Savings, Solutions, and Sustainability - Issue 3

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Welcome from CQC

Angela Boxall sheds light on Majesticare’s digital journey, highlighting technological innovations for sustainable excellence in care.

Money saving updates

The Care England team shares its pick of offers and saving opportunities not to be missed.

In the hot seat: An interview with Joe O’Connor, Four Seasons Health Care Group

Learn how relentless continuous improvement and focussing on the basics are fundamental to recovering an underperforming care business.

Decaffeination: The key to reducing falls?

Read a new report on decaffeination and falls prevention and learn about how the initiative was born, and how you can implement its findings.

Navigating the single assessment framework

Philippa Doyle breaks down the CQC’s new inspection regime in a digestible way, outlining the essential steps your business needs to take.

Fixing the workforce crisis: An end-to-end solution for adult social care

In response to the publication of Care England’s latest workforce solution, the report’s partners provide a whistle-stop

How to… Achieve eco patient hygiene and sustainable goals in your setting

Jessica Efford explores how care providers can deliver sustainable outcomes for their businesses, without compromising on delivering high-quality, person-centred care, whilst reducing costs.

Empowering care providers to find digital solutions

Blythe Senior offers advice and guidance to help providers embrace technology to transform their businesses and shares tips to overcome challenges.

Legal matters

Neil Ward updates on the Deprivation of Liberty Safeguards, drawing on the latest sector commentary to discuss the impact of Government’s stagnated reform.

A path to resilience: A blueprint for smaller providers

Fraser Rickatson summarises the latest commentary from leading sector consultancies and service organisations to sustain SMEs or prepare them for a maximum-value exit.

Members' voice: Your questions answered

Care England answers questions on third party top-ups, workforce wellbeing strategies, navigating local authority fee uplifts, and more.

CONTRIBUTORS

Angela Boxall Chief Executive Officer, Majesticare and Chair, Care England @Majesticare_ch

Richard Ayres Social Care Advisor, Care England @CareEngland

Joe O’Connor Chief Executive Officer, Four Seasons Health Care Group @FourSeasonsHCUK

Sarah Coombes Continence Nurse Specialist, University Hospitals of Leicester NHS Trust @Leic_hospital

Ruth French Operations Director, Stow Healthcare @StowHealthcare

Ioan Bishop Policy and Parliamentary Lead, Care England @CareEngland

Philippa Doyle Partner and Head of Social Care, Hempsons @hempsonslegal

Neil Eastwood Founder and Chief Executive Officer, Care Friends @CareFriendsApp

Damien Wilkins Customer Success Manager, Care Character @care_character

Giles Heckstall-Smith Director of Strategic Development, Jobtrain @JobtrainATS

Tristan Rigby Head of Wellbeing, Vivup @wearevivup

Lauren Hague Policy Officer, Care England @CareEngland

Jessica Efford Managing Director, Waterless Limited Search ‘Waterless Limited’

Blythe Senior Director, Care Tech Guide Search ‘Care Tech Guide’

Neil Ward Partner, Mills & Reeve @MillsandReeve

Fraser Rickatson Policy and Funding Lead, Care England @CareEngland

Charlotte Lezard Policy and External Affairs Lead, Care England @CareEngland

EDITORIAL

editor@caremanagementmatters.co.uk

Lead Editor: Henry Thornton

Content Editor: Aislinn Thompson

PRODUCTION

Lead Designer: Ruth Keating Director: Lisa Werthmann

Studio Manager: Jamie Harvey

ADVERTISING

Advertising Manager: Aaron Barber aaron.barber@caremanagementmatters.co.uk

WELCOME FROM CARE ENGLAND

impact of emergencies. This means that we could deploy team members more effectively and work smarter.

Angela Boxall, Chief Executive Officer at Majesticare

Chair

and

of Care England, sheds light on Majesticare’s digital journey, highlighting technological innovations for sustainable excellence in care.

Throughout my tenure, I’ve seen remarkable advancements, none more inspiring than the integration of technology to enhance residents’ care. I envision a future where technology not only improves care but also fosters environmental consciousness, allowing providers to focus on what truly matters.

In recent years, the care sector has undergone a profound transformation fuelled by technological innovations. From healthcare facilities to care homes, home care, and social services, technology has become an indispensable tool in driving efficiency, reducing costs, and promoting sustainability. Let's dive into how technology is revolutionising the care sector, leading to substantial savings, improved sustainability practices, and elevated standards.

Going paperless offers a wide range of benefits across industries, including care. Majesticare noticed significant advantages from this shift, with cost savings from eliminating paper-related expenses like printing, storage, and transportation. Digital documents enable swift creation, editing, and sharing, streamlining workflows, reducing administrative overhead, and enhancing productivity. Plus, they

can be accessed from anywhere with an internet connection, improving accessibility for remote workers.

Technology's impact in the care sector is evident in the transition from manual, paper-based processes to digital solutions.

Majesticare has embraced this shift, leveraging electronic care records and medication administration systems to streamline operations and reduce unnecessary expenditures. By digitising documentation processes, Majesticare has saved on print and stationery costs while also reducing fuel expenses associated with compliance checks and audits.

Moreover, electronic care plans have led to a significant decrease in storage space and environmental impact, showcasing Majesticare's commitment to sustainability alongside financial benefits.

Majesticare went on to introduce acoustic monitoring at night for those residents that were happy to use it. Not only does this encourage a better night’s sleep for those that live with us, but it can also detect sounds associated with emergencies such as falls, distress calls, or medical emergencies. By recognising these sounds promptly, staff can respond quickly, potentially reducing response times, and minimising the

Majesticare’s commitment to technological integration extends to maintenance, audits, and compliance processes. Transitioning to an electronic maintenance system has saved time for maintenance teams. Regulatory checks that once took hours can now be completed in half the time, thanks to streamlined digital processes and integration with other systems. Investing in technology-driven solutions ensures operational efficiency while meeting regulatory requirements.

As a forward-thinking provider, Majesticare leads in technological innovation. The introduction of Alexa Smart Properties for Senior Living at Cavendish Park represents a groundbreaking advancement in improving residents’ experiences. Through collaboration with Ascom Group, Majesticare integrated Alexa-enabled devices to empower residents with greater independence and enhance communication between residents and care teams.

The results are astounding, with an increase in service quality and residents' social activity, alongside significant financial savings.

Majesticare's journey exemplifies technology's transformative potential in the care sector. By prioritising savings, sustainability, and innovation, Majesticare achieves financial stability, regulatory compliance, and delivers high-quality care that enhances resident wellbeing and satisfaction. As technology evolves, the sector has a unique opportunity to embrace innovation, driving positive change for a sustainable and compassionate future.

The future of care looks brighter and more technological than ever.

Angela Boxall is Chief Executive Officer at Majesticare and Chair of Care England. Email: info@majesticare.co.uk @Majesticare_ch

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MONEY SAVING UPDATES

Pre-prepared meals and reduced food waste

A new research report from apetito, Nourishing Lives: A New Era of Dining in Care Homes, found that almost every care home surveyed has concerns about increased costs month on month, from rising inflation of food ingredients to labour costs associated with mealtimes.

According to the report, ongoing labour shortages only exacerbate economic pressures, with nearly threequarters of homes that cook from scratch saying the issue has impacted on meal preparations, with no sign of this abating.

Streamlining cost and efficiencies in the kitchen is a way many homes have managed costs since the costof-living crisis, including pre-prepared meal solutions. These have been found to significantly reduce kitchen labour struggles for nearly one in three care homes, due to the need for less skilled labour, minimal staff training, and ease of cooking, without compromising on the quality, nutrition, or variety of meals.

Additionally, food waste was cited as a key concern to many homes. Whilst some situations may be unavoidable, using preportioned meals can help reduce levels of food waste and ultimately save money.

At times, we need to spend a little to make savings. The following money saving updates outline five ways of achieving significant savings or return on investments to solve some of the most critical challenges faced by care providers. In this issue, topics covered include rising energy, laundry and food costs, uniform quality, and employee screening.

Focus Energy Services

Are you getting the best energy deal?

Most care providers are still overpaying for their gas and electricity, whether it’s being on the wrong contract with the wrong supplier, being on auto roll agreements, incurring hidden billing errors leading to overpayments, or overpaying brokerage commissions.

But how do you know you have the best energy deal? Care providers are not energy experts and energy brokers play an important role in helping achieve the best energy deal available. However, some brokers charge 20%, plus commission, and place care providers with the less favourable, higher commission-paying energy suppliers, serving only the broker’s pocket.

A competent energy broker must take time to understand the needs and requirements of the care provider to ensure optimal energy deals results. Energy audits can be completed at any time and help to understand if you have been sold the most appropriate energy contract.

Care providers should work with a third party to conduct an impartial review of their current arrangements and report where adaptions, savings, or changes could be made in the future. They should also establish if overcharges can be recovered immediately or pre-renewal.

By reviewing over 150,000 energy bills in the last 12 months and conducting desktop energy audits, Focus Energy Services has managed to help care providers reclaim over £5m of incorrectly charged VAT, recover on average £6,300 per site in overcharges, and has provided access to the lowest possible energy rates available to the care sector.

Richard Ayres, Care England. Email: rayres@careengland.org.uk Continued →

Alsico

Smart uniform choices: The cost saving advantage

A uniform that offers the required protection, stretch, and temperature regulation is essential for the care sector. Beyond keeping care workers comfortable, uniforms must withstand the wearer’s physical responsibilities without becoming damaged.

If garments have not been developed for the care environment or laundry process, they will quickly become a significant expense with continual disposal and re-ordering, presenting a considerable financial burden. This could also damage the provider’s reputation if misshapen or damaged uniforms are worn in the care home.

The right uniform can save money in multiple ways; high-quality uniforms last longer despite being worn in highly physical roles. This means they can be re-ordered less frequently, and some fabrics can be washed at lower temperatures, reducing energy costs, and increasing the longevity of the garment.

Partnering with a uniform supplier who can provide the right uniforms reduces time and administration required and increases the opportunity for high-volume cost saving. Selecting a uniform with legitimate sustainability credentials can reduce the investment required to meet targets in other areas.

Alsico is one of the UK’s largest workwear providers with significant experience in the care sector. It offers in-depth technical expertise, strong awareness of wider factors, and innovative solutions that enable care providers to unlock significant cost savings while meeting present and future uniform requirements.

To find out more about the range of uniforms that could save you money, email sales@alsico.co.uk or visit www.alsico.co.uk/environments/healthcare.

CareHomeLife

Spotlight on laundry

Laundry can be complex and costly for care homes to manage. Typically costing between £30-£50 per resident, per week, care environments demand laundry practices way above the status quo, creating a tension point to meet acceptable standards, whilst trying to control overheads.

