Care Management Matters Magazine April 2016

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APRIL 2016 ÂŁ4.00

ENHANCING CARE IN CARE HOMES Social care leads new models


Providers’ role in new requirements

National Living Wage

An opportunity for recruitment

Resource Finder Training providers

Includes Miele Professional 4-page company profile


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In this issue From the Editor


Is it just me…? 07 Editor in Chief, Robert Chamberlain considers how the UK is becoming a bleaker place to grow old. CMM News


A View from the Top 24 Jane Ashcroft CBE, Chief Executive of Anchor is the subject of our interview. Business Clinic The panel considers Papworth Trust’s new housing with care rehabilitation scheme.



CMM Insight review 48 A summary of the main events at our CMM Insight Learning Disability Services conference. What’s On?


Straight Talk John Kennedy explores the laws of physics and social care and looks at what the sector can learn from the Challenger disaster.









Revalidation – providers play your part Jackie Smith sets out what providers need to know about the incoming nurse revalidation and the important role they can play in supporting staff with the new requirements.


Enhancing care in care homes: how social care providers are taking the lead in new models of care Debbie Sorkin explores the important role that social care is taking in developing New Models of Care.


Bank interest rate swap agreements – an update Keith Lewin brings a further update to the ongoing subject of bank interest rate swap agreements.


National Living Wage – seize the opportunity Adam Carter discusses how the new National Living Wage could be an opportunity for the sector to adapt its recruitment practices.


Resource Finder CMM presents details of care sector training providers. CMM April 2016 3


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

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

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





Adam Carter Managing Director, Carter Schwartz

Debbie Sorkin National Director of Systems Leadership, The Leadership Centre

Ewan King Director of Business Development and Delivery, Social Care Institute for Excellence

Jackie Smith Chief Executive and Registrar, Nursing and Midwifery Council





Jane Ashcroft Chief Executive, Anchor

Jeremy Porteus Founder and Director, Housing Learning and Improvement Network

John Kennedy Independent Social Care Consultant

Keith M Lewin Solicitor and Director, Brunswicks Law Limited

SUBSCRIPTIONS Non-care and support providers may be required to pay £50 per year. 01223 207770 Care Management Matters is published by Care Choices Ltd who cannot be held responsible for views expressed by contributors. Care Management Matters © Care Choices Ltd 2016 ISBN: 978-1-910362-90-7 CCL REF NO: CMM 13.2

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From the Editor Editor, Emma Morriss discusses the role of social care in driving innovation and how providers can play their part. Our lead story this month looks at the role that social care providers are playing in developing new models of care under the Government’s New Models of Care Programme. Six Vanguards are looking at how to enhance care in care homes. The Vanguards involve collaborative working and there’s a lot that can be taken from them. Debbie Sorkin explores what is happening, where and what the Vanguards are aiming to achieve. I really hope they can help to define new models that can be replicated across the country. However, in addition to this innovation is the fact that social care is driving the process. Care providers are taking the lead. And so you should. You hold all the knowledge in these situations. You’ve worked in the sector day in, day out, for decades. You know what works and what happens. You should be driving the process. Also inside this issue, Business

Clinic looks at a different collaborative partnership. This time developed by the Papworth Trust along with Cambridgeshire and Peterborough Clinical Commissioning Group and Cambridgeshire County Council. The pilot integrates housing and social care to help people move from an acute setting into independent living via rehabilitation. Again, it was the Papworth Trust that originated the idea.

TAKING THE LEAD The models and pilots discussed in these articles are fantastic. They show that integrated working can happen; is happening. But, more to the point, they show that social care can lead the way and position itself at the forefront of innovation, driving the change. However, these articles may make it sound easy. They may make it appear like anyone can be

involved. Although everyone should have the opportunity, they don’t. At CMM Insight, one of the topics of discussion was the Government’s Transforming Care Programme and the opportunities for providers to participate in developing new services. There are pilots happening around the country to drive service design and test new approaches. However, not one provider in the room was involved in the pilots. It got me thinking. Given how tough the sector is at the moment, are you too busy with the operational aspects of the business? Do you

not have the time to be involved? Are you not in the right place at the right time? I asked the speaker at the event, how can providers get involved? The answer: use your umbrella organisation – a local or national association. Collectively, the sector can put itself in the right place, make its voice heard and effect change. Social care deserves to be at the table when decisions are being made. I know it’s not easy, but it’s important. You have the skills, knowledge and ability. You just need to break through the barriers.

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Is it just me...?

Institute of Public Health’s (IPC) new paper an interesting insight into the effect of cuts on social care. Written by visiting Professor John Bolton, the research examines the impact of cuts in six councils. Each of the councils studied had managed a minimum of 20% reduction in budget spent on social care, in the four years to 2014/15. These cuts were achieved through a number of measures including: • Squeezing prices paid to providers (20%). • Staff reductions (20%). • Reduction in Supporting People grant funding (20%). • Demand management/ promoting independence (25%).

Editor in Chief, Robert Chamberlain considers how the UK is becoming a bleaker place in which to grow older.

According to the latest report by Public Health England, we can all expect to live for longer. The statistics are region specific to a degree but, in general, men can now expect to live to the age of 84 and women until 86. What great news. That is, if our later years are in good health. Unfortunately, the prospect of growing older with care needs in the UK is looking bleaker and bleaker without Government action.

HOME ALONE Age UK’s latest research, How much would it cost to meet the unmet social care needs of older people in England? shows that hundreds of thousands of older people currently face unmet care needs and ‘chronic’ loneliness. This is, of course, largely due to the raising of local authority eligibility criteria and budget cuts to social care services. Of those receiving no assistance

towards their care needs, the report states that they are two thirds more likely to suffer loneliness when compared to those receiving at least some support. A link is made between leading such a miserable existence and susceptibility to illness. The logical conclusion drawn is that tackling such loneliness will not only improve quality of life but also reduce demands on health services. Caroline Abrahams, Age UK’s Charity Director stated, ‘Our social care system is in decline and failing to keep pace with our growing older population, leading to more older people with care needs going without formal help. Now, we can see from our analysis that this is adding to the problem of acute loneliness among older people too. These statistics are a challenge to Government policy and they are a wake-up call for the rest of us too: they mean there are a lot of very lonely and isolated older

people around us, and we all have a responsibility to do more to help them. Government should fund more local support for lonely older people and restore our crumbling social care system.’ As a result of its findings, Age UK delivered a petition to 10 Downing Street to call for Government action to address this growing crisis.

CREAKING SERVICES Even for those older people lucky enough to receive some care and support, services such as 15 minute home visits are hugely inadequate for their needs. There is a decline in the number of ‘care hours’ being provided and, amid the current financial crisis affecting the sector, there is little optimism that things will improve. Ahead of the impending Budget (due to happen whilst CMM is at print), where the possibility of further cuts are likely, I found the

The paper’s conclusions make important reading in relation to further savings and their major impact on care services. Professor Bolton concludes that there is little or no scope to make further cuts in fees paid to providers (with the exception of high-level learning disability or mental health care) or through the increased use of personal budgets. Interestingly, there is ‘little sign’ that integration with health has saved money.

COUNTERINTUITIVE When will the Government realise that its current fragmented approach to funding care and health makes little sense? Investing in tackling loneliness and greater social care support for older people is the way to reduce the escalation of needs and, therefore, reduce pressures on NHS services. This long standing counterintuitive approach beggars belief and surely cannot continue.

What do you think? Join the debate. Twitter: @CMM_Magazine Web: CMM April 2016 7

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APPOINTMENTS CORNWALL CARE Robert Black has been appointed Chief Executive of Cornwall Care.


‘Significant challenges’ in transforming care Sir Stephen Bubb has published Time for Change: The Challenge Ahead, his follow up report into transforming services for people with learning disabilities and/or autism. In the report, Sir Stephen, Chief Executive of ACEVO, found that the challenges of reforming learning disability support are larger than first thought. Time for Change: The Challenge Ahead details the findings of an extensive consultation with those affected by the Government’s Transforming Care programme,

canvassing the opinions of people with learning disabilities, their relatives and service providers. He found that there is an underestimation of the challenge ahead. This is illustrated by the fact that, in October, the NHS England proposals to move people back into the community were based on there being 2,600 people in institutional units. Research since shows that figure could be as much as 33% higher at nearly 3,500. The report also suggests that 10,000 extra members of staff will be

Cutting red tape The Government will explore options for cutting bureaucracy after care home providers have universally told the Cutting Red Tape review of inconsistent monitoring and being overloaded with formfilling. In addition, co-ordinating regulators’ activities in the adult social care sector will help to tackle poor provision and boost the time good providers can give over to caring for residents. The report from the Cutting Red Tape review of the adult social care sector has now been published alongside the Government’s response. The review collected evidence from those working in social care about their experiences of regulation and how it is enforced. The review found that, ‘while relationships between regulators and providers were generally positive and professional, there was

an overwhelming concern about the duplication of inspections and information requests and a widely-expressed concern that this was taking providers away from the delivery of frontline care’. Respondents to the review’s consultation identified the need for a robust regulatory system to underpin high-quality care and ensure residents' safety. However, it was clear that things could work better. There was a strong appetite to work together to improve the way in which regulation and contract management is implemented. The response to the review ‘recognises this desire and seeks to build on it – to develop a more co-ordinated, targeted and proportionate approach.’ The Department of Health intends to publish a review on its progress in responding to this review within six months.

needed to support people in their own community. Further, with at least 1,300 people expected to move out of hospital care by 2019, the report also details the critical need for housing. It says that housing for people with learning disabilities should be exempt from proposed Housing Benefit caps. The report details how additional housing provision might be delivered. He also called on the Government to appoint a Learning Disabilities Commissioner.

CQC care homes rating map The Care Quality Commission has launched an interactive map of care home quality ratings in England. The online resource has been developed to build a picture of services geographically and will help people who use services, their families and carers to choose the right service for them. The map is intended to make it easier for the public, providers and other partners to search for care homes by geographic location or postcode, compare ratings and read the most recent inspection reports. The Care Quality Commission will continue to review the use of the map and explore further developments.

The Board of Commissioners has announced Gary Lashko as the Chief Executive Officer of the Royal Hospital Chelsea.

VODG The Voluntary Organisations Disability Group has elected Fiona Ritchie OBE to its Board.

HALLMARK CARE HOMES Brian Lane has been appointed as Head of Chef Academy and Executive Chef for Hallmark Care Homes.

BLACK SWAN CARE GROUP Tom Lyons has been appointed as the new Managing Director of Black Swan Care Group.

HC-ONE John Ransford has joined HCOne as Head of Commissioned Services.

BATTERSEA PLACE Three new appointments have been made at Battersea Place, by LifeCare Residences. Linda Ryan has been appointed Director of Care, Hugh McGivern as Executive Chef and Paula Hawkins as Entertainment Director.

SURECARE Josh Farrer has been appointed Franchise Sales Manager at SureCare.

LNT GROUP Christine Cooper, currently Managing Director of LNT Construction has become Project Director for LNT Care Developments. CMM April 2016 9


Every care home needs a pharmacist

Experiences of patient malnutrition

The Royal Pharmaceutical Society has launched a new report entitled The Right Medicine: improving care outcomes in care homes which calls for every care home across England to have an allocated pharmacist with overall responsibility for medicines and their use. The report summarises the positive impact on patient care of pharmacist interventions in care homes including: improving medicines safety, reducing falls,

New research by the Malnutrition Task Force reveals that only half (51%) of health professionals thought malnutrition was a priority in their organisations. Only 47% also felt confident that their knowledge and skills were sufficient to help people most at risk. The survey Experiences of Patient Malnutrition by Dods Research also shows that half (50%) of the professionals interviewed felt unsure about what services or support were available in their community. About 1.3 million older people in the UK suffer from malnutrition, with the vast majority (93%) of those living in the community. Malnutrition is associated with several longterm conditions, such as chronic obstructive pulmonary disease (COPD), cancer, dementia and swallowing problems (dysphagia), as well as physical disability and social factors, which can affect people in later life, such as bereavement,

minimising inappropriate use of psychotropic medicines and decreasing medicines wastage in care homes. To improve the quality of patient care and reduce errors, avoidable hospitalisations and medicines waste, the Royal Pharmaceutical Society believes pharmacists should have an embedded role in care homes (as part of a multidisciplinary team) providing regular medicine reviews to this vulnerable group.

