Care Management Matters March 2017

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Experiences of collaborative working

Business Clinic

ÂŁ100m supported living fund

Pensions obligations Are you on track?

The modern care manager Realising their potential

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In this issue From the Editor


Is it just me…? 07 Editor in Chief, Robert Chamberlain isn’t surprised by the announcement that integration isn’t happening as quickly as expected. CMM News


Business Clinic Our panel discusses a new £100m supported living investment fund.


A View from the Top Raina Summerson, Group Chief Executive of Agincare reflects on the sector in our interview.



Event review 48 CMM reviews the CMM Insight Dorset Care Conference in Bournemouth. What’s On?






Straight Talk 50 Ben Benson-Breen extols the virtues of getting your residents outside, to places they genuinely want to visit.




Final tranche of employers: are you on track to meet your duties? Charles Counsell discusses automatic enrolment for the final tranche of employers joining this year.


Getting your house in order – contract governance in social care Emma Young looks at the benefits of contractual governance.


The modern-day care manager Paul Blane explores what’s needed from a modern manager and why it’s time to invest in them.


Social care and health: ways to work collaboratively Harnoop Atkar shares his experience of a proactive approach to collaborative working.


Care sector employment law – what you need to know Melanie Stancliffe considers some of the main areas of employment law that affect the sector.


Venusians, Martians and Registered Managers Paul Simic, Katie Barnes and Gina Kidd summarise some of the main challenges and frustrations facing managers. CMM March 2017 3


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





Charles Counsell Executive Director of Automatic Enrolment, The Pensions Regulator

Emma Young Senior Associate, Anthony Collins Solicitors

Gary Bourlet Co-Founder, Learning Disability England

Steven Rose Chief Executive, Choice Support




Laura Guntrip Associate, Lester Aldridge

Raina Summerson Group Chief Executive, Agincare

Paul Blane Director of Training Services, Affinity Training/eLearning For You




Melanie Stancliffe Employment Partner, Irwin Mitchell LLP

Paul Simic Chief Executive, Lancashire Care Association

Katie Barnes Registered Manager, Edgar Street Residential Home

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Harnoop Atkar Chief Executive Officer, Oakland Primecare

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 2017 ISBN: 978-1-911437-33-8 CCL REF NO: CMM 14.1

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From the Editor Editor, Emma Morriss explores how this issue of CMM will help you to keep operating through the ongoing pressures. Social care, the words are ringing out in the corridors of Parliament and throughout the mainstream media as the ‘care crisis’ deepens. But on the ground, care still needs to be delivered, people still need to be supported and you still need to run your business. To support you, this month we have taken a more operational approach to our content to help you with the dayto-day.

PENSIONS OBLIGATIONS For those of you who still have to meet your pensions obligations, Charles Counsell, Executive Director of Automatic Enrolment at The Pensions Regulator explores what you need to do, how long it takes and why you must do it. Although it’s an additional cost, it’s one that cannot be ignored. Additional resources will be on the CMM website for subscribers to access.

CONTRACTUAL GOVERNANCE For those providers looking to make efficiencies, Emma Young looks at contractual governance in social care and how it can help your business. If you’re confused about the ever-changing landscape of employment law, Melanie Stancliffe, Employment Partner at Irwin Mitchell looks at flexible working, minimum wage, holiday pay and working time regulations.

MANAGERS We also have two articles on care managers. Paul Blaine, Director of Training Services at Affinity Training/ eLearning For You sets out the attributes needed of a modern care manager and why providers should invest in their managers to invest in their business. Paul Simic, Katie Barnes and Gina

Kidd then summarise some of the main challenges and frustrations facing managers and explain why managers are crucial to the integration agenda.

adapting working practices. It can be difficult to achieve, but it’s not impossible as Harnoop Atkar, Chief Executive of Oakland Primecare explains.



Talking of the integration agenda, for those of you looking to collaborate with health, we have some examples of how one provider is working in this way and how it can help. There are many benefits to having a closer working relationship with GPs, sharing knowledge and

I really hope that this issue of CMM is useful and helps you to consider your operations and how to ride the social care storm. Don’t forget that providers can subscribe to the CMM website for free, to access additional resources, past features, receive daily news updates and more.

Email: Twitter: @CMM_Magazine Web:

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Is it just me...?

achieved improvements at the national level in reducing permanent admissions of people aged 65 and over to residential and nursing care homes, and in increasing the proportion of older people still at home 91 days after discharge from hospital into reablement or rehabilitation services.’

Editor in Chief, Robert Chamberlain isn’t surprised by the announcement that integration isn’t happening as quickly as expected. But it’s not time to throw in the towel.

As I write this, social care has been all over the news, again. There’s a continual stream of stories about the NHS and A&E, how targets are being missed and how the lack of social care is contributing to that. Amongst the stories was a report from the National Audit Office (NAO) stating that progress with integration has been slower and less successful than expected. Added to that, it hasn’t delivered anticipated benefits either. This isn't surprising. Breaking down the barriers between health, local authorities and social care is hard. Sharing budgets, leadership and thinking is even harder.

BETTER CARE FUND In 2013, the Government announced the £5.3bn Better Care Fund, to integrate health and social care. The Local Government Association called it, ‘one of the most ambitious programmes across the NHS and

local government to date. ‘A local, single pooled budget to incentivise the NHS and local government to work more closely together…around people, placing their wellbeing as the focus of health and care services, and shifting resources into social care and community services for the benefit of the people, communities and health and care systems.’ However, the NAO report highlights just how little it has achieved against expectations. It found that the Fund has not achieved the expected value for money, in terms of savings, outcomes for patients or reduced hospital activity. Nationally, the Fund did not achieve its principal financial and service targets over its first year. Planned reductions in rates of emergency admissions were not achieved, nor did the Fund achieve the planned savings. Compared with 2014-15, emergency admissions


increased by 87,000 against a planned reduction of 106,000, costing £311m more than planned. Days lost to delayed transfers of care increased by 185,000, against a planned reduction of 293,000, costing £146m more than planned. Other results include: local areas aren’t on track to ‘achieve the target of integrated health and social care by 2020…NHS England's ambition to save £900m through introducing seven new care models may be optimistic and the new care models are, as yet, unproven and their impact is still being evaluated.’

SOME PROGRESS However, progress is being made. The Fund has incentivised local areas to work together. The report says that, ‘more than 90% of local areas agree or strongly agree that delivery of their plan had improved joint-working. Local areas also

I think we all agree that integration is the way forward and a dedicated pot of money is great, but when the sector is fire-fighting daily, all the work undertaken to integrate services and try to make savings isn’t going to have a huge impact. The report also says that local government hasn’t been that involved in sustainability and transformation plans. It states that, ‘local authorities’ engagement has been variable, although four sustainability and transformation planning areas are led by local authority officials.’ Barriers include ‘misaligned financial incentives, workforce challenges and reticence over information sharing.’ Regular readers of CMM will know that it’s been difficult for social care to be involved in integration. Debbie Sorkin regularly writes on this, exploring how social care can get involved and why it must. However, if local authorities aren’t included, what hope is there for social care? Is the NHS just talking to itself? That won’t solve anything; social care holds many of the answers. Full integration of health and social care is necessary, but it needs time and resources, good leaders and change management. It won’t be achieved by 2020 and it certainly won’t be achieved whilst no-one is talking to each other and everyone is trying to fight their daily battles.

What do you think about integration and the lack of progress? Join the debate at Twitter: @CMM_Magazine CMM March 2017 7

8 CMM March 2017

APPOINTMENTS NHS CONFEDERATION The NHS Confederation has appointed Niall Dickson as its new Chief Executive.


Prime Minister discusses social care funding Norman Lamb MP, and former Minister for Social Care, has held a ‘positive and constructive’ discussion with the Prime Minister on funding for the NHS and social care. In a meeting with a cross-party delegation of MPs, Theresa May agreed to initiate a dialogue with her newly-appointed health adviser on a possible cross-party process to determine both how much funding these vital services will require in the future and how it should be paid for. The meeting was also attended

by Conservative MPs Sarah Wollaston, Dan Poulter and Hugo Swire, along with Meg Hillier and Frank Field from the Labour Party. They were representing a wider group of MPs who recently called on the Government to establish an NHS and Care Convention, which would engage with the public and the healthcare workforce with a view to delivering a sustainable long-term settlement for health and social care. After the meeting, Norman Lamb MP said, ‘The future of the NHS and

Slow progress on integration The National Audit Office (NAO) has warned that progress on health and social care integration has, to date, been slower and less successful than envisaged and has not delivered all of the expected benefits for patients, the NHS or local authorities. As a result, the Government’s plan for integrated health and social care services across England by 2020 is at significant risk. The NAO says that in the face of increased demand for care and constrained finances, while the Better Care Fund, the principal integration initiative, has improved joint-working, it has not yet achieved its potential. The Fund has not achieved the expected value for money, in terms of savings, outcomes for patients or reduced hospital activity, from the £5.3bn spent through the Fund in 2015-16. Nationally, the Fund did not achieve its principal financial and

service targets over 2015-16, its first year. Planned reductions in rates of emergency admissions were not achieved, nor did the Fund achieve the planned savings of £511m. Furthermore, days lost to delayed transfers of care increased by 185,000, against a planned reduction of 293,000, costing £146m more than planned. The Fund has, however, been successful in incentivising local areas to work together; more than 90% of local areas agreed or strongly agreed that delivery of their plan had improved joint-working. Local areas also achieved improvements at the national level in reducing permanent admissions of people aged 65 and over to residential and nursing care homes, and in increasing the proportion of older people still at home 91 days after discharge from hospital into reablement or rehabilitation services.

social care is more important than party politics, which has completely failed to come up with real solutions. The public are crying out for politicians to stop shouting at each other, and instead work together to make difficult decisions to ensure that patients get the right care and treatment when they need it. There is a real urgency to this situation, and now is the time to act. Today’s meeting was an encouraging first step, and I look forward to meeting with her advisers as soon as possible.’

Experiences of dementia care Healthwatch has compiled a briefing of people’s experiences of dementia care. Since the beginning of 2015, more than 1,000 people have spoken to local Healthwatch about their experiences of dementia care, from the help provided by GPs to support from hospitals and social care. Local Healthwatch have also visited more than 120 care homes; spoken to patients, those providing support and family carers. Whilst in most cases people found care to be compassionate and considerate, there were also things that could be better. Although the exact findings varied from area to area, local Healthwatch found that those they spoke to wanted to see improvements in three main areas: information, support and environment.

The Orders of St John Care Trust has appointed Kit Lendon as the organisation's new Head of Volunteering.

THE REGARD GROUP Carole Edmond has been announced as the new Managing Director of The Regard Group.

OAKDALE CARE GROUP Oakdale Care Group has appointed Paul Quirk as the manager of its first care home, Kingfisher Court.

NEW CARE New Care has appointed Cathryn Fairhurst as its Chief Operating Officer.

BARCHESTER’S CHARITABLE FOUNDATION Dr Pete Calveley, Chief Executive of Barchester Healthcare is the new Chairman of Barchester's Charitable Foundation.

MHC-UK LTD MHC-UK Ltd has announced the appointment of Dr Anthony Dean, MB ChB MRCPsych to the post of Medical Director.

BARCHESTER One of the most senior nurses in the sector, Professor Trish Morris-Thompson, currently Director of Quality and Clinical Governance at Barchester Healthcare, has announced that she is retiring.

CMM March 2017 9


Learning disabilities and dementia The Voluntary Organisations Disability Group (VODG) has published a new report, in partnership with Alzheimer’s Society, Foundation for People with Learning Disabilities, MacIntyre and the National Care Forum (NCF). It calls for the needs of people with learning disabilities and dementia to be better addressed. Learning Disabilties and Dementia focuses on how best to support the growing numbers of people with the condition. It is based on recent work with care providers, aiming to improve the quality of life of people with a

learning disability and dementia, and the challenges to this goal. The report responds to the fact that people with learning disabilities are five times more likely than those in the general population to develop dementia. Despite the increasingly high profile of dementia, there is a need to improve policy, planning and research in relation to people with learning disabilities and dementia. It highlights the need for early diagnosis of dementia in people with learning disabilities. This is key to ensuring that those there to support them receive the right

training and are able to plan for the future. Person-centred planning is crucial in supporting people to make their life preferences known and this to be the guiding principle for health and social care in putting the appropriate support in place. The report was funded through the voluntary sector strategic partner programme, which is backed by the Department of Health, NHS England and Public Health England. An earlier report, Dementia, Equity and Rights, explores the incidence and experience of dementia for people within protected minority groups.

