Care Management Matters December 2013 by Care Choices Ltd

CMM CAREMANAGEMENTMATTERS

DECEMBER 2013 ÂŁ4.00

THE ROAD TO RECOVERY Elderly care in 2014

5 minutes with... Andrea Sutcliffe

Interest Rate Swaps An update

Empathy in dementia Can it be taught?

Includes 4-page Skills Academy insert: Focus on Leadership Development: How you can develop leadership capacity in staff at all levels

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IN THIS ISSUE regulars 05

editor s welcome

Is it just me...? Editor in Chief, Robert Chamberlain discusses the disparity between fees paid by self-funders and local authorities.

News

Property News

Local Authority and Planning News

Corporate News

In Focus

5 minutes with...

Andrea Sutcliffe, the new Chief Inspector of Adult Social Care at the CQC is the subject of this special, extended interview.

Business Clinic Our panel look at the recent purchase of Crystal Fountain Village by its residents.

Spotlight on... Care sector training providers.

Conferences reviewed CMM reviews the North West and Berkshire Care Conferences, the NCF Managers Dialogue Conference and the LCS 14th Annual Healthcare Conference.

What s On?

Straight Talk

features 16

One door closes...An update on Interest Rate Swap Contracts Keith Lewin summarises recent developments with Interest Rate Swaps.

Alicia Wood discusses the CQC s plans to regulate supported living.

Elderly care â&#x20AC;&#x2019; on the road to recovery? Is the elderly care market likely to pick up momentum in 2014? Amanda Nurse shares her predictions.

Dementia care needs empathy Rosemary Hurtley and Julia Pitkin explore the need for empathy in dementia care.

Gold Standards Framework With Liverpool Care Pathway being phased out, Professor Keri Thomas explains why the Gold Standards Framework successfully supports people at end of life.

Welcome to CMM. As we bring 2013 to a close with this December issue, I m naturally drawn to reflecting on the year and how the sector has fared. It s been a tumultuous period, with increasing pressures but much to be optimistic about too. Our features this month are as reflective of the year as I am. On page 16, Keith Lewin draws the year to an end with a summary of progress with the Interest Rates Swap scandal. Compensation has been slow and providers need to act fast if they are to start the process within the timescales. Next year will hopefully see more movement and resolution for those affected. Amanda Nurse looks at the future of the elderly care market on page 21. If this is your sub-sector of social care I think you ll be interested by what she has to say about the future of elderly care in 2014. As we look to next year and beyond it is clear that there are a number of new workforce roles required to deliver personalised, integrated care. On page 39, Debbie Sorkin shares examples of organisations that are already developing their workforce and helping staff to prepare. I m pleased to report that we have an exclusive interview with Andrea Sutcliffe the new Chief Inspector of Adult Social Care at CQC. In an unprecedented change to our 60 seconds with... feature, we ve renamed it 5 minutes with... as we know there s a lot that you want to know about the future of regulation. On that note, I wish you all the best for the remainder of 2013 and into 2014. It s a time of continual change and we need to pull together to face the changes head on.

Emma Morriss Editor

The shock of the new: how providers are helping their staff prepare for integration Debbie Sorkin looks at the changing social care workforce.

Follow CMM on Twitter @cmm_magazine

CMM DECEMBER 2013 ÂŚ 3

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CMM CAREMANAGEMENTMATTERS

editorial panel Des Kelly OBE,

Mike Padgham,

Executive Director, National Care Forum

Chair, UKHCA

Professor Martin Green OBE,

David L Jones,

Chief Executive, English Community Care Association

Partner, Deloitte

Andrew Sidwell,

Paul Ridout,

Partner, GVA

Partner, Ridouts LLP

Andrew Barnsley,

Zoe Farrell,

Managing Partner, Nexus Corporate Finance LLP

Training Development Director, Catalyst for Care

December 2013

EDITORIAL AND PRODUCTION editor@caremanagementmatters.co.uk Editor in Chief: Robert Chamberlain Editor: Emma Morriss News Editor: Des Kelly Design and Production: Lisa Werthmann, Jamie Harvey, Nick Cade & Holly Cornell Editorial Assistant: Rebecca Northfield ADVERTISING sales@caremanagementmatters.co.uk 01223 207770 Advertisement Manager: Tracey Diplock tracey.diplock@carechoices.co.uk Business Development Manager: Paul Leahy paul.leahy@carechoices.co.uk SUBSCRIPTIONS info@caremanagementmatters.co.uk To request your free copy of CMM call 01223 207770 www.caremanagementmatters.co.uk Care Management Matters is published by Care Choices Ltd who cannot be held responsible for views expressed by contributors. Care Management Matters © Care Choices Ltd 2013 ISBN: 978-1-909048-78-2 CCL REF NO: CMM 10.9

contributors Alicia Wood, Chief Executive, Housing & Support Alliance Amanda Nurse, Founding Director, Carterwood Andrea Sutcliffe, Chief Inspector of Adult Social Care, Care Quality Commission Debbie Sorkin, Chief Executive, National Skills Academy for Social Care John Lucas, Partner, Hazlewoods Julia Pitkin, Dementia Care Coach and Trainer

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CMM magazine is officially part of the membership entitlement of:

Keith Cockell, Chairman, English Care Villages Ltd Keith M Lewin, Senior Partner, Brunswicks LLP Professor Keri Thomas, National Clinical Director, Gold Standards Framework Centre Michael Voges, Executive Director, Associated Retirement Community Operators

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

4 ¦ CMM DECEMBER 2013

Rosemary Hurtley, Managing Director, 360 Forward Ltd

is it just me...?

Is it just me...? Editor in Chief, Robert Chamberlain, discusses the findings of a new study published in The Telegraph into care home fees for self-funders. Consultancy group Valuing Care has carried out a study to ‘expose’ how the privately-funded are charged a premium by care providers. The findings, published in the money section of The Telegraph (11/11/13), show that those who pay for their own care are routinely charged a premium over the amount charged for their state-funded counterparts.

;/, -05+05.: The report, conducted through mystery shopping exercises, states that £636 per week is the average fee in care homes in England and councils typically pay 25% less for placements they fund. The ‘premium’ charged to non-state-funded residents varies from £6,780 to £9,750 per year dependent on which part of the country a home is situated. The South West is highlighted as a region where private residents pay up to £170 per week more than the relevant council pays. Weekly fees of £710 per week in this area are contrasted with just £580 in the North West. The study demonstrates how private payers are being forced to subsidise the system. Ray Hart, a director of Valuing Care, commented, ‘Regardless of whether it is under-funding or excess profits, self-funders are paying over the odds, whichever way you look at it.’ The statistics quantify what we already know to be the case. Councils pay below

market rate for care home beds and providers charge higher rates to selffunders to square the financial circle. No doubt members of the public will read the report’s findings and conclude that some home owners are taking advantage of wealthier clients to maximise profits rather than acting out of necessity to balance the books. The issue that should be creating a public frenzy is how the purchasing power of commissioners is being used to undercut rates to the degree that those paying for themselves have to make up the difference. If the fees paid by local authorities were more representative of the market rate then the costs to private payers could be significantly reduced.

>69:,505. 70*;<9,& The national average of approximately 50 per cent of all placements being made by councils could yet rise, adding further to this issue. The Government’s proposed social care funding reform will raise the threshold for local authority financial assistance from the current level of £23,250 to £123,000. This means that more individuals will qualify for funding, increasing the proportion of placements made by councils and further strengthening their collective buyer power. To compound the issue, I am told by our readers that there is evidence to suggest that councils actively try to

place people in homes that do not require a top up, placing greater limitations on achievable income and a greater emphasis on private client fees.

*/(5., (/,(+ The current pilot of direct payments being used to purchase residential care is an interesting development. In theory, the widespread adoption of this approach will reduce the number of placements organised by commissioners. It is difficult however to understand how the freedom granted by a direct payment to control one’s own care package translates to care home placements. Without a council’s buyer power, individuals will not be able to negotiate discounted fees from providers but I assume that their budgets will be set at a level similar to that paid by an authority. Unless councils negotiate fees on behalf of individuals, contradicting the ethos of controlling one’s own care arrangements, it is challenging to see how this will work in practice. Top-ups would surely become commonplace to make up the shortfall in budgets versus fees. Perhaps this is the fairest way to stabilise the disparity between fees highlighted in this report and reduce the need to charge self-funders a premium? 0M `V\ ^V\SK SPRL [V JVTTLU[ WSLHZL LTHPS YVILY[ JOHTILYSHPU'JHYLTHUHNLTLU[TH[[LYZ JV \R

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• Corporate • Local authority • Planning News editor - Des Kelly Impact of funding reforms The Care Bill will expose the gap between council and self-funder rates for residential care and put additional pressure on councils to raise fees, says a new Independent Age study. The report warns that councils must receive more resources for adult social care to avoid the Government’s funding reforms driving care homes out of business. It’s widely accepted that the fees of self-funders crosssubsidise local authorities. However, in applying current top-up rules to self-funder topups, local authorities will, by necessity, have to eliminate some of this cross-subsidy that exists in the market for care homes occupied by both self-funders

and council-funded users. In effect, some self-funders only entitled to a proportion of the ‘usual cost’ rate as a contribution to their care costs will be nevertheless transferred to ‘usual cost’ fee levels. This change is likely to put significant pressure on the income of care providers, who in turn will seek higher fees - an increase in the ‘usual cost’ rate - from their local authority. Given providers have already absorbed downward pressure on fees in recent years in the context of public spending cuts, it is likely that to avoid forcing providers into bankruptcy, local authorities will have to increase their

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‘usual cost’ rates. This suggests that a key consequence of the 2016 care funding reforms and the new category of self-funder top-ups is that local authorities will have to spend more than existing projections allow for in order to fulfill their duties. The report concludes that the Government must review public spending projections for demand for local authority social services budgets following April 2016, and evaluate whether public spending allocations to local Government from 2016 need to increase more than currently projected in order to address the growing shortfall between local authorities’ ‘usual cost rates’ for care and fair market prices.

Quality tops NCF managers’ priorities The result of the ballot, conducted at the NCF Managers Conference, shows the overwhelming priority of managers is that of delivering quality care and support – and for a third successive year. NCF has conducted a ballot to capture the current manager priorities at the Managers Conference for the last nine years. For the last three years asking the question ‘As a manager in the care sector, what matters to you?’ The results, based on frequency of mention, are: 1. Quality of care (2012: 1; 2011: 1)

2. Recruiting and retaining the right staff (2012: 4; 2010: 3; 2009: 2) 3. Funding/budgets and sustainability (2012: 10; 2010: 1; 2009: 1) 4. Relationships – people receiving care and support and their families (2012: 9) 5. Regulation and compliance (2012: 9; 2010: 2; 2009: 4) 6. The value of a skilled, welltrained and motivated workforce (2012: 6; 2011: 3; 2008: 4) 7. Media image and portrayal of care services (new entry)

Leonard Cheshire Disability has appointed two new managing directors in its Corporate Affairs Team: Peter Jenkins, Managing Director of External Affairs and Jane Harris, Managing Director of Campaigns and Engagement.

8. Delivering person-centred care and support (2012:2; 2011: 2) 9. Compassion (new entry) 10. Arts and creativity (new entry) 22.9% of the responses ranked quality as the highest priority. Recruitment and retention (2nd) attracted 21.6% of delegates, with funding also reappearing in the top three ranking. Interestingly there are three new entries reflecting new concerns with ‘media image’, ‘compassion’ and ‘the arts’.

Clare Pelham, Chief Executive of Leonard Cheshire Disability, has been appointed as chair of the Voluntary Organisations Disability Group (VODG). TOGETHER TRUST CEO Together Trust has appointed Mark Lee as Chief Executive. He takes over the role from David Marriott who has retired. BUPA COMPANY SECRETARY Bupa has appointed Alan Buchanan as Company Secretary. RBS HEALTHCARE The Royal Bank of Scotland Healthcare team has appointed Richard Henshaw as Business Development Director. HPC EXPANDS AGENCY Specialist healthcare property consultancy HPC has appointed James Richards to its agency team. LNT SOFTWARE John Rowley has joined CoolCare as Sales Manager.

AREA MANAGER FOR HOME CARE SOLUTIONS Home care specialists Home Care Solutions have appointed Suhail Chaudhry as a new Area Manager for its Northern branches.

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CMM DECEMBER 2013 ¦ 7

news

Workforce integration is ‘weak’ A study commissioned by Skills for Care has found that the evidence base for workforce integration between social care and health is ‘weak’. The study supported by Think Local Act Personal, looked at articles on workforce integration published

since 2002. The report focused on five key themes central to the integration agenda which were organisational structures and behaviours, staff roles, staff recruitment and retention, human resource management and regulation,

communication/ICT and, finally, training and education. The review was part of the development work to help create fit for purpose Principles of Workforce Integration that will drive change across the two sectors.

HCPC launches Be Sure The Health and Care Professions Council (HCPC) has launched its Be Sure campaign aimed at care staff, residents, carers and older people. Using a short film drama the campaign is designed to raise awareness of HCPC’s role in

regulating key health and care professionals. In particular, it wants to help people understand the importance of checking that a professional is registered and explain how to raise a concern. This is particularly important

for professions who work with the public directly such as social workers in England, hearing aid dispensers, chiropodists/ podiatrists, physiotherapists, occupational therapists and dieticians.

Adult social care ‘unfit for purpose’ The adult social care system is ‘fundamentally broken’ and ‘unfit for purpose’ health experts have warned. This damning indictment is contained in a new policy paper issued by the University of Birmingham and Birmingham City Council, following an in-depth study of adult social care provision by

local authorities across England. The policy paper, Turning the welfare state upside down? Developing a new adult social care entitled offer calls for a new approach to adult social care. The report also calls for recognition that adult social care spending is a form of social and economic investment that

helps people be active citizens, supports people to return to employment and can generate new business opportunities for local people. It also argues for a closer relationship with the NHS so that scarce public resources are used as effectively as possible and the needs of people with complex needs are met in full.

Home care commissioning Local authorities should change how they commission home care, and in particular ensure that workers are paid the minimum wage, according to a review of care published by the Equality and Human Rights Commission (EHRC). The report Close to Home warns that the way care is currently commissioned is unsustainable, leading to inadequate pay, poor working conditions for care workers and increasing threats to older people’s human rights. Although the EHRC recognises the severe financial pressures local authorities face, it found that the rates that some local authorities pay don’t appear to cover the actual costs of delivering care. The EHRC’s Close to Home review found that while budgets represent a constraint on improving contract values, some local authorities have been able to take innovative action in partnership with providers and older people to improve how they deliver care.

Winterbourne review promotes local best practice Throughout England local areas are working to transform the quality, safety and support within care provision for vulnerable adults with learning disabilities and challenging behaviour, says the Local Government Association. Joint working between health services and councils is crucial says the

Winterbourne View Stocktake. Each local area surveyed submitted a review of its own services agreed with local health and social care partners. Over 340 examples of local good practice have been submitted in the interest of sector selfimprovement. The Winterbourne View

Stocktake is a survey of chief executives of local authorities, clinical leads of local clinical commissioning groups and the chairs of health and wellbeing boards, conducted in June 2013. The Stocktake was implemented as a direct result of the abuse scandal at Winterbourne View. The self-assessment focuses on

developing necessary provision for people with learning disabilities or autism, who may also have additional mental health needs or behaviours described as ‘challenging’; the aim being, to enable them to live independently in their local communities, rather than in hospital.

multi-agency teams to work together. The tool Integration: step by step is developed by the Social Care Institute for Excellence (SCIE). It supports those professionals by throwing up a series of challenging discussion points,

based on factors, identified through SCIE research, that can help or hinder integration. It includes tips, useful reading, films clips and examples of practice to support discussion.It can be accessed via the SCIE website www.scie.org.uk.