Better Care Fund allocations Funding allocations for the 2016-2017 Better Care Fund (BCF) have been announced. The ÂŁ5.3bn BCF is designed to ensure a transformation in integrated health and social care. The BCF is one of the most ambitious programmes across the NHS and local government. It creates a local

single pooled budget to incentivise the NHS and local government to work more closely together around people, placing their wellbeing as the focus of health and care services. The BCF is a critical part of the NHS two year operational plans and the five year strategic plans, as well as local government planning.

loneliness and isolation. Malnourished older people also visit their GP twice as often, experience more hospital admissions, have longer lengths of stay and have an increased risk of infection and antibiotic use. Furthermore, nearly one third (32%) of older people admitted to a hospital or a care home from the community are already at risk of malnutrition, as are half of patients admitted to hospital from care homes. The Malnutrition Task Force was established in 2012 to reduce preventable malnutrition amongst older people. In 2013, the Task Force was awarded a grant by the Department of Health to develop the Malnutrition Prevention Programme. This Programme set out to demonstrate what could be achieved by working together across the NHS, social care, public health and with voluntary sector organisations.

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CQC and LGO information sharing The Care Quality Commission (CQC) and Local Government Ombudsman (LGO) have updated the way they share information about social care complaints. The agreement, known as an Information Sharing Agreement (ISA), covers how CQC and LGO share

Care Certificate workbook Revised Care Certificate workbooks are now available from the Skills for Care, Health Education England and Skills for Health websites. These are free resources. The Progress Log, Mapping and Sign Off sections of each Workbook are now available as a separate free download. There have also been amendments to the frequently asked questions and the PowerPoint presentation that supports the workbook.

information about complaints and concerns. It also provides details of how both organisations have agreed to work closer together, including further development to the ‘warm transfer’ of calls between the organisations. The agreement also gives CQC

POLL inspectors the capability to signpost the LGO ‘best practice’ resources and guidance directly to providers during inspections. This includes information for providers on how each organisation uses complaints and information of concern.

End of life care on the brink – according to new report The End of Life Care Coalition has produced a new report, showing that in the 12 months since the Choice Review was published, almost 50,000 people have experienced poor care in the final three months of their lives. The report, On the Brink: the Future of End of Life Care highlights the widespread failures in care for dying people and shows how poor end of life care is creating pressures throughout the health service. The evidence and personal stories in the

new report show that it is now vital that ministers and NHS England deliver much-needed reforms to end of life care. One year on from the publication of the Review of Choice in End of Life Care, the Government is yet to publish a response. The End of Life Coalition is concerned that there has been such a delay in producing a response to the independent review and will continue to call on the Government to finally deliver on the Choice Review recommendations.

Are you involved in any new model development programmes? Yes No You can vote via:

March’s results Will the next 10 years bring a fair funding solution for people requiring social care?

NO 86%

YES 14%

Source: Figures correct at time of print.

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Personalised commissioning in adult social care The Department of Health needs to gain a better understanding of the different ways to commission personalised services for users, and how these lead to improvements in user outcomes, says the National Audit Office (NAO) in a new report. Commissioning adult social care services through personal budgets and direct payments is an important way of giving care users more choice and control over their services. When implemented well, they improve users’ quality of life. The Department of Health, however, requires a deeper understanding of the best ways to implement personalised commissioning, according to the NAO. The NAO found that some authorities have transformed their

care and support processes to ration their resources fairly, share information about a broad range of local services, and monitor and manage spending on personal budgets efficiently. However, others are finding personalising commissioning a challenge as they seek to save money, and are constrained in how they can personalise care by the need to reduce overall spending. In addition, the NAO found that the Department of Health has not investigated how services can be personalised when money is tight. It is not clear whether local authorities will achieve the spending reductions they have forecast without putting user outcomes at risk.

Carterwood advises LNT Carterwood is pleased to announce the sale of a turnkey development site in Andover, Hampshire, on behalf of the LNT Group. The turnkey has been acquired by Care Concern through their funders, Target, and has planning permission for a 66-bedroom care home.

The site forms part of a major mixed use redevelopment comprising residential, leisure and commercial properties, and is situated on the western edge of Andover. Development will commence imminently and is expected to be completed in 12 months.

Target Healthcare REIT acquisition Target Healthcare REIT Limited and its subsidiaries, the only listed specialist investor in UK care homes, has exchanged contracts to acquire a 12-bed specialist care home in Bricket Wood, St Albans for approximately £2.3m including acquisition costs. A former NHS clinic, the care home has been re-designed and extensively refurbished, and when opened will provide the highest quality residential care and supported living accommodation. The care home comprises three linked bungalows, each with four bedrooms, en-suite wetroom showers, an open-plan resident day room and kitchen facilities, and staff

accommodation. Externally there are landscaped gardens as well as staff and visitor parking. Upon expiry of the planning judicial review period in March, the Group will acquire the care home which will be leased back to specialist care provider, HSN Care, for a period of 50 years. As part of the agreed terms, the Group is to provide a short-term loan facility to HSN Care in order to fund the land acquisition and refurbishment of the property, with any delays in timing or cost overruns remaining the responsibility of HSN Care. HSN Care was established to provide specialist care to adults with physical and/or learning disabilities.

New paper considers local authority savings in social care and options for the future A paper from Professor John Bolton, Visiting Professor at the Institute of Public Care at Oxford Brookes University, considers how councils in England have delivered savings over the past five years in adult social care and what options – if any – they might have in a period of continuing financial challenges. This latest paper offers a personal view based on work commissioned by the Department of Health with six councils during the 2015 Comprehensive Spending Review in Government, the Local Government Association’s Adult Social Care Efficiency Programme and the author’s direct work with a number of councils assisting them in finding savings over the last five years. Some local authorities have managed to deliver savings of around 20% or more of their gross budgets in the four years to 2014/15. Savings have been made across the board with a strong focus on

prioritising people with the greatest needs and lower-cost ways of meeting the needs of others. Earlier work suggests that Councils have minimal room to deliver further savings without a major impact on what is offered or in meeting statutory obligations, but some areas have been considered for potential further savings. The report argues that there may still be scope among local authorities to introduce or refine the provision of care, seeking to avoid formal care where that is safe and helping people in other ways, ensuring that opportunities for recovery and recuperation are consistently offered, and that an assessment of needs is not rushed when someone is in a crisis. This should help to avoid residential or other institutional solutions. All such opportunities can be best achieved if the NHS adopts similar approaches and works in partnership with adult social care to deliver improved outcomes.

Jewish Care opening

Alliance Care acquisition

The Rt Hon Alistair Burt MP, Minister of State for Care and Support, and the Chief Rabbi joined Jewish Care supporters to open the organisation’s latest redevelopment, The Betty and Asher Loftus Centre. The three year programme, costing a total of £17m, has resulted in the creation of one of the, if not the, largest care communities in the UK providing residential and day care to over 250 people every day. The care community, officially named The Betty and Loftus Centre, is dedicated to Betty and Asher Loftus for their ongoing support and the Loftus’ families’ generosity. Among the guests was 99 year old Betty Loftus who sat alongside her three sons, their wives, children and great grandchildren.

Woodboro Residential Care Home in Clacton-on-Sea, Essex has been acquired by local care provider Alliance Care Homes, part of Alliance Care Group. The purchase ensures the future for the workforce and saves the home from closure after being placed in to receivership in August 2015. For Alliance Care, the acquisition represents a strategic move to complement their existing home care business and will allow them to also offer residential, respite and reablement services to their established customer base. DC Care was instructed by the Receiver, Tim Dolder of Opus Restructuring LLP to find a suitable purchaser and all efforts were made to sell the home as operational. CMM April 2016 13


Lost in transition – new NICE guidance Young people receiving health or social care should be at the heart of decisions about their future in order to prevent them becoming lost in transition, according to the National Institute for Health and Care Excellence (NICE). New health and social care guidance from NICE aims to improve support for thousands of young people receiving health or social

care as they become adults. The independent committee of experts who developed the guideline found that support for young people moving from children’s to adults’ services can often be patchy and inconsistent. Research has found that poor transition from children’s to adult services can lead to deteriorating health, disengagement with services,

Social care funding crisis Council tax rises to pay for social care in 2016/17 will not bring in enough money to alleviate the growing pressure on the vital services due to the social care funding crisis, the Local Government Association (LGA) has warned. The LGA said nine in 10 councils in England are considering, or have approved, plans to raise £372m for underfunded social care services in 2016/17 by using new powers to increase council tax by 2%. Analysis by the LGA reveals that 143 of the 152 councils with social services responsibilities are considering, or have approved, introducing the extra social care precept in 2016/17 – this would raise £372m to pay for social care services. The majority of this extra income might have to be spent covering the

cost to councils of introducing the Government’s National Living Wage from April. The LGA has estimated that it would cost the 152 councils with social care responsibilities at least £330m to cover increased costs to home care and residential care providers in 2016/17 as a result. Council leaders warn council tax rises are unlikely to prevent the need for continued cutbacks to social care services and avoid consequences around the quality and availability of care for older and disabled people. Council leaders are, therefore, calling for the Chancellor to use his Budget to, at the very least, bring forward the £700m of new funding earmarked for social care through the Better Care Fund by the end of the decade to 2016/17.

Delayed transfers of care: signposting resource The Social Care Institute for Excellence has produced a new signposting resource for delayed transfers of care. The resource complements existing work in reducing avoidable hospital admissions and signposts planners to useful information to support the development of the delayed transfers of care plans within the Better Care Fund plans for 2016/17. Delayed transfers of care: signposting resource takes a personcentred, whole-systems approach and includes: 14 CMM April 2016

• Signposting to the most up-todate guidance, tools and practice examples. • A checklist of issues to consider when developing delayed transfer of care plans. • Sources of additional support on delayed transfer of care planning and delivery. The new resource forms part of the work commissioned by the Better Care Support Team from KPMG, the Social Care Institute for Excellence and PPL.

and broken relationships with health and social care professionals. Poor management of transition can affect young people who use a wide range of services including people with learning disabilities, those with a single long-term condition such as diabetes, those with complex health and social care needs, child and adolescent mental health service users, young people

leaving residential care and young people with life-limiting conditions. The guideline from NICE explains that the tens of thousands of young people receiving health or social care should be supported to make decisions about their futures. They should be involved, with their carers, in planning the transition between services as well as how the move is implemented and reviewed.

Social services staff drop by 25% since 2011 The total number of council-based adult social services staff has decreased by 25% over the last five years, according to new figures published by the Health and Social Care Information Centre (HSCIC). A report summarising workforce trends shows that the number of council-based adult social services jobs has fallen from 159,400 in 2011, the first year of comparable data, to 120,200 in 2015. This represents a reduction of 25% over the period. Focusing specifically on movement between 2014 and 2015, the number of adult social care jobs in councils decreased by 8% (9,900 jobs) from 130,100 reported in 2014. This is also the fourth consecutive reduction to the number of jobs of around 10,000 per year since 2011. Personal Social Services: Staff of Social Services Departments, England, as at September 2015

looks at social services employees directly employed by local councils. It does not include information on the much larger group of social care staff not employed by councils, such as those working for charities and private companies, some of whom may be employed under council outsourcing arrangements and where workforce numbers may have increased. Also, comparing 2015 and 2014, around two thirds of councils – 101 out of 152 – reduced the number of people directly working for them, with 65 of these reducing by more than 5%. The top reason for the reductions was restructure, which was cited by 50 out of 75 responding councils as a factor in the reduction of 8,500 jobs. This was followed by outsourcing (cited by 21 councils for 5,900 jobs) and redundancies (20 councils for 2,600 jobs).

Planning permission in Tonbridge Tonbridge and Malling Borough Council has approved plans for Abbeyfield Kent to build an extra care housing scheme in place of its current care home in Tonbridge. Work will start on site in the autumn for Abbeyfield Kent’s new extra care housing scheme, which will comprise 59 one- and two-bedroom apartments available for market sale and on an affordable rent basis. The Society, a Kent based charity

and housing association, is presently six months away from completion on its new care home, Barnes Lodge, which is being constructed alongside its current home, Woodgate. Once completed, the current Woodgate residents will move across to their new home, Barnes Lodge, making way for the extra care housing scheme to be built in its place. The housing scheme is due to be completed by 2018.

