APRIL 2020
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The decade ahead
What developments do the 2020s hold?
Do we need an attitude check? Changing the way we look at ageing
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In this issue 05
Inside CQC Kate Terroni considers the topic of safety and sexuality in adult social care and shares the work CQC is doing around this.
07
CMM News
09
Into Perspective We look at the sleep-ins case, with our experts discussing what either outcome could mean for the sector.
30
NCF Rising Stars Pam Casey shares how she came to be a Home Manager at The Abbeyfield Society.
33
Celebrating Excellence Suzy Lamplugh Trust won in three categories at the Markel 3rd Sector Care Awards 2019. Find out why.
46
Event Preview A look at the new MFON Megastars awards.
48
What’s On
49
Straight Talk Des Kelly examines the importance of tackling ageism and how we can go about this in social care.
50
20
25
FEATURES 36
REGULARS
From the Editor
41
20
Missing the point: Post-Brexit immigration proposals The recent announcement of a points-based immigration system has riled the sector. Liz Jones, Policy Director at National Care Forum details why it’s such a devastating blow and shares the key to making this system work for social care.
25
Continual improvement: Changing your climate Culture change takes a long time, but what can you do to improve things now? Ladder to the Moon’s Managing Directors take on this challenge and share their top tips for adjusting an organisation’s climate.
36
Projections for the decade ahead As we enter a new decade, Nuno Almeida of Nourish offers his thoughts on the changes we will see in the adult social care sector over the next ten years, from the role of nurses to the future of integration.
41
Resource Finder: Accountants We profile companies specialising in social care accountancy to help businesses run at their best. CMM April 2020
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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: Ruth Clarry Director of Creative Operations: Lisa Werthmann Studio Manager: Jamie Harvey
ADVERTISING sales@caremanagementmatters.co.uk 01223 207770 Advertising Manager: Daniel Carpenter daniel.carpenter@carechoices.co.uk Assistant Advertising Manager: Aaron Barber aaron.barber@carechoices.co.uk Director of Sales: David Werthmann david.werthmann@carechoices.co.uk
@CQCprof
@NCF_Liz
@ladderchris
@ladderben
Kate Terroni Chief Inspector of Adult Social Care, Care Quality Commission
Liz Jones Policy Director, National Care Forum
Chris Gage Managing Director, Ladder to the Moon
Ben Davies Managing Director, Ladder to the Moon
@NationalCareAsc
@jodiesinclairBB
@TheAbbeyfield
@nourishcare
Nadra Ahmed OBE Chair, National Care Association
Jodie Sinclair Employment Partner, Bevan Brittan LLP
Pam Casey Home Manager, The Abbeyfield Society
Nuno Almeida Founder and Chief Executive, Nourish
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 2020 CCL REF NO: CMM 17.2
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From the Editor The sector has been dismissed by Government once again, as the Budget gave no mention of any money specifically for social care. Many are disappointed, but there’s also a concern that this will only add to other pressures. The immigration proposals put forward earlier this year have also disregarded the sector. The care worker roles that we desperately need to fill are not paid at a high enough wage to allow employers to recruit from abroad, and with no extra funding coming our way, and the increases in minimum wage due to come into effect any day, the chance of providers being able to meet the salary thresholds to hire overseas workers is, frankly, slim to none. On page 20, Liz Jones of National Care Forum offers an overview of the new system, her thoughts on the impact this has, and how it could work in social care.
sector experiences, it’s hard not to ask why Government refuses to offer solutions. Matt Hancock has requested input in advance of crossparty talks, which is a positive step, but what will it amount to? I recently attended a lecture hosted by Care England, where Baroness Camilla Cavendish talked about the issue of ageism. She spoke on the need for societal change in the perception of the older population, saying we must rethink how we look at the ‘work timeline’ and how we age. Perhaps a change in view from Government would be useful in establishing the importance of looking after this part of the population. While social care is for adults of any age, it is often regarded as a service for ‘older people’; it’s vital that their value is appreciated, so that they are not a ‘burden’ but a resource. Des Kelly OBE has written on this topic in Straight Talk on page 50.
AN AGEIST ATTITUDE
CORONAVIRUS
With the continuous let-downs the
We are also seeing the issue of
Editor, Angharad Burnham discusses the ever-increasing pressures the sector faces and asks why Government is delaying action.
ageism extending into the way coronavirus is being handled. A quick Twitter search will show the dismay that the issue is (at the time of writing) being somewhat brushed under the carpet, with a view that because it’s worst for older people and those with disabilities, it’s not too much of a problem. We do not take this view, and are looking at all of our CMM Insight events in the coming months to ensure we are doing what we can to protect our delegates and all the people they care for. With this in mind, we have postponed our Northamptonshire Care Conference to 16th July 2020, and will keep providers abreast of
any other changes to our events. In the meantime, stay up to date with best practice in coronavirus by using the guidance on www.gov.uk, and keep learning with the CMM website. Explore thought leadership articles in our Knowledge Hub and find services that can help you run your business in our online resource finder. For registered managers who might find themselves facing increased stress as a result of the pressures currently facing the sector, there’s also the CMM Wellbeing Area, with organisations to contact and useful blogs. Providers can become a member for free.
Email: editor@caremanagementmatters.co.uk Twitter: @CMM_Magazine Web: www.caremanagementmatters.co.uk
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In an earlier edition of Inside CQC, my colleague, Debbie Ivanova mentioned that we would soon be publishing a report looking at sexual safety and sexuality in adult social care. The report – Promoting sexual safety through empowerment: A review of sexual safety and the support of people’s sexuality in adult social care – can now be read in full on the CQC website. Following a similar report into sexual safety incidents in mental health wards in 2018, we have worked with families and people who receive social care who had experienced sexual assault or sexual abuse to develop the themes of this report, along with our inspectors, provider organisations and charities. As this report was developed with stakeholders, there was a clear need to also highlight the fantastic work that is happening around the country in supporting people to have conversations about sex, sexuality and relationships, and how social care providers are creating the conditions for this to happen. This report also builds on our Relationships and Sexuality guidance that we published for social care providers early in 2019. We hope that by creating this report we are initiating a conversation in adult social care that will lead to a more open culture, where staff feel they can share concerns without fear of reprisal, where people and families are empowered to speak about their wants and needs in a sensitive way, and where people who work in social care proactively enable conversations about sexuality to take place. The starting point of the report was to analyse 661 statutory notifications describing sexual incidents or alleged abuse across all adult social care services from a three-month period. These 661 notifications made up 3% of the notifications that we received during the three-month period, showing that sexual incidents in adult social care settings are not common. The percentage of people affected in social care is also broadly in line with other data which shows the occurrence of sexual assault and abuse in everyday life. When analysing the notifications, we found that almost half of the incidents (48%) have been categorised as allegations of sexual assault, and the second most common type of incident (11%) was that of indecent exposure and nudity. Our analysis showed that sexual incidents are nearly four times more likely
Inside CQC K
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Chief Inspector of Adult Social Care at the Care Quality Commission (CQC), Kate Terroni shares details of the recent report into sexual safety and the importance of action.
to be carried out by men and that women were three times more likely to be affected by sexual incidents. In the majority of cases, we found providers had taken steps to ensure people were safe and involved, and had informed the relevant authorities. Working in adult social care is an incredibly hard but rewarding job and the majority of people using services are looked after by caring and skilled staff. To highlight this, the report also contains examples of good practice and has an equal focus on promoting sexuality and empowering people to have healthy relationships if they want to. We want this to be the start of an ongoing conversation about a sensitive topic that many people report feeling uncomfortable or poorly equipped to discuss. Recommendations in the report include providers and leaders across adult social care
developing a culture that encourages people and staff to talk about sexuality and raise concerns around safety; the development of co-produced guidance for the workforce; and improving our own systems at CQC about how we regulate this important area of care. The courageous families who worked with us on this report did so in the hope that sharing their painful stories would lead to an improvement in care for others. This difficult issue can’t be ignored. We want this report and its recommendations to impact positively on people's lives. We want to ensure people are supported to express their sexuality and have sexual relationships, should they wish. People should also be able to raise concerns and be confident that they will be responded to appropriately, and people kept safe. The only way this will happen is if we work together to make the necessary changes.
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 April 2020
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NEWS
APPOINTMENTS THE FREMANTLE TRUST The Fremantle Trust has appointed Sue Ascott as Head of Learning and Development. Sue is a Trustee on the Board at the National Activity Providers Association (NAPA).
Industry responds to points-based immigration Industry bodies have responded to the Government’s announcement of a points-based immigration system that will come into effect from 1st January 2021, ending free movement of people. The new system will mean that 'skilled workers' will be required to meet a number of relevant criteria, including the ability to speak English, to be able to work in the UK. All applicants will be required to have a job offer and, in line with the Migration Advisory Committee’s (MAC) recommendations, the minimum salary threshold will be set at £25,600. Voluntary Organisations Disability Group (VODG) said it
is extremely concerned and it believed these proposals will create instability in the social care labour market. The organisation's Chief Executive, Dr Rhidian Hughes said, 'These hugely concerning proposals by Government will only exacerbate workforce shortages in social care. Employers are already struggling to recruit and retain staff due to chronic under-funding in the sector. National Care Forum (NCF) said the new system will close the door on recruiting care and support workers from outside the UK, adding, ‘It also has huge implications for the NHS and wider health and care system as it will
affect our ability to deliver timely, high-quality care for millions of our vulnerable people.’ Care Forum Wales claimed the new policy would lead to a loss of nursing home beds and the closure of care homes at a time when the number of over-85 year olds in Wales is expected to more than double in the next 20 years. Colin Angel, Policy Director of the United Kingdom Homecare Association (UKHCA) also expressed dismay over the plans saying, ‘Cutting off the supply of prospective care workers under a new migration system, will pave the way for more people waiting unnecessarily in hospital or going without care.’
Sexuality and relationships in health and care The Care Quality Commission (CQC) has continued its work into supporting sexuality and relationships in social care, with the release of a new report, Promoting Sexual Safety Through Empowerment. The regulator is calling for adult social care leaders to establish a culture of openness, with a focus
on ensuring the people the sector supports feel empowered to be honest about their sexuality, and explore relationships, whilst being protected from harm. The report's recommendations include: • The development of a culture that encourages people to talk about sexuality and raise
concerns around safety. • The production of co-produced guidance for managers and staff that focuses on how to protect and support people using adult social care from sexual abuse. • CQC should continue to improve the system of provider notifications and how they deal with reported incidents.
Guidance for providers on coronavirus Government has produced guidance for adult social care providers on preventing and managing coronavirus in their services. The guidance is aimed at social
or community care and residential settings and gives information on how COVID-19 is spread, preventing the spread of infection, what to do if an employee becomes unwell and what to do
if a client has come into contact with someone who has COVID-19. All the latest information and guidance is available on the Government website. Visit www. gov.uk.
BRENDONCARE FOUNDATION The Brendoncare Foundation has announced that Carole Sawyers, Chief Executive, will be retiring at the end of June 2020. Carole joined Brendoncare in June 2014. Prior to this, she was Chief Executive of The Fremantle Trust, which she joined in 1992 as Director of Finance before progressing to Chief Executive in 2002.
LEGAL & GENERAL Legal & General has made two key hires for its in-house later living division. Ben Rosewall, previously Senior Director in the Healthcare & Retirement Housing division at CBRE, joins as Head of Investment; and Dandi Li joins as Investment Manager.
OUTLOOK CARE Outlook Care is welcoming Kathy Davies as its new Director of Care and Support. Kathy is a registered general nurse who has worked within social care for just over 30 years.
HEATHCOTES GROUP Natalia Lysiuk has been appointed as Director of Business Development at Heathcotes Group. Previously head of commissioning at Heathcotes, Natalia is now part of the senior leadership team with a key strategic role in the growth of the company’s nationwide service portfolio.