There is light at the end of the tunnel. With the right products and systems, care homes have the opportunity to make long-term, sustainable operational cost savings of up to 20%, by looking at the bigger picture of Total Operating Value (TOV).

This approach considers more than just the product price point, which is the natural go-to for cost-cutting. TOV guides toward strong professional brands trusted to do a better job, also considering time saving and other important reductions such as electricity, water, and wash time.

For example, an optimised laundry system for one care home group achieved up to a 40% reduction in electricity consumption due to having the confidence to lower the temperature.

Water usage reduced by 23% and wash time by 28% because of first-pass results, eliminating the need for pre-wash and re-wash. The secret is chemical quality, using a simple, safe, and effective line-up that works right the first time, eliminating unnecessary costs and labour.

To find out how much your home could save, and try CareHomeLife’s cost-savings calculator, call 01772 425310, or email info@carehomelife.co.uk.

uCheck

Fast and efficient employee screening

Recruiting new talent is no mean feat, and one of the biggest issues that recruiting care businesses face is ensuring they understand exactly who they’re hiring.

With a limited number of candidates available in today’s market, many care organisations can be guilty of rushing into recruiting an available candidate before getting the full picture of who they are, which can cause various unwanted issues.

This is where uCheck can assist. uCheck makes background checks simple for over 30,000 organisations and helps care businesses confidently recruit the best possible talent.

The organisation offers a range of background screening checks including DBS, Identity, Right to Work, and Adverse Credit, where care providers only need to pay for the checks they need on a pay as you go basis.

By working with uCheck, care providers benefit from:

• Extra time on the clock with speedy pre-employment checks.

• Better value for money by only paying for the checks they need.

• A helpful support team.

Care England members are also eligible for free registration, saving £49 plus VAT. For more information, register for free at www.ucheck.co.uk, using code CAREENGLAND24. Alternatively, call 0300 140 0022 or email info@ucheck.co.uk.

REDUCE YOUR OPERATING COSTS!

Opeque will identify potential savings and recommendations for how you can realise:

• Precise control of engineering and building services to reduce costs:

Plant room, water tanks, hot and cold distribution, heating and ventilating, lighting

• Laundry services to achieve hygienic standards HTM01-04 compliant:

Optimum processing of bed linen, towels, staff uniforms and residents clothing

• Health and Safety standards for your residents, staff and the building(s):

HSG220 is the recognised guidance for implementation in CARE HOMES

ACoP L8 and HTM04-01compliance to ensure Legionella control

Public Health England COVID -19 guidance on PPE and operational procedures

• Sustainability, carbon footprinting to achieve a ‘net zero’ emissions strategy

Opeque can assist in reducing energy bills, complying with legislation, managing health and safety and achieving a sustainable operation.

Applying industrial engineering principles, we address productivity, resource efficiency, quality control, health and safety and asset management, bringing people, utilities,

equipment, and buildings together to realise product excellence.

We have worked with many care homes to provide laundry services and water hygiene and it is from these close relationships that we believe we can further assist your care home to reduce operating costs.

Opeque Care Home Approach (OCHA) Survey

Scan the QR code to visit our online survey.

Q&A

Care England speaks to Joe O'Connor, Chief Executive Officer at Four Seasons Health Care Group and Care England policy board member, who explains how relentless continuous improvement and focussing on the basics are fundamental to turning around an underperforming care business.

IN THE HOT SEAT with Joe O'Connor

Care England: What are some of the key reasons why care home businesses you have taken on to support were failing or struggling to stay afloat?

Joe O’Connor: There are two different categories, I’d say. Firstly, there are the macro or external factors and secondly there are internal or self-inflicted factors. Often, it’s external factors, whether it’s economic shock like the war in Ukraine, high inflation, sudden interest rate increases or policy changes, such as the significant increases in the National Living Wage, that can drive stress in a sector that’s already operating on thin margins and finding it hard to generate positive cash flow.

Over the course of my career, I’ve worked with a lot of care companies that have had leasehold care homes and what we call ‘upward-only’ rent reviews, where your rent has to go up year after year no matter what. There were many years where your rent, being a fundamental part of your cost base, was increasing more per annum than your revenue opportunities, particularly for local authority facing providers.

As for the internal or self-inflicted factors, the reality is that even well-

run companies will sometimes lose track of the basics. This includes not focussing on cash flow – businesses that are profitable can struggle if profit does not flow to cash flow, then your profits don’t really matter. You may be paying your suppliers and your pay roll every month, but your customers aren’t paying you or you’re not collecting your debts.

Another example in our sector is that when I took over at Four Seasons Health Care Group in Spring 2022, when we were moving new residents in, we weren’t consistently assessing their dependency, which meant that we didn’t always take on the right service users or where they were right, we didn’t consistently access nursing funds available. By re-engineering how we were reclaiming funded nursing care and introducing a new dependency assessment system, we improved these processes significantly and it went straight to the bottom line.

CE: How can care providers work through a time of crisis and what strategies have you put in place in the past?

JO’C: I think it’s important to focus on process re-engineering, stripping

everything back, and re-assessing ways of working. This includes evaluating whether you are the right people to be doing everything within your business or are there outsourced providers that can do a better job managing certain functions, which is something I have implemented in the past.

Particular attention should be paid to the efficiency of revenuegenerating and cost-mitigating areas of a provider’s business. I talk with my team about the theory of marginal gains, our industry doesn’t have a silver bullet solution that’s going to transform our viability. If you make a large number of small gains, they will ultimately aggregate to a much more successful picture, which is something I focus on in all of my work with social care organisations.

CE: If a care provider should focus on three areas to create efficiencies, which have the most significant impact or provide a return on investment?

JO’C: Again, knowing the people you care for, and their dependencies, is key. Our new dependency assessment system that I mentioned

earlier cost only £50,000 to implement, which we introduced to over one hundred care homes in a three-month period. This enabled a much more efficient process enabling the right care delivery whilst reducing costs overnight and, not to mention streamlining processes associated with applying for and challenging claims against granting funded nursing care, amongst other benefits. The system also helped to identify evidence of over-staffing in some cases, such as nurse to resident ratios, for example. This helped us to reduce a reliance on temp agencies, while maintaining a safe and cost-effective level of staffing.

Secondly, for me, it’s about finding the top line opportunities. Things like de-commissioned units where a lot of care homes have closed since the pandemic, or even a decommissioned wing within a care home that’s been closed due to staffing or occupancy issues. What I’ve tried to focus on is bringing those wings back into service and recommission beds, and, as enquiries have been generated, being robust with local authority and private customers to secure fair fees. This has reflected the reality of the market and other providers have been doing the same. In terms of utilities, the price of our gas contract went up by 300% when our fixed rate came to an end, so I think it’s important that your fees reflect the fair cost of providing care at this time.

Thirdly, I touched upon it earlier, but focussing on reducing agency reliance is also crucial. We have focused on creating an employee proposition that compels them to want to pick up more shifts, take on more responsibilities, and ultimately, choose to stay with the business and recommend us as a great place to work. We have a high turnover of colleagues in our sector. At Four Seasons, I’ve managed to bring our turnover down from 46% to the high 20s, which is still too high, and this is a sector-wide challenge.

It’s really important here to get the culture right – we talk about having a culture that has high retention and high recommendation. I want my team members to recommend to their friends and family members to come and work for our business. So, I’d focus on colleague experience – are they not only loyal, but are they advocates of your business? Because we know most people that work in health and social care have friends and family that also work in the sector, so this is a great opportunity. I am delighted that eight out of 10 of our team members recommend us as a great place to work in a recent team survey.

There are intrinsic rewards for working in social care, not only is it a hugely rewarding vocation, but there are small, motivational things you can do, such as giving people their birthday off which we have just introduced, which make a big difference. We also reward for

Joe O’Connor is Chief Executive Officer at Four Seasons Health Care Group. Email: joe@fshcgroup.com @FourSeasonsHCUK

tenure at two years and five years of service, as we know the sector has a problem with tenure.

I’m also very much a subscriber to the campaign to come away from the word ‘staff’. We prefer to talk about our colleagues and our teams instead. What I want providers to take away from this is to focus on your colleague proposition – this reduces the high cost of re-training and the cost of recruitment, including over-reliance on sponsored visas, which we know impacts the sector.

CE: What advice would you offer to smaller care businesses that are perhaps unable to access top-level consultants or advisers to assist them in managing their costs effectively?

JO’C: It’s going to sound like a massive plug, but as Care England members, we have access to things like the MINT portal, awareness of emerging VAT issues with specialist advisors, and advice on utility procurement, as examples. I would say accessing trade associations and building relationships with your peers, is therefore crucial for smaller businesses. However, I’ve found that smaller businesses tend to be some of the most well run, as they are almost always really focussed on getting the basics right. Sometimes, as businesses grow, that’s when they can lose track of these, and inefficiencies begin to surface.

Decaffeination: The key to reducing

falls?

In April, Care England published Improving Health Outcomes for Care Home Residents: Decaffeination and Falls Prevention in partnership with Stow Healthcare and University Hospitals of Leicester NHS Trust (UHL). In this feature, we hear from each of the report’s partners about how the initiative was born, and how you can implement its findings.

The report outlines a firstof-its-kind trial whereby care home residents were offered decaffeinated hot drinks as the default option, resulting in a 35% reduction in resident falls experienced on the way to the toilet.

‘Taste the difference challenge’

In 2021, the UHL Continence Team were looking at ways to reduce falls caused by incontinence, urinary urgency, and the need to rush to the

toilet. It is estimated that inpatient falls cost the NHS more than £500m every year (NICE, 2015). In addition to this is the human cost in pain, loss of confidence and independence, and even mortality.

The simplest, low-cost method of reducing incontinence was switching to decaffeinated drinks.

Caffeine is a mild diuretic which can accelerate urine production and stimulate the detrusor smooth muscle in the bladder, resulting in urinary frequency and urgency (Le Berre et al, 2020). It is also a

stimulant that can affect sleep, and there is a greater risk of falls occurring at night for patients who need to go to the toilet (Roggeman et al, 2020).

NICE guidance (2019a and 2019b) recommends reducing caffeine intake to improve overactive bladder symptoms in both men and women. In the UK, it’s estimated that 61% of men and 34% of women are living with urinary incontinence (NHS England, 2018). Research suggests that there is a high correlation between falls and lower urinary tract symptoms occurring (Roggeman et al, 2020), and in UHL, the total number of falls associated with toileting equated to one in four (between April 2020 and April 2021).

To reduce the amount of caffeine consumed in hospital, the UHL Continence Team came up with the ‘Taste the difference challenge’. This was a simple taste test which aimed to introduce patients to the benefits of drinking decaffeinated tea and coffee for a healthier bladder, to reduce overactive bladder symptoms, and, by doing so, to reduce patients rushing to the toilet, and therefore having a fall.