Social care workforce strategy needed A new report by IPPR shows that radical change in social care workforce strategy is needed for the UK to attract and train enough new workers by 2022. Care in a post-Brexit climate: How to raise standards and meet workforce challenges identifies that training and working standards in the care sector need to be improved if it is to attract more UK workers and avoid labour shortages post-Brexit. It says that, alongside boosting funding, an ambitious workforce strategy is necessary to tackle longstanding challenges with poor working conditions and substandard care.

The report highlights that around 55,000 social care workers are EU migrants and, with uncertainty about the future of freedom of movement, the flow of EU migrant workers could provide a less reliable source of labour post-Brexit. It says that the UK will need to recruit 1.6 million low-skilled health and social care workers, two-thirds of the current workforce, by 2022, larger than any other occupation in the UK. It also claims that the level of quality and training of care workers in the UK is significantly lower when compared to similar economies, and poor workforce conditions mean that the sector struggles to recruit,

£1bn to stabilise social care ‘Emergency’ government funding of £1bn should be provided to councils in their 2017/18 budgets to help stave off an impending social care crisis in the short-term, the Association of Directors of Adult Social Services (ADASS) is urging. This vital funding, distributed on a needs-based formula, would immediately help to address the shortfall in next year’s budgets and stabilise the sufficiency and quality of the care market which is at increasing risk of collapse. The worrying fragility of the care market is reflected by an 10 CMM March 2017

ADASS survey showing that nearly two-thirds (62%) of councils have had residential and nursing home closures, and more than half (57%) have had care providers hand back contracts. With no new money announced for social care so far, and more than 97% of directors saying measures in the Local Government Finance Settlement would make either very little or no difference to funding pressures, ADASS is warning that councils will fail to meet their statutory duties without significant and immediate funding.

train and retain workers with the skills to deliver high standards of care. IPPR argues that – alongside extra investment – urgent action is needed to improve standards in the care sector, including effective minimum standards for training and qualifications to push up the quality of social care; better conditions for workers, enforced through a stronger Care Quality Commission in partnership with HM Revenue and Customs; and an industrial strategy for care with a new focus on innovation, including stimulating the potential of new technology to drive productivity improvements.

Tracscare acquires Embrace Tracscare and Embrace Group have announced the acquisition of six supported living services and a specialist ABI service by Tracscare. The transfer of these services is the latest step in Tracscare’s growth strategy, and comes about as Embrace has taken the decision to focus more closely on its core services – the provision of care and support for adults and older people in residential settings and specialist support for children and young people. The acquisition is part of an ongoing programme that has seen Tracscare focus on businesses that share its culture and commitment to quality. In 2015, Tracscare acquired Brookdale Care, a specialist residential care provider for individuals with Autism, and as a result became the largest provider of support for people with Autism in the sector. In October 2016, Tracscare acquired specialist acquired brain injury provider New Bridges, further expanding its specialist footprint. Tracscare was advised and supported by Harrison Clark Rickerbys.

CQC’s ‘Tell us about your care’ partnerships The Care Quality Commission (CQC) has launched a new partnership with a number of national charities to ensure that the views and experiences of people who use services always remain at the heart of the regulation of health and social care in England. CQC will be working with Carers UK, Disability Rights UK, Mind, The National Autistic Society, Patients Association, and the Relatives & Residents Association, as ‘Tell us about your care’ partners.

The partnerships are also an opportunity to help identify best practice examples of where highquality and compassionate care is being provided, so that others can learn from them. CQC hopes that by working in partnership with such groups, they will reach even more people who may have information that can allow them to take action against poor care, encourage improvement, and celebrate good services.

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Social care for adults with autism Two-thirds of councils worse The Social Care Institute for • Commissioners should ensure off in 2017/18 there are options for autistic Excellence has produced a guide to help people in health and social care who work with adults with autism, to increase their awareness, knowledge and understanding. The guide says that all major pieces of social care, health and equality legislation apply to people with autism, but have not been used with sufficient consistency to support them in practice. It says that staff training is key to their recognition and understanding of autism. Key findings also include: • People need knowledgeable, prompt information about autism, and where they can seek support.

people in terms of where to live and who supports them, specialist services and effective joint-working between services. • Frontline staff should endeavour to build good relationships with people with autism by being patient, sensitive, straightforward, consistent, calm, reliable and accepting of the person. • Transitions should fully involve young people, their families and carers and respect their preferences. • People with autism are likely to benefit from managed forms of personalised budgets.

Planning permission for Belong A new Belong care village designed by Pozzoni has been granted planning permission in Birkdale, Southport. The site of the new scheme will provide accommodation for more than 100 older people

including those living with dementia. Planning permission was successfully achieved after an appeal by Mosaic Town Planning on behalf of Belong, following Sefton Council's initial refusal in March 2016.


12 CMM March 2017

Government funding measures will force more than two thirds of councils to find millions more in savings than expected to plug funding gaps in 2017/18, the Local Government Association (LGA) has warned. The LGA is calling for government to reverse unexpected reductions in New Homes Bonus (NHB) payments to councils in 2017/18 and find genuinely new money to properly fund social care. The provisional Local Government Finance Settlement failed to provide any additional new government funding for councils in 2017/18. Instead, the Government brought-forward already announced council tax raising powers and redistributed £241m in NHB payments through a new Adult Social Care Services Support Grant. This will be a one-off measure in 2017/18. Early analysis by the LGA also suggests that 57 social care

authorities will be worse off as a result as they will lose more in NHB payments – compared to indicative NHB allocations published in February 2016 – than they gain in Adult Social Care Services Support Grant. Councils will also need to achieve growth of greater than 0.4% before they receive any NHB payments. The LGA said this will see 201 district councils lose out on NHB money they had planned for in 2017/18, pushing them closer to a financial tipping point. For many, this comes only a matter of months after they signed up to the Government's offer of a four-year funding settlement. Local government leaders warn these inadequate measures fail to address the long-term funding crisis in social care and mean local government continues to face an overall funding gap of £5.8bn by 2020.


STPs – Swimming together or sinking alone? The Institute of Healthcare Management (IHM) has launched Swimming together or sinking alone, a report based on revealing interviews with senior leaders in health and local government on what is really happening as managers grapple with the Sustainability and Transformation Plan (STP) process.

The report will help leaders understand the values, culture and skills they need to survive and thrive as the NHS tries to change from organisations working in silos to local health and care networks focused on the needs of patients. Under the STP process, health and local government leaders are

New falls prevention guidance The National Institute for Health and Care Excellence (NICE) has a published an update to its quality standard to help prevent falls for older people. It calls for professionals working across health and social care to ask older people about falls during routine GP appointments, when they attend hospital and during homecare visits by social care workers. Older people are at a high risk of falling, with research published in the Journal of Gerontology

suggesting that approximately 30% of people aged 65 and up will fall at least once a year. The update to the quality standard says older people should be asked whether they have had falls in the last year, or consider themselves to be at risk of falling. For example, if they ever lose their balance or feel unsteady on their feet. If an older person is then deemed to be at risk, healthcare professionals should refer the older person to the appropriate service.

coming together locally to take on two big challenges – shaping services around local needs, and doing so in a way which is financially sustainable. Barriers between primary, secondary and community care are becoming ever more permeable and, for the first time since the creation of the NHS in 1948, local government is a major

partner in shaping and delivering care. Swimming together or sinking alone analyses the difficulties these new, highly-pressured networks are experiencing, and identifies how managers need to think and act differently to make systems leadership a success.

Peer support in mental health The benefit of peer support is worth five times the money spent on it, according to a new study by Together for Mental Wellbeing. It reveals that every pound spent on peer support yields a social return worth £4.94. Peer support takes place when people with experience of mental distress support each other towards better wellbeing, as people of equal value and on a reciprocal basis, using their own lived experience of mental distress as a tool for support. In order to quantify the value of

the support for both those delivering and receiving it, Together undertook a Social Return on Investment Study. The peer support delivered over the course of a year, in three of Together’s accommodation services, was assessed to understand the ways in which peer support impacted people’s lives and what they valued most about it. From this, the return on investment in peer support was calculated using a methodology for measuring the equivalent worth of the charity’s activity in social terms.

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National Living Wage report A new report from Skills for Care provides an early insight into the introduction of the National Living Wage (NLW). Care worker hourly rates are the main focus, as well as differentials with other job roles in the sector. In March 2016 (prior to the

introduction of the NLW), 39% of independent sector direct care workers were paid below £7.20 and 80% of organisations (with 50+ workers) had workers on less than £7.20. With the pay floor continuing to rise, a challenge for providers will be

to maintain differentials between care workers, those in more senior roles and more experienced workers. It is likely that the NLW will lead to a real-term pay increase for care workers up to 2020, when the NLW is forecast to increase to £9 per hour. While not directly benefitting from

the NLW, there is evidence that social care organisations are rewarding workers aged under 25 with an increased rate of pay. The briefing goes into detail, with a summary of key findings, direct care worker pay by sector, care worker pay by region, pay trends and differentials.

Joint leadership and development framework launched Health Education England (HEE) working with Skills for Care and Skills for Health, has developed a framework to drive leadership and development in health and social care. Developing People – Improving Care is the first version of a national framework to guide local, regional and national action to support staff to develop improvement and leadership capabilities to deliver

continuous improvement in local health and care systems. The framework focuses on developing four critical capabilities: 1. Systems leadership, for staff who are working with partners in other local services on ‘joining-up’ local health and care systems for their communities. 2. Established quality improvement methods that draw on staff and service users’ knowledge and

Manager Induction Standards The reviewed Manager Induction Standards (MIS) are now available for new, aspiring and existing managers. The Standards set out what a manager needs to know and understand to perform well in their role. They are designed to be used in all care settings and to be a measure of good practice. Building on the 2012 version of the Manager Induction Standards, the revised Standards includes three new Standards: manage self; entrepreneurial skills and innovation; decision-making. The review incorporated key sector changes, including the

implementation of the Care Act, developing an effective workforce for integration, the economic picture and the need to work more digitally. The Manager Induction Standards have also been reviewed to be consistent with new Level 4 Certificates, and the Level 5 Diploma in Leadership in Care for leaders and managers which will be launched in January 2018. Skills for Care has also developed a new workbook called Becoming a Manager. It is a practical and cost-effective solution to make sure managers know and understand what they need to do.

Record year for Hazlewoods Despite the wider events of 2016, Hazlewoods Corporate Finance team, specialising in the health and care sector, have continued to see an increase in deal volumes during the year. The teams advised on 47 completed transactions valued at

£260m, representing an increase of 34% over 2015. There were also a few that didn’t complete. The increase in deal flow has led to expansion of the Health and Care team, which now includes 40 people.

The 3rd Sector Care Awards 14 CMM March 2017

experience to improve service quality and efficiency. 3. Inclusive and compassionate leadership, so that all staff are listened to, understood and supported, and that leaders at every level of the health system truly reflect the talents and diversity of people working in the system and the communities they serve. 4. Talent management to support

NHS-funded services to fill current senior vacancies and future leadership pipelines with the right numbers of diverse, appropriately developed people. The national organisations behind the framework are supporting it with actions detailed in the document. The framework will be adapted, improved and regularly reissued, based on feedback from users.

North Yorkshire care company expands St Cecilia's Care Services in Scarborough has completed the purchase of the 44-bed Queen Margaret's Nursing Home in the town and plans to invest in its future. The company already owns the St Cecilia's care home and the Eastfield House day care centre in Scarborough and is excited at the new addition. Owner, Mike Padgham said,

‘We are absolutely delighted to welcome the former Queen Margaret's Nursing Home into the St Cecilia's family and really excited about its future. It has lovely residents, excellent management and staff and is a very prominent, landmark building in Scarborough.’ The transaction was managed by DC Care’s Regional Director, Alison Willoughby.

