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MAY 2017 ÂŁ4.00


The sector’s hopes for the Green Paper

Homecare crisis

Finances on the brink

Creativity and innovation

How to embed them in your service

Registered managers

Nurturing the next generation

In this issue From the Editor


Is it just me…? Editor in Chief, Robert Chamberlain looks at the disturbing research findings highlighting the health inequalities facing people with learning disabilities.


CMM News


Business Clinic Greensleeves Care has become the first care home provider to raise funding through a Retail Charity Bond, our panel considers this approach.


A View from the Top Heléna Herklots, Chief Executive of Carers UK is the subject of our interview.


Event review CMM reviews the Surrey and Sussex Care Showcase 2017.


What’s On?


Straight Talk Brenda Metcalfe discusses the results of the project Anchor has undertaken with Middlesex University to support LGBT people in care.










The sector’s Green Paper wish list With another Green Paper on the future of care due later this year, Martin Green, Colin Angel and Matthew Wort detail their wishes.


The new DoLS: An introduction to the Liberty Protection Safeguards Stuart Marchant explores the Law Commission’s recommendations for changing Deprivation of Liberty Safeguards and what providers can do to stay ahead of any changes.


The stark financial realities of the domiciliary care crisis Nick Hood shares his research into the financial health of the homecare sector.


Embedding creativity and innovation in social care – don’t rest on your laurels Chris Gage offers his advice for providers to enable them to embed creativity and innovation throughout an organisation.


Nurturing the next generation of registered managers Cedi Frederick looks at how to develop managers of the future. CMM May 2017 3

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


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

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





Professor Martin Green Chief Executive, Care England

Colin Angel Policy and Campaigns Director, United Kingdom Homecare Association

Matthew Wort Partner, Anthony Collins Solicitors LLP

Stuart Marchant Partner, Bevan Brittan LLP





Owen Vizard Corporate Finance Manager, Hazlewoods LLP

Vic Rayner Executive Director, National Care Forum

Liz Woollett Partner, Chandler & Co

Heléna Herklots Chief Executive, Carers UK





Nick Hood Business Risk Adviser, Opus Business Services Group

Chris Gage Founding Director, The Centre for Creativity and Innovation in Care

Cedi Frederick Managing Director, Article Consulting

Brenda Metcalfe Customer Engagement Manager, Anchor

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: 978-1-911437-41-3 CCL REF NO: CMM 14.3

CMM magazine is officially part of the membership entitlement of:

ABC certified (Jan 2016-Dec 2016) Total average net circulation per issue 16,265

4 CMM May 2017

From the Editor Editor, Emma Morriss shares her thoughts on the future of social care and how it’s time for the sector to formulate its thoughts too. What a month it’s been. It appears that as soon as the Government announces some funding for the sector and an intention to look at the future sustainability of social care, all the reports get published.

CRUCIAL TIME Now is a crucial time to influence the Government. As it researches and considers the future of social care, we need to make sure it has all the information it needs to formulate to some solid plans for consultation. However, this isn’t the first time that the Government has considered the future of social care. Richard Humphries, Senior Fellow, Policy at The King’s Fund put it well on Twitter when he said, ‘Lest we forget – a reminder of social care White Papers, Green Papers & other consultations since 1998. The 13th on its way,’ and he

included all 12 covers.

NO EASY ANSWERS We know that the current situation hasn’t appeared out of nowhere. We also know that the solutions aren’t easy, they aren’t straightforward, and they may not be pleasing to the General (voting) Public. But that doesn’t mean things can be ignored or postponed any longer. Consider Phase 2 of the Care Act reforms. Whatever the reason for its ‘postponement’ – timing, finances or other, this cannot happen again. We need a real, long-term, sustainable solution that puts social care on an even keel with health, makes the public aware of the importance of social care, or even aware of what it is for a start, and moves both health and social care forward, together.

WISH LISTS The Select Committee on the Long-Term Sustainability of the NHS recently said that, ‘to allow money and resources to be used more effectively, the budgetary responsibility for adult social care at a national level should be transferred to a new Department of Health and Care.’ I think that’s a good starting point but there’s so much more. To delve into the subject further, I asked three industry experts to write their wish list for the Green

Paper. You can read the article on page 20 and there are some common themes and interesting viewpoints. What would you wish for from the Green Paper? Let me know on the CMM website, where subscribers can comment, share thoughts and create debate. If you want to keep up-to-date with all the sector developments, as they happen, that’s included in your subscription, too. Don’t forget, it’s free for care providers and, along with your daily news story and weekly round-up, there’s additional content too.

Email: Twitter: @CMM_Magazine Web:

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Is it just me...? Editor in Chief, Robert Chamberlain looks at the disturbing research findings highlighting the health inequalities facing people with learning disabilities.

Data recently published by NHS Digital to compare differences in treatment, health status, and outcomes of people with learning disabilities compared with the rest of the population makes worrying reading. The research contrasted data from people registered with their GP as having a learning disability with a control group not recorded by their GP as having a learning disability. The information was gathered for 2014-15 and 201516 involving over half of GP practices in England. The dataset included 146,005 people with a learning disability and 32,491,016 people without, representing just over 56% of GP registered patients.

KEY FINDINGS The main findings really highlight the stark differences between the health and life expectancy of people with a learning disability when compared

to those without. Regarding life expectancy, on average, females with learning disabilities had around an 18-year shorter life expectancy than the general population. Males with learning disabilities also had a shorter life expectancy, at around 14 years. When it comes to health screening, eligible people with learning disabilities don’t have the same access as those without. Fewer than one in three eligible females with a learning disability received cervical cancer screening. This has not changed from 2014-15. Whereas, over three in four eligible females without a learning disability received the test. Breast cancer screening for eligible female patients decreased in all age groups in both patients with and without a learning disability. Females aged 65 to 69 with a learning disability saw the largest

decrease, from just under 55% in 2014-15 to around 52% in 2015-16. However, there has been some improvement with three in four eligible patients with a learning disability receiving colorectal cancer screening. This is an increase from just over two in three in 2014-15. According to the data, only 46% patients known to their GP as having a learning disability received their annual health check, this figure is up from 43% in 2014-15. Finally, the data shows that obesity is twice as common in people aged 18-35 with learning disabilities and being underweight is twice as common in people aged over 64 with learning disabilities when compared with patients without learning disabilities.

IS IT JUST ME? As with all research of this nature, the question now is how can the issues

highlighted be addressed to ensure greater equality? I guess the starting point must be to ask how this situation is currently occurring. What action could be taken to increase the level of awareness about the importance of health checks amongst people with learning disabilities? Is there sufficient support to help with GP visits and follow-up treatment? Who could and should provide this support? For those living in a care setting, one would hope that the care professionals consider such health checks as a duty of care. Is this the case? When considering the growth in numbers of those supported in the community or still living with parents, I do wonder if enough is being done to ensure GP services are being accessed. Is this a grey area for support workers though? Obviously, an individual cannot be frog-marched to their doctor under duress, but are they supported to understand the importance of health checks and the possible implications of ignoring them? What obligations do providers have? To take just one example from the findings, if fewer than a third of people with learning disabilities are screened for cervical cancer (compared to three quarters of those without a learning disability) something is seriously amiss. I feel that there needs to be a structured awareness campaign, specifically aimed at improving the statistics. A campaign not only targeted at those with a learning disability, but also those who support them in any setting. Everyone should have an equal right to look after his or her health and I’m sure that this data demonstrates a lack of understanding across our population.

What do you think about this subject? Join the debate at Twitter: @CMM_Magazine CMM May 2017 7

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APPOINTMENTS HC-ONE HC-One has appointed Justin Hutchens as its new Chief Executive Officer.


Public satisfaction with social care falls... Data published by The King’s Fund highlights public satisfaction with the NHS and social care. It shows that the British public’s satisfaction with the NHS remained steady in 2016, but people are much less satisfied with social care. The findings from the British Social Attitudes (BSA) survey, carried out by the National Centre for Social Research between July and October 2016, show 63% of people were satisfied with the NHS. The change in satisfaction since 2015 (when it was 60%) is not statistically significant. Satisfaction remains high although it has fallen seven percentage points from its peak of 70% in 2010. The survey

also shows that people continued to be much more satisfied with the NHS than social care. Only 26% of respondents were satisfied with local authority social care services. Social care services are defined as ‘personal support services provided by local authorities for people who cannot look after themselves because of illness, disability or age’. Regarding social care, the report also says that, ‘Compared to questions on NHS services, there is a higher proportion of “don’t know” responses to the social care satisfaction question (12% compared to 4% for GP services). This may be because people are less familiar

with social care services and are less likely to have had experience, either personal or through relatives or friends, of using them. Ruth Robertson, Fellow, Policy, at The King’s Fund, said, ‘These results also show once again that people are much less satisfied with social care services than with the NHS. This may partly be due to the public having less understanding of what social care services are, but it also reflects the crisis facing social care funding. The clear dissatisfaction with social care services reinforces the importance of the Government’s Green Paper later this year as a crucial opportunity to put social care on a sustainable footing.’

...But resident satisfaction is at a record-high Your Care Rating 2016, the UK’s largest and most authoritative survey of care home standards, has revealed the highest level of resident satisfaction since the survey began. The survey, conducted by Ipsos MORI, questioned over 18,000 residents across 988 homes and 33 providers, resulting in the highestever average Overall Performance Rating (OPR), of 880 out of 1,000. For the 2016 Your Care Rating survey, its scope was expanded to include the views of residents’ family and friends as well as the residents themselves. Almost 11,000 took part in the Family and Friends’ survey, across 650 homes, producing an average OPR of 828 out of 1,000. The Your Care Rating survey not only looks at the performance

of individual care homes but, due to its reach, is able identify how specific regions of the UK as a whole perform, giving them an average OPR as well. Scottish care homes were awarded the highest average OPR this year by their residents, with a score of 897 out of 1,000. For the first time since the survey started in 2012, the maximum score has been achieved among the published results. Two smaller homes (20 residents or fewer) in Kent, Marlborough House in Folkestone and Rectory House in Harrietsham, managed by Embrace Group, scored full marks across all four categories: Staff and Care, Home Comforts, Choice and Having a Say, and Quality of Life. De Lucy House in Diss, Norfolk

managed by Greensleeves Homes Trust was awarded the highest score in the Family and Friends’ survey with an OPR of 973 against an average of 828. The Family and Friends’ survey this year shows that the area respondents were most happy about in relation to their loved ones was the quality of life, with an average score of 890. Northumberland and Tyne and Wear has the highest average score (893) across the regions after Scotland, according to the latest residents’ survey. As far as family and friends of the residents are concerned, the best area for care home satisfaction is Devon and Cornwall, with an OPR average of 845, followed by Wales (842) and the South Coast (841).

Westward Care has announced three new appointments. Laura Clegg joins as a General Manager at Southlands Care Home and Independent Living Apartments. Helen Lewis has become a Health and Social Care Consultant for the company. Nadine Padgett joins Pennington Court as a Nurse Manager.

NEW CARE’S ASHLANDS MANOR New Care has appointed Hayley Bebbington as Registered Manager for Ashlands Manor in Ashton-on-Mersey.

BRAMLEY HEALTH Salim Atchia has been appointed by Bramley Health as Hospital Director at Glenhurst Lodge in Maidstone.

BUPA’S BURLEY HALL CARE HOME Bupa’s Burley Hall Care Home in Burley-in-Wharfedale has appointed Jonathan Easby as its new manager.

ST MARGARET’S St Margaret’s welcomes Clare Gallie as its new Director of Fundraising, Marketing and Communications.

SKILLS FOR HEALTH AND JUSTICE Skills for Health has appointed Jeremy Newman as the new Chair of Skills for Health and Justice.

CMM May 2017 9


APPOINTMENTS DANSHELL GROUP The Danshell Group has promoted Mick Batey to Manager of its Chesterholme Hospital at Hexham in Northumberland. Danshell Group has also promoted Chris Shield to Service Manager of Whorlton Hall Hospital in Barnard Castle, County Durham. He was Deputy Manager of Newbus Grange, another Danshell service, near Darlington.

ALMOND CARE Almond Care has appointed Operations Director, Karen Jackson and Clinical Nurse Specialist, Judith Malan.

