OCTOBER 2019
www.caremanagementmatters.co.uk
A BALANCED APPROACH
Protecting people’s rights during disciplinary investigations
Changing the conversation
Taking the ‘crisis’ out of social care
Homecare in numbers
How is the market really faring?
The truth about tech
Should we fear AI in care?
The care sector’s most widely-used electronic care planning system The benefits of using technology to provide person-centred care Over 1,500 care homes use Mobile Care Monitoring system for electronic care planning, monitoring and reporting, here’s why: Staff have more time to spend with residents
Increases staff retention
Jennifer Read, Registered Manager at Catherine Miller House, says, “One of the things we worried about was, ‘Would staff be able to use the system?’. We’ve been using Mobile Care Monitoring for three months now, and not only has the system been excellent for staff, but we save time on administration and our records are more accurate. Overall, we spend more time with residents. We are very happy with Mobile Care Monitoring.”
Gaynor Abrams, Business Development Manager at MPS Care says, “Staff at our homes love the system as it’s so simple to use and means they save time on administration and can focus on care. We believe that Mobile Care Monitoring is a real benefit to our staff and a big selling point in attracting and retaining future employees and ultimately increasing retention of our staff across our group of care homes.”
Provides a return on investment
Improves residents’ quality of health and care
Rishi Sodha, Director at Handsale Care Homes says, “Person Centred Software has been extremely responsive to my needs and Mobile Care Monitoring 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 more.”
Suzanne Slavern, Team Leader, Brantley Manor Care Home, part of Pearlcare says, “Since using Mobile Care Monitoring, we have needed to give residents fewer antibiotics. This is due to a decrease in UTIs and chest infections, and we know that the live fluid monitoring recording in the system has really helped to prevent UTIs.”
Visit us at The Care Show on stan H75 and atte d our seminar nd 9th October on at 10:15am in Theatre 2
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DRIVING O
UTSTANDIN
G C ARE
In this issue 05
Inside CQC Kate Terroni, Chief Inspector of Adult Social Care discusses innovation in the sector.
07
CMM News
09
Business Clinic Our panel looks at Care Friends, a new social care employee referral app currently being trialled.
30
NCF Rising Stars 2019 Kelly Hartley of Fremantle Trust tells CMM about her career so far and hopes for the future.
33
Celebrating Excellence Jake Mills from Chasing the Stigma won the Technology Award in the Markel 3rd Sector Care Awards 2018.
46
Event Preview A preview of The Care Show 2019.
48
What’s On?
49
Straight Talk Karolina Gerlich shares her thoughts on why professionalisation of the care workforce is an essential next step.
50
37
42
FEATURES 25
REGULARS
From the Editor
20
20
We have a dream: reframing the social care conversation Neil Crowther of #socialcarefuture looks at the language we are using to try to gain support for the social care sector and explains why he thinks we have to drop the word ‘crisis’.
25
Hidden in plain sight: the true state of the homecare market Increasingly, people want to remain in their homes with help from homecare providers. But is the sector set up for this demand? Steve Sawyer looks at the data to see if we are ready.
37
Safeguarding and employment rights: a delicate balance Every employer has to sanction staff at some point. But how do you ensure you’re fair? Deborah Nicholson of Markel Law explores disciplinary investigations and how you can minimise risk when taking action.
42
How will AI change the social care sector? Artificial intelligence is coming. In fact, we are already seeing its use, from lifelike ‘pets’ to humanoid robots. Lindsay Taylor of Coffin Mew debates whether this is a good thing, and what the implications could be. CMM October 2019
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EDITORIAL editor@caremanagementmatters.co.uk Editor in Chief: Robert Chamberlain Editor: Angharad Burnham Content Editor: Emma Cooper
CONTRIBUTORS
PRODUCTION Lead Designer: Holly Cornell Director of Creative Operations: Lisa Werthmann Studio Manager: Jamie Harvey 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
@CQCProf
@neilmcrowther
@AccessHSC
@SejalRaja1
Kate Terroni Chief Inspector of Adult Social Care, Care Quality Commission
Neil Crowther Member, #socialcarefuture
Steve Sawyer Managing Director, Access Health and Social Care
Sejal Raja Head of Employment, RadcliffesLeBrasseur
@drjanetownson
@bowlercass
@FremantleTrust
@debbie_nic
Dr Jane Townson Chief Executive Officer, UKHCA
Daniel Casson Digital Development Executive, Care England
Kelly Hartley Manager, Cherry Garth – Fremantle Trust
Deborah Nicholson Head of Regulation, Markel Law
@coffin_mew
@Jakemills1
@KGerlich777
Lindsay Taylor Lawyer, Coffin Mew
Jake Mills Chairman and Founder, Chasing the Stigma
Karolina Gerlich Chief Executive and Founding Director, NACAS
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 16.7
CMM magazine is officially part of the membership entitlement of:
ABC certified (Jan 2018-Dec 2018) Total average net circulation per issue 19,630
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CMM October 2019
From the Editor Editor, Angharad Burnham looks at how mainstream media talks about social care, and why we should focus on the positives. Is our crisis message getting through? We’ve certainly seen more action from Government recently, with an extra £1.5bn announced in the Spending Round – although £500m of this is to be raised via further increases to Council Tax, and the other £1bn is for all of social care, not just adults. Change has been promised for years and although this latest announcement is welcomed, it does little more than save the sector from collapse. So what do we need to do to get the sector the support it needs?
TAKING A DIFFERENT TACK On page 20, Neil Crowther shares the #socialcarefuture view that we must stop talking about social care as ‘in crisis’ altogether. It’s falling on deaf ears and we might actually be encouraging people to believe that nothing can be done. A stronger approach, Neil suggests, would be to share messages that
give a sense of hope and possibility, explaining how people’s lives are and can be changed when they receive the right support, and that social care services require investment to continue to add this value to society. Could this be something we adopt? While most mainstream media tend to print the negative stories around care, increasingly we are seeing them picking up stories about the need to find solutions. But with these messages and reports framed in a sense of doom and negativity, the public is struggling to understand why they should back a system that is about to fail, and that’s only going to need more of their money – especially when research shows that most people aren’t planning for a time when they might be the ones needing support. Let’s continue to campaign for better investment, telling people about the different ways providers and groups are overcoming adversities to help people explore
their full potential. We need to showcase the ideas we want to put into practice to encourage reform.
FINDING THE POSITIVES With this in mind, I was delighted to attend the Care Innovation Challenge final, where young adults from a range of sectors came together to present ideas for new businesses that could make a difference to the sector. We’ve also celebrated Professional Care Workers’ Day, a hugely positive event in the social care calendar which saw representatives from across the sector talk about the wellbeing of staff. On top of
this, the Road Worlds for Seniors championship was launched at this month’s Rising Star’s care home (see page 33). This sees care homes all over the world take part in a competition to see who can cycle the furthest during September using specially-designed bikes. So yes, we are reliant on more money from central government, the funds from the Spending Round aren’t enough to get us where we need to be, and it is still an uphill struggle, with providers fighting to stay afloat, but there are positives too. Talking about the tipping point isn’t getting the message across – is it time to try something new?
Email: editor@caremanagementmatters.co.uk Twitter: @CMM_Magazine Web: www.caremanagementmatters.co.uk
STAND
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CARE SHOW
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Daily Record Management | Care Planning | Management Insights
In my first column for Care Management Matters, I spoke about my background in social care and my key priorities as Chief Inspector at CQC – hearing the voice of people who receive care across our business; delivering joined-up care as providers and regulators; and innovation. In this column I want to focus on innovation. Christine Asbury, Chief Executive of WCS Care recently talked about the need to define innovation and she shared the definition she uses, ‘Creativity is the making and communicating of meaningful new connections and ideas. Innovation is the application of these insights. In order to meet the innovation challenge, leaders must be able to manage for both creativity and innovation.’ (Isaksen 2017) A number of providers have been working with CQC as we think more about the role of the regulator in innovation – the challenge is that real innovation often operates outside known boundaries and is therefore complex to regulate. Innovation is much broader than technology, which is often what comes to mind when we think about innovative practice. It’s about new and different ways of recruiting and retaining our workforce; it can be new models of care delivery, with providers collaborating across health and social care to provide more seamless, joined-up care for the people they support. Innovation in adult social care is about promoting the trial and error of new ideas in collaboration with people who use services, ensuring that they remain safe and that when an idea works, we find a way to share that best practice locally and nationally. However, technology provides lots of opportunities to innovate and it is a topic that comes up time and time again when I speak to key stakeholders, so I want to use this column to talk to you in more detail about how we view innovation and technology at CQC. In June, we published the latest resource in our Driving Improvement series, looking at a number of case studies where technology has been used to enhance the quality of people’s lives. The resource highlights some examples where technology is being used in a positive way to provide solutions to the problems facing the health and social care sector. One example that stands out to me is a homecare agency in Plymouth where the provider has given laptops to the people they support that can be used by their care workers to record visits and notes online. This
Inside CQC K
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Kate Terroni, Chief Inspector of Adult Social Care at the Care Quality Commission, explores the relationship between innovation and regulation, and what CQC is doing to support this.
means that other professionals – such as care managers and speech and language therapists – can also have access to the notes (with the permission of those involved and in line with GDPR), but only the creator of the note can edit them. Having a system where notes can be shared might not be a radical idea, but we know that having joined-up care can seem impossible for people who receive it in their own homes, and this example is just one way in which technology can be used to improve the efficiency and effectiveness of care-giving, as well as better monitor and support the person using the service. On my shadow inspection visits, I am seeing more examples of providers using electronic care plans to enable their care staff to have all the information they require to deliver personcentred care in the palm of their hands. Care workers have told me that this technology enables them to spend more time interacting with the people they support. Some providers have talked to me about their frustration at how inspectors use electronic care plans during inspections. In light of this feedback, we will be hosting a workshop with providers and
inspectors to develop a short piece of guidance about how inspectors should use electronic care plans during inspections. We will co-produce the guidance together and make this available in early 2020. At CQC, we are looking to encourage experimenting with technology or other types of innovation and we are presenting these case studies to promote discussions about how we support technological innovation and how we should consider it when inspecting. Ultimately, we are looking for safe and effective care, and we are determined that regulation does not come in the way of innovative practice. I also want to be clear about the fact that we in no way think that technology will one day be in place of our care and support workforce. Technology is great and can have so many benefits to people using services, but I also believe that technology has the power to improve the experience of the workforce, allowing staff to spend less time on paperwork and instead focus on the reason they do their job – the people they are providing care to. I look forward to writing for you again soon and discussing what CQC has coming up in autumn.
Kate Terroni is Chief Inspector of Adult Social Care at the Care Quality Commission. Share your thoughts and feedback on Kate’s column on the CMM website, www.caremanagementmatters.co.uk CMM October 2019
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APPOINTMENTS HC-ONE
Adult social care recruitment campaign The adult social care sector is being urged by the Minister for Care to back the next phase of a recruitment campaign launched by the Department of Health and Social Care (DHSC). The first phase of the campaign generated a 14% increase in clicks on the ‘apply’ button for care roles on the Department for Work and Pensions' (DWP) Find a Job site, as well as 97% more searches for jobs containing ‘care’ or ‘care worker’. One in four (26%) care employers surveyed after the first campaign also saw an increase in either enquiries, applications, interviews or vacancies filled. The next phase of the campaign
will run from Autumn 2019 to April 2020. It will continue to bring to light the mutual reward for those working in care and the people they support, as well as showcasing the diversity of roles in the sector via posters, online TV adverts, radio, social media and digital channels. Autumn and January will see bursts of activity, underpinned by activity throughout the year, showcasing the values and flexibility of working in care through recruitment events. Two events will be held in London and Southampton, with care providers across the UK also encouraged to hold their own
recruitment events. January’s activity will build on people’s desire for change in the New Year by showcasing how a career in care could offer professional growth and development as well as more fulfilment. An updated campaign toolkit and suite of materials free to download from the website will be available for care providers to use. DHSC is also requesting that providers send in case studies of those working in the sector and continue to advertise vacancies both on DWP Find a Job and on local jobs boards. If you would like to be involved, email everydayisdifferent@dhsc.gov.uk.
