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JUNE 2013 ÂŁ4.00

SHIRKING THEIR DUTY? Ordinary residence disputes with local authorities

Crisis control

Managing negative situations

Business Clinic Integration progress in Leeds

Includes 4-page Skills Academy insert: Focus on Leadership and Graduates: why investing in Graduates works

in this issue

IN THIS ISSUE regulars 05

editor s welcome

Is it just me...? Guest Editor, Mike Parsons reflects on how radical the Queen s Speech legislative proposals really are.




In Focus


Property News


Local Authority and Planning News


Corporate News


60 Seconds with...


Jo Cleary, Board Chair of The College of Social Work, is interviewed.


Business Clinic A new service, supported by the local authorities, designed to avoid unnecessary admission to hospital or residential care recently opened in Leeds. Should more private providers look to venture down this path? Our panel discusses.



features 18

Spotlight on...

Daniel Braithwaite explains how care providers should proceed if they are caught in a dispute with a local authority over care fees.

Construction and design services.


Conferences CMM reviews the Surrey & Sussex Care Showcase and the Care Management Conference at Naidex National.


What s On?


Straight Talk

Passing the buck: dealing with ordinary residence disputes


Duncan Shine urges care home directors to place greater emphasis on staff training.

Positive Behaviour Support Lisa Hopkins explains how Dimensions support programmes can be used to help people with learning disabilities and autism live lives of their own choosing in community settings.


The necessity of understanding marketing Nicki Wakefield discusses how to approach marketing in the care sector.



31 30

Real facts control a crisis Karen Ainley outlines the best plan of attack when dealing with a crisis and explains how it could be turned into a positive.


This month, Lisa Hopkins from Dimensions introduces Positive Behaviour Support - an applied science that enhances quality of life for people with learning disabilities and autism. The support programme proactively minimises challenging behaviour by teaching people new skills, improving the support they receive and redesigning their living environments. To read this thought provoking article please turn to page 22. Also inside this issue, Passing the buck: dealing with ordinary residence disputes , on page 18, is a helpful read for those providers out there that have found themselves in a dispute with a local authority about responsibility for a person s care fees. Daniel Braithwaite explores what providers can do to try and avoid being trapped in the middle of these, often long running, disputes. The Department of Health is shortly to issue a consultation paper on penalising individual directors, trustees and managers for governance failures which result in harm to service users. There is even mention that lenders and private equity investors might also be held liable for such failures. Peter Grose of Lester Aldridge LLP Solicitors will be covering this for CMM as soon as it is published. Finally, I would like to announce that this is my final issue as Editor of CMM, it has been a very fulfilling experience to report within the care sector and I thank you all for your positive feedback and loyalty to the magazine. Emma Morriss will be returning as CMM s Editor. Many of you will know Emma from her previous work at CMM, and as Editor of a number of other national magazines at Care Choices. Please do contact Emma if you have any ideas or comments, her email is

Miranda Huntley Editor

Getting to grips with Capital Allowances Stuart Rivers addresses the new rules on Capital Allowances and advises how to make your claims count.

Follow CMM on Twitter @cmm_magazine

CMM JUNE 2013 ÂŚ 3



editorial panel Des Kelly OBE,

Mike Padgham,

Executive Director, National Care Forum

Chair, UKHCA

Martin Green,

David L Jones,

Chief Executive, English Community Care Association

Partner, Deloitte

Andrew Sidwell,

Paul Ridout,

Partner, GVA

Partner, Ridouts LLP

Andrew Barnsley,

Zoe Farrell,

Managing Partner, Nexus Corporate Finance LLP

Training Development Director, Catalyst for Care

June 2013

EDITORIAL AND PRODUCTION Editor in Chief: Robert Chamberlain Editor: Miranda Huntley Associate Publisher: Matthew Tingey News Editor: Des Kelly Design and Production: Lisa James, Jamie Harvey, Nick Cade & Holly Cornell ADVERTISING 01223 207770 Advertisement Manager: Tracey Diplock Business Development Manager: Paul Leahy SUBSCRIPTIONS To request your free copy of CMM call 01223 207770 Care Management Matters is published by Care Choices Ltd who cannot be held responsible for views expressed by contributors. Care Management Matters Š Care Choices Ltd 2013 ISBN: 978-1-909048-57-7 CCL REF NO: CMM 10.4

contributors Daniel Braithwaite, Solicitor, Pinsent Masons LLP. Lisa Hopkins, Executive Director, Practice Development, Dimensions. Jo Cleary, Board Chair of The College of Social Work. Dr Lisa Bostock, Senior Research Analyst, SCIE. Stuart Marchant, Partner, Bevan Brittan LLP.


CMM magazine is officially part of the membership entitlement of:

Paul Saper, Managing Director, LCS International Consulting. Nicki Wakefield, Director, Straight Up Marketing. Karen Ainley, Chief Executive Officer, Mosaic Publicity. Stuart Rivers, Managing Partner, Stuart Rivers Associates.

ABC certified (Jan 2012 - Dec 2012) Total average net circulation per issue 16,302

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Duncan Shine, Regional Sales Director, Skillsoft EMEA.

is it just me...?

Is it just me...? Guest editor, Mike Parsons, Chief Executive of Barchester Healthcare reflects that the legislative changes proposed in the Queen’s Speech are more radical than first thought. Political and press pundits have argued that the legislative change proposed in May’s Queen’s Speech conspicuously misses opportunities for radical reforms. There is some justification for this view. The business world pointed to a lack of measures for kick-starting the economy – programmes to help financing entrepreneurial businesses and encouraging building programmes, for example, with the associated economic benefits. Most social care commentators have argued that there is a similar lack of radical reform in proposed social care legislation. I think there is much less justification for that view. It is true that there is very little new or unexpected in the content of the proposed Care Bill – but that does not mean it avoids radical reform. The Queen’s Speech gathers proposals for change as a totality. They have been debated piecemeal in the heat of the political/care debates current at the time. Considered as a whole, however, they have a distinctly radical edge. Look at the core legislative themes: • A Bill that pulls together and simplifies previous legislation, clarifying, reforming and making planning for the future easier. • Prioritising people’s welfare, delivering on the personalisation agenda, emphasising the importance of carers and a preventative agenda. • Driving forward a pro-active policy response to the Francis inquiry, notably incorporating the appointment of a Chief Inspector of Hospitals.

• Ensuring that social care learns lessons from the Francis inquiry, too, tightening board accountability for probity about care issues and finances in both sectors. Taken together, with the clear thrust towards integrating health and social care and avoiding hospital admissions, I don’t think this agenda should be considered anything other than radical and constructive. The reason that commentators have ignored this radical core is that no-one quite believes the current coalition Government can mean what it says. There are two contributing causes to this disbelief. The first is the coalition’s faltering progress on health commissioning, which has staggered

I don’t think this agenda should be considered anything other than radical and constructive. from being a flagship policy with a simple, comprehensible heart to becoming a ragbag of political compromises and last minute sticking plasters. It doesn’t bode well for delivery of reform in social care. The second contribution to an inability to see the proposals as radically transformational is based on finances Age UK points out that since 2010, when the coalition came to power, social care funding has declined by £710 million by their calculation, while the population of over 85s (those most in need of social

care) has increased, and that neither of these trends is likely to reverse itself over 2014 to 2015. That’s no foundation for positive change. The Government will have to look honestly at the problems that face older people, social care providers and themselves if they are to preserve their core vision from the potential wreck. What can be done to preserve it? There’s always the danger of oversimplification but I think the answer is as plain to most health and social care professionals as it is to informed politicians. Hospitals are not good places to manage the care of older people, particularly those living with dementia. Money needs to flow from the health service into the community and into care homes, where adequate funding would guarantee innovation and better services. That means cutting down beds and closing hospitals, however, and backing it with further investment in social care, too. Closing hospitals isn’t something I can imagine politicians much relishing introducing into the Queen’s Speech. The fact remains that if it were linked with relatively minor extra investment it would have made a radical and positive care agenda a potential reality, with all the political and entrepreneurial energy that goes with it. It might have satisfied some of the business commentators, too, by driving forward investment, new building and new employment. Building more and better services for older people and helping kickstarting the economy. What’s not to like? If you would like to comment please email

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CMM JUNE 2013 ¦ 5

Where is the link between Health+Care? Health+Care 2013 is a new macro event, with four sub-events, set to play a pivotal role in linking the senior decision makers in the commissioning and provision of care, enabling them to take real strides towards delivering change. It will provide the stage set for the most senior professionals from all the primary and social care disciplines and organisations involved in both health and care in 2013 to come together to give a 360 approach to delivery. If your organisation serves any aspect of the health and care profession, Health+Care 2013 should be an essential part of your strategy. To ďŹ nd out more, contact event director Tom Vine on 020 7348 5261 or email or visit



12 - 13 JUNE EXCEL 2013






• Corporate • Local authority • Planning News editor - Des Kelly Government care comparison website goes live The Government has launched • Information from care information to help people providers on the specialist choose, compare and comment on services and facilities they residential care homes and home offer, with details of staff and care services on the NHS Choices other useful information such website. The new care profiles as sample menus, photos of help people to search and compare rooms and gardens; residential care homes and other • Comments from the public, care services and make confident service users, residents and choices about registered care for their families on their own themselves or family members. experiences of the care The profiles include: provider, including links to • Official information from other comment sites; the Care Quality Commission • From next month, the ability inspection reports on care for the public to give services services; star ratings;

• Official Ofsted-style rating for care services, when they are introduced. The profiles are available on the NHS Choices website and sit alongside easy to reference information on entitlements to care, paying for care, organising a care need assessment and other practical advice. More than 8,000 care providers have already added information about their services to their profile on the website, and many more are expected to do so.

SCIE survey finds substantial uptake of eLearning Two thirds of employers in social care use some form of eLearning, and over half of their staff are using it to improve the service they offer. Those are the key findings in a new Ipsos MORI survey commissioned by SCIE. ELearning means using information and computer technology (ICT) as the key element in improving care skills and knowledge, which might be using audio, video and interactive technology in training. Mobile technology is particularly important for people like domiciliary workers,

whose jobs are “on-the-go”. Among the findings were: • Employers say they appreciate the flexibility and control over learning that eLearning offers, along with the ability to vary the pace of learning; • The great majority of care staff have access to a computer at a desk or through a mobile device and 52% of all employees use one daily; • Less than 10% of staff engage with people who use services to support them using new

technology, helping with things like shopping, playing games or reminiscing; • 60% of care staff are willing to use ICT for learning and are willing to learn at home; 80% are confident about their ability to help others with eLearning; • Domiciliary organisations usually deliver less than half their training through eLearning. However, those workers are more likely to be using mobile devices because of the nature of their job.

RADCLIFFES LEBRASSEUR Julia Appleton joins RadcliffesLeBrasseur as a Senior Associate in the Healthcare Team. Julia advises on local authority/PCT funding disputes, various issues in respect of care homes law and public law and judicial review. CARTERWOOD Social care specialist surveyors, Carterwood, has appointed Tom Harrison as an Associate in the practice s growing valuation and consultancy team. Tom has specialist knowledge of the healthcare sector, having worked for the last nine years within the independent healthcare team at GVA, most recently as an Associate. COMPLETE GROUP Complete Group has further added to its team with the appointment of a new Commissioning Manager. Nicola Reilly s role will include building strategic relationships with NHS and other commissioners and developing and growing Complete s person-centred services. COMMUNITY INTEGRATED CARE National social care charity, Community Integrated Care, has announced the appointment of three new members to its Board of Trustees. Mike Gooddie, Philip Smyth and Peter Hay all join the charity at an exciting and pivotal time, as the organisation implements an ambitious change management programme and prepares to launch its new five year Corporate Strategy. BARCHESTER Barchester Healthcare announced the appointment of Professor Trish Morris-Thompson to the newly created role of Director of Quality and Clinical Governance. Trish is highly qualified, with more than 30 years experience working in the NHS.

Care is all we do.

