Care Management Matters December 2018

DECEMBER 2018

www.caremanagementmatters.co.uk

THE INTEGRATION ISSUE Does it stand a chance?

Defying the rules

How CQC is changing regulation

Employees and workers Defining the difference

Medication management Are you getting it right?

Person Centred Software Interviews Alison Redhead, Registered Manager of Minster Grange Care Home, part of LifeStyle Care

Book a demo of MCM with us: Call: 01483 604108 or email hello@personcentredsoftware.com

In this issue 05

Inside CQC Andrea Sutcliffe CBE shares her parting thoughts and explains that the Mum test will still be at the heart of what CQC does after she leaves the organisation.

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CMM News

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Business Clinic CMM looks at Heathcotes’ new approach using ‘Pods’ to encourage independence.

30

Rising Stars 2018 Julie Veritiero is Home Manager at Borough Care’s Marbury House.

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3rd Sector Care Awards Claire Thomas has made a huge impact in Wiltshire training dementia friends. CMM takes a closer look at her work.

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Event Review A review of the CMM Insight Berkshire, Buckinghamshire and Oxfordshire Care Conference 2018.

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What’s On?

49

Straight Talk Glen Garrod explores the recent Budget announcements and explains his reasons for saying we must take bigger steps.

50

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25

FEATURES 37

REGULARS

From the Editor

42

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Integration: a possibility or a pipe dream?

Organisations across the sector are trying to work more closely with health partners, but without action from the top, does integration stand a chance? Professor Martin Green OBE shares his thoughts on whether this system change is achievable.

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Key changes to CQC regulation: are we losing sight of the basics?

Neil Grant from Gordons Solicitors highlights some of the key changes CQC has been making to policy and approach, and how these are increasingly defining how it regulates the sector.

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Employment status explained: navigating the rules Melanie Stancliffe un-muddies the waters surrounding staff’s employment status, explaining the differences between employees and workers.

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The safety and efficiency of medication management Medication management is an area where the slightest error can have severe consequences. Steve Sawyer explains how providers can improve efficiencies and ensure safety procedures are followed effectively.

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

CONTRIBUTORS

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

ADVERTISING sales@caremanagementmatters.co.uk 01223 207770 Advertising Manager: Daniel Carpenter daniel.carpenter@carechoices.co.uk Director of Sales: David Werthmann david.werthmann@carechoices.co.uk Senior Sales Executive: Aaron Barber aaron.barber@carechoices.co.uk

@CQCProf

@ProfMartinGreen

Andrea Sutcliffe CBE Chief Inspector of Adult Social Care, Care Quality Commission

Professor Martin Green OBE Chief Executive, Care England

@ndticentral

Neil Grant Partner, Gordons Partnership LLP

Jill Corbyn Development Lead – Learning Disabilities, NDTi

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 2018 CCL REF NO: CMM 15.9

@TheGROWProjectS

@imhrplus

Maria Harris Owner, The GROW Project

Steph Thompson Managing Director, Waymarks and Director, Dimensions

Julie Veritiero Home Manager, Borough Care

@accesscaremgmt

@AlzheimersSupp

@GarrodGlen

Steve Sawyer Director, Access Health and Social Care

Claire Thomas Special Projects Coordinator, Alzheimer’s Support

Glen Garrod President, Association of Directors of Adult Social Services

CMM magazine is officially part of the membership entitlement of:

ABC certified (Jan 2017-Dec 2017) Total average net circulation per issue 16,336

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CMM December 2018

Melanie Stancliffe Partner, Irwin Mitchell

From the Editor Editor, Angharad Burnham looks at this month's features and invites readers to attend the Markel 3rd Sector Care Awards in December.

This month has seen several promising announcements from Government. The recruitment pilot taking place throughout November is a step in a positive direction – hopefully resulting in tried and tested methods to set the sector up for a successful campaign in 2019.

Another positive is Mr Hancock’s commitment to prevention. While his speech was fairly NHS-centric, the potential behind the vision – supporting people with disabilities into work and encouraging social prescribing to reduce loneliness – could prove life-changing for many people.

The questions we are asking now are, will we see these principles put into practice? After years of ongoing negative press, how easy will it be to change people’s perceptions of a career in social care? Will the vision for prevention yield results, or will it just be another document with grand intentions?

October also saw the

Chancellor of the Exchequer give his Budget 2018. The social care sector deflated as more insufficient and temporary funding was offered. Though welcome, sector leaders agreed that the money made available just isn’t enough to support social care to sustain services. Glen Garrod has shared his views on the Chancellor’s announcements on page 50.

MAKING CHANGES Integration remains high on the agenda, and a joined-up system will be instrumental in seeing the Government’s prevention plan become a reality.

However, the barriers are unavoidable and the truth is that, to be achievable, integration needs attention. In this edition, Professor Martin Green OBE discusses this issue and asks whether integration is really a possibility.

Turning to the Care Quality Commission (CQC), this month we have Andrea Suttcliffe’s final

column as Chief Inspector of Adult Social Care. She shares her reflections on what has been achieved in her time with CQC and looks at what the future of the organisation might hold. I’d like to thank Andrea for her contributions to CMM and wish her all the best for the future.

Delving into the changes CQC has been making, Neil Grant’s feature on page 25 highlights the ways in which the organisation has recently shifted its boundaries for inspection and regulation, examining what this means for providers and raising the question, does someone need to be regulating the regulators?

3RD SECTOR AWARDS This month, we have also had the pleasure of attending our Markel 3rd Sector Care Awards judging day. Our panel saw an incredibly high calibre of finalists this year and had a hard time deciding the deserving winners.

I’d like to take this opportunity to let the finalists know that the judges were deeply impressed by their efforts and I wish them all the best of luck. Winners will be announced at the ceremony in London on 7th December. If you don’t have a ticket to attend, book your seat now via the CMM website – we hope to see you there.

Email: editor@caremanagementmatters.co.uk Twitter: @CMM_Magazine Web: www.caremanagementmatters.co.uk

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This is my final ‘Inside CQC’ column because, as you may have heard, I will be leaving the Care Quality Commission (CQC) at the end of 2018 to take up a new appointment as Chief Executive and Registrar of the Nursing and Midwifery Council. I want to start by saying a huge and heartfelt thank you to everyone who has written to and tweeted me with good wishes about my news. I have been overwhelmed by your kind words.

When departures are announced, we like to look back at what has been achieved and wonder about what changes might come in the future.

Reflecting on progress and improvements is important, and I am proud of how CQC has changed in the five years I have been Chief Inspector of Adult Social Care. We have cemented our commitment to ensuring people who use services are at the centre of everything we do and to working in co-production with everyone impacted by our work. We have completed and built on a full round of comprehensive inspections since launching our new approach to regulation in 2014 and this has allowed us to develop an unrivalled knowledge about quality in the sector.

We have used our independent voice to talk about the importance of adult social care and speak honestly about the challenges facing the sector. We have matured as an organisation; building public confidence in our ability to carry out our role and encouraging providers to improve, as well as holding to them account for poor care. Of course, there is always more to do and I think I have left enough of that for my successor to get their teeth into!

Looking to the future, there are big challenges ahead for adult social care and the role CQC plays in raising the profile of it; being a champion for quality and speaking truth to power about the state of the sector will continue to be vital.

Some of you have been worried whether all this will continue after I have left. But please be assured, what we have built together is bigger than one person and I have a great team to carry on the good work. The progress we’ve made has been possible because we have worked in co-production with people who use services, their carers and families, providers, staff, commissioners and national bodies.

CQC knows this is how to get things done – co-production not only helps us strengthen our relationships with our stakeholders, it’s a

Inside CQC A N D R E A S U T C L I F F E C B E In this month’s CQC column, Chief Inspector of Adult Social Care, Andrea Sutcliffe CBE explains that the Mum test will still be at the heart of what CQC does after she leaves the organisation at the end of the year.

common-sense approach to making sure that we’re doing the right thing for the people who matter most and that we understand how our decisions will impact on others.

Being clear about standards and not compromising on quality for people who use services is something CQC will remain totally

“What we have built together is bigger than one person and I have a great team to carry on the good work.” committed to. Back in 2013, I first talked about the Mum test – asking ourselves ‘Is this service good enough for my Mum (or anyone else I love)?’ – and this human focus now threads through all our work.

The new case studies in our Equally

outstanding resource show that quality improvement can and will be made when providers take a person-centred, human rights approach to care, and CQC has a crucial role in sharing this learning with the sector. There’s more to do in this space and I know the team at CQC are full of ideas for the future.

The focus on person-centred care at CQC mirrors what’s happened across the sector. This rang true at the relaunch of Making it Real, a framework to support good personalised care.

It ensures people who use services are squarely at the centre for everyone working in and using adult social care – just like the Mum test.

Whatever challenges and change the future may bring, the Mum test is here to stay. It gets to the heart of why we’re all in this sector – to make a difference for people who use services, their carers and families.

I’ll finish by adding that I won’t be saying goodbye to adult social care when I leave CQC – as the 42,000 nurses who work in adult social care will appreciate – and I will keep championing this sector and the dedicated, skilled people who work in it. Thank you for being a part of my CQC adventure.

Andrea Sutcliffe CBE is Chief Inspector of Adult Social Care at the Care Quality Commission. Share your thoughts and feedback on Andrea’s column on the CMM website www.caremanagementmatters.co.uk Not a member? Sign up today.

CMM December 2018

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APPOINTMENTS HC-ONE

Sector responds to Budget 2018 The sector has responded to Philip Hammond's Budget 2018, after he announced an additional £650m for social care for 2019/20.

In the Budget, the Chancellor said, 'We will shortly publish our Green Paper on the future of social care, setting out the choices, some of them difficult, for making our social care system sustainable into the future. But I recognise the immediate pressures local authorities face in respect of social care.

'So today, building on the £240m for social care winter pressures announced earlier this month, I will make available a further £650m of grant funding for English authorities for 2019/20 and an additional £45m for the Disabled Facilities Grant in England in 2018/19.'

Leaders in the sector have

since shared their views on the announcements in the Budget 2018.

Vic Rayner, Executive Director of National Care Forum, said, 'The Chancellor had a golden opportunity to meet the shortterm funding requirements of the adult social care sector, which have been highlighted multiple times by both parliamentary bodies and sector specialists. The limited additional funding is, of course, welcome. However, it does nothing to address the immediate needs of the social care sector.'

George McNamara, Director of Policy and Influencing at Independent Age said, ‘The Chancellor’s commitment for an additional £650m towards social care will only provide a short-lived breathing space to a social care system that is already on its knees.

'…We urge the Government to address the vital need for a fullyfunded system. We believe this can be achieved by introducing free personal care in England, ensuring many older people are able to get the care and support they need to live independent lives.'

Lord Porter, Chairman of the Local Government Association (LGA) commented, 'While this funding will ease some of the immediate financial pressure facing councils and our local services, it is clear that this cannot be a one-off. This funding is a start, but the real test will come in the Spending Review next year.’

The Chancellor's full speech can be read on the GOV.UK website and Glen Garrod has shared his thoughts on the Chancellor’s Budget in this month’s Straight Talk on page 50.

Leaders react to mental capacity proposals Ministers must eliminate the conflict of interest within the ‘troubled’ mental capacity proposals, according to leaders in the social care sector.

Sector leaders have already set out their position that managers with a controlling interest over care and support businesses should not be in charge of processes and decisions to deprive people of their liberty. Further concerns about the Bill have now been raised by the Joint Select Committee.

