NOVEMBER 2017 £4.00 www.caremanagementmatters.co.uk
CQC’S NEW ASSESSMENT FRAMEWORK What you need to know
Dementia provision Where’s best to build?
What does it take to be Outstanding?
Unlocking the secrets
Recruiting and retaining staff
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In this issue From the Editor
Is it just me…? Editor in Chief, Robert Chamberlain reports on growing concerns about the future of health and social care.
Business Clinic Hampshire County Council is leading the way by piloting Amazon’s Echo and Alexa software to support people to live independently. What does the panel think?
A View from the Top Ben Maruthappu, Co-Founder of Cera answers our interview questions.
Rising Stars Samantha Curran, Home Manager at Thornbank, run by Greensleeves Care, is this month’s Rising Star.
Event review A review of CMM Insight The Lancashire Care Conference.
Straight Talk Andrew McCracken explores National Voices’ research into person-centred care and asks whether its rhetoric or reality.
The new CQC assessment framework Laura Hannah delves into the new Care Quality Commission framework that’s coming into force in November and advises providers on what they need to do to prepare.
Overview of the UK’s dementia bed provision Ben Hartley shares market insight into the UK’s dementia bed provision to highlight the best place to locate a new specialist dementia care home.
What does it take to be an Outstanding manager in social care? Cedi Frederick explores research into outstanding managers in social care and what makes them stand out.
Transfers of care: Guidance for providers on moving between hospital and home or care home Ewan King discusses recent guidance to support people moving between hospital and home or care home.
Secrets of recruiting and keeping social care staff Annette Baines looks into the secrets of recruiting and retaining quality social care staff. CMM November 2017
EDITORIAL email@example.com Editor in Chief: Robert Chamberlain Editor: Emma Morriss Content Editor: Emma Cooper
PRODUCTION Lead Designer: Holly Cornell Director of Creative Operations: Lisa Werthmann Studio Manager: Jamie Harvey
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Laura Hannah Solicitor and CQC Regulatory Expert, Stephensons Solicitors LLP
Ben Hartley Co-Founder and Director, Carterwood Ltd
Sarah LeskinenKeel Chief Operating Officer, Agincare Group
Simon Hooper Director, RemindMeCare
Jonathan Papworth Co-Director, Person Centred Software
Dr Ben Maruthappu Co-Founder, Cera
Cedi Frederick Managing Director, Article Consulting
Samantha Curran Home Manager, Thornbank
Ewan King Director of Business Development and Delivery, SCIE
Annette Baines Recruitment and Retention Programme Head, Skills for Care
Andrew McCracken Head of Communications, National Voices
SUBSCRIPTIONS Non-care and support providers may be required to pay £50 per year. firstname.lastname@example.org 01223 207770 www.caremanagementmatters.co.uk Care Management Matters is published by Care Choices Ltd who cannot be held responsible for views expressed by contributors. Care Management Matters © Care Choices Ltd 2017 ISBN: 978-1-911437-63-5 CCL REF NO: CMM 14.8
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CMM November 2017
From the Editor Editor, Emma Morriss brings you a summary of this month’s features and encourages you to attend the 3rd Sector Care Awards. The Care Quality Commission’s (CQC’s) new assessment framework comes into force this month. Are you ready for it? In an attempt to simplify the process, CQC will be using just two assessment frameworks – one for adult social care and one for health. Although the five key questions will remain, the Key Lines of Enquiry will be merged to one set of questions and prompts for social care and one for health. If you want to know more about these changes, Laura Hannah of Stephensons Solicitors explores the new framework and what’s changing in her feature starting on page 20.
will be rising demand for specialist dementia care in years to come. To help providers decide where’s best to build dementia provision, Carterwood has launched a new market insight on the subject. Ben Hartley looks at opportunities for dementia care in his feature starting on page 25.
with recruitment and retention, Annette Baines of Skills for Care gives an insight into how to find and keep good, quality staff in her feature starting on page 45. She shares the experiences of providers who have staff turnover rates of less than 10% to see what are the secrets to their recruitment and retention success. On the theme of managers, we have another in our Rising Stars interview series. This initiative showcases up-andcoming managers in the sector and this time it’s Samantha Curran of Greensleeves in Suffolk. Her interview is on page 38.
3RD SECTOR CARE AWARDS
Also this month, we have research Don’t forget that you can join us from Cedi Frederick starting on for the 3rd Sector Care Awards page 34, which looks at common Ceremony in London on 6th traits of managers of Outstanding December. services. It’s a wonderful day which CQC often cites the link really celebrates the sector. between leadership and At a time when innovation Outstanding services; Cedi’s report is really needed in the sector, DEMENTIA PROVISION goes further and explores what hearing about what works for managers of Outstanding services others and wins them awards, can Do you operate dementia have in common, from training help you to implement similar services? If not, are you looking to and support, to their personal and initiatives in your organisation. develop some? professional qualities. It makes for For more information and to With rising numbers of people interesting reading. book your ticket, visit the Events with dementia and a shortfall of Outstanding managers need page of the CMM website. care homes, it’s clear that there good staff. If you’re struggling R075 CMM_reports_ad_Layout 1 04/09/2017 15:25 Page 4 Email: email@example.com Twitter: @CMM_Magazine Web: www.caremanagementmatters.co.uk
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Is it just me...? Editor in Chief, Robert Chamberlain reports on growing concerns about the future of health and social care following the latest CQC report.
All eyes are currently focused on the Autumn Budget (November 22nd) and there is a shared hope that Government has listened to our sector’s leaders regarding our financial crisis. Adding weight to the need for an appropriate long-term funding solution are the responses to Care Quality Commission’s (CQC) annual report on the state of health and social care in England.
STATE OF CARE To quote CQC’s statement on the release of its report (October 10th), ‘This year’s State of Care shows that, thanks to the efforts of staff and leaders, the quality of health and social care has been maintained despite very real challenges and the majority of people are getting good, safe care. But future quality is precarious as the system struggles with complex new types of demand, access and cost’. Sir David Behan, Chief
Executive of CQC, points out that despite the warning that social care was approaching ‘tipping point’ after last year’s report, nursing home beds continue to reduce and there is more unmet need. Niall Dickson, Chief Executive of the NHS Confederation responded with strong words indeed, ‘It would be a tragedy if the NHS’s 70th birthday was remembered as the year England’s care system collapsed, but today’s report reveals real concerns that mental health and social care services are not sustainable. Contracts are being handed back leaving more individuals at risk… ‘Today’s report is unequivocal – the quality of services is in a fragile state as the system strains to treat and support more older people with complex conditions. There are fewer nursing home beds and homecare contracts are being handed back, because there is not enough money to pay for the care that is needed.
‘Of course, as the report acknowledges, there is more local services can do to improve coordination and the way services are organised, but the inescapable conclusion has to be that without further government funding, today’s perilous state will become
sometime next year and the cap on care costs has been kicked into even longer grass, the signs coming from Government are not promising. Does the sector need to fail before action will be taken? If Parliament can continue to ignore the facts regarding the fragility of our sector, it would seem this could be the case. The CQC report is the latest in a growing case of evidence that warns of an impending collapse of health and social care if future funding is not addressed. In the LGA Budget Submission, our sector is described as at ‘tipping point’ with an ‘immediate need’ to invest £1.3bn to ‘stabilise’ the sector. Those who continue to cite the belief that ‘fat-cat’ investors are to blame for the plight of providers’ funding need to read the VODG’s new report, True costs: Why we cannot ignore the failure in social care funding. The VODG represents voluntary organisations and the report spells out exactly how challenging the future will be for these without a financial resolution. Rhidian Hughes, VODG’s Chief Executive puts it well, ‘The
“A failure to address the stark warnings about adult social care’s future is an acceptance that it will at some point fall apart.” tomorrow’s tragedy. ‘As CQC has pointed out, this is one of the major unresolved public policy issues of our time. It is time government and indeed all the political class woke up to this challenge and accept that if social care goes down, we all go down.’
FORLORN HOPE? Amid rumours that the promised Green Paper will be delayed until
Government must develop a strong, sustainable funding plan for social care unless it wants to risk damaging both the quality and quantity of support services available to people who most rely on them.’ Obviously, Brexit is dominating political minds at the moment but a failure to address the stark warnings about adult social care’s future is an acceptance that it will at some point fall apart.
What are your thoughts on the state of care? Join the debate at www.caremanagementmatters.co.uk Twitter: @CMM_Magazine CMM November 2017
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APPOINTMENTS NHS ENGLAND NHS England has appointed Ray James as its first National Learning Disability Director.
DEPARTMENT OF HEALTH
Health and care system ‘straining at the seams’ The Care Quality Commission’s State of Care report highlights that despite very real challenges in the sector, most people are getting good, safe care. It says that this is down to the efforts of staff and leaders in maintaining quality. However, future quality is uncertain as the system continues to struggle with demand, access and cost. The Care Quality Commission’s (CQC) annual assessment of the quality of health and social care in England contains much that is encouraging. As at 31st July 2017, 78% of adult social care services were rated Good (71% were rated Good at 31st July 2016), as were 55% of NHS acute hospital core services (2016: 51%); 68% of NHS mental health core services (2016: 61%) and 89% of GP practices (2016: 83%). From this analysis, it is clear
that the quality of care has been maintained. Two percent of adult social care services, 6% of NHS acute hospital and mental health core services, and 4% of GP practices are rated Outstanding. Many services that were originally rated as Inadequate have used the findings of CQC’s inspection reports to make the necessary changes and have improved. However, the changing nature of demand – increasing numbers of older people who are frail, many with dementia, more people with long-term complex conditions – is placing unprecedented pressure on the system. In acute hospitals, this means more people waiting over four hours at A&E; more planned operations cancelled, and people waiting longer for treatment. In
adult social care, the number of beds in nursing homes has decreased across most of England and domiciliary care contracts are being handed back to councils because providers say the funding is insufficient to meet people’s needs; estimates show that one in eight older people are not receiving the help they need. A minority of care was found to be failing people – between 1% and 3% of providers across the services CQC regulates were rated Inadequate. There is also much care that needs to improve: 19% (2016: 26%) of adult social care services; 37% (2016: 39%) of NHS acute core services; 24% (2016: 33%) of NHS mental health core services; and 6% (2016: 10%) of GP practices were rated as Requires Improvement.
Looming shortfall in care home places Almost nine in 10 council areas across England could see a shortfall in care home places by 2022 unless urgent action is taken, according to research by Which?. Analysis of care home data from across England indicates that 87% of councils responsible for providing social care may not have enough places to meet potential demand by 2022, highlighting a looming local crisis in care home provision. This shortfall is predicted to be particularly acute in 14 local authority areas which, according to Which?’s modelling, could face a shortfall of 25% or more. Half of these are London boroughs.
According to the analysis, Bracknell Forest in Berkshire is set to see the biggest shortfall with 53% more care places needed by 2022. Lewisham (48%), Haringey (38%), Hartlepool (35%) and Milton Keynes (33%) are also predicted to fall significantly short if the rate of extra provision isn’t increased. Overall, the research shows there will be an estimated shortfall of 42,000 elderly care home beds by 2022 in England. While the figures paint a mostly negative picture, there are a small number of council areas that are likely to see a surplus, highlighting how mixed the regional picture is in England.
Bexley is estimated to have 26% more places than demand is expected to require by 2022, while Peterborough (17%), Stoke-onTrent (14%), Portsmouth (13%) and Trafford (10%) are also expected to exceed demand. Which? is now launching a campaign calling for the Competition and Markets Authority’s inquiry into the care home market to go beyond immediate issues around quality, fees and complaints and to confront the creaking care sector now, recognising that the national picture masks huge differences at a local level.
Professor Jonathan Van-Tam has been appointed Deputy Chief Medical Officer for England.
ROYAL ALFRED SEAFARERS’ SOCIETY The Royal Alfred Seafarers’ Society’s Belvedere House, has appointed Alice Mitroi as Deputy Clinical Manager.
SWANTON CARE AND COMMUNITY Swanton has appointed a new leadership team. Andrew Shelton-Murray is interim Chief Executive until the arrival of full-time Chief Executive, Garry Cross later in the autumn.
FOUR SEASONS Four Seasons has appointed Fiona Williams as Managing Director for the England South East Region.
