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APRIL 2019

www.caremanagementmatters.co.uk

THE BIG PICTURE How fair are CQC ratings?

Reflections on a decade

From the sector’s leading women

Making it Real

Embedding person-centred support

Resource Finder Accountancy firms


DRIVING

OUTSTA

NDING C

ARE

Person Centred Software has been extremely responsive to my needs and the software is very intuitive and closely aligned to our care homes’ needs. We’ve achieved an excellent return on investment and I wouldn’t hesitate in recommending the software. It’s worth every penny and then some. RISHI SODHA, CARE DIRECTOR, HANDSALE CARE HOMES

Person Centred Software interviews Rishi Sodha, Care Director at Handsale Care Homes. Rishi Sodha is the Care Director at Handsale Care Homes, a group of eight care homes that have implemented Mobile Care Monitoring (MCM), Person Centred Software’s electronic care system. Rishi explains that when one of Handsale’s homes, Treelands Care Home in Oldham, Lancashire, went fully paperless, it made an immediate difference to staff morale and efficiency for the care home, “At the time, a nurse pulled me into her clinic room and told me it was the first time she’d stepped foot inside there since her morning meds round and she felt it was the first full day of nursing she’d done in 10 years,” says Rishi. “She also showed me her office which contained just one shelf of paperwork replacing what she described as being a paper mountain rather than an office.” Rishi points to time saving as a major benefit. “Our nurses are saving up to 4 hours a day and the care staff between 45 minutes to an hour. I hear many homes complain about lack of staff but if a nurse can save four hours, it’s like having another staff member for a third of a shift.”

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

“Initially at board level, we saw Mobile Care Monitoring as a way to save time, but it has given us insight into things we just didn’t know. For example, we discovered that one resident was missing a sleeping care plan, and we were able to rectify it immediately.” “At a corporate level, we can now sleep calmly at night. And our home managers can go on holiday, confident that the right care is being given to everyone.” And since implementing Mobile Care Monitoring, Rishi confirms that no risk assessments have expired. “Person Centred Software has been extremely responsive to my needs and the software is very intuitive and closely aligned to our care homes’ needs. We’ve achieved an excellent return on investment and I wouldn’t hesitate in recommending the software. It’s worth every penny and then some. I know all home managers wouldn’t go back. And if I ever threatened to remove Person Centred Software, I think I’d have a riot on my hands.”

Read the full interview with Rishi at www.personcentredsoftware.com/handsale


In this issue 05

Inside CQC Debbie Ivanova, Deputy Chief Inspector of Adult Social Care, explores latest guidance around supporting people’s sexuality.

07

CMM News

09

Business Clinic Our panel looks at a new model of homecare, which brings together aspects of homecare and residential care.

28

Rising Stars 2018 Oluwakemi Yusuf is Registered Home Manager at Ipstones Avenue.

31

Celebrating excellence The Royal Alfred Seafarers Society won both the Leadership Award and the Beyond Governance Award at the Markel 3rd Sector Care Awards.

46

Event Preview A preview of the new CMM Insight Leeds Care Conference.

48

What’s On?

49

Straight Talk Michael Voges shares his opinion that the sector must look at small system change while we await wide-scale transformation.

50

24

35

FEATURES 20

REGULARS

From the Editor



41

20

A reflection on the last ten years The start of 2019 saw a flurry of announcements from women who would be leaving their posts. They go into detail about the last ten years of adult social care, and what needs to change.

24

Painting the picture: how fair is the CQC quality rating system? Mike Short from CSI Market Intelligence highlights the areas where CQC quality ratings vary and the impact they are having on businesses.

35

Making it Real: a system for change Caroline Speirs, Head of Think Local Act Personal discusses the Making it Real framework and sets out what organisations need to do to ensure they’re delivering person-centred care.

41

Resource Finder Care sector accountancy firms can support you with myriad services, from tax, to due diligence and business planning. We’ve listed firms who can support you day-to-day and beyond. CMM April 2019

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CONTRIBUTORS

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

@CQCprof

@sharonallenarhc

@JanetMorrisonUK

@ukhca

Debbie Ivanova Deputy Chief Inspector of Adult Social Care, Care Quality Commission

Sharon Allen OBE Chief Executive Officer, Skills for Care

Janet Morrison Chair, The Baring Foundation and Chair, Association of Charitable Foundations

Bridget Warr CBE Chief Executive, United Kingdom Homecare Association

@stb1106

@CSIMarketIntel

@Agincare

@AJ_Recruitment

Sharon Blackburn CBE Policy and Communications Director, NCF

Mike Short Founder, CSI Market Intelligence

Raina Summerson Group Chief Executive Officer, Agincare

Rachel Bryan Senior Marketing and Communications Manager, AJ Recruitment

@accord_care

@carolinespeirs

@RASeafarers

Oluwakemi Yusuf Registered Home Manager, Ipstones Avenue

Caroline Speirs Head, Think Local Act Personal

Commander Brian Boxall-Hunt Chief Executive Officer, Royal Alfred Seafarers Society

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

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

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 2019 CCL REF NO: CMM 16.2

Helen Fuller Managing Director, Care 4 Quality Ltd

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Michael Voges Chief Executive Officer, ARCO

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From the Editor Editor, Angharad Burnham previews what’s to come in this month’s issue and looks at the latest big news stories. The news this month has, as is often the case, largely focused on funding. Hft’s annual report, covered on page 15, showed that the lack of funding from local authorities is starting to impact on the people using services; the Local Government Association has revealed that councils can’t raise enough money through Council Tax to even fund the services that already exist; and the new Health for Care coalition has urged Government to commit to a funding settlement to avoid total collapse of the sector. And yet we still await the Green Paper, which people are increasingly concerned won’t offer any real solutions – and even once it is published, there’s a long way to go before any reform can be implemented. However, change is happening. Providers are coming up with new solutions to combat issues the sector has long faced and we take a look at one such example in our Business Clinic this month. Read

the feature on page 28 to see what you think of Caremark’s new model of homecare and whether you agree with our panel’s analysis.

QUALITY CARE We’ve also seen a report this month from Independent Age on the quality of care homes and Mike Short has used his market intelligence to look at the impact of ratings, variations across the country and more in his article on page 24.

LOOKING AHEAD In this issue, we are also saying good luck to our female colleagues who will be moving into different roles imminently. On page 20, Sharon Allen, Sharon Blackburn, Janet Morrison and Bridget Warr all impart their thoughts on how the sector has changed over the last ten years, and offer their hopes for the future of adult social care. We wish them all the very best in

their ventures and will be keenly watching as they embark on their new roles. One take-away from the feature is how person-centred care has become a key area of focus and the positive impact this is having, and on page 35, we’ve got a feature from the woman behind Think Local, Act Personal. Caroline Speirs discusses the Making it Real framework and how it can help you and your staff to think more carefully about working with individuals to support their specific needs in the way that they want. Exploring person-centred support from an often overlooked perspective, this month has seen

the release of CQC’s new guidance on sexuality and relationships in care settings. This is a welcomed document and Debbie Ivanova looks at this topic in detail in her Inside CQC column on page 7.

DON’T MISS OUT Lastly, we are looking forward to meeting colleagues in Leeds for our inaugural CMM Insight Leeds Care Conference on 20th June. Read our preview on page 48 to see what you can expect from the day and book tickets on the CMM website, where providers can sign up for free to access discounts to events and view the CMM archives.

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

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The last time I wrote for ‘Inside CQC’, I talked about CQC’s equality and human rights approach to regulation. In particular, how we use our equality objectives to focus on areas where we think we can encourage the sector to grow in confidence in how it supports difference and equality. In this column, I want to share the latest example of how we’re doing this – our guidance on Relationships and sexuality in adult social care services. The idea for this guidance came from conversations we’ve had with people who use services, providers and our own inspectors about how people should be supported to express their sexuality and have relationships when they are using care and support services. Firstly, as is often the case with sex and relationships, there is an element of taboo and embarrassment around talking openly about this. We wanted to develop some guidance that talks about the issues in a straightforward way to support providers to start their own conversations within staff teams and with people using their services. Secondly, we know that there is nervousness about getting it wrong when it comes to sex and relationships, in particular around establishing capacity and consent in relation to sexual activity. It’s not surprising that some providers have told us they feel cautious about sex and relationships – they want to protect people from harm and abuse – but it’s very important that people have the right to express their sexuality and have relationships supported. We have designed the guidance in an FAQ style to clearly answer all the ‘questions you were too embarrassed to ask’ and help providers feel confident that they have the information they need to navigate these issues. Finally, this is a very live topic. Providers are supporting people with increasingly complex needs, including people living with dementia; this and other damage to the brain can lead to some people being less sexually inhibited in their speech and behaviours. Staff supporting people with neurological impairments need to understand how the brain is influencing their behaviour and how they can support them. It’s also crucial that providers understand sexual orientation and gender identity in order to support the increasing number of LGBT+ people using services. If providers do not understand what LGBT+ means and are

Inside CQC D E B B I E

I V A N O V A

Debbie Ivanova, Deputy Chief Inspector of Adult Social Care at the Care Quality Commission (CQC) explores the regulator’s latest guidance around supporting people’s sexuality in care services.

not proactive in how they support people to be themselves when they receive care and support, then, as the film Gen Silent puts it, the generation that fought hardest to come out will go back in to survive. That can’t be right, so services must promote LGBT+ inclusive practices to prevent people from

“Some providers have told us they feel cautious about sex and relationships – they want to protect people from harm and abuse.” being faced with that choice. None of this will be rocket science to Care Management Matters readers. After all, being person-centred is the foundation of good care. But we know there are still barriers to people being properly supported to form and maintain personal, loving, intimate and sexual relationships and at CQC we believe we have

a role in sharing information that supports providers and staff to do this well. Related to this guidance, we have been carrying out work to better understand how safety incidents of a sexual nature occur within adult social care settings. This has involved analysing notifications data submitted to CQC by providers and engagement with people who use services, providers, registered managers and frontline care workers to understand the issues. Over the next month, we will be co-producing recommendations on how we can improve sexual safety – keep an eye on our monthly newsletters for information on how to get involved. When we publish the report of this work in the summer, we won’t only be talking about what we’ve found and our recommendations. We will be sharing case study examples of some of the great work happening within services to protect people from sexual harm whilst still promoting people’s rights. We hope that this, along with the guidance, will offer providers clarity and direction around this sensitive and complex area.

Debbie Ivanova is Deputy Chief Inspector of Adult Social Care at the Care Quality Commission. Share your thoughts and feedback on Debbie’s column on the CMM website www.caremanagementmatters.co.uk CMM April 2019

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Decline in quality of care homes The quality of care homes has worsened in the last year in more than a third of local authorities (37%), according to a report by Independent Age. The older people’s charity analysed a snapshot of the CQC’s inspection data in January 2018 and January 2019, and found that more than a third of local authorities saw a drop in performance between the two dates. This is a stark increase on the 22% of local authorities that saw the quality of care homes worsen between 2017 and 2018. The report also found that,

in Manchester, 44% of care homes were rated Inadequate or Requires Improvement, while in 16 local authority areas, between 30%-40% of care homes were rated Inadequate or Requires Improvement. Issues highlighted have included residents not receiving medicine as prescribed, and their nutrition and hydration not being monitored. Independent Age says that it thinks lessons can be learned from the education sector’s approach to making improvements. Ofsted’s approaches to supporting

failing schools have included a comprehensive improvement plan, such as management changes, arranging for expert help from other schools and regular reinspections. These tactics are not consistently employed across the care home sector, but could be used to help tackle poor quality of care homes. Independent Age is also calling for urgent action to end the poor and inadequate quality of care and for Government to finalise a sustainable long-term funding settlement for social care now.