SCIE’s integration tool For some time, people who use services and their carers have been calling for social care, health and other public services to be more joined-up. Organisations that provide services, along with those that commission them, along with policy-makers, now recognise

8 ¦ CMM DECEMBER 2013

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CMM DECEMBER 2013 ÂŚ 9

property news

Target Healthcare REIT Healthcare Property Consultants (HPC) has acted on behalf of private investor Mike Bullas in the sale of two care home investments to Target Healthcare REIT Limited at a price of approximately £11.5 million, including costs. The care homes are situated in St Helens, Merseyside and Longridge near Preston. Both opened in 2008, when they were acquired by Mr Bullas and provide a total of 154 en-suite bedrooms in modern, purposebuilt buildings. The homes are leased to existing operator Orchard Care Homes with a

period of approximately 30 years remaining. Target is a specialist investor in UK care homes and the acquisition sees its portfolio increase to ten care homes since it listed its shares on the London Stock Exchange’s Main Market in March 2013. Target was advised by Richard Harris of Vector Property Group throughout the acquisition.

WCS Care Group has taken possession of Drovers House in Rugby, Warwickshire. With investment totalling £6.5 million, the 75-bed care home is specially designed to facilitate the highest standards of care, including a community living model to give residents better independence and an effective level of personalised care. Working within the

constraints of an existing external design already holding planning permission, Pozzoni worked with WCS Care Group to re-plan the internal layout to suit the client’s operational requirements, incorporating best practice principles for designing for people with dementia. The home is split into six households, each one having its own team of care professionals.

HPC sells former school

BUPA plans for home BUPA Healthcare Homes is planning to build a 62-room care home in Birmingham. The property will be next to the planned £50 million dental hospital, and will contain en-

Care group obtains care home

suite rooms for older people and those with dementia The Pebble Mill site will hold the property, which will have a cinema, a hair salon, and therapy rooms.

A former residential school in Shropshire has been acquired by a private investor in a sale handled by care property consultant HPC. The former Rowden Hill School occupies a rural location west of Shrewsbury and had previously been run by a corporate operator providing day and residential education for children with special educational needs.

Sold…

The property had become available as part of a strategic restructuring to provide more contemporary facilities elsewhere.

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On behalf of private investor Mike Bullas Two care home investment properties

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10 ¦ CMM DECEMBER 2013

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property news

Swanage home in administration £6.5m Gold Standard home A 31-bed nursing and residential issues. However, the business is under construction home in Dorset has been placed continuing to trade, thanks to a into administration ahead of going up for sale. Begbies Traynor has been appointed administrator for The Old Rectory Nursing and Residential Home, run by DAH Healthcare Limited. The care home, whose 21 residents have not been affected by the situation, puts its woes down to cash flow difficulties resulting from historical occupancy rate and staffing

range of stabilisation measures taken by the administrators to ensure its viability in the medium term. The business is expected to become available for sale within the next three months. Care Quality Commission inspectors visited the home in May 2013, reporting positively. The administrators are being advised by care home experts on regulatory compliance and care delivery during this period.

£8m home planned for 2015 Social care specialist surveyors Carterwood has announced that Chiltern District Council’s planning committee has voted unanimously in favour of a new £8 million centre in the region. The home will specialise in 24-hour nursing care for the frail, elderly and those living with dementia, and Porthaven Care

Home Group, Carterwood’s client, should launch it in early 2015. Carterwood had been asked by Porthaven to prepare a detailed planning needs assessment in support of the scheme, in order to overcome challenges encountered in the planning process.

The construction phase of a £6.5 million dementia care home is is underway for Cumbria County Council as part of the North West Construction Framework. GB Group, who is partnering with Alston Murphy Ltd, won the contract for the construction, concept design,

design development and planning application of the care home. The 60-bed building has been designed to meet the requirements of the Stirling University Gold Standard for dementia design. The new home will replace the 32-bed George Basterfield house.

Leicestershire Sale HPC recently advised DRE Healthcare Limited in the sale of their nursing home. Sutton in the Elms Private Care Home in Leicestershire had traded in the same ownership since 1992. Effectively purpose-built throughout, the home offers single en-suite accommodation. Woodgate Healthcare acquired the facility in a competitive bidding process with similar offers being

received from a number of interested parties. The acquisition increases the size of Woodgate Healthcare to six homes. The sale was overseen at HPC by Director Nigel Newton Taylor.

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CMM DECEMBER 2013 ¦ 11

local authority & planning news

Care home to close Lakenheath Village Home, which has 21 beds, is to close. For a number of years, exploration has been conducted to find alternative solutions to

secure the long-term future of the home, but the conclusion was recently made that to operate the home is no longer â&#x20AC;&#x2DC;tenableâ&#x20AC;&#x2122;.

Councillors against care home closure Councillors are backing a campaign to keep a residential care home open in Basingstoke. Deeside care home, which cares for 25 people including those with dementia, was scheduled to close along with four other residential care homes in the county. Borough councillors were asked to respond to Hampshire County Councilâ&#x20AC;&#x2122;s consultation on the controversial plan before the decision is made on December 9. The County Council was

criticised by the Boroughâ&#x20AC;&#x2122;s housing and environment overview and scrutiny committee, stating there was a lack of information. It will cost around ÂŁ2.3 million to upgrade Deeside care home according to Hampshire County Council, and they wish to invest instead in Extra Care schemes, although a member of the county council stated that the exact costing for maintaining and keeping the care home open to residents is still being calculated.

New care homes for Bristol development is part of a vision that Cabinet approved a year ago to deliver a new ten-year programme of extra care housing across the city. The scheme aims to be sustainable and achieve value for money. The new homes are likely to be finished in 2017 if contracts and planning permission are approved.

Bristol will be benefiting from 200 new extra care properties, as well as a new 60-bed dementia care home in the Hengrove area, on a site currently owned by the Council. The Council predicts that Bristol will need over 500 new extra care properties within the next five years and a total of almost 1000 by 2023. The Hengrove area

Extra Care in Cheshire Work on a ÂŁ6 million extra care scheme for older people will start in the New Year. The Halton Housing Trust development â&#x20AC;&#x201C; which will be built in Widnes, Cheshire â&#x20AC;&#x201C; will comprise 50 apartments, and

five supported bungalows. The scheme is designed by PRP Architects and will be named Pingot, replacing the former Pingot Day Centre, which will be demolished if plans are accepted.

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New specialist care home in Norfolk A state-of-the-art care home has recently been opened in West Norfolk. The 62-bed care home, Downham Grange, which is owned by Kingsley Healthcare, specialises in nursing and dementia care for older people, as well as respite and day care. It is a welcome benefit to the surrounding area, as there are no other care homes with

Uncertainty in Lancashire Dozens of small firms are set to face closure in Lancashire. A number of agencies that provide publicly-funded care will be reduced by Lancashire County Council in a bid to cut costs, and the number of closures are still undecided. It is reported that the number may be drastically reduced, which would lead

to job losses and insufficient standards of care for clients. Homecare providers and the County Council are in agreement that the number of agencies must be reduced. They claim that the new agreements will lead to a better service and improvement in staff training and travel times.

Extra care in Nottinghamshire A planning application for an extra care housing scheme, worth ÂŁ21 million, will be submitted in December 2013. The housing scheme â&#x20AC;&#x201C; which will be funded by developers Ashley House, who

is providing ÂŁ19.2 million and Nottinghamshire County Council, with ÂŁ2.1 million â&#x20AC;&#x201C; will include 140 one and two bedroom apartments and bungalows, with 30 extra care units.

Potential closures in Durham Durham County Council is facing cuts of ÂŁ222 million by 2017, and as a result is consulting on five residential homesâ&#x20AC;&#x2122; future. The homes can be repaired, privatised or closed. The homes in question are Cheverley House, Belmont; Feryemount,

Ferryhill; Grampian House, Peterlee; Mendip House, Chester-le-Street and Newtown House, Stanhope. 49 people currently reside at these care homes. It is reported that the consultation on the subject will run until January 2014.

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12 ÂŚ CMM DECEMBER 2013

nursing facilities in Downham Market. It will serve the local community, West Norfolk and the surrounding areas, and will create employment for up to 80 people. The modern purpose-built care home was designed by Feilden+Mawson Architects and built by Morgan Sindall Group PLC. The home cost ÂŁ8 million to build.

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CMM DECEMBER 2013 ¦ 13

corporate news

CMG Refinanced Care Management Group (CMG) recently signed a new refinancing deal which takes effect in December 2013. The new financial package marks the culmination of CMG’s transformation programme, led by Court Cavendish. Court Cavendish has also driven improvements for HC-One

following the Southern Cross collapse. The CMG deal is Court Cavendish’s first total turnaround. Prior to its takeover by Court Cavendish, CMG was struggling to provide the minimum standards of care and was on the verge of financial collapse. Court Cavendish - under the

Choice Care Group expands Choice Care Group is expanding into Buckinghamshire with the development of a new care home for adults with learning disabilities, autism and complex needs. Beech Tree House, in Holmer Green, will provide bespoke care to individuals, enabling them to live successfully

in the community and, importantly, as close to their family and friends as possible. In line with its personcentred approach, Choice has started taking referrals in advance of the home opening to ensure that it is as tailored as possible to the needs of its residents.

Adelphi begins construction Adelphi Care Services has begun construction of two new, specially designed apartments in Shrewsbury. Adelphi operates four care homes in Shropshire for adults with autism, Asperger’s syndrome and other learning difficulties. The new homes will be an extension of this existing provision, allowing those capable of semi-independent living to do so with the help of support staff. The twobedroomed homes, one ground floor flat also suitable for a

person with physical disabilities and one first floor flat, are being built on the site of a previous house in Longden Road and are due to be finished by spring 2014. Joe Kwaterski, business development director at Adelphi Care Services, said the homes were being specially designed to make the life of their occupants easier and less stressful. The combined cost of both the initial site and bungalow and the new building work is expected to be about £350,000.

Shaw Healthcare opens home Shaw Healthcare and Camden Council have opened Maitland Park care home. The new home, the first to be completed under the Homes for Older People programme, was completed in May and will provide accommodation for 60 older people. Maitland Park provides state of the art residential

14 ¦ CMM DECEMBER 2013

care, with each room having en-suite bathrooms, guest rooms for relatives, an activity room, exercise area, café and beauty salon. There are also 35 Extra Care flats where the care is managed by the Newlon Group. Shaw Healthcare has a 30 year, £122 million contract to deliver services to the homes.

leadership of Dr Chai Patel, David Spruzen and Bob Lewis - took over the management of CMG, and in only six years has overseen a fundamental overhaul of the company’s operational and financial performance. £12 million pounds has been invested in services in the last five years with significant additional

investment planned in the coming period. In the deal announced last week, CMG’s syndicate of banks has opted to exchange a portion of CMG’s debt for a 15% stake in the business – demonstrating their confidence that CMG is well placed to continue to grow and thrive.

Ocean Community Services Ocean Community Services has opened its first community home in Bristol. The Services, which are part of Ludlow Street Healthcare Group, opened Overndale House, which will

provide a support service for women with complex and enduring mental illnesses and personality disorders. The house will provide care and accommodation for up to seven users.

Four Seasons restructures Four Seasons has completed restructuring to focus on developing three distinct businesses in strategic areas to be better positioned to meet the needs of changing care markets. The restructure is a national network of more than 370 homes providing personalised dementia and nursing care alongside residential care; a chain of 80 homes offering high quality elderly care together with hotel standard services designed primarily for the self-funding market; and the Huntercombe Group, with 61 hospitals and specialist units, will continue

to provide care, treatment and rehabilitation services in areas of mental health and brain injury that are complementary to the NHS. Each business division, complete with its own senior management team, has been structured in order to meet the needs of the changing care markets. Their regional manager structures have also been reorganised. Dr Pete Calveley has stepped down from his role as Chief Executive, Ian Smith has taken over as Group CEO as well as retaining his role as Chairman.

Avante’s Dementia Care Bond Avante Partnership has partnered with Triodos Bank to issue a Dementia Care 5% Bond to help fund two new projects. The Bond, promoted by its sustainable banking partner Triodos Bank NV, is offering investors an opportunity to help contribute to Avante’s charitable social mission, as well as achieving a sensible financial return. The Bond will go towards

building a new dementia care home on the Isle of Sheppey, Kent which will care for 75 people with dementia and people requiring residential nursing care. As well as implementing an improvement programme for nine of its existing care homes which will involve significant refurbishment works over the next three years. Avante is looking to raise £5 million from the Bond.

corporate news / in focus

Barchester starts build Work has recently started on a high specification care home near Peterborough by Barchester. The care home in Deeping, St James will be complete in November 2014. Cinnamon

Care Capital has purchased the scheme, and is collaborating with LarkPoint to build the accommodation. The care home will provide 60 en-suite bedrooms in a two-storey building.

Cornwall Care to close home Cornwall Care is closing Athelstan House residential home in Bodmin because there is no longer demand for the service it provides there. The not for profit charity has informed the 14 people living at the 38-bed home that Athelstan will close in early December because it has not had any referrals for new

residents for six months. Cornwall Care is focusing on providing all the support it can to assist the residents at Athelstan and their families in making informed choices about where they would like to live. Staff at Athelstan will be able to apply for redeployment within Cornwall Care in other homes or community services.

Castleoak projects Castleoak has handed over three leasehold care home developments with a combined value of £20 million in just eight weeks. Delivering more than 200 high-specification care beds for two of the UK’s leading care operators, Castleoak identified and acquired the land, secured planning permission and funding before completing the design and build. Two of the developments were for Care UK. Brook Court is a 67-bed care home in Kidderminster and Ambleside is a 60-bed care home in Stratford-upon-Avon. Brook Court was Castleoak’s

first development for Care UK. Both of the 30-year lease care homes were funded by the CarePlaces Fund – a partnership between Castleoak and sustainable growth investor, Bridges Ventures. Beaufort Grange, a 74bed care home in Bristol for Barchester Healthcare, is the third of the development handovers. Barchester has entered into a 35-year lease and the development is Castleoak’s first to be backed by MedicX Healthfund – a leading UK healthcare property fund established to invest in premium healthcare property.

ExtraCare Charitable Trust The ExtraCare Charitable Trust has opened its third Birmingham retirement village Based in Edgbaston, the £45 million Hagley Road Village is one of at least five retirement villages planned as part of a £200 million development programme between The ExtraCare Charitable Trust and

Birmingham City Council. The Homes and Communities Agency (HCA) has also provided £1.25 million for Hagley Road village’s development. The village, on the site of the former Lambert Court hotel, will provide 240 homes for more than 350 people over the age of 55.

In Focus: CQC Chief Inspector sets out priorities for adult social services >/(;»: ;/, :;69@& In her first major announcement as the Chief Inspector of Adult Social Care, Andrea Sutcliffe has outlined her priorities for transforming how the Care Quality Commission (CQC) will monitor, inspect and regulate care homes and other adult social care services, with a greater focus on public involvement and improvement. In promoting the Fresh Start, she has talked about making the regulatory approach ‘truly personal’ by asking the question of every care service ‘is it good enough for my Mum?’ Key proposals included in the document are awarding ratings to every care home and adult social care service by March 2016 to help people make informed decisions about their care and establishing expert inspection teams involving people who have experience of care services. The Chief Inspector’s plans and priorities are set out in A Fresh Start for the Regulation and Inspection of Adult Social Care ahead of a full public consultation in spring 2014.

