Care Management Matters December 2017

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DECEMBER 2017 ÂŁ4.00 www.caremanagementmatters.co.uk

AND SOCIAL CARE Workforce, recruitment and retention

Business Clinic

Health village plans for Burton

Garden design and change management How to increase use of outdoor spaces

Resource Finder

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In this issue From the Editor

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Is it just me…? Editor in Chief, Robert Chamberlain looks at a new report highlighting the postcode lottery of palliative care for children with life-limiting health conditions.

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CMM News

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Business Clinic Steps are being taken to develop a dedicated health village in Burton. Is this a step forward for integration? What does our panel think?

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A View from the Top Paul Burstow, Chair of the Social Care Institute for Excellence is our interview subject.

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Rising Stars Katie Reynolds, Contract Manager for Look Ahead is this month’s Rising Star.

40

Event review CMM reviews Berkshire, Buckinghamshire and Oxfordshire Care Conference.

48

What’s On?

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Straight Talk Camilla Trimble sets out detail of the Outstanding Society.

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26

FEATURES 43

REGULARS

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20

Brexit and social care: workforce, recruitment and retention What impact will Brexit have on the social care workforce? The participants of CMM’s roundtable event with NHG explore this important topic.

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Getting to the root of the matter: why aren’t care homes using their outside spaces? Debbie Carroll and Mark Rendell share their research into why care homes are not using their outside space and how this can be improved.

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3rd Sector Care Awards 2017 finalists CMM is delighted to announce the finalists for the 3rd Sector Care Awards 2017.

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Making every moment matter: taking your clients on holiday Rosemary Hurtley and Ewa Worlen explain how a care home in Sweden has found a way to support residents to take a holiday and the benefits are far-reaching.

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Resource Finder – recruitment CMM brings you details of recruitment organisations that support care providers. CMM December 2017

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CONTRIBUTORS

EDITORIAL editor@caremanagementmatters.co.uk Editor in Chief: Robert Chamberlain Editor: Emma Morriss Content Editor: Emma Cooper

@ProfMartinGreen

@VicRayner

@SharonAllenSFC

@StickyNeil

Professor Martin Green OBE Chief Executive, Care England

Vic Rayner Executive Director, National Care Forum

Sharon Allen Chief Executive, Skills for Care

Neil Eastwood Founder, Sticky People

@NHG_UK

@NHG_UK

Gaius Owen Global Projects Sales Director, NHG

Luke Evershed Group Supplies Sales Director, NHG

Debbie Carroll Director, Step Change Design

Mark Rendell Director, Step Change Design

@DebbieSorkin2

@CoxonGeorge

@DesKellyOBE

@PaulBurstow

Debbie Sorkin National Director of System Leadership, The Leadership Centre

George Coxon Independent Health and Social Care Consultant

Des Kelly OBE Chair, Centre for Policy on Ageing

Paul Burstow Chair, Social Care Institute for Excellence

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

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SUBSCRIPTIONS Non-care and support providers may be required to pay £50 per year. info@caremanagementmatters.co.uk 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: 978-1-911437-68-0 CCL REF NO: CMM 14.9

CMM magazine is officially part of the membership entitlement of:

@360Fwd

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

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CMM December 2017

Rosemary Hurtley MSc Dip COT FRSA Chief Executive, 360 Forward Ltd

@LookAheadTweets

Ewa Worlen Manager, Harakarrsgarden

Katie Reynolds Contract Manager, Look Ahead

Camilla Trimble Owner, Nazareth Lodge


From the Editor Editor, Emma Morriss introduces a recent roundtable on Brexit and the social care workforce. Brexit. Whichever way you voted in the EU Referendum, Brexit negotiations are well underway. Depending on your news outlet of choice, you may have heard differing accounts of how well, or not so well, the Government’s ongoing Brexit talks are progressing. What we do know is that there is a whole host of uncertainty around what postBrexit Britain will look like and, for our sector, which values the work of non-British EU nationals, what that will mean for the workforce.

Evershed from NHG. The conversation covered all aspects of the situation, not only looking at Brexit’s potential impact on the social care sector’s workforce, but also wider recruitment and retention issues. We concluded that, although Brexit is creating uncertainty for everyone and is a huge risk to thousands of hard-working and valued staff from the EU, we need HAVE YOUR SAY ON CELEBRATE THE SECTOR to get a handle on the sector’s THE MATTER recruitment and retention as I also had the privilege of sitting a whole. It is an ongoing and What do you think the sector in on the finalists’ interviews for important issue and one which will needs to do? How can we address the 3rd Sector Care Awards this ROUNDTABLE only get worse as the population these issues? How do we make month. Listening to the fantastic DISCUSSIONS ages, whether our Brexit is hard, our existing staff feel valued innovation happening across the soft or is no deal at all. and secure through mounting country really invigorated me. This is exactly the topic CMM We have summarised the main uncertainty? Whatever the issues in the sector, and NHG chose to discuss in a points of the discussion in our Let us know your thoughts it’s great to know that people roundtable in October. feature starting on page 20. in the comments section of the are working so hard to make a I chaired the event, which A White Paper will be CMM website, where the article difference in really creative ways. brought together Professor Martin published, which looks at can be found under the Features If you’d like to know who has Green OBE of Care England, Vic actionable solutions for the sector tab. Alternatively, you can Tweet won and help us to celebrate the Rayner from the National Care to take to address recruitment and us @CMM_Magazine, or share finalists’ achievements, there are Forum, Sharon Allen of Skills for retention, as well as supporting your thoughts on our LinkedIn some tickets remaining. Visit the Care, Neil Eastwood from Sticky our existing staff who are noncompany page: Care Management Events page of the CMM website People and Gaius Owen and Luke British EU nationals. Matters (CMM). and join us on 6th December. R075 CMM_reports_ad_Layout 1 04/09/2017 15:25 Page 4 Email: editor@caremanagementmatters.co.uk Twitter: @CMM_Magazine Web: www.caremanagementmatters.co.uk

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Is it just me...?

between services commissioned between 8am and 6:30pm, Monday to Friday and services commissioned to provide care out of hours. Just 67% of CCGs commission community children’s nursing teams to provide care out of hours. Although 64% commission services to provide community paediatricians, only 29% commission them to provide out of hours care. • More than one in five (21%) local authorities are failing to meet their legal duty to commission short breaks for children with life-limiting and life-threatening conditions. • CCGs and local authorities are failing to fund voluntary sector children’s palliative care organisations, including children’s hospices. 22% of CCGs and 72% of local authorities do not commission these services.

Editor in Chief, Robert Chamberlain looks at a new report that highlights the postcode lottery of palliative care for children with lifelimiting health conditions.

Having recently become involved with the Ambitions Partnership for Palliative and End of Life Care, my eyes are being opened to the many challenges of providing palliative care. One issue in particular, of which I was unaware, is the inconsistent level of care and support provided to children with terminal illness (and their parents). A new report produced by Together for Short Lives describes what clinical commissioning groups (CCGs) and local authorities do to plan, fund and monitor care for the 40,000-plus children with life-limiting and lifethreatening conditions in England. The research, collected during 2017, is based upon freedom of information requests sent to every CCG and upper-tier local authority in England. In all, 199 (94%) CCGs and 126 (83%) local authorities provided responses. The findings highlight real concerns over the availability of

care services, especially at night times and weekends.

WORRYING FINDINGS Describing the commissioning of palliative care for children as ‘patchy and inconsistent’, the report, Commissioning Children’s Palliative Care in England: 2017 Edition uncovers some alarming statistics: • Most commissioners are failing to assess the numbers and needs of children with life-limiting and life-threatening conditions. Just 43% of CCGs and 23% of local authorities assess the number and needs of children who require palliative care. However, only 4% of CCGs and 2% of local authorities could state how many children with these conditions are in their area. • Almost half (46%) of CCGs are failing to implement the Government’s end of life care choice commitment and, disturbingly, have no plans

to do so. Just over a third (35%) responded that they are implementing this guidance, while a further 19% stated that their plans to do so are in development. • Most CCGs have not implemented the new clinical guidance for children who need palliative care. Fewer than a third (31%) of CCGs stated that they are currently implementing the new National Institute for Health and Care Excellence guideline on End of life care for infants, children and young people with lifelimiting conditions: planning and management. A further 27% stated that their plans to implement this guidance are ‘in development’. Of concern, only 29% of CCGs commission services that can provide a paediatric palliative care multidisciplinary team that meets the requirements of the guidance. • There is a major discrepancy

TIME TO ACT Listening to the harrowing accounts of parents who have to rely upon A&E departments ’out of hours’ is heartbreaking. How can it be acceptable to leave such vulnerable children without roundthe-clock support? Guidelines are simply not sufficient and are clearly being ignored by the majority of CCGs and local authorities. These important standards must become mandatory and steps taken to ensure their implementation across the country. The sad irony of the current situation is that there is an economic argument for addressing the shortfalls. Speaking on Radio 5, Barbara Gelb OBE, Chief Executive of Together for Short Lives explained that a £14m investment to improve palliative care for children would result in a saving of £35m for the NHS. What can be the argument for Government inaction?

The full report can be accessed on the CMM website www.caremanagementmatters.co.uk Subscription required. CMM December 2017

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APPOINTMENTS UKHCA

Compliance scheme for sleep-in pay The Government has launched a new sleep-in shift pay compliance scheme for social care providers that may have incorrectly paid workers below legal minimum wage hourly rates for sleep-in shifts. Social care employers will be able to opt into the new Social Care Compliance Scheme, giving them up to a year to identify what they owe to workers, supported by advice from HM Revenue and Customs (HMRC). Employers who identify arrears at the end of the self-review period will have up to three months to pay workers. The Government says that the

scheme has been designed to help ensure workers are paid what they are owed, while also maintaining important services for people who access social care. HMRC will write to social care employers who currently have a complaint against them for allegedly underpaying minimum wage rates for sleep-in shifts, to encourage them to sign up to the scheme. Employers that choose not to opt into the scheme will be subject to HMRC’s normal enforcement approach. The Government is exploring options to minimise any

impact on the sector. VODG has responded strongly to the announcement, saying that the Government has again failed to tackle the funding of sleep-in care. The national umbrella group, which represents disability charities, says the sleep-in crisis remains critical and unresolved despite repeated calls for action from across the social care sector. The new scheme means that HMRC could now actively pursue providers who believed they were acting within guidance which the Government has admitted was ‘potentially misleading’.

Strain on adult social care budgets A survey published by the Association of Directors of Adult Social Services (ADASS) highlights the financial strain on adult social care budgets. It has found that more than half of councils expect to overspend their budgets this year by up to nearly £21m each, while all local authorities face having to help pay a potential adult social care bill of nearly £270m to fund six years of back pay for sleep-in shifts. The poll shows that sleep-in pay costs are the second biggest concern – after ring-fenced investment money – for directors in England as they approach winter pressures facing the sector. The survey found that the average cost – for councils, providers and self-funders, per council area – to pay for six years of back pay for sleep-in shifts is £1.78m. If this figure was applied

to the 151 councils in England providing adult social care, the total would amount to £269m. The potential bill comes as more than half (53%) of Directors forecast an overspend on adult social care budgets this financial year. The average estimated overspend is £2m, with the highest at £20.8m. Other findings in the Autumn Survey of Directors, include: • 67% of councils reported provider closures in the first five months of the financial year (April to August). • 48% of councils reported homecare providers handing back contracts (April to August) – an increase from 37% who said the same over a six-month period in the main ADASS Budget Survey earlier this year. • 94% of councils reported they had experienced quality challenges

(April to August) – an increase on the 74% who said the same in the main ADASS Budget Survey. • Councils say the hardest care service to obtain a place in is a care home with nursing (52%), followed by homecare (46%) and a care home (20%). • Only 52% of councils believe their agreed delayed transfer of care targets are realistic for both social care and the NHS. • 16 councils were fined for delayed transfers of care in 2016/17, with individual fines as high as £280,540. Ten councils paid the fine. In 2017/18, eight councils have been fined, with fines as high as £99,970. Six councils have paid the fine. • Only 18% of councils are confident (14%) or very confident (4%) that their Sustainability and Transformation Partnership (STP) will deliver its aims.