Mental health training A new mental health training framework will increase the quality and consistency of care, according to Skills for Health. The new Core Skills Education and Training Framework for the mental health workforce aims to increase the quality and consistency of care in mental health services. The Department of Health commissioned Skills for Care,

Health Education England and Skills for Health to develop the framework as part of the crossgovernment strategy on mental health, No Health Without Mental Health. It will improve the way the health and social care workforce care for people with mental health issues by outlining the core skills and knowledge they need to provide high-quality services.

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Commissioning bodies ‘aren’t achieving value for money’ A new report on the state of public service commissioning by think tank Reform, has found that commissioning bodies aren’t achieving value for money. Reform says that how public services are commissioned underpins their success in healthcare, criminal justice, employment services and beyond. In theory, designing contracts for services delivered by third-party providers stokes competition for service delivery, driving down prices and incentivising expert providers to deliver the best services to meet users’ needs. The State of Public Service Commissioning evaluates the

success of current approaches to commissioning. It looks at complex human services, in which there is a purchaser-provider split – such as in health and social care, criminal justice, housing and homelessness, and employment services. Where these services affect other areas of policy, the report widens its focus. The report outlines a case for change, for commissioners to learn from past actions when approaching commissioning in the future. Reform says that this is a critical step for future success, and will pave the way for Reform to set out a vision for a new commissioning framework in subsequent analysis.

Ageing HIV population faces major challenges A new report by the Terrence Higgins Trust has found that that a third of people living with HIV are over 50. Uncharted Territory says that ‘growing older with HIV is uncharted territory, and with it comes new challenges – challenges we must be ready to face head-on to stand with those aged 50 and over living with HIV’. The research found that: • 58% of respondents are living on or below the poverty line, with a third reliant on welfare benefits. • 81% were concerned about how they would take care of themselves and manage daily tasks in the future.

• 82% were concerned about whether they would be able to access adequate social care in the future • A third were socially isolated with 82% experiencing moderate to high levels of loneliness. The report says that social care is not currently meeting the needs of people living with HIV with 25% of respondents saying that they would have nobody to help them if they needed assistance with everyday tasks. It also says that people living with HIV are facing discrimination from social care professionals.

Badby Park Group grows Complex care provider, Badby Park Group has acquired the South Park Care Centre in Darlington. The acquisition, for an undisclosed sum, marks the next stage in the growth of the award-winning group, which also owns Badby Park in Daventry, Adderley Green Care Centre in Stoke and The Bridge Neurological Care Centre in nearby Middlesbrough. The modern purpose-built care

home, which opened in 2008, will now undergo a substantial millionpound refurbishment to reduce the total number of bedrooms from 67 to 54, all fully en-suite. The renovation will provide enhanced space for accommodation, therapy, rehabilitation and leading edge care facilities. The updated service will welcome the first of its new residents in the summer of 2017.

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Mismatch in social care funding The County Councils Network (CCN) has warned that there is a fundamental mismatch in social care funding. The mismatch between funding and demand has meant that counties are now at a ‘significant crossroads’ that will determine whether life critical services are sustainable in the long term. Calling for a long-term solution which included ‘genuinely new funding’, it argues that measures to frontload the social care precept and redirect a small proportion of New Homes Bonus (NHB) provide only short-term relief. In its Local Government Finance Settlement (LGFS) submission, the CCN highlighted that the precept will only have a ‘nominal effect’, meaning many county authorities would be reluctant to implement the 3%

increase. In addition, some counties would be financially worse off by 2020 if they amended original plans to raise council tax by 2%, placing further burdens on rural residents to contribute to a ‘national crisis’. This use of reserves, or the precept, is not the long-term solution and will still leave councils reducing services next year, CCN argues, especially as counties remain underfunded compared to other local authorities, and face a 93% drop in core grants by 2020. County residents already face a ‘disproportionate’ council tax burden due to underfunding of social care, meaning that many counties are set to use already stretched reserves to dampen the impact of funding reductions next year with a view to a long-term solution.

24-7 Care Limited sold 24-7 Care Limited has been sold by DC Care for an undisclosed sum. The business, which includes residential and supported living units located in Wellingborough, Northamptonshire was acquired by the Chesterfield-based provider, Heathcotes Group. Commenting on the acquisition Mikkel Togsverd, Managing Director of Heathcotes Southern

said, ‘We are extremely pleased with the acquisition of the 24-7 Care. The company has a strong track record of achieving great outcomes for people with complex needs and challenging behaviours. The acquisition is a strategic fit geographically, because of the supported living services which complement our care homes and as a model we are exploring.’

Mental health of people with learning disabilities The National Institute for Health and Care Excellence (NICE) has published a new quality standard for the mental health of people with learning disabilities. It covers the prevention, assessment and management of mental health conditions in people with learning disabilities in all settings, including health and social care. It also covers family members, carers and care workers. NICE says that everyone with a learning disability should have their mental health checked annually

amid concerns that thousands may be undiagnosed. Experts acknowledge that mental health issues may be more difficult to diagnose for people with learning disabilities. NICE is recommending that everyone with a learning disability receives an annual health check, which includes a review of their mental health. In the UK, 40% of adults and 36% of children with learning disabilities are known to experience mental health issues at any point in time.

In focus Understanding social care costs WHAT’S THE STORY?

The Chartered Institute for Public Finance and Accountancy was commissioned by the Department of Health, the Local Government Association and the Association of Directors of Adult Social Services to co-ordinate the production of a practical guide to understanding costs in social care in agreement and consultation with the Care Provider Alliance. It is part of a joint programme to support implementation of The Care Act.


To make the guide as accessible as possible, while remaining relevant and useful to those who are more familiar with the concepts used, there are introductory overviews of some basic business concepts as well a glossary of terms. Although it is aimed at commissioners, it seems advisable for providers to be aware of the guidance and the way it has been developed.


The Care Act introduced new duties for local authorities in England to facilitate and shape a diverse, sustainable market for quality care and support in their local area. This new guide is intended for adult social care commissioners who wish to develop their understanding of the costs involved in providing care to help them meet these duties. The aim is to enable and equip commissioners with the knowledge and skills to support informed dialogue with providers in the interest of working toward agreed fee rates which are affordable, good value for money and support market sustainability.

Commissioners are considered to be increasingly skilled at ‘striking the delicate balance between making the most of limited resources and meeting the statutory requirements to shape sustainable care markets for their local populations’. This is leading to a growing wealth of experience which has been the basis for this guide. It was produced with input from local authority commissioners alongside providers. Through a series of joint events, a variety of examples of innovative approaches to costing emerged. Also, this collaborative process was used to identify means of generating efficiency savings in commissioning.



The guide has been written primarily for local authorities and a wide range of people in councils – both officers and elected members – who play a role in commissioning. Therefore, different professional backgrounds, different levels of experience, and varying levels of familiarity with accountancy, finance, business and economics terminology are to be expected.

This is, of course, the key question. It is positive that the guidance has been jointly produced by commissioning and provider bodies working together. The application of the guidance at a local level to ensure good practice in relationships and outcomes will be the real test. Only time will tell if attitudes (on both sides) will actually change. CMM March 2017 17


Care Act will fail without new money The Care Act will fail unless the Government announces new money for social care, councils are warning. In its submission to the Treasury ahead of the Spring Budget, the Local Government Association said the continued underfunding of social care is making it impossible for local authorities to fulfil their legal duties under the Care Act, leaving it on the brink of failing altogether and councils facing the prospect of court challenges. The LGA also said that the funding crisis in social care is threatening the very spirit of the legislation, which is about supporting people's wellbeing and helping them to stay well and live

dignified, independent lives. Councils say that if government does not urgently announce any new money for social care, then ministers need to be ‘honest and upfront’ with the public about the limitations of the care and support they can provide. In its Budget submission, the LGA is also calling on government to set out contingency plans to deal with major failure in the care provider market, with the lack of funding already causing some providers to hand contracts back to councils or cease trading altogether. The LGA says that an inability to support people to stay well and live independent lives would constitute a failure to meet the very spirit of

the Care Act, as well as its statutory duties, which could result in judicial review. Only 8% of directors of adult social care in councils say they are confident in their capacity to meet the full duties of the Care Act in the coming financial year, according to the latest ADASS Budget Survey. It has also urged the Government to use its recently announced review of health and care to consider new longterm solutions to secure the sustainability of care and support that includes genuinely new money rather than piecemeal measures that will not alleviate the social care crisis, with councils at the heart of that discussion.

Sight loss charities merge The Royal London Society for Blind People (RLSB) and Royal Society for Blind Children (RSBC) have merged. The merger represents a landmark moment for the sector. It allows the charity to forge ahead with its plans to grow its services on a national scale and fulfil its mission that ‘no child should grow up to be poor or lonely just because they are blind’. After forming an alliance in 2014, RLSB and RSBC will now conduct all its operations under the RSBC name, making clear its position in the sector as a charity focused on childhood sight loss and its negative impact on life chances.

Planning permission granted in Allied Health Professions into Buntingford Action LNT Care Developments has received planning permission to build a 66-bed care home on the site of the former Sainsbury's Depot in Buntingford. East Herts Council Planning Committee approved the

planning application. The facility will provide residential and dementia care for those over 65 years old. Construction is due to start February 2017, with a predicted completion date of January 2018.

Dementia Friendly Wales Consultation The Welsh Government is seeking views on developing and implementing a national dementia strategy, Together for a Dementia Friendly Wales 2017-2022. As part of the Welsh Government’s consultation on its future dementia

strategy, it is asking for feedback on the key themes and actions to be included in the strategy, services available for people living with dementia, and evidence of existing good practice. The consultation runs until 7th April 2017.

Jo Cox Commission on Loneliness The Jo Cox Commission on Loneliness has been launched by colleagues and family members of the murdered Labour MP, Jo Cox. The Former MP for Batley and Spen had started work on the cross-party campaign before she was killed. 18 CMM March 2017

The Commission will work to address the impact loneliness has on so many different sections of society. It will focus on the positive action we can all take to recognise it, build connections and help ourselves and/ or others.

England’s 145,000 allied health professionals (AHPs) are being encouraged to innovate and lead within the NHS and wider care system under a new shared commitment, published by NHS England. Allied Health Professions into Action has brought together the views of the third largest workforce in the health and care system, including chiropodists, dietitians, orthoptists, paramedics, physiotherapists, art therapists and speech and language therapists. It sets out how the 12 allied health professional groups across England can be at the forefront of innovative

changes to patient care and shape future health policy, by having full involvement in transformation plans being developed across the country. The new guidance aims to provide a blueprint for clinical commissioning groups, provider organisations, health leaders and local authorities to fully utilise and involve AHPs in transformation programmes and the delivery of NHS England’s Five Year Forward View. It offers 53 examples of AHPs working to drive and support change by working innovatively, and a framework to help utilise AHPs in the development and delivery of transformation planning.

Discussion papers on Housing Choices NDTi has published the first of four discussion papers on Housing Choices. Housing Choices: Exploring and comparing the characteristics of housing and support arrangements for people with care and support needs discusses the evidence for the cost or cost-effectiveness of

housing and support options. It provides a summary of the evidence available on the costeffectiveness of residential care and other housing and support options and highlights some significant limitations in the evidence available.

Employers - if you’ve got staff on different contracts, automatic enrolment doesn’t need to be complicated. It takes just five minutes to find out if you need to offer your staff a workplace pension. Find help and get to know your responsibilities by using our Duties Checker at Don’t ignore the Workplace Pension. It’s the law.

Final tranche of employers:


I’m a small employer and am yet to implement my workplace pension scheme. What do I have to do?


