Care Management Matters June 2016

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JUNE 2016 ÂŁ4.00

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In this issue From the Editor


Is it just me…? 07 Editor-in-Chief, Robert Chamberlain asks where is the humanity, after investigations into unsafe hospital discharges. CMM News


Business Clinic Our panel looks at the future of Four Seasons Health Care given its recent financial losses.



A View from the Top 33 Harold Bodmer, the new President of the Association of Directors of Adult Social Services answers our interview questions.



What’s On?


Straight Talk Jim Halliday raises his frustrations regarding nurse recruitment.






Event preview CMM previews The Lancashire Care Conference 2016.



Volunteers in care homes – realising their value Tracy Whittle explains the role that volunteers can play in care homes, the benefits and why providers should encourage volunteers.


Creating an engaging care workforce An engaged workforce is a retained workforce. Adam Carter sets out the reasons why you should engage your staff, and how to go about it.


Shared Lives – making its mark in the sector Having received new funding from NHS England, Alex Fox explores Shared Lives and its benefits for the sector and for those receiving its support.


Is it time to reboot and rethink your recruitment? Neil Eastwood shares tried-and-tested ways to achieve recruitment success.


Resource Finder CMM brings you a selection of specialist social care solicitors. CMM June 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





Tracy Whittle Volunteering in Care Homes Project Manager, National Council for Voluntary Organisations

Adam Carter Managing Director, Carter Schwartz

Nick Hood Business Risk Adviser, Opus Restructuring

Des Kelly OBE Executive Director, National Care Forum





Diane Burns Lecturer in Organisation Studies, Sheffield University Management School, University of Sheffield

Harold Bodmer President of the Association of Directors of Adult Social Services

Alex Fox Chief Executive, Shared Lives Plus

Neil Eastwood Founder, Sticky People

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: 978-1-911437-00-0 CCL REF NO: CMM 13.4

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From the Editor Editor, Emma Morriss shines a light on the positive side of the sector and how we can all celebrate social care. The sector can be heavy going, sometimes it feels like a relentless barrage of bad news. However, we do so much good in the sector that I wanted to take the opportunity to look at upcoming ways to celebrate and share the positive.

3RD SECTOR CARE AWARDS Next month sees the nominations open for our 3rd Sector Care Awards. It'll be our third year and we're hoping for some fantastic entries. We have 12 categories: • Compassion. • Innovative Quality Outcomes. • Creative Arts. • Community Engagement. • Citizenship. • Leadership. • Collaboration (integration). • Contribution to Sector Development. • Making a Difference.

• Beyond Governance. • End of Life Care. • Technology. I would urge any readers who operate not-for-profit organisations, to take the time to enter. The event showcases some fantastic innovation and excellence. A number of winners have made it to the pages of CMM, including the Dimensions' Activate model, which we featured in Business Clinic in CMM March 2016. If you want to know more about the Awards, the categories or even read the stories of previous winners, head over to the Awards' website However, nominations don't open until 17th June, so have a think about how you may be able to enter and you'll have to wait until then to tell us all about the fantastic work you do. Keep an eye on Twitter @3rdSectorCare for updates too.

CARE HOME OPEN DAY Also happening on 17th June is Care Home Open Day. A fantastic, annual event developed to open up care homes to their communities. It showcases the fantastic work that happens on a daily basis, across the country, and encourages everyone, from clients and staff to the wider community, to participate and have fun. This year's theme is Celebration, and there's much to celebrate. From the Queen’s 90th Birthday to the forthcoming Olympic Games or

even just the recent sunny weather. Everyone should get involved and take part. For more information, visit or follow the event on Twitter @CareHomeOpenDay There's even a Growing Support Gardening Challenge, so take a look at that too and get gardening. Sometimes we all need to take a step back, to celebrate the hard work and fantastic care that the sector gives. What are you waiting for? The 17th June is coming. Let's all make a difference and celebrate the sector.

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Is it just me...?

locked psychiatric ward without the hospital going through the necessary procedure to see whether this was a deprivation of liberty. Mrs Z who was 80, had Parkinson’s disease and dementia. She was re-admitted to hospital several times after being repeatedly sent home where she was unable to cope. She later died in hospital. Her daughter said she now has nightmares and can't sleep because of what happened. She said she will be haunted by the way her mother was treated for the rest of her life.

Editor-in-Chief, Robert Chamberlain asks where is the humanity, following new investigations into unsafe hospital discharges.


Hospital discharges and delayed transfers of care are common topics. They are blamed for bottlenecks in the system and overspends by NHS Trusts. But there’s more. Each delayed transfer or hospital discharge is a person, a cherished family member, with feelings, needs and human rights. However, it appears from recent investigations that the individual isn’t always at the centre, where they really should be. A Report of Investigations into Unsafe Discharge from Hospital has been published by the Parliamentary and Health Service Ombudsman. It highlights cases investigated by the Ombudsman service where people have been discharged from hospital before they are fit to leave or without making sure they can cope on their return home.

HARROWING ORDEALS It contains, what the Ombudsman herself calls ‘harrowing ordeals’, of

real people’s lives being affected. I think it should be required reading for all health and social care professionals, to see the person beyond the workload. Here are just four examples. Mrs T, who was in her late 90s, had been diagnosed with a bladder infection by her GP, who also noticed her stomach was swollen. She became unwell overnight, so her granddaughter called an ambulance. Ambulance crew also noticed her stomach was swollen. At the hospital, Mrs T’s examination did not focus on her severe stomach pain. She was told she had a bladder infection and discharged. Just after the ambulance had dropped her home and left, Mrs T collapsed and died in her granddaughter's arms. The Ombudsman concluded that, ‘had the doctor physically examined her stomach, it's highly unlikely that she would have been sent home’. Clearly, Mrs T’s granddaughter

experienced a great deal of shock and distress from her grandmother’s sudden death. Mrs K, an 85-year-old woman with dementia, was discharged home without her family's knowledge. When her daughter arrived to see her the following morning, she found her mother without food, drink or bedding, unable to care for herself or get to the toilet. Mr A had vascular dementia and a personality disorder. After a series of incidents at his care home, he was admitted to a psychiatric ward where he remained as an inpatient for two years. Once he was considered fit to be discharged, discussions began between the hospital and the council. The council decided that Mr A was 'beyond social care' and refused to fund a dementia care nursing home for him. Despite a series of discharge planning meetings, it was nine months before a suitable nursing home was found. During this time, he remained in the

The report concluded that, ‘The people featured in this report all experienced care that falls well below established good practice and in some cases, statutory requirements. We found that while some people suffered because of avoidable clinical errors, the majority suffered because they did not have the support they needed despite being deemed medically ready to go home. Our casework on hospital discharge illustrates how failures in communication, assessment and service co-ordination are compromising patient safety and dignity, undermining patients' human rights and causing avoidable distress and anguish for their families and carers.’ Is the system that broken? Is there too little money, too much work, too many political issues, meaning vulnerable people can’t expect to be kept safe, supported and helped in their time of need? Families need to be able to trust professionals to care for their relative, as they deserve to be cared for. We need to move beyond the workload, the figures and the costs, and onto the lives of the people being affected.

What are your thoughts on this investigation? Join the debate. Twitter: @CMM_Magazine Web: CMM June 2016 7

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APPOINTMENTS ASSOCIATION OF DIRECTORS OF ADULT SOCIAL SERVICES The Association of Directors of Adult Social Services has introduced Harold Bodmer as its new President. Harold Bodmer is Executive Director of Adult Social Services at Norfolk County Council.

Care home insolvencies rise The number of care home businesses falling into insolvency has risen by 18%, with 47 care home operators in England and Wales becoming insolvent last year, up from 40 in the previous year. Research by Moore Stephens, also shows that the number of care home businesses becoming insolvent has risen by 34% over

three years, as there were 35 insolvencies in 2012/13. Local authority spending on care homes continues to fall, with estimates suggesting that there will be a £2.9bn annual funding gap in social care by the end of the decade. The Government’s introduction of a mandatory national living wage is further increasing pressure on

Dementia and comorbidities A new report by the International Longevity Centre – UK (ILC-UK) demonstrates that a failure to prevent, diagnose and treat depression, diabetes and urinary tract infections in people with dementia could be costing the UK’s health and social care system up to nearly £1bn per year. The report, Dementia and Comorbidities: Ensuring parity of care, which was supported by Pfizer, shows that people with dementia are less likely to have cases of depression, diabetes or urinary tract infections diagnosed, and those that do are less likely to receive the same help to manage and treat these comorbidities. This

can lead to people’s dementia worsening quicker, leading to greater health and social care costs. ILC-UK calculated an annual total net loss of up to £994.4m for just three conditions: £501.7m for people with dementia and depression; £377m for people with dementia and diabetes; and £115.7m for people with dementia and urinary tract infections. The report also finds that the failure to prevent, diagnose and treat comorbidities in people with dementia is leading to this group having a reduced quality of life and an earlier death than people who have the same medical conditions, but do not have dementia.

the sector as staff costs rise. It is also increasingly difficult to find finance for the sector. The research adds that with the UK’s ageing population predicted to rise by 12%, or 1.1m, between 2015 and 2020, local authority funding is set to be stretched further causing many care homes to come under increasing financial strain and face closure.

Workforce challenges The social care sector will need to fill around 400,000 jobs by 2035. In the light of this, how can care providers create a competitive edge in local labour markets, transform the sector into a career of choice and rise to the social care workforce challenge? These were questions addressed in a recent Voluntary Organisations Disability Group workforce summit, which brought together over 100 chief executives and senior directors working across the disability sector, and form the basis of a new report Rising to the social care workforce challenge.

Learning disability apprenticeships taskforce The Government has announced a new taskforce to look at improving accessibility of apprenticeships for people with learning disabilities. The taskforce comes as part of the Government’s goal to create three million apprenticeships by 2020, and to halve the disability

employment gap. The taskforce has been created by the Department for Work and Pensions, the Department for Business, Innovation and Skills, and the Department for Education. It will meet three times throughout May and June: once

to identify issues, then to explore solutions and finally to form recommendations to make to Ministers. It will be led by Paul Maynard MP and will include employers, training providers, charities and educational experts.

HICA GROUP The Hica Group has appointed a new Operations Director. Terry Peel, formerly Hica Regional Director South and West, has been promoted.

JRF AND JRHT The Joseph Rowntree Foundation (JRF) and Joseph Rowntree Housing Trust (JRHT) have appointed Shaun Rafferty in the new role of Strategic Director of Communities.

TARGET ADVISERS Target Advisers LLP has appointed Tim Kay as Investment Director.

ONE HOUSING One Housing has appointed Paul Rickard as Group Director for Finance and Resources.

SWEETTREE HOME CARE SERVICES SweetTree Home Care Services has appointed Erika Turner as its new Director of Brain Injury Services.

NURSE PLUS Heath Blake is stepping down as Chief Executive of Nurse Plus.

SENTINEL CARE SERVICES Former chef, Molly Nock has been appointed to the role of care coordinator at Sentinel Care Services. CMM June 2016 9


APPOINTMENTS ORCHARD CARE HOMES Orchard Care Homes has appointed Nicole Benn to the position of Manager of Nesfield Lodge Care Home in Belle Isle, Leeds.

TRACSCARE Tracscare has appointed Dr Felix Davies as Chief Operating Officer.

QUALITY COMPLIANCE SYSTEMS Quality Compliance Systems has appointed Abi Spence to serve on its panel of experts as its specialist on Registrations and Inspections.


Annie Sinnott MBE Annie Sinnott MBE of The Old Vicarage in Leigh near Sherborne passed away unexpectedly in hospital on 17th April. After 14 years as a community nurse, Annie Sinnott and her husband, Ian opened The Old Vicarage in 1984 with one resident and one staff member. The residential home now has 40 beds and Annie, her staff, and the home have received many national awards. Annie has had an enduring impact on the care industry. In 2007, she was awarded an MBE in recognition of her services to social care. In 2016, The Old Vicarage was rated Outstanding by the Care Quality Commission, a

testament to Annie’s dedication to providing excellent care in a safe and homely environment. Annie was held in high regard throughout the industry, invigorating every event she attended, whether as a speaker or a delegate. She would always go straight to the heart of any issue, demanding answers which everyone wanted, but dare not ask for. For this, and for her wit, her fairness, and her integrity, she was widely respected at all levels locally and nationally. Annie and Ian ensured that The Old Vicarage became truly a part of the village community life and it has been a focal point of local

NHS double standard for people with dementia

Burton Closes Hall Care Home in Bakewell, Derbyshire, has appointed a new home manager. Former Deputy Manager, Carl J D Fisher will take up the role.