United Kingdom Homecare Association has announced three non-executive directors to its Board: David Chalk of Windrush Care Ltd, Lynn James of Carebridge Staffing Ltd and Gavin Stedman-Bryce, Beyond Homecare. Lesley Megarity was reelected as Board member for Northern Ireland. Gavin Stedman-Bryce will represent members in Scotland. Trevor Brocklebank of Home Instead Senior Care was appointed Chair, following Mike Padgham stepping down. Non-executive directors departing the Board are Val McNab of Border Caring Services and Claude Suppiah of ANA Nursing.

TOGETHER FOR MENTAL WELLBEING Together for Mental Wellbeing has appointed Dr Carol Cole as Chair of its Board of Trustees.

BLUEBIRD CARE Bluebird Care has appointed Nicola Walmsley as the company’s first Training Manager.

HEALTHCARE HOMES Healthcare Homes has appointed Matt King to Board of Directors.

CARTERWOOD Carterwood has appointed Jane Thackray as HR and Facilities Manager, and Anne Jenkins as HR and Communications Assistant.

HPC HPC has expanded its team with the appointment of Sophie Bagley as Consultant Surveyor.

CMM December 2017

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NEWS

Rise in social care spending Annual social care spending by local authorities rose by £556m in 2016/17 to £17.5bn, according to NHS Digital figures. This constitutes a 3.3% increase in cash terms and a 1.0% increase in real terms and is the first time social care expenditure has risen in real terms since 2009/10. In 2016/17, local authorities were able to raise the council tax precept by 2%, which raised an additional £382m. The Adult Social Care Activity and Finance Report published by NHS Digital shows that, while expenditure has risen, there has

been minimal change in activity, which may be linked to the increasing costs in the provision of care. 1.8 million requests for support from new clients were received by councils in 2016/17, an increase of 0.2% on the previous year. Nine in 1,000 people aged 18 to 64, and 58 in 1,000 people aged 65 and above, received long-term support provided or arranged by their council in 2016/17. The number of service users receiving long-term care over the year decreased slightly year-on-year by 4,000 to 868,000. The total

number of completed episodes of short-term care to maximise independence was 242,000, a decrease of 2.1% from 2015/16’s total of 247,000. Some councils provided comments regarding the change in expenditure, citing factors including the National Living Wage and an increase of support for complex needs. According to NHS Digital, average costs of care per week for residential and nursing care have risen in 2016/17. The cost of residential care for a person aged 65 and over was £565 a week in

2016/17, rising from £549 in 2015/16. The cost of nursing care for the same age band increased to £606 a week from £563. For those aged 18 to 64, the numbers receiving residential or nursing care are much smaller than the 65 and over age group, but a similar year-on-year effect can be seen with costs for nursing care rising to £911 in 2016/17 from £871 the previous year, and residential care increasing to £1,236 from £1,205. It says that there is a large variation in year-on-year spending among councils.

so it can hold people to account at the right level when regulating providers. CQC will also: • Change the way it regulates primary medical and adult social care services. This includes how it monitors providers and

the frequency and scope of inspections. • Develop how it will monitor, inspect and rate new models of care and large or complex providers. • Update its approach to the ‘fit and proper persons’ requirement.

CQC’s next phase of regulation The Care Quality Commission (CQC) has published the response to its second consultation on the next phase of regulation. It is the second set of proposals that aim to simplify and strengthen the way CQC regulates. CQC ran the consultation from

June to August this year. People could share their views online or at consultation events. CQC received a total of 380 responses during the consultation period. It also held ten consultation events. CQC says that it will begin to implement changes to registration

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NEWS

Updated delayed transfers of care figures NHS England has published the most recent delayed transfers of care (DToC) figures. It reports that there were 168,300 total delayed days in September 2017, of which 110,100 were in acute care. This is equivalent to 5,610 daily DToC beds. The figures represent a decrease from September 2016, where there were 196,600 total delayed days, of which 134,300 were in acute care.

56.5% of all delays in September 2017 were attributable to the NHS, 36.3% were attributable to social care and the remaining 7.2% were attributable to both. The proportion of delays attributable to social care has increased to 36.3% in September 2017, compared to 34.5% in September 2016. The main reason for NHS delays in September 2017

was ‘patients awaiting further nonacute NHS care’. This accounted for 26,100 delayed days (27.4% of all NHS delays). The main reason for social care delays in September 2017 was ‘patients awaiting care package in their own home’. This accounted for 20,700 delayed days (33.9% of all social care delays), compared to 24,800 in September 2016.

Hospices offer Outstanding care England’s hospice care has the highest percentage of Outstanding services, according to the Care Quality Commission (CQC). The State of Hospice Services in England, 2014 to 2017 has found that 25% of hospices are rated as Outstanding (51 services), with a further 70% (142 services) being rated as Good. This is in comparison to around 6% of NHS acute hospitals, 4% of GP services and 2% of domiciliary care agencies, nursing homes and residential

homes being rated Outstanding. Inspectors found that hospice leaders and frontline staff displayed a strong commitment to providing truly person-centred, compassionate care and support to people using their services, and their loved ones, as well as developing strong relationships with other services in the area. However, there is more to be done to make sure that everyone, regardless of their background or circumstances, has access to high-

quality end of life care. Hospice services rated as Outstanding were found to be striving to overcome such inequalities and share their expertise to drive better care in other services. While there are only 217 hospice services registered with CQC in England, hospices across the UK care for around 200,000 people a year in hospices and the community, as well as offering bereavement support to a further 40,000 people.

Regulation for nursing associates consultation The Nursing and Midwifery Council (NMC) has welcomed the Department of Health’s consultation on proposed changes to its legislation to enable the regulation of nursing associates. The NMC expects the necessary changes to its legislation to come into force by July 2018. This will give the regulator six months until the first trainees qualify to complete the activities that need to be in place in order to open the register. This includes approving the NMC’s rules and fees, approval of the final nursing associate standards and approval of nursing associates programme providers. The consultation, Regulation of Nursing Associates in England runs until 26th December.

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NEWS

Delays in continuing healthcare Lack of care home places A report by Marie Curie has raised major concerns about a fast-track care system that is meant to allow seriously ill or dying patients to leave hospital quickly when they no longer need to be there. The findings have revealed that a significant number of people around the country are being delayed in hospital, and potentially dying there, as they wait for urgently needed Continuing Healthcare (CHC) to be put in place. While national guidance says that fast-track CHC should usually be delivered within 48 hours of being applied for, the report shows that in many cases this time-limit is being exceeded. Marie Curie estimates that in 2015/16, 57,000 people waited longer than two days for a package of care, of which just over 25,000 were waiting longer than a week. Of the Clinical Commissioning Groups (CCGs) that provided the relevant data in response to

Freedom of Information (FOI) requests by the charity (46% of all CCGs in England), less than a third (28%) were found to be meeting the 48-hour guideline, while for a further third (32%), the average waiting time exceeded a week. Some CCGs reported patients waiting more than two weeks to leave hospital. The report also raises concerns that the data represents the tip of the iceberg, given the number of CCGs that appear to not be collecting the information needed to assess how well their Fast Track CHC is being delivered. Where CCGs did offer explanation for the waiting times people were experiencing, they identified a number of contributing factors, including: CHC being a Monday to Friday service, creating delays over weekends; delays in finding suitable care homes for patient discharge; and delays due to market capacity and local provider issues.

Performance of CQC report The National Audit Office (NAO) has published a report on the performance of CQC and says that while the Commission has improved as an organisation, it needs to overcome some persistent issues with the timeliness of some of its regulation activities if it is to sustain further improvement. The report found that CQC has completed its inspection and rating programme, has significantly reduced staff vacancies and is increasing its focus on cost savings. In addition, CQC has improved how it measures its performance and acts to correct poor performance. Inspection staff, however, highlighted concerns about how well the broader information systems currently supported them. The NAO also found that CQC does not meet its timeliness targets for some of its regulation activities, such as registration and publication of inspection reports. According to the NAO, while most providers and inspectors think that CQC’s judgements are 12

CMM December 2017

fair, stakeholders have concerns about consistency. CQC is seeking to address this through its quality assurance processes and training. CQC has made progress in implementing its new strategy during 2016-17 although the NAO report says it missed early milestones on rolling out use of resources assessments and designing its approach to the next phase of inspection. It is preparing for new ways that care might be delivered and is already responding to changes such as online primary medical services. According to the NAO, CQC’s ambition to base more of its regulatory activities on intelligence and risk-based information introduces significant challenges. These must be carefully managed, and supported by digital systems and capabilities if it is to minimise the risk of missing poor care. The Department of Health and CQC must also be realistic about capacity to take on new responsibilities in this period.

Lack of care home choice is leaving families ‘settling’ for inadequate places, according to research from Which?. It says that ‘systemic failure’ in the care home sector is leaving the majority of people with limited choice and half of the people needing care having to wait for a bed. Which? found that almost half of people (48%) who had arranged care for themselves or a loved one said there weren’t any places in at least one of the local care homes they considered. The survey asked people who had arranged care for themselves or a loved one in the past 12

months to share their experiences of the care sector. The research found that a lack of good local places means many people are staying in, or moving loved ones into, care homes they aren’t satisfied with, with almost one in five people (17%) saying they settled for a care home they had reservations about. A similar number (16%) ended up opting for a home away from friends and family. When they did find a bed, as many as a quarter (25%) of care arrangers said they were left feeling guilty or annoyed that they couldn’t find a more suitable care home.

Welltower invests in Encore Care Homes Welltower, the US healthcare REIT, has agreed a development partnership with Quantum Group. This deal will provide Welltower with the exclusive option to acquire £250m of Quantum’s development pipeline, through its Encore Care Homes subsidiary. The strategic partnership between Welltower’s global scale and expertise with Quantum’s regional knowledge, development experience and operational excellence will support the delivery of first class healthcare communities in a market with a considerable undersupply of

quality care services. The first transaction to take place is a 60-bed private-pay care home located on the south coast of England. Welltower acquired the home, which opened in 2013, in a sale-and-leaseback deal for £13m. JLL played an instrumental role in facilitating the partnership with Welltower for its client, Quantum Group, and managed the first sales process through to the point of completion, including negotiating terms and mediating on legal, financial and property matters.

Bardsley Construction and Gladman Care Homes Bardsley Construction has been awarded a £7.5m contract by Gladman Care Homes, which specialises in independent living developments with 24-hour on-site care and support. Bardsley has been appointed by Gladman to provide 55 apartments with care and communal facilities in Southport. The 6,225 sq metre development consists of a four-

storey brick building with timber roof, residents’ lounges and dining facilities, landscaping and car parking. Working alongside Bardsley are John McCall Architects, Opus International and Stringer & Pickford. Construction of the scheme is due to start in December 2017 with completion planned for March 2019.


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NEWS

Rise in Deprivation of Liberty Safeguard assessments The number of Deprivation of Liberty Safeguard (DoLS) applications submitted in 2016/17 increased to 217,000, compared with 196,000 the previous year, figures released by NHS Digital show. Mental Capacity Act (2005) Deprivation of Liberty Safeguards (England) 2016/17 shows the number of applications completed was 152,000 – an increase of 45% on 2015/16 when 105,000 were completed. These figures indicate that four new applications were being made for every three being completed. A 2014 Supreme Court ruling in the case known as the ‘Cheshire West Case’ had the effect of lowering the threshold for what

constituted ‘deprivation of liberty’. This has been a contributing factor to a higher number of DoLS applications over the last three years. The report shows large regional variations for overall applications received, the proportion of applications deemed urgent, and the average time from receipt of application to sign off. The North-East had 995 DoLS applications per 100,000 of the adult population, more than double the England-wide average of 492 applications per 100,000 adults. A contributing factor to this higher rate was supervisory bodies in the North-East granting authorisations for a shorter period

of time, requiring more frequent applications as each authorisation runs out. The proportion of authorisations signed off that were planned to last less than 90 days was highest in the North-East at 24%, compared to 8% in the East Midlands where it was the lowest, and 17% nationally. There was a wide variation in the proportion of applications that were classified as urgent, ranging from 33% in the London region to 71% in the East Midlands. At a local authority level, the variations were wider still, ranging from 4% at Wakefield Council to 93% at South Gloucestershire Council. The average nationally was 50%.

The average number of days from applications being received to being completed across England was 120 days, but there were wide variations across regions. East Midlands had the highest average number of days per application at 211 days, with councils there averaging between 83 days (Derby City Council) and 319 days (Lincolnshire County Council). The region with the lowest average number of days per application was the North-East where the average application took 53 days to complete, with councils there averaging between 12 days (Gateshead Metropolitan Borough Council) and 205 days (Northumberland County Council).