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NCF Rising Stars 2020 The National Care Forum (NCF) is inviting its members’ managers and registered managers working in social care organisations to enter its NCF Rising Stars 2020 programme. Offering mentoring, training and networking opportunities for the next generation of leaders in social care, the programme includes workshops held by Neil Eastwood, apetito, and Person Centred Software. The closing date for nominations is 1st April 2020. Contact helen. glasspool@nationalcareforum.org. uk for further details.
Budget fails to mention social care The Chancellor's Budget has failed to mention social care, leaving the sector confused and frustrated. Rishi Sunak, Chancellor of the Exchequer, spoke to the House of Commons detailing his plans for the next year. However, various previous calls for action made by sector organisations went ignored, with no support offered to adult social care. Coronavirus was a theme throughout, with emphasis given on the difficulties it could cause for the NHS and the importance of investment in research. The National Institute for Health Research was given £30m of new
funding to enable rapid research into the disease. An initial £5bn will also be available to 'fund pressures in the NHS, support local authorities to manage pressures on social care and support vulnerable people, and help deal with pressures on other public services' caused by coronavirus. The NHS received £6bn to pay for 'vital services' but the budget failed to mention social care here again, with no indication that any of these funds should be used to support the social care sector. The Budget has confirmed that the £1bn of additional funding for social care next year, which
was announced at the Spending Round in 2019, will continue for every year of this Parliament. However, this will not be enough to meet funding shortfalls, and the Chancellor's only mention of social care in parliament was to say it would be dealt with in 'the next few months'. Helen Walker, Chief Executive of Carers UK, said, 'We are dismayed that social care did not get even a mention in [the] Budget, after the Government’s promise to deliver a solution. '...The Chancellor said the Government is getting things done – not social care.'
Care home closures in England
Care Home Open Day 2020
CSI Market Intelligence has released its annual report looking at the rate of care home closures in England. Say Hello Wave Goodbye – Openings and Closures of Care Homes for Older People 2019, reveals there were more than two care home closures for every opening in 2019, with homes being opened where there was not high demand and closed where there was already a shortage of beds. Mike Short, author of the report said, ‘While demand increases…for the fourth time in five years we have had to report on a sizeable loss in the
The eighth annual Care Home Open Day, in partnership with Care England, National Activities Provider Association (NAPA) and the National Care Forum (NCF), will take place on 26th June 2020. The theme this year is music, which encompasses arts, innovation and technology. Almost 44% of care homes have a private drinking facility in them, and many others have in-house choirs, art galleries, post offices, hairdressers and much more, all open to the public. Care Home Open Day is about sharing these initiatives and encouraging interaction between
number of beds available…the real problem is that local supply has for some time been very fragmented with some areas hosting too many care homes, and others becoming care deserts.’ Only one of the nine regions got away without losing beds. The North East had a nominal increase in beds of 0.2%, however, at nearly 20% above the national average, the region already has the highest supply levels in the UK. Despite being 30% below national average supply levels, the biggest loser was London.
More funding for care home nurses network The RCN Foundation has announced a major funding boost for the Care Home Nurses Network launched last year by the Queen’s Nursing Institute (QNI) and the Chief Nursing Officer (England). The three-year funding will enable the QNI to extend the reach of the new network to nurses in Wales and Northern Ireland as well as England. As part of the objective to 10
CMM April 2020
share knowledge in this sector, the QNI will deliver a number of workshops for care home nurses during 2020. The events will cover topics such as caring for residents with complex wounds, caring for residents at the end of life and how to recognise signs of a deteriorating resident. The sessions will be delivered by experts in their field and will emphasise person-centred care.
the local community and care services, so that everyone can see the contribution that care homes provide to residents and the public. Commenting on the event, Professor Martin Green OBE, Chief Executive of Care England, said 'Now well established, Care Home Open Day is a real marker in the calendar. 'Care homes really are the hub of their communities, let’s keep it that way and continue to connect.’ For more information visit the Care England, NAPA or NCF websites.
New Minister of State for Care Following a Cabinet reshuffle, Helen Whately MP has been appointed as the new Minister of State for Care. The MP was previously Parliamentary Under Secretary of State at the Department for Digital, Culture, Media and Sport, a post which she had held since September 2019. She is the MP for Faversham and Mid Kent, a seat which she has held since 2015, and has also served as Deputy Chair of the Conservative Party and Vice Chair for Women. The announcement of the new Minister of State for Care sees
Caroline Dinenage, who has held the role since 2018, stepping into a new role at the Department for Digital, Culture, Media and Sport. Helen Whately said via Twitter, 'Completely delighted to be appointed Minister of State in the Department of Health and Social Care. Looking forward to working with Secretary of State...and all the brilliant people in @DHSCgovuk & the #NHS & #SocialCare. Can’t wait to get going.' Caroline Dinenage also tweeted, 'I’m so pleased to hand the baton into such safe hands.'
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NEWS
Success for CARE badge
Advisor for care home nursing
The CARE badge has reached a key milestone, with 100,000 CARE badges purchased and delivered to those providing, receiving and supporting social care across the UK.
England’s Chief Nursing Officer has appointed the first adviser for care home nursing. The lead on health and wellbeing for Chelsea Pensioners, Professor Deborah Sturdy OBE, will be taking on the position with the aim of improving support for this important section of the social care workforce. She will provide the Chief
Launched in June last year, the CARE badge aims to raise the public profile of social care and recognise the nine million care workers in the UK. Badges can be purchased via the CARE Badge website.
Playlist for Life training Playlist for Life has launched professional training programmes aimed at individual care staff and healthcare professionals, NHS departments, care homes and community centres that work with people living with dementia. Those undertaking the
training can learn about the benefits of using personalised music to support those living with dementia, how to make playlists and how to effectively integrate them into personalised care programmes for people with dementia.
Hartford Care Hartford Care has completed its acquisition of Belford House in Four Marks, Hampshire. Comprising 32 bedrooms and employing over 40 staff, Belford House is the 15th home to join
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Hartford Care, which operates across the South of England. Belford House will be governed by the three core principles of the company: care, comfort and companionship.
Nursing Officer for England, Ruth May, with expert advice from those nurses working to deliver the high-quality clinical care for people living in care homes, helping them to stay healthy, happy and independent for longer. The new post will ensure that the voices of nurses in care homes are heard at the very top of the nursing profession.
Vida Healthcare Groundworks have begun on Vida Court, a £10.8m specialist dementia care facility in Harrogate. This will be the third development in the area by Vida Healthcare. It is expected to create up to 250 new jobs when it opens in summer next year, bringing the company’s total number of employees from 450 to 700. When completed, Vida Court will provide 100 bedrooms across eight individual houses with
features including a communal area designed to imitate a village environment with its own shop, coffee shop, cinema, hairdresser, events room and access to outside spaces. The new facility will also incorporate significant workspace areas to provide a Vida Academy training centre for staff and a new headquarters facility for Vida’s head office personnel, currently located elsewhere in Harrogate.
NEWS
Elderly Care Crisis: A Tipping Point A new study by the Centre for Economics and Business Research (Cebr) and Irwin Mitchell predicts the social care sector will face collapse in nine years if Government doesn't take decisive action. Several factors make up the report’s 'tipping point' calculation, including current care home capacity, state funding levels and pension wealth, and the signs point to the UK
reaching a shortage of supply in residential care homes by 2029 at the latest. The report reveals a funding shortfall, which is anticipated to increase to £1.5bn for 2020/21. When reviewing current spending predictions, the report found this shortfall will increase by 57% in five years, to hit £3.5bn. It also found that in spite of the auto-enrolment pension scheme introduced in 2012, many
will still find their pension will not fund their care and advises current workers will need to save hundreds of pounds more into their pensions each month in order to cover the shortfall. In addition, it revealed a wealth gap is forming that may create a tiered elderly care system, with only around the top 10% of retired households (by income) able to afford to pay for care from their income.
MS Society finds carers need more support New research from MS Society shows half of family members and friends supporting someone with multiple sclerosis (MS) are not getting the support they need, and one in three – 34% – have given up work as a result. Nearly all respondents (90%) said their health and wellbeing had been negatively impacted because of
their caring role, yet only one in six people of working-age had been offered enough support to stay in employment. With a third of people with MS not getting adequate help from the state to complete activities like washing, cooking and cleaning, the pressure is increasing on loved ones to
provide free care. 41% of family and friends who responded to the survey said they are now providing 35 hours or more of unpaid care every week. This is the equivalent of a full-time job for which a care worker would be paid on average £14,742. One in six said they provide over 90 hours of care every week.
Report into handyperson services A new report, published by Foundations, has called for the work done by handyperson services in keeping vulnerable people safe to be fully recognised by commissioners. Foundations says these services play a pivotal role as the ‘eyes and ears’ of communities in keeping vulnerable people safe and healthy in their own homes. It found that over half of local authorities (54%) either provide or commission handyperson services – delivered by in-house or independent not-for-profit home improvement agencies. All labour – and some materials – is free of charge in 41% of services (compared with 34% in 2011) and 45% provide services that aid timely discharge from hospital. The full report is available on the Foundations website.
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NEWS / IN FOCUS
Local digital adult social care projects awarded share of £4.5m 16 organisations that provide and commission adult social care services are to receive a share of £4.5m, enabling them to roll out their local digital projects on a wider scale. The organisations have been selected to receive a Social Care Digital Pathfinders grant, which supports products and services that have already been piloted in small local areas – with the
view to implementing them on a larger scale. The successful Digital Pathfinders will now commence a 13-month implementation phase with projects predominantly looking at standardising information and developing digital ways of sharing that information between multiple health and social care organisations.
Alzheimer’s Society By 2040, it is estimated dementia will cost the UK economy £94.1bn. The recent Conservative government's election manifesto pledged to double dementia research spending over the next decade through the delivery of a 'Dementia Moonshot'. In practice, this should mean an extra £800m over ten years for dementia research. Alzheimer’s Society wrote to every MP setting out key priorities that Government’s Dementia Moonshot must include in order
to have the greatest impact. These are: • A National Network of Excellence for Dementia Care Research. • Transforming care through technology. • Prioritising prevention and public health. • Funds to develop new treatments and a cure. • Investment to build capacity in dementia research.
Health and Social Care Select Committee
Care England
Following the appointment of Jeremy Hunt MP as Chair of the Health and Social Care Select Committee, the new members have been confirmed as: Paul Bristow (Conservative), Amy Callaghan (Scottish National Party), Rosie Cooper (Labour), Dr James Davies (Conservative), Dr Luke Evans (Conservative), James Murray (Labour (Co-op)), Taiwo Owatemi (Labour), Sarah Owen (Labour), Dean Russell (Conservative) and Laura Trott (Conservative).
Find out more on Alzheimer’s Society’s website.
Care England has launched its Market Intelligence Information (MINT) database for members. This will enable members to have crucial data at their fingertips all in one single repository when discussing fees or quality with local authorities and clinical commissioning groups (CCGs). MINT holds a variety of data and links to information from freedom of information requests and private and publicly available data sources. It is searchable by local authority and CCG, by parliamentary constituency, care home provider, postcode and group name and will produce reports by authority, search or advanced search criteria.
IN FOCUS Unsuitable housing for older people WHAT’S THE STORY? A new report into housing for older people has found over two million people aged over 55 are living in a home that endangers their health or wellbeing. The report, Home and Dry, highlights the need for urgent government action to address the quality of housing stock as part of an overhaul of its national housing policy, with a focus on the people and places most at risk.