Health for Care coalition The Health for Care coalition has called for Government to create a sustainable system for the sector in a letter to the Prime Minister. The new coalition of health organisations, led by the NHS Confederation, points out that in England at least 1.4 million older people who require support now receive no help because the social care system is failing. The Health for Care coalition is calling for a funding settlement, which puts social care on to a sustainable path for the longer term, as well as addressing shortterm needs from April 2020. The coalition states that this will require secure funding commitments, a workforce strategy and a diverse and stable market of providers. The coalition maintains that this is not only the right thing to

do, but that it is also needed if the health service is to deliver the ambitions of the Long Term Plan. The work of Health for Care builds on analysis commissioned by the NHS Confederation from the Institute of Fiscal Studies and Health Foundation which found that social care funding would need to increase by 3.9% a year just to meet the needs of an ageing population and an increasing number of younger adults living with disabilities. To inform the Government’s Green Paper, Health for Care has developed a set of principles to underpin a sustainable social care system, together with three recommendations to the Prime Minister that it believes are critical to achieving a long-term settlement, including that:

• Eligibility should be based on need and must be widened to make sure that those with unmet or under-met need have access to appropriate care and support. • Any new settlement should provide secure, long-term funding at a level to enable the social care system to operate effectively and deliver the outcomes that people want and need. • Significant additional funds must come with a willingness to reform and improve the ways in which care is delivered. Social care and the NHS are working together to transform and integrate local care services, but they can only go so far when services are being placed under so much strain. More information is available on the NHS Confederation website.

Council Tax won’t cover rising costs The social care precept will not raise enough money this year to prevent further cutbacks, the Local Government Association (LGA) has announced. Extensive annual research by the LGA has revealed that: • 67 social care councils (44%) are unable to levy any more social care precept in 2019/20. • 83 social care authorities are considering or have approved an adult social care precept in 2019/20, with 38 using the full 2% precept available to them. • The adult social care precept rises will raise an extra £197m to pay for adult social care services this year. This is not even equivalent to the estimated £290m that councils will need to pay for the increase in the National Living Wage this year, says LGA. The LGA states that even if all councils were to use their full Council Tax flexibilities, adult social care services would still face a funding gap of at least £1bn in 2019/20, just to maintain existing standards of care. This will rise to £3.6bn by 2025. The LGA is calling for Government to use the Spending Review to tackle the immediate adult social care funding gap and find a long-term funding solution to this adult social care crisis. CMM April 2019

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NEWS

Learning from international colleagues Australian SAGE Tour delegates have engaged in an opportunity to hear about the UK care sector from specialist sector representatives as part of a study tour designed to give SAGE delegates insight into the older people’s systems models of care in England. Participants visited significant public and private organisations, including retirement villages and care homes. They also had the opportunity to meet key decision makers

from the UK at a drinks reception hosted by Person Centred Software and the National Care Forum. Jonathan Papworth, Chief Executive of Person Centred Software, led the international exchange of best practice and sharing ideas and innovations. The guests welcomed Chelsea Pensioners Dewi and John, who provided an insight into life at the Royal Hospital Chelsea and shared life stories of serving in Her Majesties Forces.

Preparing for a no-deal Brexit Minister of State for Care, Caroline Dinenage has written to social care providers on preparing for a no-deal Brexit. Her letter states, ‘We are working closely with the Ministry of Housing, Communities and Local Government to ensure local authorities and the adult social care sector are as prepared as possible for the implications of EU Exit. ‘…The contingency arrangements that are being implemented nationally will provide a significant level of supply resilience for a full range of products that adult social care providers will require to ensure they can maintain care for the people they support. However, to enhance this resilience further, we recommend that adult social care providers take the following actions ahead of 29 March 2019:

• Providers of care services do not need to stockpile products. However, where your organisation relies on receiving products directly from the EU on a short lead time basis (i.e. 24 to 48 hours), you may need to plan for longer lead times of around three days as part of business continuity plans. • Assess your ability to receive stock deliveries outside your current normal goods receipting hours. • Refer to business continuity plan guidance issued in the 21 December 2018 letters. • Work at local level with the relevant Director of Adult Social Services.’ Further information on planning for a no-deal Brexit is available on the Department of Health and Social Care’s website.

Social care parliamentary group A new social care parliamentary group has launched in Westminster amid warnings from GMB Union that the care sector is in crisis. The All Party Parliamentary Group on Social Care (APPG Social Care) is a cross-party group of MPs who have come together to look at the care system, funding and state of staffing in the sector. The group is sponsored by GMB Union and its first inquiry will be sponsored by HC-One. This inquiry is due to take evidence in the coming months. Tim Roache, GMB Union General Secretary, said, 'Throughout our lives, we will all come into contact with care – be it our mums and dads needing help, working as a

carer or knowing someone who does. Ultimately we will all need it ourselves. 'Care workers do a crucial, professional job but are not paid, seen or valued as the frontline public sector workers they are. 'Our care system right now is in crisis, it is crumbling beneath us because the funding isn’t there. 'I’m proud GMB is supporting this new parliamentary group which will look at real lives and real situations, and will make evidenced-based proposals about what must be done in government to make sure we have a care system which values our care workers, and everyone gets the care and support they need.'

Working well with families Skills for Care is looking for providers to complete a short survey about how the sector can work better with families of people using services. The organisation has developed a draft framework with Avenues Group, which includes what staff need to know, how they need to work and what can be done in terms of training to help those looking to include the families of people using services more, and to be more active in working well with families. The framework highlights four key areas: • Understand the importance of partnership working and instilling a family, person-centred approach. • Establish and maintain positive

relationships with families. • Maintain open communication with families and review how you work with them. • Actively encourage people who need care and support to maintain family relationships and/or social contacts and networks. It also explores the values, skills and knowledge that staff in adult social care need so that employers can ensure their staff are equipped to work well with families. Skills for Care is now consulting on the framework, asking for the views of managers, staff, people using services and their families. The consultation runs until Monday 1st April 2019 and is available on the Skills for Care website.

CQC guidance on sexuality and relationships The Care Quality Commission (CQC) has published guidance on sexuality and relationships to help providers to support people's specific needs. The guidance builds on CQC's quality framework, adding further detail on issues like relationships, diversity and protecting people from harm. It covers several 10

CMM April 2019

often complex issues, including supporting people to form and maintain relationships, while also helping them to understand risks. The guidance on sexuality and relationships has been developed with the support of providers and public representative bodies. Claire Bates of the Supported Loving campaign and Sue Sharples of

U-Night Group said, 'This is a longawaited document that will give providers clarity and direction in relation to a sensitive and complex area of need. 'It affirms the link between supporting opportunities for sexual expression and personal wellbeing, within a framework of care services' regulatory responsibilities.

'Our organisations were pleased to be consulted in the development phase of the guidance, including gaining the perspective of members with a learning disability.' An easy read summary of the guidance is also available. For more details, see Debbie Ivanova’s column on page 7.


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NEWS

Unison granted leave to appeal sleep-ins ruling The sleep-ins saga will continue, it has been confirmed, as Unison is granted leave to appeal the Court of Appeal's ruling on the issue. The case between Unison, acting on behalf of Tomlinson-Blake, and Mencap will now be reviewed by the Supreme Court. This decision, which is set to increase uncertainty in the sector, could see care providers

forced to pay an estimated £400m in arrears allegedly owed to care workers deemed to be underpaid for overnight shifts. The date for the Supreme Court hearing is yet to be set, but is likely to be no earlier than October. Commenting on the decision, Matthew Wort, Partner at Anthony Collins Solicitors, said, '[This]

decision from the Supreme Court extends the period of uncertainty for a care sector desperate for extra government investment. The date for the Supreme Court hearing is yet to be announced, but it has confirmed to me...that it will not be until October 2019 at the very earliest. 'Care providers are in urgent

need of both consistency and clarity about sleep-in pay, but sadly the wait for a definitive final position on the issue is many months away. 'In the meantime, we hope commissioners of sleep-in care will maintain payments to providers, enabling them to continue their current pay practice for sleep-ins.'

Public aren’t planning for end of life care Which? Later Life Care has surveyed over 3,000 people to understand what arrangements people have in place for their own end of life care, or that of a loved one, and discovered a concerning lack of awareness of options for arranging end of life care. Seven in ten (71%) said that they have made no plans at all for their end of life care. Of the remaining 29% that have, three in ten (28%) have prepared an advance decision (commonly

known as a living will). The most common step taken among those that had made plans for end of life was writing a will (93%), outlining what should happen to their property, possessions and money after they die. Six in ten had organised a Power of Attorney, and 58% had discussed their end of life care preferences with family or friends. The research also uncovered a lack of awareness of how hospices can help with end of life care.

Of those who had never been involved in arranging hospice care, only one in three people (31%) correctly believed that hospice care is free for all, while 17% thought that patients needed to pay for care in a hospice. What’s more, just under twothirds (62%) of those who had never been involved in arranging hospice care were unaware that hospices could provide care at home as well as in the hospice. Which? Later Life Care is urging

people to do their research and ensure they are planning for end of life care, to avoid loved ones having to make stressful and uninformed decisions in moments of crisis, and to ensure their wishes for their end of life care are known and respected. Which? Later Life Care has two free and independent advice guides on end of life care options and planning ahead for end of life care, to help guide people through the process.

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CMM April 2019


NEWS

‘Declare Your Care’ campaign

Dignus Healthcare Group

The Care Quality Commission (CQC) is calling for people to speak up about their experiences of care as part of its new Declare Your Care campaign. The call for people to be more forthcoming with their views comes as new research shows that almost 7 million people in England who have accessed health or social care services in the last five years have had concerns about their care, but never raised them. Of these, over half (58%) expressed regret about not doing so. The most common reasons for not raising a concern were not knowing how (20%) or who (33%) to raise it with, not wanting to be seen as a ‘troublemaker’ (33%) and worries about not being taken seriously (28%). Over a third of people (37%) felt that nothing would change as a result. However, when people did raise a concern or complaint, the majority (66%) found their issue was resolved quickly, it helped the

RD Capital Partners, via its healthcare subsidiary, RDCP Care, has acquired Dignus Healthcare Group in a deal supported by an eight-figure funding package structured by Allied Irish Bank (AIB). Dignus Healthcare supports individuals with mental health conditions and learning disabilities. RDCP has acquired all four of Dignus Healthcare’s

service to improve and they were happy with the outcome. The Declare Your Care campaign is encouraging people to share their experiences of care with CQC to support its work to improve standards of care. The majority of people who did raise a concern or complaint were motivated by a desire to make sure that care improved for others. This included wanting to improve the care they, or a loved one, had received (61%) and improve care for everyone using the service (55%) with a smaller number also hoping for an apology or explanation (26%). The main reasons given for raising, or wanting to raise, a concern were delays to a service or appointment, lack of information and poor patient care. Additionally, over a fifth indicated that they have raised or wanted to raise concerns about the lack of communication between health and care services.

Midlands elderly care homes: Bearwood Nursing Home in Smethwick, Bartholamew Lodge Nursing Home in Wednesbury, Richmond Court Nursing Home and Caldene Rest Home both in West Bromwich. This acquisition forms part of RDCP Care’s continued growth strategy to expand their ownership of care and nursing homes.