CZAJKA CARE GROUP Sue Green has returned to Czajka Care Group to become Registered Manager of its Staveley Birk Leas Nursing Home in Yorkshire.

ST MARTIN’S CARE GROUP Mandy Postle and Gary Dixon have been appointed as directors of the St Martins Care Group. Mandy is Director of Care and Gary is Director of Quality and Operational Compliance.

PRIORY ADULT CARE Jim Willis is the new Chief Executive of Priory Adult Care, the new merged divisions of Craegmoor and Amore Care. He was previously Managing Director for the Central Region in Priory Healthcare and Partnerships in Care.

DELOITTE Deloitte has appointed Sir Howard Bernstein, former Chief Executive of Manchester City Council, as a strategic adviser, specialising in health and social care, government reform and devolution, and regeneration.

10 CMM May 2017

Changes to DoLS The Law Commission has published a new report detailing its proposed changes to Deprivation of Liberty Safeguards (DoLS) following public consultation. In the report, the Law Commission has offered its recommendations, including a new system designed to ensure that vulnerable people are no longer denied their rights. Following public consultation, the Law Commission is recommending replacing the law with a new scheme, called the Liberty Protection

Safeguards. The reforms, which widen protections to include care or treatment in the home, are designed to ensure that safeguards can be provided in a simple and unobtrusive manner, which minimises distress for family carers. The Commission also recommends a wider set of reforms which would improve decisionmaking across the Mental Capacity Act. This is not just in relation to people deprived of liberty. All decision-makers would be required

to place greater weight on the person’s wishes and feelings when making decisions under the Act. Professionals would also be expected to confirm in writing that they have complied with the requirements of the Mental Capacity Act when making important decisions – such as moving a person into a care home or providing serious medical treatment. The proposed changes are discussed in more detail in the article starting on page 24.

Future sustainability of health and social care The Select Committee on the LongTerm Sustainability of the NHS has slammed the 'short-sightedness' of successive governments for failing to plan effectively for the long-term future of the health service and adult social care. The Select Committee on the Long-Term Sustainability of the NHS was set up to investigate the sustainability of the NHS over the next 15-20 years to get beyond debates about current funding shortages and look for strategic solutions to meet the challenges in health and adult social care in the long-term. Recommendations in its final report include: • A tax-funded, free-at-the-pointof-use NHS is the most efficient way of delivering health care and should remain in place now and in the future. However, many aspects of the way the NHS

delivers healthcare will have to change. • A political consensus on the future of the health and care system is not only desirable, it is achievable and the Government should initiate cross-party talks and a meaningful national conversation. • The failure to implement a comprehensive long-term strategy to secure the appropriately skilled, well-trained and committed workforce that the system will need is the biggest internal threat to the sustainability of the NHS. • The Government should commission an independent review to examine the impact of pay on morale and retention of staff. • Health and social care are interdependent but poorlycoordinated. To allow money and resources to be used more effectively the budgetary

responsibility for adult social care at a national level should be transferred to a new Department of Health and Care. • NHS England and NHS Improvement should be merged. • The Government should do more to incentivise the take-up of new technology and innovation and make clear that there will be funding and service delivery consequences for those who repeatedly fail to engage. • National and local public health budgets should be ring-fenced for at least the next ten years with a new nationwide campaign to highlight the dangers of obesity. • The Government should be clear with the public that access to the NHS involves patient responsibilities as well as patient rights. The NHS Constitution should be redrafted to emphasise this.

Housing for older people ‘ignored’ by Government Housing for older people is being ignored by Government, failing to provide the choice of tenures and care options and confusing for buyers, says a new report from Winckworth Sherwood and Housing LIN. Highlights of The other end of the housing market: Housing for older people include: • 80% of those surveyed believe the Government’s apparent focus is unfairly skewed towards first-time

buyers. • 70% welcome the entrance of private developers. • Location, availability and affordability are the key drivers behind the decision to move. • High service charges and uncertainty around these charges holds back decisions to move. • 48% believe we need to develop more extra care and supported housing schemes. • 45% believe local authority adult

social care services should address housing need. • 46% believe housing should be an enforceable human right. The report also highlights that whilst the top and the bottom ends of the market are well catered for by private providers and local authorities, they account for just 20% of the market. The remaining 80%, the squeezed middle, face uncertainty and difficult decisions.


New analysis shows homecare market is on the brink New analysis from the Local Government Information Unit (LGiU) and Mears has found that the current homecare market is on the brink of collapse. Following on from research conducted by Opus Restructuring and Company Watch for BBC1’s Panorama programme, which identified that over a quarter of UK homecare providers are at risk of insolvency, Paying for it looks at the human and emotional costs of the

homecare market with stories from across the care system. It outlines why care is priced so low and how people in the system end up paying for cut-price care. It says that these systemic problems make provider failure more likely and leave the most vulnerable in an even more precarious position. The article starting on page 33 explores other research into the financial situation of the homecare market.

Cuts to adult social care spending analysed by IFS Across England, spending by councils on social care per adult resident fell by 11% in real-terms between 2009-10 and 2015-16. These are among the main findings of a new report the Institute for Fiscal Studies (IFS), funded by the Health Foundation, which analyses official spending data on councils’ social care spending. The figures suggest around six-in-seven councils made at least some cuts to their social care spending per adult resident, and one-in-ten made cuts of more than a quarter. Other key findings include: • There remains significant variation in councils’ social care spending across the country: spending was less than about £325 per adult resident in a tenth of council areas, while it was more than about £445 per adult resident in another tenth of council areas in 2015-16. That’s a difference of more than a third.

• Councils where there are relatively more people over pension age (particularly those entitled to means-tested benefits), and where levels of disability benefit claims and deprivation are higher, tended to spend more on social care. Higher local earnings levels are also associated with higher levels of social care spending. • In addition to council spending, care recipients often contribute towards the cost of their care through fees and charges. These raise an average of £63 per adult resident, but the amount varies widely: one-in-ten councils raise less than £35 per adult resident, while a further one-in-ten raise £95 or more.

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Cuts have been delivered, in part, by removing care from many people, argues IFS. What this means for the welfare of those no longer receiving care, the IFS says, requires further research to answer.

New care home in Lichfield Work has started on the development of a new 70-bed care home in Lichfield. The new home will be run by Barchester Healthcare when it opens in the summer of 2018. It will create around 100 jobs and provide

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Housing & Care 21 sells homecare division Ark Home Healthcare has completed the acquisition of Housing & Care 21’s homecare division. Ark has acquired 11 branches across England, creating a combined group of over 2,000 employees delivering over 50,000 hours of care per week. The acquisition completed on 6th March 2017 following a successful

integration between the two businesses. The move will strengthen Ark’s presence within its core territories across the North, Midlands and London, enabling the Group to continually improve its local proposition for customers and employees.

Planning permission for LNT LNT Care Developments has received planning permission to build a 66-bed care home on the site of the former Herne Bay Golf Club in Herne Bay. Canterbury City Council approved the planning application in March. The facility will provide residential and dementia care for those over 65. Construction is due to start in June 2017 with a predicted

completion date for May 2018. Once complete, the home will be a strong community facility, integrating with the local facilities of shops, churches and schools. It will provide accommodation with fully en-suite bedrooms, spacious communal areas, and state-of-the-art amenities including a cinema, library, garden room and tea shop, all surrounded by beautifully landscaped gardens.

Reduction in FNC The NHS-funded nursing care standard rate has been reduced to £155.05 from 1st April 2017. The reduction follows a review of agency costs by Mazars LLP in 2017. The Registered Nursing Home Association said, ‘It is difficult to put

into words the disappointment felt over such a derisory reduction.’ It concluded that the reduction of £1.25 per week is, ‘an amount which will probably be lost in the transaction cost of making the changes.’

Staffing must be Brexit priority The Cavendish Coalition has responded to the triggering of Article 50 by calling on the Government to safeguard the UK’s ability to recruit and retain staff with the skills needed to deliver high-quality health and social care. The Coalition, a group of 34 social care and health organisations working to ensure the system is properly staffed after the UK leaves the EU, has set out what the Government needs to focus on during EU withdrawal negotiations to maintain safe, highquality health and social care services. It has written to the Secretaries of State for the Home, Exiting

the European Union and Health departments, making clear its offer to work with the Government to help inform a future immigration system where public service value is used as a key assessment of ‘skill’ as opposed to salary, and which guarantees the status of EU staff already working in health and care. It is also calling for a straightforward and responsive transitional system for people from the EEA during the period between any ‘cut off’ date after which EU nationals coming to live and work in the EU will not be guaranteed leave to remain and having a new and operational immigration system.

Qualifications in Activity Provision From care staff to managers, activity organisers to day-centre staff, domiciliary workers to owners and volunteers, these courses are suitable for all. They will support learners to contribute to the planning, delivery and evaluation of individual and group activities and to meet a range of individuals’ different needs. It will further learners’ understanding of the part activity has to play in providing person-centred care. It is increasingly recognised that Activity Provision can make a significant contribution to well-being and quality of life, and the Care Sector reports a need for specialist training for their staff in this area. NAPA is delighted to offer two courses that meet the needs of the specialist activity workforce. NAPA offers: Level 2 Award in Supporting Activity Provision in Social Care (QCF) accredited by OCN London This knowledge only course is provided through distance learning with telephone tutor support. Level 3 Certificate in Activity Provision in Social Care (QCF) accredited by OCN London This higher level course is knowledge and competence based. The student will be supported throughout this distance learning course to research the assignments, write narrative comparisons and evaluate their day to day work.

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Medicines management guide for occupational therapists The College of Occupational Therapists has released a new guide to help its members understand patient group directions, a legal mechanism which, when in place, will allow them to supply and administer medicines to patients and service users. A patient group direction (PGD) allows certain registered

professionals like occupational therapists to supply and/or administer specified medicines in specific circumstances to a specific group of patients within the parameters of the document. It is created locally by doctors, pharmacists and the professionals who will be permitted to supply and/or administer the medication.

The College of Occupational Therapists is keen to provide guidance and information about PGDs for its members. PGDs have their limitations but when used appropriately, may improve patient experience, clinical effectiveness, reduce costs and provide more fulfilling roles for occupational therapists.

Once a PGD is in place, occupational therapists can treat the patient immediately without them having to wait to see a GP or district nurse. This not only speeds up care for the patient, it also means that other staff can be released to visit patients who are most in need of nursing or GP care.

Supporting disabled people to work in social care

New identification guidance for end of life care

Skills for Care is urging more adult social care and health employers to support disabled people into employment. To do this, it has worked with other leading organisations to develop new guidance. Employing disabled workers in adult social care and health: a guide for employers has practical steps to help providers attract, recruit and

Care for people nearing the end of life received a major boost with the publication of new, fully-updated guidance to help health and social care providers identify these patients earlier. The National Gold Standards Framework Centre (GSF) launched a new, revised version of its identification tool, Proactive Identification Guidance, which

develop disabled workers in their organisation. It is aimed at adult social care and health employers, individuals who employ their own care and support staff, policy makers and local authorities. It offers support for providers to recruit and retain a diverse and talented workforce by supporting disabled people into employment.

has, since its original launch in 2001, helped doctors, nurses and care home staff, both in the UK and internationally, increase identification rates by up to ten times, paving the way for improved care for people at the end of their life. It is co-badged by the Royal College of General Practitioners, and recommended as best practice.

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Next Steps on Five Year Forward View The Next Steps on the NHS Five Year Forward View has been published setting out how the NHS will deliver practical improvements. It focuses on areas such as, cancer, mental health and GP access, while transforming the way that care is delivered to ease pressure on hospitals by helping

older people live healthier, more independent lives. It is hoped that the measures detailed in the published document will also help to put the health service on a more sustainable footing for the future. With the NHS under pressure, the plan also details an accelerated

drive to improve efficiency and use of technology in order to deliver better care and meet rising demand within the constraints of available resources. Two-and-a-half years on from the publication of the original NHS Five Year Forward View, the plan spells out what has been achieved

and the changes which will take place across the health service. It focuses on key areas, including better care for older people by bringing together services provided by GPs, hospitals, therapists, nurses and care staff and cutting emergency admissions and time spent in hospitals.