CMM April 2016 15

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Concerns over advanced dementia care New research has raised concerns regarding the care of those with advanced dementia in care homes across the UK. It has highlighted that the needs of many people in the later stages of dementia are not being met and that care homes may struggle to manage those with the condition who are approaching the end of life. What are the barriers to care integration for those at the

advanced stages of dementia living in care homes in the UK? Health care professional perspective was funded by Marie Curie and carried out by the Marie Curie Palliative Care Research Department at University College London. It is based on in-depth interviews with a range of health and social care professionals. It reveals that, despite having complex needs, people with advanced dementia

Government publishes 2020 dementia plan The Government has published its plans for tackling dementia, with a blueprint that will see it aim to boost dementia diagnosis rates, encourage research and make the UK the most dementia friendly society in the world by 2020. The plan outlines a series of commitments including: • An aim for 10% of people with a dementia diagnosis to take part in research. Join Dementia Research – a scheme that matches people to suitable studies, run by the National Institute for Health Research in partnership with Alzheimer Scotland, Alzheimer’s Research UK and Alzheimer’s Society – will play a crucial role in helping to meet this target. • A pilot scheme to extend discussions of dementia risk reduction to the NHS Health

Check for people over 40. • Moves to improve the quality of care for people with dementia. Hilary Evans, Chief Executive of Alzheimer’s Research UK, said, ‘Since the first Prime Minister’s Dementia Challenge was launched, we’ve seen real progress in the fight against this devastating condition, and the beginnings of a social movement to rally people behind that fight. There is still much work to do, and Alzheimer’s Research UK welcomes this plan which signals a strong commitment to build on the achievements of recent years. We look forward to working with the Government to deliver action on research and help accelerate the development of much-needed new treatments, preventions and improvements in diagnosis.’

often receive fragmented and inadequate care at the end of life. Many of those interviewed felt strongly that care homes were ‘ill-equipped’ to provide adequate end of life care for residents with dementia. The research, published in the journal, Dementia, is part of the COMPASSION Programme: Care Of Memory Problems in Advanced Stages: Improving Our knowledge.

medical treatment but the money would be better spent on a Fast Track Discharge Fund to move vulnerable older people into care homes, according to a new report, Care after cure from the independent think tank, ResPublica. In Care after cure: creating a fast track pathway from hospitals to homes, ResPublica says thousands of hospital beds would be freed up for medical cases and residential

Castleoak, has announced a contract win with Anchor worth £16.6m. Castleoak will deliver phase two of Anchor’s luxury retirement village, Bishopstoke Park, near Winchester, Hampshire, which will see the addition of 73 luxury oneand two-bedroom apartments to the independent living community.

Hallmark Care Homes’ partnership Hallmark Care Homes has announced a new partnership with the former directors of Baxter and King Construction. Together, they have launched a joint company, Goldfinch Developments. The new venture will see Hallmark Care Homes and the former directors of the care home construction

company work together on the development of all Hallmark Care Homes’ future projects and with other selected care home providers. Goldfinch Developments’ first project will be Hallmark Care Home, Chamberlain Court, a 72-bed luxury care home, which is scheduled to open in early 2017.

Delphine Court DC Care has completed the lease of Delphine Court, a former residential care home in the village of Cockerton in County Durham. The property had been a residential care home run by a charity for a number of years, before being bought by current owner, Mr G Shaw. Mr Shaw completed a

VODG respond Tackling delayed discharge The NHS is going to waste £3.3bn care homes could look after to CQC caring for patients who don’t need recuperating patients who currently The Voluntary Organisations Disability Group (VODG) has responded to the CQC’s consultation on its 2016-21 strategy. It finds that the CQC’s consultation on its future strategy does little to strengthen sector confidence in the regulator’s commitment to efficiency. Nor does the consultation offer assurance that it will not shift further costs in running the organisation onto providers.

Castleoak and Anchor

remain on wards because they have no safe place to go. ResPublica has found caring for all delayed transfer patients in a residential care setting would cost £835m over five years to 2020/21, compared to £3.3bn in an acute bed. Care after cure argues the remaining £2.4bn should be invested in bed capacity, skills, training and facilities in residential care to allow the sector to step up to this more

substantial refurbishment of the building and contacted DC Care to find a new operator to lease the property to. DC Care found a specialist operator who was looking to establish a service in the area, for clients with a range of learning disabilities, in a supported living environment.

substantial role. A Fast Track Discharge Fund would also address the crisis which is seeing care homes closing because of the low amount they currently receive for council funded residents, and the impact of the National Living Wage. Out-of-hospital services – largely in residential care homes – for patients fit to leave wards but in need of extra support would improve under the fund, which would be used by clinical commissioning groups. CMM April 2016 17


Independent Community Care Management KPMG’s Midlands Corporate Finance team has acted as financial adviser to Independent Community Care Management (ICCM) on the sale of the business to City & County Healthcare (C&C). ICCM is a Kettering-based provider of complex care to clients in their own homes. It was acquired by private equity house Livingbridge in 2011. In 2015, Livingbridge engaged KPMG to advise on the realisation of the

New Bingley care complex

investment in order to allow ICCM to benefit from being part of a larger healthcare business and the associated access to a greater pool of care professionals C&C is a large healthcare group backed by private equity house, Graphite Capital. The acquisition of ICCM significantly bolsters C&C’s complex care division, allowing it to add scale to existing operations and to leverage its wider healthcare resources to drive growth.


individualised staff team. Croham Place is a rehabilitation service with full multidisciplinary team input, designed to provide permanent, transitional, respite and palliative care for people with physical disabilities, acquired brain injury and16:41:40 associated mental health 29/07/2015 issues.

New research from Age UK shows just how tough life is for hundreds of thousands of older people with care needs who are struggling on without any help. According to Age UK analysis of English Longitudinal Study of Ageing, there are over a million older people in this country who

lawyers C





The healthcare sector is full of facts and figures. In a typical day, Tracey might help sell a care home for several million or do some ‘hand holding’ for a partnership with just a handful of people. Regardless of the numbers involved, every client gets Tracey’s dedicated attention. Oh, and she’s pretty good at adding up the numbers on her golf scorecard too! It’s not just about knowing the law.



TRACEY.DICKENS@BIRKETTLONG.CO.UK 01206 217326 @birkettlong


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18 CMM April 2016

community in addition to residents. It is expected that the facility, which is due to be completed in the autumn, will create about 60 new jobs including care staff, nurses, catering staff, cleaning staff and administration support. The complex will also be seeking local volunteers who wish to donate their time and skills. The deal was delivered by Gail Fielding, Director in Health and Social Care, Yorkshire Bank’s Leedsbased Specialist and Acquisition Finance team.

Unmet care needs and loneliness

Bramley Health Bramley Health, formerly Glen Care, is investing in a new bespoke care service in South Croydon. A single-story, four unit bungalow is being built to complement its existing Croham Place care home. The unit will be part of the CMM larger service Croham Magazine Ad at - Sept 2015.pdf Place but will operate with an

A new elderly care complex being constructed by The Abbeyfield Society is set to create about 60 jobs with funding from Yorkshire Bank. The 84,000 sq ft facility, which is being built on the former Bingley hospital site, will offer 47 one- and two-bedroom extra care apartments, a 30-bed specialist dementia centre and a day care centre. The complex will also provide a central hub with coffee bars, lounges, restaurants and a hairdressing salon – all of which will also be open to the local

need care but who don’t receive it from any source – not from their local council, from neighbours, relatives or friends, or that they purchase for themselves. Now the charity has found that over 300,000 of these unfortunate older people are also coping with loneliness much or all of the time.


Development in jeopardy

Danshell’s corporate strategy

The development of a new extra care housing facility in Harrogate is under threat in the wake of the Government’s proposals to change housing benefit rules. Not-for-profit Harrogate Neighbours Housing Association is working in partnership with Keepmoat and North Yorkshire County Council to deliver The Cuttings. Work was due to start on the £7.7m development but it has been delayed because of the uncertainty created following the Chancellor’s plans to cap the housing benefit that the elderly and vulnerable members

Danshell Healthcare Group has launched its new corporate strategy which will cement its place as a leading provider of care services for people living with learning disability, autism and complex needs. Danshell, which was founded in 2010 and has grown rapidly to become one of the largest independent sector providers of learning disability services in the country with 23 facilities, has launched the new strategy following extensive consultation with stakeholders. The new corporate strategy

describes what Danshell is aiming for, as an organisation, in the short and medium term; over one to three years. The strategy will inform direction and decision-making processes across the company. The strategy focuses on key areas including: demographics, population and changes in service user needs; political influences and regulatory requirements; workforce availability and expertise; high-quality provision and excellent reputation; service models which reflect need and demand; and the financial environment.

newly-acquired going concerns. The total portfolio will provide over 500 high-quality, purpose built care beds. Once the developments are complete, Country Court Care Group will operate a total of 1,500 beds across 27 care homes.

Charles Russell Speechlys and Taylor Wessing were the appointed legal advisers. Conaghan & Co acted as corporate finance advisers to Country Court Care on the transaction. BDO and Grant Thornton also provided advice to both parties.

of society can claim. This could leave a potential income shortfall for Harrogate Neighbours. Under the plans, benefit would be limited to the Local Housing Allowance level which is lower than what is paid now. According to Harrogate Neighbours, this means some tenants moving to the new development would lose a proportion of their housing benefit to cover their rent and service charges. This reduced income would not be enough to cover the costs in the new development and so at the moment it makes it unviable.

Country Court Care Country Court Care has secured funding for a portfolio of eight assets comprising a mix of new build and going concern care homes. The deal was funded by vehicles advised by Cheyne Capital Management, who provided a £40m investment and development whole


loan. The assets include four 66bed care homes to be built by LNT Construction. The first home to be delivered is in Huntingdon and will open its doors in May 2016. Additional assets include the construction of a 31-bed care home in Tallington and three


• Energy-efficient to reduce on-going operational costs • Fully height-adjustable to ensure a safe, comfortable working height • Powered traverse seat to effortlessly transfer bathers in/out of the bath • Autofill, transfer chair and sensory options to offer maximum versatility

One of the new specialist baths from Gainsborough – safeguarding future care.

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04/03/2016 13:02

CMM April 2016 19

Revalidation Providers play your part


With nurse revalidation coming in for the profession on 1st April, what do providers need to know and what role do they have to play in ensuring their nursing staff adhere to the new revalidation requirements?


Jackie Smith, Chief Executive and Registrar, Nursing and Midwifery Council

When the Nursing and Midwifery Council (NMC) first decided to introduce revalidation, we had to consider a number of factors. At the forefront of our mind was the fact that any big change needed to be communicated, and in order to communicate a change you need to be able to reach the people you want to deliver that change. In the complex world of healthcare, and with over 680,000 people on the NMC register, we asked ourselves, who would be the trickiest people to reach? Near the top of that list were nurses working for social care organisations. Consider for a moment any nurses working with you or the nurse working in a small, private care home. He or she may 20 CMM April 2016

be the only nurse working in that organisation; he or she won’t be part of the NHS machine and he or she may not report to another nurse – how on earth could he or she find out about revalidation? That, of course, is where you, senior managers and providers working in the social care sector, come in. It would be remiss of me not to exaggerate how important you are in making revalidation the success it needs to be.

WHY REVALIDATION? Revalidation represents a significant change to the way in which nurses and midwives renew their registration with the NMC. The changes have been introduced as a result of some very significant challenges that have faced nursing and midwifery in recent years, including in the social care sector. Now, for the first time, nurses and midwives will be empowered to reflect on their own professionalism, actively seek feedback from patients, colleagues and service users and discuss all of it openly and frankly with a peer. There are a number of important new requirements that every nurse and midwife needs to know about. If you happen to be responsible for registered nurses in your organisation, you need to know about them too.

KEY ELEMENTS In all, there are eight key elements to revalidation that registrants will need to demonstrate. They will need to be able to show that they have practiced for a minimum of 450 hours, over a three year period, prior to the renewal of their registration. They will also need to have shown that they have completed at least 35 hours of continuing professional development (CPD). In itself, this is not a change from the current requirement; however, revalidation now asks that 20 of these hours must be met through what’s called ‘participatory learning’. In reality, this means that the


CMM April 2016 21



nurse or midwife undertakes the CPD alongside one or more colleagues. For the social care provider, this could mean organising a workshop on the prevention of falls, or the risks of bedsores – as long as it is truly relevant to the practice of the nurse, it can count towards their CPD requirement. There are also some new requirements that all nurses and midwives will have to meet. Firstly, registrants must collect five pieces of practice-related feedback over the course of three years. This feedback can be from a range of sources including patients or service users, colleagues or via annual appraisals, team performance reports or serious event reviews. This might sound like an onerous task, but it really doesn’t have to be. Feedback can be written or verbal and registrants can think smartly and make full use of the feedback that they already collect. As well as collecting five pieces of feedback from other people, we also ask that registrants prepare five of their own written reflections on their practice. Importantly, nurses and midwives should bring the experiences back to the Code, the professional standards that nurses and midwives must uphold in order to be registered to practise in the UK, and try to understand how it is relevant to their daily practice. Once these pieces of reflection have been produced, we’re asking every nurse and midwife to discuss them with another person who is registered with the NMC, as part of a reflective discussion. It is this element that proved to be the most powerful according to the nurses and midwives who piloted revalidation for us last year. There are two elements to revalidation which have not been changed at all from the current requirements, namely that, as part of their application, registrants make

declarations relating to their health and character, and that they have a professional indemnity arrangement in place. The final part of the process is to identify a confirmer and hold a faceto-face confirmation discussion with them. A confirmer is the person who verifies that the registrant has met all of the requirements necessary to revalidate, and has collected all the right evidence. We recommend, wherever possible, that the nurse or midwife’s line manager acts as their confirmer.