An Alzheimer’s Society investigation has uncovered that almost half of care home managers feel the NHS isn’t providing residents with dementia adequate and timely access to vital services like physiotherapy, continence and mental health services. This has led to instances where people have been left bed-bound, incontinent and sedated because the health service is too slow in responding


Charge for overseas nurses

everyLIFE Technologies has appointed Dr Michael Dixon OBE as the Chair of its new advisory board.

Employers that recruit nurses from overseas will have to pay an Immigration Skills Charge from April 2017. Answering a written question to Parliament from Andrew Smith MP, the Minister of State for the Department for Business,

Rachael Corbett has joined Sentinel Care Services as Deputy Care Manager.


CASTLEOAK Castleoak has made a number of key appointments to support its five-year 2020 business growth strategy. Doug Jones joins as Development Director. Ben Davies and Philippa Keogh join as Development Managers. Oliver Smith joins as Real Estate Surveyor and Jonathan Stott joins as Corporate Finance Accountant.

10 CMM June 2016

social and fund-raising activities. Annie has personally taken part in several physically demanding projects, including treks to Kilimanjaro, Nepal, and Vietnam, raising significant amounts for national medical charities. She remained modest about her own achievements, but would always be first to celebrate the achievements of others and supported many staff members to obtain qualifications and win awards. Annie was a dear and valued friend to many and loved and respected by all who knew her. Annie is survived by her husband Ian, their daughters Josie and Carey, and four grandchildren.

to their needs. The investigation, which is part of the Fix Dementia Care campaign, involved a survey of over 285 care home managers in England, conducted jointly by Alzheimer’s Society and Care England, as well as firsthand testimonies of carers of people with dementia living in care homes. It also revealed that one in five care homes surveyed are being wrongly charged by GP practices for

Innovation and Skills, Nick Boles MP, confirmed this, ‘The Immigration Skills Charge will be paid by UK employers recruiting skilled migrant labour from outside the European Economic Area. This includes employers of nurses. The charge will

services that should be free on the NHS – up to as much as £36,000 a year. The total cost of GP charges to care homes is estimated to exceed £26m a year. Alzheimer’s Society is concerned that in their hour of need, people with dementia, who like any other taxpayer have funded the NHS, are paying again to see a GP through their care home fees, or being denied timely access to services.

apply from April 2017. There will be a flat rate of £1,000 per Tier 2 migrant sponsored per year. Some public sector employers could benefit from the small and charitable sponsors' reduced rate of £364 per Tier 2 migrant sponsored per year.’

Action needed on end of life care The Care Quality Commission (CQC) has found that people are experiencing poorer quality end of life care because their specific needs are not always understood or fully considered. A different ending: Addressing inequalities in end of life care reports that only 67% (27) of the 40 clinical commissioning

groups (CCGs) surveyed said that they had assessed the end of life care needs of their local populations, meaning that one in three had not. Of the 27 CCGs that had reported that they had assessed the end of life care needs of local populations, only 18% had reported that they had

commissioned specific services for at least one of the population groups considered in its review as a result – this includes vulnerable people, older people, people with dementia, a learning disability, a mental health condition, or a chronic progressive illness other than cancer.


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Care home pay survey

Apprenticeship levy guidance

The introduction of the National Living Wage (NLW) poses the biggest financial challenge for care home operators during 2016. However, it is part of a much wider ‘existential threat’ to the care sector, which is seeing a shortage of suitable managers to manage settings that face increased red tape and a seemingly ever-shifting legal framework. The third edition LaingBuisson’s Care Home Pay Survey collected planned pay rates for hourly paid care home staff for April 2016, as well as current pay rates at the time of

The way the Government funds apprenticeships is changing. Some employers will be required to contribute to a new apprenticeship levy, and there will be changes to the funding for apprenticeship training for all employers. The apprenticeship levy requires all employers operating in the UK, with a pay bill over £3m each year, to make an investment in apprenticeships. New guidance provides information on how the levy will work, when it is introduced on 6th April 2017. It also explains the principles that funding and the levy will operate on, whether you pay the

the survey in October and November 2015. It collected data points from across the country, from small, medium and larger care facilities. Amongst the key findings is a strong positive correlation between average salaries and size of home, as measured by bed numbers. At the upper end of the range, the average basic manager salary for care homes with 75 or more beds, was £50,900 for staff in post, and £51,600 for advertised posts. The single highest advertised salary recorded was £75,000 for a 100-bed care home in the South East.

levy or not. In June 2016, there will be information about provisional funding bands, which will set the maximum amount of funding available for each apprenticeship. There will also be information on the provisional level of Government support towards the cost of training, if you aren’t a levy paying employer. Final detailed funding and eligibility rules will be published in December 2016 along with employer guidance from HM Revenue and Customs on how to calculate and pay the apprenticeship levy.

New ADASS President’s priorities Harold Bodmer, Executive Director of Adult Social Services at Norfolk County Council, has taken over from Ray James as the new President of the Association of Directors of Adult Social Services (ADASS). Addressing fellow ADASS members for the first time, Harold considered how the

adult social services landscape had changed in the ten years since ADASS was established. He emphasised the enormity of the financial challenges now facing the sector. He said he would be focusing on funding pressures, integration, social work, education and training, market

sustainability and the homecare workforce, and contributing to the new carers’ strategy. He singled out homecare as an area of specific concern, saying, ‘Sustainability of homecare is certainly what keeps me awake at night. We need to up the level of debate about this, increase

the volume, share best practice, run innovation masterclasses, whatever we need to do. We will never bring any meaning to integration while the bulk of homecare is still based on time and task and, on the whole, unconnected to the mainstream NHS provider services.’

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Me, My Family, My Home, My Friends, and My Life

Carers report bleak outlook in State of Caring 2016

In Control has published Me, My Family, My Home, My Friends, and My Life, a new report which seeks to make significant improvements to the lives and support received by children, young people and their families, moving to a single ‘whole life, whole family’ approach.

Carers UK is calling for the Government, local authorities and health bodies to redouble their efforts to support England’s 5.4 million unpaid carers, as new research from the charity reveals how a perfect storm of squeezed public services and financial pressures is pushing carers to the brink. Carers UK’s State of Caring 2016 report shows that, one year on from the implementation of the Care Act 2014 – designed to improve support for carers – carers in England are still struggling to get the support they need to care well, maintain their own health, balance work and care, and have a life of their own outside of caring. Carers’ experiences show that the positive rights outlined in the Care Act are not matching up with reality. Growing numbers of carers believe their quality of life will get worse

Funded by the Department for Education, the project focused its energies on supporting six local authorities and their partners to develop new support packages for children and young people with complex needs and complicated home lives.

SureCare in Southend A former social worker has opened a new franchise in Southend for SureCare. Sami Haider and his team of 26 staff provide care for elderly

people and those with physical and learning difficulties. SureCare Southend was officially opened on 20th April.

Upton Dene opens A £6m residential and nursing home in Chester has been officially opened by Sanctuary Care. Upton Dene Residential and Nursing Home, is positioned alongside the Countess of Chester Hospital. It features 74

en-suite bedrooms and provides residential, residential dementia, nursing and palliative care, as well as intermediate care. The nursing home is Sanctuary Group’s first care operation in Chester.

over 2016 (54%), despite the Care Act being in force, compared with expectations last year (50%) before the legislation was introduced. Under the new legislation, all carers are entitled to a timely assessment of their needs. Yet, one in three carers (29%) who reported having an assessment in the past year had to wait six months or longer for it. More alarming still, over onethird of carers (39%) looking after someone at the end of their life had to wait six months or more for an assessment. Almost one-quarter of carers (22%) had to request an assessment for themselves over the last year instead of having one offered to them, as the law requires. Not only are carers facing barriers to getting an assessment, but they told Carers UK that the assessments they have received are, consistently, not fit-forpurpose.

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New code to raise standards in retirement housing A new statutory Code of Practice continuing to raise standards in leasehold retirement housing and improve the lives of older residents has obtained Government approval. The Association of Retirement Housing Managers (ARHM) has secured ministerial approval on its new Private

Retirement Housing Code of Practice. The Code, which comes into force on 1st June, sets out the statutory obligations for managers, and the best practice they should follow. The news follows months of work with the Department of Communities and Local

End of life care workforce A lack of data about the end of life care workforce could lead to staff shortages in the next few years, warns the National Council for Palliative Care (NCPC). Its workforce report Staff prepared to care? Capacity and competence in the end of life care workforce found a lack of data about staff working in palliative

and end of life care, making it hard to know if there will be enough staff to meet the rising need for end of life care. Based on the data it did gather, 44% of senior palliative care nurses were aged over 50 in 2013, and this percentage has risen in each of the last five surveys.

Sale for Carterwood in Hereford Carterwood has successfully completed on the sale of a care home on behalf of its client Somerset Redstone Trust. Carterwood were instructed to sell the home following a strategic review of the Somerset Redstone Trust's objectives. Heritage Manor, a small,

privately-owned group of care homes has purchased Newstead House to add to its portfolio. The group already owns and operates four care homes in Herefordshire and Worcestershire, and manages two further care operations in Bury St Edmunds and Colchester.

NHS England backs Shared Lives NHS England has announced a £1.75m investment in Shared Lives. The model supports people who have needs which make it hard for them to live on their own, by carefully matching them with a carer to share their family and

lives, giving care and support in the community. The new investment will mean funding and support is made available to clinical commissioning groups. For more information on Shared Lives, see page 34.

McCarthy & Stone’s results McCarthy & Stone has announced its half year results for the six months ending 29th February 2016, the first since its successful IPO in November 2015. Underlying profit before tax increased by 23% to £39.1m, legal completions increased by 19% to 923

units at a net average selling price of £253k, delivering revenue up 33% to £250.2m, and underlying operating profit was up 10% to £40.2m, despite first half investment in new regional offices and additional operational infrastructure.

Government to update the previous Code. Key changes will entrench the recommendations made by the Competition and Markets Authority as well as anticipating those expected from the Law Commission later this year. From 1st June, residents living in the 100,000 plus homes managed

Growing Support Gardening Challenge As part of this year’s Care Home Open Day taking place on 17th June 2016, the event is partnering with Growing Support, an award-winning social enterprise tackling loneliness, social isolation and inactivity. To launch its involvement in the event, Growing Support is running a Gardening Challenge competition, with the aim of creating lively hubs of community activity in thousands of care home gardens across the UK and care home residents can scoop great prizes by getting their green

fingers working. The suggested theme for this year’s Care Home Open Day is ‘Celebration’ and care homes can decide what it is they would like to celebrate. In line with this theme, care homes will be able to enter the Gardening Challenge competition under one of four categories: ‘Celebrating Community’, ‘Celebrating Age’, ‘Celebrating Success’ and ‘Celebrating the Queen’s Birthday’.

Predicting and managing demand IPC Visiting Professor John Bolton has prepared a paper offering a personal view about how councils with responsibility for adult social care can more effectively predict and manage demand for their services. His report draws on his experience of work across the United Kingdom. It builds on a recently published paper, What are the opportunities and threats for further savings in adult social care? and aims to act as both a prompt and a guide as to what might be considered when councils need to predict and manage demand for social care. The new paper shows that demand prediction and

management is more complicated than simple population projection. It suggests that some demand on adult care is within the influence of the council and explores behaviours and practices that can help, as well as why some councils are better at doing this than others. The paper looks at the variables that might be considered when seeking to understand likely future needs, in order to predict future potential demands. It suggests that if councils want to manage demand better, they need more sophisticated analysis and performance management arrangements.

