will help bridge the gap between healthcare support workers, who have a care certificate, and registered nurses.
End of life care resources The National Council for Palliative Care has updated its Care to Learn training programme. The resource has been a popular resource for training people who are new to the sector. Following significant recent changes within palliative and end of life care, and in response to feedback from those who have used Care to Learn, the programme has been subject to a thorough process of revision and updates. It is aimed at healthcare assistants and direct care staff across all settings.
Kingsley Healthcare expansion Kingsley Healthcare has continued its rapid expansion with the multimillion pound purchase of two properties in affluent Cheshire. The acquisitions of Redwalls nursing home in Sandiway, Northwich and Sharston House nursing home in Knutsford add 92 beds to the company’s growing portfolio. 12 CMM February 2016
End rationing of nurse training places Every year, substantial numbers of nurses are recruited from overseas despite nursing courses in the UK being vastly over-subscribed. This has led to a situation where many well-qualified young people in this country are denied the opportunity to become nurses. The yearly limit on nurse education places also puts the NHS in a weak position for hiring and retaining staff as nurses.
The think-tank, Civitas proposes reforming the present financing of nurse education, under which tuition fees and living bursaries are paid upfront, and replacing it with a system whereby nursing undergraduates would take out student loans as with any other course. The NHS would then pay back the loan for nursing graduates if they work for the organisation
Priory Group sold The Priory Group has been acquired by Acadia Healthcare, the parent company of Partnerships in Care (PiC). Acadia provides inpatient behavioural healthcare services in the US, the UK and Puerto Rico. Acadia acquired the Priory Group for almost £1.3bn plus 5.363 million shares of Acadia
common stock. Approximately £925m will go towards paying off Priory’s outstanding debt. The Group was acquired from Advent International, the private equity house which has owned it since 2011. It is expected that the deal will be completed by mid-February.
Saga sells Allied Healthcare Saga has sold Allied Healthcare to Aurelius Group, a pan-European, mid-market investor. The acquisition of Allied Healthcare comprises Visiting Care, Primecare and Homecare Independent Living. Saga will receive total consideration of up to circa £19m. A one-off contribution of circa
£10m will be made by Saga to the Allied pension fund, which will transfer as part of the transaction. Saga fully wrote down the value of its Allied business to zero as at 31st January 2015. Saga now expects to recognise a small net profit on the sale in the current year’s accounts.
the facilities of a residential care centre it owns in Nottingham. The company, which runs more than 60 homes across England, has just completed its extension of Little Acres, in Nuthall. The site, which provides services for adult clients with learning or
extension has created eight extra rooms, complete with en-suites. The existing facility has been knocked through and refurbished to enhance the communal areas already in place. In addition to the interior work, the outside space has been re-landscaped.
after qualification. This would be to the exact same cash value as current course funding. All tuition fees and some level of living costs (to the level financed by current bursaries) would be reimbursed via monthly loan repayment premiums to each new graduate working for the organisation. The reform would remove the need for a limit on nurse numbers.
Hospitals to care homes new guidance New guidelines have been produced by the National Institute for Health and Care Excellence (NICE) on the transition between hospitals and care homes. The recommendations in the guidelines have been included in a NICE pathway. This is an online tool that brings together all related NICE guidance and associated products in a set of interactive, topic-based diagrams. There is also a version of the guidelines for people using services, carers and the public.
Better Extension for Nottingham centre Care Fund physical disabilities, currently PrimeLife has invested £400,000 struggling into expanding and improving has 17 beds. The single storey
Development site sold Carterwood and joint agents, JLL, have announced the sale of a development site in Wells, Somerset. The site has been acquired by Hamberley Development and has planning permission for the
development of a high quality 64bed care home. The site occupies a prominent position in Wells and is surrounded by a new residential development comprising 143 dwellings, known as Bishops Brook.
The Government’s £5.3bn Better Care Fund, designed to get health and social care services working together, is being held back by too much red-tape, a report by the Healthcare Financial Management Association (HFMA) and the Chartered Institute of Public Finance and Accountancy (CIPFA) shows. The Better Care Fund – Six Months On reveals more needs to be done to ensure the success of the Better Care Fund. However, the fund has already begun to produce improved working relationships between NHS bodies and local public services.
CMM February 2016 13
Care home complete in Dronfield NHS Care Home Research BCP has confirmed construction client. It incorporates the University programme of Stirling’s design guidelines for is now complete on Callywhite, a state-of-the-art care home located within the grounds of the Green in Dronfield. The new facility provides 39-beds over three floors for older people and those living with dementia. Callywhite’s high quality accommodation also includes eight additional close care units and was designed in conjunction with the
dementia care. Located on the same site as the existing care home, The Green, the official opening of Callywhite takes the number of available beds to 80. Like The Green, Callywhite will be managed by The Green Nursing Homes Limited. Royal Bank of Scotland supported the construction with a seven figure funding deal.
Community Integrated Care (CIC) has signed as a corporate partner to the NHS’s National Institute for Health Research programme, Enabling Research in Care Homes. By signing up, CIC’s 25 care homes across England and Scotland will participate in research that will enhance both its own provision and the wider care home sector.
The Research Ready Care Home Network brings care home staff, residents and researchers together, to facilitate the delivery of research. It aims to improve the quality of life, treatments and care of people who live with dementia and age-related conditions. It supports the Prime Minister’s Challenge on Dementia and the vision for Dementia 2020.
Adult Social Services also received a CBE for services to social care. A CBE was also awarded to Paul Farmer, Chief Executive of Mind for services to mental health. OBEs were awarded to Michelle Mitchell, Chief Executive of Multiple Sclerosis Society for services to older people and the voluntary sector and Dr Adrienne Cooper, Strategic Director for Adult Social Services, Housing and Health at Sutton Borough Council for
services to adult social services. MBEs went to Wendy Maxwell, Founder of Chill4Us Carers for services to carers, Lucy Watts, for services to young people with disabilities and Helen Macpherson Young Wilcox, Vice-Chair of Skills for Care for services to social care. Maurice Charlesworth, senior volunteer for Age UK Lambeth received a BEM for services to older people in Lambeth, London.
New Year Honours for social care New Year’s Eve saw the announcement of the 2016 New Year Honours. Awarded across all areas of society, the Honours include recognition of the achievements of a wide range of people throughout the health and social care sector. Sharon Blackburn, Policy and Communications Director at the National Care Forum (NCF) has been awarded a CBE for services to nursing and the not-for-profit care
sector. David Coull, NCF Chairman said, ‘The NCF is proud that Sharon’s achievements have been nationally recognised in the New Year Honours for services to the not-for-profit sector. She has been a consistent champion of the vital role that not-for-profit care providers play in setting standards and delivering quality.’ Sandie Keene, Director of Adult Social Services at Leeds City Council and past President of the Association of Directors of
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Concerns over benefit changes Carers UK has expressed grave concern and alarm at the Government’s announcement that it is consulting on transferring the budget and responsibility for
Attendance Allowance to local government in England and Wales. It says this would have serious repercussions for those providing unpaid care in the future.
New NICE guidance on maintaining independence and mental wellbeing The National Institute for Health and Care Excellence has published a new guideline to support older people’s mental wellbeing and independence. The guideline recommends a number of initiatives to help older people become more involved with other people and their communities, in activities that will not only benefit the individual, but wider society as a whole. There is a range of circumstances that increase the risk of a decline in independence and mental wellbeing
for people who are over 65. Those most at risk include carers, people who live alone and have little opportunity to socialise, people who have recently been bereaved, those who have a low income, and people who have recently experienced or developed a health problem or disability. The new guideline is primarily aimed at local authorities (including those commissioning services), managers, and practitioners with public health as part of their remit.
Shortage of care homes creates opportunities While the ageing population is increasing, the UK is facing a growing shortage of care homes for the elderly creating significant opportunity for investment and development, according to Knight Frank. The company’s latest UK Healthcare Report says that the UK’s population of over 65s is forecast to grow by 10% over the next five years. However, the number of new care home registrations is significantly decreasing.
Research shows there was a net loss of 189 elderly care homes in the 12 months to September 2015, equating to 2,200 fewer beds in the UK. Almost half of the beds lost were located in the South West region, with the East Midlands and Eastern regions seeing a net gain of 273,000 and 513,000 beds respectively. It concludes that the growing shortage of care homes across the UK offers strong opportunities for care home developers and investors.
New Government care home comparison site The Government has launched a new service for the public to access and compare information about every care home across the country. The information people will be able to access includes: user reviews – including star ratings; Care Quality
Commission inspection ratings; Food Hygiene Standard; levels of staff turnover and whether the home has a registered manager in post. It also has key information such as location, services on offer and contact details.
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Benefits of communication and development apps Choice Support partnered with Insane Logic to pilot the use of the communication and language development tablet application, ‘MyChoicePad’ in a number of services in Southwark. Insane Logic devised the pilot programme with a speech and language therapist to assess the impact of MyChoicePad on people with communication difficulties. The Royal College of Speech and Language Therapists outlined a set of ‘Five good communication standards’ for providers of residential services for people with communication and
learning difficulties. The guidelines underpinned the project. In 67% of cases staff noticed an increase in the initiation of communication from the people they supported. 83% of staff reported longer interactions with the people they supported that were easier to maintain with MyChoicePad. 100% of staff reported that they and the person they support had ‘really enjoyed’ using MyChoicePad together. 80% of the supported people in the pilot used MyChoicePad to support increased community access.
Sheffield care home acquired Target Healthcare REIT has exchanged contracts to acquire a care home in Sheffield. Tapton Court is a 69-bed home which was built in the 1990s and closed in 2014, and will be substantially redesigned and refurbished. The bedrooms will be enlarged and reduced in number to 46 and large en-suite bathrooms with wetroom showers added, additional public space will be created resulting in several lounges, dining space and a new conservatory, and the addition of a balcony affording good outdoor access. Completion of the acquisition is
expected in January 2016, with the refurbishment works completed by September 2016. The overall price for the acquisition and subsequent renovation of the home is £3.9m including costs. Upon completion, the care home will be leased to Care Concern Group for a period of 35 years and the transaction represents a net initial yield in excess of 7%. This will be the third home which Care Concern operates in the Group’s portfolio, along with Mossvale Care Home in Glasgow and The Ashton in Hinckley, Leicestershire.
