CMM CareManagementMatters
March 2014 ÂŁ4.00
Making the connections Support for registered managers
An unclear future Specialist care in 2014
Business Clinic Is Mears to transform homecare?
Zero-hours contracts Join the Government’s debate
Includes 4-page Skills Academy insert: Focus on Leadership and Registered Managers: The national support programme, one year on
SPEAKER
SPEAKER
SPEAKER
SPEAKER
Catherine Murray-Howard, Deputy Chief Executive, Community Integrated Care
Joe McGilligan, Chair of East Surrey CCG & Co Chair of Surrey’s Health and Wellbeing Board
Trevor Brocklebank, CEO and Co-Founder, Home Instead Senior Care
Andrew Azzopardi, Managing Director, Sunnyside House.
SPEAKER Directors of Children and Families services
Dr Toyin Ogboye, Public Health Specialist, Specialised Commissioning NHS England
Visit Health+Care, the largest national event for health and social care Health+Care provides the perfect platform for everyone from the social and health care sectors to learn, network and source innovation from the largest national sourcing floor. It will bring all the pioneers, experts and aspirants together from across the professional boundaries to showcase what is working, discuss how integration and personalisation can be improved, how patient experience and outcomes can be bettered, and how money can be saved. Through networking, inspirational plenaries and skills development sessions delegates will take away the knowledge, skills and contacts to engage with the challenge of making our care provision greater than the sum of its parts.
Your complimentary Health+Care delegate pass will allow you to: Experience 11 conference streams of CPD content | Listen to inspirational plenary sessions | Hear 350 speakers | Meet 400 providers | Join regional networking gatherings | Follow the Technology Trail | Visit interactive feature areas and much more Passes are usually £695+VAT* but senior social care and care provider professionals can get an allocation of the very limited number of FREE passes that are available. Register at www.healthpluscare.co.uk/Kaltz *Commercial companies will not qualify for complimentary passes
NEW FOR 2014 INTEGRATED CARE
Media Partner:
COMMISSIONING
In Association with:
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CMM
PUBLIC HEALTH
in this issue
in this issue regulars 05
editor’s welcome
Is it just me...?
Editor in Chief Robert Chamberlain comments on councils’ commissioning of domiciliary care in light of File on 4’s recent survey.
07
News
08
In Focus
10
Local Authority and Planning News
12
Property News
features
14
Corporate News
16
26
Business Clinic
34
60 seconds with...
38
Spotlight on... nutrition and catering
16
Mears evolving business and new approach to homecare is considered by the panel.
Tom Harrison gives an overview of the specialist care market.
22
Ian Smith, Chair of Four Seasons Health Care.
CMM profiles some organisations that can aid you in the nutrition and catering aspects of your business.
44
Conferences
45
What’s On?
46
Straight Talk
Learning disability – an unclear future in 2014
Coming together: helping managers connect to improve their services Debbie Sorkin uncovers the benefits of developing networks for registered managers.
29
The safety of medicines in care homes: working in partnership to develop practical solutions Research and new resources for medications management are explored by Des Kelly.
CMM previews the forthcoming Care Show in Bournemouth.
32
David Waters shares his thoughts on how care regulation could improve.
Earning while they sleep? National Minimum Wage and sleepover shifts
Alexandra Robinson looks at potential changes to workers’ pay when they are able to sleep at their workplace.
35
The Care Bill – learning and development programme consultation
Details of a Skills for Care consultation on future learning and development needs.
22 36
Building community for business success
Chris Gage discusses how building a community can improve your business.
42
29
Zero-hours contracts – have your say
Matt Jenkin advises on how you can join the Government’s debate on zerohours contracts.
As this issue of CMM is published, we will be holding our annual CMM Insight conference on the Future of Learning Disability Care. Over the years it’s been interesting to see the event, its delegates and programme evolve. If you operate in specialist care, whether or not you made it to CMM Insight, I think you’ll find Tom Harrison’s feature of interest. He looks at the market, how it’s faring and what to expect in the coming months. Learning disability – an unclear future in 2014 starts on page 16 and we’ll review CMM Insight next month. In the news, we have the story from the United Kingdom Home Care Association regarding the majority of local authorities paying less than the industry standard for homecare. To many this isn’t a surprise but with reducing budgets and increasing need, innovation is clearly needed from local authorities and providers. To highlight one such innovative approach, our Business Clinic this month looks at Mears Group. It has evolved the company and put itself in a position to offer a payment-by-results approach to homecare contracting. It’s an idea taken from the housing market in which it tenders for contracts in that way. The feature, on page 26 explores how it works and what our panel thinks. If you’re a homecare provider, how viable do you think the Mears’ approach would be for you? According to the Cavendish Review, an independent review into healthcare assistants and support workers in the NHS and social care settings, ‘The role of the first line manager is critical to ensuring that workers are properly valued, supervised and held to account. First line managers need more recognition and support.’ An opportunity to network with peers and easy access to information can help registered managers to deliver the best for their staff and those they care for. On page 22 Debbie Sorkin looks into how this can be achieved. Finally, for those of you heading to the Care Show in Bournemouth in March, don’t forget to catch up with the CMM team. If you’re not sure of what’s on, our preview on page 44 explains more. Emma Morriss Editor
Follow CMM on Twitter @cmm_magazine
cmm March 2014 | 3
contributors
CMM CAREMANAGEMENTMATTERS March 2014
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 ADVERTISING sales@caremanagementmatters.co.uk 01223 207770 Advertisement Manager: Tracey Diplock tracey.diplock@carechoices.co.uk National Advertising Manager: Paul Leahy paul.leahy@carechoices.co.uk
editorial panel Des Kelly OBE,
Mike Padgham,
Executive Director, National Care Forum
Chair, UKHCA
Professor Martin Green OBE,
David L Jones,
Chief Executive, Care England
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
SUBSCRIPTIONS info@caremanagementmatters.co.uk To request your free copy of CMM call 01223 207770 www.caremanagementmatters.co.uk
contributors
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 2014 ISBN: 978-1-909048-90-4 CCL REF NO: CMM 11.1
Chris Gage, Managing Director, Ladder to the Moon
Alexandra Robinson, Employment Law Associate, Blake Lapthorn solicitors
David Waters, Managing Director, Care Home Insurance Services (CHIS) and PrimeCare Debbie Sorkin, Chief Executive, National Skills Academy for Social Care Des Kelly OBE, Executive Director, National Care Forum
Publications
Matt Jenkin, Employment Lawyer, Harrison Clark Rickerbys CMM magazine is officially part of the membership entitlement of:
Paul Tarsey, Chair, Bluebird Care Sandie Keene, President, Association of Directors of Adult Social Services Su Konganda, Strategic Accounts Director, MiHomecare
ABC certified (Jan 2012 - Dec 2012) Total average net circulation per issue 16,302
4 | cmm March 2014
Tom Harrison, Associate, Carterwood Ltd
is it just me...?
Is it just me...? Editor in Chief, Robert Chamberlain reflects on the recent survey into council rates for domiciliary care and contrasts the findings with Association of Directors of Adult Social Service’s commissioning guidance for directors. I’m sure you will have seen the extensive media coverage of the BBC Radio 4 File on 4 programme’s survey findings where just four out of 101 councils were found to be paying at or above the United Kingdom Home Care Association’s estimated minimum price for domiciliary care. The minimum rate of £15.19 per hour reflects the current minimum wage and the margins required to deliver ‘sustainable homecare services to local authorities’. The BBC’s interviews with various local authorities included Warrington Borough Council where the lowest rate of just £9.09 an hour was revealed during the research. I won’t go further into the findings in this column as they have been wellpublicised in recent weeks (and are also covered in CMM’s news section). It is clear that domiciliary care is the key to preventing or slowing the development of acute health needs, and financial neglect of this sector due to under-funding by commissioners will cost the system much more in the longer-term. In light of the research, I thought it would be interesting to revisit the Association of Directors of Adult Social Service’s (ADASS) Top Tips for Directors Commissioning and Arranging Home Care Services to compare and contrast the findings with their guidance.
Assure yourself of the contracting process, employment terms and conditions and the status of the domiciliary business in your area. Examples include: • Can you ensure that tendering processes reflect rates which enable at least the full costs of the National Minimum Wage, providers’ costs of sale and overheads? • Are you satisfied with providers’ investment in training frontline staff? Assure yourself there is a professional and effective commissioning process in place. Examples include: • Seek assurances that people who use domiciliary care services, and stakeholders, are fully-engaged in service design and specification. • Be assured about the process for hearing customers’ complaints and commendations and, in particular, on the amount of care contact time and its quality. • Are you sure that there is a shift from contracting by time to contracting for outcomes and that this is reflected in an increasing focus on reablement and enabling independence?
Advice unheeded?
The survey findings suggest that the majority of councils are commissioning Commissioning guidance based on price rather than outcomes. There is little evidence of commissioners The section specifically relating to considering care providers’ overheads commissioning includes the following tips Banner ad_Layout 1 07/10/2013 16:09 Page 2 during a tendering process and this from ADASS. would rule out any interest in ‘investment
in training frontline staff’. Through tendering, many local authorities chose to work with a small number of larger ‘contracted’ domiciliary care providers. Smaller agencies struggle to compete on price due to the lack of economies of scale enjoyed by their corporate counterparts. In these circumstances, it is difficult to understand how the people receiving care have a great choice over their provider or input into the design of their care package. In these austere times, councils obviously have to balance the meeting of care needs alongside budget constraints. However, if the tendering processes employed are biased towards affordability rather than choice, flexibility of approach and, perhaps, quality (including duration of visits) then domiciliary care will be purchased more like a commodity.
Joined-up thinking Domiciliary care is undoubtedly a critical ‘cog’ in the move to reduce future social care and NHS costs. However, while it remains being purchased in silos with no direct link to overall healthcare budgets, social care commissioners will put their own financial pressures first. If integration of health and social care is to be successful there is going to have to be greater joined-up thinking in the way the individual ‘cogs’ fit together and where best to invest in the system. If you would like to comment please email robert.chamberlain@caremanagementmatters.co.uk
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cmm March 2014 | 5
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news
NEWS
APPOINTMENTS APPOINTMENTS
• Corporate • Local authority • Planning News editor - Des Kelly New ‘fundamental standards’ for health and care The Department of Health has published the new fundamental standards for consultation. All health and adult social care providers registered with the Care Quality Commission (CQC) will have to meet the fundamental standards. These are the basic requirements that providers should always meet
and the standard of care and service that patients or care service users should expect. They will be legal requirements; the CQC will be able to take enforcement action including prosecution, where appropriate, when they find breaches. The consultation sets out the aims for the fundamental
standards and the principles behind the new standards. It also includes a draft of the regulations that will introduce the fundamental standards. The consultation closes on 4th April and you can have your say online at http://consultations.dh.gov. uk/standards/fundamentalstandards
Councils ‘pay too little for homecare’ Most councils in England are paying less than the industry recommended minimum for personal homecare, a BBC investigation has found. The UK Homecare Association (UKHCA) has produced a report showing that a minimum of £15.19 an hour is required to cover wages, training and travel.
However data obtained by the BBC, under the Freedom of Information Act, found that this amount was paid in just four out of 101 cases. The investigation, by BBC Radio 4’s File on 4 programme, found the average minimum rate paid by councils was £12.26 an hour. Care and Support Minister
Norman Lamb said, ‘Local authorities must consider how they can do things differently to deliver better outcomes and quality care for people who need it. We know there are plenty of good examples of commissioning by councils, but we want this to be the reality everywhere.’