Managing medicines for adults in the community

Better Care Fund policy framework published

NICE has produced a new guidance on managing medicines for adults receiving social care in the community. It covers medicines support for adults (aged 18 and over) who are receiving social care in the community. It aims to ensure that people who receive social care are supported to take and look after their medicines effectively and safely at home. It gives advice on assessing whether people need help

The policy framework for the implementation of the statutory Better Care Fund (BCF) in 2017-19 has been published setting out proposals for further integration by 2020. It provides an overview of legislation and makes clear the policy intentions of integrating health, social care and other public services. The bodies have committed to working together to produce a set of resources, integration models and indicators for integration to help local areas towards the goal of person-centred, co-ordinated care. It also includes details of how the £2bn extra social care funding should be spent. The Local Government Association (LGA) responded saying the policy framework, including the additional funding for social care, reiterates what was announced in the Budget by clearly stating that

with managing their medicines, who should provide medicines support and how health and social care staff should work together. The guideline includes recommendations on: governance arrangements and joint-working between health and social care; assessing medicines support needs; staff training and competency; and sharing medicines information and record-keeping.

Dementia care for LGBT communities A new National Care Forum and strategic partners' report examines why social care services must develop better dementia care for LGBT communities. Anyone can develop dementia, but for lesbian, gay, bisexual and transgender (LGBT) people, the experience of dementia support contrasts with that of their non-LGBT peers. That is why the partnership of voluntary organisations has launched Foundations for the Future:

dementia care for LGBT communities. This is the third report in a series exploring how care professionals can provide the most appropriate support. The report describes the growing need for appropriate care for LGBT people with dementia. Along with the learning that can be applied from existing high-quality dementia care for LGBT people. It also promotes the next steps towards creating stronger dementia care strategies.

Glenholme Healthcare Goldfinch Developments has secured a contract worth £5.2m with specialist care provider, Glenholme Healthcare Group. Goldfinch was appointed to carry out the work on the Glenholme site in Lincolnshire after sourcing the land and giving early detailed advice on build-ability, 14 CMM May 2017

design and specification. The 64-bed home, which has the potential for a further 20 assisted living apartments, is being built across a two-acre site and will specialise in nursing and dementia care. The home is scheduled to open in late summer 2018.

the funds can be used to meet adult social care need more generally, help stabilise the care market as well as on measures to support hospital discharge. The £1bn of additional social care funding this year, followed by £674m in 2018/19 and £337m in 2019/20, represents vital funding needed for services over the next three years. It went on to say that the extra funding announced in the Budget is seen as merely a starting point and short-term pressures remain. To close the funding gap still facing social care, by 2020 and beyond, additional funding needs to be recurrent and put into local government baselines. In addition, the LGA argues that it is crucial that the Government's Green Paper on social care finds a long-term solution that reforms and fullyfunds our care system.

Report highlights unrealistic expectations of savings A new report from the Nuffield Trust challenges the idea that moving care out of hospital will save money. Exploring 27 initiatives to reduce hospital activity, in five key areas: elective care, urgent and emergency care, admission avoidance and easier discharge, at risk populations, and self-care, the analysis considers whether the claims made on behalf of the movement of care away from hospitals are correct.

Whilst there is quite a deal of evidence about the ability to improve overall patient outcomes if this model is pursued, there is limited evidence of the ability to save costs. In fact, it goes on to suggest that for many of these approaches, the costs may actually increase. It cites the example of STPs which are struggling to meet their potential because of the unrealistic expectations around savings.


Former nursing home in Somerset acquired The Care Home Group has acquired the former Rosewell care home in North East Somerset. The 80-bed home closed in the summer of 2016 and its residents relocated after its previous operator decided to sell the premises. The Care Home Group

has now completed its purchase of the home and will fully renovate it into a luxurious 50-bed home with large en-suite studio apartments and spacious communal areas with stunning views across the northeast Somerset countryside.

NCPC and Hospice UK merger The trustee boards of both Hospice UK and the National Council for Palliative Care (NCPC) have agreed to work towards the merger of the two organisations. The process of due diligence and formal merger agreement is being taken forward. Tracey Bleakley, Chief Executive of Hospice UK, will become the

Acting Chief Executive of NCPC from May 31st, during the interim period before a merger is agreed. Hospice UK also announced that Claire Henry MBE, current Chief Executive of NCPC, will be joining the Hospice UK team as Director of Improvement and Transformation in June.

Modernisation of North West learning disability services People with a learning disability, autism or both in the North West will be supported to lead more independent lives in their communities since plans to modernise learning disability services in the region were approved. The plans include the closure of Calderstones (now known as Mersey Care Whalley site), England’s last standalone NHS learning disability hospital. Plans will now be finalised setting out how local NHS and social care leaders will deliver the reforms set

out in Building the right support. Over the next three years, care will increasingly be provided through teams in the community, with a number of smaller inpatient units located across the North West providing medium and low secure services when needed, for short periods of time. Whilst the NHS will no longer commission secure forensic services at the Whalley site, a new clinical model for secure and forensic learning disability care is being implemented.

Workforce integration and development Skills for Health has published a working paper on integrating health and social care workforces. Integration and the development of the workforce offers guidance to providers on how their workforce needs to adapt to support successful integration. Developed in co-ordination with

health and social care employers in the UK and internationally, the paper is the third in Skills for Health’s series of research papers on the health sector workforce. The paper argues that high-quality and effective workforce development is essential to ensure the buy-in and support by staff to make change happen.

In focus Brexit – Triggering Article 50 and its implications for the care sector WHAT’S THE STORY?

Article 50 of the Lisbon Treaty is the formal process by which the UK formally notifies the European Union (EU) of our decision to withdraw from it. The Prime Minister signed the letter officially declaring our intentions on 28th March. Thus, starting what is expected to be a two-year process of talks on the terms of the withdrawal.


Leaving the EU involves two sets of negotiations. The first, referred to as the ‘divorce’ talks, covers the financial settlement, citizen rights and borders. The second is the future relationship between the UK and the EU – in other words, the trade deal. At present, even the scope of talks has not yet been agreed. There continues to be much speculation about the implications, both positively and negatively, but the truth is no-one really knows.


The likelihood is that little will actually happen until after the elections due to take place in France and Germany. This effectively means the timescale for getting agreement is more like 18 months than two years. Opinion seems to be as divided as ever on the big issues that need to be agreed. Clearly, trade and EU

legislation are amongst the most complex matters to resolve. However, every sector is already considering the possible impact, including the care and health sectors.


The decision to leave the EU is already having an effect within care and health (as with every sector) as a period of economic and political uncertainty has begun. For the care sector, the issue of staffing is probably the most important and immediate. Workers from other European countries no longer see the UK as such an attractive option and this is said to be impacting on the recruitment of nurses, in particular. The high turnover associated with social care and the reliance on labour from EU countries will have to be met by agreements with other countries. There could be issues of regulation to be considered, with worker rights and entitlements to be settled. Funding pressures faced by the social care sector (as well as the NHS) look set to continue at least until 2020. The importance of the recently announced Green Paper on future sustainability of the care sector should not be underestimated as an opportunity to plan for the future. CMM May 2017 15


L&Q launches supported housing subsidiary

Health and wellbeing in rural areas – new report

L&Q has launched a new care and support subsidiary, L&Q Living. L&Q Living brings together more than 6,600 supported and sheltered housing units from both L&Q and East Thames, following their merger in December last year. The £47m per annum subsidiary will provide accommodation and support for older people, adults with learning disabilities, with mental health needs and young people

Poor health in rural areas is being ‘masked’ by idyllic images of the countryside, local government and public health leaders have warned. A new joint report, published by the Local Government Association and Public Health England, says not enough is known about the health and wellbeing of people living in the countryside. They warn official statistics are failing to paint an accurate

across London and the South East. It aims to build upon the existing services provided individually by both East Thames and L&Q by becoming a sector leader in dementia and autism care, expanding mental health provision and developing a new model of accommodation and support for vulnerable young people, focusing on those who are leaving care or who have complex needs.

picture of people's health outside our cities. This lack of information is masking pockets of significant deprivation and poor health in rural areas. Health in rural areas aims to dispel the myth of rural areas being affluent and idyllic communities by warning around one sixth of areas with the worst health and deprivation levels in the country are located in rural areas.

Audley Retirement secures planning permission 10 years of the Audley Retirement, the luxury Cooper’s Hill will be the 13th properties for over 55s, along with NMDS-SC retirement village operator, has addition to Audley’s portfolio, facilities including a restaurant, secured planning permission to begin work on its latest development located in Englefield Green near Egham, Surrey. Continuing its unbroken record in achieving planning permission for new developments, Audley

providing 78 luxury apartments. Formerly part of Brunel University, the site is located within the 66 acres of the Magna Carta Park. The development will provide a selection of luxury retirement

bistro, library, health club and swimming pool, many of which are open to the wider community alongside property owners. Audley Retirement’s Cooper’s Hill is expected to open in early 2019.

Skills for Care is celebrating the 10th anniversary of the National Minimum Data Set for Social Care (NMDS-SC) going online. It now provides gold standard intelligence for the growing adult social care workforce.

STPs failing to engage voluntary sector

Enhanced health support for care homes

NAVCA has published its annual survey on relations between the voluntary sector and the local health and care system. It shows that although relationships are improving overall, in some key areas the voluntary sector is being ignored or overlooked, especially in the formulation of Sustainability and Transformation Plans (STPs). The findings are from an online

Research by the Health Foundation looks at the impact of a package of enhanced support for older people living in care homes. It finds that care home residents who received the enhanced support were admitted to hospital as an emergency 23% less often than similar residents in other parts of the country. The analysis was conducted by the Improvement Analytics Unit, a

survey that ran in November and December 2016 and attracted 72 responses. The answers provide valuable information about how local health bodies are working with their local voluntary sector, a key aim of the NHS Five Year Forward View. NAVCA’s survey found only 16% of respondents described involvement as ‘Good’.

Integrated health and social care 2020 Research to inform the Integration Standard and the next phase of the Government’s integration plans has been published by the Social Care Institute for Excellence. The Government wants to see the integration of health and social care in every area of England by 2020. The Department of Health’s initial thinking included the concept of an Integration Standard, with associated 16 CMM May 2017

metrics that enable qualitative and quantitative data to measure the performance of each area, giving a clear picture of progress. The report, Integrated Health and Social Care 2020 presents the findings from a programme of scoping research and engagement to better understand what excellent integrated health and social care should look like and to test out the Integration

Standard with national stakeholders and local areas. The study confirms full support for the ambition of integration by 2020, because bringing together health and social care is universally seen as the right thing to do. Achieving it at a time of austerity is particularly challenging and the extent to which it will include social care providers is still an open question.

partnership between NHS England and the Health Foundation. The impact of providing enhanced support for care home residents in Rushcliffe explored the work undertaken in Rushcliffe in Nottinghamshire that was developed by Principia, a local partnership of general practitioners, patients and community services with the aim of providing better quality of care for people.

Priory merges adult care The Priory Group has merged its two adult care divisions, Craegmoor and Amore Care, to create Priory Adult Care. The new division began operating on 3rd April. The new Priory Adult Care division has more than 230 care homes across the country with over 4,500 beds.

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Cardiff nursing home transfers to Linc Cymru

South Manchester extra care facility completes

Ty Coch nursing home in Llanishen has become the latest addition to the portfolio of health, social care and affordable housing schemes run by Linc Cymru (Linc) in South Wales. The home employs 90 staff, caring for 60 elderly residents, and has been run as a successful nursing

Village 135, an innovative £18m extra care scheme in Wythenshawe is now complete. Designed by Pozzoni Architecture on behalf of Wythenshawe Community Housing Group, the scheme provides accommodation for residents aged 55 and over. Designed in the style of a high-end residential development, Village 135 is split across two sides of Hollyhedge Road and is connected via a glass bridge. Linking the two buildings together allows residents

home for more than 20 years. Staff have been transferred across to become employees of Linc. CSSIW, the regulatory body for social care in Wales, oversaw the transfer of Ty Coch to Linc following an initial exchange of contracts in January.