The UHL Continence Team worked collaboratively with staff and housekeepers providing education on the benefits of switching to decaffeinated tea and coffee, to proactively promote decaffeinated tea and coffee with patients during World Continence Week (June 2021).

As part of the implementation process, the Continence Nurse Specialists worked collaboratively with catering staff, providing face to face education to housekeepers on every ward as well as providing patient information leaflets. The Senior Executive Team were fully supportive of the project and even took part in their own ‘Taste the difference challenge’.

Patient feedback was collected from 699 patients who tasted a decaffeinated tea and coffee, with 50% of patients reporting that they could not ‘taste the difference’, and 76% of patients saying that they would switch to decaffeinated having heard the health benefits. Patient feedback was the main driver for an organisational change and, from 13th February 2022, decaffeinated tea and coffee was served as the default option across UHL, with caffeinated tea and coffee served on request only.

In June 2022, the Adult Continence Team conducted a three-month survey of ‘outpatient clinic’ patients, who had been diagnosed with an overactive bladder who had switched to decaffeinated tea and coffee. 63% of patients reported an improvement of their bladder symptoms since switching.

In relation to reducing inpatient falls, since the switch to decaffeinated tea and coffee as the default option, falls occurring in UHL, specifically on the way to the toilet, have reduced. Between April 2020 and February 2021, prior to switching to decaffeinated tea and coffee, in UHL there were 17.4 falls per month. In the first year of implementing decaffeinated tea and coffee, falls reduced by 30% and current data up until September 2023, shows a reduction of 61% to 6.75 falls per month.

The science behind decaffeination is clear, and our work at UHL has shown that making this simple switch can make a real difference to people’s lives.

Prioritising health outcomes for care home residents

UHL’s ‘Taste the difference challenge’, masterminded by Sarah Coombes, was a real eye-opener for us at Stow Healthcare. The premise was simple: would the introduction of decaffeinated tea and coffee for our residents see a reduction in falls associated with going to the toilet?

Following the implementation of decaffeinated hot drinks as the default ... toileting-related falls fell by 29.21%.

For those of us who work in social care, the impact of falls sustained by older people, whether in a care home setting or their own home, can be life changing.

Working in partnership with Care England, we wanted to show that you don’t need to wear a white coat to start your own research project. We conducted a six-month trial from 1st June 2023 to explore whether offering decaffeinated drinks as the default option across Stow Healthcare’s eight care homes for older people would reduce the number of falls associated with going to the toilet.

Preparation was everything; before the trial started, we completed blind taste testing with residents across each home, using simple question sheets for residents and staff to record if they could ‘taste the difference’ between caffeinated and decaffeinated drinks (only 19% could tell the difference). We kept residents, their families, and our staff well informed about what we were doing, and why, with promotional information such as posters, drinks coasters, and easy read one-pagers.

Collating and analysing the data each month was a relatively swift process, relying on staff systematically recording falls as is their normal practice – no changes to recording were implemented. We know it will not always be possible to categorically confirm a fall happened in connection with someone going to the toilet; not all residents can articulate this information, and staff may not always know this from the location of a fall. However, in most cases it was possible to determine where a fall was very likely to relate to an attempt to use the toilet. Falls data

was also retrospectively collated for the four previous months, as a comparator.

Following the implementation of decaffeinated hot drinks as the default option, toileting-related falls as a proportion of average occupancy fell from 5.11% to 3.33% compared to the four-month pretrial data. This represents a 34.72% reduction in falls relating to toileting. Toileting-related falls as a proportion of total falls also fell by 29.21% over the trial period.

Resident feedback has been encouraging. One resident told us, ‘Since being on decaf, once I go to sleep, I sleep right through until about 5am. I used to wake frequently through the night to go to the loo. Having an undisturbed night has made a huge difference to me, as I am no longer so tired during the day.’

Staff have been equally engaged with the project, with one nurse saying, ‘It has been great to see the difference that decaf appears to have made to some of our residents. I know that some of them feel proud to be part of this research. I think decaf has helped people’s urinary continence –one person just has a pad for reassurance now as they know they can get to the loo on time.’

We consider the trial to have been a huge success and will be encouraging residents to drink predominantly decaffeinated hot drinks going forwards, whilst continuing to offer information and choice. I would really encourage care providers to think about how they can engage with simple research projects such as this with little or no cost to them, and potentially hugely rewarding health outcomes for those they care for.

Facilitating cost-effective solutions for the care sector

Being involved in the decaffeination initiative has been an immense privilege for all of us at Care England, typifying the simple, cost-effective solutions we are constantly looking to facilitate for our members.

We first learned of Sarah Coombes’ ‘Taste the difference challenge’ at a meeting of the All-Party Parliamentary Group for Bladder and Bowel Continence Care, where she presented her findings to a room filled with parliamentarians and interested stakeholders from across health and social care. Hearing about the impact decaffeination had had on inpatients at UHL, the applicability for adult social care was immediately clear.

We put on a webinar with Sarah for our members and were delighted when Stow Healthcare expressed an interest in working with us to put decaf to the test in a care home setting. The results of

that trial, as outlined in our recent report, show that the simple switch can have incredible results for care home residents.

In the face of a wide array of challenges facing adult social care, the decaffeination trial is a great example of the sector taking initiative to come up with innovative solutions to major challenges.

Learning from our colleagues in the NHS, too, has been right at the heart of this work, showing the value of the health and social care system coming together when it matters most.

This project also epitomises what we hope to achieve at Care England: using our networks to develop meaningful, cost-effective solutions that can have a real impact on the lives of the people our sector supports.

We are ambitious about the potential of decaffeination and the impact it can have on the health and social care sector. With fragility fractures in social care estimated to cost the NHS £1.1bn per year, replicating these results across the sector could save £85m per

year in prevented falls and hospital admissions. That’s not to mention the thousands of lives which would be positively impacted.

So, now, we are encouraging care providers to explore what decaffeination could do for your residents. With the support of our partners we have built a platform of resources to support you to make the switch (www.careengland. org.uk/decaf) and would be delighted to work with interested care providers to help build our evidence base.

Finally, we would like to express our gratitude to UHL and Stow Healthcare for their partnership and look forward to working with them to build on these trial results going forwards. A particular thank you also goes to Tetley and NESCAFÉ B2B by Nestle Professional, who kindly provided free decaffeinated tea and coffee for the first three months of the trial.

Find out more about how to switch to decaf at www.careengland.org.uk/decaf or by emailing Ioan Bishop (ibishop@careengland.org.uk).

Sarah Coombes is a Continence Nurse Specialist at University Hospitals of Leicester NHS Trust. Email: tastethedifferencechallenge@uhl-tr.nhs.uk @Leic_hospital

Ruth French is Operations Director at Stow Healthcare. Email: enquiries@stowhealthcare.co.uk @StowHealthcare

Ioan Bishop is Policy and Parliamentary Lead at Care England. Email: ibishop@careengland.org.uk @CareEngland

References

Le Berre M, Presse N, Morin M, Larouche M, Campeau L, Hu YX, Reid I, Dumoulin C. (2020)

What do we really know about the role of caffeine on urinary tract symptoms? A scoping review on caffeine consumption and lower urinary tract symptoms in adults (Neurourology Urodynamics, 2020) Jun;39(5):1217-1233

NICE (2015) Falls in older people: assessment after a fall and preventing further falls (QS86). Manchester: NICE, 2015

NICE (2019a) Urinary incontinence and pelvic organ prolapse in women: management.

(Recommendations. Urinary incontinence and pelvic organ prolapse in women: Management. Guidance. NICE)

NICE (2019b) How should I manage a man with overactive bladder as the predominant symptom? (Scenario: Overactive bladder. Management. LUTS in men. CKS. NICE)

NHS England (2018) Excellence in Continence Care, england.nhs.uk

Roggeman S, Weiss JP, Van Laecke E, et al (2020) The role of lower urinary tract symptoms in falls risk assessment tools in hospitals: a review, F1000Research, 9: 1-8

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Navigating the single assessment framework

When tackling the new single assessment framework, providers need to keep in mind that:

• The regulations have not changed.

• The way you deliver care has not changed.

• What has changed is the way CQC inspects, assesses, and scores.

The landscape of social care inspection in the UK has undergone a significant transformation with the introduction of the CQC’s new single assessment framework. While the fundamental regulations governing social care provision remain unchanged, the methodology of inspection, assessment, and scoring by CQC has evolved.

This article aims to provide a detailed exploration of the framework, offering insights into strategies for navigating this new regime in the most cost-effective manner possible.

The shift from key lines of enquiry to quality statements

One of the most notable changes brought about by the CQC’s new single assessment framework has been the transition from the previous 303 key lines of enquiry to 34 quality statements. On the surface, this reduction in the number of statements might suggest a simplification of the inspection process. However, the reality is more nuanced. While fewer in

number, the quality statements encompass a broader range of elements, requiring a more comprehensive understanding and demonstration of compliance from social care providers.

For providers, adapting to this shift involves a two-fold approach:

1) Keep doing what you’re doing.

2) Start reviewing each quality statement and look at what evidence you have within your service to demonstrate your compliance.

Delivering the care is the easy part. The vast majority of providers are going to score ‘Good’ in ‘Caring’, because caring is what you and your staff teams do. The harder elements of the inspection regime are producing the evidence to demonstrate your service is ‘Safe’, and ‘Well led’. Those two key domains are the ones to focus on. Get these right, and ‘Effective’ and ‘Responsive’ should follow.

The importance of evidence-based compliance

At the heart of effective compliance with the CQC’s single assessment framework lies the concept of evidence. The adage ‘If it's not written down, it didn't happen’ encapsulates the essence of this principle. Providers are required to document their policies, procedures, and training protocols meticulously.

Philippa Doyle, Partner and Head of Social Care at Hempsons, explains how to navigate the Care Quality Commission’s (CQC’s) new inspection regime in the most cost-effective way, outlining the essential steps your business needs to take in preparation.

This documentation serves as tangible evidence of their commitment to delivering safe, high-quality care.

Moreover, compliance extends beyond mere documentation. Providers must also demonstrate a proactive approach to risk management and continuous improvement. This involves not only identifying potential risks but also implementing measures to mitigate them effectively. Additionally, providers must ensure that their staff are adequately trained to respond to various scenarios and that these training initiatives are well documented.

Key areas of focus

Within the framework of the CQC’s new single assessment, two key domains emerge as focal points for providers – safety and effective leadership. While delivering compassionate care may come naturally to many social care professionals, effectively demonstrating safety and leadership poses unique challenges.