Judy Downey, Chair of the

Relatives & Residents Association said, 'The Joint Committee on Human Rights has joined the chorus of disapproval about this Bill. It has highlighted the fact that the Bill does not meet the requirements of the European Convention on Human Rights. Let’s hope that the Government takes notice and urgently redrafts the Bill accordingly.'

The Mental Capacity (Amendment) Bill was introduced to the House of Lords on 3rd July 2018. Sector leaders welcomed the

very first discussion with senior officials and Ministers on 25th October 2018 – a meeting that was held with provider, commissioner and charity representatives.

Professor Martin Green OBE, Chief Executive of Care England, said, 'We want to work jointly with the DHSC and Ministers and we welcome the interest shown by them…We hope the many detailed items which were discussed have been captured by officials and will now be actioned in terms of government amendments to the Bill.'

HC-One has announced that former Care Quality Commission Chief Executive, Sir David Behan CBE has joined the company board as a NonExecutive Director. Sir David will be working to ensure the company continues to develop its strong quality record and build on existing work to develop industry-leading career opportunities for staff.

CARE SOUTH Simon Bird has been appointed Chief Executive of Care South.

Simon has been with Care South since 2011, most recently in the role of Deputy Chief Executive.

SKILLS FOR CARE Skills for Care has announced that Dimensions Chief Executive Officer, Steve Scown and Suzie Bailey from The King’s Fund have joined their board of trustees.

SANCTUARY GROUP Sanctuary Group has announced David Bennett’s decision to retire as Group Chief Executive at the end of the year, having joined the organisation in 1986 and led it since 1991.

The Board has appointed Craig Moule, Sanctuary’s Chief Financial Officer, as Group Chief Executive with effect from 1st January 2019.

CAREMARK Caremark has strengthened its core team for the second time in 2018 with the formal appointment of Managing Director, David Glover, and a duo of Compliance Managers, Alan Frew and Sharon Kemp.

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NEWS

APPOINTMENTS CORNWALL CARE Cornwall Care has appointed Anne Thomas as its new Chief Executive Officer.

CAREWATCH CARE SERVICES LTD Carewatch Care Services Ltd has appointed Mark Stephenson, a healthcare professional with more than 15 years of leadership experience, as its new Chief Executive Officer to drive growth and service excellence.

HEATHCOTES GROUP Heathcotes Group has appointed Hocine Benhafsi as Head of Recruitment to support its nationwide expansion. He will be overseeing recruitment for over 62 specialist services for adults with learning disabilities, mental illness and associated challenging behaviours.

DFN CHARITABLE FOUNDATION The DFN Charitable Foundation has announced the appointment of a new Chief Executive Officer, Kevin Horne.

Kevin joins after 21 years heading a multi-million pound business services enterprise, through which he actively developed employability initiatives to support those with learning disabilities.

CHRISTCHURCH GROUP Christchurch Group has announced the appointment of Sheila Manisier to the position of Business Development Director.

Sheila has extensive experience of the sector with a particular interest in specialist services for people with complex needs and brain injury rehabilitation.

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CMM December 2018

Social care recruitment pilot The Department of Health and Social Care (DHSC) has been conducting a care worker recruitment pilot throughout November to inform a national campaign due to start in 2019.

The month-long programme aimed to promote jobs in the adult

social care sector in Gloucestershire and Tyne and Wear. The care worker recruitment pilot started on October 31st and has been testing various marketing methods in each region to identify the best channels in different areas.

Working with local providers,

DHSC is looking to convey a positive message about care work – that it is different every day – and is highlighting the sorts of roles and tasks that people working in the care sector carry out, as well as the difference they can make to others.

Funding announced for social care research Social care research in England will get up to £20m in new funding through the National Institute for Health Research (NIHR), boosting research to improve adult social care across the country.

The investment by the Department of Health and Social Care will fund the next five years of the NIHR School for Social Care Research. The School funds adult social care research and training for research staff. It brings together leading academic centres for social care research in England, and supports world-class research by social care professionals and academics to improve the way social care is delivered.

The new funding will allow the School’s partner organisations to

build on their work in areas such as mental health, dementia, and care homes. Two new partners have joined the School – Kings College London and the University of Birmingham – bringing the total number of partners to seven.

The School will launch a call for research proposals in Summer 2019.

The Government is committed to improving the evidence around social care so that people are provided with better and more effective services in the future. The NIHR has already invested £30m into the School for Social Care Research, which celebrates its 10 year anniversary in 2019. Thanks to the new investment, the School will continue to build the evidence

base and develop capacity in social care research in England over the next five years.

Ongoing research projects include investigating how staff in supported accommodation can support people with challenging behaviours, looking at whether providing adaptations to bathing facilities in people’s homes can improve quality of life and relieve pressure on other services, and studying how hearing dogs can affect people’s wellbeing and mental health.

The £20m investment into social care also includes £1.8m investment for training researchers through the new NIHR Academy, which will be co-ordinated through the School.

Latest on sleep-ins Following months of campaigning and nearly four months after the Court of Appeal judgement the Government has revised its guidance on sleep-in payments.

The announcement follows a cross-sector letter signed by care, health and education organisations urging the government to clarify how sleepins should be remunerated.

The guidance reflects the law in paying for sleep-in work as determined by the Court of Appeal’s judgment in the joined cases of Mencap v Tomlinson-Blake and Shannon v Rampersad.

But it neither helps anyone nor goes far enough, says Voluntary Organisations Disability Group (VODG), which has been calling on Government to resolve these issues since 2014.

The official guidance notes that

further court judgements may again change the circumstances under which the national minimum wage is paid.

Unison has already lodged an appeal to the Supreme Court, creating renewed uncertainty for employers over retrospective and ongoing costs.

Government is therefore avoiding real action until this potential legal action concludes, effectively imposing a state of uncertainty, probably until 2020, says VODG. The ongoing lack of clarity not only affects care provider organisations but also individuals using personal budgets or direct payments to employ and manage support staff.

VODG is now calling on Government to: • Introduce through a statutory

instrument regulatory clarity on pay rates for sleep-in shifts.

• Work with providers and local government on a sustainable funding solution that will ensure care workers are valued and fairly paid.

• Provide clarity on the Social Care Compliance Scheme in the light of new guidance.

• Confirm that the current legal position means employers will not face potential HMRC retrospective action to recover underpayment of national minimum wage for sleep-in work – now or in the future.

• Work with organisations to produce information so that people who use services and their families, the workforce, employers and commissioners understand how sleep-in shifts should be remunerated.

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NEWS

CQC consultation on fees The Care Quality Commission (CQC) has published its consultation on the fees it proposes to charge providers in 2019/20.

The proposals follow the plans CQC set out to continue to meet the Treasury’s requirement to recover its ‘chargeable costs’ in full from providers.

CQC will analyse the feedback from this consultation to prepare a response and a final fees scheme to recommend to the Secretary of

State, whose consent is required to implement the scheme from 1st April 2019.

CQC has promised to continue to look carefully at its costs. It has also promised to continue to demonstrate that it is fair, efficient, effective and proportionate.

CQC’s budget, in relation to the overall spending on health and adult social care in England, remains at 0.16%.

The regulator is estimating

National Care Group

that: • Community social care locations supporting up to 22 service users will see a fee increase of no more than £144 per annum. This represents half of all locations.

• The average residential social care provider with 26-30 beds at one location would see a fee reduction of £64 under the new proposals.

The consultation on fees runs until midday on 17 January 2019.

National Care Group (NCG) has announced the acquisition of Atlantic Support (Devon) Ltd (Atlantic). Financial details of the deal were not disclosed.

Atlantic currently cares for 13 people with mental health needs.

The acquisition of the Atlantic business continues NCG’s growth nationwide, becoming the company’s first site in Devon.

Millions are underestimating the cost of care Millions of people are underestimating the cost of a care home place, according to Which? research.

When the consumer champion asked people to estimate the cost of a private nursing home place in their region, more than half (55%) came up with a figure that fell short of the average cost.

On average, people are

underestimating the cost of care in a care home in England by £237 per week – the equivalent of £12,000 a year.

One in 10 people underestimated the true cost by more than £757 per week – the equivalent of £39,000 a year.

A quarter gave a figure that was too low by more than £507 per week, the equivalent of

£26,000 a year.

Three in 10 people admitted that they simply did not know the weekly cost of a care home with nursing in their region, while only one in seven people (15%) got the answer right or overestimated the cost.

Londoners had the most unrealistic expectations overall, underestimating the cost of care

in a care home with nursing by an average of £540 a week – the equivalent of £28,080 a year.

People in the East Midlands were the closest to giving an accurate figure, underestimating the true cost of care at £721 a week – just £74 short of the real figure. But this was still the equivalent of a £3,848 a year shortfall.

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CMM December 2018

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What a no-deal Brexit would mean for social care

Markel 3rd Sector Care Awards finalists 2018

Care England has submitted evidence to the Health and Social Care Select Committee’s inquiry into the impact of a ‘no deal Brexit’ on health and social care.

The impact largely has to do with recruitment and retention, an area in social care which can already prove difficult to get right and have long term successes in.

Professor Martin Green OBE, Chief Executive of Care England says, ‘The prospect of a no deal Brexit only accentuates the fragility within the social care sector.

‘It magnifies potential uncertainties in the recruitment and retention of foreign workers upon which many independent community care providers depend.

‘Currently the sector includes 233,000 employees that have a foreign nationality. With vacancy rates running at around 90,000

The Markel 3rd Sector Care Awards finalists have been announced, with a selection of nominees from a range of voluntary sector care providers.

Recognising achievements in a range of settings, the Markel 3rd Sector Care Awards uncovers the person, care provider or community group that is going above and beyond on a daily basis.

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at any one time, this dependency is significantly important to the sustainability of the sector – particularly as it is predicted that by 2035 an extra 650,000 social care jobs will be required to keep pace with rising demand.’

Care England has recently produced a briefing for its members regarding Brexit. The main focus is the recruitment and retention of foreign workers, including registered nurses, with particular reference to areas of the country that may be most at risk.

For example, in the South East of England, 23% of the social care workforce is non-British, with regional unemployment at 3.7%.

This is compared with the picture in the North East of England, which has only a 4% dependency on non-British social care workers and has an unemployment rate of 4.4%.

Rantzen and her daughter, Rebecca Wilcox, this year’s ceremony will take place on Friday 7th December at the London Marriott Hotel, Grosvenor Square. As well as announcing the well-deserved winners, there will be a three-course lunch and entertainment to capture the spirit of the day.

A full list of finalists can be found on the CMM website.

Crown Care Group Crown Care is set to add to its portfolio by opening a state of the art care home, with support from Yorkshire Bank. The £4m in funding will assist with the development of a luxury 78-bed care home, due to open in Hucknall in 2019, designed to accommodate those living with dementia. The home will create a minimum of 40 full-time jobs, plus

a further 20 roles once the site is fully operational.

Crown Care currently operates 14 care homes across the North East and Yorkshire. It is undertaking an ambitious expansion plan, involving investment in excess of £115m to create care villages and care homes across the UK, providing 700 jobs in the process.

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The Homecare Deficit 2018 A report from the United Kingdom Homecare Association (UKHCA), The Homecare Deficit 2018, suggests that councils in Great Britain and Northern Ireland’s Health and Social Care Trusts are continuing to exploit their purchasing power.

The report's author claims that, 'Councils are buying homecare services for older people on the

cheap'.

