Care Management Matters July 2014 Issue

CMM CAREMANAGEMENTMATTERS

JULY 2014 £4.00

DEMENTIA Best practice and end of life care

A perfect storm?

Homecare’s dangerous situation

Spotlight on…

Care sector software

Business Clinic LNT refinance

Includes 4-page Skills Academy insert: Focus on Leadership: the Emerging Leaders Programme

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in this issue

IN THIS ISSUE regulars 05

editor’s welcome

Is it just me...?

Editor, Emma Morriss explores research into the cost-effectiveness of care and questions continued silo-thinking.

07

News

11

Property News

12

Local Authority and Planning News

14

Corporate News

25

60 seconds with...

26

Business Clinic

37

Spotlight on...care sector software

21

Johann van Zyl, Chief Executive Officer of PJ Care.

Our panel discusses LNT Group’s new financing deal with L&G.

CMM profiles the leading care sector software providers.

44

Conference review

45

What’s On?

features

46

Straight Talk

16

16

CMM reviews the Derbyshire and Nottinghamshire Care Conference.

Martin Green raises concerns about financial constraints and local authority commissioning practices on the Care Act.

Raising the status of care work: Going above and beyond the minimum Chris Tarry looks into the findings of the Kingsmill Review and argues that we need to go above and beyond the minimum.

21

Understanding dementia and the role of end of life

Simon Chapman explores the need for best practice in end of life care for those with dementia.

28

28

32

Homecare – a perfect storm The pressures on homecare are examined by Colin Angel.

A new system for personal budgets

David Roe responds to Colin Slasberg’s Straight Talk feature from CMM June.

34 34

Welcome to the July issue of CMM. This is the last CMM before our summer break and I’m pleased to report that the Care Act has finally received Royal Assent.

It feels as though we’ve been waiting a lifetime for it and I must admit I was underwhelmed by the response when it finally became law. If I hadn’t have known it was coming, I may well have missed it.

Though I’m fairly certain that was due to the fact that we already knew what was going to be in it.

We’ve covered the Act quite a lot in recent issues so this time we only have one piece which discusses it.

Martin Green delivers our Straight Talk in which he raises concerns about financial constraints and local authority commissioning practices in light of the Care Act. You can read Martin’s thoughts on page 46.

Also inside this issue, Colin Angel takes a long, hard look at the pressures facing homecare. His article on page 28 considers whether the sector is facing a perfect storm with zero hour contracts, short visits and commissioning practices.

I’d welcome your thoughts on the pressures you face and how we can resolve them.

Our Business Clinic, this month, focuses on the recent refinancing of LNT Group

by Legal & General. We’ve asked our panel whether this kind of institutional funding is the future for the sector, or is traditional bank lending still a viable option. The story, with the experts’ responses are on page 26.

Finally, for those of you who haven’t completed our CMM survey, please do. The survey is available online at www.surveymonkey.com/s/ CMMQuestionnaire.

Thanks, and I’ll see you in the autumn.

Emma Morriss Editor

Fire safety advice

Best practice in fire safety is summarised

by Tom Welland.

Follow CMM on Twitter @cmm_magazine

CMM JULY 2014 | 3

contributors

CMM CAREMANAGEMENTMATTERS July 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, Holly Cornell & Gemma Cook ADVERTISING sales@caremanagementmatters.co.uk 01223 207770 National Sales Manager: Paul Leahy paul.leahy@carechoices.co.uk SUBSCRIPTIONS info@caremanagementmatters.co.uk To request your free copy of CMM call 01223 207770 www.caremanagementmatters.co.uk

Care Management Matters is published

by Care Choices Ltd who cannot be held responsible for views expressed by contributors. Care Management Matters © Care Choices Ltd 2014 ISBN: 978-1-910362-09-9 CCL REF NO: CMM 11.5

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

contributors Alex Gipson, Lending Manager, Legal & General Chris Tarry, Freelance Consultant, Carterwood Colin Angel, Policy and Campaigns Director, United Kingdom Homecare Association David Roe, Consultant, LaingBuisson Johann van Zyl, Chief Executive Officer, PJ Care Jon Smart, Partner and Head of Care Team, Freeths LLP

Publications

CMM magazine is officially part of the membership entitlement of:

Lawrence Tomlinson, Chairman, LNT Group Martin Green, Chief Executive, Care England Phil Hall, Chairman - Healthcare, JLL Simon Chapman, Director of Public and Parliamentary Engagement, The National Council for Palliative Care and Dying Matters coalition

ABC certified (Jan 2012 - Dec 2012) Total average net circulation per issue 15,991

4 | CMM JULY 2014

Steve Roe, Corporate Banking Relationship Director, Yorkshire Bank Tom Welland, Conformance and Regulatory Affairs Manager, Fireco Ltd

is it just me...?

Is it just me...?

Editor, Emma Morriss examines Four Seasons’ research that residential care can be more cost-effective than homecare for those with high-level needs and asks if silo-thinking will ever stop.

I read with interest, this week, a release from Four Seasons Health Care in which they had analysed the cost of homecare versus residential care for individuals being supported by local authorities. The analysis revealed that, ‘Providing just a few hours of care visits a day for elderly people in their own homes may be costing the taxpayer more than it would to provide around the clock care in a care home.’ It goes on to say that, ‘If the person has a requirement for more complex nursing care needs or they are receiving supplementary social benefits on top of basic State Pension and Attendance Allowance, then less than two hours of domiciliary care every 24 hours could cost the public purse more than a full-time care home place.’

According to GMB research also out this week, the amount local authorities pay for residential care varies from £326.45 to £597.87 depending on the local authority in question. Domiciliary care costs, according to the same GMB report, vary from £7.88 per hour to £24.00 per hour, with an average of £13.59. Looking at these figures the cost of, say, three hours a day, over the course of a week is less than the lowest residential care fees paid in the GMB report. However, that’s just looking at the costs to the average social care budget. What Four Seasons is factoring in, is the cost to the overall public purse when considering State Pension, Pension Credit, Attendance Allowance, Housing Benefit and the personal expense allowance, which come from the Central Government budget.

Banner ad_Layout 1 07/10/2013 16:09 Page 2 Four Seasons explained, ‘People who

have homecare funded by local authorities and who are receiving basic State Pension and Attendance Allowance need only require a carer in their home for a total of about three and three quarter hours out of every 24 hours for the total cost to the taxpayer to be comparable or more expensive than it is to provide around the clock care in a care home.

‘If the person is receiving more complex nursing care or receiving additional social support such as Pension Credit and Housing Benefit then providing between one and three quarter and two hours of

‘With a drive to integrated health and social care and the combined Better Care Fund, surely this type of thinking isn’t helping progress?’ domiciliary care every day is likely to cost the taxpayer as much as it would to provide a care home place. When a high level of care is required, the care home will almost invariably be a more cost-effective and much safer option.’

The Four Seasons calculations are based on slightly different numbers to those I’ve used above but they still come to the same conclusion. Their figures show, ‘Typical costs of nursing care in an independent

sector care home of circa £583 and typical costs of independent sector domiciliary care of circa £14.90 per hour.’

Obviously, by looking at just the social care budgets, it is cheaper for local authorities to provide care at home, but by factoring in the implications on the wider Government budget, there must be other considerations. Those specialist providers out there will identify the parallels between this and some of the reported early drivers towards supported living – where supported living was deemed to be cheaper than residential care, due to the reduced social care costs, however the other costs were just passed on to other departments.

It feels as though we’re still unable to move beyond the silo-thinking of, ‘This is my budget and any impact on other budgets isn’t my issue’. With a drive to integrated health and social care and the combined Better Care Fund, surely this type of thinking isn’t helping progress?

And, of course, choice has to be a main consideration too. Ian Smith, Chairman of Four Seasons said, ‘People should be supported to live in their own home provided it is what they want and in their best interests. But the decision should not be driven by ideology or financial considerations, rather there should be an informed choice that includes understanding the real costs involved.

For this to happen requires a more joined-up approach to health and social care funding.’

If you would like to comment please email editor@caremanagementmatters.co.uk

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news

NEWS

APPOINTMENTS APPOINTMENTS DR PETE CALVELEY

• Planning • Local authority • Corporate News editor - Des Kelly The Care Act 2014 After much waiting, the Care Act finally received Royal Assent. According to Care and Support Minister, Norman Lamb MP, ‘It represents the most significant reform of care and support in more than 60 years, putting people and their carers in control of their care and support. For the first time, the Act will put a limit on the amount anyone will have to pay towards the costs of their care.’

The main points of the Act, as set out by Mr Lamb in his article for the Department of

Health, include: increasing transparency and openness and helping drive up the quality of care across the system; a minimum eligibility threshold across the country; councils will have a duty to consider the physical, mental and emotional wellbeing of the individual needing care. They will also have a new duty to provide preventative services to maintain people’s health. The system will be built around each person – what they need, how they can best be cared for, and

what they want. Providing and legislating for Personal Budgets gives people the power to spend money on tailored care that suits their individual needs as part of their support plan. It puts forward a new system to cap the amount people have to spend on care, regardless of how much they have in savings or assets. It also increases the means-testing level.

There are draft regulations for the Act which are open for consultation, see In Focus on page 8 for more details.

Call for a common standard for complaints For the first time, the Local Government Ombudsman (LGO) has published its complaints statistics for social care providers and local authorities. The report highlights the impact that people feel when services let them down. As England’s social care ombudsman, the LGO receives complaints about a wide variety of issues across

social care and has reported a 130% increase in adult social care complaints since it took on responsibility for registered independent sector care providers in 2009.

In the last year, there has been a 14% increase in the number of complaints and enquiries received about adult social care. In 2013, the LGO received 2,456 complaints and

enquiries about adult social care. This is a small number in the context of 1.3 million users of adult social care in England. The LGO calls for a set of common standards for complaint handling, with mandated data returns to CQC, clear signposting obligations, and the right to advocacy support when complaining about care services.