CMM JUNE 2013 ¦ 7


Social care funding: ‘a bleak outlook is getting bleaker’ A substantial squeeze on services for older people, people with disabilities and on fees to providers, has been recorded by the latest annual survey of social care budgets carried out by the Association of Directors of Adult Social Services. The survey shows that, despite much welcomed resources being transferred from the NHS to local authorityfunded social care, directors of adult social services are planning to save another ÂŁ800 million in the 12 months to April. Overall, in the three years since the beginning of the current austerity programme, some ÂŁ2.68 billion savings will have been made by adult social care - 20% of net spending. And although many of these savings have been achieved by increased efficiencies, social care leaders have been quick to point out that these efficiencies weren’t simple ‘backoffice’ adjustments, but were gained by ‘providing different,

more cost effective packages of care, or reduced levels of care, to many elderly or disabled people.’ According to ADASS President Sandie Keene, ‘gazing into the next two years, without additional investment from that already planned, an already bleak outlook becomes even bleaker.’ Two of the most marked trends indicated by the survey show that some 13% of the planned savings (ÂŁ104 million) will result in direct withdrawal of services, while nearly a fifth of councils thought that a reduction in the levels of personal budgets would be ‘highly important’. The ADASS survey shows that areas likely to be ‘highly important’ as aids to saving resources in the coming year include: • Shifting activity to cheaper settings (40%) • Increased personalisation (47%) • Better procurement practices (68%)

Only 14% of directors anticipated increasing charges to users as highly important, while 65% reckoned that increased prevention and early intervention would provide significant savings opportunities. However, when asked which areas had been affected by savings to date, some 30% of directors said that fewer people can access services, and nearly 50% said that providers are facing financial difficulties. 45% of councils did not increase fees to care homes at all. Significantly 86% thought that the quality of life for services users had not been lowered, while only 5% thought that the quality of care was lower. However, looking to the next two years, the prognosis is clearly more severe. Half (55%) of directors feel that the quality of life for users will not worsen: a near-fifth, though, (19%) think it will.

Mike Parsons to retire The Board of Barchester Healthcare has announced that its founder and Chief Executive, Mike Parsons, will be retiring from his role as Chief Executive at a date to be finalised in the next few months. Mike, who has been with the company for over 20 years will remain in his post until that point and will work with the Board on identifying a successor, and to put in place plans for an effective handover. Mike will remain on the Board of Barchester as a non-executive director to ensure that his experience of running the company and his great knowledge of the sector will be available to the Board and to his successor in due course. Mike will continue as Chairman of Barchester’s Charitable Foundation and as Vice-Chairman of the Industry Association ECCA. He and his family remain very significant shareholders in the company.

Challenge of ageing stimulates new alliance Government should face up to our ageing society and better address its implications, argues the Ready for Ageing Alliance. Six major national charities: Age UK, Anchor, the Centre for Policy on Ageing, Independent Age, the International Longevity Centre-UK and the Joseph Rowntree Foundation have formed the

Alliance to urge all political parties to face up to the major changes and challenges from our rapidly ageing society. Last month’s ‘Ready for Ageing’ report by the Public Service and Demographic Change Committee argued that there has been a lack of vision and coherence in the ageing strategies of successive

governments. The Committee accused the Government of ‘woeful unpreparedness’ for our ageing society. The Ready for Ageing Alliance believes that living longer is potentially a great gift but that politicians must do more to make the most of this huge societal change. The Alliance believes that Government failure to respond

to demographic change will have significant and major negative impacts on the future of the UK, not just in terms of health, care and pensions, but also in relation to the future success of the UK’s economy. A failure to respond adequately now could also foster unhelpful intergeneration tensions and division into the long term.

Labour proposes independent commission on whole-person care Labour leader, Ed Miliband, has called for the swift integration of health and care services so that the NHS can be made financially sustainable. He cited figures from the Nuffield Trust which show, unless we improve the way

services are delivered, growing care needs will leave a shortfall of up to ÂŁ29 billion a year by 2020 in NHS funding. Mr Miliband announced the launch of an Independent Commission to find ways of integrating health and

social care for the next Labour government so that these key public services are affordable. The Independent Commission on Whole-Person Care, will be led by international expert and former DH specialist

Sir John Oldham OBE. The Commission will produce recommendations on achieving Labour’s vision of ‘whole-person care’, without another topdown reorganisation and within existing resources.


                                 Nurse call – Passive Monitoring - Care Planning and Assessment – Risk Management – Care Delivery Reporting –

8 ÂŚ CMM JUNE 2013


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Co-founder Director of Supreme Home Care, Jacky Earnshaw, says “There is nothing more exciting or rewarding than starting a business which you know, if you get it right, will help people stay living independently in their own home. We often get notes or messages from our clients thanking us for very simple things; staff continuing to turn up despite heavy snow, staff accompanying a client to a granddaughter’s wedding. All of these things are really important to our clients, but for us this is all part of the service.” Jacky and her business partner Sue Robson started Supreme Home Care from scratch in 2006 and have a very successful domiciliary care operation in Shropshire, clearing the £1m turnover in under 4 years. Sue Robson stated “The key to our success has been the quality of the service we deliver. This has not changed despite the service growing and it is this same attention to detail that we encourage with our Franchise Owners.”

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Jacky Earnshaw, Director of Care with Sue Robson, Business Director.

Sue and Jacky are determined to apply the same principles as they grow their franchising network. They are now both fully involved in Franchisee support, personally undertaking the majority of the training. “We are not looking to recruit big numbers of franchisees as we know how much support will be needed to get established in the market” they confirm “Supreme Home Care think it is key for new franchisees to spend lots of time seeing how the Shropshire service runs and learning how to set up and run the same management systems and processes. We think it is important to receive support from the very people who set up the original, successful service. We have learned that all our franchisees have different learning needs and we try to match our style and the speed of training to meet each individual.” If you have a passion to provide high quality domiciliary care and want to know more about a Supreme Home Care franchise then Sue and Jacky can be contacted at Supreme Home Care Franchising Ltd, 6 Pearson Rd, Central Park, Telford, TF2 9TX. Call 01952 216700 or email

news / in focus

Councils demanding expensive tracking solutions A number of councils in the UK are demanding that third party care providers purchase expensive tracking solutions, despite the existence of cheaper alternatives. Following a Freedom of Information (FOI) request from mobile solution provider Skillweb, it has been revealed that a third of the 98 UK councils surveyed require contracted care services to use a commissioned and stipulated electronic call monitoring system. This software is known to be expensive for domiciliary care

providers to implement and puts pressure on businesses at a time when budgets have already been significantly reduced. Trevor Snaith, head of research at Skillweb and local authority councillor, commented: ‘We identified that providers were being forced to use legacy systems, which are quite expensive. What businesses want to be able to do is to use a low-cost product. I was alarmed to see that over 30 per cent of the councils were insisting that certain systems should be used.’

‘Britain Cares’ campaign The public is being asked to show that it backs local support for disabled people as part of a new campaign from the disability charity Scope. It aims to use a powerful demonstration of public backing to encourage the Government to put in place the funding to make sure disabled people get local support for basics like getting washed, dressed and out of the house. Members of the public are being asked to take a photo of themselves

with the words ‘I Care’ written on them (or something they can hold) and send it to their MP. As part of this, the MP will be asked to call on the Secretary of State for Health, Jeremy Hunt, to ensure disabled people have the essential support they need to live their lives. A Britain Cares website, where people and community groups can upload photos and find out more, is live. It also marks the start of a social media push backed by the hash-tag: #BritainCares

New measures unveiled to protect people if care providers fail New measures have been announced to protect people who rely on care services in the event their care home or service provider goes into administration. It is proposed that legislation be introduced to give CQC powers to oversee the financial stability of the largest and most difficult to replace care providers. The role of local authorities is also being clarified so that, if a care provider fails, local authorities will have ultimate responsibility

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for ensuring continuity of care for all people receiving care regardless of who is funding the services. The CQC’s oversight of finances, and the clarity of the local authority role, will give people who depend on care providers, along with their families and carers, an added level of assurance that their care needs will continue to be met. These new powers are subject to Parliamentary approval.

In Focus: CQC sets out its strategy for 2013 to 2016 WHAT’S THE STORY? The Care Quality Commission (CQC) has published its strategy Raising standards, putting people first for the next three years emphasising that its role is to be firmly on the side of patients and people who use services. In launching its plans it has also promised to publish better information for the public, helping them to easily find and understand its reports on care services – this will include ratings of services.

WHAT ARE CQC PLANNING? The CQC will change the way it inspects to make sure it looks at the things that are most important to people: are services safe, effective, caring and well led, and do they respond to people’s needs? The plans also include using information and evidence more effectively to predict, identify and respond to services that are failing. This includes listening better to people’s views and experience of care and to care staff to hear about their concerns. There will also be a more thorough test for organisations applying to provide care services, making sure that named directors, managers, and leaders of a service commit to meeting CQC’s standards and are tested on their ability to do so. CQC has announced that it will be introducing bigger, more expert inspection teams that will spend longer talking to people. These will be led by a Chief Inspector who will also oversee performance ratings.

WHAT ARE THE IMPLICATIONS? CQC Chief Executive David Behan said; ‘People have a right to expect safe, effective, compassionate, high quality care. CQC plays a vital role in making sure that care services meet those expectations. We recognise that quality care cannot be achieved by inspection and regulation alone – that lies with care professionals, clinical staff, providers and those who arrange and fund local services - but we will set a bar below which no provider must fall and a rating which will encourage and drive improvement.’ The strategy sets out a clear statement of purpose, role and principles. It introduces the notion of ‘fundamental standards’ of quality and safety. It also seeks to clarify the relationships that the regulator expects to have with the public, health and social care providers and other they regulate. It is evident that CQC is seeking to demonstrate that it has new management and is preparing for a future in which the organisation demonstrates it has an open and transparent culture.

WHAT HAPPENS NEXT? There can be little doubt that David Behan inherited an organisation with a troubled history. It is probably a matter of public record that the regulator had established a reputation that was the antithesis of what is being set out in the new strategy. The failure to listen to key stakeholders compounded the challenges of extended responsibilities and reduced resources. Raising standards, putting people first represents a new chapter and a renewed opportunity to refresh CQC - they will be judged, and held accountable, on delivery of this vision.

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Alzheimer’s Society’s specialist training DVDs cost just £249 + VAT each Order your copy today, or contact us for more information T 01904 633581 E: Both packages include a DVD with film footage as well as a CD Rom with all notes and training exercises. They are designed to be delivered by you, direct to your staff, and cover the basics in dementia awareness, communication, well-being and person-centred approaches. On completion of the training learners can take a short certificated assessment which provides successful candidates with an Alzheimer’s Society certificate and badge – contact us for more details. Alzheimer’s Society also offers a range of products to assist people with dementia in their daily lives – please visit our online shop at to view the full range, and for details of how to place an order. Alzheimer’s Trading Ltd (registered company no: 02737333) is a wholly owned subsidiary of Alzheimer’s Society (registered charity no: 296645) to which it Gift Aids all taxable profits at the end of the financial year.

CMM JUNE 2013 ¦ 11

property news

Care Homes Review from Colliers International Brockenhurst staffing environment which home places over the next 20 Colliers International’s bispecialist combined with inflationary annual review of the care home years and depending on the pressure on rates of pay is rate of new developments, sector reveals that overall care home limiting their ability to maintain this demand could result in occupancy levels in longlevels of profit. We expect this improved occupancy. This term care of the elderly have to be a continuing theme for the increase will primarily benefit reached their lowest level since re-opened


2002. In personal care homes occupancy levels have dropped to 88.3 per cent, while levels in nursing care homes remained static at 90.1 per cent during the second half of 2012. Adrian Ilott, Director Healthcare in the Manchester office of real estate advisers Colliers International says: ‘The Government and local authorities continue to favour the provision of care at home for the elderly for as long as possible, with the decision to refer into a registered care environment often being based on a financial or budgetary consideration rather than one relating solely to care needs. ‘However, demographic pressures mean we are likely to see an increasing demand for more care and nursing

well-located and presented homes offering high quality but cost effective care. ‘We have also witnessed a decline in profits for nursing care homes because of the ‘perfect storm’ of stagnant income levels and rising costs. In recent years we have seen significant increases in food and utility prices, two costs that amount to a significant proportion of non-payroll costs in the elderly care sector. For both care and nursing homes, non-payroll costs have increased in percentage terms during the second half of 2012. In personal care homes, operators have been able to counter their increasing nonpayroll costs with savings in wage costs, but nursing care homes have a more constrained


sector in the remainder of 2013.’ Adrian continued: ‘Our research data highlights that occupancy levels continue to edge down and those residents who are referred to a home often have increasingly high levels of care needs. Despite this, average fees in the nursing home sector, after being adjusted for inflation are no better than those seen in 2008. Operators have been forced to closely control costs in order to maintain the viability of their homes and safeguard the future of the residents they care for. ‘Whilst the level of home closures has increased, it is a testament to the efforts of care operators that the overall number of closures has not in fact been higher.’