>/(; +6,: ;/, 9,769; :(@& Inspections of adult social care services will be structured around the five key questions that matter most to people – are the services safe, caring, effective, well-led and responsive to people’s needs? CQC intends to rate care services as outstanding, good, requires improvement or inadequate, so that the public has clear information about services. As part of these changes, CQC will explore how its ratings can encourage services to improve and how they can influence the timing of future inspections.

(5+& Other plans and priorities in A Fresh Start for the Regulation and Inspection of Adult Social Care include: 1. From April 2015, subject to the Care Bill becoming law, CQC will monitor the finances of an estimated 50 to 60 care providers that would be difficult to replace if they were to go out of business. 2. CQC will take a tougher stance when registering care services by ensuring that those who apply to run them have the right values, motives, ability and experience. CQC is committed to taking tougher action against services that don’t have registered managers in place. 3. CQC will discuss the risks and potential benefits of mystery shoppers and hidden cameras to monitor care, and whether they could contribute to promoting a culture of safety and quality, while respecting people’s privacy and dignity. 4. CQC will encourage those providing care in residential homes to explore how they can be involved in the local community and will work with Healthwatch to get its views on care homes locally.

>/(; /(77,5: 5,?;& The next steps are for CQC to discuss and explore these proposals with the public, people who use services and their carers, care providers, CQC’s own staff, and organisations with an interest in its work, ahead of its public consultation in spring 2014. The document also raises the issue of building confidence in CQC, avoiding duplication in monitoring and the use of strong internal quality assurance mechanisms. The CQC also commits to ‘building and sustaining strong relationships across the sector’ including through the use of jointly agreed Memorandum of Understanding.

CMM DECEMBER 2013 ¦ 15

One door closes...

AN UPDATE ON INTEREST RATE SWAP CONTRACTS

Keith Lewin follows up his previous articles on Interest Rate Swap Contracts (Swaps) to bring readers up to date with the latest machinations.

he pressure group Bully Banks has been largely instrumental in raising the scandal of Swaps misselling and largely responsible for keeping it in the news over the past 12 months. Bully Banks is pressing Parliament, the financial services regulator – now called the Financial Conduct Authority (FCA) – and the banks themselves to recognise the issue and to ‘do the right thing’ by unwinding those Swaps which ought never to have been contracted. A Swap is a complex financial instrument, a bet, otherwise referred to as a ‘derivative contract’ through which a business could effectively cap the amount of interest that it would pay if, after having borrowed a capital sum, say, £1,000,000, interest rates rose above a specified level. The products are sometimes referred to as a ‘hedge’ against interest rates rising. The flip side of the deal was that if interest rates fell below a certain level, the customer would pay a larger amount to the lender. Undeniably, interest rates are at a historically low level, with Bank of England’s Base Rate just 0.5 per cent. For a customer to get out of the arrangement, banks charge or seek to charge large penalties, which most customers cannot afford. The bet was one which – from a customer’s point of view – was against interest rates rising. Few realised, and the banks didn’t explain, that if interest rates fell, the customer would pick up a large bill. The Swaps were sold to customers with a substantial asset base, typically real estate. Many sectors were targeted, not just care homes: hotels, restaurants, public houses – anyone with a chargeable capital asset.

*<99,5; +,=,3674,5;: As I write this, HSBC and the Royal Bank of Scotland (RBS) announced they will soon begin to make interim payments to businesses which were ‘taken advantage of’ before the ﬁnal resolution of their claims.

16 ¦ CMM DECEMBER 2013

Barclays Bank and Lloyds have said that they too will make an initial payment to customers on a ‘case-by-case basis for those customers in financial distress’. One might expect that all businesses lumbered with such products, which have resulted in them making enormous interest payments over several years, will be in ‘financial distress’. It has been calculated that the mis-selling of Swaps may cost the banking sector £7 billion or more. The banks have provided a fund of £3 billion, setting up departments to process claims. It is reported that banks have spent about £500 million on establishing departments to review all of the Swaps contracts, which are expected to process about 30,000 claims. However, just 30 claims have so far been resolved and the total sum of £2 million paid out. On any view that is not good performance – certainly not for affected customers. At the beginning of 2013, the FCA, which had reviewed 173 Swap arrangements, found that at least 90% failed to comply with regulatory requirements – i.e. mis-sold. Martin Wheatley, Chief Executive of the FCA has said the misselling of these products was a cultural problem. And the FCA said in October that progress on compensation had been slower than expected. Mr Wheatley explained, ‘I welcome the moves to pay compensation in two stages. I’ve been urging the banks to consider what more they could do to ensure the small businesses affected by Swap mis-selling get the compensation they’re owed as quickly as possible.’ He might well do. If the FCA fails to ensure that the banking sector behave properly in this matter its authority will be undermined. If the conduct of the banks in selling Swaps had occurred in the USA, a very different approach would probably be taken. Starting first with imposing very large penalties for their misconduct, then obliging them to properly address the customers so ruthlessly exploited. We may yet see the FCA impose fines on the banks.

CMM DECEMBER 2013 ¦ 17

one door closes...

-<9;/,9 *64730*(;065:

Worryingly, some of the Swaps contracts are further complicated/ undermined by having a direct link to LIBOR – London InterBank Offered Rate – which we all now know was fraudulently manipulated by the very banks who were relying on it when setting interest rates. The mis-selling of PPI (Protection Payment Insurance) to the banks’ retail consumers looks like it’s costing the banks more than £18 billion; it might be that, anxious to keep some ﬁnancial strength in their balance sheets, the banks will continue to go slow on the refunds and compensation, possibly obfuscate and, if at all possible, avoid making payments. A cynical view? Possibly, but, at every turn the banks seem to have failed to meet what the country’s majority consensus would regard as the ‘morally correct thing to do’. Worryingly, the banking regulator required the banks to investigate themselves and to make amends to those customers it decides were mis-sold a Swap. This will seem, to many people, as the banks acting as ‘judge and jury’ in their own cause. Worse, there is no appeal. The only remedy would be to sue the bank. Contracts, if they are to be litigated on before the courts, must be the subject of legal proceedings within six years of the date of the making of the contract. With this information, one can readily see why the banks might be inclined to drag out the time considering such deals. They know that once a contract is more than six years old they can ignore that Swap and that customer with legal impunity. I imagine that as there are many businesses which fall within the legal rule barring actions which are more than six years old that any redress will only be obtained via political and media pressure. Bully Banks, it seems to me, will have a longer life as it presses for all those businesses who have been exploited to be properly treated and compensated. The banks have much to do to rehabilitate their collective and individual reputations; to demonstrate that they have rediscovered their collective moral compass. This, in my view, is a consideration behind HSBC and RBS ‘breaking ranks’ with the rest of the banking sector. They want to be seen as different. As reformed. They could, for example, agree to review all Swaps including those which can no longer be litigated. If they did, they would clearly increase their ﬁnancial liability beyond that which they are legally obliged to do; however, it would demonstrate in concrete terms that they are reformed.

(56;/,9 ;>0:; However, there is yet another twist in the scandal of Swaps deals. In this latest chapter – something which most right-thinking people will regard as, at its lowest, ‘sharp practice’, it has been reported that RBS has been foreclosing on properties which are pledged as part of the Swaps arrangement and then selling them at auction. Taken in isolation, perhaps there is little wrong with that...property will ﬁnd its own true level at a sale by auction. However, foreclosure is an ‘aggressive’ act by a bank seeking to rehabilitate itself and seeking to do the right thing by making initial payments to those it has deemed were mis-sold a Swap. Auction sales typically take place at pricing levels below the price one might reasonably expect as a market value between

18 ¦ CMM DECEMBER 2013

a willing seller and willing buyer. The buyer at the auction of properties repossessed by RBS has sometimes been West Register – another part of the RBS empire. Jeremy Roe from Bully Banks said of these sales, ‘It’s a scandal that needs to be investigated. What was a major high street bank doing acquiring such a substantial property portfolio from its customers? ‘If you stand back and look at what RBS has done you have to say questions come immediately to mind and they are questions which we’re saying require investigation and require an answer.’ These reports require further investigation by the FCA and throw into question whether the banks should be allowed to be judge and jury in their own cause. There simply is an inadequate level of transparency in the whole process of reviewing Swaps and deciding whether they were mis-sold. As mentioned above, one of the factors to keep in mind is that in the Swaps review process currently underway, if the bank doesn’t view the arrangement as having been mis-sold there is no process for appeal, and one faces having to sue the bank at a time when the business has been starved of cash by the payments made to the banks under the Swaps contract. For many businesses mis-sold Swap contracts in 2007 and 2008 they are soon going to fall foul of the court limitation provisions. Those with contracts entered into earlier than 2007 will already effectively be barred from bringing a claim before the courts. For such businesses an alternative might be to stop paying the sums due and force the bank to bring the claims before the courts based upon the business’ failure to meet its contractual obligations and then, in defending, argue that the contracts were mis-sold. Clearly, this is high risk and requires careful thought and strategic planning with lawyers – don’t simply stop paying. Meantime, if you/your business has been mis-sold Swap contracts, notify your bank and the FCA to ensure that they are aware of your assertions so that the facts and circumstances can be considered.

796.9,:: On 14th October 2013 there was an appeal hearing in the Court of Appeal in the conjoined cases of Guardian Care Homes v Barclays Bank and Unitec v Deutsche Bank. Each of the cases were previously heard by High Court judges who were asked to give permission to the claimants to plead improper manipulation of the LIBOR rates. Mr Justice Julian Flaux in the Guardian case gave the permission, Mr Justice Jeremy Cook refused it. Therefore the cases went before the Court of Appeal to decide whether the additional claims relating to LIBOR could be added into the cases. A decision will not be available for some time. Guardian Care Homes is suing Barclays Bank for sums up to £70 million. So the stakes are huge for Guardian and are likely to have much wider ramiﬁcations if Guardian succeeds in this aspect of its case. The Guardian case is due to go for full trial in 2014. I will no doubt then report again. CMM -VY 2LP[O»Z WYL]PV\Z HY[PJSLZ VU PU[LYLZ[ YH[L Z^HWZ ZLL *44 4HYJO HUK *44 1\S` 2LP[O 4 3L^PU PZ :LUPVY 7HY[ULY H[ )Y\UZ^PJRZ 337 2LP[O 3L^PU'IY\UZ^PJRZ L\

CMM DECEMBER 2013 ¦ 19

WHY HAVE YOU DECIDED TO MERGE? We decided to merge because we were increasingly having the same position on policy and we believed that by merging, we could strengthen the voice of the independent care sector. We also believe that this is a critical time for the health and social care sector and the potential of what our services could do is not well understood by either health or social care commissioners. We believe that by joining forces, we will have a stronger platform to show what

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There can be no argument that the period between 2008 and 2012 has not been the easiest for the care sector property market. The sharp decline in residential property values, linked to the ﬁnancial downturn, passed onto the care home sector. It was like catching a cold from a fellow passenger in a

crowded tube train; not to stretch the metaphor too far, the care home property market then entered a particularly dark tunnel, with no visible light at the end. As someone who has been involved in selling care homes and care businesses since 1990 I can’t remember a more depressed or depressing period for the industry. Up to the end of 2012, trading conditions were as difﬁcult as I have known, with values written down and access to capital severely restricted. The market slowed and then stopped.

.,5<05, 67;040:4 Good for everyone then that all things in life are cyclical, and so it is proving once again with economic conditions. 2013 has seen genuine optimism return to the sector

CMM DECEMBER 2013 ¦ 21

elderly care – on the road to recovery?

and the property market finally kick start itself back to life. Of course, no market is homogenous. Timing, allied to a host of different variables, determines the economic state of the various strands within our industry at any one given moment. But to draw a generality it would be fair to say that in 2013 the sector has been given back some impetus and we head towards the end of the year with renewed purpose for 2014 ahead of us. At the top end of the corporate sector activity has been keener. The UK healthcare market has seen both growth and diversification in terms of funding sources. Our industry is now globally attractive and we are seeing funding from the United States, South East Asian and Middle Eastern sources. In particular, we have seen increased investment from Healthcare Real Estate Investment Trusts (REITs), many linked to backing from high net worth individuals. Sale and leaseback models, often avoided following the demise of Southern Cross, are now seeing renewed activity, and this looks set to continue through 2014. Larger scale care home portfolios are being viewed with greater interest as assets that are once again capable of yielding long-term income streams for investors. But demand is definitely focused on the premium end of the market and there is limited supply. Whilst we have seen some increase in the quality of stock coming to the market, there is still not enough, particularly in relation to operational homes. In part, this is due to the inertia caused by the recession. Owners hold on to assets, waiting for economic regeneration before seeking a disposal. There is inevitably a lag between better economic conditions and improved supply into the market. We anticipate that demand in 2014 will remain concentrated on modern, future-proof facilities. This in turn may have a knock on effect for the smaller care home owners, where property condition and size may not be of the same specification. Multiples are still somewhat depressed for anything other than premium assets, and

22 ¦ CMM DECEMBER 2013

with some private equity sources still unconvinced about sustained market growth, this may continue to be the case for a while yet. Funding criteria being employed by the banks has been somewhat relaxed, and there is the suggestion of increased access to capital. However, again we anticipate this will probably focus on assets of a certain size and quality. One area that could see increased activity in 2014 is that of 30-bed plus homes – these may typically be quality conversions in afﬂuent areas. For those operators averse to growth through development, this type of asset may prove to be attractive as a means to growth through acquisition. Inevitably a good quality property will need to be allied to strong EBITDA performance. This situation may be aided by banks being generally unsure about lending on smaller assets, where long-term viability may be in doubt due to a lack of future-proofed facilities. It is important to remember that a large proportion of the UK care home stock is, or will become, unﬁt for purpose in the near future. This will inevitably lead to a further concentration of activity on a certain quality level. Demand for supply is built into the nation’s demographic,

but we anticipate that fulﬁlment of that demand, and correspondingly high occupancies, will only be met by the best quality accommodation.

.,6.9(7/@ As money continues to flow from US REITs we anticipate the development market will remain increasingly buoyant. Geographically, the focus for funds has been on areas of affluence, in particular the South East. We do not anticipate this changing overnight; however, significant increases in residential land values, allied to increased building costs, may encourage a ripple effect over time. Residential developers have returned and are now outbidding care developers introducing the need to look further afield. Having said that, we still anticipate

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elderly care â&#x20AC;&#x201C; on the road to recovery?

every owner considering disposal to prepare their asset in the best possible way.

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concentrated wealth proďŹ le to be J a key driver â&#x20AC;&#x201C; it may simply need to be in a different part of the country. Our indications are that the South West and the West Midlands will, over time, become more attractive to developers than they have been historically: a recent site sale in the West Midlands attracted signiďŹ cantly more interest than we have previously seen and resulted in several unconditional offers; a turnkey development in the South West produced a similar level of interest, in marked contrast to previous years. So, if the market in 2014 is to be dominated by overseas money and future-proof facilities, what can the smaller seller hope to achieve? We do not anticipate a major shift in multiples over the next year, excepting perhaps at the very top end of the spectrum, so it falls to

24 ÂŚ CMM DECEMBER 2013

The problems encountered in trying to sell a property in the care home sector are, in large part, the same as those found in selling any property, with the added complication that you are selling a business as well. However, much can and should be done in mitigation before a property even comes to market. All good agents should be able to provide their clients with a detailed checklist of issues to address prior to marketing a business. That assistance should continue throughout the sales process. We would obviously recommend appointing experienced healthcare agents, but owners should not be swayed by lavish praise. It is not always in your best interests to instruct the agent that produces the highest valuation of your business. This can prove to be a costly error, as pitching a sale price in excess of market conditions will merely result in a long period of silence and few, if any, viewings. With so much concern about the long-term viability of smaller assets,

it is vitally important to have up-todate and readily accessible ďŹ nancial information. Clear evidence of strong EBITDA over a sustained period is the best way to reassure purchasers. If this cannot be readily evidenced, ask your agent what can be done to provide reassurance; above all you are looking for honesty from an agent. One that delivers a realistic valuation of your business, based on strong sector knowledge, and an understanding of conditions in your local area, will be most likely to secure a sale.