EVOLUTION NOT REVOLUTION For providers working in the social care sector, some of this may seem daunting. However, it is important to remember that, as a process, revalidation is more evolution than revolution. Although there are some new elements, it’s more the case that revalidation is asking nurses and midwives to evidence things that they are already doing. In the social care setting, particularly in situations where a small number of nurses might be leading the care delivered to patients without a director of nursing above them, it will be particularly important to point them to places where they can find out more. We have a wealth of information available on our dedicated revalidation website. The reality is that every single nurse and midwife will need to pass through this process at some point within the next three years. It affects every registrant, in every healthcare setting, across the UK. Nurses working in social care will need the support of their management team, like you. The time is now to make sure you, and your staff, are ready for revalidation. For more information and to access the wealth of information available on revalidation, visit CMM

What is revalidation? REVALIDATION:

• is the process that allows nurses to maintain their registration with the NMC; • it builds on existing renewal requirements; • it demonstrates a nurse’s continued ability to practise safely and effectively; and • is a continuous process that nurses will engage with throughout their career. Revalidation is the responsibility of nurses and midwives themselves. They are the owner of their own revalidation process.


• an assessment of a nurse or midwife’s fitness to practise; • a new way to raise fitness to practise concerns (any concerns about a nurse or midwife’s practice will continue to be raised through the existing fitness to practise process); or • an assessment against the requirements of a nurse’s current or former employment.


• to raise awareness of the Code and professional standards expected of nurses and midwives; • to provide nurses with the opportunity to reflect on the role of the Code in their practice as a nurse and demonstrate that they are ‘living’ these standards; • to encourage them to stay up-to-date in their professional practice by developing new skills and understanding the changing

needs of the public and fellow healthcare professionals; • to encourage a culture of sharing, reflection and improvement; • to encourage nurses to engage in professional networks and discussions about their practice; and • to strengthen public confidence in the nursing and midwifery professions.


One of the main strengths of revalidation is that it reinforces the Code by asking nurses and midwives to use it as the reference point for all the requirements, including their written reflective accounts and reflective discussion. This should highlight the Code’s central role in the nursing and midwifery professions and encourage nurses and midwives to consider how it applies in their everyday practice. The Code (paragraph 22) requires nurses to fulfil all registration requirements. To achieve this they must: • meet any reasonable requests so we can oversee the registration process (22.1); • keep to our prescribed hours of practice and carry out continuing professional development activities (22.2), and • keep their knowledge and skills up-to-date, taking part in appropriate and regular learning and professional development activities that aim to maintain and develop their competence and improve their performance (22.3).

Jackie Smith is Chief Executive and Registrar at the Nursing and Midwifery Council. Twitter: @TheNMC Are your nursing staff ready for revalidation? Share your thoughts on the CMM website Subscription required. 22 CMM April 2016

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CMM April 2016 23


JANE ASHCROFT CBE Jane Ashcroft CBE is Chief Executive of Anchor.

REFLECTIONS ON THE LAST DECADE The changes in terms of demographics, family shape, economy and political environment have been phenomenal. It’s good that the importance of personcentred care is more widely-recognised and dementia care is increasingly mainstreamed. It is good that there is now a wider range of services across social care and housing. We’ve grown, developing retirement villages and new care homes as well as acquiring homes. We have more than 1,000 locations across England, serving about 40,000 older people. We’re committed to growing by ensuring we provide the best possible services, being the best place to work and the best run organisation – progressing these and our growth plan. Almost as amazing as what has changed is what hasn’t. It’s astounding that successive governments have failed to implement a long-term solution to capping care costs. At the same time, State funding is declining. Politicians like to say we need a partnership on funding – usually that’s code for ‘the State can’t afford this’. We really do need a partnership and we need politicians to be far more proactive. PROJECTIONS FOR THE NEXT DECADE Longer life expectancies provide great opportunities to create new models of care and housing that people want – and more demanding customers are

forcing us to innovate. Our recent Silver Chic report showed that technology will have a big impact. Who knows? Maybe we will be able to follow the sun with revolving housing one day. Technology will never replace great care provided by compassionate human beings. But where we will find these great people? The living wage is a step forward, though funding it is a major issue. Anchor leads the way in rewarding colleagues for their commitment to providing high-quality care and their hard work. Every colleague who has reached level 2 NVQ is paid the living wage. Even those who do not have this qualification are paid above the minimum wage because we value them. We’ve seen that commitment to colleagues pays dividends in reduced turnover and higher engagement scores – this was recognised when we made the Sunday Times Best Companies list for the first time this year. INSIGHT I love nothing more than being in our care homes and other services. Chatting with residents and colleagues is always informative and enjoyable. It’s not unusual to come across two or more generations of the same family involved with Anchor and it’s a real honour to see what an impact Anchor has on people’s lives. INFLUENCES I’ve been influenced by so many people and

our customers and colleagues inspire me too. Baroness Sally Greengross has been a passionate advocate of positive ageing and is a role model for her hard work and integrated approach. Care England’s Martin Green is always inspiring because of his championing of the sector – and never has his influence been needed more. I was really pleased to work with Douglas Quinn in getting Your Care Rating off the ground. His commitment and drive has ensured that it has grown to become an important way for consumers to make decisions about care. For my career, Des Kelly has been key as he recruited me into social care 20 years ago and has been a mentor and friend ever since. And Connie Oppong, Manager of Greenhive Care home in Peckham, is a true inspiration to me and to many colleagues, achieving the first ‘outstanding’ rating for an Anchor home and for any care home in London through her absolute focus on Anchor’s objectives – best customer service and best place to work. ADVICE Not to listen to advice! Actually, the best advice I’ve ever been given is that whether you think you can or you think you can’t, you’ll be right. The main advice I would give to someone coming into a job like this is to listen to lots of different views and to be out and about in your services and around the sector. Don’t get stuck behind your desk or you will make bad decisions. CMM

An extended version of this interview can be found at Subscription required.

‘Forever Better’ with Miele Professional Miele Professional is the global leader of commercial laundry equipment, dishwashers, washer disinfectors and sterilisation equipment designed for use in a wide range of industries. For decades, Miele has been setting the trend in the development of laundry machines and cleaning methods for the care sector. Miele offers flexible solutions for care homes of all sizes, as well as a variety of accessories which complement individual requirements. With a history spanning over 113 years, the Miele brand has always been a purveyor of the highest standards of cleaning, in both a domestic and a commercial capacity. Starting with just 11 employees, the Miele and Miele Professional brand has grown through the ages to become one of the leading manufacturers of commercial laundry, dishwashing products, and other high quality appliances. Miele Professional provides the highest quality products designed to deliver exceptional results every day. Renowned for their outstanding build quality, innovative technology and energy efficient performance, Miele prides itself on its attention to detail. In 2012, over 87,000 machines were sold worldwide allowing more businesses to enjoy the Miele triedand-tested process technology and the simple and safe machine operation.

Miele Professional understands that reliability and speed are both important factors when considering laundry needs in the care environment. In these sites, machines run for long periods of time and any downtime has to be minimised. Of course, cost-effectiveness is key, but businesses are increasingly interested in looking at lifetime costs and purchasing machines that last longer and are more reliable in the long run, rather than simply focusing on upfront costs. Miele Professional’s ethos is “Immer Besser” meaning “Forever Better” and all products are designed to last, and have an operational lifespan of over 30,000 cycles.

Miele Professional’s CPD seminar

In summer 2015, Miele Professional launched its first CPD seminar for architects. The seminar programme was built to enable a discussion with architects around the many considerations that are required when designing an efficient laundry in a new care home, using Miele Professional’s decades of experience in the field.



Infeed side of laundry

Outfeed side of laundry

Ironing Drying Sorting

The seminar aims to give architects a deeper understanding of the implications of regulations that need to be considered in a care home; the machines and services required; and offers best practice examples of room size and layout. It gives background on the care home market and the very specific requirements of this area, before moving onto design considerations. It also covers environmentally-friendly solutions, and ideas for future-proofing the laundry room, something that Miele is a particular specialist in due to developing its range of energy-efficient machines for care homes. When designing an on-premise laundry, the key factors that need to be considered include the space available, the number of residents and the nature of the laundry being processed. The type of care provided by the home is the primary factor to consider as this will impact on the size of machines and laundry room required.

Meeting health regulations is also crucial. Department of Health guidelines around the decontamination of linen for health and social care state that, in order to kill bacteria, linen should be thermallydisinfected using washing cycles that achieve 65 degrees Celsius for at least ten minutes, 71 degrees for at least three minutes or 85 degrees for one minute. Miele Professional uses an independent validation system, NeQis, that allows laundry managers to make sure that their washing machines are meeting these temperatures for the required time. The NeQis unit is fitted to the machine and produces reports which can run straight to the user’s computer, allowing any failures to be identified instantly.

Information about Miele Professional, and the seminar, can be accessed through To book a seminar, please contact Kate Jones at Miele Professional on 01235 233491or

National care group, The Orders of St John Care Trust and why they continue to choose leading provider of laundry services, Miele Professional The Orders of St John’s Care Trust (OSJCT) provides high-quality care for older people, with a person-centred approach. This includes residential, nursing and specialist dementia care in care homes and independent living schemes. OSJCT is a long-standing client of Miele Professional. It has trusted Miele Professional to provide the kind of quality equipment it requires in its care homes on a number of occasions.

conjunction with the main contractor and the architect on this latest development in Warminster.” Miele Professional installed a full on-premise laundry at the new site, including one of their brand new, next generation P12 Ironers. OSJCT was not only impressed by the wide selection of programmes available on the machines installed and the consistently good results achieved, the organisation was also hugely appreciative of the training that staff received on the new equipment, a personal touch that most manufacturers neglect to offer.

Whilst planning the laundry layout of their latest development in Warminster, OSJCT determined that sourcing machines from Miele Professional was the best choice for the home. As with all of OSJCT’s sites, the new care home in Warminster required a reliable, efficient laundry system of the highest quality. OSJCT has come to expect a first rate standard of service from Miele Professional. Lee Fisher,

Development Project Surveyor at OSJCT explained, “Miele fullyengaged with us, providing design proposals up-front for subsequent consultation. This worked well in terms of ensuring that the specification was fit-for-purpose and met our requirements.” “I personally have always received excellent customer service on behalf of OSJCT. I was able to establish an excellent professional working relationship with Miele, working in

OSJCT continues to invest in Miele Professional, having tried and tested the machines at various sites within the organisation and found them to be the most robust commercial equipment on the market. When asked if he would recommend Miele Professional to other similar businesses, Lee Fisher commented, “Absolutely, they offer excellent customer service, after service and the follow-up is also excellent. They also provide value for money in all aspects including service delivery, after care, quality, durability and life expectancy of equipment.”

Q&A with Les Marshall, Sales and Marketing Director at Miele Professional

How can investing in onpremise laundry solutions help tackle pressures on care home businesses? Due to the nature of the laundry being washed, care homes are reliant on having access to highquality laundry 24-hours a day, seven days a week. Having equipment on the premises gives control over the process from start to finish. It also means that care homes can be sure their laundry meets the relevant regulatory obligations, such as ensuring infectious laundry is cleaned to legal standards. What are the main considerations when it comes to hygiene and infection control? Controlling hygiene, and the possible spread of infection, is hugely important in a care home – not just because of the higher likelihood of infections being present, but because residents are particularly vulnerable to the spread of disease. Managers need to take the utmost care that these risks are being managed across all areas – thinking not just about soiled laundry, but also cutlery and crockery that may have been passed onto others without having been thermally disinfected in a dishwasher.