Fernlea, operated by Priory Education Services, part of the Priory Group, has reopened as a residential facility for young people aged from 16 to 25 who have autistic spectrum disorder (ASD), including Asperger’s Syndrome and associated learning difficulties. The home has been completely renovated to accommodate the new residents, a new manager has been employed, with extensive experience operating a facility such as this and the site is fully registered with CQC. Fernlea will provide education, care and essential life skills for young adults to equip them with the necessary life, independence and social skills as they progress towards more independent living.

The Future of Learning Disability Care The Renaissance Hotel, Manchester M3 2EQ • 19 September 2013

Now in its 6th year, this national conference will once again bring together the most influential organisations to explore current and future developments in the specialist sector. OUR STIMULATING CONFERENCE PROGRAMME WILL: • Have speakers focused on helping your organisation • Motivate you to see Learning Disability Care differently • Be a great networking opportunity • Include a range of useful workshops • Include an exhibition aimed at providing you with products and services to help your organisation • Include a live Business Clinic where you can ask questions to a panel of industry experts.

DELEGATE SUMMARY: • Major Providers • Independent Specialist Providers • Providers of Supported Living • Local Authorities

• • • • •

Major Lenders Insurers Property Consultants Solicitors Suppliers to the sector


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property news

Castleoak sees variety in six new starts Castleoak, the specialist care development and construction group, has started work on six new projects to deliver 316 care beds with a total contract value of over £27 million. The Group’s latest projects include two with new customer, BUPA, a specialist care unit and care homes in two separate reprovisioning programmes. Castleoak site teams in Cardiff and Tunbridge Wells have begun work on the Group’s

first design and build projects for BUPA - a 78 bed and a 74 bed care home respectively. At Llanelli the Group is building an 18 bed specialist assessment and rehabilitation centre with six extra care apartments for people with brain injury for the Brain Injury Rehabilitation Trust. At Chesham in Buckinghamshire, work has started on a 62-bed care home, the last of eight projects and 600 bedspaces

Castleoak is delivering as part of Project Care, the county’s reprovisioning programme which sees Housing Solutions in partnership with the Fremantle Trust and the local authority. At the same time, the Group has started work on the first two of ten new care homes, at Chantry (80 beds) and Mildenhall (60 beds), as Care UK’s development partner in the £45 million Suffolk reprovisioning programme.

Care home and meals-on-wheels sold The Chimes Rest Home in Lytham St. Annes has been sold by specialist property adviser Christie + Co. The care home had been operated privately by the current owners since 1991 during which time they had established a strong reputation in the area for residential care for the elderly, along with a very

successful meals-on-wheels service which operated from within the home and serviced the local area. The home, registered for 21 service users has been bought by local care home operators Mr and Mrs Boodhoo, who were keen to acquire a care home in an area with which they were already familiar.

Butterwicks sale Butterwicks Healthcere Agents are pleased to announce the sale of Strathmore Lodge Residential Care Home in St Albans to Mr J Ball for an undisclosed sum. The home is registered for 19 beds with planning permission to extend by four additional beds. The sale took some six months through to completion. Butterwicks states that there is still very strong demand for both small and large homes alike in the Home Counties and M25 corridor and reports keen interest from investors, developers and experienced cash buyers looking to return to the healthcare business. The sale was handled by Peter Butterwick.


CMM JUNE 2013 ¦ 13

local authority & planning news

Central Beds tenders Home Care Solutions, which provides a range of services to the elderly and disabled in their own homes, has won a tender to be placed on Central Bedfordshire Council’s Domiciliary Care Framework Agreement. With its headquarters in St Neots, Cambridgeshire, Home Care Solutions will work in partnership with Central Bedfordshire Council to deliver high quality domiciliary care to people in the area. The care provider has an extensive history in domiciliary care, having operated care services in Bedfordshire, Buckinghamshire, Cambridgeshire, Luton, Oxfordshire and Nottinghamshire since its foundation in 1999. Another local homecare provider, Caremark (Luton & South Beds) has been successful in their Tender application

for the complete Domiciliary Care services (Adults and Children’s Services) in central Bedfordshire. This will see the registered home care provider working in partnership with central Bedfordshire Council to deliver home care to people within their area and offers an excellent opportunity for Caremark (Luton & South Beds) to continue fostering joint partnership relationships within the community.The Tender will run for the next 3 years with an option for a 12 month extension. Caremark (Luton & South Beds) are part of a franchised network of offices, providing personalised care and support to people of all ages, disabilities and ethnicities across the UK, who wish to remain living safely and independently at home and who may require some support to do so.

Home Care Solutions sign three-year contract with Rutland County Council Home care provider Home Care Solutions have agreed an initial three year contract with Rutland County Council to provide domiciliary care services to the elderly, and adults with learning disabilities, mental health problems and physical disabilities. Sarah Stephenson, Managing Director of Home Care Solutions, said: ‘We are delighted to have won

the tender for domiciliary care services in Rutland. At Home Care Solutions we have a philosophy of thinking local and acting personal, delivering high quality, reliable and friendly home care services with dignity and respect. It is a mark of our success and ability to provide high quality services which has led the firm to sign this contract with Rutland County Council.’

Firm set to reopen care home A residential care home closed down by the city council is to be re-opened after Lovett Care bought the former Hilton House, in Hartshill, for £560,000 at auction. The firm, which also runs Goldendale Care Home, in 14 ¦ CMM JUNE 2013

Tunstall, is re-opening the Hilton Road building as a dementia care centre. Lovett Care hopes to transform the Hilton House building into a 60 bed complex with the possibility of creating up to 50 new jobs.

Northern Health Trust to close care homes in long term The Northern Health Trust has said it eventually intends to close all the residential homes in its area. In a statement, the trust said it planned to close half of its nine homes in the next three years and, in the longer term, stop providing residential care entirely. The plans are part of a wide-ranging reform of elderly care provision across Northern Ireland. The move has been criticised by local politicians and unions. Unison said Pinewood residential home in Ballymena and Westlands in Cookstown would close in November; Rathmoyle in Moyle would close in January 2014 and the remainder would shut between 2014 and 2018. Unison added the closures would remove any choice for

vulnerable people while another union, Unite, described the move as ‘privatising elderly health care’. The trust’s statement said: ‘At present the trust manages nine residential homes and we propose that no more longterm admissions are made to any of our homes. We would intend to close up to 50% of our homes over the next three years and in the longer term stop providing statutory residential care entirely. Some private residential care will be available.’ Una Cunning, Director of Older People’s Service at the Northern Health Trust said: ‘Older people have consistently told us that they want to remain at home for as long as possible. We are also planning for a growing older population and the ensuing demands on the service.’

Leicester City Council to close or sell off care homes Plans to close or sell eight care homes in Leicester have been announced by the city council. The authority said low resident numbers and growing demand for home-based care had forced them to make changes and find alternatives for elderly people. The homes, which accommodate more than 160 people, will be closed or sold in phases over the three years.

Three homes will be closed in the first phase later this year. Two homes will then be sold in 2013/2014. Depending on the outcome of these two phases, a further two homes will be sold and another considered for closure. The authority said there would be further consultation with residents and trade unions before a final decision is made.

Housing 21 scheme open A new Housing 21 extra care housing scheme for older people in All Saints Road, Warwick is now open. The £8 million development at Rohan Gardens provides 42 two bedroom apartments which visitors to the open days will be able to look around and find out more about the opportunities to rent or purchase on a shared ownership

basis. The Rohan Gardens development is the first of six that Housing 21 is providing in a partnership with Warwickshire County Council, Willmott Dixon and the district councils in Warwickshire to develop extra care schemes across the county, three of which are partly funded by the Homes and Communities Agency.

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corporate news

Two domiciliary care providers to merge A Yorkshire domiciliary care provider, Springfield Homecare Services, has purchased Newcastle upon Tyne-based Positive Live Choices in order to merge together to provide a stronger service. With revenues of £13 million and 800 employees Springfield is already a strong player in the domiciliary care business in Yorkshire.

The acquisition of the domiciliary care business will bring an extra 2,000 hours of care to Springfield’s offering, along with regional expansion into the North East of England and relationships with new local authorities. Springfield’s acquisition was backed by an investment of £4.4 million provided in June

2012 by the Business Growth Fund (BGF). Set up to support SME growth, BGF is backed by Barclays, HSBC, Lloyds, RBS and Standard Chartered. Positive Live Choices provides care services to people with learning disabilities and the elderly based in Newcastle, Gateshead and Darlington. The business has seen steady growth since it was

established in 2007, with revenues of £1 million and 90 staff. Cofounder Amanda Dickinson is to remain with the business in the role of general manager. Founded in 1996 Springfield Homecare gives personal and domestic care to people in their own homes. Based in East Leeds, it also has offices in Hull, York and Knaresborough.

Mears acquires domiciliary care business Social housing maintenance company Mears Group has expanded its presence in the domiciliary care market with the acquisition of Independent Living Services (ILS) for £22.5 million. ILS provides home nursing services in Scotland to around 3,400 patients and over 40% of

its work is in providing higher acuity care. The company recorded revenues of £24.4 million for the year ended 31 January 2013. To help fund the acquisition, Mears has placed 6,368,069 shares to raise £19.7 million. The rest of the balance will be funded through

Mears’ existing debt facility. David Miles, Chief Executive of Mears, said: ‘Fundamentally, the acquisition will provide Mears with the platform to provide higher acuity home services across the UK, complementing Mears’ existing care capabilities and developing the capability to offer

longer term continuing healthcare in the home - an area in which Mears does not currently operate.’ In 2011, Mears acquired a group of home improvement agencies from Anchor Housing and the supported living division of Choices Care Community Services.

dcm healthcare and NHG merger dcm healthcare has announced its merger with Nursing Hygiene Group (NHG). The merger took

place at the start of May. NHG has been operating for over 25 years and has invaluable

experience in the healthcare market how dcm operates as a supplier. nationally. Following the merger, Purchasing will be done centrally there will be very little change in from the head office as NHG.

2013 LCS and Adam Smith Institute Health and Social Care Spring & Summer Events May 15, June 4 and July 1. Time : 3.30-5.00pm. Afternoon tea will be served The Cholmondeley Room, House of Lords, Westminster, overlooking the Thames The events are kindly hosted by Baroness Jolly and Lord Ribeiro CBE Organised by LCS International in partnership with the Adam Smith Institute, these are now established as leading annual policy events in the health and social care calendar. They bring together senior people in the private and public sectors and facilitate discussion between the NHS, Social Services and the independent and voluntary sectors on the significant challenges and opportunities in health and social care. They are held against the background of the new Health and Social Care legislation,the Care and Support Bill now before Parliament and anticipated implementation of Dilnot. The events will be hosted by Baroness Jolly and Lord Ribeiro CBE. On May 15, Lord Ribeiro CBE will chair a panel of speakers: Lord Norman Warner, Rt Hon Paul Burstow MP and Professor Steve Field CBE, Deputy National Medical Director – Health Inequalities NHS England. On June 4, Rt Hon Norman Lamb MP, Minister of State, DoH and Baroness Jolly will chair. On July 1, Baroness Jolly will chair a panel of speakers: Rt Hon Stephen Dorrell MP, Liz Kendall MP, Shadow Minister for Care and Elderly People and Mike Farrar CBE, CEO of the NHS Confederation.

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16 ¦ CMM JUNE 2013

corporate news

Four Seasons Health Care acquires Optimum Care Four Seasons Health Care has acquired Optimum Care, which operates 17 care homes. Optimum Care, which was created in June 2007 with the backing of Graphite Capital, operates the homes under the Avery brand name. The 17 homes have a total of 1,213 beds and employ about 1,100 staff. This is the first significant

strategic addition to Four Seasons since it came under the ownership last year of Terra Firma, one of Europe’s leading private equity firms. Guy Hands, Chairman and Chief Investment Officer of Terra Firma, said: ‘Terra Firma is committed to ensuring that Four Seasons delivers the highest standards of care. We welcome the Optimum homes

Bright Care heads down the franchise route Bright Care is launching a franchise drive with the eventual aim of becoming one of the biggest enterprises of its kind in the UK. Edinburgh-based Bright Care, run by young entrepreneur Tim Cocking, has already achieved a £1 million turnover since it began trading in October 2010 and now employs 65 people in the

capital and in a pilot franchise in Glasgow. The aim is to establish franchise footholds in Scotland’s major centres of population before branching out into the rest of the UK. Cocking, the Scottish Young Entrepreneur of the Year in the 2012 Prince’s Trust National Business Awards, has a target of 150 businesses over the next eight to ten years.


into the Four Seasons family and look forward to them becoming an integral part of Four Seasons.’ Dr. Pete Calveley, Chief Executive of Four Seasons, said: ‘With Terra Firma’s support we have a new capability to develop our position as the leader in an independent sector that has an increasingly important role alongside the NHS and local

authorities in provision of elderly health and social care. We are also determined to lead the sector for quality and value. These Optimum homes have a very good reputation that is well deserved and reflects the high quality of the assets.’ The transaction will not result in any noticeable change to the day-today operations of the homes, or for their residents or staff.