The Homecare Deficit 2018 exposes the scale of underfunding of a fragile state-funded sector across each of England’s nine government regions and in Wales, Scotland and Northern Ireland.

Using data obtained under Freedom of Information legislation, UKHCA found the average price paid for homecare in the UK is

£16.12 per hour, almost £2 per hour less than UKHCA’s Minimum Price for Homecare of £18.01 per hour.

UKHCA calculates that the UK’s homecare sector needs at least £402m per year to ensure that homecare workers receive the statutory National Living Wage, while also ensuring that homecare providers can meet their statutory obligations.

However, the size of the deficit this year would be £921m if national governments and local councils were to commit to raising the status of the homecare workforce to at least the independently calculated Real Living Wage. Neither of these figures account for the additional costs of people currently going without care and support.

expenditure (£14bn) was spent on long-term care (residential, nursing or community care), an increase of £369m or 2.7% on 2016/17 (£13.6bn).

• Overall, the number of people receiving long-term care provided or arranged by local authorities has decreased each year since 2015-16, down 14,750 (1.7%) to 857,770 in 2017-18. The number of 18-64 year olds in receipt of long-term support has increased for the second year in

a row, up 7,360 (2.6%) to 292,380 since 2015-16, while the numbers of 65 and over in receipt of long-term support has fallen for the second year in a row, down 22,110 (3.8%) to 565,385 since 2015-16.

• 58.6% of all people receiving long-term support are female.

This increases further for those supported in a care home (61.9%) and further still when considering those in a care home with nursing (63.4%).

Requests for adult social care A report from NHS Digital has revealed that local authorities receive 5,100 new requests for adult social care assistance every day.

The new figures from Adult Social Care Activity and Finance, England 2017-18 show that local authorities received 1.8m new requests for adult social care support in 2017-18, an increase of 1.6% on 2016-17.

These requests were received from 1.3 million people; those

aged 65 and over accounted for 71.6% of the requests. Similar to previous years, 77.1% of the requests originated from the community and 20.1% originated from a discharge from hospital.

Other findings in the report include: • Gross current expenditure by local authorities on adult social care was £17.9bn in 2017-18, an increase of £0.4bn or 2.3% in cash terms on 2016-17 (£17.5bn).

• 77.9% of total gross current

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NEWS

Government loneliness strategy

Interface between health and social care

The Prime Minister has launched the first cross-Government strategy to tackle loneliness, and has confirmed all GPs in England will be able to refer patients experiencing loneliness to community activities and voluntary services by 2023.

The practice, known as ‘social prescribing’, will allow GPs to direct patients to community workers offering tailored support to help people improve their health and wellbeing, instead of defaulting to medicine.

As part of the long-term plan for the NHS, funding will be provided to connect patients to a variety of activities, such as cookery classes, walking clubs and art groups, reducing demand on the NHS and improving patients’ quality of life.

Up to a fifth of all UK adults feel lonely most or all of the time and with evidence showing

The Public Accounts Committee has published its report into the integration of health and social care. Interface between health and social care says that Government ‘lacks an effective overall strategy or plan to achieve its long-held aim to integrate these two sectors’. It recommends: • The government should set out a costed 10-year plan for social care to go alongside its 10-year plan for the NHS. • The Department of Health and Social Care (DHSC) and the Ministry of Housing, Communities and Local Government should ensure their 10-year plans and the green paper address the challenges of fragmented funding and separate means-testing, including consideration of any legislative change needed.

• NHS England should set out how it will support the national rollout of new care models, including

loneliness can be as bad for health as obesity or smoking, the Prime Minister has also announced the first ever ‘Employer Pledge’ to tackle loneliness issues in the workplace.

Government will also partner with the Royal Mail on a new scheme in Liverpool, New Malden and Whitby which will see postal workers check up on lonely people as part of their usual delivery rounds.

Postal workers will be speaking with isolated people to help link them up with support from families or communities if required.

The Prime Minister also confirmed £1.8m to increase the number of community spaces available – the funding will be used to transform underutilised areas, such as creating new community cafes, art spaces or gardens.

specialist healthcare business agents

how it will accelerate slow uptake.

• The DHSC, Ministry and NHS England should set out how accountability will work under a new integrated care system, and how the public can find out about the progress and performance of health and social care locally.

• The DHSC, Ministry and NHS England should write to the Committee by December 2018 to set out how they will develop and support local leadership consistently.

• DHSC should ensure its workforce plan addresses the previous criticisms made by the Committee and make sure it tackles the barriers between health and social care, particularly disparity in pay and conditions and the transfer of pension arrangements.

Professor Martin Green OBE shares his thoughts on the future of integration in his article on page 20.

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NEWS / IN FOCUS

Capacity to deliver social care A quarterly survey of council leaders and chief executives has revealed a steep decline in the capacity of councils to deliver social care. The New Local Government Network Leadership Index found that since March, the confidence of council leadership that they have sufficient powers and resources to deliver social care for adults has fallen by 21%. This figure is taken from the 150 councils responsible for delivering social care.

57% of council leaderships identified cuts to central

government funding as the main cause of their financial problems, while 31% also identified the rise in demand for social care – both adults and children – as the cause.

To tackle these financial pressures, 97% of respondents are planning to increase Council Tax from March 2019.

The survey also found that 46% of council leaderships expect adult social care costs to rise more than any other local public service if a deal is not struck with the EU prior to Brexit.

Westgate Healthcare Westgate Healthcare has expanded its portfolio with the opening of Riverdale Care Home, a 32-bed property in Essex. The development has been supported

by Clydesdale Bank and has been designed with features including a sensory garden, potting shed, spa salon, cinema room, fine dining room and café.

Talking to patients about dying The Royal College of Physicians (RCP) latest report, Talking about dying: How to begin honest conversations about what lies ahead, explores the reasons that doctors and other healthcare professionals find it hard to talk to patients about dying.

Based on conversations with doctors, patients, carers and medical organisations, the report reveals the barriers that stand in the way and offers solutions and resources to help. Barriers include: • Culture – Some physicians felt that death could be perceived as a failure and that modern medicine is expected to cure all ailments. However, the evidence from patients and carers is that many people do want to talk about death and planning helps patients feel more empowered about care and decision making.

• Confidence – From medical students to consultants, there were many doctors who felt uncomfortable initiating conversations about the future with patients; medical students and junior doctors had little practice with real patients; training doesn’t prioritise the

‘soft’ skills needed; and diagnostic uncertainty was often an issue.

• Practicalities – Confusion over whether hospital doctors or the patient’s GP should be having the conversation; reluctance to begin conversations when the doctor was not going to be responsible for the patient’s care going forward; workforce pressures; lack of privacy; lack of prioritised clinic or ward time to have the conversations; and the challenges of being sensitive to different cultural and religious beliefs.

One of the major issues identified is that professionals need to begin conversations about planning for end-of-life care nearer the time that patients are given a terminal diagnosis, as early conversations allow patients choice and control over the remainder of their lives.

The evidence shows that patients who have had these conversations and have end-oflife care plans put in place have a better experience than those for whom the conversations come in the final days or hours of life when they can seem unexpected to patients and carers.

IN FOCUS Social care’s post-Brexit workforce WHAT’S THE STORY?

A report has been published examining the potential state of the health and social care workforce after Brexit.

Commissioned by the Cavendish Coalition, Brexit and the Health and Social Care Workforce in the UK – put together by the National Institute of Economic and Social Research (NIESR) – highlights the increasingly crucial role European Economic Area nationals are playing in UK social care services.

WHAT DID THE REPORT FIND?

The NIESR report forecasts a potential shortfall of around 5,000 to 10,000 nurses in the NHS in England by 2021. That is on top of existing vacancies, which stood at 41,722 (11.8%) at the end of June.

Between 2011 and 2016, the number of European Economic Area nationals employed in social care grew by 68%, or 30,600 people. There were 42,000 registered nurses working in adult social care in England in 2017, with almost a third of registered nurses (32.4%) estimated to have left their role within the past 12 months, meaning a vacancy rate of 12.3%, equivalent to around 5,000 vacancies.

While it is anticipated there will be provision for doctors and nurses coming to the UK after Brexit, if Government follows the guidance of this autumn’s Migration Advisory Committee report, as it has indicated it will, there could be particularly significant implications for social care's workforce after Brexit. The

sector relies on lower-paid colleagues who would be effectively cut off by a salary threshold of £30,000 and with no special allowance like that recommended for seasonal agricultural workers.

The Cavendish Coalition is warning that the future immigration system must enable the health and social care system to continue to attract the brightest and best from the EU and the rest of the world.

WHAT ARE THE RECOMMENDATIONS?

The report recommends that any future immigration system needs to be uncomplicated, transparent and cost effective for applicants.

It also suggests that the system should be responsive to the changing health needs of the population.

As well as this, NIESR says in the report that the UK and devolved governments must review their workforce planning approaches across the social care sector, incorporating international recruitment into the costed strategy.

The report also notes that, while all levels of Government should work together to review career routes within social care, the Home Office in particular should guarantee that its settled status programme for EU nationals will be honoured in the event of a no-deal Brexit.

Lastly, Brexit and the Health and Social Care Workforce in the UK states that professional regulators should frequently review their processes for registering international professionals.

CMM December 2018

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NEWS

Final consumer law advice

Cuts to council-funded care

Following a public consultation and feedback from the industry, the Competition and Markets Authority (CMA) is publishing its final advice for care homes on their responsibilities and obligations under consumer law. This includes advice on what upfront information care homes must give to prospective residents and their families when they are making a decision about which care home to move into, as well as when to give this information and how.

It also covers other areas where care homes need to be compliant, including how they

The Care and Support Alliance (CSA) has found that more than a quarter (29%) of disabled 18 to 64-year-olds who rely on council funding have had their care cut over the last year.

Respondents to the survey often reported that there had been no change in their needs and the CSA is suggesting that disabled people’s legal rights to care are being breached. In the most worrying cases, people’s health, safety and wellbeing was being jeopardised as a result.

An estimated £6.3bn has been taken out of adult social care in real terms since 2010 and overall council budgets were cut by 49% in real terms over the same period. Meanwhile, need has steadily increased because of a rise in the numbers of older and disabled people, creating an ever bigger gap between the demand for and supply of care. It would

handle complaints and the use of certain terms and conditions that are likely to be unfair. This latest publication incorporates CMA’s advice for care homes on charging fees after death, which it consulted on separately and published earlier this year.

To help care home providers digest the full advice, CMA is also publishing a short introductory guide that summarises the key points they need to know, as well as short advice for residents on what their rights are. All of this information is available on the CMA website.

Studley care home investment Runwood Homes Senior Living has invested £6m to rebuild former Warwickshire County Council owned care home, Four Acres, turning it into a modernised and

expanded version of the former home.

The home has 66 beds and supports older people, including those living with dementia.

not be surprising therefore if cash strapped councils had been forced down a path of restricting the care they provide – but any such move would be in clear breach of the law under The Care Act and in defiance of disabled people’s rights, says CSA. In 2017, CSA research showed that the majority of professionals who undertake care assessments felt that their managers expected them to reduce the help on offer to people in need of social care.

Social workers also revealed their experiences, with one saying, ‘We are being encouraged to write care plans that do not include any form of social interaction’, and another saying, ‘The view within the council is that only 20% of all those assessed should be receiving formalised care packages from the local authority and that 80% should only receive information and advice.’