Sector responds to Spending Round The Chancellor of the Exchequer, Sajid Javid has announced the amount of money dedicated to social care in his Spending Round. In his speech, Mr Javid recognised the need for a wellfunded and successful social care sector. He stated, 'We can’t have an effective health service without an effective social care system, too. 'The Prime Minister has committed to a clear plan to fix social care, and give every older person the dignity and security that they deserve. So I can announce today that councils will have access to new funding of £1.5bn for social care next year.' The sector has welcomed this money, but is keen for it to reach the services that need it and many say that it still does not go far
enough. Professor Martin Green OBE, Chief Executive of Care England said, 'If the Chancellor had neglected social care in his Comprehensive Spending Review, it would have morphed into an incomprehensive spending review, as it is essential to set the books straight for social care. This money is extremely welcome but it must reach the front line.' Others also commented, including Julie Ogley, President of Association of Directors of Adult Social Services (ADASS), who stated, ‘We recognise this as a positive first step...It is not as much as we and others have set out is needed and we will want to understand the detail including how this fits with other funding
for local government and the NHS. We look forward to working with the Government, with those across parliament, partners across the sector, and with those people who need care and support to take forward longer-term funding reform and to develop a social care long term plan.' Niall Dickson, Chief Executive of the NHS Confederation said, 'These are sticking plaster solutions...The £1.5bn of extra funding for councils to cover social care is a start but it’s barely enough to enable local social care services to limp on for another year…The fact that £500m of this is dependent on precepts is also disappointing: this risks penalising less affluent areas, where it is much harder to raise funds in this way.'
HC-One has announced that Sir David Behan CBE has been appointed Non-Executive Chairman of the Board. Sir David joined the Board as a Non-Executive Director in November 2018 and will assume his new role from 31st October.
CQC The Care Quality Commission (CQC) has appointed Kevin Cleary as Deputy Chief Inspector of Hospitals and lead for mental health. He will join CQC in September where he will report to the Chief Inspector of Hospitals, Professor Ted Baker.
SOMERSET CARE Somerset Care Group has appointed Gary Ridewood as Chief Executive Officer following his successful stewardship whilst acting as Interim Chief Executive since November 2018. The Group has also announced that Robin Khokhar will take on the role of Head of Nursing Operations.
ROYAL STAR & GARTER Kate Silver has taken on the Director of People role at The Royal Star & Garter Homes following the announcement of Siobhan Creighton’s retirement. Siobhan retired after 17 years, helping to bring about some of the most significant changes in the Charity’s 103-year history.
CORNWALL CARE Cornwall Care has appointed three new executive directors. Richard Bates joins as Director of Finance; Richard NixonEckersall is the charity’s new Director of Workforce and Organisational Development and Tracy Hampson has become Director of Operations.
CMM October 2019
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NEWS
Disparity in care home fees Just Group has found a disparity in care home fees for council-funded and self-funded clients and is calling for urgent reforms to tackle the unfairness. Residents of care homes in England who meet their own fees are charged an average of £12,500 a year more than those whose bill is picked up by their local authority, the analysis reveals. The average annual fee for self-funders is £44,252, while the average fee paid by councils is £31,720.
A Competition and Markets Authority’s report found that the fees paid by councils don't cover the costs of running care homes, which therefore requires homes to increase prices for self-funders, increasing the disparity in care home fees. This subsidy is highest in homes with a fairly even mix of places between the two groups. According to Stephen Lowe, Group Communications Director at Just Group, a lack of Government progress on reforming the later life
social care market is putting more financial pressure on those needing care and their families. Just Group states this is also a material factor in people waiting before putting any plans in place for themselves – more than half (51%) of over-45s are delaying making plans for later life until new policy is clarified, according to Just Group’s 2019 Care Report. Mr Lowe stated, 'The public isn’t fooled by promises and no action – more than half (52%) agree that
social care policy is being neglected because of Brexit. 'Brexit is undoubtedly a big issue but the parlous state of today’s social care system is letting everybody down – councils, care homes, care workers and of course the residents who are most vulnerable of all. The promise of more funding is welcome but it doesn’t address the total absence of any long-term policy to address the fundamental problems within the social care system.'
Petition to fix issues faced by social care More than 150,000 members of the public and over 50 health leaders have signed a petition for Government to fix the issues faced by social care. In what is believed to be the largest petition of its kind, the Prime Minister is urged to end the vast cuts in social care that have left around 1.4m older people in England unable to access the care and support they need. In a letter to the Prime Minister, NHS leaders have welcomed his commitment to ‘fix the crisis in social care once and for all’. They have pledged their support and are calling for: • Cross-party talks to help deliver a more sustainable social care system, backed up by a long-term
READER SURVEY Please take a few minutes to send us some feedback and influence future editions of CMM. Visit www. caremanagementmatters. co.uk/survey for the chance to win a free enhanced listing on www.carechoices.co.uk.
LAST MONTH'S SURVEY WINNER We are pleased to announce the winner of last month's reader survey prize is AnneLotte Venter. 10
CMM October 2019
financial settlement. • Genuine long-term funding alongside key reforms to help fix the issues faced by social care with a solution that lasts a generation and more. This must include a widening of the eligibility criteria to ensure those people most in need get the care and support they require. The letter and petition have been organised by the NHS Confederation, which leads the Health for Care coalition of 15 national health organisations who have joined forces to make the case for social care. The health leaders who have signed the letter believe extra investment and reform of social
care is not only the right thing to do for vulnerable people who need support, but that a failure to deliver a solution will result in further pressure on local hospital and other NHS services. Niall Dickson, Chief Executive of the NHS Confederation, which is leading the Health for Care coalition, said, 'The level of distress being experienced by hundreds of thousands of vulnerable people and their carers is now much greater and on a wider scale than at any time in living memory. This is a crisis and it has to be urgently addressed. We welcome the Prime Minister’s early commitment to find a solution. As our petition shows, the public recognise the human cost of inaction and they
want this resolved. Successive governments have failed to address this issue – the new Government has a chance to put this right.' A separate report published this week by the Health for Care coalition reveals the major gap in funding that local councils are facing in meeting the care needs of their local residents. To merely maintain the status-quo it says a cash injection of £1.1bn to £2.5bn is required. This funding gap is likely to grow, with estimates from the Personal Social Services Research Unit at the London School of Economics estimating that the number of older people needing publicly funded social care could increase by 300,000 by 2035.
Warnings over future of social care A leaked Cabinet dossier, known as Operation Yellowhammer, reportedly warns that a rise in costs, particularly inflation, could impact on the care of older and vulnerable people. It warns that increased inflation would ramp up staffing and supply costs and may lead to provider failure, with smaller providers hit within two to three months and larger providers within four to six months, after a no-deal Brexit. The Independent Care Group (ICG) says this worst-case scenario document provided yet more evidence of the need to support the social care sector immediately.
The Group’s Chair, Mike Padgham, said, 'Social care is already in crisis with 1.4m people living without the care they need and providers failing. This latest document about the time after a no-deal Brexit warns, potentially, of even worse to come. 'The whole sector needs urgent help, with smaller providers likely to be hit hardest and therefore in greatest need of support…Social care must be a top priority.' The ICG says making social care zero rated for VAT would be a good first step to aid providers in dealing with any rising costs. 'Altering VAT would be a start
and then we have to very quickly get more funding into social care to avert a disaster brought about through fewer and fewer providers being able to cope with increasing demand,' says Mr Padgham. 'This crisis grows deeper by the day and we cannot wait around any longer whilst people live without the care they need,' he added. The ICG has written to the Prime Minister inviting him to visit social care providers on the front line at its base in North Yorkshire to see the challenges which are currently facing the adult social care sector.
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NEWS
Professionalisation of care workers The All Party Parliamentary Group (APPG) on Social Care has produced a report focusing on the workforce issues in social care. The inquiry, Elevation, Registration & Standardisation: The Professionalisation of Social Care Workers, calls for an immediate and urgent national programme to be created for the professionalisation of care workers. The APPG on Social Care says this should be sponsored by Government to implement vital reform, including: • The establishment of a new, identifiable, national care body for England with NHS affiliation,
implying equal status with NHS staff. • Mandatory registration of all social care workers within 24-36 months, in line with the devolved nations – this timeframe should include the drafting and consideration of the legislation. • A defined qualification package, starting from a reformed, compulsory and accredited Care Certificate. This should lead to an engaging framework of training and various career development pathways, badging or digital credentials for the employee, and transferable qualifications,
so that providers don't need to retrain staff or repeat induction programmes. • The consolidation of funding for workforce training in England into one single body. • As part of the immediate national programme, a collaborative exploration between existing sector stakeholders in England, Social Care Wales, the Scottish Social Services Council and the Northern Ireland Social Care Council, into the desirability and feasibility of new, equivalent NHS-signified sector bodies offering corresponding
regulation, standards and fluid, equal qualifications and skills structures. The report was released on the same day as a research report from National Association of Care and Support Workers (NACAS), carried out by Care Research. The Well-Being of Professional Care Workers details issues relating to the mental health and happiness, physical wellbeing and economic wellbeing of care professionals and makes several recommendations. It is available to download on the NACAS website.
Park in Berkshire, Scarcroft in West Yorkshire and Stanbridge Earls in Hampshire. These four villages will represent a total gross development value in the region of £400m, providing a total of over 500 units with extensive facilities.
Schroders Real Estate is working with Octopus Real Estate, a significant investor in healthcare facilities throughout the UK, to invest in the development of new retirement villages. Together, they will provide
the majority of equity for the developments alongside Audley Group which will be responsible for the operational delivery of the villages and long-term ownership, as it does across its current portfolio of 20 villages in the UK.
Audley Group Audley Group has formed a joint venture with the real estate arm of Schroders and Octopus Real Estate, to fund the development of four retirement villages. The agreement covers the Audley Villages sites at Cobham in Surrey, Sunningdale
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CMM October 2019
NEWS
Guidance: Preparing for a nodeal Brexit The Department of Health and Social Care (DHSC) has updated guidance exploring what adult social care providers and local authorities need to do when preparing for a no-deal Brexit. It looks at supply of medicines, medical devices and clinical consumables, business continuity plans, workforce considerations,
the EU Settlement Scheme, recognition of professional qualifications and data sharing, processing and access. More information is available on the Government website, which also lists who to contact if you require assistance with preparing for a no-deal Brexit. Visit www.gov.uk.
Target Healthcare Target Healthcare has completed the acquisition of two properties, in Ripon, Yorkshire and Stourport, West Midlands, for approximately £18.6m, including transaction costs. Both investments – The Moors Care Centre in Ripon and The Wharf Care Centre in Stourport – are modern, well-equipped care homes with 100% en-suite wetrooms, underpinned by supportive
fundamentals. The yield is representative of assets of a similar standard and location within the Group’s portfolio. The homes are let on 35-year leases with RPI-linked cap and collar to a subsidiary of Maria Mallaband Care Group. Target Healthcare was advised by Dickson Minto and Maria Mallaband Care Group was represented by Freeths.
INTUITIVE | INNOVATIVE | INSTANT
Sort out social care says ADASS The Association of Directors of Adult Social Services (ADASS) has published a new statement, with a call for Government to sort out social care. In July, Prime Minister, Boris Johnson announced a personal commitment to sorting out social care ‘once and for all’. In response to this commitment, ADASS has published a report, Sorting out social care for all once and for all, setting out what needs to be done by Government to tackle the crisis. Its recommendations include: • Short-term funding, including continuation of the Better Care
Fund and Improved Better Care Fund, to prevent the further breakdown of essential care and support over the course of the next financial year. • Long-term funding and reform, to enable care and support to be built for the millions who need it and to create a social care system that is truly fit for the 21st century. • A long-term plan for adult social care, which puts a support system in place that links with other public services, including the NHS, and supports resilient individuals, families and communities.