05 :<44(9@ The prospects for 2014 look better than they have done for some time. The combination of overseas investment, relaxed funding criteria and a renewed view of the sector as a relatively safe asset capable of producing good income streams, suggests increased activity in the coming year. Certainly the high quality end of the sector should continue to produce sustained activity, through both corporate operators and new developments. There will continue to be challenges for smaller operators with less future-proofed assets and we expect these to come under increased pressure from the level of development activity taking place. Overall, it is something of a relief to forecast a period of renewed activity and potential growth. Our agency team has grown steadily over the past year and we anticipate market conditions will hopefully aid in the continuation of that process in 2014. CMM (THUKH 5\YZL PZ MV\UKPUN KPYLJ[VY VM *HY[LY^VVK (THUKH U\YZL'JHY[LY^VVK JV \R

5 minutes with...

5 MINUTES WITH...

ANDREA SUTCLIFFE Andrea Sutcliffe is the new Chief Inspector of Adult Social Care at the Care Quality Commission TELL ME MORE ABOUT YOUR ROLE? As Chief Inspector of Adult Social Care, I am responsible for developing CQC s new regulatory approach for the sector. Adult social care is the largest and fastest growing sector that CQC regulates ‒ there are over 12,600 providers across 25,000 locations in the country ‒ and so, this is an incredibly important task. Working with everyone from across the sector, including people using services, their families and carers, I will transform the way CQC monitors, inspects and regulates adult social care services. This will include introducing a new ratings system so that our judgements are clear and accessible. Also, I will structure our inspections around five questions that matter most to service users and their families: are the services safe, effective, caring, well-led and responsive to people s needs?

WHAT MADE YOU DECIDE TO TAKE IT? Because it is a great job with great potential to make a diﬀerence. I love working in adult social care as our services have the potential to completely transform people s lives. As Chief Inspector I want us to work with the sector to make this a reality. I know that, quite properly, concerns have been raised about failings in care services but we should also recognise that there are some fantastic services in adult social care and

some truly amazing staﬀ who provide care sensitively and compassionately. By celebrating the good, improving standards and tackling poor care, I hope that we can make a diﬀerence to the lives of people who use social care services.

WHAT WILL BE YOUR FIRST JOB IN POST? My first job in post actually started before I officially joined the organisation! CQC is in a period of considerable transition and as the Chief Inspector of Adult Social Care, I felt it was important to outline my initial thoughts, ideas and priorities for leading this change ‒ I have done this in a signposting document, which is available on our website. This is just the start of my engagement with people working in adult social care and with people who use these services and beyond. I intend to go out and about to find out what people think, ahead of our full public consultation next spring. If you have any views on my initial priorities, please get in touch at: cqcinspectionchangesASC@cqc. org.uk.

WHERE YOU DO YOU SEE SOCIAL CARE INSPECTION GOING? We know that service providers and the public want a strong and independent regulator whose judgements they can have conﬁdence in and whose ﬁndings they can rely upon.

Following overwhelming support for this in CQC s previous consultation, June 2013, my aim is to make adult social care inspection more specialised. Currently CQC uses a general inspection model, whereby an inspector could visit a hospital one day and a care home the next. This will change. I ll be bringing in expert teams, with inspectors who specialise in adult social care and I will involve more people who have a personal experience of care services ‒ our Experts by Experience. Our inspectors will use their professional judgement to assess the quality and safety of care, supported by objective measures. They will also issue ratings for services, which will highlight good and outstanding care and encourage services to improve.

WHAT DO YOU HOPE TO ACHIEVE IN YOUR FIRST YEAR AND GOING FORWARD? A year from now, I hope to have held an engaging public consultation on the proposed changes to inspecting, monitoring and regulating the sector; to have thoroughly tested these changes through pilots and to have started the implementation of the new approach, including ratings and inspection narratives against the ﬁve key questions. By March 2016, I expect CQC to have issued every adult social service in England with a rating, stating whether they are Outstanding, Good, Requires

Improvement or Inadequate. Ultimately, I hope for regulation to drive improvement across adult social care so that people get the best possible services.

WHAT WILL YOU TAKE FROM YOUR TIME AT SCIE TO APPLY TO THE NEW ROLE? I learnt a great deal as Chief Executive of SCIE. I have a much better understanding of coproduction and the impact this can make, and so I want to build this into the design and delivery of the new regulatory and inspection system for adult social care. Another key learning is around personalisation and the need to ensure CQC s approach is person-centred, reﬂecting the tremendous progress adult social care has made in this area already. Finally, I will take the connections and relationships that I have made with people right across the sector ‒ they will be invaluable in helping to support the improvement of services.

TELL ME A LITTLE ABOUT ANDREA I am a bit of a football fan ‒ I went to the World Cup Final in South Africa in 2010 and am a lifelong Sunderland supporter, I love hiking and travelling, I try to make the most of the London cultural scene ‒ but fail miserably most of the time and I have an adorable cat, called Archie. CMM

WHAT WOULD YOU LIKE TO SEE ANDREA ACHIEVE AT THE CARE QUALITY COMMISSION? ARE YOU OPTIMISTIC ABOUT HER ROLE AND WHAT IT MEANS FOR ADULT SOCIAL CARE? LET CMM KNOW. EDITOR@CAREMANAGEMENTMATTERS.CO.UK

CMM DECEMBER 2013 ¦ 25

Focus on Leadership Development: How you can develop leadership capacity in staff at all levels Welcome to the National Skills Academy for Social Care’s Leadership Section

Debbie Sorkin, Chief Executive of the National Skills Academy for Social Care, outlines different approaches to strengthening leadership for people working at different levels in the sector.

Welcome to our latest issue. With the government’s response to the Francis Report and the Cavendish Review being so current, it’s timely to look at how employers can develop their staff teams at all levels, and at the different approaches that can be employed to make it both affordable and effective.

At the Skills Academy, we’ve adopted a variety of approaches to enable staff working at all levels, from Graduate Trainees onwards, to develop in their thinking, their practice and their careers.

But how do you do this, in the face of current resource constraints?

Aside from traditional taught sessions, we use blended learning approaches; individual coaching and mentoring As we know, social care is one of the largest employers in to encourage self-reflection; real-time projects on current the country, with a workforce of c. 1.5 million1. Roles can organisational issues; and action learning sets. We’re also be varied and complex. As the Dilnot Review illustrated, the increasingly finding, as with the Registered Managers’ greatest increase in the population in recent years has been Programme, that local networks and alumni groups can be a in the ‘oldest old’, with multiple conditions that require significant source of continuous learning and development multiple responses. In September, the Office for National for people. Overleaf, we share some of our experiences and Statistics reported that the number of people aged 90 approaches. and over had grown by a third between 2002 and 2012. Similarly, there are more people with disabilities growing And we have evidence that developing staff has a service and older than ever before. a business impact. As illustrated in the October 2013 issue of CMM, our Graduate Trainees generate significant cost savings or new opportunities for their hosts. And from an employer So more than ever, we need a well-trained, well-qualified perspective, Care Management Group, a leading provider workforce, composed of people who are committed to of services for people with learning disabilities, are now making their careers in the sector. At present, some of strong advocates for the effectiveness of coaching, saying: those careers can be short-lived. In the National Care “Providing our staff with the ability to share experiences with Forum’s 2013 Personnel Report, respondents reported a Skills Academy coach has been a powerful tool, with some that they were seeing over 30% of new recruits leaving of our managers transforming beyond expectation.” within one year, with fully 56% leaving within two years2. How can employers be expected to undertake succession planning, and ensure consistent quality, when it has little And in the end, this is the best argument for career guarantee of a pipeline of talent coming through in their development. If you support your staff, you support your organisations? organisation and the service you can provide. So if you’re an employer, or a manager, and you want your service to One way that employers can reward staff, and encourage stand out, invest in staff learning and career development. them to stay, is by demonstrating their commitment to It’s the best investment you will ever make. training and developing their workforce, so that people see social care as a sector in which they can develop a For more information on Skills Academy programmes, worthwhile career, and development becomes the norm. please go to www.nsasocialcare.co.uk. The size and structure of the adult social care workforce in England, September 2013 National Care Forum Personnel Statistics Report, August 2013

Learning from the start: supporting and developing Graduate Trainees Andy Williamson, Programme Manager, National Graduate Trainee Scheme The National Skills Academy for Social Care is now in the fourth year of its flagship National Graduate Trainee Scheme. The Scheme provides graduates with a comprehensive programme of learning and development. Trainees on the year- long programme all study towards the Institute for Leadership and Management (ILM) Level 4 qualification, as well as undertaking a series of Managing in Social Care development days. This is delivered through a series of study days, tutorials and action learning sets, all of which are designed to ensure the trainees are able to link the theory with the practicality of their work placements. The Graduate Scheme is a fast-track management scheme, and trainees are given real responsibility early on in their work placements. It is important they are adding significant value from early on with the idea being that, at the end of the Scheme, they are ready to move into middle-management roles. Recent alumni, for example, have moved into roles such as Deputy Home Manager, Area Coordinator and Learning and Development Officer. In order to ensure they are able to add value on the Scheme, and be job-ready at the end of it, it is crucial that they are able to understand the theory behind good leadership, and transfer this to the workplace. The ILM Level 4 qualification focuses on leadership skills, with modules including ‘Understanding the Management Role’, ‘Delegating Authority in the Workplace’,

‘Understanding Innovation and Change’ and ‘Developing Mental Toughness.’ The Managing in Social Care development days focus on provide insight into operational management challenges, the range of problems that managers may face and the strategies and solutions for addressing these challenges. This part of the programme is also recognised by the ILM as an Endorsed Award. The study days, tutorials and action learning sets are designed to support the trainees through their learning in a variety of ways, and the feedback from trainees and managers has been extremely positive. In a recent evaluation survey, the vast majority of trainees and managers reported that they could see the link between the learning and the contribution trainees are able to make in the placement, with trainees ﬁnding the development days extremely useful. Trainees bring their learning together by delivering group projects towards the end of the programme, focussing on topical issues in the sector. Last year’s group projects were incredibly well received. If the Graduate Scheme is to achieve its aim of developing a pipeline of leadership talent in the sector, it is critical for their development and their credibility that they understand the link between the theory and the practice. If they do, then they are well on their way to becoming the leaders of the future they have been recruited to become.

Supporting Staff new to management: the Front-Line Leaders Programme Terry Linehan and Laura Dennis, Programme Tutors for Front-Line Leaders Social care staff working in Front-Line Leadership roles, like Shift Leaders or Team Leaders, will commonly be in their ﬁrsttime management role. But they will not always be prepared for management, especially the line management of people who were previously their peers. And yet Front-Line Leaders have a particularly important role to play in demonstrating good leadership behaviours, engaging staff, being role models for good practice and contributing towards a positive culture. So the Front-Line Leaders programme is a crucial foundation for leadership in social care. Front-Line Leaders is mapped to the Leadership Qualities Framework, and is based on the idea at the heart of the LQF, that good leadership behaviours should be developed at all levels of social care. It is especially important to develop Front-Line Leaders, as they interact most with people using services and they also have the most immediate overview of the way staff meet their wishes and needs. If you want to drive up standards of care, you need to start with Front-Line Leaders. As with the Graduate Scheme, the methods used in the programme blend approaches to learning, including two-day workshops, personal study and virtual Classroom sessions held online. All of the sessions are high energy and are designed to set people thinking about what they do – and could do – in their workplace. In one of the virtual classroom discussions during the pilot phase earlier this year, for example, we focused on

‘Monkey Management’ – an approach to empower staff to take ownership for solving problems and to reduce upward delegation. And although there was some trepidation during the pilot, partly due to the use of technology in the programme and partly because this was the ﬁrst time that Front-Line Leaders had been brought together to develop as a management group, the participants really embraced the management tools on offer and all used them (with great success) back in their own workplaces. So although employers might need to consider the implications of using virtual or online learning methods for staff who are unused to this, or to seeing themselves as Managers, persevering with blended learning approaches can yield real results. At the same time, part of our learning from developing programmes over the past few years has been the importance of linking development to accreditation, and to social care criteria and standards, wherever possible. So Front-Line Leaders is mapped to CQC Essential Standards and the Skills for Care Managers’ Induction Standards. In addition, learners who successfully complete all elements of the programme are eligible to achieve the ILM Level 4 Award in Leadership. So it gives learners a platform for CPD alongside new skills and resources. And it gives employers more effective leaders, who can drive service improvement and who have a solid grounding to go on and develop in the organisation.

Building culture and leadership confidence: developing Registered Managers Jerry Garrett, Values in Action: Programme Delivery Partner for Lead to Succeed Lead to Succeed is a suite of five one day workshops, aimed at Registered Managers. It forms part of the National Skills Academy’s growing offer to this key group of care professionals. Beginning with a workshop exploring the challenge of leading and developing a positive culture, the programme seeks to combine the existing knowledge and experience of participants with a well -researched and presented set of ideas, challenges and practical strategies. The suite recognises the background that many care managers have come from, which reflects high levels of skill as a carer or nurse, but often little formal training as a manager or leader. It is written and delivered with an emphasis on plain English and an adherence to an explicit value base. Taking its lead from the findings of the Francis report and the research conducted by the Academy, the culture workshop addresses the challenge of embedding values and examines in detail the practical strategies and key management structures required to achieve this goal. Each of the workshops is structured in the same way, enabling the suite to acquire a coherence which means real focus can be sustained on the content of each workshop as delegates become increasingly familiar with the structure. The second day addresses successful leadership and managerial behaviour, challenging common assumptions and emphasising the importance of reflecting values and priorities in behaviours and attitudes. The third workshop explores the key management processes

of supervision and appraisal, emphasising the importance of developing positive professional relationships which are supportive, based upon skill recognition and reward and focused on performance, learning and development, reinforcing the conclusions of the Cavendish Review. Each of the five workshops contains a clear action planning process. A key aim is to promote the competence and confidence in individuals to introduce change and improvement and the fourth workshop focuses on the leadership and management of change in support of this. The final course looks at leading and managing the inspection process, with particular reference to CQC. The Academy’s excellent contacts within the sector mean that this workshop is up to date at all times. It looks to emphasise a positive approach to inspection and provides a detailed toolkit for preparation and the conscious integration of values and practice on a daily basis. This approach effectively links this last module to the first of the programme by reflecting on care culture and how to establish it. The programme has been running for over a year and has proved highly successful. The following quote from one of our delegates is typical:“Fantastic workshop that when combined with all five courses have made for a very valuable and transforming experience which I will embed in my own development and that of my home.”