Future of supported housing

Do STPs include care homes?

Following uncertainty around the future of supported housing, a tailored approach to protect and encourage the supply of a wide range of supported housing has been set out by Government. All long-term housing will remain in the welfare system and a proposed ‘sheltered rent’ for sheltered and extra care housing will keep rent and service charges at an appropriate level, protecting the housing needs of older and vulnerable people. Local areas will be taking a bigger role in providing short-term and emergency housing through a ring-fenced grant to local authorities by April 2020, allowing vulnerable people to access secure accommodation without worrying about meeting housing costs. The grant will be underpinned by a National Statement of

Care England and the Good Governance Institute has published a discussion paper exploring sustainability and transformation partnerships (STPs) and care homes. It has been developed through a literature review and desktop review of all 44 STPs, and includes a series of case studies on best practices from the six NHS England vanguard sites. The review of all STPs has found that, although there are some examples of good work involving the role of care homes in the STP process (particularly in the NHS England Enhanced Health in Care Home Vanguards), there are still many gaps and a lack of understanding of how the care home market in England can help STP footprints achieve the ‘triple aim’ outlined by NHS England.

Expectation setting out how local authorities should plan effectively for provision in their area. The reforms aim to ensure: • Funding certainty for the sector, encouraging long-term investment and new supply. • Local areas have a greater role in commissioning services. • Councils have a stronger role in providing the right services for their local areas. The Government’s latest policy statement includes further consultation on the detailed implementation of the flexible funding models for both sheltered rent and long-term supported accommodation. The consultation on the detailed implementation of the flexible funding model for supported housing will run until 23rd January 2018.

The research has found that only five of the 44 STPs include independent care homes or social care providers as partner organisations. Only two include specific strategies for how dementia and mental health conditions can be effectively managed in the care home setting. The briefing paper looks at the working between STPs and care homes, whilst also identifying the gaps in the STP process and how care homes can fill these. The paper also explores in what circumstance STPs make reference to social care, focusing particularly on care homes, before presenting some case studies which demonstrate the impact that an effective care home sector can have on the performance of the health system as a whole.

Construction begins on new Hallmark care home Work has begun on a 77-bed care home in Surrey which will be leased by Hallmark Care Homes. The new home, which will provide residential and dementia care, is being built at a cost of £8m across a one-acre site by contractor Lawrence Baker and will be the

care group’s first lease deal. The home, when opened, will provide a spacious, luxurious and sociable environment where family members are encouraged to spend time in the home, participate in activities and spend time with their loved ones.

Facilities at the home will include a state-of-the-art cinema, hairdresser, therapy room and café. Each bedroom will have an en-suite bathroom and most of those on the ground floor will have access to their own patio. Other communal areas will

include an interactive kitchen where residents can assist in the preparation of meals and landscaped gardens designed by David Fountain. The new care home is scheduled to open its doors in spring 2019. It will be Hallmark’s 18th care home. CMM December 2017

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NEWS

Uncertainty around funding local services Almost 60p in every £1 that people pay in council tax may have to be spent caring for children and adults by 2020, leaving increasingly less to fund other services. Analysis by the Local Government Association (LGA) illustrates the strain being placed on council budgets as a result of the rising demand for adult social care and children’s services. For every £1 of council tax collected by councils in 2019/20, the LGA forecasts that 56p will be spent on caring for the elderly, vulnerable adults and children. This

is up from 41p in 2010/11. As a result of the pressures on adult social care and children’s services, less funding will be available to be spent on other vital services. By 2020, local government in England will have lost 75p out of every £1 of Revenue Support Grant funding that it received from Government to spend in 2015. Almost half of all councils, 168 councils, will no longer receive any of this core central government funding by 2019/20. Government plans to allow

local government as a whole to keep all of its business rates income by the end of the decade are in doubt after the Local Government Finance Bill, which was passing through parliament before the election, was not reintroduced in the Queen’s Speech. The LGA says this has led to real and growing uncertainty about how local services are going to be funded beyond 2020. As part of its Autumn Budget submission, the LGA said local government must first and foremost be allowed to keep all of

the business rates it collects locally each year to plug growing funding gaps. A fairer system of distributing funding between councils is also needed. However, councils are clear that keeping more business rates income on its own will not be enough to sustainably fund local services in the long-term. The LGA said the Government needs to set out how it intends to further fund councils to meet future inflation and demand for services, such as social care and homelessness, into the next decade and beyond.

Four Seasons announces financial restructure Four Seasons Health Care High Yield Bond Group (FSHC) has announced its intention to launch financial creditor and leasehold estate restructuring. As part of the proposed restructuring, Terra Firma will inject equity value by way of 24

homes outside of FSHC that they valued at £136m. These homes contribute an EBITDA increase of £18.9m and a cash flow increase of £17.1m. Existing Senior Secured Notes (SSNs) of £350m will be exchanged for £350m of New SSNs. The

existing Senior Notes (SNs) of £175m will be exchanged for £60m of New SNs and 20% of the equity in the restructured group. In addition, there will be no payment of the existing SNs’ £10.7m December interest. There is also a proposed

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CMM December 2017

rebasing of certain of the leasehold rents to market, as many homes are currently paying over market-levels of rent. In addition, as of 16th October 2017, FSHC has separately refinanced the term loan facility with a new £40m term loan.


NEWS

Delayed transfers of care report Health Charter for social care providers

An Age UK report on delayed transfers of care finds that four million hospital bed days have been lost since 2011 due to problems securing social care. Added to this, delays getting homecare have rocketed by 209% in six years. In 2016/17 alone, nearly one million hospital bed days were lost (954,799) due to an inability to access social care, with an excess cost of £173m, excluding equipment and adaptations. Over this period, there has been a trend towards more older people staying in the community with homecare rather than going into care homes and nursing homes, but the numbers of bed days lost – because older people are waiting in hospital for homecare to be put in place – have continued to skyrocket: from 143,916 in 2011/12 to 341,837 in 2016/17, an increase of 209%. Age UK reveals that the starkest increase was last year, between 2015/16 and 2016/17, when there

was a 27.2% rise in the number of bed days lost through an inability to have social care arrangements in place, from 695,037 days to 954,799 days. The latest available figures show that in the period between April and July 2017, there have been 13.2% more days lost to social care than during the same period in 2016. Age UK is arguing that these figures represent huge numbers of older people unable to start their recovery out of hospital, putting them at risk of infections, loss of mobility and psychological distress. It is also a terrible waste of NHS resources and shows short-sightedness from successive governments in not addressing the social care crisis as it has spiralled year-on-year. An excess bed day in the NHS costs between £2,089 and £2,532 a week for non-elective and elective inpatients respectively, compared to about £519 for a place in residential care and less still for homecare.

A refreshed Health Charter for social care providers to tackle health inequalities for people with learning disabilities has been published. Public Health England and VODG (the Voluntary Organisations Disability Group) have launched the updated Health Charter for social care providers who support people with a learning disability. The Charter

was developed with people with learning disabilities and their families to support providers to improve the overall health and wellbeing of people with learning disabilities. This updated version of the Charter includes information on the STOMP campaign for social care providers to stop the over-medication of people with learning disabilities and/or autism.

New owners for Gloucester home Christie & Co has recently concluded the sale of Cavendish Care Home on Stroud Road in Gloucester to a new entrant to the care sector. The home, which had been owned and operated by the Rigby family was registered to provide accommodation for up to 24 elderly clients in 22 bedrooms and

specialised in the care of residents with dementia. The new owner has acquired the entire share capital in the limited company – Cavendish Care Home Limited – and plans to continue to build on the excellent reputation that the home has achieved under the previous owners.

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17


NEWS

Multiple medications and falls link found

Funds needed to tackle care crisis

Older people who take a combination of at least five different drugs are 21% more likely to fall, a Leicester study into medication and falls has found. Falls can cause serious injuries and treating them can be costly to the NHS, which is why a team of researchers from the Leicester Diabetes Centre wanted to see whether polypharmacy, taking multiple medications, has an impact. The National Institute for Health and Care Excellence (NICE) recommends tailored care for people with multi-morbidity, mainly taking 10 or more different drugs. However, the latest findings

A desperate plea for additional funds to tackle the growing health and care crisis ahead of the Budget is being made by a coalition representing hundreds of health and care organisations across the UK. A letter co-ordinated by the NHS Confederation, which represents organisations across the healthcare system, was sent to the Treasury ahead of the Budget on 22nd November. The letter was also signed by the medical royal colleges, social services directors, the leading national charities involved in health and care, university hospitals and the organisation representing the country’s 6.5 million unpaid carers. It warns that the NHS Constitution is already being

have shown there’s a risk in those who take half that amount of medication. The study used data on more than 5,000 people from a group of people aged 60 or over, where they were asked to self-report on the drugs they had taken within the last two years. A total of 35% of those who said they took more than five treatments reported a fall within two years. The results suggested the incidents of falls over two years were 21% higher in those taking five or more drugs compared to those who take fewer. The study findings have been published in BMJ Open.

Care home acquired by RD Capital Partners St Nicholas House on the Welsh/ Shropshire border has been acquired by RD Capital Partners (RDCP Care) in a buyout deal leveraged by Christie & Co. The sale marks RDCP Care’s second acquisition this year following that of the Kings Bromley Home in Staffordshire. Previously owned by Roger and Sheila Hill, St Nicholas House

is a purpose-built facility which was established as a care home in 1986 and reconstructed in 2010 to extend its nursing and residential services to accommodate 49 residents. RDCP Care will be transferring the care home’s current staff. The acquisition was supported by a funding package provided by Allied Irish Bank.

Demand for retirement housing Demos has published a new report to encourage the supply of, and demand for retirement housing. Unlocking the housing market: Helping first time buyers by helping later life buyers explores the options available to encourage greater demand for and supply of retirement housing. The project considers the ways in which older people can be encouraged to move into retirement housing, including financial incentives; as well as the financial factors which currently thwart supply – in particular focusing on the impact of the current Community Infrastructure 18

CMM December 2017

Levy (CIL) and s106 regimes on the viability of retirement housing schemes and the options for their imminent replacement. The objective of the project was to set out a range of possible options to improve both demand and supply, and identify the most feasible way forward as the Government engages with the sector in order to implement the proposals as set out in the Housing White Paper. This project involved extensive qualitative research with citizens and experts as well as rapid evidence assessments and economic modelling.

breached and that millions of patients and those needing social care now face unacceptable delays and difficulties in accessing treatments, care, information and support. It cites the Care Quality Commission, which has concluded that frontline services are now in a precarious condition. The coalition of organisations recognises that there will be many calls on public spending, but is clear that without additional resources in this area there will be a further deterioration in what can be provided for patients, and service users and carers. It urges the Chancellor to revisit the current spending plans for 2018/19 and 2019/20 to ensure that the system is supported to maintain high standards of care.

New report suggests cap for social care funding The Institute and Faculty of Actuaries (IFoA), together with Independent Age, have produced a joint report on social care funding, Will the Cap Fit? What the Government should consider before introducing a cap on social care costs, assessing changes to social care funding policy and the potential implications of those changes. The report aims to encourage Government to develop, as soon as possible, a social care system that is sustainable in the longterm. IFoA and Independent Age say that a carefully designed care cap could provide a means of social insurance, which previously has not existed, for families to plan for later life with certainty. The report assesses the amount individuals would have to contribute towards their own care based on: • A £35,000 cap based on the Dilnot Report. • A £72,000 cap contained in the Care Act.

• The report’s proposed allinclusive £100,000 cap. These scenarios are applied to a range of typical pensioner households, varied by gender, age, region, and level of assets and income on starting to pay for care. This allows the report to demonstrate the impacts and likelihood of individuals benefitting from a cap or meanstest based on their specific circumstances. The report recommends implementing an all-inclusive cap of £100,000. This would cover all cumulative care costs, providing individuals who have the means to pay for their own care clarity on their likely future care costs. They would have to pay for the first £100,000 of costs, with anything beyond this being met by the State. This would reduce complexity and make the balance between individual and State provision easier to understand.


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CMM ROUNDTABLE WITH NHG Q

What impact will Brexit have on the social care workforce? What do we, as a sector, need to do to mitigate the risks and address the issues?