£83 million extra care contract for Housing 21 Housing 21 has signed a joint contract with Derbyshire County Council and Keepmoat for the provision of new extra care facilities. The £83 million contract will deliver up to 800 extra care apartments across the county, with the consortium committing to their operation for 125 years. Tayo Bilewu, Director of Property for Housing 21 said:

‘Housing 21 is delighted to be working in partnership with Derbyshire County Council and Keepmoat on the delivery of these extra care housing schemes. This exciting project will bring huge benefits and improve the lives of many older people across the county.’ Housing 21 already owns and manages extra care and sheltered accommodation within the county.

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local authority’s responsibility for the provision of accommodation and community care services under the National Assistance Act 1948 and their responsibility to provide domiciliary care under the Chronically Sick and Disabled Persons Act 1970 extends only to those individuals who are ‘ordinarily resident’ in the area of that local authority. There is no statutory definition of ordinary residence and it is not as simple as just looking at where a person lives or where they have lived for most of their life.

IN WHAT CIRCUMSTANCES DO DISPUTES ARISE? There are numerous ways that these disputes can arise but particular recurring themes seem to be: • Where a local authority moves an individual to a service out of area for a special type of support; • Where an individual wants to move to a different area (i.e. to be nearer family); • Where an individual is moving from a residential service to a supported living placement that is out of area; and • Where a care home containing an out of area placement is deregistering. In addition, local authorities are understandably keen to avoid footing the bill for anyone unnecessarily so they will look to pass on the responsibility for fees wherever they can. It will always be useful if a provider is able to correct any misconceptions that the authority might have about this issue.

WHAT DOES THE LAW SAY? Whilst ordinary residence is not defined in statute, the courts have attempted to define it. In the case of R v Barnet London Borough Council ex parte Shah it was described as ‘a man’s abode in a particular place or country which he has adopted voluntarily and for settled purposes as part of the regular order of his life for the time being, whether of short or long duration’. Therefore a person’s ordinary residence can change as soon as they relocate provided that the move is voluntary and for the purposes of settling. Where a person lacks capacity, this test obviously does not work and in December 2012 a High Court case re-affirmed the law covering this situation. In R (Cornwall Council) v Wiltshire Council and others the High Court were asked to determine


PASSING THE BUCK: dealing with ordinary residence disputes

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When cash-strapped local authorities get into disputes about responsibility for a person’s care fees, it can often be to the detriment of the provider as well as the individual. If the provider has already accepted or retained the placement and neither authority will pay the fees in the interim, then the provider can ďŹ nd themselves in an impossible situation where they are not getting paid but they cannot abandon the individual and do not want to escalate matters with a customer. Daniel Braithwaite explores what providers can do to try and avoid being trapped in the middle of these, often long-running, disputes. CMM JUNE 2013 ÂŚ 19


the ordinary residence of an individual who lacked capacity and determined that he was ordinarily resident in the area where his parents lived even though he had never lived in that area. In reaching this decision the court used elements from two previously established tests; namely (1) that where a person is disabled such that they are totally dependant on a parent or guardian then their ordinary residence is that of their parent or guardian or; (2) the test should be the same as that where the person has mental capacity but without the requirement that the person adopts the residence voluntarily and should consider all the facts of the person’s case including physical presence in a place and the reason for it. This demonstrates that the courts are taking a very subjective approach and in this case report the issue was described as ‘an intensely fact-sensitive process’. It is therefore not surprising that local authorities get into disputes about this. However it may be surprising for providers to hear that the law on the conduct of these disputes is clear. The Ordinary Residence Disputes (National Assistance Act 1948) Directions 2010 set out what should and should not happen when two local authorities cannot decide where an individual is ordinarily resident. The following passages are of particular interest: Section 2(2) states that: ‘One of the local authorities in dispute must provisionally accept responsibility for the provision of such services to P, pending determination of the dispute’. Section 2(4) says: ‘If the local authorities in dispute are unable to agree which of them is to accept provisional responsibility, the local authority in whose area P is living must do so.....’. The Department of Health (DH) guidance on ordinary residence at Part 1 paragraph 5 expands these concepts: ‘The provision of services should never be delayed because of uncertainty about which authority is responsible. An agreement to provide and fund services until the issue of ordinary residence is resolved has no bearing on the ultimate outcome. Where there is a dispute as to a person’s place of ordinary residence, one of the local authorities concerned is under a duty to provide any community care services required pending resolution of the issue’. The statutory obligations of the local authorities are therefore clear and subject to relationship management concerns; providers should not be afraid to make this clear to them.

WHAT ACTION CAN PROVIDERS REASONABLY TAKE? As well as reminding authorities of their statutory duties, providers should check the contracts they have in place with the authorities involved, particularly the payment and notice provisions, to see whether an authority is in breach. If there are dispute resolution provisions then these can be used to try and bring the authority to the table and if they fail to comply with them, it potentially adds another element to the provider’s case.

WHAT CAN PROVIDERS DO IF LOCAL AUTHORITIES IGNORE THEM? In any ordinary residence disputes between authorities the Secretary of State is available to arbitrate and in the event that the authorities involved have failed to resolve the dispute within four months (from the date on which the dispute arose) then arbitration is mandatory. Four months is obviously not an acceptable period to wait for a cash flow dependent provider so it is worth noting that anonymised details of key determinations the DH have made are published on its website. If a provider is trying to help expedite a dispute, it should be very compelling if they are able to point the

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disputing authorities to an equivalent scenario already adjudicated on. If an authority will still not engage then the provider might consider notifying that authority’s monitoring officer (providers should consider this in any instance where an authority is considered to be acting other than in accordance with the law). The monitoring officer has a specific duty to report on matters that they believe are, or are likely to be, illegal or amount to maladministration. If this fails to have the desired effect then the next step would be to consider either a judicial review, a breach of contract or restitution claim. The provider may have a strong case for either and may wish to at least threaten or allude to it. In the case of judicial review in particular it is imperative that the provider acts on these issues and seeks advice quickly. There will no doubt be important relationship considerations to take into account when considering any such action.

DIFFERENCES IN SUPPORTED LIVING The National Assistance Act 1948 provides that where a person is placed in residential care, out of area, they are deemed to remain ordinarily resident in the area in which they were ordinarily resident immediately before the placement (i.e. the placing authority). The situation differs for supported living because currently, when a person is placed in supported living out of area, their ordinary residence does transfer to the new host authority. This is because the individual is not then being provided with housing under the National Assistance Act 1948, instead they have their own tenancy. The exception to this is where the person does not have capacity and no deputy or lasting power of attorney is in place; in this scenario ordinary residence may not change. Similarly, in the event that a residential service is re-registering as a domiciliary care service and arranging tenancies, the DH guidance makes clear that out of area placements at that service would acquire a new ordinary residence in that area. Landlords should note that the law and guidance discussed in this article will not generally apply to disputes over provision of housing for supported living tenants. The guidance expects that where a person is a tenant, housing benefit is paid according to which local authority area the property is in.

THE CARE AND SUPPORT BILL The government’s draft bill includes provisions seeking to clarify and extend the law around ordinary residence, in particular: • Amending the law so that, irrelevant of the type of care or accommodation, an individual will be treated as ordinarily resident in the area in which they were ordinarily resident immediately before they began to live in accommodation of that type; • Including a requirement that, in the period until an assessment is carried out, the new local authority must provide the same care package that the previous local authority provided before the move; and • Including more prescriptive provisions requiring local authorities to co-operate with each other. The consultation responses to these proposals were largely welcoming and the Joint Committee’s report on the bill which was published on 19 March 2013 does not seek to amend these principles in any material way, so watch this space. CMM Daniel Braithwaite is a solicitor at Pinsent Masons LLP


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CMM JUNE 2013 ÂŚ 21

Positive Behaviour Support In the aftermath of the Department of Health’s review into the Winterbourne View case, national support provider for people with learning disabilities and autism, Dimensions, is experiencing increased demand to support people moving from out-of-county and institutional settings. Lisa Hopkins explains how Positive Behaviour Support can be used to help people with learning disabilities and autism live lives of their own choosing in community settings.

As the 2014 date to resettle people from long-stay hospitals to more appropriate settings draws closer, Dimensions is keen to ensure its capability and experience in supporting people in this way is put to good use. Invariably, it is the organisation’s Consultant Behaviour Analysts who are called upon to offer their expertise because those moving away from institutional settings often display behaviour which can be described as ‘challenging’. It is estimated that between 10 - 15 per cent of people with learning disabilities display challenging behaviour such as selfinjury, aggression and tantrums. All too often challenging

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are not over-supported and are enabled to lead more independent lives tailored to their needs. This not only improves quality of life for the individual but can also mean considerable savings for local authorities. For example, a recent total annual saving to local authorities for just five individuals supported by Dimensions amounted to £325,000.


behaviour is cited as a barrier to community inclusion for people with learning disabilities because of the way it can interfere with family life, employment and education. But with the right support and techniques in place, people who display challenging behaviour can play an active part in their community. Positive Behaviour Support is an applied science that enhances quality of life and proactively minimises challenging behaviour by teaching people new skills, improving the support they receive and redesigning their living environments. Positive Behaviour Support emerged from three major sources:

applied behaviour analysis, the normalisation movement and person-centred values. It allows people to develop non-aversive, person-centred strategies for improving quality of life and minimising or eliminating challenging behaviour. Dimensions, which was recognised for best practice in the Department of Health’s Review of Winterbourne View towards the end of last year, sees many positive outcomes for people with learning disabilities and autism who have such strategies introduced to their Behaviour Support Programmes. Positive Behaviour Support goes a long way to help make sure people

Before John joined Dimensions in August 2011 he was living in an assessment and treatment centre. Prior to being admitted to the centre, John resided in supported living with three other individuals but this broke down due to his challenging behaviour. While John lived at the centre, Dimensions was approached to see if they were able to support him and it was decided that if a thorough transition plan was put into place then it would be possible. During the assessment stage it was identified that John experienced a great deal of social anxiety when meeting new people, experiencing new situations and environments. With this in mind it was thought the best approach would be for staff to get to know John very well prior to supporting him. John helped to recruit his own staff, introductions took time and worked at John’s own pace. Due to the nature of John’s physical aggression it was decided that he would require 3:1 support. A behaviour support programme was developed, providing staff with the necessary proactive strategies required for supporting John and thus ensuring success. The information contained within the programme focused on reducing challenging behaviour while at the same time increasing John’s quality of life. Strategies included providing John with plenty of social interaction on his own terms, allowing John more control over his daily life, giving staff strategies on how they would assist to develop a predictable week and training staff to recognise precursor behaviours and respond accordingly. This would allow staff to bring an episode of challenging behaviour to a close quickly and safely. Another aspect of John’s support that needed attention was the

J CMM JUNE 2013 ¦ 23

positive behaviour support


reduction of support required. Based on 16 hours a day, his initial package of support was expensive and one of John’s goals was to be more independent. After the first three months, support in the community was reduced to 2:1 and in-house support was reduced to 1:1. This resulted in dramatic savings and soon after John’s support was reduced to 1:1 fulltime. All of this has led to a life where John feels more included in his community and is far less likely to display challenging behaviour. He has a much better quality of life and is extremely safe and happy. For the local authority, this positive support has led to more than £130,000 savings per year than the previous support package which saw him receiving 3:1 support.

REDUCED PHYSICAL INTERVENTIONS The Behaviour Support Team consists of 13 Consultant Behaviour Analysts who are all qualified in Applied Behaviour Analysis. Positive Behaviour Support reduces the need for physical interventions; instead pro-active strategies are used to prevent those challenging behaviours from occurring in the first place. What is really important is that this stops restrictive practices. Staff working with each person are observed and given immediate feedback in using Positive Behaviour Support techniques. Having the Behaviour Support Team available to model strategies and provide coaching for staff helps to reduce staff stress and reduce turnover, enabling greater consistency for people we support. We don’t exclude anybody from Dimensions and it’s about the offer of working in partnership with all involved - families, the person we support and local authority teams so that everyone is consistent. If a person we support wants to go home at weekends, then their families can use the same strategies. Dimensions’ commitment to working proactively to support people with challenging behaviour is reflected in the fact that it has one of the largest in-house Behaviour Support Teams within the sector. As well as providing expertise for

24 ¦ CMM JUNE 2013

people supported by Dimensions, the organisation also provides Behaviour Support services for other organisations, families, and providers. Having a Consultant Behaviour Analyst in every region across the organisation means that those people currently in out-of-county settings moving back to their own communities, can access the experts in both of those regions.