Safety encompasses various dimensions, including physical safety, infection control, and medication management. Providers must ensure that their facilities are safe environments for both patients and staff. This involves conducting regular risk assessments, implementing robust infection

control measures, and maintaining accurate records of medication administration.

Effective leadership, on the other hand, involves fostering a culture of accountability, transparency, and continuous improvement within the organisation. Leaders must lead by example, prioritising patient safety and staff wellbeing at all times. This entails promoting open communication channels, soliciting feedback from both staff and service users, and implementing mechanisms for learning and improvement.

Unpacking the quality statements

To effectively navigate the CQC’s new single assessment framework, providers must delve into the specifics of each quality statement. Providers should also keep in mind how the quality statements frame questions in a different way. As an example, let's examine the first ‘Safe’ quality statement on learning culture.

Quality statement one – learning culture

‘We have a proactive and positive culture of safety based on openness and honesty, in which concerns about safety are listened to, safety events are investigated and reported thoroughly, and lessons learned to continually identify and embed good practices.’

This statement emphasises the importance of fostering a proactive and positive culture of safety within the organisation. Key elements include:

• Openness and honesty – encouraging staff to report safety concerns openly and honestly.

• Thorough investigation – conducting comprehensive investigations into safety events and incidents.

• Continuous learning – extracting lessons from safety events to identify and embed best practices.

Providers are expected to provide evidence across various categories, including feedback from partners, organisational processes, duty of candour records, and evidence of learning and improvement. Compliance with this quality statement requires a multifaceted approach, involving organisational learning, continuous improvement, and adherence to regulatory standards such as duty of candour (Regulation 20).

Aligning with the fundamental standards

In addition to the quality statements, providers must also ensure compliance with the fundamental standards outlined by the CQC. These standards serve as the baseline for assessing the quality of care provided by social care organisations.

Let's explore some of the key regulations relevant to safety and effective leadership:

• Regulation 20: Duty of candour – providers must be transparent and honest in their dealings with patients and their families, particularly in cases of safety incidents.

• Regulation 17: Good governance – providers must demonstrate effective governance structures and processes to ensure the delivery of safe, high-quality care.

• Regulation 12: Safe care and treatment – providers must assess and mitigate risks effectively, ensuring the safety of patients under their care.

Practical tips and strategies

Compliance with the CQC’s new single assessment framework requires a comprehensive understanding of the regulatory landscape and a proactive approach to risk management.

Here are some practical tips and strategies for providers:

• Stay updated – keep abreast of changes to regulations and guidance issued by the CQC.

• Document everything – maintain thorough records of policies, procedures, and training initiatives, ensuring compliance with regulatory standards. You should also consider that you might need to present evidence in a different way to get the best marks.

• Proactive risk management – conduct regular risk

assessments and implement measures to mitigate identified risks effectively.

• Foster a culture of learning – encourage staff to engage in continuous learning and improvement initiatives, fostering a culture of accountability and transparency.

• Seek expert advice – don't hesitate to seek guidance from legal or compliance experts when navigating complex regulatory issues.

Navigating the path ahead

In conclusion, navigating the CQC’s new single assessment framework requires a proactive and systematic approach to compliance. By prioritising safety, effective leadership, and evidence-based practice, social care providers can demonstrate their commitment to delivering high-quality care. In addition, by unpacking the quality statements, aligning with fundamental standards, and implementing practical strategies, providers can navigate this new inspection regime in the most cost-effective manner possible.

Providers can find out more on the topic from the recording of the first of four Care England webinars, run by Hempsons, titled, ‘CQC single assessment framework: Quality statements analysis and how they link with the fundamental standards of care’. The recording can be found on the Care England website at www.careengland.org.uk/cqcwebinar. Care providers can also register for the upcoming second webinar, titled, ‘CQC Well Led Quality Statements: An analysis’ on the Care England website.

Hempsons offers training to assist providers with the CQC’s new single assessment framework and also to ensure you are operating in accordance with the fundamental standards of care.

If you need any help, you can also contact Hempsons’ free social care advice line for up to 30 minutes' free advice. Call 01423 724056 or email socialcare@hempsons.co.uk.

Philippa Doyle is a Partner and Head of Social Care at Hempsons. Email: p.doyle@hempsons.co.uk @hempsonslegal

Fixing the workforce crisis:

An end-to-end solution for adult social care

In response to the publication of Care England’s latest workforce solution, Building the Future Care Workforce: An End-to-End Solution for Recruiting and Retaining Care Staff, the report’s partners provide a whistle-stop tour of the essential guidance.

The adult social care sector faces substantial challenges in recruiting and retaining qualified professionals. This crisis is exacerbated by demographic change, an ageing population, and increasing rates of multimorbidity resulting in higher demand for care. The gap between demand for care and workforce capacity is now growing to unsustainable levels.

Staffing shortages have a real impact on the viability of care providing organisations, existing members of staff, and the people who draw on care and support services. According to Care England and Hft, as a result of staff shortages in 2023, over half (54%) of care providers increased agency use, 44% turned down new admissions, and 18% had to close services altogether.

Unfortunately, recent Government initiatives to address workforce challenges in social care have failed to deliver meaningful outcomes. Where investment has been made, the impact has been minimal – 84% of care providers reported that the grants administered by Government in 2023, including the Market Sustainability and Improvement Fund – Workforce Fund, had no impact on the financial sustainability of their organisation.

To support care providers, local authorities, and other partners to address the workforce crisis in social care, Care England has partnered with four innovative services – Care Character, Care Friends, Jobtrain, and Vivup – to develop an end-to-end solution that increases recruitment, develops staff, and supports careers in the sector over the long term.

In isolation, each of these services has been shown to have a significant impact on recruitment and retention. Brought together, the solutions enhance and improve outcomes for care staff, providers, and those drawing on care,

beyond any single recruitment and retention solution available in the market today.

Care Friends: Digital employee referral programme (ERP)

One of the most effective ways of recruiting into the sector is using the existing workforce as recruiters and rewarding them for identifying those not already in a paid care role. Thus, ERPs can be used to grow capacity and offer incentives for hires that address specific diversity and inclusion goals.

According to the latest Employee Referral Benchmark Study 2023, the adoption of ERPs is rapidly increasing as employers recognise their effectiveness in finding top-quality candidates.

The report highlights that:

• 74% of companies are now implementing an ERP, indicating its popularity as a hiring strategy.

• Employers rate that referred hires are 71% better in terms of quality compared to non-referred hires, showcasing the value of employee referrals.

• Referred candidates have a faster hiring process compared to non-referred candidates.

• ERPs have been shown to result in a 38% lower turnover rate, reducing the need for constant recruitment at a cost of between £4,000 and £6,000 per hire.

Care Friends is a well-established digital ERP for the care sector. The Care Friends app provides a digital platform that makes it easy and rewarding for care workers to choose who they would like to work with, and to identify and connect with those in the local community with the values necessary to work in a direct care role. It also deliberately incentivises recruitment of those ‘new to care’, thus growing capacity where, when left to their own devices, individual employers prioritise hiring existing care sector staff.

Data from Care Friends shows that care providers using the platform can source between 15-30% of their annual hires via referrals, up from an average of between 0-7% with a traditional referral scheme. These hires have a much lower turnover rate (up to six and a half times lower in the first year of employment) than hires from internet job boards, delivering a significant return on investment.

Some of the many benefits of Care Friends include:

• Enhanced recruitment efficiency.

• Improved retention rates.

• Increased local capacity growth.

• Building long-term recruitment infrastructure.

• Giving care workers a performance bonus.

• Cost savings and return on investment.

Care Character:

Values-based recruitment

Values-based recruitment is a model designed on recruiting those that have demonstrated the values consistent with working in the adult social care sector.

At the most fundamental level, values-based recruitment and retention is about ensuring quality of care. Not qualifications or previous experience, but a measure of how well an individual will deliver care, alongside a measure of how their values match with those of your organisation (perhaps this being a secondary measure).

Traditional recruitment methods are characterised by a focus on skills and prior working experiences. However, this can result in new recruits that are less suited to care work subsequently leaving the sector altogether, or supporting existing care workers to move between care services at significant cost to the employer.

Values-based recruitment considers values as better criteria for workforce selection. The main point at the core of the model is that skills and experience can be learned, while values are an

individual trait that cannot be acquired. When values-based recruitment is combined with a focus on learning and development, the solution is even more effective.

Skills for Care’s data shows that 62% of staff recruited via values-based recruitment practices have lower rates of sickness and absence. 72% of staff employed using a ‘values based’ approach perform better than those recruited via traditional methods. Skills for Care estimated a 23% return on investment when adopting a values-based recruitment approach.

Care Character is a recruitment and retention assessment tool specifically designed for the care sector. It is based on academic research from the PhD study, Recruitment and selection in the UK care sector, conducted by Dr John Michael Barratt.

The aims of the research included establishing criteria for the effective performance of care workers in adult social care and developing a strategy for the recruitment and selection of effective care workers. The study also identified the drivers of retention and attrition in the adult social care sector.

Care Character’s Care Qualities are: communication; compassion and empathy; dutifulness; teamworking; inclusivity and respect; adaptable and resilient; and procedural compliance.

As part of the recruitment process, candidates complete a short online assessment that is designed to evaluate their behaviours and skills across these Care Qualities. The recruiter or hiring manager then receives four reports based on the results, recorded on a 10-point scale.

The four reports integrate values-based recruitment into every part of the process. One goes to the candidate to help them reflect on their suitability and prepare for their interview. The second goes to the interviewer, who can use it to assess suitability

and access tailored interview questions.

The third report can be passed to individuals receiving care and family members to help them better understand their carer’s qualities. The fourth report is crucial to the onboarding process. It’s used by new staff members and their line managers to guide learning and development, which helps with improved retention.

Care Character’s Care Qualities should be the minimum starting point for care organisations, given the rigour behind the research. They can be adapted for individual organisations but are essential values and skills that are the focus of values-based recruitment in the care sector.

Jobtrain: Applicant tracking system (ATS)

Manual, labour-intensive and often inefficient hiring processes contribute to an average hire time of 78 days across the adult social care sector. As a result, valuable applicants are often lost and accept offers elsewhere. This is often because onboarding and compliance processes are protracted and lack engagement between hiring companies and new hires ahead of their start date.

Online recruitment software (commonly called an ATS) is a suite of tools designed to manage every aspect of the hiring process securely online and automate many of the manual and time-consuming tasks associated with managing hiring, This includes online applications, assessment, interview booking/scheduling, tracking of compliance and onboarding, engaging new hires, and access to real-time insights and data.

ATS software increases candidate engagement throughout the process, reducing recruitment administration by at least 50% and hiring time by as much as 60%. This helps to avoid agency and overtime/shift enhancement costs backfilling vacancies at

up to double the cost of an employee.