DC Care DC Care has announced the recent sale of Hamilton House, a care home in Plymouth registered for up to 36 residents within the categories of old age, dementia and palliative care. Owned by Mr Dawson since
1984, the home has been acquired by Ian Darbyshire of Darbyshire Care Ltd. The sale was handled by Southern Region Director Andy Sandel and Senior Sales Negotiator Clare Duffey.
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NEWS / IN FOCUS
Food and drink guidance from VODG New food and drink guidance from Voluntary Organisations Disability Group (VODG) has been produced in a partnership with Lancaster University. The university is working with the VODG to publish a document for social care providers, outlining good practice on food and drink provision for people using care services. The Learning Disability Mortality Review found that men with a learning disability are on average dying 23 years earlier than those without a learning disability, with the figure standing at 27 years for women. Many of the causes of these deaths are preventable, says VODG, with interventions around nutrition and hydration fundamental to supporting people to live a healthy life. As part of its commitment to tackling health inequalities experienced by disabled people, VODG has partnered with Professor Chris Hatton at Lancaster University to explore how social care providers can support disabled people to maintain healthy levels of nutrition
and hydration. A new good practice guide has been developed for frontline managers and service leaders to share key learning and to highlight examples of good practice. Professor Hatton has helped services consider the food and drink they offer to people with learning disabilities against evidence and guidelines for healthy eating and drinking. The new resource, Good food matters, recognises that staff practice and individual behaviour in relation to food and drink requires a long-term, organisational commitment. Sustained change involves addressing organisational cultures and personal attitudes as well as embedding a focus on supporting people to eat high quality food, says VODG. The resource is available for free download on the VODG website. Printed copies of the resource will also be freely available at a series of events VODG is hosting for social care providers who want to improve the health of people with a learning disability.
Funding for research into social care The National Institute for Health Research (NIHR) has announced projects which will receive a share of £2.5m of funding for research into social care. This comes as part of the organisation's commitment to improving social care and building research in the sector. Twelve new projects have been funded, ranging from finding the best ways to care for people living at home, to looking into online tools that help adults with learning disabilities learn to read. NIHR has also announced that it will be investing in future social care research. It will conduct annual funding calls via the Research for Patient Benefit (RfPB) programme, under the banner of Research for Social Care (RfSC). Up to £3m of funding will be offered.
This is part of NIHR’s ongoing efforts to build and improve social care research in England. In November 2018, the organisation announced that it will fund a third phase of the NIHR School for Social Care Research, with just under £20m committed over five years. This includes £1.8m specifically for building research capacity in social care, with PhDs, career development awards and internships planned. Professor Martin Knapp, Director of the NIHR School for Social Care Research, said, 'NIHR is investing in research skills and researchers, as well as working with local authorities and social care providers. As the leading funder of social care research, NIHR has an enormous amount to contribute.'
IN FOCUS More Harm than Good WHAT’S THE STORY?
Age UK is calling for a more considered approach to prescribing medicines for older people, in a report titled More Harm than Good. According to the charity, nearly two million older people who are on seven or more prescription medicines are at risk of side effects. In some cases, they are severe and potentially life-threatening. Age UK’s report says that too many older people are on more prescribed medicines than they need to be and provides evidence that prescribing more drugs isn’t always the best option, particularly when it comes to older people.
WHAT DID IT FIND?
The report suggests that two million people over the age of 65 are taking at least seven prescribed medicine – and almost four million are taking at least five prescribed medications. It also demonstrates that medicines are sometimes prescribed: • In excessive numbers. • In unsafe combinations. • Without the consent or involvement of the older people concerned. • Without the support older people need to take them. This causes significant numbers of older people avoidable harm, says the charity, and they are more at risk of this than other age groups due to the increased likelihood that they have more than one health condition. No medicine should ever be stopped without the advice and support of a GP or another clinician. However, research has found that one in five prescriptions for older people living at home may be
inappropriate, and Age UK is calling on the Government to take into account the harmful effects of inappropriate ‘polypharmacy’ (multiple medicine use) on older people as it carries out a review of overprescribing in the NHS.
WHAT CHANGE IS NEEDED?
In its report, Age UK calls on the NHS to ensure that: • There is zero tolerance of inappropriate polypharmacy. • Older people are supported and involved in decisions about their medicines. • High quality medicine reviews become routine for all older people taking medicines on a long-term basis. • Care planning and new prescribing decisions take full account of existing medicines. • Care homes maintain an appropriate clinical pharmacy lead and an accurate record of medicines. • Polypharmacy is a core competency of clinicians working with older people. • Older people, especially those living with dementia, have access to the support they need to manage their medicines. Caroline Abrahams, Charity Director at Age UK says, ‘Getting the medicines right for older people who live in care homes is especially challenging but also all the more crucial...The NHS Long Term Plan published earlier this year commits to rolling out Enhanced Health Care in every care home in the country... It is really important that this commitment is put into practice, to protect older people in care homes from the polypharmacy risks many of them face.’ CMM October 2019
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NEWS
Research into council complaints Following research into council complaints, Healthwatch is urging local authorities to promote a culture of learning from the complaints they receive about social care. Local authorities focus on reporting the number of complaints they receive, rather than communicating what they are learning, says Healthwatch,
which is calling for complaints managers to be given support to demonstrate how councils respond to feedback to help make improvements. The research into council complaints looked at how easy the reports were to access. Healthwatch found that, of 152 councils, only 55 reports were made publicly available in 2017/18,
compared to 72 the previous year. Many of these reports lacked investigation into why complaints were being made, the frequency of specific or common complaints and how to achieve a resolution, and Healthwatch found a lack of consistency in approach, making it impossible to understand national trends or learn from comparisons between councils.
Cash boost for hospices The Prime Minister has announced a £25m cash boost for hospices and palliative care services so they can continue to provide support for those at the end of their lives. This money will help keep many of these facilities open, says the Government, and will improve the quality of end of life care, ensuring people die as comfortably as possible. The hope is that the cash boost for hospices will also support the sector in relieving workforce
pressures as well as introducing new services – such as out-of-hours support, respite care and specialist community teams. The announcement follows campaigning from Chief Executive of Hospice UK, Tracey Bleakley and its Chair, Robert Peston. They recently met with Health and Social Care Secretary, Matt Hancock to discuss the pressures facing hospices – from falling fundraising and legacies to reduced
local statutory support. Mr Hancock said, 'End of life is vitally important...This cash boost will protect our precious hospices and palliative care services so people across the country will have the best, most personalised and dignified choices when they die. 'We should expect the highest quality support, so we can spend the last days of our life with our loved ones, dying with dignity in the way that we want to.'
Capital Care Group Independent nursing and care home provider, Capital Care Group has completed a multi-millionpound refinance deal with Allied Irish Bank (GB) in Birmingham to support its growth plans. Capital Care Group currently has six nursing and care homes: Hillcrest Manor and Portland House in Shrewsbury; Haresbrook Park in Tenbury Wells; Westfield Lodge in Stoke on Trent; Weston Park in Macclesfield; and its latest acquisition, Anville Court in Wolverhampton. The group provides specialist care services to adults and older people, including nursing care, residential care and dementia care. The funding package from Allied Irish Bank (GB) is designed to underpin Capital Care’s ambitions to grow the group to 1,000 capacity within the next two years and also includes the full suite of day-to-day banking facilities.
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CMM October 2019
NEWS
Musical Care Taskforce launched Reasonable adjustment flag pilot Music for Dementia 2020 and Live Music Now have launched a Musical Care Taskforce with the aim to make music an essential element of dementia care. The Taskforce, which brings together more than 60 representatives from across the music, dementia, health and social care sectors, will look at ways to bring music to people living with dementia who are not able to access music otherwise. Music for Dementia 2020 is a campaign to make music available for everyone living with dementia by the end of 2020. To create this Taskforce, Music for
Dementia 2020 have partnered with Live Music Now, a UK-wide charity that delivers interactive music programmes in care homes, hospitals and a range of community and healthcare settings. Members of the Musical Care Taskforce will be brought together in a series of meetings over the next 18 months, working within their organisations to advance the objectives of the group. They are actively looking for other dementia groups from across the sector to join the Taskforce and help shape the campaign as well as to contribute to activity.
Willowbrook Care Home Carterwood has completed the sale of Willowbrook Care Home, a 75-bed, purpose built, registered care home in Birmingham, to Care Concern Group. The business has been
transformed under the ownership of shareholder, Paul Willis and is an industry leading facility in the care of elderly people with dementia and mental health needs.
NHS Digital has announced a 'reasonable adjustment flag' pilot to support people with learning disabilities to receive better care from health services. The pilot will see a reasonable adjustment flag added to patient records, which will let doctors, nurses and other health and care staff know that a person has a learning disability and might require adjustments to the services provided so they get the best care. In the trial, staff will access the information through a patient’s record on the Summary Care Record application, a program designed to share key information about patients. In the longer term, it will be integrated with clinical systems so that staff will be able to see it on their own screens as soon as they search for the patient. The reasonable adjustment flag can alert a practitioner
to a patient’s need for a longer appointment or a quiet waiting area as well as how to communicate with them or who to involve in decisions about their health and care. The pilots will run in Gloucestershire and Devon until the end of September. Various care settings will be involved, including GP surgeries, hospitals and community services for learning disability. They will look at how care is impacted when that information is readily available to staff from the first point of contact onwards. The trials will seek to test the technology behind the flag and gather feedback from staff, patients and carers. NHS Digital will then explore a potential expansion, including widening the geographical area, giving access to more care settings and trialling integration with clinical systems.
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SOLD
Owned by Mr Dawson since 1984, who looks forward to a well-earned retirement, the home has benefitted from extensions and regular refurbishment to maintain its high spec presentation. Its impeccable reputation for care provision has also ensured the home rarely has a vacancy! The home has been acquired by Ian Darbyshire of Darbyshire Care Ltd, who also acquired Drake House through DC Care in 2014, a highly successful care operator expanding their portfolio in South West England.
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NEWS
Care Innovation Challenge winner announced A winner has been announced in the Care Innovation Challenge 2019, a competition for entrepreneurs to come up with new ideas and businesses to resolve some of the sector's biggest pressures. Run by Care Innovation Hub, the competition saw entries from entrepreneurs from a range of backgrounds, including airport designers, engineers, social care workers and scientists. Finalists presented their ideas and business plans to a group of sector leaders, hosted by the Department of Health and Social Care. Each finalist was given seven minutes to present, followed by three minutes of questions from a panel of judges and the wider room. Ideas tackled issues
such as social isolation amongst older people, retention of staff, childcare for care workers and falls prevention. The winning model came from Team Orchard, who looked to solve issues surrounding medication management. The team's idea involves an automated medication system, which would avoid errors, automatically log when a person has or has not received their medication and would store medicines safely. Runners up included Maaha Suleiman, who has established a viable resolution to ensuring culturally-appropriate care, and Olly Webb who came up with a simple solution to providing easy activities in care homes that support residents' general health.
Legal & General Guild Living, Legal & General’s new operator and developer of urban later living accommodation, has announced the acquisition of a prime 2.5 acre town-centre site in Walton-on-Thames. This site represents the third scheme currently under development for Guild Living, as it aims to deliver over 3,000 new homes in the
next five years to meet the UK’s longevity and urbanisation needs. Subject to planning, the Walton site will deliver around 300 new age-appropriate homes for the local area. The site has been purchased by Guild Living from British Land. Knight Frank advised Legal & General on the acquisition.