TECHNIQUES TO OVERCOME VICTIMISATION Clive Pressinger*, who is in his 40s, spent much of his 20s and 30s in long-stay institutionalised settings and was victimised by local teenagers when he began living in the community a few years ago. They kicked his door late at night, stole his lawnmower, let his guinea pigs out of their cages at night, pressured him into giving them money and had even woken him up in the middle of the night by standing in his bedroom. Through working with Susie Jenni, a Consultant Behaviour Analyst at Dimensions, Clive learnt to say ‘I don’t know you’ and walk away if teenagers asked him for money, to call the police using a panic button if someone was harassing him at home or by using a mobile phone when out of the house on his own. Together, Susie and Clive’s support team worked with him to role play scenarios to help him prepare, including situations involving the local police. Now, Clive has moved to a nicer area and has bought his own house. He continues to be supported by Dimensions. Susie Jenni said: ‘We have made a real difference to his life. I don’t know what would have happened if the Behaviour Support Team hadn’t got involved. To see him own his own home and living a happy, fulfilled life and displaying fewer episodes of challenging behaviour is so just so nice. ‘It’s despicable to think he used to be in a wheelchair in an institutionalised setting. Now he lives the life he wants to and is such a lovely person to spend time with. When he comes across scenarios that would previously lead him to display challenging behaviour, he

knows what to do.’

RESULTS Nick Barratt, Lead Consultant Behaviour Analyst, stressed the importance of understanding the purpose or ‘function’ of a person’s challenging behaviour, ‘A functional behaviour assessment is a procedure for gathering information on all the factors that contribute to a person’s challenging behaviour. It allows us to generate a hypothesis about the purpose their behaviour serves. ‘Once the behaviour support programme is in place, it’s essential to monitor progress. We use quantitative and qualitative methods to determine whether the programme is effective in enhancing quality of life and reducing challenging behaviour, and also whether it is being implemented properly. ‘Everybody has rights as citizens to a good quality of life and it’s all about making sure that people with learning disabilities and autism who display challenging behaviour have the same opportunities as everyone else, including the opportunity to live in ordinary settings.’ As the Government has mandated for more people to be moved from institutional settings to more personalised settings and integrated into community life, the right support is absolutely vital to ensure their smooth and successful transition. People with learning disabilities and autism should and want to be living in the community. They should be receiving person-centred support which is tailored to them and their needs, wants and aspirations. Positive Behaviour Support has seen excellent results; financially and for the people being supported. Going forward, the emphasis needs to be on the outcomes achieved through this technique and people will enjoy fulfilled and happy lives where their challenging behaviour is reduced. CMM Lisa Hopkins is Executive Director for Practice Development at Dimensions and heads up the Behaviour Support Team. For more information, visit www. *The name of this individual has been changed to respect their privacy.

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HOW LONG HAVE YOU BEEN INVOLVED IN THE CARE SECTOR? It seems like I ve worked in the care sector forever! Even when I was at university, studying politics, I worked in both day and residential care during the vacations. I then taught in the Pacific islands for two years with the United Nations as a volunteer and worked in Australia in a children s home. After training as a teacher I worked as a Group Worker in a therapeutic secure community with children and young people with complex needs in the 1970s. All these experiences helped me become a social worker. I am proud to have been one for more than 30 years and I still maintain my registration. I have worked as a Director in three councils for over 10 years, covering both children s and adults social services. I was also Assistant Chief Inspector in London with the former Social Services Inspectorate in the Department of Health. WHAT ARE YOUR OBJECTIVES AS CHAIR OF TCSW? I have been involved in setting up both the National Skills Academy for Social Care (NSA) and The College of Social Work (TCSW) and now I m chair of both. The common theme running through both organisations is an emphasis on leadership. I believe that leadership starts with all of us - both organisations are membership organisations which


need to be responsive to their members and be a voice for their members. I am determined that now we are established, the College will be the voice of the entire profession. I want the College to support social workers do the best job possible and to take responsibility for their own professional development. Over the next year, together with Annie Hudson, our new Chief Executive, we will continue to build up our membership, which now stands at more than 5,500. I hope our members will be involved in every aspect of our policy development and that more members represent the College as mentors, media spokespeople and as our newly appointed policy champions. We will continue to work collaboratively with others, as we have already done with Action for Children and Age UK. Annie s experience in the Protecting our Children documentary series for the BBC will be invaluable in giving confidence to our members to speak up for social work. My longer term objective is to support more of our members to take up active roles on the College s Board and Professional Assembly and become the future leaders of the profession. Ultimately the measure of our success is whether social workers see the College as theirs - just as important and relevant to them as, for example the College of General Practitioners is to GPs. I also want us to be the first place any government body, pressure group or partner organisation turns to for opinion and intelligence about social work in England.

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REABLEMENT AND INTEGRATED OUT OF HOURS CARE: SMART BUSINESS VENTURES? A new Leeds service designed to avoid unnecessary admission to hospital or residential care and to support people to leave hospital sooner opened its doors to patients in April. Other similar step-up/stepdown care facilities have been successful in helping to support the health service whilst providing more opportunities to the care sector and offering a broader choice to service The South Leeds Independence Centre (SLIC) is the city’s first intermediate care unit, providing 40 community intermediate care beds. SLIC is in Beeston, south Leeds. The centre, which was formerly a council-run residential care home, has been extensively refurbished and will provide person-centred care, focused on rehabilitation and promoting independence. The old care home, Harry Booth House, was earmarked for recommissioning during the first phase of the council’s reshaping of older people’s residential services in 2011.

The aim of the centre and this new model of working will be to provide more intensive rehabilitation and reablement care in a community setting to prevent the condition of patients deteriorating and needing to go into hospital. The centre will also be a bridge between hospital and getting patients into their own homes sooner, with all the support they may need. The centre will include a multidisciplinary team of staff from LCH, including nurses, occupational therapists, physiotherapists, doctors with non-

registered staff coming from Leeds City Council to form an integrated health and social care team. The team at the centre is made up of health and social care professionals including nurses, physiotherapists, occupational therapists and care assistants, with access to dieticians, joint care managers and medical practitioners for specialist input. Through joint health and social care commissioning and by staff working together more closely in a community setting, it is hoped fewer people will need to go to hospital or residential care and those who do will

Integrated working needs to be improved

Integrated care services are the future

Dr Lisa Bostock Senior Research Analyst SCIE

Paul Saper Managing Director LCS International

The first question that all professionals need to ask about integration is what s its purpose? Or, what are we trying to achieve from integration - whether the provider is a council, a charity or from the independent sector. There are a number of benefits, including less duplication and better planned services. However, all these are means to the end of better outcomes for people who use services. People who use services know what they want in terms of quality of life. So, it s important to define outcomes that matter to service users and carers. Service users and carers must be involved in care planning and in influencing future care options. Independent providers are no exception. Also, SCIE s review of the literature suggests that the evidence base underpinning joint and integrated working needs to be improved. It largely consists of small-scale evaluations of local initiatives which are often of poor quality and poorly reported. No evaluation studied for the purpose

26 ¦ CMM JUNE 2013


of our 2012 Research Briefing included an analysis of costeffectiveness. We did, however, evaluate recent Leeds City Council integration work. The local authority wants people to have a single point of access for either health or social care services; it s in the process of creating twelve integrated teams across the city, working with adults with longterm conditions. It s designed to minimise delays, reduce the number of professionals involved, reduce duplication and ensure information is shared more effectively. Councillor Lucinda Yeadon is Executive Member, Adult Social Care at Leeds City Council. She is featured with others in a You Tube video on integration. She says: The local authority, health organisations and third, as well as independent sector organisations are working together to deliver a more joined-up service . She says that, irrespective of who provides which bit of which service, the individual must be at the centre of everything that these agencies do.

The way care is delivered in the UK today, too many patients struggle as they are shuffled around from one location to another. People stay too long in hospitals; rehab services are rather poor and lack the investment in new technologies that is very much the norm in other parts of the world; and the level of hospital re-admission rates here are an expensive burden on the whole system. The flip side is how care could and in fact should develop in future with greater emphasis on co- ordination of care and communications about care at the bedside and patient level, at the hospital level, and at the commissioning level as well. NHS England now fully accepts that co-ordination and communication systems must in future become a lot smoother. NHS England s number one objective is when people are in a change of life phase due to critical illness or have need for rehabilitation, new care pathways

will be put in place in order to help respond to individuals needs, look after them better in future in the most appropriate setting and transition most of them home at the highest possible level of function. How fast we see progress in this country revolves around our capability to adopt new IT platforms, and the speed we are able to overcome, in particular, shortages in trained staff who provide physical therapy, occupational therapy and speech and language therapies too. Leading companies will look to establish new continuum of care services in local integrated markets and extend their capability to deliver good outcomes whilst at the same time reduce their running costs. LCS anticipates over the next few years introduction of new types of sub-acute or step-down provision, and in some cases, the conversion of care home assets and community hospital assets to aid delivery in this sector.

business clinic

receive support and care so they can live more independently for longer in their own home or local community.

COUNCIL AND NHS SUPPORT The unit is jointly commissioned by Leeds City Council and NHS Leeds South and East CCG, with Leeds Community Healthcare NHS Trust as the lead provider. The new integrated team has been on site since mid-March undertaking training and getting the new facility ready to receive patients. As a team they have developed a set of patient care standards, which they have all signed up to and will be a key part of how they deliver the new service. Talking about the new SLIC, Councillor Lucinda Yeadon, Executive Board Member for Responsible Adult Social Care in Leeds said: ‘I am delighted that the South Leeds Independence Centre has opened its doors to patients this week. The SLIC is a really big step forward in achieving our aim to provide services that are responsive and proactive in preventing older people from needing more intense care and support services following an illness or stay in hospital. ‘Leeds City Council is committed to creating better lives for older people in

the city, and will continue to work in partnership with our partners in health to deliver improved outcomes for people in our care.’ Rob Webster, Chief Executive at Leeds Community Healthcare Trust said: ‘We know that it is really important for people to get the right care in the right place from a team that is well trained to look after them and get them back on their feet. Having this resource is fantastic for the city and the people of Leeds. It enables us to provide excellent care and show how partnerships can make a difference.’

OUT OF HOURS SOCIAL CARE IN BLACKBURN AND DARWEN Blackburn with Darwen Council introduced a similar service in November, its Out of Hours Integrated Service (OOHIS). Council bosses have hailed the service, between November and April it prevented more than 50 unnecessary admissions to hospital or care homes. The service provides a single point of contact and uses the expertise of health and social care professionals to provide assessment, signposting and referral for

users. If someone suffers a minor fall at home, for example, paramedics can refer the patient to OOHIS, which will then set up a series of visits until further support is in place for the longer term. It also supports hospital discharges to try to avoid people who have just come back from hospital being readmitted again. Councillor Mohammed Khan, Executive Member for Health and Adult Social Care, said: ‘The scheme is still in its early days but I am pleased with some of the results we have seen so far. This service is a real innovation and an excellent example of the council working with the NHS to benefit people of this borough.’ Dr Chris Clayton, Clinical Chief Officer of Blackburn with Darwen Clinical Commissioning Group, said: ‘It’s still early in the service’s development but the first results look encouraging.’

Over to the experts... Do these public sector examples offer lessons for the private sector? Should more providers look to diversify their services? How can more private sector care providers get more involved with integrated services?

Skills are readily transferrable Stuart Marchant Partner Bevan Brittan LLP Private sector providers looking to develop alternative income streams should actively engage with the concept of integration. Skills used in running nursing homes can be readily transferrable into the reablement model with a few tweaks. Step down care focuses on allowing people to get out of hospital quicker and in a more supported way, en route to their own accommodation. This avoids hospital costs at both ends, in terms of speedier discharge and avoidance of preventable re-admissions, so is beneficial to Clinical Commissioning Groups. Step up care offers GPs an alternative route for people who need support but not necessarily a hospital admission to sit on a ward. So, the benefit for commissioners is obvious, and providers should be able to negotiate fees between standard nursing home rates and hospital costs, the additional fee representing a more intensive nursing, occupational therapy

and rehabilitation model. Is it sustainable? Yes, certainly given the policy shift away from hospitals. A word or two of warning. Providers must have effective clinical governance processes, staffing levels, eligibility and exclusion criteria, and support networks. I have worked with providers who have operated these services but found themselves under scrutiny when they are referred people - at both ends: step up and step down - whose clinical needs should be met in a hospital. Robust admissions and discharge procedures must be in place so as not to be exploited as a cheap(er) dumping facility. If something goes wrong, the provider will have to establish that it was a correct decision to admit a person. Given that these are time limited placements, providers would also be well advised to look carefully at what the contract says about admission, discharge and penalties for not discharging someone quickly enough .