Charles Counsell, Executive Director of Automatic Enrolment, The Pensions Regulator

This year, around 700,000 employers will see the start of their workplace pensions duties and this will include care sector employers. Under the law, all employers must put certain staff into a workplace pension and make contributions into it. The roll out of automatic enrolment started in 2012 and this year marks the 20 CMM March 2017

largest number of employers to see their duties start. If your duties have not already come into effect, you are likely to see them start this year. There are around 8,500 employers who manage care homes across the UK and like many sectors who have temporary, part time and lower paid staff, the care sector is one that is at risk of failing to meet their legal duties. This is because employers may wrongly assume they will not have duties in respect of these types of staff and are unclear how the law affects them. While we know the vast majority of employers want to do the right thing for their staff, there will be some employers who do not

relish the task. We also recognise the care sector has unique challenges, including financial pressures, and that it has many other statutory duties to meet and regulations to abide by. However, automatic enrolment is the law and applies to all employers, including people who run all types of care facilities. Workplace saving is now the norm and staff expect to save for a pension. The Pensions Regulator (TPR) is responsible for ensuring employers comply with the law. It provides plenty of information and tools to help employers understand how the law applies to them and what they need to do to comply, so that staff get the pensions they are entitled to.

WHEN DO I NEED TO IMPLEMENT AUTOMATIC ENROLMENT? Every employer has a staging date which is a date set in law and is specific to them. It is when their workplace pensions duties start. TPR recommends that employers start preparing for automatic enrolment 12 months before their staging date. This means you will have time to understand how the law applies to your business and to meet your deadline to comply. TPR will write to you well in advance of your staging date so that you have enough time to get your plans in place. The communications include an essential guide. Don’t ignore communications from TPR as all employers will have duties. You can also check when your duties start by heading to TPR’s online Duties Checker tool. Larger employers have already passed their staging dates, as well as a number of smaller employers, including those who run care homes. Others should now be


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well underway with their plans. The majority of small employers, however, will see their duties start over the coming 12 months.

WHAT DO I HAVE TO DO TO MEET MY WORKPLACE PENSIONS DUTIES? Your workplace pensions duties will vary depending on whether or not you have staff to put into a pension. Using TPR’s Duties Checker takes just five minutes and you will be able to find out what you will need to do and when. Broadly, you will need to check which staff must be put into a pension. These are staff who are aged 22 and over and under State Pension Age, who earn more than £10,000 a year or £192 a week. You must write to all your staff individually to tell them how automatic enrolment applies to them. Even if a member of staff is not eligible for automatic enrolment, you must write to them so that they have the option to join a pension. To help employers with this task, TPR provides template letters on its website. If you have staff who must be automatically enrolled, you will need to choose a pension scheme that can be used for automatic enrolment. TPR has easy-to-understand information about which schemes employers can use, including a list of providers that employers can choose from. There is also a checklist of questions you should ask potential pension providers. Choosing a scheme need not be difficult, but you should leave enough time to make your decision so that you choose a scheme that is right for your organisation and your staff. More information about choosing a pension can be found on the TPR website. You will also need to ensure the payroll software you use is suitable for automatic enrolment and is

compatible with your chosen pension scheme. If someone else is managing automatic enrolment for you, you can nominate them as an additional contact with TPR. This person will receive tailored information from TPR. Just make sure TPR has the right contact details for you and anyone assisting you. Five months after your staging date, you must complete and submit a declaration of compliance. Do not forget to do this as it is a legal requirement and tells TPR what you have done to meet your duties.

HOW LONG DOES AUTOMATIC ENROLMENT TAKE AND HOW MUCH WILL IT COST? Smaller employers TPR spoke to spent around 10 hours over a 12-month period before their staging date, carrying out their automatic enrolment tasks. These employers said that taking the time to first read the step-by-step guide on the TPR website saved them time overall. The time and cost of automatic enrolment will vary from employer to employer, TPR research of microemployers – with between one and four staff – showed that 60% of them had no set-up costs. Those that used a business adviser paid around £400. Set-up costs will depend on various things, including whether and how you use a business adviser, how you run your payroll and which pension scheme you choose. Costs will also vary if you have more staff, as some providers or business advisers may charge based on the number of staff. Costs may also vary depending on where your business is based. More information on understanding your costs can be found on the TPR website. There is a risk of paying more if you leave your plans to the last minute, so

allow plenty of time to shop around for providers and services, so that you find a scheme that is right for your business and your staff. It is also worth noting that there is no financial benefit to complying late. Employers who fail to comply by their deadline will need to pay any outstanding contributions back into the scheme so that staff do not lose out.

WHAT HAPPENS IF I DON’T COMPLY? TPR takes an educate and enable approach and wants to help employers meet their duties. However, it will use its enforcement powers where an employer ignores their duties and is deliberately noncompliant. When TPR becomes aware an employer is non-compliant, it usually sends a compliance notice. This tells the employer what they need to do to comply and sets a deadline for action. Failure to act may lead to a fixed penalty notice, which is a £400 fine. It is worth noting that even if you subsequently go on to meet your duties, you will still have to pay the fine. Employers who continue to fail to meet their duties are at risk of an escalating penalty notice. This means they will have a deadline to comply before the start of a daily fine. This is between £50 and £10,000 a day, depending on the size of the employer. The vast majority of noncompliance is because employers have left tasks to the last minute, so it is essential to start planning in good time. If you find that you have missed your staging date or are concerned that you will not meet your duties on time you should contact TPR immediately – don’t wait for a fine. More information on what happens if you don’t comply can be found on the TPR website. CMM

case study Paul Taylor, who is the registered provider of the Ingham House Care home in Eastbourne, put 16 staff into a workplace pension in 2015. He said that automatic enrolment was now ‘second nature’ and ‘just part of the payroll process’. He stressed, however, that getting ready for the legal duties could not be left to the last minute, ‘It’s not something you can sit down and do on the day or in a couple of hours. You need to prepare, you need to plan.’ Mr Taylor, who now has 31 staff out of 37 automatically enrolled, also urged other care providers not to put their head in the sand. ‘If you’re a small employer and you think you’ll get overlooked – it’s not going to happen. You need to attack it head on.’ When starting the process, Mr Taylor said that while he considered paying for outside advice, he decided to implement and manage automatic enrolment in-house. He began by choosing his pension scheme and software provider, ‘We looked for a good scheme and a good payroll provider that offered support.’ He also advised other employers in the care sector to ensure their pension scheme and payroll software were compatible and to use automated systems. Mr Taylor also stressed the benefits of automatic enrolment for staff, ‘It’s virtually effortless for staff – it’s harder to opt out than it is to stay in. As an employer, you are contributing – for every pound they put in, you are also putting in. Automatic enrolment catches people that wouldn’t ordinarily be paying into a workplace pension and I am pleased as an employer that my staff are benefitting in this way.’

Charles Counsell is Executive Director of Automatic Enrolment at The Pensions Regulator. Email: Twitter: @TPRgovuk Web: For additional resources and an interview with a provider who has auto-enrolled, visit Subscription required. CMM March 2017 23

GETTING YOUR HOUSE IN ORDER CONTRACT GOVERNANCE IN SOCIAL CARE Care providers can make efficiencies and avoid costly sanctions by having clarity around contractual issues. Emma Young looks at contractual governance in social care and why you should get your house in order.

24 CMM March 2017

The financial crisis faced by the care sector has reached tipping point. Despite a recent decision by Communities Secretary, Sajid Javid, to allow councils to raise extra funds through increasing the dedicated social care precept allowance to 3%, it’s clear this is not enough to solve the crisis. Successive opportunities for the Conservative Government to truly take a stand on health and social care have been and gone. First there was the Party

conference, in which Prime Minister Theresa May neglected to mention social care in her 7,000 word speech. To make matters worse, David Mowat, the Minister for Social Care, even turned down an invitation to attend the main social care fringe event at the conference, organised by the Care and Support Alliance (CSA). Local government is acutely aware of the funding black hole, with the Association of Directors of Adult Social Services saying ÂŁ1.6bn

is needed just to keep care at the same level it is and, given that social care providers now also have to find funding for a 30p rise in the National Living Wage, care providers are under greater pressure than ever to stay out of the red. Not surprisingly, the industry as a whole is feeling the pinch. From September 2010 to July 2016, the total number of care homes in England has fallen from over 18,000 to just over 16,600, according to the Care Quality Commission. Research published in CMM February reported that one in four care homes is at risk of going out of business.

As overheads rise and significant government intervention remains absent, action must be taken by providers themselves to secure finances, improve cashflow and ensure there is enough money in the bank. Providers have no choice but to react to the situation they find themselves in, and this begins by examining their own practices. Businesses must open up new financial channels and streamline existing ones.

IMPROVING EFFICIENCIES One way in which providers can

begin to shore up the books is to look at how they currently manage their contracts and see what can be done to improve efficiency. Although this may cost a little initially, the rewards outweigh the investment very quickly and save the costs of pursuing or repeatedly having to write-off bad debts. Failure to have appropriate contractual terms and clear systems in place leaves providers wide open to abuse, at risk of losing money and exposes them to sanctions and fines by the regulators – both the Care Quality Commission (CQC) and the Competition and Markets Authority

(CMA). Three key elements to securing a robust system are having: 1) A clear communication strategy, 2) Enforceable contractual provisions, and 3) An enabling culture to support managers or administrators in asserting rights and interests in an appropriate way.

COMMUNICATION Some providers aren’t transparent in terms of their pricing structures. Given the competition, it is understandable that care homes may not want to, for example,


CMM March 2017 25



provide fee rates online, but it is increasingly important to be more upfront about what the real costs of care will be and how these may be met in the longer term. Issues to be clear about right from the start with a client, whether an individual, local authority, clinical commissioning group or other party, include the status of the placement (eg continuing healthcare (CHC), nursing care, respite, etc), the impact of the 12-week property disregard on the placement, and whether a topup arrangement is permitted in the particular circumstances. In addition, it is imperative that the responsibility for recovery of payment and the potential consequences of any change in circumstances, such as

families in accessing sound financial advice as well as supporting them in asserting their right to public funding and other benefits (CHC, etc). Providing managers or administrators with access to template letters and checklists to support existing policies on these matters is a practical means of ensuring the salient points get picked up.

CONTRACT TERMS Next, it is important that contract terms are transparent and understood by the client. A wellcrafted contract means that not only are issues such as fees addressed, but the resident and their families are assured about the standard of care

“Not only are there significant financial incentives to having robust terms in place, there is increasing scrutiny on contracts in the care sector.” care needs or finances, are also outlined and properly understood. Businesses should have a clear communications plan that outlines who is being talked to – the resident, their representative, a person making a top-up payment or the commissioner who has placed them, how it is known if the person has the means to pay the fee or a top-up for a reasonable period and what the policy is when the money runs out. All communications should be open, in accessible language and any considerations about the resident’s mental capacity (both at the time of entering a home and in the future) should be addressed head on. Care providers can do a great deal to support individuals and their

and support that is being provided, as well as managing expectations around the scope of the package. The whole process of entering into contractual arrangements should uncover any issues early on and allow the parties to resolve these before problems crystallise. The importance of well-written and enforceable agreements cannot be underestimated from a financial perspective. This makes sense for everyone involved, but for the provider it is essential that it is able to secure prompt payment – fees of many thousands of pounds stack up fast and it is simply wrong for some residents to subsidise those who are not meeting the financial commitment that they signed up to.

Make sure, therefore, that there is full understanding of all terms relating to fees, especially how they are increased and the impact on topup arrangements; notice provisions, especially the circumstances in which the home can ask the resident to leave; and the management of changing care needs and the consequences for the resident and provider. Not only are there significant financial incentives to having robust terms in place, there is increasing scrutiny on contracts in the care sector. These must comply with consumer rights regulations and be written in plain English. The CMA has recently announced an inquiry into reports of ‘potentially unfair practices and contract terms being used by some care homes’. This is on top of the obligations under CQC’s regulatory framework which require care homes to provide terms and conditions for residents, wherever possible, before the individual enters the home. The sanctions that flow from failure to meet these requirements, not to mention the reputational damage this could involve, mean providers can’t afford to get contract governance wrong.