Delivering home adaptations

Effective complaints processes

A report from the Centre for Ageing Better, Adapting for ageing, jointly published with Care and Repair England, identifies examples of good practice on providing life-changing adaptations in the home.

The report reveals innovative approaches and calls for other councils and service providers to learn from it. Examples include proactively raising awareness of available support and how to access it, delivering home adaptations quickly and without means-testing, linking adaptation services with vital home improvements and working with handyperson services.

More than 90% of people over the age of 65 live in mainstream housing, rather than specialist

As part of Voluntary Organisations Disability Group’s (VODG’s) commitment to the NHS England Ask, Listen, Do campaign, the body for disability organisations is hosting a roundtable on the importance of listening to and acting on the views of the people they support.

It says an effective complaints system not only allows people

retirement accommodation.

Only 7% of UK homes meet basic national accessibility requirements.

As older people increasingly want to stay in their own homes for as long as possible, it is clear that something needs to be done to enable this.

The report highlights the benefits of a proactive, preventionfocused approach to providing adaptations in older people's homes, while improving the information and advice offered on the options available. Previous research shows that investment in adaptations is highly costeffective, helping to improve wellbeing, keep people out of hospital, prevent or delay moves into residential care, and reduce the need for carers.

Octopus Healthcare Octopus Healthcare, part of the Octopus Group and leading investor in healthcare facilities throughout the UK and Ireland, has announced Sefton Council’s 18

CMM December 2018

approval of a major redevelopment of the former Birkdale School for Hearing Impaired Children in Southport into an extra care accommodation site.

to feel valued and listened to, it can also improve outcomes and bring about positive change. The NHS England initiative encourages providers of health, social care and education services to learn from and improve the experience of people with learning disabilities, autism or both and family carers when they give feedback, raise a concern or make a complaint.

Call for better products for older people Minister of State for Care, Caroline Dinenage has called on businesses to develop more products and services that meet the needs and aspirations of older people.

The Minister said more inclusive, innovative and attractive products should play an important role in helping people to remain healthy, active and independent for longer, whilst also offering opportunities for growth to businesses. These could be anything from home appliances like eye-level ovens

and walk-in showers, to the use of new technologies such as AI and robotics – for example, Amazon Alexa is being used in some cases as a memory aid.

Much of the support equipment currently marketed to older age groups, such as grab rails, ramps and bathing aids, is unattractive and clinical-looking, which research shows can put people off making vital changes to their homes that would keep them safe and living independently.

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INTEGRATION: a

possibility or a pipe dream?

Integration is a hot topic, and has been for some time. Organisations across the sector are doing what they can to work more closely with health partners and there’s pilots-a-plenty experimenting with how health and social care can support each other. But without real action from the top, does integration stand a chance?

Professor Martin Green OBE shares his thoughts on whether this system change is achievable in the current market.

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CMM December 2018

Over the past few years, there has been a concerted attempt to talk about integration. Recently, this culminated in the Department of Health becoming the Department of Health and Social Care, but sadly we have discovered a change of name does not deliver an integrated system. We need to examine to what extent all the rhetoric about integration has been translated into practice.

In relation to the Department of Health and Social Care, the evidence is clear. They may have changed their name, but they have certainly not changed their spots. Since the announcement of a new title on the headed paper, we have seen the old practices rear their heads.

Several announcements have been made of huge amounts of money being offered to support the NHS, while social care received the announcement that the Green Paper was to be postponed. A few weeks ago, we had a ‘crumb from the table’ of an extra £241m for social care, but only on the condition that we can help the NHS deal with the self-induced delayed transfer of care crisis.

THE HOSPITAL ISSUE It was very interesting to watch the BBC documentary, Hospital, about the Queen’s Medical Centre in Nottingham, which was dealing with significant issues around delayed discharge. In the programme, they never once reached out to residential care providers to see what they could deliver. Incidentally, Nottingham champions itself as a beacon of integration, but the documentary clearly showed that there was no sense of what could be delivered outside the NHS that could solve the problem.

Finally, there was a scene where the

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CMM December 2018

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INTEGRATION: A POSSIBILITY OR A PIPE DREAM?

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room was packed with expensive managers, one of whom hung their head in their hands and issued the words, ‘We might even have to bring in the private sector’.

There was little evidence of an approach to integration in that hospital, only a focus on dogma and organisational myopia. One of the major problems which faces the NHS, is that its staff are often so blinkered that they think the only solution to anything is an NHS service, or more taxpayers’ money going into existing services.

MAKING IT PERSONCENTRED Whenever I go to events and meetings that are about integration, there is much talk about organisations, systems, local authorities and very occasionally a word about the providers who deliver care, but I think this completely misses the point.

True integration has nothing to do with organisations and systems, but it should be judged by the experience of people who use services.

The problem with our current approach to integration is that it is always defined by organisational goals and it is as if the organisation, rather than the citizen, is the objective.

The attempt to deliver integrated services is a very well-worn path, and I am old enough to remember many abortive attempts at integration.

We had local and health authorities delivering joint appointments, in the expectation that this would deliver better outcomes, more efficiencies and seamless services. There was also a move towards co-location of services, with the expectation that this would deliver better communication and more integrated outcomes. However, this too failed to live up to its anticipated success because, once participating organisations faced funding challenges, they retreated into their silos, rather than crafting an integrated and joint solution that would have been better for citizens and delivered more positive outcomes and efficiencies.

It is my view that we need to re-claim the word integration and set it firmly in the context of the experience of people

who use services.

LEARNING FROM OTHERS There are many examples of services which are delivered by a range of different organisations, yet are completely seamless when it comes to the experience of the customer. The airline industry is a really good example of this. I do not know when I leave Austrian airspace and go into German airspace, despite the fact that there is an enormous technical and managerial shift going on behind the scenes. What I experience is a flight from A to B, and I neither know, nor care, who is doing what in the background.

The experience of the citizen has to be the ‘holy grail’ of an integrated service,

of some obsolete services, as well as a massive cultural change in the NHS and social care.

WHAT ABOUT THE POLITICIANS? We are seeing a number of areas, such as Greater Manchester, attempting new approaches to integrated services across their respective cities. What is interesting to note is that, in all the discussions about reconfiguration and joint working, one area has been left completely untouched, and that is the local politicians.

It is frankly ridiculous to have layer after layer of local politicians who do not have the same outcome measures. We see it in London with local authorities,

“True integration has nothing to do with organisations and systems, but it should be judged by the experience of people who use services.” and we must judge every service’s success not on its structure, or whether it is public, private or voluntary, but solely on its outcomes.

If we were really going to deliver integration, we would align the success measures of the whole system, focus them on the experience of the person who uses the service and, I think, we need to start using three high-level measures for success. The first measure should be person experience; the second should focus on the outcomes that are achieved; and for the third I think we need to question whether we are using our resources, both financial and human, in the most effective way.

To ensure we have a truly and wholly integrated service, we would inevitably have to start thinking differently across the whole of both sectors, and this would require some re-configuration of the current system and the decommissioning

CCGs and the London Assembly, all working to different outcome measures and often in conflict with one another.

We need to align these measures so that everyone is working together, towards the same goals.

RHETORIC OR REALITY? I do not believe that this rhetoric about integration will be delivered. What we will see is what we have always seen: tinkering around the edges, changes to the headed paper, endless amounts of money spent to move staff from one employer to the other. And in the midst of it all, citizens getting fragmented and un-co-ordinated services from two systems that work on hugely different resource levels, completely disconnected outcome measures, and have no operational plan that will turn rhetoric to reality.

CMM

Professor Martin Green OBE is Chief Executive of Care England. Email: MGreen@careengland.org.uk Twitter: @ProfMartinGreen What are your thoughts on integration? Do you agree with Martin that much more needs to be done before it can be considered possible? Share your thoughts and experiences on the CMM website where you can also feed-back on this article www.caremanagementmatters.co.uk CMM December 2018

23

Good luck!

With your next CQC inspection!

Gordons Solicitors wish all CMM readers a very Merry Christmas and a Happy New Year!

neil@gordonsols.co.uk | 01483 451900 | www.gordonsols.co.uk

KEY CHANGES TO CQC REGULATION: are we losing sight of the basics?

The way in which the Care Quality Commission (CQC) regulates providers is constantly evolving. While some of the changes follow on from consultation with the sector, others are introduced without any public scrutiny. At most, they may have been raised at meetings with the various trade associations. Neil Grant from Gordons highlights some of the key changes of policy and approach that increasingly define how CQC regulates the sector.

I am concerned that there appears to be a growing tendency within CQC to change the way it registers and regulates the sector by introducing new guidance or revising existing guidance without due regard to the statutory framework or the need for proper consultation.

The risk of this is that CQC comes to make up its own rules without proper accountability, either by way of parliamentary scrutiny or public consultation, potentially leading to arbitrary decision-making.

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CMM December 2018

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KEY CHANGES TO CQC REGULATION: ARE WE LOSING SIGHT OF THE BASICS?

>

THE NEW RATINGS LIMITER

CQC has a number of rules that limit the rating that can apply at overall provider level or at key question level to adult social care services.

The original overall provider level rating limiter, linked to compliance, came out in October 2014 when ratings were first introduced for adult social care. It stated that, ‘the overall rating for a service would not normally be better than ‘requires improvement’ if enforcement action is being taken.’

In January 2017, the internal CQC guidance for inspection staff was strengthened with the inclusion of a new limiter, which stated, ‘In addition, the overall rating of a service cannot normally be better than ‘requires improvement’ if there is a breach of regulations’ and this is included in the latest internal CQC guidance document, Inspection guidance – judgements and ratings.

Inspectors are required to follow CQC’s inspection methodology in the interests of consistency.

This new limiter was never the subject of any formal consultation exercise and it is only being applied to adult social care services, not the NHS or GP practices.

However, the main problem is that this ratings limiter appears to be being applied in a blunt and arbitrary manner, with no regard to proportionality or professional judgement.

As an example, CQC inspected a care home and awarded ‘good’ ratings for safe, effective, caring and responsive. The inspection report commented that the service remained well-led but awarded ‘requires improvement’ for that key question because of a failure to display the previous rating on the provider’s website. The provider had, however, displayed the old rating in the entrance to the home, so the omission was not willful but still amounted to a breach of regulations.

Ordinarily, four ‘goods’ and a ‘requires improvement’ would generate an overall rating of ‘good’, but here, because there was a breach of regulation, the overall rating was downgraded to ‘requires improvement’. This was a simple error, capable of easy and 26

CMM December 2018

swift resolution. It was completely disproportionate and unreasonable to describe this highly-successful service as requiring improvement and the inspector should have been allowed to exercise professional judgement rather than be bound by

“It would be better for CQC to abandon this ratings limiter and allow inspectors to exercise professional judgment.”

a strict rule of this nature.

The other area causing services that otherwise would be ‘good’ overall to be downgraded is in relation to failures to notify CQC of incidents or authorisations of Deprivations of Liberty. A service may be ‘good’ across four key questions, but if a couple of notifications are not sent to CQC, it will be rated as overall requires improvement.

The above points are in no way intended to minimise the importance of displaying ratings or making the necessary notifications to CQC, but are made to highlight the importance of putting such matters in context.

It would be better for CQC to abandon this ratings limiter and allow inspectors to exercise professional judgment. It is also unfair to apply it to adult social care but not the NHS or GP practices.