Thinking about more senior roles: Inspiring Leaders Symone Stuart, Programme Manager for Inspiring Leaders

The Cavendish Review drew attention to the vital role of the first-time manager, including Registered Managers, in care settings. Registered Managers were singled out as being critical to ensuring that workers were properly valued, supervised and held to account. Through discussions with our Members, more formal consultations and the findings of our national Registered Manager surveys, Managers told us that as well as formal accreditations, they would value more practical support in developing the behaviours and tools they needed to improve outcomes, for both the people whose use the services they manage and for their organisations. They also wanted support so that they felt able to apply for more senior roles. With this in mind, the Skills Academy has developed its Inspiring Leaders programme. This has been specifically designed to help build leadership capacity and confidence, while also heightening the awareness of participants to their own potential. Mapped to both the Skills Academy’s Leadership Qualities Framework and the ILM level 5 Award in Leadership and Management, the programme works with four core modules: • Myself as a leader • The people side of leadership • Steering not rowing • Person-centred outcomes.

Critically, each of these modules identiﬁes key skills, provides underpinning knowledge and explores workplace practice relevant to the social care sector. At the same time, there is increasing emphasis on written assignments and on thinking about different models of leadership. Led by Insight Management, who are highly experienced and specialised facilitators, the focus of Inspiring Leaders is very much on action and on taking responsibility for gaining and maintaining momentum for change. Participants explore practical approaches for understanding and achieving excellence within their roles and take real life challenges from their day to day work, creating plans around how they will tackle them going forward. Regular reviews and ongoing support throughout the programme are provided by online discussions with the tutors and peers. Participants who successfully complete all elements of the programme are eligible for an ILM Level 5 Award in Leadership and Management. As well as completing all four Modules, participants undertake a written assignment and present a service improvement plan to assess their learning. In addition to the achievement of an accredited award and enhanced skills and behaviours for the individual learners, the practical approach adopted by Inspiring Leaders enables Managers to better understand their leadership role within an organisation, and to start to consider how they might develop further.

Developing the top leaders of tomorrow: encouraging people to make the jump Helen Smith, Programme Manager, Leadership Programmes In last year’s Social Care White Paper, Caring for our future, one of the key leadership challenges that was identified was the need to develop a pipeline of talent, to secure the leaders who would be capable of inspiring the workforce of the future to deliver high quality care. At the same time, the feedback we were getting at the Skills Academy from many of our Members was that it was proving difficult for them to get internal candidates to apply for Director-level roles. This was despite being highly supportive of the idea of organisations ‘growing their own’ in terms of staff development and promotion. The Skills Academy therefore developed Emerging Leaders, to support people already working in significant management roles, for providers or in user-led settings, who wanted to make an even bigger contribution and who had high aspirations for themselves, their service and the social care sector. Emerging Leaders is therefore aimed at instilling confidence as much as competence. For participants, the programme puts the emphasis on developing people’s leadership potential; building their confidence to lead in a complex and changing environment; enhancing their impact and value to employers and people using care and support services; and expanding their contribution to the wider community of practice across the sector. At this stage, the emphasis is also very much on the individual. So Emerging Leaders is tailored to suit participants’ needs, starting with a thorough assessment of leadership and management preferences via a Myers-Briggs Type Indicator; a completion of a short biographical note for people to introduce themselves and their aspirations to other participants; and an online 360° assessment linked to the Skills Academy’s Leadership Qualities Framework, that gives

participants’ colleagues an opportunity to provide constructive feedback on leadership styles and behaviours. This is then fed back to participants on an individual basis by the Course Directors, Richard Field and Christine Young, both of whom are established specialists in leadership development. Following on from the increased self-awareness gained through the psychometric testing, the learning programme is a blend of residential workshops, 1:1 coaching and action learning sets, complemented by a work-based project that incorporates an organisational visit. Each participant also has an individual mentor. The workshops are all focused on different aspects of leadership: • Leading self – including creating influence and impact • Leading with others – including creating culture, inspiring and leading effective teams • Leading to achieve – including working in collaboration, having courageous conversations, and developing a performance culture • Leadership challenge – including developing resilience and leading with integrity. Our aim is for this programme to become the recognised route to excellent high-level leadership in social care. And we already know, from the feedback we’ve received, that it’s having results, with participants gaining promotion to Director and in some cases Chief Executive roles. One quote from a participant is typical: “The Programme has enabled me to better understand what it means to lead and to be a leader, and encouraged me to consider what is most important to me in how I fulfil that role. It has encouraged me to be more open, to have more confidence in my ability to lead, and it has reminded me that it’s OK not to know all of the answers all of the time.”

Linking and reflecting: developing capacity at the top of organisations Maureen Hinds, Head of Programmes By the time you get to people already working as Chief Executives or Directors of Adult Social Services, the question is sometimes asked about what further development might be useful or even necessary. In the current social care climate, with its unprecedented challenges and changes, leadership support and development is more important than ever, especially for individuals who might not have other places to go for support. But the development that is particularly valued is around space for reflecting on one’s own leadership style; on forging networks with peers; and on learning from leading authorities both inside and outside social care. So the Academy’s Top Leaders programme, run by a team led by noted leadership development consultant Allison Trimble, emphasises self-reflection and awareness. It brings leaders together to develop their own practice and build peer networks across health, social care and allied sectors. At the same time, it looks to stitch together social care provision and commissioning, alongside linking social care with health and other sectors, so that participants can learn from each other and become familiar with thinking about what integration of

services might mean for them. Top Leaders offers a unique opportunity to explore the dynamics of change and to consider how shared leadership across organisational and system boundaries can happen well and in service to people with social care needs. Participants, who are commonly drawn from across private sector and notfor-proﬁt providers alongside local authority commissioners, undertake a common module with participants in the NHS Leadership Academy’s equivalent programmes. This enables them to reﬂect together on how best to lead integrated agendas. Like Emerging Leaders, Top Leaders is designed around a mix of residential workshops, 1:1 coaching and action learning sets. At this level, the programme is highly experiential and tailored to the needs of individual participants, so the content can shift depending on emerging themes and priorities. But we know from experience that some of the most valuable learning comes from giving people space to think and change; and from enabling them to make links with a community of practice that they can maintain, and that will continue to support them in their roles.

business clinic

RESIDENTS BUY CARE VILLAGE A group of retirement village residents have joined forces to buy their development from the administrators creating the country s ﬁrst mutually-owned village for the over 60s. When a provider of care or housing with care goes into administration it leaves a huge amount of uncertainty and the lives of the residents potentially at risk. When Crystal Fountain Village went into administration, over 90% of the leaseholders joined forces to buy the freehold from the administrators, making it the ﬁrst mutually-owned care village in the country.

*9@:;(3 -6<5;(05 =033(., Crystal Fountain Village in Gloucestershire was run by Bluchie Limited and was a typical retirement village. It is comprised of 73 properties presented in traditional Cotswold style with the usual communal facilities associated with care village developments including a library, dining room and lounge. Properties range in size from one-bedroom ﬂats to four-bedroom houses. Bluchie held the freehold to the site and operated the management company.

Domiciliary care was also provided by another company in the Group. The residents, now mostly in their mid-80s, were leaseholders of their properties, owning 90 per cent. There was a 10 per cent transfer fee if sales were made on the open market. The site had originally included an on-site residential care home; however this had proven to be uneconomical to run. The care home closed which residents were particularly unhappy about and it was converted into ﬂats.

went into administration. Some residents or executors had been trying to sell their properties but about 50 per cent were standing empty. When the administrators put the village on the market, we, the Residents’ Association, expressed an interest in acquiring it, but they [the administrators] had to test the market. Having done so, in the end they decided we were appropriate buyers.’

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Once it was agreed that the residents were suitable purchasers they instructed Charles Russell LLP, Cheltenham to work on the deal. Nigel Morton, Head of Real Estate at the ﬁrm explained, ‘We were instructed in early 2012 to work on the deal for the residents to take over Crystal Fountain Village. They decided they wanted to take over the site and managed to raise the nearly £2 million needed to achieve that. This was raised by the residents and

In 2011, as the housing and retirement village markets slowed, some residents were struggling to sell their properties and units were standing empty. Bluchie ran into financial difficulties and administrators, Deloittes, were called in. Betty Young, Vice-Chair of the Residents’ Association explained, ‘About three years ago, they got into financial troubles and

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Closure of the care home was a major blow

Hard to see it becoming common

Keith Cockell Chairman English Care Villages Ltd

John Lucas Partner Hazlewoods

I have to congratulate the residents on pulling off this deal. What crystallised the residents action was the loss of the onsite care facilities which they had originally bought into. Understandably the closure of the care home was a major blow and undermined any confidence in the company that was running the site. I think the outcome is a great one but to some extent for the wrong reasons. The closure of the care home has unified everyone and they have gone on to purchase the freehold of the site which will create a strong community and sense of pride in what they have and where they live, this has to be a great result. What they have achieved is to purchase the freehold of the site as a group of owners which is a process open to anybody living in a leasehold property. What they have not achieved is the re-establishment of the care home which was very much the part of the original

26 ¦ CMM DECEMBER 2013

package. The problem originated because the care home was not viable because of its size and the company was not well-founded financially. We do not grow infirm at the same time and one of the great benefits of a care village is knowing that if your spouse is in need of high levels of care you can be on the same site and share as much time as possible with them. The delivery of domiciliary care from an outside agency is a sensible compromise but not as good as the original concept of residential and nursing care onsite. The next generation of care villages will offer smaller, targeted family group care homes with between 11 and 12 residents, four or five of these will create between 40 and 60 bed spaces in total. This is sustainable within the wider community but offers special benefits to the residents within the care village.

It s good news that the residents were able to save the business, and nobody was caused distress. It s also fantastic to see the future of employees secured and positive news for the local economy. It s hard to understand whether the deal was driven by a small number of more affluent residents, or whether the investment was spread between the group. Whilst this is a great solution it s hard to see it becoming common. Care villages that have encountered difficulties (and many have found it hard) have been through debt restructuring, reorganisation or have been acquired. We aren t aware of too many in administration at present and there are potential corporate and private equity backers searching for good investment opportunities. This is borne out by the recent investment by Oaktree Capital in Pegasus. Additionally, there must ve been a significant amount of teamwork and

we presume, leadership within the Residents Association which may not be the case elsewhere. Finally, a word of caution. There may have been interesting conversations around return on investment and ownership changes on a resident moving out or on death. It could be interesting unwinding the ownership. Residents families may have diﬀerent views of their inheritances being locked into the village and how funds may be extracted. They may need incoming residents with similar views on investing their funds. That said, once development is ﬁnished and occupancy higher, the residents may have created substantial capital value that can be realised in the medium term. Hopefully, we ll hear more in future about the exact ownership and funding structure which could lead to more innovative developments ‒ which can only be a good thing for the care sector.

business clinic

their families, meaning that bank funding wasn’t required. However there were a number of empty units still on the site and the residents didn’t want to take on that liability, some of which have remained with the administrators.’ The residents were able to fund the purchase, as they had opened up the Residents’ Association to enable family members to join. Although they have signed a non-disclosure agreement so they cannot divulge all the details of the deal, Betty was able to share some information with CMM. ‘One reason we decided to open up the Residents’ Association to families was some of the former residents were now living in nursing homes and some properties were in the hands of executors, but were still paying the service charge on their properties and they too needed representation. This enlarged membership enabled us to raise the necessary funds to purchase the freehold and help to support change and development on the site.’ Nigel continued, ‘It wasn’t a straightforward deal as nothing of this type had been done before. We needed to accommodate the requirements of the administrators and their needs to sell on the empty units. The administrators still have involvement in the site and are involved in any major decisions but the basic control is

now with the residents. ‘It was essential that we set up a structure that was sustainable, that was critical to prevent it happening again. That’s why after a lengthy process it was completed in October.’

>66+*/,:;,9 =(33,@ Now under new ownership and renamed Woodchester Valley, the site is in full operation with the freehold now held by Woodchester Valley Freehold in which participating leaseholders all hold a vote. Their Estates Management Company has appointed Mainstay Group as managing agent. Betty explained, ‘We’ve appointed an experienced managing agent called Mainstay to look after maintenance and service charge matters, however the staff are employed by Woodchester Valley Estates Management Ltd as it’s important we give them continuity in what has been an uncertain time. We also acquired further land and a derelict pub, the Crown Inn, down the road. This gives us a bigger portfolio than just the freehold of the site.’ In addition, as part of the deal, the transfer fee is now down to 1 per cent for the participating leaseholders. Woodchester Valley also has a

relationship with Horsfall House, a charity in Minchinhampton who provide a full range of care services for the elderly in the area, including nursing, dementia, a day centre and home care services for those living independently. Betty ﬁnished, ‘Our philosophy here is that unlike a proﬁt making company we’re not in it to make money, we’re a social enterprise. As a mutual, the leaseholders decide the services they require and that determines the level of the service charge. We just want to run the village successfully and for people to be happy here. We encourage everyone to be as independent for as long as they can. We’d like to lead the way for others to follow our model. Our deal took a very long time because there was nothing like it before us, but we’re hoping others will follow our lead.’ CMM

Over to the experts... Is this approach of residents joining forces to save their care village in administration likely to be replicated around the country? Has this paved the way for others to follow suit? Or is it a particular situation given the nature of the village, the model of tenure and the aﬄuence of the residents? What does our panel think?

Only necessary in rare circumstances Michael Voges Executive Director ARCO Firstly I would like to congratulate the residents of Woodchester Valley for their courage and perseverance in securing their freehold after Bluchie Ltd went into administration and taking on the challenge of operating the scheme. That is no mean feat. Will this happen again? I think it is unlikely. A number of factors combined to create the perfect storm that brought Crystal Fountain to its knees. • Bluchie Limited was part of a larger group that was heavily in debt to HBOS (the troubled banking group that had to be rescued in 2008). • Not all of the new units in the village had been sold and, as the economy fell into recession, values were falling and stock levels were rising. • The landlord company had obligations to buy back leases

that it could not meet. The residents are, of course, the key stakeholders in a retirement village and, as such, should have a high degree of influence and control over the management of their homes. It must be said that good operators in the sector seek to achieve this in different ways. One of our members (Retirement Security Ltd) gives ownership of the management company to the residents when they buy their flats. Others will have resident Board members, strong Residents Associations or financial monitoring groups. In most cases, the presence of a good landlord company, with a strong balance sheet, that is able to support the village and reinvest in it as required, will be a positive benefit to residents. Only in rare circumstances should it be necessary for residents to take such radical action.

Our turn to look after you Helping you maintain a healthy business With over 20 years of health and social care experience, you can rely on Hazlewoods to provide support at all stages of your business lifecycle. Our dedicated team can provide expert advice on accounting, tax, business strategy and sales across the full spectrum of health and social care. To ﬁnd out more, please contact Andrew Brookes Tel: 01242 246670 Email: andrew.brookes@hazlewoods.co.uk Web: www.hazlewoods.co.uk @HazlewoodsCare

CMM DECEMBER 2013 ¦ 27

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Dementia CARE NEEDS

empathy Rosemary Hurtley and Julia Pitkin explore the need for empathy in dementia care and the principles empathetic dementia care is based upon.

It is amazing that we have to talk about compassion, empathy and kindness when working in social care; surely this comes with the territory? But when caring for individuals living with dementia it is necessary to understand the condition, the person and the importance of empathy in supporting them.

<5+,9:;(5+05. +,4,5;0( We know that: • Dementia is a neurological impairment combined with health and life experience, an individual’s personality and the social world they live in. • When someone has dementia the way people behave towards them can affect their behaviour and response. • When caring for someone with dementia it is always important to visualise the world from their perspective in that moment. • When they express strong feelings it is important to focus on the person not just the dementia.