Care loans scheme could cost five times more A care loans scheme to help people meet the cost of care in their old age could be almost five times more expensive to administer than the Government estimates, new analysis has revealed. Figures published by the Local Government Association, which represents councils in England and Wales, show the cost of the scheme could reach more than £1.1 billion by 2025 in comparison to an estimate based on Government assumptions of £230 million. Council leaders back the introduction of a deferred
payment scheme which would work in a similar way to student loans, with people able to borrow to pay for care against their estate to help them manage the shift towards individual responsibility to meet care costs. The loans would be repaid from the sale of the individual’s home. But the potential costs associated with introducing deferred payments schemes across 152 different local authority areas could place additional strain on already over-stretched council budgets. The LGA is calling for a new national body, underwritten by
central Government, to oversee the scheme, and manage the financial costs associated with it. The Government has pledged £110 million to help councils cover the new costs incurred for the first year, but whether this is sufficient will depend on how many people opt into the system to receive loans. In subsequent years, the adequacy of funding will depend on the number of people requiring loans and the amount of time it takes for the debt to be recovered once a loan is complete.
FOUR SEASONS CEO Four Seasons Health Care has appointed Tim Hammond as Chief Executive Officer of its dementia and nursing care business. He joins in quarter 2 of 2014. MCCARTHY & STONE APPOINTS CEO McCarthy & Stone has appointed Clive Fenton as Chief Executive Officer. He joined 17th February. THE COMPLETE GROUP The Complete Group has appointed a new Commissioning Manager. Shirley Shinkfield joined in January as Commissioning Manager. MANORCOURT HOMECARE MD Manorcourt Homecare, the homecare services division of the Healthcare Homes group, has appointed Mike Osborne as Managing Director. CMG Care Management Group (CMG) has appointed John Ransford CBE to its leadership team as a non-executive director. PRIORY EDUCATION SERVICES Priory Education Services has appointed Allison Hope-West as Director of Autism. FOUR SEASONS BOARD Four Seasons Health Care has appointed Dr. Claire Royston, Group Medical Director, to its board. CQC CORPORATE SERVICES The CQC has appointed Eileen Milner as its new Director of Corporate Services. SCIE CEO Tony Hunter has started his role as Chief Executive of the Social Care Institute for Excellence. PAPWORTH TRUST CEO Vicky McDermott, Vice Chair of Scope and NHS Operations Head is to become Papworth Trust s Chief Executive.
CMM MARCH 2014 ¦ 7
in focus / news
In Focus: New social
Your Care Rating
care topics for NICE following consultation
The results from the 2013 Your Care Rating survey of care home residents are out. The survey obtained views from over 20,000 residents from 1,055 homes and were analysed to give each an Overall Performance Rating (OPR) out of 1,000. The results paint an encouraging picture with an average OPR score of 871. The highest score achieved was 991 for St Leonard’s Rest Home,
WHAT’S THE STORY? The Department of Health (DH) opened up a public consultation last spring to seek people’s views on new topics for the National Institute of Health and Care Excellence (NICE) to produce social care quality guidance and standards from 2015 onwards. The DH received over 270 responses from voluntary organisations, NHS foundation trusts, care home workers, carers and service users.
WHAT IS NICE GUIDANCE?
GP services in care homes
NICE guidance is for NHS England, local authorities, social care staff, charities and anyone with a responsibility for commissioning or providing healthcare, public health or social care services. They also have a responsibility to support these groups in putting guidance into practice.
The health and wellbeing of older people in care homes depends on them accessing GP services in a timely way. Effective joint-working between GPs and care home management, the involvement of residents and their relatives and the engagement of care staff are factors that can affect the outcome and lead to quality improvements. A new guide from the Social Care Institute for Excellence is primarily written for managers and senior staff of care homes but it has also been written with GPs in mind, as well as members of
WHAT RESULTED FROM THE CONSULTATION? As a result of the consultation, the following five topics have been identified for formal referral to NICE. 1. Falls - regaining independence for older people who experience a fall. 2. Care and support of older people with learning disabilities. 3. Medicines management - managing the use of medicines in community settings for people receiving social care. 4. Regaining independence - short term interventions to help people to regain independence. 5. Adult social care - service users and carer experience of adult social care.
NICE has been requested to add these five topics to their social care work plan from 2015. The DH will continue to review and expect to refer another group of topics early next year. Full details can be found at: https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/274200/2014-01-16_-_NICE_social_ care_quality_standard_consultation_report.pdf
Planning for care costs Support Minister, Norman Lamb, and the Director General of the ABI, Otto Thoresen, have signed a joint statement of intent committing
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The National Skills Academy for Social Care has been named WorldSkills UK Organising Partner of the Year for 2013. The winning team was announced at a Parliamentary reception organised by City and Guilds to celebrate the Skills Show Gold Medal
winners, and hosted by Gordon Birtwistle MP, Government Apprenticeship Ambassador to Business. The Skills Academy has run the Health and Social Care category for the past three years, helping to raise the status of social care as a career of choice.
to work together to help people get the information they need to plan and make decisions about how to pay for their long-term care. A number
of companies have stated a commitment to developing this financial market and have indicated the sorts of products that could emerge.
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8 ¦ CMM MARCH 2014
clinical commissioning groups and joint health and wellbeing boards. www.scie.org.uk/publications/ guides/guide52/ Meanwhile, Care England has revisited its report of 2008 on the practice of GPs charging retainers to work with care homes. The new research shows this continues to be a widespread practice and that pronouncements that health care was free at the point of need, were not necessarily true for residents of care homes. www.careengland. org.uk/paying-health-care-realitymany-care-homes
Award for NSA
WHAT HAPPENS NEXT?
Government and Association of British Insurers (ABI) have committed to working together to help people plan for their future care costs. Care and
Hampshire. However, not all homes achieved the national average and scored significantly lower. Ten homes scored 700 or below. The survey also scores four main sub-themes out of 1,000, the national average score for each was (a) staff and care – 869; (b) home comforts – 852; (c) choice and having a say – 852; and (d) quality of life – 923. For full results visit www.yourcarerating.org.
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CMM MARCH 2014 ¦ 9
planning news
Notaro in Somerset Sedgemoor District Council planning officials have granted planning permission for Notaro Care Homes’ innovative 88 bed dementia nursing home intended for Bridgwater, Somerset helping to create 120 new jobs. The 88 bed care home, consisting of 64 bed dementia nursing home and 24 assisted
living units will be built in Bower Lane, Bridgwater. The home will offer a combination of accommodation, supporting services, and residential day and activity spaces, on site therapy room, assistance and specialist healthcare that can be tailored and evolved to meet the individual needs of the residents.
Craegmoor in Lancashire Craegmoor is investing in a new residential service in Leyland, Lancashire for young adults with autistic spectrum conditions. This new development will provide specialist support and enablement in a specially adapted home in Leyland close to Craegmoor’s existing site Oxen Barn, also situated in Leyland. This service will provide four single en-suite bedrooms with shared living space and a self-contained apartment and will encompass the best principles of specialist residential care and develop a pathway to
The home will be split across a two-storey build and a three-storey build and will be surrounded by large secure gardens, designed specifically for individuals living with dementia. Inside the building all rooms will have their own en-suite and cleverly designed interiors with state of the art technology such as wireless care
planning and intelligent bedroom lighting/sensors. Residents will be able to enjoy the relaxing communal areas and innovative touches such as the real sunlight room, hair and beauty salon, craft/ activity rooms and café. Detailed planning is currently being prepared so that works can start as soon as possible.
Park House opens dementia wing
more independent living. The home has been carefully designed to ensure that the environment is optimised for individuals on the autistic spectrum, including the use of therapeutic colours for wall coverings, lighting and furnishings. The Leyland-based Autism Service will bring together the best qualities of a ‘local’ service with the support and expertise of an established and well respected service provider. The service is planned to open in May 2014.
A new wing has been added to the Eastgate Care owned and managed Park House in Bulwell, Nottingham to accommodate dementia residents. This provides a total number of 73 places for residents. The unit will provide superb, much needed extra care facilities with access to the experienced Park House Nursing Team. Wide corridors join the spacious bedrooms, which all have their own en-suite facilities, consisting of a wet room style shower, toilet and wash basin.
A huge L shaped lounge with a glass frontage, gives great visibility of the surroundings and makes the whole unit bright and attractive. Easy access enables individuals to move through to the lime-green dining area. All will be tastefully decorated with vibrant colours particularly suitable for dementia residents, known to be both attractive and soothing. Outside the landscaping will allow for meandering paths and a herb garden and seating in the sensory area.
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planning news
Home Group £1.6m development OSJCT opens show suite Affordable housing provider Home Group has completed a £1.6 million development in Middlesbrough which will enable adults with physical and learning disabilities to live their lives to the full. Home Group appointed construction company Strategic Team Group to build the homes on its behalf on the site of the former St Pius Roman Catholic Church. The development in the Park End area of the town has seen 25 self-contained one, two, three and four bedroom properties built on the site of a former church and presbytery. The development has been partly funded by a £633,000 grant from
the Homes and Communities Agency. Now that building work has been completed on the Amersham Road site residents will soon start to move into their new homes. The scheme, which will be staffed 24/7 will help people with conditions ranging from autism and Asperger’s syndrome to those with complex learning or physical disabilities including visual impairment and neurological disorders. The homes have been built to the Code for Sustainable Homes Level 3 meaning they are energy efficient. Heating will also be provided from an environmentally friendly Biomass district system.
New scheme in Tunbridge Wells The Abbeyfield Culverden Society, and The Abbeyfield Kent Society have begun building a new extra care scheme in Tunbridge Wells. The scheme will provide 19 luxury one and two bedroom apartments
for rent, delivering accommodation for couples and those living alone. The scheme will target older people in Culverden, Rotherfield, and Tunbridge Wells and will act as a community hub.
The Orders of St John Care Trust (OSJCT), has opened the show suite at Lincolnshire’s newest care facility – Apple Trees Care & Reablement Centre. Located in Grantham, this brand new care facility will provide some of the best care in the UK for people living with dementia. OSJCT is one of the few care providers with the services of a specialist Dementia UK trained Admiral Nurse, who will be on hand to offer help and advice to all carers.
All 54 bedrooms offer ensuite facilities; complete with a 24-hour call system and cutting edge technology to help promote a safer environment. The care centre is arranged around a cosy, home style living areas with a kitchen, lounge and dining area. The home will have a shop, tea room and hair salon. Outside, the specially designed landscaped gardens include a sensory area with raised planters, vegetable patches and water features, as well as a specially designed, secure terrace.
New care home to open in St Ives A new, state-of-the-art care home offering high quality residential, dementia and nursing care is to open in St Ives, Cambridgeshire. Field Lodge will officially open in February. It will offer places for 72 residents and provide employment for around
70 people. The facilities at Field Lodge include en-suite bedrooms, landscaped gardens featuring sensory and butterfly areas, a cinema, hair salon and nail bar. The Slepe Tea Room is also open to members of the local community, who are welcome to visit for free refreshments.
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CMM MARCH 2014 ¦ 11
property news
Hazlewoods’ 2013 deals Hazlewoods and its specialist health and care advisery team had another busy year in 2013, they advised on 41 completed transactions valued at £192 million. The social care sector continued to attract interest from private equity investors, and this was accompanied by greater availability of bank debt. Although trading conditions continue to be challenging, many operators are cautiously optimistic. It does however depend upon what sub
provided to Acorn Care and sector of social care and what Education on their acquisition geography you operate within, and of Meadowcroft School. clearly the quality of the business. • Acquisition advisery services The team advised a number of provided to Cambian Group clients either in their acquisition on their acquisition of Whinfell strategies, or to successfully exit Autism School. their businesses and the pipeline • Financial due diligence on going into 2014 is very positive. behalf of Voyage Care Limited With an ever increasing number of on their acquisition of Ingleby buyers it has been interesting to see Corporation Limited. the trends in EBITDA multiples. • Financial due diligence and A selection of the completed advisery services provided to a health and social care transactions number of other private equity undertaken during 2013 include: houses and corporate acquirers. • Acquisition advisery services
Closed care home available near Taunton Sharpe House, a care home in Wiveliscombe which is due to close, is being marketed for sale by specialist property adviser Christie + Co. The home is registered with CQC for 10 clients and is a long-established home caring for adults with a learning disability. Formally two separate properties, Sharpe House
currently comprises ten single bedrooms arranged over ground and first floors, numerous bathrooms/WCs, lounge, conservatory, fitted kitchen and ancillary/storage space. Externally, there are enclosed gardens to the front of the property and off-road parking for a number of vehicles. Commenting on the property’s
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availability, Simon Harvey, Director of Christie + Co’s South West Healthcare team said, ‘We believe there is an opportunity to re-establish Sharpe House as a care home due to its retention of CQC registration and wellestablished position and we anticipate a positive early interest being shown.’