New home in Lancashire The Stocks Hall Nursing and Care Group’s new care development in Lancashire has opened with the help of NatWest support. Set in
Mawdesley, Lancashire, Stocks Hall Living includes 42 nursing/residential care beds, and 13 luxury apartments that can be purchased privately.
Strong Life Care acquisition Strong Life Care has acquired Earls Lodge Care Home in Wakefield, with the support of seven figure loan from Lloyds Bank Commercial Banking. Established in 2010, Strong Life Care provides specialist residential care for the elderly and those suffering with dementia in Yorkshire and the East Midlands.
To expand its portfolio, the company bought the purpose-built Earls Lodge Care Home. The new home offers specialist dementia and nursing units with en-suite bedrooms and has landscaped gardens, a dementia café and activities room and has the capacity to accommodate up to 50 residents.
Dementia Diaries Dementia Diaries is a new national project that brings together people’s diverse experiences of living with dementia as a series of audio diaries. It serves as a public record and a personal archive that documents the day-to-day lives of people living with dementia. As the use of technology often becomes more difficult for those living with dementia, the project uses 3D printed mobile handsets which are customised to be as simple as possible. This allows the team
to record audio diary entries and capture thoughts and experiences as they occur. Handsets are linked to a dedicated voicemail and, as soon as a diary entry is recorded, it is automatically sent via the internet to the editorial team at On Our Radar. The team listens to it, transcribes it and curates it for publication. The shared aim is that the project will improve understanding of the diverse experiences of living with dementia and how communities and services can best offer support.
Staying afloat in a perfect storm Carterwood has published new research in conjunction with the members of the National Care Forum. Staying afloat in a perfect storm includes key information on fees, funding and occupancy data across the NCF members. It
shows occupancy levels of 92.6% for the best quality assets and generally higher fee rates than typically reported. The South East and London were the strongest performers in terms of both fee rates and occupancy levels.
Triangle Community Services Triangle Community Services, a subsidiary of national charity, Friends of the Elderly, has expanded its home care service by opening a branch in Bournemouth. This latest launch will be Triangle Community Services’
sixth home care branch to open in the country, alongside its day clubs and extra care services. The service will deliver personalised home care to older people in Bournemouth and the surrounding areas.
Implementing Dementia 2020 The 2020 Challenge sets out how the Government wants to see society at large, including the NHS, social care, voluntary and community sectors responding to the challenge that dementia presents over the course of this parliament. It includes developing care homes as community hubs. Discussion is taking place with the Social Care Institute for
Excellence about resurrecting the Dementia Innovation Exchange to highlight and promote best practice and share learning. The Innovation Exchange could underpin a ‘virtual leadership academy’ led by care providers showcasing their outstanding services, possibly offering modules of training/ support for health and social care leaders (locally and nationally).
Avante Care & Support Avante Care & Support has celebrated providing 25 years of care and support through its care homes and home care services. To ensure everyone was involved with celebrating Avante Care &
Support’s milestone birthday, the care homes and services all hosted celebratory parties on the same day inviting all residents, family members and staff to join and raise a glass. CMM February 2016 17
NEWS / 2015 POLL RESULTS
Your Care Rating research is supported by, and reviews, almost 40 providers including Anchor Trust, Barchester, Care UK and MHA. Each care home is awarded an Overall Performance Rating (OPR) out of 1,000. Last year, the national average mark was 872 with scores ranging between 631 and 995. The Your Care Rating survey report will be available soon on the Your Care Rating and Ipsos MORI websites with detailed results for each care home available on the Your Care Rating website at the same time.
2015 POLL RESULTS 9% S6 YE
March 31 NO Can social care save the NHS?
July 1% Are your clients:
Y E S70
September NO 31 Do you believe social care will receive the funding it needs from Government? %
October Have you received your CQC quality rating?
November Will you be able to afford to pay the National Living Wage?
DON’T KNOW 29%
Local authority funded 11%
Self-funded 19% Both 70%
Don’t know 27%
NO 33% 0
May Are you involved in working towards integration?
June What impact will the new Conservative Government have on social care?
April YES 69% Do you feel confident about your business in 2015?
YES 69% NO 31%
Yes - 47%
No - 53%
February Are you ready for the forthcoming Care Act changes?
come to receive it. Under-served looks at veterans’ priorities, the aspects of care they value and the aspects they would like to change, and at the challenges faced by those who seek to provide that support. Ultimately, this report presents a series of recommendations for Armed Forces charities and Government concerning how this care can be improved.
Under-served: improving residential care services for working age veterans is a new report from Demos. It is the first examination of ex-service personnel, a small, poorly understood group, and thus relatively ‘invisible’ to policymakers tasked with planning and funding care. It looks at the care they need, the care they receive, and how they
More than 20,000 residents, representing just under 40% of those invited to participate, have given their views in the UK’s largest annual survey of care home residents. The Your Care Rating survey, conducted by leading market research organisation, Ipsos MORI, provides residents in over 1,000 care homes with the only large-scale, independent and formalised opportunity to share their views on the care they receive in homes across England, Scotland, Wales and Northern Ireland. The
Improving care services for working age veterans
December Do you feel that social care is in crisis?
YES 84% NO 16%
NO 31% 0
Don’t forget that you can cast your vote in our monthly polls on the CMM website www.caremanagementmatters.co.uk Source: www.caremanagementmatters.co.uk Figures correct at time of print.
18 CMM February 2016
T: 0845 094 1995 firstname.lastname@example.org www.omnihrs.co.uk
Rota hell? Why you should think about moving to a computerised rota system Timetabling the complex schedules of staff can be a problem for many care homes. Ashly Sarsons, Registered Manager at The Bevern Trust, a charity dedicated to helping people with profound disabilities, explains why she took the plunge with computerised rota system, OmniRota. Rotas really shouldn’t be this hard Scheduling the large care team, housekeepers, specialist staff and admin team at Bevern House is no picnic. With a team of 58 staff members, each shift not only needs to have the right number of staff including a shift leader and a senior, but also requisite numbers of female staff and those appropriately trained for medication, driving, lifeguard duties, epilepsy care etc. Add in specialist activities, the constantly changing needs of the residents and staff turnover and you soon have a real headache coordinating staffing levels and ensuring that the service is covered at all times. Oh and you need to make sure that everyone is given their fair share of weekends off. Ugh.
The short straw Pity the manager who’s been given this daunting task. For The Bevern Trust, this fell to Ashly Sarsons, the Registered Manager, and it was taking her 10 hours every two weeks for two weeks’ worth of a rolling six week rota.
We looked for rota software because we wanted to save time and reduce the amount of mistakes made. Ashly Sarsons, Registered Manager
A personal pressure Ashly can now take comfort from the fact that all the complex rules are no longer stored only in her head and that she alone doesn’t have to try to remember them all whenever she draws up a rota; a big personal advantage of having the software and avoiding a key man dependency for the service. It also makes planning much easier. Whilst changes are inevitable (and are almost daily), the fact that the changes can be processed using OmniRota means that all of the impacts of a change can be considered and planned for.
Taking the plunge Ashly believes that people often shy away from taking the plunge into rota software because they can’t quite believe that it’s capable of doing the job. I think OmniRota is brilliant. Both myself and the staff have adapted well to it. It is better than I expected as I couldn’t imagine a bit of software being able to take so many different variables and make it work. Ashly Sarsons, The Bevern Trust
OmniRota - A new rota system OmniRota takes just minutes to work out the best, fairest rota that meets your ‘rota rules’ and flags any exceptions: where the home is under-staffed or if your pre-agreed guidelines are not being met. And it’s simple to adjust for last minute changes. It also provides reports to show the parity of allocations and can send individuals’ rotas to their phones, emails or to Intradoc247 to be distributed easily to staff.
Getting started “Basically they help you to work through it to come up with your rota rules”, Ashly explains. “The set up process was hard for me as a lot of the rules were in my head and writing it all down and remembering everything took a few times to get right but the service was brilliant and I was really supported to get it right.” It has saved so much time which in turn relieves the stress and pressure from the manager to get the rota out on time. Ashly Sarsons, The Bevern Trust
OmniRota software has been developed specifically for use by GP surgeries, hospitals and care homes. It has been bought by almost 100 organisations throughout the UK and Australia, managing rotas from 5 to over 50 staff. Find out today how your practice could save time and effort and ensure fair rotas for less than you might think. We’re so confident that you’ll be impressed by OmniRota that we’re offering a free, no obligation, 30 day trial. Visit www.omnihrs.co.uk to take a virtual tour
Ashly Sarsons is Registered Manager for The Bevern Trust, a charity dedicated to helping people with profound disabilities to get more from life. CMM February 2016 19
Sky TV packages In Lounge from £69.00 a week (ex VAT)
With themed movie sessions and inspirational documentaries, Sky TV brings your residents together, stimulates their senses and enhances their wellbeing.
Packages billed monthly. Sky TV minimum term is 12 months. Standard cost of the Sky Lounge Package is £299 per month(ex VAT). Standard cost of Sky In room is £40 per room, per month (ex VAT). Installation of equipment is not included, please call for more information. Charge of £50 per box (ex VAT) applies if Sky does not install your equipment. Channels available dependant on chosen package and scheduling may be subject to change.
20 CMM February 2016
for your Care Homes
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To find the right package for your residents and your business call
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Believe in better
Please visit www.sky.com/business for full channel details. Calls to Sky cost up to 7p per minute plus your provider’s access charge. Caught in the Act 6 Luangwa, Zambia, Africa :Elephants in water. Andre Rieu - And The Waltz Goes On, showing from 15 February. Copyright: © Andre Rieu Productions. Correct at the time of supply 11.01.16.