The Jobtrain ATS addresses these challenges by prioritising candidate experience, streamlining recruitment processes, ensuring compliance, and enhancing communication with new hires.

The adoption of an ATS not only meets the immediate recruitment needs but also offers a significant return on investment by optimising resources and improving overall workforce management.

The Jobtrain ATS provides a sophisticated but easy-to-use onboarding and compliance hub to manage every aspect of the offer, onboarding, and compliance process with full audit trails and visibility for stakeholders.

All aspects of offers, contracts, checks, references, and new starter forms can be managed, tracked, and signed securely online via a self-service hub for new hires and employers, significantly speeding up the hiring process.

Some of the ways in which Jobtrain solves recruitment challenges include:

• Increased reach and engagement with potential candidates and increased quality applications.

• Reduced administrative burden of care recruitment.

• Fast and efficient new hire onboarding and compliance.

• Increased acceptance rates.

• Enhanced employee engagement.

• Reduced turnover.

• Increased new hire performance.

Vivup: Employee assistance and wellbeing programme (EAP)

EAPs have been shown to improve retention rates. They support care staff as employers can equip the workforce with the tools they need to build personal resilience and deal with issues before they escalate, become difficult to treat, or affect workplace performance and presenteeism.

An EAP keeps staff well and at work by supporting their mental, physical, and financial wellness with a blend of preventative and in the moment solutions, such as telephone and face-to-face counselling. Further, using an EAP solution helps employers demonstrate commitment to the workforce and in turn, attract and retain more valued staff by enhancing employee benefits, offering a solution equivalent to a £1,500 per annum pay rise.

Demonstrating a commitment to employee wellbeing through long-term solutions, such as preventative mental health support and financial assistance, Vivup helps organisations within the care sector establish themselves as an employer of choice. In turn, these organisations will be better positioned to attract more talent and ensure that talent stays on board, by offering a secure career that supports staff now and in the years to come.

Some of the benefits of Vivup for care providers are:

• Reduced absence rates.

• Alternative to increasing pay.

• Reduced burnout.

The positive impact of providing this kind of mental and financial support is already being felt in other care-related organisations. Cwm Taf Morgannwg University Health Board provides community, primary, mental health, and hospital care to 450,000 individuals in the local community. During the pandemic, it became clear that a dedicated mental health programme was needed to safeguard employee wellbeing after leaders realised their existing services no longer met requirements given the huge spike in anxiety, stress, and uncertainty.

An EAP solution provided three vital strands to form good mental health habits in and out of the workplace. First, a 24/7 telephone helpline calmed the high levels of fear and anxiety being experienced by staff and reassured them that support was always available. Next, access to responsive counsellors with high referral rates allowed for more in-depth mental health care. Finally, a wide range of available online resources enabled staff to initiate self-help behaviours to work through challenging times.

To read Building the Future Care Workforce: An End-toEnd Solution for Recruiting and Retaining Care Staff, visit the Care England website.

Neil Eastwood is Founder and Chief Executive Officer at Care Friends. Email: neil@carefriends.co.uk @CareFriendsApp

Damien Wilkins is Customer Success Manager at Care Character. Email: damien.wilkins@carecharacter.com @care_character

Giles Heckstall-Smith is Director of Strategic Development at Jobtrain. Email: giles@jobtrain.co.uk @JobtrainATS

Tristan Rigby is Head of Wellbeing at Vivup. Email: tristan.rigby@vivup.co.uk @wearevivup

Lauren Hague is Policy Officer at Care England. Email: lhague@careengland.org.uk @CareEngland

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HOW TO... ACHIEVE ECO PATIENT HYGIENE AND SUSTAINABLE GOALS IN YOUR SETTING

Jessica Efford, Managing Director at Waterless Limited, explores how care providers can deliver sustainable outcomes for their businesses, without compromising on delivering high-quality, person-centred care, whilst reducing costs.

In recent years, the Government and some households have changed their mindset to make their homes greener in terms of vehicle emissions, less waste, and cleaner energy. In the social care sector, ‘green plans’ are being implemented to ensure the settings in which care is provided produce as little carbon as possible, are energy efficient, and use renewable energy sources wherever possible. But providers may overlook how greener principles can be implemented in the delivery of personal care to care home residents.

Seeking clarity

So, how can we make this easier and highlight genuine products that help reduce carbon, save money, and deliver exceptional personal care? First of all, let's start with the pitfall of ‘green washing’ – this is where claims are either misleading, or false, to get you to purchase products and services based on green-tinted glasses. For example, ‘Designed in the UK’ and ‘Formulated in the UK’ does not mean ‘Manufactured in the UK’, so

emissions will remain high. This also acts as a detriment to the local economy, stopping the stimulation of job availability and business development.

The term ‘Fully recyclable’ plastic is also quite a stretch as this mainly suggests the material is a plastic that is recyclable. Most are not, and that’s not good enough. Even after the Government has incentivised recycled material, products are still being made from 100% virgin polymer plastics without any recycled material. We should look towards 100% recycled or biodegradable plastic alternatives, such as sugar cane, for example.

Reducing costs

Now you are aware of some of the less genuine claims, let's look at costs. If you are a manager, it is important to look at the total ‘cost of use’ not just the cost of the product. When we look at personal care consumables and solutions, a lot of the time items appear cheaper, but you will find

they are not a concentrate, or are several millilitres (ml) less, an example being aerosol free, skin cleansing foam, available from Nilaqua, a Waterless Limited brand. Although this is more expensive than aerosol-based products, you only pump 0.5ml per pump and target specific areas. In the end, you are saving 50% of costs by using only one bottle, instead of two aerosols.

With waste becoming more stringent, it is also important to look at waste management. Are products recyclable, how much space do they take up, are they single use, will I need to pay to dispose of more waste? Elsewhere, do you offer cycle to work schemes; are you using renewable energy? These changes often make a big difference, and in some cases do not cost much or any more. Walk and cycle to work schemes promote healthier lifestyles for your staff and may leave them feeling fresher for the day ahead. You do not necessarily have to provide a bike, but you could offer an area to change and wash, or a water bottle etc. These are great ways to support the environment, but they don’t directly impact on the people being cared for.

Managing time

Staff time is critical – it is the largest cost for care providers, averaging at around 67% of total costs, and staff need to be able to complete their jobs efficiently and effectively. It is not helpful implementing product changes that are going to increase time spent on the delivery of personal care, especially given the workforce challenges currently faced by care providers. Products that can save you time as well as money are always worth considering. Some simple examples include rinse free cleaning and biodegradable wipes and concentrate floor cleaners and sanitisers, but what about personal care?

In terms of personal care products, Waterless Limited has been pioneering water saving, eco alternatives since 2009. Nilaqua provides a range of eco personal care products, which have been tested by experts and proven to be cheaper when considering the cost of use, including the cost of energy,

water, and care delivery time. The products also reduce emissions.

Essential solutions

The following five essential solutions for care homes will save money (up to 50%) and contribute to the green pledges you may wish to make in support of the CQC's new quality statements:

1. Shampoo wraps. Swap single use, plastic shampoo caps, made abroad, to UK-made biodegradable shampoo wraps, which can be microwaved to a comfortable temperature and are versatile for washing around sutures and long hair.

2. Incontinence cleansers. Swap incontinence aerosols, to dual use aerosol free, dermatologically tested body and incontinence cleansers, allowing you to purchase fewer products.

3. Foaming soap. Do you know the difference between foaming soap and liquid soap? This is a classic case of appearing cheaper. Foaming soap lasts twice as long as liquid soap. As foam appears bigger, users do not over pump the bottles.

4. Eco refill dispensers. There is not always time and knowledge to blend and mix sachets to create the perfectly dosed surface spray or hand soap. However, there is no excuse to not use bulk refills when it comes to alcohol free hand sanitiser and foaming hand soap. When you break down the cost of five litres, you will find it is often less than one pence per wash.

5. Wet wipes. They clog drains, break macerators, and take years to break down. We always recommend an aerosol free skin cleansing foam instead. However, if you insist on wet wipes, try bamboo patient cleansing wipes in 100- or 500wipe tubs (remember that bulk buying is cheaper). With pull through tub lids to stop the wipes drying out, further waste can be reduced by using eco refills to replace the wipes inside the tubs. This avoids binning the plastic and the eco refills are much cheaper, ensuring you can be environmentally friendly without incurring costs.

Sustainable outcomes

Business effects from switching to Nilaqua include streamlining time spent completing personal care tasks, such as washing hair, by up to 50% compared to traditional methods. In addition, switching to Nilaqua eradicates the need for additional products, such as moisturisers – using alcohol-based gels reduces energy, water, and waste costs, achieved by not turning on that metered

‘We trialled Nilaqua’s Towel Off Shampoo and Body Washes as the eco option and this was hugely successful, showing a reduction in stress, aggression, and time. We recommend Nilaqua for these situations, not only from an eco perspective but for the health and wellbeing of our residents.’ Castlemeadow Care.

‘Just wanted to update you on the use of the shampoo wraps this morning in our namaste session. It went down amazingly and was so easy to use! Lauren and I were very impressed and are keen to see this implemented for our use within our home.’ Reminiscence Co-ordinator, Llys Cyncoed Care Home.

‘Your products have been a great hit and have worked wonders. Two people living with dementia and four people at the end of life have been able to have a good wash and hair wash without causing any distress or discomfort. The shampoo has

Person-centred focus

Finally, it is all very well being eco friendly as a service, but it has to also benefit the people in receipt of care. They need to feel clean, be comfortable with any switches, and the fragrance needs to be to their taste. People deserve the best at all stages of life, especially when it comes to care. Nobody wants to use the product that has a medicinal feel or smell. These little touches create a comforting pleasant experience and more importantly, help to restore dignity and reduce the resource needed to deliver personal care, which can be intimidating and uncomfortable for some residents.

shower, running a bath, or binning hundreds of large wet wipes and then paying to have the waste removed from site.

These simple switches can reduce the total cost of providing personal care by up to 50%. They also promote an eco-friendlier care service whilst enhancing personal care delivery and comfort to residents. At this point, it’s important to hear first-hand from those who have switched and made advances in their sustainability journey.

made a huge difference in promoting both dignity and respect. The families are now looking to purchase from you. Thank you so very much for sharing such excellent and innovative products with care providers.’ Jo Ardrey, Apple Homecare.

A study into hair care in the NHS

Waterless Limited in partnership with Maidstone and Tunbridge Wells NHS Trust, has explored the eco options of patient care, aiming towards net zero. In this study, we looked at the impact of switching shampoo caps and traditional methods with Nilaqua’s Towel Off Shampoo.

The study concluded that Nilaqua is the most environmentally friendly and cost-effective solution for patient bathing in terms of plastic waste, local economy impact, water use, and CO2 emissions. The full study is available on request.