WHAT DID THE REPORT FIND? Published by the Centre for Ageing Better and Care & Repair England, the report found over 4.3 million homes in England don’t meet basic standards of decency, most commonly because of the presence of a serious hazard to their occupants’ health or safety. According to the report, households headed by someone aged over 75 are much more likely to be living in a nondecent home, a problem that has worsened for this age group, while two million households headed by someone over 65 find it difficult to heat their home. The largest number of nondecent homes is among owneroccupiers, with many facing financial or practical barriers to maintaining their home; 20% of all homes in the private rented sector are non-decent. One of the major causes of death and injury amongst older people are falls in the home, while cold homes exacerbate health conditions including arthritis, COPD, and asthma, and increase the risk of an acute
episode like a stroke. Although the average cost to repair these homes is estimated to be below £3,000, there are no specific policies in place to address non-decency, and previously available funding for low-income homeowners to maintain or repair their homes has been withdrawn. The Centre for Ageing Better and Care & Repair England are calling on Government to place this issue at the top of its agenda and act urgently to address the quality of housing stock, which the charities call a 'national scandal'. The people and places most at risk must, they say, be the focus of government housing policy.
WHAT DO EXPERTS SAY? Dr Anna Dixon, Chief Executive at the Centre for Ageing Better, said, ‘Our report...shows the shocking scale of non-decent housing across England, with too many people in later life unable to afford or manage the vital repairs and maintenance their homes need. The result is millions of people living in conditions that put their health or safety at risk – it’s a national scandal.’ Sue Adams, Chief Executive at Care & Repair England, said, 'Older people across the country tell us how important their homes are to their health and quality of life. Concerted action to make those homes safe, warm, decent places to live is a win-win solution. 'Everyone gains – the NHS cuts costs, the national housing stock is protected and individuals have improved lives.' CMM April 2020
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Older people’s hospital SCIE publishes two new guides admissions in the last year of life The National End of Life Intelligence Network has released a new report, Older people’s hospital admissions in the last year of life, which explores the relationship between hospital admissions and age, sex, and cause of death in people aged 75 years and older, who comprise the majority (around 69%) of all people who die. The hospital admissions considered include emergency admissions, planned admissions and day cases. It describes number
and type of admissions and proportion of admissions that were emergency admissions within 30 days of a previous discharge. The report found there were 817,714 hospital admissions during the last year of life for the 341,621 people aged 75 years and older who died in 2017 (69% of all deaths) and just under a quarter of admissions and just over two-fifths of days spent in hospital in people aged 75 years and older occurred during their last year of life.
The Social Care Institute for Excellence (SCIE) has launched two new guides for those managing care services. Promoting positive mental wellbeing for older people is a quick guide for registered managers of care homes to help them to identify older people’s individual needs and to improve their mental wellbeing by offering personalised support. The second guide, Evaluating personalised care, aims to help practitioners measure and evaluate the impact of
personalised care programmes, initiatives or new ways of working. It is for anyone who is involved in delivering a personalised care intervention or initiative at a local level, e.g. commissioners, performance or data managers, operational managers, lead professionals or practitioners in health, local government or voluntary and community sector organisations. Both guides can be downloaded from the SCIE website.
places in which we live, our local economies and the capacity of other vital local services. In this way, we are seeking to move away from thinking about ‘social care’ in transactional terms and towards a foundation built on human relationships and connections.’
To support that shift, LGA believes the role of councils’ universal services, housing, public health, health, the voluntary and independent sectors, and – most crucially – the voice of people with lived experience, need to be incorporated into plans.
LGA calls for change The Local Government Association (LGA) has set out the main issues that it believes need to be addressed to ensure that people can live the lives they want to lead, and the kind of action it wants to see from Government. In The lives we want to lead,
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towards change, towards hope, it calls for a change in the way we talk about social care, stating, ‘Thinking about the future of social care means thinking way beyond social care. It...needs to be considered in terms of the role it plays...in strengthening the
NEWS
New statistics on England’s social care workforce published NHS Digital has published its latest annual report on the local authority-employed adult social care workforce in England. Personal Social Services: Staff of Social Services Departments, England 2019 covers the 113,300 workers employed by local authorities in adult social care services – accounting for approximately 6.9% of the total adult social care workforce in England. As at September 2019 there
were 113,300 adult social services jobs in local authorities in England (held by 109,600 people), up 0.9% or 1,000 jobs from 2018. This is the second year on year increase since reporting began in 2011 and is broadly stable since 2016. Between 2011 and 2019 there has been a decrease of 28.9%, or 46,100, local authority jobs. Nearly half of all local authority job roles (52,500 jobs, or 46.3%) were in direct care providing
roles. The report found the professional job group, which includes social workers and occupational therapists, has remained relatively stable, currently reporting 21,100 roles. This is the only job role group to have increased since 2011, also up 1,300 jobs between 2018 and 2019. In 2019, an estimated 3.4 million hours per week were worked by 109,600 adult social
care staff within local authorities, up 25,000 hours per week since 2018. The average age of adult social care staff in local authorities is 47.5. This is 4.3 years older when compared to the latest available equivalent for the independent sector (Skills for Care, 2019) and 4.6 years older than the NHS workforce average age. The full report can be downloaded from the NHS website.
Supporting Adult Social Care Innovation Supporting Adult Social Care Innovation (SASCI) is a new project, which aims to build the evidence base to support the sector to start up, implement, develop and spread affordable innovations that work well for everyone. SASCI is interested in hearing
what people and organisations are doing differently to improve the lives of people receiving social care and the staff delivering care. This could include changes to processes for allocating or managing care or assuring and improving the quality of care; working with commissioners of care in different
ways to design or manage services or particular types of services; new services and products; changes to an organisation’s business model perhaps involving repurposing of space or ownership; using technology in a different way to drive forward changes in outcomes for people or deliver efficiencies
for the organisation or broader system. The SASCI project is also interested in bringing senior leaders from the sector together to help identify directions for the project. Contact the team at sasci@lse.ac.uk or visit the website for more information.
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NEWS
Care home complaints guide The Chartered Trading Standards Institute (CTSI) has launched a new complaints guidebook for the UK care home industry. In 2018, the Competition and Markets Authority (CMA) Care Homes Market Study, found that it can be incredibly stressful for care home residents and their representatives to organise a move to a different care facility. The CMA also found that many residents and their representatives found it difficult to make complaints directly to care homes,
and perceived the complaints processes to be unclear, complicated and confusing. In response to this, CTSI, in collaboration with the Department for Business, Energy and Industrial Strategy (BEIS), produced a new guide for registered managers and care home owners. Written by industry experts, the guidebook, entitled Care Home Complaints, assists care home operators in understanding consumer law and implementing a complaints process.
Approval of new apprenticeship standards The Leader in Adult Care (Level 5) apprenticeship standard has now been approved for delivery, with the funding band agreed at £7,000. This new standard is designed for job titles such as registered, assistant, deputy, unit or service manager and is expected to be as popular as the existing Care Leadership and Management framework which had over 6,500 starts last year. It’s estimated it will take
Welsh loneliness and isolation strategy Backed by a £1.4m fund over three years, the Welsh Government’s loneliness and social isolation strategy will support community-based organisations to deliver and test, or scale up approaches to tackling loneliness and social isolation. Launched by Deputy Minister for Health and Social Services, Julie Morgan, the strategy is seen as the first step in helping to change how people think about
loneliness and social isolation. It has four priority areas: increasing opportunities for people to connect; improving community infrastructure that supports connected communities; cohesive and supportive communities; and building awareness and promoting positive attitudes. The 48-page strategy highlights trigger points in older people that can lead to loneliness and isolation such as bereavement, retirement, giving
up driving, taking a caring role and the onset of ill-health. In addition, there will be future discussions with the Welsh Commissioners for Children and Older People about what further resources for practitioners might be required, and a ‘national summit’ will be organised to discuss the recommendations contained in the research report, to raise awareness, share good practice and consider what more can be done.
Securing the future of social care funding Voluntary Organisations Disability Group (VODG) has published Securing the future of social care funding. The new report calls for a national conversation about creating a social care future between people who use services, professionals and also policy makers. The report sets out the main issues facing disability organisations and why it is of utmost importance that Government puts in place a sustainable funding plan. VODG calls the lack of resolution to the funding of care for disabled and older people 'a story of sustained political failure', stating, 'There is simply no other area of policy which has had so many formal reviews without 18
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leading to a legislative change.' In Securing the future of social care funding, VODG encourages Government not to delay reform of the social care sector any longer and asks for policy makers to work with the sector to ensure community resources are both responsive and preventative. The report focuses on four key themes: • Social care under strain. • The impact of under funding. • Future funding – the options. • NHS restructuring – what it means for the social care and voluntary sectors. The Group ends the report asking Government to aid in creating a responsive and preventative system, brought about by 'political nerve and insight from political
leaders who are prepared to invest in the system'. Dr Rhidian Hughes, VODG Chief Executive, said, 'This government has an opportunity to ensure that social care to support people to live independently becomes a national priority. 'We need a well-resourced and sustainable care and support system and this report sets out the issues we need to have in our national conversation about social care for older and disabled adults.' VODG states that it stands by to 'play its part securing the future of social care for the benefit of individuals, families and communities.' The full report is available on the VODG website. Visit www. vodg.org.uk.
around 18 months to complete the standard, which includes gaining the Level 5 Diploma in Leadership and Management for Adult Care, before end-point assessment through Observation of Leadership and a Professional Discussion. The Lead Practitioner in Adult Care (Level 4) apprenticeship standard has also had its funding band approved at £7,000 with the assessment plan in the final stages of approval.
Disabled Facilities Grants in 2020-21 Local authorities are set to benefit from a share of £505m made available for Disabled Facilities Grants (DFGs) for 2020/21. Expected to be allocated this year, in a letter to local authority chief executives, Government said, ‘The DFG is capital funding for the provision of home adaptations to help older and disabled people to live as independently and safely as possible in their homes. Where agreed locally (and in two-tier areas with the express agreement of district councils), a portion of the grant may also be used for wider social care capital projects. A grant determination letter outlining the conditions of grant usage will be issued to local authorities to coincide with the payments being made.’
Avery Healthcare Avery Healthcare is opening three new services this summer and autumn. As a mark of progress, Avery has celebrated by ‘topping out’ developments in Droitwich, Edenbridge and Kettering.
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HEADER
Post-Brexit immigration proposals The sector was taken aback recently when Government published its proposals for a new immigration system, quickly following a set of recommendations published by the Migration Advisory Committee (MAC). No one in the sector was pleased with the new proposals, and Liz Jones, Policy Director at the National Care Forum (NCF), sets out why.
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On 19th February, Government announced its proposals for a new points-based immigration system post-Brexit, which it intends will come into force on 1st January 2021. This, the Government says, ‘Sets out how we will fulfil our commitment to the British public and take back control of our borders. We are ending free movement and will introduce an Immigration Bill to bring in a firm and fair points-based system that will attract the high-skilled workers we need to contribute to our economy, our communities and our public services. We intend to create a high wage, high-skill, high productivity economy.’ The proposals have caused dismay across the social care world – including amongst providers of care and support, those who receive care and support, those who work hard on the front line to deliver care and support, and those who commission care and support.