A

Professor Martin Green OBE, Chief Executive of Care England; Vic Rayner, Executive Director of the National Care Forum; Sharon Allen, Chief Executive of Skills for Care and National Skills Academy for Social Care and representing CommonAge; Neil Eastwood, Founder of Sticky People and Author of Saving Social Care; Gaius Owen, Global Projects Sales Director at NHG and Luke Evershed, Group Supplies Sales Director at NHG.

In October, CMM drew together leading names in the sector, along with partner NHG, to explore the impact that Brexit may have on the social care workforce. The knowledgeable panel, chaired by Emma Morriss, Editor of Care Management Matters took a close look at the workforce, recruitment and retention issues facing the sector and the impact that Brexit is likely to have on what is already a difficult situation.

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AND SOCIAL CARE

WORKFORCE, RECRUITMENT AND RETENTION

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BREXIT AND SOCIAL CARE: WORKFORCE, RECRUITMENT AND RETENTION

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BACKGROUND – BREXIT AND EU CITIZENS

On 23rd June 2016, the UK voted to leave the European Union. Article 50 was then triggered on 29th March 2017, marking the start of two years of negotiations towards formally leaving the EU on 29th March 2019. Since then, there have been five rounds of negotiations in which the rights of EU citizens have been discussed. In his speech after the most recent round (12th October), David Davis MP, the Brexit Secretary reassured EU citizens living in the UK that their rights and status will be enshrined in UK law by the Withdrawal Agreement. It will involve registration and a new administration process, which he called ‘streamlined and low cost’. He added that, ‘Any EU citizen in the UK already in possession of a permanent residence card will be able to exchange it simply for settled status in a simple way. They will not have to go through the full application process again.’ However, there are still many points to discuss. In her Florence speech on 22nd September, Prime Minister Theresa May confirmed that the UK wants EU citizens that live in the UK to stay, that they are valued and contribute to the nation, saying ‘it has been, and remains, one of my first goals in this negotiation to ensure that you can carry on living your lives as before.’ Theresa May also confirmed that Britain wants a two-year transition period following leaving the EU in March 2019. For EU citizens, this would continue to allow the free movement of people, although new citizens arriving from the EU would need to register from 29th March 2019. However, leaked documents seen by The Guardian (5th September) imply deterring all but highly-skilled workers from the EU. ‘It proposes measures to drive down the number of lowerskilled EU migrants – offering them residency for a maximum of only two years.’ Until Brexit talks conclude, there will be ongoing uncertainty around the impact it will have on EU citizens living and working in the UK and those which we value in our social care system.

SOCIAL CARE WORKFORCE Looking at the social care workforce, it’s important to understand the current picture to identify potential issues. Skills for Care’s new State of the Adult Social Care Sector and Workforce Report 2016/17 sets out the current social care workforce. It estimates that approximately 1.45 million people work in adult social care and 275,000 new job roles will be needed by 2025, if the workforce grows proportionally to the projected increase in the elderly population. Average staff turnover across the whole sector is 27.8%, rising to 31% in domiciliary care. With 6.6% of roles in social care being

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vacant, there are approximately 90,000 vacancies at any one time. Looking to the nationalities of social care workers, 83% of the adult social care workforce is British, 7% (95,000 jobs) have an EU nationality and 9% (125,000 jobs) have a non-EU nationality. Delving into the percentage of EU citizens in specific job roles, 3% of registered managers, 3% of social workers, 16% of registered nurses, 8% of care workers, 2% of senior managers and 6% of administrative/ancillary staff have an EU nationality. A recent Skills for Care survey of 1,200 personal assistants found that 4% had an EU nationality. With 90,000 vacancies and 275,000 roles to fill by 2025, and Brexit putting at risk the future status of 95,000 EU citizens working in the sector, it could push the sector’s already precarious workforce issues over the top.

WORKFORCE ISSUES FACING THE SECTOR As well as already struggling with workforce, the messages coming from Government are unclear and this makes it difficult for providers to give clear guidance to their staff to help them plan for the future. EU nationals add a lot of value to the social care workforce, they may be more likely to take on evening and weekend shifts, or work in live-in care because they don’t have as many

“We need to support our current staff who are EU nationals and tell them that they are valued members of the sector.” commitments that require convenient work hours. One employer reported that if his business lost 40 staff who were EU nationals, he would require 60 local staff to fill the shifts. The National Minimum Data Set for Social Care puts this at 44 local staff to replace 40 EU nationals. It’s worrying then, that data from the Nursing and Midwifery Council has shown a substantial reduction in the number of applicants to the nursing register from EU nationals since the referendum. Data published in November shows that the number of nurses and midwives from Europe leaving the register has increased by 67% over the last 12 months, while the number joining the register from the EU has dropped dramatically by 89%.


BREXIT AND SOCIAL CARE: WORKFORCE, RECRUITMENT AND RETENTION

“Given the workforce issues facing the sector that are only going to be exacerbated by Brexit, health and social care needs to futureproof its workforce.” Anecdotally, live-in care providers have reported that, although they are not losing their staff who are EU nationals, they are seeing fewer coming for interview. Brexit’s impact on the value of the pound could also affect staff from the EU as it may make the UK a less attractive place to live and work. Brexit appears to be having some negative impact on recruitment, but beyond the NMC data, there is no evidence of significant turnover impacts. However, it’s not just Brexit that is causing workforce issues, there’s the increase in National Living Wage, the Apprenticeship Levy, the sleep-ins crisis and, on a wider level, the financial issues facing health and social care, sustainability and transformation partnerships and accountable care systems. These put pressure on the sector and its ability to recruit and, importantly, retain staff. Added to this is the real crisis in nurse recruitment, where there is an even more urgent need for solutions.

WORKFORCE PLANNING Given the workforce issues facing the sector that are only going to be exacerbated by Brexit, health and social care needs to futureproof its workforce. It’s essential that both sectors come together to workforce-plan. Providers need to look at their own future workforce requirements; identify their staff, their nationalities, whether Brexit could impact on their right to work here or whether they may retire soon. Consider what gaps will need to be filled over the next five years. It’s essential that providers use the National Minimum Data Set for Social Care to track this, as it also feeds into the data used for Government and sector-wide workforce planning. The sector also needs to consider the diversity of the workforce. Social care benefits from having a diverse workforce, which could be seriously affected by Brexit. More needs to be done to ensure the people supporting clients are as diverse as the clients themselves. This need for diversity will only grow. The sector requires a broader set of perspectives which needs to be considered and planned for.

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BREXIT AND SOCIAL CARE: WORKFORCE, RECRUITMENT AND RETENTION

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SECTOR RESPONSE

As the country progresses towards Brexit, it is time for the sector to take action. Social and economic value As well as health and social care coming together to workforce plan, there needs to be parity of esteem and remuneration for health and social care staff. Messages coming out about the impact of Brexit on health need to include social care too. Social care not only adds social value, it also adds to the UK economy, Skills for Care estimates this to be £41.8bn per annum and it needs to be communicated. Also, it’s important that social care is seen as the highlyskilled and hugely rewarding work it is. There is an unfair conflation of low pay and low skill and, whilst many in the sector are paid minimum wage, this is a highly-skilled workforce undertaking complex work. It is also a hugely fulfilling role and we need to change public perception of the reality of working in social care. Public understanding of social care One way of raising awareness of social care could be to create a sector brand. This would enable it to be recognised widely and come together to share its values, potential and pathways for employees. We then need to communicate this. Social care, unfortunately, competes with the NHS which has a worldrenowned brand. However, social care offers as much potential, it just isn’t as understood by the public. Providers need to work together to develop a recognisable brand for the sector, to help address issues around workforce, funding and everything else that is piling on the pressure. When it comes to recruitment, the public’s understanding of the NHS means that people understand what job roles are on offer. They also have the NHS Health Careers platform which makes it is easy to locate roles. In social care, it is more difficult, there’s no central platform, people don’t know where an entry level role can take them, or even the different types of providers they could work for. It’s only those who have experience of social care who truly understand it. As a sector, we also need to inform children at a younger age, advise and guide them on the benefits of working in social care, make the most of what we have to offer – far beyond a low-paid, hard work environment. The sector also needs champions, people who can promote the benefits of social care at all levels. This could be I Care… Ambassadors going into schools or celebrities who have a connection with the sector helping to raise the status amongst media and wider public. The NHS is held close to people’s hearts, the media may knock it down, but it then builds it back up again. This rarely

happens with social care. Social care is generally presented negatively, meaning people don’t see it for what it is, a fantastic service that can support people to live their lives as they wish. Changing the narrative of care work will also help to change public perception. We need to tell people it’s fun, rewarding and fulfilling; there are opportunities, there’s support, qualifications and development. Supporting managers and the workforce We also need to support managers, they are crucial to this. Good leaders make for good services, good managers make for good teams. Focusing on supporting them will help everything else fall into place. Recruiting the right people into an organisation helps, but having the right management, creating the right environment and nurturing their teams can help to retain those workers and slow down the sector churn. The sector needs to think differently about its workforce – can we offer flexibility or job shares, can we make the most of apprenticeships, what personal and professional development can we offer that might not be into management, but could be into other areas of the sector? Looking to more senior roles, can we hire people who have retired early from the health service, but who don’t want to stop working altogether just yet? The sector also can’t shy away from the fact that we need to think creatively about how care is delivered. If we don’t have enough people to deliver care in a traditional sense, we need to change the way we care. If younger people aren’t seeing traditional care work as a future career path, what can we do to change the pathway? We need to offer them different opportunities that play to their strengths and interests. It is time to set out a picture of what care will look like in the future and work towards transforming the sector together. There are opportunities out there if we think smart and look at what we can do not only to attract staff, but to change care delivery. Other sectors’ response to Brexit Finally, we need to look at how other sectors are tackling workforce issues relating to Brexit, this will help us tackle ours. Industries such as hospitality and retail have a high volume of EU nationals; we must understand how they are tackling the situation and adapt their approaches for social care.

VALUE OUR WORKERS Most importantly, we need to support our current staff who are EU nationals and tell them that they are valued members of the sector. They are facing uncertainty and worry and will want reassurance, whether that’s a letter of support or assistance with becoming UK citizens if they so wish. We need to nurture the staff we have while the future is uncertain. CMM

CMM and NHG will be publishing a White Paper of potential solutions to the workforce issues arising from Brexit and the wider recruitment and retention issues facing social care. Look out for it in a future issue of CMM. 24

CMM December 2017


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CMM December 2017

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CMM December 2017


GETTING TO THE ROOT OF THE MATTER

Why aren’t care homes using their outside spaces? somewhere. It didn’t. In fact, we found it in an altogether more complex and unfamiliar place: the indoors, or more accurately, in the subtle and subconscious practices and procedures, norms and daily habits, beliefs and values, of the care setting itself. In other words, in the setting’s ‘care culture’.

Debbie Carroll and Mark Rendell explore why care homes are not using their outside space and how this can be improved. CARE CULTURE IS ON A SPECTRUM

While working with care providers to develop their outdoor spaces, we noticed that the designed outside spaces in some care settings were not being used as much as we thought they should be. This concerned us as it threw into doubt the success of the designs that had been implemented and, potentially, the reputations of garden designers, too. If, as a result of design efforts, there was no increase in residents using their gardens than before the designer came along, was the design support cost-effective? And if not, what were the implications of this for our own practices, and for our peers’ too? This led us to a deceptively simple question that needed an answer, ‘Why aren’t care home gardens used more actively?’ Although it sounds simple, the research journey we went on to find the answer challenged our assumptions about the role of a designer in care homes (and other similar settings). We assumed the answer would lie in the outside space

To delve into this more, we visited care homes and plotted all the different interactions and relationships that they had along a spectrum, from task-oriented care near the bottom towards increasingly person-centred and relationship-centred care at the top. From this, we could clearly see the factors that influenced care homes’ engagement levels and attitudes towards the outdoors. Our key findings identified that the more mature and advanced the care home’s culture, the higher their levels of active and meaningful engagement with the outside space, regardless of the garden’s condition or appearance. Those homes that were practising person-centred care and beyond tended to use their staff to engage residents with the garden and were correspondingly more spontaneous, prepared and informal in the way their residents interacted with their garden. Care home cultures that were lower on the spectrum, tended to use garden features and elements to help activate the outside space and were more group-based,

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CMM December 2017

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GETTING TO THE ROOT OF THE MATTER: WHY AREN’T CARE HOMES USING THEIR OUTSIDE SPACES?