ENABLING CULTURE Lastly, look to management. Managers are quite properly focused on the quality of care the home provides, but they should also focus on the finances. It is vital that dayto-day responsibility for applying and managing the organisation’s policies sits with the manager and that they are up to speed with processes and are applying them in the necessary manner. Again, managers already have considerable administrative workloads, but they need to understand the importance of contract governance and keeping proper records of financial arrangements with residents. This is particularly important given the

paper trail may need to last longer than their own tenure with the business or time at a specific site. Simple procedures that can be introduced range from straightforward checklists signed by the manager to ensure all relevant information (both in terms of care needs, capacity and finances) has been brought to the resident’s attention, to clear policies that provide a framework for managers to make judgements, particularly around the minimum level of fee it is acceptable to agree in any particular circumstance.

SUFFICIENT KNOWLEDGE Of course, managers are not lawyers, and it would be unrealistic to expect them to understand complex legal frameworks. Briefing notes on difficult issues, such as understanding the legal status of a particular ‘representation’, dealing with residents who may lose capacity during their stay, assessing capacity to sign the contract and the right to remain in the home (at the private rate) if their money runs out, should be provided to ensure managers are well-prepared to deal with common circumstances. To bring all this together, providers need to foster an enabling culture that builds confidence in its managers and other administrators. In this context, what is sometimes neglected but should be at the centre of operations is training. Managers need to have sufficient knowledge of policies and procedures, the relevant regulations and legislative framework and support in dealing with difficult situations, for example, through roleplay or other innovative methods. While it may seem that the initial outlay in getting these points in place may be expensive, investment around these issues will undoubtedly be crucial to achieve sustainability in the long term. CMM

Emma Young is Senior Associate at Anthony Collins Solicitors. Email: Twitter: @ACSLLP What governance processes do you have in place? Share your thoughts on the CMM website Subscription required. 26 CMM March 2017

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NEW SUPPORTED LIVING FUND There’s a new £100m supported living investment fund looking to expand provision in the sector, is it the boost providers, commissioners and people with learning disabilities need? Specialist supported housing supports people with learning disabilities or physical disabilities to live independently, within their communities, with security of tenure and care and support as required. Its growth began in 2001, with the Government’s White Paper Valuing People. It pledged to transform services and enable people to lead full and independent lives. Further Government policy has built on this and local authorities have followed, with some significantly reducing the amount of residential care being commissioned for people with learning disabilities. The sector has responded by shifting services towards supported living, although it hasn’t been without its issues. These include different funding streams, ever-decreasing local authority budgets, considerations around regulation and concerns of isolation. Although provision has steadily increased, in October 2016, Rob Grieg, Chief Executive of NDTi wrote in the Guardian that he was aware of policy coming full circle, back to residential care. He wrote, ‘commissioners have started to move back to a residential care model on supposed cost grounds’. He cited a consultation in Rochdale, ‘which seeks a £1.4m saving by “transforming” supported living provision and replacing it with a range of residential care and other services.’ Despite these pressures, for those looking to commission, operate or live in supported living, there’s a new pipeline of money for development to help increase supply.

NEW INVESTMENT FUND The Supported Housing Investment Limited Partnership (SHIP) is a new joint venture between USS, one of 28 CMM March 2017

the largest pension schemes in the UK, and Morgan Sindall Investments (MSIL), a developer and investor that works in strategic joint ventures with the public sector. The joint venture has committed £100m to drive forward and expand the future pipeline of supported living. The fund is predominantly for investment in HB Villages, a specialist developer of purpose-built supported living apartments for vulnerable adults with learning and/ or physical disabilities. MSIL owns a 50% stake in HB Villages. However, it does create opportunities for other developers, as well as providers, to work with HB Villages. Richard Dixon, Director of MSIL explained the intentions for the fund, ‘Although the primary focus is on HB Villages and providing it with the capital it needs to drive forward and expand its development pipeline, SHIP also has the ability in appropriate circumstances to invest in good quality portfolios of specialist supported housing that have been delivered by other developers and investors.’ USS, as an investor, looks for long-term, stable returns.

HB VILLAGES HB Villages was set up as a strategic national response to what the company says is, ‘the widely acknowledged undersupply of “fitfor-purpose” housing for vulnerable people, enabling them to lead better and more independent lives.’ Its model provides purpose-built accommodation for vulnerable adults with learning or physical disabilities. The accommodation is designed to provide individuals with a greater level of independence and the ability to live in their own home, whilst receiving the care and support that they require. Integration

and inclusion in community life is encouraged, along with the development of skills that enable greater independence (supported by the care provider). HB Villages has delivered hundreds of apartments in 30 towns across England, valued at around £70m. It also has a £100m live development pipeline of apartments in planning or construction – with a significant proportion being built by MSIL’s sister companies, Lovell Partnerships Limited and Morgan Sindall Construction and Infrastructure Limited. MSIL’s property and asset management business, Community Solutions, will manage the portfolio of future schemes which SHIP invests in. HB Villages’ schemes are commissioned by councils and clinical commissioning groups where significant local need has been identified. Once constructed, the properties are leased to partner housing associations on a longterm basis. The schemes are 100% privately-financed. Investors receive a return based on rental income, so as an investment proposition, Richard explained, ‘it is particularly suitable for long-term investors, such as significant UK pension funds like USS’. The schemes bring together high-quality bespoke housing, personalised adaptive technology and person-centred support in a single integrated model. The HB Villages team works in partnership with registered social landlords, care providers and commissioners, including Inclusion Housing, Lifeways and technology provider, ATEL. The new fund and the expansion it brings will increase opportunities for other providers to be involved. Richard continued, ‘HB Villages is already working with a number of

registered social landlords and care providers…and it is keen to work with other high-quality providers to ensure that the right type of specialist supported housing and the associated care packages are delivered for local communities.’

DRIVING DEMAND SHIP sees long-term demand for supported living. Richard explained more, ‘As attitudes and government policy towards care have changed, to move increasingly in favour of greater independence, demand for purpose-built accommodation in the form of adapted apartments has grown rapidly. ‘Specialist supported housing provides a cost-effective alternative to residential care. The fixed costs associated with specialist supported housing are lower than residential care homes, so too is the cost to the taxpayer. The relevance of this solution is particularly acute in the current context where local authorities are coming under severe pressure to fund the costs of care for the vulnerable and elderly in the communities they serve.’ CMM

OVER TO THE EXPERTS... Is this dedicated investment in supported living welcomed? Will it create more opportunities for people to live independently? Is there sufficient demand for this additional supported living provision? Will it create opportunities for care providers? Will it face barriers with certain local authority strategies? Could this increase in the supported living pipeline put residential care at risk or is there sufficient demand for both types of provision?

GOOD TO SEE MONEY, BUT HOW FAR WILL IT GO? People with learning disabilities want to be more independent and so it’s good to see more money for supported living because supported living gives people more choice and control over their lives. However, I worry about how far this money will go. Social care is facing a huge funding crisis and, compared to this, £100 million seems like a drop in the ocean. Whether this works depends on whether people with learning disabilities and families are involved in making the decisions. People with learning disabilities and families should work in partnership with providers and commissioners and be involved with the planning. Only the people who are going to use that funding know how it should be spent. Some local authorities are moving away from supported living and are trying to take us back in time to when there was only


residential care and people with learning disabilities were kept away from their communities. This is what is happening in Rochdale and other local authorities may want to do the same because of cuts. This is wrong. We know that independent living is not ‘too expensive’. What’s expensive is creating the wrong housing for people with learning disabilities and then having to change it later on. Every person with a learning disability should be able to choose how they live, where they live and how they are supported. For me personally, as a person with a learning disability, I feel residential care is a step backwards. So I think it’s good that this money will be used to help people live more independently within their communities.

Gary Bourlet Co-Founder, Learning Disability England

Whilst this dedicated investment can only be welcomed, I believe that its impact will, sadly, be negligible. Currently, there’s a high level of uncertainty around tenants’ future ability to claim sufficient levels of Housing Benefit (HB) to meet rent levels of schemes like this. The Government’s Local Housing Allowance (LHA) cut announcement made the provision of new supported housing considerably more difficult. The provision of new schemes substantially reduced immediately following this and hasn’t recovered. In an attempt to ‘unblock’ the system, the Government published a consultation on the future funding of supported housing. It says that HB for supported housing tenants will be limited to LHA levels. It also announced a devolved local ‘top-up fund’ to bridge the gap between the extra costs of supported housing over and above the LHA cap, to be administered by local authorities. Experience tells us that such ‘funds’

are seldom sufficient to meet local needs and councils don’t always use them as intended. Schemes like this will need to charge rent in excess of LHA levels. As attractive as an investment of £100m may seem, most providers and local authorities will be wary. Understandably, Pension Funds need to protect their investments, rents need to be guaranteed. Although the proposed changes to HB will not come into effect until 2019, the worst-case scenario for providers (and councils, if they share risks) is that, if HB/local top-up funding is insufficient, they could be left with the liability for increasing numbers of unlettable voids for 20 years or more. SHIP is a good potential source of funding that could provide muchneeded homes, but the Government needs to provide assurance about the future of long-term funding.

Steven Rose Chief Executive, Choice Support

INVESTMENT AND INNOVATION IN PROVISION IS WELCOME Over the years, mainstream models of care have changed considerably. The supported living model has continued to increase its presence in the market and remains a popular area of growth for many of our clients. Legally, in supported living services, there must be a clear separation between the care provided and the accommodation. Some service users are attracted to the model due to the security of tenure of accommodation and the ability to exercise choice over who provides their care – meaning that service users can retain some independence and control, compared to a traditional care home placement. However, those factors can also present challenges for providers, who need to consider the practical implications and how to address situations where, for example, individuals lack the capacity to enter a tenancy agreement or need to be deprived of their liberty in order to receive care.

Both the demand and supply of supported living services has continued to grow over recent years. However, this type of service is not suitable for everyone and there continues to be a need for traditional care homes also. Personalisation requires consideration of how the needs of each individual can best be met, rather than a blanket preference towards any one model of care. Any investment in improving the provision of care services in the sector is welcome. Innovation of new, good quality, fit-for-purpose services remains imperative. This will also be welcome news to local authorities, which are required by the Care Act to help develop a market that delivers a wide range of sustainable highquality care services, which will give people more control and help them to make more effective and personalised choices over their care.

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RAINASUMMERSON Raina Summerson is Group Chief Executive of Agincare.