Caremark in Kent Caremark Limited has welcomed Martin Steyn, its newest franchisee

SAVE THE DATE Berkshire Care Conference Reading, 20th October 2016 14 CMM June 2016

by ARHM members across England will have the additional reassurance that their manager is committed to delivering best practice. The Code is also made available as a public document so that it may be used by anyone if they need guidance to help resolve a dispute with their manager.

for the territory of Tunbridge Wells, Tonbridge and Malling.


Greensleeves’ new image Greensleeves Homes Trust has changing its name to Greensleeves Care. This change of brand identity is the result of extensive research conducted with residents, relatives, trustees and staff across its care homes and head office. It found that what mattered most to everyone

is the delivery of care at its homes. As part of the new identity and logo, Greensleeves Care has also adopted the strapline ‘You’re among friends’ to communicate the genuine warmth that is tangible in its homes and the personalised approach to care.

Your Care Rating to develop staff survey Your Care Rating will develop and pilot a staff survey this year. It is hoped that it will complete the

picture of life in residential care, allowing the views of residents, relatives and staff to be triangulated.

Financial health of care homes A new report has highlighted the financial health of care homes. Produced by Opus Business Services for BBC Radio 4’s You and Yours programme, it includes research into the financial health of nearly 6,000 care home operators. Of the 5,871 operators included in the research, it found

that 1,635 operators or 28% are at risk of failure. This equates to 5,600 care homes, an increase of 17% (4,800 care homes) in 2014. It also points out that 761 care home operators are classed as ‘zombies’ – these are companies that pay out more to cover their debt and interest, than they make in profits.

Augustus Court opens Angela Rippon joined staff and residents to celebrate the official opening of Meridian Healthcare’s newest residential care home, Augustus Court in Garforth, Yorkshire. Acquired by HC-One in 2015, Meridian Healthcare

welcomed its first residents to Augustus Court in February 2016. Once full, the £5.7m care centre will provide a home to 58 residents, of which 15 have already moved in. It will create up to 40 jobs for the local area.

Bowthorpe care village completed Construction of the new £18.9m care village in Bowthorpe has been completed and residents and tenants have begun moving into their new homes. It is a partnership between Saffron Housing, NorseCare, the Homes and Communities Agency, Norwich City Council and Norfolk County Council. The care village has been

constructed on a 2.3-hectare site and comprises NorseCare’s Mayflower Court, an 80-place specialist dementia care home, and The Meadows, Saffron Housing Trust’s 92-apartment housing with care scheme. The care village is part of a wider development site, which Norwich City Council plans to use for homes, community facilities and open space.

In focus CQC publishes business plan WHAT’S THE STORY?

The Board of the Care Quality Commission (CQC) has approved publication of its business plan for April 2016 to March 2017, which sets out the first phase of its fiveyear strategy for health and adult social care regulation in England.


The new Business Plan 2016/17 is set in the context of the increasing pressures faced by the care and health system in England. It acknowledges that both providers and staff are being asked to deliver significant efficiency savings to ensure that the system remains sustainable for the future, while meeting the more complex needs of the population. As a result, the way in which health and social care is delivered has begun to undergo a fundamental transformation – providers are changing the way services are organised and how they deliver care in response to pressure and opportunities to do things differently. Traditional boundaries between organisations and sectors are beginning to blur as organisations redesign their services to meet changing needs. The way services are regulated is evolving to reflect these changes. Nevertheless, CQC’s purpose remains unchanged, ‘to make sure that health and social care services provide people with safe, highquality and compassionate care, and to encourage improvement.’


CQC states that its focus will be on regulating for quality in a time of straitened public finances. It plans

to deliver this in 2016/17 under the following priorities: 1. Deliver a new approach to regulation. This includes completing the first comprehensive inspection programme, which leads to services receiving a quality rating, as well as ensuring that registration processes support providers to deliver highquality care while encouraging innovation. 2. Shape the future of health and care regulation. By making better use of intelligence, developing a shared view of quality with providers, and a framework with NHS Improvement on how well NHS acute hospitals use their resources. 3. Build an effective, efficient, learning and values-based CQC. Developing the skills needed internally to embed the necessary culture and values and to respond to the changing needs of the organisation and wider system. 4. Demonstrate the difference CQC makes. Evaluating, measuring and reporting on its performance, quality, management assurance, impact and value for money. Using this evidence to learn and improve, and be publicly accountable.


CQC will shortly publish the full strategy for regulation over the next five years. This will include further details about how it will target and tailor its inspection activities once the comprehensive programme has completed, as well as how it intends to develop a shared view of quality with providers within the resources available. CMM June 2016 15


Sustainability and Transformation leaders Senior figures from across health and care, who will be leading work on Sustainability and Transformation Plans (STPs) within their ‘footprint’ area, have been confirmed. The recently announced 44 STP footprints are geographic

areas that will bring local health and care leaders, organisations and communities together, to develop local blueprints for improved health, care and finances over the next five years, delivering the NHS Five Year Forward View.

Hazlewoods advises on Prime Care sale Hazlewoods Corporate Finance has recently advised on the sale of Prime Care Holdings Limited and its subsidiaries (Prime Care) to Apex Companions Limited (Apex Care). The Hazlewoods team was led by John Lucas. Founded in 2001, Prime Care is the domiciliary care arm of Centra Care and Support and provides care to elderly service users to help

them to live as independently as possible in their own homes. Prime Care operates on the south coast of England; it has six branches in Bournemouth, Brighton, Eastbourne and Hailsham (together, East Sussex Central), Hastings, Seahaven and Worthing. Legal services to Centra Care and Support were provided to the vendor by Rachel Reeves and Kiran Deshi of Shoosmiths LLP.

Revalidation – a ‘major success’ The introduction of revalidation for nurses and midwives has been a major success, with the majority of those due to renew their registration revalidating successfully. Latest figures show 90.48% (14,362) of the 15,873 due to revalidate in April have successfully renewed their registration through revalidation and only 1,401 have left the register. This is in line with the number of registrants normally expected to leave the register in any given April. Revalidation is the biggest change to the regulation of nurses and midwives in the NMC’s history and was introduced by the regulator in April, fulfilling a key recommendation from the Francis report into the failings at Mid Staffordshire NHS

Foundation Trust. The new process means that the UK’s 692,000 nurses and midwives now have to demonstrate on a regular basis that they are able to deliver care in a safe, effective and professional way. While the majority of the 15,873 due to revalidate in April have now completed the process, a small number of applications (106) have been granted an extension or are subject to additional checks by the NMC. In addition to the high proportion of the April cohort submitting their revalidation applications, 96% of them now have an NMC Online account. NMC Online allows nurses and midwives to find out their renewal dates, as well as carry out other registration processes.

The Royal Hampton opens The Duchess of Northumberland has opened a luxury assisted living scheme in Ponteland. The Royal Hampton, built on the former

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Dementia Research Institute funding A quarter of a billion pounds has been pledged towards the UK’s first ever Dementia Research Institute, as two major UK charities announced £100m of new investment. Alzheimer’s Society and Alzheimer’s Research UK have both pledged £50m each towards the work of the Institute, led by the Medical Research Council (MRC), in

one of the single biggest financial commitments to dementia research in the history of both charities. The Institute has already been backed by £150m of government investment. Set to be fully up and running by 2020, the Institute will have a central UK hub with a network of regional centres and is expected to

Season reveals rapid growth plan for next two years One Housing’s extra care arm, Season, has announced a rapid growth plan that will create over 550 new extra care apartments and 450 jobs at nine sites over the next two years. The new sites include two locations in Tottenham, as well as developments in Lambeth, Lewisham, Essex and Oxford. The schemes will include independent living flats with 24-hour care,

restaurant dining, spa and health and wellbeing activities. All of the sites will include flats for affordable rent and there will be a number of shared ownership homes. The rapid expansion reflects the urgent need for appropriate affordable housing for older people across the UK. Once completed, these projects will make One Housing one of the largest extra care providers in the South East.


engage hundreds of scientists. It will focus on the innovative, discovery science needed to unlock the understanding of the mechanisms underlying the development and progression of the dementias. This research will help to drive new approaches to diagnosis, treatment, care provision and, ultimately, prevention of the disease.

Staffordshire firm secures planning Knights professional services has secured planning permission for a dementia unit at St Quentin care home in Staffordshire. Having originally been refused by the local authority in 2014, permission for a 24-bed extension to the home was granted this month, following a successful appeal by Knights.

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Avonbourne Care Centre opens Edwina House Nursing Home Avonbourne Care Centre in Wiltshire has opened with a special visit from HRH Princess Alexandra. The new 120-bed care centre in Old Sarum is run by The Orders of St John Care Trust. It provides 72 specialist nursing beds and 48 dementia beds. Each wing is arranged into small household units, with communal dining and lounge areas and specialist bathing facilities, to

give a domestic feel. The home also includes several ‘destination zones’, including a ‘high street’ themed first floor, complete with a shop, cafe, hair salon and cinema. The rest of the building is fully furnished throughout and decorated to a high standard, incorporating breakthrough dementia technologies to assist residents.

The journey to integration The Local Government Association has published The journey to integration: Learning from the seven leading localities detailing the experience of seven localities in developing integrated care. It attempts to understand the successes and challenges on the journey to integration. It examines each locality against a range of factors, including care model, leadership, workforce, payment

model and information flow. The report was commissioned from Carnall Farrar by the Local Government Association. It concludes that it is possible for integration to have significant impact in terms of improved health outcomes and financial sustainability, and sets out the key lessons for other localities to consider in embarking on integration themselves.

HSCIC name change The Health and Social Care Information Centre (HSCIC) is changing its name to NHS Digital from July. Noel Gordon, currently the

Non-Executive Director and Chair of the Specialised Services Commissioning Committee at NHS England has agreed to lead NHS Digital as its new Chairman.

Worried providers write to commissioners Independent Care Group is writing an urgent letter to commissioners amidst fears that providers could close due to the introduction of the National Living Wage. A recent survey by the Independent Care Group (York and North Yorkshire) found that dozens of social care providers feared for their future

survival. It is now writing to local councils and health trusts who commission social care warning that the introduction of the National Living Wage, coming on top of severe financial cutbacks, poses a real threat to the delivery of social care across the region.

Field House Rest Home DC Care has finalised the acquisition of Field House Rest Home in Clent, Stourbridge to experienced Blackadder Corporation. DC Care was 18 CMM June 2016

instructed by the owners, Mr and Mrs Lane, to sell the Grade II listed home as a retirement sale, having originally purchased the home in the early 1970s.

DC Care has sold Edwina House Nursing Home in Palmers Green, North London. The home was

sold for an undisclosed figure to an existing, experienced care home operator.

Adept Care Homes Adept Care Homes has agreed a £4.7m deal with Avery Healthcare Group to acquire two of its Redditch care homes. The deal, supported by a seven figure funding deal with Royal Bank of Scotland, sees the local business acquire Bowood Court Care Home and Bowood Mews Care Home in Redditch. The two properties are to undergo a complete refurbishment, expected to cost in the region of £600k and

to take around 12 months. The new owners plan to create six separate care suites within the homes. It is anticipated that around 15 residents will be cared for in each suite, benefitting from a more intimate service by being looked after by the same team of familiar faces each day. All bedrooms are also to be refurbished with en-suite bathrooms. Adept Care Homes also plans to add new social facilities to the properties.

Specialist facility in Derby A new facility for young adults with acquired brain injuries or complex disabilities has opened. Nightingale House, in the heart of Derby, is former private nursing and midwifery hospital and later a Macmillan unit. It underwent a £1.5m renovation project to transform it into a home offering residential and short breaks services for young adults with complex needs.

It has been developed by Progress Care Solutions, which has a portfolio of specialist residential facilities across the West Midlands and has now added Nightingale House to the East Midlands region. It has eight residential suites adapted and designed to meet individual requirements along with four additional rooms for clients wanting a short break stay.

Westbourne care home opens A brand new, purpose-built, luxury care home and roof top apartments, The Lindsay, located on the grounds of the former Bridge Club on Lindsay Road, Poole has opened. It is the second care home to be operated by Primetower,

following the opening of The Links in Broadstone in 2012. The Bridge Club apartments located on the 5th floor are the first of its kind offering older people the opportunity to rent individual apartments. The Georgian style landmark building has 62 bedrooms.