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formal and timetabled in their interactions with the outside space. We also discovered that fearful attitudes towards health and safety effectively ‘capped’ the active use of the outside space, particularly for those homes on the lower areas of the spectrum.

little above halfway along the spectrum of care culture practices we identified. This enabled care settings to locate where they were against person-centred targets and identify a route forward, based on the ‘steps’ included on the map, to reach and exceed person-centred care practices.

A TOOL TO HELP ARTICULATE CARE CULTURE AND MATCH DESIGN SUPPORT

A NEW APPROACH TO COLLABORATING WITH CARE SETTINGS

Following this discovery, we felt it was important to compile the information and help describe the different indicators of care culture along the spectrum, as clearly and simply as possible. To do so, we created a ‘map’ to help care settings identify and locate their current care culture practices and then plan a route forward along the spectrum towards greater relationshipcentred care practices and, increasingly, active use of the garden. We didn’t want to just say ‘what’ needed to be done to activate care home gardens, but show ‘how’ it could be done as well. It was during the creation of the map that we identified how a designer or outside specialist could support care settings more successfully and cost-effectively. We described a range of ways to support care settings at different points along the spectrum, including, but not restricted to, purely design-based interventions. We helped care homes to establish where their culture was before work started and resources were committed; this enabled the designer to then match and deliver what would be sustained by the home as it progressed on its culture change journey, towards greater relationshipcentred care and more active engagement with outside spaces. Additionally, the map also located ‘person-centred care’ a

Following the research and development of the map, we could see why previously designed gardens had fallen out of use after the novelty had worn off. In the main, it was because they had been ‘over-designed’. They were beyond the current capacity of the setting to use them optimally. To address this, we developed a new approach to collaborative working between designers or outside specialists and care settings, we call it ‘relationshipcentred design’. It requires the care setting to be in the driving seat and ensures that the designer’s support starts from the setting’s current culture, not from where either party thinks it should be. This is a major shift in garden design and landscape architecture practice from one-off, whole site design interventions to a more sensitive, relationship-based approach. This new approach entails smaller (and perhaps more modest) interventions, but on a longer-term basis, alongside the care home’s culture change journey. It is based on being fully aware of the care culture, prevailing attitudes and beliefs of the setting.

WHAT DOES THIS MEAN FOR CARE SETTINGS? For a care home manager who wants to use their outside space more actively, a key priority must be to take a deeper look at the subtle and often subconscious

processes, habits and beliefs that make up their setting’s care culture. Not only could these be holding the care team back from engaging their residents more actively with their outside spaces, but it is through an honest review of care culture practices that they can also gauge how personcentred they are and what they may need to address to move forward on their own culture change journey to more advanced care practices. Addressing care culture and embarking on a culture change journey is not a ‘quick-fix’. It requires dedication, courage and determination on the part of everyone, but the rewards are manifold, for both staff and residents. For care settings on the lower half of the relationship-centred care spectrum, it’s important to avoid the trap of believing that a new garden will transform the home’s culture overnight by resulting in more active engagement with the outdoors. Our findings strongly indicate that if the care setting hasn’t been using what it already has outdoors, then it’s unlikely that the new garden will overcome these well-established and ingrained normative practices once the novelty value of the new space has worn off. The issue is not with the garden itself, but the fact that the care home believes that a new garden will kickstart excitement and engagement with it. These care homes need to look at their current attitudes and practices to using the outside space before the design process starts. The garden can then be appropriately improved to facilitate more active use of it.

THE OUTSIDE SPACE IS PART OF THE OVERALL CARE ENVIRONMENT We have heard a lot of reasons

why care setting gardens are not being used more actively, including not having enough money, time or staff. However, we noticed that many of the homes performing at the top of the spectrum in our research appeared to have the fewest resources and still managed to create seamless and spontaneous engagement for the residents between the indoors and outdoors. They had worked out that they couldn’t afford not to do it. It did not require more money, time or staff for these homes to open the doors and help residents to cross the threshold into their garden, it was simply seen ‘as just another room’, and a valued part of the overall care environment. What was actually involved here was culture change: focusing increasingly on the needs of their residents as individuals, and replacing fear from lack of knowledge, with confidence that they knew what their residents wanted to do and were determined to fulfil those wishes, in a safe, imaginative way. There are many reasons to commit to culture change and to become more person-centred in care practices, not least because the Care Quality Commission demands it. The dividend of practising at this higher level appears to us to result in happier residents, who are more fulfilled and contented in their lives, naturally engaging with the outdoors, as and when they wish to. We now draw on all our skills to support our care and design sector clients to grasp the nettle that is care culture, working proactively to help them identify their subtle and complex care cultures and to support their efforts to progress along the care culture spectrum, reap the rewards of greater engagement with the outdoors for their residents and collaborate with outside specialists more costeffectively too. CMM

Debbie Carroll and Mark Rendell are Directors of Step Change Design. Email: debbie@stepchange-design.co.uk and mark@stepchange-design.co.uk

Have you considered the impact of your care culture on the use of your outdoor spaces? CMM subscribers can share their thoughts at www.caremanagementmatters.co.uk CMM December 2017

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HEALTH VILLAGE ON THE HORIZON: A STEP FORWARD FOR INTEGRATION? Steps are being taken to develop a dedicated health village in Burton. Billed as a ‘landmark development’ is this innovative approach to health, social care and community on one site a step forward for integration? STRIDE, the strategic estates partnership between Morgan Sindall Investments’ health brand Community Solutions, Arcadis and Burton Hospitals NHS Foundation Trust, has announced that plans for a £55m health village development in Burton have been approved by the Board. The Burton Hospitals NHS Foundation Trust has signed an option with STRIDE to progress the landmark development on surplus land, called Outwoods, adjacent to its Queen’s Hospital site in Burton. Although the exact timescales are not set in stone, STRIDE will progress the scheme towards outline planning before the end of 2017. However, if outline planning is successfully granted in the first quarter of 2018, the team hopes to start construction in the second quarter of 2019. In the meantime, they will be undertaking a programme of public consultations.

HEALTH VILLAGE PLANS The development, which is scheduled to provide GP and community services for about 30,000 patients, also currently includes plans for an extra care development and a step-down facility to mitigate delayed discharges, as well as accommodation for vulnerable adults and a 100+ place nursery to support the growth of intergenerational care in the area. The health village will also benefit from the inclusion of a community hub, which STRIDE hopes will support greater integration between the different groups supported on the site and the local community. 30

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Peter Cox, Director of STRIDE said, ‘We have outlined what is expected in the main on this site. We have yet to confirm what health services will wrap around the GP practices as this is part of the next phase of our development process. The Queen’s Hospital site provides a full acute hospital service and the Outwoods development will complement this. ‘We are currently looking at innovative ways of funding this development and this will be based on the individual types of development planned as part of the overall scheme. Community Solutions will be responsible for the overall development, which will include putting together the funding packages.’

DRIVERS FOR THE DEVELOPMENT Given that policy is encouraging integration and there is a distinct need for services to reduce delayed transfers of care, Peter explained what they are hoping to achieve with the health village, ‘There are two major drivers that this development meets. By having complementary frontline services, particularly the primary and community care provision, it supports keeping people out of hospital and, in particular, delivering primary care at scale can ensure patients don’t use A&E. ‘In addition, by providing supported living, either through the extra care or the accommodation for adults with learning disabilities, these modern, supportive environments will have an additional impact on this. ‘Developing step-down facilities also ensures that patients can be released in to a more appropriate

environment freeing up beds in the hospital.’

POLICY DIRECTION The development comes from a number of policy drivers locally and nationally. Burton Hospitals NHS Foundation Trust’s Strategic Plan for 2014 to 2019 says that the Trust intends to ‘evolve with the changing landscape of healthcare and take a lead on delivering innovative approaches to delivering care.’ Added to this, NHS Property and Estates: Why the estate matters for patients, an independent report by Sir Robert Naylor for the Secretary of State for Health, published in March 2017, set out to develop a new NHS estate strategy, one that is fit-for-purpose and presents the opportunity to rebuild NHS infrastructure to meet modern standards of service delivery for the future. The review also says that, ‘The NHS estate is one of the key enablers to change in the health system and directly contributes to the delivery of high quality healthcare to patients. It is also a significant source of untapped value.’ It could be used to release capital to fund NHS transformation, the Five Year Forward View and Sustainability and Transformation Partnership plans. Chief Executive of Burton Hospitals NHS Foundation Trust, Helen Scott-South explained more, ‘We have long-recognised the need to ensure services in the community, including GP services, are better integrated into the services we provide at Queen’s. ‘The development proposed, in lieu of a standard housing

development, enables a greater focus for the community in providing more seamless care. ‘We are also conscious, as outlined in the Naylor report published earlier in the year, that the NHS has to make better use of its surplus land and we are delighted that our partners in STRIDE have put forward this exciting development.’ STRIDE is supporting the Trust in its strategic plan for the future and is striving to deliver real efficiencies and innovation across all aspects of the Trust’s operations, as part of its journey to deliver an outstanding patient experience, every step of the way. The health village is part of the joint venture’s plans to deliver efficiency savings and infrastructure projects over 10 years. Peter Cox finished, ‘We are very excited to be working with the Trust to realise the enhanced health outcomes which will be delivered through this development, by drawing on our wider property development skillset as well as our experience in the health sector developing health facilities.’ CMM

OVER TO THE EXPERTS... What are your thoughts on this proposed health village to integrate health, social care and community in Burton? Is this an ideal solution to bring together services and the wider community? Is it a solution for surplus NHS land that could be replicated elsewhere? Is there a risk that it’ll lead to segregation of people living on the site? What does the panel think?


SHOULD CHAMPION PERSON-CENTRED CARE ‘The traditional divide between primary care, community services and hospitals…is increasingly a barrier to the personalised and coordinated health services patients need.’ The NHS Five Year Forward View is predicated on moving away from acute hospital services and towards community-based approaches. The NHS has also acknowledged the need to work with social care, the voluntary and community sectors and local communities on an equal basis. We have evidence of the benefits that can be achieved through better links between health and social care. Amongst the Enhanced Care in Care Homes Vanguards, the project in Nottinghamshire found a 29% reduction in A&E attendances amongst care home residents. Anything that gives practical expression to the coming together of support around the person, more join-up between health and social care, and greater emphasis on

wellbeing, is to be applauded. But we know that people’s wellbeing isn’t just about the NHS. It’s about meaningful activity, social connection and good housing. Social care can provide all of these. My reservation about the health village is, therefore, if it comes to be seen as centred on the NHS, with a primary purpose of saving the NHS money. For example, Peter Cox notes that, ‘we have yet to confirm what health services will wrap around the GP practices’; and the major drivers include ‘keeping people out of hospital and… ensuring patients don’t use A&E’. A better way of describing might be to start with the person, and what the development and services wrapped around them can do. The Five Year Forward View champions person-centred care. It would be great if the health village could do the same.

Debbie Sorkin National Director of Systems Leadership, The Leadership Centre

WATCH TO SEE HOW THIS SCHEME DEVELOPS We need a genuine collaborative approach to new ways to provide care for our vulnerable people. This plan should be welcomed and has the potential to offer a new model that is credible and creative. There may be some hurdles to overcome prior to a viable plan progressing and providing the choice we might desire for those needing this type of provision. Although, industrial-scale silos of older people may not feel very integrated to some. I’m a strong protagonist of a diverse care market and particularly smaller ‘homely homes for life’ – an option for people to choose to live as an integral part of an ordinary community. My care homes with fewer than 20 residents are exactly this. Although not made explicit, my impression is that the Burton plan is somewhat reminiscent of the retirement village model that tends not to take account of the

reality of decline in health of those with advance, late stage and end stage frailty and/or dementia. Such people, once they need more care, will not be easily supported in these facilities. Idealising provision for those living with multiple complex needs retaining independence, whilst laudable, can be unrealistic for many. Right care, right place, right time and readiness must be considered in a positive and proactive way. Health villages will be attractive to those able to find, and afford, one. Many will be well-suited to this type of living for a considerable time, but perhaps not lifelong living. The mention of local consultation, I hope, will take account of the need for life-long planning for those who will ultimately need 24/7 care. I will watch to see how this scheme develops.