New ‘Care Certificate’ pilots Health Education England, Skills for Care, Skills for Health and NHS Employers have jointly launched documentation for the new Care Certificate that will pilot across England.

The pilot will test a set of standards designed to help employers to assess not only workers’ skills, but also the knowledge, behaviours and

values that are required to deliver compassionate and quality care. Achievement of the Care Certificate should ensure that the support worker has the required values, behaviours, competences and skills to provide high quality, compassionate care.

Camilla Cavendish’s review proposed the implementation of

clear, concise, common training standards across the health and social care sectors, building on existing best practice. The Care Certificate, which will help ensure that healthcare assistants and social care support workers and their employers can deliver a consistent high quality standard of care. The new certificate is planned for March 2015.

Dr Pete Calveley has taken up his new position as Chief Executive of Barchester Healthcare.

CQC DIRECTORS The Care Quality Commission (CQC) has appointed two new Non-Executive Directors. Robert Francis QC published two reports into the catastrophic failure of care at Mid Staffordshire NHS Foundation Trust. Paul Rew, an experienced non-executive director in both the private and public sectors, will chair CQC’s Audit and Corporate Governance Committee. Their terms of office are three years.

CHOICE CARE GROUP NONEXECUTIVE CHAIRMAN Specialist care provider Choice Care Group appointed a new non-executive chairman. Steve Page took up his new post with effect from 1st June 2014.

ILC-UK David Sinclair has taken on the role of Director at ILC-UK after Noreen Siba’s retirement. David has been with ILC-UK for over three years.

CQC APPOINTMENTS The Care Quality Commission (CQC) has appointed 11 new Heads of Adult Social Care Inspection who will support the adult social care directorate in transforming the way services are regulated and inspected.

CASTLEOAK Nigel Watkins has joined Castleoak as Commercial Director for its construction business.

NEW CENTURY CARE New Century Care has appointed Mel Ramsey as Chief Executive Officer. Mel will join in July when she leaves her position at Embrace Group.

COLTEN CARE DIRECTOR OF OPERATIONS Colten Care has appointed Elaine Farrer as its new Director of Operations. Elaine has more than 30 years’ care sector experience including various director level roles.

CMM JULY 2014 | 7

news

Better Care Fund investigation MHP Health has published All in this Together? investigating how councils are using the Better Care Fund, the Government’s £3.8bn pot of money to drive integration in 2015-16.

The Fund itself has largely been welcomed, but challenges with it are clear and were recognised with the news that it may be delayed and with

the acute sector continuing to stress that this is not new money (and that a significant proportion of it is being taken from its pockets). In order to assess whether the new Fund will be effective, an assessment needs to be undertaken of how existing health to social care transfers have been spent. www.mhpc.com/health/all-inthis-together

CQC partnership in adult safeguarding Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission has announced an important step forward clarifying the roles and responsibilities of everyone involved in safeguarding adults. In partnership with NHS England, the Directors of Adult Social Services, the

Local Government Association and the Association of Chief Police Officers, this document sets out how individuals and organisations should work together to prevent abuse and neglect from happening and ensure the safety and wellbeing of anyone who has been affected.

Medication in homecare handbook The Royal Pharmaceutical Society (RPS) has published a Handbook for Homecare Services which will aid the implementation of the Professional Standards for Homecare Services. The RPS believes that patients receiving homecare services must receive consistently high quality

services so they can get the best outcomes from their medicines.

Multiple agencies need to work together to ensure the seamless provision of this care.

The handbook is designed to share best practice and facilitate shared care for those involved in the provision of medicines.

Commissioning Assistive Technology Skills for Care has launched its new microsite Commissioning Assistive Technology, featuring resources to support people in social care and health sector with responsibility for commissioning assisted living technology (ALT) and assisted living services.

8 | CMM JULY 2014

The tools provide a summary of commissioning models, good practice and challenges facing commissioners, as well as a discussion of workforce development issues and a guide to assessing the impact of assisted living technology. http://cat.skillsforcare.org.uk/

IN FOCUS Care Act 2014: launch of care and support consultation WHAT’S THE STORY? The Care Act 2014 has received Royal Assent and is now law. The reforms within the legislation will be introduced in two stages from April 2015. The Care Act is intended to make the system fairer by putting people in control of their care and limiting the amount anyone may have to pay for the support they need. It brings together 60 years of legislation into a single statute. The Department of Health is now asking for views on the draft regulations and guidance for Part 1 of the 2014 Care Act.

WHY DO THE REGULATIONS AND GUIDANCE MATTER?

to over 300 pages. There are a total of 84 questions in the consultation grouped into the following sections: • General duties and universal provision.

• First contact and identifying needs.

• Charging and financial assessment.

• Person-centred care and support planning.

• Integration and partnership working.

• Adult safeguarding.

• Moving between areas: inter-local authority and cross-border issues.

The Department of Health has included 11 factsheets which summarise the key points in the guidance.

The draft regulations and guidance have been developed by working with expert groups, including users of care and support, local authority staff, voluntary sector organisations, social workers and national representative bodies including those drawn from local government.

These regulations and guidance will help support councils in making the reforms in the legislation a reality. Although most of the responsibilities under the Act will mean new duties on local authorities they will, in turn, have considerable implications for providers of care and support services.

WHAT HAPPENS NEXT?

WHAT DOES THE CONSULTATION COVER?

http://careandsupportregs. dh.gov.uk/

The consultation documents consist of 32 separate sections (chapters) running

The Government has advised local authorities that they will be given six months to prepare for implementation and, therefore, it is necessary to have the final version of the regulations and guidance ready for the 1st October 2014.

The 10 week consultation is open until Friday 15th August and is concerned with the changes that will come into effect from April 2015.

A further consultation on the reforms relating to funding and introducing a cap on care costs that come into effect from April 2016 will take place this autumn.

You can join in conversation about the consultation on Twitter by using hashtag #CareAct2014.

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04/06/2014 17:03

property news

48-bed care home sold on behalf of Bromford Carterwood has announced the sale of a 48-bed residential care home on behalf of clients Bromford, who sold the home as part of a strategic restructuring to concentrate on other areas of care. The home has been purchased by Blackadder Corporation Ltd – a private operator of a small group of homes. Each home within the Blackadder group is run and marketed as an individual entity, with its own

image and market positioning, reflecting local market conditions in each case.

Geoff Butcher, Chairman and CEO 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.’

Camelot Care £1.5 million extension Camelot Care, which boasts a care home in Devon and Somerset, is extending its current care home at Camelot House in Wellington to provide a 28 bed dementia unit. RBS fully supported and funded this £1.5 million project which is expected to complete in July 2014.

Camelot Care has been operating for 15 years in Wellington and Plymouth with a further care home in the process of being developed in Bridgwater called Avalon House. The team pride

themselves on providing quality nursing for those with mental health disorders and people with dementia. To extend its offering and meet increased demand, Camelot Care is extending the existing property in Wellington to accommodate a 28 bed dementia unit, Camelot Lodge, which will adjoin the Camelot House site.

RBS has shared a banking relationship with joint owners, John and Angela Teasdale, for over a decade so know their business well.

Carterwood assists in securing scheme permission Chiltern District Council’s planning committee has voted unanimously in favour of a new £8 million centre specialising in 24-hour nursing care for the frail elderly and those living with dementia. This should see the home being launched by Porthaven Care Homes Group, in early 2015.

Carterwood had been asked by Porthaven to prepare a detailed planning needs assessment in support of the scheme, in order to overcome challenges encountered in the planning process. Carterwood

Director Ben Hartley said, ‘This has been a difficult journey for our client and has needed considerable determination to see it through. We are glad that our demonstration of local need, through evidencing a comprehensive package of circumstances, has helped Porthaven to see their project through to fruition. Porthaven have an excellent track record for producing the highest quality facilities, and we have no doubt that this new home will substantially benefit local residents in the years to come.’

Colchester care home supported by Clydesdale Bank A new Colchester residential home, being funded by Clydesdale Bank, is set to create 150 new jobs and boost dementia care services locally.

Stour Valley Care Group is constructing the £7 million 60-bed purpose-built care home.The new home, which will be known as Mistley Manor, is located on the outskirts of the picturesque town of Manningtree. The property, due to open in late summer, comprises 49 en-suite bedrooms and 11 penthouse suites offering bespoke care packages. Four luxury bungalows are located adjacent to the home on a site named Mistley Grove.

To help meet the complex

needs of residents with dementia, the home’s entire design is based on pioneering research into dementia-friendly design published by experts at the University of Stirling.

The first floor of the home will be also dedicated to dementia care and incorporate facilities including a ‘living journey’ corridor which is designed to help stimulate the memories of residents with dementia needs.

Mistley Manor will replace an eight-bed care home which Stour Valley Care Group formerly operated on the same site. The family-owned group, now in its fourth generation, continues to operate two other care homes, both also located in the Stour Valley area.

Cambian acquires Mencap specialist educational colleges Cambian Group, the mental health provider which provides services to over 2,400 people, has acquired three specialist educational colleges from the charity Mencap in a deal brokered by specialist property adviser Christie + Co on behalf of the charity.

The three colleges, Pengwern College in Rhyl, Lufton College in Yeovil and Dilston College in Corbridge, Northumberland, provide a specialised environment to support young people with learning disabilities, autism, and complex health and behavioural needs. This is Cambian Group’s first venture into providing further education services to young people with learning disabilities.

Richard Lunn, Director and Head of Healthcare at Christie + Co said, ‘This is an excellent acquisition for Cambian Group, allowing it to widen its offering in the provision of mental health, and now further educational, services. We are pleased to note that Cambian is committed to ensuring the colleges remain

as leading places of specialist further education for young people, building on the excellent work of Mencap.’