Westward Care Westward Care has announced that the final phase of development at their Southlands location in Roundhay, Leeds is complete, representing the end of a £4.3m investment. Peter Hodkinson, managing director of Westward Care, said, ‘We’re delighted to be able to announce that the final phase of investment in Southlands is complete and we look forward to

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NEWS / IN FOCUS

Access to personal health budgets extended Wheelchair users and people who access aftercare services under the Mental Health Act are being given the right to a personal health budget to choose their own tailored health and care support. Personal health budgets have proved successful and costeffective in helping people with complex needs stay healthy and independent for longer, improving wellbeing, joining up local health and social care services and helping reduce pressure on emergency care. Over 40,000 people currently benefit from the scheme but access will be increased so that up to 200,000 people can receive a

personal health budget by 2024. As well as extending the legal right to wheelchair users and people eligible for free posthospital aftercare under the Mental Health Act, the NHS will also work to expand access for more people with ongoing mental health needs, veterans, people with autism, those with learning disabilities and people receiving adult social care support. The move is part of the NHS Long Term Plan’s aim to expand personalised care which will be rolled out to 2.5 million people by 2024 via measures including personal health budgets and social prescribing.

Call for participation in dementia research The Minister for Care is calling for more participation in dementia research as part of the Government's national Dementia 2020 Challenge. More than 100,000 people with dementia are being urged to take part in research studies to help make England the best in the world for dementia care, support, research and awareness. To help tackle the global health challenge, Government launched the Dementia 2020 Challenge in 2015. Progress on the Challenge has already turned out the following results: • The dementia diagnosis rate has increased from 59% in 2015 to 67.9% which is above the requirement of 66.7% of people living with dementia. • There are now over 2.8 million Dementia Friends. • Dementia is included in NHS Health Checks, increasing the number of people aged 40-74 who are given advice on reducing their risk of dementia. • One million health care staff have received a level of dementia training so they can recognise and understand dementia, and

signpost individuals and carers to appropriate support. • Government's investment in dementia research has risen hugely, at over £82.5m last year. A review of progress on the Challenge also identified opportunities for where further progress could be made. These include: • Improving participation in dementia research to generate breakthroughs. Less than 4% of people diagnosed in England are currently involved in studies. The aim is to have 25% of people with a diagnosis signed up to Join Dementia Research. • Improving public awareness of the risk factors around dementia, such as heavy drinking, diabetes or high blood pressure. Recent Alzheimer’s Research UK found that only 1% of the public were able to name the seven known risks for dementia. • Enhancing our understanding of early onset dementia, including prevalence, diagnostic rate and whether GPs need additional training to improve care for younger people with dementia.

IN FOCUS Hft annual Sector Pulse Check WHAT’S THE STORY?

Hft’s annual Sector Pulse Check has revealed that financial pressures could start to directly impact the vulnerable adults who rely on social care. The report shows that the number of providers handing back contracts has more than doubled in the past 12 months. This is the second Hft annual Sector Pulse Check report, carried out by independent economics and business consultancy Cebr, and is the first of its kind to focus primarily on learning disability providers. Based on survey analysis from social care providers, it provides an annual snapshot of the financial health of the social care sector over the past year and an idea of how providers suspect the next twelve months will progress.

WHAT ARE THE FINDINGS?

The research found that, in 2018, more than half (59%) of providers had been forced to close down some parts of their organisation or hand back contracts to local authorities to deal with cost pressures. 68% envisaged having to do the same in the near future, while 11% foresaw a decline in care quality if their financial situation did not improve. This could mean that those who are supported by the sector may begin to be directly affected by the funding pressures, says Hft. The survey also found that recruitment remains a challenge, with 80% of providers reporting low wages as the biggest barrier to recruiting and retaining staff. In the last year, the number of providers citing the increased

cost of agency workers as one of their main cost pressures has increased from 13% to 63%. This comes second only to rising wage bills. The report also highlighted that: • More than three-quarters (78%) of providers have increased their focus on recruitment over the past year, with twothirds (67%) of these running a dedicated campaign to help reduce staff vacancies. • Only 4% of providers have completed their preparations for Brexit, while a further 28% have either not yet started or were less prepared than last year. • There is a lack of confidence that Government will resolve the sleep-ins crisis, with the majority of the sector (72%) stating they did not believe that this year would see a decisive end to the issue.

WHAT DOES THE SECTOR SAY?

Voluntary Organisations Disability Group (VODG) Chief Executive, Dr Rhidian Hughes said, 'People with a learning disability rely on the state to pay for essential care services and this new report puts the spotlight firmly on Government and its failure to adequately fund the sector. 'Local commissioning is not keeping pace with the rising costs of care provision, investment in the sector is being seriously eroded and the sustainability of future services is now under real threat. 'This situation is not fair to the individuals and families who rely on care services, nor the workforce, and Government must take steps to immediately shore up the sector.' CMM April 2019

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NEWS

Mandatory learning disability and autism training Government has announced plans to introduce mandatory learning disability and autism training for NHS and social care staff. As part of an eight-week consultation on the training, Government is seeking the views of health and social care staff, employers, charities and people with a learning disability or on the autism spectrum, as well as their families and carers. Up to 2.8 million health and social care staff at all levels who regularly have contact with people using services could be legally required to undertake the training

under new Government proposals. The plans have been welcomed by campaigners and will help to address the difference in life expectancy between those with a learning disability and those without. Currently, the life expectancy of women with a learning disability is 18 years lower than those without, with a 14-year gap for men. People with autism also face barriers to accessing healthcare. All relevant staff could receive a level of training to provide: • An understanding of learning disability and autism and the

impact they have on someone's life, including challenging unconscious attitudes which can lead to a failure to spot key symptoms, and ensuring individuals, their carers or families are listened to. • Knowledge of the fundamental rights of people with a learning disability or autism, and how these can be translated into action, e.g. the need to provide information in an accessible format and make sure people’s views and concerns are heard. • Advice on how to make practical reasonable adjustments to

improve how people with a learning disability and people with autism, of all ages, are supported. The proposals would see people with autism and those with a learning disability involved in the training, to help challenge attitudes and unconscious bias. Government is exploring routes to make the training a legal requirement, and expect that it would become part of health and care workers’ education and training, either before qualification, or in the role if already qualified.

Monitoring the Mental Health Act The Care Quality Commission (CQC) has published Monitoring the Mental Health Act in 2017/18 and has found some improvement in the quality of care planning for patients who are subject to the Mental Health Act. However, it continues to have concerns around

the quality and safety of mental health wards. CQC has concluded that there has been an overall improvement in some aspects of care in 2016 to 2018, compared with findings in 2014 to 2016. It found: • A higher proportion of care plans

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CMM April 2019

were detailed, comprehensive and developed with patients and carers. However, there was still room for further improvement. • The provision of information about legal rights to patients and relatives was still the most frequently raised issue. In many

cases, patients may struggle to understand information given to them on admission because they are most ill at this point. • The greatest concern is about the quality and safety of mental health wards; in particular acute wards for adults of working age.


NEWS

State of Local Government Finance Survey Nearly all councils plan on raising Council Tax this year, according to the 2019 State of Local Government Finance Survey. Of the councils that responded to the Local Government Information Unit (LGiU) and The Municipal Journal survey, more than half (53%) are eating into their reserves to stay afloat, four out of five (81%) are investing in commercial developments while

nearly half are planning on cuts to services. Eight in ten senior council decision makers believe the current system for council funding is unsustainable. A quarter of councils said planned cuts to services in the coming year would be noticed by the public. Worryingly, the financial situation is so bad for one in 20 councils (22 councils in England) that they are concerned

they won’t be able to deliver the legal minimum service for residents. Children’s services and education are the top immediate financial pressures for the second year running (36% of councils), ahead of adult social care (23%) which has historically ranked highest. However, adult social care is still under severe strain, being named as the top long-term

financial pressure (37% of councils). Services for vulnerable people are going to be facing cuts, according to the State of Local Government Finance Survey, with councils planning to reduce activity in adult social care (29%), children’s care services (24%), special education and disability support (16%), homelessness support (11%) and funding for local Citizens Advice services (18%).

Recruitment campaign for care workers in Wales DC Care A new recruitment campaign for care workers in Wales has been launched to attract more people to the social care sector. The campaign, called WeCare, is a collaboration between Social Care Wales and leading organisations representing social care, early years and childcare in Wales, as well as other national bodies. It is part of a long-term strategy to develop the workforces in the

care and health sectors over the next decade, to provide a highquality, seamless service to the people of Wales. The campaign will highlight the breadth of career opportunities in care, from childminders to home care co-ordinators and care home managers. Currently, around one in 17 adults in Wales works in social care or early years and childcare

(around 113,000 people), making it a bigger employer than the NHS. But this area of work is growing. The WeCare campaign uses real care workers and focuses on the challenges they face as well as what makes their work rewarding and worthwhile. More information about the recruitment campaign for care workers in Wales is available on the WeCare website.

DC Care has announced the sale of Clitheroe Care Home Limited, located in Clitheroe, Lancashire. The home is registered for 28 people who need care and support, and is a former private residence, with a purpose-built extension. Alison Willoughby, Regional Director, appraised the business and managed the sale alongside Sales Negotiator, Lisa Rushworth.

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NEWS

Staff of social services departments

Mental health support for NHS staff

NHS Digital has published its latest annual report on components of the staff of social services departments in England. Personal Social Services: Staff of Social Services Departments, England 2018 includes information on the people employed by local authority adult social services as at September 2018. It covers the 112,200 workers employed by local authorities in adult social care services in 2017, accounting for approximately 6.8% of the total adult social care workforce in England. The report is compiled from data collected by the National Minimum Data Set for Social Care (NMDS-SC), which is managed by Skills for Care on behalf of the Department of Health and Social Care.

Government is setting out new plans to provide better mental health support for NHS staff. The new support will be based on recommendations by Health Education England (HEE) and could include: • Post-incident support for NHS frontline staff, such as peer group support or a more formal psychological assessment. • A dedicated mental health support service giving confidential advice and support 24 hours a day. • Fast-tracked mental health referrals for NHS employees if requested as a priority from either a GP or an occupational health clinician. • Improved rest spaces for oncall staff and trainees during and after their shifts, providing security, shower facilities and refreshments. • An ‘NHS workforce wellbeing guardian’ in every NHS organisation, responsible for championing mental health and wellbeing support for staff.

Information in the report includes: • The number of local authority adult social care jobs by job role and employer type. • Starters, leavers and vacancy rates. • The proportion of jobs with zero hours contracts, by job role group. • The average number of hours per week which are worked by adult social care staff within local authorities. • Individual worker characteristics such as gender, age, ethnicity, pay and qualifications. • Average number of sick days taken by adult social care staff in local authorities. You can read the full report on the NHS Digital website.

Carer Passports initiative recognised Carer Passports, a UK initiative championed by Carers UK that recognises the role of unpaid carers in the UK health system, has been selected as a global innovative practice by the International Alliance of Carer Organizations (IACO) and global group, Embracing Carers. A 2017 Embracing Carers global carer survey revealed that a quarter (24%) of unpaid carers feel their role as a carer is not recognised within the healthcare system – despite the critical role they play in maintaining their loved one’s health. Carer Passports are used to help hospitals identify unpaid carers and gather important insight that informs patient care. They bring better co-ordination, understanding and communication between hospital staff and carers and have shown to improve care and health outcomes for patients.

Carer Passports also help carers to feel more valued and become more confident about what they can expect from hospital staff. The scheme provides carers access to support such as free hospital parking, discounts in the hospital canteen or information and resources, depending on what benefits the hospital is able to offer. Carers UK has championed the use of Carer Passports in hospitals and was funded by the Department of Health and Social Care to develop a suite of resources to help hospitals develop and implement Carer Passport schemes, such as template application forms and publicity posters. Carer Passports are the second practice featured as part of a global Innovative Carer Practices series to spread and scale new ways to support carers around the world.