Increase in care providers using NHSmail The number of care providers using NHSmail has surged since the start of the year, from 97 providers to 1,076. NHSmail gives care homes the ability to securely share residents’ data and queries with doctors, nurses and GPs in the NHS, and get timely responses. It also connects them securely to pharmacists, dentists and anyone else in health and care with a secure email. It can be accessed from mobile devices as well as desktops and includes a full directory of all NHSmail users. 18
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Last year, an ‘Entry Level’ of the Data Security and Protection Toolkit was released, with record numbers of care providers signing up and gaining access to NHSmail. NHS Digital’s Social Care Programme formed a partnership with the Care Provider Alliance to work nationally with all care providers to help them embrace the digital agenda. This has included sector-led guidance for completing the different levels in the Data Security and Protection Toolkit, which can be found on the Digital Social Care website.
Changes to NHS Health Checks An evidence-based review into NHS Health Checks has been announced to see whether changes should be made to the ‘one-size-fits-all’ approach. The review aims to show whether tailored programmes will be beneficial to preventing diseases. The changes are part of a wider shift from blanket approaches to public health, to a modernised, future-proof system that takes risk or personal choices into account. The new-look NHS Health Checks should make prevention and treatment much more effective, drawing on the lessons from areas like cancer. Currently, health checks are offered on a standard basis to everyone aged 40-74, with little attention to their individual risks or needs. The checks are intended to spot the early signs of major conditions that cause
early death, including stroke, kidney disease, heart disease and type 2 diabetes. It is an important part of the public health services commissioned by local authorities across the country. The review will explore a specific check-up for those approaching retirement age to help prevent or delay future care needs. It will also explore the digitisation of the NHS Health Checks where appropriate and consider increasing the range of advice checks can offer – for example, prevention of musculoskeletal problems or early action on hearing loss. As part of this new promise, a review of the NHS Health Check programme will also look at ways to maximise uptake so more people can benefit from new smarter checks, targeted towards those most at risk.
Tribunal rules in favour of CQC A First-tier Tribunal has ruled in favour of the Care Quality Commission’s (CQC's) decision to refuse an application submitted by Lifeways Community Care to vary a condition of its registration. Lifeways, a care provider for people with a learning disability, autism or mental health issue, was seeking to add another location to its portfolio to support people who require accommodation and personal care. The provider has been registered with CQC to provide accommodation for people requiring personal care since 2010. The Tribunal panel’s unanimous view was that it 'was obvious the proposed care home had an institutional look to it and clearly had characteristics of a campus style setting which stood out and was apart from the surrounding neighbourhood' and that the Springside proposal was 'completely inappropriate' with reference to the national guidance and policy. The panel also felt that 'the proposed care home and the extent to which it departs from national policy and
guidance creates unacceptable and serious risks to service users in the provision of care'. Importantly, the First-tier Tribunal confirmed the importance of Registering the Right Support and the associated guidance in shaping care provision for people with learning disabilities and/or autism by concluding, 'The national policy and guidance is (and is supposed to be) aspirational. It seeks to transform existing care provision going forward. The panel accepts that the evidence establishes that the small domestic model of care promoted by the policy and guidance is (despite the challenges involved) realistic, workable and achievable.' This is an important judgement as it further clarifies what is an acceptable care setting, says CQC. The appearance of the proposed service did not match with the residential area it was located within and was too big, as there was a supported living service on the same site. This did not promote integration with the local community.
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WE HAVE A DREAM REFRAMING THE SOCIAL CARE CONVERSATION
It’s not easy to find an article on social care in the national press that doesn’t contain the word ‘crisis’ or ‘breaking point’. While the attention on the issues is welcome, is this stance helping, or are we just desensitising the general public? Neil Crowther shares his thoughts on this and why it’s so important we craft our messages in the best way.
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“We all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing the things that matter to us. That’s the #socialcarefuture we seek.” Martin Luther King never gave an ‘I have a problem’ speech. Painting a vivid picture with his words, King passionately set out his dream of a different, better world where, ‘one day right there in Alabama little black boys and black girls will be able to join hands with little white boys and white girls as sisters and brothers.’ King appealed directly to the ‘American dream’, invoking shared values and hoping that ‘this nation will rise up, live out the true meaning of its creed: “We hold these truths to be selfevident, that all men are created equal.”’ Emotionally heavy, while factually light, his vision remains a touchstone for gauging political commitment to, and progress on, racial equality in the USA and around the world. King framed the debate.
WHY THIS IS IMPORTANT Framing is, in a nutshell, about drawing the pictures in our audience’s heads of the world we hope to bring about, speaking to and igniting values to motivate people to support and pursue this world, and giving a clear sense of the path – the solutions – that will take us there, so that people are left with a sense of opportunity and possibility. It is about setting the terms of the debate. Where we fail to present a story, people rely on the existing pictures in their heads, meaning that no matter how many facts or great ideas we give people, our messages often fail to take root. If we neglect to consider people’s emotional brain – the values and moral intuitions which powerfully guide our receptiveness to new ideas and arguments – we either miss opportunities to enlist people’s support, or worse, direct them away from our goals by igniting unsupportive values. If we fail to leave people with a sense of hope and possibility, we create a sense of fatalism: in the absence of clear answers, over time any sense that ‘something must be done’ subsides and is replaced with an abiding sense that ‘nothing can be done’. Organisations and social movements are beginning to employ these insights into our cognition and psychology in the pursuit of social change. LGBT+ campaigners have successfully shifted the frame from demanding ‘civil
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CMM October 2019
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WE HAVE A DREAM: REFRAMING THE SOCIAL CARE CONVERSATION
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rights to same sex partnerships’, which invoked difference and ‘othering’, to ‘equal marriage’, with messages and imagery rooted in shared values of love, commitment, family and belonging. In the UK, the Joseph Rowntree Foundation is striving to circumvent negative attitudes to social security by reframing poverty itself, describing it as ‘restricting and restraining’ people and positioning benefits as a solution that ‘unlocks’ people from these constraints, with their messages rooted in the values of compassion and justice.
WHERE WE ARE NOW Those of us involved in #socialcarefuture have a dream. Unfortunately, our new research into how the story of social care is presently being told by campaigners for change, how it is reported by the print media and how it is understood by the public presents instead a bit of a nightmare. Social care is uniformly talked about as ‘in crisis’, so much so that ‘tackling the social care crisis’ has become the de facto policy goal. The story is one of money – public or private – with social care a question of meeting a growing and unaffordable financial cost. To individuals and their families, the cost is described as ‘catastrophic’, threatening their home and savings. Very large sums of money are proposed to solve this crisis, but frequently characterised as insufficient or unattainable. Rather than looking at it in terms of people’s lives, social care is spoken about as a ‘sector’, depicted and seen to be both under pressure and dangerous and, through its failings and lack of money, a cause of unsustainable pressure on councils and the NHS. Those requiring support are positioned as both the cause and the victim of these pressures, with the ageing population a ‘timebomb’. Working age adults do not feature in the current story of social care, save their presence in an overall reference to ‘the vulnerable’. Social care is seen as an end in itself, ‘looking after’ people ‘who cannot look after themselves’ through life and limb care, rather than as transporting people from one life situation to a better one, or as aiding their life chances. The story of social care is often a footnote to that of the NHS, with ‘patients’ now being the single most common group descriptor of those using or seeking its support. National government is the only ‘active agent’ in these stories, with funding the only issue to be addressed. Those requiring or using support are never depicted as having agency.
DOES THIS FRAMING WORK? Some will argue that crisis messaging has helped elevate social care up the public and political agenda. Social care is certainly enjoying a new level of political salience, featuring prominently in the Conservative Party leadership contest and with progressive proposals for funding via general taxation emerging from all sides of the political spectrum. Prime Minister Boris Johnson, speaking on day one of his Premiership pledged to ‘end the social care crisis once and for all’. It is however worth noting that in Johnson’s promise to ‘protect you or your parents or grandparents
“Social care is uniformly talked about as ‘in crisis’, so much so that ‘tackling the social care crisis’ has become the de facto policy goal.” from the fear of having to sell your home to pay for the costs of care’ the Prime Minister echoed the words of his predecessor, Tony Blair during his speech to the Labour Party Conference in 1997. Moreover, by focusing on property wealth and security, this message – when allied to the overall story of social care being told, reported and heard by the public – seems likely to be directing people away from those shared, outward-looking values needed to build support for paying more taxes, especially when overlaid with the social and economic anxieties of Brexit. The persistence of crisis messaging, allied to the non-appearance of government proposals for reform does however appear to have fostered fatalism among the public. Despite the current high profile of social care, in June of this year, Just Group reported, ‘For years we found around two-thirds of over-45s expressed interest in the debate [on social care funding] but that dropped this year to just over half, while those saying they are not interested has almost trebled to 17%.’ Similarly, the issue has dropped off Ipsos Mori’s Issues Index (which measures month by month the priorities of the British public), having featured regularly in the latter months of 2018.
Absent of a forward-looking vision of what social care is and does, the crisis message also risks becoming a self-fulfilling prophecy. As Julia Unwin has argued about housing, ‘If you talk about housing in terms of desperation and need, then you can’t be surprised if it becomes an emergency service.’ While the Care Act 2014 offered a vision and legislative framework for wellbeing, with personalised, community-based care and support being the means to those ends, the debate around funding frames care as a safety-net for the most vulnerable, offering only life and limb personal care. The shortfall in spending on social care is inarguably a major cause of its current ills and the lack of progress by governments since 1997 to achieve consensus on long-term funding of care is itself a result of failing to find a way to build public support for change. But rows over the funding of social care have sidelined the crucial question of what care and support should do for us and how it needs to work. This is why the primary focus of #socialcarefuture’s work is on shifting thinking about what social care should and can be and do in the future. If and when the funding tap is turned back on, we want to make sure any new resources are invested in ways which unlock the abundant resources and power to make change that already exist among individuals, families and communities.
WHAT MUST BE DONE In May of this year, 80 participants in the #socialcarefuture movement, including selfadvocates and directors of adult social services, people from disabled people’s organisations and from service providers, parent-led organisations and academics met in Manchester to begin drafting our shared dream for the future. We now need to do lots more deep listening to understand how the public thinks and feels about social care, to understand the values that will motivate them to support change, or which may stand in the way, to craft and test our messages and to support people to begin telling our story. We’re making good progress in drawing together the financial and practical support we need to put this project into action, covering the costs of expert advice, research and project management and plan to start work this autumn. We want our dream to become reality, and writing and telling our story lies at the heart of how we plan to achieve this. If you share our dream and would like to support us or be involved, please get in touch. CMM
Neil Crowther is a member of #socialcarefuture. Email: socialcarefuture@gmail.com Twitter: @socfuture What are your thoughts on the crisis messaging in the media? Do you feel it’s a help or do you think we need to reframe the debate? Let us know on the CMM website, where you can also feed back on Neil’s article, www.caremanagementmatters.co.uk CMM October 2019
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Hidden in plain sight THE TRUE STATE OF THE HOMECARE MARKET Local authorities are becoming increasingly eager to shift people away from residential care, encouraging those who can to remain living in their homes with support from homecare providers. But is the sector set up for this demand? Steve Sawyer, Managing Director of Access Health and Social Care looks in-depth at the data to uncover the hidden dynamics of UK homecare.
Analysis is becoming ever more important for the care sector, as providers seek to maximise their offering and improve services on stretched budgets. With so much analysis of the UK homecare sector based on qualitative surveys, we wanted to tap into real-world data and find out how providers are operating and the scale of the challenges they face. Using anonymised data from more than 4,700 registered locations, which account for around a third of the sector, captured over four weeks in March this year, our Hidden Dynamics of Homecare report
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HIDDEN IN PLAIN SIGHT: THE TRUE STATE OF THE HOMECARE MARKET
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looks at standards in three key areas, as well as what it takes to be an Outstanding provider in a difficult climate. Sadly, while revealing some exceptional practice, our findings lay bare all-too-familiar challenges – a result of chronic under-funding and increasing demands of an aging population, particularly from those who do not have family support to fall back on. It remains to be seen whether or not Boris Johnson’s government can deliver on its pledge to ‘fix’ the social care crisis, although the timing of his announcement in his first speech as Prime Minister was certainly significant. What is clear is that a focus on supporting the homecare market will need to be an essential part of his plan. We have reached the point where care organisations, and workers on the front line, must be questioning how they can meet safety and quality standards with so few resources.