Jan Tregelles, Chief Executive of Mencap, added, ‘We are pleased to announce the sale of the colleges. We have already informed all stakeholders including current and future students, their parents, all staff and the relevant regulatory authorities, whom have welcomed the plans. Mencap is committed to ensuring we provide the best value for money for our donors while helping people with a learning disability as much as possible. Our focus is on providing educational support for people with a learning disability within their local communities.

‘The Cambian Group shares our values and ethos in relation to delivering quality services that promote choice, opportunity and respect. We believe the Cambian Group’s involvement will help push the colleges forward in meeting these goals through increased investment.’

CMM JULY 2014 | 11

local authority and planning news

Abbeyfield’s planning permission in Tonbridge The Abbeyfield Kent Society has been granted permission by Tonbridge and Malling Borough Council to build a care home and extra care scheme to replace Woodgate, a residential home in Tudeley Lane.

Planning permission has been granted for a three-story 101 bed care home which will include a nursing facility. Phase two of the project will lead to the construction of an extra care scheme which will consist of 52 one and two bed apartments.

The care home will be built

on a site next to the existing Woodgate care home and once completed, the current residents will be moved across to the brand new home. This will then allow for the extra care scheme to be built, causing minimal disruption to the residents at living at Woodgate. The new build aims to meet the changing needs of the older people in Tonbridge and support the community for many years to come.

The project will create plenty of jobs in the construction

industry for some years to come and in the care sector, once the build is completed and open for business. The new home will boast more spacious bedrooms, all with en-suite, plenty of large dining and living areas and improved washroom and assisted WC facilities. Restaurants, therapy and spa room, communal gardens, a shop and a hair and beauty salon are just some of the amenities the development will have to offer.

The extra care scheme, built across from the care home,

will provide residents with the independence of living in their own apartment with the added benefit of 24 hours a day care, companionship and support. Caring Companions, The Abbeyfield Kent Society’s domiciliary team will be onsite and will provide tailored care packages to suit residents’ individual needs and requirements.

Building work is due to start during the autumn of 2014 and the first phase is scheduled to be completed in 2015.

Craegmoor opens service in Redcar Craegmoor has opened its £1.8 million 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 project will create up to 35 new jobs.

Specialist care village to open in Warrington Work has commenced on a new £9.5 million specialist nursing and dementia care village on Loushers Lane in Warrington.

The care village, called Belong Warrington, will create around 100 jobs and consist of 72 spacious rooms, all with ensuite, and 18 independent living apartments, all of which will be surrounded by landscaped gardens. It includes extensive

village centre facilities, which are open to the public. The construction work has also been completed by local contractors, ensuring further investment and support of the local business community. Funding has been provided by The Royal Bank of Scotland (RBS).

Belong is part of CLS Care Services Ltd, one of the largest providers of care homes in the

North West. Belong currently operates four established villages in the North West, with Warrington becoming the fifth.

The village is currently under construction with a planned completion in August 2014.

Belong villages are designed to offer 24 hour care for people who need some degree of personal, dementia or nursing care. They provide

various options including apartments which can be bought or rented. There is a village centre with a range of facilities open to the public, and a specialist day care service – ‘Belong Experience Days’ are provided. The ‘Belong at Home’ domiciliary care is also available to the wider community to support people in their own home.

day of the year, and staff at Eleanor strive to deliver clientfocused services with dignity and respect.

Eleanor Care is part of the

Eleanor Healthcare Group which provides a range of services including homecare, patient transport services and care homes.

Poole homecare branch opens Eleanor Care’s new homecare branch in Poole has been officially opened. Eleanor Care, which operates throughout London and Poole, Dorset,

12 | CMM JULY 2014

provides a range of care services including home care, live-in support and specialist care. The company’s services are open 24 hours a day, every

corporate news

Care UK £170m growth strategy Care UK is on track to achieve ambitious growth plans that have already created around 870 jobs and it expects to create another 480 during the next 12 months as it pushes ahead with a major care home building programme.

Over the past 15 months, Care UK has opened 10 new, state-of-the-art care homes that represent an investment of approximately £76 million.

Another 15 homes are currently, or will shortly be, under construction, bringing with them additional investment estimated to be in excess of £95

million. These include a new £8 million care home, Scarlet House which opens in June.

Paul Humphreys, Group Finance Director of Care UK, said, ‘In two and a half years we have increased our number of care homes beds by 74 per cent and predict that by 2016 we will provide places to more than 8,000 people. Our ability to commit significant resources, combined with attracting substantial investment from our funding partner, show genuine confidence in the expertise and vision of our team.’

Bridges Ventures invests in Alina Homecare Bridges Ventures has announced its investment in Alina Homecare, a new organisation that has been established to provide high quality homecare across the South of England.

Alina Homecare, the latest investment of the Bridges Sustainable Growth Fund III, has a clear mission to improve standards of care within the home setting. A key organisational focus is to provide better support with greater and more specialised training for its care staff, leading to improved outcomes

for service users. It aims to work closely with service users, local authorities, the NHS and other organisations to innovate and be a catalyst for the much needed integration between health and social care.

The company has just completed its first acquisition, a family-owned single-branch business in Hertfordshire with over 100 staff and a strong local reputation for providing excellent quality care. This acquisition follows the opening of Alina’s first ‘greenfield’ branch on the south coast in March.

Promedica24 moves into England Promedica24, Europe’s largest live-in care provider is today announcing its expansion into England. Promedica24, which provides bespoke 24-hour live-in

care services, has been providing care services in Germany and Poland for a decade.

Promedica24 is registered by the Care Quality Commission

and can now offer its services in England. It is currently recruiting and training carers in the UK and other European countries.

Promedica24’s fees fall into

three simple and transparent price brackets and each care package is carefully tailored, based on a care needs assessment by Promedica24.

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corporate news

City & County acquisitions City & County Healthcare Group has added two new businesses to the organisation. The acquisition

of the assets of Spirit Care Ltd, in the complex care segment. a complex care business, will The second acquisition, HFH increase City & County’s footprint Homecare Ltd, a London based

provider offering a wide range of at home care services, will expand the group’s presence in the region.

Colliers’ Care Homes Review Occupancy rates rose across all sectors in the second half of 2013 (H2 2013), with the specialist care sector experiencing an upturn, reaching 91% occupancy for the first time since H1 2001.

Despite increased demand, pressure on fees continues, according to the 19th biannual Care Homes Review from Colliers International.

The report, which focuses on the five key performance indicators of the care home industry, occupancy rates, average weekly fees, payroll costs, non-payroll costs and profit margins (EBITDAR), found that occupancy levels are HCD_quarterpage_ad:Layout 1 looking positive in all sectors.

In nursing and specialist care occupancy is around 90%; whereas occupancy levels in personal care remain just below that figure.

Average fees have fallen in long-term elderly care, with nursing care weekly fees experiencing the biggest decrease during H2 2013, a decrease of £13 (2%) to £648.

Personal care has suffered the least from inflationary pressures, nominal fees reduced to £518 per week, a decrease of £5 per week in six months.

In contrast, specialist care fees have increased by £66 (more than 4.6%) to £1,490, up 2% on H2 2012.

10/6/14 17:27 due Page Despite pressure to 1

lower occupancy levels and continued cost constraints, profit margins have remained stable since 2012. However, the specialist care sector saw a decrease in profits of 2.6% to 37%. This fall is mainly due to non-payroll costs such as heating and lighting, which are up 10% from 2012 and 143% from 2002 to £16 per person per week on average.

Despite marginal profit increases, workers saw a decline in wages across all sectors. As a proportion of total revenue, wages in the nursing and personal care sectors make up 56.3% and 50.9%, respectively. Wages in the specialist care sector have also

gone down and now stand at 52.1%.

The report also reveals that non-payroll costs remain broadly unchanged. It showed a slight rise in the long-term elderly care sectors, as well as an increase of more than one percentage point in the specialist sector.

The report reveals that the investment market is heating up, reminiscent of predownturn levels between 2005 and 2006. Increased interest in the care home asset class stems from rising competition in the main property asset classes, which has occurred as investors look for opportunities in alternative sectors.

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CMM JULY 2014 | 15

Raising the

status of

care work The Kingsmill Review for the Labour Party has made a number of recommendations for raising the status of care work. Chris Tarry looks into the findings and argues that we need to go above and beyond the minimum.

It can’t have escaped many people’s notice that we have a General Election looming in 2015. In previous electoral years there has not been much focus from any of the main political parties on social care issues. Not traditionally seen as a vote winner, it currently occupies more centre stage positioning than in the past, partly because of a demographic imperative, but also in no small measure due to national media focus on recent care home abuse cases.

Following that media attention, the circumstances in which care workers are employed and, in particular, their training, conditions, contracts and rates of pay, have come under scrutiny.

As part of Labour’s social care policy development, Ed Miliband MP, Leader of the Labour Party, commissioned Baroness Kingsmill to conduct an independent review into 16 | CMM JULY 2014

(NMW). An Her Majesty’s Revenue and Customs (HMRC) investigation into 80 care providers found that almost half (47 per cent) were not compliant with NMW.

the working conditions of care workers. The desire was that the review would lead to recommendations that would form part of Labour’s manifesto heading into the next election, and that those proposals would aim to alleviate and, ultimately, put an end to worker exploitation within the sector. The result was the publication of Taking Care – an independent report into working conditions in the care sector.

Given the importance of the industry economically, Skills for Care estimates the market to be worth £43 billion and growing, and the vital nature of the work carried out by those employed in the care sector, the bald facts highlighted by the report are staggering:

• An estimated 307,000 care workers, or one-fifth of the adult social care workforce, are on ‘zero hours contracts’, meaning their work and income is not on a stable basis.