NACC Care Chef of the Year The line-up for the grand final of the National Association of Care Catering (NACC) Care Chef of the Year 2017 competition has been announced. The prestigious culinary competition seeks out the UK’s best chef working in the care sector. The national final takes place on Wednesday 7th June. The finalists are: Callum Chapman, The Close Care Home, Burcot; Paul Criggall of Turning Point Smithfield Services, Manchester; Glenn Francis of Abbeyfield

Ballachulish; Craig Handley of Sunrise Senior Living of Cardiff; Roger Heathcote of Signature at The Miramar, Herne Bay; Adam Hedges of Sunrise of Mobberley; David Higgins, Brendoncare Foundation, Wincester; Simon Lewis, Gracewell of Frome; Peter McGregor of Perry Manor, Worcester; Martin McKee of The Hawthorns, Aldridge; Stuart Middleton of Meallmore Lodge Care Home, Inverness; and Sam Nurse of Coombe Hill Manor, Kingston-uponThames.

to easily access the facilities on each side and creating an inclusive and sustainable village environment. The scheme is made up of 135 two-bedroom apartments, ranging in size, all of which are designed to meet ‘home for life’ standards. A range of community facilities, some of which can be used by the public, are also on site including meeting spaces, an IT suite, laundrette, health consultant space and spa. Residents also have access to sensory gardens, sun rooms and a roof top terrace.

Innovation in reablement A new reablement scheme is proving to be popular with those people using the service and their families, as well as with commissioners and providers. Somerset Care has developed a video which showcases its innovative work with Yeovil District Hospital.

Through the partnership, the hospital is discharging patients with reablement requirements directly to Somerset Care. The Trust provides the staff to deliver the occupational therapy and physiotherapy, while Somerset Care provides the care staff.

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The CTBF looking to sell home

Somerset care home acquired

The Cinema and Television Benevolent Fund (The CTBF) has announced the intention to sell its Glebelands Care Home to Greensleeves Care. The sale is part of The CTBF’s ongoing review of the support it provides to people working behind the scenes in Cinema, TV and Film, to better meet their changing needs. The charity launched its

Pondsmead Nursing and Residential Home has been acquired by Avon Care Homes Group with support from NatWest. The business provides care for up to 76 residents and sits within a 19th century former mansion house in Oakhill, near Bath. The home’s previous owners brought in Avon Care Homes in 2016 to manage and drive up standards.

National Care Plan two years ago in partnership with Anchor, which allows beneficiaries and their parents to choose any Anchor Care Home in England at a preferential rate. With fewer and fewer beneficiaries choosing Glebelands, The CTBF has been looking at the best way to secure the home’s future. This has led to the discussions with Greensleeves Care.

Liberty Retirement Living launches Places for People and Octopus Healthcare have joined forces to launch a new £200m business to tackle the undersupply of retirement housing in the UK and provide aspirational homes for over-55s looking to downsize. Liberty Retirement Living plans to deliver 25 retirement villages and 2,700 units over the next five years,

after Octopus Healthcare created a new partnership with one of the UK’s largest property management and development companies, Places for People. Liberty aims to become a sector leader in the provision of accommodation and lifestyle services for the over-55s within the next three years.


Shortly after, the company was offered full sale of the business, including the premises. Pondsmead will be the sixth care home to come under the ownership of Avon Care Homes, which has more than 20 years’ experience in the sector. Led by founder, Mrs Cristina Bila, the Group has significant investment plans for the business.

A new resource on social prescribing in London A resource has been developed by the Healthy London Partnership for commissioners on implementing social prescribing. It is not a definitive guide but offers commissioners practical assistance on learning from the best available evidence to support local implementation. All five London Sustainability and Transformation Plans identified

a focus on social prescribing as a means of implementing a range of person-centred approaches in tandem with preventative initiatives and maximising the use of community based assets. The new resource aims to help local leaders in London to take the first steps towards implementing social prescribing for their communities.

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CMM May 2017 19

The sector’s Green Paper wish list 20 CMM May 2017


With the announcement of another Green Paper on the future of care due later this year, what would the sector like to see in the document?


Professor Martin Green, Chief Executive, Care England. Colin Angel, Policy and Campaigns Director, United Kingdom Homecare Association. Matthew Wort, Partner, Anthony Collins Solicitors.

AN OPPORTUNITY TO GET A TRULY FINAL SOLUTION Professor Martin Green, Chief Executive, Care England

The announcement that there was to be yet another Green Paper on the future of social care, on one level filled me with the feeling that I was participating in the sequel to ‘Groundhog Day’, but on another, I felt it was an opportunity to influence the debate on the future of long-term care and to get a truly final solution. I hope the Green Paper will build on the previous work done on this issue. We must not go down the road of endless research into the question. What this Green Paper needs to do is frame the answer, and frame it in a way that will be both sustainable and long-term. It is now 20 years since Tony Blair asked Lord Sutherland to Chair the Royal Commission on the future of long-term care. There are people who are currently being supported by care services, who, if they had known 20 years ago what the current position would be, would have been able to make provisions for their care. One of the greatest challenges for citizens is to know how to plan for the future when the Government constantly changes the baseline and develops short-term policy for a long-term issue. The new Green Paper must set forward a bold vision for the future of care and it must be a vision that looks to the future, rather than just reconfiguring what we have had in the past. Demographic change is already upon us and it is clear there are going to be many more people who need care and support, but the workforce to deliver it is not keeping pace with demand. If you look at the gap in the workforce supply, it already is quite clear that we might have to craft different solutions and challenge the way in which we deliver health and care in the current silos. I hope that the Green Paper will also acknowledge that most people who receive social care do so because they have a health condition. The Green Paper must set out a vision for integration which is about the outcomes to citizens, not focus too much on the sustainability of organisations. The biggest challenge any government will face is that they are going to have to move resources across the system from the NHS and into social care. This will require a radical change in what we do, and previous attempts to reapportion money, such as the Better Care Fund have only tinkered around the edges. What we need is a fundamental reappraisal of government spending, in the knowledge that the challenge of the 21st-Century is helping people to live well with long-term conditions. The current system was fit-for-purpose in 1948, when we diagnosed an issue, sent people to hospital, cured them and when life expectancy was 66. The 21st-Century system must support people to live well with several longterm conditions, and enable them to manage their own health in ways that support them to have independence and choice. I sincerely hope that the Green Paper acknowledges many of these realities because if it doesn't, it will be yet another missed opportunity and will represent wilful political neglect.


CMM May 2017 21



Colin Angel, Policy and Campaigns Director, United Kingdom Homecare Association Given that we have an ageing population, many more people are increasingly likely to fund their own care. A social care Green Paper must not just confine itself to the current crisis in state-funded care, it must also consider options for people who fund their own support. It can't just be a quick fix. Green papers are discussion documents, intended to test reaction to a range of policy options. This one needs to describe the balance of responsibility for funding social care between the individual and the State. Successive governments have ducked this issue, but it is no longer an issue in the distant future; people born at the start of the baby-boom are already in their 70s. The Green Paper needs to set out options for what the public will need to fund, whether this is through higher central government taxation, increased local government taxes, or a requirement for people to fund themselves through insurance or savings. The Green Paper should consider: tax breaks for self-funders, other financial incentives to release money from property assets, and salary sacrifice schemes. In relation to state-funded care, the Green Paper should consult on giving more teeth to the Care Act 2014, which has no independent policing of whether councils genuinely comply with their statutory responsibilities. Councils can, and I believe do, make decisions on whether to comply with the Act based on whether they are likely to be challenged through judicial review. Government should consult on whether a regulator – such as the Care Quality Commission – should play a role in overseeing how councils spend public money intended for social care, and whether they are effective in shaping their local care market – as recommended by the Communities and Local Government Select Committee. The Green Paper is also an opportunity to ask whether the current responsibilities between councils and clinical commissioning groups are appropriate or effective; reducing duplication could represent significant savings for the public. The Green Paper must also present options for better ways to get money to frontline services. The Social Care Precept has been criticised for helping councils in deprived areas the least, while the Better Care Fund has been bureaucratic and used to increase capacity, rather than stabilise markets. A relatively straightforward solution to support providers would be for Government to change the VAT status of regulated care, to cushion the effects of low council rates by allowing providers to reclaim their input tax. As the UK prepares to exit the EU, this becomes a more practical option. Social care providers will be looking for the Green Paper to ensure that councils and the NHS understand (and fund) the real costs of care, particularly as an incentive for greater long-term investment. Providers will also hope to see some practical approaches to the labour market, to ensure that recruitment problems are not exacerbated by Brexit.


It is a huge relief that Philip Hammond has finally recognised the need for a long-term systemic change to the UK health and social care sector. A Green Paper, set for release later this year, is tipped to outline recommendations for an overhaul in the way services are funded, commissioned and accessed. While this is a tentative step in the right direction, the success of such an initiative will depend wholly on the outcomes it achieves. From the better integration of services, the introduction of new legislation, providing more funding that can be directed towards best-value outcomes and encouraging individuals to plan for their own care needs, the Government must act now to address urgent concerns in the sector, or endanger its very existence. Announced by the Government in June 2013, the £5.3bn Better Care Fund was lauded as a revolution in health and social care integration, creating a single pooled budget to encourage the NHS and local government to work together more closely. Nearly four years on, there is little evidence that large-scale integration is working. In 2014, The Barker Commission proposed merging the NHS and social care in England, with a combined budget, on the grounds that the NHS is free at the point of need, while social care support is means-tested. An integrated budget under a single commissioning body may seem challenging to implement, but is exactly what the sector needs – eliminating the incentives for patients to stay in hospital, while ensuring the focus is placed on reaching the bestvalue outcomes for individuals based on their specific care requirements. With the NHS under unprecedented pressure, current efforts to reduce the burden of elderly care on the healthcare system are not working in many places, and it is time to explore legal intervention. One possibility is making local authorities legally obliged to provide sufficient services to prevent delayed transfers of care, and subsequent penalties if they fail to do so. If patients can be moved into suitable community or residential facilities, or provided with homecare, this would release significant NHS resource. However, this will only work if local authorities are allocated sufficient funds to provide the required level of support and NHS and local authorities are put under legal duties to deliver integration. The Green Paper must find ways to incentivise individuals to anticipate and plan for their own elderly care needs. Delayed until April 2020, after initially being planned for introduction in 2016, the ‘care cap’, which limits the total costs an individual will pay for their own care to £72,000, could provide a basis for individuals to plan for their future, especially if such costs could also be insured. Attitudes towards long-term social care provision need to change. We are actively encouraged to plan for our pensions, why shouldn’t it be the same for our care? Attractive incentives to invest in care insurance, perhaps in the form of tax breaks, should be introduced to encourage individuals to make such plans. The Government needs to work alongside the insurance industry to ensure that a suitable suite of products is available to meet this demand.

Professor Martin Green is Chief Executive of Care England. Email: Twitter: @ProfMartinGreen Colin Angel is Policy and Campaigns Director at United Kingdom Homecare Association. Email: Twitter: @ColinTWAngel Matthew Wort is Partner at Anthony Collins Solicitors. Email: Twitter: @ACSLLP What would be on your Green Paper wish list? Share it on the CMM website Subscription required. 22 CMM May 2017

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The new DoLS An introduction to the Liberty Protection Safeguards The Law Commission has made a number of recommendations to the Government around changing Deprivation of Liberty Safeguards. What has been recommended and what does this mean for the sector? Stuart Marchant explores the Law Commission’s report on the subject. 24 CMM May 2017

In March, the Law Commission concluded its review of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) and published its final report, along with a draft Bill, introducing a new statutory scheme named the Liberty Protection Safeguards (LPS). As many felt might happen, the Law Commission’s report recommends the repeal of the current DoLS. However, given the issues around the current system, most people want to know whether it would create a simpler process that is easier to work with. Also, would the new system ensure the person concerned is at the centre of all decision-making?

KEY CHANGES TO DOLS The report proposes a number of key changes to DoLS and clarifications that would be covered by a new LPS. These include considerations around who the safeguards apply to, where they apply and any specific arrangements to which they may apply. Regarding who they apply to, the Law Commission recommends extending the age range of LPS to include young people aged 16 to 17. The Law Commission is also seeking to cure one of the procedural gaps created by the Supreme Court in the Cheshire West case by recommending that LPS would also apply to community settings. Added to that, the report also recommends that, ‘The Liberty Protection Safeguards apply to arrangements which are proposed or already in place to enable the care or treatment of a person, and which would give rise to a deprivation of that person’s liberty.’ The specific arrangements that may be authorised under the new process are: 1. That a person is to reside in one or more particular places. 2. That a person is to receive care or treatment at one or more particular places. 3. About the means by, and the manner in which, a person can be transported to a particular place or between particular places. To explain this more, the Law Commission says, ‘A DoLS authorisation simply authorises a “deprivation of liberty”. By contrast, an authorisation under the LPS would authorise particular arrangements for a person’s care or treatment insofar as the arrangements give rise to a deprivation of liberty.’ It clarifies to say, ‘This focuses attention at the authorisation stage not simply on the binary question of whether a person should be deprived of their liberty or not, but on the question of the ways in which a person may justifiably be deprived of liberty.’