CMM February 2016 21
What does 2016 hold for social care?
Des Kelly OBE, Executive Director, National Care Forum
In the run up to the Autumn Spending Review, we had the unprecedented situation of major care provider representative bodies calling on the Government, through the joining of the Care Provider Alliance, with the Association of Directors of Social Services (ADASS), the Local Government Association (LGA), the NHS Confederation and the Care and Support Alliance. The call was to commit to redirecting money, saved as a result of the
deferral of the care cap, into reversing the decline in the care system. It is a moot point whether this unified call made any real difference. The Minister for Community and Social Care, Alistair Burt MP, argued at the NCF Annual Lecture at the beginning of December that the best deal possible had been secured for social care. By this he meant the addition of a further ÂŁ1.5bn to be added to the Better Care Fund and the 2% social care precept that local authorities will be able to levy to local Council tax to support care services in their area. What are we to make of this difference of view? The Chancellorâ€™s Spending Review announcement led to a further joint response
trying to make out
THE WRITING ON THE WALL 22 CMM February 2016
from providers, commissioners and organisations representing people using services. It argued that the settlement falls far short of the funding necessary to avoid a crisis within the care sector. In fact, working together, ADASS, LGA, NHS Confederation, the Care and Support Alliance and the Care Provider Alliance called for urgent talks with Treasury, the Department of Health and the Department for Communities and Local Government. This is an extraordinary situation, which is an indication of the shared level of concern for the fragile state of the social care sector and the potential knock-on implications for the NHS. Arguably, the social care sector is already in crisis. That crisis is largely the result of chronic under-funding within the public sector which, with continued austerity measures, has worsened in the last 12 months. It is occurring at a time of growing demand, resulting primarily from the ageing of the population, alongside growing expectations of people who use care and health services. All care providers appear to be using the same strategy to protect themselves
CMM February 2016 23
TRYING TO MAKE OUT THE WRITING ON THE WALL
against the pressures caused by cuts to local authority budgets. That is by aiming at the growing numbers of people able to fund the full cost of their care. However, such crosssubsidisation is not sustainable, certainly for the longer term.
CONTINUALLY RISING COSTS The Chancellor’s surprise announcement in the Summer Budget Statement in July, of a new National Living Wage (NLW), starting at £7.20 per hour from April 2016 and rising to £9.00 per hour by 2020, captured media headlines while catching most employers off-guard. In my view, the situation was not well-handled by the care sector, which responded to the announcement by saying it would only be possible if local authorities committed to paying more for care. Meanwhile, other sectors responded positively, welcoming the proposal. Don’t get me wrong, the introduction of the NLW will add cost, especially if current differentials are maintained, and it will probably result in some care providers exiting the sector and a further loss of capacity. Although, I don’t think it will be at the levels of 30% being suggested, as dire warnings, by some of the larger corporate providers. However, in addition to this rise in the wage bill, providers are trying to cope with rising costs associated with agency usage to fund apprenticeships, future pensions and Care Quality Commission regulation and inspection.
new Conservative Government in May to delay the introduction of the funding reforms contained in part two of the Act (saving some £6bn) means at least a further four years of uncertainty and perceived unfairness surrounding the cost of providing social care. In fact, it makes many of the aspirations of the Care Act seem like rhetoric. Early intervention and prevention seems a nice idea but closer integration between care and health (let alone housing) is down to relationships at a local level with deals being made against all odds. The Autumn Spending Review looked rather different for the NHS, which had its budget increased, albeit on the promise of delivering significant efficiency savings. However, there appears to be
turnover rates now reported to be well above 30%. Continued concerns and criticisms of quality add to negative public perceptions and a sense that the sector is in difficulty. This is something of a vicious circle. The social care workforce is ageing, with the corresponding issue that the proportion of the workforce under the age of 25 is only about 12%. Funding for training is under severe pressure and career structures are patchy at best. Unless the sector addresses these fundamental issues, it is hard not to conclude that a crisis is looming. Similar difficulties are faced by care providers in seeking to secure the best leaders as Registered Managers with succession plans in place to ensure the next generation of senior
“Unless the sector addresses these fundamental issues, it is hard not to conclude that a crisis is looming. ” little evidence, beyond the Better Care Fund, that the fundamental relationship between care and health is properly understood by politicians. As a result, the little that was secured for social care, in the way of resources, is ‘back-loaded’ so that it will not be available before 2017 or even later. This has brought concerns that it will undermine the implementation of the Care Act by local authorities and also jeopardise the delivery of the NHS Five Year Forward View strategy.
MANAGING THE INTEGRATION WITH HEALTH
CONTINUING WORKFORCE CHALLENGES
In 2015, the first part of the landmark Care Act was implemented, bringing a new focus on wellbeing and prevention to social care along with national eligibility and new rights for carers. However, the decision by the
The challenges of the workforce, recruitment and retention in particular, show no signs of diminishing in 2016. For nurses working in adult social care, the situation has got worse, with average
staff. As a consequence, pay rates for Registered Managers are rising, perhaps as much as 8%, as supply and demand factors begin to have an impact.
THE IMPACT OF REGULATION AND INSPECTION CQC is talking tough, despite strong political criticisms of its own performance. It, too, has challenges in recruiting to full strength. However, of all the concerns raised, by me, on a regular basis, it is those relating to inspection, the quality ratings process and associated matters that appear to be the biggest worry for providers and managers. CQC still has a huge task to complete the ratings for the best part of two-thirds of care services by the end of 2016. Nevertheless, some
interesting information is emerging from the 9,000 or so evaluated and rated so far. Around 30% of services rated so far have been judged as ‘Requires Improvement’ or ‘Inadequate’ which, I think, is high. However, it is difficult to know if this proportion will remain once all services have been rated. The ratings system is arguably still bedding in and, clearly, it is not an exact science. I predict that 2016 will see more legal challenges as providers seek to defend their reputation and their services, but it may also lead to further loss of provision and capacity.
WHAT ABOUT WINTER? 2015 started with regular headlines and news stories about local crises caused by the fact that hospitals were full – mostly of older people. The Department of Health has been developing a resilience plan to avoid a reoccurrence of the situation for this winter. It is unlikely that hospitals (and the NHS) will be able to avoid this completely, for many of the reasons covered already. There are fewer places available in hospitals, despite growing demand, and there will probably be less capacity in care homes or domiciliary care as providers exit the sector. Winter will come and it will bring pressures with it, whatever the weather does. Unless there is a more joined-up approach to health and care services, it is hard to see an improved situation as soon as next year. I realise that this assessment of the next 12 months is somewhat bleak – I believe it will be. That is not to disregard innovative and quality interventions in care services that I know to be happening. Many of the inspirational work by care providers was abundantly evident at the recent 3rd Sector Care Awards and it is great to celebrate such achievement. However, overall 2016 will be an even more challenging year for the care sector than the one now ended. CMM
Des Kelly OBE is Executive Director of the National Care Forum. Email: email@example.com Twitter: @DesKellyOBE What are your thoughts about social care in 2016? Share your opinions at www.caremanagementmatters.co.uk Subscription required. 24 CMM February 2016
Celebrating leaders and managers Every year our annual Skills for Care Accolades recognise the very best adult social care employers who have shown commitment and innovation in developing the skills and knowledge of their workers. One of nine categories this year is the Most effective approach to leadership and management, because we know high quality care and support services need to be well led. But we also know that doesn’t just happen, as it takes organisations time to develop their best leaders and managers. This category recognises that effort. Whilst it is true that, to a certain extent all nine categories recognise effective leadership, we also want to use the Most effective approach to leadership and management category to share the learning from Future Directions, Robert Owen Communities and Sonnet Care Homes, who are this year’s three finalists.
In this supplement we are sharing what the Skills for Care verifiers said when they visited each of the finalists. I think that most organisations will find learning more about their hard-won experience useful in either benchmarking their leadership style or improving it. Now in its 13th year, hundreds of organisations submitted applications and told us about their work. We stage the event because we think a public celebration of outstanding achievements is something that is extremely important and something we need to do more of. I know when I talk to Accolades finalists that just making the final three makes staff feel valued and
See inside for more information on the Accolades’ finalists.
Sharon Allen reassures them that their work throughout the year is appreciated, not just by their employers and those they support. When I was CEO of a major provider, having effective managers helped me sleep at night, but we also need to share our knowledge and experiences, which is why I’m grateful to the finalists for allowing us to share in this supplement what works well for them.
Accolades Over the last 13 years the Skills for Care Accolades have celebrated innovative and excellence in workforce development and every year there is a category that recognises the key role leaders play in making sure the growing adult social care workforce can access career-long quality learning and development opportunities. The Most effective approach to leadership and management category invites entries from employers who have demonstrated a clear commitment to developing the skills of leaders and managers at every level of their organisation. This category was created because Skills for Care knows that high quality care and support is driven
by skilled, knowledgeable and effective leaders and managers who set the values and direction of any social care organisation. But, as their careers develop, even the best leaders and managers need support, so the three finalists Future Directions, Robert Owen Communities and Sonnet Care Homes have developed programmes that develop their skills and knowledge. One of the key aims of the Accolades is to share the hard-won expertise that these three innovative and effective organisations have developed to support their leaders and managers to deliver high quality, values driven care and support.
Future Directions Future Directions provides 24-7 personalised social care services to people aged between 16 and 70, many of whom have complex support needs, working closely with individuals, families, housing providers, communities and commissioners. Many of Future Directions’ managers are ‘home-grown’ as a result of early identification and investment in leadership
potential amongst those in support worker roles. Staff turnover is relatively low - running at 16.5% - in comparison to other organisations within the sector. Through a range of development interventions, leaders and managers have been directly involved in helping to shape the vision and direction of the organisation based on a review of where the
organisation has been, where it is now, and where it wants to get to. Future Directions’ strategy has included ‘at its heart’ developing the leadership behaviours that nurture a shared understanding of the links between vision and values, and the ways in which this provides a centre-point for achieving outcomes for the users of services.