What are the most important factors when designing a care home laundry? The layout of the room is crucial to ensure that clean and dirty linen are kept completely separate to prevent recontamination when the clean laundry leaves the machines. Tied to this is the importance of leaving enough room for workers to transport and manage laundry. The laundry also needs to be in a convenient location for access and for employees and residents to use regularly. What are the latest innovations in care home laundry equipment? The biggest development for care homes is barrier washers. These achieve the highest levels of hygiene by keeping clean and dirty laundry in different rooms and, therefore, entirely separate. Dirty laundry is loaded into one side of the machine and the clean items are removed from the other side, in a separate clean-room, where there is no chance of cross-contamination. The machines also carry out safe thermal disinfection. Miele Professional barrier washers have special hygiene packages: thermal disinfection, chemo-thermal disinfection and incontinence/soiled laundry.

For more information on how Miele Professional can help you, call 0845 519 2698 or visit

What is the most important thing you have learnt through your years of involvement in the care sector? We need to remain aware of the impact that having clean clothes, bed clothes, sheets and linen can have on a resident’s wellbeing. We will continue to improve, through product development and processes, to ensure we keep residents’ care at the forefront of everything we do.

ENHANCING CARE IN CARE HOMES How social care providers are taking the lead in New Models of Care

e ial car c o s w es ho loping r e o v l e p x d e in e t in e Sork portant par t’s social car i b b e i D g an im re and how ference. n i y a l a if is p els of C aking the d d o M m New that’s p i h s r leade The NHS in England recently set out planning guidance for local places, asking health economies around the country to prepare what it calls ‘Sustainability and Transformation Plans’ for the next five years. These plans, designed to help deliver the NHS’ Five Year Forward View, are expressly predicated on the NHS taking a broad-based approach, working in real partnership with social care, local government, voluntary and community services and other sectors. Whilst there is understandable scepticism about how this will work in practice, some parts of the country have been


CMM April 2016 29



trying it out for real, with social care playing an equal role with health.

NEW MODELS OF CARE In particular, there is an NHS England New Models of Care Programme, where some 50 partnerships, called ‘Vanguards’, are trying out new ways of working in order to get better outcomes for service users. The aim is to stop people going into hospital when they don’t need to and to get them out of hospital as soon as they’re ready. Within the Vanguards, there are six places that are looking at how to achieve better care for older people in residential care. They’re called the Enhanced Care in Care Homes Vanguards. They are: Airedale and Partners; the Wakefield Care Home Project; Sutton Homes of Care; the Gateshead Care Home Project; East and North Herts Clinical Commissioning Group; and Nottingham Commissioning Group. Some of these places have long histories of joint-working; others have come to collaborative working more recently, but all of them are committed to better services and outcomes for older people. As part of their work, they need to show: • Strong and inventive partnerships, including with the community and voluntary sector. • A focus on residents’ capabilities (ie an asset-based model). • In-reach services provided in partnership. • Use of new technologies and telemedicine. • Innovative approaches to local assets, including intermediate and respite care beds. • Multi-agency and multi-disciplinary teams. • Flexible workforce models. • Redesigned hospital discharge processes. • Training and support for staff and families around end-of-life care. The social care providers involved in the groups, sometimes extending the offer to homecare, are doing just that.

THE WAKEFIELD VANGUARD In Wakefield, social care providers are linking up with the voluntary and community sector, housing associations, the local authority, emergency services and the NHS, to develop a much more holistic approach to people’s health and care. It’s not just down to medical issues; it’s about ‘somewhere to live; somewhere to love; something to do’ to optimise residents’ health and life experience. This would mean, for example, that an older person in extra care housing could be supported to resume their hobby of walking following a hip replacement, helping to improve both their physical health and their quality of life. The Wakefield Vanguard has set up a number of network hubs, looking at different service mixes and trying out new ways of operating. One network has a particular focus on working with a community geriatrician, with weekly GP visits to residents with complex neurological issues in specific homes. Two others involve advanced nurse practitioners acting as care co-ordinators for residents identified as high risk, with regular pro-active care visits 30 CMM April 2016


and better links with GP practices. A fourth is prioritising better collaboration between primary and secondary care, and Age UK, with better use of video links and access to shared care records. As a corollary, there has been more emphasis on skills development for care home staff, funded through the Vanguard, so that staff can deal with more complex medical needs and prevent emergency call-outs. There has also been a move towards multi-disciplinary teams working within care homes, with the registered manager being the pivotal figure, working with a range of health and social care practitioners including district nurses, social care staff, pharmacists and specialists in palliative care. It is having a really positive effect. Outcomes from the pilots include a 25% reduction in ambulance calls; 30% reduction in A&E attendances, and at least 50 weekly visits to care homes by GPs – a significant increase. As a result of care reviews, 53% of residents saw changes in their medication, often with less medication required.

AIREDALE Airedale has placed similar emphasis on training and development for social care staff across its 248 care homes. This time with an emphasis on better use of technology and telemedicine. The aim is to have telemedicine in all care homes by April 2016 so that, for example, staff supporting a care home resident with Parkinson’s disease will be able to access clinical advice and support through secure video conferencing at any time of the day or night. This means that in the event of a fall, an experienced nurse in a tele-health hub will be able to assess them using a video link, and after discussions with an A&E consultant, will be able to arrange for them to be cared for in their familiar surroundings, rather than transferring them to A&E.

GATESHEAD AND HERTFORDSHIRE In Gateshead, providers are taking advantage of a ‘ward round’based service that sees GP practices and community nursing teams aligned to care homes across the borough. In practice, this means fewer avoidable hospital admissions and better quality of care. Across East and North Hertfordshire, the Hertfordshire Care Providers Association has brought providers on board to support enhanced training for care staff so that they can take on more flexible and skilled roles. The aim is to create dedicated multi-disciplinary teams for care homes that will include GPs, community psychiatric nurses, district nurses and community geriatricians. These will be alongside a rapid response service so that care homes have access to services in two localities with a combination of community nurses, matrons, therapists and homecare staff who can be deployed within 90 minutes if required. As a result, care home residents can be supported by

staff who will be accredited because they have undertaken a package of education and training. In addition, residents will know that should their condition deteriorate, a team of experts is ready to respond to their needs before making an assessment as to whether they need to go to hospital.

SUTTON In Sutton, providers working alongside local GPs, Age UK and the Alzheimer’s Society are involved in building a provider network to support training across local care homes, as well as a new model of care that enables people to get specialist support at home rather than having to go into hospital. Again, this is

“None of this would be happening if social care hadn’t stepped up to the plate” translating into enhanced education and training for care home staff, with specialist modules in dementia, diet and nutrition, falls prevention and management, diabetes and working with challenging behaviour.

NOTTINGHAM Finally, in Nottingham, which has 83 care homes in the city alone, with residents generating 5% of all hospital admissions despite only accounting for 0.5% of the city’s population, a dedicated care co-ordinator role has been developed. People are already in post and are working across residential and homecare with new specialist teams, including a dementia outreach team, a care homes nursing team and a medicines management team. The care co-ordinators are supported by better links with primary care and more or better use of technology. Specific GPs are aligned with specific residential and nursing homes, and do regular ‘ward rounds’, supported by telehealth pilots that are collecting data for GPs and health professionals to do ‘virtual ward rounds’ when they can’t be in the homes in person.

STEPPING UP None of this would be happening if social care hadn’t stepped up to the plate, with owners, managers and staff taking up their leadership role, both within their own organisation and working collaboratively with others, as true systems leaders. It shows the difference that real social care leadership can make to the quality of care, and quality of life, that people experience. It’s social care leadership that’s making the difference. CMM

Debbie Sorkin is National Director of Systems Leadership at The Leadership Centre. Email: Twitter: @DebbieSorkin2 For more information about the Enhanced Care in Care Home Vanguards, visit and search Enhanced Health in Care Home Vanguards. CMM April 2016 31

INNOVATION IN REHABILITATION AND INDEPENDENT LIVING The Papworth Trust has launched an innovative, inpatient rehabilitation scheme to bridge the gap between hospital and a person’s home. Much has been written about the benefits of housing and its integration with health and social care in supporting people to remain independent. It also has the potential to reduce admissions to hospital, assisting with alleviating NHS and social care pressures. Despite all this, housing has been seen as a lesser partner in the drive to integration and new models of care and support. However, the Papworth Trust’s new scheme aims to address that. It has been developed to promote independent living as an integral part of rehabilitation, or intermediate care, to get people back home and living independently.

THE SCHEME MacFarlane Grieve House in Cambridgeshire comprises 28 purpose-built, self-contained flats. It has been designed to bridge the gap between a hospital stay and discharge by replicating a resident’s home. It provides each patient with over four hours of social care and one-and-a-half hours of occupational therapy every day. It supports residents to regain practical skills, confidence and independence while also providing short-term care, 24-hours a day. Vicky McDermott, Chief Executive of the Papworth Trust explained the aim of the scheme. ‘MacFarlane Grieve House was developed under a pilot initiative with numerous partners across Cambridgeshire. The reason is to deliver better quality care and support for those who are medically stable and no longer need to be in an acute setting. We are supporting people who are leaving hospital having recently suffered 32 CMM April 2016

life-changing injuries or illness and helping them reintegrate with living independently. When in residence, patients receive intensive therapy, 24-hour care and the opportunity to progress towards a higher level of independence before returning home. The facility is a “home from home” with extended visiting hours and the opportunity to practice independent living techniques in a safe and supportive environment. ‘There are, of course, impressive savings from using the beds in this service, as opposed to in the NHS. We calculate this to be around £800 per bed, per week. The accommodation can support 30 people at any one time. However, as the expected length of stay is approximately three weeks, the Papworth Trust hopes that it will eventually support around 200 people per year. Eight beds have been commissioned initially. Vicky added, ‘The initial pilot, and contract, is with Hinchingbrooke Hospital in Huntingdon and, as such, that is currently our only referral source as this is where the current contract is held. We are looking to fill the rest of the units from many other referral sources. We hope, and expect, that other Cambridgeshire hospitals come on-line very soon to receive these excellent benefits. We believe the scheme will play a crucial role in easing some of the pressure on beds at nearby hospitals.’

MAKING IT HAPPEN The idea was first initiated by the Papworth Trust. Cambridgeshire and Peterborough Clinical Commissioning Group and Cambridgeshire County Council were key partners in its design and

implementation. Nursing services are provided by the Cambridgeshire and Peterborough NHS Foundation Trust. Vicky continued, ‘The CCG holds the Vanguard funding [for the new care models programme, one of the first steps towards delivering the NHS’ Five Year Forward View and supporting improvement and integration of services]. As such we are contracted to them. However, the model has been designed to be easily-replicated and, as such, this is a focus for us. Additionally, this ties in with Simon Steven’s [Chief Executive of NHS England] view that Vanguard funding should be used to innovate and test, with a view to rolling out services that work and have the desired impact. Then, following some evidence-based research due to be published at the end of April 2016, we hope to take the service delivery and all the lessons learned to the wider health community under our social purpose model.’ The scheme is funded under the Urgent and Emergency Care Vanguard which aims to improve the co-ordination of urgent and emergency care services and reduce the pressure on A&E departments through new approaches. It is only funded as a pilot until the end of March 2016, at which point the Papworth Trust will have to bid with the clinical commissioning group for funding to expand the service into the next financial year.

ADDRESSING CHALLENGES TO THE NHS The Papworth Trust believes that MacFarlane Grieve House is a radical new approach to rehabilitation. They

are confident that it will save the NHS money, reduce the likelihood of a patient returning to hospital and also provides a model that can be rolled out nationally. Vicky concluded, ‘One of the biggest challenges in our current healthcare system is people returning to A&E after they have been discharged from hospital without appropriate rehabilitation. This is expensive for the NHS and detrimental to the health of every individual who is left vulnerable after acute care. ‘We believe that our model for rehabilitation will allow hospitals to discharge patients into our care, happy in the knowledge that they will receive first-class social care and occupational therapy that will enable them to return home and go about day-to-day tasks with improved mobility. ‘This will also mean that hospitals can discharge patients quicker, which will free up more beds. A recent review by the CCG highlighted the disparate nature of beds and how the current system is ineffective in meeting the current and future rehabilitation needs of patients.’ CMM

OVER TO THE EXPERTS... With a need to align health, housing and social care, will this housingbased rehabilitation model offer an effective solution? Can housing with care offer a suitable alternative to in-home or care home-based rehabilitation or reablement? Will the model be easily replicable across the country? What does the panel think?