George Coxon Independent Health and Social Care Consultant

HAS POTENTIAL TO BE AN INNOVATIVE APPROACH Community development has to be a vital aspect of the future of the NHS. It was a policy driver behind the introduction of Sustainability and Transformation Partnerships and it is widely acknowledged that acute services need to be properly integrated with primary care at a local level. It’s good for people (patients), communities and the NHS. However, for such health services to be truly successful (in other words, efficient, effective and economic), they also need to be aligned to adult social care services, both within local authorities and the independent sector. There can be little doubt that this proposal has the potential to be an innovative approach to the delivery of local healthcare services. Surplus NHS land is undoubtedly a source of ‘untapped value’ that could help to unlock systems to create change that results in new services and new ways of working.

Arguably, it could bring necessary leadership at a local level. Nevertheless, integration is as much about relationships as structures and systems. It requires many different partnerships in order to work best. Co-operation between hospitals and GPs is a start. Adding specialist supported housing could facilitate models of intermediate care and support. It would be even better to see the partnership extended to other parts of the health infrastructure such as pharmacists, physiotherapists and occupational therapists, and to the range of adult social care provision. Better still for the partnership to include engagement with local authorities and community groups, including people receiving care and support and their carers. That really would be a ‘game changer’ for me.

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A VIEW FROM THE TOP

P A U L B U R S T O W Paul Burstow is Chair of the Social Care Institute for Excellence.

REFLECTIONS ON THE LAST DECADE While much has changed in social care in the past decade, there is very much a sense of Groundhog Day with many of the debates about the future. A new Act of Parliament, the Care Act, which I helped to craft, now governs adult social care. Its central tenant of wellbeing is a break with the past. However, its ambition has yet to be realised. Clearly, funding of the social care system remains a major unresolved issue. Added to this, who pays for care and how, is still stuck in the mud too. At the same time, it’s great that there is innovation going on. Some of it is driven by necessity but also it is developing out of a growing recognition that business as usual is not just unsustainable, it is undesirable too. For me personally, the past decade has seen some of the most fulfilling and most frustrating years of my working life. The opportunity, as Minister of State for Care Services, to set in place a new Act of Parliament was extremely fulfilling. However, it has been tempered by the growing realisation that efforts to reform the way care is paid for have been kicked into the long grass. PROJECTIONS FOR THE NEXT DECADE Looking forward to the next decade, whether government – of any persuasion – grasps the nettle on the funding of care and who pays for care, is hard to predict. For the sector to be sustainable

for the long term, we need a cross-party settlement that will create certainty and allow people to plan for their future. I am certain that the next decade will see a growth in asset-based approaches to promoting people’s resilience and wellbeing. We’ll also see more co-production and greater use of technology in the sector. I think that there will also be a number of successful accountable care models, which aim to promote population health and will embrace housing as a partner. The Social Care Institute for Excellence, of which I’m Chair, has a strong reputation and offering to the social care sector. Already a key player in quality improvement and service redesign, the Social Care Institute for Excellence is well-placed to support NHS, local government and provider organisations in adopting asset-based thinking, coproduction and as a go-to partner for the Department of Health and Department for Education. INSIGHT Since leaving Parliament, I have developed a portfolio career which often puts me at the intersections between health, care, housing and technology. As Minister, you are an executive, your days are often diced into timepressured slots and you are juggling many priorities and problems. As a Chair, the art is to be a strategic leader, helping to create the conditions

in which your executive team give their best. It’s a fascinating shift and learning about how to manage the inherent tensions is very rewarding. INFLUENCES I got involved in politics because of Shirley Williams, The Rt Hon. the Baroness Williams of Crosby. She held many roles in Government, including Liberal Democrat Leader in the House of Lords and Secretary of State for Education and Science. It is her style and passionate belief in social justice and the power of community that have shaped my thinking. My other influence has been my friend and mentor Graham Tope, elected Liberal MP for Sutton and Cheam in a famous by-election in 1972, who has always helped me to keep a sense of perspective and also to keep my feet on the ground. LESSONS I think an important lesson to share is to be thoughtful and respectful of people on your way up. It’s the right thing to do. ADVICE Building on this, as I say above, be thoughtful and respectful of people on your way up. And also, if you are planning a busy portfolio career, find a good Executive Assistant to help you manage the diary and to put a professional face on what you do. CMM

Read about Paul’s typical day at www.caremanagementmatters.co.uk where you can also access links to some of the Social Care Institute for Excellence’s work that Paul mentions here. Subscription required. CMM December 2017

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3rd Sector Care Awards 2017 finalists CMM is delighted to announce the finalists for the 3rd Sector Care Awards 2017. The standard of entries in the 12 categories was incredibly high and the judges all remarked how difficult the shortlisting process had been. Dame Esther Rantzen will reveal the winner of each category at the 3rd Sector Care Awards 2017 ceremony in Central London on 6th December. The 3rd Sector Care Awards 2017 are hosted by CMM

Corporate sponsor:

Supported by:

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and supported by National Care Forum, Learning Disability England, The Care Provider Alliance, Association of Mental Health Providers and Voluntary Organisations Disability Group. The event is sponsored by Markel, ACCTV, Boots, The Baring Foundation, Triodos Bank and Person Centred Software. Tickets for the Awards Ceremony can be booked at www.caremanagementmatters.co.uk/events

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The finalists in each category are: Compassion Award Lisa Livingstone and the staff team at Darlington Road, Real Life Options Pav Hughes, Outlook Care Castle Supported Living Innovative Quality Outcomes Award Tree Tops Unit, Belmont View Care Home Aspire, Community Links Safe Families for Children Creative Arts Award Milestones Trust Silver Birches, Accord Housing Association Creative Arts, Autism Together Community Engagement Award Alzheimer’s Support Community Links Safe Families for Children Citizenship Award Volunteer Reviewers, Camphill Village Trust Castle Supported Living Leadership Award Colin Lee, Royal Air Force Association Caroline Betts, St Raphael’s Hospice Jessica Sherratt, Felix House – Milestones Trust End of Life Care Award The Beeches Team, St Monica’s Trust Hospice at Home Team, Treetops Hospice Care Chaplaincy Team, MHA Collaboration (Integration) Award Second Step Community Links Carers Trust Making a Difference Award James Rule, Widnes Vikings Charity Foundation Maria Ball, Quantum Care Ltd Susan Moore, Hunts Community Cancer Network (HCCN) Beyond Governance Award Neil Allen, Making Space Anne Fowie, Bluebell Wood Children’s Hospice Melba Wilson, Advance Contribution to Sector Development Award PHB Pilot Project, Treetops Hospice Care Anna Filsell, West Bay Housing Association Ltd Widnes Vikings Charity Foundation Technology Award Choice Support Quantum Care WCS Care CMM December 2017

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Making every moment matter Taking your clients on holiday A holiday may feel out of the reaches of those living in care settings. However, a care home in Sweden has found a way to support residents to take a holiday and the benefits are far-reaching. Rosemary Hurtley and Ewa Worlen explain more.

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Celebrating summer with a holiday makes new memories. However, for people living in care homes, accessing holidays can become a thing of the past. But, why should they? I have spent a lot of time in Sweden exploring the approaches to care and ageing. On my latest trip, I experienced the joyful living that is the aspiration of one particular care home. It is a place that is inspired and modelled by the manager, who empowers staff and is always seeking opportunities to bring joyful moments to the residents living there. Normally in care settings, it is the staff who take the holidays, not the residents; but not this one. At Harakarrsgarden, holidays are a time of refreshment together – just like a family: living, working and playing together. This is made possible because Burlövs kommun, the Swedish borough in which the home is set, owns a holiday home by the sea. It takes about an hour to travel by car. The destination was originally a summer residential property for disadvantaged children who needed a holiday. This is very much part of

Swedish values, investment into the wellbeing of its citizens. However, nowadays it’s hardly used for this purpose. As the home is no longer used specifically for children, it is now at the disposal of care homes in the BurlÖvs region. Harakarrsgarden was the first to use it. It costs around £200 per day to rent, but this cost is not passed onto residents as it may limit who is able to take advantage of the breaks.

PLANNING THE BREAK Seizing the opportunity, Ewa Worlen, Manager of Harakarrsgarden set about making holidays a normal aspect of daily life, one that is naturally included into the annual planning of life in the home. For the past three years, the home has offered holidays for residents and those attending its daycare service. The first year, it was treated as an experiment. The staff felt that five residents sleeping over for one night would be

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MAKING EVERY MOMENT MATTER: TAKING YOUR CLIENTS ON HOLIDAY

>

enough, Ewa explained, ‘We did not dare to take more. In fact, we thought it would be very stressful and hard for the staff to manage. It was not at all like that.’ Before the first trip, Ewa held planning and brainstorming meetings with her activity coordinator to plan all aspects of the trip. It was important that the holiday continued to create the community aspect that care homes need in order to deliver person-centred care for the residents, staff and families. Planning the breaks wasn’t easy. However, to make it happen, Ewa was willing to take risks. She explained, ‘We learned much during the first year, from what to pack to what to do while we were there. Every year we get better. This year, we packed the sunshine as well.’

MAKING THE BREAK After that first year’s experiment, they have progressed to a week’s holiday. To make the breaks a reality, Ewa and her team involve everyone, working together; not just staff, but residents and family members too. Although it involves careful planning, it’s worth it as the fun and relaxation everyone experiences and the shared activities they participate in helps to foster deeper relationships. Ewa continued, ‘Whilst on holiday, staff and residents share duties, such as cooking, laying tables and doing the dishes. ‘We ate some wonderful fresh Swedish summer food, much of which was put under the grill. We had wine with the food…We planned the menus during our brainstorming session. It was simple and different.’ The staff who accompanied the residents included the activity co-ordinator and home manager, along with care staff who volunteered. The daycare manager also came on the days her guests were there. Following the first experiment, more able residents slept over with five to six residents and three staff members staying overnight at a time. New guests then arrived every day.

THE BENEFITS OF THE BREAKS Feedback from residents was that they enjoyed every moment. There were even those who didn’t want to return home after their short break had ended, so plans were changed to enable them to stay for the whole week. Residents enjoyed the ability to be in nature, to eat outside, to take a dip in the sea. Importantly, they enjoyed being in control, especially as everybody was living as equals in the house and holidaying together. Although all the residents live with

dementia, no-one experienced any specific anxieties. There was also no observable restlessness from being in a new situation in unfamiliar surroundings. For staff, they commented that there was no stress. They were able to enjoy being together with residents and their families, without any sense of clock-watching or feeling under pressure to undertake caring tasks. They learned much about the residents in a different way, focusing on relationships not tasks. They felt it was easier to let the residents do as much as they were able in a completely new environment. All the staff were very engaged in the process and there were many offers of help. They gained as much personal enjoyment from the holiday as the residents did. Residents’ families were happy with the breaks too and expressed how pleased they were about the care and support provided. It also gave them greater insight into how much the staff do with the residents and how they work. The wives of two residents also went on the trip. Although their husbands were unable to attend, it provided an enjoyable respite for the women to get away without their ‘resident’ spouses. Ultimately, it’s a joyful time for all involved. Ewa said, ‘It’s an adventure to make a difference. The first and last duty for us is to make a difference for the residents.’ However, it’s not just limited to summer; Ewa continued, ‘Now it is autumn, we enjoy it just as much. Many residents have picked mushrooms in the woods, and it’s lovely to smell and polish the yellow chanterelle and to eat them in a sandwich in the evening is golden time’.

PLANNING A HOME HOLIDAY, KEY LEARNING POINTS 1. Involve everyone in planning the details from the beginning. 2. Managers, encourage feedback on what worked well and what processes and practicalities could be improved for following holidays, this enables you to continually improve the experience for everyone. 3. Start planning for smaller numbers of residents initially, and build on the successes and learning with confidence. 4. Find everyday experiences that everyone can join in and keep it simple.

LEARNING BY DOING Initially, not everyone was convinced of the benefits of the holidays. One staff member had been extremely sceptical, with very low expectations of the residents’ capabilities to participate in or enjoy the break. However, having experienced the holiday, she later commented on how much her attitude had changed towards the residents. Ewa said, ‘It has revolutionised how that particular staff member communicates with residents. Beyond that, it promotes opportunities for residents and staff to share the normal small things of everyday life together as a means of community building and learning. This ensures that both experience a sense of significance, meaning and purpose.’ CMM

Rosemary Hurtley MSc Dip COT FRSA is the co-developer of the 360 Standard Framework® and Chief Executive of 360 Forward Ltd and a Consultant Occupational Therapist. Email: rosemary@360fwd.com Twitter: @360Fwd Ewa Worlen is Manager of Harakarrsgarden. Email: Eva.Worlen@burlov.se 38

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RISING STARS

Katie Reynolds is Contract Manager for Look Ahead managing three services across Hertfordshire and Berkshire.