REFLECTIONS ON THE LAST DECADE We recently launched the Agincare Health and Social Care Academy. As part of that work, we built a portfolio of ‘careers in care’ and the huge variety of current roles, and the routes people have taken in their health and social care careers, reflecting some of the changes over the last decade. A decade ago, we were operating across limited locations with about 700 staff. We were growing rapidly, largely through successful bids on local authority contracts. Commissioners were learning about how to commission wider care services from the independent sector, contracts were lengthy and mainly block arrangements. Our meals on wheels service was providing a valuable preventative service for thousands. We were one of the few organisations providing live-in care with a dedicated team. Our ‘Agincare journey’ reflects the significant changes over the last decade. Austerity measures triggered kneejerk behaviours from the main ‘purchasers’ (local authorities), the impact of which were far-reaching and remain today. Contracts for meals on wheels is a barometer of this, with few remaining and most major providers no longer operating as it is simply unviable; we heavily subsidised several services before having to cease. Local authorities started driving prices down (though expectations up) amongst desperate measures to fulfil required budget cuts. There was demand for low

prices but without guarantees or block payment. The ageing population led to investment in ‘the market’, risking care being seen as a commodity to trade in and fuelling criticism and generalisation of ‘greedy’ private providers. The cost of care continued to rise due to external pressures, more expensive administrative requirements and complexity of service delivery. Recruitment and retention at all levels became a national problem for many reasons: demographic, pay, diminishing job satisfaction with increased risks, a blame culture and negative stereotyping. Due to such issues, all roles within social care have become more complex and difficult, so it makes me incredibly proud to have so many staff who have grown and developed with Agincare over this time. The diversity of our team, the vast array of skills and experience and the passion and commitment shown to social care despite its many challenges never ceases to amaze me. PROJECTIONS FOR THE NEXT DECADE The social care crisis is not close to being addressed and may not yet have reached rock bottom. There will be more failing providers, more people with unmet needs, and ongoing problems with attracting workforce and adequate funding arrangements for a decent system that meets the needs of society. Brexit presents potential risks to us in respect of

political attention, government priority and workforce supply. The many challenges for the sector are written about almost daily. However, times of crisis often bring opportunities. There will be opportunities to change outdated ways of working, for partnership working and collaboration, for wider recognition of shared needs and outcomes, even improved public awareness raising and responsibility. Agincare now operates from over 50 locations, across two groups: home based community services and care home services, with over 3,000 staff. We provide a vast array of services, including carers’ respite, extra care, support and care into prisons, live-in care, discharge to assess services, reablement, intermediate care and nursing care. We have developed partnerships looking to provide adaptable and responsive services. Our team has lobbied hard, and will continue to do so, for social care and our workforce to get wider recognition. We have demonstrated that we always want to give more and better, whatever the conditions, and that we can continue to flourish, thinking creatively about, not just survival, but positive change and growth. There is no doubt that the coming decade will bring worry, continued challenges and tough decisions. But, as ever, it will also bring moments of real fun, immense satisfaction, reward and great experiences with amazing people. CMM

Read Raina's full interview and her typical day on the CMM website Subscription required. CMM March 2017 31


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CARE MANAGER Paul Blane explores what’s needed from a modern manager and why it’s time to invest in them to invest in your business. What does the modern care manager look like? It’s a question that many operators seek to answer because, if you have the wrong type, then your business will deliver the wrong outcome. Too often our care manager is not ‘modern’ at all; yes they are loyal, caring, committed to working long hours and a real ‘hands-on’ person, but


CMM March 2017 33



are these really the ingredients needed in a modernised care world? There is no doubt that there are years of management experience within the industry. In my time, I have encountered many managers who remember the days of local authorities being the inspection body, the birth of the National Minimum Standards, the Health and Social Care Act and Care Quality Commission. Indeed, I have concluded that these people have been there and done it, by rising through the ranks.

WE NEED PROBLEM SOLVERS Whilst the experience is great, it is not the answer. The answer lies in the attitude and that is where we must really turn our attention. Managers must embrace the changing times that the modern world has brought us. They can’t afford to continue with the same old statements – ‘there is no time’, ‘we are under-staffed’, ‘I tried to recruit but no-one wants a job’, ‘it’s because of the pay’. Simply, managers must become the problem solvers. It is important to realise that, if the above statements are the opinion of the manager, what message does that deliver to the care team? Are they the ones who accepted low pay when the rest of the country would not, should there be more staff to help, is there no time to do all the jobs, so why bother? All of these are negative and negativity breeds negativity.

MONEY ISN’T EVERYTHING Although the analogy is a little old now, given their current performance, Leicester City won the Premiership Football League last season with an overall weekly salary bill equivalent to the salary of just three of Manchester United’s players. Do you think they did that by believing that other clubs had better players, were paid more money and had better facilities? No. They believed that they had the best team of players, the best fans, the best stadium and they set their sights high: to win the Premiership. That was the goal of the manager and his job was to instil a belief that made the players determined to achieve; in other words, he believed that positivity bred positivity. Flipping this back to Manchester United, who did not win the league, what did they do? The answer is that they had to reflect at the end of the season. They realised that they had listened

to negative statements from individual players declaring that the team was not good enough to win the league. They saw a fantastic stadium half empty, fans who did not believe and a manager publicly stating that people had to realise that Manchester United was not the team it once was. Ultimately, they came to the conclusion that every part of their business plan would be jeopardised if they did not dismiss the manager and bring in someone who could bring back belief and achievement. You may think that your care operation is a million miles from the worlds of Manchester United and Leicester, but is it really? Leicester, at odds of 500-1, wanted to win the Premiership; I wonder what odds you would give for your organisation to achieve ‘Outstanding’ in your CQC inspection report 12 months from now. Then ask yourself: would I place a bet? If not, then why not? You’re now reflecting, which is exactly what Manchester United did.

ACHIEVING YOUR POTENTIAL Before you go dismissing your care manager, it is important to realise that it is often the case that they are good enough, but it is lack of investment by the operator that means they do not achieve their potential. How can a manager possibly know how to achieve ‘Outstanding’ if they have never been shown what it looks like? How can they achieve ‘Outstanding’ if they do not have a plan in place to do so? It’s a simple question and one you should ask yourself and your care manager. If they, or you, cannot produce a plan immediately, then you are not ready to achieve. Take the time to read an ‘Outstanding’ report and then compare it to yours. It is essential that we begin to equip managers with the skills and tools to plan the future and ensure that the whole team believes in that future and knows what success looks like. The Registered Manager’s Award is not adequate as investment. Managers need meaningful support and mentoring, supervisions and appraisals; they need management training. If they are the lead that the team must follow, then let’s make sure they are going the correct way. The most critical part of your business plan is your care manager, yet it is the area we tend to invest in least. The modern manager must understand the importance of the CQC Report and how it can affect the business plan and the business. Currently, anecdotal evidence is

highlighting that banks want to do business with providers that are ‘Good’ in four of the five areas CQC inspects. Insurance companies are said to be charging higher premiums to businesses who ‘Require Improvement’ and, in some cases, have refused to insure those who are ‘Inadequate’. We have seen an increase in local newspaper and social media articles highlighting operators who receive less than ‘Good’; these are causing negative stories within your local communities, right from where you are trying to recruit your staff.

LEADERSHIP Within the CQC’s The State of Health Care and Adult Social Care 2015/16 report, the word ‘Leadership’ is used 71 times. This is no coincidence. Leaders that deliver ‘Good’ or ‘Outstanding’ services have better staff retention, higher occupancy and better opportunity for growth than those who receive ‘Requires Improvement’ or ‘Inadequate’. It is because of this that our managers must make time to get this right. Your internal inspection should start today. Are you ‘Safe’, ‘Effective’, ‘Responsive’, ‘Caring’ and ‘Well-Led’? Why wait for the inspector to tell you when you can seek to find the evidence yourself? It’s all about the big data, finding out the information that allows you to make informed decisions. Are you compliant with your staff training needs? Can you send instant information to the team? Do staff have access to information around the clock, bearing in mind we deliver 24hour care? Are your clients happy? How do you know? Is your team competent to carry out their roles? Where is the evidence? There are so many questions to ask, but without the answers you will continue to do what you did yesterday, and the day before. The modern-day manager must plan for the future, not the past.

ACHIEVE GREAT THINGS Our care managers should realise their potential. In a world where big care businesses crave ‘Outstanding’, what price is put on the manager who achieves this? The world of care management is similar to any other market, if the manager wants to achieve great things they will make it work; if they don’t, then they won’t. What they are deciding is your future; you might want to discover what they have planned. CMM

Paul Blane is Director of Training Services at Affinity Training/eLearning For You. Email: Twitter: @Affinity_Paul How do you value your managers? Share your thoughts on the CMM website Subscription required. 34 CMM March 2017

Deputy Managers West Sussex We are looking for skilled and enthusiastic Deputy Managers, to join our wonderfully talented team. Providing specialist care for people with learning difficulties, physical disabilities, neurological conditions and care for older people, Sussex Health Care has almost 20 homes, providing almost 550 beds.

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Social care and health:

Ways to work collaboratively Care providers need to work more closely with health partners; it can have benefits for all involved. Harnoop Atkar shares his experience of a proactive approach to collaborative working with health and what you may be able to emulate.

The ‘crisis’ facing both health and social care is having a considerable impact on older people, as some of the most vulnerable members of society. While politicians look at how to alleviate the pressure on services, there is a significant role care homes can play now. Residential care has, in the past, been regarded as the ‘Cinderella service’ separate to, and apart from, other community-based or acute services. However, with an ageing population whose experience of limiting and long-

term conditions is increasing, residential and nursing care services are playing a greater role. This means that they need to work more closely with health to support people and create solutions to ease the pressure in the system. The first steps are already being taken. Enhanced Health in Care Homes (EHCH) is one of the new care models set out in the NHS’ Five Year Forward View. The aim of EHCH is to tackle the disconnect between care, health and rehabilitation services to improve


CMM March 2017 37


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health outcomes for those in residential care. While the framework to achieve this joined-up approach, developed following the experiences of ‘vanguard’ projects across England, was published last September, it is currently just an option for clinical commissioning groups (CCGs) and local authorities to commission. In the meantime, care home operators can be proactive in developing their own mutually beneficial relationships with primary care services.

WORKING WITH GPS Care homes’ links with GP services have, and continue to have, their share of tension, but there can be great benefit to both sides in negotiating a working practice. The majority of residents in a care home are likely to be registered with the local GP surgery. The doctors there are known to them and have an understanding of the person’s history. This is particularly important when supporting elderly patients with complex needs or cognitive impairments, such as dementia. Visits to homes to see individual residents can be time-consuming for GPs and escorted visits to appointments in surgeries impact on available resources for home managers. As such, establishing a weekly ‘clinic’ at a care home can be an efficient use of time and resources for both parties. We are finding this arrangement at our Loughton-based home, Woodland Grove, is resulting in residents’ care being better managed. With regular access to GPs, issues can be monitored and referrals to secondary care are greatly reduced. Of course, the resources available to GPs to provide services to care homes vary greatly. However, strong relationships with local practices help to develop the will and the understanding of the benefits to all concerned. Greater involvement with CCGs is another way forward for independent care providers, as an increasing number

of CCGs are taking on the full or joint commissioning of GP services.

EASING PRIMARY CARE PRESSURES Residential care also plays an increasingly beneficial role in easing the demand on hospital beds that winter and other pressures bring. With unprecedented levels of demand on NHS services, particularly in A&E, winter pressure bed contracts with CCGs can be mutually beneficial. A care home bed has the potential to represent around a 50% saving on a stay in hospital. Given this is such a significant amount, it is surprising that there have not been more examples of the NHS and care homes working together. In our experience, these contracts become transition beds for those who no longer need hospital care, but are not yet ready to go home. This means that the hospitals taking advantage of these beds can reduce the instances of delayed transfers of care that they experience and improve system flow. Care homes benefit from a fixed source of income and a known number of occupants that resources can be planned for. However, the challenges come in deciding how many beds to make available and managing the end of a contract to minimise wastage of resources. As part of our commitment to connected services, we issue a weekly bulletin to local CCGs highlighting bed availability for these arrangements. This ad-hoc approach is not ideal and it would be far better if there was a framework for us to feed into. However, it is better than nothing at all.

KNOWLEDGE SHARING Collaborative working can also help to increase primary care services’ understanding of residential care and the needs of people living in it. This includes the fact that residents often have complex health needs and multiple medications. There is also an opportunity

for care providers to help develop primary care’s understanding of the sector and its clients at the earliest stage and become involved in the education of its staff. To help with this, we are working in partnership with universities to develop a nursing excellence programme. Students will be offered a placement as part of their degree course working at our homes to get a good understanding of the care of older people. This knowledge can then be shared, whether they work in primary or secondary healthcare, or within the care sector itself and, therefore, improve the way in which nurses gain a more holistic view of primary and social care. Having well-qualified and well-trained staff within care homes improves their ability to act as a primary triage service within homes, minimising the need for contact with community health services. It also allows for more effective communication with external teams. Staff are more confident in their knowledge and their professionalism, which ultimately leads to a better outcome for residents.

LIMITED BY FUNDING It must be acknowledged that the care sector’s ability to adapt its working practices and invest time and resources into collaboration is currently limited by the funding crisis. Although an additional £101m was announced in December to help spread EHCH and the other new care model vanguards, the sector really needs to see investment from the Better Care Fund now, to develop a long-term strategic view of how care homes and community health services can work together to the benefit of those that need them most. Whatever the wider situation, building relationships and having positive conversations with those most closely involved with your home can bring significant benefit for little outlay, and strengthen your position in readiness for a joined-up approach to health and social care provision. CMM

Harnoop Atkar is Chief Executive Officer of Oakland Primecare. Email: Do you work in collaboration with health? Share your experiences at Subscription required. CMM March 2017 39

Care sector employment law WHAT YOU NEED TO KNOW Melanie Stancliffe considers some of the main areas of employment law that affect the sector.

including flexible working; minimum wage requirements; working time arrangements; and holiday pay calculations.