Renovation in Scunthorpe Renovation work is now underway to create a new 22-bed elderly care home in Broughton, Scunthorpe. Supported by a funding deal with Royal Bank of Scotland, Ann Tuplin Care Services has begun renovation work on its new home, Carseld. Carseld, which means ‘home of care’ in old English, is to be opened on the site of the former St George's Care Home in Brickhills, which

closed in March 2015. Ann Tuplin Care Services is a domiciliary care provider operating throughout North Lincolnshire. Run by husband and wife team Noel and Ann Tuplin, Carseld will be the company’s first residential care home, providing accommodation for up to 22 permanent residents as well as offering a 30-day rehabilitation service.

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VOLUNTEERS IN CARE HOMES realising their value



What role can volunteers play in care homes? What are the benefits? Why should providers encourage volunteers? Tracy Whittle, Volunteering in Care Homes Project Manager, National Council for Voluntary Organisations

Compared to other areas of health and social care, very little has been known about the impact of volunteers in care homes, that is until recently. The Volunteering in Care Homes project was a three-year pilot project funded by the Department of Health to evaluate the impact of volunteers, recruited to social support roles, on older residents’ quality of life. The project evaluation highlighted that volunteers can, indeed, have a profound impact, not only on the social and emotional wellbeing of the residents, but on the care home staff, volunteers and relatives, with the potential for further benefits to the care home business and sector. That being said, the introduction of volunteers into care homes has not been without its challenges and the learning will enable other providers to avoid the pitfalls and successfully engage volunteers to reap 20 CMM June 2016

the benefits. However, for volunteering to truly flourish in social care, it needs to be valued by the sector and viewed as integral to the services being provided.

NATURE OF VOLUNTEER INVOLVEMENT In analysing the findings of the project, volunteers were recruited to roles that had been identified to meet residents’ social needs. The roles were split roughly between one-to-one befriending roles (51%) and activity-based roles (49%), which involved supporting residents individually, or in small groups, in activities that included arts and crafts, reminiscence, cat therapy, boccia and digital skills. Volunteer involvement ranged from a regular, ongoing weekly commitment to irregular and sometimes one-off engagement.

BENEFITS OF VOLUNTEERS IN CARE HOMES Impact on residents Over the course of the project, 493 residents were supported across 13 care homes. The most significant contribution of volunteers has been on the social and emotional side of residents’ quality of life. For many, the involvement of volunteers has delivered fundamental socialisation, company and ‘someone to talk to’ as well as more substantial, long-term one-to-one befriending relationships and support, helping them settle within the home, adding purpose to their lives, enjoyment, supporting them in overcoming bereavement and, generally, reducing distress and anxiety. ‘She is always laughing in her room when they are there – you can see the smile on her face is completely different to when they are just sitting there…’ [Relative] The nature of the volunteer roles meant that the residents were provided with mental and physical stimulation. Such activities as reminiscence, games and quizzes, reading the newspaper or simply chatting were ‘keeping them sharper and a bit more interested in their environment for longer’. [Home Manager] Impact on staff The evaluation highlighted that the involvement of volunteers had a positive impact on staff satisfaction in terms of their job (68%), retention (61%), stress levels (71%) and feelings of job security (54%). There was concern at the outset of the project that staff would fear that volunteers were replacing their roles, but this did not come out in the evaluation, probably because of the distinct volunteer roles. Impact on relatives Many residents who engaged in the project did not have any relatives or visitors. However, where they did, the evaluation also found that volunteers made a difference to relatives too, the main impact being increased satisfaction with the care that their relative was


CMM June 2016 21



receiving. As well as satisfaction, it can offer peace of mind to relatives and reduce any negative feelings of anxiety or guilt. Impact on the care sector • Adding value Managers and staff identified that volunteers brought a range of benefits to the home. In addition to the sheer time and resources they contributed, they had added value to and complemented the support that staff were able to provide to residents. Over the course of two and a half years, the Volunteering in Care Homes project placed 259 volunteers, who provided just under 10,000 hours to support residents. The return on investment broke even 18 months into the project. In the final six months, the value of volunteering exceeded the sum invested by just over £11,000. • Supporting regulatory requirements Volunteers support care homes to respond to the Care Quality Commission’s (CQCs) five Key Lines of Enquiry asked of all care services. They enable residents to live their lives as they wish and, in so doing, evidence that the care home is responsive, caring and effective. The additional eyes and ears of volunteers provides evidence that the residents are kept safe, whilst the act of engaging with the wider community is evidence that the home is well-led. • Championing the care home sector Volunteers can play a significant role in helping the sector challenge some of the misconceptions that the public have about the care home environment, older people and dementia. Volunteers who have had a good experience within the home act as ambassadors and share that positive experience with others. They are the link between the home and the local community, helping to break down barriers and bringing residents and members of the community together. The project highlighted the reciprocal nature of the volunteer/resident relationship. In addition to the benefits experienced by residents, a number of volunteers recorded that they had gained a range of benefits from their volunteering experience within the care home. These included developing confidence, satisfaction from helping, a sense of community and developing communication skills.

• Investing in the future Volunteering should never be used as a replacement for paid staff. However, at a time when the sector is concerned with meeting the demands of an ageing population and a looming staffing shortage, volunteers not only provide additional resource but an opportunity to nurture the workforce of the future. Some younger volunteers in the project were able to see a career in the sector.

REAPING THE BENEFITS The evaluation highlighted that volunteers were overwhelmingly satisfied with various aspects of their volunteer management. However, some volunteers did record dissatisfaction around the lack of substantial ongoing co-ordination and support provided by some care homes. The key barrier to effective volunteer management was lack of staff time, especially in those homes with a high ratio of residents to staff. For care homes to maximise the benefits of volunteers, this capacity needs to be found. Without staff time and commitment to the volunteer management role, volunteers will feel unsupported, limiting their potential impact and, in the worst case scenario, leading to a high volunteer turnover. This last point can cause upset to residents and require further work from staff to recruit new volunteers. The Volunteering in Care Homes Toolkit brings together practical learning from the project and contains guidance, references to other resources and organisations that can help. It also contains templates on how to set up a volunteering programme in a care home.

INVEST IN VOLUNTEERS This project has evidenced that volunteers recruited in roles to support the socialisation of residents can have profound impacts, not only on the residents’ social and emotional wellbeing, but on their physical and mental wellbeing. Bringing volunteers into a care home has benefits for staff; reducing their stress levels and leading to job satisfaction. Moreover, it brings peace of mind to relatives and can add a wealth of benefits to the business and sector by adding value, supporting regulatory requirements, improving the reputation of the sector and investing in the future workforce.

The potential benefits of volunteers will only be maximised by care homes investing in the infrastructure to support volunteering. This primarily includes building the skills, understanding and capacity of the staff team to welcome and support volunteers. Support and resources are available to help make this happen but if volunteering is to flourish in care homes, it needs to be valued by the sector and viewed as integral to the services being provided. Regulators and commissioners of care are in a key position to encourage and incentivise volunteering in care homes to support this change. Only when volunteering is valued by care homes will it be awarded the required importance and investment to fulfil its potential. CMM

Maximising volunteer involvement Here are some of the top tips for maximising volunteer involvement. • Before embarking on developing a volunteering programme, be clear on why you are involving volunteers and their role within the organisation. Involve residents, staff and relatives in the planning. • Staff may not have managed volunteers before so you may need to think about training to ensure they have the skills and understanding for the role. • Identify a key contact for volunteers before you start the recruitment process. • Put in place the necessary policies and procedures. • Recruit volunteers who are: • Able and willing to commit to the role and provide regular hours. • Understand the care home environment and its demands. • Have good communication and emotional skills. • Provide an induction into the care home and a basic induction training. Dementia awareness needs to be built into this initial training. • Offer effective ongoing management of volunteers in co-ordinating day-to-day activities, broader role development and emotional support.

Tracy Whittle is Volunteering in Care Homes Project Manager at National Council for Voluntary Organisations. Email: Twitter: @NCVOvolunteers Do you encourage volunteers? Would you, having read the results of this project? Share your thoughts on the CMM website. Subscription required. 22 CMM June 2016

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Adam Carter sets out the reasons why you should engage with your staff, and how you can go about it. The UK care sector is, quite simply, huge. At present there are around 17,300 organisations providing social care services across some 39,000 establishments in England alone, employing an estimated 1.45 million people – an increase of 15% (200,000 jobs) since 2009. Of these jobs, more than two-thirds (900,000) are employed by

> CMM June 2016 25


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the private sector according to Skills for Care. As the country’s population continues to rise, estimates suggest that by 2025, there will be an additional 1.5 million people aged over 65 or over. While this is good news in terms of living longer being indicative of us all living healthier lives, it raises one very important question: How can care providers meet this growing demand and ensure they have a workforce with the right skills in the right roles? The first thing organisations need to focus on is not how to find the talent they need, but how to retain that which they already have. Indeed, staff turnover within social care remains one of the highest of all industry sectors, with as many as one in four of all workers leaving their role each year – three-quarters of whom had been in their present role for 12 months or more. This suggests that while workers remain in their current position for a year or more, there is a point whereby they feel compelled to actively seek a new role elsewhere. What makes a worker jump ship in search of their perceived career nirvana with another employer? What are employers not doing, which is seeing them lose the talent they sorely need – often to a competitor? It is a question of engagement. Rather, the lack of.

REASONS WHY PEOPLE LEAVE Open the pages of most business magazines and it is almost certain that there will be the results of a recent survey that aims to shine light on the reasons why staff decide to leave their employer. Pay rates, working hours, increased pressure, lack of career progression and training, too much of a top-down management style or simply not getting on with their boss are just some of the multitude of cited rationale. But while some of these things may be valid, more often than not they are objections that could very easily be overcome, providing the organisation has an effective employee engagement programme in place. Some people reading this and recognising that we are a specialist recruitment firm for the care sector may be wondering why we would be

advocating various methodologies on how employers can retain staff, rather than recruit for those who are leaving or have already left. After all, that’s how we recruiters make our money, right? Indeed it is, but we wouldn’t be very good at our jobs if the talent we searched, found and placed with our clients decided to up-sticks in search of their next opportunity within a few short months or a year. That’s not in our interests nor those of the clients that we support. We want to find the right people for the right roles, roles they intend to remain in so they can realise their own personal career

reason why organisations hadn’t introduced one. However, there is a wealth of evidence to the contrary, including that from Towers Watson themselves.

INTERNAL COMMUNICATIONS They found that where there was an internal communications strategy in place, care providers reported having a more engaged workforce that results in greater patient outcomes and higher levels of recorded patient satisfaction. This, in turn, leads to improved organisational and financial performance.

“Unless organisations invest in engaging their workforce, they run a very real risk of losing out in the war for talent.” ambitions as much as the employers hiring them can gain a greater return on their recruitment investment. Which is why retention of that top talent is not just a nice-to-have, it is essential to ensuring longer-term business success for care providers.

RETENTION Research has shown many times that care providers can make significant improvements to their staff retention levels through enhanced lines of communication and engagement throughout the organisations. Yet despite this, many employers remain resistant to introducing any form of engagement programme. A factor that sees the UK currently languishing in 18th place out of the top 20 leading industrial nations. According to Chartered Institute of Personnel and Development, employee engagement levels throughout the UK, currently stand at just 35%, with HR Magazine putting this figure marginally better at 37%. The reason for this would appear to be born out of financial considerations. In a 2013 report, Towers Watson found that a perceived lack of evidence over the potential financial returns to be gained from having an employee engagement programme in place was the primary

These reflect the findings of the MacLeod Review (2009). It found that organisations with an employee engagement programme in place reported: 1. Improved productivity of individual employees and better overall organisational performance. 2. Engaged employees demonstrated greater levels of innovation. 3. Engaged employees are significantly more loyal to their employer. But that isn’t all. The MacLeod Review also revealed that such a programme resulted in fewer cases of lost days caused by sickness and absenteeism, higher levels of productivity and performance, and improved employer attitudes. This, by default, then raised the perception of the organisation itself as an employer of choice, which made recruiting staff in the first place even easier. In today’s climate, this can make the difference between your organisation attracting the best talent or falling behind as the ‘also-rans’ for your sector. Having an internal communications strategy isn’t simply a nice-to-have, it just makes good business sense. Unless organisations invest in engaging their workforce, they run a very real risk of losing out in the war for talent. The Institute of Employment

> CMM June 2016 27


6. Be accessible: Research show that those born in the 1980s and 1990s, the so-called ‘millennials’, are more likely to read their social media feeds than a company email. So, if that’s where that particular demographic ‘hangs out’, shouldn’t you be also? Be accessible to staff on social media and be prepared to enter into conversations with them via whatever channel they use most.