• Nearly a third of care workers receive no regular, ongoing training.

• Over 41 per cent of care workers do not receive specialised training to help deal with their clients’ specific medical needs, such as dementia and strokerelated conditions.

• As many as 220,000 care workers might be being unlawfully paid less than the National Minimum Wage

In an interview with Management Today, Baroness Kingsmill summed up the situation, ‘Care is in crisis…

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CMM JULY 2014 | 17

raising the status of care work

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care workers are undervalued, underpaid, undertrained and underregulated. They don’t have the status of nurses. They don’t have the status of childminders. They are subject to no regulation and no registration.

This workforce of 1.5 million people is almost invisible.’

THE RECOMMENDATIONS To tackle the situation the report makes, amongst others, the following recommendations: • Care managers should be registered and have a Licence to Practice.

• Eventually all care workers should be registered and have a Licence to Practice.

• The licensing system should include standards of proficiency and a commitment to continuous professional development.

• The Care Quality Commission (CQC) should have the power to prosecute providers who employ care managers or workers without a licence.

• The CQC should be required to monitor evidence of non-payment of the NMW. It should have an absolute requirement to refer cases where workers are being paid less than the legal minimum to the HMRC for investigation.

• There should be an end to zero hours contracts.

Some estimates put the social care workforce at around two million and, if demand for care increases in line with demographic projections for an ageing society, this number is likely to increase. The social care workforce has been identified over many years by the Low Pay Commission as one of the poorest paid.

Submissions to the Kingsmill Review and recent studies carried out by the HMRC do nothing to dispel this view.

But the problem is not simply one of meeting legal obligations, low wages are endemic within the social care workforce. Little wonder then that turnover rates range from 20 per cent to 30 per cent per annum, surely a sign of difficult conditions and instability across the sector.

If we recognise that a system of low pay and exploitation of a workforce is likely to threaten the quality of care delivered, then we should also recognise that low pay is not the only contributing factor; poor care delivery can be the result of many different contributors. Similarly low pay is not the preserve of one particular strata of the social care spectrum, it exists in the public and private sectors, the profit making and non-profit making, the large and the small organisation. Plus, it has many drivers.

RAISING THE STATUS The call for a properly regulated workforce seems entirely sensible. This is especially so given the desire to eliminate the boundaries between health and social care.

The NHS workforce is tightly regulated, and in many cases performs similar functions.

Proper qualifications and the development of a career path should attract a higher quality workforce over time. This will impact on how we pay for care generally. As Independent Age said in its submission to the review, ‘A review on exploitation in the care sector cannot be divorced from a wider more fundamental look at how we pay for care and whether as a society we are prioritising public expenditure on long-term care. The two issues are inextricably linked.’

Baroness Kingsmill rightly sees this as a long-term goal with no short-term fix. The immediate call from the review is for a Licence to Practice

for care managers. It is a first step towards the profession of care worker achieving the status it surely deserves.

Licensing of the wider workforce will follow, should the recommendations ever be translated into legislation by whichever Government is in power. The key here will be to go further and introduce minimum standards of training and professional development, in line with other professions.

Specialist care services, for example those involved with the treatment of dementia patients, would then be able to develop a specialist workforce that would automatically achieve status within the industry.

The review spells out its long term aim, ‘The ultimate objective is the professionalisation of care work. We believe that longterm changes in the sector are needed to improve the status of care workers, create opportunities for pay and raise standards across the sector.’

THE NEED FOR RESPECT In my opinion there is, however, a more fundamental aim to be addressed alongside those highlighted by Baroness Kingsmill, and that is the need for respect. If we truly respect the requirement to care properly for our elderly, as opposed to it being politically or socially expedient, then we are more likely to give care workers the respect they deserve for the job they do.

This would then transmit into the payment of commensurate wages and the desire to ensure that the sector encourages worker development through an appropriate system of qualification, registration and development. If we don’t respect the need for care then we will never truly respect those who provide it and so exploitation will continue.

The Kingsmill Review

rightly highlights the longterm under-funding of the care sector, but alongside this states that many of the changes required are not about funding. This is both politic and pragmatic. Politic because there is no evidence that the coalition will suddenly shift the balance of funding in favour of the care sector, any more than either of the two main parties will, if elected to power.

Pragmatic because the review focuses on changes to existing systems and practices; notably, a weak and fragmented regulatory environment, poor local authority procurement practices, and poor workforce planning and management skills within care providers.

This is not surprising coming from an experienced reviewer of the labour market, well grounded in real politic.

CARE WORK DEFINES SOCIETY The functions carried out by care workers are vital to the survival of the current care system. They provide personal and highly intimate care to the most vulnerable members of our society, which has both economic and social benefits.

However, I believe their work stands for more than that. The quality of the care we deliver to those in need defines the health and strength of our society. If we do not deliver over and above a minimum quality threshold then we will have lost our right to be called a civilised society. I do not consider this to be an extreme view or one that would not be reflected by the majority of the population, if asked. Why then do we perpetuate a system that exploits those who contribute to what defines us? The Kingsmill Review goes a long way to addressing the issue.

CMM Chris Tarry is a freelance consultant to Carterwood.

Chris.tarry@carterwood.co.uk

CMM JULY 2014 | 19

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g dement n i d n ia a a t s nd r e d

nd of life e f o e l o r e th

Un Simon Chapman explores the need for best practice in dementia and how end of life must always be a consideration.

The impact of dementia, in all its forms, is increasingly recognised and discussed by policy-makers and in the media.

This is, in part, thanks to the priority given to it by the Prime Minister in his national dementia challenge which has led to a great deal of activity based on the three themes of improving health and social care, creating dementiafriendly communities and improving research. Thanks to UK leadership, dementia was a prominent item on the agenda at the G8 summit in December 2013.

However, whilst this is all welcome, much more attention needs to be given to ensuring that the end of life care needs of people affected by dementia

are being met. Those working in the care sector, for whom understanding dementia and giving care and support to people affected by it is already core business, have an essential role.

Many of the statistics are already familiar. It is estimated that there are about 800,000 people in the UK living with dementia, and that there will be over 1 million by 2021. Two-thirds of people with dementia are women.

Over 60,000 deaths a year are directly attributable to dementia (the number may be higher, but it is not always recorded on death certificates). 80 per cent of people living in care homes have a form of dementia or severe memory problems.

g CMM JULY 2014 | 21

understanding dementia and the role of end of life

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END OF LIFE CARE AND DEMENTIA People with dementia are much more likely to die in a care home than the rest of the population. Research published by the National End of Life Care Intelligence Network in 2010 showed that about 59 per cent of people recorded as dying with dementia died in a care home, compared with, at that time, about 20 per cent of the overall population. In many instances, nursing home care, dementia care and end of life care are completely synonymous.

It was in this context that, over eight years ago, the National Council for Palliative Care (NCPC), working with partners in the dementia and care sectors, established the Dementia Steering Group. The Group’s remit was to ensure that national agendas and policy in relation to dementia and end of life care are joined up in a consistent and coherent way, and to improve understanding of how quality of life and experience of care for people with dementia can be made as good as possible, right until the end of their lives, with support beyond then into bereavement for the people close to them.

The Dementia Steering Group has done a great deal of work to influence policymakers since it was first set up. What follows are some of the key insights and concepts that it has promoted.

22 | CMM JULY 2014

UNDERSTANDING, PLANNING AND RELATIONSHIPS ARE ESSENTIAL TO GOOD CARE Although the profile of dementia is being raised, understanding of the condition in its different forms and its impact on people is still not what it should be. This lack of understanding manifests itself in different ways. Part of that is lack of diagnosis. Only about 44 per cent of people with dementia are given a diagnosis. Whether this is because of a failure to recognise it, a misplaced belief that because dementia cannot be cured ‘nothing can be done’, or an attribution to ‘getting older’, it is still unjustifiable.

Early diagnosis enables the person, whilst they still have mental capacity to make important decisions, to plan and discuss their future care, including their end of life care, in the knowledge of what lies ahead.

Lack of understanding also impacts on the care that people receive. This operates at different levels: there is a need for better understanding of dementia, and also a need for people involved in care to develop a good understanding of the needs, personality and life story of the person they are caring for.

Particularly as people’s dementia advances and they become less able to communicate verbally in the ways that they used to, it may be that they start to behave in ways that hitherto would have been seen as out of character.

These can include being agitated, frustrated, confused, anxious, fearful, aggressive, pacing or calling out. This can be alarming or challenging to cope with.

It is important for carers and staff to understand that this is not just ‘part and parcel’ of dementia that nothing can be done about. This behaviour may well be a symptom or sign of distress or an attempt to communicate an unmet need.

Understanding the person with dementia and who they are is also vital to inform and support good care. The work of organisations such as the Life Story Network and My Home Life have emphasised the importance of developing relational care, based on a commitment to knowing the person being cared

Research published by the National End of Life Care Intelligence Network in 2010 showed that about 59 per cent of people recorded as dying with dementia died in a care home

understanding dementia and the role of end of life for and ensuring that the things that are important to them are identified, recorded and respected.

That approach to relational care should also include the person’s family and friends. Even when the person has moved to live in a care home, those who have been their informal carers do not stop being carers. They have an interest in the person’s care and wellbeing, as well as considerable expertise and insight into the person and how to care for them. They should be involved and seen as partners in the person’s care.

This is not just a matter of good practice. People with dementia will be living with impaired mental capacity.

They may require support to enable them to make some decisions about their care and end of life care, whilst other decisions may have to be taken in their best interests. The Mental Capacity Act 2005 sets out the legal framework within which supported and best interests decision-making must take place.

This includes involving people who are interested in the person’s care, as well as the need to be informed about the person’s current and future wishes, beliefs, feelings and values.