With Skills for Care estimating the social care workforce to be 1.48 million and that it will need to increase to meet demand for services over the coming years, social care is one of the UK’s largest and most complex from an employment law perspective. There is an array of complicated issues for employers to contend with,

Most businesses function on the basis of the flexible working hours of their staff. This is vital to enable you to meet the needs of your business and to operate profitably. Looking at it from the point of view of employees, many will need some flexibility at some stage in their career – whether it’s due to family commitments or lifestyle choices. In

40 CMM March 2017


an industry reliant on staff working shifts and not the traditional 9 to 5, with a large proportion of female workers, there are considerable advantages to flexible working. Offering flexible working can have an overwhelmingly positive impact on a business: maximising the available labour sources; improved customer service; reduced absenteeism, sickness and stress; attracting a wider range of candidates, such as part-time workers; higher staff retention; and a greater sense of responsibility, employee commitment and loyalty. The historic objections based on the difficulty in monitoring performance

are being soundly de-bunked, in favour of fluidity, improved culture and improved morale. Flexible working is here to stay and it has benefits for employers who embrace it.

FLEXIBLE WORKING PROCESS Employees do not have a right to work flexibly, but they do have the right to request it. They can only apply once a year, but that request can give you an opportunity to discuss your structure and needs with the employee concerned. Changes can be proposed to

working patterns, hours of work or location worked. Once an employee puts a flexible working request in writing, you need to discuss it with them and come to a resolution within a reasonable period. Depending on whether it fits with your business needs, you can agree or reject the employee’s request. In most cases, a compromise is achieved, which is designed to achieve what the business needs and to accommodate some of the individual’s requirements. Points to consider when looking at flexible working arrangements with staff include: 1. Ensure that you identify the core business needs (eg the need for workers’ presence in core hours to meet Care Quality Commission (CQC) requirements). 2. Communicate that openly with the employee. 3. Operate any agreed changes on

a trial basis initially and evaluate how well they are working after an agreed period. 4. Carefully formulate policies to establish the standards required of care workers during their working time. 5. Monitor the individual’s attendance and performance. A business can terminate the flexible working arrangements during the trial period or at any time thereafter if there are concerns.

THE MINIMUM WAGES Despite the atypical working arrangements of many individuals working in social care, those classified as ‘workers’ (which includes agency workers and employees) are entitled to be paid no less than the National Minimum Wage (NMW) or National Living Wage (NLW) for the work they carry out. There are different rates for

different age groups of workers and the rates increase every April. The biggest change over the last year has been the introduction of the NLW for workers aged 25 and over. They are now entitled to the NLW which is £7.20/hour (before deductions). This will increase to £7.50/hour in April 2017. The appropriate rate must be paid for the time that workers are: 1. At work. 2. Travelling on business during normal working hours (this does not always include travelling to and from work). 3. Attending training during normal working hours. 4. In specific circumstances, on stand-by or on-call. This isn’t cut and dry, though. The law is complicated around paying travel time for domiciliary care workers, as well as pay for workers on stand-by or on-call, such as those who have sleeping time as part of

their contractual arrangement. There have been recent developments regarding these more complex aspects of employee pay. For example, the Care Act statutory guidance, states, ‘When commissioning services, local authorities should assure themselves and have evidence that service providers deliver services through staff remunerated so as to retain an effective workforce. Remuneration must be at least sufficient to comply with the national minimum wage legislation for hourly pay or equivalent salary. This will include appropriate remuneration for any time spent travelling between appointments.’ This was brought to light last year when an ex-employee brought a legal case against MiHomeCare after she was not paid for the time she spent travelling to and from appointments. Lawyers in the case argued that without payment for her travel time, the employee


CMM March 2017 41



was being paid less than the minimum wage per hour. The company settled the case agreeing that the employee should have been paid for travel time. As the employer’s decision in this matter was a settlement and not a court decision, it is not binding. Unfortunately, there is no set guidance on this matter. The leading decision is the ‘Tyco decision’ where the European Court of Justice held that for peripatetic workers, who are not assigned to a fixed place of work, the time spent travelling from their home to their first assignment, and from their last assignment back to their home, should constitute working time. However, the decision in Tyco does not affect payment of the National Minimum Wage for travel time. The cases regarding the obligation to pay the relevant minimum wage during ‘sleeping’ time, whilst on-call and time spent travelling, is constantly developing. For any businesses whose workers undertake these tasks, you must keep abreast of developments, keep clear records and accurately calculate your staff’s wages. It is recommended you get professional advice around these aspects of pay.

WORKING TIME REGULATIONS With many care workers undertaking flexible working practices, it is important that you are aware of Working Time Regulations and the implications on working patterns. Working Time Regulations were designed to protect the health and safety of those legally called workers (and employees). The minimum obligations are: 1. Working time – the average working time (including overtime) of each worker/ employee must not exceed 48 hours per week and eight hours per day on average. A worker can

opt-out of this 48-hour limit. 2. Rest breaks – workers should be given adequate rest breaks. This includes 11 hours’ uninterrupted rest per day, 24 hours’ uninterrupted rest per week, and a rest break of 20 minutes when working more than 6 hours per day. 3. Leave – workers are allowed 5.6 weeks’ paid holiday each year (this can include public holidays). This means a full-time worker has the right to take, and be paid for, 28 days for each complete year that they work (pro-rated if they work part time or leave part-way through the year). Social care must also cater for the more onerous requirements of care workers undertaking night work. Night-time work is generally defined as the period between 11pm and 6am. Individuals are night workers if they regularly work at least three hours during the night. Under the Regulations, night workers must be provided with enhanced protection such as: • The opportunity to receive a free health assessment when starting night work and at regular intervals thereafter. • Being transferred to day work where possible, if a doctor has advised that the night work is causing health problems. • For those doing work involving special hazards or heavy physical or mental strain, not to work more than eight hours in any day. Employers can enter into an agreement which modifies or excludes the limits on night work. A commonly used example is to redefine the meaning of ‘night time’. These agreements are particularly useful for those who wish to engage live-in carers. However, such agreements are not always

suitable or possible and professional advice, good record-keeping and monitoring are essential.

HOLIDAY PAY Under the Working Time Regulations, a worker is entitled to be paid during statutory annual leave at a rate of a week's pay for each week of leave. The pay figure is calculated in accordance with the complicated ‘week's pay’ rules, which depends on a number of factors and a distinction between the workers with ‘normal working hours’ and those ‘without normal working hours’. Due to the fluctuating hours and atypical working patterns within social care, paying the correct holiday pay requires attention. A distinction must be made between these two types of worker: • A worker with ‘no normal working hours’ – for these workers, a week’s pay is calculated as an average of all remuneration earned in the previous 12 working weeks. This remuneration figure should include any overtime and commission. You cannot pay the contractual salary figure alone. • A worker with ‘normal working hours’ – in this case, a worker will have their week’s pay calculated with reference to their normal working hours. This usually means that their holiday pay is based on their basic salary only. Pay for this purpose disregards any overtime hours (except if they are guaranteed compulsory overtime) and excludes additional commission, overtime premiums or allowances from the computation.

AGENCY, EMPLOYEE OR WORKER? The nature of social care can throw up complex employment law issues.

Defining which obligations are owed to which individuals can be a minefield because there are three different legal statuses, each with its own obligations. Most of the legal requirements discussed above apply to the category of ‘workers’. A ‘worker’ provides their own services but has a significant degree of control over how they work, when they work and how they carry out their work. They can work through an agency or even their own company. ‘Employees’ are under the control of their employers. They provide their own services and they cannot refuse to do the work required of them. Employees benefit from stronger legal protections than workers (eg employees are entitled to minimum notice periods and to not be unfairly dismissed). The third category is a genuinely self-employed individual. They are only entitled to the rights in their agreement with the person for whom they work. There are key touch points which help define the status and rights of the employee: 1. The type of contract/offer provided to the individual. 2. The ‘label’ applied – whether it's employee, worker or selfemployed. 3. How you deal with absences or the failure to perform to CQC requirements. 4. Who provides the DBS check, 5. Whether the individual is paid against their own invoice. 6. The wording of any termination or warning letter. It is clear that employment law in social care is complicated. This article only touches on some of the points for consideration. You need to be thorough, informed and clear with your staff, policies and processes, but if you’re ever in any doubt, it is recommended you seek professional advice. CMM

Melanie Stancliffe is Employment Partner at Irwin Mitchell LLP. Email: Twitter: @irwinmitchell What employment law situations do you face? Share your experiences on the CMM website Subscription required. 42 CMM March 2017

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CMM March 2017 43

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Venusians, Martians and Registered Managers The critical role of managers and why they need respect

Paul Simic, Katie Barnes and Gina Kidd summarise some of the main challenges and frustrations facing managers and explain why managers are crucial to the integration agenda.

The 2016 Lancashire Care Conference included two workshops for registered care managers (RCMs) Care homes from Venus, Hospitals from Mars? How to work better together and Registered Care Managers: who’d be one? – Valuing RCMs. The issues raised have been consistent themes running through the local Registered Care Manager Network meetings facilitated by Lancashire Care Association (LCA). These workshop titles represented enduring and continuing challenges. Challenges that are going to need to be ‘sorted’ if the integration agenda is to be more than words, and the independent care sector can take up its rightful place and work seamlessly with NHS and social services to ensure that care pathways aren't littered with as many holes, breakdowns and obstructions as our gridlocked roads. It is increasingly recognised how important RCMs are in the system, yet how undervalued and unregarded they are.


CMM March 2017 45




Some years ago, as part of a Safeguarding project, LCA ran focus groups for RCMs. The emerging themes were written up in two discussion papers. The discussion papers’ titles each represented the key point arising from the respective focus groups. FG1 was entitled Through a glass darkly, highlighting the fact that RCMs often felt they were outside of key dialogues and relationships when working with social services and NHS colleagues. It also highlighted that when things were being planned, the public sector ‘usual suspects’ took the lead and, later down the line, there might be some ‘The decision has been made now, we are “consulting” with you’ consultation; definitely not observing the so-called ‘Gunning Principles’ on consultation (proper engagement at a formative stage in a fair process). The other theme that emerged in FG2 was discussed in the paper R-E-SP-E-C-T...all I’m asking for is a little… The points here were that the managers in the groups felt that whatever their level of expertise and qualifications, they were rather looked down on by managers and clinical and professional staff in the local authority and NHS, and whatever they could contribute was disregarded. These echoed findings in the NIHR report, Care Home Managers: a scoping review of evidence, which noted the central importance of RCMs, but also their status as ‘an overlooked group’. There were two aspects to this latter area of discussion. Firstly, the perception that there was a rather colonial view held by the public sector, that the independent sector (especially the private sector) was a lower order in some way and its representatives of a lesser value than public sector and NHS professionals. Secondly, they felt that their skills levels and knowledge were disregarded or deprecated and seen as less than their public sector peers. This is a disparity which also arose in relation to the dynamic between managers and Care Quality Commission inspectors when comparing competence and legitimacy. It also featured largely in the dynamic between care home managers and hospital ward staff who often, the charge was put, didn’t recognise care homes as part of the care team. Managers reported, ‘Hospital staff don’t communicate with the person’s support staff’; ‘They won’t share any clinical information’, (the Data Protection Act being used as a shield to any inquiry). Also, that RCMs weren’t recognised as holding any skills or knowledge in contrast to hospital nursing staff, reporting, ‘There’s a lack of equal professional recognition’ and ‘The staff in the acute wards do not value the expertise of the RCM’. Another issue, which was equally strongly felt across the original focus groups, and which endured into the recent conference workshops, was the sense of relative isolation of the RCM. There wasn't the means for a more collegiate approach, where a peer network was facilitated and a learning culture encouraged. It was felt keenly by some that proprietors were not always supportive of peer professional group time, seeing it as ‘time out’ from core business and care requirements. This was set in the context of a threatening environment, where managers felt the system was in place to pounce on failings rather than develop and facilitate success and achievement.