CMM DECEMBER 2013 ¦ 29

dementia care needs empathy

When communicating with someone with dementia, remember that it is more than just exchanging facts – it is about connecting with the individual on their level. Person-centred care is about understanding the person behind the dementia, what motivates them, what their experiences are, what they like and dislike. To deliver effective, compassionate, person-centred care and services we must examine our ability to build trusting relationships. To build trusting relationships care staff need empathy and compassion, but can this be taught? If it can, we need a structure to help us know how to build relationships. This is less about skills (because that will follow) and more about a mind-set based on the importance of that relationship to each person within it.

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We need many more people who can do this well. Not understanding but ‘talking the talk’ Secondly, we have the individual with good caring intentions, but who don’t, for whatever reason, make person-centred carers. They fulﬁl the needs of the individual living with dementia from a physical point of view such as nourishment, hygiene, medication and sleep with a well-intentioned custodial attitude. Their natural response to dealing with any distressing emotional issues is distraction or avoidance such as offering a cup of tea, or telling the person not to worry. They tend not to make a personal connection naturally or to acknowledge the emotional distress being experienced by the individual. In our experience, this type of worker makes up the majority of the caring workforce. An organisation’s policies, procedures, training programmes and work organisation structures may reinforce the behaviours of this type of care worker so that person-centred outcomes often are not experienced. Neither ‘walking nor talking’ Thirdly, there is the individual with little or no caring instinct who should, in our opinion, consider a different career. I believe we have all experienced such workers and the media has exposed some of the worst cases.

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The person needs to feel loved, competent and a master of their destiny. The quality of their life depends on the quality of their relationships with the people around them. When holding conversations, consider empathy as a process which involves listening, associating, imagining, exploring and responding.

What is it that the ﬁrst group of care staff do, and do well that makes the care they deliver person-centred? Is it possible to ﬁnd a structure to their experience that will help us coach others in the empathy and compassion needed for person-centred care? There are some practical approaches that can help those who talk the talk to begin to walk the walk. To be able to deliver personcentred care with empathy for those with dementia they need to: • ensure they listen more closely to the people they care for, gaining a greater insight into their experience of dementia, • have deep conversational and sensory skills to ensure individuals live well with dementia, • understand that dementia care is something beyond simply ‘good care’ but a commitment to a relationship built on acceptance and love, • support families in emotional situations that are so heartwrenching, helping them to stay together longer at home .

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It is possible to categorise care staff as broadly having three types of personality, those who ‘walk the walk’, those who ‘talk the talk’ and those who ‘neither walk nor talk’.

Care staff need to know how to have meaningful conversations and develop a deeper understanding of the person with dementia. They need to meet a person’s deeper emotional and psychological needs behind their behaviour or be able to prevent challenging or distressing situations from occurring. This can happen by building trusting relationships but it requires more than just an attitude of treating people with dignity, respect and kindness. Communication is the key. When communicating with someone: • 7% of the message is communicated from the words we use, • 38% is based on the tone of our voice including the pitch and emotion used, • 55% from our body language such as our gestures, expressions, positioning and eye contact.

Empathy involves interpersonal skills, overcoming any barriers to communication and being able to express yourself effectively both verbally and non-verbally. Empathy is a ﬂow of small interactions and gestures that give a positive message to the person with dementia. The aim is to encourage the person to share their experience at that moment by conveying two important messages with concern, warmth and feeling: 1. You are important to me. I am listening. 2. I want to understand.

Walking the walk These individuals are inherently empathetic and emotionally intelligent individuals; they immediately understand the founding principles of person-centred care. They are not afraid to explore the whole person and take on board all of what makes the person who they are. This includes not only the existing neurological damage, but their life story, physical health, personality and emotional needs. Some issues will be painful for the care worker and the person experiencing dementia. However, this care worker naturally ‘walks in their shoes’ no matter how uncomfortable or painful for them.

30 ¦ CMM DECEMBER 2013

dementia care needs empathy

This can be done by observing the body language of the person with dementia and associating this with the feelings they may be experiencing. It is then possible to adjust your listening and conversation accordingly. It is important to help the person to express their feelings to restore a sense of balance in the way they are feeling. Also, work with the family to explore possible reasons behind any behaviour alongside their psychological needs around attachment, identity, control, signiﬁcance and comfort.

+,=,36705. ;/, 9,3(;065:/07 There are eight principles to follow to enable a therapeutic or empathetic relationship to grow between the care staff and the person with dementia. 1. It is important to acknowledge the world from the perspective of the individual experiencing dementia. 2. Understand the impact of past life events on the individual and how these may affect their experience of dementia now. 3. Individuals experiencing dementia have a unique language. The responsibility for learning this language is with all of the people interacting with them and the enabling of managers to support learning. 4. An individual experiencing dementia can express strong feelings. It is important to remain centred and calm, focusing on the individual, not the dementia or yourself. 5. Create a safe social environment where the individual can express their feelings without fear of judgement or exclusion. 6. Understand the psychological needs of individuals experiencing dementia. 7. Understand that events happening in the present may trigger a memory of events in the individual’s past with the associated feelings. 8. Repeatedly use conversational skills that meet a psychological need and acknowledge the person’s feelings, thus helping them live as well as they can with the dementia. Once your staff begin to build this relationship they can maintain it by: • Maintaining their trust and respect. • Learning the conversational skills that demonstrate empathy. • Identifying an emotional or psychological need the person may be missing. • Working with the care team and families, sharing what you know about the person so they continue their life’s journey.

;9(0505. 05 ,47(;/@ Traditional training courses explore attitude, theory, skills in practice, coaching, assessment and principles of a therapeutic relationship. However, success depends on the mind-set of the care staff. Skills can be taught, but a culture of care that is relationship-centred is essential in order to build or recreate a dementia-friendly community for the person living with dementia. CMM

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EMPATHETIC RELATIONSHIPS AT A GLANCE To build and maintain empathetic relationships staff must: • Encompass the values and principle beliefs of an empathetic carer. • Discover an individual’s unique life story through their words and actions. • Learn to appreciate the world from the individual’s perspective. • Be ‘in the moment’ with the person as they express their feelings. • Use listening and spoken skills that create a therapeutic relationship. • Work in partnership with families and as a caring team.

A TRAINING FILM FOR EMPATHY This year we produced a film called Conversations that Matter: Breaking through Dementia, sponsored by SCIE and Crowd Funding, to illustrate an advanced communication skill that works. It shows three scenarios illustrating how the techniques are applied; each one beginning with a relationship breaking down as caregivers misinterpret the language and behavior of the person with dementia. The scenarios are then rewound to show an alternative conversation, that’s more empathetic and relationship-focused and meets everyone’s needs. The film is intended to help those supporting someone with dementia more effectively through using advanced communication skills. The film shows well-intended care which isn’t sufficiently informed with the necessary knowledge, skills and practice required to deal with challenging or distressing situations that occur and often leave carers feeling inadequate and distressed. The film illustrates some common experiences and explores what hasn’t worked and why, from the perspective of the person with dementia demonstrating techniques that work.

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CMM DECEMBER 2013 ¦ 31

GOLD STANDARDS

FRAMEWORK With the Liverpool Care Pathway being phased out, Professor Keri Thomas explains why the Gold Standards Framework for Care Homes works and is successful in supporting people in care homes at the end of life. ‘Many of the problems in the care of the dying highlighted in this report are due to poor understanding among clinicians of existing guidance in care for the dying, and an unwillingness to discuss with patients, their relatives and carers the prospect of death and the clinical uncertainties that accompany it. The Government must therefore ensure that its arms-length bodies collaborate with the clinical professional bodies and other key players in the system, and inject considerable funding into the system, to ensure that guidance on care for the dying is properly understood and acted upon, and tick-box exercises are conﬁned to the waste paper basket forever.’ The above paragraph is the conclusion of the executive summary of the Independent Review of The Liverpool Care Pathway (LCP), More Care Less Pathway, chaired by Baroness Julia Neuberger. The ten members of the review panel were so struck by the evidence submitted to them about the failings of LCP that they recommended it be phased out over six to twelve months, the Department of Health (DH) agreed with them. Where does that leave care homes and how should it affect the way you care for residents as they approach the end of their lives?

.<0+(5*, The DH is issuing end of life care guidance in January 2014. Almost all of the evidence presented to the LCP review panel

32 ¦ CMM DECEMBER 2013

centred on patient care in hospitals, where the pathway was too often being used inappropriately as a tick-box exercise with little or poor communication with relatives. One of the key recommendations of the review group was for ‘an end of life care plan for each patient, backed by conditionspeciﬁc good practice guidance’. The review group also cited Gold Standards Framework (GSF) Training Programmes as a best practice example that includes care over a longer period of time than just that for LCP and said they would continue to be part of the solution.

.63+ :;(5+(9+: -9(4,>692 So what is the GSF programme in care homes and how does it differ from LCP? The GSF Programme is a comprehensive framework for all people nearing the end of life with any condition in any setting and includes care of the dying. GSF is widely regarded as best practice but only GSF Accredited care homes can say they are performing correctly and are recognised by the Care Quality Commission (CQC), commissioners and included on the publicly available database. GSF programmes help practitioners to proactively anticipate and avert problems by identifying patients earlier, clarifying their particular needs at each stage (using needs-based coding and needs-support matrices), helping assess their conditionspeciﬁc clinical needs (using clinical assessment tools) and personal wishes and

preferences (using advance care planning discussions) and enables clinical teams in different sectors to plan and provide care in line with their wishes, avert crises and ensure ‘a gold standard’ of care. This will enable them ‘to live well and die well in the place and the manner of their choosing’.

,5+ 6- 30-, *(9, 05 *(9, /64,: The GSF Centre provided Baroness Neuberger’s review with the findings of its 2012 survey of more than 100 homes. Seventy nine homes used LCP, most found it beneficial, few experienced problems and, crucially, relatives’ feedback on the use of the LCP had been good. LCP was introduced to try to emulate the care provided in hospices to patients entering the dying phase. It has always been a recommended tool within the GSF care homes training programme. So why did it transfer so much better to care homes than hospitals? There are several key elements to the provision of effective and compassionate end of life care. The GSF set out to identify these and incorporate them into its programme. The first and most fundamental step is the early identification of end of life care patients. Whereas in hospital, staff may only be encountering a person for the first time as they approach the dying phase, more often than not, care homes will have known their residents for months, if not years. The programme encourages homes to engage residents in conversation about their care wishes at the earliest possible opportunity. For many nurses or care assistants this can prove challenging at first, but once they have overcome their initial fears, they find huge rewards in it. Many attest to residents and families welcoming the opportunity to discuss their preferences. Having established these good lines of communication, care home staff can then continue to instigate regular conversations. Then, when the resident enters the dying phase and there is a necessity for very sensitive discussions about how and where to care for them, all parties are wellprepared and communication issues are less likely to occur.

6--,905. 469, GSF is about much more than just the ﬁnal days, helping frame the whole way staff care for their residents and their entire means of operating. One of the main criticisms of the LCP centred on it

being implemented in a functional, tickbox way. The GSF provides staff with the confidence to plan and assess residents’ care and take greater responsibility. This helps instil increased confidence, which translates into more personalised, compassionate and efficient care. Almost as importantly, increased competence and confidence encourages GPs and other health professionals to trust the care home staff, creating better relationships and more co-ordinated care so crises are avoided. Care homes that have completed the GSF Care Homes Training Programme (2,500 homes including almost half of all nursing homes) and gone on to be accredited (200 apply for accreditation each year) demonstrate significant improvements in outcomes for residents as they approach the end of life. Most significantly perhaps, residents in accredited homes are twice as likely to die in their preferred place (the care home) and 50% less likely to undergo an avoidable hospital admission. Whereas LCP was disseminated to hospitals with little training, the GSF Care Homes programme involves at least a year’s training and support and at least six months to embed the new practices, before accreditation takes place. The programme provides homes with quality improvement and accreditation gives quality assurance and recognition. Alan Rosenbach, Special Policy Lead at CQC emphasised the increasing important influence of GSF on inspection, ‘At the CQC we place great value on the work of the GSF, which has undoubtedly helped to drive up standards of palliative care in care homes. The vital importance of this to people approaching the end of their life, and their families, can hardly be overstated. GSF accreditation will shape the thinking of our new approach to inspection and regulation – a measure of the significance for this work. GSF accreditation can become a part of the inspection process.’ But GSF is about much more than helping homes pass an inspection as highlighted by the manager of Malthouse in Dorset, ‘We feel our residents have welcomed the opportunity to discuss their end of life wishes. Some are clear about their wishes and some choose to have loved ones with them. We explore their worries and wishes. This is what GSF is all about; it’s about people – individual people – wonderful precious human beings.’ CMM 7YVMLZZVY 2LYP ;OVTHZ PZ 5H[PVUHS *SPUPJHS +PYLJ[VY H[ .VSK :[HUKHYKZ -YHTL^VYR *LU[YL PUMV'NZMJLU[YL JV \R

CMM DECEMBER 2013 ¦ 33

SPOTLIGHT ONâ&#x20AC;Ś care sector training providers Training is an integral and on-going aspect of delivering social care whatever the setting. Training can be delivered in a variety of different ways to all members of staff, focusing on everything from Common Induction Standards, through catering or activities to leadership. If you are looking for the right training for your organisation, delivered in your preferred way and addressing the subjects your staff and company require, the following organisations will help you in your search. Please mention CMM when contacting them.

34 ÂŚ CMM DECEMBER 2013

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Aged Care Channel (ACC) provides training, learning and development solutions for those who care for older people. We use the power of storytelling to convey key messages that will engage, inform and inspire care staff to deliver high quality care. Our programmes are ﬁlmed in real care home settings, featuring real residents, relatives and staff. Available as a live broadcast, DVD or via our online platform, our delivery methods put learners and their managers in control.

Our comprehensive learning programmes provide: • Support evidence for CQC outcomes. • Full learning resource materials. • Support to run facilitated learning sessions. • Support for CPD and qualiﬁcation attainment. ACC’s experience in the sector allows us to work with industry leaders, developing learning solutions that address key training issues faced by care providers today and in the future. Awarded Centre of Excellence status by the National Skills Academy, we believe that we offer the most powerful training available to care companies in the UK today.

Telephone: 01908 802808 • Email: sascott@acctv.co • www.agedcarechannel.co.uk

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BVS is the UK’s leading provider of video-based training solutions for the care sector. Over 125,000 care staff were trained with BVS products last year putting our products at the forefront of your training requirements. Our aim is to improve the skills of staff working in care through the use of videobased training in settings that mean something to the workforce. All our resources are developed by leading consultants in the care sector and offer you a cost-effective and

time-efﬁcient way of training your staff. Our resources will help you to meet the required standards set by the Care Quality Commission and to meet Skills for Care Common Induction Standards. We have over 100 titles to choose from covering care home, domiciliary care and childcare environments and also offer an online training solution through our web portal.

Telephone: 0845 644 2866 • Email: info@bvs.co.uk • www.bvs.co.uk

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Within the top 200 Skills Funding Agency Providers in the UK, Care Training East Midlands (CTEM) has been delivering a dynamic variety of training and support to businesses across the East Midlands since 1995. We have worked with a wide range of employers including Derbyshire Care Services, Pathway Care Solutions and Framework Housing Association.

We offer a variety of work-based qualiﬁcations in health and social care which can be tailored to meet the needs of your organisation, including: • Fully comprehensive Apprenticeship schemes for both new and existing employees . • Accredited and CPD short courses, including health and safety, and food hygiene. CTEM also offers a free bespoke recruitment service to ensure that your new recruits are well-prepared before they even begin their role with you. CTEM offers a free consultation including a breakdown of any funding or grants available.