HEATHCOTES Heathcotes Group has appointed Natalia Lysiuk as Head of Commissioning.
CARTERWOOD Carterwood has engaged Sara Livadeas as a senior consultant.
EDEN FUTURES Eden Futures has appointed Andy Dean as Chief Financial Officer.
IDEAL CAREHOMES Ideal Carehomes has employed Sue Shaw as Home Manager at Mountview which is due to open in November.
CMM November 2017
Social care under-funding must be reversed Successive governments’ failure to properly fund social care is leaving millions of people at risk of losing vital support, according to new analysis. Ahead of the Autumn Budget on Wednesday 22nd November, VODG (Voluntary Organisations Disability Group) has published True Costs: Why we cannot ignore the failure in social care funding. The report is a stark warning to Government that the chronic under-funding of social care must be reversed. It pinpoints three key challenges faced by voluntary sector providers of adult social care, which mean that funding is insufficient. These are: • Increasing demand for services. • Rising costs of providing services. • Workforce recruitment and retention problems.
VODG’s report stresses that demand for services is rising; by 2025 there will be 11.7 million disabled people in England. This group of people, representing more than 20% of our population, is also ageing, which means that more older people will need disabilityspecific support. Action is vital as the need for support is growing just as funding for that support is dwindling. Since 2010, for example, cumulative adult social care savings have amounted to £6.3bn, according to the Association of Directors of Adult Social Services. Voluntary sector providers are disproportionately affected by such budget cuts because the people they support are mainly publicly-funded. In addition, staff turnover is high and increasing, at 31% in 2016 up from 25% in 2015. National figures
show that in 2017, there were an estimated 90,000 vacancies across the sector at any given time. The report acknowledges that adult social care has won some additional funding, but this is a drop in the ocean given demand, rising costs and workforce issues. In addition, there are other pressures on the sector like the increased National Living Wage (NLW), the retrospective requirement to provide NLW back pay to sleep-in shift workers for up to six years and Brexit, which has the potential to create much instability. To create a strong, sustainable solution for social care, the report demands that Government must take decisive action, including: • Identifying a long-term, sustainable funding solution particularly for working age adults.
• Dropping the retrospective action to recover mistaken underpayment of NLW for sleep-in shifts from some providers. • Work with relevant bodies, VODG included, to develop a plan for a sustainable social care workforce. The Local Government Association has also published its Autumn Budget Submission, in which it details the unfunded cost pressures facing local government and why, with many local services facing significant funding gaps, it is vital that the Budget recognises that councils cannot continue without sufficient and sustainable resources. It proposed that the £1.3bn needed to stabilise the adult social care provider market must be met urgently, either through further business rates retention or grant funding.
Short reprieve More Teaching Care Homes needed in sleep-ins crisis The Government has handed the sector a short reprieve on its National Minimum Wage (NMW) enforcement over back pay. In July, the sector warned that social care was facing a sleep-in crisis over up to six years in wage back pay to workers who undertake sleep-ins. The Government then adopted a policy of suspending HM Revenue and Customs enforcement activity concerning payment of sleep-in shifts by social care providers. This was due to end on Monday 2nd October. The Government has now announced a further one-month suspension of the minimum wage enforcement to minimise disruption to the sector and seek to ensure workers receive the wages they are owed. During this temporary pause, it intends to develop a new enforcement scheme for the sector to encourage and support providers to identify back pay owed to their staff. 10
CMM November 2017
Building on the successful Teaching Care Homes Pilot Programme, FoNS, in partnership with Care England and the Burdett Trust for Nursing, is recruiting for a further five care homes to participate in the next phase of the programme. Participating homes can be from any sector of social care. The programme involves: • Three representatives from each home, the home manager, a registered nurse and a care
worker will be the leads for their home. • Six workshop days focusing on person-centred practices, leadership and team-working, learning, innovation and improvement. Dates for these are between March 2018 and February 2019. • Mentorship and on-site support from a FoNS Practice Development Facilitator to support the home to work on a specific area of improvement.
• A small practice improvement bursary. Organisational sponsorship is required/essential and at present the programme is only available to care homes in England. The programme does come with a bursary to support the team and the programme. The closing date is 14th November and the programme will start in March 2018. More information is available at www.fons.org
Choice in end of life care: Government progress The Government has published a new report on how the National End of Life Care Programme Board is delivering personalisation and choice in care for people at or near the end of life. This report sets out the level of progress that the National End of Life Care Programme Board has made in implementing the Government’s choice commitment around end of life care. The measures include: • Supporting the roll-out of digital palliative and end of life care
records to all areas by 2020. • Inspecting and rating NHS hospital and community services for end of life care. • Providing support to trusts to help them improve end of life care services. • Testing personal health budgets for people approaching the end of life to give them choice and control over their care. • Developing metrics to assess quality and experience in end of life care. • Working to change the nursing
and medical undergraduate and postgraduate curricula to improve patient choice and quality of care. Summarising the Board’s progress, the report’s closing remarks say that, ‘In the year since the publication of the Government’s response to the Independent Review of Choice in End of Life Care, good progress has been made on making high-quality personalised end of life care a reality for all.’
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Does austerity kill? Research published in the BMJ Journal of Epidemiology and Community Health has found a link between delayed discharge and increased mortality rates. With 2015 seeing the largest spike in mortality rates in almost 50 years, the researchers set out to examine any link with delayed discharge. Using data on mortality and death counts from the Office for National Statistics and comparing it to NHS data on transfers of care in England,
they concluded that the increase in delayed discharge in 2015 was associated with increases in mortality. The researchers found that it accounted for up to a fifth of mortality increases. They conclude that austerity could be the reason for this, saying, ‘Our study provides evidence that a lower quality of performance of the NHS and adult social care as a result of austerity may be having an adverse impact on population health.’
Guide to staff retention published by NHS Employers NHS Employers has launched an in-depth guide to staff retention, which brings together the lessons learned from the 92 participants in the retention collaborative run by the organisation since late 2016. Staff Retention: A Guide for Employers explores seven
key themes looking at data indepth; developing organisational values and culture; supporting new starters; supporting flexible working; development and career planning; flexible retirement options; and building line manager capability.
Free flu vaccinations for care home staff NHS England, Public Health England, the Department of Health and NHS Improvement have unveiled measures to boost the uptake of flu vaccinations along with a package of new contingency actions to respond to pressures on frontline services this winter. Intensified preparations include providing free flu vaccines for hundreds of thousands of care home staff at a cost of up to £10m. Many people with flu show no symptoms, meaning healthcare workers who feel fit and healthy can unwittingly infect vulnerable patients. Getting vaccinated is the best way to stop the spread of influenza and prevent deaths. It can also ease pressures that a heavy flu outbreak would place on services such as doctors’ surgeries and busy hospital wards. NHS staff are already offered the vaccination for free to protect
CMM November 2017
patients and the public. This winter, in recognition of how important this is, NHS England will extend free jabs to approximately one million care home workers and has set aside £10m to fund it. Commenting on NHS England’s decision to offer complimentary flu vaccinations to care home workers, Professor Martin Green OBE, Chief Executive of Care England said, ‘We applaud NHS England’s policy to offer free flu jabs to workers in care homes. Care England has long campaigned on this issue. In the past, the independent sector has been overlooked and providers have had to foot the bill themselves, which in a climate of severe financial pressures has been difficult. Being ready for winter and offering extra capacity to the already stretched NHS is yet another area where the independent sector can help.’
Adult Social Care Survey 2016-17 NHS Digital has published the Personal Social Services Adult Social Care Survey (ASCS) England 201617, an annual survey conducted by councils with adult social services responsibilities. The survey seeks the opinions of people aged 18 and over who are in receipt of longterm support, which is funded or managed by social services. According to the survey, 70.1% of people receiving social services care feel ‘as safe as they want’. This is an increase of 0.9 percentage points from the previous year’s report (2015-16). Further to this,
86.4% of service users reported that the care and support services they receive have helped them in feeling safe, up 1.0 percentage point from 2015-16 (85.4%). Other key findings include: • Overall satisfaction: 64.7% of service users were extremely or very satisfied with the care and support services they received. • Activities of daily living: In 201617, there was a general increase in the proportion of service users who needed assistance with activities of daily living. • Choice: 67.6% of service users in
the community reported that they have enough choice over the care and support services they receive and a further 6.3% reported they don’t want or need choice. • Social contact: 45.4% of service users reported they had as much social contact as they would like. Just over a fifth (21.6%) reported that they did not have enough or had little social contact, with 15.9% reporting they had some social contact but not enough and 5.7% reporting they had little social contact and felt isolated.
The survey includes questions on the impact that care and support services have on a service user’s quality of life. It also collects information on the primary reasons for support and self-reported general health and wellbeing. The report uses data collected from a sample of 72,600 service users who participated in the survey and these are weighted to make inferences (or estimates) about the questionnaire responses for the whole eligible population (653,000 service users).
New tool to assess frailty in older people Researchers have designed a new tool to help GPs assess which older people are the most frail and vulnerable. The new tool helps GP surgeries provide better care to the most vulnerable patients, improve health service planning and potentially make better use of resources.
The electronic frailty index (eFI) uses 36 indicators of frailty using routine data already held on GP databases. These include conditions such as anaemia, diabetes, heart and kidney problems, mobility issues and even social vulnerability. The tool uses the codes that GPs regularly assign to these conditions
and flags up those patients who are at the most risk. It identifies those older people who might be living with mild, moderate and severe frailty who are at increased risk of future nursing home admission, hospitalisation, longer length of hospital stay and mortality.
The eFI tool was developed by Dr Andrew Clegg from the University of Leeds and tested by Dr Lynn Lansbury of the University of Portsmouth. Lynn trialled the tool in a GP practice to demonstrate how it works successfully in a busy primary care setting.
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CMM November 2017
What happens when people leave hospital?
Cost of falls and fractures in Northern England
A new briefing from Healthwatch England outlines where important steps have been made towards improving the discharge process for patients. However, the 2,083 people’s stories used to compile the findings also continue to show significant variation. This highlights the need for good practice to be spread and properly evaluated to ensure it is having the right impact. What happens when people leave hospital and other care settings? looks at what 46 local Healthwatch heard about people’s experiences of the discharge process since 2015. Key findings include: • People still don’t feel involved in decisions or that they have been given the information they need, including advice on possible side effects of new medications or who to call for advice out of hours. • People continue to experience delays and a lack of coordination between services,
highlighting specific problems with hospital pharmacy services, patient transport, and care homes or family members not being notified when people are about to be discharged. • People feel left without the services and support they need after leaving hospital, with discharge plans not considering patients’ other clinical needs or home environment, including whether or not patients have carer responsibilities.
New figures show the significant cost of emergency admissions for falls and fractures among older people in Northern England. A 2017 report, commissioned by the Academic Health Science Network for the North East and North Cumbria (AHSN NENC), has revealed that in 2014/15 there were 12,654 emergency admissions for falls in the North East and North Cumbria, costing an estimated £84,973,249 to the region’s NHS. The AHSN NENC aims to raise awareness that falls are not a normal part of ageing, or something that ‘just happens’ as
Free oral healthcare e-learning
Albion Care Communities expands
Skills for Health and Health Education England have launched a new free Oral Healthcare e-learning course to support anyone interested in learning more about oral health and mouth care. It will be particularly useful for those providing care for others. The course, commissioned by Health Education England, teaches learners about the importance of oral healthcare for themselves and those who they care for. The learning includes the latest guidance and supports personcentred holistic care. It was informed by oral healthcare professionals and complements the Care Certificate standards. 14
CMM November 2017
Healthwatch is calling for a fuller understanding of what’s happening in local areas, with local leaders urged to use the experiences of the people behind the delayed transfers of care statistics to identify where improvements can be made. The briefing also highlights a number of approaches that are already helping to reduce delays getting people out of hospital, such as Discharge to Assess and Red2Green.
Albion Care Communities (ACC), a rapidly growing investor and developer of quality care homes for the elderly, has announced that it has commenced two further developments in Abergavenny and Hereford. The two state-of-the-art care homes are due to open in early
you get older; and that they are preventable. Every year, there are around 255,000 falls-related emergency hospital admissions in England among patients aged 65 and older. Falls are estimated to cost the NHS more than £2.3bn a year and the annual total cost of fragility fractures to the UK has been estimated at £4.4bn. The report also found that around a third of all people aged 65 and over fall each year and amongst older people living in the community, 5% of those who fall in a given year will suffer from fractures and hospitalisation.