Robert Owen Communities Robert Owen Communities (ROC) is a charity supporting 400 people with learning disabilities in the Devon and Cornwall area. Its work is based on a fundamental belief that all those with a learning disability should be supported to do the things they want to do and the organisation strives to make this happen through a focus on personalisation.
Those supported by ROC have an active voice in making a difference by not only contributing to service improvement in the immediate surroundings of their care provision, but also in influencing the wider social care agenda across Devon. ROC’s approach to leadership and management is underpinned by a clear commitment to enabling staff and stakeholders
at all levels to contribute to the formulation of its shared vision and values. Its work is centred on bringing personalisation to life through the development of a person-centred plan for every individual using the Progress for Providers assessment tool to evaluate managers’ practice in embedding personalisation in their day-to-day work.
Sonnet Care Homes Sonnet Care Homes employs 175 people across two care homes on the same site. The New Deanery provides residential care for older people and St. Mary’s Court offers nursing care for older people and dementia residential care for both older and younger adults. Their leaders and managers have developed innovative and engaging approaches to effective leadership that have improved organisational performance and brought about widespread behaviour change across the workforce. Sonnet’s success has been driven by an unrelenting focus on
developing effective leadership values, behaviours and attitudes using the ‘Judgement Index’ diagnostic tool to bring rigour to this endeavour. The core values model ‘Kindness, Comfort, Respect’ (KCR) has been the energising force behind the creative leadership strategies employed to actively engage staff and users of services. Collaborative KCR Forums are used to tackle shared challenges with great results, and the KCR Stars scheme celebrates those small successes which often go unnoticed, but mean the most to the Sonnet residents who are at the heart of their thinking.
To view the full list of finalists visit www.skillsforcare.org.uk/accolades Winners will be announced at our awards ceremony on Thursday 10 March 2016. Good luck to all the finalists.
Free People Performance Management Toolkit Managing your staff is important. Staff who are managed properly provide the best care.
People performance management matters. Good performance management of your staff helps to make sure your organisation is providing the best quality care. Our People Performance Management Toolkit can help you manage your staff. It contains helpful scenarios, like what to do if someone is on extended sick leave or if there is a drop in performance.
The toolkit is available at www.skillsforcare.org.uk/peopleperformance
THE LINK BETWEEN GOOD BUSINESS AND COMMUNITY ENGAGEMENT
Realistically, when it’s busy, reaching out to the community can slide down the ‘to do’ list. However, we would argue that it is well worth spending time improving community links because of the very practical benefits that it can deliver to quality of life in the home and business outcomes. Involvement
In the final article of the series from My Home Life, on keeping your focus on quality when money is tight, Tom Owen and Jess Watson look outside the care home to consider how strengthening links with local people and community groups can improve your business outcomes.
ENGAGE WITH YOUR COMMUNITY AND REAP THE REWARDS
CMM February 2016 25
ENGAGE WITH YOUR COMMUNITY AND REAP THE REWARDS
from community groups and volunteers is normal in hospitals and hospices – so why should a care home be any different? A care home isolated from its local community has fewer opportunities to demonstrate the value of its work while those that make concerted efforts to reach out to the community are more likely to attract potential customers. Word of mouth is a huge marketing tool; if you are well known to the church, school and wider community – chances are you’ll be recommended to those looking for a care home. There is no doubt that the public will feel more assured by care homes that are well integrated into the wider community. It may indicate to them that the home has an open and transparent culture and,
“Aside from the business-focused benefits, the importance of community contact for your residents cannot be understated.” therefore, has nothing to hide. As well as improving the atmosphere, if families or potential residents notice volunteers, groups and other visitors are regularly popping in, it may offer reassurance to them that there are supporters of the home helping to make it even better. Some managers, who support volunteers to contribute to the home, have described a knock-on effect for staff. In some way, it has helped staff to be less institutional and task-focused; it has helped them to have a new outlook on their work, reconnecting with their role and purpose in supporting very frail citizens. Managers who were originally nervous about how staff would respond to volunteers told us it had been a great experience. This was especially true when volunteers were able to pick up conversations with residents when the staff lacked the time to spend with them. With staffing levels as limited as they are at the moment, welcoming in the community can be a real asset to delivering quality care. If you have connections with young people, such as partnerships with local schools, you could be showing the next generation what caring is really like – potentially sparking their interest in working in your care home. Many care homes have created opportunities which fit into structured placements for young people, like Duke of Edinburgh Awards or work experience. Of course, aside from the business-focused benefits, the importance of community contact for your residents cannot be understated. This is beautifully demonstrated by a lady living in an Essex care home who welcomed her ‘befriender’ volunteer by saying, ‘Oh it’s so nice to see someone who hasn’t 26 CMM February 2016
seen me naked!’. We can’t expect one busy group of people to be able to fulfil all our residents’ individual needs; we need to look outside of the care home for more support from our neighbours.
WHY ISN’T IT HAPPENING? If connecting care homes with the community is so overwhelmingly positive and the benefits are so clear, why aren’t all care homes a hive of community activity? Whilst we know a great many care homes are working hard to bring in volunteers and community groups, we also hear of some common barriers to building these relationships. 1. Both sides are unsure of a ‘way in’. Sometimes, it can feel hard to ask local people and groups to get involved in the home and, similarly, sometimes the community are not sure whether they are allowed to invite themselves in. 2. Sheer workload. Simply the amount that care homes have to do on a day-to-day basis can impact on the homes’ ability to encourage the community to come in, or to support those volunteers to play a meaningful role. 3. Some care homes have risk-averse cultures. This can make them wary of inviting outsiders in. This sector-wide fear culture stems from a desire to protect the people being cared for, but the tendency to say ‘no’ to new things because of the potential risks can lead to care homes being isolated from their communities. 4. People find care homes difficult places to be in. Typically, the general public doesn’t fully understand, or struggles with, seeing extreme frailty and people in the later stages of dementia. Many find the realities overwhelming, difficult to respond to, and don’t have the knowledge or training to know how to communicate with, or support, these people.
WHAT WORKS? Care homes have shared examples that have worked for them to overcome these challenges. • Have one person taking the lead in making community contacts and supporting volunteers. Ideally, we want all staff to take a responsibility for supporting stronger connections with the community and potential volunteers. However, if this isn’t effective, it’s worth ensuring that there is one point of contact for anyone who gets in touch wanting to contribute. Care homes report it is better if this isn’t the manager as they are just too busy. Instead, they might be an activities coordinator, or another dedicated member of the team. Some homes have a member of the care team supporting volunteers with a slightly different job description and a minor salary increase. Though, of course, it will
ENGAGE WITH YOUR COMMUNITY AND REAP THE REWARDS
vary depending on your team. It is still vital that the manager supports engaging with the community and models a welcoming approach. For newcomers to feel welcome, everyone needs to know who they are, their role, and see that they are part of the care home ‘team’. • Many managers have told us they felt really anxious about opening their doors, for fear that their residents are kept safe. However, their biggest incentive was acknowledging that quality of life for their residents was simply not possible without looking outside the care home for support. When they were able to weigh these positives with their concerns, they felt confident in welcoming the community into the home. • New visitors to care homes will feel better able to cope if they’re supported to understand the context of the home and what they may encounter there. You can start this process by inviting people to look around before they commit to a volunteering role. Some homes have asked potential volunteers to attend relevant parts of staff inductions. Again, the whole team can help by being available to answer questions from the newcomer. These questions could range from ‘How do I get in the door?!’ up to ‘Who do I talk to when I’m worried about someone?’.
HOW TO GET STARTED Begin by asking residents about their desires and interests. Some managers in Essex and Kent that worked with My Home Life found that asking residents ‘what are your simple pleasures?’ seemed to provoke a positive response. You may also want to ask them about what they used to do when they lived in the community. What were the places and people that were important to them? And then open up a space for residents to consider what connections with the wider community they would benefit from and what support they want from the care home to make this happen. It may also be helpful to survey staff on their pursuits outside of work and map these to residents’ interests, asking staff to bring their connections into the care home. Think about where there may be ‘win-wins’ for both the community and the residents. Don’t forget that within the home you have a lot to offer, such as your residents’ expertise – their years of experience, skills and ideas could be a huge resource for outside groups. Think about targeting people who might be looking for opportunities to connect with the home.
Visits from local churches or visitors from a Christmas party or Care Home Open Day are great community connections to build on. One of the quickest and easiest ways to build your engagement is to contact the people you already know, send them a ‘thank you’ for their past contribution to the care home community, and ask them ‘how can we do more together?’. The list of possibilities can grow very quickly, so keep coming back to your residents’ interests and use that to shape your plans.