Ironically, although CQC adopted the Ofsted ratings model, the latter applies far greater flexibility in how it awards good ratings. Ofsted may identify compliance issues but still rate a service as ‘good’ if, overall, it is performing to that standard.

This issue is all the more important given that CQC is going to be increasing its focus

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KEY CHANGES TO CQC REGULATION: ARE WE LOSING SIGHT OF THE BASICS?

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on services that are repeatedly rated ‘requires improvement’.

COMPLIANCE CONDITIONS When taking enforcement action against NHS hospitals, CQC has often had to regulate using conditions of registration or warning notices, as it is not feasible to deploy cancellation or suspension powers on them.

However, regulation via ‘compliance’ or ‘positive’ conditions is now increasingly being used in the adult social care arena.

An example of a compliance condition that has become quite common is one that requires the registered person to undertake monthly care planning reviews on all the service users, with a monthly report to CQC on the outcomes of the reviews and any changes made to care plans. Such a condition can be unduly onerous on a service and is likely to take the manager off the floor to carry out this work, given the obvious fear that a breach of a condition, without reasonable excuse, is a statutory offence with an unlimited fine. CQC will say that conditions should not performancemanage a provider or manager, so why are conditions being deployed in this way, in the first place?

I have argued successfully that, on legal and factual grounds, such conditions should not be imposed and that a more proportionate approach could be available. For example, CQC could ask the provider to voluntarily supply reasonable amounts of information or it can request information under sections 64 and 65 of the Health and Social Care Act 2008.

A further weakness in CQC’s use of compliance conditions is that they are taken from CQC’s ‘Conditions Bank’ so standard wording is being used which may not cover the situation in a particular service.

Furthermore, there can be issues about the clarity of compliance conditions and whether they are reasonably achievable. CQC says

that conditions must not include reference to the date when the condition will take effect or the length of time for which it will continue to have effect. This calls into question the reasonableness of the condition. Its duration should be clear; it should not be open-ended.

DEFINITION OF A PROVIDER Finally, there is one major change in the offing. Currently, CQC regulates organisations that directly provide the service to the client. However, it has indicated that it wants to register and inspect any related organisations that may direct and/or control systems of care, such as parent companies and care management companies. CQC says it doesn’t need a change to legislation to register these associated organisations – it is enough for it to apply a new interpretation to ‘carrying on a regulated activity’ and widen the scope of provider registration.

As I set out in my article, Cats, Dogs and CQC registration, which is available on the CMM website, I believe that if CQC wants to widen the definition of a provider, it should lobby the Government with clear reasons as to why it is necessary, as such an important change should be introduced via legislation. After all, CQC is not a lawmaker.

There is a hint that CQC is starting to listen to the sector on this particular issue. The latest I have heard is that CQC is planning to go back to first principles as part of a broader piece of work looking at future provider assessment. It is hoped that that there will be a far greater degree of engagement with the sector on any future proposals than has so far been the case and that it will seek legislative change if it wishes to widen the scope of registration.

OPERATING WITHIN OBLIGATIONS CQC carries out an essential public

function and much of its work is of a commendable standard. However, it needs to ensure that it operates in accordance with its statutory duties and obligations at all times.

Ratings decisions should be reasonable and proportionate, and CQC needs to move away from applying rules in a blanket fashion without regard to the facts and circumstances of the case.

My main fear is that it will lose sight of the importance of getting the basics right, namely registration, inspection, compliance and enforcement.

Only time will tell, and I wish the new Chief Executive, Ian Trenholm, every success in his stewardship of the inspectorate.

CMM

Neil Grant is Partner at Gordons Partnership LLP. Email: neil@gordonsols.co.uk What do you think of CQC’s changes to the way it inspects and regulates services? Does there need to be more legislation around CQC’s powers? Share your thoughts on the CMM website and feed-back on this feature www.caremanagementmatters.co.uk CMM December 2018

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STEPPING DOWN – SUPPORTING PEOPLE BACK INTO THEIR COMMUNITY Supporting adults with learning disabilities to have equal opportunities, understand their rights and be in control of their own lives is on everyone’s agenda. But for individuals, providers and families, it can be hard to know whether someone is ready to move back into the community. As a potential solution, Heathcotes is using ‘Pods’ as a step-down service from their care homes.

Heathcotes operates a number of residential services for people with learning disabilities. Many of these homes have large gardens that often go partly unused.

Some of these gardens have been fenced-off to create a more manageable space, but the organisation had long been looking for a solution to make these areas into practical, usable parts of the service.

USING UNUSED SPACE The idea for the Pods came about when a remote office was required at one of the care homes. The only space available to build this was in a corner of the garden.

Heathcotes worked with architects to design a building that suited the garden setting without making it look spoilt, but which was also practical and functional.

The outcome was a success, with an office that suited the service’s needs. It occurred to Heathcotes at this point that the design they’d used could be adapted to provide living accommodation in the unused garden spaces, and the concept for the Pods was born.

WHAT IS A POD? Pods are designed as independent living spaces, where residents who are thinking of moving back into the community can live for a time until they are confident about managing outside of the home.

The Pods enable Heathcotes 30

CMM December 2018

to provide a full care pathway and are used as a stepping stone to enable further independence.

The resident is still a part of the home and has as much support as required, but lives in the Pod which has its own bedroom, bathroom, living space and kitchen. The person is then supported to build their independent living skills in this environment while they prepare to move into the community.

The Pods are either registered as supported living or as a variation on the home’s original registration, depending on the commissioning need in the local area.

The idea is that the amount of support the person receives and the amount of time they live in the Pod for can vary according to each individual’s needs. For some, this can be intense support, lowered over a period of time; for others, this may be minimal support before furthering their independence.

EXPANDING QUICKLY Seeing the potential in the project, Heathcotes conducted a full assessment of all its garden spaces to identify where Pods could be matched with a need for this type of accommodation. It has now begun to build them across those services in which they can be used.

One Pod has been completed and is currently in use and another three are already under development.

Heathcotes is also working with operational teams, families and external professionals, including social workers, commissioners and community nurses, to identify individual service users who may benefit from the Pods setting. This will only include people whose long-term goal it is to step down into the community.

Individuals for whom it is suitable and appealing will be supported through transition from the current service into the Pods and will likely live there on a time-limited basis. Where possible, Heathcotes is aiming for individuals in a service to move into a Pod on the same site, or at a nearby service, to allow familiarity with staff and the local area to continue.

So far, the project has been smooth-sailing. There have not been any issues with planning permission to date and staff, service users and families have all been receptive to the initiative.

OUTCOMES The Pods are still in their very early stages, with one individual currently residing in the first Pod, but they are seeing positive results.

Rebecca Wright, Senior Commissioning Manager at Heathcotes said, ‘The service user currently residing in the Pod has settled in very well and has continued to build on independent living skills whilst still benefiting from the social aspect of living in

the home, with the Pod being in close proximity of the residential service.’

Rebecca went on to comment on the outcomes they have seen in this case, saying, ‘This has been a very positive step which has been evidenced by a significant reduction in previous behaviours.

For this individual, living in the Pod has had a notable positive impact on their self-confidence, independence skills, drive, determination and their general happiness and wellbeing.’

FUTURE ASPIRATIONS Although it is a new project, Heathcotes has established the outcomes it is hoping to see overall from the use of Pods.

The organisation is anticipating that people will leave their services with increased independent living skills and that people who are using the Pods can be supported in a less restrictive setting. Heathcotes is also hoping that the Pods will support people to live happy and meaningful lives as independently as they are able.

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OVER TO THE EXPERTS...

What are the potential risks and barriers with this project?

Is it replicable and can the outcomes already seen be reflected elsewhere? How can the project be developed to support more people?

JUMP THE EXTRA STEP What strikes me about this project is, who would really choose to live in a temporary structure in the garden of a residential service? And why? Faced with the opportunity of space and resources, you have to ask who the Pod idea is really serving?

Heathcotes’ Pod initiative seems to talk about separation and segregation as acceptable norms. Worryingly, Heathcotes suggests the Pods are only for those who are thinking about moving back into the community.

Who is commissioning Heathcotes services to keep people out of communities? What is society missing out on because of their exclusion? Everyone has potential for connection, contribution and control – relationships, work and real lives.

The focus of the Pod claims to be on building towards independent living skills and a transition to where people actually

A GREAT AND INNOVATIVE INITIATIVE want to be. Why not jump the extra step (after all, change is hard) and go straight to what people want?

Why not support people to consider what’s important to them, where they would like to be, what skills, attributes and personalities they would like to see in their staff team and build a home and support around what someone wants, rather than what is available?

There remains real concern about the emergence of on-site supported living services. They risk taking the same approaches of residential institutions and hospitals, but with reduced regulation and regulatory oversight.

There is a real danger that people will be ‘placed’ temporarily to build skills or independence but will never move on.

As the saying goes, ‘a house is not a home’. A shed in the garden is not independent living.

Jill Corbyn Development Lead – Learning Disabilities, NDTi

The barriers for any project will always be funding and support of the local funding bodies, local authority and clinical commissioning groups, which, in my experience, will often believe they can deliver cheaper care – and more effectively. However, we know that they are too disjointed to offer a full continuing support solution.

The Pods are a great and innovative initiative to promote independence in the learning disability community and offer a one stop support solution, including for young people going through transition. In my experience at The GROW Project, the smallest change in circumstances can be enormously difficult for someone with a learning disability.

The outcomes of the Pods can only be achieved if the correct level of support is provided, which of course would come at a cost.

The GROW Project has been successful in providing members with opportunities that promote independence, but the support required is too costly for funding and therefore can result in a loss of choice and opportunity.

Whilst the Pods would work for those that are able to be more independent, my concern would be the outside world once the person has left the relative ‘safety net’ of the pod. There is no question that the Pod initiative will work for the majority, and independent living could be achieved; the failing would be in the community, where people are often ignorant to inclusion, and support requirements rather than promotion of equality.

Maybe the way forward is Pod villages, offering a safe environment to people who have the ability and desire to live independently.

Maria Harris Owner, The GROW Project

ARE THEY NECESSARY FOR THE INDIVIDUAL? Pathways to independence can be difficult to construct and must be tailored to the individual to give them the best possible prospects for leading a full, independent life centred on choice and control.

There are so many variables, not least the property markets in which the ideal homes for people who need support must be found.

It can be incredibly difficult to help someone secure the home that they want and need, and any new property options must be welcomed.

The challenge is to make sure that each individual gets to the right living environment for them.

Temporary/staged moves may be right for some people but not for others and greater ambition for the person is almost invariably rewarded.

However, it is hard to give a really robust response to Pods without knowing more about the model. For example, I want

to know if the Pods come with different fundamentals, such as a fresh staff team, positive behaviour support or changed approaches to communication and family engagement. And what’s the policy on restraint?

If Pods are to be used carefully and conscientiously as part of a constructed pathway on a temporary basis where someone can see their next step, then they may prove to be an innovative use of suitable land and building technology.

However, my real question would be whether they are necessary for the individual. The risk with such devices is that they become the norm and another step in an already complicated, protracted pathway that, for many, could be sidestepped in order that community living can be achieved.

Steph Thompson Managing Director, Waymarks and Director, Dimensions CMM December 2018

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RISING STARS

CAREER HISTORY I’ve worked in the care sector for 30 years. I started as a care assistant, following in my Mum’s footsteps, and have been working my way up ever since.