£8.5 million dementia care home An £8.5 million dedicated dementia care home is opening in Lymington at the end of March. The home, owned and run by Colten Care will operate in four house groups of 15 residents each. Every aspect of the home has been designed with dementia care in mind including themed rooms, colour schemes, corridor and room features and navigational aids. There is a hairdressing salon, cinema, activities room, café, retreat and even a ‘Linden Square’ complete with ‘shop fronts’ evoking the Georgian grandeur of Lymington. References to Lymington and the local area throughout the home will help the overall aim of prompting both interactivity and reminiscence.
property news
Carterwood sells 48-bed home Castleoak secures the Blackadder group is run and Carterwood has announced the planning permission marketed as an individual entity, sale of a 48-bed residential care home on behalf of Bromford who sold the home as part of a strategic restructuring to concentrate on other areas of care. The sale was achieved after competitive best and final bids were generated through highlyfocused marketing activity. The home has been purchased by Blackadder Corporation Ltd, a private operator of a small group of homes. Each home within
with its own image and market positioning, reflecting local market conditions in each case. Geoff Butcher, Chairman and Chief Executive of Blackadder, said, ‘Royal Court with its 48 separate flats was a unique opportunity, and with the help of Carterwood and Bromford we have managed to complete the transaction very smoothly and look forward to developing Royal Court to its full potential.’
Castleoak has secured planning permission for a ninth Suffolk care home, which it will build for Care UK as its development partner for the ÂŁ45 million Suffolk reprovisioning programme. The new care home adjacent to Hartismere Hospital, Eye, will have 60 bedrooms and provide residential as well as nursing and specialist dementia
care. Like all the other new Suffolk care homes, it will also incorporate a wellbeing centre for use by local older people as well as residents. By 2016 the ten new homes and wellbeing centres will have replaced all Suffolk County Council’s former care homes and wellbeing centres, which date mainly from the 1960s and 1970s.
Specialist care home to open in Llantarnam Work has completed on a ÂŁ1.3million development project to open a new specialist dementia care home in Llantarnam. Llantarnam Care Home is owned and run by Arun and Rita Patel from Oakville Care Limited who have secured a ÂŁ920,000 Funding for
Lending loan from The Royal Bank of Scotland. Located on Pentre Lane, Llantarnam Care Home will be a new residential care home specialising in dementia care and is due to open its doors in Spring 2014. It brings 35 jobs to the area and unrivalled
facilities including spacious rooms – all with en-suite, cafÊ, coffee lounge for residents and their families and landscaped gardens. The construction work has also been completed by local contractors ensuring further investment and support of the local business community.
A funding package has been secured to support the construction of the new care home which consists of the Government-backed Funding for Lending loan facilities arranged by Graeme Tipple from The Royal Bank of Scotland.
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CMM MARCH 2014 ÂŚ 13
corporate news
Target Healthcare REIT Target Healthcare REIT Limited, a specialist investor in UK care homes, has acquired the feuhold of a 61-bed, purposebuilt care home in Scotland, for approximately £4.3 million including acquisition costs. Located in the suburbs of Glasgow, the care home is a modern facility which was opened in November 2013. The acquisition is in accordance with the Company’s investment policy and the consideration is in line with market value. The home provides 24-hour nursing care for residents, as well as offering respite care and day care services. Built over two floors, the property features generously proportioned bedrooms, each of which include en-suite wet room facilities. The home benefits from large public spaces which are pleasantly furnished as well as a broad range of facilities, including a variety of quiet lounges and dining areas, landscaped gardens, a hairdressing salon and cinema room. The care home is leased to
Mossvale Care Home Limited for a period of 30 years and the transaction represents an initial yield in excess of 7.75%. The rent payable under the lease is subject to an annual uplift in line with the retail prices index subject to a cap and collar. Mossvale Care Home Limited developed the property and now forms part of the Care Concern Group. Headquartered in Slough, Care Concern Group currently operates 22 care homes across the UK and represents the Company’s fourth tenant. The completion of this transaction sees Target Healthcare’s investment portfolio increase to eleven care homes since it listed its shares on the London Stock Exchange’s Main Market in March 2013 and represents its first acquisition since it successfully raised £45.5m in the last quarter of 2013. The Company maintains a good pipeline of investment opportunities and is currently in advanced negotiations to acquire further properties.
Availl opens in central London Care and nursing provider Availl has opened its latest branch in central London covering the boroughs of Hammersmith and Fulham, Kensington and Chelsea, Westminster and Camden. The opening of their fifth branch sets in motion Availl’s expansion plans for 2014. With an ever-increasing demand for
care services, coupled with Availl’s strong reputation, central London is expected to become a major contributor to the growth of the business. In 2014, Availl will also concentrate on expanding its franchise network with the aim of continuous growth throughout the year.
Your Housing Group starts work in Chester Your Housing Group and contractors Cruden Construction have started work at the Kingsway Extra Care development in Chester. Located on the site of the former Woodfield School the extra care development will comprise of 82 high quality 1 and 2 bedroom apartments available for rent, sale and shared ownership. The contemporary modern apartments have wet rooms and well equipped kitchens. There will also be assisted bathrooms and a pamper
bathroom within the development. The development is the result of partnership working between Your Housing Group, Cheshire West and Chester Council and the Homes & Communities Agency (HCA). Funding has been provided by the HCA and Your Housing Group. The extra care development will be built by Cruden Construction, with work beginning onsite in January 2014. The development is due for completion in Spring 2015.
Mears Pre-Close Trading Update Craegmoor invests in Redcar Mears Group anticipates reporting results for the full year to 31st December 2013 in line with management expectations, coupled with strong cash performance. Its current order book stands at £3.8 billion and the bid pipeline remains at £3.0 billion. The Group has 90% visibility of consensus revenue forecast for 2014 from continuing operations of 911 million. It has now fully integrated acquisitions into the business and disposed of Mechanical and Electrical division, Haydon. Mears continues to benefit
from a strong balance sheet. The efficiency with which the Group manages working capital continues to be a cornerstone of the business as evidenced by net debt being less than management expectations as at 31st December 2013. The Group has extended its existing revolving credit facility of £120 million by a further two years to July. The Group will be announcing its results for the year ended 31st December 2013 on 18th March 2014. CMM’s Business Clinic on page 26 explores Mears growth and its innovative approach to homecare.
MacIntyre wins award MacIntryre, a national charity that provides learning, support and care for more than 900 children and adults with learning disabilities, at more than 120 MacIntyre service centres across the UK, has been announced the winner of the 14 ¦ CMM MARCH 2014
2013 CareKnowledge Workforce Development Innovation Award. Cornwall County Council’s Adult Social Care team and the Scottish Autism’s Practitioner Research Programme won the ‘highly commended’ prizes and were each awarded a £250 cash prize.
Craegmoor, part of the Priory Group, is investing £1.8 million in a new residential service in Redcar for people with autistic spectrum conditions. The purpose-built home on the site of the former Stead hospital on Kirkleatham Street, will initially provide, over two floors, 12 single en-suite bedrooms, large lounge and separate dining room and a quiet room. The home has been carefully designed to ensure that the environment is optimised for individuals on the autistic spectrum,
including the use of therapeutic colours for wall coverings, lighting and furnishings. The second phase of the development will provide individual flats to encompass the best principles of skill development and focus on a pathway to independent living in supported tenancies. The Redcar Autism Service will bring together the best qualities of a ‘local‘service with the support and expertise of an established and well respected service provider. It is planned to open in May 2014.
Midland Heart opens Cedarwood Midland Heart has officially opened its brand new Cedarwood service at Good Hope Hospital. Cedarwood, a revolutionary new service brought to Good Hope Hospital by Housing and Care Organisation, Midland Heart, supports patients who are medically fit and due to be discharged but need additional support to get back on their feet before returning home.
An existing ward has been redeveloped to provide a 29 private bed purpose built reablement facility based within the grounds of Good Hope Hospital. In the first eight weeks of operation Cedarwood has seen over 80 customers come through their doors and complete the process of reablement getting them ready to return home.
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CMM MARCH 2014 ¦ 15
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Learning disability – an unclear future in 2014 The last two years have seen a difficult time for the learning disability sector and for the specialist care market generally. Media focus has been intense, public scrutiny heightened and financial pressures considerable, all leading to a sector that might justifiably think it has been somewhat under the cosh of late. So, what of 2014 – does the year promise some respite?
Financial pressures Recent years have seen increasing financial pressure on social care budgets as part of the wider long term austerity measures affecting the country. Recent research from the Health and Social Care Information Centre, Personal Social Services: Expenditure and Unit Costs, England highlighted that the money spent on adult social care by the social services departments of Councils with Adult Social Services Responsibilities (CASSRs) in England 16 | cmm march 2014
was £17.2 billion in 2012 to 13, ‘this is almost unchanged (a decrease of less than half of one per cent in cash terms from the £17.2 billion spent in 2011–12, but represents a two per cent decrease in real terms)’. Expenditure on people aged 18 to 64 with learning disabilities accounted for 30 per cent of the total expenditure (£5.2 billion). Little wonder then that the learning disability sector has been targeted by some local authorities (LAs) as a source of potential savings. One consequence of this is that we have seen a rise in the number of clients being asked to re-negotiate fee rates with commissioners. Some have reported commissioners actively requesting fee reductions, with varying degrees of success. For example, one operator in the North East of the country reported ‘aggressive fee negotiation from a number of LAs in our region’. The same provider told us that as part of achieving reductions in rates, some LAs are employing specialist negotiators to act on
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tom harrison considers the factors likely to affect the learning disability market in 2014.
their behalf. This pressure to reduce fee rates is not limited to one part of the country. Another provider based in the Midlands reported that he was being contacted ‘on a daily basis by authorities looking to reduce fee rates’.
Local authorities’ stance To put a local authority hat on, we could look at any number of positioning statements. To take a random example, a southern county’s market position statement contains the following, which should leave the reader in little doubt as to their financial focus: ‘Commissioners of services for people with learning disabilities want to work with existing providers to ensure they are able to deliver the highest quality services at the lowest possible cost. ‘The Council is seeking to renegotiate a range of contracts to
ensure that all services deliver value for money. ‘We recognise the difficult market conditions and are clear that there will be some providers who do not meet these expectations, and we will not be working with those providers in future. As such, some providers may leave the local market or fail.’ It would be an understatement to say the message is clear. Of course all local authorities will say they have a duty to achieve value for money when they spend taxpayers’ money, but the sector should ask who decides what value is: the commissioner, the provider, or the service user? These three parties may not always be in agreement over such a definition.