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CMM April 2019

HEE made the recommendations in its report on the mental health and wellbeing of NHS staff and learners, commissioned by the Department of Health and Social Care last year. The recommendations to improve mental health support for NHS staff will be considered as part of the ‘workforce implementation plan’, which will be led by NHS Improvement Chair, Dido Harding and Leeds Teaching Hospitals Trust Chief Executive, Julian Hartley. HEE spoke to staff whose wellbeing had been affected by their experiences in the NHS workplace, as well family members who had lost relatives through suicide. They also visited organisations that are already demonstrating good practice in supporting staff mental and physical wellbeing to understand how these initiatives could be rolled out across the NHS. The measures should help NHS organisations make positive progress on sickness absence rates, staff performance and retention.

Workforce Development Fund The Workforce Development Fund 2019-20 is now open for grant applications. Both large national organisations and lead organisations of employer-led partnerships are eligible for the funding. The Workforce Development Fund is disseminated by Skills for Care with a view to supporting adult social care employers in England with the cost of developing their workforce. The investment is designed to ensure workers have the right skills and knowledge to be competent and confident in their roles. The fund will provide enhanced funding for courses aimed at developing leaders and managers. Government is committed to

investing in the continuing professional development (CPD) of new managers, existing managers, deputies and aspiring managers. The Fund will continue to support the learning and development of frontline workers with enhanced funding available to learners completing an apprenticeship standard. Large national organisations can apply for a grant to support the CPD of their workforce. They must have more than 1,000 careproviding employees and provide adult social care services in two or more Skills for Care defined areas. The deadline for applications is 1.00pm on Friday 5th April 2019. For more information, visit the Skills for Care website.

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A REFLECTION A REFLECTION

ON THE LAST TEN YEARS

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The start of 2019 saw a flurry of announcements that some of the women who have been leading the sector through the last decade would be leaving their posts. As they embarked on their next challenges, we spoke to them about the last ten years of adult social care, how it has evolved and what they think has to change in the future.

WE MUST RECOGNISE THE SKILL OF THE WORKFORCE In the just shy of nine years that I have been Chief Executive Officer at Skills for Care, the most significant change has been how adult social care has gained political traction. Featured in the main news items on TV, radio and print and regularly discussed in both houses of our Parliament, this is a welcome transition from the days when social care held little political or public interest. Equally important is the broad acceptance that the full involvement (often termed coproduction) of people who access care and support in developing policy, shaping services, and every aspect of social care, is the only way to achieve what people want. It’s not perfect and there is still work to do, but there has been a definite change in the way we organise, talk and do which is hugely welcome. Despite all of this, social care is still a sector that has neither sufficient recognition nor funding. The profile of the sector and the 1.47 million people who work in it is still too low, too negative and not reflective of the reality. I have said many times that it is a source of national shame that social care is talked of as a largely minimum wage sector and that it is infuriating when people conflate low pay with low skill. Social care workers are highly and widely skilled people providing support that enables our fellow citizens to transform their lives. They should be appropriately recognised and rewarded. The key to getting it right is recognising that person-centred has to be both the way we design and provide care and support and the way we recruit, develop, retain and reward the workforce. Two sides of the same coin. It is about acknowledging that high-quality, relationshipbased care and support is a human right, one that many of us will be glad is there at some point in our lives.

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Sharon Allen OBE, Chief Executive Officer, Skills for Care Twitter: @sharonallenarhc CMM April 2019

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A REFLECTION ON THE LAST TEN YEARS

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IMPROVEMENTS HAVE BEEN MADE DESPITE REAL CHALLENGES The three key things I’d really highlight as progress in the last 10 years are involvement of people using services, workforce development and inspection. We have seen real innovation in co-production, involving those using services in defining quality and engaging them in continuous feedback and service improvement. As a founder and Chair of the Campaign to End Loneliness, we’ve seen myriad community schemes flourish, maximizing both the assets of the people using services and the richness of communities. From chatty cafés to community navigators and social prescribing – all have helped inclusion. And care providers large and small have made real in-roads by ensuring they ‘live’ a user-led culture. But quality can’t be delivered without real commitment to workforce development, and Skills for Care has really led the way in supporting providers and the profession to offer improved career pathways, recognition and reward and to help retain the best talent. And the final element – the inspection and regulation regime has improved vastly – it offers clarity, is values-led and has resulted in swifter action where vulnerable clients are at risk. Whether care providers love it or loathe it, the Care Quality Commission has set the tone and expectations for quality. But it’s hard to put these improvements down on paper in the shadow of the real challenges social care faces. Austerity has taken a huge toll. The numbers receiving local authority funded care has fallen hugely (as needs grow); providers are going under or teetering on the edge; with pressures on paying a decent wage, there are staff shortages, and the pressure shows in terms of quality, consistency and reliability. Self-funders are left to fend for themselves. Despite the positive framework set out in the Care Act, without money it’s more a statement of hope than reality. An idea of what might have been? Access to information and advice, person-centred prevention, support for carers, deferred payments and the care cap. Without a fundamental commitment to a new funding settlement for social care and greater integration with health, none of these aspirations have been fully realised. We should be angry – very angry. As Westminster mires itself in Brexit, social care burns. A wishy-washy green paper is expected but not looked forward to. Meanwhile vulnerable people struggle to live with the dignity and support they need. It’s shameful. Janet Morrison, Chair, The Baring Foundation and Chair, Association of Charitable Foundations Twitter: @JanetMorrisonUK

I MUST BELIEVE WE CAN MAKE THE NECESSARY CHANGES The last ten years have been challenging for homecare, particularly where state-funded care is concerned. Increasing financial constraints have led to knee-jerk commissioning by local authorities (risking both client dignity and staff job satisfaction) and removed capacity to innovate. There is significant unmet need and ‘preventative’ support is seen as an unaffordable luxury. Most homecare workers are still shamefully poorly paid for their highly skilled work. Meanwhile, the work is increasingly complex, often involving nursing tasks. Technology has transformed some of the office tasks, such as rostering and communication, and is beginning to enrich people’s lives at home. Providers, frustrated by the constraints, are still determined to maintain quality services for their clients. If you are able to pay for your own homecare, you see its true advantages: flexible, consistent care, meeting your specific needs and preferences, enabling you to remain healthy and safe at home, less likely to need hospital admission, and less demanding of scarce local authority resources. Isn’t that really the point? Shouldn’t we be delivering a system which is genuinely geared to maintaining people’s health, wellbeing and independence; saving the state money in both social care and health? A system where the gaps and barriers between the delivery of tailored services around the individual (housing, leisure and transport as well as social care and health) are deliberately eliminated? I can imagine the murmurs of ‘get real!’, but I have had the pleasure of working with many people who absolutely share that vision and work tirelessly to help make it happen; seeking opportunities to build trust and understanding and responding together to the needs and preferences of the individual. The NHS Long Term plan rightly promotes a move to community and the (two-year-delayed) green paper and Spending Review might possibly help move things forward. With financial, directional and practical help from Westminster and the devolved governments, harnessing the goodwill that is undoubtedly available, I must believe we can make the necessary changes. Of course, it will take time and will involve that most painful of acts – sharing or relinquishing power and sharing budgets – but the demographics and economy (if nothing else) mean that we must commit energy, determination and resource to its achievement. Bridget Warr CBE, Chief Executive, United Kingdom Homecare Association Twitter: @ukhca

WE HAVE ACHIEVED MUCH BUT THERE’S MORE TO BE DONE The key to great social care centres around people who use services, their families, significant others and the staff that work with them. The relationships between these groups of people make or break the reality of a great or not so great experience for the person in need of care and support. Listening is a key part of any relationship. In the last 10 years, the voice of people using services has become significantly louder, and social care is getting more airplay. More professionals now start from the perspective of people using services, which has to be applauded. The opportunity for people to engage and influence policy and practice has significantly increased – including negotiating how language is used and the different meanings it has across the sectors. Conversations have begun to shift from being about ‘them’ to being about ‘us‘, recognising that we are all citizens who use services. Sadly, more airplay does not equate with the value of social care being better understood. Successive governments, plus multiple reports by various reputable organisations, have articulated the changes that need to take place, but social care and the people who work in this amazing sector are not held with the same as esteem as the NHS. It seems that the relationship falls short and those that need to hear and then act do not do so. I am a great believer in ‘being the change you want to see’. We all have a part to play. Social care is not a Cinderella service. We need to strongly articulate why social care is good for citizens and society; good for the NHS; and good for the economy. We have achieved much but still more needs to be done. We can’t do that which we have always done; we need to embrace new ways of working which engage people, our communities and technology. Money is an issue and we do need more of it; however, it is part of the solution, not the only solution. CMM Sharon Blackburn CBE, Policy and Communications Director, National Care Forum Twitter: @stb1106 What do you think the most important changes have been in social care’s last ten years? Share your views on the CMM website www.caremanagmentmatters.co.uk or tweet @CMM_magazine CMM April 2019

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Painting the picture HOW FAIR IS THE CQC QUALITY RATING SYSTEM? Quality ratings – they’re a huge part of running a care business and every provider is aiming for the coveted Outstanding. But are they fair? How do they differ from region to region and between sectors? What are your chances of achieving a Good rating? Mike Short from Care Sector Innovations uses his insight to share a picture of the trends.

In October, the Care Quality Commission (CQC) will have completed five years of inspections using the ‘Mum Test’ process, measuring its five Key Lines of Enquiry (KLOEs) to establish one of four ratings for all locations under its supervision. Over the last four and a half years, the ratings, especially the non-compliant ones, have caused controversy, sparking a number of national media stories slating the state of care quality. Not being a care provider, I have never had a professional axe to grind with CQC. However, to build up market intelligence on the care sector, I keep a constant eye out for trends. My first editorial on the subject

was in May 2015, just a few months after the introduction of the Mum Test, when I analysed a snapshot of early ratings published on the CQC website. My headline was Why is a Care Home in West Sussex Ten Times More Likely to be Classified Inadequate than a Care Home in the West Midlands? Okay, maybe I did have an axe to grind, because the ‘victim’ was West Sussex, my home county. The analysis established that only 2.5% of all care homes in the West Midlands were rated Inadequate, compared to 17.5% in the South East. West Sussex had an even greater proportion than its mother region, with 25% given the Inadequate rating, ten times that of the West Midlands.

Over time, regional variances have reduced, probably due to the increased volume of ratings. Care standards will vary between providers for numerous reasons, but my concern is that the different subjectivities of local teams of inspectors, along with other issues, affects the comparison of care quality on an even field.

VARIATIONS BETWEEN SECTORS Care providers are used to the CQC knocking on the door on a regular basis, turning up unannounced to undertake an inspection. Around 95% of care homes in the UK have an inspection rating on their public records, and many will have been inspected a number of times over the last four and a half years. 94% of GPs and 75% of homecare businesses have also been through the process, but only 37% of NHS hospitals currently have a published quality rating. And even this is greater than the 25% of their independent ‘competitors’ that have been rated. Why should certain sectors be under constant

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CMM April 2019

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PAINTING THE PICTURE: HOW FAIR IS THE CQC QUALITY RATING SYSTEM?

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scrutiny, while the mighty NHS is relatively untouched by CQC? If you look at the results of the inspections that have been undertaken at NHS hospitals, it is worrying that the percentage of ratings given is not higher. The percentages of services rated Good or Outstanding are as follows: • Care homes: 78.4%. • GPs: 95%. • Homecare: 87%. • NHS acute hospitals: 44.6%. On the basis that so few NHS acute hospitals have had an inspection report published, only one in six of all NHS acute hospitals have proved they are compliant, so why have the rest not been inspected?