THINKING DIFFERENTLY We must take all opportunities to shape these proposals to support the care sector, rather than allow them to hinder us. It’s quite simple; we need a system that will: • Use the points-based system to award extra points for care worker roles. • Create a three-year visa for care workers. Why? Because the occupation is in national shortage and the sector is facing growing demand for labour, in a time of full employment. If Government does not enable recruitment from outside the UK there will be real, human consequences – care facilities will close, homecare services will be reduced and the people who need the services will suffer, and, whilst there is a lot of work going on to recruit more care workers in the domestic space, that is simply not going to fill the shortage. Let’s have a more detailed look at the Government’s stated aims, why they pose such a challenge for social care, and how they hinder a system already under pressure. Government’s stated proposals for the new system are: • ‘The points-based system will provide simple, effective and flexible arrangements for skilled workers from around the world to come to the UK through an employer-led system.’ • ‘All applicants, both EU and non-EU citizens, will need to demonstrate that they have a job offer from an approved sponsor, that the job offer is at the required skill level, and that they speak English.’ • ‘In addition to this, if the applicant earns more than the minimum salary threshold of £25,600 then the individual would be
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MISSING THE POINT: POST-BREXIT IMMIGRATION PROPOSALS
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eligible to make an application.’ • ‘However, if they earn less than the required minimum salary threshold of £25,600, but no less than £20,480, they may still be able to come if they can demonstrate that they have a job offer in a specific shortage occupation, as designated by the MAC, or that they have a PhD relevant to the job. In effect, applicants will be able to ‘trade’ characteristics such as their specific job offer and qualifications against a salary lower than the minimum salary or the ‘going rate’ in their field.’ For social care, the proposed system seems to deliver entirely the opposite to, ‘Simple, effective and flexible arrangements for skilled workers from around the world’ and ‘A firm and fair points-based system that will attract the high-skilled workers we need to contribute to our economy, our communities and our public services.’
IDENTIFYING THE ISSUES Good care workers, wherever they come from in terms of nationality, are highly skilled – they bring compassion, care and resilience to supporting and caring for some of our most vulnerable citizens, across lots of different settings, including people’s own homes. They work with people to live the best lives they can, with choice and dignity and independence. The focus on formal qualifications in the new system entirely misses the point for social care as it fails to recognise the value and skills that care workers do truly contribute ‘to our economy, our communities and our public services’. Compassion, care and resilience rarely accrue a PhD – but they are hugely valuable in helping us provide care and support for those who need it most, when they need it most. Surely we all want to encourage skilled care workers to come to the UK to support us and our loved ones? Salary thresholds are also not helpful. Whilst Government has taken on some of the advice in the MAC report in terms of reducing salary thresholds, this is of little help to social care. The £25,600 threshold hugely exceeds the annual pay of front-line care staff – Skills for Care data tells us that, for adult social care, estimated average salaries in the UK range between £16,400 and £18,400. Equating levels of pay with levels of skill is highly misleading in the context of social care. Low pay and low skill are in fact very different
things. Those with experience of working in care, receiving care, or commissioning care will mostly tell you that it is very misguided to equate skill with pay. The main reason care staff are not paid as highly as staff in other sectors is that pay levels within social care are directly constrained by the level of funding received from the state to pay for people’s care (be that from local authorities or clinical commissioning groups). The state has huge purchasing power in this market, so social care providers are not operating in a traditional free market system, but rather they are stuck in a pseudo-market situation. The MAC recognised this in its recent advice to the Government, where it acknowledges that a move away from free movement to a points-based system, with the salary threshold of £25,600, will increase pressure on social care. However, it does not think that the post-Brexit immigration system should have a role in relieving that pressure, stating, ‘We remain of the view that the very real problems in this sector are caused by a failure to offer competitive terms and conditions, something that is itself caused by a failure to have a sustainable funding model.’ At present, there are no reassuring signals from Government that funding for social care will increase any time soon, although the Budget may surprise us all. The National Care Forum – and much of the sector – has been calling for a three- to five-year funding settlement now, to protect the provision of care, as part of the start of a long-term funding solution and a long-term vision for social care shaped by those who use it now, and those who will in the future. It seems extraordinary that Government is advocating free market conditions to correct the problems of wages in the social care labour market and, at the same time, has presided over ten years of reductions in the very budgets that essentially set the price for that labour market.
THE REALITY OF THE NUMBERS Skills for Care data (the best we have on this topic) tells us that there are currently 122,000 vacancies on any one day in social care (a vacancy rate of 7.8%); there is also a turnover rate of 30.8% (44,000 leavers in the last 12 months), and there are 115,000 workers in care who hold EU nationality (8%), as well as a further 134,000 who hold a non-EU Nationality (9%). Hopefully all those who hold
EU nationality have achieved EU settled status or are applying for it now. The sector has been actively encouraging this for many months. The social care workforce is estimated to be 1.62 million people strong. The projected growth of the population aged 75 and over highlights that, by 2035, the number of adult social care jobs needed in England could rise by 800,000. We cannot see how this projection can be met by the UK labour market alone, despite the suggestion that the eight million economically inactive people might come to the rescue (note: 2.3 million of them are students, two million have long-term conditions or disabilities which hinder or prevent working, 1.1 million are retired, and 1.9 million are already at home, many of them caring for family). And while digital technology has a significant role now and in the future of care, it will not replace the human touch – compassion, care and resilience cannot be automated.
SHAPING FUTURE THINKING Work was going on in earnest to ensure that whatever immigration proposals were formulated by Government did not cause untold damage to the health and care workforce. The locus of this work has been with the Cavendish Coalition, of which NCF is a member. This health and care coalition has been working since the outcome of the EU referendum to build a strong understanding of the importance of the international workforce for the whole care and health system. Together, we have formed a number of key asks from Government. These include the solutions I mentioned previously: using the points-based system to award extra points for care worker roles and creating a three-year visa for care workers. Whilst we were not optimistic that the new immigration system would favour social care after having read the runes in the MAC report, we had hoped that the Home Office would take more time to consider and respond to the issues for social care in any future immigration system. It seems that this is not the case. This means that there is much work to be done to shift the outlined system. We will be working with partners across the sector to think about how to challenge the Government’s approach and build a pointsbased system that hits the mark for social care. CMM
Liz Jones is Policy Director at the National Care Forum. Email: liz.jones@nationalcareforum.org.uk Twitter: @NCF_Liz What are your feelings on the immigration proposals? What will it mean for your business? Make your voice heard by commenting on this article on the CMM website, where you can also leave feedback on this feature, www.caremanagementmatters.co.uk CMM April 2020
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HEADER
Continual improvement: improvement: Improving the culture of an organisation is an essential part of a leader’s role, but culture shift can take a long time. What can be done now to change the way people are working? Ladder to the Moon’s joint Managing Directors, Chris Gage and Ben Davies, share a practical approach to developing leadership and changing the work climate. At the heart of the services achieving the Care Quality Commission’s (CQC’s) Good and Outstanding ratings are values that encourage creativity, innovation and continual improvement. Care leaders know this and develop strategies to deliver high-quality, person-centred, and relationshipcentred care. However, all too often this is undermined by an established culture that is still too task-focused, too risk-averse, too focused on pieces of paper rather than people.
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CONTINUAL IMPROVEMENT: CHANGING YOUR CLIMATE
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We are all familiar with Peter Drucker’s saying, ‘Culture eats strategy for breakfast’. But changing the culture of an organisation is easier said than done. If you want to shift your culture so that the people in your organisation are open to change and able to continually improve, best practice suggests two key areas to focus on: developing the climate people work in, and developing yourself and the leaders around you.
ADDRESSING THE CLIMATE There is a well-established link between the climate of an organisation (i.e. the observable habits that characterise life in an organisation, or a ‘snapshot’ of its culture, if you will) and the quality of services, wellbeing of employees, and the organisation’s overall success. If you focus on improving climate every day, over time improved habits become ‘the way we do things round here’ – your new culture. Whilst culture is hard to alter, climate on the other hand is changeable, more easily observable, and more responsive to improvement efforts. It has been suggested that, even when successful, cultural interventions can take nine years or more to implement and embed, while climate improvements can be implemented and measured within seconds. For example, we worked with a service manager who leads a heads of department meeting every day, where every individual sat in the same spot and followed the same agenda. The mood of the room was congenial and pleasant. Conflict was low, but so too was challenge and involvement. As one individual admitted, ‘I come fourth, just after activities, so I usually fall asleep until I hear the word “activities”.’ The leader was coached to shift climate, and one morning walked into the meeting room, asked everyone to shift three seats to the left and then began the regular agenda in a random order. The climate in the room shifted immediately: people energised, suggesting ideas, volunteering for action. By intentionally addressing the climate, the leader increased the group’s ability to improve. Factors such as trust, openness, debate, playfulness and humour are vital to raise awareness and prompt reflection and action. You can use established measurement tools or you 26
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“A climate which supports debate is a climate open to continual improvement.” can use informal approaches through conversation. A critical step for the leader when working on climate is to increase trust between people in the organisation. To do this, you need to first show trust and be open to feedback. If a manager takes a high-trust approach, concerns can be seen as a catalyst for continual improvement and held up as an example for further learning about the service. For example, one care home we worked with introduced an anonymous box for concerns and suggestions which anyone could post in to. These were pulled out and discussed at regular staff meetings, with a focus on how to create solutions. This process has the multiple benefits of increasing safety through anonymity, building trust by seeing concerns addressed, and increasing debate, which in turn reinforces a learning culture. If you want more playfulness and humour (and it’s a key factor in reducing stress, building teamwork, and increasing creativity), you need to model the way. We often support leaders to use games as a significant tool in managers’ and head of department meetings, as well as handovers. As one Chief Executive we work with said, ‘I used to think games were for children, I now realise that they are a key ingredient for success in care.’ A climate which supports debate is a climate open to continual improvement. Increase formal and informal interactions between staff, particularly management and employees. Approaches such as eating lunch together make management more visible by attending events in your service. Close the office door (with you
on the outside) and spend time ‘on the floor’ as a role-model and teacher.
DEVELOPING LEADERS Just as it is necessary to be intentional about developing the climate that people work in to prompt lasting and continual improvement, it is also necessary to be intentional about developing yourself and the leaders around you. Look outwards and inwards for opportunities to grow. Exemplary leaders look to their teams, enabling others to find solutions to the collective challenges faced by all, and create the conditions for others to take the lead. Part of this is recognising failure as an opportunity to learn. You can encourage positive risk-taking by drawing out the learning rather than attaching blame. This is often a significant personal learning step for managers. Looking at yourself as a leader, as a rule of thumb, self-awareness and interpersonal competencies (otherwise known as emotional intelligence or EQ) account for 80% of the factors that will determine your success as a leader, whereas technical or hard skills (IQ) contribute 20%. The more you can develop self-awareness, selfmanagement, social awareness and relationship management, the more effective you will be as a leader. It can also be useful to look at the many factors that influence performance and isolate a single factor to help you understand it better, even though they all work together in real-life situations. One factor we focus on with care leaders is style – how you prefer to perceive, react to, and deal with the world. This
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CONTINUAL IMPROVEMENT: CHANGING YOUR CLIMATE
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is particularly important while leading and problem-solving, which is at the heart of a culture of continual improvement. Your style influences how you work individually, as a team, and how you will approach the rest of your organisation. One example of style that we see regularly is for a ‘people preference’. When making decisions, managers’ problem-solving style is often to consider first the effect a choice will have on people – on people’s feelings and the need to support harmony and positive relationships. When ‘people preference’ individuals who have come from a care worker background move into the service management role, they find themselves asked to make decisions based on the successful completion of tasks. In the interests of standards and quality issues, it’s necessary to look first at choices and decisions that are logical and can be justified objectively, using impersonal, rather than personal, judgments. Of course, being able to address outcomes for the benefit of both
people and task is possible, but when it comes to preference of style, when ‘people’ managers are asked to prioritise ‘task’ in their decision making, they can struggle, particularly if they aren’t aware of this preference. This results in managers spending a lot of their time out of alignment with their preferences – what psychologists call ‘coping’. ‘Coping’ takes energy and can reduce motivation. Leaders might want to reflect on the way their resource is used and find ways to enable managers to operate in line with their preferences. One practical approach is for service managers with a ‘people preference’ style to spend 8.00am to 10.00am helping with breakfast, ensuring the start of the day is focused on people. As well as having a personal benefit (playing to a leader’s strengths), this also develops a climate which is more conducive to improvement, because the staff are talking over breakfast, gaining insight into their customers, discussing ideas, and building trust. Another approach is to have separate roles for general managers and clinical
managers. Going even further, another solution could be to have a clinical manager, who is heavily task-focused, and a wellbeing manager, whose explicit role would be to focus on people. ‘Coping’ can also be reduced by learning. When managers have learnt to appreciate the different preferences, and therefore strengths, of their colleagues, they report significantly reduced stress, and value their colleagues more. This is particularly true when they have also invested in values-awareness and appreciate the similarity of their underlying values, even though their approaches are different. This suggests a significant benefit in leaders learning about interpersonal dynamics, and enabling their teams to do the same, to deliver increased productivity and continual improvement. Develop yourself, the leaders around you, and your organisation’s climate and, to paraphrase Peter Drucker, your culture will serve you your strategic vision for lunch. CMM
Develop the climate that people work in
Develop yourself and others
1. Be intentional about developing the climate you want to create.
1. Be intentional about self-development.
2. Have informal conversations across the day to acknowledge values-in-action.
2. Create the conditions for others to lead.
3. Make management more visible by eating lunch together and attending events in your service. 4. Demonstrate trust in your colleagues. 5. Be more playful: introduce a game to open or close HoD and handover meetings. 6. Be open: invite anonymous feedback and discuss the concerns and suggestions openly.