Oaklea Care in Somerset sold Oaklea Care has been sold by DC Care. The group of learning disability care homes, all located in the Yeovil area of Somerset, comprises four properties, providing care and accommodation to 15 residents with mild to moderate learning disabilities.
2019, each providing facilities to 70 residents. Care services will include residential, nursing and dementia care. In August, ACC opened its first development, Pine Martin Grange, a 64-bed purpose-built care home in Wareham, Dorset. ACC is rapidly becoming a
The business became available when the proprietors, Mr and Mrs Jackson decided it was time to retire. The home came to the market towards the end of April and the deal was completed in August, just three months after the initial offer was formally accepted.
leading regional investor and developer with 271 beds currently in operation or development. To date, the company has raised approximately £50m in debt and equity funding and has access to further finance to enable its ambitious expansion programme.
Retirement transitions in later life One in five adults (20%) who retired in the last five years have admitted to finding it difficult, according to a survey, carried out as part of a partnership between the Centre for Ageing Better and Calouste Gulbenkian Foundation UK Branch. The data also revealed that only around half of UK workers (56%) planning to retire in the next five years are looking forward to it, with 41% worried about managing their
money, a third concerned about feeling bored (33%) and missing their social connections from work (32%), and nearly a quarter (24%) worried about losing their purpose. Some 17% of workers are worried about being lonely in retirement. But despite this, most retirees do little to plan, the survey suggested, with over half (56%) of people who had retired in the last five years revealing they didn’t seek
any advice or help to prepare. The survey was carried out by YouGov with more than 1,000 people who had retired in the last five years, and more than 1,000 who are anticipating retiring within the next five years. It is part of a study exploring how the process of retirement affects people and what kinds of intervention and support could help people.
NEWS / IN FOCUS
Health village receives approval STRIDE, the partnership between Morgan Sindall Investments’ Community Solutions, Arcadis and Burton Hospitals NHS Foundation Trust, has announced that the £55m health village development in Burton has reached an important milestone. The Burton Hospitals NHS Foundation Trust has signed an option with STRIDE to progress the landmark development on surplus land adjacent to its Queen’s Hospital site.
STRIDE will now progress the scheme towards outline planning before the end of 2017. The development, which is scheduled to provide GP and community services for about 30,000 patients, also currently includes extra care residences, a step-down facility to mitigate delayed discharges, as well as accommodation for vulnerable adults and a 100+ place nursery. The health village will also have a community hub.
Pressure on STPs STPs are under pressure as local government and health organisations struggle to integrate, a new survey suggests. The survey of local authority and NHS organisations involved in Sustainability and Transformation Plans (STPs) suggests there is a worryingly long way to go to achieving successful partnership working. In the survey, which was conducted by CIPFA and iMPOWER, 55 of the 56 respondents stated that they do not believe full joint-working will be achieved in the next five years. Furthermore, the survey shows that a quarter (25%) believe relationships are currently ‘limited’, while 54% believe them
to be reasonable and only 21% very strong. The survey also throws up some serious question marks on the financial capacity of STPs to invest in important prevention measures. A significant majority (95%) of those surveyed agreed that investing in prevention is essential or important. However, only one in six (15%) expect to be able to use any of the additional £2bn announced in the Spring Budget towards prevention activities. Indeed, research from CIPFA and iMPOWER indicates that almost all of the available budgets this year will be spent meeting operational challenges or sustaining the market for local providers.
Supporting people to be independent In a new guideline on intermediate care, the National Institute for Health and Care Excellence (NICE) is urging health and social care staff to support people to safely continue with everyday activities, such as climbing stairs, dressing themselves or cooking after a period of illness or if they have been struggling at home. NICE has set out how health and social care staff can support people to be independent following a hospital stay or when daily life at home becomes too
difficult. The new guideline covers how to assess intermediate care needs, including setting goals with the person so that they can overcome the problems they are experiencing. NICE says staff should talk openly about any risks but in a positive manner so as not to discourage people. The aim is to ensure that people can confidently get on with the things they would like to do themselves whilst any risks are discussed and managed safely.
IN FOCUS State of the Adult Social Care Workforce 2016/17 WHAT’S THE STORY?
Skills for Care has published its annual The State of the Adult Social Care Sector and Workforce Report exploring the sector’s workforce in detail. It uses pay, hours and total jobs data from its National Minimum Data Set for Social Care (NMDS-SC) in conjunction with data on private sector profits, indirect effects like the sector’s extensive supply chain and induced effects, including money spent by people working in adult social care. It suggests that the adult social care sector contributed an estimated £41.8bn to the English economy in 2016/17.
WHAT ARE THE FINDINGS?
The report reveals that the workforce has continued to grow. The number of adult social care jobs was estimated to have increased by around 1.5% (20,000) between 2015 and 2016. The number of adult social care jobs in England as at 2016 was estimated to be 1.58 million and the number of people working in adult social care was estimated to be 1.45 million. Around a quarter of the workforce (24%) were on a zerohours contract (325,000 jobs). This has remained relatively stable between 2012/13 and 2016/17. The average age of a worker was 43, and a fifth (305,000 jobs) were aged over 55. Since the introduction of the mandatory National Living Wage, care workers’ pay in the independent sector has increased at a higher rate than previous years.
WHAT ABOUT RECRUITMENT AND RETENTION?
According to the report, the staff turnover rate of directly employed staff in adult social care was 27.8%. This was approximately 345,000 leavers per year, while almost three-quarters of all workers remained in their roles. Despite high turnover overall, approximately a quarter (26%) of employers have a turnover rate of less than 10%. Approximately two thirds of new starters were recruited from within the sector meaning the sector retains their skills and experience. Adult social care has an experienced ‘core’ of workers. Workers had, on average, eight years’ experience and around 70% of the workforce had been working in the sector for at least three years. Skills for Care estimates that 6.6% of the roles are vacant, giving an average of approximately 90,000 vacancies at any one time.
ARE WE RELIANT ON OVERSEAS STAFF?
The majority (83%) of the adult social care workforce was British, 7% (95,000 jobs) had an EU nationality and 9% (125,000 jobs) a non-EU nationality. The proportion of the adult social care workforce with a British nationality has been consistent over the past five years. The proportion of EU (non-British) workers has risen two percentage points and non-EU workers has fallen four percentage points over the period. CMM November 2017
Sale of South Yorkshire Care Ltd Insolvency practitioner, SFP has completed a sale of the business and assets of South Yorkshire Care Limited, ensuring the essential care provided to elderly and vulnerable residents continued without interruption, and saving the futures of all 101 employees. The company began trading in 2009 and had four care homes, in Harrogate, Lincoln and two
in Grimsby. Despite turning over more than £1.5m in 2016, the company ran into arrears with HMRC which led to a Company Voluntary Arrangement (CVA) being implemented. When South Yorkshire Care could not meet the terms of the CVA, a pre-pack sale was pursued via Administration. Following an initial review of the business, the
Joint Administrators conducted a valuation of the care homes, marketed them and subsequently looked to carry out a pre-pack sale without business interruption, to ensure the safety of the residents. SFP’s Simon Plant and Daniel Plant were appointed Joint Administrators of the Company on 1st September 2017, with the sale completing simultaneously.
Equally Outstanding – equality and human rights in care CQC and partners have published a new good practice resource, Equally Outstanding exploring how a focus on equality and human rights can help to improve quality of care. Using case studies from the NHS, social care and primary medical services, it looks at how services rated Outstanding have prioritised equality and human rights and the positive effects this has had on care quality and staff engagement. The resource also helps set out the ‘business case’ for equality and human rights.
Human rights principles of fairness, respect, equality, dignity and autonomy should be at the heart of good care. Evidence points to a clear link between quality of care and whether people who use services feel their human rights are respected and they are treated equally. Analysis of 14,000 adult social care ‘provider information returns’ showed that services rated Good or Outstanding were more likely have undertaken some specific work on equality in the past 12 months.
Epidemic of elder abuse Research released by Action on Elder Abuse says that older people across the UK are being abused on a significant scale. With almost 10% of older people (aged 65+) saying that they have experienced abuse of some kind, it is possible that one million older people in the UK have experienced abuse. The research supplements existing academic research regarding the scale of elder abuse, which estimates that around 4% of the older population, or 465,000 people, are victims of some form of abuse each year. In addition, a secondary analysis of this study carried out by King’s College London and the National Centre for Social Research, found that when the definition was broadened to include abuse perpetrated by neighbours and acquaintances (in addition to that by friends, family 16
CMM November 2017
and carers), and when any single incident of psychological abuse or neglect was counted, the likely prevalence of elder abuse was 8.6% of the population. This means 998,560 older people would be likely to be being abused annually. Despite the likelihood that many older people are victims of targeted crime each year, an additional analysis has shown that most of those who abuse older people are going unpunished, with just 0.7% (3,012) of cases resulting in a successful criminal conviction in 2015/16. This means it is likely that 99% of those who commit crimes against older people are not punished. For this reason, Action on Elder Abuse is campaigning for tougher penalties for those who abuse older people by making it an aggravating factor for sentencing.
There is also a link between whether staff feel they are treated equally and with respect and the quality of care provided. Case studies in Equally Outstanding show that where organisations value and support staff equally, this will help lead to better care. Equally, a care setting where staff do not feel valued and respected is more likely to experience absenteeism, high staff turnover and recruitment problems – with implications for both care quality and finances.
New creative arts resource A new online resource has been developed giving practical examples of using creative arts in care homes to improve residents’ lives. Inspiring care home residents to be creative can be found on the Social Care Institute for Excellence’s website and offers practical guidance on how to engage residents in creative arts, such as dance, puppetry and digital arts. It offers lots of inexpensive creative ideas, adaptable for people with different cognitive function, including those at the end of life. Using arts in care homes can help providers demonstrate that they are addressing two of the Care Quality Commission’s key lines of enquiry (being responsive and caring) meaning that participation in the arts can no longer be regarded as an optional extra. The resource was funded by The Baring Foundation and written in association with the National Activity Providers Association (NAPA).
Access to healthcare for people with disabilities The BMJ Open has published the results of a study into access to healthcare for people with disabilities. The aim of the study by the researchers at Cardiff University and the University of Chile was to investigate differences in access to healthcare between people with and without disabilities in the UK. They were researching whether people with disabilities would be more likely to have unmet healthcare needs and whether there would be gender differences, with women more likely to report unmet needs. The study found that people with a severe disability had higher odds of facing unmet needs. The largest gap was in ‘unmet need
for mental healthcare due to cost’, where people with a severe disability were 4.5 times more likely to face a problem. Women with a disability were 7.2 times more likely to have unmet needs due to ‘cost of care or medication’, compared with men with no disability. The researchers concluded that people with disabilities reported worse access to healthcare; with transportation, cost and long waiting lists being the main barriers. They say that these findings are worrying as they illustrate that a section of the population, who may have higher healthcare needs, faces increased barriers in accessing services.
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Nursing Hygiene Group merger New retirement village in announcement Stoke-on-Trent Representatives from Nursing Hygiene Group (NHG) and Clinicare Supplies have announced that the two companies are merging, with change of ownership effective as of end of October. This merger represents the joining of two businesses very similar in their products and services, with strengths that are highly complementary and it will
enable them to provide a new and broader set of services to their clients. Both companies will continue to operate separately throughout the integration period, and will bring to market a newly-combined and branded, single entity business by July 2018. This is to ensure a smooth transition across all workstreams and minimal disruption to clients.
A new 140-apartment retirement village has opened in Stoke-onTrent. The £21.6m Maple West development in Chell is the third to be completed in a £60m project to deliver 390 extra care apartments across three sites in Stoke-on-Trent. Maple West comprises 140 apartments and has been built by Seddon Construction Ltd on the site of the former Westcliffe Hospital in Turnhurst Road.
The three retirement villages have been developed by Sapphire Extra Care Ltd, a partnership between Your Housing Group, Eric Wright Group and Kajima Partnership Ltd. The apartments will be managed by the consortium on behalf of the city council. The project, administered by the city council and sponsored by the Homes and Communities Agency, will meet a clear housing need.