THE MUM TEST RATINGS MIX As all providers know, the five KLOEs are Safe, Effective, Caring, Responsive and Well-Led, and each are given an Outstanding, Good, Requires Improvement or Inadequate rating. The KLOEs are then aggregated to come up with the Overall rating. If the same rating is given for each KLOE, then the Overall rating will match these. But what if there is a mix across the ratings given for individual KLOEs? Amongst many other permutations, these are a few of the more pertinent examples I came across when analysing the latest list of CQC care home ratings: Homes rated Requires Improvement: Home A: Four Requires Improvement and one Inadequate. Home B: Three Good and two Requires Improvement. Homes rated Inadequate: Home C: Three Good and two Inadequate. Homes rated Outstanding: Home D: Three Good and two Outstanding.

Home A, which did not achieve a single compliant rating across any of the KLOEs, is given a Requires Improvement rating. Home C who is compliant with three Goods but has two Inadequacies is relegated to Inadequate. Is that fair? One predominantly compliant home rated worse than one without any compliance? And what does Home B think? They achieved three Goods against Home A’s zero, and no Inadequacies, and yet they share the same Requires Improvement rating. Out of all the five KLOEs, safety will be top of the CQC Inspector’s list. If a home is not Safe, this in itself is an inadequacy. However, looking at a group of Home A examples, in 50% of cases Safe was the one KLOE that was judged to be Inadequate. There are some peculiarities at the top end of the ratings as well. As we can see above, Home B is rated Requires Improvement. Now consider Home D which, like Home B achieved three Good ratings, but instead of two Requires Improvements, gained two Outstanding, and was awarded an Outstanding rating. It’s almost as if all the hard work Home B has put into achieving three Goods is totally ignored. And of all the care homes currently rated Outstanding, only 4% gained the top rating across all five KLOEs, whilst 58% only achieved two.

THE RISE OF INADEQUATE Having noticed the start of a sharp increase in Inadequate ratings, we have been monitoring care ratings on a quarterly basis since the beginning of 2017. The analysis measures all care home ratings published during the relevant quarter. Only 0.1% of homes inspected in the first quarter (Q1) of 2017 were rated Inadequate, but this rose to 1.7% of those rated in Q2,

5% in Q3 and 11% in Q4 – over 100 times more Inadequate ratings than in Q1. In 2018, the proportion of Inadequate ratings each quarter dropped slightly to 9% of homes rated in Q1, 8.4% for those rated in Q2, 7% in Q3 and 6.8% in Q4, but this is still much higher than early 2017. We have to ask, has care quality reduced a such a rate, or has CQC moved the goalposts?

DO RATINGS IMPACT CLOSURES? In 2018, we lost 300 care homes through closure, and with them nearly 10,000 beds. This led to thousands of vulnerable older people being displaced and losing the familiarity and continuity of their home and the people who cared for them. 150 care homes were opened during the same period, continuing the pattern of one opening for every two closures that we’ve seen over the last few years. Supply continues to fall away whilst demand for beds continues to rise. There are many reasons for care home closures. Too much supply against local demand, low local authority contributions to care and a low percentage of selffunders, unsuitable and ageing properties, challenges in recruiting and retaining staff, or even the owners just throwing in the towel due to being totally unimpressed with their local authority and the Government’s lethargy towards the sector. Nationally, there’s a fairly even split amongst ratings levels for those homes which have closed. Of all the care homes that closed in 2018, 34% had an Inadequate rating at the time of closure, 29% Requires Improvement and 36% Good. On a regional basis, however, there were massive variances in the care ratings of the homes that closed.

In the North West, 51% of homes that closed had an Inadequate rating, compared to just 22% for their neighbours, Yorkshire and the Humber. And yet only 1.8% of all care homes in the North West are Inadequate, and 3.1% in Yorkshire and the Humber. This suggests care quality is a much greater factor for closure in the North West, and conversely there are more commercial pressures causing homes to close in Yorkshire and the Humber. Across the country, smaller homes of up to 40 beds accounted for around 75% of all homes that closed and yet around 40% of them had a Good rating. It is a shame that so many care homes working hard to get Good CQC ratings are lost. Homes with 60 beds or more accounted for around 20% of all beds lost through closure. Around 90% of these homes were rated either Inadequate or Requires Improvement, and it is likely that poor care quality was a key factor behind the closures. Closures due to poor CQC ratings cause major issues for care providers and their livelihoods, their employees (how do we encourage people into a career in care if there is a chance of closures and job losses?), and heartache for the residents and their families.

MAINTAINING ANALYSIS Very recently, CQC was forced to abandon its local system review programme after the Department of Health and Social Care ignored a request for approval to continue. I strongly believe that this, or something similar, should be maintained and certainly include ongoing analysis of the type of anomalies that I have highlighted here to ensure that the systems across the country are fair and that providers are given an equal chance, no matter their sector, location or size. Perhaps we should all be lobbying to bring this into effect? CMM

Mike Short is Founder of CSI Market Intelligence. Email: mike@csi-marketintelligence.co.uk Twitter: @CSIMarketIntel How do these statistics relate to care provision in your area? Are you facing closure following a CQC inspection? Share your thoughts and feedback on this feature on the CMM website www.caremanagementmatters.co.uk 26

CMM April 2019


A law firm with a different perspective Health and social care providers need regulatory lawyers who prepare for the future rather than react to the present

At Gordons, we scan the health and social care system looking out for changes that will affect our clients’ businesses, thus assisting them in adapting to the future and enabling them to prosper and grow. Neil Grant, who leads the Health and Social Care Provider Team at Gordons, invites discussion with providers about the coming challenges, whether it be the Liberty Protection Safeguards or changes to CQC regulation. Please feel free to call Neil on 01483 451900 to have an informal discussion about changes that may affect your business over the next year and beyond.

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PATCHCARE – BRINGING THE RESIDENTIAL CARE MODEL TO THE COMMUNITY PatchCare draws on positive aspects of homecare and residential care that work and brings them together to create a person-centred method of caring for people in their homes. Kevin Lewis, Founder and Chief Executive of Caremark, wanted to create a service to help get social care out of the crisis being faced and to provide better support to the people affected by loneliness and isolation. There is a national shift to move away from time and task-based commissioning in the home care sector and PatchCare is aiming to offer an alternative solution.

HOW DOES IT WORK? The idea behind PatchCare is to provide all of the benefits of a care home in a person’s own home. Areas are divided into small geographical ‘patches’, with no more than ten people per patch who require services. Two care workers are allocated to each patch and provide visits based on the people’s needs. This might be helping them to get out of bed and get washed and dressed or supporting them at mealtimes, for example. Having two dedicated care workers for a small area means that clients can receive more visits over the course of a day as needs arise, rather than scheduling visits with limits on the time a care worker can spend with people. Some tasks are planned – e.g., a morning routine might be planned between the two care workers, based on when clients prefer to get up, eat breakfast and get dressed – but as care workers have a small distance to cover, they can easily travel from one person to the next and back again. Care workers can be contacted via a mobile app, which they can also use to 28

CMM April 2019

communicate with each other. Care workers also arrange outings and social events for their patch, so that the people using the service can leave their homes to meet with others. This might be a shopping trip or an outing to a local tearoom. Care workers are paid on a salaried basis, rather than by the hour, and always know when they are working, with set shift patterns. The clients also know who to expect at which points of the day, as the PatchCare system means that consistency of care workers remains. All travel time and waiting time is also included in the care worker’s salary.

THE TRIAL To test the system, Kevin implemented a pilot in West Sussex, which began in April 2018. This was initially funded by the local authority for six months but has been extended to complete in March 2019. The Caremark head office team were involved in setting up the trial, which was run by the managing directors of Caremark Mid-Sussex and Crawley, with the support of their existing team. Two occupational therapists employed by West Sussex council were also involved in monitoring the clients. The pilot has been extremely successful so far, with positive impacts on the people who use the service. Sue Hills, Managing Director of Caremark Mid-Sussex and Crawley said, ‘Whilst most people will see the obvious longterm financial benefits for the local authority and NHS, our

team focused on the fantastic improvement of wellbeing for our clients. To hear at the start of the trial that some of our clients had little or no will to continue living, and to then see the transformation to them enjoying life, it is heartlifting.’

CHALLENGES The original idea behind the social aspect of the PatchCare system was to find a central location as a hub for all the gatherings. The team considered using a vehicle similar to a mobile library, to be shared between several different patches, but it was decided that the cost was in excess of what could be afforded. However, the team has found that using local community venues such as a garden centre has been successful. Some clients have also hosted in their own homes. PatchCare also has the difficulty of charging people even when they are not at home, for example if they are in hospital. The clients must still be charged in order to cover the cost of the salary of the care workers supporting them. However, the care workers do still visit the clients when they are in hospital, which allows for an improved experience, with the workers able to inform hospital staff of any specific requirements and supporting the client to leave hospital sooner. This also negates the difficulty of clients ‘losing’ care workers that they have become familiar with. They can maintain existing relationships as care workers won’t be allocated to a different person

while the client isn’t receiving support.

THE OUTCOMES The trial has seen benefits for clients, care workers, the local authority and NHS services. The people using the service are receiving more responsive support, without limits on the amount of time they are allocated. Loneliness and isolation are also being reduced through the service, and clients have been seen to deteriorate less quickly, and regain skills in some cases. Care workers have regular shift patterns and a guaranteed salary, making it easier to recruit staff. The ability to form lasting connections with the clients has also created a more rewarding role for the care workers, helping with retention. For authorities and the NHS, the hope is that this service will result in fewer calls to 999, as clients will be able to contact their PatchCare care worker. The service could also be more cost effective than traditional models of care, and help to reduce hospitalisation and delayed discharges. Caremark has over 100 offices across the UK and aims to have PatchCare implemented in all of them by the end of 2019.  CMM

OVER TO THE EXPERTS... What are the implications of this model of care for the wider sector? How can it be replicated by others? What are the barriers?


SUPPORTIVE AND ENABLING, BUT A CHALLENGE It is always heartening to read about projects with the potential to show positive results for peoples’ lives and which can help support people living well in their own homes for as long as possible. PatchCare seems to embrace some of the philosophy and approach of the Buurtzorg model; localised community engagement, continuity, self-directed team support, building of trusted relationships and the prevention of escalation into more costly service provision. However, whilst the model is claiming to have been effective as a project with local authorities and have proven results for commissioners and people receiving support, as yet there are no published outcomes of this. The service described appears to be largely supportive and enabling, pointing to check visits, shopping, social interaction and suchlike. With recent national reports of how many people across the

country are being deprived of even basic care, with criteria for funding set at moderate – or, more usually, at critical – levels, it seems unviable that the roll out of this at any real scale will be achievable in the current social care environment. Therefore, offering apparent job security and long-term assurances of focused, salaried frontline care team posts may be challenging. Given Caremark’s private pay model and experience, this would seem to naturally be targeted to a private pay market, though again the co-ordination of this and charging mechanisms may also be challenging here. The principles underpinning PatchCare are to be supported and the benefits for workers and recipients of care understandable, but to make this both a viable and reliable service in the current climate will be the challenge.

Raina Summerson Group Chief Executive Officer, Agincare

A GREAT STEP FORWARD There is no question about it, homecare recruitment is extremely challenging. It is great to see some out of the box thinking on how to make working in homecare more attractive to the right people. Homecare workers are often rushed and unable to provide the level of care they would like due to a lack of time. Being paid for contact time, travel time and reductions for waiting times can often be confusing and off putting to good candidates in the recruitment process. Having a smaller area to cover, having more time to spend with clients on a social level and building up good relationships and trust with their clients will bring some of the residential care attractiveness to the home care sector. I also think making work more enjoyable and fulfilling will have a positive impact on

retention which is also a big problem in homecare. The smaller geographical areas could also open up job opportunities for non-drivers who may be able to walk from house to house. Job advertising costs could be significantly reduced if providers are able to make better use of marketing in their local community and become less reliant on the costly online job boards. I can see the challenges that could be faced when it comes to charging people for cancellations and whether local authorities would pay in these circumstances. However, from a recruitment perspective I think this model is a great step forward and it's fantastic to see Caremark paving the way for innovative thinking in homecare.