REACH OUT AND ASK FOR HELP Earlier in this series, we talked about positive organisational culture and strong leadership being a foundation for community engagement. Here we see this in action. The key to building lasting relationships with the community is a welcoming and open approach, modelled by care home leadership and taken up by the whole team. It is credit to the care home sector that so many care homes are coming up with new approaches to strengthen links with the community. Let’s not underestimate the work involved but also the huge pay-off in the long-term. Care homes need to be cherished by their communities for the vital role that they play, it is up to the sector to reach out and ask for help. CMM
HELPFUL RESOURCES • www.carehomeconnections.wordpress.com contains helpful advice and resources on bringing the community into your care home. • There’s a complete toolkit on how to recruit, train and manage volunteers in care settings from the Voluntary Organisations Disability Group and the National Care Forum (Search ‘VODG NCF Volunteer management’). CMM subscribers can also access an article on this at www.caremanagementmatters.co.uk feature/ managing-volunteers • The website of the ‘Volunteering in Care Homes’ project being run by The National Council for Voluntary Organisations has further resources and case studies (Search ‘NCVO Volunteering in Care Homes’). • My Home Life www.myhomelife.org.uk
Tom Owen is Co-Director and Jess Watson is Social Action Lead at My Home Life England, based at City University London. Email: firstname.lastname@example.org Twitter: @MyHomeLifeUK Do you engage with your local community? Share your experiences at www.caremanagementmatters.co.uk Subscription required. CMM February 2016 27
SMALLER SCALE SALE AND LEASEBACK TO RELEASE EQUITY The sector has utilised the sale and leaseback model of finance for many years, however now it is evolving on a smaller scale. Companies are starting to offer it as an opportunity for smaller investors to purchase a single care suite and lease it back to the operator. Is this a solution for providers to release equity? Sale and leaseback has been a popular investment and operating model for care homes. An investor buys the care home property and leases it to the operator for a fixed term. Guaranteeing rental income over the term of the lease, the care provider releases the equity in the building and then pays rent for the use of the site whilst operating the care business. However, once seen as a good way of releasing equity for the care provider, sale and leaseback has faced an increasing number of hurdles over the years. Traditionally a model for larger providers, such as the now defunct care provider Southern Cross, it was reliant on ongoing demand for beds, along with consistent or increasing fee rates, to ensure income covered rent and operating costs. As local authority fees have stalled, and operational costs increased, the model can put pressure on an operator’s ability to meet rent obligations. This is most common with those providers reliant on local authority contracts, as was the case with Southern Cross. Today, the model is mainly applied to the high quality care providers who operate from newbuild properties, commanding consistent and high fees from privatepay clients. It is favoured by the relatively new care sector investors, such as Target Health Care REIT. Real estate investment trusts, like Target, use sale and leaseback as a basis for their business model. Some of Target’s recent investments look to achieve an initial yield of around 7%, over an average term of 30 to 35 28 CMM February 2016
years, depending on the details of the specific agreement. Over the last couple of years, Target has utilised this sale and leaseback approach to invest in properties operated by providers such as Ideal Carehomes and Priory Group.
SMALLER SCALE SALE AND LEASEBACK Where sale and leaseback has begun to falter as a model for a wide spectrum of providers, there is now a smaller-scale model emerging. This model is based on smaller investment into individual care suites. The Care Home Group is one such organisation. New to the market, it is offering investment opportunities in care suites in homes, which it is currently acquiring across the UK. In this instance, The Care Home Group enables people to invest in care home suites via its investment arm, Care Home Invest. The properties will then be managed by the company’s operational division, Care Home Manage, working in partnership with a leading care home management company. Its brochure says that it offers investors unique, low-risk purchase and leaseback opportunities on individual care suites within care home businesses. Investors are able to purchase a care suite in one of the Group’s homes on a 125-year lease. They can then lease the suite back to the Group over 10 years. It says that it ‘guarantees a truly hands-off’ investment that generates a return from day one, whether the suite is occupied or not.’
Michael Kennelly, Commercial Director of The Care Home Group said, ‘We plan to be much more than an investment company; bringing smaller investors into the market through our investment model will enable us to build our portfolio of homes and refurbish them to a high standard, and by doing so bringing much needed private finance into a sector that is clearly not going to survive on public funding alone. ‘The Care Home Group will also own and manage all its homes, as well as offering its suites for retail purchase by owner/occupiers. We feel that this will give investors a higher level of confidence and enables us to use investment to build on those businesses, improve the care environment and occupancy levels and deliver the best standards of care.’
MECHANICS OF THE PROCESS The Care Home Invest brochure sets out the mechanics of its process. Investors are able to purchase a specialist care suite at a discounted early entry price of between ££76,950 and £111,950. Net yields on the investment are said to be 8% from day one. Returns are assured from day one, with income paid monthly in advance, whether or not the suite is occupied. At any time following the purchase, an investor can opt for The Care Home Group to market the care studio on their behalf, at its full retail price, to prospective residential customers, with a 20% return on its sale, and an opportunity to then
purchase further suites for continuing returns.
POTENTIAL ISSUES The single unit, buy-to-let model discussed here has been used for student accommodation with mixed results. However, it has carried some issues. Some situations faced by investors into student accommodation include rental guarantees not being achieved and limited exit opportunities. Rooms in student accommodation are unlikely to be attractive to purchasers other than students, or other investors, making resale limited. There have also been questions raised over whether the Chancellor’s announcement of stamp duty on buy-to-let properties will apply here. From 1st April 2016, people purchasing additional properties, such as buy-to-let and second homes will be required to pay an CMM extra 3% in stamp duty.
OVER TO THE EXPERTS... Are these smaller scale sale and leasebacks an opportunity for providers to release equity? Is there the market from individual investors? Are providers in a position to offer the returns like those set out by Care Home Invest? Are there too many potential sticking points in, what is currently, a difficult operating climate? Will the stamp duty changes effectively close down the model altogether? What do the experts think?
RAISES MORE QUESTIONS THAN ANSWERS We are all acutely aware of the ageing population and the potential requirement for increasing care, however, I am not certain that this model of sale and leaseback for smaller investors is the solution to this issue. Care homes have never been just about the property and their value has been largely dependent on the quality of care delivered. What happens if a care home gets an inadequate rating and performance suffers and requires additional equity? Care can never be truly hands-off. In my experience, homes with absentee owners have been more prone to issues than others with fully engaged owners. Therefore, the management of the homes would be a crucial factor to take into account and how those people would be tied into any arrangements. I would also be concerned about the liquidity of any investments.
PROVIDES AN OPPORTUNITY TO RELEASE EQUITY
How quickly could they be realised? What would be the demand for such assets, which, if based on the experience of student accommodation, might not be great? What happens at the end of the 10-year term? Presumably, the care home would need to be sold to repay investors – therefore, you would be dependent on the vagaries of the market. Clearly care home values have increased over the last 10 years. However, this isn’t guaranteed going forward; just look at what’s happened to commodity prices at the end of 2015. Understanding the terms of the arrangements would also be needed. Are the rents upward only? What happens if the home defaulted on a payment? To me – it raises more questions than answers at this time.
Paul Birley Head of Public Sector and Healthcare, Barclays
if buying off plan as a new scheme will have both development and management risks. Are proposed rents overinflated to attract investors but too high for the local market? Once the scheme loses its ‘new’ factor, will rental levels settle? Investors are often in the hands of the operator in terms of rent and client demand. Operator reputation and the attractiveness of the scheme are paramount. The investment market is limited to other cash investors as it is not always suitable for mainstream buy to let mortgages. Investors can be dependent upon the operator to sell their asset and this will not be a priority if there remains unsold suites from the initial development. Although the revised stamp duty rates will have an impact for more significant investment, the level of investments here will often be beneath the threshold.
Jessamy Venables Senior Agent, Carterwood
THE SECTOR NEEDS INNOVATION BUT IT MUST BE RIGHT The challenge for the independent sector is to get the care side right and the business side right in what should be a values-driven sector. Getting the business right is what enables the expression of those core values of service and quality. Public funding is clearly inadequate for the task, long-term underfunding has created a sector in crisis, and the Better Care Fund and Council Tax precept together will hardly lessen the gap. We need to look for answers and innovation. Our ‘actual costs’ exercise in Lancashire, conducted by LaingBuisson in 2014, showed local authority fees at, or around, a zero return while it seems to have been NHS policy to drive down Continuing Healthcare fees. Local authority and clinical commissioning group commissioners still have, if not monopsony power, ‘super-customer’ muscle. Commissioners knowingly (they might argue unavoidably, but can’t argue unknowingly) underfund
The issues that led to the demise of tenant operators of sale and leaseback are well documented. Funds have learnt from past mistakes. Perhaps too much weight was put on covenant strength without thinking about operator track record, the implications of fee freezes, wage increases and regulatory issues. Funds now seek businesses that attract private clients that provide a pressure valve on fee freezes and staff cost increases. This model is an opportunity to release equity and develop new schemes. The sector is attractive to smaller investors. It follows similar investments in student accommodation where developers also state appealing and guaranteed initial returns. This, unfortunately, isn’t always the case. Investors must do their homework. Do developers/operators know the local market and will the scheme meet CQC regulations and fill at a suitable rate? I would advise caution
and know there are consequences. New schemes like this need to be explored but there seems a disconnect between the high returns quoted and the levels of risk one would expect to be associated with such returns (some sources have quoted 12% pa) even in a buoyant market. It is difficult to see how public funding would attract investors. Our advice to providers in our area (although the matter is still to be formally discussed at the Lancashire Care Association Board) would be ‘caveat emptor’ and make sure you get the right independent financial advice. If it looks too good to be true it probably is. Having said that, the care sector needs innovation in financial products to meet the needs of care providers and care users more than ever. However, anyone in the care business should be in it for the long-term and for the right reasons.
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CMM February 2016 29
Getting safeguarding right Safeguarding starts with good leaders, good communication, openness and joint-working. Ewan King looks at what organisations can do to keep people safe.
30 CMM February 2016
Policies and procedures are ‘necessary scaffolding’ in making care providers safer. That’s according to Des Kelly OBE, Executive Director of the National Care Forum. In his blog, Cherishing Registered Managers, he says that policies and procedures should only be a framework within which relationships can develop between care workers and people receiving support. Des points to Registered Managers, in particular, as the ‘doers’ who carry the major responsibilities for leading improvements to services. Nowhere is all of this more important, than in the area of safeguarding. Let’s put policies and procedures to the side for a moment, important though they are, and talk in the plainest terms. Is your service good enough for your mum, or for that matter, for anyone you hold dear? 10% of social care providers are ‘inadequate’ at safeguarding, according to the Care Quality Commission (CQC), which applies the ‘mum test’ to its inspections. Safeguarding is a really important issue for the CQC and for the sector as a whole. The statistic above should worry everyone, even those providing good safeguarding practice. Perhaps consider what the CQC says about Avenues South East Services, who recently achieved an ‘Outstanding’ rating. ‘People told us that they felt safe using the service. They said, “The staff look after me.” People’s relatives told us they were confident that their relative was safe using the service.’ Achieving this can often only happen where support is underpinned by excellent leadership and practice.