Carterwood’s staffing and dementia analysis Carterwood has launched staffing and dementia analyses for older people’s care homes. The bespoke, site-specific analysis will help operators mitigate risk and respond to the opportunities presented by the staffing crisis and demand for specialist dementia care. Carterwood’s new staffing
analysis report provides a detailed study of a new development’s proposed staff catchment area, to help reduce the risk of investing in a new care home, only to be unable to recruit sufficient staff. The analysis also considers how to reduce potential spend on agency staff, how to maximise the opportunity to recruit staff, and
what the financial implications of the development decision on the operating cost base could be. The dementia analysis offers new and previously unavailable data about specialist dementia provision. With comprehensive national information in relation to dedicated dementia beds, Carterwood analyses provision
in a specified location to give an accurate competitive picture for decision making. The dementia analysis can be used for strategic reviews where reconfiguration to dementia care is being considered, or for acquisition purposes. Ben Hartley of Carterwood explores the dementia analysis in an article starting on page 25.
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Engage with social care, STPs told The Care Provider Alliance is calling for greater engagement between Sustainability and Transformation Partnerships (STPs) and the independent and voluntary adult social care sector. 44 STPs are working across England to transform the health and care system. However, despite the size and vital importance of the independent and voluntary adult social care sector, the engagement of STPs with it is generally still at an early stage. The Care Provider Alliance has written to STPs to encourage
greater engagement and also make practical suggestions as to how this can be done. The Alliance is calling on each STP to review its engagement with the independent and voluntary adult social care sector and, by March 2018, to share information on its website (or otherwise) about how it is taking engagement forward with the sector. The Care Provider Alliance is also calling on the providers of adult social care services to take time to understand the role of STPs in their areas, and to be ready to engage positively and openly
with these partnerships on behalf of the sector. Alongside this call, the Care Provider Alliance has published a more detailed report summarising the results of its work in this area over recent months. This is part of a wider programme of work funded by the Department of Health and supported by NHS England. The Care Provider Alliance’s report suggests that, while some STPs are already positively engaged with the sector, in many areas any engagement is still at a very early stage.
Care home to be redeveloped as extra care The Abbeyfield Kent Society will be closing The Dynes Residential Care Home in Nightingale Road, Kemsing, with plans to redevelop the property as extra care housing. Citing undersized rooms, the need for modernisation and viability as issues within the home,
the Society has made a decision to close The Dynes, giving residents and staff six months’ notice of the planned March 2018 closure. It will fully support both residents and staff ahead of, and during, their move, either to another Abbeyfield Kent care
home, or elsewhere. The Society has responded to challenges within the care sector and submitted plans to Sevenoaks District Council to build 51 extra care apartments for over 55s on the site currently occupied by The Dynes.
Meals on Wheels Week Meals on Wheels Week returns on 6th to 10th November 2017. The National Association of Care Catering (NACC), the event organiser, will be leading a series of activities to raise awareness of the important role that the Meals on Wheels service plays in modern society, including a roundtable discussion with MPs. The debate will engage MPs from across the political parties to discuss what more can be done with the Government to sustain Meals on Wheels services in the UK. Meals on Wheels services have been under continual threat of closure due to ongoing social care budget cuts and NACC research released last year revealed that the number of councils providing Meals on Wheels to vulnerable older people had dropped below 50% for the first time. A social media campaign will also be launched on Twitter.
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T H E
N E W
CQC ASSESSMENT FRAMEWORK
CMM November 2017
I understand that the Care Quality Commission’s (CQC’s) new assessment framework comes into force in November. What do I need to know and how can I prepare for the new inspections?
Laura Hannah, Solicitor and CQC Regulatory Expert, Stephensons Solicitors LLP
The CQC’s strategy for 2016 to 2021 sets out its aim to achieve a more ‘targeted, responsive and collaborative approach’ with the aim that more people receive high-quality care in the future. This is only the most recent part of a changing regulatory landscape in which the CQC has radically changed its approach to health and social care services in recent years. In December 2016, the CQC issued its first consultation, Our Next Phase of Regulation, which proposed a standardised approach across the health and social care sector for the first time. A response to this consultation was published in June 2017 and this confirmed the changes to be made to the current assessment frameworks. A second consultation was published in June 2017 and a third is expected later this year. The CQC has already confirmed that it will be moving from its current 11 separate assessment frameworks to just two: one for healthcare, and one for adult social care. The purpose of this is for the CQC to try to ensure that its end-to-end approach, from registration, monitoring and inspection to rating and
reporting, provides a single, highlevel process that can be tailored to individual providers. It is hoped that by reducing the number of assessment frameworks, this will improve the clarity and transparency of inspections and ratings, help providers to understand how they are being assessed, allow the public to compare services and ensure that inspectors make assessments in a consistent way. The CQC believes that this will reduce complexity and confusion, particularly for providers that deliver more than one type of service. However, in the response to the initial consultation, there was some concern from providers that having only two assessment frameworks may take the process of simplification too far and be unsuitable across the whole of the two sectors. In light of this, the CQC has set out its plans to continue to develop and publish additional sector and servicespecific materials that link to the assessment frameworks and provide more detailed information about how they will apply in the context of a particular service. The ‘Five Key Questions’ will remain in place as the basis of the assessment frameworks. As such, the CQC will continue to assess care homes by asking whether they are safe; effective; caring; responsive; and well-led. However, the Key Lines of Enquiry (KLOEs) will be merged to provide one set of questions and prompts for the healthcare sector and one for adult social care. A number of changes have also been made to the KLOEs and these are intended to simplify the process by more closely aligning the five questions and
CMM November 2017
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THE NEW CQC ASSESSMENT FRAMEWORK
the characteristics that reflect a rating.
NEW, STRENGTHENED THEMES THROUGHOUT THE FRAMEWORK The wording of some KLOEs and prompts have been revised to provide clarity. Additional prompts have been added and some have been moved between the key questions. The new KLOEs also include six new, strengthened themes that the CQC has deemed necessary to improve on. These include: • System leadership, integration and information-sharing. • Information governance and data security. • Technology. • Medicines. • End of life care: Delivering good quality care at the end of life. • Personalisation, social action and the use of volunteers. Whilst this has resulted in more KLOEs overall, and some duplication across themes, the majority of the content remains the same or similar to the current frameworks. The CQC has also acknowledged that, for some KLOEs, prompts and characteristics will not necessarily need to be applied in all settings and will only be applied where they are relevant and proportionate to the type of provider being inspected. In fact, the new KLOEs helpfully make clear the types of services within the sector that each KLOE or prompt applies to, so this may at least streamline this large document. It is, however, apparent that the new KLOEs will need to be monitored and reviewed regularly by the CQC, in order to measure their success and, if necessary, adapt them further to ensure that they continue to reflect the most current methods. In strengthening its assessment of well-led, the CQC has also made it clear that there is a demonstrable link between
leadership, culture and the delivery of safe, high-quality care, and its focus on well-led is intended to support and reinforce this link. The new well-led framework includes a clearer emphasis on ensuring sustainability of services, which we have already seen to be an increasing focus of inspections and a consideration for the CQC in deciding whether to pursue or continue with enforcement action in recent years. It is envisaged by the CQC that these changes to the KLOEs will make them more relevant by bringing them in line with changes and innovations in care and national policy. It is also hoped that the changes will encourage providers to focus on the needs of people using the services as a whole and encourage greater accountability from providers overall.
WHEN DO THE CHANGES COME INTO FORCE? The CQC has confirmed that the new assessment framework for community and residential adult social care services will be introduced in November 2017. The CQC has also indicated that no changes will be made to the assessment framework for a further two years whilst it assesses the success of the changes. This is likely to reflect the approach it has taken in recent years. The last assessment framework was introduced in early 2015 and the first consultation was issued in December 2016, during which time the CQC assessed the suitability of the framework and identified suggested improvements through its inspections and monitoring of care providers under that framework.
WHAT SHOULD PROVIDERS DO NOW? Overall, many of the criteria from the new assessment framework remain the same and it should
not be too much of a shock for providers facing an inspection after November 2017. In fact, it will undoubtedly benefit those registered providers that deliver more than one type of service across the adult social care sector, as the one framework for all of these types of services will hopefully reduce complexity and confusion and provide a more consistent approach to regulation. In recent years, there has arguably been a lot of contradictory findings across different services in the same sector, which has possibly resulted in varying ratings. Having just one framework for adult social care services may help providers understand more easily what is expected of them. The success and effect of such changes will not be clear until the new framework is introduced and, therefore, providers need to spend this time between now and the implementation date in November 2017, ensuring that they are familiar with their respective new assessment framework. The new KLOEs for the adult social care sector have already been published by the CQC and it is strongly advisable for registered providers to spend time reviewing these to ensure that they are prepared for their next inspection and know what will be expected of them. For those providers who have based their current internal policies, procedures or quality monitoring systems on the current framework, these will also need to be reviewed and updated as soon as possible to ensure that they are compliant and in line with the new framework. In any event, registered providers should be mindful of the new KLOEs for inspections being undertaken now. Whilst they do not apply to inspections until after November 2017, a good understanding of the future framework and, in particular, the strengthened themes throughout, will provide any inspectors
reviewing a service with confidence in a provider’s ability to lead a well-led service in the future. There is also nothing stopping providers from using the new KLOEs immediately as a basis for any factual accuracy challenges against draft inspection reports, where they support a challenge against the CQC’s approach, or lack thereof, to a particular key line of enquiry. Providers may also wish to consider the additional sector support which is available to them during this period of change. Specialist care consultants can assist in providing care homes with practical advice on compliance, and they can also carry out audits or mock inspections of the care home prior to any CQC inspection. This would enable providers to address any areas of non-compliance in advance of their inspection. Specialist legal advice may also be sought where a registered provider or manager wishes to challenge a finding or decision of the CQC, including factual accuracy challenges to draft inspection reports. This process will remain the same after November 2017. For registered providers and managers of care homes facing an inspection under this new assessment framework, it is important that they are fully prepared for their next inspection. This includes having a good working knowledge of the new framework. As with any change, there are likely to be some stumbling blocks along the way and a need for further modification to the assessment framework as the CQC learns from its future inspections. It is therefore extremely important that providers and managers seek specialist assistance where required and make detailed and supported challenges to any findings or decisions that are not accurate or consistent with the CQC’s strategy and framework. CMM
Laura Hannah is a Solicitor and CQC Regulatory Expert at Stephensons Solicitors LLP. Email: email@example.com Twitter: @SolicitorsLLP
Are you ready for the new inspection framework? CMM subscribers can share their thoughts and access details of the new framework on the CMM website. www.caremanagementmatters.co.uk CMM November 2017
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Overview of the UK’s dementia bed provision
Where’s the best place to locate a new specialist dementia care home? Ben Hartley shares market insight into the UK’s dementia bed provision.
Supporting a person in the later stages of dementia to live in their own home is very challenging for all involved. As a result, Alzheimer’s Society states that 283,000 people with dementia live in care homes, and dementia is often one of the main reasons behind their move. As every care home operator knows, dementia is more than just memory loss. The care of people with dementia requires expertise and, often, specialist dementia care commands higher fees.
CMM November 2017
OVERVIEW OF THE UK’S DEMENTIA BED PROVISION
The opportunity to develop specialist dementia care homes is significant. As people with dementia are living longer and with more complex health conditions, their need for care is increasing. Alzheimer’s Society urges that providing care to people with dementia must be the primary concern and focus of the care home sector. The well-publicised study by The Lancet in August 2017 predicts that more than 70,000 care home places will be needed by 2025. Since it’s estimated by Alzheimer’s Society that in excess of 80% of residents living in care homes have significant memory issues or dementia, to meet this challenge the sector is going to need 56,000 more dedicated dementia beds within eight years. The question then is, ‘where’? In order to build a detailed picture of local dementia provision, Carterwood has launched a new dedicated dementia analysis. We have surveyed more than 10,000 care homes and updated our comprehensive database
“Our new data shows that today, around a quarter of older people’s care home beds are dedicated to dementia, and circa 7,500 homes are registered to provide some form of dementia care.” through over 4,000 telephone interviews, covering private, not-for-profit and local authority homes. For any given location in England, Northern Ireland, Scotland or Wales, as part of our improved market assessment report, we can now provide a unique and comprehensive overview of the dementia competition and its quality. Our new data shows that today, around a quarter of older people’s care home beds are dedicated to dementia, and circa 7,500 homes are registered to provide some form of dementia care. This leaves around 4,200 homes not registered for dementia. The proportion of dedicated dementia beds is, however, gradually increasing, with operators recognising there will soon be a shortfall of dementia beds. Some 61% of homes for older people built since 2010, for example, provide some form of dedicated dementia care, and 36% of all care home beds built since 2010 are dedicated to people with dementia. Significantly, 37% of all older people’s care homes registered for both frail and dementia care offer a dedicated dementia unit.