Evidence of a relational or ‘life story’ approach will help demonstrate compliance with the Mental Capacity Act. This is an issue in which the Care Quality Commission is likely to take a close interest.

This approach will require trained care staff with the competence and confidence to communicate and provide care that is tailored around the individual and their needs and preferences. ‘More/better/different education and training’ frequently appears in the list of recommendations at the end of reports on how to improve services or develop new cultures of care. However, education and training are not ends in themselves; it is only worth investing in programmes that work.

The acid test should be: have we succeeded in changing behaviours and practice? The overall goal should be: are we doing all that we can to ensure the quality and experience of care for the people we look after is as good as it can be? This should be up to and including end of life care.

People with dementia will be living with impaired mental capacity. They may require support to enable them to make some decisions about their care and end of life care, whilst other decisions may have to be taken in their best interests.

2030 VISION AND FUTURE PLANNING NCPC is using its 2030 Vision project to consider the long-term impact of demographic change. It is well known that our population is ageing. It is less often discussed that numbers of people dying each year are now starting to increase after years of decline. About 500,000 people die each year in England and Wales at the moment. This is predicted to have increased to about 590,000 by about 2030. We need to think and plan now for the models of care that will be needed in the future. Recently we have been exploring what this means for architecture, design and the built living environment.

The emphasis in the Prime Minister’s Challenge on creating dementia-friendly communities is important here. What are the dementia-friendly communities that can provide people with flexible care and support, meeting increasing needs as their dementia develops, right until the end of life? Whilst at the same time maintaining a safe, familiar and stable environment, which is so important for people with dementia. There are already examples of different levels of care being provided in the same site, with a strong sense of community being engendered.

A key issue here is market development. This requires investors

willing to back innovative schemes, and a supply of land at reasonable cost on which developments can be built. An aspect that has been considered less is the need to engage the public in this. If people are to plan ahead, and invest in new forms of living arrangement, they need to understand what it is they are being asked to buy into.

The language can be bewildering: sheltered; extra care; supported care; assisted care.

NCPC leads the Dying Matters coalition, which has been set up to raise public awareness and change behaviours about death, dying and bereavement. One of the things that we have learned is that jargon is a real barrier to people having discussions about their future care right until the end of life, for themselves and the people close to them. This includes them thinking about long-term care.

End of life care is an important consideration for everyone and it’s essential to ensure that the end of life care needs of people affected by dementia are being met.

CMM

Useful resources Difficult Conversations on Dementia How Would I Know, What Can I Do? An accessible guide on how to help people with dementia who are in pain and distress.

A 2030 Vision: Building communities and environments to support people to live and die well www.dyingmatters.org www.ncpc.org.uk

Simon Chapman is Director of Public and Parliamentary Engagement at The National Council for Palliative Care and the Dying Matters coalition.

Email: s.chapman@ncpc.org.uk

CMM JULY 2014 | 23

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Stronger together: Skills for Care and the National Skills Academy merge to offer ‘one stop shop’ for quality learning and development Welcome to this first supplement sponsored by Skills for Care and the National Skills Academy after our successful merger. I’d like to take this opportunity to thank everyone who worked so hard to make the merger happen.

Sharon Allen, Chief Executive Officer - Skills for Care A STRATEGIC FOCUS Our merger brings two very clear advantages for our growing sector.

The first and most important benefit, is that 17,000 adult social care employers will now have a ‘one stop shop’ for their learning and development needs, from day one of induction right through to senior management roles.

It makes absolute sense that one strategically-focused organisation supports the 1.5 million-strong workforce. Those who work in the sector want to access a single, joinedup learning and development offer that will enhance their skills and knowledge, or their career aspirations.

It’s something sector employers have been very keen to see and now it is here.

STRONGER TOGETHER The other main benefit is that both organisations are bringing together a huge amount of sector expertise that can only result in us having a stronger voice, and being even more effective in ensuring available learning and development meet the needs of workers who offer care and support to millions of people in our communities.

I meet many people as I travel across the country who have made the transition from care worker

to manager, and then into senior management roles. There is no doubt that developing the skills, knowledge and confidence of the next generation of leaders and managers is critical if we are to make person-centred care work.

TOMORROW’S LEADERS ARE ALREADY IN THE WORKFORCE I know from my own experience as the CEO of a care provider, the importance of having skilled, confident and compassionate managers. Noone should face the daunting task of being a care manager without adequate support and guidance.

That’s why I’m pleased this supplement is taking a look at the Skills Academy’s Emerging Leaders Programme.

This is a real success story as we are now recruiting the fifth cohort of those who have experience of managing and leading services who want to become more effective in their current role and/or progress to become senior managers, heads of service or directors. What I really like about the programme is that it doesn’t assume a one-size-fits-all approach to developing the skills of aspiring leaders, and recognises that learning needs to be fitted around usually busy working and

personal lives.

A critical bonus is that feedback is offered in a safe environment designed to reinforce good practice, and I wish this sort of programme had been around when I first started thinking about becoming a manager.

I think it shows that things have progressed since I started my career which was much more of a ‘sink or swim’ world. I often wonder how many people sank when, with a bit of support, they might have made great leaders.

That’s why I can assure you that we will never be complacent, and the Emerging Leaders Programme is only one part of the Skills Academy’s extensive suite of products and services. Yes, we have made progress, but there is still much more to do as the sector faces some significant challenges over the coming months.

FORWARD TOGETHER Our merger means we can offer the whole sector a coherent and integrated approach to the learning and development needs of employers and their teams. I am confident, working together, we can deliver quality learning and development opportunities that will help meet the increasing demand in the decades ahead.

“Caught up in the day job”: Finding time for reflection Gill Bruton, Regional Director - Community Integrated Care I was delighted to have the opportunity to take part in the National Skills Academy for Social Care’s Emerging Leaders Programme from March to September 2013.

As an experienced manager leading a team through significant changes, it’s all too easy to get caught up in doing the “day job” and sometimes seems impossible to find the time to take a step back to self-reflect and consider alternative practices. The Emerging Leaders Programme allowed me to do just that. The commitment of attending the two day residential sessions worked really well in that this was quality time away from the workplace, which enabled me to fully immerse myself in the programme.

The structure of the workshop sessions was an intense mixture of trainer-led input, with discussions, exercises and group work along with self-directed learning. The content focused on the Leadership Qualities Framework and included a broad range of core management and leadership capabilities as well as management coaching and mentoring skills. But what worked well for me was that the course leaders were able to flex the content to suit the group’s preferences and if we wanted to spend more time on one particular area, then this was accommodated.

The course leaders were highly knowledgeable and learning was both relevant and current, focusing on live issues and

challenges so that theory could be related to real situations. I was able to bring my own personal work related issues to the programme and through debate, discussion and challenge from colleagues, was able to identify a range of alternative solutions which was exceptionally beneficial.

I went away with a valuable set of resources including course materials and reading lists which I have been able to use with my team back in my workplace. Importantly, I know where to go if I need to explore a particular area in more depth or if I need any advice, ideas or guidance.

Of particular value for me was the opportunity to further widen my network of contacts. The group included both providers and commissioners and the vast array of knowledge and experience within the room brought a rich depth of creativity, debate and discussion throughout the programme along with lots of opportunity to socialise during the evening.

Everyone working in a social care setting will recognise the challenges that local authorities, health services and service providers face on a daily basis, juggling budgets against a backdrop of striving for continuous improvement for the people they support. I feel that the Emerging Leaders Programme is highly relevant in this context and I can definitely say that it has had a positive impact on my performance and would have no hesitation in recommending this to colleagues.

The Facilitators’ Journey Christine Young, Richard Field and Belinda Weir - Emerging Leaders Facilitators The Joint Directors of the Emerging Leaders programme were appointed in May 2012 and established a set of principles. This involves: • Drawing out and building on what course members know, especially about what works well • Facilitating share of knowledge • Commitment to interactive and collaborative working • Achieving a balance between theory and practical application • Keeping the client and community central to learning conversations The programme has a strong focus on developing personal competence and confidence to enable individuals to make a lasting positive contribution to organisational performance and achieving better outcomes for patients, clients and the wider community.

Two years on, we are recruiting to a fifth cohort. We have continued to build on the strong foundations established in the first year and to adapt to the changing needs of our clients. In addition to the open access programmes, we now provide programmes for whole organisational cohorts and have recruited new facilitators to meet growing demand and to bring health expertise to the team.

Emerging Leaders continues to be a rewarding programme to facilitate. It has a rich participant mix of operational and 1

senior managers, and heads of service. Bringing together commissioners and providers representing local authorities, private organisations and the voluntary sector has resulted in some lively and rather frank discussions! By the end of each programme there is a real sense that participants have further developed their individual and collective understanding of the emerging social care landscape.

The programme delivers benefits for individuals and for their organisations. Some participants have progressed in their careers; many report increased confidence as leaders and many have enhanced key leadership skills and knowledge. This, combined with a focus on applying learning and improving performance, is having a positive impact in the workplace.

There is no doubt that this is the right programme at the right time for those currently leading within the health and social care system. The combined challenge of responding to increasing demand whilst ensuring optimum service delivery is a challenge. All this is taking place against a backdrop of new legislation, organisational change, the widespread introduction of commissioning and the push for integration.

We therefore need leaders with the skills and confidence to introduce more flexible and innovative approaches to work and who can collaborate effectively with a diverse range of stakeholders across the whole system. The Programme is helping to deliver that.

Feedback from Emerging Leaders Course Stuart Whittaker, Operations Manager - Mencap I have recently participated in the fourth cohort of the Emerging Leaders Programme held at the National College for Leadership in Nottingham.

A key theme of the course was to gain an understanding of our personality ‘type’ using the Myers-Brigg model.