SAFEGUARDING AND LEADERSHIP If you don’t have safe organisations, you probably don’t have good leadership. For leaders, it is about constantly espousing the values of creating those caring, person-centred and safe organisations. Social care plays an important role in helping people with care and support needs to live full lives, free from abuse and neglect. This includes preventing abuse, minimising risk without taking away control from people, and responding proportionately if abuse or neglect has occurred. Safeguarding is a fundamental CQC requirement for providing ‘Good’ care and support. You can’t think about being ‘Outstanding’ unless you get this essential factor right. An ‘Outstanding’ service is a responsive service. It is transparent to users, carers, commissioners and others, and recognises its own mistakes as a valuable source of learning. Being open and honest is a key aspect of leadership. The Social Care Institute of Excellence’s (SCIE) report, A definition of excellence for regulated adult social care services in England, says that excellent services treat people with the utmost respect and dignity. The staff in an excellent service get to know the people that they care for and support. They make sure that the following challenging goals are achieved: the service is ‘well-led’; it’s staffed by skilful people; and it has good connections with the local community. This will go a good way to providing a personcentred care and support package, with proper outcomes, for everyone using the service. Staff should be inspired to have positive aspirations for everyone they support. If you truly value people, you are surely less likely to devalue them to the point where they may be harmed.
CMM February 2016 31
GETTING SAFEGUARDING RIGHT
SAFEGUARDING AND CO-PRODUCTION
Another CQC ‘Outstanding’ report now. This time, Prince of Wales House in Ipswich, which has as its ethos, ‘Everyone who comes through our doors will be included in our home and supported to feel safe, secure and wanted’. If you work co-productively with service users, carers and relatives to design services, care plans and policies, then it’s more likely that safety will be fully embedded into the way care is provided. How is this done? It’s about inspiring staff to involve residents in decision-making and the design of services. If they are involved in shaping services, they can be involved in their own safeguarding. SCIE has helped lots of organisations audit how they involve service users in safeguarding. We know how powerful it can be when, in the words of one safeguarding lead, we have heard the voice of the individual and we are not just making decisions on their behalf. Working co-productively in this way, with all parties, means that providing good safeguarding practice is, perhaps, a much less a daunting task. Increasingly, leadership is also about looking outside the organisation that people work for; and working in conjunction with others. Counter-intuitively, in some respects, people are not always safer when they are kept in a single organisation and when they don’t interact with the wider world. Safeguarding concerns raised in 2011, over Winterbourne View, fall into this category. It follows that people should be safer when they interact with a wide range of organisations and people – such as local volunteers, library and leisure services and, of course, other care providers. Good leaders recognise this. Another service rated ‘Outstanding’ by the CQC, Robert Owen Communities, was praised because, ‘The service worked in partnership with other organisations in creative and innovative ways to improve people’s independence.’
SAFEGUARDING AND A SYSTEMS APPROACH Organisations increasingly function within a complex system of commissioners, partners, communities and collaborators. To succeed in this environment, leaders need to become adept at working with service users, relatives and volunteers. They also need to be able to operate in networks, working across organisational boundaries, and building shared values and trust. Leaders must remove barriers that stop their staff collaborating with others. This can be described as using a systems approach. If an organisation seeks to make people safe, then leaders need to ask questions about who they have to work with differently, to achieve that goal. By adopting a systems approach, leaders can learn about best practice, they can reduce the risks of harm, they can assess risk much earlier and they can build a whole systems approach to safety. SCIE’s systems approach was originally developed in our work with child protection, known as ‘learning together’, it looks at how lessons can be learnt in safeguarding.
SAFEGUARDING TIPS Tips for providing good safeguarding practice on a day-to-day basis. • Act upon safeguarding complaints, incidents and comments promptly. • Recognise your mistakes, and successes, as a valuable source of learning. • Be responsive and innovative – by learning from other organisations, policy developments and research. • Build links between your organisation and local communities – people can be safer when they are part of vibrant communities. • Ask service users how they want safeguarding to be handled – make sure it’s a regular discussion point with staff, residents and relatives.
SAFEGUARDING AND LEGISLATION The Care Act 2014 introduced new safeguarding duties for local authorities. These include making sure that local adult safeguarding procedures are in place, for all the various professionals that keep people safe. Local authorities, care providers, health services, housing providers and criminal justice agencies are all important safeguarding partners. Councils need to make sure that the right enquiries are made when someone has a concern about safeguarding. On top of that, the Care Act now stipulates that it’s the council’s responsibility to arrange independent advocates for people who don’t have anyone else in their lives to support them, and who need help to understand the safeguarding process. SCIE has lots of resources on good safeguarding practice, from films to guides and from e-learning materials to at-a-glance briefings. There are plenty of other safeguarding resources, from a housing guide looking at safeguarding, to training on the Deprivation of Liberty Safeguards.
NECESSARY SCAFFOLDING Is all of this easy to achieve? Not at all, and not at a time when resources are being squeezed more than ever and it is difficult to find good staff. However, there are ways to improve safeguarding that are cost-effective and that reduce costs over time. Back to Des Kelly from the National Care Forum, and his ‘necessary scaffolding’. Services should regularly review and develop their safeguarding policies, procedures and values. However, it’s not good enough that the paperwork is simply being filled in correctly. The staff should be fully-engaged with the service, and then fully-engaged with the people they safely care for and support. Des won’t mind if I don’t finish by quoting him. It takes effort, time, constant reflection and learning to get safeguarding right, so I shall quote Aristotle instead. He said, ‘We are what we CMM repeatedly do. Excellence then, is not an act but a habit.’
Ewan King is Director of Business Development and Delivery at the Social Care Institute for Excellence. Email: email@example.com Twitter: @EwanDKing CMM subscribers can read the reports referenced in this article at www.caremanagementmatters.co.uk Subscription required. 32 CMM February 2016
Another portfolio sale for CARTERWOOD
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CMM February 2016 33
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34 CMM February 2016
A VIEW FROM THE TOP
ANNA GALLIFORD Anna Galliford is Chief Executive of FitzRoy.
REFLECTIONS ON THE LAST DECADE FitzRoy was started by Elizabeth FitzRoy, a mother of a child with Down’s syndrome, over 50 years ago. It has always been a pioneering force for people with learning disabilities delivering a compelling vision of ‘homes in communities’. Reflecting on the history of the sector, we must learn from previous mistakes. During the eighties, the new plan for ‘Care in the Community’ saw the closure of large institutions. We all hoped that this would change lives for the better, but the lack of capacity within communities proved a significant block. The vision is still a work in progress. We recently researched the concerns of families, particularly in light of further local authority budget cuts and a pressure for social care to provide more for less. In our report Who will care after I’m gone? we discovered that many families feel in crisis. They often have profound anguish for their loved ones with learning disabilities, and are struggling to understand a confusing system of care that takes a short-term approach. Families told us they live in fear of the dire consequences of incorrect assessments and the lack of consistent and quality care. Some were so worried they were driven to wonder if it would be better if their child died before them. The research also revealed concerns over the low status given to highly-
skilled care professionals. There has always been a gulf between the status of healthcare workers and care professionals. This disparity has a direct impact on recruitment and retention and has created big problems for those relying on services. This high staff turnover is killing trust, costing money and wasting resources. PROJECTIONS FOR THE NEXT DECADE The report came just after NHS England’s Building the Right Support. This sets out a welcome vision for the future of a national plan to close inpatient facilities for people with a learning disability. This is welcomed and it is fantastic to finally see commitment to ending the type of inappropriate hospital care that led to the Winterbourne View scandal. We, however, fear the consequences on already stretched community resources. Community services need investment to take on extra capacity. Local authority budgets will continue to see further cuts impacting directly on local services and care providers. Families are already facing waiting lists for housing, and scaled back day services, this won’t change. We have long held the view that we need to take a ‘whole of life’ approach to integrated care, and our research highlights this need. To tackle the problems that are stacking up we must work creatively to
deliver innovative solutions to social care. This is already being done in some areas through schemes like Shared Lives. In addition, we must address the low social status care workers are given. INSIGHT Short-term planning is creating many ongoing problems for people, whilst costing money for local authorities when care packages break down or focus on crisis provision. A real commitment to a whole-life approach, one that integrates the care needs of each individual, from education, housing and employment to healthcare, will stop the crisis escalating. LESSONS It is vital that we listen to people with learning disabilities and their families and then commit to putting their experiences and needs at the heart of future social care planning. ADVICE Never lose sight of your mission and your founding values. When times are tough don’t retreat to a place of safety, challenge yourself to push for creative solutions and innovations. Above all, listen to the people using your services and the staff working on the frontline for they hold the keys to the future changes necessary. CMM
The FitzRoy report Who will care after I’m gone? is available on the CMM website at www.caremanagementmatters.co.uk Subscription required. CMM February 2016 35
3RD SECTOR CARE AWARDS 2015 Following the success of the inaugural 3rd Sector Care Awards in 2014, the event returned to central London in December and welcomed back Dame Esther Rantzen as host. Supported by the National Care Forum (NCF), Care Provider Alliance, Housing & Support Alliance, Mental Health Providers Forum and Voluntary Organisations Disability Group, the Awards offered a much needed opportunity to celebrate hard work and dedication in the 3rd Sector in current tough times. Before winners were announced and celebrations took place, attendees were rewarded with a fantastic performance from Certitude Community Choir. This was followed by introductions from Robert Chamberlain, Editor in Chief of CMM and Des Kelly, Executive Director of the NCF.