Studies defines ‘employee engagement’ as ‘…a positive attitude held by the employee towards the organisation and its values [whereby] an engaged employee is aware of business context, and works with colleagues to improve performance within the job for the benefit of the organisation. The organisation must work to develop and nurture engagement, which requires a two-way relationship between employer and employee.’ The question now becomes one of – how can organisations go about implementing an employee engagement programme?

IMPLEMENTING EMPLOYEE ENGAGEMENT At its most basic, employee engagement is about creating a two-way channel of communication that, in practice, can be achieved in a number of ways. Some will require employers to become more techsavvy, whilst for others it will be the need to adapt their leadership style from being less top-down to one that is more of a level playing field. Here are some examples: 1. Get your staff to buy-in to the company vision and mission. Share your goals and

objectives for the year ahead, so that your employees understand where the business is heading and the contribution they will make to achieve these plans. 2. Engage with your teams. Create collaboration tools, such as focus groups, town hall meetings or in-house forums that encourage employees to openly share ideas and best practice. 3. Empower employees by giving them a voice. Giving employees an opportunity to contribute and have their voices heard on the future direction of the organisation is a strong driver of engagement. 4. Ensure clear lines of communication and communicate often. Keep staff updated with the latest news and developments not just within the organisation itself, but also across the sector. Newsletters, regular all-staff emails, intranet sites and monthly meetings can all prove an invaluable tool in maintaining staff engagement. 5. Demonstrate your support for their career aspirations. Evaluate staff development on a regular basis, with a focus on supporting staff training needs, whilst keeping an eye on the long-term development of managers and potential new managers, as part of your overall succession planning strategy.

Silicon Valley technology companies dominate the top ‘employers-to-workfor’ lists, when it comes to employee satisfaction. This is because they recognise and place enormous value on the importance of having a strong workplace culture that their employees can identify with, and do so with a sense of pride. To quote business analyst Simon Sinek, organisations should focus on ‘why they exist, not what they do’.

ENGAGEMENT IS CRITICAL Of course, not even the most optimistic of industry observers would ever go so far as to suggest that staff attrition rates will be eradicated altogether, simply by improving existing lines of communication. However, regardless of how many people you employ, ensuring that your employees remain actively engaged with the business is critical to the long-term competitiveness of your organisation. Senior management can no longer shy away from sharing unpalatable truths through internal memos or the occasional town hall meeting. They have to get ‘out there’, speak to people, encourage two-way communication at all levels of the organisation and lead by example. To make it work, effective internal communication needs genuine commitment. You can’t deliver on your organisational goals unless your people feel committed, listened to and valued. It is not about finding gimmicky ways to motivate your staff in the short-term; it’s about getting their full ‘buy-in’ and having them on board for the journey. CMM

Adam Carter is the Managing Director of Carter Schwartz. Email: Twitter: @carter_schwartz How do you engage your workforce? Share your experiences on the CMM website. Subscription required. 28 CMM June 2016


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THE TALE OF FOUR SEASONS HEALTH CARE Four Season’s Health Care is our largest provider of care services. However, in its parent company’s financial results for 2015, it has posted a loss of over £263m. With more than £500m in debts, is the provider on the brink of collapse? Or is it doing enough to keep going? Recent history hasn’t been great for Four Seasons Health Care; regularly hitting the headlines connected to financing. Since the collapse of Southern Cross Healthcare in 2011, it has been seen, by some, as the next in line for difficulties. The sector’s major provider, it supports around 20,000 people across its three, newlydivided and clearly-defined brands. Four Seasons Health Care, which focuses predominantly on the local authority market; brighterkind, it’s growing self-funding brand; and The Huntercombe Group, which offers high complexity, hospital services.

ANNUAL RESULTS Late April saw the publication of the annual report and financial statements for Elli Investments Limited, Four Seasons Health Care’s parent company. The figures making the headlines are: operating loss – £263.6m; gross profit – £51.1m; and net debt – £509.9m. In November, credit rating organisation Standard & Poor’s said that the company’s financial structure was unsustainable in the short-term, suggesting the provider risked running out of money within 2016. Moody’s followed suit with a similar outlook at the end of April.

LONG-TERM PLAN Writing in the Chairman’s review of the results, Robbie Barr, who recently took over the position from Ian Smith, addressed concerns over the company’s financial structure. He explained the company’s plans. ‘Whilst the group’s cash position, 30 CMM June 2016

operational strategy and anticipated disposal proceeds will ensure that the group has adequate financial resources and liquidity for the medium-term, I recognise that the group’s capital structure is not suitable for the long-term needs of the business. The business recognised this last summer and appointed advisers and my goal is to ensure that we work with the group’s stakeholders to reach a capital structure which results in the group being well-positioned to fulfil its potential for its residents, staff and providers of capital. In this regard… FSHC Group Holdings Limited and advisers have started the process of engaging with key stakeholders and we hope to resolve the capital structure of the group during the course of 2016.’

SECTOR PRESSURES No-one would argue that the sector is in a difficult period. Pressure is mounting on all providers, but especially those supporting people under local authority contracts. There are a number of welldocumented factors contributing to this; continued underfunding of care through local authority fees – which Elli Investments reports to be 15% below the LaingBuisson fair price for care calculation; the national shortage of nurses, leading to an ongoing reliance on agency staff; the National Living Wage, which although only just introduced and therefore not impacting on these figures, will have an effect in 2016. Added to this, Four Seasons also faced a drop in occupancy, which the

report says has been affected by a record number of winter deaths.

OPERATIONAL DEVELOPMENTS There’s more to a company than its financials, and Four Seasons is aware of the long-term needs of the business. Not only, as mentioned by Robbie Barr above, has it started a process of looking at its capital structure, it has also taken numerous operational steps. It has separated the group into three brands. Four Seasons Health Care, brighterkind and The Huntercombe Group are all operating as independent businesses. Doing so has enabled each to focus on its core clients. Four Seasons Health Care has concentrated on improving quality, which has resulted in only three homes being under Care Quality Commission embargoes, the lowest level for nearly three years. Added to this, the organisation is getting involved in other sector developments. Four Seasons Health Care has been working with the NHS to open up more care home beds to help tackle the issue of delayed transfers of care. It has between 350 and 500 patients at any one time, who have been discharged into its care homes under intermediate care. It has also introduced a 24/7 rapid response assessment and admission services. This service is aimed at helping hospital discharge teams, clinical commissioning groups and social workers to help find appropriate placements for patients to enable quicker discharge or avoid admission in the first place.

brighterkind has refurbished a number of homes and is rolling out three ‘signature elements’. These are ‘high standards of personalised care; an enhanced recreation and activities programme that supports physical and mental wellbeing and is enjoyable; together with a superior food and dining experience. The business has also introduced a caring partner scheme, which is aimed at providing value added services to its residents including vision and hearing tests.’ It reports that its agency payroll has also reduced and average weekly fees have increased. The Huntercombe Group has progressed with re-provisioning services from adult services to child and adolescent services, as well as having withdrawn or scaled back its learning disability services. It has also rolled out an electronic patient record system at key sites to reduce the burden of record-keeping. CMM

OVER TO THE EXPERTS... Clearly, Elli Investments has to find a suitable financial structure for the long-term. The company’s substantial debts and operating losses cannot continue. However, there is an acknowledgement of the issues and already action in place to address the situation. Will this be sufficient to safeguard the business for the future? Will the Care Quality Commission need to step in under its market oversight role? Also, are the operating changes enough to help keep the different brands moving forward? What does the panel think?

A PROBLEM WITHOUT AN OBVIOUS SOLUTION Four Seasons is a sprawling corporate empire made up of over 150 companies, with its top company offshore in the Cayman Islands and its ultimate owner, Terra Firma also offshore, this time in Guernsey. So far as it’s possible to tell from these opaque arrangements, this is a classic private equity structure, involving the minimum of fixed equity capital and the maximum amount of debt. This financing model is designed to multiply the investment return for the owners and is fine, in financial terms, so long as it is supported by a profitable business, which can generate the cash to service the debt mountain. Unfortunately, Four Seasons is clearly not profitable and two of the world’s leading credit rating agencies have now warned that the debts are unsustainable unless there is a major restructuring. This process will involve delicate


negotiations with stakeholders, who will have to be persuaded that the profitability issues at Four Seasons can be resolved. This is not just about re-jigging the debts to cut the interest bill and reduce the cash flow strain from loan repayments. Much more fundamental commercial and operational changes are needed to make the business viable; under the current circumstances it’s very hard to see how it can be returned to profit. There is a limit on how much higher fees for privately-funded residents can be hiked, fees for local authority residents are capped by budget constraints and costs just keep rising, the latest pressure coming from the National Living Wage. Right now, this is a problem without an obvious solution.

Nick Hood Business Risk Adviser, Opus Restructuring

However, all the facts of the situation are detailed in the article: fee rates – on both the local authority and private pay side – have sustainability problems; occupancy (related to fees and efforts to keep people out of care homes); tougher regulation; rising staff costs; staff retention difficulties, all of these together with the reputation and perception of the care sector. I’m not sure that re-provision will be sufficient to tackle them. They all add up to an ever-more challenging time for care providers or a ‘perfect storm’ to use the easy cliché. It is a cliché with an assured truth. However, this is a crisis much bigger than the care sector, it will have ramifications across healthcare and the NHS, for informal carers as well as people in need of care and support.

Des Kelly OBE Executive Director, National Care Forum

ARE DEBT-BASED STRUCTURES IN THE PUBLIC INTEREST? Four Seasons has become the poster boy of the funding crisis in residential care. Margins are being squeezed by local authorities and big chains complain that they are not being paid a fair price. But critics argue that the problem is debt-based financial engineering, so local authorities are putting money into a leaky bucket. The Chairman now observes ‘the group’s capital structure is not suitable for the long-term needs of the business’. The more general question is whether debt-based structures are in the public interest? Our recent public interest report Where does the money go? explains what debt-based financial engineering means and how it works in care. We conclude that private equity owners believe a fair price should give them 11 to 12% return, which would cover buying the chains at eight or nine times earnings. Some chains are financed with debt, interest payments are non-taxable but profits

It seems likely that Four Seasons Health Care represents the highest profile (and largest) manifestation of a crisis in the care sector. A crisis which has been happening for some time. Arguably, we didn’t really need market oversight to identify it. It is a slow-motion crash, perhaps five years in the making. The fundamental problems faced by the care home sector were not resolved when Southern Cross collapsed in 2011. In fact, many of the difficulties Four Seasons Health Care faces are rooted in the earlier financial crisis. The strategy outlined in the article of segmentation, specialisation and diversification is occurring across the social care sector and for most social care providers. Creating smaller divisions can improve management and quality, although it brings with it higher costs.

are taxed; the rates of interest are high on external bonds and internal debt; cash is routed through multiple jurisdictions; and limited liability is gamed to compartmentalise risk of failure, which is increased by the capital structure. In this case, there is £525m of external debt at 10%, which has a cash interest cost of around £50m; and another £311m of intra-group debt at 15%. This incurs another charge of nearly £50m before any profit can be found. Beyond that, matters are complicated, because its care homes are part of a group of 185 companies, tiered in 15 levels. This kind of debt-based financial engineering may have its place in high-risk, high-return activities; but we believe it is completely inappropriate in care, where it should be a low-risk, low-return activity.