WHAT DOES DEMENTIA CARE LOOK LIKE? Before we look at geographical differences and opportunities in dementia provision, it’s important to first analyse in greater detail what dementia care looks like in the UK. 26
CMM November 2017
A dedicated dementia environment not only provides a safe, therapeutic space for residents living with dementia, but gives a home the added advantage of enabling the other care home residents to have appropriate access to outside space at all times. Just 10% of care homes are entirely dedicated to older people with dementia, and the average size of a dedicated dementia-only home built since 2010 is 47 beds. While this proportion would need to increase in order to stay in touch with the growing demand for dementia care, there will always be people who need personal and nursing care. This generally makes mixed registration homes with a dedicated unit more attractive for operators.
AVAILABILITY OF DEMENTIA BEDS There is almost no difference in the availability of dementia beds in rural versus urban locations, and the level of provision is evenly split between private and not-for-profit operators. Perhaps not surprisingly, care homes with nursing are almost twice as likely to contain specialist dementia beds as personal care homes. Some 41% of care homes with nursing provide a form of dedicated dementia care. Furthermore, the larger the home, the more likely
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OVERVIEW OF THE UK’S DEMENTIA BED PROVISION
it is to cater for dementia. The vast majority (83%) of homes with more than 60 beds registered for dementia, for example, provide a dedicated unit within the home. The average size of a dedicated unit is 27 beds, often occupying an entire floor.
GEOGRAPHICAL DIFFERENCES IN SUPPLY OF DEMENTIA BEDS If we analyse the geographical differences, it’s clear that while people with dementia live throughout the UK, the current supply of dementia beds is not evenly distributed. Notably, the South West has the lowest proportion of total registered dementia beds at 21%, with Devon’s dementia beds accounting for just 12.2%. In contrast, Northamptonshire’s proportion of dedicated dementia beds tops the UK at 35.8%. Demand and supply for dementia care also varies considerably depending on the locality. In Hackney, for example, there are no homes providing any form of dedicated dementia care. Travel 11 miles down the road to Barking and Dagenham, and you’ll find 60% of beds can support residents with dementia. The reasons behind local differences may stem from the profile of the local population. Differences such as these most certainly reinforce the need for a sound market understanding when deciding where best to locate a new specialist dementia care home.
OPPORTUNITY FOR DEMENTIA PROVISION To a large extent, the local demand and dementia opportunity will also depend on the quantity and quality of existing provision. Our dementia research, combined with mystery shopping, means that for the first time we can build a detailed picture of the local provision by answering questions such as: Is the physical environment fit-for-purpose? Can people be cared for safely and without undue restriction? Can people stay in the home for life, or will they have to move on? This information can be used to assist in planning a new development, or to determine what changes could be made in the category of care being provided in an existing home to meet local demand. According to Alzheimer’s Society, approximately a third of family members have reported that the person with dementia had moved since first going into care, the most common reason being an increase in needs. To conclude and answer the first question, ‘where’s best to locate a new specialist dementia care home?’, you’ll need to appreciate that locational differences, ranging from the age profile of a population to the existing and planned dementia bed supply, can have a very significant impact on the success of your new scheme. Obtaining market information specific to your shortlist of preferred areas is an essential prerequisite for planning and due diligence. CMM Ben Hartley is Co-Founder and Director of Carterwood Ltd. Email: email@example.com Twitter: @CarterwoodLtd
Do you intend to build dementia provision? CMM subscribers, share your plans and access the references in this article at www.caremanagementmatters.co.uk *Source of statistics: A-Z Care Homes Guide and Carterwood, unless otherwise stated.
CMM November 2017
WHERE NEXT FOR ASSISTIVE TECHNOLOGY? JUST ASK ALEXA Hampshire County Council is leading the way by piloting Amazon’s Echo and Alexa software to support people to live independently. The Amazon Echo is a voicecontrolled, hands-free speaker. It uses the Alexa Voice Service to search the internet, play music, share the news and more, with the use of a simple command ‘Alexa’ to wake it up. Alexa is able to learn new functionality and skills and is designed to adapt to personal preferences, vocabulary and speech patterns. PA Consulting, which leads the Argenti Telehealthcare Partnership, and Hampshire County Council, whose care technology services are managed by Argenti, are working on a pilot to trial Alexa in social care. Steve Carefull, Director at PA Consulting Group explained how the pilot developed, ‘We have been thinking about “where next” for care technology and observing the growth in consumer digital connected devices. The Local Government Association was offering grants for local authorities to try out digital solutions in social care, so we helped the Council to submit a bid and they were awarded funding for the Alexa Cares pilot. We’ve been talking with Amazon about the way “skills” need to be developed to work on the device and getting a heads-up on capabilities that may be relevant in digital care provision.’
THE PILOT The pilot will trial and refine one skill that PA already had in development, which links Alexa with alerts on a digital device, such as an electronic picture frame and prompts users. It will also develop a new skill to support the entry of a care worker into an individual’s home, ideally including prior identification of the care worker and the ability to log in 30
CMM November 2017
and out. It will test the feasibility of integration with the homecare rostering system. Finally, it will forecast, measure and establish approaches to track the benefits of both skills, to encompass financial savings, as well as improvements perceived by clients and staff. Alexa will listen to clients’ questions and speak the answers. Steve explained, ‘Speech is human beings’ preferred method of communication, so we hope this interaction will feel natural and warm. Alexa is not a person though, it cannot replace human to human interaction; that is not the aim. ‘Defining the user cohort and need is key; we always seek to start with the problem rather than the technology. We know that medication adherence is an issue for many and that poor adherence can have serious consequences; we also know people can become worried or confused when a care worker is late, so we plan to focus on these first. It is hoped that the devices and skills will be trialled in the homes of 50 of Hampshire’s adult social care clients by the end of 2017, with evaluation taking place in spring 2018. ‘We expect the focus for the pilot to be on frail older people and possibly people with learning disabilities who have a degree of independence. Of course, a key issue will be that people must want to be involved in the pilot; this won’t be imposed on anyone.’
BENEFITS There are obvious benefits to be gained from using Alexa. Steve continued, ‘It provides a route for delivering support in a way that can be seamlessly integrated in people’s lives. The fact that a
device like Echo does so many other things: provides the news and weather, plays music, tells jokes, reads stories and so on, makes it desirable and useful in a range of ways. ‘We need to develop a series of expected and measurable outcomes and benefits to test the effectiveness of the pilot. The evidence that Alexa works in the desired way will be essential if we are to expand provision in the future. Benefits will be measured in qualitative terms (user satisfaction) and quantitative terms (tracking actual usage and estimating if and where other costs of care have been reduced or avoided). ‘This is just the start of a revolution in care technology that will see disruptors like Google, Apple, Amazon and others delivering services people want in ways not possible a few years ago.‘
CHALLENGES The pilot isn’t without its challenges, though. The skills will need to work as intended every time, ownership and use of data will also have to be clear. There are practical considerations at client level too: do they have broadband and are they willing to have an Amazon account? Steve added, ‘The focus must be on the risk the individual is exposed to and the outcomes they seek. Whilst the technology is exciting, it is only the “how”; the important thing is the “why”.’
THE FUTURE Looking to the future, Alexa’s capabilities and limitations are being explored and the team will look at other roles it might play. Steve continued, ‘A consumer
device, which can do many different things out of the box would be a tremendous way to seamlessly integrate services, like emergency calls and falls detection, into people’s lives; sitting in the background and ready to respond when needed. ‘As we look further down the road, there’s the challenge of getting the service “wrap” right. For example, who will respond if a vulnerable person calls for help through an Echo? ‘However, even if this pilot is a roaring success, I’m not going to suggest that everyone with a care need should get an Echo; that’s just not the way personalised care works. As we see new technology being deployed in ways perhaps not envisaged even by its developers, more people will start to perceive how they could benefit in their own circumstances. ‘If they then go out and buy a device or an app that helps them to live safely for longer at home, or that can alert a carer in an emergency, then that has to be a good thing. It will also help local authorities, who are struggling with the doublewhammy of demographic growth and budget cuts, as people who might previously have turned to social services for help can help themselves instead.’ CMM
OVER TO THE EXPERTS... What are your thoughts on this new pilot? Do you think there are other social care applications? What challenges would this bring? Does this open the door for mainstream technology companies to disrupt the care sector?
EXCITEMENT ABOUT SPOKEN INTERFACES IS JUSTIFIED
TECHNOLOGY HAS AN IMPORTANT PART TO PLAY Agincare is working with Argenti and Hampshire County Council to support the realisation of this pilot, as we see some practical applications that may assist people in their homes and promote independence. We want people who use our services to have an early opportunity to help develop and test these. We believe that this pilot has scope to assist with the prompting of medication or myriad other reminders, such as eating, drinking or turning on heating. In addition, a challenge in homecare is keeping people adequately informed of arrival times of their care staff, given delays caused by road works or the need for staff to sometimes stay longer with people due to illness or accidents. Our staff do their best to keep people informed, but if it is possible to interface with the electronic monitoring required by Hampshire County Council, Alexa could keep
people informed as to who their care worker is and their likely time of arrival; even perhaps help the hard of hearing or the infirm have advance notice that they are about to arrive to give them more time to answer the door. Assuming the challenge of interfacing various systems effectively can be overcome, then technology has an important part to play in social care. However, we cannot forget that the single most important part of a care service to most people is human interaction. Sadly, due to lack of money, there seems little time for this in funded homecare now; with most local authorities only able to fund care for people with critical or substantial needs, which requires a real person to visit. Perhaps in 10 years’ time, we’ll be asking if there can be such a thing as robotic personal care.
Sarah Leskinen-Keel Chief Operating Officer, Agincare Group
RemindMeCare is exploring adding voice to its software to assist care and management. For the hope for ‘voice’ is that it provides an intuitive interface for people with limited computer experience. The flipside is that the apparent ‘naturalness’ often results in end users assuming the system is far more capable than it really is. This can lead to disappointment and eventually rejection of the system. Therefore, expectation management and a sensitive introductory phase for the technology is critical. Voice is not a miracle solution for engaging end users to complete the same process-driven tasks that the telecare industry had difficulties with delivering. Cultural understanding, personal preferences and history are even more important sensitivities where a dialogue with an artificial intelligence agent is concerned. The wreckage of earlier ‘revolutionary’ technologies litter
the road to personalised care delivery, however the excitement about spoken interfaces is justified. That’s why we’re holding the ‘Talking Healthcare – Using voice tech to improve care’ conference to explore who’s doing what and how with voice in healthcare. The much sought after transformation in healthcare, in which technology is expected to play a fundamental role, needs to involve an effective integration of the many new innovations; including the Internet of Things, wearables, big data, virtual reality and voice. These need integration into an ecosystem that enables the consumer to easily improve care provision and not just be bewildered into confused nonadoption. We hope to start a dialogue that brings voice to the forefront of innovation across the care sector.
Simon Hooper Director, RemindMeCare
TO BE ENCOURAGED IF IMPROVES QUALITY OF LIFE Use of modern technology to improve quality of life is something to be encouraged, so long as it is being done to improve quality of life and not to abdicate social responsibilities. In this Alexa trial, there are a number of concerns that I have. The first is that if this initiative is being used primarily to reduce cost, it will be used to reduce the number of hours care that an elderly or isolated person will be allocated. Humans are designed for social interaction – which is why we join together into villages, towns and cities. We thrive on interaction with other people, and for many elderly people receiving care in their home, the only human interaction they receive is from their care workers. The second concern is how elderly people will react to being ‘told’ what to do by Alexa. Having
had a similar device for a number of months in our home, we have changed from saying ‘OK Google, turn the radio off please’ to ‘OK Google, shut-up’ – because the second phrase is more reliable. If Alexa behaves similarly, and this is the primary interaction people have with the outside world, then it could lead to frustration and possibly behaviour changes leading to increased episodes of challenging behaviour. Hopefully, the trial will identify some ways to reduce social isolation, possibly by connecting like-minded people and creating virtual villages, but there is no better way for humans to interact than face-to-face, sharing food or a cup of tea. I suspect this is what most elderly people yearn for more than a computer telling them what to do.