Advice for providers So what advice can be given to a provider coming under fee pressure? The consensus from clients we have spoken to is
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cmm march 2014 | 17
learning disability – an unclear future in 2014
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that there is more emphasis than ever on fee justification. It is now crucial that providers are able to present a clear financial argument for the fee levels they charge. There is evidence that this helps to mitigate against the overarching desire of commissioners to reduce costs wherever they can. One operator told us, ‘We have not seen large scale reductions in fees. But that is probably due to our approach to fee negotiation. We are providing much greater breakdowns of how our fees are calculated in order to limit the room for argument. All providers will need to show detailed financials and be able to account for how their fees are calculated in order to avoid difficult renegotiation.’ Another provider told us, ‘Some operators have managed to avoid reductions in fees. The key has been to prove value for money. Local authorities will pay higher fees as long as this is proven.’ The negotiating position of an operator will depend upon a number of factors and influences, including, inter alia, the level of fees currently being charged, the level of acuity catered for, the level of existing competition in the locality and even the relationships between the commissioner and operator. Looking ahead to the next year, it seems likely that not only will there continue to be fee pressures, but there will also be an imperative for all providers to have detailed financial breakdowns to justify their fee rates.
Supported living v Residential care Over recent years, there has been significant change in the learning disability market, where, in line with the national focus, local authorities seek to make placements into supported living rather than traditional registered care homes, which had previously been the ‘default’ option. The supporting philosophy has been to provide greater independence and living choices for service users. There are, however, significant variations in approach between different, and often neighbouring, local authorities, which can lead to different commissioning climates in which cross-boundary services have to operate. The policy has been most acutely applied in relation to lower level services and particularly those that do not require nursing care. As a result, some sector purchasers are focusing towards services with higher dependency needs with attached high fee rates, as opposed to those units with lower fees, which are seen as a greater investment risk. Some recent evidence has contradicted this, suggesting that as the financial pressures on local authorities continue to grow, increasing the focus upon service cost, some commissioners are shifting policy back towards residential care provision. One operator summarised the mixed approach the market is seeing, ‘Some LAs prefer supported living models, some prefer registered care – it really depends on specific demand within each local authority boundary. For us it’s crucial to show care pathways leading to more independent living models – but if we were ten miles away then this might not be the case.’ Taking a straw poll of client opinion, it seems that the overall trend is still towards supported living provision but perhaps the swing is not as great as previously predicted and there are individual examples of the trend being reversed, particularly as service user needs get greater. Some providers are also considering moving to a hybrid model, combining both support living and registered care. 18 | cmm march 2014
Looking ahead in 2014 New development • We are seeing an increase in the development of services at the higher end of the market. This mirrors the picture in elderly care, where facilities that are of good quality and future-proofed are attractive to investors and purchasers. • In terms of unit sizing we have seen typically 6 to 8-bed units, but we know some operators are looking at larger units of up to 10 beds. • We are aware of some local authorities looking for low dependency units of up to 20 beds. It may be that this sector of the market will experience some growth. • Given the fractured nature of some commissioning intention, it could be argued that providers should be looking to include both supported living and registered care facilities within the same portfolio. This has the benefit of offering some fee protection no matter what commissioning pressures. • We do believe that there will always be demand for good residential care facilities to focus on higher need provision, where fee levels are likely to be in excess of £1500 per week. • A potential gap in the market may be for facilities specifically aimed at the over 65s. Traditionally there has been no ‘elderly care’ learning disability sector; however, life expectancy for learning disability service users is increasing and operators may look to develop to cater for this market at the top end.
Higher need referrals • Many of our clients have commented that the level of challenges faced by service users being referred to registered care is increasing across the board. • There is potentially a knock on effect for the incidence of safeguarding issues, which is also an area of concern for providers. • Pressure is being put on staff training and recruitment. With the wider job market getting stronger, it is likely that the recruitment of quality staff will become more difficult. Increased pressure on training budgets is another likely consequence. • Some operators predict that staff quality may slowly erode as a consequence of fee pressure and greater needs combined.
What will it bring? • Overall it is fair to say that the learning disability market going forward is difficult to predict. What will be built, where and for whom, is likely to be determined at a local rather than national level, with different authorities having very different requirements. • There will inevitably continue to be pressure on fees. How this will affect operators may well depend on the business acumen and financial skills of any one company. • We do not see demand for high quality provision decreasing; this is in line with social care facility development across the industry as a whole. • Investors will continue to support both registered care and supported living models, as long as fee rates remain high enough to support long-term business viability. The learning disability market is a complicated one and there are widely differing opinions as to how it will change over the coming year. One thing is clear though – it is very unlikely to stand still. cmm Tom Harrison is an Associate at Carterwood Ltd. tom.harrison@carterwood.co.uk
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cmm march 2014 | 19
Coming Together Helping managers Connect to imProve Their services Debbie Sorkin reports on how new local networks and workshops are fostering professionalism and a sense of recognition amongst registered managers.
A year ago, strong leadership was identified in Caring for our future: reforming care and support as fundamental to the provision of high-quality care and as essential to the delivery of all the proposals in the White Paper. It followed that registered managers, as the lead professionals in home care and care home settings, had a pivotal role. Caring for our future recognised the especially important impact they had on people’s experience of care and support, and the need to provide more support for registered managers to combat the isolation they could often feel. This was reiterated more recently in the Cavendish Review, which was explicit in the need for support, ‘The role of the first line manager – whether a ward sister, 22 | cmm march 2014
midwife or community lead, or registered manager in a care home – is critical to ensuring that workers are properly valued, supervised and held to account. First line managers need more recognition and support. ‘As social care expands, it will be more important than ever to ensure that a trained and competent cohort of experienced, new and aspiring registered managers is available to meet the demand.’
Everyday Excellence This recognition stemmed from Everyday Excellence, a national survey of registered managers commissioned by the Skills Academy in 2012. Everyday Excellence showed
that whilst managers commonly came into the sector imbued with strong social care values, they found that the pressures with which they were faced, and the isolation they often felt, made it increasingly difficult for them to put their values into practice. At the same time, registered managers themselves recognised their need for training and development in key areas, including people management, leadership, business skills and communication skills. They were looking for particular forms of support, including a national network, access to information, and a membership body or community of practice to which they could belong, that would provide some form of recognition of the status of the role. Since last year, broader trends such as the increasing emphasis on integration of health and social care, and the growth in personal budgets, have made it even more essential that registered managers have the necessary leadership confidence and management skills to operate with confidence and competence. It’s also evident that there is still insufficient recognition in the sector of just what registered managers do, and of the value of what they achieve on a daily basis.
All of this has formed the context for the development of the Skills Academy’s national support programme for registered managers, launched by Norman Lamb MP in March 2013.
Support for registered managers The national support programme for registered managers, which has received support from across the sector, is rooted in the needs identified by registered managers. It uses the behaviours identified in the Skills Academy’s Leadership Qualities Framework to put values at the heart of social care practice and strengthen leadership capacity. The programme aims to better-equip registered managers to meet the challenges they face; to reduce their isolation by networking them at local and national level; and to enable them to recognise their leadership role. The programme is based around four key themes: • putting values into practice: building practical support and engagement amongst registered managers at local and regional level;
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cmm march 2014 | 23
layout one coming together: helping managers connect to improve their services
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• gathering and disseminating information, including around values-based recruitment; • engaging with employers; • promoting the idea of registration and/or accreditation. There is a national online network and easy access to information, guidance and support through pages on the Skills Academy website dedicated to registered managers. There are helplines for HR and legal support, and support from experienced registered managers. There is help in recruitment through the Academy’s ValuesBased Recruitment Toolkit. There will be a new written and online Guidebook for Registered Managers, coming out later this spring and registered managers form a distinctive community of practice within the Skills Academy.
Network support Two key aspects of the programme are funding to establish or strengthen local networks, so that we could support managers in networking with, and supporting, each other; and funding for local workshops on key issues. Both of these have really taken off, and we expect to be supporting some 60 local networks around the country, from Devon to Northumbria, by the end of March 2014, with more coming later in the year via a regular call for funding applications. The networks support Registered Managers working across residential, nursing and home care, with meetings commonly taking place at different venues across a county or region, to ensure that meetings are accessible to everyone. On the one hand, they enable sharing of information and best practice; on the other, they provide registered managers with a ‘safe space’ at a time of real financial constraint to discuss challenges and gain insight into improving the quality of their own services. Crucially, they bring registered managers into contact with each other and reduce their isolation, so that they do not have to face issues alone. In the words of one participant, ‘Being a registered manager can be a lonely and isolating role. It is important to have an opportunity to step back for the service and reflected on what can be done better, hear about new ways of working, and sharing and learning from their peers, is a simple way of supporting the development and delivery of high quality services that meets the needs of service users. I found out that the concerns I had were shared by other managers and this made me feel more confident.’ Another participant at the other end of the country echoed this view, ‘I think I run a good and a safe home with quality care at its core...but I feel I need to raise the bar through developing my own leadership skills. You can just become too task focused and risk averse which really misses the aim of your service having its residents as the core purpose.’ And a care association running networks across a region noted, ‘One of the common issues raised by managers, especially those within smaller organisations, is the lack of real opportunity to network and share 24 | cmm march 2014
with peers. The feeling that you are the only one facing the challenges inherent in managing a service trying to innovate and maintain high quality provision is alleviated by sharing issues, concerns and ideas with others. Knowing what others are doing and learning from one another is a great way to stimulate thinking and drive change within services.’ The service is particularly valued by Managers in rural settings. In the words of one facilitator, ‘We made a bid as we wished to reach out to other managers more isolated in rural areas by raising our public profile. We also wanted to attract speakers of interest to our group. This required funding. We are very passionate and serious about the forum and want to see it continue. Our Forum is a chance to meet other managers in an informal setting. We share ideas and receive free workshops on a regular basis. Networking helps us to create more connections, raise our visibility, and increase self-confidence with actual results. In the longer term, it results in more business and social contacts. Being a care manager can be lonely at times... we don’t feel lonely anymore.’ Similarly, the free workshops and events bring registered managers together to share experiences and best practice, have easy access to sector developments and learn tools and techniques to combat stress and enhance wellbeing. They combine a practical approach to learning with a tangible insistence on making sure that learning can be implemented. They also include leadership and management development, with the emphasis on registered managers as leaders and on innovative approaches to leadership. So one pilot project, fully-subscribed at an early stage, brings registered managers together with horses to strengthen their leadership skills.
Making a difference The Academy will be undertaking more formal evaluations of the networks and workshops, and their impact on service quality, as time goes on, but in the meantime, we are committed to supporting and expanding them. Ultimately, the aim of this programme is to build practice and leadership confidence amongst registered managers, to strengthen the pipeline of talent in the sector and to drive up the quality of care and support to people who use services, by improving the quality of leadership which is so fundamental to quality. The Skills Academy website has details of networks or workshops, if one doesn’t yet exist in your area, think about applying to set one up. We know that they can make a real difference to the way registered managers value themselves and their service. cmm Debbie Sorkin is Chief Executive of the National Skills Academy for Social Care. Email: debbie.sorkin@nsasocialcare.co.uk. For more information about the Registered Managers’ Programme and the local networks and workshops visit: www.nsasocialcare.co.uk/ registered-managers.
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business clinic
Mears’ transformation to deliver payment-by-results homecare
Mears Group has transformed its service to focus solely on social housing and domiciliary care. Using this, it’s looking to roll out innovative, payment-by-results, domiciliary care. Is this a new dawn for homecare? The Mears Group has evolved considerably from the small, private building contractor it began as in 1998. The change has been gradual; firstly it built up its maintenance and repairs business with local authority contracts. This led to floatation on the Alternative investment Market (AIM) in 1996. It went on to acquire other organisations to bolt onto its offering including mechanical and electrical division, Haydon. As it grew, the company continued on its path of acquisitions, adding domiciliary care provider Careforce in 2007 and Supporta in 2010. These were merged to create Mears Care The significant acquisition of Anchor’s Staying Put, home improvement services and Choices supported living division in 2011 set Mears’ care and repair vision. Acquisition of Morrison Facilities Services, providing repairs and maintenance to social housing clients and ILS, a Scottish homecare company offering high acuity
homecare rounded of the company. Towards the end of 2013, Mears disposed of Haydon, leaving a different, but interesting business. Offering a full service from social housing repairs, through to home improvement, domiciliary care and supported living services. Mears announced in January that it could now ‘focus fully upon its core and growing social housing and care businesses.’