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Diane Burns Lecturer in Organisation Studies, Sheffield University Management School, University of Sheffield and Joe Earle Research Associate, Queen Mary University of London

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HAROLD BODMER Harold Bodmer is President of the Association of Directors of Adult Social Services (ADASS) and Director of Adult Social Services at Norfolk County Council. REFLECTIONS ON THE LAST DECADE There have been huge changes in social care. The most important being personal care budgets. We have seen a whole new approach to the engagement of people who use services in determining, planning and managing their care. Making it Real arrangements have supported this. We also saw the welcome and very significant introduction of the Care Act. This has built on much of the thinking of the last decade and given a really firm foundation for the next decade. Unfortunately, it is being implemented in the toughest period of austerity. The last five years have seen a 31% reduction in adult social care funding, and the next two years are going to be very difficult. We have transformed our services, improved efficiency, cut services and maintained customer satisfaction. This is a tribute to the way in which this has been managed by local authorities. However, fewer people are receiving services and further reductions will impact on quality. Although we’ve seen welcome and radical change in social care thinking and practice, it has probably also been the most challenging decade for social care. PROJECTIONS FOR THE NEXT DECADE The next decade will continue to be very difficult in terms of resources. There are big opportunities, though, with devolution and integration; giving local authorities a real chance to help shape the future

of health and social care services. As the NHS experiences some of the financial pressure that social care has experienced, there is an added incentive for joint-funded approaches to ensuring the right support is available in communities. The social care sector is very well-placed to lead this work. If we don’t succeed in integration over the next decade, we may as well give up. We have a clear policy directive and the burning platform of austerity to push us into looking for more ways to do things differently. There is, however, a danger in assuming that integration saves money. There is no evidence of this, although if integration means joining services around individuals, it’s got to be better. What is clear is that unless the intrinsic value that social care provides to society is recognised with reasonable funding, there will be no social care services to integrate. I believe we need a concerted campaign to promote awareness of social care. This needs to include the whole spectrum of voices across the sector. Social care must be viewed in the same light as the NHS when it comes to funding. ADASS’ call for social care to be protected and aligned with the NHS is more important than ever. INSIGHT I have worked in social care for 39 years, I trained as a social worker in South Africa and then in the UK. I’ve been Director of Adult Social Services for Norfolk County

Council for 11 years. Norfolk is a fascinating place to work, with all of the challenges of delivering social care in remote rural communities, in a county with a rapidly increasing population of older people. My role as ADASS President is only three weeks old and I’m finding out, on a daily basis, quite how big it is. There is huge support from director colleagues who I am already leaning on heavily for advice! I have five priorities for the year ahead: the funding gap; raising the profile of social care and the imperative need for this to be properly funded; integration; ensuring that social work with adults has the same status as social work with children; social care markets, in particular, homecare; carers and responding to the new Carers’ Strategy. Someone described being President of ADASS as being similar to running in a relay: you have the baton for a short time before you pass it on, so you have to make as much of it as you can without dropping it! INFLUENCES I think it’s not always the obvious encounters with people that you’d describe as having had the biggest influence on you. Social care provides a mass of these encounters, too many to name. ADVICE The best advice I was given when I first became a manager was to accept that you will make lots of mistakes! CMM

Read previous interviews on the CMM website at Subscription required. CMM June 2016 33


Making its mark in the sector Shared Lives has the potential to ease the financial burden on health and social care. This has been realised by new funding from NHS England. Alex Fox explores the model in more detail, the benefits for the sector and for those receiving Shared Lives support.

It’s widely accepted that social care as currently funded and constituted, is facing unprecedented challenge. Budgets are falling at such a pace that the Association of Directors of Adult Social Services and other bodies have declared the situation a care funding crisis. The overall sector has shrunk by 7% in the past two years, with further contraction to come. This is despite demographic pressures suggesting a need for the sector size to travel in the opposite direction. At the same time, many of the care models and approaches that 34 CMM June 2016

we have traditionally known are coming under greater scrutiny. Whether scrutiny is around concerns over expansion of, and quality offered by 15-minute homecare packages, or more fundamental questions about the nature, suitability and accountability of large scale, and increasingly discredited institution-based approaches, following Winterbourne View and the death of Connor Sparrowhawk and others in long-term NHS care. It’s also accepted that the traditionally separate worlds of the NHS and social care need to

integrate. They need to join up and talk to each other (sometimes literally), if progress is to be made. This is not just in terms of achieving the savings that the funding climate demands, but more importantly, in achieving improved outcomes for individuals and reducing pressures on services.

MEETING THE CHALLENGE This challenge is at the heart of our newly-announced, NHS Englandfunded project to propel the Shared

Lives model of care into mainstream health service thinking. Shared Lives isn’t a new idea; around 13,000 people across the UK choose to live in, or use Shared Lives. However, it is innovative, growing and a tried and trusted approach to supporting people to live good lives, often at a fraction of the cost of residential or institutional-based care. It even has the potential to support up to 37,000 people through a targeted expansion programme. This could include thousands of older people, and those with dementia and mental health support needs.

SHARED LIVES AND HEALTH Although Shared Lives is most often seen as a social care provider, people using Shared Lives frequently find a positive, and sometimes quite dramatic, improvement in their health. More Shared Lives schemes are working in partnership with clinical commissioning groups, health and wellbeing boards and mental health trusts to develop and enable the people using Shared Lives, not just to live good lives, but healthier lives.


CMM June 2016 35

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The patient becomes more dependent on others and less mobile, and begins to cut their daily activities. As the fear of falling increases and activity diminishes, muscle strength weakens causing more and more falls. Falls are often considered a contributing reason for admission to a nursing home.

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Last month, NHS England launched a £1.75m investment in Shared Lives to help more people to be cared for in a home, not a hospital. Shared Lives carers go through a rigorous approval process before being matched with someone who has support needs and who either visits their chosen Shared Lives carer regularly, or moves in with them and lives for a short or extended period as part of the Shared Lives carer’s household in the community. People using the scheme may have learning disabilities, dementia, mental health conditions or other needs. Many have complex combinations of health and social care support needs; which more traditional health services find challenging to meet. Shared Lives has a 40-year history as a local authoritycommissioned, social care option, but this new development reflects the increasing evidence of health outcomes. A recent survey of Shared Lives carers showed that 87% believed their support had improved the mental health of participants, and 75% had received positive feedback from an NHS professional about the effect of their support.

THE FUTURE OF SHARED LIVES The new investment from NHS England will mean funding and support is being made available to clinical commissioning groups to enable: • People with learning disabilities to move out of medical institutions into ordinary family homes. • People recovering from strokes and other health crises to receive their step-down care in a Shared Lives household. • Live-in mental health support,

including acute support as an alternative to hospital-based treatment. • Dementia support including day support and short breaks for family carers. It’s an exciting new path for Shared Lives – and we believe it may be the first of its kind in the world. Following April’s launch, we received a significant amount of interest, and further detail was released as clinical commissioning groups were asked to express a formal interest in becoming one of the six to ten pilot areas, either as a new Care Quality Commissionregulated Shared Lives scheme or driving the expansion of an existing scheme with a specific healthcare or NHS focus. Clinical commissioning groups are being asked to match-fund the new development and will recoup their investments in the savings they will make. Shared Lives is cheaper than other forms of care: the cost for an individual with mild to moderate learning difficulties to use Shared Lives, instead of another form of regulated care, could be on average £26,000 cheaper per year. This is around £8,000 cheaper for people with mental health conditions. Much higher cost reductions can occur when people with learning disabilities and additional, complex needs move from expensive, medical or out-of-area services into Shared Lives. The cost comparison between Shared Lives, typically costing £250 to £450 per week for a live-in arrangement, and a hospital stay, is also more favourable, especially for types of care less-associated with Shared Lives, like acute mental health care. These figures are cash savings and do not include any additional monies or efficiencies, which often

come with a Shared Lives match. This cost-effectiveness stems from the careful recruitment and matching process, the backup of an established Care Quality Commission regulatory framework, and the close relationships which form between people and their Shared Lives carers. These Shared Lives carers have the time and space to get to know, not only what an individual needs, but also what they may be capable of doing for themselves. Simon Stevens, Chief Executive of NHS England said, ‘Whether helping someone with a learning disability to build a full life with a network of friends and family, or enabling an older person to recover from an operation in the peace and quiet of a familiar environment – people naturally value care and support in a loving family home. That’s why Shared Lives is an example of the kind of community and people-centred approach which needs to play a much bigger part in the NHS of the future.’ We are expecting first responses to the Expression of Interest at the end of May, with areas chosen shortly afterwards and announced in the Summer.

SHARED LIVES, REAL LIVES To put Shared Lives into context, here’s James’ story. James (not his real name), grew up with his mother, who has a number of personal challenges, and his disabled brother. James developed renal failure and underwent a kidney transplant aged ten. He requires a specialist diet and medication, alongside regular dialysis. He spent the latter part of his childhood in foster care, then moved into an independent

flat with a small support package. However, at this time, both his mental and physical health deteriorated and he misused substances, stopped medication and suffered serious renal failure. James became homeless and when he was referred to a rural Shared Lives scheme; he was thin and frail, feeling very alone and overwhelmed, unable to contemplate a future. James moved in with Shared Lives carers, Fred and Joan, who have a wide experience of working with people with mental health difficulties. Support with diet, health and fluid intake led to James regaining weight and thinking more positively. When James suffered a life-threatening infection, Joan and Fred ensured that he gained rapid medical attention and helped James work with health professionals and make informed decisions and choices about his in-patient and post-discharge care. James is now planning for his future, whilst the arrangement costs the NHS £275 per week. Many other Shared Lives carers told us how their support had reduced reliance on primary and acute services, identified misdiagnoses, or challenged unnecessary medical interventions.

EASING THE BURDEN Shared Lives is cementing its place in the sector where new models of care need to be explored. It fits well alongside more traditional forms of health and social care and can help to ease the financial burden on the sectors. The investment in the future of Shared Lives has the potential to offer another option for people in need of health and/or social care services and can help to improve lives too. CMM

Alex Fox is Chief Executive of Shared Lives Plus. Email: Twitter: @alexsharedlives You can see more about the project, and details of how to apply if you are an interested clinical commissioning group or NHS trust or scheme, at CMM subscribers can read more about Shared Lives Plus at Subscription required. CMM June 2016 37

IS IT TIME TO REBOOT and rethink your recruitment?

Neil Eastwood shares triedand-tested ways to achieve recruitment success.

My work brings me into daily contact with those responsible for recruiting frontline care staff across all types and sizes of provider. All told, I must speak with over 750 managers and recruiters a year. Each one of these conversations are valuable touch-points, which collectively create a rich real-time picture of a wide range of recruitment methods and of the changing behaviour and shifting expectations of applicants. Due to the fragmented nature of our social care system, employers can feel isolated and their methods and approaches to recruitment can gradually become out of step with best practice. Without any external benchmarks then inertia can set in. If you are seeing diminishing returns from your efforts to attract new staff, then it could be time to rethink your recruitment. If that sounds of interest, I’d like to propose five underlying principles to get you started.

WE NEED TO THINK BEYOND SIMPLY FILLING THE HOPPER Care recruitment is often treated as a numbers game. In many cases, the goal that recruiters work to is to get as many prospective new starters in play as possible. This is on the basis that a percentage of applicants will leak away at every stage of the recruitment process. Let’s take internet job boards as an example. The number of applicants lost at each stage of the recruitment funnel is often quite similar between employers. A typical example might be – of 100 application emails in your inbox, you will invite 20 to interview. Eight of these actually show up and after references and DBS checks, five make the first training day and three go on to complete three months of employment. One, or fewer, can be left after 12 months. There are many flaws with this ‘quota’ method from a quality care perspective and as job boards and other job-seeker ‘marketplaces’

become clogged with competing employers, it is going to become unsustainable in the coming years. In order to break out of this mindset, we need to shift our measure of recruitment success much later, to how many of our recruits successfully complete at least 12 months of employment. This simple change will bring the performance of each source of new staff into sharp focus. Of course, once a candidate becomes an employee then there are many factors outside the recruiter’s control that can push someone to leave the organisation. This could include a stroppy supervisor; unrelenting requests to cover shifts or a lack of appreciation. The list goes on. But as I have witnessed time and time again, if the right person is selected and they build relationships with their clients, then they will be loath to break that powerful bond. As such, choosing the most suitable applicants always wins out over ‘any warm body’ because they will stay longer and be better at their job. That is why a focus on the long game ensures you concentrate your efforts on selecting and nurturing the stayers. This simple change of focus will force you to rethink your approach to sourcing, attracting and screening candidates.