3. Have clarity on your own personal values. 4. Identify your preferences and when you are ‘coping’, support others to see theirs, use psychometric tools to help you gain insight. 5. Recognise failure as learning. 6. Explicitly connect with diverse ideas, outside your organisation, and indeed outside the care sector.
Chris Gage and Ben Davies are joint Managing Directors at Ladder to the Moon. Email: chris@laddertothemoon.co.uk Twitter: @ladderchris Email: ben@laddertothemoon.co.uk Twitter: @ladderben What do you do to change the climate in your service? What’s your approach to developing yourself and your staff? Let us know by commenting on this article on the CMM website, www.caremanagementmatters.co.uk CMM April 2020
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INTO PERSPECTIVE
THE SLEEP-INS CASE The sleep-in ‘crisis’ has rarely left headlines since the issue arose in 2016. The most recent appeal was heard in February this year, and the sector is hoping that the Supreme Court will make its final decision later this year.
THE CASE SO FAR
The Supreme Court has recently heard the latest appeal in the sleep-ins case, and is due to make its decision later this year. But what do we want for the outcome? How has the case progressed so far, and what could the impact of either outcome be? Our experts share their thoughts.
The debate around sleep-in shifts came into the public eye when former Mencap employee, Clare Tomlinson-Blake challenged the fact that she wasn’t being paid National Minimum Wage (NMW) for the entire duration of her sleep-in shift, but was only paid if she was required to be awake, after the first hour of waking. She took the case to the Employment Tribunal, which ruled that she was entitled to receive NMW for all of the hours she spent either sleeping or awake – a decision which was unsuccessfully appealed by Mencap at the Employment Appeal Tribunal. Mencap escalated the case to the Court of Appeal and, on 13th July 2018, the Court of Appeal ruled in favour of the provider, stating that care workers were not entitled to be paid NMW for the hours spent sleeping on a sleep-in shift. It did, however, say that NMW should be paid for all waking hours when staff were required to carry out duties. Unison, representing TomlinsonBlake, lodged an application to appeal to the Supreme Court to appeal the decision once again. The Supreme Court has now heard the case, and the sector is awaiting its final decision, which is not likely to be made until summer at the earliest according to experts.
THE BACK-PAY BILL Before the decision by the Court of Appeal, the entire sector had 30
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concerns over what it would mean for social care providers were the Employment Appeal Tribunal’s decision to be upheld. Surveys showed that nearly 70% of the care sector was threatened by the sleep-in pay crisis, with an estimated £400m back-pay bill that providers were worried they would have to find, despite not being able to afford it. As a tool to help, HMRC created the Social Care Compliance Scheme (SCCS), introduced on the back of three separate appeal cases dealing with the issue of sleep-ins (one of which was the Mencap v Tomlinson-Blake case). The SCCS was aimed at encouraging providers to reimburse staff for any NMW ‘underpayments’ related to sleep-in shifts. It effectively gave providers who signed up to it more time to determine whether they had underpaid staff and more time to pay care workers the arrears. Many providers were reluctant to sign up, and once the Court of Appeal upheld Mencap’s appeal, the scheme became somewhat redundant until the Supreme Court’s decision is made.
VITAL CONSIDERATIONS The sleep-ins case has become an important topic for the social care sector. The uncertainty puts increased stress and pressure on providers, and the back-pay bill is still unaffordable for most. But at a time when the sector is keen to improve the perception of care and encourage people to see it as a skilled and valuable profession, what would be the better outcome?
Roles and responsibilities must be made clear
Clarity cannot come soon enough
Nadra Ahmed OBE, Chair, National Care Association
Jodie Sinclair, Employment Partner, Bevan Brittan LLP
There are two major challenges faced by social care providers – and they have equal weighting – which will ultimately seal the fate of the sector in the coming years: workforce and funding. They are inter-dependent and a solution to one without the other is unsustainable, putting every provider in the country at risk. However, if you have a sustainable workforce and a viable income, we know that you will be okay going forward – with a blessing of a good CQC report. With this focus in mind, the debate around the impact of sleep-in staff pay is one which must be considered carefully. The first thing to be clear about is, what is the purpose of a sleep-in staff member at any given time? The answer to that question will bring us to a framework that should assist with an outcome which is fair and equitable for all. This debate inevitably centres around what is deemed to be fair. The roles and responsibilities of a sleep-in care worker must be clear from the outset. The time that they have to be ‘available’ as opposed to be ‘on shift’ needs to be clear, because the purpose of the sleep-in is
to provide additional support, when needed, in exceptional circumstances. That said, the fact that they are away from their home deems them to be ‘on shift’, so the question is, does a partial agreed payment recompense for the inconvenience of being on-site, based on the premise that it is unlikely that they will be disturbed from their sleep? To date, local authorities have paid a set amount for sleep-in arrangements within their contracts and any deviation from this will have a fundamental impact on the ability to employ sleep-in care workers for a night service that is based on ‘peace of mind’. The impact of any change to this will make contracts undeliverable, as the client may not need a waking care worker during the night. Central to this is can a care worker be paid for sleeping if it is deemed that they are working? In the event they are woken up and required to work, they should definitely be paid the National Living Wage in addition to the agreed sum, but if they are paid the same as waking staff for sleeping, why would they not be expected to carry out waking duties?
The ongoing sleep-in cases of Royal Mencap Society v Tomlinson-Blake and Shannon v Rampersad were heard by the Supreme Court in February but the social care sector will have to wait a little longer for the outcome, as the Judgment is not expected until the summer. Whether workers are entitled to be paid for time spent actually working during these sleep-in shifts or the full duration of the shift, including sleeping time, will be a landmark decision for the care sector, whatever the outcome. The outcome of the case is not easy to predict. If the appeal is successful, an already stretched sector will have greater financial exposure with increased staffing costs, claims for up to six years of back pay from staff who have already brought claims and potential HMRC fines, with an estimated cost of £400m to the wider sector. It is reported that Mencap, on its own, could face arrears of pay of up to £20m. Given the potential costs there is real concern around the potential impact on the ongoing sustainability for many providers operating in the sector. It is not inconceivable that some providers could face insolvency particularly when funding cuts are
already affecting the sector. One possibility is that the Government will re-open the social care compliance scheme to assist providers to make any arrears of pay that fall due as a result of the Supreme Court’s decision. If the appeal is not successful, it may create further recruitment challenges in an industry which is already desperately short of workers. Staff need to be recognised for the valuable contribution that they make to this sector to ensure that an already stretched industry can not only recruit but can retain and develop an established and valued workforce for the work that they do. This is particularly important given recent comments from the Government that they are part of a “low-skilled” workforce whose employers may find it more difficult to attract migrant workers following recent announcements regarding the Government’s post-Brexit immigration policy. Clarity on this important issue is essential and cannot come soon enough. More important will be the need for commissioners and providers to be working together as collaboratively as possible for the benefit of the entire social care sector. Watch this space.
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NCF RISING STARS Pam Casey is Home Manager at The Abbeyfield Society.
CAREER HISTORY I started my career in social care when I left school. I worked in a care home in Nottingham and loved it from the start. I progressed quickly to a senior care worker role but left the sector a couple of years later to set up a family business with my husband. I worked in the business for about 12 years and I'm so glad I did, because it taught me so many skills that have been useful to me in my current role as a Home Manager. After I had my second child, I decided to go back to social care, wanting to fulfil my own ambitions to become a mental health nurse. I registered with a care agency as a care worker before committing to a degree to ensure that this was the path that I wanted to take. I was very fortunate to have had the opportunity to work in numerous different settings such as hospitals, brain injury units, respite centres for people with multiple sclerosis, nursing homes and
residential care homes. I realised very quickly how much I enjoyed working in the care home setting and applied for a care post at a new home near me. I decided not to pursue the nursing degree; instead, I choose to be involved in building up a new dementia unit at the home I was at. My first management role where I lead a team was at a 106-bed home in Coventry; I was the Unit Manager on a dementia suite which had 34 beds. The part I loved the most was developing care workers to seniors and then unit managers. After two years at the home, my role expanded to a Care Manager role and I was overseeing two dementia units at the home. After having been there for three years I decided it was time to see if I had what it took to become a registered manager.
ORGANISATION I now work as a Registered Manager in a care home with 28 beds for older people; we achieved a Good Care Quality Commission (CQC) rating in all areas within the first six months of my post. We are a not-for-profit organisation and our key values are Care, Respect, Honesty and Openness. It’s important to me that residents feel we uphold these values. We try to create a home-from-home and keep residents involved in day-to-day decision making. I've been known to bring wallpaper samples in for them to vote on their favourite – it's about building an environment where they have a say.
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NCF RISING STARS
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Our activities are focused on not just doing things for leisure, but on making sure that everyone gets to utilise their skills. Our residents know that if they want to do something, even if it needs a bit of planning, we will try to make it happen. There’s also a structure to our activities, so that people can plan their weeks without worrying that they are going to miss out on something.
CURRENT ROLE I’ve been in my current role for about 18 months. In my previous job, I found that, while I was making decisions, ultimately, the overall responsibility was with the registered manager, and I was ready for the step up. I’m so glad I did it – it has stretched me in so many ways. It’s all worth it, when you get to see the changes you’re making. What I love most is that every day there’s what I call a ‘golden nugget moment’ – a moment when you receive a
these are the moments that make me love what I do. I also love to mentor and develop my staff. With three quarters of them having been at the service for 15 years or more, I wanted to know what it was about this team that has made them all stay for so long. I’m not sure I’m at the end of answering my question, but one thing that’s obvious is that they are very valued by the organisation. The time management part of the job is hard, it’s a bit of a juggling act. And I find while questioning yourself about whether you have made the right decisions on a daily basis is natural, you also have to trust in yourself and believe that you’ve done everything that needs to be done.
amazing to be able to learn from others, sharing practices and ideas. Lots of this year’s group have achieved Outstanding ratings and it’s brilliant to be able to share reports and ask what they’re doing. We also visit each other to see how everyone prepares for inspections. When you first come into the registered manager role, you can feel a bit alone – there isn’t another registered manager beside you on a daily basis. The NCF Rising Stars programme has given me a group of people to talk to who are on the same journey as me. Just knowing you have people going through the same moments as you is a huge support.
NCF RISING STARS
The aim is to try to achieve an Outstanding in our next inspection, at least in one or two areas. I am looking forward to the journey with our residents in trying to achieve this. Right now, I couldn’t see myself doing anything other than managing a home, but in terms of my career I’ll just see what’s in store. At the moment, my main objectives are for us as a team to do bigger and better.