Rachel Bryan Senior Marketing and Communications Manager, AJ Recruitment

EXCITING AND INNOVATIVE The PatchCare initiative is an exciting and innovative development for homecare in the UK, providing the opportunity to streamline and engage with clients on a person-led basis. The positive impact is twofold. Firstly in terms of the continuity, flexibility and responsiveness that the care provision allows, and secondly from a provider and organisational perspective. Travel and waiting times often cause issues for homecare staff, creating concern and occasional disharmony between employers and staff. The concept of salaried homecare staff that PatchCare enables gives peace of mind and stability. This more rounded approach to homecare appears to be more collaborative, involving and integrating health and social care professionals on a case by case or ‘patch’ basis and if this is rolled out, it could improve

monitoring of homecare clients. Rural communities in the UK can often face challenges when trying to access affordable homecare provision and this could be a potential barrier to the rolling out of this model. The social aspect is a refreshing concept, helping to combat loneliness in older people within our communities. More than one million people over the age of 75 in the UK go for over a month without speaking to a friend, neighbour or family member. The ‘hub’ idea could help to address this, resulting in decreased loneliness in some communities. This model of care could revolutionise the way homecare is organised and managed, with the client receiving more personalised and rounded care and support.

Helen Fuller Managing Director, Care 4 Quality Ltd CMM April 2019

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RISING STARS

CAREER HISTORY My career in social care began in 2005, however I joined Accord in 2010 as a support worker based at Ipstones Avenue. In 2013, I was offered the opportunity for a promotion. I found the idea of a promotion daunting, but I was assured by my manager that I had the potential and, with full support and training opportunities, I was promoted to acting team leader in 2014. Initially, I found it challenging managing a team that I had been working alongside previously; the dynamics of our relationship had changed, but it quickly settled as I became more used to the role and earned the trust and respect of the team. Within seven months, the role was made permanent and in October 2017 I applied for the registered manager position. Throughout my career development and successes, I have been very well supported by the management team at Accord. I have been given access to courses which have enabled me to develop the skills I require to manage my role and enhance my learning.

ORGANISATION

Oluwakemi Yusuf is the Registered Home Manager at Ipstones Avenue, owned by Accord Housing Association.

Ipstones Avenue is a five-bed care home, which is purpose-built to support people with learning disabilities and autism. There are five male customers in the home, with the majority of our residents having come from institutional settings. All of our residents are non-verbal and do exhibit behaviour that can be challenging. This creates an additional level in supporting their needs, as we need to really get to know them to understand when something might be wrong. Triggers could be as little as playing the wrong type of music, so it is important to recognise and rectify such things quickly. We support every customer as an individual, and we regularly update their support plans so that there is consistency in the way we support them and to ensure all staff can understand each customer’s likes and dislikes. To ensure the care is as consistent as possible, it is also really important that we retain our staff, as it can be very hard on our residents when new faces come into their home to support them. Staff morale is vital here and we want staff to be as happy as the customers.

CURRENT ROLE I never had the registered manager role in mind when I started at Ipstones Avenue; I hadn’t considered it as a possibility. However, when the opportunity came to step up, and I was offered reassurance and support, it made me really proud that the management team believed in me. Not only has this developed my skillset, it has also developed my self-confidence. As a result, I now take every opportunity to acquire knowledge and grab it with both hands.

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RISING STARS

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I never want to stop supporting our customers – I’ve always been dedicated to being on the floor, involved in the day-to-day, and my dedication is stronger than ever. It’s imperative that I have quality time with each individual customer as often as possible. This is very important considering their needs, as they rely on us to see the signs when they are feeling unwell. I have every confidence in my staff, they are extremely competent and always work to the best of their ability. Working on the floor alongside them not only allows me to watch them flourish, but it means that I can help them develop and we can identify and discuss where our customers require support from other agencies. It is really important that we can work in this supportive, open and transparent way. One thing I wasn’t expecting from the registered manager role was the demanding paperwork. I have to make sure it doesn’t take away from what’s important at the time. Obviously, having the correct paperwork in order is hugely important, but you could easily forget the care side of the job if you’re not vigilant about how you split your time. Time management and prioritising have become key skills for me when striking a balance. I do find that sometimes I struggle to switch off. My job is a part of me and when I leave the scheme, it’s like I leave that bit of me there. I try to create a balance between work and home life and make a conscious effort to not overthink, but even when taking a holiday, this is difficult. Fortunately, I can rely on my team, who I trust to keep things running smoothly when I am not there. Investing and trusting in them and their abilities is important. Having an open-door policy is also key to establishing good working relationships. The absolute best part of being a registered manager is looking at our customers and seeing their quality of life. We make sure they don’t go without, and that nothing ever gets missed. It’s fantastic to see them smiling, being their true selves and happily living their lives. When relatives visit and comment on how happy their loved ones are, this really makes me feel like I’m doing something right. A huge part of this is the team's commitment. They know that new faces are a trigger for our residents and we do everything we can to make sure new staff are integrated in a way that makes each customer comfortable. This environment also means that if ever a shift needs to be covered or swapped, staff are happy to adjust for the benefit of the customers.

RISING STARS I didn’t know about the Rising Stars programme until I was nominated. When I read up about it, I felt so valued by our management team. I was full of pride to think that the Executive Director had thought of me for the programme, it is a real honour. I was really looking forward to becoming a part of the programme. I have used the knowledge I’ve gained to develop

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myself, and re-invested it back into my team and organisation. It’s a brilliant programme and I’ve had opportunities to meet people I wouldn’t normally have had the chance to meet. Ive learned that you can be whoever you want to be – you just have to be determined. My mentor has also been a huge support in guiding me and allowing me to continue to learn and develop in ways I had not thought possible. Working in a small service for people with such a high level of needs can be difficult, and it’s been amazing to learn from people who are supporting people with a totally different set of requirements. Networking and knowing I can contact people if I need help has been another huge benefit of the programme.

FUTURE CAREER I know I still have a lot to learn as a registered manager, but I’d eventually like to work up to a Head of Service role. I have an idea of what I need to achieve to get there, and I know my organisation will be supportive and keep offering me the opportunity to develop myself. Being given the opportunities I have, I have learned to believe in my own skills and abilities, to be braver and acknowledge my strengths.

ADVICE My advice would be to believe in yourself. I have often been too scared to take certain steps, even though I knew deep down they are what I wanted to achieve. I would often wait until I’d been pushed by others who had recognised my strengths, rather than beginning those journeys for myself. Throughout this process, I’ve realised that the only thing that can limit me is myself. I also think it’s vital for every manager to understand the importance of managing in relation to the personalities of the people they manage. This means investing in your team and getting to know people, learning not only how to support and develop them, but also how to get the best out of them. You have to do it in the way that works for you. Let your staff know that they are valued, respected and needed; lead them the way they need you to and always work as a team; the help and support they will give back to you is priceless.  CMM Oluwakemi 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


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11/02/2019 09:33


Making it Real: a system for change

Caroline Speirs, Head of Think Local Act Personal (TLAP) discusses Making it Real, an approach that sets out what good care and support looks like, and lays out how you can implement it in your organisation.

About twelve years ago, I was involved in discussions with a local authority and clinical commissioning group to agree good support for my dad, who had dementia. A day centre was the only support on offer. No doubt, this provision worked for some, and still does, but it failed spectacularly to provide meaningful support for my dad and our family. Not because there was anything wrong with the centre; it just wasn’t what he wanted or needed. The family implored health and social care colleagues to support him to do things he

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MAKING IT REAL: A SYSTEM FOR CHANGE

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loved and that had meaning for him, which in his case meant attending festivals and concerts, visiting galleries and going swimming. It seemed we were asking for the impossible. More than a decade later, what has changed? Can people who access services say that they are living the life they want, and doing the things that are important to them, as independently as possible? This should be a straightforward outcome, and it’s an outcome that we know to be essential to our wellbeing. Yet, for too many people who require support, it

account of the Care Act 2014, with its emphasis on wellbeing, and to reflect the growing importance of personalisation within health. The framework sets out what good, genuinely personalised care and support looks like from an individual’s perspective. It then illustrates what the workforce can do to change its practice to deliver an approach that is far more person- and community-centred. It is built around six themes that reflect the most important elements of personalised care and support, such as wellbeing and independence and active and supportive communities. It consists

“Think Local Act Personal (TLAP) has always believed that genuine transformation requires new relationships and new conversations.” remains very challenging to live the life they want to lead. Making it Real helps organisations overcome these challenges so that the people who are using services are empowered to lead the life that is important to them. There is no doubting the profound push for transformation across our health and social care system. Think Local Act Personal (TLAP) has always believed that genuine transformation requires new relationships and new conversations. Making it Real provides a framework to develop these and can lead to a more equal power-sharing arrangement, where people acknowledge the expertise of the ‘professionals’ and, similarly, people are recognised as experts in their own life. It can help dissolve the hard border that exists between what the system thinks is needed and what the person knows to be important to them.

HOW DOES IT WORK? Making it Real was first launched some years ago, but has now been radically reframed to take

of ‘I’ statements that describe an individual’s perspective and ‘We’ statements that express what organisations should be doing to live up to those expectations and make the ‘I’ statements a reality: ‘I am supported by people who listen carefully so they know what matters to me and how to support me to live the life I want.’ ‘We don’t make assumptions about what people can or cannot do and don’t limit or restrict people’s options.’ Making it Real supports the workforce to examine their practice through a different lens. By looking at their current practice against the statements, organisations can identify areas where progress needs to be made. By using the Making it Real framework – and therefore grounding transformational policy in the reality of people’s lives – organisations can also feel far more confident about any changes

they are making. The approach is relevant for all adults who require support, as well as carers and the people who are supporting them, and works across all settings including communitybased support and care homes. Large organisations with multiple branches or homes can get involved individually or as a group. Whilst the context may differ, the common element is that support should be based on what matters most to people in their lives.

CO-PRODUCTION IS KEY Making it Real has been the most co-produced document I have had the pleasure to be involved in. People with lived experience worked with organisations as equal partners in its development and content. Over 200 people from across the health, care and housing sector were involved in the new project. People with lived experience, including carers, continue to work with TLAP to support organisations to implement Making it Real. The framework is fundamentally about people, relationships and conversations, so genuine coproduction is key to success.

CQC has been privileged to be involved in Making it Real. It is an incredibly useful way to support people in understanding what good and outstanding person-centred care looks like and what they should expect from providers. David James, Care Quality Commission (CQC)

EARLY SUCCESSES Organisations who have adopted Making it Real have changed their practices and report good outcomes for the people and carers they support. Manor Community, a provider in Bristol, supports people with mental health issues, learning disabilities and older people. They use the Making it Real ‘I’ statements to identify the extent to which the people

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MAKING IT REAL: A SYSTEM FOR CHANGE

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they support feel that those statements ring true. They then work together to develop action plans to improve any areas that aren’t meeting expectations. Shropshire Council has been working with Making it Real for some years. It has set up three local advisory groups in different areas across the county. These are open to people with lived experience and carers, the workforce and volunteers, who want the opportunity to co-design service development. The advisory groups feed into and influence the council’s Making it Real Board, which is chaired by a carer who describes himself as a critical friend to the council. The Chair praises Shropshire Council for its enthusiasm for the Making it Real ideals and its willingness to listen to voices from outside the council.