Care England has negotiated a 20% discount to use at www.nilaqua.co.uk, just enter the code ‘CareEngland24’ at checkout.

In addition, Nilaqua is stocked by all reputable distributors to the sector for those who wish to purchase via their usual consumable suppliers.

Email: sales@waterlessltd.co.uk Search ‘Waterless Limited’

Jessica Efford is Managing Director at Waterless Limited.

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Empower ing care providers to find digital solutions

The digital care revolution can seem confusing and overwhelming. Here, Blythe Senior, Director at Care Tech Guide, offers advice and guidance to help care providers embrace technology to transform their businesses and shares tips to overcome challenges.

In the fast-paced and ever-evolving world of care, providers are continually faced with the challenge of selecting the most suitable software solutions to enhance their services whilst meeting the diverse needs of people in their care. There are also additional considerations, such as managing tight budgets and keeping up with ever-changing regulations.

With a vast array of options available, ranging from care management systems to resident engagement platforms, the process of choosing the right technology can be challenging and overwhelming. This is where organisations such as Care Tech Guide step in to provide invaluable support and guidance to help care providers embrace technology to transform their businesses.

LUNCH & REFRESHMENTS are included

5th November 2024 Pride Park Stadium, Pride Park, Derby DE24 8XL

Bringing the quality of a national conference to a local stage. The EMCAA Conference is a FREE event, focusing on the issues that matter to providers in the East Midlands region.

• Presentations are delivered by leading sector representatives offering expert insight into the local landscape.

• Network with like-minded providers, learn more about delivering best practice in a changing market.

• Exhibition of carefully selected services and products.

• Registration is FREE and includes lunch and refreshments throughout the day.

www.caremanagementmatters.co.uk/event/east-midlands-care-association-alliance

Where to start

We understand that some care providers feel lost in the sea of digital solutions, which can lead to many problems, one of which is not knowing where to start. Care Tech Guide has built an extensive Knowledge Hub to help educate people about the different types of technology available, the features of them, and their benefits to stakeholders. This is a free resource for care providers to explore and learn so you can start your digital journey with a solution that will bring you benefits and solve your biggest problems first. The following section describes the essential features of three key digital solutions that can revolutionise your business.

Care planning software has transformed social care environments, benefiting care providers, staff, and people drawing on care and support. This digital solution streamlines planning, communication, and care quality by automating records and providing a centralised view of care plans. Customisation meets individual needs, freeing staff from administrative tasks to focus on compassionate care. Real-time updates promote transparency and collaboration among people receiving care and support, families, and staff, enhancing overall outcomes. For more information, visit https://caretechguide.co.uk/careplanning-deep-dive-features-and-benefits.

eMAR (Electronic Medication Administration Record) is a digital system used to manage and document the administration of medications to the people you support. The traditional Medication Administration Record (MAR) is a paper-based, manual record that staff use to document details of medication administration with an increased risk of human error throughout the process. The eMAR system digitalises and automates the medication administration process, offering several advantages over the traditional paper-based methods.

Many care providers often consider the option of implementing eMAR and care planning software either simultaneously or sequentially. Certain care planning solutions offer medication management features, facilitating the recording of dosages, scheduling medications, and logging them on an electronic MAR chart. This sets them apart from a comprehensive eMAR system, which encompasses a broader range of electronic medication administration functionalities, with the key difference of having a direct pharmacy integration which automatically updates medication prescriptions to reduce manual entry even further. For more information, visit https://caretechguide.co.uk/ emar-deep-dive-features-and-benefits.

Rostering software is designed to efficiently create and manage staff schedules, including planning shifts around training and meeting commissioned hours. This software maintains employee information, compliance rules, staffing budgets, and automating

schedule creation and management to save administrative time and enhance efficiency. It tracks time and attendance, manages time-off requests, schedules shifts, and provides statistical analysis. By preventing under or over staffing and schedule conflicts, it improves customer service quality, transforming workload management in care homes and social care environments. For more information, visit https://caretechguide.co.uk/rostering-deep-divefeatures-and-benefits.

Transitioning from paper-based processes to digital systems can streamline tasks, automate repetitive processes, and reduce time spent on administrative tasks.

Why digitise?

There are many reasons to digitise your processes: saving money can be a big driver, and many systems can offer a good return on investment within the first year by increasing the efficiency of your administration processes, reducing staff turnover therefore reducing recruitment costs.

Consider the sheer volume of paperwork involved in your current processes – the printing, copying, and storing of thousands of documents. Not to mention the cost implications and the hassle of ensuring compliance with data retention policies. How many times have you found yourself driving to a service just to retrieve information buried in a filing cabinet?

By digitising your systems, you not only eliminate these inefficiencies but also gain greater transparency and remote access. Plus, the ability to analyse your data swiftly and derive insights from reporting tools empowers you to make more informed decisions. It's not just about saving costs – it's about transforming your operations for greater agility and effectiveness.

Digitising care processes offers a multitude of benefits beyond cost savings. One significant advantage is the increase in time efficiency. By transitioning from manual, paper-based processes to digital systems, care providers can streamline tasks,

automate repetitive processes, and reduce time spent on administrative duties. This newfound efficiency allows staff to allocate more time to direct care with those that you support, improving the quality of service and enhancing the overall care experience.

Additionally, digital systems enable real-time access to critical information, facilitating quicker decision-making and response times. Ultimately, embracing digitalisation in care processes not only saves time but also enables care providers to deliver more effective and timely care. With improved access to comprehensive information and better communication channels, care providers can deliver more personalised and timely care tailored to the specific needs of individuals, leading to increased care and improved outcomes for the people they support.

Increasing data accuracy is another paramount benefit for care providers thinking of moving to digital solutions. With manual, paper-based methods, there's a higher risk of errors, misplaced documents, and incomplete records. Transitioning to digital systems ensures that data is entered accurately and consistently, reducing the likelihood of mistakes and discrepancies.

Digital platforms often include built-in validation checks and error alerts, prompting users to correct any inaccuracies in real-time. This not only improves the reliability of data but also enhances the overall quality of care delivery. By ensuring that client information is accurate and up-to-date, care providers can make more informed decisions, provide tailored interventions, and ultimately improve client outcomes. Additionally, accurate data is essential for regulatory compliance and reporting purposes, helping care providers demonstrate accountability and adherence to standards of care.

Empowering the sector

As social care undergoes digital transformation, it's crucial to ensure that staff wellbeing remains a central focus. Digitisation can alleviate administrative burdens and streamline processes, allowing staff to dedicate more time to meaningful interactions with the people they care for. By implementing user-friendly digital tools and providing comprehensive training, care providers can empower staff to embrace technology confidently and efficiently.

Digital solutions can facilitate better communication and collaboration among care teams, fostering a supportive work environment and enhancing job satisfaction. Additionally, digitisation can enable staff to access relevant information and resources more quickly, reducing stress and improving

overall efficiency. By prioritising staff wellbeing alongside digital innovation, care providers can create a positive and sustainable work culture that ultimately benefits both staff and the individuals they support.

Care Tech Guide’s user-friendly interface makes it easy for care providers to explore digital solutions by product categories. We’ve found common problems experienced in care and identified their digital solutions, so you don’t have to spend hours deciding which technology you need. At the core of Care Tech Guide’s platform is a curated directory of over 500 products, carefully selected to meet the diverse needs of care providers. Whether it's optimising staffing and scheduling or enhancing resident experiences, our platform offers a comprehensive range of solutions to address everyday challenges in caregiving.

Too often, crucial decisions hinge on the charm of a salesperson or a whirlwind of product demos, leaving buyers with little time to spare for deeper research. While suppliers offer reference customers, their selections can often be biased. Recognising the significance of trustworthy reviews, we've developed our review system over years, incorporating feedback from various stakeholders.

Our platform strikes a careful balance between transparency, brand representation, and unbiased consumer insights. Care providers gain access to verified peer reviews, ensuring reliability in decisionmaking. Each review undergoes rigorous vetting to maintain platform integrity. Subscribed suppliers can respond, showcasing their dedication to customer satisfaction. This feedback loop not only strengthens suppliers' market reputation but also provides valuable insights for care providers in their decisionmaking process.

Care Tech Guide brings support and guidance for care providers navigating the complexities of the digital care landscape. Our commitment to empowering care providers with knowledge, resources, and trustworthy reviews is unwavering. With our extensive Knowledge Hub, curated directory of products, and transparent review system, we strive to simplify the process of selecting and implementing digital solutions. At the heart of Care Tech Guide lies a passionate team dedicated to enhancing and elevating caregiving services within the social care sector. With our collective expertise and deep understanding of care technology, we stand ready to guide care providers through the ever-evolving world of digital solutions.

Sign up for free today on the Care Tech Guide website at https://caretechguide.co.uk, explore the Knowledge Hub at https://caretechguide.co.uk/ knowledge-hub, find new technology, and leave a review on any product you’re already using.

Blythe Senior is Director at Care Tech Guide. Email: engage@caretechguide.co.uk Search ‘Care Tech Guide’

Maximising Funding, Minimising Stress with MINT: Your Essential Toolkit for Social Care Negotiations

Now more than ever, data solutions are key to managing rising costs against increasingly constrained authority budgets. Fraser Rickatson, Policy and Funding Lead at Care England, showcases Care England’s Market Intelligence Tool (MINT), designed to equip providers with insightful funding and market data.

Robust data is crucial to demonstrate the need for funding to sustain services. The MINT system empowers care providers with data, enabling them to advocate for financial support to ensure sustainable, quality care. In a powerful, easy-to-use solution, MINT delivers comprehensive insights into a range of continually updated Care Quality Commission (CQC) and funding datasets reflecting the latest developments, empowering care providers to stay ahead when setting and negotiating care fees.

Market intelligence

Having market intelligence is crucial when entering fee negotiations. MINT provides insights into CQC data by location, local authority jurisdictions, ownership, and registration status, and includes a breakdown of every care service's CQC ratings in full. This allows care providers to present a full report of the local market, outlining how their services compare to competitors within a set radius. Understanding your position in the market strengthens your bargaining power with authorities and integrated care boards (ICBs).

MINT offers detailed CQC information on local health services and pharmacies, enabling providers to make informed decisions about partnerships and identify gaps in services. Knowing the makeup of the local population is important to help providers tailor their services to meet specific community needs and demographics. By presenting this data on a heat map of the population with downloadable reports, MINT ensures providers have the tools to effectively lobby for funding and enhance the sustainability of their services.

Funding

MINT's 'Funding dashboard' is a game-changer in negotiating fees. This unique tool provides

comprehensive profiles of every commissioning authority in England, delivering both the latest and historic fee and funding data.