Payment-by-results Payment-by-results isn’t too common in social care but it is in social housing. Operating in a social care environment of task-based services, short home care visits and rising costs it was clear to Mears that this approach could transfer across. Alan Long, Executive Director of Mears Group explained, ‘Contracts based on outcomes isn’t new to us but it is new to social care. In
social housing and maintenance we don’t give costs for individual jobs, we instead tender for the whole service. The local authority looks at its costs for home maintenance across all its stock over a year and we tender to reduce the maintenance cost. We invest in prevention, quality products and repairs to improve stock and reduce callouts, therefore reducing costs. It’s in our interest. There was a real driver to bring this to homecare.’ Outcomes aren’t just on price; they include customer satisfaction and social outcomes too such as recruiting more apprentices and improving communitybased facilities. How does this apply to social care, where it’s people’s lives? Alan continued, ‘In social care there are a range of outcomes that we tender to meet, these are the outcomes of the individual, the local authority and social outcomes too. For example, personal outcomes for one client may be to enable him to become independent enough to go
We need to see the positives
Attempts to address shortfalls are welcome
Sandie Keene President Association of Directors of Adult Social Services
Paul Tarsey Chairman Bluebird Care Group
Looking at the approach being taken by the Mears Group, we really need to be positive, and welcome the creativity and direction of travel that commissioning for outcomes in this way takes us. I know that Directors of Adult Social Services will recognise the inherent difficulties, and although these are not insurmountable, in the context of the way local authorities have had to batten down all hatches recently - especially in their capacity for change management - it may well be some years before we realise the potential of these initiatives. But those positives are there, despite the shroud of negativity that sometimes seems to be draped over all our efforts. And we need to see them to be able to seize the opportunity to: • Improve our focus on people, not tasks, • Broaden our support for people beyond the personal care task and into the wellbeing context,
26 | cmm March 2014
• Build this changed focus into our thinking about health and social care integration. Interestingly, looking at this approach, it could take us back in the direction of doing business with large scale single providers of multiple services – but isn’t this what local authorities used to do? Bearing in mind that this approach could lead to doing business with large scale single providers of multiple services, there are things that we need to be careful about. They include: • Maintaining a personal approach, • Supporting micro providers. We must also question whether self-funders would buy into an outcomes-based approach to their homecare. They might want to know more clearly what their money is spent on. Incidentally, and controversially, in our experience self-funders are quite happy to pay for 15 minute slots if that is what they asked for.
There is an old saying ‘if it ain’t broke, don’t fix it’. However, if it IS broken then you MUST fix it, and most people would acknowledge that state-funded social care is, indeed, broken. The majority of our services are for privately-funded customers and that gives us an insight into what people need and what they want. The overwhelming message we get from our customers and their families is that they want to address the shortterm needs and try to avoid hospital admissions, deterioration in physical or mental wellbeing as well as the alltoo-often forgotten focus on quality of life. Therefore, any attempts to address the shortfalls of the current system are welcome. I congratulate Mears for its vision and innovation but wonder whether the creativity shown by Wiltshire County Council will be reflected on a wider scale. The current mantra from local authorities is all about cost and, whilst I hope this wouldn’t be the
case, I fear the up-front cost to the local authority may be higher, with any benefits being further down the road. The current short-termism of local authorities, where it sometimes seems that virtually nothing matters but the price, may well get in the way of innovation. We must also not forget that a large proportion of local authority work is provided by smaller companies and these businesses sometimes do not have the in-depth resources to assist with this kind of evolution. I am not convinced that local authorities will want to marginalise a significant part of their supplier base by further complicating the provision agenda. We have seen the absolute chaos which has happened in some areas with electronic monitoring and whilst some places have made it work well, other districts have over-engineered the controls making it difficult to provide any care at all, and equally importantly, get paid for it.
business clinic
to the shops once a week. We’ll put in place a support package to build his confidence and capability to do that. His support then reduces. The commissioner’s outcomes may be to move people from hospital to home quicker, we’ll look at how this can be achieved and set up a plan. We are integrating services to achieve all of these outcomes, to deliver care that is safe and secure. The more we can join together the better it is for all involved. ‘The real cost in social care isn’t per unit of time, it’s in quality of care over time and to reduce escalating costs. If we deliver quality care which keeps people independent for longer we will reduce the ongoing real costs in the system. It’s not a short-term fix, it’s a long-term vision. The market needs a step-change; it needs innovation by integrating housing with assistive technology, community care, health – by having a range of services to give people an all-round offering.’ Alan’s clear that it’s not just for Mears to lead the way. ‘It’s not just about us doing this; it’s for other providers to do too. More tendering should be joined-up; providers should be encouraged to work with others if they don’t deliver something themselves. Local authorities are starting to become interested in this and there is an
increasing recognition of it. A number of local authorities are beginning to tender in this way and Wiltshire County Council is a leading example of how it can be applied.’
Wiltshire County Council In September 2013, Wiltshire County Council entered into a partnership with Mears to deliver care services as part of the council’s ground-breaking Help to Live at Home service. In a move away from traditional domiciliary care contracts, and as discussed by Alan above, Mears isn’t being paid on a task and time basis, instead, the payment-by-results model pays providers on meeting desired outcomes that have been agreed directly with service users. In order to achieve the outcomes, Mears uses technology and resources within the group, which are typically beyond the scope of a traditional domiciliary care contract, as well as drawing on the wider community. This includes aids and adaptations, telecare, community equipment and partnerships with community groups and charities. Working closely with local health services, Help to Live at Home is designed to enable rapid hospital discharge and strong links with local hospices is allowing palliative care to be provided in people’s
own homes. The length and stability of the contract also enables providers to move away from zero hours contracts and actively encourages career development for care workers, meeting commissioning and social outcomes.
Falling into place Mears’ experience and position in the market enable it to offer this and the company announced in its January Trading Update, ‘While still early days, there are indications now that a number of other local authorities are looking to follow the lead of Wiltshire. It will be particularly beneficial to Mears that Wiltshire is a strong reference site to support the Group securing other similar opportunities.’
Over to the experts... The refocus of Mears’ business appears to have given it a great footing to transform the homecare sector. But how accessible is this model for other providers? Can others integrate services in a similar way? Will it see the end of 15 minute visits and increase preventative services? Will it give them a monopoly over the market? What does the panel think?
Traditional homecare will need to redesign Su Konganda Strategic Accounts Director MiHomecare It is important to understand that payment -by-results funds providers on the basis that specific outcomes are achieved and this is part of a wider shift towards outcome-based commissioning in social care. MiHomecare has taken this approach further by introducing preventive services that embody the Government’s vision to avoid costly and long-term social care problems by investing in evidence-based early intervention programmes. Our current service offering integrates housing, health and social care to prevent people from reaching crisis point and entering an overburdened care system. Wiltshire County Council’s Help to Live at Home contract pays providers on achievement of service user driven outcomes as opposed to paying for tasks completed, and with recent trends
showing more local authorities are focusing on this model to deliver efficiency savings, providers of traditional homecare will need to redesign their services to deliver outcomes rather than outputs. The goal of this model is to empower organisations to innovate and deliver results in ways they have chosen, knowing that they will be paid and held accountable for their performance. From local authorities’ and commissioners’ perspectives, for this to be successful, services will need to be developed on what people want or need and believe in, to enable outcomes to be delivered efficiently and effectively. The Wiltshire County Council model encompasses this and promotes an incentivised bottom-up approach with the person requiring care at the heart of the service.
cmm March 2014 | 27
Boots Pharmacy Care Services Let’s look after your residents’ health needs We believe that 25 years of dedicated, local service from a brand you can trust can make a big difference to your organisation, your employees and the care you give to your residents. Boots Care Services give you the support and tools you need to deliver the best possible healthcare. From expert advice from our dedicated Care Services team to providing a unique training service for your care workers – there are lots of ways we can help everyone in your organisation feel good.
We can offer your Care Home: Free access to our unique Boots Care Learning eLearning website*, an ever growing resource of information and training that’s relevant to Care Homes and their residents, including: • Care of Medicines Foundation and Advanced level courses – accredited by the Royal Pharmaceutical Society • Monitored Dosage System (MDS) – covering the Manrex system • Diabetes, which affects 26% of Care Home residents. To help Carers and Nurses care for residents affected by this condition, we’ve created two courses, covering: – Building an understanding of your residents’ conditions and their needs – Giving great care to residents with Diabetes • Dementia – for Carers and Nurses, following the story of two fictional dementia sufferers • Parkinson’s – bite-sized learning for Carers and Nurses, including symptoms and medication • Cancer – supporting those working in care to understand the condition and support available • Respiratory – covering Asthma and COPD to help Carers and Nurses provide compassionate care
Coming soon – we’ll be adding further topics, including: • Heart Health • Patient Pack Dispensing (bottles and boxes)
• Pharmacist Advice Visits, including Antipsychotic medication audits, where appropriate • Expert support and advice from your dedicated Care Services team • Dedicated, purpose-built care service rooms in our stores • 28-day delivery of medication • Daily delivery of medication with two cut off times to meet emergency and mid-month medication requirements – we can supply the majority of our customers on a Saturday • Advice and support 7 days a week • Free prescription management from collection to delivery • Patient information leaflets
For further information please call us on 0115 949 4047† or email care@boots.co.uk *There’s no charge for Boots eLearning if you receive your residents’ monthly medicines from Boots †Call charges apply, please contact your service provider for details
boots.com/carehomeservices
Our eLearning is available to all care homes. Call 0115 949 5740† for details
layout one
The safety of medicines in care homes
working in partnership to develop practical solutions Des Kelly explores research and resources to improve the safety of medicines in care homes.
In the Care Quality Commission’s latest State of Care report, although standards are improving medicines management is still an issue. ‘Our inspectors reported that all types of adult social care service improved the safety of their services in 2012/13. However, the results still leave a long way to go – particularly for nursing homes where almost one in five inspections found a problem to do with the safety of residents, and for residential homes, where the figure was one in eight. Common problems [include]: Failing to give out medicines safely, and not maintaining adequate records of who needs which medicine.’ But care providers cannot improve medicines management alone.
Multi-disciplinary action Paul Burstow MP, the then Minister of State for Care Services, launched a series of prototype tools in 2011. It marked the end of the first phase of a partnership project established to follow up the Department of Health funded Care Homes Use of Medicines Study (CHUMS) report which found an unacceptable level of errors in medications received by older residents of care homes.
Mr Burstow said, ‘To address the problems associated with medication errors and improving the quality of medicines use in care homes more generally, it is necessary to consider the relationship between GPs, hospital doctors, hospital and community pharmacists, PCTs, the needs and experiences of residents and their families, alongside medication management systems and administration within care homes. Also managers of care homes have to demonstrate leadership and set standards to ensure improvements are made and sustained.’ The main finding of the originals CHUMS study was: • Residents were taking an average of eight medicines each; • On any one day seven out of ten patients experienced at least one medication error; • Whilst the mean score for potential harm was relatively low, the results did indicate opportunity for more serious harm. Following the CHUMS report, an initiative was established led by the
g
cmm march 2014 | 29
the safety of medicines in care homes
g
Care Provider Alliance, with the Royal College of General Practitioners, the Royal College of Physicians, the Royal College of Psychiatrists, the Royal Pharmaceutical Society, the Royal College of Nursing, the Health Foundation and Age UK. The initiative meant issues and concerns about medication standards, administration and management in care homes could be tackled through a multi-disciplinary teamwork approach. Change needed to involve prescribing practices, the support offered by community pharmacists and medication management and administration within care homes. In the first year the project working groups developed a series of practical prototype tools for further testing. ‘Task Groups’ covered key themes for each group of stakeholders: people receiving care and support, care home staff and other professionals; and worked on developing resources to address them.