CAREER HISTORY I started my career as an assistant support worker at a young people’s hostel in Southwark. It was a busy and challenging service for 116 people with complex needs. It taught me a lot very quickly and I made some great friends working there. It had a great energy and I was inspired by working with passionate support workers who wanted to make a difference to young people’s lives. I then worked my way up to support worker and onto team leader. I worked there for just over two years, before moving to a team leader role in a mental health service closer to home in Hillingdon, where I led two services for people with long-term mental health conditions. It was in 2016 that I then became a contract manager for two supported living services in Hertfordshire, Oakview and Linden Road. This year, I took on responsibility for residential home, Common Road in Berkshire. As Contract Manager, I am the Registered Manager for the services and manage the team leaders and senior support workers; it’s a larger team with responsibility over the three services. I split my time across the three services and try to dedicate a full day to each, although sometimes my priorities mean I move from service to service as needed. Oakview in Stevenage offers supported living for 10 adults, each with their own flat and a lively communal space. Linden Road in Redbourn is home to two gentlemen living in their own bungalows, whilst Common Road in Berkshire supports one gentleman in his own home where dedicated teams of support workers provide personalised care and support. We’ve achieved a lot in the services in a few years and look forward to continuing the great work. Most clients are supported via local authority funding or continuing healthcare. I help the team support 13 clients in total. Most of my clients have a learning disability or autism, some have physical disabilities or mental health conditions too. All of the services enable service users to lead fulfilled and happy lives, with an emphasis on choice and control, offering a flexible and responsive service, enabling them to achieve greater independence, improved quality of life and integration into the wider community. Look Ahead has a range of services across London and the South East. We’re specialists in delivering mental health, young people, homelessness and learning disability services. Learning disability services, which I work in, are a small but growing part of the business.

CURRENT ROLE I came to this role in 2016 looking for a new challenge. I knew I wanted to keep working with people to make their lives better and keep learning too. I knew it would be hard when I took it on, it’s a definite step up from team leader. There’s a higher level

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of responsibility, more interaction with the Care Quality Commission and a lot of hard work. I’ve learned to juggle everything, though I need to prioritise more as there’s more to do. You need to get on, get things done and move onto the next thing at a really fast pace. That said, I do enjoy the role. The best part is seeing the clients having fun and enjoying activities, events and holidays. Knowing that we’re responsible for helping someone live their life as they wish, and take a holiday, which they may not have had the chance to do for a long time is fantastic. Some of our clients have come to us from long stays in hospitals and seeing them develop and learn new skills,

“If people are given opportunities to try things and to develop their skills, you might be surprised at what they can achieve.” even if it’s learning to vacuum or undertake simple domestic tasks, and come so far is wonderful. I really get a boost when there’s an atmosphere of fun and happiness. The hardest part has to be the juggling and managing difficult situations, though. As Contract Manager everyone looks to me to make the decisions, it is my responsibility after all. However, you have to think about things from all angles; many decisions are on my shoulders and I need to carefully consider the impact of each important decision I make.

RISING STAR I didn’t know I’d been nominated to be a Rising Star, it was one of our operations managers who nominated me. I was really pleased to be chosen, to know that someone sees potential in me and that I’m working hard to achieve the best for the people I support. I’m enjoying meeting the other Rising Stars, sharing experiences and learning from each other. I’ve got a lot from my relationship with my mentor, Karen, too. She works for the Royal Masonic Benevolent Institution and has enabled me to visit their services, learn about what they do and how they do it, given me advice and support. She’s been very lovely and supportive, she invited me

to visit their head office and set up meetings for me, I met another manager and people from HR and compliance. It was great to be able to speak to them all about what they do and learn from them. I was given books on management by Louise, their Head of HR and I got a great insight into other services that I might not have been able to visit and see behind the scenes otherwise. It’s been really good to see other services in this way, she’s really open and supportive. I’m looking forward to catching up with the Rising Stars again at the National Care Forum Managers Conference.

THE FUTURE Looking to the future, I’d like to carry on getting experience in this role as I’m still fairly new. I’d definitely like to learn more from other services. I’d also like to try working in other services but stay in management as that is where I feel my strengths are. Rising Stars is really important to helping me realise my future too. It’s giving me the opportunity to meet people from other organisations and services, to see similarities and differences, what works and what might not and see more of what’s out there in the sector.

ADVICE My advice to others would be to prioritise your work, make a good list and don’t get bogged down with the little things. Also, and as importantly, have fun. Don’t get too serious. Yes, you have responsibility and you must take that seriously, but you support people’s lives and those people need to live in a fun environment. I had a manager that was really supportive of me and I think that really helped me to become the manager I am. I think it’s important for managers to be calm with people, support them, enable them to grow and be themselves. People need someone to listen to them and guide them in order to grow, and a nurturing environment can help people shine. To become a good manager, people need the right resources too and someone who will enable them to become the best they can. If people are given opportunities to try things and to develop their skills, you might be surprised at what they can achieve. CMM Katie 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 December 2017

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THE RAINY DAY FUND FOR EVERYDAY HEROES

THE CARE WORKERS CHARITY SUPPORTS THE BASIC WELFARE OF CURRENT, FORMER AND RETIRED CARE WORKERS.

Recent quotes from people we’ve helped;

There are nearly 2 million care workers in the UK, contributing to one of Britain’s largest workforces, and caring for some of the most vulnerable people in our society.

us. When you are disabled and not working you feel as though you have slipped into obscurity, as if you have become invisible. Now we know we ARE seen, we matter and that is priceless.”

As a country, we depend on our care workers to be there for us on our rainy day. With your support The Care Workers Charity can be there for them on theirs.

HOW WE CAN HELP

SUPPORT OUR WORK

If you work, or have previously worked, within the UK Care Profession in a registered domiciliary, residential care or supported living service, subject to our application criteria we may be able to offer support.

Getting involved is easy; you can put your organisation forward to become a corporate supporter, or nominate us as your charity of the year, take on a fundraising challenge or simply speak to a colleague about our work, it all helps.

To find out more about our grant application process, simply visit www.thecareworkerscharity.org.uk

To find out more about how you can help, email our CEO direct alex@thecareworkerscharity.org.uk

HOW WE HAVE HELPED “We have been overwhelmed by the kindness shown to

Caroline and Brendan, Social Services

“Things have never been the same since the arrival of the children’s bunk beds and accessories. Our baby now thinks her little bed is her ‘own bedroom’ as she sleeps longer both day time nap and at night. The older children now see bedtime as happy time.” Pete, Community Integrated Care

“I did some fundraising for The Care Workers Charity…I never thought the shoe would be on the other foot. When it became our time of need, I approached the charity with my plea and they warmly supported my daughter’s needs.” Claire, Shaw Healthcare Group

SEND A DONATION Text ‘GBCA17 £10’ to 70070 to donate to The Care Workers Charity and make a difference today

To send a donation through Just Giving visit www.justgiving.com/careworkerscharity The Care Workers Charity, Hill Place House, 55a High Street, Wimbledon Village, SW19 5BA W: www.thecareworkerscharity.org.uk E: info@thecareworkerscharity.org.uk

Charity no. 1132286


Resource Finder

RECRUITMENT

Profiles4Care Ltd Tel: 0330 363 9996 Email: info@profiles4care.com Website: www.profiles4care.com

SECTORS

Recruitment has never been a bigger issue for the sector. Finding the right staff is essential, but keeping them within your organisation is just as important. CMM has drawn together a number of different social care recruitment organisations to assist you in your search and selection of the right staff. Not all of the organisations are recruitment agencies, some use tried-and-tested approaches to help you improve your recruitment, techniques to enable you to recruit people with the right values to support your clients and technology to help you simplify the process. Whatever your workforce need, the following organisations should help you to find and keep the right staff for your clients.

• Domiciliary care. • Residential care. • Education. • Community services. • Housing associations. • Local authority. • NHS trusts. • Nursing. • Supported living. • Training. • University/college.

JOB LEVEL/SERVICES • All job levels. • P4C is not a recruitment agency. • Values-based recruitment assessments. • Values-based benchmarking. • Leadership assessments. • Team building. • Employee appraisal. • Decision-making assessments. • Language assessments. • Numeracy assessments. • Staff retention. • Staff development. • Reducing sickness and absence. • Improving staff performance. • Improving consistency of care. • Risk mitigation in health and social care devolution. • Multi-site and divisions solution. • Employee development. • Employee training identification.

LEAD INDIVIDUALS Marc and Kelly are Profiles4Care’s primary contacts. They both have extensive experience in championing

values-based recruitment across and beyond adult health and social care, ensuring that employers have access to cost-effective tools enabling the recruitment, retention and development of the right staff for our sector.

COMPANY INFORMATION Developed specifically for the health and social care sectors, in collaboration with the Department of Health, the Profiles4Care valuesbased system has been extensively tested and the longitudinal benefits researched, the results of which include: total cost of recruitment falls by an average of 22.8%; 72% of employers reported that staff employed and supported using ‘values-based’ approach perform better; 75% stated that staff recruited for their core values have greater understanding of social care values including empathy and dignity; 62% agreed that staff recruited for values have lower rates of sickness and absence. Staff turnover dropped by 6.4% for employers who recruited for values. The estimated return on investment on every £1 invested in a valuesbased approach is £1.23. Profiles4Care is also the awardwinning Competition Organising Partner for the WorldSkills UK Health and Social Care competition, part of the world’s largest vocational training event. WorldSkills UK inspires young people and adults to be ambitious in their pursuit of skills to the highest level.

Marc Jones Director Tel: 07866 518021 Email: Marc@profiles4care.com Kelly Jones Business Development Manager Tel: 07703 714983 Email: Kelly@profiles4care.com

CMM December 2017

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CONNECTING ALL AGES ACROSS THE COMMONWEALTH!

CommonAge (The Commonwealth Association for the Ageing) is an accredited Commonwealth organisation that was founded in 2013. Our aim is to ensure elders in all Commonwealth countries are supported to enjoy the highest possible quality of life in their senior years. From Australia and Antigua to Vanuatu and Zambia, through our growing networks, we are sharing ideas, creating connections, and combating ageism across the 52 countries of the Commonwealth.

CommonAge

 SAVE THE DATES

We believe older people can continue to make a valuable contribution to the societies and communities in which they live and all generations should live and work together in peace and harmony in a truly inclusive Commonwealth.

16 –18 April 2018 Inaugural Commonwealth Elders’ Forum

04–14 April 2018

 YOU TOO CAN GET INVOLVED! Be a part of our story telling project and help celebrate ageing across the Commonwealth. Visit our website for more details.

Deadline extend ed – 12 January 2018

Follow us on Facebook and Twitter, and join the conversations on our LinkedIn discussion group.

@CommonAgeAssoc

facebook.com/commage.org

CommonAge/SAGE Study Tour of UK social care services (with the option of joining the Elders Forum as part of the post-tour programme)

21 April 2018 International Care Homes Open Day Visit www.commage.org to find out more

CommonAge discussion group

www.commage.org


RESOURCE FINDER

Sticky People

The Care Hub

Tel: 0845 604 8064 Email: neil@stickypeople.co.uk Website: stickypeople.co.uk

Tel: 0330 335 8999 Email: Info@thecarehub.com Website: www.thecarehub.com

SECTORS • All adult social care providers.

JOB LEVELS • All levels.

LEAD INDIVIDUAL Neil is a well-known expert in the recruitment and retention of frontline social care staff. He is author of the Amazon no.1 Bestseller, Saving Social Care, which is the best-practice guide to help employers maximise the effectiveness of their recruitment and retention activity. Neil regularly speaks, blogs and comments on workforce issues in social care. He was previously a senior manager at a national care provider. ‘Neil Eastwood knows how the care sector works, at all levels, and applies a practical approach which empowers teams to overcome

barriers to recruitment and retention and hire with success and confidence.’ Steve Allen, Group Chief Executive, Friends of the Elderly.

COMPANY INFORMATION Sticky People is not a recruitment agency. The company provides advisory services to care providers on how to be better recruiters. It also holds the UK licence for the award-winning PeopleClues candidate screening tool, used by over 1,000 care recruiters and managers in the UK. ‘Why do we use PeopleClues? Our interview no-shows have been reduced, retention rates are higher, the quality and consistency of our care teams are enhanced – that’s why we use PeopleClues.’ Tim Jones, Group Director, Right at Home. If finding enough suitable frontline staff and keeping them is on your list of issues, then why not get in touch?