A PROMISING ALTERNATIVE We’re keen to encourage promising alternatives to the situation whereby someone is discharged into a residential setting, only because there is nowhere else suitable for them to go. We have a new resource for NHS England looking at delayed transfers of care. Tackling this problem can only be done through adopting a whole systems approach, involving a wide range of organisations and individuals, including those receiving the care itself. Although residential settings have an important role to play in supporting certain groups of people they may lack certain opportunities to maximise people’s independence. Services like this one can help people to take a step forward on the road to greater independence. There are potential economic, health and social benefits to the use of independent living, coupled with social care, to rehabilitate people. The benefits are well-documented:

A GREAT EXAMPLE BUILDING A POWERFUL EVIDENCE BASE rapid hospital discharge, avoiding unnecessary readmissions, avoiding unnecessary care home admissions and improved outcomes for patients. Integrated services in general as a way of helping people get back home from hospital, well and ready to continue living independently, also carry these potential benefits. However, achieving this does require a coordinated, integrated approach by all partners to deliver services successfully. Preventative services can illustrate how important the role of housing is in relation to effective health and social care delivery. At the Social Care Institute for Excellence, we have produced a Prevention Library which highlights emerging practice and research in the provision of preventative services in adult social care. It contains plenty of examples of preventative services to show what works in practice.

Ewan King Director of Business Development and Delivery, SCIE

A ‘BEST IN CLASS’ EXAMPLE No-one would argue that this Papworth Trust scheme in Cambridgeshire is anything but a ‘best in class’ example of supporting vulnerable people to live independent lives in their own homes. It is reassuring to see that some health organisations are at the vanguard in recognising the return on investment in some housingbased initiatives. Now we need to prove that such schemes can be replicated at scale across other health and social care economies. This would not only help make significant inroads into the system pressures but also relieve patients’ experiences of the care ‘bridge’ between hospital and once they get home. What is clear is that we need improved integrated working with the housing and their services. Only if we achieve this will real progress be made into the delayed transfers

of care, emergency readmissions and A&E visits that cost the NHS so much and mean so much misery for patients, family and carers. I believe that it is these issues that partners working locally through health and wellbeing boards, Better Care Fund arrangements and other local transformation programmes should be addressing – while building on the success of the estimable Papworth Trust project. For example, we should also be making better use of technology to enable care services, housing aids and adaptations. However, the Cambridgeshire project and other initiatives such as ‘step-up’ facilities provide the foundation of excellent reablement services that promote independent living. Let’s build on them and not discharge our responsibility.

The link between quality of housing and quality of life is clear. Most recently, the House of Lords Select Committee on the Built Environment called for wider provision of specialist housing, noting, ‘The places that we create have a profound effect upon the quality of life, behaviours and experiences of people who live and work in them.’ The potential impact of housing on health, in terms of illness prevention and keeping people independent, is also at the heart of NHS England’s Healthy New Towns Programme. Housing associations and social care organisations with an interest in housing have been at the forefront of developing partnerships with the NHS to provide solutions to transfers of care and flexible options for people leaving hospital. Papworth Trust’s work here is a great example. We’re seeing it in other regions too. In the north-east, Keiro has worked with local authorities and

Thirteen Housing Group to set up The Gateway Centre, a 40-bed facility offering a range of residential, rehabilitation and support services. In Greater Manchester, Community Integrated Care has worked with Pennine NHS Trust and University Hospital South Manchester to set up intermediate care units to support older people before they return home. However, these initiatives take time to develop, and need to evidence return on investment, in terms of savings for hospitals, income for providers and, crucially, the experience of service users. If we want to see more we need to consider them joint ventures, with the NHS and social care as equal partners for the long-term and demonstrating why it works. The Papworth Trust’s evidence base has the potential to make a powerful contribution.

Debbie Sorkin National Director of Systems Leadership, The Leadership Centre and Vice-Chair of Papworth Trust

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Keith Lewin brings another update to the ongoing subject of bank interest rate swap agreements.

As a quick refresher on what an interest rate swap is; a bank interest rate swap agreement (‘Swap’) is a complex financial instrument, a bet, otherwise referred to as a ‘derivative contract’, through which a business could effectively cap the amount of interest that it would pay if, after having borrowed a capital sum of say, £1,000,000, interest rates rose above a specified level. The products are sometimes referred to as a ‘hedge’ against interest rates rising. The flipside of such a deal was that if interest rates fell below a certain level, the customer would pay a larger

> CMM April 2016 35



amount to the lender. Undeniably, interest rates are at an historically low level, with Bank of England’s Base Rate still at just 0.5% – as it has been for years. The bet was one which – from a customer’s point of view – was against interest rates rising. Few realised that if interest rates fell, the customer would pick up a large bill. For a customer to get out of the arrangement or contract, banks charged, or sought to charge, large penalties, which most customers could not afford. Some businesses of modest means with relatively modest loans discovered that they were liable for millions of pounds to buy themselves out of the Swap. The Swaps were sold to customers with a substantial asset base, typically real estate. Many sectors were targeted, not just care homes, but hotels, restaurants, public houses – anyone with a chargeable capital asset. There have been a number of High Court cases in which the Swap deal has been a central feature; some of those claims failed.

BANK REVIEWS The banks have been reviewing many of the Swap agreements and have made some payments to customers – where the bank concerned has decided that the customer had been mis-sold the Swap product. In many cases, the banks have taken the view that large companies can ‘look after themselves’ and, so far as I know, payments have so far been made only to smalland medium-sized enterprises. Much of the work has been undertaken by, or with significant input and oversight from, the big accountancy firms.

NEW DEVELOPMENTS A very recent court decision will cause mixed emotions among those businesses which were mis-sold Interest Rate Swap products by their bank. Holmcroft Properties, a care home operator, was one such customer; it alleged that it had been mis-sold Swaps products. It submitted to the redress scheme, which the Financial Conduct Authority (FCA) had required the banks to devise and operate, and the FCA had required the bank to nominate a reviewer, in this case the reviewer was KPMG. Holmcroft Properties, which had initially been awarded about £500,000 under the Barclays scheme, was dissatisfied with the process and the sum awarded to it. This was because the claim made by the company included claims in respect of its consequential losses, which totalled about £4.8m, and were not compensated. In April 2015, Holmcroft Properties obtained permission from Mr Justice Parker to bring judicial review proceedings concerning the redress scheme as operated by Barclays Bank, and reviewed by KPMG. The judge had decided that, for the purposes of the redress scheme, KPMG could potentially be considered to be a ‘public body’ and, therefore, susceptible to a judicial review application.

The decision in the judicial review hearing had been reserved and was announced on 24th February 2016. In short, while the court found that KPMG was contracted to oversee Barclays Bank’s redress scheme, as required by the FCA (the relevant regulator at the time of promulgation of the scheme), it was not carrying out a public function such that it was amenable to judicial review. The claim was dismissed. The solicitor representing Holmcroft Properties said, ‘While naturally we are disappointed with today's decision, there are

“It seems therefore, that there is more litigation to follow before the issue of Swaps is finally put to bed. Meanwhile, the litigation continues to operate as a ‘drag’ both on the businesses challenging the banks and the banks themselves.” two aspects of the judgment that are surprisingly encouraging.’ He went on to say that the judges’ ruling on the question of KPMG’s public function ‘is not clear cut. We believe it offers very credible grounds for appeal and will be making an application to do so.’ The solicitor also said of the judgment, ‘The second encouraging part of the judgment is that it quite explicitly indicates that there is value in pursuing an alternative legal route to securing compensation for affected businesses, focusing on the issue of breach of duty,’ and added that this point ‘bodes very well’ for a proposed class action. KPMG welcomed the ruling. A statement made on behalf of KPMG said, ‘We’re particularly pleased that the court acknowledged that the redress process had been “conducted in a conspicuously scrupulous way” and we welcome the decision of the court that KPMG is not subject to judicial review in our role as independent reviewer.’ Barclays also said it was satisfied with the judgment, ‘Barclays remains committed to achieving an appropriate, fair and reasonable outcome for all customers through its review of past [Interest Rate Swap products] sales.’ In addition to a possible appeal by Holmcroft Properties, other customers of various banks, including Barclays, have a number of cases progressing through the courts as they believe that they have not been properly served by the compensation process as it has been applied to them. It seems therefore, that there is more litigation to follow before the issue of Swaps is finally put to bed. Meanwhile, the litigation continues to operate as a ‘drag’ both on the businesses challenging the banks and the banks themselves. CMM

Keith M Lewin is Solicitor and Director of Brunswicks Law Limited. Email: Twitter: @BrunswicksLaw The judgment of the Administrative Court can be accessed on the CMM website Subscription required. 36 CMM April 2016































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It has been around four months since the Chancellor announced that the muchanticipated, new National Living Wage would come into effect in April. Since that time the media has been awash with commentaries overwhelmingly denouncing the new legislation as being the death knell for the care sector. But what if its introduction is exactly what the sector needs right now? This is not an attempt to cause controversy by going against the grain of what is, by and large, a piece of legislation that has garnered marginal support to date. Rather, whilst we all recognise the significant impact that the new living wage will, invariably, have on the way care organisations manage their existing workforces, there is a need for balance too. Indeed, although many employers are still calculating the affordability of the National Living Wage, there is a shift in the way in which low pay is now being viewed. Many employers are beginning to see the introduction of the National Living Wage as an opportunity to review their recruitment practices. There is an increasing focus, by providers, on staff retention over the longer-term, rather than the short-termism approach that has been the mainstay of the sector since time immemorial. So, where are we now and what do we see happening over the coming months?

SITUATION ANALYSIS The care sector has been under the spotlight for a number of years and not always for the right reasons. From the Winterbourne View abuse and its much-publicised Panorama exposé to the alleged abuse of elderly residents at six care homes across South Wales – these and other high profile stories have left a stain on a care sector that is having to work harder than most to position itself as an employer of choice. However, that’s just one side of the coin. Arguably, the greatest challenge the sector has faced is to secure a better deal for its workforce, both in terms of pay 38 CMM April 2016

and conditions, and to stem the flow of workers leaving the profession. Social care has long been flagged as a sector of concern when it comes to how much the average worker takes home each month. The make-up of the workforce is typical of what we associate with a low-pay industry – according to the Resolution Foundation a disproportionate number of workers are part-time, migrant workers and female. For any industry observer from the outside looking in, these factors paint the picture of a sector that is either flat-lining or stagnating. However, nothing could be farther from the truth. Indeed, according to official figures, Britain’s ageing population currently sees nearly one in five (18%) of the population of England and Wales being more than 65 years old, by 2065 this figure will have risen to more than 25%. This rising demand for care makes this one of the fastest growing sectors of the economy, with analysts predicting that it will need to add an additional one million jobs over the next 10 years. However, with high staff turnover and many employers struggling to find the right talent they need, a factor compounded by the rising costs of paying their staff thanks to the new living wage, what can be done to ensure there is the workforce in place today, to meet the demand for tomorrow? Perhaps controversially, the new living wage could be a catalyst for positive change.

THE BENEFITS OF THE NATIONAL LIVING WAGE The principle of staff being paid a fair wage that is in accordance with the cost of living, is universally agreed upon. Practically speaking, however, the increases that come into effect in April, together with further increases to a statutory minimum of £9 per hour in 2020 pose several serious issues for care providers. Not least that the costs need to be offset ‘somewhere’. Faced with this challenge of


NATIONAL LIVING WAGE SEIZE THE OPPORTUNITY Adam Carter explores the impact the National Living Wage and how it’s an opportunity for the sector to adapt its recruitment practices.

CMM April 2016 39

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Much of this is down to the way employers engage with their workers. Research from Towers Watson showed that those care employers who actively engaged their staff reported having a more committed workforce that was also more productive. This led to lower staff attrition levels compared to those employers with no such engagement policy in place, which by default, resulted in improved organisational and financial performance. These findings are supported by those of the MacLeod Review in 2009. Of course, not even the most optimistic of industry observers would hang their hat on improving existing lines of communication as being the saviour of the care sector’s recruitment challenges. There’s also the way in which the sector promotes itself as an ‘employer of choice’ too.



restrictive budgets and the need to attract and retain the staff they sorely need, care providers can lessen the impact of having a higher wage bill by becoming savvier in the way in which they recruit and retain staff. Staff turnover rates within the care sector have consistently remained high – the shortage of skilled workers coming into the profession is one reason for this. This isn’t unique to the care sector, however, other sectors seem to be better at retaining the staff they already have.