My career with Borough Care began 16 years ago and has spanned across all of our services, from intermediate care to dementia care homes, high-dependency homes, and extra care schemes. It feels like I’ve worked in all the different types of service you can work in, but if I’ve taken anything from my experiences, it’s that – for me – it doesn’t matter which part of the organisation you work in; it’s about supporting people to live their best possible lives and you can do that in all adult social care services.

Before I took on this role, I was lucky enough to work a secondment. I spent 18 months carrying out medication audits and had an instrumental part to play in implementing a new electronic system across all of our homes. Part of what I loved about this project was getting the opportunity to train people in using the new system – sharing my knowledge with others is a really important part of my job and is something I take with me everywhere I go.

ORGANISATION

Julie Veritiero is Home Manager at Borough Care’s Marbury House.

Marbury House is a rehabilitation-based home. Individuals that come to stay at Marbury House are usually transferred from an hospital setting following treatment or surgery. The primary goal for the placement is that we complete an holistic assessment and enable people to regain independence and return home. It is a multi disciplinary team made up of care teams as well as staff from across the health sector and adult social care.

Borough Care is such a great organisation to work for because it really invests in its staff and offers so many different directions for us to go in, because of the diverse services it operates. I like working so closely with the NHS and think I’ve picked up a lot of skills from my experience doing this.

CURRENT ROLE My current role is as Home Manager. I’ve been here since September 2017 and it still amazes me how much can change so quickly here. We have 41 beds which are all local authority funded, as our referrals almost always come from hospitals.

My days are usually spent negotiating between meetings with our in-house multidisciplinary team and generally trying to keep on top of all the other things that are happening. The aim of our service is to get people out of hospital and back into their own homes. We don’t provide long-term support to people so it’s an extremely fast-paced environment and that can be challenging but I’m a very positive, proactive person and feel I manage the pressure well.

My ultimate goal has always been to be a registered

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Qualifications in Activity Provision From care staff to managers, activity organisers to day-centre staff, domiciliary workers to owners and volunteers, these courses are suitable for all. They will support learners to contribute to the planning, delivery and evaluation of individual and group activities and to meet a range of individuals’ different needs. It will further learners’ understanding of the part activity has to play in providing person-centred care.

It is increasingly recognised that Activity Provision can make a significant contribution to well-being and quality of life, and the Care Sector reports a need for specialist training for their staff in this area. NAPA is delighted to offer two courses that meet the needs of the specialist activity workforce.

NAPA offers: Level 2 Award in Supporting Activity Provision in Social Care – accredited by OCN London This knowledge only course is provided through distance learning with telephone tutor support.

I have grown in confidence through the NAPA course.

Level 3 Certificate in Activity Provision in Social Care – accredited by OCN London This higher level course is knowledge and competence based. The student will be supported throughout this distance learning course to research the assignments, write narrative comparisons and evaluate their day to day work.

The course has certainly made a difference to the provision in our home.

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CMM December 2018

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RISING STARS

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manager. I’ve tried different roles within the company, like the secondment I did, and have enjoyed many of them, but my career has led me here.

I was already working with Borough Care as a deputy manager when I applied for the Home Manager position. I was interviewed and was successful in obtaining the position at Marbury House.

As a deputy manager, I had an idea of the amount of responsibility involved in being a registered manager and I knew that taking full legal responsibility would be a big change. I think it helps that I was prepared for this as it meant I could take it in my stride – it wasn’t a surprise to me to suddenly feel like I had a lot resting on me because during the deputy role I held a lot of responsibility and accountability.

One of the best parts of my job, and something I’ve always loved, is seeing the difference you can make to someone’s life, whether that’s having a conversation with them about something they’re interested in or supporting them to live independently again. Knowing that you’re also making a difference to their families is invaluable too.

Training staff is another great passion of mine. I’m a strong believer that caring, in itself, can’t be taught. To work in care, you have to be passionate about keeping people safe and secure. I think if you can identify those people and pass on your knowledge to help others to progress, your staff will be happy. I always do what I can to develop my staff and I don’t believe in holding precious what you know. In this service, where the constant change of patient flow makes it so hard, it’s important that you can just carry on and keep up, so I will do anything I can do to support my staff to do that.

RISING STARS It was our Head of Care who suggested I apply for Rising Stars. I knew a little about it from someone else at Borough Care having been part of it last year, but I didn’t properly understand it until I got all of the literature through.

I was surprised and pleased that my managers wanted me to be part of it. I am always looking at my staff and seeing how I can develop them and build them up to progress, and it was nice for someone to see something in me that they wanted to support.

The Rising Stars programme has been really beneficial and so in line with all the things I feel strongly about. The sharing of ideas and experiences has always been important to me and the programme actively supports that. Care is evolving – people are sharing – but there is still an issue with feeling like someone might plagiarise your work. In my opinion, this is exactly what we should be doing. If someone has done something and it has actually worked, the whole sector should be copying them and adapting the success to meet their own service’s needs. Sometimes, we get very bogged down with systems and forget to share innovations and skills and that’s a shame.

In terms of my own career, I’m always thinking of progression. I like the idea of becoming an Area Manager – my time on secondment showed me that that could be a good fit for me. I think I’d just like to keep moving forward. My career so far has been quite organic so I’ll keep following that path.

ADVICE My advice to anyone aspiring to be a registered manager is to be open to mentoring and support. Ask questions as you step up and find out what is involved in a role before you take it on.

Learn your line manager’s job and make sure it’s right for you before you make any decisions.

I think there should be more mentoring programmes in care, so people can work alongside someone for a day or a week and really understand the work that person is doing and what responsibilities they have. People also need to be encouraged to build and use the network of support between registered managers so it’s easier for them to communicate with each other and learn.

CMM Julie is part of the second cohort of Rising Stars. This innovative programme, developed by National Care Forum and supported by Carterwood and apetito, 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 2018

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EMPLOYMENT STATUS EXPLAINED:

NAVIGATING THE RULES

Recruiting and retaining staff is tricky in the care sector at the best of times. With the turbulence we are seeing in this area currently, the last thing any provider needs is a claim being brought against them for breaching employment law. Here, Melanie Stancliffe from Irwin Mitchell un-muddies the waters surrounding staff’s employment status.

The increasing prevalence of work arrangements once considered atypical, including zero hours contracts and the so-called ‘gig economy’, has brought the complicated issue of employment status into the public domain. Staff are becoming increasingly confident about challenging their status in order to gain important and valuable employment rights.

To give some context on the current scene, a recent report by Skills for Care found that 90% of the adult social care workforce are employed on permanent contracts, with the remaining 10% working on a temporary basis as casual, bank or agency staff. It notes that a third of care workers are engaged on zero hours contracts, rising to 58% for homecare workers.

In terms of employment status, this varies by job role, with managers and senior care workers more

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EMPLOYMENT STATUS EXPLAINED: NAVIGATING THE RULES

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likely to be classed as ‘employees’, and many staff providing care classed as ‘casual workers’, often on zerohour contracts.

It’s important to note that there is no specific legal meaning attached to someone labelled a casual worker.

They can be engaged via a zero hours contract or as bank or agency staff, and they can be employees or workers.

WHAT’S THE DIFFERENCE? Employment law recognises three categories of person: ‘employee’, ‘worker’ and those who are ‘self-employed’.

It is not always easy to determine the status of an individual, and the concepts used by the courts to decide cases can sound archaic to modern ears. The law has been interpreted in numerous cases, but the courts have not been able to devise a single test that will conclusively point to the distinction in all cases.

When determining the status of a worker, the courts will look at factors that point both towards and against the status being claimed and will undertake a sort of balancing act.

Employees To be an employee, the individual must work under a contract (written or oral) and perform the work themselves – they can’t send someone else in their place or refuse to accept work given to them. In addition, the employer must provide work in accordance with the terms of the contract and pay the employee, even if it has no work for them to do. The employer will also ‘control’ when the employee works, what they are required to do and how much autonomy they have.

Workers Workers also have to work under a contract and, usually, must undertake the work themselves and agree the terms under which work is offered and accepted. This is known as ‘mutuality of obligation’. They do not have to accept work, but when they are working they will usually be integrated into the employer’s organisation.

The important thing to remember is that courts will ignore any written agreement between the parties if it does not reflect the reality of the relationship.

THE RIGHTS OF STAFF Employees and workers have rights that are not available to those who are genuinely self-employed. These include rights to: • Receive the national minimum wage.

• Receive paid holiday.

• Receive rest breaks.

• Be protected against unlawful discrimination.

• Not have deductions taken unlawfully from their wages.

These rights are available from the start of their employment (‘day one’).

Employees also have additional rights, including the right to not be unfairly dismissed, to receive a redundancy payment and to take time off and receive 38

CMM December 2018

pay for family leave (such as maternity, paternity and adoption leave).

In addition, employees should be given minimum periods of notice (one week for every year worked up to a maximum of 12 weeks’ notice) and to receive an itemised pay slip. Not all of these rights are available for employees from ‘day one’. For example, employees must have at least two years’ service to bring a claim for unfair dismissal or to receive a redundancy payment.

PART-TIME VS FULL-TIME Casual workers may be able to compare their terms and conditions with those enjoyed by full-time workers and bring claims if their own are less generous. Under the Part-time Workers (Prevention of Less Favourable Treatment) Regulations, part-time workers have the right

“The important thing to remember is that courts will ignore any written agreement between the parties if it does not reflect the reality of the relationship.” to not be treated less favourably than full-time staff working under the same type of contract. For example, if an employer pays a full-time, comparable member of staff a higher rate of pay than the part-time worker, this might amount to less favourable treatment.

What amounts to the same type of contract is not always easy to determine. For example, in Wippel v Peek & Cloppenburg, [2005], the European Court of Justice held that a worker on a zero hours contract who could turn down work could not compare herself to a fulltime worker who was required to work a fixed number of hours per week and could not turn down work. This was because there was no full-time worker who worked according to business need and was free to turn down work.

ZERO HOURS CONTRACTS A zero hours contract is an agreement between an individual and an employer where the employer sets out the terms under which the individual will be engaged but provides no guarantee that it will offer any work. The agreement may require the worker to either accept any work that is offered, specify that they can turn down a certain number of offers for work, or allow them to turn down any work offered.

Zero hours contracts are attractive to employers

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EMPLOYMENT STATUS EXPLAINED: NAVIGATING THE RULES

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because of the flexibility they provide. However, they are usually less attractive to staff because they may not know in advance how many hours they will be offered and therefore how much money they are likely to earn. The prevalence of zero hours contracts in the care sector is likely to make it harder for employers to find, recruit and retain suitable people.

Many employers assume that any staff they engage under zero-hour or other contracts will be ‘workers’ rather than ‘employees’ and can be dismissed with little or no notice and without following normal procedures.

However, this will depend on the actual relationship between the parties. Written agreements, especially in zero hours contracts, often state that the individual’s employment status is that of a worker. Even if that reflects the initial position, a person’s employment status can change over time. For example, if a company engages an individual on a casual basis, but regularly provides work and there is an expectation that this will continue, they may obtain ‘employee’ status and become entitled to those rights.

For example, in the case of St Ives Plymouth v Haggerty, [2008], Ms Haggerty was one of a number of bank staff engaged as a casual worker to provide cover as and when required. The work fluctuated considerably and at short notice. Ms Haggerty was not obliged to work any particular shift or a minimum number of shifts but, in practice, over a nine-year period, she worked regularly. Ms Haggerty left a shift early one day, was disciplined. She chose not to return to work. Instead, she claimed constructive unfair dismissal. To succeed with her claim, she had to show she was an employee (rather than a worker) and had at least two years of uninterrupted service. The employer accepted that Ms Haggerty was an employee during her individual assignments, but it argued that because there were breaks between these for holiday, illness and other unspecified reasons, she did not have two complete years of service.