CMM JUNE 2013 ¦ 27

28 ¦ CMM JUNE 2013

The necessity of understanding marketing If you are a care provider who wants to grow your business then you need to truly understand sales and marketing. Nicki Wakefield discusses how to approach this area. Demand for care is set to explode, but in the real world lots of organisations are struggling. If you’re running a care home you can’t afford empty beds and if you have a home care agency you need enough service users to create economies of scale. Either way you may have historically won your business through tenders and may now be looking at the self-pay market or people with a direct payment as the answer to a funding shortfall. In these difficult times cutting the money available for marketing may seem like a good idea, but when each enquiry is worth thousands or even hundreds of thousands of pounds this could be a false economy, particularly if you miss vital steps out of the

process and have to waste time and money redoing things. Unfortunately most people think marketing is about leaflets and websites. You may need these, but more importantly it’s about understanding customer need, how you stack up against your competitors, talking to the right people and educating your staff about their role in marketing your organisation.

FACE YOUR ISSUES So, what’s the answer? Most care organisations have one of three key issues and it’s useful for you to understand which challenges you face. Is it making people aware of your service, generating telephone enquiries and / or converting

those enquiries into service users or residents? It is important to think about things holistically, otherwise you could end up spending a fortune on promoting your organisation only to find out that your website isn’t encouraging people to pick up the phone, or your calls are being handled ineffectively by a care worker who is unable to articulate your messages. So before you go out and update your advert or create a new website, there are a few foundations that you need in place. You’ll want people looking for a service like yours to find you regardless of whether they are looking online or talking to a health/social care


If you need help generating and converting enquiries you might want to take a look at Straight Up Marketing’s Care Marketing Toolkit. The toolkit is a user-friendly step-by-step guide to marketing your care organisation and is aimed at non-marketing specialists who want to develop their marketing skills cost-effectively. The online collection of over 80 videos includes supporting documents and telephone

professional or other sign poster. Once they find your organisation you’ll need to show them that you provide good quality care that meets the specific needs of the individual at a good price. If you can also prove that you have a good track record, manage risks well and make the process stress-free then there should be no reason for buyers to go elsewhere. That is as long as you communicate things well, and at every stage in the process.

WHOLE COMPANY APPROACH So marketing is not all about leaflets and websites, it’s about your organisation as a whole and it’s no surprise that those organisations that are growing tend to understand sales and marketing. Why do you think large care providers are centralising their call handling? It’s not because they like call centres, it’s a way of controlling the message and being able to track return on investment. If you’re serious about getting your marketing right, get to grips with who is looking for your services and what your competitors are doing. This will help you to think about the things you do really well, the evidence you have and who you need to talk to. Once you’ve done that, it is important to think about how you’re going to monitor what has been effective for you. CMM Nicki WakeÄeld is the Director of Straight Up Marketing.

consultancy and should help you avoid the mistakes that many providers are making. Sign up to the Care Marketing Toolkit and get access to six videos for free. 03333 440645

CMM JUNE 2013 ¦ 29



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A CRISIS For many a crisis is the moment when realisation dawns that something beyond their control has turned their world upside down. Sometimes personally, often corporately. Karen Ainley explains how to deal with a crisis and, if managed correctly, turn it into a positive. By its very definition a crisis is a time of intense difficulty, trouble or danger. A crisis also usually means that you didn’t see it coming and are confronted with an instant set of decisions. For many the first reaction is to say nothing, try to bury the issue and hope it will go away. In almost every situation this will never work and eventually will backfire on you. It was America’s 16th President, Abraham Lincoln who said: ‘I am a firm believer in the people. If given the truth, they can be depended upon to meet any national crisis. The great point is to bring

them the real facts.’ In that short simple phrase the stoic leader during the American Civil War encapsulates the very meaning of Crisis Management - although in the mid 19th century ‘Crisis Management’ had probably not been invented as a phrase let alone an industry!

HANDLING A CRISIS Facts are vital and it is important to understand them and get them out to the media, clients and the wider public.


CMM JUNE 2013 ¦ 31

real facts control a crisis

J Being truthful will almost always rescue any situation where a crisis looms. But this doesn’t mean you need to give chapter and verse. The first golden rule of Crisis Management is to ensure you never offer ‘No Comment’ as a reaction. To the media and to the people it implies immediate guilt. Unfair it may be but perception is both the enemy and ally of any crisis. Public reaction will determine the course of any crisis and that reaction is usually guided by the printed press and the broadcast and internet media. Hoping to solve an issue by hiding away will only exacerbate the problem and what may start as a small concern will quickly snowball out of control if it isn’t contained and dealt with quickly. In essence this is what Abraham Lincoln meant when he said: ‘The great point is to bring them the real facts.’ It would be fair to say that the care sector has had its share of crises, whether it is over client care, conditions of homes or communication with relatives. A crisis can appear in a number of forms but the most common is usually after a less than favourable CQC report or a relative contacting the media to make a complaint. The first any owner or manager is likely to know that an internal matter is now about to become a crisis is when a call comes from the media, usually from a local newspaper or radio station. The internet and social media also pose another problem. Once a tweet, Facebook or blog comment has hit the world of wireless communication what was a local issue is now a global problem that can be read by quite literally anyone in the world.

GET A PLAN IN PLACE The second golden rule is not to panic. The definition of panic is sudden uncontrollable fear or anxiety, often causing wildly unthinking behaviour. Don’t let this be you! Every company dealing in face-to-face contact with the public or caring for their needs should have developed a Crisis Management plan. If you don’t have one then here is a simple guide to ensuring you can meet any crisis head on and if you do have a plan then well done and this is your chance to check it is up to date. • Always appoint one person who will

32 ¦ CMM JUNE 2013

deal with the media and be the voice and face of your company; • You should ensure you have a critical friend, someone who can assess the issue quickly and ask you the questions that the media and the public are likely to ask and check you have the answers. This should be a trusted person who is independent of your company rather than anyone who has a vested interest, as their view is often likely to match yours and you should be prepared to face challenge.

in and one of two things will happen. You will either say ‘No Comment’ and that breaks the first golden rule or you will say something that isn’t true which breaks the third golden rule. Always tell the media that you will be giving them a full statement, preferably a recorded interview or statement for broadcast media, and tell them how long it will be before you call them back. Make sure you do call them back!

This is where a Crisis Management consultant is invaluable and will guide you through the check list and get your

Fourth golden rule, always be truthful. There will be times when you cannot give all the information to the media because


‘When responding to the media, relatives and the public remain calm, especially if you are being provoked.’ message across to the suspecting media and sceptical public; • Next, collect the facts. What has happened, what are the complaints or problems, what actions have been taken by your company, what does the media know? • Quite often you will learn about the crisis after many of these issues are already known. Therefore it is critical you get on top of the answers and gather all the information from staff, relatives and the media.

KNOW THE SPECIFICS Third golden rule, always be sure of your facts. If you ‘think’ you know something, there is a racing certainty you don’t! Don’t answer questions from the media until you understand the situation and have been properly briefed. While the media will be pressing you for your reaction it is vital you know the facts remember old Abe’s comment above! If you don’t do this then panic will set

of legal reasons, for example if arrests have been made or an investigation by the police, the CQC or you is underway and you cannot reveal details until this is concluded or it involves personal information about a person that you do not have permission to reveal. When responding to the media, relatives and the public remain calm, especially if you are being provoked. If you argue against someone in the public domain you will lose control and lose the argument. Result - the crisis will heighten. Fifth golden rule, prepare your key messages. Once you have gathered the facts then prepare a set of messages you wish to deliver. These are the views you want to public to hear and understand. If you follow this simple guide then you can meet any crisis with confidence and you will be trustworthy in the public’s eye. Above all, Abe Lincoln would be proud of you! CMM Karen Ainley is the CEO of Mosaic Publicity.

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CONSTRUCTION & DESIGN SERVICES Are you planning on renovating your care facility, or perhaps considering an extension? Or is a new build a possible development on your business agenda? CMM shines a spotlight on a selected group of specialist services which are ready to help you fulďŹ l your architectural, building and design needs. If you are contemplating making any design or structural changes to your care business it is extremely important to consult specialists who understand the needs and expectations of your residents, staff and the regulator. There are a number of construction and design companies that operate solely in the care sector. These companies can utilise their expert knowledge and experience to provide comprehensive advice and services. Gone are the days when a care facility had to look and feel like a care facility. The personalisation agenda gave backbone to the idea that the design of care homes, care villages, supported living communities and extra care housing should look like a home, rather than a sterile and clinical environment. 34 ÂŚ CMM JUNE 2013

For those living with dementia, carefully thought out design can help with orientating a person and help them to maintain and sustain personal identity. If you are looking at a new build it might be an idea to consider how the care facility could be built to provide links with the local community, is it viable to include a few small shops or a hairdressers? Technology is another major consideration to undertake, you want your building to be equipped for the latest advancements in telecare and telehealth. It is also wise to investigate the most sustainable energy options. There is any number of considerations to undertake when renovating, extending or building your care facility. Luckily there are a number of reliable companies who have the answers. To discuss any of the following services in more detail, please call the company directly.

Experts in the planning, design, development and build, of nursing, mental health and specialist care homes throughout the UK

Building Construction Partnership ltd Excellence In Construction

For more information please contact us on:

01924 910815

Care is all we do.

CMM JUNE 2013 ÂŚ 35

spotlight on… construction and design services


Building Construction Partnership Ltd is a construction company that provides a range of quality building and associated construction services to a varied client base in the care sector, specialising in nursing homes, specialist care, mental health, residential homes, dementia care and care villages. BCP offers turnkey design and build carefully managed with budgets to ensure cost assurance; from land sourcing and feasibility, through the planning process to completion, including furnishings and equipment, offering a variety of solutions financing of projects.

company was built on the keen knowledge and experience of Managing Director Brian Bullock, who personally holds over 25 years’ construction experience in the sector. A great measure of BCP’s reputation and quality is the returning clients and relationships built within the industry.

Established in 2001 as a specialist care contractor, Building Construction Partnership has a large portfolio of nursing, mental health and specialist care homes across the UK. The

BCP builds nursing homes, specialist care, mental health, residential homes, dementia care and care villages throughout the UK.

BRIAN BULLOCK Managing Director Brian is a Chartered Builder who has been in a management role within the building industry for 30 years and over 20 of those exclusively specialising in nursing homes and the healthcare industry, instrumental in developing designs seen in many of our modern homes. One of the strengths Brian brings to Building Construction Partnership is his use of those years of experience to

The directors at Building Construction Partnership have been working with a limited number of specialist suppliers and operators for over 25 years, maintaining continual ties with industry leaders, and have a client base of individual and national operators throughout the UK and the Isle of Man.

work with clients’ specific needs to advise, design and build homes that meet all the requirements of a modern home, fit for the future but within the budget constraints necessary to bring a project to fruition. Brian says: ‘The design and development of care homes has moved on a long way over the last 20 years and it has been good to be involved with care home development and to work with people who really care and want to do their best for the people who live in the homes we build.’

Telephone: 0800 019 9750/01924 910815 • Email: •


Care Consultants Ltd provides project management skills which bring together all the different elements required to get a project off the ground, completed to time and against budget with minimal disruption. That could be a brand new care home or series of them, extensions or refurbishments. Managing Director Nick Borrett’s extensive experience of the sector means that he

knows how to unravel what sometimes can be a labyrinth of practical and legal issues, saving time and money. From resolving challenges, to specialist advice and training, Care Consultants can offer support on care, construction and regulation. The company is based in Nottinghamshire with a national coverage. Current clients include MHA, Grahamcare, Sisters of Mercy, Auchlochan Trust. Services include new builds, extensions, refurbishments, remodelling, CQC Standards, dispute resolution and trouble-shooting.

Telephone: 0115 965 5776 • Email: •


Carless & Adams Partnership is a highly regarded construction consultancy offering clients a wealth of experience in providing independent expert advice. As an inter-disciplinary firm, we provide a comprehensive range of professional services covering all aspects of the design and building process - both for new build and refurbishment projects. Areas of expertise include: • Feasibility, concept and detailed design; • Cost management; • Risk analysis;

• • • •

Contract administration; Statutory approvals; Procurement strategy; and Programme management.