36 CMM February 2016
Dame Esther then took to the stage to get the ceremony underway. Taking great care to turn the spotlight on each winner in turn, Dame Esther used her friendly interviewing technique, effortless charm and openness to explore the fantastic work being rewarded. She ensured that the audience knew exactly why each winner deserved their award. The excitement and spirit of the day had most people turning to their phones to share their achievements and celebrate successes on social media. This culminated in the Awards’ hashtag #3rdSectorCareAwards trending on Twitter. This meant that the fantastic work of the sector had an opportunity to receive increased recognition and spread goodwill well beyond the event’s attendees. Showcasing what the event aims to achieve, the winners of 2014’s Creative Arts Award, Halas Homes, concluded the ceremony with a powerful dance performance which left Dame Esther in tears. This emotive and inspiring finale from
Dance Unity, an integrated dance troupe comprising trained dancers and people with a learning disability, served as a poignant reminder of why everyone in the room strives for excellence on a daily basis. After such a successful event, the 3rd Sector Care Awards
left attendees energised, empowered and motivated to keep pushing the boundaries of best practice. The Awards will return in 2016 and nominations will open in due course. For updates and a full list of finalists, visit www.3rdSectorCareAwards.co.uk
CMM February 2016 37
From exit to event
IN RETIREMENT COMMUNITIES
38 CMM February 2016
Michael Voges explores the benefits of retirement communities and how a change to their funding structure can encourage investment and boost the market.
Delayed discharge. Care crisis. Loneliness. At this time of year in particular, as charities ramp up their campaigning and newspapers report on hospital bed shortages, we’re all made acutely aware of the crises surrounding older people’s care, housing and support. Perhaps less is made of the extent to which housing-based solutions such as retirement communities can help address these issues, and how important private sector funding streams – rather than just government funding – are to the sustainability and growth of this socially-beneficial sector. Retirement communities – also called ‘extra care’ or ‘housingwith-care’ – are a form of housing for older people. They offer older people the independence of their own home and front door but, in contrast to traditional retirement flats or general needs housing, they also provide on-site care as and when it is needed, 24-hour staffing, and access to communal wellbeing and leisure facilities and activities such as gyms, craft rooms, greenhouses and cafés.
BENEFITS OF RETIREMENT COMMUNITIES As a result of their mix of housing, support and social activities, retirement communities can dramatically improve and maintain older people’s wellbeing and
reduce NHS and social care costs. In a recent study by Aston University comparing residents in retirement communities with a control group, NHS costs were reduced by 38% for those moving into extra care housing. Added to this, the local authority costs of providing lower and higher level social care were reduced by 18% and 26% respectively per person, per year when compared to providing the same level of care to those outside retirement communities. Unplanned hospital stays (which contribute to delayed discharge) reduced from eight to 14 days, to one to two days for those in retirement communities. For new residents, measures of depression were reduced by 15% after 18 months, with those with low mobility seeing the greatest reductions in this mood measure. These are impressive figures, meaning that retirement communities can save the NHS and local authorities millions of pounds. On a human level, they mean that older people are enabled to regain the joys of friendship and fitness, whilst their relatives can be confident that they are well supported. Yet despite the benefits of extra care schemes (and their popularity amongst those who live in them), only 0.5% of those over 65 live in a retirement community in the UK (compared to around 5% in countries such as New Zealand,
CMM February 2016 39
FROM EXIT TO EVENT – UNLOCKING INVESTMENT IN RETIREMENT COMMUNITIES
US and Australia). There is definite scope for the sector to grow in order to meet demand and various reasons for this, including a lack of planning focus on older people’s housing and lack of awareness of the model amongst practitioners and older people alike.
INVESTMENT IN THE SECTOR One, often overlooked, obstacle to the growth of retirement communities is private sector investment, and whether there is an appropriate legal framework to allow operators to lever-in this investment, relating to the middle market, in particular. This is because making the operation of retirement communities stack up can be tricky when targeting those older people – a majority – that want to buy a leasehold rather than a rented property. Firstly, extensive facilities can be costly to run, but bring a wealth of benefits to older people. While the service charges for these facilities may be no higher than maintaining a large family home in need of various minor repairs, it can mean that older people worry about being able to afford the ongoing service charges on their often modest incomes. At the same time, the Landlord and Tenant Act aimed at leasehold properties, in general, means that operators are constrained, via the legislation’s formulae, in the management fees they can set. While the Act has been invaluable in protecting leaseholders in ‘normal’ leasehold housing, the reality is that operating care services, dining options, activity services and other housing-related support services on site is expensive and involves business and reputational risk
which is difficult to price into fees to be recovered via the formulae. Combined, these liquidity issues for residents, who may have considerable assets which are locked up in their properties, and profitability issues for operators mean that new forms of charging and payment are needed to address the chronic undersupply of retirement housing.
EVENT FEES Business models such as ‘event fees’ can overcome this. These fees are paid when a retirement community property is sold. Rather than paying up-front or during occupation, these fees are taken when residents leave the retirement community. When transparently disclosed, event fees can be a practical way of making retirement properties affordable, especially for those on middle incomes or who are asset rich but cash poor. For example, an operator might set a fixed service charge that only rises in line with inflation. This provides certainty to residents. The service charge could even be capped and fixed, giving residents the reassurance that their, often modest, pensions will be sufficient to pay for their living costs and service charges for the foreseeable future. In exchange, the resident would give up a certain level of equity in their home. This may range from between 1% to 30%. However, it could suit some older people to give up larger parts of their housing wealth, for example 50%, in return for no service charge. They could benefit from extensive social, support and wellbeing services while still having money to spend as they wish. In essence, these fees can be a way for older people to access their housing equity to contribute
to their occupation costs while living in a retirement community. In addition, these fees can be critical to the business models and viability of operators as they offer a secure income stream. This model of event fees also presents an opportunity and incentive for new retirement communities to be built and operated, which, due to the crossover of housing and care, require specialist skills to run and carry additional financial and regulatory risks.
THE LEGAL VIEW The benefits of these fees are acknowledged by the Law Commission, which is looking into the legal framework surrounding this income stream. It recently published a consultation document on the issue. The Law Commission’s verdict, so far, is that event fees can be a useful tool to reduce service charges and provide incentives for investment. However, the Law Commission is also crystal clear that event fees need to be disclosed up front – prominently, clearly and transparently. This is something ARCO’s members fully agree with. Our Consumer Code is explicit in its insistence on transparent disclosure of all fees, including event fees. In 2013, the Office of Fair Trading produced a report on ‘exit fees’, as they were previously known. This was triggered largely by undisclosed use of event fees in the market for retirement flats, those without care. It is this abuse which the Law Commission’s work will hopefully put an end to.
INCREASED INVESTMENT In my view, older people will be able to make up their own minds as to whether they want to pay these
fees or not, if they are prominently displayed and residents can make informed decisions about them. In other countries, such as Australia and New Zealand, event fees of around 20 to 30% are well-known and accepted by residents. As such, it is probably no coincidence that these countries have much higher levels of people living in retirement communities. If followed through to law, we are confident that the Law Commission’s review will increase investor confidence and enable new offers to emerge that make occupation costs more predictable and/or affordable. This will persuade new operators, both private and not-for-profit, to increase their investment in the sector. Investment that is needed, and should be welcomed, in a sector that can play a significant part in how we deliver care for older people in the future. Continued government investment, for example continued housing benefit support for those with more moderate means, is clearly needed to sustain and develop this part of the sector. In addition to this, it is also evident that we must shine a light on private sector investors and individual homeowners, who will not require a direct government subsidy or support. Levels of housing-withcare provision for homeowners are currently far lower than in the affordable housing sector. The lowest levels of provision are in the ‘middle market’. We must ensure that the right legal environment exists to enable this part of the sector to develop. If the Law Commission’s work can deliver a legal framework that ensures robust rights for consumers while allowing operators to develop creative business models, the sector is bound to thrive. CMM
Michael Voges is the Executive Director of the Associated Retirement Community Operators (ARCO). Email: email@example.com Twitter: @ARCOTweets You can share your thoughts on event fees in retirement communities and read the reports mentioned here on the CMM website www.caremanagementmatters.co.uk Subscription required. 40 CMM February 2016
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Becoming an adult - building the best future for young people with additional needs
CMM February 2016 41
Learning Disability Services:
Current Developments and Future Opportunities National Conference
25th February 2016 • NEW VENUE – The Hilton, Reading
> Transforming your Service
> The Commissioning Landscape
> Market Opportunities
> Operating in Austerity
> Recruitment and Retention
> Regulating Supported Living
> And much more...
Visit www.caremanagementmatters.co.uk/events for the full agenda and to book. CMM subscribers receive a 10% discount for booking online.
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42 CMM February 2016
Y CE S DASPA TOING N OKMAI BO RE
CONFERENCES • EXHIBITIONS
SUPPORTING PEOPLE WITH DEMENTIA
Driving up quality by ongoing self-assessment
Sarah Maguire and Peter Kinsey look at ongoing selfassessment as an important factor in driving up quality.
In the last issue of Care Management Matters, we looked at the Driving Up Quality Code. We explored the reasons why providers should sign up to the Code and make a public commitment to improve the quality of service provision for people with disabilities, following the shocking abuse that took place at Winterbourne View. Signing up to the Code is not a tick-box exercise. It is a commitment to embrace scrutiny. Providers embrace the feedback from people who use services, families, staff and professionals, on the quality of their service provision. By creating this culture of openness and transparency,
the intention is for good organisations to flourish and poor provision to be exposed and addressed.
WHAT MAKES A GOOD PROVIDER? Scrutiny of the service can be undertaken through an inclusive, reflective, honest and open self-assessment process. There is no set way to undertake a selfassessment. It is not about trying to be a â€˜perfect organisationâ€™ or to compete with others. There is no such thing as a perfect organisation, however being able to
CMM February 2016 43
DRIVING UP QUALITY BY ONGOING SELF-ASSESSMENT
spot that people are living an unfulfilled life in an unsafe environment is the mark of a good provider. Being open and honest about this is the mark of an even better provider. Being able to celebrate success is important, but as important is
“Being able to celebrate success is important, but as important is to know where we are failing or where we have made mistakes.”
to know where we are failing or where we have made mistakes. The self-assessment process needs to ensure that both the positive and negative aspects are reflected upon and addressed.