Throughout the course we were given practical examples of the meaning of Myers-Brigg and how we were likely to respond, interact and lead in different situations. With this information we are able to plan an approach which means we will be more effective in challenging or stressful situations. I am also less likely to revert to my ‘default’ style which is not always the best style for the best results.

We were also given some techniques to help us recognise ‘type behaviour’ in others – giving us a clue as to how they might react to our proposals and ideas and how to negotiate successfully with them.

Early in the course, we gathered 360 degree feedback from colleagues at different levels. We were challenged during telephone coaching conversations on how we would reflect on responses and what we would do differently as a result. This was then reviewed three months later and I was able to describe what simple but effective changes I had made in my approach to give clearer direction and get greater understanding and motivation amongst the people that report to me.

A part of the course which I also found useful was the

idea of ‘appreciative enquiry’. This technique helps us ask the questions that cut to the heart of an issue where someone has a concern or resistance preventing them from delivering what is required. By summarising and reflecting back what you hear helps the individual objectify the issue and become more solution-focused thereby overcoming barriers to achievement.

This approach also works well when having difficult conversations. We were encouraged to think of having ‘courageous conversations’ and using the knowledge of personality type gained earlier be prepared to discuss and resolve tricky issues. By understanding potential objections it has helped me prepare for them and have a calmer, rational discussion in situations where it is easy for things to become emotional and difficult.

We spent a significant amount of time focusing on the finance model for care homes and the facilitators had prepared a very detailed scenario for us to work through.

This helped me understand the nature of funding from local authorities as well as private individuals and how variable and fixed costs should be calculated. Most importantly, I learned how to recognise risks and take corrective action quickly. Many of the course attendees were in commissioning teams so understanding their perspective was very useful for me as a provider of care and support services and will help me in future meetings.

Emerging Leaders – just one of the ways in which we embed leadership at all levels Maureen Hinds, Head of Programmes - National Skills Academy for Social Care The Emerging Leaders Programme, now into its fifth cohort, has proved an amazing success for learners and the Skills Academy alike. The programme follows on from Inspiring Leaders, which was designed for those new to a leadership role in social care, taking people onto the next stage in which they can become more effective and increase the impact that they make on their teams, and most of all on the people that they support.

As Sharon Allen highlights, Emerging Leaders is just one of a whole range of leadership programmes that the National Skills Academy has developed since its inception in 2009. We have listened to the needs of our organisational and individual members, who told us what they needed in order to enable leaders working in social care to be bolder, more confident, and to perform their often challenging role with pride. Our programmes work for leaders at all levels; graduates that are exploring a career in social care by taking part in our Graduate Management Training Scheme, Black and Minority Ethnic Leaders that want to help to create balance in the make up of social care leaders, right through to Top Leaders, people that are running organisations or otherwise working in strategic level roles. We have also developed a strong and much needed

membership and networking offer for Registered Managers, a group that has for too long been neglected and undersupported as true leaders in their own right.

All of our programmes, including Emerging Leaders, are rooted in the Leadership Qualities Framework (LQF), which sets out what ‘leadership looks like’ at four levels, explaining the skills and behaviours that are vital to success for all social care leaders. The LQF has been a great success, and we are now developing a range of case studies to illustrate the ways in which it is being used by our members and Endorsed Providers of training. In July, we will be publishing our latest case study which examines the lessons of the LQF for communicating with the sector.

The next cohort of Emerging Leaders will come together in September 2014. We are looking forward to working with another group of dynamic people who are already making an impact, to further enable and empower them to deliver change for themselves and for the people that they support. And coming together with Skills for Care will enable us to do more together – bringing a leadership angle to the existing offer for the workforce will give employers one portal through which we intend to meet all of their needs, and the needs of their employees.

for Strategic Leaders

Emerging Leaders Programme Are you a senior manager or Head of Service? Do you see yourself as a director or chief executive of tomorrow?

Are you an experienced operational manager? Do you want to be a more effective leader in your current role?

Our Emerging Leaders Programme has been designed to meet these needs, and delivers an exciting programme specifically tailored to develop strategic leadership in adult social care. The programme provides a structured learning journey which is shaped by participants as the programme develops.

Leaders increasingly have to do more, and to meet more complex needs, for less. The demand for social care is rising, in line with welcome changes to health care and life expectancy.

At the same time, personalisation means introducing more flexible and innovative approaches, so that service users can have meaningful choice and control in their lives.

Strategic leaders deal with a complex and evolving environment. With a focus on the experience of service users, we help participants to develop their leadership potential at a vital point in their careers.

The Emerging Leaders Programme includes: bespoke learning & development based on analysis of learners’ needs four residential workshops over eight months one to one telephone coaching

ongoing focus on client and community impact action learning sets integration between learning & workplace opportunity for optional post programme mentoring

Workshop topics Topics covered include: Exploring your context: challenges and opportunities Vision and values Commercial awareness Developing a performance culture Workshop 1 Leading Self

Workshop 2

Action Learning

Leading with Others

“The Programme has enabled me to better understand what it means to lead and to be a leader, and encouraged me to consider what is most important to me in how I fulfil that role. It has encouraged me to be more open, to have more confidence in my ability to lead, and it has reminded me that it’s OK not to know all of the answers all of the time.”

Workshop 3

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Workshop 4 Organisational Visit

Pre-course preparation

Collaboration and partnerships Creating and maintaining highly effective teams Leading change with integrity

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If you are interested in the Emerging Leaders Programme, simply get in touch using the contact details below. leadership@nsasocialcare.co.uk | www.nsasocialcare.co.uk | 0203 011 5270

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60 seconds with...

SECONDS WITH...

JOHANN VAN ZYL Johann van Zyl is Chief Executive Officer at Specialist Neurological Care Provider PJ Care.

TELL US ABOUT YOUR CAREER AND HOW YOU CAME TO BE WORKING AT PJ CARE?

I was born and brought up in South Africa and started in business there in the early 1980s when the Apartheid system of racial segregation was still in place. My company began by helping black taxi drivers in South Africa secure loans to pay for their vehicles, and later became successful helping black people start their own businesses.

The mid-1990s saw the end of Apartheid and the business evolved so that we became consultants to a number of big car manufacturers who were keen to invest in South Africa.

In 2007, I went to work as Chief Executive Officer for a gold mining company. It meant travelling around a huge area of Africa, seeing wonderful, wild and beautiful places like Ethiopia, Sudan and Namibia, and living in Tanzania. I had a fantastic time.

After five years, I decided I was getting too old for all the travelling. I met Jan Flawn, who is Chair and Founder of PJ Care, just by chance. She happened to be looking for a Chief Executive to help her develop the business.

She offered me the job in August 2012 and I jumped at the chance.

WHAT ATTRACTED YOU TO THE ORGANISATION? I was incredibly impressed with Jan. She is so passionate about good quality care and she has a real vision for how things should be. She saw inappropriate care for people with neurological conditions when she worked as a nurse and has created a company which provides the kind of care, treatment and rehabilitation people deserve.

WHAT ARE YOUR PLANS FOR PJ CARE?

In the short-term, we have plans to renovate and expand our Bluebirds and Mallard House Care Centres in Milton Keynes.

In the longer term we will open another large centre – similar in scale to Eagle Wood.

More generally, we will be looking to cement PJ Care’s position as the industry leader in neurological care and rehabilitation.

HOW DO YOU SEE THE BUSINESS EVOLVING IN THE COMING YEARS?

Like all specialist providers to the NHS, we are waiting for the new commissioning landscape to settle.

We will need to emphasise to NHS England’s teams of specialist commissioners that we need to work in partnership to give people the highest quality care.

In the meantime, we will continue to push the message that specialised longer-term neurological care and treatment is, as the evidence shows, the way forward, clinically and in terms of cost. There is every reason to believe that NHS England’s five-year strategy for specialised commissioning, due to be published in July, will reflect this.

WHAT WAS THE BEST ADVICE ANYONE EVER GAVE YOU?

My father was my mentor, and he said to me, ‘Never forget, you spin the flywheel. It’s all on you.’

What he meant by this was that leaders must always remember an entire team relies on them.

We have a duty to always be on top of our game.

CMM JULY 2014 | 25

business clinic

LNT’S INSTITUTIONAL INVESTOR THE FUTURE OF FINANCE?

Does a new 10-year deal between L&G Capital and LNT Group, owner of Ideal Carehomes, signal a change in care sector financing?

The LNT Group’s Founding Chairman, Lawrence Tomlinson, has been a vocal advocate for the need for sensible financing in business since the credit crunch. As one of two Entrepreneurs in Residence at the Department for Business, Innovation and Skills, he published an independent report in November 2013 which looked into bank lending practices and how certain banks deal with businesses in distress. In April 2013, the Group had negotiated a £100 million refinancing of the business with a collective of banks. With that up for renewal in September 2014, the Group has announced a £51 million debt facility with L&G Capital. As the insurer looks to increase its involvement in the care sector, is this the future of financing?

LNT GROUP The LNT Group, chaired by British entrepreneur Lawrence Tomlinson,

REFINANCING In April 2013, the Group finalised a £100 million refinancing, though the process was not straight forward. At the time, Lawrence Tomlinson was quoted as saying the deal had taken two to three years to come together, involved four different banks and had ‘issues’.

He named Santander and Yorkshire and Clydesdale Banks in the process, plus it’s reported that RBS and Bank Leumi were also involved. Mr Tomlinson went on to say that the amount of paperwork involved was ‘phenomenal’ and that the whole process was ‘complicated’.