I didn’t know about the NCF Rising Stars programme until I was nominated. I hadn’t been with the organisation long, so in my mind,
“The people we care for have such rich histories and have achieved so many things. At times we are the only voice for them.” positive comment or see someone happy. When I do the pre-assessments, I meet individuals who are afraid of moving into a care home because they think it’s an ending. I try to support our residents to understand it’s a new chapter in their lives, and they can carry on making memories and getting involved in things. When I see our residents enjoying their lives,
I had ‘won’ when my Director and Regional Manager told me they wanted to put me forward. I didn’t think I was going to be selected – you hear of so many things that people are doing and I just felt honoured to be nominated. When I heard that I had been selected it caught me completely off-guard. I’m so glad I was, because it’s been
FUTURE CAREER
ADVICE I would say to aspiring registered managers, just to go for it, trust your judgement and use the support around you. For me, it’s a privilege and an honour to be responsible for other people’s lives – the people we care for have such rich histories and have achieved so many things. At times we are the only voice for them. Be prepared that it is not always a nine to five job and lead your teams to share the same vision as the organisation and yourself. 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. Applications for 2020 are now open, contact Helen Glasspool at National Care Forum. Email: helen.glasspool@nationalcareforum.org.uk Twitter: @NCFCareForum
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NCF supports its members to improve social care provision and enhance the quality of life, choice, control and wellbeing of people who use care services. We work directly with not for profit providers of care and support services across the UK offering: ME MBE RSH
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PROJECTIONS FOR THE DECADE AHEAD As we enter 2020, we’re asking what the next ten years might hold for social care. Nuno Almeida of Nourish shares the three key areas that he thinks will change the face of the sector in the decade to come. We are now in the year that so many governments and institutions used as a signifier of the ‘distant future’ in the early years of the millennium. Let’s all prepare for events called ‘2020 Vision’, and for lots of promises and attempts to set lofty, ambitious goals for 2030 and 2040. The Prime Minister’s promise of a plan for social care has already been kicked into the long grass – again – but what does the next decade hold for social care? I believe that, on the cusp of this new decade, there are three key areas that will shape the evolution of health and social care, regardless of what governments do (or don’t do, as seems to be more often the case).
AGEISM – AN OPEN DEBATE AROUND HEALTHY AGEING ‘We live in a world where people age 60 and over will soon outnumber children aged five and under.’ (World Health Organisation, 2019) At the World Economic Forum this year, it is as important that we discuss ageing as it is that we discuss global warming and economic growth. This is the decade when society will have to address its perceptions of ageing. It has become clear that our collective attitudes are themselves a leading cause for loss of quality of life. A person who believes the negative
stereotypes associated with ageing will shorten their life by seven and a half years, compared to a person who manages to focus on staying active and living with purpose. This is the decade when the exponential growth of the population aged 60 and over, seen by many as a threat to our economies and a burden, will evolve to be seen as another, different, driver for growth. The transition towards seeing this part of the population as a diverse group of individuals with strengths, rather than simply ‘pensioners’, is already taking place as people start realising that age and health are different matters – and that it’s possible to live healthily for longer. But this can only continue if each and every one of us avoids fitting our own existence into the traditional narrative of what it looks like to get older. '“Old” is a meaningless social construct that boxes an amazingly diverse array of people. Might as well try to group horses, oranges and orangutans. Problem is it drives social policy and, worse, we can internalise the expectations that come with the label.’ (John Beard, Former Director of Ageing and Life Course, WHO) Businesses will have a role to play – over 60s are consumers, after all – but health systems and governments need to increase awareness of the importance of living a healthy, active and engaged life as we get older. This may well be the lever that determines whether
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PROJECTIONS FOR THE DECADE AHEAD
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our older people are drivers of economic growth or a cost and a burden. It seems the solutions we need for this growing new segment of our population are therefore not always ‘more hospitals’ or ‘more care homes’. We will realise in time that building communities is just as important, and the solutions may end up being more green parks, flexible employment for older people, or nurseries and care homes built next to one another, which can all lead to greater overall happiness and more vibrant economies. Alongside existing care homes, I foresee a surge of activity in creation of communities. Both existing care homes opening up to communities around them, and an increase in extra care or housing with care schemes. Some of our neighbours may live with learning difficulties, some of our neighbours may have nursing needs – but they will all be valued parts of the community. Maybe this sounds like ‘Vision 2030’ territory, but I think this is on the cusp of happening, and not a long way away.
However, there clearly is progress being made in the creation of shared data within health and social care. Local Health and Care Records (LHCRs) are a significant advance – now, when healthcare teams and local authorities interact with a person, they are doing so whilst holding the same data about this individual. This is a seismic improvement compared to siloed organisations with the person being completely in charge of coordinating multiple entities. Despite the advancements, as ever in very large and complex projects, this journey is suffering from a ‘last mile’ challenge. I say ‘last mile’ as I see it as being similar to the challenge telecoms operators faced when bringing highspeed internet to every home. This does not diminish the value of the work done so far in implementing LHCRs – they are an essential building block for integration – but we need to bring the benefits to the care teams supporting each person receiving care.
INTEGRATION: THE LAST MILE CHALLENGE
There is little doubt that nursing professionals, alongside skilled care workers and healthcare assistants, hold the key to enabling the health and social care sector to meet increased demand. But for this workforce to be effective, roles need to be questioned. In 2020, we mark Florence Nightingale’s 200th birthday – 110 years after her death, how we can reinvent nursing and the part that nurses play? In my opinion, nurses will become even more important sources of knowledge, mentors and leaders in the upskilling of the workforce over the next ten years, whether as part of teams in care homes, or as district nurses working in a co-ordinated fashion with care workers – the role will become one of defining the correct protocols for a care team, ensuring everyone has the skills they need and can confidently use them, and ensuring everyone then monitors the quality of care, and how outcomes are being met. This vision for a future of nursing where care protocols are set and monitored by nurses allows a nurse to deliver a much greater impact – in such a structure, with digital monitoring of risk and adherence to prescribed practice, each trained nurse can oversee far higher numbers of people; but to achieve this, we need to give nurses the tools, including: • A mandate to train others, and teach skills and protocols to healthcare assistants and care workers. • The right digital tools to monitor risk, and
The second area I think will change in the next ten years is integration of health and social care. Integration is still as urgent as ever, but all attempts to accelerate it tend to grind to a halt under the weight of complexity. A person receiving care in the community, moving between a care home, hospital and back, or someone managing the care of a relative in their own home, still has to deal with services and systems that make their lives a lot harder than they should be, often resulting in degradation of quality of care. And although budgets for health and social care are often a factor, they are not the only factor. We have learnt that integration is not achieved in isolation by the NHS, or by local authorities. The terms ‘co-design’ and ‘cocreation’ have become part of the vocabulary in recent years and, where these are done well, we see people’s experiences of care improving significantly. Saying this, the moment integration started being discussed, everyone rushed to make their area the ‘hub’ for aggregation of patient data. GPs felt they were the natural hub. Local authorities felt they were the natural hub. District nurses felt they were the natural hub. And yet, people kept experiencing clunky journeys of care, assessments by different entities, contradictory advice and signposting.
THE ROLE OF NURSES
mechanisms for escalation that allow nurses to get involved when they can make a real difference – either in upskilling others, or in dealing with acute cases. • Nursing schools that encourage continuous professional development fit for different approaches to the role of nursing – including encouraging a larger number of nurses to become clinical leads of multiple care worker teams. It is also easy to see that there is an opportunity to do more regarding nurses having a full picture of the person they are caring for, which means that, over the next decade, we need to find and implement the right systems for information sharing, leading to natural coordination of care around each person.
DIGITAL TRANSFORMATION As mentioned above, digital is an essential part of enabling roles to change shape and will continue to enable true integration between health and care teams. What providers are increasingly demonstrating is that digital transformation focused on recording the interactions between care workers and people receiving support is far more effective in monitoring and encouraging improvements in care quality than some other systems focused on time and attendance. Care management teams are also starting to use data analytics to improve their ability to audit at scale, and to develop strategies for monitoring and mitigating key risks in their services. Analytics are enabling providers to think proactively in defining what needs to be managed and rolling out business intelligence and dashboards to empower teams to focus on those key aspects. I believe that over the next ten years there is unique potential for digital to deliver a transformation to the sector. Where in other sectors this means consumers now deal with smartphones rather than people, what it will mean for social care is very different: we can maximise the eye-to-eye and skin-to-skin contact between care services and people receiving support, while ensuring that care is safe, and enabling care teams to act in a co-ordinated fashion. We must create safe services with the right quality and capacity, fit for the demands of the next decade – managers as always will either drive this change or be driven by it. Embracing this change and steering it is invariably the attitude that leads to the best outcomes. CMM
Nuno Almeida is Founder and Chief Executive of Nourish. Email: getintouch@nourishcare.co.uk Twitter: @nourishcare What do you think social care will look like in ten years’ time? Do you agree with Nuno? Share your insights on the CMM website where you can comment on this article, www.caremanagementmatters.co.uk 38
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Albert Goodman
Resource Finder: A C C O U N TA N T S
Tel: 0330 333 5039 Email: enquiries@albertgoodman.co.uk Website: albertgoodman.co.uk
SECTORS • Nursing homes. • Residential homes. • Residential dementia homes. • Learning disability homes. • Extra care. • Domiciliary care. • Supported living.
SERVICES • Cloud bookkeeping and training packages. • EBITDAR and business advisory (including benchmarking). • Tax compliance and advisory. • Sales and acquisition tax advisory. • Due diligence for sales and acquisitions. • Share valuations. • Succession planning. • Forecasting. • Payroll.
LEAD INDIVIDUALS Julie has a depth of experience in looking after businesses in the care sector which few can match, with over 25 years’ experience supporting businesses from start up, growth planning through to exit. Accountancy is her profession and the care sector is her passion. She offers vital support to our care business clients, with up-to-date sector knowledge adding value to the breadth of advice given. She
From help with managing taxes to support with succession planning, preparing for sale and due diligence during acquisitions, these accountancy firms specialising in the care sector can help you keep track of your finances.
is a well-respected researcher in the sector, contributing to sectorwritten articles. Neil Hutchings is Albert Goodman’s corporate finance specialist, having joined the firm in 2008. Over the past 12 years, he has developed extensive corporate finance, audit, accountancy and business advisory skills, over a wide range of companies and organisations. Neil has vast experience in the buying and selling of care homes and care home groups and is wellconnected within the corporate finance sector.
COMPANY INFORMATION Albert Goodman LLP, established for over 150 years, has developed a dedicated team to support providers in the care sector to navigate through business challenges, with wider contacts in the sector adding value to the advisory given. In addition to the accountancy and tax compliance, business advice is given throughout the year through management accounts production, KPI reporting and variance analysis from budget to actual, monitoring occupancy and cash flow, providing timely reporting for inhouse management and to meet bank covenant requirements.
Julie Hopkins Director Tel: 01935 423667 Email: julie.hopkins@albertgoodman.co.uk
Neil Hutchings Corporate Finance Manager Tel: 01823 286096 Email: neil.hutchings@albertgoodman.co.uk
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RESOURCE FINDER: ACCOUNTANTS
Bishop Fleming
Hazlewoods
Tel: 03333 21900 Email: TGodfrey@bishopfleming.co.uk Website: www.bishopfleming.co.uk
SECTORS • Nursing homes. • Residential homes. • Learning disability homes. • Extra care. • Supported assisted living. • Challenging behaviour and special needs. • Rehabilitation. • Domiciliary care agencies.
SERVICES • Sales and acquisition tax advice and support. • Raising finance and refinancing. • Cloud accounting solutions. • Business performance monitoring and benchmarking. • Accounting and audit. • Tax planning. • Payroll. • Wealth management.