MINT provides extensive, detailed information, from 2018 onwards, for older people and working-age adults, to empower providers with insights into funding trends and patterns. This encompasses minimum, average, Fair Cost of Care, and the highest rates paid by the authority, along with uplift rates and percentages offered by authorities and their neighbours.

The volume of data in MINT's funding dashboard allows providers to compare their rates with regional averages, and against particular authorities, to identify discrepancies between what local authorities should pay and what they actually pay, highlighting any gaps and enabling providers to build a compelling case for sustained or increased funding.

Other data

MINT’s ever-expanding and evolving dataset ensures care providers have essential information for fee negotiations. Including the latest average private fees per service type per local authority area and offers insights into how other providers’ ESG strategies influence commissioning practices. Key data on continence, NHS continuing healthcare (CHC), and NHS-funded nursing care (FNC) payments for every ICB are highlighted.

Moreover, MINT offers resources developed by Care England and our legal partners, including briefings, template letters, and calculation sheets, to guide providers through challenging and negotiating fees, and has contact information for engaging with authorities and ICBs.

MINT offers exclusive access to data on every authority’s capacity and demand, both historic and current. It details the recent funding received and provides a report outlining each authority’s commissioning practices for the coming year. This information, available only through MINT, empowers care providers with unparalleled insight to navigate and anticipate future trends, ensuring you can effectively plan and advocate for necessary funding and support to sustain and enhance your services.

MINT is an essential asset for any care provider seeking to navigate the complexities of authority funding and secure the best outcomes for the people you support. See how MINT could benefit your organisation. Visit www.careengland.org.uk/mint

Fraser Rickatson is Policy and Funding Lead at Care England. Email: frickatson@careengland.org.uk @CareEngland

LEGAL MATTERS

Deprivation of Liberty Safeguards reform

Neil Ward, Partner at Mills & Reeve, updates on the Deprivation of Liberty Safeguards, drawing on the latest sector commentary to discuss the damning impact of Government’s stagnated reform.

Deprivation of liberty

DoLS is a process which ensures depriving an individual, who lacks capacity, of their liberty is in the person’s best interests, is necessary to prevent harm to them, and is a proportionate response to the likelihood and seriousness of that harm. It is a process which is to be followed by the authority responsible for the individual’s care.

The legal test to establish whether someone is deprived of their liberty is whether they are under continuous supervision and control and are not free to leave. In practice, this is the case in many environments where people are receiving care and treatment, such as care homes and hospitals.

Age UK published a recent report, A Hidden Crisis: Older People and Deprivation of Liberty in Care Homes, which found that the system for protecting the fundamental right to liberty of older people with diminished capacity is in ‘urgent’ need of reform. The report found that the backlog of Deprivation of Liberty Safeguards (DoLS) applications waiting for authorisation exceeds 100,000 – ‘so big it will probably never be eradicated’. The charity found that almost 50,000 older people have died without proper legal safeguards in place.

If someone lacks capacity to consent to such arrangements (known as ‘P’ in Court of Protection proceedings), the arrangements will need to be authorised. If P is living in a care home, the relevant framework is the DoLS. Under the DoLS framework, the care home must ask the local authority if they can deprive P of their liberty. Assessments will then take place to determine whether the arrangements are in P’s best interests, before the deprivation of liberty is authorised by way of ‘standard authorisation’. If the care home needs to authorise the deprivation of liberty in the interim, an ‘urgent authorisation’ can be put in place.

DoLS reform delayed

The DoLS framework was first introduced in 2009 and has received significant scrutiny from healthcare professionals implementing the framework and the House of Lords Select Committee in its 2014 report. The process is regarded as overly complex and bureaucratic, adding to the backlog of applications.

As such, the Government has committed to replace DoLS with a new framework known as the Liberty Protection Safeguards (LPS) since the Mental Capacity (Amendment) Act was introduced in 2019. The LPS scheme is intended to improve human rights outcomes for those deprived of their liberty, with the introduction of a simplified authorisation process applying to all settings, not just care homes and hospitals. The process would be more streamlined than DoLS and embedded into existing care planning. The aim is to better support those with dementia, learning disabilities, and autism who may need assistance with their everyday decision making.

However, the Government announced in April 2023 the implementation of LPS would be delayed ‘beyond the life’ of the current Parliament. Since then, the Government has not announced any further support for DoLS or funding to tackle the backlog.

Uncertainty ahead

It is unfortunate that LPS continues to be kicked into the long grass, with no certainty of when it will come into force. It does mean that those required to implement DoLS in

We

know DoLS is not the easiest framework to use but it is here to stay, at least for the foreseeable future.

health and social care settings must ensure they have the required resources, staffing, and understanding of the principles of the Mental Capacity Act and sufficient training to guarantee good practice.

We know that DoLS is not the easiest legislative framework to use but it is here to stay, at least for the foreseeable future. It is vital that care providers continue to make applications in line with the Mental Capacity Act 2005 to ensure that the rights of those who may lack the relevant capacity are protected.

Contact Mills & Reeve if your DoLS team requires support with managing your processes and/or training. It has an expert and friendly team that can support you and your teams. For more information, visit the Mills & Reeve website.

In addition, a Guide to the Court of Protection (CoP) and Deprivation of Liberty Safeguards (DoLS) for the Busy Care Home Manager can be found on the Care England website.

Neil Ward is a Partner at Mills & Reeve. Email: neil.ward@mills-reeve.com @MillsandReeve

A PATH TO RESILIENCE: A blueprint for smaller providers

Fraser Rickatson, Policy and Funding Lead at Care England, summarises the latest commentary from leading sector consultancies and service organisations that provide solutions to sustain Small and Medium Enterprises (SMEs) or prepare them for an exit which maximises their commercial value.

The independent adult social care sector continues to face significant financial and operational challenges despite warnings from the sector, driving 56% of care providers to consider exiting the market altogether according to the 2023 Sector Pulse Check report, which could be devastating for both older people and working-age adults.

Many larger organisations can navigate these challenges more effectively through restructuring, securing additional funding, or utilising existing assets, or using costly consultancy practices less accessible to SME providers, which constitute over 60% of the sector. Without adequate support, these vital SME services are at a heightened risk of closure, potentially destabilising the sector and leaving many without essential support. Regardless of the obstacles faced by SMEs, the demand for care homes is set to increase. Demographic shifts are changing the profile of care

seekers, who are likely to enter care later in life with more complex needs, with expectations of hotel-like standards. Meeting these demands necessitates significant investment in infrastructure, technology, and innovation, further straining smaller providers struggling due to continued underfunding.

Nonetheless, the landscape, though daunting, is not devoid of prospects for smaller providers. By adapting the strategic approaches outlined in this feature and those taken from our Future Proofing Care report, SME providers should be empowered to tackle challenges head on.

Recognising distress

Providers must stay alert to early distress signals and take swift action to mitigate them. A key signal of a care home facing difficulties is a drop in occupancy rates, which significantly impacts revenue and, if not addressed, can lead to more severe financial issues.

Equally important is the feedback from regulatory bodies like the Care Quality Commission (CQC), where repeated poor reports indicate that immediate corrective action is needed to prevent damage to reputation and avoid increased scrutiny.

Addressing issues such as financial mismanagement, escalating debts, and cash flow challenges early, using strategic interventions, can prevent further decline, setting care homes on a path to recovery.

Furthermore, the role of staff competency and engagement in delivering high-quality care cannot be understated. Addressing skill gaps with training and upskilling programmes is crucial for improving care quality and staff morale, which is pivotal for a successful turnaround. Lastly, rebuilding trust with stakeholders, including regulatory bodies and local authorities, involves comprehensive audits and action plans.

A robust response

A proactive approach is fundamental, focusing on early detection and swift action to address potential problems, as outlined previously. Key to a successful turnaround is conducting independent business reviews and engaging interim managers.

These reviews provide an objective assessment of a care home's health across operations, finance, and compliance, pinpointing critical areas for immediate improvement. Interim managers offer new insights, identifying and rectifying overlooked inefficiencies,

leading to transformative changes.

Collaboration with stakeholders, including families, local authorities, and regulatory bodies, forms a comprehensive strategy for improvement. This partnership enhances the care home's services and public image, supported by community involvement and advocacy.

Sharing best practices promotes a culture of learning and adaptation, crucial for maintaining competitiveness. Technological integration is imperative for modernising operations, enhancing care delivery, and engaging with broader communities. A robust online presence optimised for search engines, and activity on social media, extends a care home's reach and improves its reputation.

Physical improvements

Renovating or refurbishing care homes offers a cost-effective way to meet modern standards, comply with regulatory requirements, and achieve operational profitability without the financial strain of constructing new facilities. Despite the challenges posed by a lack of capital, renovation allows for the upgrade of facilities at a significantly lower cost, approximately £60k per room, compared to the new build costs of £125k to £150k per room.

This approach not only maintains existing operations and income streams, but also makes it possible to attract capital by meeting modern layout standards and ensuring regulatory compliance for the foreseeable future.

For example, two care homes, one derelict and one bought from administration, significantly enhanced their services through cost-effective strategies. The provider renovated a 1970s council dormitory with 57 beds into a modern, 50-bed facility divided into four zones, achieving new-build standards at half the cost. Situated in a deprived area, the revamped home has since maintained over 99% occupancy and was awarded ‘Best care home in Scotland’.

Cosmetic upgrades, while low-cost, can significantly improve the atmosphere of a home, making it more inviting and comfortable for residents. A residentcentred approach to refurbishment is critical, which can be achieved by involving both staff and residents in the planning process to ensure that changes meet the actual needs of those living and working in the home.

Securing finance or investment

While it can be a challenge, exploring diverse lending options and engaging in discussions with lenders is crucial. Employing a specialist team with care sector experience from the beginning can greatly assist in securing finance that supports both the development and expanding needs of operations.

Investors and lenders have distinct preferences and evaluation criteria, including strategic alignment for trade investors, low risk focus for debt lenders, growth potential

for equity investors, and stability for real estate investors. Understanding these preferences is essential for tailoring proposals and negotiations.

Approaching banks necessitates transparency and the presentation of empirical evidence to support applications. Banks assess care homes based on various factors, including inspection reports, annual accounts, occupancy levels, and the financial performance of the facility.

The loan's terms, such as the loan to value ratios, interest rates, and covenants like debt service cover and leverage, are crucial elements of financing arrangements. These terms vary widely depending on the lender’s assessment of risk, the operational model of the care home, and the borrower’s financial health and track record.

Effective financial management, including proactive forecasting and transparent communication about staffing and operational challenges, is critical for maintaining a strong relationship with lenders. Lenders prioritise projects that demonstrate a clear path to profitability and compliance with operational standards.