Focus on people receiving care and support Ensuring residents had a voice, choice and control This group looked at prioritising residents’ rights to information and choice around medications; finding ways to engage and empower residents to take control of medicines; and encouraging staff to take a more person-centred approach to medications. The result was to capture this ethos by developing a Resident’s Charter and ‘easy read’ material.
Multidisciplinary communications and relationships This explored the need to encourage good relationships and information flow within the multi-professional teams involved in a resident’s care; improving care planning; and developing tools and incentives to reduce the high number of medications. It culminated in work on medication record systems and proposed a national award around innovation in this important area of practice.
Focus on care home staff Leadership to change culture and practice The group wanted to clarify what good leadership and management in relation to medication actually looks like, developing ways to empower and inspire staff to improve through the leadership role. The 30 | cmm march 2014
group produced a ‘leadership story’ which describes best practice in care home and amongst care providers.
on the use of technology and IT systems following analysis of some existing systems. It was later decided that this work was beyond the scope of the project.
Staff development and support The aim was to develop teams that are competent, confident and empowered to support residents in managing their medicines as it is essential to best practice. As a result it produced a comprehensive learner workbook and guidance for employers, which was subsequently informed by considerable input from Skills for Care.
Focus on other professionals Standards and guidance For other professionals the group looked into describing best practice in medications management at each stage of the care pathway; developing a set of principles to inform the development of guidelines for the medication management pathway. Triggers that should initiate a review of medications were also identified.
Identifying and caring for deteriorating residents Additional work was undertaken to give practical guidance and assessment tools to measure changes and risk, as well as offer advice on over the counter or homely remedies.
IT systems and solutions An initial outline report was produced
Additional resources Alongside the tools the project has published a systematic review of reports and a literature review, completed by the Centre for Policy on Ageing that may be of use in preventing medication errors in care homes. All of the task groups had a multiprofessional membership and were encouraged to provide feedback to other groups as the work progressed.
Testing the toolkits with care homes The second part of the project involved testing the toolkits within a variety of settings. The aim was to gather a range of opinions; establish which tools were useful and in which settings they could be most useful; and gather enough information to be able to recommend next steps. There was a very positive response to the initial call for test sites. 163 care homes undertook to test some or all of the tools and provide feedback, promising a good spread of different types and sizes of care homes. Of these homes, 82 homes completed the evaluation.
Percentage of homes tested that would continue using specific toolkits Leadership guidance
84
Framework for management
78
Risk assessment
73
Training guide for employers
72
Symptom assessment
72
Homely remedies guide
72
Learners’ workbook
70
Residents’ charter
69
Medication record
47
Top tips for prescribing
33 0
20
40
60
80
100
layout one Using the toolkits in care homes The tools’ presentation and usability were generally praised and many homes expressed an interest in using the tools in the future. Take up and interest depended on individual care homes’ attitudes and their management context. It wasn’t assumed that all homes would wish to take up all the tools, there were differences in attitude to the tools both within and between the different categories of care homes. A case by case approach allowing the tools’ relevance to be assessed by each home would probably provide the best outcomes. All homes said that they would wish to adopt a ‘pick and mix’ approach to uptake of the tools. Care homes are extremely busy places and this was reflected in the mismatch between the number of homes that wished to engage with the project and the number that actually did. In addition, the ability to submit detailed evaluations was compromised by lack of time for many participating homes. Staff felt the tools were succinct and would reduce some of the excessive documentation and repetition. It was clear throughout the implementation of the project that multiple demands are placed on care homes especially in the areas of standards and audit. If improvement tools are to be successfully introduced then the staff that are expected to introduce them need to have the time and resources at their disposal to do so effectively. The project team felt it is vital that care home managers are included in initiatives about improving standards and practices in care homes. Many said they were not included in developing new initiatives within the sector. They said they felt they could add to new ideas using their experience as demonstrated in their involvement in this project. Managers need to be supported by the providers and any future involvement needs resource allocation to be considered. Staff from some care homes expressed anxiety during the testing phase about the role of the Care Quality Commission (who were represented on the project working group), contract monitoring teams and other teams that assume a monitoring role within care homes. It was common to hear of the different and often inconsistent advice about the management
‘Multiple demands are placed on care homes especially in the areas of standards and audit’
of medicines. The overall view was that the tools were clear and concise and many staff would like these to be adopted within the sector and other visiting teams to the care homes also adopt them to enable a consistent approach.
The use of the resources The work of the project to develop and further test the toolkits is now complete. The resources are freely available on the National Care Forum website www.nationalcareforum.org.uk to enable care providers to improve medicines
management, help residents to understand their rights and to develop safer working practices so that medicines are administered more safely and drug errors are reduced. A resource pack and the project reports have been passed on to the National Institute for Clinical Excellence in the hope that it will inform their commission from the Department of Health to develop quality standards and practice guidance in this important area. cmm Des Kelly OBE is Executive Director of the National Care Forum. des.kelly@nationalcareforum.org.uk
cmm march 2014 | 31
layout one
Earning while they sleep? National Minimum Wage and sleepover shifts
32 | cmm march 2014
The question of whether employees are entitled to be paid the National Minimum Wage (NMW) when they are able to sleep during their shift can be difficult to determine but this is a particularly important issue for employers in the care sector. Confusion can arise over whether the employees are entitled to the NMW for the whole of the shift, or just for the time during the shift when they are awake and working. The Employment Appeal Tribunal (EAT) has considered this issue and provided guidance in the case of Whittlestone v BJP Home Support Ltd (BJP).
The facts Mrs Whittlestone was employed by BJP to provide care services to service users. She was paid at the rate of £6.35 per hour under her contract for the time that she spent providing care at the homes of service users between 7.00 a.m. and 10.00 p.m. Her shift related to the time spent with the service user and started from the moment of arrival to the time of departure. In addition, Mrs Whittlestone was required to undertake sleepover shifts from 11.00 p.m. to 7.00 a.m. to provide potential physical care to three young adults who had Down’s Syndrome. She was provided with a camp bed and bedding in the living room of the house occupied by the adults. Although she regularly undertook sleepover shifts, there was no evidence that Mrs Whittlestone ever woke from her sleep in order to provide any specific care. Mrs Whittlestone claimed that she was entitled to be paid the NMW for the sleepover shifts, which was more than the £40 per week that she had received from BJP.
The discussion It was common ground that Mrs Whittlestone’s work fell within the scope of ‘time work’ under the NMW Regulations. This is work that is paid for by reference to the time for which an employee works – for example, hourly paid work. Mrs Whittlestone argued that this applied to both the shifts and the sleepover shifts. Under the Regulations, there is a provision whereby an employee who by arrangement sleeps at or near a place of work and is provided with suitable facilities for sleeping, is only paid the NMW for the period during which they are awake. However, the EAT clarified that this provision did not apply in this case. Where an employee’s presence at a particular place is part of their work, the
hours spent there are classed as time work. The employee is, therefore, entitled to the NMW even if they are sleeping and not actually carrying out any activity. The issue comes down to the facts, but broadly there is a distinction to be drawn between two scenarios. Firstly, a situation where specific hours at a particular place are required, with a risk of disciplinary action if they are not spent at that place and the worker is at the disposal of the employer during that period. This will normally constitute time work – an employee is working merely by being present at the premises. For example, a night sleeper in a residential care home who sleeps throughout much of the night is entitled to the NMW for that period if he is required to deal with anything that might arise during the course of the shift. If the employee is required during the night to perform certain tasks or undertake
‘This decision could have farreaching implications for the care sector at a time when Government cuts are already seeing the sector’s resources significantly stretched.’ certain responsibilities, the employee is in truth working throughout the period in question even if actual tasks only come up intermittently or infrequently and even if the employee is entitled to sleep in the intervals between the tasks. Secondly, a situation where a requirement is imposed on an employee to live at or near a particular place, but it is not necessary for that employee to spend designated hours there for the performance of their duties. This is unlikely to be time work – the employee’s presence facilitates work but is not itself work. For example, an employee who is provided with sleeping accommodation and is simply ‘on call’ because he is required to be at or near his place of work and available to work. If that employee went out, he would not be disciplined as long as he remained available to attend work if called on. In that case, the employee can only claim NMW for such hours as he is awake.
The decision In this case, the EAT held that the work carried out by Mrs Whittlestone during
the sleepover shift was time work, and that she was entitled to be paid NMW for that sleepover. The EAT took into account the evidence that there was an agreement between BJP and Mrs Whittlestone that she would sleep over at service users’ homes and she would have been disciplined if she had not been present throughout the period of time. The EAT remarked that ‘she could not for instance slip out for a late night movie or for fish and chips’. The fact that her physical services were not called on during the night was irrelevant since her job was to be there. In effect, she was not just ‘available’; she was required to be there.
Far-reaching implications Clearly, each case will be fact specific and it will be important to examine the purpose of the employee’s presence at a particular location. Is the employee merely available to work during his shift, or is he required to be present and at the employer’s disposal? This decision could have far-reaching implications for the care sector at a time when Government cuts are already seeing the sector’s resources significantly stretched. Failure to pay the NMW can lead to Employment Tribunal claims or penalties from Her Majesty’s Revenue and Customs (HMRC). It was reported by HMRC at the end of 2013 that more than 2,400 workers in the care sector were underpaid the NMW in the last two years across the United Kingdom. HMRC investigations have identified nearly £340,000 in arrears for over 2,400 workers and also over £110,000 in penalties to employers for breaking the law. The Government has set out changes to the enforcement of the NMW which could see penalties of up to £20,000 being imposed. With the changes due to come into force in February, this is an issue that requires careful but swift consideration by employers. Although the regulations are still in draft form so there is no firm date as yet. Finally, this case involved time work, but in cases of unmeasured work (as might apply, for example, in the case of a live-in carer), difficulties can arise in calculating the employee’s working hours. One solution can be to enter into a ‘daily average agreement’ with the employee, setting out the average hours that the employee is likely to spend working each day. cmm Alexandra Robinson is an Employment Law Associate at Blake Lapthorn solicitors. alexandra.robinson@bllaw.co.uk
cmm march 2014 | 33
60 I a n
seconds with... S m i t h
Ian Smith is Chairman and interim Group CEO of Four Seasons Health Care. What’s your background?
I was previously CEO of General Healthcare Group. I helped to shape the healthcare reforms introduced by the Blair government. I also published a book called Building a worldclass National Health Service. I am an Adjunct Professor at the Imperial College Business School where I am working building a healthcare cluster of international competitiveness. I am an Honorary Professor at Salford University and a member of the advisory Board of its Institute for Dementia. More broadly I have been CEO of leading companies in information, logistics, construction and consulting. I have served on Parliamentary Reviews and worked on the Israeli/Palestinian peace process. I have an MA from Oxford and an MBA from Harvard.
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What do you enjoy about your role?
I am part of a first class team in a dynamic organisation that is the largest in the sector. It has taken a lead in developing specialist services for people with higher levels of care needs and has a commitment to set the benchmark for quality in our services. In this we enjoy the active support of our owners Terra Firma. Whether working in management or frontline, we are privileged to be in jobs where, either directly or indirectly, we can make a difference for the better to people’s lives.
What’s your plan for Four Seasons now?
We have changed our structure to focus on three strategic business areas: homes that will provide dementia and nursing care; 34 | cmm march 2014
80 homes designed primarily, but not exclusively, for selffunded clients who choose care homes as a lifestyle choice; The Huntercombe Group of hospitals and specialist units that provide services in mental health and brain injury. One immediate priority is the roll out of staff training and remodelling homes to create specialist dementia care environments with our PEARL dementia care programme (Positively Enriching and Enhancing Residents’ Lives). We are also developing a template for our private homes’ business that combining excellence in care with four star hotel standard services and leisure activities programmes.