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A VIEW FROM THE TOP
DRBENMARUTHAPPU Ben Maruthappu is Co-Founder of Cera.
REFLECTIONS ON THE LAST DECADE The sector has changed a lot over the last ten years. To start with, we’re in a very different place demographically. There are now over 11.8 million people over 65 in the UK, which has triggered a huge increase in demand for funding. Social care funding has at the same time faced significant reductions since the 2000s. As such, the social care sector has had a tricky time keeping up, and its workforce has been affected by pay cuts, which has deterred good care workers from remaining within the sector. That’s why we decided to launch Cera nearly a year ago, bringing technology and social care together for the first time. PROJECTIONS FOR THE NEXT DECADE To start, I believe the sector needs to implement a three-pronged approach to modernising the service. First, the social care and healthcare sectors need to work more closely together. Secondly, we need to become more open to using technology in the sector. Thankfully, technology is cheaper and more accessible than it was a decade ago. This makes it easier to integrate new, useful innovations into healthcare services. Artificial Intelligence, for example, can help us to deliver a much more proactive, high-quality and consistent service.
Finally, funding must improve. Thankfully, social care is now a political priority, with the Government investing an additional £2bn into the sector, as announced in the Spring Budget. The NHS can then begin to actively organise services around its patients – perhaps by shifting more responsibility to homecare providers. INSIGHT I am extremely passionate about healthcare, and indeed helping others. It is important to me that Cera has as positive an impact as possible – we want to help tackle key issues within the healthcare sector at large, in addition to playing a key role in assisting the NHS in all the positive work it does. It is also of paramount importance to me, and the business, that we treat our care workers well because they really are the fabric of what we do. At Cera, for example, we pay our care workers up to double national living wage. This is possible because we have digitalised our back-office operations, which removes the hefty and unnecessary cost of admin. INFLUENCES Lots of people and experiences have influenced my career so far. I learnt a great deal from Simon Stevens, the Chief Executive of the NHS, who I worked with for three years whilst co-developing the NHS accelerator. I
also gained firsthand experience of how difficult it can be to navigate the care industry, when my mother suffered a fracture and I struggled to organise care for her. LESSONS Prior to founding Cera, and even now, I have come to appreciate the value of cross-pollinating business-focused ideas. Observing companies in other sectors – particularly those disrupting their space – is of great value to us. We don’t want to repeat the same mistakes of other disruptors or healthcare providers – we want to be as innovative as possible, as efficient as possible, and that sometimes requires thinking outside the box. At Cera, we use digital systems not too dissimilar to that of Deliveroo, for example, to increase the number of patients a care worker can see in a day, and optimise geo-spatial operations. It is important for us to learn from other start-ups who are using innovative technology to better serve their customers and improve their business. ADVICE I would suggest that we take a more collaborative approach to the health and social care industries. I believe operating in silos is not good for any business – we need to share resources in order to be as efficient as possible. CMM
Read about Ben’s typical day on the CMM website www.caremanagementmatters.co.uk Subscription required. CMM November 2017
What does it take to be an Outstanding manager in social care?
Cedi Frederick shares research into outstanding managers in social care and what makes them stand out.
Article Consulting recently surveyed the managers of care homes that had been rated Outstanding by the Care Quality Commission (CQC), to gain an insight into what makes them different to other managers, and how they have been able to achieve the coveted Outstanding rating. The resulting In Our Own Words report gave these outstanding managers the opportunity to have their voices heard and directly contribute to the growing debate on what makes a care home Outstanding. The report provided a unique insight into the individuals who are members of what is still an all too exclusive club, by identifying and analysing the common values and behaviours these managers seem to possess. The report quotes managers extensively and looks at the challenge of achieving an Outstanding rating through their eyes. The research generally reflected what we already know from other studies and reports about the managers of care homes: they are 34
CMM November 2017
overwhelmingly female, aged between 55 and 64 and are likely to have been promoted from within the service. The majority have worked in the sector for over 20 years.
BENEFITS OF TRAINING Article’s research identified that the managers of Outstanding care homes had accessed significant levels of training and support in the last 12 months. This included: • Networking (78%). • External training (72%). • Internal training provided by their group (72%). • Accessing online information (61%). Networking, both internally and externally, was the most useful source of support, development and guidance for managers, followed by internal training provided by their group. Looking at the total number of formal
training days received in the last 12 months, 44% of the managers surveyed said they had received between six and 10 days, whilst 28% of managers stated that they had received more than 10 days’ training. If there’s a correlation between training and Outstanding services, Boards should be asking their chief executives how many days’ training and development are managers accessing a year? At the same time, perhaps chief executives should be asking operations and HR directors to bring forward training and development strategies for managers. Added to this, organisations should beware of the manager who says they’re far too busy to go on training sessions or to seek out their peers and others to share knowledge and learning. To cement any correlation, perhaps as part of its inspection regime, the CQC should ask managers how many days’ training and development they have accessed in the last 12 months, in addition to ‘…are you supported by your manager and the organisation’? And for those managers whose organisations do not provide six to 10 days’
CMM November 2017
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WHAT DOES IT TAKE TO BE AN OUTSTANDING MANAGER IN SOCIAL CARE?
training and development a year, they might want to ask for it. In addition to their own training and support, the managers of Outstanding care homes highlighted investment in training and development for their staff as being pivotal in achieving their Outstanding CQC rating. This included the provision of mentoring and networking opportunities. Sharing learning and experience was also highlighted as being important as a way of embedding a culture of good practice.
LIFE INSIDE THE HOME 90% of the managers of Outstanding care homes who responded to the survey highlighted the importance of recruiting the right staff, valuing them and, as one manager described it, ‘Being willing to manage-out staff who shouldn’t be working in care’. Alongside recruiting the right staff, managers also focused on creating a culture that is built on genuine care and compassion, one which puts residents at the centre of everything the home does. Managers also highlighted the importance of working in partnership with families, maintaining twoway communication and creating a supportive environment.
THE QUALITIES OF AN OUTSTANDING MANAGER When asked what the top qualities that the manager of an Outstanding rated care home needs to have, those that were most frequently highlighted included: • Passionate (71%). • Caring (53%). • Dedicated (41%). • A ‘can-do’ attitude (41%). The research showed that these managers have a clear vision and focus on leadership as much as they focus on what might be considered purely managerial tasks. Managers were also quoted as ‘doing whatever it took to get the job done’ by ‘working 24/7’, with one manager reporting that they frequently worked up to 100 hours a week. Unsurprisingly, when asked what got in the way of achieving an Outstanding CQC rating, managers’ responses were consistent: • Staffing, including recruitment and retention. • Financial constraints. • The increasing levels of paperwork. • A lack of time.
• The unrealistic expectations of others.
WHAT MAKES OUTSTANDING MANAGERS DIFFERENT? Not content with just gathering data about how managers of Outstanding services go about the job, the research sought to get under their skin and even in their heads. The intention was to understand what, if anything, makes them different to other managers. The managers who took part in the survey were invited to take the Judgement Index, an online assessment of values-based behaviours in their working and personal lives. The results were fascinating. Three of the main areas measured by the Judgement Index focus on a person’s capacity with ‘people’, ‘task’ and ‘strategic thinking’. Judgement Index research of frontline care staff has shown they have stronger ‘people’ and ‘task’ scores, and weaker strategic and lateral thinking ability. However, the outstanding managers had an even balance across all three. Having achieved this balance means that when faced with challenges, they are more likely to place equal consideration to ‘people’, ‘task’ and the ‘strategic’ consequences of the decisions they make. It means that they can see the bigger picture. When measuring the balance of value someone has towards ‘people’, ‘task’ and ‘strategy’ then combining this with three personal dimensions of ‘self-esteem’, ‘role in life’ and ‘self-image’, the outstanding managers had an even balance in all six key areas. This is very rare when compared with managers across other sectors. People with these six qualities tend to be self-assured and consistent in their approach, often displaying natural leadership abilities. Another key area the Judgement Index measures is problem-solving, and a manager’s ability to understand, process and make decisions at pace. With an average group in any industry, it would be expected that only 15% would score ‘extremely capable’ in this area. These 15% would be able to problem-solve and come up with quality decisions quickly, often leaving others behind in their exceptional capacity. It is striking, then, that 75% of the managers of Outstanding care homes scored in this ‘extremely capable’ bracket – far more than we would expect to see. The Judgement Index’s previous research identified that within the care sector, people score much better in ‘intuition’ than the
average population. Intuition can include noticing and sensing subtleties in other people and their behaviour, but also in the environment. This is important in social care, especially when looking at compliance and risk. All of the outstanding managers profiled fell into the ‘strong’ bracket for ‘intuition’, solidifying the belief that outstanding managers have outstanding capacity for intuition, noticing and sensing. Another area measured by the Judgement Index is around following directions accurately. 85% of the outstanding managers had the strongest possible score in this area meaning their precision and attention to detail is very high. As a result, they are likely to expect this same precision and accuracy from their staff and this may be a key factor in their success. Worryingly, however, the Judgement Index assessment identified most of the managers had a susceptibility to burnout, probably due to their high motivation levels and strong work ethic. Whilst none were in the ‘danger zone’,
“The research showed that these managers have a clear vision and focus on leadership as much as they focus on what might be considered purely managerial tasks.” it’s worth noting that it is common to see high performers, like these managers, experiencing burnout at some stage, especially when working up to 100 hours a week. Perhaps the most striking result of all is that, when compared to other care managers, the managers of Outstanding care homes all fall into the top 10% when rated in strength across all areas measured by the Judgement Index. This is an exceptional outcome. It shows that whilst it takes a team effort for a home to achieve an Outstanding CQC rating, it’s clear that all Outstanding homes have an outstanding manager. CMM
Cedi Frederick is Managing Director of Article Consulting. Email: firstname.lastname@example.org Twitter: @CediArticle
What do you think of this assessment of managers of Outstanding services? Share your thoughts at www.caremanagementmatters.co.uk Subscription required. In Our Own Words can be downloaded from Article’s website www.articleconsulting.co.uk CMM November 2017
Samantha Curran is Home Manager at Thornbank, which is run by Greensleeves Care. Based in Ipswich, it supports 31 residents, some with dementia.
CMM November 2017
CAREER HISTORY I always wanted to be a nurse as a child, however, I didn’t make the grade. When I left school, I became an apprentice hairdresser, earning the princely sum of £25.90 per week. It was mainly the people-based element of the role which I enjoyed. Although, I had to give it up for health reasons. I then went into retail and was a window-dresser for the Burton Group. Again, I enjoyed working with people. However, I had a hankering for care. When my mum became a care assistant at a local authority-run care home nearby, she encouraged me to join. I started off as a relief care worker, also covering domestic roles and kitchen work when needed. I worked both jobs for a while, until I was encouraged to become a permanent, full-time care worker. This was in 1994. After I joined I soon moved up to acting team leader and was encouraged to work towards my NVQ Level 3. Following achieving that, in 1997, I became a team leader. I stayed at the Suffolk County Council-run care home until it was sold in 2013, at which point I decided that I wanted to take a short break, took redundancy and decided what to do next. It didn’t take me long to want to start working again. I then applied to be a deputy manager for Greensleeves at its first purpose-built home, De Lucy House in Diss. When I first started, it was a building site. I joined in July, the home manager had started in the March. We built up the staff team as the home built and following CQC compliance checks, it opened in September 2015.