For example, ‘An authorisation under the LPS could cover deprivation of liberty in any setting and in more than one setting so as to take account of, for example, planned admissions to hospitals and respite care, as well as arrangements for the person’s travel between venues.’ In the case of urgent authorisations, the LPS says that it, ‘Would replace urgent authorisations with a statutory authority to deprive someone of liberty temporarily in truly urgent situations and in sudden emergencies, but only to enable life-sustaining treatment or to prevent a serious deterioration in the person’s condition.’ Beyond that, deprivation of liberty cannot be imposed on someone until arrangements have been authorised. The term ‘arrangements’ has been kept ‘intentionally broad’ so it could cover arrangements that have previously been an area of uncertainty for providers.

CHANGES TO THE MENTAL CAPACITY ACT 2005 As part of the Law Commission’s report, it is proposed that the LPS would operate within an amended framework of the Mental Capacity Act 2005 (MCA). The proposed reforms would be to improve decision-making across the MCA and include: • All decision-makers would be required to consider a person’s ascertained wishes and feelings when a best interests decision is taken. • Providers will need to ensure that there is an important formal written record of each decision-making process. The Law Commission says that the record must confirm that, ‘A formal capacity assessment has been undertaken and rights to advocacy have been implemented. This applies to cases that cover, ‘Decisions to move a person into particular accommodation, to restrict their contact with others or to administer certain types of medical treatment to them.’

THE APPROVED MENTAL CAPACITY PROFESSIONAL The report also recommends replacing the existing best interests assessor with the expanded role of Approved Mental Capacity Professional. Their role is to determine whether or not to approve the arrangements and they must meet with the person and consult with other key individuals to do so. They must not be involved in the day-to-day care or treatment of the person. The LPS would require a referral to be made to an Approved Mental Capacity Professional if:


CMM May 2017 25



• it is reasonable to believe that the person does not wish to reside or receive care or treatment at a particular place or accommodation; or • the arrangements are for the protection of other people. The written approval of the Approved Mental Capacity Professional would enable the authorisation of arrangements by the ‘responsible body’.

WHO WOULD AUTHORISE LPS ARRANGEMENTS? The LPS sets out three criteria for identifying the responsible body for authorising arrangements in any case. It states that: • The responsible local authority in most cases will be the authority that is meeting the person’s needs or in whose area the person is ordinarily resident. • If the arrangements are, or are proposed to be, carried out primarily in a hospital, the responsible body is the hospital manager. • If the arrangements or proposed arrangements are being carried out primarily through NHS Continuing Health Care, the responsible body is the relevant clinical commissioning group in England or local health board in Wales.

WHAT ARE THE CONDITIONS FOR AN LPS AUTHORISATION? The LPS sets out the following conditions, which must be met in order for the responsible body to authorise arrangements: • The person lacks capacity to consent to the arrangements which would give rise to a deprivation of the person’s liberty. • A medical assessment has confirmed that the person is of unsound mind within the meaning of Article 5(4)(1)(e) of the ECHR. • The arrangements are necessary and proportionate by having regard to the likelihood of harm to the person and/or other individuals if the arrangements were not in place, and the seriousness of that harm. • The required consultation has taken place (for instance, with friends and family members). • An independent review has been taken out. • The authorisation would not conflict with a valid decision of a donee or a deputy as to where the

person should reside or receive care or treatment.

THE AUTHORISATION ITSELF Under the proposals, an authorisation can have effect immediately, or up to 28 days later. It can last for an initial period of up to 12 months and can be renewed for a second period of up to 12 months and, thereafter, for periods of up to three years. As mentioned under the changes to MCA, the responsible body must produce an ‘authorisation record’ which must include matters such as details of the arrangements authorised. The Law Commission is clear, however, that, ‘An authorisation does not provide statutory authority to deprive a person of their liberty; instead, a new section 4AA of the Mental Capacity Act would simply provide a defence to civil or criminal liability in respect of acts done pursuant to an authorisation.’

WHAT SAFEGUARDS WILL BE INTRODUCED? The LPS recommends the introduction of a number of safeguards, including: • The responsible body keeps the authorisation under review with a duty to hold reviews at planned times and due to changes in circumstances. • The appointment of an Independent Mental Capacity Advocate or appropriate person to represent and support the person if the responsible body ‘proposes to authorise arrangements’ and throughout the period of the authorisation. • The right to challenge the deprivation of liberty legally.

GUIDANCE FOR PROVIDERS The LPS system proposed by the Law Commission encourages best practice, having learned from DoLS and the Courts, so providers would be well-placed if they started to implement some aspects of the proposed system now, including: • Documenting the person’s wishes and feelings in best interests decisions and making judgements which reflect these. • Planning care interventions and any consequent deprivation of liberty that may occur and documenting issues in care plans that are discussed with individuals, their families and other professionals.

• Identifying the kind of arrangements that may require authorisation in future so that you are well-placed to respond to changes – if nothing else, this will improve a thinking culture around issues that affect individuals in your care.

NEXT STEPS FOR DEPRIVATION OF LIBERTY Although the Law Commission has produced these recommendations and a draft Bill, it doesn’t meant change will happen any time soon. We now have to wait for the Government to respond to these proposals and decide whether to accept some or all of the changes or whether to introduce an amended version of the system. In any event, providers would be advised to start considering some of the proposals as outlined in the guidance above. CMM

IN OTHER RELATED NEWS… In other related news, coroners will no longer have a duty to undertake an inquest into the death of every person who was subject to an authorisation under the Deprivation of Liberty Safeguards (DoLS) under the Mental Capacity Act 2005. This follows the Policing and Crime Act 2017 amending the definition of ‘state detention’ in section 48 of the Coroners and Justice Act 2009 (CJA). The amendment removes those lawfully deprived of their liberty, by the Deprivation of Liberty Safeguards or by court order from the Court of Protection, from falling within the meaning of ‘state detention’ in the CJA. To accompany the change, which came into force on 3rd April, the Chief Coroner issued new guidance. This guidance makes it clear that where a death occurs on or after 3rd April 2017 any person subject to a Deprivation of Liberty is no longer ‘in state detention’ for the purposes of the CJA. Such a death should be treated like any other death outside the context of state detention. As such, it only needs to be reported to the coroner if one or more of the other requisite conditions are met. However, the guidance also makes clear that where there is a concern about the death, such as a concern about care or treatment before death, or where the medical cause of death is uncertain, the coroner will investigate thoroughly in the usual way.

Stuart Marchant is Partner at Bevan Brittan LLP. Email: Twitter: @BevanBrittanLLP What are your thoughts on these proposed changes to DoLS? Share your thoughts and read the Law Commission’s summary of proposed changes on the CMM website Subscription required. 26 CMM May 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.


Supported by:

Organised by:

INNOVATIVE FUNDING ROUTE FOR THIRD SECTOR CARE PROVIDERS Greensleeves Care has become the first care provider to raise funding for growth and development through a Retail Charity Bond. The Bond was so successful that it closed in under a week. Does it open the door for others to use similar approaches to raise funds? Given the current financial climate and the specific requirements of lenders to the sector, routes to finance for those providers looking to develop, expand or upgrade their services can be difficult. However, Greensleeves Care has found an innovative way to raise funds for investment through a Retail Charity Bond. Although Greensleeves Care does have access to the traditional financing routes, it selected this alternative approach to raise £33m for investment in the business, with a view to increase that to £50m as needed, and it only took a week to raise the funds.

GREENSLEEVES CARE Greensleeves Care is a not-forprofit care provider that developed from the Women’s Royal Voluntary Service. It supports 789 residents in 20 homes across the Midlands, South and East of England. It offers both care homes and care homes with nursing. The company is in a strong position with its quality of care, with nearly 85% of its rated homes having been awarded ‘Good’ or ‘Outstanding’ by the Care Quality Commission. Its five-year average occupancy sits at 93.9%, around 75% of its clients are privately funded and the remaining 25% are local authority or NHS funded. Although the company is in a strong position in the market, it is not immune to the pressures facing the sector, including rising costs, the National Living Wage and reductions in local authority fees. In 28 CMM May 2017

such an environment, it can make growth and business development difficult. The company decided to use the Retail Charity Bond platform to raise funds for investment as this funding source best supported the ongoing development strategy of the charity. The Bond facility offered Greensleeves the security of a known long-term interest rate and repayment profile, supported by borrowing covenants that it says better matched the aims of the organisation.

RETAIL CHARITY BOND The Retail Charity Bonds platform was created by Allia, a charity and specialist in social investment, to help charitable borrowers access finance that will enable them to grow and increase their social impact. Phil Caroe, Director of Impact Finance at Allia explained more, ‘Bond finance is typically far lighter on covenants than bank debt and doesn’t need to be secured on the borrower’s assets. It offers borrowing at a fixed cost, usually for up to ten years, as well as the opportunity to raise profile and connect with new audiences. ‘The demand from investors for retail eligible bonds is very strong, particularly for ethical investment opportunities. However, the costs and compliance burden of issuing listed bonds tend to make it prohibitive for borrowers to issue their own bonds for much less than £50m.’ Allia, therefore, set up Retail

Charity Bonds to make it simple and affordable for charitable borrowers to raise unsecured loan finance through bonds listed on London Stock Exchange. The platform was launched in 2014 with the first Bond for Golden Lane Housing which raised £11m, closed early and was oversubscribed. The funds were used to buy and adapt around 30 properties, providing homes for over 100 people with a learning disability. Two other Bonds have subsequently been issued, for Hightown Housing Association raising £27m, and Charities Aid Foundation raising £20m. The Greensleeves Bond is the largest-to-date at £33m, with the lowest interest rate and brings the total raised by the platform to £91m.

TERMS OF THE BOND The Greensleeves Homes Trust Retail Charity Bond was launched on 7th March and closed a week later, on the 14th, after raising £33m from a wide range of individual, ethical and institutional investors. The Bond will pay a fixed rate of interest at 4.25% per year, over nine years and is expected to mature on 30th March 2026, with a final legal maturity on 30th March 2028. The minimum initial subscription amount for investors was just £500. The finance from the Bond will enable Greensleeves to increase the number of residents it supports through buying and developing new homes, as well as going to pay off all existing debt. With a total of £50m of Bonds created, there is also the

option to raise up to a further £17m by selling more Bonds as needed in the future. Paul Newman, Chief Executive of Greensleeves Care, said, ‘We are delighted that we have been part of the largest ever Retail Charity Bond issue. The money will be put to immediate use to buy and develop new homes and sites as we invest in our portfolio and our ability to increase the number of older people who benefit from our awardwinning care.’

SUCCESS Following the success of this Bond, Allia expects more care home providers to look at raising funds in this way. Phil Caroe continued, ‘Quality care for the elderly is an increasingly vital issue in the UK. Allia is very pleased to help Greensleeves Care increase the number of older people they are able to look after, and through this Bond to demonstrate the appetite from investors for supporting the care home sector.’ CMM

OVER TO THE EXPERTS... Are retail bonds an alternative route to funding for the sector? Does the success of the Greensleeves Retail Charity Bond and the short timescales in which it raised its funding indicate a good appetite for investment in quality care? Will other not-for-profit care providers follow suit? What other routes to funding are there for providers at the moment?