The Employment Appeal Tribunal found that Ms Haggerty did have sufficient service to succeed with her claim. There was an expectation that she would be offered work and, because this arrangement had existed for a long time, these mutual obligations were ‘just sufficient’ to find there was an overarching contract of employment (sometimes referred to as an ‘umbrella contract’). This meant that the gaps in her employment could be ignored.

AGENCY WORKERS Some employers prefer to use agency staff to meet temporary staff shortages. Temporary workers work for the agency’s clients but are paid by the agency. This has some advantages as, in almost all cases, the hirer will not become the employer of the temporary worker, even if the worker is engaged over a long period of time.

However, this does not mean that the hirer has no

responsibilities towards the agency worker. From ‘day one’, agency workers have the same rights to use the staff canteen, transport or childcare facilities offered as those directly employed by the hirer. Then, after 12 weeks, they have the right to receive the same pay and holiday as comparable workers. Both the hirer and the agency can be held responsible for any breach of these responsibilities.

In addition, the hirer will also be liable for any discrimination the agency worker suffers whilst at work.

Hirers should therefore make sure that all staff (whether it directly employs them or not) behave appropriately at work and are aware of workplace policies.

CMM

TIPS FOR EMPLOYERS To avoid difficulties, we suggest that companies consider the following when recruiting care workers: 1 Decide what type of contract to offer and whether you wish to engage an individual as a worker or employee. Zero hours contracts are really only suitable if you have no idea how many hours you need the individual to work and need complete flexibility. If you expect to be able to offer a minimum number of hours per week, set these out clearly.

2 If you decide to engage an individual as a worker, don’t use a Section 1 statement or contract of employment as these documents will suggest that they are an employee.

3 Review the contracts of all of your casual staff.

How long have they worked for you? Have your expectations changed since the beginning of the contract? Are there any gaps in their employment? The answers to this may suggest that you need to amend the arrangements and put new contracts in place to reflect the relationship.

Melanie Stancliffe is a Partner at Irwin Mitchell. Email: melanie.stancliffe@irwinmitchell.com Twitter: @imhrplus What are your experiences of claims around employment status? Share your views and feed-back on this feature on the CMM website. Not a member? Sign up for free today www.caremanagementmatters.co.uk CMM December 2018

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The safety and efficiency of medication management With increasing pressures on care providers, medication management is an area where the slightest error can have severe consequences. Here, Steve Sawyer from Access Health and Social Care, explains how care providers can improve efficiencies and ensure safety procedures are followed effectively.

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CMM December 2018

The Care Quality Commission’s (CQC) recent State of Care report found a steady decrease in the number of residential care homes, while domiciliary agencies continue to grow and increase in number, a pattern of change that has been constant for the past five years and is expected to continue.

Providing care to people in their own homes can be complex, with a number of challenges and considerations, all posing a risk to the comfort and safety of patients.

Medication management may be one of the most significant of these, meaning that, understandably, it is an area CQC places under extreme scrutiny during inspections.

With the huge potential consequences for patients, it is surprising to see so many reports of care providers being placed in special measures for inadequate administration of medication. In community care, with so many stakeholders across a number of locations, the risks to patient safety are heightened and could prove costly.

REGULAR REVIEW Taking time to monitor the number of medicines being taken, particularly by older people, is an important step to ensure you are managing clients’ medication correctly. Seen by most in the sector as the use of five or more medicines on a daily basis, polypharmacy can considerably increase the associated risks of individual drugs when combined with other treatments.

By working closely with clients to monitor their reactions and any concerns about new medications, care providers can go some way to prevent any problems from going unnoticed.

For homecare providers, NICE guidelines highlight the need to ensure that workers spend enough time with the client to have a conversation. This is a vital opportunity for care workers to discuss the impact of medications, as well as any problems or side-effects. However, with some councils still commissioning care visits of 15 minutes, care workers are facing stringent time constraints. As a result, this opportunity for conversation is often lost, and the chance of errors in the management of a client’s medication is increased. It is vital to ensure, where you can, that care workers are reporting any signs of side-effects or medication issues, so that problems can be identified and resolved.

SECURITY OF MEDICATION Although care homes offer a more controlled environment than caring for someone in their home, in theory enabling better medication management, there are various factors that could breach regulations or risk patient wellbeing.

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THE SAFETY AND EFFICIENCY OF MEDICATION MANAGEMENT

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For example, care homes are more at risk of a failure to adequately store and dispose of all medicines. Depending on individual support needs, a number of different storage methods could be required, with some patients requiring easy access to take their own medication.

In these environments, extra precautions should be taken to ensure that medication that could cause harm is appropriately secured.

TRAINING IS ESSENTIAL Well-trained staff are generally less likely to make mistakes, so ensuring that all involved in the administration of medication are fullytrained and competent is an essential starting point for care homes and homecare workers.

Guidelines from NICE stipulate that service providers should be providing adequate induction training to new employees, continued learning and development, and an annual review of competencies of all staff involved in the medicine administration process.

Service providers should look to develop internal training programmes or work with an accredited external provider so that those managing the medication process are fullytrained and will be compliant if inspected by an external assessor.

Another advantage of an effective training programme is that well-trained staff have greater job satisfaction, so providers should see improved retention rates and reduced recruitment costs.

THE ISSUES WITH PAPER CHARTS Given that we know CQC, the Care Inspectorate and clinical commissioning groups place so much importance on medication records being accurate, legible and consistent, care providers failing to take adequate steps to ensure the highest level of client safety run the risk of action being taken against them, a negative CQC inspection result, or even being placed in special measures.

Paper Medication Administration Record (MAR) charts are still used by many care providers. These paper records are far from perfect in reducing the constraints of care workers. Maintaining accurate and legible records can be challenging when staff are left to scribble down notes and put information into small boxes and it can be extremely difficult to ensure that care workers record medication in a consistent way.

The biggest worry of all is that, with reduced

time to spend with clients, the care worker forgets or doesn’t have a chance to record all of the relevant information on the MAR chart at all.

Gaps in communication between prescribers, care workers and administration staff is a problem that not only impacts on patient safety, but also on administration work and costs, particularly for homecare providers.

For example, if a prescription is changed, or a course of antibiotics is prescribed, in most cases the provider is responsible for ensuring that paper MAR charts are updated and replaced in the client’s home. If an up-to-date MAR chart is not available to care workers, they will not be able to give the person the correct medication or dose.

To tackle this, more providers are choosing to adopt digital eMAR systems. These automatically update computer-based systems with all the information the care worker inputs on a remote device (such as a smartphone), including any detailed notes.

IS EMAR THE SOLUTION? The aim of eMAR charts is that gaps in medication records are reduced or avoided completely. eMAR systems can also help to ensure that records are consistent, understandable and comprehensive. Care workers can use an app to view the correct dosage for each client and can see any additional medications that were or were not previously administered.

To go back to the antibiotics example, when using paper charts, these infrequent courses of medication can cause issues if records are not updated accurately. An eMAR system would alert the care worker that an additional drug should be given. The systems prompt care workers to log their actions, and back office staff are alerted to any missed medications, so problems can be investigated and resolved, meaning clients are less likely to miss their medication.

The ability for family members to view detailed information from care workers on a smartphone app is also beneficial. Most systems allow family to check that medication has been administered correctly, as well as access further notes about their loved one’s general health or happiness.

Additionally, by integrating digital technology, homecare providers can create more efficient scheduling for their staff.

Information about the time at which each client requires their medication can be used to create adaptable schedules that then feed into the daily tasks for each care worker.

Case study A homecare service based in Surrey recently took on a new client who was living with diabetes. The previous care company had not been functioning well and had made serious medication errors. As a diabetic, the importance to this client of correct timing and dosage of medication, as well as appropriate dietary requirements, was critical.

After their negative experiences with the previous provider, the client and their family were understandably anxious to ensure that the medication and dosages they were receiving were correct. The new provider used eMAR records, so that staff were able to easily identify what medicines were needed and when, meaning that the client was always receiving the correct dosage at the right time. The comfort this provided to the client helped to improve quality of life and reassured their family that they were safe and well.

THE DOWNSIDES Concerns have been raised that, if medical information is required in an emergency, digital records could be inaccessible.

However, this could be overcome with the use of on-call staff who are able to access the eMAR charts. Paramedics, for example, could then still see detailed information about a patient when needed. This may prove to be safer than the use of paper charts, which could be inaccurate or difficult to read.

COMPLIANT MEDICATION MANAGEMENT The impact of the CQC in improving standards of service quality cannot be understated, but there is still work to be done by providers to ensure that outstanding standards are retained and improved in the future.

To deliver outstanding, safe and sustainable care, more providers need to think beyond traditional practices. New technology has to be central to the strategy of providers moving forwards. The challenges of such a displaced service, particularly for managing medication, will not go away, so implementing new ideas and solutions into care services will be crucial.

Above all, the most effective method to ensure a successful and compliant medication process, for both domiciliary care providers and care homes, will be focused on an effective strategy, encompassing security, training, learning and development, up-to-date records and continued assessment.

CMM

Steve Sawyer is Director at Access Health and Social Care. Email: hsc.info@theaccessgroup.com Twitter: @accesscaremgmt Have you implemented an eMAR system in your business? How did it impact on your service? Or if you haven’t, what are your reasons for holding back? Share your opinions on the CMM website www.caremanagementmatters.co.uk 44

CMM December 2018

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3rd Sector Care Awards

Claire Thomas – Community Engagement

Claire Thomas from Alzheimer’s Support won the Community Engagement Award in the 3rd Sector Care Awards 2017 for her dedication to supporting communities to become more dementia friendly.

One of my favourite photographs is a picture of an older man helping do up the zip on a small child’s coat. The small child is a pupil at Holbrook Primary School in Trowbridge, and the gentleman is a member at Alzheimer’s Support’s Mill Street Day Club, also in Trowbridge, and has dementia. The photograph to me sums up what community engagement is all about – bringing people together to achieve something good.

At Alzheimer’s Support we work to enable people in Wiltshire to live well with dementia and to maintain as much independence and control over their lives as possible. We believe that people with dementia are valued members of their communities, and that the feeling of being valued can come in many different ways, from being part of a group of friends, to being able to help a child do up their coat.

RAISING AWARENESS Living well with dementia requires the support and 46

CMM December 2018

understanding of the community within which people live. But how are people to understand dementia if no one tells them? This is the issue that the Dementia Aware Project in Wiltshire was set up to address. Alzheimer’s Support (which works solely in Wiltshire), Alzheimer’s Society and Wiltshire Council worked together to make Wiltshire communities more dementia friendly, using Dementia Friends Information Sessions as the main way of doing this. The project ran for two years, and over 5,600 people attended Dementia Friends Information Sessions.

In addition, most areas of Wiltshire have small groups of people within them working to make their communities more dementia friendly.

It was particularly helpful to have Wiltshire Council as a partner in the project. Wiltshire is divided into eighteen area boards – which are a level of local government below Wiltshire Council. Each has a Community Engagement Manager who had responsibility for supporting their area to become dementia friendly. I worked closely with these staff members to draw in members of their communities who had an interest in and desire to do this. Each area was different, and some were more enthusiastic than others, but all of them had some dementia friendly activities going on by the end of the project. Without the top-down support of Wiltshire Council I believe this would have taken a lot longer.