Third-party financing, when done correctly, plays a significant role in ensuring that care providers can undertake necessary refurbishments, adapt to evolving regulatory standards, and enhance their service offerings to remain competitive in a challenging market.

A fresh perspective

A management takeover offers a strategic solution which enables owners to mitigate challenges by outsourcing day-to-day operations to care home operators. This approach allows owners to maintain ownership benefits while relieving them of the operational stress, ensuring efficient management and maximisation of returns.

Additionally, management takeovers can enhance a care home's market value through improved operational systems and updated regulatory ratings, making it an attractive option for those considering an exit strategy.

For those looking towards ownership transition, management buyouts provide a pathway for the existing management team to assume ownership, leveraging their operational expertise for the home's continued success.

Employee share ownership plans offer a tax-efficient method for this transfer, fostering a sense of commitment and alignment with the company's goals among employees. The flexibility in the seller’s posttransition involvement offers a customisable approach to ensure continuity and support the business’s strategic evolution.

Market dynamics

With a significant portion of care homes at risk of becoming outdated, understanding market dynamics is essential for navigating the challenges and seizing opportunities within the sector.

Awareness of the evolving landscape, including the aesthetic expectations of care homes and

the financial implications of operating older facilities, enables providers to strategically position themselves. This involves recognising the potential for displacement by newer, modern homes and the competitive pressures exerted by larger operators and those with access to more substantial liquidity and innovative design approaches.

For smaller providers, being attuned to the market means understanding the risks associated with older facilities, which may become uncompetitive without significant investment and reconfiguration.

Yet, it also highlights the opportunity for repurposing or transitioning homes to meet current demand in other sectors, such as mental health or non-care uses, thereby opening alternative revenue streams. Additionally, the awareness of funding trends is critical for planning future financing and investment strategies.

Smaller care home operators need to be proactive in assessing their position within these market dynamics, recognising when and how to act to enhance their competitiveness. This might include leveraging the unique appeal of older, potentially converted homes that can offer a more homely atmosphere at competitive rates.

Exit planning and preparedness

Exit preparedness is essential for care providers aiming for a successful transition, as the journey from marketing to finalising sales demands meticulous planning at every stage.

The initial presentation of the business to potential buyers sets a critical precedent, necessitating a strategic approach to negotiations and the due diligence process. A thorough grasp of the sale procedure, particularly the intricate due diligence phase, underscores the importance of enlisting specialised legal and financial advisers.

Understanding the fluid nature of value – shaped by changing market conditions and the perceptions of potential buyers – is crucial for aligning expected prices with the realities of the market. Early preparation, rectifying any operational or financial concerns, and possibly shifting towards a more corporate operational model, can significantly widen the appeal to a diverse array of investors and lenders.

Pre-sale preparations, or ‘housekeeping’, ensures that the business's operational facets, including employment practices, property management, and adherence to regulatory standards, are beyond reproach. Strategically managing site visits and engaging in welltimed negotiations, informed by a solid understanding of the current market landscape, positions the business advantageously in the eyes of potential purchasers.

Highlighting the care sector's enduring resilience and the business’s readiness for future challenges, coupled

with proactive succession planning and comprehensive operational documentation, markedly increases the business's attractiveness, paving the way for a smooth and beneficial sale.

For care providers, laying the groundwork early is imperative for securing the best possible return on their investment. This entails a detailed comprehension of what potential buyers and financiers are looking for, adjusting business models to meet these expectations, and establishing a detailed reporting system to satisfy informational needs.

The strategy for exit readiness should also tackle strong succession planning and the demanding due diligence expected by buyers. Cultivating a positive reputation and presenting the business as both sustainable and prepared for future challenges are crucial for attracting favourable investments.

By proactively planning for exit, care providers can ensure a more seamless transition and lucrative sale, effectively leveraging market opportunities to maintain the business’s relevance and desirability in an ever-changing sector.

The Future Proofing Care report is a ground-breaking paper, exploring in detail solutions to help sustain the adult social care market, and written by industry experts in their fields to offer every care provider a digestible solution to help sustain, turn around, grow, or develop their services in an unstable and ever-changing social care sector. The report is now available on the Care England website and its authors have been listed below.

Report authors

Tony Stein, Chief Executive Officer, HM Solutions.

Carol Higgins, Business Development Director, HM Solutions.

Andrew Whelan, Director, Westcott Care.

Tony Thiru, Chief Executive Officer, Fulcrum Care.

Jimmy Johns, Director, Christie Finance.

Lee Howard, Regional Director, Christie & Co.

Lucy Corner, Managing Director, Cornerstone Care Solutions Ltd.

Jeremy Huband, Consultant, Cornerstone Care Solutions Ltd.

Dipe Rajani, Director, Miva Care.

Claire Wheatley, Partner, RWK Goodman.

Bharti Moore, Partner, RWK Goodman.

Claire Wheatley Partner, RWK Goodman.

Charles Leach, Director, Salus Properties.

Fraser Rickatson, Policy and Funding Lead, Care England.

Fraser Rickatson is Policy and Funding Lead at Care England. Email: frickatson@careengland.org.uk @CareEngland

In this, the second of a series of four webinars, Philippa Doyle, Head of Social Care at leading health social care and charity lawyers, Hempsons, will examine two of the CQC’s ‘Well Led’ Quality Statements and provide you with insight and guidance into what the CQC is looking for when assessing you against these questions.

MEMBERS' VOICE

Your questions answered ??

At Care England, we are always keen to hear from our members and we strive to answer any questions and queries our members may have. In this issue of Savings, Solutions, and Sustainability, Charlotte Lezard, Policy and External Affairs Lead at Care England, provides the answers to support providers with questions about third party top-ups, workforce wellbeing strategies, navigating local authority fee uplifts, and more.

Q: How do we access the higher NHS-funded nursing care (FNC) rate of £324.50 announced for 2024/25?

Charlotte Lezard: Individuals in your care will only receive the higher rate if they qualified for the highest FNC rate before October 2007 and continue to do so. We have worked tirelessly with the Department of Health and Social Care since 2014 to ensure that the FNC rate reflects the true cost of providing nursing care.

The standard rate from 1st April 2024 is £235.88 after a cost collection exercise completed in late 2023 and represents an uplift of 7.4% for both the higher and lower rates. This represents a win for the care sector operating in a challenging time and is a testament to our collective efforts.

Q: Care providers are now being charged to transact with Tradeshift, the electronic invoicing solution used by the NHS Shared Business Services, which we were told when we integrated would be free to use. Can they do this?

CL: Subscription tiers apply to those sending more than 600 invoices per year. Tradeshift has confirmed that they currently have no intention to remove access

to the platform if care providers do not pay for a subscription and send more than 600 invoices per year. However, the care provider will not be eligible to use the Tradeshift technical support services until they do pay for a subscription as this is for paid subscription members only.

What this effectively means is that care providers can continue to send their invoices via the Tradeshift platform free of charge; however, should they require any technical support from Tradeshift they will need to subscribe to the relevant tier. Tradeshift’s terms and conditions state that they reserve the right to charge for this service in the future.

Q: Can I charge third party top-ups? Some local authorities have introduced measures that limit how much can be charged under a top-up or have completely restricted providers from charging them.

CL: We have prepared a briefing note informed by RWK Goodman which reflects upon this issue, providing clarity on the key conditions of top-ups, when they can be charged, and when they can be restricted and/or limited.

Continued →

In essence, local authorities shouldn’t put in place restrictions that inhibit providers from charging top-ups. Some local authorities incorporate and impose restrictions via contracts and/or frameworks; however, this may be challengeable. If you would like a copy of the briefing note, contact info@careengland.org.uk.

Q: As an organisation we are revamping our workforce wellbeing strategy. Do you know of any resources or examples which you could share to help?

CL: Skills for Care, the strategic workforce development and planning body for adult social care in England, has a page dedicated to wellbeing support which you can review within its ‘Support for leaders and managers’ page. Within this suite of assets, I would draw particular attention to the ‘Wellbeing resource finder’.

We offer deals with commercial partners available via our ‘Resources and guidance’ website page, ‘Care England discounts and free support.’

For further inspiration, you can read our Building the Future Care Workforce paper, which includes Employee Assistance Programme Vivup, which boosts retention through proactive solutions such as financial support forums and burnout prevention strategies. For more information, see pages 22-26.

Q: Do adult social care providers have to introduce the Patient Safety Incident Report Framework (PSIRF) into their services?

CL: PSIRF covers anything that meets the definition of a patient safety incident. Whilst it isn’t mandatory for all social care providers, it is mandatory for all CQC-registered providers who contract under the NHS Standard Contract. There are several guidance documents on the NHS website (or type ‘NHS PSIRF’ into your search engine). You will need to weave the framework into your safety incident response policy and plan.

An organisation’s patient safety incident response policy should describe the overall approach to responding to and learning from safety incidents. PSIRF has four key principles: compassionate engagement and involvement of those affected by patient safety incidents; application of a range of system-based approaches to learning from patient safety incidents; considered and proportionate responses to patient safety incidents; and supportive oversight focused on strengthening response system functioning and improvement.

Q: How is Care England helping care providers overcome poor local authority fee uplifts this year?

CL: We have produced a lobbying pack with Anthony Collins solicitors which contains lots of helpful information to aid negotiations with local authorities, available via the ‘Resources and guidance’ page of

our website. We suggest when writing letters, you review this first to ensure you can quote the right Care Act or Framework terms to get the best possible outcome. There is also a great piece on personal budgets within the pack which might be helpful.

Care England members also have access to our MINT system (the system that will allow you to benchmark local authority fees). MINT is available via our website where you can find out more about the system and learn how best to use it to satisfy your requirements.

We also currently have a panel of free legal advice available to you as a Care England member, available via the ‘Care England discounts and free support’ page of our website.

Q: We are looking to prepare for an assessment under the single assessment framework. Are you able to help?

CL: We know that the new regulatory approach is one of the biggest priorities for providers, so we’re making sure the sector can be prepared for an assessment. Recently, we ran a webinar with our legal partners at Anthony Collins, which gave an overview of what providers can do to be prepared for the new framework, and how to challenge a decision using the factual accuracy process or rating review. The presentation slides and meeting notes can be found via the ‘Regulatory and Governance Special Interest Group’ page on our website. A further webinar will be hosted on 2 July. See page 44.

As well as resources for providers, we are working with senior figures at the CQC to help overcome issues with the framework. We have heard concerns from across the sector about several elements of the new approach, and we are raising these and offering pragmatic solutions to ensure the way care is regulated is proportional and consistent.

We would welcome any feedback providers are willing to share about their experience of the single assessment framework to help inform ongoing dialogue. Email Charlotte Lezard at clezard@careengland.org.uk.

Charlotte Lezard is Policy and External Affairs Lead at Care England. @CareEngland

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