HOW CAN IT WORK FOR YOU? The beauty of Making it Real is its ability to work on a number of levels: individual, operational and strategic. Individual – Making it Real can be used to generate a really good and meaningful conversation about what matters to people. It takes as its starting point a clear understanding that citizens who require support to live their lives well are not empty vessels but experts in their own lives and have insight and expertise to contribute. Operational – organisations can use Making it Real in a wide range of ways to inform operational delivery. In particular, it can be a helpful self-assessment tool to identify where an organisation needs to make progress to ensure that it is delivering personalised care and support. Changes made to operational approaches as a result of using the ‘I’ and ‘We’ statements include developing new recruitment procedures to ensure people who access services have significant

involvement in selecting and appointing new staff; embedding the ‘I’ and ‘We’ statements in Service Level Agreements; and using the framework as a key element in contract tender exercises. Strategic – a number of organisations have established Making it Real boards or advisory groups to ensure that the ‘I’ and ‘We’ statements inform strategies, policy development and plans. Warren Heppolette, Executive Lead, Strategy and System Development at the Greater Manchester Health and Social Care Partnership, says that Making it Real can be used corporately in terms of business planning and for developing targets. He advocates using it for performance setting, and describes it as a much better framework than the dry and bureaucratic frameworks currently used. At a national level, Making it Real is being used to support the implementation of the Quality Matters framework and conversations are being held with CQC colleagues to explore how Making it Real can support the regulatory framework in future. Whilst all of these practical changes are positive, underneath the surface, a powerful alchemy is taking place: embracing the principles and philosophy of Making it Real supports a new dynamic, where power is shared and relationships are prioritised over transactions. As Sally Percival, carer and Chair of the National Co-production Advisory Group has asserted, ‘Making it Real is not just another thing for organisations to do. It is a vision, inspiration and a guide that, if used in the way intended, will help people to lead their lives to the fullest.’

Making it Real is about helping everyone to have ordinary lives. Dame Phillippa Russell, Carers UK

A LONG WAY TO GO In 2019, we know that there are excellent examples of innovative approaches that challenge the one size fits all approach, but there is still a long way to go before it becomes genuinely routine. I know Making it Real can help make this shift, and there is really only one rule that must be observed if Making is Real is to be genuinely implemented: it must be co-produced. If this is unfamiliar territory, there are lots of resources on the TLAP website, from top tips to our ladder of co-production. The ultimate goal must surely be for people who access care and support to be able to say, ‘I can live the life I want and do the things that are important to me as independently as possible.’ CMM

Caroline Speirs is Head of Think Local Act Personal. Email: caroline.speirs@tlap.org.uk Twitter: @carolinespeirs How do you ensure your service is person-centred? Have you used the Making it Real statements successfully? Share your stories and feed-back on this feature on the CMM website www.caremanagementmatters.co.uk 38

CMM April 2019


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SERVICES • Accounting and tax. • Business planning. • Refinancing, business acquisition and sales. • Payroll. • Wealth management.

LEAD INDIVIDUAL Tim Godfrey heads up the firm’s healthcare team of specialists advising single and multi-site care home clients across a wide geographic area. He provides invaluable insight into the issues having an impact on the sector and assists clients in areas such as commercial and tax structuring, funding, and financial reporting, including the use of technology. Tim comments, ‘The sector is currently facing many challenges, particularly on funding, rising costs, ongoing viability tests and increased regulation. My focus

is on helping clients maximise their business performance and value in the face of these challenges. Using cloud-based, real-time financial reporting data, we empower the aspirations of our clients. Our specialist benchmarking tools and reports, together with our proactive advice, enables our clients to manage their business more effectively, while keeping their fingers on the pulse of the dayto-day financials.’

COMPANY INFORMATION Bishop Fleming is a dynamic UK accountancy firm, providing a comprehensive range of services across a wide range of sectors. We’re currently ranked the 29th largest firm in the UK by turnover and have been one of the fastest growing firms over the last decade. Bishop Fleming has seven offices, 30 partners and over 350 staff. We pride ourselves on being relationship-led and place our client and people relationships at the heart of our business. That’s why we have been awarded the Gold Standard in our recent Investor in Customers survey, which demonstrates our commitment to delivering exceptional client service.

Tim Godfrey Partner and Head of Healthcare Tel: 07973 699915 Email: tgodfrey@bishopfleming.co.uk

SECTORS • Residential and nursing homes for the elderly. • Learning disability/challenging behaviour. • Specialist needs education colleges. • Assisted living/close care/extra care. • Drug, alcohol and eating disorders independent hospitals. • Domiciliary care. • Supported living. • Children’s services. • Secure units. • Foster care agencies. • Primary healthcare.

SERVICES • Accounts, audit and tax. • Accounts preparation. • Business planning and advice. • Corporate finance. • Tax advisory services. • Benchmarking. • Sales and acquisitions. • Preparing the business for sale. • Exit planning. • Valuations. • Assisting in negotiations. • Minimising the effects of income tax, capital taxes, VAT and Stamp Duty Land Tax. • Due diligence. • Raising finance. • Estate planning.

COMPANY INFORMATION Hazlewoods’ Health and Care team have been specialists in the sector for over 25 years, acting for over 200 different health and social care providers. For the 17th consecutive year, we are ranked the number one corporate finance adviser in sub-£50m health and care transactions.* Our specialist team offers a full range of services to enable us to deliver wealth creation to health and care business owners. We advise many clients on their strategy from early stage to disposal. Services include accountancy, audit, tax planning and mitigation, business strategy, acquisition and disposal advisory. Due to the high level of activity in 2018, we successfully advised on 173 completed transactions valued at £724m. 2019 has begun where 2018 left off, although headwinds such as Brexit and staff cost increases do continue to challenge buyers and sellers alike. We act for a wide range of care providers, including individual care home owners, corporate groups, not-for-profit organisations and private equity houses.

Rachael Anstee Partner Email: rachael.anstee@hazlewoods.co.uk

John Lucas Partner Email: john.lucas@hazlewoods.co.uk *Source: http://www.experian.co.uk/marketiq– Number of healthcare transactions in the UK from January 2002 to December 2018.

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RESOURCE FINDER

Morris Lane

Smith & Williamson

Tel: 01202 715950 Email: mail@morrislane.co.uk Website: www.morrislane.co.uk

SECTORS • Care homes. • Nursing homes. • Domiciliary care agencies. • Charities. • Property development.

SERVICES  • Acquisitions. • Disposals. • Accounts. • Auditing. • Business plans, support and advice. • Company secretarial. • Corporate finance. • Payroll services. • Tax advice and services. • Management accounting.

LEAD INDIVIDUALS Roger Morris heads up the Morris Lane team of specialists working with their healthcare focused clients. Roger is an award-winning member of the Chartered Institute of Taxation and has over 30 years’ experience in the sector. Roger is ably supported by lead accountants specialising in the sector, Michelle Cordy, Dan Baker, Jon Hoyle, Michelle Pettifer and Sam Turner. The team provides a proactive service to enable clients to achieve their ambitions, to maximise their profitability, and to increase and protect their wealth.

COMPANY INFORMATION The firm has clients located throughout England and Wales and is believed to advise more care home operators than any other accountants in the UK. Its strength lies in listening to clients about their business and personal goals and providing timely advice through the business cycle on how to achieve these, so they can fund their preferred lifestyle and ultimate exit from the business. This includes preparation of budgets and forecasts, regular and timely advice on any changes in tax and accounting law, as well as keeping them up-to-date on financial matters relating to the sector. The firm ensures clients are compliant in terms of producing their annual accounts and tax returns, as well as providing management accounts if required by lenders in accordance with specific loan covenants. It prides itself on providing bespoke advice including the structuring of acquisitions and disposals in order to maximise value and minimise the effects of income tax, corporation tax, capital taxes, VAT and Stamp Duty Land Tax. Morris Lane also works closely with other professional advisers in the sector, including finance and capital allowance specialists together with their clients’ legal teams.

Tel: 0238 082 7631 Email: greg.palfrey@smithandwilliamson.com Website: www.smithandwilliamson.com

SECTORS • Residential care homes. • Nursing homes. • Dental. • Healthcare professional practices. • Charities.

SERVICES • Acquisitions and disposals of care homes and groups. • Business valuations. • Financial due diligence. • Cash planning, management and forecasting support. • Reporting services and resolving financial questions/challenges. • Pension scheme deficit advice. • Support with preparing for closure, disposal of assets and dealing with surplus funds. • Accounts preparation and audit. • Business outsourcing. • Business and employment taxes. • Employee benefits consulting.

LEAD INDIVIDUAL Greg is a Chartered Accountant with 30 years’ experience advising clients and is National Head of the Restructuring and Recovery Services team. Greg has extensive experience in the care sector through both his restructuring advice to care homes and businesses, as well aas his expertise when covering insolvency matters.

COMPANY INFORMATION Smith & Williamson LLP is an

Roger Morris Partner Tel: 01202 715950 Email: roger.morris@morrislane.co.uk

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independently owned financial and professional services group that has been looking after the affairs of businesses and their owners for over 100 years. One of the top 10 accountancy firms in the UK, Smith & Williamson LLP has over 1,700 staff and partners across 12 offices in the UK, Ireland and Jersey. Through its wider network, it can draw on skills and resources from around the world through the Nexia International network. Businesses in the care sector have come under intense financial pressure recently, such as the reduction in public funding, the effect of the minimum wage and staff shortages as well as increasing regulatory and compliance requirements. Where these factors are putting pressures on margins and cash, we offer support and advice tailored to the needs of the operator. This advice is designed to help management make informed decisions about the best route forward, including cash flow, funding and working capital support and reorganisation of the business. External expertise can help at crucial stages of a business lifecycle. Our experts are ideally placed to assist in discussions with key internal and external stakeholders. As well as restructuring advice, Smith & Williamson LLP provides regular accounting and audit services to care sector clients. Through our corporate finance team, we are able to offer support for major transactions.

Greg Palfrey National Head of Restructuring and Recovery Services Tel: 0238 082 7631 Email: greg.palfrey@smithandwilliamson.com


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Celebrating excellence Markel 3rd Sector Care Awards

years, including winning several national and regional awards for its high levels of care. Last year, the Society celebrated awards for Housekeeping Manager, Shirley Campbell, who won the Leadership Award, and Chairman, Captain Glass, who was awarded the Beyond Governance Award, for their contributions to the Society, home, its staff and residents.