The care sector is still largely misunderstood. Yes, the abuses mentioned above haven’t exactly shone a positive light on what it’s like to work in care. However, more needs to be done on the way in which care employers promote the benefits of having a career in the sector in the first place. This starts at the recruitment stage itself. There is a plethora of diverse roles and specialist areas within the care sector, each offering varying degrees of opportunity for career development and progression, whether they are for graduates, supervisors or managers. Yet this message doesn’t quite seem to be getting out there. The result is a huge, relatively untapped talent pool which employers need to get better at addressing with their recruitment advertising and candidate attraction strategy. Looking internally, regular staff evaluation, ongoing staff training and continued professional development programmes can go a long way in ensuring that employees feel valued and employers hold on to the talent they already have. However, pressure from

the Care Quality Commission and the implied urgency that comes from the regulator, sees many employers respond quickly to unfilled vacancies or tackle unexpected staff turnover by making rapid appointments. This knee-jerk approach to recruitment can result in poor quality hires, which end up adding to the organisation’s recruitment costs. The sector really needs to push back against this, to ensure they take the time that is needed to get the right person on board. Indeed, according to the Chartered Institute of Personnel and Development, the cost of hiring the wrong person is £8,200, rising to £12,000 for senior managers or directors. As such, improving staff retention rates is essential for the sector to both manage and anticipate future demand. No employer deliberately sets out to hire the wrong people. Nor do they want high staff turnover rates coupled with the ongoing pressure to fill these vacancies quickly. That said, these things are still commonplace within the care sector. For some, the necessity of balancing the needs of the business in the here and now often takes priority over putting in measures that could reduce recruitment costs over the long term. Creating a positive working environment with fair pay and conditions is not some Utopian ideology, it is a right. The National Living Wage will, undoubtedly, have dramatic consequences for the entire care sector. However, while the increase to monthly wage bills will see many care organisations looking to make cuts in a bid to balance the books, significant savings can be made without the need for knee-jerk reactions. Simply focus on ‘selling’ the benefits of a career in care. This will attract the best talent to want to work for you. Also extol those benefits through a range of internal engagement and staff development initiatives once they are on board. These approaches will go some way to ensure that staff costs are controlled and manageable whilst competitiveness is maintained. CMM

Adam Carter is the Managing Director of Carter Schwartz. Email: What are your thoughts on the National Living Wage? Will it make you rethink your practices? Share your thoughts on the CMM website Subscription required. CMM April 2016 41

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COMPANY PROFILE BVS Training Ltd is the leading provider of award-winning, videobased training courses for the care sector. Our resources and our customer service reflect how we endeavour to maintain this position and our standards. We have provided video-based training for more than 20 years and are proud of our high-quality materials, all of which are CPD certified. Our resources, developed in collaboration with leading consultants in the care sector, are all filmed in the appropriate environments and produced in-house. We deliver best practice training concepts and ensure that our materials are kept up-to-date as legislation or best practice changes. Our work with care managers

and trainers from a range of different experience levels ensures that the products meet training needs in the workplace, continue to be relevant, easy to use and flexible, and contain the right level of detail. Videos are available to purchase on DVD, accompanied by supporting materials including lesson plans, hand-outs, trainer guides, a quiz and certificate templates. Our videos are also available on our online portal where a multiple-choice quiz, automatic resets and other functions ensure your training provision is largely selfadministering. Please visit any product page on to view a sample video or go to our online portal to set up a demo account. Our training materials help you to meet the standards required by Care Quality Commission inspectors and Skills for Care’s Care Certificate standards in England and Social Care Induction Framework standards in Wales. With over 70 care specific training titles, including full induction programmes for care home and domiciliary care environments, we can meet all your staff development requirements in a cost-effective and time-efficient way.

Tel: 0161 928 9987 Email: Website:

SECTORS • Care homes. • NHS trusts. • GP practices. • Housing associations. • Charities. • Hospices. • Prison Services. • Recruitment.

• Educational institutions. • Disabled people’s user-led organisations. • Domiciliary care agencies. .


• eLearning. • Online assessment. • Distance learning.

Essential Training Tel: 01924 427806 Email: Website:



• Health. • Social care.

• Face-to-face – classroom. • Face-to-face – in-house. • Distance learning. • e-Learning.

Kwango Ltd Tel: 01908 592359 Email: Website:

Care Skills UK


Tel: 0800 2851968 Email: Website:



• Care homes. • Domiciliary care. • Housing with care.

• In-house. • Face-to-face.

44 CMM April 2016

Embrace Learning

• Residential care. • Domiciliary care. • Elderly care. • Learning disabilities. • Dementia care. • Short-term/respite care. • Health services.

• Social care services. • Education services.

DELIVERY • Online, interactive individual, group or team eLearning. • Available to view on handheld devices including iPad and iPhone.


Skills for Care

Redcrier Training Solutions

Tel: 0113 241 1716 Email: Website:


Tel: 01823 332200 Email: Website:

SECTORS • Residential homes. • Nursing homes. • Domiciliary care.

DELIVERY • Face-to-face taught courses. • eLearning. • Silver Box Training System.

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

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

regis Tel: 01243 555444 Email: Website:



• Care and nursing homes. • Domiciliary care. • Housing with care. • Large and small organisations. • Training providers.

• Online learning. • Face-to-face. • One-to-one. • DVD with comprehensive resources. • Workbooks for Care Certificate.

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

DELIVERY • Face-to-face training. • Placement. • Online resources.

COMPANY PROFILE Skills for Care helps to create a better-led, skilled and valued adult social care workforce. We provide practical tools and support to help adult social care organisations in England recruit, develop and lead their workforce. We work with employers and related services to ensure dignity and respect are at the heart of service delivery. Our support is from entry level right through to those in senior leadership and management roles. We’ve developed a selection of free materials to help you implement the Care Certificate in your workplace. These include: • A workbook that covers what learners need to know and understand for each standard in the Care Certificate. • A guidance document. • The framework assessor document. • A self-assessment tool. • A mapping document that sets out how the Care Certificate maps

across to other resources that are used within the sector. The resources and more information can be found at www. We run excellent leadership and management learning programmes, including: • The Moving Up programme for black, Asian and minority ethnic (BAME) social care managers and leaders. • The Top Leaders programme aimed at leaders within the most senior positions in health and social care. • The New Directors programme, designed in partnership with the Association of Directors of Adult Social Services. • The National Graduate Management Training Scheme where we match specifically selected graduates with host organisations for a 12 month placement. More information on all of our programmes can be found at www. To help employers find high quality learning and development providers we’ve introduced our Endorsement Framework. Care providers can search our online directory to find learning providers endorsed by us and their courses at endorsement. We also have local area teams across the country who can signpost you to relevant tools and the availability of funding for learning and development. Visit

CMM April 2016 45


Social Care TV

The Grey Matter Group (TGMG)

Tel: 01953 853070 Email: Website:



• Residential care. • Domiciliary care. • Supported living.

• eLearning. • DVD.

Tel: 0345 873 0373 Email: Website:

SECTORS • Health and social care settings. • Residential care. • Domiciliary care. • Hospitals. • GP practices. • National health and social care training providers.

DELIVERY • Continuous competence recording. • Online/Cloud-based technology. • PC/laptop/tablet/smart phone. • eAssessments. • eLearning. • ePortfolio. • Free workbooks. • Links to your policies and procedures.

COMPANY PROFILE Specialising in the Care Certificate and core competence subjects, our business exists to provide you with the support and resources you need to evidence safety to practice and prepare for Care Quality Commission inspections. Our system will provide you with the data you need to efficiently and effectively manage workforce development. We ensure the learning your staff undertake is relevant and transferable into the workplace, and that it impacts positively on their practice and morale for the benefit of the people receiving care and support. Our customers use our resources to suit their business needs. The assessments can be used during the interview process, prior to induction, post

46 CMM April 2016

induction and as refreshers. Our ‘know – understand – do’ methodology values the prior knowledge that staff bring to your organisation, allowing you to evidence and record knowledge and tailor learning and development to meet clearly identified learning needs, rather than ‘sheep dipping’ staff through expensive, generic training programmes. Assessments are supported by eLearning and curated links to other resources, including your organisation’s policies and procedures. We have supported organisations to make considerable time and cost savings and to achieve step change in their learning and development outcomes. With over 1 million assessments recorded in our unique assessment solution, our role is to ensure your setting receives maximum value and impact from your training and development activities. The system is modular, with configurable assessments and continuous competence recording. It can easily be connected to existing in-house learning management systems or it can stand alone. We are the leading provider of continuous competence recording in social care with 10 years of operational expertise and more than 100 years of direct health and social care sector experience within our professional team. We are proud to have achieved various awards including a Skills for Care Accolade for our eLearning club.

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Does a new 10-year deal between L&G Capital and LNT Group, owner of Ideal Carehomes, signal a change in care sector financing? The LNT Group’s Founding Chairman, the Group is LNT Software, an integral Lawrence Tomlinson, has been a vocal care sector software package. advocate for the need for sensible REFINANCING financing in business since the credit In April 2013, the Group finalised a crunch. As one of two Entrepreneurs £100 million refinancing, though the in Residence at the Department for process was not straight forward. At Business, Innovation and Skills, he the time, Lawrence Tomlinson was published an independent report in quoted as saying the deal had taken November 2013 which looked into two to three years to come together, bank lending practices and how involved four different banks and had certain banks deal with businesses in ‘issues’. He named Santander and distress. In April 2013, the Group had negotiated a £100 million refinancing Yorkshire and Clydesdale Banks in the of the business with a collective of process, plus it’s reported that RBS banks. With that up for renewal in and Bank Leumi were also involved. September 2014, the Group has Mr Tomlinson went on to say that the announced a £51 million debt facility amount of paperwork involved was with L&G Capital. As the insurer looks ‘phenomenal’ and that the whole to increase its involvement in the care process was ‘complicated’. sector, is this the future of financing? He has, however, given very positive feedback about several of the banking partners involved in LNT GROUP the 2013 refinance. He told CMM, The LNT Group, chaired by British ‘Whilst there were complexities in entrepreneur Lawrence Tomlinson, the 2013 refinance which were costly, includes a number of different, and far-reaching companies including the and at times challenging, it met care sector focused Ideal Carehomes, our finance needs for 2013 to 14. I found Santander and Yorkshire Bank LNT Construction and LNT Software, particularly helpful throughout the plus LNT Solutions and Ginetta Cars. past year, and Leumi continue to be a Ideal Carehomes is a care home operator, offering high quality services key partner in enabling our care home developments.’ After all this, the deal for older people without any third would have needed to have been party top ups. Its homes are mainly renegotiated in September 2014. across the UK and are designed and With renegotiation on the horizon, developed to be future-proof. LNT Group has just announced a LNT Construction designs and £51 million debt refinancing with builds care homes, not only for Ideal L&G Capital. L&G Capital is a new Carehomes but for third parties too business line created by Legal and including Anchor, Avery, Sanctuary and Nugent Care. Having built 52 care General to provide five key functions: direct investments; implementing homes since 2009, with 36 being run by Ideal Carehomes, it offers providers the investment strategy across the balance sheet; managing the Group’s turnkey solutions and is currently Shareholder Funds investments working on developments in the and managing the Group’s debt and south and Home Counties. The third care-focused company in liquidity. One of the drivers behind

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It’s not L&G’s first investment in the care home sector. It acquired 13 care homes from MHA for just over £70 million in December 2013 and it forward funded and purchased five care homes in Suffolk with Care UK for £31 million. These were funded on behalf of Legal and General Property’s Managed Property Fund. L&G DEAL The deal between LNT Group and L&G Capital, which was announced in mid- TARGET HEALTHCARE REIT May, is a £51 million debt facility, over On the same day as the L&G ten years, to LNT Group incorporating Capital announcement, Target all its subsidiaries. It is secured Healthcare REIT Ltd announced that against the Group’s portfolio of care it had acquired a portfolio of three homes and will give the company homes from Ideal Carehomes for the ability to move forward with approximately £13.9 million. These building a sustainable and growing have been leased back to the operator build pipeline of new care homes. for 35 years. The announcement Mr Tomlinson explained the drivers comes just a month after Target behind the deal with L&G Capital, ‘Our Healthcare REIT acquired two decision to take a debt facility from other Ideal Carehomes, the first for Legal and General was largely driven £3.8 million and another, due for by the offer of long-term finance and completion in summer 2014, for £5.1 their understanding of our business million. In 2013, Target Healthcare model which we believe paves the REIT also acquired homes from Ideal way for a fruitful partnership for the Carehomes in September for £4 future.’ million and £18 million for four homes Alex Gipson, Lending Manager at in March. CMM Legal and General, said, ‘Organisations OVER TO THE EXPERTS... that hold enduring business models and that, therefore, operate and Given the tough nature of the bank plan over medium- to long-term finance market, highlighted by the horizons are clearly better matched ‘issues’ faced by LNT in 2013, do to external capital that operates over these new financing options mark similar long-term durations. For this the future for care sector financing? reason, the financing needs of LNT’s Are more providers going to have to Ideal Carehome business provides a look farther afield than the traditional very natural fit with Legal & General’s banks to access finance? Will we long-dated pension and annuity see more organisations such as liabilities and we expect increasing L&G begin to meet the needs of the opportunities in sectors such as market, not necessarily being met the care home market, supporting by the traditional banks? Is this the organisations committed to delivery changing face of care sector finance? of long term solutions to meet What does our panel think? increasing demand.’




the business is the slowdown of bank lending which is leading to a shortage of investment capital. This has led the organisation to focus on replacing bank and Government capital with long-term institutional debt or equity funding, as it has done with LNT.