CURRENT ROLE I’d been at De Lucy House for about a year when the operations manager asked me if I’d considered being a home manager. Although I had, I wasn’t sure if it was too soon in my career and my time with Greensleeves to be moving on. However, she was confident in my abilities to do the job and I, too, had confidence in myself, so I seized the opportunity, applied and got the role at Thornbank in Ipswich. I formally started the role in January 2017. I worked in both care homes in December 2016 and over Christmas to ease the transition at De Lucy Care Home, which needed to recruit a new deputy manager. I didn’t want to leave them without one. I wanted to become a registered manager to progress my career. However, I couldn’t have done it without the right support and encouragement. It felt like the natural next step. That said, I was very nervous of the move and the level of responsibility that’s involved. But, it is the best thing I could have ever done and the support I have really helps.
Having now been in the role for a while, it’s really met my expectations. Although the home is different, it’s an old Victorian building with an established staff team, as opposed to the new-build, new team of De Lucy House, management is still management. My residents and my staff are my top priority. It goes hand in hand. The best part of my role has to be the achievements I have made. I enjoy the fact that I am responsible for the happy, comfortable and homely care that is delivered by my hardworking team. It helps me to achieve my aims, and those of Greensleeves: to make life comfortable, worthwhile and happy. Happy residents and staff. The hardest part has to be managing numerous expectations, though. They can leave me feeling pulled in different directions at times.
RISING STAR I was nominated to be a Rising Star by my line manager, Greensleeves’ Northern Area Manager, Ann Connell. I couldn’t believe it when I was nominated. I was extremely proud to be one of only 10 people to be involved in such an initiative. It’s quite an achievement and a brilliant opportunity. I want to use the Rising Stars initiative to improve my knowledge and expand my networking opportunities to develop my managerial skills. Being a home manager can be quite lonely and I’m enjoying having a network of people who are experiencing similar things. I love learning and developing my skills, so it’s great to speak to other managers about what they’re doing and keep in touch with them. Also, the Rising Stars seminars and conferences help me to continue with my professional development and keep updated on innovation in the sector.
THE FUTURE Looking to the future, I would like to progress in a management role. I know that I have a lot to learn and need to take my time to develop, achieve and feel confident to make the next step. However, ultimately, I’d love to be an area manager. The Rising Stars initiative is instrumental in helping me get there.
ADVICE My advice to other managers or aspiring managers is to never give up, always listen and always smile – there’s no need not to. Smiling is infectious for staff and residents. I believe you should leave any personal issues behind when you walk into the care home. The advice that helped me the most has come from previous managers who have been my role models. Their encouragement has been fantastic. Something I was told that has stuck with me is to allow for your personal time. You have your own life too. Also, remember that Rome wasn’t built in a day, be realistic with what you can do and don’t beat yourself up. Finally, I believe it’s important as a manager to listen, take the time to share information and resources as well as being there for people to discuss things with you. Ultimately, it comes down to communication. CMM Samantha is part of the first ever cohort of Rising Stars. This innovative programme developed by National Care Forum and supported by Carterwood is designed to identify leading lights within organisations who will shape and form the care sector in the future. More information about the programme, the candidates and future opportunities can be found at www.nationalcareforum.org.uk
CMM November 2017
TRANSFERS OF CARE:
GUIDANCE FOR PROVIDERS ON MOVING BETWEEN HOSPITAL AND HOME OR CARE HOME
Ewan King explores recent guidance to support people moving between hospital and home or care home.
CMM November 2017
Our Chair at the Social Care Institute for Excellence Paul Burstow, recently said that so much has been written about transfers of care that it is sometimes hard to see the wood for the trees. So, where do you start in addressing the issue? One starting point is to realise that transfers of care are not just about transferring people from hospital. It’s vital that other moments on a person’s journey to and from hospital are dealt with properly and by a multi-disciplinary team. All of this should be underpinned with a personalised approach to providing care and support; staff in care homes, hospitals and elsewhere must adopt a person-centred approach for everyone they offer care and support to. Does that sound daunting? Well, you’ll be pleased to know that a big difference can be made by attention to the small details.
QUICK GUIDE TO TRANSFERS OF CARE A new quick guide from ourselves and the National Institute for Health and Care Excellence (NICE) looks at both the small things that can help transfers of care and also the complex issues that lie behind transfers to and from hospital. The guide is based on the NICE guideline Transition between inpatient hospital settings and community or care home settings for adults with social care needs. In the guide, we look at
provision for people who are moving between hospital and home, including care homes. It’s only four pages long, but we feel it gives enough information in an accessible way, to really support managers in providing the best experiences for people moving between home and the community.
COMMUNICATION The guide starts by getting the care and support worker to ask where the person being transferred wants to be. This is because, when people with care and support needs transfer into and out of hospital, good communication and integrated services are essential. Registered managers and their teams have an important role to play in this, as part of the community-based team supporting people who are transferring in and out of hospital. The community-based team have a role in: addressing unmet care and support needs, avoiding unnecessary hospital readmissions and admissions to care homes, and addressing delayed transfers of care. As such, it’s important to ensure that the person, their carers and all health and social care practitioners involved in someone’s move between hospital and home are in regular contact with each other. This can include things like making sure that written material appears in Plain English. Good communication is important to ensure that any transition is
CMM November 2017
TRANSFERS OF CARE: GUIDANCE FOR PROVIDERS ON MOVING BETWEEN HOSPITAL AND HOME OR CARE HOME
well-coordinated and that all necessary arrangements are in place. Beyond communication, there is also a number of things that can be done before admission, at the time of admission, and at discharge from hospital.
BEFORE ADMISSION It’s good to think about who might be at risk of hospital admission and to support them to make a care plan in case this happens. Even though it might not seem like the time to think about it, it’s a good idea to also make sure that you are familiar with the hospital’s discharge planning protocols and processes. Before someone is admitted to hospital, health and social care practitioners and advocates should explain to the person, and their family, what type of care they might receive when they arrive in hospital.
WHAT HAPPENS ON ADMISSION? When someone is admitted to hospital, the admitting team need to have all the information they require about the person who is arriving at hospital. This might include: • Care plans, including any preferred routines, and advance care plans. • Communication and accessibility needs. • Current medicines. • Triggers to behavioural issues. • Details of family, including carers and next of kin. • Housing issues. • Preferred places of care. Even at this sometimes-early stage, all relevant practitioners should start assessing the person’s ongoing social care needs and start discharge planning, even if this seems counter-intuitive. Added to this, to provide person-centred care, it’s best to
encourage people to follow their usual daily routines as much as possible during their hospital stay.
DURING THE HOSPITAL STAY As soon as the person is admitted to hospital, identify the staff who form the hospital‑based multidisciplinary team that will support them, such as doctor, dietician, social worker, housing specialist. Registered managers can also keep in touch with the hospital team and share any information that might affect discharge planning. In the hospital, work can be done with the discharge coordinator to help develop the discharge plan. It’s never too early to start this process. For instance, at each shift handover and ward round, members of the hospital‑based multidisciplinary team should review and update the person’s progress towards hospital discharge.
WHEN DISCHARGED NICE guidelines on discharge are clear: make a single health or social care practitioner responsible for coordinating the person’s discharge from hospital. This co-ordinator can keep in touch with people who are supported at home and must make sure that the individual knows how to contact your service if they need to.
WHAT YOU CAN EXPECT FROM THE HOSPITAL TEAM In the quick guide, NICE and SCIE talk about ‘discharge planning principles’. These are: • Ensure people experience continuity of care. • Decisions about long-term care should only be made after a crisis has been resolved. • Discharges need to be planned and co-ordinated, despite any
pressure on freeing up hospital beds. As we say above, it’s important to start discharge as soon as possible after arrival. This includes having contact with a named discharge co-ordinator, who should do things like arrange follow-up care, including any specialist equipment and support. Crucially, a copy of the discharge plan, including things like medicines being taken, contact information for after discharge and details of useful services, should also be made available to people who are offering ongoing care and support in the community.
QUICK GUIDES FROM NICE AND SCIE Moving between hospital and home, including care homes is one of a series of quick guides that have been developed to meet the
needs of busy frontline health and social care professionals. The others are on planning for children and young people transitioning to adult services and recognising and preventing delirium. Hospital transfers aren’t solely about avoiding unnecessary admissions. That’s one part of it undoubtedly, but it’s also important to remember the whole journey someone may experience from a community setting, to hospital and back again. Registered managers and their teams have an important role to play as part of the communitybased team, supporting people transferring in and out of hospital. Thinking beyond the obvious, for instance by planning discharge when someone actually arrives at hospital, is a good way to make sure that someone’s journey to and from hospital is as good an experience and as person-centred as possible. CMM
RED BAG SCHEME: SIMPLE BUT EFFECTIVE HELP ON ADMISSION TO HOSPITAL Sutton Homes of Care has launched a simple idea to help care home residents to receive quick and effective treatment should they need to go into hospital in an emergency. The red bag keeps important information about a care home resident’s health in one place, easily accessible to ambulance and hospital staff. It also has room for personal belongings (such as clothes for day of discharge, glasses, hearing aid, dentures etc) and it stays with the patient whilst they are in hospital. When patients are ready to go home, a copy of their discharge summary (which details every aspect of the care they received in hospital) will be placed in the red bag so that care home staff have access to this important information when their residents arrive back home. The red bag also clearly identifies a patient as being a care home resident and this means that it might be possible for the patient to be discharged sooner. This is because the care home has been involved in discussions with the hospital and has an understanding of the resident’s care needs, so they are able to support the resident when they are discharged. Communication between care home staff and trust staff has improved greatly because of the red bag and staff say they now have a better understanding of each other’s roles. The red bag scheme has been developed in partnership with Epsom and St Helier Hospital Trust, Sutton and Merton Community Services, London Ambulance Service and staff from Sutton care homes. It has been rolled out in other areas of the country.
Ewan King is Director of Business Development and Delivery at the Social Care Institute for Excellence (SCIE). Email: Ewan.King@scie.org.uk Twitter: @EwanDKing
How do you support clients into and out of hospital? CMM subscribers, share your experiences at www.caremanagementmatters.co.uk 42
CMM November 2017
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CMM November 2017
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SECRETS OF RECRUITING and keep ing SOCIAL CARE STAFF Research from Skills for Care reveals that quality training, positive working conditions, flexibility and competitive pay rates are the key to finding and keeping the right staff to deliver quality care and support. Annette Baines looks into how providers with low staff turnover recruit and retain their workforce.
Skills for Care collected evidence from 140 adult social care organisations who have staff turnover rates of less than 10%, to look at what they do to keep their staff after theyâ€™ve successfully recruited them. The Recruitment and retention in adult social care: secrets of success report found common themes amongst organisations with staff turnover rates well below the national average of 27.3%.
PLANNING YOUR WORKFORCE Almost two thirds of these organisations use workforce planning tools to ensure they have the right mix and numbers of staff to deliver the care and support needed. Having a recruitment plan enables them to act strategically rather than reactively, so they can consistently target people with
CMM November 2017
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the right skills and values and build on recruitment methods that they know work well. Crimson Hill Support told us, ‘[Having a recruitment and retention plan] helps you keep focused on what you need as an organisation. It clearly highlights how and why you’re recruiting.’
ATTRACTING MORE PEOPLE In their efforts to attract more people to work for their organisation, employers said that investing in staff development, having a positive workplace culture, offering flexible working patterns, competitive pay rates and using a values-based approach to recruitment work well for them. Some also use local events, volunteering opportunities and apprenticeships to attract more people to their vacancies. All of these help them to develop a strong reputation, which employers said was ‘priceless’ in successfully recruiting and retaining staff. Highfield House is a residential care provider which benefits from a strong reputation as a good employer and care provider. It told us, ‘We stress the importance of providing an excellent service which is caring, respectful, enabling and appropriate for individuals’ requirements and how rewarding the work can be. ‘We pay well, compared with many places, and offer plenty of training, development and qualifications as well as hands-on, daily support from management. We do not employ agency staff so our team are genuinely close and trusting of each other. ‘Our work environment is friendly and encouraging. Our excellent reputation has been built over 30 years with the same owners of the business in place and daily available.’ When advertising their job vacancies, organisations find that the best ways to promote them are through ‘refer a friend’ initiatives, adverts on their website and social media, in local papers and on posters in the local community. They particularly highlighted the importance of using word-of-mouth through existing employees, which can be a valuable avenue to pursue. As well as being low or no cost, there’s a greater potential of attracting people with the right values and behaviours because existing staff know the organisation’s core values and can share these with the people they know.