PAY AND PROFITABILITY It is reassuring to see that, despite funding shortages, providers are maintaining minimum wage compliance, with care workers paid £8.81 on average per hour of state-funded homecare contact time, excluding travel time and pay. That’s above the minimum wage which was set at £7.83 at the time. While the average invoice for state-funded homecare has risen in the past year, from £16.35 per hour to £16.88, it is still well below the £18.01 recommended by the United Kingdom Homecare Association (UKHCA). Looking at the most frequent type of state-funded visit – one that lasts 30 minutes – providers make an average margin of just over £1.20 each time before operating costs. Included in these costs are pension and National Insurance contributions, as well as holiday and sick pay, but not other overheads, such as training, rents and administration. When all operating costs are included, it is estimated that homecare providers are in fact losing £1.68 per hour on state-funded care. An Opus Restructuring LLP and Company Watch report, which studied more than 2,700 companies, found they made a pre-tax loss of £4,000, with losses across the sector totalling £10.5m. While it would appear admirable that these firms are plugging a shortfall in local authority funding, it is clearly not sustainable over the long term. Operating costs are only going to increase in line with demand for services and if they are inadequately funded, these providers will simply go out of business or hand back local authority contracts. Where there is a gap in homecare provision, people using services could be forced prematurely into residential care, rely on their
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CMM October 2019
“When all operating costs are included, it is estimated that homecare providers are in fact losing £1.68 per hour on statefunded care.”
families more or be unable to return home after a hospital stay. An obvious solution would be to rely less on the notoriously low rates from commissioning authorities and it is worth noting that Outstanding providers typically deliver 70% private-funded visits. Of course, this is not an option for some, usually those operating in areas of high deprivation, where the problem of profitability is even more pronounced. Outstanding providers in these areas with 60% or more state-funded visits tend to pay staff more (£9.32 compared to the overall average of £8.81), resulting in a meagre 65p margin on a 30-minute visit before operating costs. Where they do benefit, perhaps unsurprisingly, is from better retention rates of three years’ service compared to the two years seen in non-Outstanding firms.
COUNTING THE COST OF HIGH VACANCY RATES Care work tends to rank among the lowest-paid professions, something which is, according to the National Audit Office, contributing to a vacancy rate of 7.7% and turnover of almost 34%. Like most professions, there seems to be a direct correlation between pay and retention, as well as the extent to which providers invest in staff development and offer flexible working. Drilling down into our figures further, the average age of a homecare worker was 43 and it is also notable that there is a link between age and length of service. Where the average workforce age was 40 or above, providers saw higher retention rates, at 2.9 years compared to 1.6 years, while those using services stayed with
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HIDDEN IN PLAIN SIGHT: THE TRUE STATE OF THE HOMECARE MARKET
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the same provider for 1.7 years rather than 1.4. Mature care workers also command higher pay than their younger counterparts – £4.53 for 40 to 45 year olds on a 30-minute state-funded visit, rising to £5.29 for 50 to 55 year olds. In contrast, under-35s receive just £4.09 on average. Looking at attitudes of those using services and their families, it is interesting to note that they overwhelmingly associated the age of a care worker with experience and longevity. Whether or not these beliefs are well-founded, it could explain why a higher average age and length of service could contribute to a CQC Outstanding rating. Client interviews (qualitative research) and continuity of care form part of the regulator’s assessment, so it follows that these providers would perform well. Equally though, it could be that providers who have already developed a positive working culture, and invested in resources and technology, can attract more experienced, and generally older, care workers.
LONGER VISITS DRIVE UP STANDARDS One of the biggest challenges for care workers is that they simply do not have adequate time to spend with clients, particularly as visits during the week are also less frequent than at weekends. Since 2015, there has been a minimum recommendation that staff spend at least 30 minutes with each person – and it is heartening to see that providers and local authorities acknowledge this, with most making this their standard length of visit. However, this still isn’t sufficient time to deliver quality care. Of all the Outstanding providers included in our data, just 28% of private-funded visits were 30 minutes or less, rising to 45% among non-Outstanding. Looking at state-funded care alone, there seemed to be no significant difference across the sector, with Outstanding companies reporting that 74% of visits lasted longer than 30 minutes, compared to non-Outstanding ones at 73%. Our figures also reveal that almost 47% of state-funded visits lasted an hour for Outstanding providers, while 17% were 30 minutes and a little over 6% were 45 minutes. Indeed, those who delivered the highest proportion of 60-minute visits were more likely to receive the top rating.
“We cannot continue to rely on the goodwill of providers to cover the rising cost of care.” Across the board, however, many local authorities may have little choice but to commission 30-minute care visits. Worryingly, our data suggests this type is actually the norm, rather than a minimum requirement. There is no question that more funding is needed to ensure there are enough care workers available in a local area and that they are not rushing from one house to the next.
GUARANTEEING QUALITY Whatever changes we see in the health and social care sector over the coming years, homecare will play an even greater role in delivering vital services. Given the high costs of residential care, let alone hospital admissions, it makes sense to support people to stay in their homes for as long as possible. But we cannot continue to rely on the goodwill of providers to cover the rising cost of care. Like any business, they need adequate funds in order to pay competitive wages that attract and retain staff and, most importantly, guarantee the highest quality of care. More providers will, I’m sure, also see value in technology that reduces their operational costs, enabling them to meet demand in a sustainable way and put more resources into the frontline of care, but government funding is desperately needed to enable providers to focus on developing their business, rather than just keeping it afloat. CMM
Steve Sawyer is Managing Director of Access Health and Social Care. Email: hsc.info@theaccessgroup.com Twitter: @AccessHSC Where does your business fit into these figures? What are the biggest pressures for you and how have you overcome them? Share your experiences, feed-back on this article and read the Hidden Dynamics of Homecare report on the CMM website, www.caremanagementmatters.co.uk
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EMPLOYEE REFERRAL: MAKING IT WORK Employee referral schemes are a great way to find new staff – and frequently staff found via other employees are more likely to stay at a service for longer. But the bureaucracy and paperwork make it an underused resource. So what if it was simpler? Care Friends is a new mobile app developed by Neil Eastwood of Sticky People. The idea emerged from Neil’s research into social care recruitment and retention, where he repeatedly saw that employee referral and word of mouth was the best source of high-performing, long-staying care staff. He also found that most staff in the sector say they love their jobs and are pre-disposed to recommend it to others, but the number of referrals remained stubbornly low. Upon researching employee referral schemes in both the care sector and other areas, Neil saw that the schemes themselves were often the issue. Staff had to fill in paper forms, weren’t aware of the benefits of referring friends, and it was an admin-heavy task. He decided to develop Care Friends to see whether this could help improve people’s use of employee referral schemes.
TESTING THE CONCEPT Once the concept was refined, Neil ran a series of focus groups with care assistants, homecare staff and learning disability support workers. He also interviewed in-house recruiters, registered managers, directors and owners. At the same time, he approached a company that had developed a similar app which they were testing in different sectors. They agreed to let him use it as a prototype to prove the concept in a pilot. The app was trialled alongside Surrey Care Association, whose members gave feedback and one, Melody Care, went on to run a six-month pilot. That pilot and the feedback from the recruiter and staff helped inform the build of the Version 1 Care Friends app and, supported by the Cornwall Adult Health and Social Care Partnership, 30
CMM October 2019
to win an EU grant to support a much larger beta trial in Cornwall in the Summer of 2019. That beta trial runs until December, with employers collecting data and providing feedback on the app.
HOW IT WORKS Care Friends is made up of two main elements: an app that care staff download to their device and a web portal that in-house recruiters use to manage the employee referral scheme. The entire system is built using the concept of gamification – introducing game-playing elements like earning points and competition with others for example – to make the process of referring people fun and engaging. A care worker would hear about the app from their employer and download it directly from their app store. They would enter a company code which identifies the company they work for and agree to the scheme rules. Then they share listed jobs with their friends and contacts either directly via SMS or What’s App, for example, or more widely via social media. They can personalise the message prior to sending. The recipient is sent a trackable link to open a brief expression of interest form to find out more. This both alerts the recruiter to contact them and awards points to the referrer automatically. A point is worth £1. The recruiter is able to manage these referrals easily from their portal, send notifications to staff and track how well this cohort of applicants performs against other recruitment channels. Points can be awarded to referring staff on key milestones in the referral process, such as sharing a job, receipt of an expression of interest, successful interview, starting work and their referral reaching 12 months’ employment.
The system also offers a bonus of points if the referred starter is new to paid care work, thereby growing the social care workforce. Managers are also able to award any staff bonus points as a way of motivating and engaging them. For example, as an instant thank you for picking up a dropped shift, for achieving their Care Certificate or for a compliment from a client.
TECHNICAL DIFFICULTIES Although the concept is relatively straightforward and the user interface for care staff is simple, the complexity behind the scenes to build a system that works for both single-site, small care providers and multisite, multi-million-pound employers is considerable. Neil says, ‘We had underestimated the sheer amount of bug-fixing and re-testing that a project like this requires. That has led to delays in launching and cost overruns, but this seems to be the experience of almost all start-up software suppliers in the care sector. ‘We had anticipated that replacing a previously manual, paper-based process with a digital one would require lots of thinking and effort to ensure care providers were supported to launch and familiarise their staff with the app. To overcome this, we have worked with an internal communications agency to produce a launch toolkit for employers and have used the latest guided navigation software to help recruiters get started. This has paid off. Focusing on successful implementation cannot be overstated.’
DELIVERING RESULTS The early pilot activated a third of the workforce as recruiters in the local community and Care Friends
is looking to improve on that in its beta trials. One unexpected success was relating to DBS checks. New starters were encouraged to download the app on acceptance of the job – so they still had to wait for DBS checks and references to come back. Neil says, ‘In social care, typically as many as half of this group would drop out prior to starting training. But when they downloaded the app, they started recommending their friends to join them and were much more likely not to drop out as they had started accruing points waiting for cashing in once they joined.’ Care Friends is hoping to be able to demonstrate metrics like whether referrals show up for interview more often, whether they are more likely to be hired, whether they stay employed longer and whether more people are being encouraged to work in social care. The ultimate aim of the app is for Care Friends to make a meaningful impact on the current and future vacancy rate, on reducing the growing spend on temporary agency staffing and on improving retention rates both by bringing in high-quality new staff and by allowing managers to instantly recognise the contribution of staff. Neil continues, ‘There are many more exciting possibilities for the platform once it has scale, but for now we need to stay focused on ensuring the app delivers on its core purpose – to help solve the impending recruitment crisis.’ CMM
OVER TO THE EXPERTS... What are the considerations when looking at this technology? Do you think staff will use it? What could be the challenges of implementing this?
A GREAT INITIATIVE This is an extremely interesting concept and, removes the administrative burden in running such a scheme. In view of the difficulties that care homes face in recruiting staff, this is an excellent idea. However, I would suggest the following considerations. This scheme is a benefit for employees. Employers should ensure that benefits are accessible to all employees. Some may not have a smart phone to download the app, and therefore be unable to participate in this benefit scheme. This could result in grievances being raised by employees and potential discrimination claims. It is important that all employees are treated equally, and therefore it may mean that the company has to run two schemes. Being heavily reliant on a scheme such as this to recruit staff, i.e. recruitment via friends and family, may impact on reaching a diverse workforce and impact on
MUST BE INTUITIVE AND FAIR a company’s equal opportunities policy, to ensure that there is a balanced workforce. With the implementation of GDPR, consideration will need to be given as to how the applicant’s data that is being accepted via the portal is managed by the company. A privacy notice will need to be prepared and made available to applicants. The privacy notice will need to include details of data that is being processed, the reason for processing the data, how long the data will be retained, confirmation that the data will be held securely and the rights of the individuals regarding that data. This is an important consideration to avoid breaching the current data protection regulations. As I stated earlier, my view is that this is a great initiative, and should take into account the above considerations.