DIVERSIFY YOUR APPLICANT SOURCES We are all guilty of over-reliance on internet job boards. My personal view is that this medium has made things worse, not better, for the social care recruiter. This is with the possible exception of the live-in care sector, where candidates can, at least, be sourced from around the world much more easily. Internet job boards have lowered the barriers of entry too far for candidates, encouraging multiple half-hearted applications. Page after page of identikit job adverts, make it a struggle for employers to stand out unless their pay rates are, or appear to be, well above the market rate. Not only that, by relying on this source, we are biasing our candidate pool


CMM June 2016 39


towards only those actively jobseeking. Active job seekers can often be driven by motivations other than altruism and caring, such as the need for any job or a preference for serial job-hopping. To overcome this, I encourage employers to be active in as many of the main five social care recruitment channels as possible (see chart). Employers should also test the sources in each, such as the examples shown, to find a mix that works for their particular needs and setting. By widening your recruitment options, you will attract a more diverse range of applicants and, I would argue, are more likely to find candidates who are motivated to care for your clients for the right reasons.

PRE-SCREEN FOR MOTIVATION AND ATTITUDE A recent US study looking at the motivation of domiciliary care staff found that 60% of those polled chose the work because they enjoyed being with, and wanting to help, older people. Another 32% chose the care sector because of a lack of other opportunities. The remaining 8% saw it as a stepping-stone to other healthrelated work. The study went on to discover that, keeping all other factors constant, the 32% of care workers who had motivations other than the caring aspect were significantly more likely (62.5% vs. 25.6%) to have clients who fell and fractured a bone, than those who enjoyed being with and helping older people. We also know from extensive psychological research that those whose personalities suit their job role are more likely to stay and enjoy the work. Pre-screening applicants against these criteria helps recruiters fast-track the right candidates and look beyond simply favouring those with existing experience of paid care work. The further unsuitable applicants

go through your recruitment process, the more they cost the organisation in time, effort and money. Introducing effective early stage screening techniques allows recruiters to prioritise those with the most chance of becoming high-performing, longterm employees.

THE ‘CANDIDATE EXPERIENCE’ MATTERS MORE THAN EVER If you recruit primarily from an active jobseeker source like a job board then your whole approach to applicants can quickly reflect your experience with this type of jobseeker. All too often, I see the frustration of the recruiter, who regularly deals with high volumes of poor suitable candidates, coming across in the job advert. ‘You MUST be available to work weekends.’ ‘We DO NOT accept provisional licence holders.’ ‘You must be friendly and reliable.’ Of course, it is essential to give applicants hurdles to jump over to confirm their commitment during the application process. However, it is also critical that our tone of voice communicates friendliness and warmth, however fickle and unreliable our applicants appear. This is because relationship-centric people, those tuned to the needs of others, seek a family-like and caring culture from their workplace. Brusque advert wording and curt telephone or text exchanges will dissuade this group faster than those who desperately need a job. Friendliness and a genuine interest in the jobseeker throughout the application process are, therefore, important aspects of candidate experience. This is becoming even more important as competing employers, such as those in retail and hospitality, can be much more tuned-in to the importance of the candidate experience due to their dealings with increasingly demanding customers.

They are also much more aware of their brand reputation, and of the downside risk of negative social media feedback from unhappy applicants. In addition, a recruitment process geared-up only for those actively seeking work, can be unsuitable for other types of potential staff. A hesitant return-to-work mum, curious about whether a paid care role is for her, probably shouldn’t be hustled into an interview. An informal chat with an existing member of the care team would be much more appropriate at the early stages of contact. Similarly, making uploading a CV a mandatory first step, will dissuade those who don’t have an up-to-date one prepared. As such, whilst candidate experiences should always be warm, it must also be tailored to the needs of the individual. Also, how you handle those you reject for a job, plays an increasingly important role in your reputation. Especially as disaffected jobseekers are more likely to take to social media and review sites to vent their frustrations.

RECRUITMENT IS A SHARED RESPONSIBILITY Too often, particularly in larger employers, recruitment is seen as the responsibility of a central HR team. In smaller providers, it may be a burden, juggled by overworked registered managers. It is too important for either situation to prevail. By getting all staff to understand what traits and behaviours you seek in your care or support workers, you move from perhaps a single person, or even no-one, waking up every day thinking about recruitment, to an entire organisation on the lookout for new staff. Also, once you properly engage with your local community, your stakeholders and use social media to reach out to targeted groups, then the

The five social care recruitment channels with examples of sources Online • Internet Job Boards • CV Search • Social media • Own website • YouTube Print • Local newspapers • Door drops or flyers • Hyper-local opportunities Outreach • Employee referrals • Applicants’ referrals • Good leavers • Customers’ family networks • Applicants that reject you • Over 55s • Informal carers Partners • Nursing colleges • Military bases • Women’s social organisations • Outplacement services • Training facilities • Hospices • Jobcentre Plus • Causes and charities Migrants • Sourcing from overseas chances of connecting with a diverse range of prospective new staff, not on job boards, rises even further. If you then re-purpose your recruitment process to identify the strongest applicants earlier, and make them immediately feel that they have found the right place for them, a place where they are going to be valued and listened to, then you have just rebooted your recruitment ready for the challenges ahead. CMM

Neil Eastwood is Founder of Sticky People. Email: Twitter: @StickyNeil What recruitment processes do you use? Share your techniques on the CMM website. Subscription required. 40 CMM June 2016

© Sticky People


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Nominations open 17th June

Are you in? @3rdsectorcare

The London Marriott Hotel Grosvenor Square Grosvenor Square, London W1K 6JP Wednesday 7th December 2016 • 11.00 - 16.30

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Supported by Department of Health 42 CMM June 2016

Resource Finder


Specialist social care solicitors offer the sector a wide range of services and expertise. They are able to support you with regulation, contracting, procurement, employment, dispute resolution, mental capacity, tax, acquisitions and more. If you’re looking for a solicitor for a specific service, the following solicitors and their lead individuals should be able to help.

CMM June 2016 43


bevan brittan


Tel: 0870 194 1000 Email: Website:

Tel: 0845 519 0690 Tel: Crisis Helpline 07855 855588 – 24-hour, 365 days Email: Website:

SECTORS • Independent health and social care providers. • Acute and emergency care. • Community health. • Mental health. • Primary care.

SERVICES • Serious incidents, safeguarding and health and safety investigations. • Commercial dispute resolution. • Care support – from capacity and consent to deprivation of liberty. • Contracting. • Procurement and competition. • Regulation. • Employment. • Property and construction. • Commercial structuring and finance.

LEAD INDIVIDUALS Stuart and Carlton are responsible for Bevan Brittan’s independent health and social care team with extensive experience in assisting all kinds of care provider. They say, ‘Most of our clients are providers of care services, either in the private and not-for profit sectors or the NHS. We work with small and large organisations on quality, compliance, commissioning and

strategy issues which are often testing and difficult, and our colleagues work closely to provide other types of support for providers. 'We give sensible and practical advice on technical legal issues and regulation which are part of delivering care services. Importantly, the team’s advice and representation is always centred round our clients’ best interests, being mindful of their legal responsibilities, commercial interest and the value of their reputation. It speaks volumes that our clients genuinely like working with us and we are always happy to speak to care providers who may just need a quick conversation to provide reassurance or guidance.’

COMPANY INFORMATION As a firm, Bevan Brittan is uniquely set up to advise organisations who work in health and social care because of its broad client base across public service delivery. The firm draws on this experience to help independent sector social care providers on all aspects of their business, from commissioning and procurement issues and challenges to specialist advice and support on care and regulation. Offices located in London, Leeds, Birmingham and Bristol, with national coverage.

Stuart Marchant Tel: 0370 194 7712 Email:

Carlton Sadler Tel: 0370 194 1633 Email:

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SECTORS • Adult Placement schemes. • Boarding schools. • Care homes with nursing. • Care homes for older people, EMI and reminiscence units. • Care homes for younger adults. • Children’s homes. • Domiciliary care. • Learning disabled provision. • Private hospitals. • Psychiatric hospitals, including secure and medium secure units.

SERVICES • Registration guidance and help. • Compliance and enforcement. • Regulation – Care Quality Commission (CQC), police, environmental health.

• Challenging inspection reports. • Challenging CQC investigations. • Opposing notices of cancellation including urgent cancellation applications to the courts. • Dealings with local authorities – including contract compliance, proposed termination and fees. • Safeguarding – adult and children. • Inquests. • Commercial. • Contractual – commissioners and suppliers. • Crisis management. • Debt recovery. • Reputation management. • Employment. • Fee negotiation. • Due diligence. • Free weekly newsletter – Brunswicks’ Healthcare Review.

Birkett Long LLP Tel: 01206 217326 Email: Website:

SECTORS • Care homes (independent and groups). • Nursing homes (independents and groups). • Domiciliary care. • GP partnerships, dental practices and pharmacists. • Construction contractors and developers.

SERVICES • Buying/selling healthcare businesses.

• Shareholder and investor agreements. • Property/land acquisition. • Property/land disposal. • Public sector work involving health trusts. • Regulatory advice. • Wills, trusts, lasting powers of attorney. • Mental capacity. • Reclaiming care fees. • Court of Protection work. • Independent financial advice, including pensions, life assurance and investments.


Druces LLP

Lester Aldridge

Tel: 0207 216 5557 Email: Website:

Tel: 01202 786135 Email: Website:

SECTORS • Care homes/supported living. • Charities and not-for-profits. • Entrepreneurs. • GP and dental practices. • PLCs. • Private healthcare. • Property development and investment.

SERVICES • Business sales and acquisitions. • Banking, finance and tax. • Capacity and court of protection. • Contentious trust and probate. • Contracts and commercial agreements. • Debt and equity capital markets and fund-raising. • Dispute resolution and litigation. • Employment. • Property, planning, development and construction. • Turnaround and restructuring. • Wills, trusts and estates planning.

LEAD INDIVIDUALS Druces health and social care practice is led by partner Christopher Axford, who specialises in mergers and acquisitions in regulated industries and has particular expertise in advising financiers, investors, owners and operators in the healthcare sector. He has worked on a number of pioneering deals, including advising on care home portfolio

restructuring, big ticket care group acquisitions, as well as advising on high value financing facilities and fundraisings for innovative care projects. He backs up his hands-on transactional experience with an in-depth understanding of healthcare’s regulatory framework, including being a contributing author to Jordan’s Care Standards: A Practical Guide. David Smith is a fellow partner in the healthcare team with over 25 years’ experience of advising entrepreneurial growing companies, both public and private. His practice has a particular focus on capital markets and a combination of capital raising and mergers and acquisitions.

COMPANY INFORMATION Health and social care is a primary sector for our firm and that is recognised by Legal 500 who note that Druces '…is known for its focus on the care sector'. Our healthcare group is made up of lawyers who are passionate about helping a broad range of clients in an industry that is experiencing significant growth and subject to ever more complex regulation. Our team comprises individuals from our corporate and commercial, litigation and dispute resolution, property, and restructuring and insolvency teams. We have acted for many operators, owners, investors, banks and other lenders.

SECTORS • Adult care homes. • Supported living. • Independent hospitals. • Children’s homes. • Schools. • Fostering services.


• Safeguarding investigations. • Contractual disputes. • Drafting contracts. • Debt recovery for care fees. • Inquests. • Employment. • Care home sales and purchases. • Health and safety. • Environmental health. • Professional misconduct.

• Care Quality Commission (CQC) enforcement action.

Lockharts Solicitors Tel: 0207 383 7111 Email: Website:

SECTORS • Care homes. • Healthcare professionals. • Doctors. • Dentists. • Pharmacists. • Optometrists. • Vets.

SERVICES • Care Quality Commission (CQC) processes. • Commercial contracting.

• Provider company formations and federating. • Dispute resolution. • Healthcare law. • Partnership agreements. • Practice mergers. • Professional regulation and registration. • GP rural dispensing. • Superannuation. • Commercial property. • Surgery ownership, leases and developments. • Commercial sales and acquisitions.