What pressures do you see facing the sector? There is a national shortage of qualified nurses of the right calibre. For all independents a significant pressure is the disconnect between year on year increases in non-discretionary costs versus local authority fees that have been reducing in real terms.
What do you like to do away from the office?
It sounds like a cliché but I am never really totally away from the office. The nature of my role is that I take aspects of it with me at weekends. I have three children – all of whom are grown up now. The youngest is studying in the United States to be a fashion designer. I read books on history. I am a Manchester United supporter. My father was from Salford, and my mother from Merseyside. I was brought up in Birkenhead supporting United, which probably taught me a high degree of resilience. cmm
layout one Skills for Care is consulting on the learning and development needs that will arise from the forthcoming Care Bill. The Care Bill brings together existing care and support legislation into a new, modern legal act and builds the system around people’s wellbeing, needs and goals. It is due to be implemented in 2015/16 and there are major implications for the learning and development needs of the social care workforce.
Skills for Care’s programme Skills for Care, in partnership with the National Skills Academy for Social Care and The College of Social Work, has been asked by the Department of Health to lead a project to produce and oversee the implementation of a national learning and development programme across England. It will have nationally recognised standards and guidance to ensure consistency of delivery. The project will identify the target workforce and produce a learning and development needs matrix detailing the learning and development needs of all roles, including level needed and priority. All current relevant principles, standards and qualifications will be reviewed and, if necessary, revised to achieve alignment with the programme. It is essential that the project achieves wide engagement with key stakeholders and the process will include a range of nationwide consultation activities beginning in March 2014.
Making it happen
The Care Bill – learning and development programme consultation Get involved The consultation will go live on the Skills for Care website on 3rd March and will run until 11th April. More information and details of how you can get involved can be found here www.skillsforcare.org.uk/carebill.
Following the consultation phase a comprehensive and quality-assured learning and development programme will be produced, together with a suite of learning materials, support and guidance for potential learning providers/trainers, and, guidance for employers on delivering the programme. The programme will be designed for use by all care and support organisations and agencies in England and the learning and development materials will be designed to be adaptable to allow for flexibility of use, enabling each organisation to develop its own tailored approach whilst maintaining consistency. Nationwide roadshows and train the trainer style workshops will be delivered across England to ensure that all those involved in running the programme have the knowledge, skills and resources needed to deliver consistent learning and development to a high standard. Delivery of the learning and development strategy is expected to take place between October 2014 and April 2015. cmm march 2014 | 35
Building community for
business
success Care settings offer more than a place to live; Chris Gage discusses how building community can improve your business.
Great care providers know delivering quality of life, particularly through supporting relationships, personalisation and activities, is crucial to the success of their business. Yet we know that care homes and housing schemes can sometimes feel like a disparate group of people who live together without particularly connecting with each other. Staff may still be task-focused rather than relationship-focused. At the door they may leave behind a lot of their interests and passions that may help them connect with residents. Management can end up focused on processes rather than experience. Families can feel excluded and the Alzheimer’s Society’s Low Expectations report showed only 44 per cent of family members felt that opportunities for activities for their relative were good. Moreover, whilst the quality of relationships, personalisation and activities have always been a challenge for care providers to get right, these are now becoming increasingly business-critical. 36 | cmm march 2014
We are seeing on-going operational challenges, with new National Institute for Clinical Excellence guidelines on activities as part of their mental health standard for care homes and the Care Quality Commission reintroducing ratings for care homes in autumn this year. Meanwhile customers’ expectations, whether they are commissioners, private clients or self-funders, continue to increase.
Vibrant communities Developing a vibrant community can be crucial for meeting these challenges. We know from our work and the feedback from clients that a connected care community, with a shared vision for what they want their service to be like, naturally develops the relationships, personalisation and activity we all want to see. In our experience, one powerful way to build
community is through creative events that are co-created, inviting and enabling contribution from staff, residents and family members. The unique strength of creative events is that anyone can make a valuable contribution within this creative context. There is nothing to get right or wrong, and anyone at any life stage is able to contribute and be acknowledged for it. This creates a level playing field to support the growth of relationships between everyone involved. It also provides a platform for recognising and celebrating the personal talents, interests and skills of staff, residents and family members. The outcome of building community in this way is that staff feel they have permission and confidence to develop relationships with residents. As this happens, staff engagement and confidence improves alongside client quality of life. One carer involved in a recent Ladder to the Moon service development project commented a few months afterwards, ‘I think job satisfaction is better, it has brought the fun side in more, being able to do more activities or sit down with residents, even if it is just for 10 minutes. The outlook is more relaxed. Because we do more with [residents] they seem more relaxed and content- and I’m happy because they’re happy.’ A thriving sense of community also provides a wealth of good news stories of enjoyment and wellbeing that can be used to actively promote a service or spread through word of mouth. Importantly, a strong community also contributes to good safeguarding practice. One of the best safeguards is people coming in and out of care services regularly who really know people; it is this kind of culture that stops a care setting being an institution.
Sustaining impact How can ‘community’ and the shifts in attitude it involves be embedded and sustained in a care environment? The approach needs to include a catalyst to challenge expectations of whole teams, but this also needs to be accompanied by long-term follow-through, with the support and permission of the whole management structure. Creative events can be a catalyst but when combined with coaching for senior managers and leadership teams it can create an environment for sustainability. Along with building skills in creative behaviours and communication, coaching sessions provide reflective space. Participants spend time with colleagues thinking about what good care looks like, identifying shared values and what is important to them. This can be very powerful and everyone has ownership of the vision. Coaching also enables leaders to recognise their own capacity for realising their vision. Activity co-ordinators too are enabled to see themselves
as leaders and trained to enrol their colleagues in engaging with residents in new ways.
New builds and transitional projects Providers might also look particularly closely at the opportunities for developing community vision in new builds and transitions. Cultures are always easier to establish than to shift; and with new builds being developed all the time there is a great opportunity to start care cultures on the right footing. Small teams of staff and residents beginning in new services can form an influential core, and this can be achieved efficiently before the team expands. Equally, new builds provide an opportunity to develop new talent in a positive culture. Often I’ve heard people talk about brilliant new recruits, whose enthusiasm and energy has faded after a week on shift with members of the team stuck in a negative or limited view of their job. Instead, you can bring new recruits into an environment where they can contribute to a new vision of what care should be will support success. Focusing on developing a connected community can also be very powerful at points of transition in a care service. Norse Care has recently looked into developing a connected community to support the re-provision of three of their existing residential care services into one new building. A main aim is to make sure that the team has a clear vision that they have ownership of and a culture that nurtures and nourishes creative ways of doing things. The aim is for everyone to know each other and how their job relates to management. With creative community events, exciting things will be happening ‘from the off’ enabling strong relationships to be formed and setting an expectation of contribution and activity for the future life of the home.
The power of community Connected communities generate the results care providers need including establishing vibrant services that support activity and personalisation, meeting National Institute of Clinical Excellence standards and achieving outstanding Care Quality Commission ratings. The key is focus on building a shared vision, empowering a team to drive it and giving them permission to focus on the human things that we all want from our lives, relationships, creativity and community. cmm Chris Gage is Managing Director at Ladder to the Moon www.laddertothemoon.co.uk
cmm march 2014 | 37
Spotlight on…
&
nutrition catering
Ensuring your residents have their nutritional needs met is an important aspect of running a care business. The Care Quality Commission inspects on care and welfare including meeting the nutritional needs of service users. CMM brings you details of organisations that can help your nutrition and catering obligations.
BVS Training Limited www.bvs.co.uk
Good nutrition is essential for both the long and short term health and wellbeing of the elderly. For this reason it is important that social care staff have the right knowledge of good nutritional care in order to combat malnutrition and to protect the elderly from infection. It is important that meal times are prioritised, respected and not interrupted. It is crucial that older people have access to a choice of food that: • Is satisfactory in quantity and of good quality, • Meets any specific dietary, cultural and religious requirements, • Is provided in an environment that encourages eating, ensuring meals are enticing and appropriate.
• Nutritional Requirements of Older People • Summary Duration: 30 minute DVD in 10 sections to be used in a suggested 3-hour training session. Equivalent to 3 hours certified study FREE training resources included are a Lesson Plan, Trainer’s Guide, 5 hand-outs, Q&A sheets and other supporting materials. Supports Skills for Care’s Common Induction Standards (Revised 2010) 8.11 and Knowledge Sets for Nutrition and Well-being. PRICE: £105 + VAT With well over 15,000 customers nationwide, you can rest assured that BVS Training is the right choice for all your training needs. We strive to deliver the highest quality DVD and Online Training at the most affordable prices to ensure you get the maximum value out of your investment.
This DVD, which is aimed at care workers and kitchen assistants, will examine what constitutes a healthy diet for the older person. Filmed in a real working care home and featuring Care Chef of the Year 2007 Patrick Moore this is an invaluable resource in ensuring that elderly service users are provided with healthy, nutritional meals. This title is also available as an Online Training course.
All our products are CPD accredited and trainers will find our lesson plans and Q&A sheets easy to use. They also address Skills for Care’s Common Induction Standards and comply with CQC’s regulations.
Subjects covered include: Introduction • First Drink of the Day • Health Problems and Diet • Breakfast, the First Meal of the Day • What Makes a Good Diet • Encouraging Service Users to Enjoy Their Food • Providing Nutritious Snacks • Protecting the Service User from Foodborne Infection
BVS Training is proud of its 14 years in the social care sector and as the market leader in DVD and Online Training we can provide you and your team the solution to getting your training sorted.
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38 | cmm march 2014
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Protecting your Care Business ...
... better than ever before CHIS (care home insurance) and PrimeCare Insurance (domiciliary care insurance), two specialist services under one roof. It is this recognised market expertise that sets us apart from others, enabling care providers Ƥ risk-related matters. Call us now on 01273 645928 or email simon@chis.net for your free no obligation quotation for your insurance needs.
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40 | cmm march 2014
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spotlight on…nutrition and catering
Fretwell-Downing Hospitality
Saffron Patient Ordering - Experience and improve efficiency within healthcare catering operations. • Enhance patient experience – ensuring a more interactive and sociable order taking process. • Nutritional analysis – Nutritional analysis can be generated for all recipes and menus and can be presented next to each patient to allow more informed choices. • Reduced food wastage – More accurate orders are taken reducing the need for overproduction.
Saffron Patient Ordering can be used in conjunction with Saffron Catering Management Solution to enable you to: • Manage food costs – complete control over the costing of recipes and menus. • Streamline purchasing – Simplify and streamline the way you purchase from your suppliers with totally automated purchasing from P2P. • Manage your stock – easily keep track of stock levels and location with real time information. • Improve your profitability – track exactly how each catering unit across various locations are performing with real time data.
Telephone: 0114 281 6060 • Email: sales@fdhospitality.com • www.fdhospitality.com
Pritchitts
Care home chefs across the UK rely on Millac Gold to help them fortify their menus. With 328Kcal per 100ml it’s a simple way to increase the calorific value of your dishes. It’s also incredibly versatile
and can be used in any recipe where you would usually use cream – sweet or savoury, hot or cold. Better than fresh cream however, it has a long shelf life, the ability to whip up to three times its volume, won’t over-whip, can be re-whipped and won’t split. Video case studies with care home chefs are available online, where a free trial pack is also available.
Telephone: 020 8290 7020 • Email: care@pritchitts.com • www.pritchitts.com
Nestlé Health Science
Nestlé Health Science, through its Nestlé HealthCare Nutrition business, makes a positive difference in the nutritional health, well-being and quality of life of patients through the development and delivery of innovative, medically-recognised branded nutritional solutions. Our range of solutions helps to optimise the nutritional
intake of individuals whether their goal is to combat disease and/or recover better and faster or to stay healthy. Our range addresses normal and disease-specific nutritional needs and related services including patient and healthcare professional education and training. Nestlé Health Science has worldwide headquarters in Lutr, Switzerland. For more information on our product range in the UK please contact our Careline to arrange a representative visit.