Clients range from large corporations and public bodies to small companies and individuals. All appreciate the personal working relationships we develop to create mutual benefit for current and future projects. Whether it is a healthcare, residential, education, leisure, commercial or industrial project, every commission is personally overseen by a Partner. This results in the highest possible quality and high levels of repeat business. Committed to quality management, we provide a highly effective range of services in today’s increasingly complex and fast-changing environment.

Telephone: 01628 665 131 • Email: •

36 ¦ CMM JUNE 2013

spotlight on… construction and design services


Castleoak has worked solely in the care sector since 1996 and has built over 150 care homes and 3000 apartments in extra care schemes and retirement villages across the country for many of the UK’s leading not-forprofit and commercial care operators. The Group offers complete turnkey design and build solutions, from inception to furnishing and equipping. In addition, its specialist, thirteen-strong development team offers the full range of services, sourcing excellent sites in prime locations, undertaking thorough, site-specific market analysis, completing acquisitions and achieving planning permissions before turnkey sale or lease agreements are reached with customers ahead of our design and build team starting on site.

MELVILLE KNIGHT Group Chief Executive Melville Knight has spearheaded care specialist Castleoak’s growth - first as a design and build partner, then a developer. He was instrumental in the creation of the CarePlaces Fund to deliver more high quality, funded turnkey developments for care providers, while offering investors attractive returns in a growing market.

The Group has also created a specialist care home development fund - the £80million CarePlaces Fund - in partnership with Fund Manager, Bridges Ventures, which has already invested in eight care homes and is growing. Castleoak has a partnership approach in all that it does: the Group usually works on projects right from the feasibility phase to its handover, including the commissioning and registration processes. Equally, Castleoak works with customers that introduce projects after planning consent is obtained. The Group’s commitment to the care sector runs deep, and it supports key care sector events each year, including the National Care Forum’s Annual Conference since its inception and the English Community Care Association’s Annual Conference. It is also a foundation supporter of the Housing LIN. Its own Innovation Exchange event was the springboard for the establishment of Your Care Rating, the sector-wide quality initiative launched last year. Mel is responsible for Castleoak’s overall strategic direction, customer satisfaction and company growth. He is on the Board of the recently launched, sector-wide, independent resident survey, Your Care Rating, and played a lead role in its development. He says: ‘We see ourselves now as a solutions provider to the care sector. The issues facing providers do not warrant a “one-size-fits-all” approach. We hope that we can put forward a range of land, design, construction and funding solutions that will deliver the right result for all parties and speed up the much-needed provision of new, high quality care facilities around the country.’

Telephone: 0292 054 8800 • Email: •


Cowan Architects is a specialist in the care market offering 30 years of innovative and award-winning design solutions. The practice has been involved in a variety of healthcare projects ranging from new-build hospitals with long-term wards for patients with profound disability to short-term surgical wards, theatre proposals, pharmacy provision and GP surgeries. The practice is well versed in addressing the complex issues that face healthcare

professionals, such as implementing a rolling programme of major alterations and refurbishment, whilst maintaining a functioning facility. Cowan Architects has also completed a number of care homes for people with specialist requirements, working closely with clients, carers and occupational therapists to ensure that the environment provided has high-quality design solutions that reach beyond the client’s basic clinical needs. Its extensive experience has made Cowan Architects nationally recognised for its Expert Witness work with four architects giving advice to the High Court on disability matters.

Telephone: 01342 410242 • Email: •


Under the Construction (Design and Management) Regulations 2007 it is mandatory to appoint a CDM Co-ordinator on all notifiable projects. Dobson-Grey endeavours to ensure that as you as the client are provided with the reassuring support to

enable you to guarantee your project complies with the right focus on health and safety. Dobson-Grey has the competence and necessary experience to ensure compliance with the CDM regulations on any size of project large or small. Experience includes local authority regeneration, new build and residential projects, refurbishments, commercial retail developments and the care home sector.

Telephone: 01789 298006 • •


One Creative Environments Ltd (One) is an integrated building design business that can support care providers with all aspects of their care home design - from creating a brand new facility including all architectural and engineering services, through to the refurbishment of existing facilities.

sustainable and award winning environments. One’s dynamic multi-disciplinary team comprises architects, landscape architects, masterplanners, structural and civil engineers, building services engineers, interior designers and BREEAM assessors. The team’s expert knowledge and collaborative approach saves clients time, resource and money – and they only have to liaise with one contact for all of the services employed on a project.

Specialising in health and social care facilities, the One team has more than 30 years’ experience in creating high quality, efficient,

Due to their extensive experience and their proactive approach, One’s designs solutions are not only affordable but also cost effective to run and maintain in the long term.

Telephone: 01905 362300 • •

CMM JUNE 2013 ¦ 37

spotlight on… construction and design services


Robinson Lloyd Architecture is a specialist healthcare practice offering cost-effective design solutions to clients in every field of Acute, Mental Health, General and Social Healthcare. As a long established practice it offers advice on Planning and Development, Building and Engineering Design and Health & Safety. Clients include many of the larger NHS

Trusts, private care home groups and owner-run nursing and care facilities. The team of highly skilled designers and engineers can guide clients through the legislation to ensure compliant buildings. The company fully understands the requirements of the CQC and OFSTED and can advise clients on obtaining registration. It is a one-stop-shop service which covers every aspect of building procurement. All projects are managed by a senior member of staff and the same attention to detail is given to every project regardless of size.

Telephone: 01604 671633 • Email: •


Tunstall Healthcare provides telehealthcare solutions that play a pivotal role in supporting older people and those with long-term needs to live independently, by effectively managing their health and well-being.

conditions in their own homes, improving quality of life and preventing avoidable hospital admissions. Tunstall’s innovative range of non-intrusive telecare sensors, such as the smoke, flood, bed and chair occupancy sensors work with Lifeline home units to offer a comprehensive way of managing the risks to a person’s health and home environment, 24 hours a day.

Telehealth solutions offer a way of delivering tailored care for patients with long-term Telephone: 01977 661234 • Email: •


Tanner & Tilley specialises in providing planning consultancy services to the care industry and advises clients on a wide range of specialist care facilities, including: care villages, care homes, extra care accommodation, brain injury units and family group homes for people with learning disabilities. Tanner & Tilley can help clients to optimise their development objectives with the following services: • Site appraisals - feasibility studies;

• • • • •

Care needs assessments - demographics - analysis of existing care provision; Preparation and submission of planning, conservation and listed building applications; Community consultation - public exhibitions - lobbying; Planning appeals - written representations - hearings - public inquiries; and Property portfolio assessment and advice on alternative development potential.

In recognition of Tanner & Tilley’s outstanding services to the retirement housing and care sector, the company has been presented with the award for ‘Best Performing Planning Consultancy’ in November 2011 for the second year running.

Telephone: 01202 430348 • Email: •


in the cultural, education, housing and office sectors. A key element of the practice’s work focuses on developing designs to support those with a range of special needs.

Wright & Wright is an award-winning architectural practice based in London. Formed in 1994, the practice has built a strong portfolio of projects in the UK for prestigious clients

All projects are underpinned by a commitment to delivering the highest quality buildings and to supporting clients through every stage and aspect of a project.

Telephone: 0207 428 9393 •


WSW provides a comprehensive and specialist service to the care sector, undertaking maintenance, refurbishment and fitting out. Services include, looking after the inside and outside of your premises, roofs, windows, entrances, resident’s rooms, common parts, kitchens, quiet rooms. It also creation of EMI suites with specialist secure facilities and completes DDA and Fire Safety Compliance surveys and implementation. Bathroom refurbishment and conversions to wet rooms are also covered by WSW.

Design and build utilising the experience of our architects and designers in residential, care and specialist dementia facilities. Turn Key WSW provides a comprehensive service that includes all furniture and furnishing requirements. Designs will include mood and colour board renditions. Planned Maintenance WSW provides a comprehensive list of work required, a time line for completion and a cash flow projection. The service is available throughout the South Midlands, South East and East Anglia.

Telephone: 0208 216 2000 • Email: •

Next edition: Spotlight on software If you would like to feature in the next spotlight please email or send a tweet to @CMM_Magazine 38 ¦ CMM JUNE 2013


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CMM JUNE 2013 ¦ 39


Like all people involved in property transactions, buyers and sellers of care homes need to be fully cognisant of Capital Allowances and the tax relief they provide.

WHAT ARE CAPITAL ALLOWANCES? Care home owners are among those able to claim some of the highest amounts of Capital Allowances available to property owners. This is simply as a result of the nature of the property involved - in the majority of cases, care homes are large buildings of considerable square footage containing large quantities of fixtures - often referred to as plant or machinery. A fixture is defined by the Capital Allowances Act (CAA) 2001 as ‘plant or machinery that is so installed or otherwise fixed in or to a building to become, in law, part of that building or land’. Care home fixtures cover a range of items - heating, lighting and electrical systems, air conditioning, water systems, lifts and alarms to name but a few. So why are Capital Allowances so valuable? Capital Allowances arise from capital expenditure on: • Purchase of an existing or newly built care home; • Construction of a new care home; • Alterations, extensions and refurbishments to a care home. For example, a company which buys new premises for £1 million containing fixtures such as electrical systems, heating and toilets could generate £300,000 of Capital Allowances. If the company pays tax at the proposed new corporation tax rate of 21 per


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getting to grips with capital allowances cent, then it would benefit from a tax saving of £63,000 (or J £120,000 if owned by individuals paying tax at 40 per cent). The company would obtain £7,000 of this in their first year (£13,000 for an individual) and then £6,000 in the second year and so on until all the full £63,000 tax saving is received.

A GREY AREA Yet despite the potential for huge tax savings, confusion can reign when it comes to Capital Allowances. Across the property landscape, not just in the care sector, they remain one of the least exploited and best methods of reducing building owners’ income tax or corporation tax liabilities. Armed with a level of knowledge and, importantly professional advice, care home owners can take advantage and ensure they are claiming the Capital Allowances they are entitled to as a matter of routine. However, when it comes to the buying and selling of property including care homes, new rules have come into force which make the whole Capital Allowances arena somewhat more complicated.

THE NEW RULES Changes in the Finance Act 2012 have introduced this layer of complexity - and risk - in the claiming of Capital Allowances for all parties involved in a property transaction. Dating back to April 2012, there must be a record of agreement in a prescribed format that sets out the allowances claimed by the seller and the allowances that are passing to the buyer. From April 2014, all expenditure that qualifies for Capital Allowances must be identified by the seller, but not necessarily claimed, before the transfer to a new owner. The significance is that the new owner cannot claim any allowances if this is not done and done correctly. The main reason why the new fixtures changes have arisen is due to less scrupulous buyers formulating claims without proving they are certified to claim. To comply with the new record of agreement requirement, the seller and buyer must use one of two procedures to fix the value where the seller has made a claim for particular fixtures. The two parties agree a value between themselves, or a procedure to agree a value, and issue either a Fixed Value Requirement (FVR) or a Disposal Value Statement (DVS). The correct use of these procedures is vital to ensure Capital Allowance claims are not restricted or worse, cannot be made by the new owner of the property. In the vast majority of cases, an FVR will be issued. This involves the parties making an election under section 198/199 of the CAA 2001 within two years of the property transaction date. Apart from the basic required information, the election must include details that are sufficient to identify the fixtures and there must be a sum for the fixtures and the integral features. A DVS is employed for example where the property involved has not been sold at the open market value or where the seller is a non-taxpayer. The DVS has to be obtained by the buyer from the seller within two years of the seller ceasing to own the fixtures. Where parties cannot agree the transfer value of fixtures, they can apply to the First-tier Tribunal for a ruling. Application to the tribunal must be made within two years of the property

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transaction date. HMRC accepts that the value of the fixtures agreed by the parties can be any sum between the original claim cost and £1.