Sejal Raja Head of Employment, RadcliffesLeBrasseur
Over the last five years, cloudbased digital apps have been introduced for homecare delivery management. Rotas and care records are updated in real-time over wifi and mobile phone networks. Transparency of data and ease of communication enables providers to drive improvements in quality, safety and efficiency. Another key benefit is that in agencies using these systems, care workers have access to smartphones. Once staff have smartphones, it is easy to install apps like Care Friends. At present, though, only a proportion of homecare agencies are using digital care planning apps and issuing smartphones to staff. So one challenge could be availability of devices to enable staff to use Care Friends, as not many can afford their own. Staff will adopt an app if it is simple, intuitive and offers a clear benefit to them. Staff already
familiar with smartphones are likely to implement new apps quite readily, provided they add value. If training and support for using the app are inadequate, staff are less likely to feel confident and may not start using it. This could be exacerbated if performance of the app is affected by bugs. Another challenge might be maintaining use once the initial novelty has worn off and/or staff have referred all the contacts they have. Management challenges can also arise if friends and family work in the same service. If the app is intuitive and used regularly and fairly by managers to reward staff in real-time for a range of performance metrics, such as referrals for recruitment and picking up extra shifts, staff are more likely to feel engaged and motivated to continue using it.
Dr Jane Townson Chief Executive Officer, UKHCA
COULD BE A SOURCE OF STAFF COHESION There are three types of organisation this app could market itself to: those with no digital capacity, who might find it hard to integrate the app into their systems; those with some digital capacity but not in recruitment, who could use it as a stand-alone app; and those who have digitised recruitment – would they be able to incorporate the app into their digital recruitment platform? Gamification means Care Friends could be fun to use, and the potential for in-house competition means it could be a great source of staff cohesion. The benefits of incentivising new recruits to complete the joining process also leads me to think there could be the other unseen benefits – maybe in terms of people creating their own profile/ brand on the app. It is unclear whether joining the app is obligatory – could there be any prejudice in an organisation if
a person decided not to download the app? However, if staff members weren’t using the app, this could be a point of discussion which might help understand staff motivation. An organisation would need to understand clearly the issues this app is addressing and whether it fits within its digital strategy. While the article does not discuss the cost/benefit issues involved, this might also be an important factor. The challenge for Care Friends is to define its market and the questions it is addressing. If it fits with the profile of an organisation, I think staff would enjoy using this app and an organisation could use it to achieve greater efficiency and incentivise staff. I wonder whether integration with other systems could be a way forward for Care Friends.
Daniel Casson Digital Development Executive, Care England CMM October 2019
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NCF RISING STARS 2019 Kelly Hartley is Manager of Cherry Garth, run by The Fremantle Trust.
manager and so when I got promoted to deputy manager, they sent me to work with a manager in London for 18 months to develop my skills. I’m now a registered manager at Cherry Garth care home.
ORGANISATION
CAREER HISTORY I started my career in the British Army, where I spent 12 years as a healthcare assistant. When I left, I wanted to go into social care and I joined The Fremantle Trust in 2004 as a care worker looking after older people. Soon after that, I moved to a learning disability service where I worked my way up to assistant manager. My husband’s work took us abroad for three years, but I knew when I came back to England that I wanted to rejoin The Fremantle Trust. They didn’t have any senior positions available so I joined as a care worker again, before becoming senior care worker and then assistant manager again within 18 months. I’ve spent my whole social care career with The Fremantle Trust and I wouldn’t want to work anywhere else. They’ve helped me develop into the manager I am now. They knew I wanted to work my way up to registered
Cherry Garth is a 60-bed residential care home for older people, including those living with dementia. We care for them from very early stages of needing support through to the end of their lives. We have an engaging activity programme which gets us really heavily involved with our local community. We use the village hall for boules, have parties at the school, invite the church to hold services in the home and have a Strollers Club so residents can go for walks around the village. We were runners-up for community engagement in the Dignity in Care Awards with Buckinghamshire County Council, and we are very well known in the village – lots of residents come from the local area. Our reputation is spread by word of mouth, so we don’t need to do a lot of advertising, and lots of our employees live locally too.
CURRENT ROLE I’ve been a registered manager for just over a year now. I wanted the job so that I could improve the lives of people I care for in a bigger way. I’m passionate and innovative, and I want people to have what’s best for them. I have always had
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NCF RISING STARS 2019
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ideas about ways we can develop services. Being a registered manager means I can implement some of these ideas to give residents more – we’ve put in a bar and a library and we’ve just turned an unused room in the home into a craft room. We’re also opening a coffee shop which will be named and run by the residents, whose families will be able to come in and support them by helping out too. Something I’m really proud of is our sensory garden. The outside space wasn’t used much when I first came here, but we’ve made it a vibrant and interactive space with lots of places to sit, and everybody loves it now. For me, being a manager is also about improving the lives of your employees. I see it as a responsibility to support them if they are facing things in their personal lives – you have to recognise that people have issues outside of their work and help them with these as far as you can to get the best out of them. This is a job where you learn as you do. You see a manager sitting at their desk, while you’re rushing around on the floor and dealing with emergencies, and you think that it looks straightforward. But the truth is, some days I don’t know whether I’m coming or going. I love the job but it’s definitely more difficult than I ever anticipated. The marketing, financial and HR side of things makes it complex. I knew about budgets as a deputy, but you have to consider occupancy levels and agency costs within this. It can also be quite lonely. I’m lucky at The Fremantle Trust as there are other managers within the organisation I can pick up the phone to. My own manager is really supportive which helps and I feel extremely encouraged
in my role. Even though it’s hard sometimes, the job is better than I ever expected. I get really excited when our plans come together and I’ve never felt so fulfilled. When I did care work, I loved it, and even though I have other responsibilities, I do still get to do that. I’m not a manager who just sits in the office – I frequently sit with residents for a chat and I make sure I support with breakfast and lunch. I love seeing employees and residents happy. I wish more people would work in care as we put our all into supporting residents and it can be hard to get cover when people are sick or need shifts swapped. I’ve done a huge recruitment drive though and we have reduced our agency hours in the last year by two thirds, so I’m really pleased about that.
NCF RISING STARS I didn’t know anything about NCF Rising Stars when I was nominated. My manager nominated me and I had to research the programme. I read up on it but didn’t really grasp the scale of the programme until I went to the NCF annual conference and met the other Rising Stars. I am so happy to be chosen. It’s such a privilege and it means a lot that my organisation saw potential in me and recognised the work I do. I’m going to meet with my mentor, Helen Woodland to get some new ideas for Cherry Garth and am looking forward to the guidance she can give me. I’m also really looking forward to having the support and getting to go to all the NCF Rising Star events, especially the managers’ conference. Rising Stars is a fantastic opportunity and I feel really privileged and honoured that I’ve been selected
by NCF. Everyone has been so lovely and made me feel really special. The whole experience has been brilliant. I was so nervous going to meet everyone but was made to feel so welcome. It’s a fantastic thing and I’m hugely appreciative to be part of it. I look forward to being part of NCF for the rest of my career now.
FUTURE CAREER In the future, I would probably like to become a director. It’s not something I aspire to at the moment, because I like being in the home. For now, I’m setting my sights on aiming for an Outstanding rating in my next inspection, which is due any time! I want to keep developing the service and getting residents involved in things so that we are offering the best service we can. Hopefully being a part of the Rising Stars programme will help with this, as I can talk to others and get advice and guidance. Attending the events has already given me so much inspiration too.
ADVICE For aspiring registered managers, I would say always ask for help, even if you think the question is stupid – just ask. Someone once told me, ‘You don’t know that you don’t know something until you don’t know it’. I stand by that and believe there’s no such thing as a stupid question. I am lucky to be very well supported by my organisation and I think other companies should make sure they are doing this. It’s been so important to have had support from all departments, especially HR – they are invaluable. CMM
Now in its third year, the NCF Rising Stars Programme addresses the need to invest in and develop the skills of the next generation of leaders in social care, with registered managers from the NCF membership selected to take part each year. For more information, contact Helen Glasspool at National Care Forum. Email: helen.glasspool@nationalcareforum.org.uk Twitter: @NCFCareForum
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Safeguarding and employment rights:
A DELICATE BALANCE The UK’s adult social care system employed an estimated 1.49m people across 39,000 establishments in 2018. With such a large workforce operating in a demanding, highly-regulated environment, it is inevitable that issues around employee conduct will arise. Deborah Nicholson of Markel Law discusses disciplinary investigations and how you can minimise risk when taking this type of action.
If an incident occurs in a care service, employers know that their priority is to safeguard their clients. Adult care facilities have a particular responsibility to the people they care for, and local authorities and regulators are clear that they expect operators to act quickly and decisively if an issue arises relating to staff conduct, investigating what has happened and identifying changes that need to be made. However, as much as things must be put right, it is imperative that employees are treated fairly in any investigatory process, not only to protect them, but to protect the provider too. Having the right
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SAFEGUARDING AND EMPLOYMENT RIGHTS: A DELICATE BALANCE
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justification for any action taken, and following the correct procedure, can help all parties to minimise any potential fallout, including claims in the Employment Tribunal.
YOUR PROCEDURES First and foremost, an organisation should have its own set of documented procedures that are sufficiently flexible to deal with the multitude of scenarios employers could be faced with. These procedures should be communicated to staff and there should be evidence that this has been done. A common route is to provide an employee handbook to a staff member when they are inducted into the organisation, and ideally remind them of their obligations at regular intervals. It is important that all staff can understand the procedures and that management knows how to apply them if the need arises.
TAKING THE RIGHT PATH Before you begin any disciplinary action, it’s important to ask yourself if the reason for taking action is appropriate. This question, of course, is difficult to answer with any degree of certainty at this early stage. However, it’s worth running through some initial questions before the action against your employee is launched to make
sure your rationale will stand up to challenge: • Do you understand from the initial disclosure, what has happened and who is involved? It may be that you need to undertake some further investigation to establish this. • If there is a client involved, what is the status of their welfare? • Are there any records (or other material) that you can take possession of that may assist you and which need to be preserved? • Have you risk-profiled the disclosure and considered whether any interim steps are necessary? • Is this a case of alleged abuse and/or inappropriate behaviour? • Is there an allegation of dishonesty? • Has there been an error relating to the care of a resident, e.g. medication? • Who will investigate the concerns? Are they able to act independently? Of course, this list won’t cover all eventualities and there is the issue of seriousness of offence. However, it is a good starting point to help establish the basis of the investigation, which will be fundamental moving forwards.
WHEN AN INCIDENT OCCURS If it appears that disciplinary action is warranted, it’s important to be
proportionate and fair towards the employee. Always keep this in mind and ensure you broadly follow this checklist of key steps in the event of disciplinary action: 1. Inform the employee of the allegations against them – together with supporting evidence – in confidence, and in writing, before the initial disciplinary meeting. 2. Ensure the employee understands they can be accompanied during the meeting. 3. During the meeting, make clear the potential disciplinary action that could be taken and the levels of management with the authority to take the disciplinary action. 4. Give employees the opportunity to challenge the allegations before decisions are reached. 5. Provide a right to appeal, and details of how to do this.