Neil Eastwood Founder Tel: 0845 604 8064 Email: neil@stickypeople.co.uk

SECTORS • All types of care. • Care home. • Nursing homes. • Domiciliary care. • Supported living. • Mental health.

JOB LEVELS • Recruits at all levels. • Specialist in frontline staff and senior specialist roles.

LEAD INDIVIDUAL Scott spent 15 years in the IT training and software space before moving over to recruitment in 2010. Rather than set up yet another care recruitment agency, Scott decided to set up The Care Hub to address some of the key challenges faced by the sector with regards to sourcing, engaging, hiring and retaining talent.

COMPANY INFORMATION The Care Hub is the only company in the UK whose sole focus is to help care providers, like you, to source,

attract, engage and hire talent without the need to use expensive recruitment and staffing agencies. Our friendly support team will partner with you to ensure that you are sending out the right message, to the right audience, through the right channels, all of the time. Our innovative and easy-to-use Applicant Tracking and Candidate Management platform will enable you to post a job in minutes, screen your candidates for suitability and fit and, manage all your candidate communications from a single, easy-to-use dashboard. The Care Hub is fully integrated with leading vendors such as Sticky People and Profiles4Care for Values Based Assessments and GB Group for online DBS checking. If you’re looking to reduce your recruitment agency spend, source more, higher-quality candidates, as well as reduce the administrative burden and time it takes to hire someone, then you should call The Care Hub today and request a free demo. Contact The Care Hub today to start finding talent for yourself and put a stop to using expensive staffing agencies.

Scott Sherriden Managing Director Tel: 0330 335 8999 Email: scott.sherriden@thecarehub.com

CMM December 2017

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RESOURCE FINDER

Severn Angels Nursing Agency

CV-LIBRARY Tel: 01252 810995 Email: r.entwistle@cv-library.co.uk Website: www.cv-library.co.uk

SECTORS

JOB LEVELS

• Independent and not-for-profit care providers. • NHS trusts. • Private hospitals.

• Recruit at all levels and roles. • 945,600 registered CVs in the healthcare sector. • Delivering 98,800 monthly job applications.

LogicMelon Tel: 01480 270354 Email: matthew.tingey@logicmelon.co.uk Website: www.logicmelon.co.uk

SECTORS

• Private hospitals.

• All sectors. • Independent and not-for-profit care providers. • Residential care. • Domiciliary and homecare.

JOB LEVELS • Recruit at all levels. • Specialist in frontline staff and senior specialist roles.

Tel: 01905 930707 Email: info@severnangels.co.uk Website: www.severnangels.co.uk

SECTORS

JOB LEVELS

• Nursing homes. • NHS trusts. • Private hospitals. • Community nursing. • Mental health services. • Learning disability services. • Prison health services.

• Support workers • Healthcare assistants. • Registered general nurses. • Registered mental health nurses. • Social workers.

Vanity Staffing Tel: 01256 838610 Email: info@vanitystaffing.com Website: www.vanitystaffing.com

SECTORS • Private nursing homes. • Private hospitals.

Logic Care Recruitment

JOB LEVELS • Registered general nurses.

Tel: 01932 869850 Email: marion@logichsc.com Website: logichsc.com

SECTORS • Nursing homes. • Residential care homes. • Supported living services. • Community-based care services. • Domiciliary care. • Housing associations. • Extra and sheltered housing schemes.

46

CMM December 2017

• Charities. • Non-NHS hospitals. • Local authority social services. • Children’s services. • Independent fostering agencies.

JOB LEVELS • All job levels covered.

• Registered mental health nurses. • Clinical lead. • Deputy manager. • Manager. • Healthcare Assistant.


2018

AL CE ON EN TI ER NA NF CO

CONFERENCES • EXHIBITIONS www.caremanagementmatters.co.uk

@CMM_Magazine #CMMInsight

SAVE THE DATE 1ST MARCH 2018

THE RENAISSANCE HOTEL, MANCHESTER

CMM Insight – The ‘must-attend’ national learning disability and mental health conference Learning Disability & Mental Health Services CMM Insight brings together the leading names and influencers to explore developments and opportunities in learning disability and mental health services. Tickets £195 +VAT • CMM website subscribers receive 10% discount for booking online.

SPONSORSHIP AND EXHIBITING OPPORTUNITIES AVAILABLE Tel 01223 206965 Web www.caremanagementmatters.co.uk

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EVENT REVIEW

BERKSHIRE, BUCKINGHAMSHIRE AND OXFORDSHIRE CARE CONFERENCE 18th October, Bracknell

The CMM Insight Berkshire, Buckinghamshire and Oxfordshire Care Conference took place in October and was the first time that delegates came together from all three counties. Chaired by Fidelma Tinneny of Berkshire Care Association, she opened the day with a rousing speech about the current state of the sector. Setting the tone for the day, Fidelma was followed by Simon Bottery, Senior Fellow, Social Care at The King’s Fund. Simon’s overview of the state of the social care market wasn’t particularly uplifting, calling it ‘a pretty grim picture overall’, however, it’s not possible to sugar-coat the current situation facing the sector. Simon was followed by Kay Puddle, Inspection Manager at the Care Quality Commission (CQC). CMM always welcomes CQC representatives at its event, and delegates value the opportunity to hear them speak. Kay explored the new assessment framework that came into force on 1st November, reiterating that it’s ‘evolution not revolution’. She also ran through the changed Key Lines of Enquiry which was welcomed by all in the room. The panel discussion took place next featuring Fidelma, Kay, Simon and Ed Watkinson, Director of Care Quality at Quality Compliance Systems, with many questions from the floor being directed to Kay. Ed then took to the stage by himself to discuss leadership, the CQC and the importance of well-led. He focused on how to evidence great leadership to the regulator, given the inspectorate’s focus on leadership in care. He explored what the CQC is looking for from good leaders and how they could evidence that they are delivering what is expected. He gave Corporate sponsor

providers a lot of interesting points to take away.

WORKSHOPS A series of workshops enabled delegates to hear about the homecare market, the role of digital technology in modern care, and how to improve business outcomes through investing in quality. Duncan White, Senior Policy Officer at UKHCA updated providers on the difficult environment in which homecare is operating. Luis Zenha Rela, Head of Customer Success at Nourish Care shared the importance of digital technology in creating an efficient care business and Tom Owen, Co-Director at My Home Life explored how the My Home Life initiative can help providers to deliver quality care.

AFTERNOON SESSION The afternoon session brought delegates back together to hear about values-based recruitment from Marc Jones, Director of Profiles4Care. With huge pressure in the sector from recruitment and retention, Marc’s focus on values-based recruitment can help providers to identify and employ the right staff with the right values, who they are also more likely to retain. Alex Bayliss, Consultant from AEB Social Care then wrapped up the day with his rousing speech on safeguarding. He said that safeguarding is so much more than a process. Everything the sector does is about protecting and empowering the people it supports. He was clear that providers and managers need

Sponsors

Supported by

Profiles4Care 48

CMM December 2017

to think about all aspects of their service when considering if there are safeguarding concerns. Fidelma concluded the day with a fantastic summary of the key themes which brought together all delegates and sent them on their way fired-up and ready to make a difference. CMM Insight Berkshire, Buckinghamshire and Oxfordshire Care Conference was sponsored by Quality Compliance Systems, Christie & Co, Profiles4Care and Nourish. Organised by


WHAT’S ON? 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:

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 Event: Falls Prevention and Management in Older People Date/Location: 6th December, Manchester Contact: Healthcare Conferences UK, Tel: 01932 429933

• More time with residents • Less paperwork • Evidence of work done

Embrace Technology … Embrace Cura “Using Cura has made my life so much easier, in our recent inspection, I could show how I monitor and assess the quality of service provided at the touch of a button. After reviewing all other systems on the market I found Cura to be the most comprehensive with the widest functionality.” John Shirreffs, Managing Director, Liberty Placements Ltd

Contact the Cura Systems team today on 020 3621 9111.

020 3621 9111 info@cura.systems www.cura.systems

Event: Improving End of Life for People with Dementia Date/Location: 5th February, London Contact: Healthcare Conferences UK, Tel: 01932 429933 Event:

Health and Care Explained: How the System Works and How it is Changing Date/Location: 7th March, London Contact: The King’s Fund, Tel: 0207 307 2409

CMM EVENTS 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:

The Transition Event Midlands 17th May, Coventry 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 December 2017

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C A M I L L A

T R I M B L E

Camilla Trimble sets out detail of the Outstanding Society, what it hopes to achieve and how simple things can make a difference.

In 2015, my care home, Nazareth Lodge in Dorset achieved its Outstanding rating from the Care Quality Commission (CQC). It was a fantastic accolade and one we are all proud of. However, we wanted to do more, we wanted to share expertise and help others on their journey to Outstanding. To do this, I spoke to Martin Green at Care England and asked his thoughts on founding an organisation of Outstanding rated providers to work together. Martin reached out to other members who had also achieved Outstanding and our founding members cover a broad range of services, from learning disabilities to dementia, residential and nursing care. We launched the Outstanding Society in 2016 and involved the CQC from the start. Andrea Sutcliffe, Chief Inspector of Adult Social Care was very supportive.

O W N E R

N A Z A R E T H

We held our first meeting with 40 members, this increased to 80 for the second meeting. The meetings usually involve guest speakers and we’ve had the CQC and Skills for Care present, we also had Professor Ursula Gallagher speak on safeguarding. Our next meeting is with Andrea on 11th January and the founding members try to meet regularly. Although we all currently hold an Outstanding rating, we all face reinspection and need to demonstrate what we’ve achieved and initiated since our last inspection to try to retain the rating. Earlier this year, 10 Outstanding homes had been re-inspected, five had dropped to Requires Improvement, one dropped to Good and four retained Outstanding. It is this which makes us want to roll out the Outstanding Society, to share best practice and disseminate information. We would like to begin supporting those providers with a rating of Requires Improvement who want to raise their standards. We’re hoping it will become a befriending programme. I believe with eight to 16 weeks of contact, support and mentoring, we can offer ideas and encouragement to managers who have an awful lot of potential to improve their services, but who might just need some mentoring to achieve it. We would like to have 50-60 providers and managers around the country offering to befriend and help launch this service. Solutions don’t always need to cost the earth either. Our home has a team of volunteers who visit residents and become advocates for them. We host cheese and wine parties where families and our volunteers are invited. Residents enjoy themselves and having events and regular visitors makes them feel special, especially for those residents who don’t have any family or whose relatives are unable to visit often. Knowing that someone outside the staff is there for them, visiting regularly and getting to know them really gives them a boost.

L O D G E

Simple solutions are effective. I send all residents a postcard when I go on holiday. Many residents don’t get post anymore and it’s lovely to receive something addressed to them. It makes them feel part of the family. We also have animals in our home; I bring in my dogs, we also have chickens. We’ve even set up an enterprise making and selling dog biscuits with all proceeds going to Cinnamon Trust. We also have conversation points on the back of our menus. They’re just simple things that staff or residents can use to start conversation and make meal times more enjoyable for everyone. These things don’t cost much but really contribute to the family environment of the home. Attention to detail goes a long way too. These ideas, along with guidance on specific areas, could help to break down the issues other homes face and work to overcome them. It’s important to look at every area of the business, what opportunities there are for improvement with care, food and daily life. Looking to the future, we’d really like the Outstanding Society to pick up pace next year. With new inspections now in force, there’s more that can be done. We’d like to get every Outstanding provider to share what they do to help all providers. We need to share issues and common problems and how they can be overcome. We can’t rest on our laurels, all providers are being re-inspected against the new framework, inspectors are looking for more examples of innovation and we can’t stand still whilst we support others to move forward. There’s always room for improvement. We’ve achieved a lot in such a short space of time. We’re not funded, we’re all providers with our own homes to run. The support from Professor Martin Green at Care England, Georgina Turner at Skills for Care and the CQC helps no end, but we need to do more to get everyone on board. CMM

Camilla Trimble is Owner of Nazareth Lodge in Dorset. Email: sctrimble56@gmail.com

Providers interested in joining the Outstanding Society or calling on the assistance of its members should contact Care England for more information. www.careengland.org.uk 50

CMM December 2017


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