SELF-ASSESSMENT IN PRACTICE Care provider, CMG Ltd, is an organisation that has undertaken two company-wide self-assessments since signing up to the Code. It has also encouraged individual services to undertake a self-assessment process. CMG was keen to ensure that the process of gaining feedback was not only inclusive but creative and engaging. The company invited over 100 people it supports – staff, relatives and external professionals – to a ‘self-assessment day’. Rather than simply asking people to fill out forms, it held a series of creative workshops. In 2015, the theme of the selfassessment day was ‘The road to quality’. Each workshop was facilitated by one of the company’s regional directors and attendees were split geographically into each workshop so that they could address both organisational and local issues. Discussions then took place around each of the five areas of the Code. The people supported by CMG created artworks to display different modes of
transport, eg. tractors, trains and boats and also took part in the workshops. On the day, feedback on what the organisation does well and what could be improved upon was pinned to the displays. The day culminated with a ‘road to quality’ being laid out through the centre of the room, with everyone posting a ‘brick’ containing an idea. All the feedback from the day was then evaluated and written up into a report which included a comprehensive, but achievable, action plan of activities that the company would undertake to address the ‘things it could do better’. This document was then circulated company-wide and to all participants. CMG also made sure that, in its 2015 event, it reflected upon the action plan from the 2014 event and outlined how it had addressed each point. Therefore implementing and building upon the previous year’s feedback to continuously improve. Choice Support took a slightly different approach to its organisational selfassessment. It organised an event that was a cross between a café conversation and speed dating. The comapny invited people it supports, families, staff, commissioners, care managers and housing providers and had 14 sessions across the organisation in one year. Each session was chaired by a trustee. Conversations were fast and furious and people were encouraged to be open and honest. Its subsequent action plan then took the form of a traffic light system to highlight progress.
RECOMMENDED PRINCIPLES It is, of course, up to each organisation to decide how it wants to carry out its self-assessment process. However, it is recommended that organisations should stick to the following principles: Include a range of people: The selfassessment should not be carried out by managers in isolation. It should involve the active participation of the people they support, families and frontline staff. Wherever possible, external colleagues,
such as commissioners and members of the local learning disability team should be encouraged to participate. Include a range of evidence: Use as wide a range of evidence as possible, and preferably from more than one source. For example, evidence can be gathered from sources such as: meeting minutes; survey questionnaires from staff, people you support and families; focus group discussions; reviewing complaints and Care Quality Commission reports. Breadth and depth: Particularly for larger organisations, the self-assessment needs to ensure that all areas of the organisation are looked at and it is representative of all employees, not just managers or Board members. Each provider will need to think of ways to ensure that all staff are involved in the process to understand their unique contribution to the organisation. Constructive challenge: The organisation should rigorously challenge itself and encourage active and open discussion. Make it okay to be open about what obviously isn’t working and also to question practice that is more commonly accepted but shouldn’t be. Creativity: Try to explore creative ways of ensuring meaningful involvement by participants to make it a positive, enjoyable and motivational exercise. This could include, for example, the use of video, social stories or drama. Ongoing improvement and action planning: The self-assessment is not a ‘pass or fail’ test, but a recognition that there will always be room for improvement and change. The feedback provided from your self-assessment process should be documented in a report alongside an action plan, to ensure the suggested improvements are actually made. The openness and transparency of self-assessment is beneficial to the organisation, those it supports, their families, carers, commissioners and inspector. An organisation that is willing to look at how well it does, constantly improve and build upon its assessments will reap the rewards for everyone. CMM
Peter Kinsey is Chief Executive of CMG Ltd. Email: firstname.lastname@example.org Twitter: @PeterKinseyCMG Sarah Maguire is Director of Quality and Safeguarding at Choice Support. Email: email@example.com Twitter: @Choice_Support You can find out more about Driving Up Quality at www.drivingupquality.org.uk Twitter: @DrivingUpQualit 44 CMM February 2016
WHAT’S ON? Event: Safeguarding Adult Reviews Conference Date/Location: 22nd February, London Contact: Capita Conferences, Tel: 0870 400 1020 Event:
Next Steps for Health and Social Care in Greater Manchester Date/Location: 26th February, Manchester Contact: Westminster Health Forum, Tel: 01344 864796 Event:
Priorities for the Future of Health and Social Care Policy in Wales Date/Location: 2nd March, Cardiff Contact: Policy Forum for Wales, Tel: 01344 864796 Event: Deafness & Dementia Conference 2016 Date/Location: 3rd March, Chester Contact: Deafness Support Network, Tel: 0333 220 5050 Event: Delivering integrated care for older people with frailty Date/Location: 15th March, London Contact: The King’s Fund, Tel: 0207 307 2596
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Event: NCPC Flagship Conference and Awards 2016 Date/Location: 23rd March, West Midlands PageContact: 1 National Council for Palliative Care, Tel: 0207 697 1520 Event: Care and Dementia Show 2016 Date/Location: 11th/12th October, Birmingham Contact: The Care Show, www.careshow.co.uk
CMM EVENTS Event: Date/Location: Contact:
CMM Insight 2016 25th February 2016, Reading Care Choices, Tel: 01223 207770
Event: Date/Location: Contact:
The Transition Event 2016 26th May 2016, Birmingham Care Choices, Tel: 01223 207770
Event: Date/Location: Contact:
Derbyshire and Nottinghamshire Regional Care Conference 2016 TBC, Nottingham Care Choices, Tel: 01223 207770
Event: Date/Location: Contact:
Lancashire Regional Care Conference 2016 TBC, Clayton Le Moors Care Choices, Tel: 01223 207770
Event: Date/Location: Contact:
Berkshire Regional Care Conference 2016 TBC, Reading Care Choices, Tel: 01223 207770
Please mention CMM when booking your place. CMM February 2016 45
ADAM CARTER • MANAGING DIRECTOR • CARTER SCHWARTZ
Adam Carter shares ways to improve the sector’s recruitment situation in 2016.
2015 was undoubtedly the year staffing shortages in social care leapt to the public’s attention. The shortage of nurses and care workers to manage demand became all too apparent, as did the lack of skilled senior managers and leaders who can deliver successful outcomes. Add an ageing care workforce to the equation and you would be forgiven for thinking that, against this backdrop, the future of the sector looks bleak in the year ahead. However, a break in the clouds is possible which could shine a light on the care sector in 2016 for all the right reasons – providing it learns how to tap into the talent base it needs to safeguard its future. Vacancy rates for nurses in social care are running at 9% compared to 7% in the NHS, with nursing homes reporting a 55% increase in the use of external agencies. This is being compounded by the fact that 30% of all care home nurses in England are
aged 55. Combined, these factors are what led the recent Independent Age and the International Longevity Centre-UK report to warn that the sector faces a possible shortfall of one million care professionals by 2037 – 50,000 in 2016 alone. Then there is the issue of leadership. Pressure on budgets is having a direct impact on the number of middle managers being developed as future leaders. This means there is an increasing absence in the number of available senior managers and leaders with the skills and strategic business acumen to run organisations. This is not exactly news. But over the last 12 months we have seen a move on behalf of some independent care providers to remedy this problem – a move which it is hoped will catalyse others to follow suit. Barchester Healthcare is a case in point. They have created the role of ‘care practitioner’ whereby a senior carer (NVQ level 3) is given a greater level of training which allows them to take on some parts of the nurse’s role. This up-skilling of their workforce will provide them with 150 care practitioners on the floor each year. Thereby plugging many of the gaps. But the up-skilling of staff needs to be extended to every level of the organisation. Everyone considering a career within the sector, regardless of whether in a medical or administrative capacity, needs to see that there is a clearly defined pathway through which employees can progress. Even if their ambitions stretch all the way to the top of the organisation. This needs to be supported by training routes, perhaps dual training which allows individuals to progress their career in both health and social care without the need to retrain, that will help people to further their careers without the need to jump ship and swim to the NHS’s shores where further opportunity awaits. This is one area where the care sector has fallen woefully short and a key reason as to why the shortage of staff both entering and staying in the independent
sector is more acute than the NHS. Turnover rates in the care sector have been on the rise for some time and much of that is down to its inability to ‘sell’ itself as a career of choice – something that the NHS is much better at doing. By better extoling the benefits and opportunities to be gained in having a career in the care sector and working hard to boost their appeal as an ‘employer of choice’, providers will go some way to overcome the difficulties they face in recruiting the talent they need. Until they do, it is unlikely that we will see any sort of slowdown in the use of workers from overseas over the next 12 months. For some reason, women dominate the care sector but, the higher up the ladder you look, the fewer women you see occupying senior management and Board level roles. Indeed, only six women have appeared in the top 100 most powerful people in health in almost a decade. This is a significant factor in the shortfall of leaders within the sector and one that we expect will be given greater attention in the coming year. Indeed, as the Government’s gender diversity agenda develops apace, care providers will need to make it clear that there is a direct path to leadership, with opportunities for advancement including formal programmes to facilitate women’s development as they move up to the next level…and the one beyond that. The care sector can only benefit, and become stronger, with gender diversity. Until it learns how to do this, it will continue to miss out on many of the right people to do the right jobs. There is no silver bullet to fixing the recruitment issues that affect all levels of the care sector. The very act of setting the ball rolling and implementing some of the initiatives above will shift some of the obstacles. In doing so, the care sector could shake off some of the stresses and recruitment strains it experienced in 2015 and start the next 12 months with a renewed sense of optimism. CMM
Do you face recruitment issues? Do you think it’ll improve in 2016? Share your thoughts on the CMM website www.caremanagementmatters.co.uk Subscription required. Twitter: @CMM_Magazine 46 CMM February 2016
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