The Dementia Friends sessions were an invaluable way of encouraging people to become more dementia friendly because at the end of each session people are challenged to do one dementia friendly action. During the course of the project we learned that simply running Dementia Friends sessions, publicising them and hoping people would turn up often resulted with only one or two attendees. Instead we focused on running sessions for groups, and where possible opened these up to the general public. I ran sessions for businesses, including domiciliary care providers and care homes, health centre staff, churches, clubs, charities and schools. I offered the sessions to many organisations and worked with the large number of people who were interested, rather than worrying about those who were not.

My Dementia Friends online dashboard currently says that I have made 2,027 Dementia Friends. This means that I have spoken, face-to-face, with 2,027 people and told them what dementia is, how it affects people and the simple actions that anyone can take to support people living with dementia and make our communities more dementia friendly. I do this through my work for Alzheimer’s Support, but anyone can do the free daylong induction that Dementia Friends regularly provides,

become a Dementia Friends Champion and do the same.

Most people respond enthusiastically to a Dementia Friends session, although the results may not be immediately visible. I was walking down the street in the town where I live when I was stopped by a man who had attended a session I had run some time before. He explained that he was from a local church, and, following my session they had encouraged two older men they knew with dementia to come to the church’s men’s group. These men were now coming regularly and were once again part of their community and valued members of a group.

ENCOURAGING COMMUNITIES A large part of the Dementia Aware Project involved getting out into communities, talking to people and getting to know who was doing what. Our aim was not to set up more professionally-run community groups, but to encourage communities themselves to respond to the needs identified in their particular area.

An example of this was a local church which had recently undergone a major refurbishment and wanted to open up the church building to isolated people in the community, including people with dementia. I brought together representatives of the church, the local health centre and the local council to discuss the opportunity. As a result, a small grant was made by the local council to support the church, health centre and Alzheimer’s Support to work together for six months to set up a monthly café for people at risk of isolation. After this period the church felt confident enough to continue running the café without additional support, and it is still running.

My role was, through my work in the community, to recognise such opportunities when they arose and to make the most of them, and I was honoured to win the Community Engagement Award at the 2017 3rd Sector Care Awards.

FUTURE AMBITIONS The Dementia Aware Project was funded for two years and that funding is now finished. However, Alzheimer’s Support continues to engage with communities in Wiltshire, and the award has helped to raise the profile of our work.

Working in one county, we are able to focus our services on the needs of our local communities and the people with dementia and carers within them. We currently have 40 community groups of various sorts running regularly across the whole of Wiltshire.

My focus is now on businesses and schools in Wiltshire – raising awareness of dementia and encouraging them to support people with dementia in their communities. I love being able to work so locally and to support people of all ages to make a difference where they live. And it is this that I find engages people most – knowing that they are helping their neighbours, relatives, friends and colleagues, and possibly even making sure that good services are available should they themselves have need of them in the future.

CMM Claire Thomas is Special Projects Coordinator at Alzheimer’s Support in Wiltshire. Email: clairet@ alzheimerswiltshire.org.uk Twitter: @AlzheimersSupp

The Markel 3rd Sector Care Awards is run specifically for the voluntary care and support sector. Book your ticket today to hear the inspiring stories and innovative work of this year’s nominees. Tables and sponsorship opportunities are also available. Visit www.caremanagementmatters.co.uk/3rd-sectorcare-awards With thanks to our supporters: National Care Forum, Learning Disability England, The Care Provider Alliance, Association of Mental Health Providers and VODG. CMM December 2018

47

EVENT REVIEW

BERKSHIRE, BUCKINGHAMSHIRE AND OXFORDSHIRE CARE ASSOCIATION CONFERENCE 2018 11th October 2018

The Berkshire, Buckinghamshire and Oxfordshire Care Association Conference 2018 took place in October at the Windsor Marriott Hotel in Slough and saw delegates attending from all three counties.

The event was run in association with Berkshire Care Association, Milton Keynes and Buckinghamshire Care Association and Oxfordshire Association of Care Providers.

Delegates gathered to hear about best practice and latest research, to gain an understanding of the local scene.

SETTING OUT EXPECTATIONS Fidelma Tinneny, Chair of Berkshire Care Association opened the day, telling attendees what to expect, setting out the challenges of providing care in the current environment, and stating her belief that those working in Berkshire are doing a good job.

Fidelma then passed over to John Kennedy, Independent Social Care Consultant, who compared the slots and time limits we see in social care provision to a pizza delivery service.

He shared his thoughts on the Care Quality Commission’s State of Care report, which had been released that morning, and asked, do we really need commissioners?

Simon Osbourne from CQC was next to take to the stage, exploring what the future of regulation and registration might look like.

His presentation focused on the local scene, establishing how each authority area was performing and looking at the changes coming that providers could look out for.

Simon’s presentation was followed by a break, where delegates had the opportunity to speak to those exhibiting, find out about their Corporate sponsor

48

Sponsors

CMM December 2018

innovative services and products, and speak to other attendees to share ideas.

BEST PRACTICE After the break, Claire Henry welcomed everyone back to their seats with a talk on best practice in end of life care. She asked the audience, how do you want to die, and encouraged people to think about what is truly important to those receiving end of life care.

Claire emphasised that conversations around death are courageous, not difficult, and that we should all keep in mind a person who is dying still has a sense of humour.

A panel discussion was next on the agenda, focusing on questions including how do we move away from blame culture; does computerised care planning really work; and how can local providers work more closely with hospitals?

number of nurses in social care and highlighted that there are positives to be found, despite the pressures.

As the last speaker of the day, Sophie Coulthard from Judgement Index asked what role values have in recruitment and retention.

She spoke about creating a wellbeing policy for staff, using social media to your advantage, and reinforced the importance of making informed decisions when hiring.

The day was a great success, packed full of information for delegates to learn and share.

CMM gives thanks to the sponsors, without whom the event would not have been possible; QCS, Gordons Partnership LLP, Judgement Index and Sekoia.

WORKSHOPS Questions answered, delegates broke out for workshop sessions. These included discussions around best practice in fire safety, care homes going digital to free-up staff time, and managing the CQC inspection process.

The engaging workshops gave useful tips for providers to take back to their businesses and put into practice.

AFTERNOON SESSION After lunch, the delegates came back together to hear Dr Crystal Oldman give an insightful presentation into the role of registered nurses in social care. She gave stark figures about the Supported by

Organised by

WHAT’S ON? Event: Hospice UK National Conference Date/Location: 27th-28th November, Telford Contact: Compleat Conference Company, Tel: 01489 668333 Event: The King's Fund annual conference 2018 Date/Location: 27th-28th November, London Contact: The King’s Fund, Tel: 0207 307 2409 Event: The Future of Ageing 2018 Date/Location: 29th November, London Contact: ILC-UK, Email: events@ilcuk.org.uk Event: Outstanding social care: exploring good practice Date/Location: 4th December, London Contact: The King’s Fund, Tel: 0207 307 2409 Event: Falls Prevention & Management in Older People Date/Location: 5th December, Manchester Contact: Healthcare Conferences UK, Tel: 01932 429933 Event:

Health and care explained: how the system works and how it is changing Date/Location: 13th March, London Contact: The King’s Fund, Tel: 0207 307 2409

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CMM EVENTS Event: Date/Location: Contact:

The Markel 3rd Sector Care Awards 2018 7th December, London Care Choices, Tel: 01223 207770

Event: Date/Location: Contact:

CMM Insight Dorset Care Conference 2019 7th February 2019, Poole Care Choices, Tel: 01223 207770

Event: Date/Location: Contact:

The Transition Event 2019 16th May, Solihull Care Choices, Tel: 01223 207770

Event: Date/Location: Contact:

BAPS – SEND Blogging Awards 16th May 2019, Solihull Care Choices, Tel: 01223 207770

Event: Date/Location:

CMM Insight Lancashire Care Conference 2019 19th September 2019, Venue TBC Care Choices, Tel: 01223 207770

Contact:

Please mention CMM when booking your place.

Sign up online to receive discounts to CMM events.

CMM December 2018

49

GLEN GARROD • PRESIDENT • ASSOCIATION OF DIRECTORS OF ADULT SOCIAL SERVICES

Glen Garrod, President of the Association of Directors of Adult Social Services (ADASS) explores the recent Budget announcements and says we must go much further than these baby steps.

For years now, ADASS and anyone with an interest in the sector have been calling on the Government to ensure more funding is provided for adult social care – a long-term, sustainable financial platform.

Last month’s Budget was another ‘lost opportunity’ to do this – instead there was a short-term, temporary and wholly inadequate offer, presumably with the intent to shore up the sector.

But the measure that was taken represented a baby step, and not the giant leap forward we need.

Firstly, the money is split between children’s and adults’ social care, meaning it is now up to be negotiated against a variety of competing

demands, bartered and traded to offset overspends and between different departments. That is no way to ensure that a sustainable basis for care – care that older and disabled people depend on – is put in place.

Secondly, it was nowhere near enough. £650m (for adults’ and children’s services), including £240m of previously announced money rolling over, does not come close to the £2.35bn that ADASS estimates the sector needs just to stand still each year.

Although we have called for a long-term funding plan to be brought forward in the green paper, colleagues across the sector are struggling now in the face of unprecedented funding shortfalls and the consequences of eight years of austerity.

The £240m provided by Government for this year and next is a positive step and recognition that adult social care has a reputation of delivery. But we must go much further, much faster.

It’s crucial that these funds are not tied into stringent conditions or merely allocated to reduce pressure on the NHS, but left for local departments to make decisions that reflect the needs of people needing care and support in their area.

The human impact of the longterm funding crisis in social care will be felt by all of us, especially our parents and grandparents who need care and support, as well as adults with disabilities trying to live as fulfilling a life as possible.

Our amazing social care staff do all they can to provide exceptional care, but with no long-term funding plan for social care, the sombre truth is that people will face reduced choices and delays when it comes to deciding what care will work best for them, and that social care departments are increasingly having to cope with more demand, with less funding available to support it.

This situation will only get worse as the population is changing, demand is growing and people have increasingly complex needs for care and support.

That’s why the Government’s green paper is so important, because it is a chance to build toward a more sustainable future. At the centre of that green paper must be a cast iron commitment to supporting people to live the lives they want to lead. And that can only be honoured with a longterm funding solution for adult social care.

We are talking about how best to look after our grandparents, parents and children; adults of all ages in our communities who live with a range of disabilities and conditions. These people are an essential part of our communities and make them stronger; the care we

“We are talking about how best to look after our grandparents, parents and children.” offer them must be properly resourced.

In addition to significant additional (and genuinely new) investment, what we need is an across-the-board commitment to shifting the centre of gravity; away from the acute sector and the back door of hospitals, and more toward prevention and the steps that can be taken to help people retain their independence and place in local communities and reduce their need for ongoing long-term support.

With social care accounting for nearly 40% of total council budgets, other vital services are depending on the Government for getting this longterm funding solution for social care right.

We’ve seen some positive steps this year, with the move to incorporate social care in the Department of Health and Social Care, and the £240m to ease winter pressures. We now need a big, bold move to ensure we can make sure care is sustainable.

CMM

Glen Garrod is President of the Association of Directors of Adult Social Services. Email: mediaenquiries@adass.org.uk Twitter: @GarrodGlen 50

CMM December 2018

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