KEEPING A HOUSE IN ORDER

The Royal Alfred Seafarers Society won both the Leadership Award and the Beyond Governance Award at the Markel 3rd Sector Care Awards 2018. No care home would run smoothly or even function without dedicated staff. This is no different at the Royal Alfred Seafarers Society’s Banstead-based care home, Belvedere House where, like any care home, the staff are the building blocks creating a caring and supportive environment for its 70 residents. The Royal Alfred prides itself on the exceptional care provided to residents at its home, as well as the hard work and dedication of all members of staff and those associated with the Society. The charity focuses on building a strong workforce and offering the best support for staff, something that was recognised at 2018’s 3rd Sector Care Awards. The Royal Alfred, which caters for retired seafarers, their families and dependents, as well as residents living with dementia at its care home, Belvedere House, has a proud history dating back more than 150 years and has achieved many successes over the 46

CMM April 2019

Housekeeping Manager Shirley Campbell was recognised with the Leadership Award for ‘demonstrating outstanding leadership which has significantly contributed to care and service excellence within a culture that puts people and quality first’ and has been instrumental in the smooth-running of the Society’s home for more than ten years. Shirley was commended by judges as ‘kindness itself’, as well as being committed and driven. She covers a range of duties, from helping new residents settle in to the home to spending time with families, managing a team of 15, handling rotas and supporting and managing her team to keeping the home looking spotless. As Housekeeping Manager, Shirley even ensures the hanging baskets are always well-watered and handles her role in a compassionate, empathetic and kind manner while remaining professional in everything she does. As well as her personable approach to resident care, Shirley also acts as a mentor to junior members of her team, supporting them in their development and training and lending a supportive ear when needed. Shirley is exceptional in her role because she keeps a round-the-clock service running smoothly and ensures residents live richlyenhanced lives due to her work. Working with residents is Shirley’s favourite part of her job and was a key part of why she applied for the housekeeping role, to spend more time with the residents. Shirley Campbell said of her award win, ‘I have always worked in the healthcare sector and have been with the Royal Alfred since 2007. Winning the Leadership Award means so much to me and is testament to the quality of the home itself, having nurtured me through


my career, when I started out as a care assistant. I couldn’t think of a better place to work, nor a better home for the residents who I enjoy supporting each day.’ Shirley possesses an array of different skills and all residents know her door is always open. She is known around the home as ‘the fixer’ and is able to fulfil the request of all residents no matter how small or large the task, from fixing glasses and personal items to arranging furniture for residents’ rooms and helping to sew and mend clothes.

CHAIRMANSHIP OF TRUSTEES Skilful chairmanship at Trustee level in the social care sector is paramount to ensure a high level of competent governance and oversight of charitable activities; in this case for ensuring the high levels of quality care that are expected by residents’ loved ones. Captain Duncan Glass, who was awarded the Beyond Governance Award for someone who has ‘made an outstanding and sustainable contribution to the organisation’, has been a Trustee with the charity since 2003 and was described by the judging panel as ‘demonstrating an outstanding and sustainable contribution to the Royal Alfred’, overseeing its widespread development since taking on the Chairman role in 2009. As Chairman of the Board of Management, Captain Glass has been pivotal in ensuring that governance of the Society allows effective generation of income to reinvest back into the home, enabling the nursing care home to deliver the very highest standard of care. Overseeing the 150th anniversary celebrations was a particular highlight of his time as Chairman. Captain Glass, Chairman of the Society said, ‘Ever since my involvement with the Royal Alfred started over 15 years ago, I have always been so proud of the level of genuine care and compassion the home welcomes all residents with. I would like to commend my colleagues who support me in my role and who have made it possible to develop such an outstanding level of care at our home.’

AN EXAMPLE OF EXCELLENCE The Royal Alfred is no stranger to winning awards, securing five award wins over the past three years alone, but the 3rd Sector Care Awards supports everything the charity stands for, including the genuine and exceptional care provided by the charity. The Society carries out regular surveys to measure the experience of residents and staff. In the latest residents and families survey,

100% of respondents stated the expected standard of service is being met and this is in no small part down to the hard work and dedication of both Shirley and the staff at Belvedere House. To ensure that these high levels of care are continued, the charity invests in an inhouse trainer at the home, Sharon Hicks, who delivers an average of eight courses per month for staff across the home providing additional support whenever it is required. The Society prides itself not only as an excellent care provider, but also as a place which nurtures its staff throughout all stages of their career.  CMM

MARKEL

3RD SECTOR CARE AWARDS

Commander Brian Boxall-Hunt is Chief Executive Officer at Royal Alfred Seafarers Society. Email: enquiries@royalalfred.org.uk Twitter: @RASeafarers

The Markel 3rd Sector Care Awards is run specifically for the voluntary care and support sector. Visit www. caremanagementmatters.co.uk/3rdsector-care-awards to see 2018’s winners and find out more about this year’s event. Sponsorship opportunities are available. With thanks to our supporters: National Care Forum, Learning Disability England, The Care Provider Alliance, Association of Mental Health Providers and VODG. The Leadership Award was sponsored by

CMM April 2019

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EVENT PREVIEW

CMM INSIGHT LEEDS CARE CONFERENCE 2019 20th June 2019, Oulton Hall, Leeds

CMM Insight is expanding, with a brand-new event in Leeds. The Leeds Care Conference will take place on 20th June at Oulton Hall and is a continuation of the Insight series, bringing the quality of a national conference to a local stage. Delegates can expect a packed agenda, produced in conjunction with Leeds Care Association to ensure the event covers the topics most crucial to the providers in the area.

Neil Eastwood from Sticky People, whose presentation will teach providers how to find staff with the right values, as he reveals the latest innovation and thinking in this complex area of the sector. Delegates will have the opportunity throughout the day to explore the useful exhibition, with sector-specific organisations to help you in running your business.

EXPLORING KEY ISSUES

A series of workshops will allow delegates to choose from three sessions looking in-depth at specific sector developments. For those wishing to know more about how to handle investigations and inquests, a Q&A session will focus on how providers can ensure they aren’t at risk and what they should do if they find themselves in this situation. Alternatively, for businesses who are looking to discover the best ways technology can support care delivery, a session on the benefits of digital developments will leave

FOCUSED WORKSHOPS

Peter Hodkinson from Leeds Care Association will Chair the day and will join us in welcoming Cath Roff, Director of Adults and Health at Leeds City Council to the stage, where she will discuss how local authorities can work alongside providers, and how this way of working can support better outcomes for people, efficiency, and finances. Cath will be joined by the likes of Karen Splisbury from University of Leeds, and

In association with

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CMM April 2019

Corporate sponsor

Supported by

you with the skills to implement technology in your business even if you don’t have digital expertise. The workshops are repeated to allow delegates to attend the two sessions of their choice.

BOOK TODAY Delegates attending the CMM Insight Leeds Care Conference will be sure to come away from the day with a host of ideas and information, which they can take back to their organisations and use to support their business goals. The conference is also CPD certified, so delegates will be able to collect CPD points before they leave at the end of the day. Book your tickets on the CMM website, www.caremanagementmatters.co.uk. Sponsorship and exhibition opportunities are also available. CMM *Topics and speakers are subject to change.

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Event: Date/Location: Contact:

ADASS Spring Seminar 2019 29th April – 1st May, Staffordshire ADASS, Tel: 0207 072 7433

Event: Date/Location: Contact:

LaingBuisson Social Care Conference 16th May, London LaingBuisson, Tel: 0207 833 9123

Event: Date/Location: Contact:

Digital Health and Care Congress 22nd-23rd May, London The King’s Fund, Tel: 0207 307 2409

Event: Date/Location: Contact:

NCF Annual Conference 2019 5th June, London National Care Forum, Tel: 0247 624 3618

Event: Date/Location: Contact:

Health Plus Care 26th-27th June, London Health Plus Care, Web: www.healthpluscare.co.uk

Event: Date/Location: Contact:

Care Home Open Day 2019 28th June, Nationwide Care Home Open Day, Web: www.carehomeopenday.org.uk

Event: Date/Location: Contact:

NAPA Annual Conference: Year of the Arts 16th July, London NAPA, Tel: 0207 078 9375

Event: Date/Location: Contact:

Care England Conference 2019 13th November, London Care England, Tel: 0207 492 4840

CMM EVENTS Event: Date/Location: Contact:

CMM Insight Leeds Care Conference 20th June, Leeds Care Choices, Tel: 01223 207770

Event: Date/Location: Contact:

CMM Insight Berkshire, Buckinghamshire and Oxfordshire Care Conference 17th October, Maidenhead Care Choices, Tel: 01223 207770

Event: Date/Location: Contact:

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

NEW FOR 2019

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MICHAEL VOGES • CHIEF EXECUTIVE OFFICER • ASSOCIATED RETIREMENT COMMUNITY OPERATORS

The sector’s minds are firmly focused on whole system reform. But what about changes that don’t require complete overhaul? Here, Michael Voges puts forward his hopes that we don’t miss out on opportunities while we wait for wider transformation.

For years, the social care sector has been waiting for a Green Paper which has shown so few signs of life that we are all starting to get a bit concerned for its welfare. We all know that there is a clear need for systemic reform of the social care system, including baseline funding which has created a challenging environment for many providers’ business models. By my estimate, around two thirds of all media commentary around social care relates to baseline funding for people using services who are reliant on the Government to pay for their care. This focus is something that must continue; a leading industrialised economy such as the UK must be better at providing for its most vulnerable. However, an area that receives less attention is the supply-side revolution which is already underway outside of those providers we traditionally associate

with social care. In my view, the Government has been insufficiently focused on market shaping and ensuring appropriate frameworks for investment in health and social care outside the realm of public sector commissioning. However, these new models of provision can play a significant part in expanding the supply of social care, and in meeting increasing demands. The housing with care market is currently seeing very significant interest. It is seeing large-scale investment both from private companies and from traditional care home providers. It has major potential benefits, however, only 0.5% of over-65s live in specialist housing with care communities in the UK, while in other countries this figure stands at 5% or more. The reason for this? Curiously, this is not a failure of commissioning or funding – it is the lack of a joined-up market shaping approach, which has led to our planning and regulatory systems being unable to categorise, comprehend and process this type of housing appropriately. Nevertheless, our sector’s ambition is to expand provision by 230% by 2030, providing housing with care for an additional 175,000 older people in the UK. This will require an investment of £40bn, but will save the NHS and social care services more than £5bn over the next 12 years. It will also free up more than 525,000 bedrooms in the UK, helping to solve the housing crisis. And this isn’t untested. Consider a country like New Zealand, which has long had a well-regulated retirement community sector. Five of the 15 largest housebuilders there are retirement community operators – who operate largely without subsidy and are investing £1.5bn in the New Zealand health and social care infrastructure over the coming years. These services were not commissioned – instead, a sensible regulatory and legislative approach created a framework for investment to be channelled into areas which meet customers’ needs and aspirations. Extrapolate the New Zealand figures

to the UK and this would mean an investment of £20bn. The benefits would be felt by society at large. Importantly, this is not an ‘invest to save’ proposition for the Government – it is more a question of letting us invest so they can save. But for this to happen, our thinking about health and social care needs to go beyond the commissioning mindset. We must look at introducing more clarity into the planning and regulatory systems as well as more cooperation between those authorities responsible for planning and those responsible for social care provision. We know that the Secretary of State understands this and has put prevention at the heart of his agenda. The NHS Long Term Plan talks extensively of how to improve provision outside acute and primary care services – with housing with care being a prime example of how this can be achieved in the community. However, this also requires a joined-up approach with other Government departments. To put together an appropriate legal and regulatory framework on planning and consumer protection, the Department of Health and Social Care will need to work with officials in the Ministry of Justice, the Ministry of Housing, Communities and Local Government and others. There are also other areas in which a more joined-up approach is required. For example, advances in big data, artificial intelligence and robotics will require a co-ordinated approach to issues such as health and safety and CQC regulation – and a sensitive and sensible approach to personal privacy – to come to fruition. What these projects have in common is that they sit outside the “mainstream” discussion on social care, as they are beyond the realm of funding, commissioning and traditional service delivery. I sincerely hope that, while we await the Green Paper and any following change, a grown-up debate about how regulatory and legislative reform and market shaping can change the care sector can be added to the general debate about social care in the UK. CMM

Michael Voges is Chief Executive Officer at Associated Retirement Community Operators. Email: info@arcouk.org Twitter: @ARCOTweets 50

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Profile for Care Choices Ltd

CMM 16.2 April 2019  

The Big Picture. How fair are CQC ratings?

CMM 16.2 April 2019  

The Big Picture. How fair are CQC ratings?