INVESTIGATIONS AND EVIDENCE Once you do begin your investigation, do not underestimate the importance of being thorough. Failure to conduct a proper inquiry can result in a successful counter-challenge by the accused at tribunal, as in the case of Gough vs East Midlands Crossroads, where the judge ruled that the investigation into the alleged incident(s) was ‘wholly inadequate’, even though the management team genuinely believed Mrs Gough’s actions amounted to gross misconduct. Regardless of what the management’s belief is, it is critical to go through the proper process, take witness statements and interview people. If you think you can proceed on the basis of a strong belief at an early stage, you should question whether you are the right person to undertake the investigation and act objectively. Any assessment that there is a case for the employee to answer must be based on actual evidence; speculation will not stand up to independent scrutiny in the Employment Tribunal. The assessment should consider all the evidence and not that which merely supports the allegation. If there is an appeal against a decision to dismiss, it is important that this is given proper scrutiny, as it provides employers with a chance to remedy any defects in the earlier investigation and initial decision.
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STREENER VS BARCHESTER HEALTHCARE
The recent Employment Tribunal decision in Streener vs Barchester Healthcare has also emphasised that a disciplinary investigation must be objective and undertaken properly or employers are at risk of being found guilty of unfair dismissal. In this case, the claimant – the home’s deputy manager – was alleged to have spoken to a resident in an inappropriate, confrontational way, stating that if the resident was not prepared to have a bath then she would have to stay in her soiled state. The disclosure also stated that the claimant was prepared to leave the resident in her room rather than making proper efforts to persuade her to have a bath and restore her dignity. A disciplinary investigation was commenced and the claimant was eventually suspended from work. The witness evidence obtained during the investigation established that there was an incident between the claimant and the resident relating to an unpleasant smell coming from the resident’s room; however, the statements were inconsistent in establishing what the claimant said to the resident and how she said it. In an additional complicating factor, it transpired the resident was the aunt of the claimant. A brief report was prepared and the claimant was summonsed to a disciplinary meeting. The invite letter sent to the claimant contained no details of the alleged incident and did not identify the resident involved. Various unsigned statements were sent to the claimant, together with the investigation report and other supporting documentation. The claimant was subsequently dismissed for gross misconduct on the basis her conversation with the resident constituted verbal abuse and a report was made to the Disclosure and Barring Service (DBS). The claimant launched an appeal, challenging the summary of her interview and denied being rude and abusive, stating she had followed the
approach in the resident’s care plan in relation to the management of difficult behaviours. The claimant had worked for the respondent for 13 years as a deputy manager and had an excellent record. The appeal was considered on the papers and dismissed. The claimant then brought a claim for unfair dismissal and was successful. She was awarded £11,603.21 in compensation after a reduction of 40% was applied for contributory conduct. The Employment Tribunal concluded that the actions of the claimant did not amount to gross misconduct, although she was criticised for approaching the
independent and not tainted by the allegation(s). • The more serious the allegation, the more rigorous the investigation needs to be. • Witness statements should be signed and dated or there is a risk they will carry less weight. • Disclosure of the evidence should be made to the employee to allow them to understand and respond to the case they have to answer. • The employer should state what the allegation against the employee is. It is not sufficient to expect them to deduce it from the witness statements
“Before you begin any disciplinary action, it’s important to ask yourself if the reason for taking action is appropriate.” situation in a confrontational way. The Tribunal stated, ‘There can never be an excuse on the part of a member of staff of a care home to show anything less than tolerance and patience towards a vulnerable resident even if that resident is also their effective next of kin.’ Interestingly, the Employment Tribunal was complimentary in relation to the very clear policy framework that was put in place by the operator. The issue here was around the interpretation of that policy and the execution of the investigation.
THE IMPORTANCE OF PROCESS There are some very helpful learning points contained within the judgement: • Any complaint and further disclosures should be properly documented, especially where the report is made over the phone. • The motives of the complaint are a very relevant consideration for an investigator. • The investigator should be
or to make a vague reference to an incident without addressing where, what, when and who. • A decision maker should be given a framework/prompt to encourage them to justify in writing why their decision is necessary and proportionate. • Where the matter involves a resident, the investigator needs to consider whether they are able to give an account of what occurred. If they are unable or unwilling, this should be documented as part of the investigation. • Any mitigation advanced by the employee must be considered even where the findings reach the threshold for gross misconduct. This case should not serve as a deterrent to those who quite rightly want to take a hard-line approach to safeguarding concerns. However, it does emphasise the need to follow a proper process, especially where dismissal for alleged abuse has such a significant impact on an individual’s future employability. CMM
Deborah Nicholson is the Head of Regulation at Markel Law. Email: Deborah.Nicholson@Markel.com Twitter: @debbie_nic How do your processes hold up? When have you needed to test them and what have you learnt? Share your knowledge on the CMM website, where you can also feed-back on this article, www.caremanagementmatters.co.uk This article does not constitute legal advice and serves to provide observations on the aforementioned Tribunal decision. 40
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How will AI change the social care sector? Regular readers of CMM will be aware of, and may even be experiencing, care staff shortages. Regular turnover, a shortage of skilled and experienced staff and a rising demand for care workers are all issues faced across the country. We need a solution, but is artificial intelligence (AI) the answer? Lindsay Taylor of Coffin Mew shares her thoughts. 42
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Skills for Care regularly investigates and reports on the state of the adult social care sector and workforce in England. In its September 2018 report, Skills for Care estimated that the sector turnover rate was 30.7% – equivalent to around 390,000 staff members leaving their roles in the previous 12 months. It also found that: • The vacancy rate was 8%, or around 110,000 positions at any given time. • The estimated sector workforce was 1.26m directly employed staff with the turnover rate increasing by an average of 7.6% between 2012/13 and 2017/18. • The turnover rate for care worker roles was noted as the highest at 37.6% and within the domiciliary providers category this figure jumped to 42.3%. • Retention of new staff was identified as a huge issue, with the largest proportion of staff turnover a result of workers leaving shortly after joining the sector. • Sickness equated to an average of 5.1 days over the preceding 12 months or 6.5m days across the estimated workforce of 1.26m people. When considering business operations, providers clearly need to prioritise certain essential tasks should there be any shortfall in staffing. Sadly, this can leave precious little time for resident interaction and other less urgent needs, potentially leaving residents at risk of feeling isolated or lonely. With demand for care workers ever-increasing, and with current vacancies not always being filled, there is concern around how the sector will cope, both in the near future and as the years roll on.
THE PEPPER TRIAL One forward-thinking response has come from a
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HOW WILL AI CHANGE THE SOCIAL CARE SECTOR?
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collaboration between the University of Bedfordshire and Advinia Health Care. Utilising £2.5m of funding from the European Union, a trial has been set up dispatching robotic humanoid companions to care homes. These four-foot-tall robots known as Pepper were designed in France. They are now manufactured and marketed by the Japanese corporation Softbank Robotics with the sole intention of interacting with care home residents. The robots use an impressive piece of tech that allows the AI to continually learn from their interactions. Imagine a culturallycompetent and sensitive robot that has the capability to learn your favourite music but can also remind you to take medication. The robots are not intended to replace care workers, and indeed they do not have working limbs so cannot undertake manual tasks. Instead they can assist residents in communicating with family members through video calls, either with voice commands or using touch screens. Using facial recognition, the AI can focus more on topics of discussion that interest the resident and steer clear of anything that might upset them – much like a human companion would. If the humanoid companions can successfully recognise a person in distress, which the trial aims to identify, they will be able to alert a care worker to attend and assist. Whilst it would be ideal for human care workers to have the opportunity to sit with residents for long periods of time to ensure that loneliness is abated and reminders for important personal tasks are undertaken, this is not always possible. Instead, companions like Pepper could take the strain off busy care staff, ensuring residents benefit from increased social interaction and
improved mental wellbeing. Recently, Pepper even spoke in front of MPs of the Education Select Committee, explaining how AI as a service could cut costs for caring for the elderly. As Pepper explained, ‘Assistive intelligent robots for older people could relieve pressure on hospitals and care homes as well as improve the care delivery at home and promote independent living for the elderly people.’
CARE HOME PETS Similar AI has already been successfully tested in care homes. Kenwith Castle care home in Devon was the venue for the initial meeting between KC the dog, Keno the pony and residents who lived there. The AI animals responded to residents’ petting and noises and it was noted, in particular, they were are to provide effective and positive interaction with people living with dementia. The pets were not considered a replacement for the live animals that also visited, but as an additional resource. One family was so impressed, they purchased a robot dog for their elderly parent. These AI companions do not require feeding or upkeep (save batteries or charging) and there is no risk of neglect or need for an alternate caretaker should the owner become ill or incapacitated for any length of time, so they tend to be well-suited for people who receive care services. There are several other types of AI on the market which could be utilised for the benefit of people using care services. What about the resident who is fiercely independent but cannot feed themselves? A robotic arm at their command could be an excellent replacement, allowing them to eat at their own pace and retain some of their independence, while freeing-up a care worker to assist somebody else.
MORAL AND PRACTICAL CONCERNS OF UTILISING AI These developments in AI have not impressed everyone. Judy Downey of the Relatives and Residents Association charity has said that it is like ‘treating people like commodities.’ Indeed, there is a concern that some could see simply having a robot present as a box being ticked that a person’s emotional needs will be met. However, as Judy argues, human beings are much more complex creatures with individual needs. Dementia, for example, affects everyone differently, but for many it can mean that they become easily confused. There is then a difficulty in knowing whether people with dementia understand that they are interacting with robots and not live animals or humans. It is unethical to risk causing distress to anyone by using AI which blurs the lines and appears to think and act like a human. Is it fair to expect someone to spend their time with robots, just because of the sheer lack of human care worker availability? This is where it is important to retain that human factor. A human, whether care worker or family member, can oversee the interactions and determine, with the person being cared for, whether an AI solution is suitable. It is important to emphasise that the intended aim of AI is to be a tool to support busy care workers and improve the lives of people using the support, rather than to replace proper care. A resident may prefer to spend long periods of time with Pepper, who is in effect catering to their personal emotional needs of companionship. Or they may not enjoy it and other options can be considered, such as ensuring, where possible, they have more human interaction. From a care worker’s perspective, is there a risk that
AI could be seen as an easy and (relatively speaking) cheap replacement? After all, a robot might require maintenance, but it will never call in sick or have other responsibilities than those assigned to it. It is very easy to envisage a small army of Peppers stationed throughout a care home together with other AI which could very well complete manual tasks – overseen by a smaller number of human workers, but we can probably all agree that this is not somewhere we would want ourselves or our loved ones to be cared for. Despite these concerns, by utilising robots with task-specific AI, it is easy to see how care workers could be freed from repetitive manual labour. For the health and safety of both the person using services and the care worker, guidelines exist regarding correct lifting procedures. For those who are immobile, it can often take two care workers to move someone. A person who wants to move at a particular time may find that two care workers cannot be freed-up immediately; however, the Japanese nursing-care robot, Robear has the ability to lift patients from their beds into wheelchairs and can even help them to stand up. This AI implementation in Japan isn’t about replacing jobs, but intends to complement existing care by promoting independent living and improving quality of life. It will be interesting to see the results of the Pepper trial when published and whether it will lead to wider implementation, but when discussing AI, we must never forget who is at the heart of these considerations. The AI described above may come across as future-shock, but it is currently here to support and care for the most vulnerable in our society – being a companion and lending digital voices to those who need the most support. CMM
Lindsay Taylor is a Lawyer in the care and protection sector at Coffin Mew. Email: LindsayTaylor@coffinmew.co.uk Twitter: @coffin_mew Are you implementing AI in your business? What encouraged you to do so, or what is holding you back? Let us know by commenting on this article or leaving your feedback on the CMM website, www.caremanagementmatters.co.uk CMM October 2019
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Markel 3rd Sector Care Awards
CELEBRATING EXCELLENCE IN TECHNOLOGY Jake Mills from Chasing the Stigma won the Technology Award in the Markel 3rd Sector Care Awards 2018.
Back in 2014, I never thought I would set up and run a national mental health charity. I was performing stand-up comedy across the UK, had met my now-wife and was planning my future. From the outside, everything looked like it was going well – but behind the scenes, I was struggling with debilitating mental health issues, that eventually led to a suicide attempt. Thankfully, that was the turning point in my life. After working through my issues and reaching a point of recovery, I set my sights on helping others. Removing the stigma from mental health became my goal, and almost six years later I am proud that this little idea of mine has turned into a national charity, Chasing the Stigma, that is helping thousands of people across the country.