LEAD INDIVIDUAL Tim Godfrey heads up the firm’s specialist care homes team advising clients across a wide geographic area. Tim and his team provide invaluable insight into the issues impacting on the sector and assist clients in areas such as commercial and tax structuring, funding, and financial reporting including the use of technology. Tim comments, ‘The sector is currently facing many
challenges, particularly on funding, rising costs, ongoing viability and increased regulation. At Bishop Fleming, our focus is on helping clients monitor their business performance in order to protect their value in the face of these challenges. Using cloud-based, real-time financial reporting allows us to have meaningful conversations throughout the year. Our specialist benchmarking tools and reports, together with our proactive advice, enable our clients to manage their business more effectively, while keeping their fingers on the pulse of the day-to-day financials.’
COMPANY INFORMATION Bishop Fleming is a dynamic UK accountancy firm, providing a comprehensive range of services across a wide range of sectors. We have seven offices in the South West through to the West Midlands and our membership with Kreston gives us international reach. We pride ourselves on being relationship-led and place our client and people relationships at the heart of our business. That’s why we have been awarded the British Business of the Year at the British Chamber Business Awards 2019.
Tim Godfrey Partner and Head of Healthcare Tel: 07973 699915 Email: TGodfrey@bishopfleming.co.uk
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CMM April 2020
Tel: 01242 237661 Website: www.hazlewoods.co.uk
SECTORS • Residential and nursing homes for the elderly. • Learning disability/challenging behaviour. • Specialist needs education colleges. • Assisted living/close care/extra care. • Drug, alcohol and eating disorders independent hospitals. • Domiciliary care. • Supported living. • Children’s services. • Secure units. • Foster care agencies. • Primary healthcare.
SERVICES • Accounts, audit and tax. • Accounts preparation. • Audit. • Business planning and advice. • Corporate finance. • Tax advisory services. • Benchmarking. • Sales and acquisitions. • Preparing the business for sale. • Exit planning. • Valuations. • Assisting in negotiations. • Minimising the effects of income tax, capital taxes, VAT and Stamp Duty Land Tax.
• Due diligence. • Raising finance. • Estate planning.
COMPANY INFORMATION Hazlewoods Health and Care team have been specialists in the sector for over 25 years, acting for over 200 different health and social care providers. Our specialist team offer a full range of services to enable us to deliver wealth creation to health and care business owners. We advise many clients on their strategy from early stage to disposal. Services include accountancy, audit, tax planning and mitigation, business strategy, acquisition and disposal advisory. Due to the high level of activity in 2019, we successfully advised on 165 completed transactions valued at £715m. 2020 has begun where 2019 left off, although headwinds such as Brexit and staff cost increases do continue to challenge buyers and sellers alike. We act for a wide range of care providers, including individual care home owners, corporate groups, not-for-profit organisations and private equity houses.
Rachael Anstee Partner Email: rachael.anstee@hazlewoods.co.uk
John Lucas Partner Email: john.lucas@hazlewoods.co.uk
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Embracing diversity in adult social care
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Professor Trish Hafford-Letchfield from Middlesex University shares latest research and best practice in supporting people to be open about their identities in care.
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It is safe to say that working positively and inclusively with people who have diverse sexual and gender identities can be a very challenging area for social care, yet numerous research studies have shown that this remains a peripheral issue for the workforce.
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This is despite evidence showing that the LGBT+ community experiences higher incidence of mental health issues, such as anxiety and depression, suicide and problematic substance use, and that their general health can be worse than that of heterosexual or cisgendered people. Additionally, findings from research with LGBT+ adults indicate that they lack confidence in care services, causing a reluctance or delay in seeking help. This is primarily a result of people’s previous experiences of discrimination, but is also down to a continuing lack of clear direction in working with members of the LGBT+ community, and a distinct absence of targeted policies and practice guidance. Opportunities have been made to remedy this within generic policies impacting on care (such as in mental health, dementia and ageing), but they have so far been disappointing and have only paid cursory attention to the LGBT+ community’s specific needs and circumstances.
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As well as this, people could face discrimination, or fear facing discrimination, in services such as care homes and supported housing, where other residents might be intolerant of living with LGBT+ people who are open about their sexuality and gender identities. These fears must be seen in the context of the enormous disparities and inequalities that LGBT+ people face.
from the ground up
There is also an issue in the idea that some professionals and care workers might operate from the presumption that all people identify as heterosexual or cisnormative (meaning that we see people with a fixed stereotyped gender). Whether or not this is true for a social care professional, the idea itself makes it very difficult for people using services, and their carers, to talk openly about their lives and relationships.
The scope of the issue In 2018, Government commissioned a national survey with over 108,000 LGBT+ respondents to find out more about the prejudices they are facing. Some of the findings make for difficult reading in light of perceived progress – LGBT+ people reported being less satisfied with their life than the general UK population, with particularly low scores for transgender respondents.
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More than two thirds of LGBT+ respondents said they still avoided holding hands with a same-sex partner for fear of a negative reaction from others. Verbal harassment or physical violence is an ever-present experience which was significantly underreported, and ‘conversion’ or ‘reparative’ therapy offered to ‘cure’ people with different identities is still present in UK society. This all feeds in to how people will feel about being open about their sexual and gender identities in later
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facing up to a rising need
Better domiciliary care
is it just me...?
straight talk
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Graduate Management programme in health and social care Could you host an ambitious graduate? Our one-year programme fast-tracks graduates towards leadership roles, and we’re looking for forward-thinking health and social care employers to invest and grow with them.
The benefits of hosting a graduate Financial and practical value. Fresh thinking and insight. Injection of new ideas. Complement your professional network.
Their questioning of what we do and why we do it was helpful in identifying many areas for improvement. Cheshire East Council Applications close Monday 6 April 2020.
Find out more www.skillsforcare.org.uk/ hostagraduate | #HostAGrad 44
CMM April 2020
RESOURCE FINDER: ACCOUNTANTS
Morris Lane
Moore Stephens
Tel: 01202 715950 Email: mail@morrislane.co.uk Website: www.morrislane.co.uk
SECTORS • Care homes. • Nursing homes. • Domiciliary care agencies. • Charities. • Property development. • Learning disabilities.
SERVICES • Acquisitions. • Disposals. • Accounts. • Auditing. • Business plans, support and advice. • Company secretarial. • Corporate finance. • Payroll services. • Tax advice and services. • Management accounting.
LEAD INDIVIDUALS Roger Morris heads up the Morris Lane team of specialists working with their healthcare focused clients. Roger is an award-winning member of the Chartered Institute of Taxation and has over 30 years’ experience in the sector. Roger is ably supported by lead accountants specialising in the sector, Michelle Cordy, Dan Baker, Jon Hoyle, Michelle Pettifer and Sam Turner. The team provides a proactive service to enable clients to achieve their ambitions, to maximise their profitability, and to increase and protect their wealth.
COMPANY INFORMATION The firm has clients located throughout England and Wales and is believed to advise more care home operators than any other accountants in the UK. Its strength lies in listening to clients about their business and personal goals and providing timely advice through the business cycle on how to achieve these, so they can fund their preferred lifestyle and ultimate exit from the business. This includes preparation of budgets and forecasts, regular and timely advice on any changes in tax and accounting law, as well as keeping them up-to-date on financial matters relating to the sector. The firm ensures clients are compliant in terms of producing their annual accounts and tax returns, as well as providing management accounts if required by lenders in accordance with specific loan covenants. It prides itself on providing bespoke advice including the structuring of acquisitions and disposals in order to maximise value and minimise the effects of income tax, corporation tax, capital taxes, VAT and Stamp Duty Land Tax. Morris Lane also works closely with other professional advisers in the sector, including finance and capital allowance specialists together with their clients’ legal teams.
Roger Morris Partner Tel: 01202 715950 Email: roger.morris@morrislane.co.uk
Tel: 0207 334 9191 Email: carehomes@moorestephens.com Website: www.moorestephens.co.uk/healthcare
SECTORS • Care homes. • Nursing homes. • Residential homes. • Retirement homes.
SERVICES
• Business outsourcing. • Corporate finance. • Governance. • IT consulting. • Restructuring. • Risk. • Tax. • Wealth management.
• Accounting. • Audit.
Smith & Williamson Tel: 0238 082 7631 Email: greg.palfrey@smithandwilliamson.com Website: www.smithandwilliamson.com
SECTORS • Residential care homes. • Nursing homes. • Dental. • Healthcare professional practices. • Charities.
SERVICES • Acquisitions and disposals of care homes and groups. • Business valuations. • Financial due diligence.
• Cash planning, management and forecasting support. • Reporting services and resolving financial questions/ challenges. • Pension scheme deficit advice. • Support with preparing for closure, disposal of assets and dealing with surplus funds. • Accounts preparation and audit. • Business outsourcing. • Business and employment taxes. • Employee benefits consulting.
For more information, and other services to support your business, from solicitors to compliance specialists, visit www. caremanagementmatters.co.uk/directory
CMM April 2020
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CELEBRATING EXCELLENCE IN CAMPAIGNING, COLLABORATION AND DEVELOPMENT Markel 3rd Sector Care Awards
Suzy Lamplugh Trust won in three categories at the Markel 3rd Sector Care Awards 2019: Campaigning for Change, Collaboration and Contribution to Sector Development. Here, we find out more about the charity.
Suzy Lamplugh Trust is the UK’s pioneering personal safety charity and leading stalking authority. Our vision is a society in which people are safer and feel safer from stalking, violence and aggression, so they can live life to the full. Our expertise covers frontline advocacy, policy, research and political and media engagement. Our experience of providing support and advocacy to victims of stalking has given us an in-depth understanding of the dangers and harms posed to them, and the long-term trauma they often face. We work closely with the senior police officers who have responsibility for stalking and harassment and have a broad base of knowledge across the public and voluntary sectors, as well as strong and effective working relationships with key sector stakeholders.
OUR ROOTS The Trust was founded in 1986 by Diana and Paul Lamplugh following the disappearance and, later, presumed murder of their daughter, Suzy. At the time, very little research had been done into personal safety and the term was rarely used. 46
CMM April 2020
Paul and Diana became the foremost experts on personal safety and Diana travelled throughout the UK raising awareness of the subject. Diana and Paul were both awarded OBEs for their work for the charity. In 2006, they were jointly awarded the Beacon Prize for Leadership for their work in raising awareness of personal safety and addressing the causes of and solutions to violence and aggression in society. The Trust exists to continue their work and ensure that no other family has to go through the Lamplugh family’s awful experience of losing a loved one. Our work always prioritises supporting victims and ensuring that their voices are heard.