He has, however, given very positive feedback about several of the banking partners involved in the 2013 refinance. He told CMM, ‘Whilst there were complexities in the 2013 refinance which were costly, and at times challenging, it met our finance needs for 2013 to 14. I found Santander and Yorkshire Bank particularly helpful throughout the past year,

Alternative providers have been fleet of foot

Can be attractive for certain businesses

Jon Smart Partner and Head of Care Team Freeths LLP

Steve Roe Corporate Banking Relationship Director Yorkshire Bank

This is, for sure, a very different market than pre-recession. The ‘alternative’ players - institutions, pension funds, private equity investors, international family trust offices, REITS and property companies - were bolder during the recession and have stolen a march on the traditional banks now that the care market (and wider economy) is improving.

According to Colliers’ recent report, the UK care home investment market is heating up and is reminiscent of 2005 and 2006 when keen competition in the main property asset categories (retail, industrial and offices) drove money into other sectors such as care. This time around, these alternative players have generated sufficient activity to push investment yields down by some 50 basis points over the last six months.

Anecdotal evidence suggests that by the middle of 2014 yields will have fallen further with several market defining deals in the works.

The speed of the recovery has left the banks behind, a bit. The alternative

26 | CMM JULY 2014

includes a number of different, and farreaching companies including the care sector focused Ideal Carehomes, LNT Construction and LNT Software, plus LNT Solutions and Ginetta Cars.

Ideal Carehomes is a care home operator, offering high quality services for older people without any third party top ups. Its homes are mainly across the UK and are designed and developed to be future-proof.

LNT Construction designs and builds care homes, not only for Ideal Carehomes but for third parties too including Anchor, Avery, Sanctuary and Nugent Care.

Having built 52 care homes since 2009, with 36 being run by Ideal Carehomes, it offers providers turnkey solutions and is currently working on developments in the south and Home Counties.

The third care-focused company in the Group is LNT Software, an integral care sector software package.

providers have been fleet of foot in taking advantage. For now they are doing all the headline deals. But with stability and growth returning (and the irresistible demographics of an ageing population underpinning the care market) so will the banks.

They will have to be competitive to regain market share from the new players, who are here to stay. So in the next year or two I see the care funding market being a plural blend of providers with more choice and competition than ever before. This will be good for the market and, ultimately, the economy.

The debt facility with Legal & General will support LNT’s plans to build between six and eight new care homes and create around 500 jobs a year. Freeths acted for LNT on the L&G deal and all of the Target Healthcare sales and leasebacks. We are delighted to have helped LNT realise these deals as it is this kind of dynamic company and many like it that will create the jobs to make the recovery a reality for everyone.

Clearly this type of institutional debt funding can be attractive for businesses with a particular need, in certain circumstances. The debt required would usually need to be of a significant size which most care operators possibly won’t require. Larger operators who are more complex in structure and often have more complex funding requirements over longer terms may find this attractive.

Every lending decision is different depending on the requirements of the customer but our experience is that bank funding remains an attractive option for the majority of care home operators because of its flexibility, terms and relative speed of being made available.

At Yorkshire Bank we are continuing to see strong levels of demand across the UK and have supported a growing number of new and existing customers looking to refinance or provide new development funding.

After talking to a lot of healthcare operators, our own research is suggesting that businesses are looking to the future with confidence in the UK economy and confidence in their ability to grow.

The vast majority of healthcare businesses we’ve spoken to said they plan to make a significant investment in the next year.

Many are looking to improve their existing assets, develop new services or move into new markets.

Traditional banking services have a role to play alongside longterm institutional investors who maybe don’t provide day-to-day or specialist banking services, or flexible funding for growth opportunities.

As the economy continues to show signs of improvement, we are seeing growing numbers of care home operators looking to invest in their businesses for the future and we are ready to help realise those ambitions.

business clinic

and Leumi continue to be a key partner in enabling our care home developments.’ After all this, the deal would have needed to have been renegotiated in September 2014.

With renegotiation on the horizon, LNT Group has just announced a £51 million debt refinancing with L&G Capital. L&G Capital is a new business line created by Legal and General to provide five key functions: direct investments; implementing the investment strategy across the balance sheet; managing the Group’s Shareholder Funds investments and managing the Group’s debt and liquidity.

One of the drivers behind the business is the slowdown of bank lending which is leading to a shortage of investment capital. This has led the organisation to focus on replacing bank and Government capital with long-term institutional debt or equity funding, as it has done with LNT.

L&G DEAL The deal between LNT Group and L&G Capital, which was announced in midMay, is a £51 million debt facility, over ten years, to LNT Group incorporating all its subsidiaries. It is secured against the Group’s portfolio of care homes and will give the company the ability to move forward with building a sustainable and

growing build pipeline of new care homes.

TARGET HEALTHCARE REIT Mr Tomlinson explained the drivers behind the deal with L&G Capital, ‘Our decision to On the same day as the L&G Capital take a debt facility from Legal and General announcement, Target Healthcare REIT Ltd was largely driven by the offer of long-term announced that it had acquired a portfolio finance and their understanding of our of three homes from Ideal Carehomes for business model which we believe paves the approximately £13.9 million. These have way for a fruitful partnership for the future.’ been leased back to the operator for 35 years.

Alex Gipson, Lending Manager at Legal The announcement comes just a month after and General, said, ‘Organisations that Target Healthcare REIT acquired two other hold enduring business models and that, Ideal Carehomes, the first for £3.8 million and therefore, operate and plan over mediumanother, due for completion in summer 2014, to long-term horizons are clearly better for £5.1 million. In 2013, Target Healthcare matched to external capital that operates REIT also acquired homes from Ideal over similar long-term durations. For this Carehomes in September for £4 million and reason, the financing needs of LNT’s £18 million for four homes in March. CMM Ideal Carehome business provides a very natural fit with Legal & General’s longdated pension and annuity liabilities and we Over to the experts... expect increasing opportunities in sectors Given the tough nature of the bank finance such as the care home market, supporting market, highlighted by the ‘issues’ faced by LNT organisations committed to delivery of long in 2013, do these new financing options mark term solutions to meet increasing demand.’ the future for care sector financing? Are more It’s not L&G’s first investment in the providers going to have to look farther afield care home sector. It acquired 13 care than the traditional banks to access finance? homes from MHA for just over £70 million Will we see more organisations such as L&G in December 2013 and it forward funded begin to meet the needs of the market, not and purchased five care homes in Suffolk necessarily being met by the traditional banks? with Care UK for £31 million. These were Is this the changing face of care sector finance? funded on behalf of Legal and General 2014.pdf 28/05/2014 15:10:00 What does1our panel think?

Property’s Managed Property Fund.CMM Magazine Ad June

A first, but certainly not a last for the sector Philip Hall Chairman-Healthcare JLL The decision by Legal & General Capital to provide £51 million of long-term debt is good, not only for the LNT Group, but also for the wider industry.

It is a vote of confidence by one of the country’s top insurers in the economic fundamentals of the sector. It may be a first but will certainly not be the last such offer from a major insurance/pension provider. Companies like Legal & General are natural providers of long-term financing given their long-term annuity liabilities.

These deals that the LNT Group have been able to conclude reflect the focus they have on providing costeffective, quality care on a consistent basis across their portfolio.

Target Advisers identified Ideal Carehomes and the LNT Group as excellent long-term partners some four years ago,

when their product was less recognised for its enduring features, and Target Advisers continue to show faith in its fundamentals.

The sector needs a longC term and moderate approach to its financing needs from a M variety of sources including Y banks, insurers and Real Estate CM Investment Trusts (REITS); but this is only likely to be MY delivered sustainably on the CY back of a deep commitment by healthcare providers to quality,CMY and long-term financial stability, K with credible and sustainable base costs and fees which are sufficient to deliver quality care.

As the market recovers it is easy to forget the lessons of the last few years. Healthcare should never be a short-term play in financial engineering.

Successful lending and borrowing requires a long-term commitment and an alignment of interests.

A member of my staff is claiming they’ve been unfairly

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CMM JULY 2014 | 27

Colin Angel explains how short visits and the use of zero hours contracts are inescapably linked in homecare and how commissioning practices are creating a dangerous situation.

Homecare

28 | CMM JULY 2014

A PERFECT STORM

The quality implications of very short homecare visits and the terms and conditions of the homecare workforce have received significant attention over the last year. It is vital that people who use homecare services have sufficient time allocated to meet their needs effectively and with dignity, and receive services from workers who are highly-motivated and willing to make community-based care a long-term career choice because they are properly rewarded for the essential services they deliver.

Recent public scrutiny has damaged confidence in social care, but short visits and the use of zero hours contracts are inescapably linked. In some quarters, there are still suspicions that outsourcing the delivery of social care to the private sector has led to a lowering of quality and deterioration in workforce conditions as a result of a profit motive. However, the root cause is really the way that homecare services are commissioned by councils (and to a lesser extent by the NHS).

Around 70 per cent of homecare in England is purchased directly or indirectly by the State, and it is largely councils using their dominant purchasing power to drive down prices and ration the amount of service people receive to contain costs, which have created the issues the sector faces.

ATTENTION ON SHORT VISITS A series of investigations and reports have focused attention on short homecare visits. The Equality and Human Rights Commission’s (EHRC) report, Close to Home: An inquiry into older people and human rights in home care, commented on the experience of people receiving homecare and there has been significant reporting by current affairs programmes on the use of short homecare visits. While the

focus has been on 15-minute visits, which account for around 10 to 16 per cent of care commissioned by councils, the wider picture is even more worrying. In 2012, the United Kingdom Homecare Association (UKHCA) estimated that 73 per cent of homecare visits in England were for no more than 30 minutes. As the majority of people receiving state-funded homecare in England and Wales will have a significant degree of frailty or disability, this suggests that much of the personal care delivered in people’s own homes is likely to be shoehorned into inadequate time-slots. This is incompatible with the responsive, dignified care that people who use services expect, and hugely stressful for frontline care workers.