HOW TO PROCEED The changes mean that Capital Allowances must now be dealt with at contract stage not after purchase. So what is generally the procedure and where are the pitfalls? A price to buy a home is agreed between the parties. The sellers’ solicitor draws up a draft contract and the buyers’ solicitor issues enquiries. Within those enquiries is a section on Capital Allowances which in our experience are generally poorly answered. This practice will have to change because incorrectly or inadequately answered replies could put buyers in a position that precludes them from making claims post April 2014 and will also prevent the record of agreement from being drawn up correctly to withstand challenge from HMRC. Knowledge is everything and if the buyer is not made aware of the correct Capital Allowance position of the seller then the buyer may be prevented from claiming. After 2014 any reply to enquiries coming back that says the seller has not claimed for all plant or even not claimed for just some of the plant will have to be addressed at contract stage to preserve the new owners’ ability to make a claim. It is possible that in this scenario the buyer would pay for a capital allowance report to be prepared by the seller so that the seller would be able to pool their allowances and elect with the buyer an agreed sum of allowances to pass to the buyer. It is going to be a cumbersome procedure, but it is the system that could evolve subject to legal warranties in sale contracts and will be driven by the high value of tax relief available. It is clear that Capital Allowances are highly valuable to the care home sector and the legislative changes have without doubt made the claiming of them more complicated. Care home buyers and sellers should take time to understand what is required of them in the transaction process to ensure as individuals they meet all the requirements - and that neither of them loses out financially. There has been some particularly good news recently. The last Autumn Statement increased the Annual Investment Allowance (AIA) to £250,000. The AIA is the sum whereby a taxpayer who incurs expenditure receives 100 per cent tax relief in the year of expenditure up to £250,000 no matter whether that taxpayer is an individual or a company. Using our earlier example where there was £300,000 of Capital Allowances, the impact of the AIA at £250,000 is to increase the first year saving from £7,000 to £54,000 for a company or from £13,000 to £104,000 for an individual owner and should give a welcome boost to home owners looking to refurbish, build or extend their homes. Notwithstanding the foregoing, the complexity surrounding Capital Allowances is easily dealt with by the use of experts in the field and now, perhaps more than previously, those involved in care home property deals should seek professional advice to ensure the rules are followed to the letter so they do not miss out on hard earned tax relief. CMM Stuart Rivers is Managing Partner of Stuart Rivers Associates, Capital Allowance Consultants based in Harrogate, North Yorkshire.



discussed the Prime Minister’s Challenge on dementia. The presentation focused on delivering quality care, with an indepth analysis on how managers can improve support for people with dementia and their carers.

Naidex National, the UK’s largest event focused on disability, homecare and rehabilitation closed its doors following three busy days of healthcare seminars, new product launches and new technology at the NEC, Birmingham. The introduction of the Care Zone and new Care Management Conference at the show ensured the needs of care home managers and owners were a primary focus. The Care Zone brought together stands from organisations such as the Care Quality Commission and The Alzhemier’s Society with those offering products and innovations with particular relevance to the care management sector, such as Boss Seating and Mangar International. The new Care Management Conference proved to be an extremely popular addition to the Naidex National programme. Running throughout the show’s three days, the conference was free to attend and offered the latest thinking and advice, from recommended moving and handling practice to training, attracting and retaining staff, budgeting and marketing support. The conference kicked off with a warm welcome from Andrew Barker, managing director of Mangar and was followed by a workshop led by Sharon Allen, CEO of Skills for Care, on how to attract and retain the perfect workforce. Other highlights on day one included a talk from Professor Martin Green OBE, Chief Executive of ECCA, who shared his expertise in managing budgets and coping with cuts. Later on in the day, Professor Alistair Burns, the Department of Health’s National Clinical Director for Dementia, who

Days two and three saw a constant flow of visitors who were treated to talks on a wide range of subjects. One of the most packed seminars was delivered by Trevor Brocklebank, managing director of Home Instead, who shared his expert knowledge and experience on working with local authorities and tailoring everything to the individual. The debate on day three was another hit, chaired by Alan Rustad, the editor of Care Home Magazine, with contributions from Simon Patient, owner of Heritage Manor, David Coull, Chief Executive of Coverage Care in Shropshire, Paul Mancey, Chief Executive, Orchard Care Homes and Barry Sweetbaum, Founder, SweetTree, it concluded with some heated questions on the role of the care home in the future. Fiona Davies, event director for Naidex National (organised by i2i Events Group) said: “Naidex National has been an incredibly well received show, with visitors responding well to the high calibre of speakers and the seminar programme, whether they’re healthcare workers or working in business in the sector. “We’re particularly delighted that the Care Management Conference has proved to be such a popular addition to our portfolio of professional development seminars and would like to thank everyone who spoke at the conference as well as those who attended.”

Supporting Partner

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THE SURREY & SUSSEX CARE SHOWCASE 13 MARCH, BRIGHTON Over 400 social care employers and their staff braved the unseasonal snowy weather to attend The Surrey & Sussex Care Showcase, the region’s biggest business and training event for adult social care organisations at Brighton Racecourse on Wednesday 13 March. With the topical theme ‘Working together for the Future of Care’, the big attraction for visitors was the Care Showcase’s tried and tested mix of business seminars, training and networking opportunities and exhibitor stands. Top level speakers from the Department of Health, Care Quality Commission, Fire and Rescue Services, Lloyds TSB and BUPA updated visitors on the latest in dementia training, legislation, CQC registration, finance, recruitment and much more. This year’s event was officially opened by Mrs Susan Pyper, Lord-Lieutenant of West Sussex who toured the exhibition and stopped to chat to exhibitors including Erica Lockhart and the team at Surrey Care Association who represent the interests of over 700 care employers in the county and are a driving force behind the Showcase. On the exhibition stand for the East Sussex Association of Blind and Partially Sighted People (ESAB) Rex, the black Labrador guide dog, was helping Steve Saunders and Trisha Prince promote ESAB’s latest offer of free vision awareness training courses which are suitable for businesses and the general public. NHS Sussex was also amongst the exhibitors in the busy exhibition area.

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Eleanor Langridge, project manager for the Pan Sussex Integrated Dementia Care Pathway showed how the ‘This is Me’ bag is designed to include personal information about the individual with dementia which can help care professionals if that person is transferred to hospital. Team GB 2012 Paralympics athlete Sophia Warner was at the Showcase answering visitors’ questions for Brighton based independent living specialists Simplicare Centre. Sophia is the commercial director of UK Athletics and is also the vice president of the Children’s Trust in Tadworth, Surrey. Sophia was enthusiastic in her support for aims of the Showcase saying, ‘I want to help change the image of what disability is all about. It’s not just about the elderly; it’s about children and young people with disabilities too.’ Erica Lockhart, Chief Executive of employers’ representative body Surrey Care Association and one of the Showcase organisers said, ‘The Care Showcase helps us highlight and share all the good practice that goes on day by day, year by year

within the adult social care sector locally. Of course, there are challenges facing the sector in a time of economic downturn but there are opportunities too and employers tell us that the Showcase plays an important part in bringing those challenges and opportunities alive for them.’ The Surrey & Sussex Care Showcase 2013 was sponsored by Lloyds TSB and supported by Brighton & Hove Council, Surrey Care Association, Surrey County Council, East and West Sussex County Councils. The event’s media partners were Care Management Matters and Care Choices. FOR MORE INFORMATION ABOUT THE SHOWCASE VISIT WWW.CARESHOWCASE.ORG.UK

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LCS and Adam Smith Institute: 2013 Health and Social Care Spring and Summer Events Programme

‡ Care villages & care homes ‡ Extra care accommodation ‡ Brain injury units ‡ Family group homes for people with disabilities ‡ Sheltered housing / assisted living accomodation


4 June/ 1 July, London


LCS, Tel: 0207 387 6828 Web:


Derbyshire & Nottinghamshire Care Conference: The Future of Care & Commissioning


5 June, Nottingham


Care Choices, Tel: 01223 206964 Web: nottsderbycare


Rising to the Dementia Challenge


13 June, London


Community Care, Tel: 0208 652 8722

01202 430348

Web: Event:

Health+Care 2013


12 - 13 June, London


Media Zoo, Tel: 0207 384 6980 Web:




Care Roadshow Derby


18 June 2013, Derbyshire


Broadway Events, Tel: 01425 838393 Web:


NASHiCS Learning and Development Forum

Lost your keys? No Problem!


20 June, Manchester


Mosaic Events, Tel: 0845 6434 812 Web:

Visit our website for more details and to order your keys securely online:


The Key Replacement Service Tel: 020 8343 2943 Fax: 020 8343 2994 Email: sales' Colton House • Princes Avenue • Finchley • London • N3 2DB


Dementia London 2013: A National Crisis


24/27 June, London


Public Service Events, Tel: 0161 831 7111 Web:


Northern Care Business Conference


3 July, Leeds


Laing & Buisson, Tel: 0207 923 5344 Web: Conferences/ForthcomingConferences

CMM JUNE 2013 ¦ 45

straight talk

straight talk Many care homes struggle to provide a basic level of care to residents, Duncan Shine urges care home directors to look again at how staff are trained in order to improve standards and meet regulatory requirements.

DUNCAN SHINE REGIONAL SALES DIRECTOR SKILLSOFT EMEA Training can be understandably time-consuming for any business, especially for carers who cannot easily take a break. Their time is needed to provide care and finding the intervals to learn new skills or hone current skills can be tricky. Nevertheless staff training is key to improvement so it shouldn t be neglected. While an outsourced training provision can allow care managers to focus on operations, it can also be costly and may not provide the flexibility to address either a change in business needs or the individual carer s needs. The length of training courses can also have an effect on new carers. When taking any job, new recruits will expect an induction training course and if this proves difficult to organise, new carers will not feel supported and may feel unable to perform their jobs to an adequate standard. Care home directors must also encourage a change in attitude from managers and staff. With the care home sector under scrutiny, care managers can t afford to ignore the need for a complete cultural and behavioural shift. While the majority of care homes (63 per cent) are meeting standards and going beyond the call of duty basic standards need to be viewed as a starting point and not the end goal in all care homes. Implementing a training programme is vital, but for it to be successful, it must be tailored and in keeping with business demands. To ensure this cultural and behavioural change is made, training needs to be incorporated into the carer s job role from the offset. Advertising training as part of the job description will help boost recruitment as it will show that as an employer, you are ready and willing to develop employees skills. By offering continuous learning opportunities, employees will appreciate that a future employer wants to build their carer skills and develop them professionally. It will also ensure that all staff are made fully aware of the importance that is placed upon training. By instigating this kind of programme, care organisations will start to see a gradual cultural shift. It won t happen overnight, but staff and residents alike will begin to see an improvement in care standards. Nevertheless, organisations need to make sure that training is accessible and can be done without too much disruption to

carers day to day activities. By offering staff a blended learning approach that encourages both classroom and e-learning, care home directors will reap the benefits of a more skilled and informed workforce. Blended learning captures the best of both worlds by allowing learners to pick and choose how they want to learn and affords them greater flexibility and convenience about when they want to learn. Further to this, by developing learning strategies that incorporate a wide variety of learning activities, care homes will be able to more efficiently utilise learning resources while offering employees more learning flexibility and improved performance support. Carers would also be able to choose the type of learning that best suits their particular learning style, the amount of time available and the kind of information they need.

Directors need to take responsibility for training their staff to ensure they fully understand the importance of their role. Care organisations that view their obligations and industry compliance as just a tick in the box will struggle to meet the needs of those in their care. Faith needs to be restored to this sector, so care home directors must make serious changes where they look to not only meet but exceed their obligations. Incorporating a continuous learning approach, whereby all employees are aware of the standards of support they need to be offering, is vital. The care home industry is unfortunately being let down by a small number of establishments who are failing to meet the necessary standards through lack of training and skills development. To improve this overall perception and reputation of care homes, directors need to take responsibility for training their staff to ensure they fully understand the importance of their role; especially as they are often caring for those who are vulnerable and in need of support.


46 ¦ CMM JUNE 2013


Will you be a winner in 2013/14? Nominations are now open for Accolades 2013/14 The annual Skills for Care Accolades celebrate the very best practice in social care and reward employers and organisations for commitment to workforce development and innovation. Achieving an Accolade proves you are improving the lives of people using social care services through workforce development.

Does this sound like you or your organisation? If you provide a high quality service and invest in developing your staff we want to hear from you. You can also nominate yourself, another organisation or employer that you think would be a worthy winner of an Accolade.

There are eight categories all applicable to the adult social care sector: ƒ ƒ ƒ ƒ ƒ ƒ

ƒ ƒ

Best employer of under 250 staff Best employer of over 250 staff Best individual employer who employs their own staff Best provider of learning and development Best employer support for Apprenticeships Best employer support for the assessed and supported year in employment (ASYE) Best recruitment initiatives Most effective new approach to service delivery

To enter Accolades 2013/14 or for more information visit The closing date for nominations is Thursday 5 September 2013.

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Care Management Matters June 2013  

The complete management journal for the care sector.

Care Management Matters June 2013  

The complete management journal for the care sector.