WHAT WE’VE ACHIEVED The positive outcomes achieved by the Trust include contributing to the passage of legislation; providing support and advocacy to victims; producing innovative research; managing a programme to prevent stalking reoffending; providing co-ordination and support within the Violence Against Women and Girls (VAWG) sector; running the National Stalking Helpline; and building links outside this sector to raise awareness of the impacts
experienced by victims of stalking and workplace aggression and violence. 2019 marked a hugely productive year across our training, campaigns and operational work. In February 2019, Government pledged to legislate for national minimum standards for taxi and private hire vehicle licensing and to establish national enforcement powers for licensing officers and a national licensing database. The Suzy Lamplugh Trust made these recommendations as part of Steering Towards Safety in Taxi and Private Hire Licensing, a research report we launched in 2018. The recommendations were also included in the report of the Ministerial Task and Finish Group (of which Suzy Lamplugh Trust was a member), which was submitted to Government in 2018. Following its agreement in February 2019, Government has since withdrawn its support to legislate for minimum standards, but we continue to lobby. The Trust was instrumental in the passage into law of the Stalking Protection Act on 15th March 2019, a crucial piece of legislation which would allow police to act early to protect victims of stalking. Stalking Protection Orders (SPOs) will allow police officers to protect victims from abuse, harassment and stalking before a criminal investigation has concluded. The police, rather than victims, are required to apply and pay for the orders, which is an important issue for victims. SPOs came into effect in January 2020 and represent a significant strengthening of the protections previously available in England and Wales, and an acknowledgement of the suffering victims of stalking can face. As part of the Trust’s ongoing Stay Safe at Work Campaign, we launched ‘Suzy’s Charter for Workplace Safety’ on our annual Personal Safety Day in November 2019. The Charter outlines simple yet effective steps that employers and employees can use to make their workplaces safer and it was developed as a result of close work and consultation with unions, corporations, and the police. The agreement of such a range of stakeholders on the content of the Charter has been a great achievement; we hope to continue working with employers across all sectors to implement it in workplaces over the course of this year. Last year, we also provided personal safety training for over 6,000 people and organisations, helping companies to embed personal safety in their workplace culture. Throughout 2019, Suzy Lamplugh Trust continued to manage the Multi-Agency Stalking Intervention Programme (MASIP), a world-first project that takes a holistic approach to identifying and tackling stalking, with comprehensive victim support at the
centre of its work. Operating across three sites in Hampshire, Cheshire and London, MASIP brings together criminal justice professionals, health practitioners, and victim advocates to provide innovative way for these agencies to collaborate on preventing reoffending and keeping victims safe. We’re already seeing exciting signs of a more effective approach developing, with stalking victims reporting that they feel safe, supported and listened to. We hope that the MASIP project will continue to produce positive results, develop new approaches, and further our understanding of how to effectively tackle stalking and keep people safe.
MARKEL 3RD SECTOR CARE AWARDS
OUR GOALS FOR THE FUTURE The team at Suzy Lamplugh Trust was thrilled to have our ‘Contribution to Sector Development’ and our ‘Campaigning for Change’ and ‘Collaboration’ work recognised by the judges of the Markel 3rd Sector Care Awards. It has been a challenging and exceptional year for the Trust; receiving the awards in these categories is a testament to our teams’ dedication to the Trust’s mission to help people to feel safe and be safe. We are also grateful to the Awards’ headline sponsor, Markel for the complementary consultancy services offered to us by Janjer, and we intend to use these to explore how we can increase our social impact. In the coming years, we plan to use our experience in victim advocacy, research, and engagement with policymakers to continue our work to ensure perpetrators of stalking are better managed, and victims are kept safer and better supported. Alongside the UK-wide ‘safety net’ provided by our national service, we want to transform the provision of stalking support services in the UK by taking our quality casework service to more victims. The maturity of our service, the expertise gained from directly supporting thousands of victims and our position as a leader in the sector make us uniquely positioned to ensure that local provision is more accessible and of consistently high quality. By combining work on policy, engaging with key services, including criminal justice professionals and healthcare providers, campaigning, training and providing practical support for victims, we hope that 2020 will see continued progress in ensuring that people are – and feel – safer. CMM Suky Bhaker is Chief Executive of Suzy Lamplugh Trust. Email: info@suzylamplugh.org Twitter: @live_life_safe
Headline Sponsor The Markel 3rd Sector Care Awards is run specifically for the voluntary care and support sector. Nominations open on 14th June. Enter today at www.3rdsectorcareawards.co.uk. Sponsorship opportunities are available. With thanks to our supporters: National Care Forum, Learning Disability England, The Care Provider Alliance, Association of Mental Health Providers and VODG. The Campaigning for Change Award was sponsored by
Janjer Ltd
The Collaboration (Integration) Award was sponsored by The Contribution to Sector Development Award was sponsored by CMM April 2020
47
EVENT PREVIEW
mfon
INTRODUCING MFON MEGASTARS My Family, Our Needs (MFON) has launched a new awards ceremony, putting young disabled people at the heart of the celebrations. The setbacks, hardships and challenges that families with disabled children can face are often down to barriers and insufficient support systems. However, there are extraordinary things happening on a daily basis in communities up and down the country and MFON Megastars wants to celebrate them.
THE SEND SPOTLIGHT There aren’t many awards ceremonies which focus entirely on young people. Through the work My Family, Our Needs does with parents and professionals to support young disabled people, it is clear that when facing adversity, young people are often brave, sometimes fearless and always the drivers for change. Their spirit is at the heart of the Special Educational Needs and Disabilities (SEND) community and they are its most important members; full of ideas and the determination to make the world an entirely different place. They have a voice which isn’t heard enough and the purpose of MFON Megastars is to give them that voice and make them feel as special as they are. The awards are inclusive and inspired by passion, so, as there is often a person or group who has helped a young disabled person
Introducing...
achieve what matters to them, there is also an award for them. The Marvellous Mentor award can be for a teacher, a sports coach, an employer or anyone who has championed the person they believe in.
CATEGORIES There are six categories in total: • Overcoming Adversity – conquering challenges and overcoming obstacles, nominees in the category will have shown bravery and strength to get to where they are today. • Creative Arts – Whether art has been used as therapy or a form of expression, the talented nominees in this category could be artists, dancers, musicians or singers who excel in their creative craft. • Making a Difference – Nominees in this category will have made a difference to the lives of people with additional needs whilst also living with their own disability. • Super Sibling – Nominees will have supported their brother or sister through tough times and difficult hardships. They may not necessarily have a disability themselves, but they go above and beyond for their sibling who does. • Marvellous Mentor – A constant source of support and strength for a young disabled person, the nominees in this category will be
the people shouting loudest about a young person’s success. • Fundraiser of the Year – Nominees in this category may have raised money for one individual or a large organisation but they will have been passionate, driven and tireless in their campaigning.
GET INVOLVED Nominate today to recognise the people overcoming challenges, or get in touch with MFON to help them shape this fun, positive event with young people, their parents, carers and professionals at its heart. Whether you work with a disabled young person or you support a family who has an MFON Megastar in the making, you can help them be recognised for their talents, kindness, sheer determination and spirit. To find out more about the awards, visit www.myfamilyourneeds.co.uk/mfon-megastars. Sponsorship opportunities are also available, email lisa.werthmann@carechoices.co.uk
mfon
Putting young people in the spotlight 48
CMM April 2020
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Event: Date/Location: Contact:
Autism and learning disabilities care in England 28th April, London Westminster Health Forum, Tel: 01344 864796
Event: Date/Location: Contact:
ADASS Spring Seminar 2020 29th April – 1st May, Staffordshire ADASS, Tel: 0207 072 7433
Event: Date/Location: Contact:
LaingBuisson Social Care Conference 13th May, London LaingBuisson, Web: www.laingbuissonevents.com
Event: Date/Location: Contact:
Digital Health and Care Congress 20th-21st May, London The King’s Fund, Tel: 0207 307 2409
Event: Date/Location: Contact:
NCF Annual Conference 2020 2nd June, London National Care Forum, Tel: 0247 624 3618
Event: Date/Location: Contact:
Residential & Home Care Show 24th-25th June, London Media Partner Residential & Home Care Show, Web: www.residentialandhomecareshow.co.uk
Event: Date/Location: Contact:
Care Home Open Day 2020 26th June, Nationwide Care Home Open Day, Web: www.careengland.org.uk/carehomeopenday
Please check with event organisers that conferences have not been cancelled or postponed due to coronavirus before booking or attending.
CMM EVENTS Event: Date/Location: Contact:
BAPS – SEND Blogging Awards 21st May, Leicester Care Choices, Tel: 01223 207770
Event: Date/Location: Contact:
CMM Insight Leeds Care Conference 11th June, Leeds Care Choices, Tel: 01223 207770
Event: Date/Location: Contact:
CMM Insight Northamptonshire Care Conference Conference 16th July, Northampton NEW DATE Care Choices, Tel: 01223 207770
Event: Date/Location: Contact:
CMM Insight Lancashire Care Conference 10th September, Blackburn Care Choices, Tel: 01223 207770
Please mention CMM when booking your place. Sign up online to receive discounts to CMM events. CMM April 2020
49
D E S K E L LY O B E • C H A I R • C E N T R E F O R P O L I C Y O N A G E I N G
Ageism surrounds us in our daily lives, despite people living for longer than previous generations. Des Kelly OBE examines the importance of tackling ageism and how we can go about this in social care.
At the time of writing, the first few deaths from coronavirus in the UK have been reported. I’ve found it rather disconcerting that, as they have all (so far) been old and ill, it might be less of a general concern. Worse still was the report on the comments of Professor June Andrews, addressing the Scottish Parliament audit committee, that COVID-19 could assist hospitals with delayed discharges because people would be ‘taken out of the system,’ (The Independent, 8th March 2020). Surely both represent a reflection of entrenched views of older people and the prejudice of ageism? It is my sense that ageism is everywhere. It is often insidious rather
than explicit, part of the language used and thus shaping attitudes along with ways of thinking and behaving. Take birthday cards for example. Every stereotype about the negative aspects of ageing can be found in birthday cards: physical appearance, forgetfulness or limits to mobility are used in patronising ways for the purpose of a joke. These attitudes then become normalised and routine amongst families, in workplaces and services – including those of care and health. Writer, Ashton Applewhite (author of This Chair Rocks: A Manifesto Against Ageing) notes mantras such as ‘70 is the new 50’ also reinforce the vitality of being younger. She argues that ageist views start with the language we use to emphasise vulnerability and dependence, rather than resilience and independence. According to Applewhite, there is a growing awareness of ageism but it isn’t being translated into policy. Many still see older people as a problem, less capable (and less worthy maybe), as a burden and a cost, rather than viewing added years as a bonus and an opportunity for individuals as well as society. The fact that we are living longer is something to celebrate. On average, men and women are living some ten years longer than their parents and 20 years longer than their grandparents. This represents a dramatic shift in the demographic make-up of society and has wide-ranging implications. Advances in medicine, public health, standards of living, lifestyle and so on have contributed to longer lives but we are yet to properly put in place policies to ensure that the benefits of these extra years can be fully enjoyed. There are now almost 12 million people aged over 65 in the UK, and 3.2 million are aged over 80 (see The State of Ageing in 2019: Adding Life to Our Years, a report from Centre for Ageing Better). However, men at 65 in the UK can expect to live about half of the remainder of their life without disability, i.e. ten of 19 years. For women, ten of 21 extra years, on average, of longer
Des Kelly OBE is Chair of Centre for Policy on Ageing. Twitter: @DesKellyOBE 50
CMM April 2020
life will be free of disability or ill-health. Furthermore, in less than 20 years, the number of people aged 65 and over will increase by more than 40% to the point that, by 2036, one in four of the population in the UK will be aged over 65. I wonder if we are really ready for the potential changes that this will bring. ‘Unlike other prejudices such as racism and sexism…ageism is unique in targeting our future selves,’ says Ashton Applewhite. To address this, I think we need to start with the young, and the younger the better. The award-winning Channel Four programme, filmed at The St Monica Trust, Old People’s Home for Four Year Olds set a wonderful template for this – there was no evidence of ageism on the part of the children featured. By starting with education, we can put more emphasis on ageing throughout life, such that integration of the generations is simply natural and age diversity is something positive – each generation can learn from the other. We need to rethink work, as an older workforce will undoubtedly be the workforce of the future. People will work longer than the current generation of retirees. This will require a different way of behaving around retirement and how it is described and portrayed, including greater flexibility, more part-time working, breaks and the like. Relationships, of course, are the key to social connectedness and so much else – fulfilment, life satisfaction, selfesteem – the antidote to loneliness and isolation. Policies that tackle the causes of preventable ill-health and health inequalities, such as decent housing and public transport, are vital, as are leisure and ongoing learning and creative opportunities. Clearly there’s a range of complex factors to consider. Nonetheless, casual ageism in popular culture and everyday life needs to be called out and challenged. I think those in social care are well placed to offer leadership in tackling ageism.
Social
matters
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