Telephone: Careline 00800 68874846 • Email: nestlehealthscience@uk.nestle.com • www.nestlehealthscience.co.uk
Pattersons
Future Care from Churchill China’s Art De Cuisine range is a collection of specialist ceramics designed to assist independence and wellbeing. This china collection features individual pieces ergonomically designed for the healthcare market.
The collection includes plates, cups and mugs, designed to support independence and maintain confidence. The deep plates aid eating with use of an undercut to ease food on to the cutlery, and a contemporary wide rim to assist stability and handling. The stacking cups and mugs are also engineered to provide additional grip and stability with a wide base and ergonomically designed handle that reduces the risk of touching the hot cup. Future Care is available to order online.
Telephone: 0117 934 1270 • Email: mark@pattersons.co.uk • www.ukcaresupplies.co.uk
Next edition: Spotlight on assistive technology and nurse call systems If you would like to feature in the next Spotlight please email editor@caremanagementmatters.co.uk or tweet us @CMM_Magazine
www.caremanagementmatters.co.uk cmm march 2014 | 41
the use of zero-hours contracts has been an area of much debate, with arguments being presented for and against their use in the care sector and elsewhere. matt jenkin advises on how you can have your say on them.
The Government has reacted to the debate around zero-hours contracts, and in December launched a consultation on their use and to obtain views on how such contracts could be used in the future. The consultation closes on 13th March 2014. Zero-hours contracts commonly refer to a contract of employment under which an employee has no set hours and is paid only in relation to the hours they actually work. A key component of such contracts is that the employer is not obliged to provide any work to the employee. As such, zero-hour contracts do provide flexibility for both employer and employee – but there are concerns that they are open to abuse.
The consultation With that in mind the purpose of this latest consultation is, according to the consultation, to, ‘…maximise the opportunities of zero hours contracts while minimising abuse and setting out core standards that protect individuals.’ This looks to be good news for employers, as it doesn’t appear from this that one of the options that is being considered is the outright banning of such contracts. As such, employers using such contracts should be able to continue to use them. The consultation document identifies two areas of concern. The first is the use of exclusivity clauses which can be used to prevent an employee from working for another employer.
42 | cmm march 2014
Whilst these arrangements can be justified in some cases, the consultation has identified that ‘…there is not always a clear or obvious reason why this should be part of the employment contract.’ A number of options are suggested, from banning the use of such clauses in contracts where there is no guarantee of work, right through to an employer-led code of practice with possible Government endorsement. The second issue identified by the consultation is concerns over a lack of transparency in the terms of zero-hours contracts, which leaves employees unclear on the terms and their corresponding employment rights. Options to improve transparency include improving the information available to employees on their rights if employed on a zero-hours contract, and also producing model clauses for zero-hours contracts. Details of how to participate in the Government’s zero hours consultation, which closes on 13th March, can be found at www.gov.uk/government/consultations/zero-hours-employmentcontracts. cmm Matt Jenkin is an employment lawyer at Harrison Clark Rickerbys. Email: zerohourscontracts@hcrlaw.com
cmm march 2014 | 43
conference preview
Care Show preview
26/27 March, Bournemouth
The Care Show once again returns to the Bournemouth International Centre on 26th and 27th March. Focusing on Shaping the future of care for older people, attendees will have the opportunity to visit a wide range of care sector companies that exhibit as well as attend packed seminar programmes.
What’s on? Dementia Seminar Theatre Leading industry commentators will take part in thought provoking sessions comprising a mixture of panel discussions and presentations. Topics include: • Dementia care in the community. • Dementia and the physical environment. • Activities to improve health and wellbeing in dementia. • Dementia and nutrition. • Making care homes feel like home for people with dementia. • Inspirational dementia care programmes and their results. • How technology can improve dementia care. Keynote Seminar Theatre Featuring leading industry commentators, the Keynote Seminar Theatre will offer delegates an opportunity to hear about and discuss issues that affect their business. Topics include: • Reputation management for care providers. • CQC regulation and inspection. • Care Bill and the opportunities it presents. • Business outlook for the care sector – 2015 and beyond. • Attracting the self-funder: A growing marketplace. • Understanding the local care market. • Steps in constructing a practical transformational plan. • Digital marketing 101. Homecare Theatre The United Kingdom Home Care Association (UKHCA) is working with the Care Show to produce a programme of seminars tailored to the
interests of homecare providers. The introduction of a presentation theatre specifically focused on homecare themed issues is further recognition of the importance of the role of the homecare sector in meeting people’s care needs. Topics to include: • Future and current challenges in homecare. • Individualised Service Funds (ISF). • Recruiting for values. • Top tips when setting up a homecare business. • Staying ahead of the National Minimum Wage. • Dealing with dementia in homecare. • 10 top tips in marketing your homecare business. • Medication management in the homecare. • Review websites and NHS Choices. Alongside these interesting presentations are a diverse array of products, services and suppliers from architects and designers through all kinds of essential equipment to insurance and training companies. Confirmed exhibitors include: Advanced Health & Care Care Choices Clydesdale Bank and Yorkshire Bank Courtney-Thorne Danfloor Haigh Skills for Care Exhibitors new to Care Show include: Active Minds Care Shop Forbo Flooring Pop Up Room Company Saniflo For more information or to register to attend, visit www.careshow.co.uk/bournemouth CMM is the official media partner magazine for the Care Show. Photography courtesy of the Care Show’
44 | cmm March 2014
what’s on?
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Showcase 2014: Driving up the Quality of Social Care 11th March 2014, Brighton Surrey Care Association, web: www.careshowcase.org.uk Implementing the new statutory framework for Adult Safeguarding under the Care Bill 12th March 2014, London Healthcare Conferences UK, Tel: 01932 429933 Social Care 2014 19th March 2014, London Govtoday, Tel: 0161 6865576
Event: Date/Location: Contact:
HR in Social Care 20th March 2014, Central London Collinson Grant, Tel: 0161 703 5600
Event:
RCN Older People’s Nursing conference and exhibition 2014 25th March 2014, Birmingham Royal College of Nursing, Tel: 020 7647 3580
Date/Location: Contact:
Prove your water systems are free from LEGIONELLA BACTERIA
Improving End of Life Care: Beyond the Liverpool Care Pathway 25th February 2014, London Healthcare Conferences UK, Tel: 01932 429933
Event: Date/Location: Contact:
Care Show Bournemouth 26/27 March 2014, Bournemouth The Care Show, www.careshow.co.uk/ bournemouth
Event: Date/Location: Contact:
Reforming Social Care Conference 2014 27th March 2014, Central London GovKnow, Tel: 0845 647 7000
Event: Date/Location: Contact:
Skills for Care Annual Conference 2014 27th March 2014, Birmingham Skills for Care, Tel: 0113 241 1295
Event: Date/Location: Contact:
Next steps for mental health policy: integration, access and public mental health 29th April 2014, Central London Westminster Health Forum, Tel: 01344 864796
Event: Date/Location: Contact:
Improving elderly care services: funding, integration and personalisation 8th May 2014, Central London Westminster Health Forum, Tel: 01344 864796
CMM EVENTS Event: Date/Location: Contact:
The Transition Event 22 May 2014, Birmingham Care Choices, Tel: 01223 207770
Please mention CMM when booking your place. cmm March 2014 | 45
straight talk
straight talk David Waters shares his thoughts on how CQC operates and how it could be of more benefit to society. David Waters Managing Director Care Home Insurance Services (CHIS) and PrimeCare The Care Quality Commission (CQC) has recently decided its role is to act more as a police service than an improving regulator, which is a great shame for care operators and their residents. As an insurance broker specialising in care we have to evaluate which are the most significant risks for care homes and which are less significant. Part of this evaluation is to understand the regulator’s report and its requirements. As part of our risk analysis this regulator’s report is very useful, although it invariably throws up issues about the relationship CQC enjoys, or more frequently doesn’t enjoy, with care providers. Occasionally we see CQC take a highly authoritarian stance. The word ‘abuse’ seems to have a different definition for CQC and fellow state employees to that of the Oxford English Dictionary, and occasionally a complete over-reaction to a quality care provider working in the best interests of its residents (or clients). Rather than join the squabble that CQC seems to engender within the care community, I believe we should initially take a view as to what we require of our care regulator, especially a regulator which has been in existence, albeit in different guises, for 12 years. Surely it is reasonable to expect a regulator who has been operating over such a long period of time to be able to do a reasonable job and have taken the vast majority of bad care providers out of business. If not, then CQC needs to consider why it has failed and take steps to address the position. As a member of the public, facing up to my own mortality and needs in older years, I am positively frightened by everything CQC puts out in the public domain. It would have us all believe our entire population in care is abused and maltreated. If it had done a reasonable job in the 12 years of its existence, this would not be the case. Our care regulator is funded by care providers who have no choice other than to be a customer. So what I, and I believe society too, want from our care regulator, is a service which restores the faith in the quality of care for the benefit of society. I’m lucky that I do know the good providers; most people are not so fortunate.
Yes, they must remove the bad care providers. But, since they know what bad care looks like, they must also know what good care looks like. This knowledge should be used to develop all care providers to provide good care for the benefit of society. Incidentally, I find it strange that the Financial Conduct Authority (FCA) has within its brief from Government to ensure that the public has high confidence in the financial world and yes, that does include our bankers. Yet the care regulator does not have the same public confidence expectation. Why is this? It is also crucial that CQC gives greater thought to its services. Firstly, the word abuse must be used in accordance with the Oxford English Dictionary. Who gave Government quangos the right to change the definition of words? Abuse to the vast majority of our society is about cruelty, violence or neglect. So, how does the failure to complete a form correctly – as I have seen on more than one occasion – become described as abuse? We also need the care regulators to have an arbitration facility. They seem quick to publish reports which are critical of any care provider but rarely issue the corrective report with the same alacrity. This, of course, fits with a view that CQC is providing a service which it believes is for its own benefit, more than for that of society. Professor Martin Green of Care England has long advocated the Advisory, Conciliation and Arbitration Service (ACAS) being a reasonable arbiter. I have to agree, not so much because I see many care providers taking CQC to arbitration, but it would check CQC and other care regulators are doing the job we all require of them. There is a general election just over a year away. Let’s get together and let our politicians know how concerned we are that CQC is undermining the public’s confidence in care; ask your local candidates what they will do to improve social care and the perception the public has of social care. Are they brave enough to stand up for the benefit of those in care and their families? Would they make different demands of CQC? If so, how and what would they hope to achieve? The system of care regulation must be done better and the politicians who created the CQC need to make sure they have a regulator which works for the benefit of those in care, not for their own benefit as it currently appears to me with CQC.
Do you agree with David? Please email your thoughts to editor@caremanagementmatters.co.uk 46 | cmm March 2014
Following the success of 2013 ’s event, where over 600 people attended and benefited from the conference, we’re once again bringing you…
In association with
Becoming an adult - building the best future for young people with additional needs
Thursday 22nd May 2014 at the National Motorcycle Museum in Birmingham. (Coventry Road, Bickenhill, Solihull B92 0EJ)
To register your interest in attending, book your place or sponsor this event please contact us on 01223 207 770 or email info@progressmagazine.co.uk. The Transition Event is the one-day forum for young people with additional needs, their parents and professionals to explore the move to adulthood. Incorporating a series of main presentations, workshops, interactive sessions and an exhibition of service providers.
www.progressmagazine.co.uk/events.html
Supported by
SoLO Life Opportunities Principal sponsor
Associate sponsor
Sponsor
Please visit www.progressmagazine.co.uk/events.html for more information or contact us on 01223 207 770