AN EXCITING OPPORTUNITY FOR QUALITY CARE PROVIDERS Financial markets continue to innovate and develop in the UK. With the London Stock Exchange establishing the Order Book of Retail Bonds in 2010, this has opened an additional source of funding to UK businesses alongside bank debt. With historically low interest rates, investors and savers are attracted to the relatively high rates of return achievable through retail bonds. This in turn has improved liquidity and demand, especially for good quality investments, which is evidenced by the oversubscribed nature of the Greensleeves Care Bond. While retail bonds have been around for a number of years, they remain a niche funding platform alongside other corporate style investments such as private placements and corporate bonds. Debt securities, with increasing publicity and liquidity in the market, continue to grow in popularity, especially with the covenant light structure and longer

term commitment offered when compared to bank debt funding. We continue to see an increase in alternative funding methods within the care sector. These include the sale of ground rents, and property sale and leaseback to improve business liquidity, which continues to be supported by mainstream bank funding. Private equity involvement in the care sector also remains high. With the Greensleeves Care Bond being the fourth Retail Charity Bond to be issued, we see this as an exciting opportunity for good quality care providers to consider alternative funding solutions to supplement or even replace existing bank debt, to balance ongoing funding requirements, between short and medium term, providing management with security of funding and freedom to continue to develop and enhance their care provision.

Owen Vizard Corporate Finance Manager, Hazlewoods LLP

SOME VERY VALUABLE LESSONS TO SHARE In a post-Brexit world, the notion of ‘taking back control’ has a mixed appeal. However, in the context of the Greensleeves’ charitable bond, taking back control seems very much the order of the day. The financing of the organisation through the Bond creates opportunities for the organisation to adopt a more holistic approach, rather than managing a portfolio of debt linked to individual assets, with varying timescales, interest rates and covenants. At a trustee level, I am certain that there are some very valuable lessons to share. It would be very interesting to understand their thought process as they took the bold step to engage in a financing model that sits outside the known parameters of what could be seen as a relatively traditional industry, with a reliance on tried and tested financing models. I see this as a great example of innovation within the not-for profitsector, showing how it can begin

to expand the way in which it views its strengths and assets, and also a recognition by the wider investment world that the not-for-profit sector is made up of strong, business-savvy organisations, with a strong focus on quality, and a great potential for growth. I recall the excitement in the housing sector when Golden Lane Housing launched its charitable bond in 2014, and the big news then was that the original bond closed two weeks early having raised £11m, after two and a half weeks of trading. The very fact that Greensleeves’ Bond sale closed after a week, raising three times as much, suggests to me that there is appetite in the market for more of the sector to explore this as a much-needed additional route into raising capital, and supporting the development of new homes, and the redesign of existing stock.

Vic Rayner Executive Director, National Care Forum

BANK FINANCE MAY PROVE MORE ECONOMIC Like many other proven operators with great pedigree, Greensleeves has admirable ambition to invest in its assets and strive to meet the growing demand for excellent quality care. There are increasingly more routes to access finance for investment, banks have capital to lend, although lending facilities come with varying sizes of hoops to be jumped through. Similar operators are considering retail bonds for reasons such as: the reduced cost of debt servicing with no requirements for capital repayment until maturity; increased flexibility and control over use of funds, enabling a confident and decisive approach to opportunities often difficult to achieve with bank financing; relaxed covenants and perhaps the absence of a potentially distracting, sometimes intrusive, oversight of an anxious lender. However, when evaluating the overall cost during the term, bank finance may prove itself significantly more economic. With record-beating

low interest rates, capital can be borrowed for less. Operators with their sights set on multiple newbuild schemes can access revolving facilities offering interest-only debt servicing, capital repayments can be profiled over 15-25 years. Furthermore, full repayment at maturity implies its own restraints and the pressure of needing a bulletproof business plan to ensure borrowings are not held as costly working capital for too long. Supportive and experienced stakeholders offering investment funds for expensive infrastructure have been a feature in the market and will surely retain their place for due deliberation.Ideally, most advisers would usually recommend a carefully considered combination of a number of options, a bespoke fit for each individual organisation – as we know too well, the finance market is prone to change.


Liz Woollett Partner, Chandler & Co CMM May 2017 29


WHO WE ARE There’s lots happening this year! National Care Forum is the strongest • As well as the main programme of voice for not-for-profit care providers speakers and workshop sessions and providers of quality care and support • Put your questions forward to our ANNUAL CONFERENCE 15-16 MAY 2017 services in the UK supporting a wide range panel including Andrea Sutcliffe, of services including home care, housing #NCF2017 Chief Inspector Adult Social Care, with care, day care, intermediate care, outreach, CQC, Margaret Wilcox OBE, incoming president residential and nursing care, and specialist provision for all adults ADASS and Prof Keith Willett, Medical Director, Acute Care, NHS and older people. England WHY ATTEND? • Governance Hub - A focused event for Trustees and Non-Execs The NCF Annual Conference is an opportunity for members, non• The Rising Stars Programme for the next generation of members and those within the care sector to: potential leaders who are currently Registered Managers • connect up • help build evidence • Technology Exhibition for all delegates - leading on from our • support and promote • developing leadership and latest event on data and technology and its potential use in the innovation promoting growth. care sector ‘Unlocking Data’s Potential’


• The much anticipated performance by award winning Homeward Bound • Visit the Partner Exhibition – bring your questions to organisations representing insurance, food & hygiene, legal advice, procurement, chartered surveying and architecture

Members and Non-members are welcome to attend the NCF Annual Conference and contribute to the conversations and debate

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HELÉNAHERKLOTS Heléna Herklots is Chief Executive of Carers UK.

REFLECTIONS ON THE LAST DECADE It’s been tough for many people who need social care; and those who are charged with commissioning it and providing it. The frustrating thing is that we know so much more about how vital social care is to our society; how to provide good quality care; and how we should train and support people to do this. The Care Act 2014 sets out a positive vision that has wide support in the sector, but there hasn’t yet been the political will to recognise the importance of social care and invest in it properly. We are a caring society. Most care in this country is provided, unpaid, by families and friends – 6.5 million in the UK and growing. But too many are finding this increasingly difficult as they’re hit by the impact of cuts to benefits; cuts to social care; and pressure on the NHS. PROJECTIONS FOR THE NEXT DECADE I have two sets of projections – one with my glass half full; one with it half empty. In my optimistic view, by the end of the next decade there will be recognition of the role and contribution of unpaid carers in our society, where carers are respected, valued and supported. Our industrial strategy will invest in social care as part of the vital infrastructure of our country, and it will have become a career of choice, with the status it deserves. Social care will be integrated with health and housing, with the right links across into employment

and the social security system. We will, though, still be having debates about the affordability of public services… When my glass is half empty, I see a lack of good quality, affordable care; a series of ‘sticking plaster’ measures applied as we’re met with winter crises; the shocking findings of undercover documentaries; and unbearable pressures on the NHS, with more and more being expected of unpaid carers whose health and wellbeing worsens each year. Whilst the pessimist in me thinks that we will be closer to the half empty version, the campaigner and optimist will continue to push for the half full version. INSIGHT I started my involvement in the social care sector at 18. I took a year off before going to university and signed up with Community Service Volunteers as a full-time volunteer in what was then called ‘an old folks home’. I learnt a huge amount from my time there, and remember to this day some of the conversations I had with the residents, their families and friends, and the staff. The experience stayed with me, and influenced my career direction – from running a day care centre, to developing new services, then carrying out strategy, public policy and campaigning work to change things for the better. As Chief Executive of Carers UK, my role combines many of these things and I can see the difference that the charity makes, and I feel fortunate to work with so

many inspiring people. At Carers UK, we provide information, advice and emotional support; campaign on the issues that matter most to carers; champion carers’ rights at work and support from employers; and provide expertise and help to those who seek to support carers. We are committed to working in partnership and lead two major awareness raising campaigns, Carers Week – 12th to the 18th June this year, and Carers Rights Day – 24th November. INFLUENCES Many and varied. Certainly, family and friends, as well as the experiences of carers and their everyday battles to get the best for those they care for. LESSONS ‘Speak truth to power’ was the mantra of my first manager at Age Concern England, and it is very important to me – particularly in this role, when I need to represent the experiences of carers. What I continue to learn is all the different ways to do this, from the diplomatic to the more forceful. ADVICE I hesitate to offer advice, but I think ‘lead by example’ would be one. It’s difficult to live up to, but I think it matters that you try. The other is to have a combination of passion and persistence – I think you need both to be effective. CMM

Read about Heléna's typical day on the CMM website Subscription required. CMM May 2017 31

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The stark financial

realities of the

domiciliary care crisis

Nick Hood shares his research into the financial health of the homecare sector. The BBC1 Panorama programme, Britain's Home-Care Crisis, broadcast in March, laid bare the plethora of problems besetting the UK’s homecare sector. The impact of resource constraints was set out for all to see. There were tales of recruitment and staff retention issues and

warnings of worse times to come from local authorities and other organisations, including the United Kingdom Homecare Association. With the support of financial health monitoring specialists, Company Watch, Opus had worked closely with the producers of the Panorama programme for


CMM May 2017 33



six months prior to it being broadcast, providing them with statistics on the sector. This was essentially the financial bedrock on which the programme rested. The headline-grabbing point we made was that over one in four (27% in fact) of all the homecare providers in the UK are at serious risk of failure. This is a threat, which has systemic implications, not just for domiciliary care, but for the whole care system.

been allowed to develop where, as pointed out so eloquently on BBC Radio 4 recently by the Chief Executive of Mears, local authorities squeeze domiciliary care fees, when this is by far the cheapest way of caring for the elderly and vulnerable? The weekly cost is significantly below that for a residential care place and a fraction of the cost of an NHS bed. Equally, why is it acceptable that homecare providers

“The headline-grabbing point we made was that over one in four (27% in fact) of all the homecare providers in the UK are at serious risk of failure. This is a threat, which has systemic implications, not just for domiciliary care, but for the whole care system.” As the care industry is well aware, but as successive governments have seemed unable to grasp, the various subsectors of health and social care are interwoven in a complex web of interdependency. If domiciliary care is not available for the elderly and vulnerable, this puts pressure on NHS resources, including A&E admissions and delayed transfers of care. Added to that, it also stresses the residential care sector, which is in the grips of a very similar crisis, both in terms of capacity and finances. This illustrates one of the most serious problems underlying the current situation: the existence of entrenched silos within the system. The NHS, domiciliary care providers, care home operators and their paymasters in local and central government can all be driven by their own agendas and guard their independent budgets. How else has a situation 34 CMM May 2017

should invest time and money to train care staff, only to see them poached by nearby NHS hospitals? The outcome is a domiciliary care sector in danger of collapse, according to many pundits, and one which astoundingly loses an average of £11.66 per client per year on its estimated 900,000 clients, based on the latest financial information available. Our original research for Panorama covered the accounts of some 2,600 companies, which tell Companies House that they provide non-residential care services. Subsequent to the programme’s transmission, we expanded the sample to include the latest financial information for three major national domiciliary care providers, who had not previously been included because their official business description was not within this definition.


27% 18%


0 -10 76

Our analysis has been carried out using the Company Watch methodology, which allocates a financial health score (H-Score®) out of a maximum of 100. This is derived from the analysis of a company’s published financial results. Companies with an H-Score of 25 or less are placed


37% 18%



Chart 1: Financial health scores of domiciliary care providers


“The average net worth of providers is only £314,000, confirming how small the players in this sector are.”

The average domiciliary care provider makes a post-tax loss of £4,000 per year. Eliminating the three national operators from this calculation, the smaller operators were marginally profitable, earning a tiny profit after tax of £6,000 a year, a 40% drop from the previous year, when the average was a profit of £10,000 per annum. Overall, one in eight providers showed a loss in its latest accounts. The latest annual pre-tax losses for the sector total £10.5m. Because of the delay in filing accounts at Companies House, these figures do not yet reflect the effect of the introduction of the National Living Wage, which will add materially to the sector’s losses. In addition, an employment tribunal ruling in 2014 has created a further significant burden by confirming that staff sleeping overnight at clients’ houses must be paid the National Living Wage for every hour in their ‘sleep-in’ shift, rather than the lower flat rate shift allowance commonly used in the sector. Between them, these two factors will add several hundred million pounds to the cost base of a sector which employs some 650,000 people and is battling just to preserve its revenues, never mind increase them to cover this huge extra burden.

in what is known as the Warning Area. Not all companies in the Warning Area will fail; however, of the companies that do fail, the vast majority were in the Warning Area prior to their collapse. The spectrum of health scores across the domiciliary care sector can be illustrated by Chart 1. It can be seen that while 55% of companies have an H-Score of 51 or higher and 37% are in the highest bracket, 27% sit in the warning area.