TAKING ON THE RIGHT PEOPLE Claxton House, which is part of Atlanta
Healthcare shared their experience of recruiting the right people, ‘Don’t just fill vacancies, fill them with the right people.’ Investing in ‘raw talent’ ranked higher than taking on people based on prior work experience or qualifications. These organisations place a high emphasis on the candidate’s values and behaviours in recruitment, like kindness, compassion, reliability, life experiences and a willingness to learn. To support this approach, they’re effective in ensuring that values and behaviours are communicated to potential candidates in promotional materials, such as their website and social media, job adverts and descriptions and during pre-interview opportunities, such as taster days. These organisations use a range of recruitment methods, including application forms, CV’s and supporting statements. Lots also use work experience or taster days, preinterview assessments, pre-employment training and apprenticeships to find out if candidates are the right fit for their organisation. Embrace Quality Care shared its recruitment process, which includes: • Pre-interview visits to ensure candidates understand the values, attitudes and behaviours required for the role. • Interview questions that explore attitudes, values and beliefs as well as critical-thinking skills. • Consideration of how the candidate will integrate into an established team.
DEVELOPING TALENT AND SKILLS To develop their talent and skills, these organisations invest in successful candidates by delivering quality inductions, accessing funding like the Workforce Development Fund to meet their learning and development needs, having mentoring schemes in place, and creating open and positive environments where everyone understands and embodies the organisation’s values. Nine out of 10 employers referred to providing learning and qualifications to develop the skills and knowledge of their employees. They talk to them about their development needs through induction, regular supervision, performance appraisals and reflection on practice. Induction, supervision and reflection were also used to ensure that staff understand and continue to uphold values and behaviours in
everything they do. They recognise that effective staff development needs to be supported by a positive working environment, where employers listen to staff and follow up on their ideas and positively reinforce and recognise good practice. Old Hastings House suggests that providers should, ‘Know your staff, what motivates and makes them tick. Above all, reinforce to staff that they are your most important asset by nurturing them and celebrating their achievement, so they know their key value to the overall team. After all, the best leaders are home-grown.’
KEEPING YOUR PEOPLE Retaining good staff is vital to the success of any organisation. These organisations meet the challenge of keeping people by investing in learning and development, respecting and valuing their staff, paying above the local minimum pay rates, creating flexible work patterns and understanding staff have responsibilities outside of work. One community care provider highlighted the importance of offering progression opportunities as a way of keeping staff. They said, ‘Provide an ongoing and structured personal and career development plan which is reviewed on a regular basis. Ensure that training and development opportunities are available to support their ongoing needs.’ Others placed emphasis on making your staff feel valued. Linton Support explained, ‘We believe in valuing our staff…our staff know that their voices are heard and that all individuals in the organisation are striving to offer the best possible support for our clients. This pride in our clients, our achievements and our team promotes better staff engagement and more opportunities for the individuals we support.’
OTHER RECOMMENDATIONS The report also offers recommendations to help organisations drive down their staff turnover rates, including the importance of using quality data like the National Minimum Data Set for Social Care (NMDS-SC) to plan recruitment activities, the collective need to improve the image of the sector as a great place to work, the clear benefits of valuesbased recruitment, investing in staff learning needs and a positive working culture that values and listens to staff. CMM
Annette Baines is Recruitment and Retention Programme Head at Skills for Care. Email: email@example.com Twitter: @SkillsforCare
CMM subscribers can access the report, key messages and infographic at www.caremanagementmatters.co.uk More information is also available at www.skillsforcare.org.uk/researchreports CMM November 2017
THE LANCASHIRE CARE CONFERENCE 2017 21st September 2017
CMM returned to the North West for the Lancashire Care Conference 2017 with Lancashire Care Association. The day brought together providers from across the region to explore the role of the independent sector in shaping social care in the North West. The event was chaired by Paul Simic, Chief Executive of the Lancashire Care Association who opened the day, welcoming all delegates and setting out the day-to-day realities facing the sector, including pressures from regulation, workforce and funding. The keynote speech was delivered by Louise Taylor, Corporate Director of Operations and Delivery at Lancashire County Council. Louise returned to the conference, having presented in 2016 and delivered an update to delegates. She reflected on the changes that had been made by the council following last year’s event and invited more feedback to ensure an ongoing, open relationship between the council and providers. Many delegates found the presentation open and honest and were grateful of the opportunity to hear an update from the council. Accompanying Louise was Councillor Graham Gooch, Cabinet Member for Adult Social Care at the council who attended a number of presentations and workshops to hear about the local care market. Rob Tovey, Head of Inspection (North) Adult Social Care at the Care Quality Commission followed Louise and engaged the audience with his presentation on inspection and regulation now and into the future. He encouraged Good and Outstanding providers to share their good practice as providers want to learn from others. It was fortunate then, that Rob was followed by Jonathan Cunningham MBE, Owner and Proprietor – Rosebank Care Home and STORM Consultancy who discussed what it takes to be Outstanding and offered best practice advice to Corporate sponsor
delegates. He encouraged providers to close the compliance gap and then reach for the stars. A rousing panel discussion then followed with a lot of engagement from the floor. Providers took full advantage of the opportunity to ask specific questions of the morning’s speakers.
last year’s event, as well as looking at issues managers still face and potential solutions to address them, Katie Barnes and Gina Kidd encouraged interaction from the floor to share experiences.
Delegates came back together for the afternoon session. Kelly Jones, Business Development Manager for Profiles4Care shared best practice on recruitment and retention based around recruiting for values and the benefits it can have. Kelly was followed by Andrew Dawson, Solicitor and Director at Brunswicks Law Ltd. Andrew asked who watches the watchers, saying that, ultimately, providers do and if they want to influence Government, their best route is via their local MP. Summarising the day, Paul Simic told delegates that they are the key players, the talent, the creatives and they need to shape the system. It’s certain that delegates left with a huge amount of information to take back to their organisation. Feedback for the event has been fantastic and there was a real buzz around the exhibition hall all day. This year’s CMM Insight Lancashire Care Conference was sponsored by QCS, Brunswicks Law Ltd, Cowgill Holloway, Just, Profiles4Care and RBS.
Delegates then separated out for a choice of workshops to enable them to delve further into specific subjects. Exploring how investing in quality can support business outcomes, Tom Owen of My Home Life encouraged providers to look for ways to retain staff, including offering flexibility and benefits that connect someone’s personal interests to their role. He also encouraged community engagement and involving local businesses as it is recognised by the CQC. Duncan White of the United Kingdom Homecare Association’s workshop on delivering quality homecare in a turbulent market was somewhat sobering. Homecare providers are facing unprecedented pressures, however, there are opportunities out there, including working within local communities to prevent people entering hospital. The third workshop was held by the Lancashire Registered Care Managers Network. Serving as a summary of developments since
CMM November 2017
WHAT’S ON? Event:
Community Health Services: Shifting the Focus to Out-of-Hospital Care Date/Location: 31st October, London Contact: The King’s Fund, Tel: 0207 307 2409 Event:
NCF Managers Conference: Taking Care Forward… the Role of the Manager Date/Location: 6th-7th November, Warwick Contact: National Care Forum, Tel: 0247 624 3619 Event:
Shaping Tomorrow: Care England 2017 Conference and Exhibition Date/Location: 16th November, London Contact: Care England, Tel: 0207 492 4846 Event:
The Future of Ageing 2017: Transforming Tomorrow Today Date/Location: 29th November, London Contact: ILC-UK, Tel: 0207 340 0440 Event: Hospice UK National Conference 2017 Date/Location: 22nd-24th November, Liverpool Contact: Compleat Conference Company, Tel: 01489 668333 Event: The King’s Fund Annual Conference 2017 Date/Location: 29th-30th November, London Contact: The King’s Fund, Tel: 0207 307 2409 Event:
INTRODUCING THE STUNNING
Enhanced Health in Care Homes: Lessons from Good Practice on Embedding Integrated Care Date/Location: 5th December, London Contact: The King’s Fund, Tel: 0207 307 2409
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Event: Date/Location: Contact:
The Transition Event East 2017 15th November, Peterborough Care Choices, Tel: 01223 207770
Event: Date/Location: Contact:
3rd Sector Care Awards 2017 6th December, London Care Choices, Tel: 01223 207770
Event: Date/Location: Contact:
CMM Insight – Dorset Care Conference 2018 8th February, Poole Care Choices, Tel: 01223 207770
Event: Date/Location: Contact:
CMM Insight – Learning Disability and Mental Health Services 1st March, Manchester Care Choices, Tel: 01223 207770
Event: Date/Location: Contact:
BAPS – SEND Blogging Awards 17th May, Coventry Care Choices, Tel: 01223 207770
Please mention CMM when booking your place. CMM November 2017
A N D R E W M C C R A C K E N • H E A D O F C O M M U N I C AT I O N S • N AT I O N A L V O I C E S
Andrew McCracken explores National Voices’ research into person-centred care and asks whether its rhetoric or reality.
For at least 20 years, policy-makers have been aspiring to deliver ‘person-centred’ care. There have been revised definitions of quality, national commitments, and phrases like ‘people at the heart’ and ‘empowered communities’ have become ubiquitous. What difference, if any, have policymakers’ stated ambitions made to the experiences of people who need and use services? We wanted to know. National Voices’ report, Personcentred care in 2017 is the first attempt to judge personalisation and choice across health and social care, based on the reports of service users, patients and carers. Since 2011, National Voices has been at the forefront of making the case for person-centred care. There is a growing body of evidence that personcentred approaches are important for ensuring the overall quality of care and for improving outcomes.
Person-centred care means different things to different people, but the common ingredients are good information, good communication, involvement in decisions, care coordination and care planning. In adult social care, partly in response to the advocacy of service users, ‘personalisation’ has developed over the last two decades to be recognised as formal mainstream practice. This was reflected in our findings. 89% of adult social care service users said their care and support helped give them control over everyday life. 63% of personal budget holders said they could make better everyday decisions. In the NHS, too, there were some encouraging findings. Over 70% of general practice patients and hospital inpatients said that information was good, staff listen, and they received good explanations of tests, treatments and procedures. In adult social care, just over 90% of those using community adult social care said they were involved in decisionmaking about their care and support needs. 35% said they were always involved as much as they wanted in arranging their care and support. However, our study did not show a completely positive picture. A key deficit area is personalised care planning. We found that personalised care and support planning doesn’t really happen in the NHS, with only 3% of GP patients reporting having a written care plan. In social care, where the Care Act 2014 enshrines care planning in law, there are still no national survey data available to assess whether it is happening. The Care Quality Commission did look into personalised care planning as part of a review of the care of older people. It found that in some services, including some residential settings, there are significant barriers to personalised care planning. It found that care plans are: commonly seen as actions for health and social care professionals to take; are not always focused on setting out how services and support can help
ensure people’s goals and preferences are achieved; and may not include information about how people were involved in developing or reviewing their own plans. I don’t want to be completely ‘doom and gloom’ about care planning, there is some good work going on. Initiatives like the Social Care Institute for Excellence’s project on personalisation in care homes – which extends personalisation beyond budget holding – and the encouraging results shown by care homes taking part in NHS England’s ‘vanguards’ scheme, are making important progress. As part of our research, we looked at secondary analysis of patient and service-user surveys and found some evidence of inequalities. There are lower scores for person-centred care amongst people who are over 75, from a BAME background, LGBT, or have mental as well as physical health conditions. This data is not routinely assessed and can be hard to explore. Adult social care should think about how it could provide good national data on such inequalities. We also studied data from carers, recognising that most care is actually provided by them. The latest surveys show that a majority still report poor experiences, with only 23% getting a social care assessment (as is their right), and 69% saying their GP has not acted to support them. Overall, our study showed a mixed picture. There are positive signs that people are getting good information, communication is improving, and involvement in decisions is getting better, especially in social care. But there are still poor levels of personalised care and support planning, and little evidence of care co-ordination. It’s worth noting the difficulty we had in conducting this research. What matters to the system is what it chooses to measure, and personcentred care is not adequately measured. Yes, there have been advances towards more person-centred services, but for now, the policy rhetoric is not quite matching the reality experienced by people. CMM
Andrew McCracken is Head of Communications for National Voices. Email: Andrew.McCracken@nationalvoices.org.uk Twitter: @HelloMcCracken 50
CMM November 2017
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