BACK TO BASICS The reason Chasing the Stigma has been so successful in the mental health arena is because we have come in as outsiders, looking into a complex and overly-bureaucratic system. We have identified the gaps in the mental health ‘market’, so to speak, and filled them with simple ideas that have a lasting impact. Our approach from the beginning has been to focus on the basics, which not many organisations seem to have done in the past. Our database, the Hub of Hope, is very simple yet innovative in its approach. We found that people who were struggling with mental health 46
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issues were finding it difficult to find local services near them, for a number of reasons. Either they did not know the service existed, didn’t know where to look for the service, or the service wasn’t particularly easy to find. Therefore, by simply entering a postcode or device location, the Hub of Hope amalgamates these services into one place, making it much easier for people to find the services closest to them as well as national support, too. There is also a functionality to focus on certain issues, such as depression, eating disorders or psychosis, to narrow down results even further. Not only that, the Hub of Hope offers a talk now option, which can put you directly through to the Samaritans or our new crisis text service, which we have launched in partnership with Shout and Crisis Textline. Quite simply, you’re not alone.
SIMPLE, BUT EFFECTIVE Since launching the Hub of Hope in July 2017, over 40,000 unique users have visited the site or app, signposting them to the nearest and most relevant mental health support services from our database of more than 1,200 national and grassroots organisations. The site has had over 170,000 unique page views, furthering our ambition to become the go-to tool for mental health support. Our approach to mental health awareness
SHARING OUR KNOWLEDGE In addition to the Hub of Hope, our new programme – the Ambassador of Hope – is also borne from this concept. By providing companies and individuals with basic mental health training – so the trainee is then able to provide an individual seeking help with information about where to go and who to contact – the programme is equipping employees and the general public with the tools needed to help and provide support. So far, we have used the programme to train more than 1,500 individuals across many organisations, including The Regenda Group, Liverpool City Council, System Group, Mando and Mashbo. We also have a commitment from the Disclosure and Barring Service to train all 900 members of their staff. The training isn’t a fast track to becoming an armchair psychiatrist – it provides knowledgeable and useful information about how to help someone who is looking for somewhere to turn. The Ambassador of Hope badge indicates to those in need that the person wearing the badge is available to talk to and provide appropriate support. There is nothing complicated about providing support. If you simply provide information, the chances of someone being equipped to access treatment and move forward with their lives is dramatically increased.
LOOKING TO THE FUTURE Chasing the Stigma has been lucky over the past couple of years to have gained support from a vast array of companies and individuals, including Natasha Devon MBE and Everton Football Club. We are also proud of the fact that, along with Everton FC, plans to build a dedicated
mental health centre in Liverpool are underway. This will be an invaluable resource to the people of Merseyside, and we can’t believe that in the space of five years the charity has gone from a few Twitter posts to working with a Premier League Football Club on the construction of a centre that will change — and even save — lives. We are also very lucky to have won the Technology Award in the Markel 3rd Sector Care Awards 2018. This meant a lot to us, as the focus of our work has been to use digital innovation to help more people than ever access services, and for this to be recognised by Care Management Matters showed that our work is vital and celebrated. We have achieved so much over the last two years, but we are forever looking to the future. While we strive to change the conversation surrounding mental health, it is the responsibility of the Government and local authorities to put their money where their mouth is when it comes to funding services and treatment. Chasing the Stigma can open the discussion and point people in the right direction, but the response and future of mental health services lies with those in power. CMM Jake Mills is Chairman and Founder of Chasing the Stigma. Email: info@chasingthestigma. co.uk Twitter: @chasingstigma
MARKEL 3RD SECTOR CARE AWARDS
The Markel 3rd Sector Care Awards is run specifically for the voluntary care and support sector. Nominations are now closed for this year’s Awards. Be the first to find out who the finalists are by following the Awards on Twitter: @3rdSectorCare #3rdSectorCareAwards With thanks to our supporters: National Care Forum, Learning Disability England, The Care Provider Alliance, Association of Mental Health Providers and VODG. The Technology Award was sponsored by
Book now
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The London Marriott Hotel Grosvenor Square Friday 6th December 2019
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EVENT PREVIEW
THE CARE SHOW 2019 9th-10th October, Birmingham
The Care Show 2019 is set to be more educational, more interactive and more creative than ever before. Taking over the NEC, Birmingham on the 9-10th October, The Care Show returns as a leading care-focused event to provide expertled, CPD-accredited conference sessions, hands-on training, latest solutions and networking opportunities to support those connected to and responsible for providing excellent care for others.
TAKING TIME TO LEARN It can often feel like you’re too busy to take time out, but spending your time at this event can help you to make efficiencies in your service in the future. Over 200 manufacturers and distributors will be in attendance, covering everything your organisation would need, from flooring to furniture and from fire safety to the latest technology. The Care Show 2019 is also bringing insightful content for home care providers. The organisers are delighted to announce their latest partnership with the United Kingdom Home Care Association (UKHCA) who will be hosting their annual England Conference and AGM at the show. The Care Show will be a main event in the calendar for domiciliary care providers to gain the latest understanding into what is happening in the sector and meet with suppliers and specialists who can help improve their business and quality of care. Also new for 2019 is The Care Show’s partnership with The STORM Care Managers Inner Circle, who will also be hosting their annual conference at The Care Show, inviting their 1,100-strong membership of care managers to attend their largest event to-date. Jonathan Cunningham, Founder of STORM Care Managers Inner Circle said, ‘Our membership will be over the moon to be associated and be part of the largest care show in the UK.’ As the Inner Circle moto states, #sharingiscaring and they are delighted 48
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that The Care Show are sharing their event with the Inner Circle.
EDUCATIONAL THEMES As well as exploring the exhibition, you can use your time at The Care Show to learn more about: Design – How your care home environment can impact on your staff and residents. Looking at interior design and architectural build. Dementia – Highlighting case studies where excellent care has been delivered and what other services are available for those looking after people living with dementia. Wellness – Supporting your staff and looking after you should be fundamental in every business. Hear about tips to improve wellbeing in your company. Business – Looking at the ‘how to’ of improving your business. From filling your beds to how to retain your staff, there is something for every manager and owner to learn on their journey to becoming Outstanding. Regulation and compliance – The Care Quality Commission, Key Lines of Enquiry, safeguarding – make sure you are aware of the latest rules and that your team is compliant. Be ready for your next inspection. People – Without your staff and those you care for, you wouldn’t have a business. Are you doing everything you can for those key stakeholders? Learn from leaders within the sector. Technology – A growing sector within care. Learn about case studies where technology is making a positive impact and discover new innovations to help improve levels of care. Complimentary passes to attend The Care Show are available to any care provider. To request your pass and make sure you don’t miss the UK’s largest gathering of the care community, visit www.careshow.co.uk/CMM For sales and sponsorships enquiries, contact Event Manager, Michael Corbett on m.corbett@closerstillmedia.com or call 0207 348 1855. CMM
WHAT’S ON? CONTEMPORARY DURABLE PERFORMANCE
Event: Date/Location: Contact:
Care Show 9th-10th October, Birmingham Care Show, Web: www.careshow.co.uk
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Future of Care 15th October, Leeds Broadway Events, Web: www.futureofcare.co.uk
Event: Date/Location: Contact:
Change Makers: NCF Managers’ Conference 4th-5th November, Kenilworth National Care Forum, Web: www.nationalcareforum.org.uk
Event: Date/Location: Contact:
Care England Conference 2019 13th November, London Care England, Tel: 0207 492 4840
Event: Date/Location: Contact:
Hospice UK National Conference 20th-22nd November, Liverpool Compleat Conference Company, Tel: 01489 668333
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National Children and Adult Services Conference 20th-22nd November, Bournemouth Local Government Association, Email: events@local.gov.uk
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Future of Ageing 5th December, London ILC-UK, events@ilcuk.org.uk
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CMM Insight Lancashire Care Conference 19th September, Blackburn Care Choices, Tel: 01223 207770
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CMM Insight Berkshire, Buckinghamshire and Oxfordshire Care Conference 17th October, Maidenhead Care Choices, Tel: 01223 207770
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CMM Insight Dorset Care Conference 6th February, Poole Care Choices, Tel: 01223 207770
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CMM Insight Leeds Care Conference 11th June, Leeds Care Choices, Tel: 01223 207770
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KAROLINA GERLICH • CHIEF EXECUTIVE AND FOUNDING DIRECTOR • NACAS
Karolina Gerlich of National Association of Care and Support Workers (NACAS) explains why she believes professionalisation is not just a good idea, but essential to maintaining standards and respect.
I’ve worked in frontline social care for many years and I’ve lost count of the number of people, including family and friends, who’ve told me that anyone can do this job. Care work is a skilled and unique profession that deserves recognition, respect and celebration. The skills and expertise care workers demonstrate every day make a significant difference to people’s lives. This is not always fully appreciated or understood until people experience this care first hand. The efforts of care workers go well beyond simple physical care; they provide companionship and psychological support and invest large parts of themselves into their roles. No value can be placed on the ability to make someone laugh or smile and make their day better. The role is complex
and requires high levels of patience and empathy. It is time to finally recognise care work as a profession, akin to nursing, physiotherapy, or dentistry. That’s why we celebrated Professional Care Workers’ Day on the 4th of September – a day of recognition for the amazing work that care workers do every day. On that day especially, we wanted to shout out loud that care workers are skilled professionals who need to be better respected and valued. We asked the industry to come together and applaud those who are there day in and day out, in the snow, scorching sun and pouring rain, at night, on the weekends, at Christmas and Easter. I strongly believe that professionalisation (via registration, a robust training framework and professional development opportunities) is essential to ensure good-quality care. At NACAS, we believe that everybody should receive outstanding care. We also constantly remind people that care workers cannot be expected to deliver care with respect if they do not receive it themselves. Registration of care workers is the driving mission of the National Association of Care and Support Workers. We have submitted evidence to both social care all-party parliamentary groups, focusing on registration as a route to professionalisation. Supported by good training and professional development opportunities, and together with better pay and working conditions, this should dramatically improve the quality of available care. But all of this has to be supported by increased funding from the Government. Many other professions that involve looking after people’s health and wellbeing require qualification and registration already. They have industry standards transferable from one employer to another and formal opportunities for personal development. In healthcare, professionals are regulated and supported with their training and continuous professional development.
This means more consistent care, improved standards and staff who feel supported in their roles. It is time for the care industry to come together to demand the same. We want to protect people who use services and care workers themselves. Being registered should give care workers access to appropriate levels of training and make it easier to deal with breaches of contract and bullying in the workplace. Registration should look at competence and recognise the skills and knowledge that can be gained after a few years’ experience. It should not be a system that accepts only a single qualification, as that would exclude a large portion of the workforce. It must be adaptable and enable staff to demonstrate the care, compassion and skill needed to do the job. Care workers should feel proud to register and be able to maintain the required level of skill to retain their registration. Registration should not be seen as limiting an individual’s choice but that, the same way we have only qualified dentists or nurses, only people with the right values and skills should be available. The choice will still be plentiful, just much safer. We have recently launched a petition demanding a professional register for care workers. We hope that as many people as possible will sign it so we can fight for this important change. Both Professional Care Workers’ Day and the petition for registration are part of our social movement; we are driving towards professionalisation of the workforce, to benefit the whole of society. The movement also aims to educate people outside of the social care sector about care work and abolish myths that the job boils down to personal care. We are on a mission to drive the quality of care upwards and ensure that the workforce responsible for this amazing care is properly paid, trained and included in decision-making at every level. CMM
Karolina Gerlich is Chief Executive and Founding Director of the National Association of Care and Support Workers. Twitter: @KGerlich777 50
CMM October 2019
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