ZOMBIE COMPANIES A zombie company is one with total liabilities that exceed its total assets in its latest published accounts, making it technically insolvent. As such, it continues to operate with the agreement (tacit or otherwise) of its creditors. Based on our research, there are 294 domiciliary providers in the UK that fit this definition, amounting to 11% of the total. Their total ‘negative equity’ was £38m.

ASSET PROFILES The average net worth of providers is only £314,000, confirming how small the players in this sector are. This makes them particularly vulnerable to


CMM May 2017 35



pricing pressures from local authorities. They are also likely to have limited reserves to withstand any sustained losses. Average gross assets are also reducing, indicating lower investment in the sector. The average total assets per operator is now £538,000, compared to £625,000 a year ago, a drop of 14%.

ANALYSIS OF REGIONAL VARIATIONS We also looked at the differences between different regions of the UK and especially at how overall financial health varied. Northern Ireland has the most financially secure providers with an average H-Score of 73, while the North West has the lowest average H-Score of 48. Worryingly, the three national chains in our sample are the weakest, with an average H-Score of just 34. The comparative average Company Watch H-Score per region is in Chart 2.

The South West has the highest percentage of providers (36%) in the Company Watch Warning Area, followed closely by the North West with 34% at risk of insolvency. Unsurprisingly, these two regions also had the most zombie companies, 17% in the South West and 15% in the North West.

OVERALL FINANCIAL PICTURE The overall financial picture of the UK’s domiciliary care sector is one of negligible or negative profitability. Too many providers are in a vulnerable financial position and there is a worrying number of ‘zombie’ companies. Some of the regional variations are also a matter of concern. Pressure will inevitably mount for more capacity within the sector to deal with the predicted rise in the number of people needing care, as the Baby Boomer demographic spike plays out. Equally, the parallel financial

“The overall financial picture of the UK’s domiciliary care sector is one of negligible or negative profitability. Too many providers are in a vulnerable financial position and there is a worrying number of ‘zombie’ companies.” crisis in residential care and the NHS can only have the effect of increasing the demand for homecare for those needing care and support. Additional public funding for social care was announced in last month’s Spring Budget, but many care experts have dismissed this as too little and far too late, a view we share. Even then, the domiciliary care sector may miss out on its

Chart 2: Average H-score per region 61

East Anglia 57

London 51




North 48

North West


N Ireland 62

Scotland 54

South East 51

South West


Wales 34

National Chains











fair share of this sticking plaster solution, as it competes with residential care and NHS carerelated services for this funding. The parlous state of finances in the domiciliary sector were highlighted in March, when one of the largest providers in the South West, Cleeve Link Homecare went into liquidation. This left local authorities struggling to find alternative providers for almost 500 elderly and vulnerable clients. Our research suggests that many more providers may suffer the same fate. Insolvency apart, the parallel risk is that more and more domiciliary providers will simply leave the market altogether because the returns available do not justify the risk, compounding what is already sustained pressure on all aspects of social care. Our research uncovered 69 providers who had simply shut up shop in the three-month period up to February 2017. Sadly, this worrying trickle has every chance of becoming a flood, leaving significant numbers of the sector’s 900,000 clients without a care package. Is this really what a civilised society, or any government representing it, should contemplate? CMM

Nick Hood is Business Risk Adviser at the Opus Business Services Group. Email: Twitter: @NickHood5 The full report is available on the CMM website at Subscription required. 36 CMM May 2017

AWARDS 2017 Creative & innovative ways to achieve excellence

SAVE THE DATE 6th December 2017 The London Marriott Hotel Grosvenor Square Grosvenor Square, London W1K 6JP @3rdsectorcare #3rdSectorCareAwards

Appreciate. Celebrate. Network.

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Sponsored by:


How can organisations that achieve ‘Good’ or ‘Outstanding’ ratings continue to innovate and drive forward their quality? What role does creativity play in retaining or improving quality ratings? Chris Gage shares his advice for providers to enable them to embed creativity and innovation throughout an organisation.

Over half of the Care Quality Commission’s (CQC) ‘Outstanding’ ratings require ‘evidence’ of creativity and/or innovation and, despite their elusiveness, it is these two words that are at the heart of what it takes to be, and remain, ‘Outstanding’. As Christine Asbury, WCS Care’s Chief Executive and a founding member of the Centre for Creativity and Innovation in Care states, ‘Creativity and innovation is central to delivering WCS Care’s values, and we do this by giving our staff the freedom and confidence to try new things to ensure every day is well lived for residents.’ It’s an approach that works for WCS Care – around 40% of their care homes are recognised as ‘Outstanding’. We all know that there can be inconsistencies in inspection, but some of the most successful leaders in the sector agree that by focusing on a creative approach to care and support, free from fear of inspection, the best results are likely to come.

CREATIVITY IN SOCIAL CARE The word ‘creativity’ is itself a barrier to ‘Outstanding’ success, for almost everyone has a different perception of what it means to be creative. It’s ‘thinking outside the box’, it’s making things (a cake, a painting), it’s being expressive (singing, dancing, writing), it’s problem-solving,


38 CMM May 2017

CMM May 2017 39



and, too often, it is ‘not me’. With so many different opinions on what is ‘creative’ and not enough confidence, no wonder people don’t know where to start. That is why I believe it is incredibly important for the sector to agree its meaning, and the definition we use at the Centre for Creativity and Innovation in Care (CC&IC) is ‘bringing something new and of value to life’. There are plenty of definitions, but almost all have these two components – newness and value. If something is new but doesn’t have value, then it is a novelty, frippery or timewasting and so the other element of value must be absolutely grounded in real outcomes for the people that use your services. Equally, to make something of value (care planning, an event, a team meeting) creative, you need to add an element of surprise or delight – the ‘ooh, ahh, wow factor’. However, here’s the extra challenge; organisations need to innovate continuously in order to keep surprising and delighting clients and regulators. The first time around, you may wow your inspector with one or two unusual approaches, but the bar is going to be raised in the intervening period, and next time you are going to need almost every member of staff and resident mentioning new things that have happened that have delivered valuable outcomes. For that to happen you need a culture of innovation. Innovation is essentially the process of making creativity consistent, but it is too often seen as the domain of the technology companies. However, according to PWC, by 2018 innovation spending in healthcare will outstrip the technology sector. There is every reason to innovate in social care, what is required is the leadership to implement and support it. Paul Musgrave, Chief Executive of Forest Healthcare and founding member of CC&IC added, ‘We want creativity to be routine. We want it to be so business as usual that we don’t even have to think about it, although, of course, that doesn’t mean we won't have a lot of fun along the way bringing life and vibrancy to how we care.’

A CREATIVE CULTURE If you want to be continually creative over time, you need a culture of creativity and 40 CMM May 2017

innovation. If you want ongoing originality, that is also demonstrably valuable, it can't just be about implementing the latest thing, you need to have continual innovation within your organisation. To achieve this, you need: 1. Creative leadership. According to Collective Genius: The Art and Practice of Leading Innovation, being a leader is about ‘setting the stage’ for others to perform on, not ‘acting on it’. 2. A creative climate. Nurturing behaviours around trust, debate, playfulness and freedom that are easily observable and can be learned. 3. Creative business processes. Specific internal structures and systems that encourage, support, facilitate and permit newness. These factors significantly impact an organisation’s ability to keep innovating and they correlate to financial performance, through staff engagement, occupancy, fees and valuation. They are interlinked and interdependent, they reveal the values and heart of an organisation, by shining a light on what the organisation prioritises. A leader sets the climate through business processes. If any of these elements are out of kilter, a less than positive cycle prevails. I often see leaders whose priorities aren't aligned with their actual day-today behaviours. They want creativity and innovation, but spend their time on counter-productive (from an innovation standpoint) management processes. Instead of recognising people who try something new (regardless of whether or not it works), they prioritise the processes that disempower the individual, reducing their freedom to be creative, without realising the impact of that decision. An overreliance on audits, compliance monitoring, rigid agendas, task lists, timetables etc can show a lack of creative leadership. Of course, we need these things to run safe and effective services, but too much control and not enough trust will certainly get in the way of an innovative culture. Paul Musgrave, Chief Executive at Forest Healthcare has recognised that creativity isn’t a component of a process within a process. He believes that to make progress, you have to invest in the leadership, the climate and the supporting

processes that make these things flourish. He explained, ‘We have to embrace the opportunity to turn the way we operate on its head; creative care can’t be something that we do when everything else is done, because that day will never come. It is the thing we should focus on first and then everything else will get easier, this is why we have joined CC&IC to consolidate and develop this approach. 20 years of business research tells us that this kind of

“If you want to be continually creative over time, you need a culture of creativity and innovation.” forward-thinking investment in developing and supporting a consistent, creative culture will lead to increased innovation potential and improved business results, and we have seen the results in all of our homes, including our three “Outstanding” ones.’

EMBEDDING CREATIVITY IN SOCIAL CARE Organisational creativity needs to be thought about at all levels – the level of the individual staff member, the team and the whole organisation – in order to achieve innovation as business as usual. At individual level, it is about building creative confidence and skills in staff. It’s certainly not money or accreditation that help achieve this. It is intrinsic motivation that forms part of the magic formula. People doing new and useful things for their own sake, for the personal reward of a job well done, or a great outcome. Attracting staff who want to innovate and who come with passion and an open mind, free from the constraints of ‘that is how we’ve always done it’. Everyone is creative, we all do things that are new and valuable every day, in the conversations we have, in the problems we solve. In part, it is about developing creative confidence in every team member, whatever their role in the organisation. There is plenty of research that the more creative we believe

ourselves to be, the more creative we are. The conditions that we operate in day-to-day have a significant impact on how much our creativity will or won’t show up at work. How teams are led and operate have an impact on the behaviours you see from staff and the overall customer experience. How safe we feel as individuals has an impact on how willing we are to suggest and try out new things – if staff have more control and freedom to innovate and be creative, they will. Simple. At the organisational level, it’s important to ask yourself, is there a strategic investment in creativity and innovation? Do you have a strategy for creativity? Is it embedded in your practices and processes? Is the way you manage risk getting in the way? Does the hierarchy help or hinder what you want to achieve on the frontline? Are you rewarding your regional and service managers in the right way? Do people have the freedom to act on their intrinsic motivation?

BE CREATIVE FIRST, THE REST WILL FOLLOW We work with chief executives who are passionate about embedding creativity at the heart of their organisations and the wider care sector. They recognise that creativity can’t wait for all the process and boring work to be done, they have flipped their thinking – creativity comes first and it enables the rest to follow with more ease. This makes organisations more attractive to stakeholders, more appealing to customers and employees and, as a byproduct, to the Care Quality Commission. However, it doesn’t stop there. Committing to creativity and innovation to deliver better care is great, but it needs to be evidenced. It’s important to measure and benchmark the observable behaviours that deliver a culture of creativity and innovation, support people to shift their behaviours and work collaboratively with other senior leaders to develop new practices and approaches for the sector.

The sector shouldn’t be complacent. ‘Good’ and ‘Outstanding’ care is fantastic, but it can’t stop there. There is value in continuous creativity and innovation and making these aspects of social care ‘business as usual’. The final word goes to Christine Asbury, who says, ‘Don’t be afraid to try new things and don’t be put off if things don’t work first time, every time – you’re only human, you just have to keep trying until it works well for you and, most importantly, the people you care for. ‘Once you’ve got your approach to high quality care right and it has clear benefits for residents, the rest will fall into place – but you can’t rest on your laurels; it’s vital to keep finding new ways to adapt and move forward, regardless of your home’s rating. ‘We’re keen to join with other innovative organisations to share approaches and push for a transformation of care together – being part of the Centre for Creativity and Innovation in Care will help achieve that.’ CMM

Chris Gage is the Founding Director of the Centre for Creativity and Innovation in Care and Managing Director of Ladder to the Moon. Email: Twitter: @LadderChris How do you innovate? Is creativity embedded in your service? Share your thoughts on the CMM website at Subscription required. CMM May 2017 41

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Cedi Frederick looks at how social care can develop the registered managers of the future. The role of registered manager is, without doubt, the most challenging in adult social care. I describe the ideal registered manager as needing to have the business skills of Richard Branson, Oprah Winfrey’s ability to connect and empathise with people, Churchill’s leadership qualities, Margaret Thatcher’s determination, Nelson Mandela’s vision,

Gandhi’s wisdom and, of course, like David Blaine or Dynamo, the ability to create magic. The heightened profile of the Care Quality Commission’s (CQC) regulatory regime and rating system now sees providers issuing press releases when one of their care homes is rated as ‘Outstanding’, whilst a care home rate as

> CMM May 2017 43

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‘Inadequate’ becomes front page news in the local newspaper. Behind both the press release and the local newspaper headline is a registered manager who is regularly working 60/70 hours a week under enormous pressure to deliver.