Telephone: 0115 9599 544 • Email: info@ctem.uk.com • www.ctem.uk.com

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Dementia Care Matters was established in 2009 and recognises that managers and staff struggle, just with training alone, to change cultures of care. Care homes can contract with Dementia Care Matters for a one to two year culture change programme known as a ‘Butterﬂy Project’. Dementia Care Matters has pioneered a ‘household model’ where three elements - Leadership Consultancy, Team Leader/Nurse Modelling and Coaching, and the Being a Star learning programme for staff

– are led by a Dementia Care Matters’ Project Consultant. Currently 60 care homes across the UK, Wales and Ireland, spread across the corporate, local authority, charitable and ‘one-off ‘ provider organisations have adopted this model. This can lead to achieving Dementia Care Matters Quality Mark.

Telephone: 01273 242355 • Email: info@dementiacarematters.com • www.dementiacarematters.com

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We are accredited with City and Guilds to deliver qualiﬁcations in adult and childcare awards at all levels, across the South. An approved provider for the Skills Funding Agency, with a contract for the provision of the Adult Single Budget, First City Training is able to identify various streams of funding. First City Training is passionate about high quality training, priding ourselves on our vibrant style of training and ﬂexible approach. We believe that well-trained staff are

conﬁdent, motivated and committed and can make a unique and informed contribution to the wellbeing and lives of both adults and children. Additional training also offered includes: • Induction for new staff. • Moving and handling. • Safeguarding of vulnerable adults. • Emergency ﬁrst aid at work, including CIEH Training. • Health and safety, including CIEH Training. • Dementia training. • End of life training. • Person-centred planning and support. • Bespoke training at company request.

Telephone: 01793 612380 • Email: Enquiries@ﬁrstcitygroup.co.uk • www.ﬁrstcitytraining.co.uk

CMM DECEMBER 2013 ¦ 35

spotlight on…care sector training providers /(:*( 3;+

Horses lead courses offers a powerful learning experience using horses to develop individual and team interpersonal skills, team working and leadership.

tricky. Horses provide a mirror, which allows you to discover how others perceive you, develop your strengths and work on any weaknesses. Sessions provide an opportunity to experiment with the concept and dynamics of effective leadership and teamwork, receiving honest feedback from the horses.

In social care leadership roles, as part of a team or when dealing with challenge, it is essential to understand the impact our communication and approach has on others and how to vary what we do to gain the results we need.

A part of Hasca Ltd, we offer tailor-made sessions to meet the needs of the organisation for either individuals or teams, ranging from half to two day residential courses.

Getting constructive immediate feedback from people in any given situation can also be Telephone: 01992 633 111 or 07803 206 939 • Email:Lynda@horsesleadcourses.co.uk • www. horsesleadcourses.co.uk

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Activities Training and Assessment Certiﬁcate Award ‘A.T.A.C is a totally unique training opportunity for activities coordinators’. This accredited distance learning course provides underpinning evidence of your competence as an activity coordinator. It is fun, easy to work through and can be completed in the workplace at your own pace.

supervised a team of activity coordinators for sixteen years. The award is an excellent opportunity to validate your role and comply with the CQC requirements of competence for ‘persons engaged in providing meaningful activities’. (QCF units: ACT 201, ACT 202, ACT 204, ACT 206, ACT 208 and HSC 2023) Priced at just £95 inclusive of enrolment, course material in PDF format, tutor support, course marking and ﬁnal certiﬁcate.

The authors, INCARE Services, have been an established training provider since 1991 and Telephone: 0208 144 9491 • steve@incareservices.com • www.incareservices.com

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Winner of the National Skills Academy Excellence Award for Learning, Kwango provides a wide range of engaging, accessible and cost effective healthcare and social care e-learning. Our carers awareness e-learning course is designed to provide knowledge, skills and strategies for carers, people who receive care and professional workers. The aims of the course include helping practitioners to understand: • Who is a carer? • The position of carers in law and their rights.

• • • • •

The importance of the ‘Support Triangle’. ‘Common Core Principles’ for working with carers, including young carers. Key messages from carers, research and carers’ organisations. The diversity of carers and their needs. Support networks at local and national level.

It contains interviews and quizzes to further engage learners and can be accessed 24/7 for just a ‘one-off’ fee. Whatever size your organisation, let Kwango help you provide the best quality of care.

Telephone: 01908 255600 • Email: sales@kwango.com • www.kwango.com

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MYA – Helping your team deliver… Great Food, Great Value, Safer, Compliant Catering Operation MYA have been an integral training partner for investors, care managers and operations directors since 1991. Our team provides bespoke, accredited and vital training to keep your staff informed and motivated. We apply our comprehensive industry knowledge to help you deliver the very best from all aspects of your catering operation. Our courses include: Compliance courses: • RSPH Basic Food Hygiene, • RSPH Intermediate, • HACCP Training. Creative courses: • How to create appealing nutritional menus. • Understanding basic nutrition and how to make diet food appealing. • Basic craft skills. • Advanced craft skills.

Supervisory courses: • Financial management for catering departments. • Purchasing skills. • Housekeeping management. Suitable for: • Domiciliary care. • Supported living. • Care home and nursing. • Physical disability care. • Mental disability care. • EMI care. • Respite care. • Food production and catering units. Our in-house courses are provided at your premises or at our modern offices. We can accommodate flexible group sized training. We provide a fully-interactive course with an industry accredited tutor, support and learning materials and subsequent qualifications certificates for each employee. We encourage businesses to utilise our on-going support to refine and adjust their training requirements. ‘We want to change the perception and quality of food served in care sector catering operations. By improving the presentation, style and delivery and ensuring every bit of nutritional content reaches the customer’s plate, we can tangibly improve food offers and make business sense.’

Contact Daniel Blackstone for speciﬁc course prices and availability. Telephone: 01453 765 643 or 07889 704 821 • Email: daniel.blackstone@mya-consulting.co.uk • www.mya-consulting.co.uk

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The Silver Box Distance Learning system created by Redcrier Training Solutions is one of the most flexible, versatile and costeffective training tools currently available. The Silver Box is a bespoke training system that can be tailored around specific Telephone: 01823 332200 • Email: jamie@redcrier.com • www.redcrier.com

36 ¦ CMM DECEMBER 2013

training needs to cater for all different types of care and any amount of staff. The Silver Box is a tried and tested distance learning system that will increase staff knowledge, competence and overall efficiency within your care setting, whilst becoming a very cost effective solution that will save time and money.

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CMM DECEMBER 2013 ¦ 37

spotlight on…care sector training providers

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The Social Care Institute for Excellence’s (SCIE) eLearning resources and Social Care TV ﬁlms are free to access, easy to use and are developed by social care experts. The training and development resources are quality assured. They can be downloaded and used in training sessions and team meetings, or by individuals who want to expand their own knowledge.

including: • Safeguarding adults and children. • Integration with health and other services. • Coproduction with people who use services and carers. • Dignity. • Personalisation. • Mental health. • Mental capacity. The resources include key learning points and most are mapped to the Qualiﬁcations Credit Framework.

SCIE - Sharing knowledge, improving lives They cover a comprehensive range of topics in both adults and children’s services

Telephone: 020 7535 0900 • Email: info@scie.org.uk • www.scie.org.uk

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SVT has launched a new qualiﬁcation aimed at the social care sector and the general public. The Level 2 Certiﬁcate in Dementia Care was written by Joe Pope, Business Manager and Director of SVT (Care) Ltd.

and non-accredited, and is aimed at anyone working within the social care sector or for anyone caring for someone with dementia or just wanting to gain a better understanding of the subject.

This course is aimed at care staff that have little or no knowledge of dementia and it would be suitable for anyone aged 16 or older who have an interest in operating in a caring role for older people.

‘I also feel that we can all beneﬁt by raising our own awareness of this condition as it would help us to understand people who are suffering from this as well as helping us support others who are affected by this. Knowledge is power. The beauty of distance learning is that it can be studied anytime and anywhere so the individual can ﬁt it in around work and home life.’

This qualiﬁcation has been developed in-line with a nationally-recognised qualiﬁcation from City & Guilds to help meet the dementia strategies for the UK, improving health and care services that support individuals diagnosed with dementia.

SVT has been an established international training provider for over 16 years. We deliver levels 2, 3 and 5 diplomas in Health and Social Care with a candidate base throughout the UK including Jersey, Guernsey, Isle of Man and Northern Ireland.

Joe explains, ‘The distance learning course is available and accredited by City & Guilds,

For further details of the courses available, contact one of our course advisers.

Telephone: 01472 240112 • Email: info@vocationaltraining.org.uk • www.vocationaltraining.org.uk

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The Grey Matter Group provides an online assessment system that measures and evidences knowledge and competence against national standards and QCF units. We provide free workshops, such as ‘Manage staff development to evidence competency and reduce training costs’ – details, dates and booking can be found at CIS-Assessment.co.uk. We offer workforce development consultancy, and support, and undertake various projects. For example, we have created a learner management system in partnership with a local authority to support them to manage training provision and training needs analysis for council staff and their private/voluntary sector. Our focus and passion is about enabling organisations to improve training and make efﬁciencies by using technology solutions. Assessment subjects are wide-ranging, they include Common Induction, and the subjects are relevant to social care, as they are mapped against national standards and QCF units. Assessments can be used during interview to ascertain if people have the right knowledge and attitude, or they can be used to plan induction, identify training needs and priorities, training needs analysis and provide evidence to inspectors. Established in 2007 by Alex and Sarah Knapp – who have technology and social care backgrounds, and a wealth of experience – The Grey Matter Group has 18 case studies, plus three video case studies on its website from customers explaining how they have used the resources to save time/money, and improve the quality of care/support

services. These can be found at CIS-Assessment.co.uk, under resources. The Grey Matter Group has won several awards, including ‘Innovative Partnering Solutions’ from the Local Government Chronicle and our assessments are suitable for anyone, anywhere, and in any care setting. We deliver our services online – through the Internet – at a time, place and pace to suit learners. Paper assessments with randomised questions are also available. Our customers include 47 local authorities and thousands of private and voluntary care sector organisations (national and regional). We work with care associations, individual employers, personal assistants, healthcare providers and training providers. We are Project Managers for Log on to Care, a website resource and e-learning provision for a partnership of ten local authorities, providing free e-learning in the Thames Valley. We have recently won a Skills for Care contract to develop online assessments and e-learning speciﬁcally for personal assistants, which will offer 500 free assessments and courses. The Common Induction Standards workbooks are free for anyone working in social care. Assessments are funded in various areas across the UK – you may be entitled to free access. We provide annual contracts and monthly pricing plans from as little as £1 per person, depending on the number of licenses purchased and size of subject. We currently employ seven people, plus a variety of specialists and we are proud sponsors of Skills for Care’s Accolades.

Telephone: 0845 873 0373 • Email: Info@TGMGroup.net • www.CIS-Assessment.co.uk

38 ¦ CMM DECEMBER 2013

THE

SHOCK NEW : how providers are

OF THE

helping their staff prepare for integration Debbie Sorkin reﬂects on new roles, training programmes and development patterns that are arising from the call for integration and on how they can pay dividends for providers.

At the recent National Children’s and Adults’ Services Annual Conference, integration across social care, health and other sectors was the key theme and preoccupation. At the same time, as Jon Rouse, Director General for Social Care, Local Government and Care Partnerships noted in his speech to the conference, neither the social care nor the health workforce is currently trained in an integrated way. There is a real question mark as to how well-prepared the social care workforce is to work with the reforms that will come with the Care Bill, and how conﬁdent people working at all levels of social care feel about taking up a leadership role, so that there is an equal balance between social care and health.

CMM DECEMBER 2013 ¦ 39

the shock of the new: how providers are helping their staff prepare for integration

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This issue, which has become increasingly pressing, is being considered by the Government as part of its response to Camilla Cavendish’s review into training and support for healthcare assistants and frontline social care workers. The Cavendish Review recommends joint training in a common core programme of knowledge and skills, through a Certificate of Fundamental Care, because ‘it is clear that society is increasingly going to need a flexible workforce that can operate across the boundaries of health and social care, with more and more shared knowledge.’ The aim here is not just to embed common understanding and standards but also to cut through the swathe of staff roles, job titles and responsibilities that currently exist – a consequence of a lack of clear, and clearlyunderstood, career paths across the sector. As Camilla Cavendish also noted, ‘Health and social care do not yet offer the kind of clear, simple career ladders available to staff who join Tesco, or Specsavers. A clearer career path in health and social care would make it easier to attract and retain staff. At the moment, many workers are not sure they can see the way forward.’ This is playing out in staff shortages. The Care Quality Commission suggested last month that there were some 4,000 services in England without a Registered Manager in place. Earlier this summer, the National Care Forum reported in its Annual Personnel Report that 32 per cent of workers joining the not-for-profit sector left within a year. The issue is not just about training the workforce; it’s about having a workforce to train.

40 ¦ CMM DECEMBER 2013

3,(+05. -964 ;/, -965; Many employers are already taking matters into their own hands, by putting a clear career path and training and development into place to enable people to stay and progress. Barchester, for example, alongside its Apprenticeships operates the Barchester Business School. This offers two routes into management: a vocational route beginning with a Certiﬁcate in Team Leading through to a Vocational Diploma at QCF Level 7; alongside a post-graduate route offering courses from a Post-Graduate Certiﬁcate in Management through to Masters level. There is also a Graduate Nurse Management Programme that spans both clinical and management topics. At the same time, Barchester categorises its job groups alphabetically, so maintenance comes before

management on the list. This supports the idea (identified in the Cavendish Review) that ‘whole crew’ training and development pays dividends. As Professor Martin Green, Chief Executive of the English Community Care Association stated, ‘When we fragment training it causes problems, because everyone is not on the same page.’ This approach is not confined to residential care. The Good Care Group, which delivers live-in care at home, provides all of what it explicitly calls its Professional Carers with a 17-module training programme. It builds reflective practice into a clear pathway for professional development, including its own Apprenticeship in Health and Social Care, an 18-month vocational programme that covers both sectors. Also, it is not something that takes years to come to fruition. HC-One, when it took over services from Southern Cross, instigated a training and development

programme for staff called touch, which is centred on kindness in recognition of the crucial vocational aspect of being a care professional. Touch emphasises personal accountability alongside professionalism as being at the heart of safe and kind care. Over a period of seven months last year, over 90 per cent of HC-One staff participated actively in the programme and training was cited in the 2013 staff survey as the best thing that the organisation had done for the people who worked there.