CRITICAL SUCCESS FACTORS The workshops identified some critical success factors, approaches and structures that need to be in place for RCMs to take up their leadership role and, therefore, for integration to work more effectively. It goes without saying that money was regarded as important, but over the course of the discussions on the issues in local RCM Network meetings it was not seen as the main issue. Being valued, appreciated and recognised stood out. The critical success factors were: 1. Support/license: empowerment from the proprietor and the system. Some RCMs complained of directors who are focused on money rather than care. This highlights one of the RCM’s ‘USPs’: their ethical responsibility in their role to address care first and foremost, in a squeezed system under increasing financial pressure, but also the conflict that it can create with a business’ ‘bottom line’ issues. Companies should support their RCMs, not leave them to deal with everything alone and RCMs should be given license and help to build a support and information sharing network. Developing a collegiate and learning culture is an important step towards not being isolated. 2. Facilitative structure: RCMs called for more networking opportunities; with networking as a core task not marginal or an add-on. They wanted space and time for more regular meetings, training opportunities for the key management skills needed to do the job and opportunities for relationship building through continuity in networking. 3. Open culture: trust, honesty and openness were highlighted in the workshops, drawing a contrast with tribalism and threat, which were felt to be endemic features of the health and social care system. Finding the means to build relationships, trust and understanding in the local context, eg through ‘learning together’ workshops and ‘shadowing’ across organisational boundaries, was also seen as critical to a ‘one workforce’ approach to integration. 4. Regard and ‘worth’ issues: the final critical success factor applies as much to RCMs as providers of care, as for the care/service users they are supporting: the importance of being treated with dignity, being valued, and being listened to. Whatever happens in terms of professional regulation and oversight nationally, our work in Lancashire highlights the importance of nurture and generative approaches to building identity and developing voice. The lessons we take away are: to build opportunities for ‘learning together’ with RCMs and colleagues from health and social services; to take opportunities to raise the profile of RCMs and to improve their standing in the local care networks; to express the RCM voice strongly so as to obtain a more balanced narrative in the public discourse on care and to develop leaders and leadership processes. Having a coherent development strategy and facilitation is of central importance in helping RCMs develop into the competent, confident and well-supported professional group society needs them to be. CMM

Paul Simic is Chief Executive of Lancashire Care Association. Email: Twitter: @PaulSimic Katie Barnes is Registered Manager of Edgar Street Residential Home. Email: Twitter: @EdgarStreet3 Gina Kidd is Operations Manager of Lakeview Rest Homes (and RCM Network Secretary). Email: Facebook: @LakeviewRestHomes Are these your experiences of the role of registered managers? Share your thoughts on this and any challenges you may face on the CMM website Subscription required. 46 CMM March 2017





Where innovation meets inspiration









28–29 June 2017 | ExCeL London

Discover new telecare innovations and technologies to enhance the services you provide. Make savings and access new pots of funding - hear from ministerial speakers about developments in the regulation of adult social care that directly affect your business. Find out how to build, retain and develop a quality workforce. Find out how to implement the National Living Wage with minimal damage to profits. Find out how to encourage choice of care. Start networking with Trusts to promote community-based services. Network with CCGs, Local Authority Directors, Trusts and GPs who could uncap new pots of funding and help improve your business.


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2nd February 2017, Bournemouth

CMM was delighted to hold the first Dorset Care Conference on 2nd February in Bournemouth. Held in association with Bournemouth Dorset and Poole Care Providers Federation and Dorset Care Homes Association, the agenda was tailored to the needs of providers in the region. Chaired by Shan Seewooruthun, Chair of Dorset Care Homes Association, there was a real sense of anticipation in the packed conference room. In his opening speech, Shan discussed the importance of collaboration between providers to support each other. He also mentioned interesting work that Dorset Care Homes Association had been doing with the Dorset Echo to increase the positive PR around social care. He explained that a negative article can really damage the sector and it takes a lot of hard work to revert that.

SETTING THE SCENE After Shan had set the scene for the day, Patrick Hall, Fellow of Social Care Policy at The King’s Fund delivered a policy overview summarising what many in the sector already know – there’s not enough money, and a lot of demand. Patrick highlighted this shifting balance, the real terms impact of the social care precept, the rise in delayed transfers of care and the lack of funding

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48 CMM March 2017


from the Government in the Autumn Statement. Not the most positive of presentations, but it was delivered with honesty and humour, and certainly gave a starting point for the presenters who followed to offer solutions for delegates.

QUALITY Ed Watkinson, Director of Care Quality and Quality Compliance Systems was next on stage. Ed set out a very interesting and practical presentation for providers on how to achieve an Outstanding rating. Preparation is the key. Understand what the inspector is looking for, view an inspection as an opportunity, ensure all staff are happy and prepared, even holding a mock inspection if needed. His takeaway statement was, ‘If providers only do one thing after today, it should be to develop an evidence file. It's vital.’ Phil Boyce an Inspector with the Care Quality Commission (CQC) spoke next. Phil discussed the CQC’s priorities for 2017 and the challenges inspectors face. He also highlighted the pressures facing the sector; the CQC is acutely aware of these and has raised them widely. Phil then spoke of the importance of strong leaders, saying, ‘If leadership is sporadic or chaotic there's no hope of achieving a high rating. Great leadership

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is the only way.’ The panel discussion followed and inevitably featured many questions for Phil Boyce around inspection, consistency of inspection and specific issues local providers were facing. When discussing quality ratings, Colin Angel, Policy and Campaigns Director at UKHCA said, ‘Don't chase an Outstanding rating, chase an Outstanding service.’

WORKSHOPS The workshops offered delegates the opportunity to hear Colin discuss meeting the challenges around homecare, Sarah-Jane Dale, Head of Area (South West) at Skills for Care explore why leadership matters and Adrian Poole, Partner and Head of Medical and Care at Porter Dodson discuss employment law. All were very informative.

AFTERNOON SESSION The afternoon session began with a presentation from Dawn Jacobs, Head of Healthcare South East at Barclays. Dawn gave an overview of the drivers for funding in the sector. She called the future environment for care providers ‘volatile, uncertain, complex and ambiguous’ but reiterated the need for good leaders at all levels of an organisation. Neil Eastwood rounded off the day with his well-received presentation on recruitment and retention. Easy to listen to, full of simple but effective strategies, Neil really knows how to tackle these issues. The feedback from the day has been excellent, with many delegates hoping to return next year. CMM was delighted to be able to bring its regional conference format to Dorset with the support of its sponsors, Quality Compliance Systems, Barclays, Morris Lane and Care Choices, as well as all of the exhibitors.

WHAT’S ON? Event:

Showcase 2017 Developing Resilience in Health and Social Care Media Partner Date/Location: 8th March, East Sussex Contact: Surrey Care Association, East Sussex County Council, West Sussex County Council and Brighton and Hove City Council, Web: Event:

Skills for Care Annual Conference – Recruitment and retention: the road to success Date/Location: 9th March, Liverpool Contact: Skills for Care, Tel: 0113 241 0977 Event: Getting Real About the National Commitment Date/Location: 10th March, London Contact: National Council for Palliative Care, Tel: 0207 697 1520 Event: Naidex 2017 Date/Location: 28th-30th March, Birmingham Contact: Naidex, Web:

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Event: Health + Care 2017 Date/Location: 28th-29th June, London Contact: Health + Care, Tel: 0207 348 5777

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Digital Health and Care Congress 2017 – Embedding Technology in Health and Social Care PageDate/Location: 1 11th-12th July, London Contact: The King’s Fund, Tel: 0207 307 2409

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CMM Insight 2017 – Learning Disability and Mental Health Services 2nd March, Manchester Care Choices, Tel: 01223 207770

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The Transition Event Midlands 2017 18th May, Birmingham Care Choices, Tel: 01223 207770

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BAPS SEND Blogging Awards 18th May, Birmingham Care Choices, Tel: 01223 207770

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CMM Insight – Lancashire Care Conference 21st September, Blackburn Care Choices, Tel: 01223 207770

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CMM Insight – Berkshire Care Conference 18th October, Bracknell Care Choices, Tel: 01223 207770

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3rd Sector Care Awards 2017 6th December, London Care Choices, Tel: 01223 207770

Please mention CMM when booking your place. CMM March 2017 49


Ben Benson-Breen extols the virtues of getting your residents outside, to places they genuinely want to visit.

We all know the feeling in mid-winter, it’s cold and miserable outside, it gets dark in a few hours and it’s just easier to stay snug and warm indoors. That is totally understandable, however, once we get out of the habit of going out and default to doing what is safe and comfortable, a world of possibility is lost. John, a care home resident and recent participant on one of our Out & About outings said it better than I can, ‘When people are living in a home,

gradually their outlook can become diminished if they only see the four walls they are living in…it’s very easy to get nice and comfortable indoors; not want to go out.’ This is a sentiment echoed by participants in the Natural England 2016 report, Is it nice outside? ‘If you are out in the open, it brings a whole new perspective to how you feel, you are not in an enclosed space indoors where you are thinking “well, this is my world, that’s their world out there”.’ What we find is that for many people both living and working in care homes, there is an understandable temptation to settle for what is familiar and comfortable. Leaving the home can present many practical challenges – staffing, transport, knowledge of where to go, time to plan and organise – but the biggest challenge, as ever, is mindset and the fear of the unknown. Unless we fully recognise the positive impact of keeping those in care connected to the outside world and support our carers to make this happen, it is easy for inertia to win. However, when we get it right and keep people connected to places and communities that have meant something to them in their lives, magic happens. A great example of this is Martin, he’s 94 and lives in a Surrey care home. He attended a recent trip to Brooklands Motorsport and Aviation Museum. An Autocar journalist for 40 years, who first visited the venue as a child, Martin is passionate about cars, but hasn’t written anything for many years. The trip reignited his passion and got him writing again, ‘Motoring and writing about cars has been my life…It was a wonderful day. I haven't actually written anything for a long time, so when this

opportunity came up to start again, it was wonderful.’ Debbie Bailey, Activities Lead at Priory Court where Martin lives added, ‘Martin is absolutely passionate about automobiles…He's started writing an article about his trip and he's going to write some articles for us here at Priory Court too. I think that's an amazing feat, I really do.’ Margaret, who doesn't usually attend trips out due to anxiety, was enticed to participate because of her love for Kew Gardens. The day took her mind off a close friend's illness and has helped build her confidence to consider other trips out. In both cases, it was the appeal of a destination that they genuinely wanted to visit again that overcame the resistance and inertia to leaving the home. This created the potential for an experience which expanded their horizons, allowing them to restore connections to a place of personal significance. Once people start having experiences like this there is a snowball effect within the wider community of the home. Going back to John, he said, ‘It’s a great talking point, when we all come back from the visit and sit down, we talk about what we’ve seen…when the others hear the stories they wish they were there too and there might be just a hint of jealousy!’ It’s these experiences that we want to encourage with Oomph! Out & About. We have created a full-service solution for resident outings – including transport, driver and a rich variety of local venues chosen by you, priced to be accessible to any service. Let's work together to ensure everyone in care can stay connected to the places, passions and communities that matter most to them. CMM

Ben Benson-Breen is Head of Activities and Wellbeing at Oomph! Email: Twitter: @OomphWellness Do you support your residents to get out and about? Share your experiences on the CMM website Subscription required. 50 CMM March 2017

Introducing t u o b A & t u Oomph! O A radical new solution to keep those in care connected to the passions and places that matter

"It’s a great talking point, when we all come back from the visit and sit down we talk about what we’ve seen... everybody thoroughly enjoys these trips out, very worthwhile." John, Participant

“We’ve wanted to have a bus for such a long time so the staff and residents are delighted to have this service. Now that we are going out on regular trips the residents can’t stop talking about them!" Carol, Home Manager

Contact us for an information pack

0203 601 6363