CURRENT REGISTERED MANAGERS The 2016 Skills for Care State of the Adult Social Care Sector and Workforce report paints an interesting picture of registered managers which, if it hasn’t caused providers to reflect and consider the implications by now, it should. According to the report, there were 22,500 registered managers in post at March 2016, and they had on average been in the sector for over 18 years, with eight years in their current role. This data supports what we intuitively know, that many worked their way up to become a registered manager, perhaps starting as care or support workers. The report also stated that around 20% of registered managers left their role in the previous 12 months and that 11.2% of posts remained vacant. These numbers are higher for care homes with nursing. One can only speculate how many of those managers left their posts following a poor CQC report and how many vacant manager posts were a result of managers finding it impossible to live up to the ideal, and perhaps reluctantly finding less stressful ways to make a living. Of course, I can only speculate, we don’t know. However, given this level of turnover, when combined with the demographic data contained within the Skills for Care report that shows 29% of registered managers were aged 55 or over and could retire within the next 10 years, perhaps it begs the question, where will the next generation of registered managers come from?

BARRIERS TO FINDING REGISTERED MANAGERS We know from the 2016 Skills for Care report that 73% of registered managers were recruited from within the adult social care sector. Some might argue that such a high figure shows that the sector has an established route for those in the sector who have the ambition to become a manager to build a career. However, we would be complacent to think that whatever has worked in the past, be that by luck or design, will continue to work and bring forward the registered managers of the future. Many providers have responded to the increase in the National Living Wage by flattening the hierarchical structure within their services. This

is mainly because they cannot afford the pay increases for each tier of the hierarchy that would maintain the differential in the hourly rate paid between frontline care workers, seniors, team leaders and assistant manager. Whilst in some cases, that difference was as little as 50p an hour, it encouraged staff to take the next step up the ladder. It allowed managers to incrementally increase levels of responsibility that provided staff with the experience and confidence to work their way up to registered manager over a number of years. An unintended consequence of combining roles, or in some cases removing whole tiers within the hierarchy, is that it makes that next career step a little higher, and potentially beyond some staff. This fracturing of the ‘next generation’ manager

“An unintended consequence of combining roles, or in some cases removing whole tiers within the hierarchy, is that it makes that next career step a little higher, and potentially beyond some staff.” pipeline, will only be made worse with the further increase in the National Living Wage, which came into force in April. To add to that worsening situation, some staff who previously might have thought about taking at least the next step up the ladder towards becoming a registered manager, now see how demanding and stressful the manager’s role has become and may be asking themselves, ‘You know what, is it worth all the hassle?’. One final area of consideration that may impact on the future, is the changing attitude to work of the groups described as ‘Generation Y’ and ‘Millennials’, (born between 1983 and 2000) and how different it is to the ‘Baby Boomer’ generation (born between 1946 and 1964), who make so many of today’s managers. How many of today’s 20 and 30-somethings are going to remain in adult social care for 18 years, and work their way up to become the registered managers of the future? Many may see their vocation as cause related, in working with vulnerable people more generally, and may work across different care and support sectors. Although, ‘Generation Y’ and ‘Millennials’ are more likely to have degrees and be more


CMM May 2017 45



comfortable with technology and the digital age, meaning that, arguably they have many of the base requirements needed to become registered managers of the future.

PREPARING CARE MANAGERS OF THE FUTURE We’ve seen the current picture and the barriers to increasing the pipeline of future registered managers, so, what should providers start thinking about to respond to and prepare for a future where there may not be enough registered manager calibre people to go around? If organisations do not have a workforce planning strategy in place that is reviewed on an annual basis, now might be a good time for them to start developing one. If not for the whole organisation, at least for their registered

“If organisations do not have a workforce planning strategy in place that is reviewed on an annual basis, now might be a good time for them to start developing one.” managers. This should include the age profile of those in post, the possible retirement profile of those in post over the next five years, capacity and succession planning. This will, at least, create a ‘conversation piece’ for senior managers to start considering the possibilities and options. With resources being limited, very few organisations will have in place a formal ‘Next Generation Managers’ programme, but there are things that, with commitment and planning, can be achieved to keep the pipeline of future managers open. A good place to start might be developing an understanding of who amongst their care and support staff sees their future as a registered manager, including understanding and testing the motivation of those who have expressed an interest through a formal evaluation process. Such an approach will give an indication of how wide the base of the talent pyramid is, as one should expect many to drop out.

However, this cannot be done in isolation and will only work as part of an organisational culture that is open, engaging and encourages ambition and learning. Those staff who have expressed a desire and shown that ambition to become a registered manager should be encouraged to start investing in their own futures by taking short qualification courses in their own time and at their own expense. This could be through distance learning or as evening courses. In return, the organisation commits to providing opportunities for those staff to develop their management and leadership skills and competencies. This could be through acting up or secondment opportunities, internal or external mentoring, involvement in ‘Task and Finish’ or working groups, giving additional responsibilities to individual staff members and even giving them the opportunity to sit in on management development training. This would inspire staff to want to become registered managers, encourage them to take a proactive approach to their own development and increase their understanding of what is required to become a successful registered manager. Organisations should also consider making a special effort to engage their ‘Generation Y’ and ‘Millennial’ BME staff in such initiatives. With over 80% of today’s managers being of white ethnicity (London is the exception, where 48% of registered managers are white), clearly some organisations are failing to reflect their staff demographics or local populations and are not establishing role models for others to follow. Finally, it’s worth remembering that the Care Quality Commission is clear that ‘A person (M) is not fit to be a registered manager in respect of a regulated activity unless M has the necessary qualifications, competence, skills and experience to manage the carrying on of the regulated activity’. It is this regulation that has limited the number of people from outside the sector being directly appointed as registered managers. With a potential crisis in registered manager numbers heading towards the sector, it is crucial for the long-term sustainability of adult social care that the sector maintains the pipeline that has delivered 73% of today’s registered managers from within.  CMM

Cedi Frederick is Managing Director of Article Consulting. Email: Twitter: @CediArticle Do you have registered manager vacancies? What are you doing to secure the pipeline of registered managers for the future? Share your thoughts on the CMM website Subscription required. 46 CMM May 2017



In one of the most hotly-anticipated seminars at the annual Surrey and Sussex Care Showcase, the Care Quality Commission’s Chief Inspector for Adult Social Care, Andrea Sutcliffe, outlined her views on how quality care can be sustained in the face of increasing challenges to the sector.

HIGH PROFILE SPEAKERS With the theme of Developing Resilience in Health and Social Care, the Showcase’s seminar programme offered care providers a unique perspective on a wide variety of topics, including dementia and end of life care, technology, staff recruitment and leadership, and even a look at Australian models of homecare. Andrea Sutcliffe headed a list of high profile speakers at the Showcase, which also included Keith Hinkley from the Association of Directors of Adult Social Services (ADASS), Professor Graham Stokes from Bupa and Vic Rayner from the National Care Forum (NCF). Keith Hinkley spoke about working in partnership to achieve the best possible outcomes in social care and health, asking whether integration can really make a difference. Professor Graham Stokes discussed dementia and how it is time to think differently

48 CMM May 2017

about the condition. Vic Rayner explored how the sector can stay positive with the many challenges it is facing.

CHALLENGING ENVIRONMENT Erica Lockhart, Chief Executive of Surrey Care Association and one of the Showcase organisers said, ‘There has never been a more challenging environment across the whole spectrum of social care provision. The inspection approach of the Care Quality Commission, pressure on fees and costs together with the uncertainty about how health and social care services will be integrated, mean care providers must have robust strategies in place to ensure a sustainable long-term future for the sector. Our Showcase helps keep providers abreast of developments and best practice in the sector enabling them to face up to the challenges ahead.’ Attracting over 600 care providers and care staff from across Surrey and Sussex, this year’s Showcase was officially opened by The Mayor of Brighton & Hove, Councillor Pete West.

ONE-STOP-SHOP The Showcase’s extensive exhibition area also offered a ‘one-stop-shop’ for information and

advice on products and services from over 65 training providers, legal and business advisers, care associations and suppliers to the care industry. The Surrey and Sussex Social Care Showcase was supported by Surrey Care Association, East Sussex County Council, Brighton & Hove City Council and West Sussex County Council with additional sponsorship from QualitySolicitors Burroughs Day, Cura Systems and Aon. CMM was media partner for the Showcase 2017.

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Brenda Metcalfe shares the results of the project Anchor has undertaken with Middlesex University to support LGBT people in care.

One in three women and one in four men will need care at some time in their life. For many, this transition from home to care home can be an upsetting process, but for some lesbian, gay, bisexual and transgender (LGBT) people this can be particularly worrying. Stonewall has revealed that 31% of LGB people expect to be treated worse than heterosexual people by care home staff, while 47% said they would feel uncomfortable telling care home staff their sexual orientation. It’s, therefore, not surprising that the charity found 95% of LGB people would prefer to remain in their own homes in later life. That’s despite the

fact that many people require care that can only be provided by a care home. The majority of straight older people take for granted that we can be ourselves wherever we are. But for LGBT people that’s just not the case. Stonewall found 70% of LGB people don’t feel they could be themselves in a care home and 65% feel they would have to hide things about themselves from others. It is with this background that we at Anchor wanted to make a difference and provide – as our strapline says – happy living for the years ahead for everyone, irrespective of their sexual orientation. We have launched several initiatives to make our 121 care homes and 900 retirement housing properties a welcoming environment for older LGBT people. As England’s largest not-for-profit provider of care and housing for older people, Anchor launched its LGBT group in 2007 and we have regularly consulted its members about our services. The group proved so successful and influential that it has won two Tenant Participation Advisory Service Connecting People awards and was shortlisted in 2012 in the equality and diversity category. Hearing the personal testimonies from older LGBT people about how lifechanging living in our retirement housing has been spurs me on to ensure all our customers have happy and fulfilling lives. I often hear how our LGBT customers appreciate living with an organisation which formally recognises their rights and ensures that our colleagues treat them with dignity and respect. This is why I’m keen to further improve on these successes, which is how our latest project with Middlesex University, led by Dr Trish Hafford-Letchfield, Professor of Social Care, came about. We applied for joint-funding from Comic Relief for the project which saw

volunteers going into six of our homes in London to ask staff questions about their views on how to provide care to LGBT people, and looking at how each home operated. We are always keen to improve our services, so were glad to receive feedback which we have already implemented. One of the reasons why we don’t know of any LGBT people living in our care homes is that we have never asked that question, so we will now be reviewing the conversations we have when anyone moves in with Anchor. Activities and even general conversations are often centred around the assumption that relationships are heterosexual and this fosters a sense of isolation for older LGBT people. As a result, going forward, activity programmes in Anchor care homes will include celebrations of LGBT events and cultures. Through training, we are also helping staff to understand the needs and aspirations of LGBT customers. This is also reflected in our recruitment process, where we ensure each candidate is suitable to work with Anchor’s values and behaviour framework concerning LGBT equality. We have also set up an Equality and Diversity staff group following the project. Middlesex University and Anchor are keen that other care providers are able to provide inclusive care for all older people, so the team has put together an audit tool which will help other organisations in the sector ensure their care homes are LGBT friendly, helping them look at their services and practices through the eyes of an older LGBT person. Often discrimination is not intended, but LGBT people’s needs just might not be considered. The LGBT audit tool can be downloaded from Anchor’s website. CMM

Brenda Metcalfe is Customer Engagement Manager at Anchor. Email: Twitter: @Anchor_Trust How do you support LGBT people in your services? Share your experiences on the CMM website Subscription required. 50 CMM May 2017

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Care Management Matters May 2017  

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The complete management journal for the care sector

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