Ablution Revolution?

Ablution Revolution? A Comprehensive Research Study into Wetroom Provision in UK Care Homes

Integration in practice

Ben Hartley analyses the provision of ensuites and wetrooms in UK care homes and draws some interesting conclusions.


It is said that, apart from death and taxes, the only certainty in life is change - a truism, for sure, but one that warrants some reflection when we consider how society thinks about the way we care for our older people, and particularly in relation to residential settings.



Before launching into the research I’d like to draw comparisons with the hotel and guesthouse sector. It’s not that long ago that ensuite bathrooms in hotels and guesthouses were a dream for the future. Today, it’s as standard as the beds in the room. Residential care for older people though might not be keeping up with the ablution revolution, which was our starting point in deciding that there needed to be some in-depth work to establish the current position.

30 CMM February 2015

We embarked upon a thorough and extensive research project, carrying out a comprehensive survey over six months involving more than 6,000 telephone interviews. It reveals a very interesting picture. The research includes data from the whole of the UK and comprises information from private, not-for-profit, local authority and some NHS care homes.

Includes 4-page Skills for Care insert:

Right to work

Where we were unable to contact a care home directly, we made a number of assumptions based on data from other sources including the A-Z Care Homes Guide and the Care Quality Commission. The principles of what we did and why are relatively easy to convey. The detail, however, is trickier and, unless you are a stats lover, a little less inspiring.

A view from the top



Social care and cultural representation

For the purpose of this research, we describe an ensuite bedroom as one where there is at least a WC and wash hand basin. Such a room may also provide, though this is not a requirement for the purposes of our definition, a shower cubicle, bath or wetroom.



By contrast, our definition of a bedroom with an ensuite wetroom is one where there is a full wetroom, i.e. a walk-in shower complete with level access as well as the WC and wash hand basin. In effect, this is a subset of the ensuite bedroom provision – simply characterised by a higher level of facility.


Headline results We know that care homes aren’t keeping pace with the rate of change witnessed in hotel stock, however, although we knew that provision was more limited, the findings have shown an even bigger gap in provision than anticipated.


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Better domiciliary care

Who’s who... recruitment

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25th February, The Hilton, Reading

This year’s CMM Insight conference coincided with the future of learning disability services hitting the front page news. Sir Stephen Bubb’s Time for Change: The Challenge Ahead report was released earlier in the week and this political backdrop highlighted the importance of events such as CMM Insight for the sector. As well as highlighting the challenges in moving people from inappropriate in-patient settings into the community, the report also commented on the need for 10,000 extra members of staff to support people. With the agenda featuring a recruitment and retention presentation from the ever-engaging Neil Eastwood of Sticky People and a view of the policy and commissioning landscape from Kate Brittain, Senior Policy Adviser at ACEVO, delegates were poised to get the most from the day.

EXPERT ADVICE With specialist advice from Rhidian Hughes, Chief Executive of Voluntary Organisations Disability Group about how best to operate in austerity, there was also expert advice on how to deliver the services commissioners need from Lisa Hopkins, Managing Director of Dimensions. Deborah Ivanova, Interim Deputy Chief Inspector of Adult Social Care (South Region) at the Care Quality Commission updated delegates on how learning disability services were performing in quality ratings as well as the inspectorate’s progress in developing a methodology for inspecting housing with care. Delegates were then treated to something a little different from Carterwood in the form of Carterbox, their very own version of Gogglebox.

Organised by

48 CMM April 2016

With a sofa, some slippers and a cup of tea, Amanda Nurse and Tom Hartley used pop culture and news footage as the context for their market update presentation. Following on from this was the panel discussion and roving microphones were kept busy for the duration, as questions kept flowing from the floor. Enthused and engaged after the morning session, delegates headed into the lunchbreak ready to network and attend the afternoon workshops.

AFTERNOON SESSION The afternoon session provided the opportunity for delegates to hear about more operational topics. The first workshop, MyChoicePad was highly interactive, with people wanting to get their hands on the technology which is transforming the lives of people who use it. Using Makaton, a language programme that supports spoken words with symbols and signs, the team at Insane Logic who developed the product, are helping to make communication easier for those with learning difficulties. In the second workshop Peter Kinsey, Chief

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Executive of CMG and Sarah Maguire, Director of Quality and Safeguarding at Choice Support explored the Driving up Quality Code and how it can help providers to improve their business. Returning to the main stage, Alan Marshall, Director of Community Services at Voyage Care took a practical look at transforming services from residential care to supported living. Tracy Winter, Employed Barrister at Citation then explored employment law considerations. After a full day of specialist knowledge, delegates left armed with useful information to support and strengthen their business and more aware of the products and services available to help them.

WHAT’S ON? Event:

Dementia 2020 - Transforming care, support and research Date/Location: 12th April 2016, London Contact: Govconnect Ltd, Web: Event: Naidex 2016 Date/Location: 26th to 28th April, Birmingham Contact: Naidex, Web: Event: Dementia: Quality of Care 2016 Date/Location: 27th April, Manchester Contact: Open Forum Events, Web: Event: Community Care Live Date/Location: 10th/11th May, Birmingham Contact: Community Care, Web: Event: Care Home Open Day - Celebration Date/Location: 17th June, Nationwide Contact: Care Home Open Day, Web: Event:

Consequences of injury

Event: Health+Care 2016 Date/Location: 29th/30th June, London Contact: Closer Still, Web:

Event: Care and Dementia Show 2016 Date/Location: 11th/12th October, Birmingham Contact: The Care Show, Web:

Consequences to the worker

Evidence suggests repeated manual lifting is a leading cause of musculoskeletal disorders in EMS professionals. Paramedics and EMT workers are valuable employees and should not be put at unnecessary risk. Manual lifting, however, is a regular part of their working day and evidence suggests it is a leading cause of musculoskeletal disorders

Consequences to the worker are:

• Ongoing pain suffered through a musculoskeletal disorder


Moving fallen residents is a regular part of the working day for many care professionals but the repetitive nature of lifting can cause serious back injury. The Mangar ELK and Camel inflatable lifting cushions provide a safe, stable lift, whilst minimising the moving and handling requirement from staff. Inflatable lifting cushions are proven to: • Maintain patient dignity • Reduce risk of back injury to carers • Reduce costs associated with staff sickness

Lifting cushions support the dementia-friendly principles of care.

To find out more and have a FREE, no obligation demonstration please get in touch. Email: or call 0800 2800 485

Media Partner

Event: Digital Health and Care Congress 2016 Date/Location: 5th/6th July, London Contact: The King’s Fund, Tel: 0207 307 2596

If you have residents that fall, talk to us about a FREE demonstration

• The loss of their ability to perform duties

• Time off required to recover and recuperate, often resulting in reduced earnings

Patient falls are a regular part of the working day in a healthcare environment and performing a safe lift is vital for both the wellbeing of the fallen person and the EMS professionals. Injuries among EMS professionals can be costly not only to employers and employees but also can negatively impact the quality of care that a patient may receive.

Consequences for the employer

When an employee is affected by a musculoskeletal injury the impact on the employer can be significant as skilled, experienced workers take time off to recover.

Financial implications such as compensation claims and human resource costs including:

• Recruitment - advertising, interviewing and background checks

• Enhanced fees for agency personnel

• Overtime payments

• Training of new workers

• Reduced productivity as new workers learn the job


Royal College of Nursing Congress and Exhibition 2016 Date/Location: 18th to 22nd June 2016, Glasgow Contact: Royal College of Nursing, Web:

Event: Date/Location: Contact:

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

Event: Date/Location: Contact:

CMM Insight – Lancashire Care Conference 22nd September, Lancashire Care Choices, Tel: 01223 207770

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CMM Insight – Berkshire Care Conference October, Berkshire Care Choices, Tel: 01223 207770

Please mention CMM when booking your place. CMM April 2016 49

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2/10/16 10:38 AM


John Kennedy explores the laws of physics and social care.

The news is full of the crisis in health and social care. We all know that something has got to change. We all know that the NHS is unsustainable without an effective social care system. We all know that things are not going to get any better. The things we should be celebrating; like living longer and having more effective treatments for medical ills are, instead, portrayed as the reason for our failing system. Or, just as commonly, it’s claimed that the bosses are useless, nurses are callous, care assistants are careless and money has nothing to do with quality. I’ve argued for a long time that we need a radical rethink of how we view, and how we support, social care to be the essential part of our society and economy that it needs to be. It should be as fundamental to our society as the

infrastructures of rail, roads and power. If what we want is kindness, compassion and warm human care, why do we surround it in a system that’s impersonal, adversarial and super-critical? What we want is good relationship-centred care that is human, kind and empathetic. Why can’t we do it? Many of you will recall the terrible disaster, 30 years ago, on the 28th January 1986 when the space shuttle Challenger broke up shortly after lift off. All seven of the crew were killed along with the loss of billions of dollars worth of space shuttle and the reputation of NASA. Why did the Challenger break up? Technically it was all down to a rubber ‘O’ ring about half an inch thick. This ‘O’ ring was part of a seal that prevented the hot exhaust gasses on the shuttle’s solid rocket booster from escaping and threatening the integrity of the fuel tanks. On 28th January, the seal failed and hot gasses damaged the fuel tank. It broke away and the destabilised shuttle broke up at 48000ft, travelling at twice the speed of sound. Why did the ‘O’ ring fail? NASA has an enormous system of checks, protocols, launch procedures, safety checks and yet this thin ‘O’ ring didn’t work on the day. Why? Well there was nothing wrong with the ‘O’ ring, nothing wrong with the seal. After all, it had worked well in the previous 26 shuttle flights. All previous flights had lifted off in an ambient temperature above 12 degrees. On the 28th January it was cold, below freezing. When cold, the thin rubber ‘O’ ring became rigid and hard, not soft and pliant. It didn’t make the seal and failed. The company that designed and made the seal had concerns about the 'O' rings’ integrity, in below freezing temperatures. However, the launch went ahead. The outcome was tragedy. Interestingly, the decision to launch was made between the managers and engineers. Those with the most to lose, the astronauts, weren’t included in the process. The cause of the disaster was not

the ‘O’ ring. It was not because there wasn’t enough paperwork, check boxes or audits. It was because the people in the ‘system’ collectively denied the laws of physics. Now, getting back to social care (and health), I think we ignore the obvious facts. The ‘O’ ring represents every person working in health and social care. Each one a tiny player in a huge complex system. If one fails, tragedy can result. Underpaid, overworked, undervalued care workers, without the warmth around them to be ‘soft and pliable’, can become ‘rigid and hard’. Tired and anxious doctors can’t be ‘soft and pliable’; can’t be good ‘O’ rings. Fearful, overburdened care home managers, constantly criticised, struggle to concentrate on what matters most – the relationships they nurture. The ‘O’ rings are failing to make the seal. Care providers can’t recruit enough of the right kind of ‘O’ ring, hospitals can’t recruit CE ‘O’ rings. Social care is under too much pressure. Current Care Quality Commission ratings highlight, on a daily basis, the poor performances of providers. It’s not because the people working in them are useless. It’s because we’ve made their task too hard, too complex and too vulnerable. What are we doing about it? We are making it even colder. Denying resources, ramping up the blame and shame. Everyone standing back, demanding quality without putting any of their own ‘skin in the game’. We are just telling the ‘O’ rings to be kinder, safer and cheaper, and they can’t do it. We are just like those engineers, convincing ourselves that things will be fine, even though they knew the ring would fail. We can’t afford to ignore the laws of our humanity. The system needs to turn up the thermostat and make everyone warmer. Care needs more money, more status, less bureaucracy and more thought. Then we can all be good, safe ‘O’ rings and our shuttle will fly. CMM

John Kennedy is an Independent Social Care Consultant and Author of The John Kennedy Care Home Inquiry Email: Twitter: @JohnnyCosmos Do you agree with John? Share your thoughts on the CMM website Subscription required. 50 CMM April 2016

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