5,> 963,: (9, ,4,9.05. There are new roles coming into place to bridge the gaps between health and social care. 360 Forward, the training and development organisation, has developed Elizabeth Nurse and Elizabeth Care Worker roles, which are currently being piloted in the independent sector. Elizabeth Nurses are specialist nurses in the

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CMM DECEMBER 2013 Â¦ 41

the shock of the new: how providers are helping their staff prepare for integration

health and social care of older people in care homes and Elizabeth Care Workers combine care and health functions in an enhanced care assistant role. Both these roles reﬂect how the diversity and complexity of the health and social care needs of older people in residential care have continued to increase, whilst also going hand in hand. They now include acute and chronic illness, dementia, intermediate care, re-ablement and end of life care. The idea behind these roles is that they cut through current constraints in skill mixes and scopes of practice, to provide the range of competencies required of lead nurses and care assistants in residential and nursing settings. There are increasing opportunities for Graduate Trainees in social care who are able to work at a strategic level on issues facing care organisations and identify new areas for development. At the National Skills Academy for Social Care, our National Graduate Training Programme has enabled both large and small provider organisations to work in new ways and prepare for integration. One of the Graduate Teams last year speciﬁcally looked at what worked in health and social care integration, identifying and sharing good practice. This year, another team is looking at how local authorities, working with the independent sector, can best shape integrated social care and health markets. We have expanded the scheme to introduce a paid Internship programme to give a wider range of provider organisations, especially SMEs, access to Graduate Trainees. Again, they have provided an additional resource to providers around preparing for integration,

42 ¦ CMM DECEMBER 2013

focusing on what this means for older people, people with learning disabilities and – working with the Mental Health Foundation – people with mental health issues. We will be looking to expand the scheme from 2014 onwards,

more internal candidates to apply for Registered Manager positions as they arise. For Registered Managers themselves, there’s already a national support programme and local networks to help them connect with one

people using care and support services, as this is crucial. On the one hand, public and private sector resources are shrinking. On the other, providers increasingly want to work with people using care and support services, in

‘Integration is coming towards us at speed, and preparing for it, alongside all the daily pressures involved in providing care, is daunting. But it needn’t be impossible.’ to meet the rising demand for new roles and new areas of expertise.

)90+.05. .(7: >0;/ ;9(0505. Like others in the sector, we are bringing in new patterns of training designed to bridge gaps, span health and social care issues, and engender new working patterns. For example, we are already working with Bupa to bring social care leadership behaviours to a cohort of their Graduate Nurses. Together with Shropshire Partners in Care, we’re planning a joint Lead to Succeed programme across health and social care. We’re making sure that people at all levels of the social care workforce learn about commissioning agendas as part of their leadership development with us. And we’re introducing new programmes, like Inspiring Leaders, which is aimed at bridging the gaps between Front-Line Leader and Registered Manager roles, so that providers can encourage

another, share good practice and identify training and development. Like others, we’re mirroring support for the independent sector with help for the public sector. For example, we are working with Public Health England, the Virtual Staff College, the Local Government Association and the NHS Leadership Academy on a new, combined programme called Leadership for Change, which is designed to help leaders, with responsibility for public services, ﬁnd new ways of leading together in order to bring integrated services together. We will be building new leadership development programmes for people at more junior and operational levels in local authority commissioners, so that people become accustomed to the ideas around integration before they get to senior level. Over and above the workforce, we are looking to develop new leadership roles and capacity amongst wider communities and within

order to give them real choice and control. Therefore, we will all need to look to our communities as potential assets and to have all the training, expertise and resource we can muster.

4(2, ( :;(9; Integration is coming towards us at speed, and preparing for it, alongside all the daily pressures involved in providing care, is daunting. But it needn’t be impossible. There are many examples of how providers support staff to develop training and careers, and there is help available, not just from the Skills Academy but also from SCIE, Skills for Care and – at local level – Care Provider Forums and Associations. The key thing, whether it’s in how you structure your training, or how you structure your staff teams, is to make a start. CMM

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conference review

NORTH WEST CARE CONFERENCE – THE FUTURE OF CARE AND COMMISSIONING

17th October, CMM Bolton CAREMANAGEMENTMATTERS

discussion enabled delegates to discuss this important subject with industry experts both regionally and nationally as well as each other. Given the recent mention of the use of hidden cameras as a possible way to monitor the quality of care in certain settings this initially dominated the discussions.

The North West Care Conference 2013, supported and organised by CMM in association with the Lancashire Care Association, brought together leading care providers from the North West to debate the future of care and commissioning on a local and national scale. Providers were able to engage in the contentled sessions from national and regional speakers who offered guidance, support, information, debate and ultimately, advice on how to improve their business. The interesting and informative day was a great forum for providers. Delegates had the opportunity to hear presentations on a range of subjects including the state of the market and developing markets, the reality of bank financing, how to engage with integrating health and social care as well as hearing directly from the Department of Health about the social care funding reforms. A safeguarding panel

Robert Chamberlain, the Editor in Chief of Care Management Matters opened the conference, with a Chair introduction from Paul Simic, CEO of the Lancashire Care Association. Alongside the main stage presentations ran a informative and interactive workshops. Using your hidden resource – the relatives: Building your reputation in dementia. How to make efficiencies that don’t impact on care quality. How to market your care home – three simple steps to full beds. The day included a well-supported exhibition of manufacturers, suppliers and advisers to the sector. The event was made possible by the generous sponsors Shakespeares, Lloyds Bank and supported by Care Sector Alliance Cumbria.

BERKSHIRE CARE CONFERENCE – THE FUTURE OF CARE AND COMMISSIONING The last in the series of 2013 regional care conferences, supported and organised by Care Management Matters, was held in Berkshire in association with the Berkshire Care Association. Following the successful format of events in Derbyshire and Nottinghamshire, and the North West, the day brought together delegates from around the county to debate and discuss factors influencing and affecting their services on a national and regional scale. Chaired by Fidelma Tinneny, Board Member for Berkshire Care Association the packed programme was tailored to the needs of providers in the region. Opening proceedings Alan Rosenbach, Special Policy Lead to CEO at the Care Quality Commission (CQC) explored how the CQC is working to rebuild public and provider confidence in the sector. He was followed by a provider’s guide to safeguarding and an explanation of the state of the local care market. Delegates were then able to engage with a panel of experts, sharing their thoughts and questions on the topics already covered and anything else. It was an incredibly interesting debate with delegates being able to share real concerns. Alan Rosenbach took away many points for discussion with CQC.

7th November, CMM Reading CAREMANAGEMENTMATTERS

to strengthen it at every level; a supply and demand analysis focusing on Berkshire and what’s happening in practice that will affect delegates’ businesses; care home marketing; and designing care homes for dementia. Each offered delegates practical input into their business and operational issues. The afternoon session saw a repeat of the morning workshops enabling delegates to attend more than one. Final presentations of the day focused on an interpretation of the forthcoming Care Bill and innovative ideas for taking forward services. The event was a huge success with a large number of exhibitors showcasing their products and services. The day was made possible by the generous sponsorship of Robinson Lloyd Architecture Ltd, jhai Ltd, Carterwood and Shakespeares. Special thanks have to go to McCullough Moore who supported and arranged both regional events alongside Care Choices and CMM.

Workshops delved into the subjects of leadership and how

CMM DECEMBER 2013 ¦ 43

conference preview

LCS 14TH ANNUAL HEALTHCARE CONFERENCE With a focus on Austerity, Demographics and Health and Social Care Reforms, this one-day conference on health and social care brought together leading names from business and politics across these two intertwining sectors. The opening session was chaired by Lord Warner, former Minister of State at the Department of Health, his panel of presenters included the Rt Hon Paul Burstow MP, former Minister of State at the Department of Health, Anita Charlesworth, Chief Economist at Nuffield Trust, Dr Phillip Lee MP and Baroness Martha Lane Fox of Soho, CBE, Chair of the Government Digital Service Advisory Board. The focus of their presentations and the following panel discussion was the fiscal challenge and political response. Stephen Collier, Chief Executive of General Healthcare Group chaired the second panel session of the day which incorporated presentations from Lord Warner, Sir Cyril Chantler, Chairman of UCL Partners, Mike Farrer CBE, Chief Executive of NHS Confederation, Dr Charles Alessi, Chair of National Association of Primary Care and Dr Robin Lee of Sagentia. The focus of the

session was new approaches to services and funding. Funding, quality, regulation and workforce challenges were explored in session three chaired by Sir Stephen Bubb, Chief Executive of ACEVO. Panellists and presentations were Ian Smith, Chairman of Four Seasons Healthcare, Sebastian Habibi, Deputy Director of Social Care Strategic Policy and Finance at the Department of Health and Stephen Gay, Director of the Association of British Insurers. Finally, Julia Manning, Chief Executive of 2020Health chaired a session on changing delivery of health and social care: the Government perspective, with an interesting presentation from Dr Daniel Poulter, Minster of State at the Department of Health. The ultimate feeling was that there are a number of challenges to the future of health and social care, including the changes necessary to deliver an integrated system. There is a lot to do but this forum proved important to moving the conversations forward.

NATIONAL CARE FORUM MANAGERS DIALOGUE CONFERENCE 2013 Celebrating 20 years since the establishment of the Care Forum and 10 years since it became the National Care Forum, this annual event took on a different approach with the addition of the word ‘dialogue’ to the title. It was clear to all delegates that the two days would be an opportunity to engage, discuss, share and learn from each other. The focus of the event was recognising the future... the role of the manager. Andy Bradley, Founding Director of Frameworks 4 Change opened the proceedings with some interactive sessions around listening, hearing, understanding and compassion. Enabling delegates to get to know each other and understand the importance of truly listening when people talk. Ebony Gayle of the Health and Care Professions Council introduced the Council’s new film encouraging delegates to check the credentials of health care professionals who visit their clients. Helen Sanderson, CEO of Helen Sanderson Associates explored practical ways to embed personalisation in residential care. Helen was followed by Bill Hodgson, National Professional Adviser, Adult Social Care at the CQC summarised the inspectorate’s new start to inspection. Detailed workshops followed the break and included information on how to support registered managers to be leaders presented

44 ¦ CMM DECEMBER 2013

21st October, London

28th/29th October, Gloucestershire

by Debbie Sorkin, CEO of the National Skills Academy for Social Care. Other workshops focused on performance and dementia: using creative activities; SCIE and the NICE collaborating centre for social care; Connecting care making the most of technology; Driving up quality in learning disability services; Quality initiatives and end of life care; Live practice issues; From training to learning: making it stick; Update from Skills for Care; Conversations that matter: breaking through dementia; Compassion in practice and the 6Cs; Making it real: marking progress; Marketing and the delivery of services. A special mention has to go to Ping Pong: motivational activity training who not only delivered a workshop but brought their ping pong kits to the conference dinner to enable delegates to have a go for themselves. Day two’s main presentations included an interactive panel session on the role of improvement bodies; an update on progress with Your Care Rating – giving residents a voice and concluded with the role of future managers. Principal sponsors of the event were Advanced Health & Care, CMM, The Consortium Care, Carterwood, Payingforcare.org, Pharmacy Plus, Pozzoni LLP and SCA Hygiene Products. The event was also supported by Skills for Care, Social Care Institute for Excellence, National Skills Academy for Social Care, 6Cs Live and The Health and Care Professions Council.

what’s on?

WHAT S ON? Event:

Next steps for dementia care - commissioning, the Dementia Challenge and the Care Bill

Date/Location:

26th November, Central London

Contact:

Westminster Health Forum, Tel: 01344 864796

Event:

Care Managers Networking Breakfast

Date/Location:

27th November, East Midlands

Contact:

Care Training East Midlands, Tel: 0115 9599 544

Event:

Learning Disability Today

Date/Location:

28th November, London

Contact:

Learning Disability Today, Tel: 01273 434 943

Event:

Supported Housing

Date/Location:

2nd December, Central London

Contact:

Capita Conferences, Tel: 0870 400 1020

Event:

Safeguarding Adults in Care Homes and Hospitals

Date/Location:

4th December, Birmingham

Contact:

Community Care Conferences, Tel: 020 8652 4659

Event:

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for Funding, Commissioning Services and Provision of Care Date/Location:

4th February 2014, Central London

Contact:

Westminster Health Forum, Tel: 01344 864796

Event:

ALTENPFLEGE 2014

Date/Location:

25-27 March 2014, Hanover, Germany

Contact:

Sector Marketing, Tel: 01275 33591

Event:

Reforming Social Care Conference 2014

Date/Location:

27th March 2014, Central London

Contact:

GovKnow, Tel: 0845 647 7000

CMM EVENTS Event:

The Key Replacement Service Tel: 020 8343 2943 Fax: 020 8343 2994

Palliative and End of Life Care: the Next Steps

The Future of Learning Disability Care Conference 2014

Date/Location:

25th February 2014, Manchester

Contact:

CMM, Tel: 01223 207770

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Please mention CMM when booking your place.

CMM DECEMBER 2013 ¦ 45

straight talk

straight talk Alicia Wood discusses proposed new regulation for supported living as set out in CQC s A Fresh Start.

ALICIA WOOD CHIEF EXECUTIVE HOUSING AND SUPPORT ALLIANCE The CQC s new approach to inspection, A Fresh Start has many positives and is going in the right direction. Listening to the views of people who use services and their families is a huge step forward. It will support more effective inspection and ensure that regulation really gets to the heart of what good services should be achieving. Equally welcomed is the end of the simplistic compliance framework to one of questioning based on five key areas: Are they safe? Are they effective? Are they caring? Are they responsive? Are they well-led?

We ve moved away from talking about supported living as a concept because it s often identiﬁed as a service model rather than a way of living. We talk about housing and support and start from the basis that people have their own homes and the rights that entails. The service or scheme is simply the support that enables people to live in their own homes. Providers and commissioners have widely misunderstood and distorted supported living so that it s a slightly more ﬂexible version of residential care that often doesn t give people their entitled rights.

These ﬁve areas dovetail with the recently launched Driving Up Quality Code that is a provider-led response to delivering better services to people with learning disabilities post-Winterbourne View. It moves us away from a tick box and compliance model towards an approach of questioning ourselves on what we are actually doing and the resulting narrative, giving a richer and truer account of what we do and believe in as providers. I like the push for going beyond minimum standards and the statement that mediocrity is unacceptable along with the focus on openness and transparency and in particular, making this a marker of an outstanding provider in the ratings.

CQC needs to be clear about this to develop successful regulation of support in people s homes. We need to think of how we develop regulation of this type in the same way we do with domiciliary care. Categorising supported living as a model that is diﬀerent to people having support in their own homes sends out confusing messages about it.

It is clear that despite A Fresh Start, there will remain the inevitable tension between regulation and rules, and how this will impact on providers abilities to support people to make real choice and take control of their lives. There s a danger this will be clouded by the return to ratings and could become an unwelcome distraction as providers enter the race for stars and put less focus on the rights of people they support and enable them to take the same risks as the rest of society.

The report states that Supported living is a policy that has enabled many people to achieve greater independence in their lives and has very positive outcomes for them. However, we know that people who use those schemes do not have the same safeguards as people living in residential care . This is odd considering the history of abuse cases in residential care homes and the lack of evidence for people being less safe when supported in their own homes. Perhaps this is more to do with anxieties about the greater rights and choices people have when living in their own homes. The regulatory framework needs a more sophisticated reﬂection of the Mental Capacity Act when regulating services that are focused on choice and control, which of course means that people have the right to make choices that not everyone agrees with.

Ratings could be a useful way to highlight poor providers but so much will depend on tools used to measure services and who is Finally, supported living mainly refers to people with learning involved in the process. If Experts by Experience and families are able to play a key role then we may have a better chance of ratings disabilities but CQC needs to think more widely about the shift away from residential care for older people and those with that have meaning and can be used as a measure of quality. physical and sensory impairments. More people will want to be in their own homes (whether alone, in extra care or sharing The move away from one size fits all inspection to a range of with others) with high quality support. If I had strangers waltzing approaches including professionals, specialists and Experts by through my home with unannounced visits or on an open day, Experience will see good supported living providers pleased that I wouldn t be too pleased, yet I d still want CQC to be making common sense has prevailed. This recognises that supporting people in their own homes requires a different type of regulation. sure that the organisations that support me are good and I m safe. This report alludes to some of those challenges so we hope An immediate worry, however, is the use of supported living that CQC has a 21st century response and creates a regulatory schemes ; it shows a lack of understanding of supported living framework that takes us into the future. which is reflected in the sector.

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46 ¦ CMM DECEMBER 2013

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