Christopher Axford Tel: 0207 216 5557 Email: David Smith Tel: 0207 216 5572 Email: CMM June 2016 45

Care and attention when you need it most. Whether you’re looking for commercial insurance, a comprehensive surety solution or an employee benefits package, you’ll require the advice of a professional broker who knows the market inside out. The Henderson Insurance Broking Group is one of the UK’s top five leading independent insurance brokers operating from 14 offices across the UK. Our success is based on our professionalism, independence and a commitment to always putting our clients’ interests first.

Henderson Insurance Broking Group Fountain House, 130 Fenchurch Street, London EC3M 5DJ T: 0207 280 0918

Authorised and regulated by the Financial Conduct Authority.


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RadcliffesLeBrasseur Tel: 0207 222 7040 Email: Website:

SECTORS • Medical defence organisations. • PLCs. • National institutions. • Charities. • NHS and private healthcare. • Entrepreneurs. • Private clients. • Professionals.

SERVICES • Healthcare. • Business. • Property and tax. • Private client services.

LEAD PARTNER Andrew advises in all areas of healthcare law. He has extensive experience of advising on issues arising from inspections, adult safeguarding, police investigations following serious incidents, and Deprivation of Liberty Safeguards. He acts for a large number of care home operators as well as NHS clients. Andrew regularly advises on care home law, mental health law, public law and judicial review and personal injury matters. He has been involved in many of the most important mental health cases in recent years and is seen as a leading practitioner in this field. He also has experience of large clinical negligence claims. Andrew has extensive advocacy experience, including attending inquests on behalf of healthcare clients. Andrew acts as adviser on regulatory matters involving the Care Quality Commission (CQC),

the Health and Safety Executive (HSE) and Police. Andrew is a regular lecturer and contributor of articles to the health and legal press, and provides an educational programme to clients and others, especially relating to mental health, care homes and human rights. Andrew is recognised by both Chambers and Partners and the Legal 500 as a Leading Individual.

COMPANY INFORMATION RadcliffesLeBrasseur is proud of its reputation as one of the leading UK law firms for the care home sector. The firm has many years of experience advising managers and operators of care homes, both in the private and public sector. Our lawyers are skilled in advising on specialist issues, such as CQC registration issues and other regulatory matters, adult safeguarding investigations and Deprivation of Liberty Safeguards, inquests, complaints and HSE prosecutions. Problems can arise at any time, and to be of all round service to our clients, the firm operates a 24-hour helpline to provide advice, often on matters requiring an urgent application to the Court. The firm also assists clients with employment, corporate and property matters. In addition, the firm provides educational lectures, seminars and briefings to enable our clients to keep up-to-date with the latest developments. We also offer a free monthly care home bulletin focusing on the latest news, guidance and legislation.

Mr Andrew Parsons Head of Healthcare Tel: 0207 227 7282 Email:

rhw Solicitors LLP Tel: 01483 302000 Email: Website:

SECTORS • Care home owners. • Dental practices. • Doctors. • Veterinary owners. • Garden centre owners.

SERVICES • Care home transactional matters. • Care Quality Commission (CQC) matters.

• Dispute resolution. • Employment. • Wills, trusts and probate. • Tax. • Residential property. • Family. • Mediation. • Children matters. • Commercial business services. • Intellectual property rights. • Commercial property.

Shakespeare Martineau Tel: 0115 945 4629 Email: Website:

SECTORS • Care homes with nursing. • Care homes for older people. • Children’s homes. • Domiciliary care. • Supported living. • Learning disabled provision. • Mental health. • Social housing. • Charities. • Education. • Local authorities. • Not-for-profit organisations.

SERVICES • Registration and commissioning. • Regulatory compliance. • Safeguarding and health and safety interventions. • Mental health and capacity issues, including deprivation of liberty. • Court of Protection and deputyships.

• Business improvement. • Quality assurance system and care plan reviews. • Fee analysis and renegotiation. • Family and children’s matters. • Dispute resolution and litigation. • Employment and HR. • Commercial property sales and acquisition. • Property construction/ development. • Planning. • Corporate and partnership law. • Business sales and acquisition and private equity investments. • Commercial contracts (public and private sector) and procurement. • Intellectual Property. • Residential conveyancing. • Wills and probate. • Tax, trusts and inheritance. • Debt recovery. • Structuring/re-financing debt. CMM June 2016 47



In association with


22nd September, Mercure Blackburn Dunkenhalgh

Taking the Lead: Partnership, integration and the independent care sector, The Lancashire Care Conference is back to tackle the issues facing providers in Lancashire. The Lancashire Care Conference returns this year with a new title to reflect the position of the sector in the region. Taking the Lead: Partnership, integration and the independent care sector will, once again, draw together the leading experts to bring the quality of a national CMM Insight conference to the regional care market in Lancashire. Produced in partnership with the Lancashire Care Association, the agenda has been tailored to meet the specific business needs of providers in the region.

LANCASHIRE COUNTY COUNCIL CONFIRMED We are pleased to announce that we have confirmed involvement from Lancashire County Council. Louise Taylor, Corporate Director of Operations and Delivery at Lancashire County Council will deliver the keynote presentation on the local commissioning landscape. There will also be the opportunity to ask her questions, if time allows.

FULL AGENDA Delegates will be able to hear leading names in the sector discuss topics including the local commissioning landscape, regulatory considerations and an inspection update, safeguarding and getting it right, exploring the local Corporate sponsor

48 CMM June 2016

Supported by

care market, and recruitment and retention. There will also be a series of workshops on the challenges around homecare in the current market, the Registered Managers Network in Lancashire and Employment Law. There’s something for every operator in the region and more, so please do book your ticket today. The event is even CPD accredited, so you can earn CPD points during the day, adding to the value of your attendance.

SUBSCRIBER DISCOUNT Speakers are in the process of being invited and the Events page of the CMM website will be updated with new speakers as they are confirmed. CMM website subscribers can also receive a 10% discount off their ticket. Don’t forget that subscription to the CMM website is free for care providers and free for the first three months for non-care providers. The event is supported by our Corporate Sponsor, QCS who will be in attendance. We will also have a good array of products and services in the exhibition hall, to enable you to find out how they can support your business. If you operate in the Lancashire region, don’t miss out on your opportunity to hear more about the market, find out what is happening, solutions to any specific pressures you may be facing and network with your peers. Organised by

WHAT’S ON? Event:

What next? – Shaping the future of retirement communities in the UK Date/Location: 6th July, London Contact: Associated Retirement Community Operators, Web: Event: Care Home Open Day - Celebration Date/Location: 17th June, Nationwide Contact: Care Home Open Day, Web: Event:

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

Wellbeing and Cost Benefits Matter: Linking these in Quality Dementia Care Date/Location: 21st June, Guildford Contact: Dementia Care Matters, Tel: 0207 720 2108 Event: Supported Housing Date/Location: 22nd June, London Contact: Capita Conferences, Tel: 0207 202 0532 HCD-ipad offer ad 91x110mm_May16:HCD



PageEvent: 1

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

Media Partner

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

A new future for social care? Good practice approaches to meeting care and support needs Date/Location: 12th July, London Contact: The King’s Fund Tel: 0207 307 2596

Order from our June ‘Special Offers’ catalogue and

Claim your FREE

iPad Mini 2


Call our office for details *Terms & Conditions apply

Call us now: 020 8236 0060

Event: NAPA London Conference: Activity Providers Toolkit Date/Location: 5th October, London Contact: National Activity Providers Association, Tel: 0207 078 9375

CMM EVENTS Event: Date/Location: Contact:

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

Event: Date/Location: Contact:

CMM Insight – Berkshire Care Conference 20th October, Berkshire Care Choices, Tel: 01223 207770

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

J I M H A L L I D AY • O W N E R • M A M S E Y H O U S E N U R S I N G H O M E

Jim Halliday shares his frustrations around the recruitment of nurses.

Mamsey House has experienced many of the issues relating to well-publicised stories regarding nurse retention and recruitment. In the UK, there are currently 24,000 nursing vacancies, and recruitment into the nursing home sector, especially where I am in rural Somerset, has been very hard for us. We have attempted recruitment through a variety of means and have concluded that recruitment of nurses from overseas is our best option. Recruitment agency costs (upwards of 10% – ie. £3000 per nurse) is compounded by the competition for nurses with other nursing homes. This is resulting in other ‘sweeteners’ now being required: paying for flights, providing airport pick-ups, finding and furnishing cheap accommodation, providing interest free loans. From January 2016, the recruitment of nurses has become harder with the impact of mandatory English language

IELTS examination requirements. Due to the shortfall in available nurses, the industry is now recruiting foreign staff with a European PRN (Provisional Nurse ID). These foreign nurses have no experience of working in the UK and, therefore, have a European PRN. When they have secured employment in the UK, they must then apply to the Nursing and Midwifery Council (NMC) to have their PRN registered as a PIN. Once the PIN is received they may work nursing shifts. Of all the frustrations that I could raise around this situation; I am particularly discouraged by the NMC’s PIN Registration Process. It is taking too long. It was generally accepted in September 2015 that the process would take four to six weeks to complete. The average wait time, in March 2016, is now over four months. During the first three months of employment, care homes, therefore, have to pay the new foreign nurses at high rates to simply work as carers, whilst in the interim also paying for agency or temporary nurses. Without a shift nurse, there is no nursing home. We believe the process is inefficient. Applicants provide their required documentation and initial NMC registration fee, and are then put in an NMC queuing system. There is no feedback for at least 10 weeks (currently 70 working days), before a case officer is allocated. There is no Queue ID, or visibility of the number of applicants or current wait time. This makes staffing, rota planning and management impossible for providers. After the 70 working days, a case officer will review the application and, if any detail is missing, then this is requested. The applicant must then re-submit any missing forms, which take 10 to 15 working days to scan. They are then not provisionally checked; the applicant must wait a further 70 working days for another case officer to be allocated. If the documentation is correct, then the receipt of the Final Declaration and addition to the NMC Register is another 15 to 20 working days.

There is no service level agreement for managing the turnaround of PINs. I understand there to be around 20 European Case Officers. When I enquire as to the status of a PIN application progress, the telephone queuing system indicates that the number of frontline call operators is also inadequate. We do not have enough nurses in the UK, and combined with the new IELTS examinations, we are now also dissuading foreign nurses from supporting us in the UK, because we are making them wait four months for a PIN. Foreign nurses come to the UK to earn money, and they initially have to wait four months before starting work at a nurse pay rate. This only increases the likelihood of their leaving employment and thus compounds the issue of nurse attrition rates in the UK. I have recently written to my local MP to raise the following question in Parliament, ‘Is it acceptable that given the various barriers-to-entry facing EU nurses, that the NMC compounds the issue of nurse shortages with an average PRN to PIN processing time of over four months?’ To give this context, here’s a situation I am currently facing, which I feel is quite common across the country. I have recently recruited three Polish nurses. One of these new staff started employment with us at Mamsey House on 12th January – at a competitive industry pay rate, with an expected nurse PIN registration date of 10th January 2016. On 1st April, I was advised that a realistic target date for his PIN receipt is 14th July 2016. Meanwhile, I am paying our new nurse an above normal rate as a care assistant, for which he is vastly over-qualified, whilst I potentially have an inadequate number of nursing staff and, therefore, the threat of paying a temping agency an above-industry pay rate of £22 per hour for six months at 35 hours per week. What can be done about this? How can we address the nursing shortage if our own processes are a hindrance? CMM

Share your thoughts on this issue at Subscription required. Twitter: @CMM_Magazine 50 CMM June 2016

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Homecare Theatre / 29th June 2016 / 11.05am – 11.35am

This is your ticket to join the discussion about the Fourth Age of Care and the biggest issues faced in terms of care delivery. All delegates will also be offered the opportunity to download a free app, openPASS. This will show you how family, Community Workers and Health Care Professionals can access up-to-date care plans and records in real time.

CQC inspector, South London Where: Stand N90




When: 29-30th June 2016

Venue: London ExCeL

“The difference between good and OUTSTANDING”

The Fourth Age of Care – Care is evolving and adapting



Make sure you’re talked about for the right reasons…

05/05/2016 11:48