Despite much positive discussion around commissioning homecare services to achieve the desired outcomes for people who use such services, the reality is that councils continue to stipulate the amount of time allocated for specific care tasks to be undertaken, and pay providers solely for ‘contact time’ (time spent in the service user’s home). This type of prescriptive commissioning may feel like an effective way of rationing severely limited resources, but it creates an inflexible system where neither the provider, nor the care worker, is likely to be paid for any extra time the service user may require for fluctuating needs or emergencies, particularly where the process to reclaim payment for additional time spent can be so onerous as to be unviable.

Individual Service Funds (ISFs) offer a greater degree of flexibility by allowing the person using the service to agree how their needs are met directly with their care provider, who manages an allocated personal budget on their behalf. While ISFs do not necessarily increase the total amount of time available, and aren’t suitable for everyone, they can provide a better

g

CMM JULY 2014 | 29

homecare – a perfect storm

g

way of getting the most out of a finite resource. The service user and provider can work out the best combination of visits (or other services) according to the user’s preferences, without needing repeated referrals back to the commissioner to change care plans or visit lengths.

However, until we can move away from the commoditisation of homecare as a service paid for in minutes or fractions of an hour, commissioning for outcomes will be largely a matter of rhetoric. A system of payment-by-results would appear to be the answer, but such systems are in their infancy in social care. For a system to be effective, it must be designed and tested with independent sector providers before being implemented. A badly designed system, particularly if imposed top-down by commissioners with insufficient commercial experience, could be disastrous for the stability of local providers.

A MINIMUM PRICE FOR HOMECARE Commissioning very short homecare visits while paying for ‘contact time’ creates an additional problem for providers and their ability to comply with the National Minimum Wage Regulations. Minutes shaved-off a homecare visit save councils money, but increase providers’ costs disproportionately, as a worker’s travel becomes a larger proportion of the hourly cost.

UKHCA recently produced a minimum price for homecare services of £15.19 per hour, necessary to meet legal compliance with the National Minimum Wage and maintain a sustainable homecare service.

Using the Freedom of Information Act, BBC Radio 4’s File on 4 - Cut-Price Care was able to establish that only four out of 101 councils paid at least this rate for the homecare services they commissioned.

UKHCA’s minimum price was not an exercise in wishful-thinking. UKHCA has published the assumptions used in its calculations, including payment of flatrate National Minimum Wage for both the time workers deliver care and time spent travelling, an issue recently scrutinised by HM Revenue and Customs in its report National Minimum Wage: Compliance in the social care sector.

UKHCA’s minimum price presents an uncomfortable challenge to local councils paying an average below £15.19/ hour. They must either demonstrate why UKHCA’s assumptions are unrealistic;

30 | CMM JULY 2014

or admit that they are forcing providers into the dangerous territory of noncompliance with the law and unsustainable staff turnover rates; or that they are tacitly asking providers to cut corners in areas which directly affect the quality of services, such as training, supervising or managing a mobile workforce.

BEING SQUEEZED A second EHRC report, Close to Home Recommendations Review, commented on the added implications of under-funded care, ‘Squeezing hourly rates, or placing too much emphasis on cost rather than quality, may increase the risk of rushed visits. It may also lead to ‘call cramming’, whereby providers over-book visits on a care worker’s rota, making it impossible for them to spend the allocated time on each visit.’ The Commission makes the link between such inflexibility and a risk to the human rights of people who receive homecare.

While it is an extremely unpopular message for politicians or local authority commissioners, the underfunding of social care is a genuine issue that will not be solved by slicing the cake more thinly, or looking for ‘efficiencies’ in a system which is already exhausted.

ZERO HOURS IN HOMECARE The rise in the use of zero hours contracts across business sectors has been analysed by the Institute of Personnel Management, and their use in social care has been criticised by the Cavendish Review for Government and the Kingsmill Review for the Opposition.

Feedback from homecare providers suggests that many of the drawbacks reported in mainstream media, including ‘working one day and not the next’, or being prevented from working for other employers, are rare in the homecare sector.

We also hear from providers who operate both guaranteed-hours and zero-hours contracts, that even when given a choice, many workers continue to opt for more flexible working arrangements.

Risks to the continuity of care for people who use services and the unpredictability of income for workers are, however, important factors to consider. The use of zero-hours contracts has been extensive in the homecare sector for well over a decade.

UKHCA believes that, unlike other sectors,

their use has not increased significantly as a result of public spending constraints.

However, the economic environment makes their use a certainty for the foreseeable future. The palatability of zero-hours contracts for the workforce and observers has no doubt been worsened by employers struggling to keep workers’ pay rates above annual increases in National Minimum Wage.

Service users’ needs have always changed from week to week and require a degree of flexibility which has meant that zero-hours contracts have been extremely useful in responding to changing demand.

However, more recently, as councils have pursued the noble aim of personalisation and choice of provider (or the more stark reality of placing new packages of care at the lowest price available), many providers face increasingly unpredictable patterns of purchase.

A reduction in the use of zero hours contracts is more likely to be successful where councils can guarantee volume purchase, which either necessitates a return to block contracting arrangements, or a radical reduction in the number of ‘approved providers’ that councils trade with.

However, the aggressive price-cutting by councils, paying £2 or £3 per hour below the real price of care, simply does not leave money to pay for care workers’ downtime.

Even where employers will be able to offer some degree of guaranteed working, such contracts are likely to be restricted to peaktimes of activity, such as early morning and late evenings, where there are particularly concentrated periods of activity.

Calls for the sector to abandon zero hours contracts, without a complete reassessment of how much such services will cost the State, are naïve in the extreme.

If central Government and local councils are serious in a desire to see providers offer guaranteed hours contracts, they must back their commitment with sufficient funding and adequate commissioning of statefunded care, otherwise they are making empty promises to the workforce and people who use services.

Without considered action on the funding, pricing and contracting of homecare services, the social care sector faces a perfect storm.

CMM Colin Angel is Policy and Campaigns Director at United Kingdom Homecare Association. colin.angel@ukhca.co.uk

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A NEW SYSTEM FOR PERSONAL BUDGETS David Roe responds to Colin Slasberg’s Straight Talk feature from CMM June and argues that the approach to personal budget formulation needs to change significantly, to support personalisation, and to meet the new agenda to deliver and sustain better outcomes and well-being cost-effectively and dynamically.

In the light of the Care Act 2014, there is an urgent requirement for a new national system for personal budgets to be designed and introduced, as soon as possible.

The challenge is to come up with an approach which promotes empowerment of the individual, to make their own support choices, whilst recognising that commissioner cash budgets are very limited and need to be spent optimally, over the medium term. From the research Colin refers to, it is clear that up-front allocations have not worked, as they do not take account of personal circumstances and goals, so always need to be personalised, and often substantially altered.

INDIVIDUALISED AND FLEXIBLE Every situation can be different, so there is no substitute for developing personal budgets on an individualised, flexible basis.

The imperatives to do this are increasing, in order to: 1) Fully take into account the varying support resources every individual already has at their disposal, or could further draw on, including carer/ family, friends and community support; this is partly dependent on living arrangements and home location accessibility; all options need to be considered, to make support as costeffective as possible, whilst ensuring

32 ¦ CMM JULY 2014

that the burden placed on personal carers is not excessive.

2) Take account of the specific risks facing the individual, in their living environment, bearing in mind their support needs and resources, including their capabilities, behavioural challenges, possible loneliness and social isolation.

3) Consider the need to invest in the individual’s support (rather than assuming continuing dependency), either to prevent needs escalating, or to help develop capabilities which can then lead to lower support needs for the future (building on existing personal ‘assets’/capabilities, given clear evidence of the payback, both for the individual and commissioner, against a background where most commissioners still admit to not investing for the future).

4) Allow individuals to make their own decisions about the optimal combination of support resources they utilise at different levels of cost, between professional support from registered providers, where their specialist experience is key, through to lower cost personal assistants, expenses for attendance at educational and activity centres, to free support from family and friends, and in

the community.

5) Revise budgets frequently and dynamically, to take account of variations in capabilities, needs, risks, support resource availability, as well as current/increasing levels of cost needing to be paid for.

6) Respond to the ramifications of more widespread use of outcomesbased commissioning.

None of this should undermine the opportunity for individuals to have their own personal budgets and to plan their own support. On the contrary, abandoning the entirely wasteful activity of preparing up-front budget allocations should remove a barrier to personalisation, and free up some commissioner/care manager resources to assist more directly in personal budget formulation and review.

COMMISSIONER INFORMATION SUPPORT AND CHOICE FOR THE INDIVIDUAL Commissioners/care managers will need to provide the information role envisaged in the new Care Act, by furnishing individuals with details of good quality providers, outlining their relative costs, and quality ratings, so that individuals can then exercise choice based on personal preferences and

value for money. As part of this, it will be incumbent on commissioners to ascertain the true costs of care with providers, per hour of support.

Individuals should be able to make their own choice of support resources, although this may need to be from a list of those meeting minimum quality and guaranteed support level criteria. Commissioners will still need to be accountable for ensuring that limited financial resources are deployed wisely to meet agreed needs, so will need to monitor progress against goals and approve revisions, working in more effective partnership with individuals and providers.

A STANDARD PERSONAL BUDGET FORMULATION MODEL It is hoped that there will be improvement and standardisation in needs assessment approaches, including to focus more on prevention and investment. In conjunction with this, a standard framework can quite readily be developed to translate needs into levels of support required, in hours per day or week, and preferred associated resource support to be assigned, somewhat more systematically and consistently than currently. This can then, in turn, be used to apply relevant costs per hour, so that individuals can prepare their own proposed personal budget, with assistance as needed.

It is suggested that this be developed

for each common area of support in turn, as relevant to each individual (ie personal care, domestic support, social activity support, education, work etc.), and then aggregated, adding in proposed expense costs to produce the total budget.

Such a consistent analysis framework for support costs could be applied right across social care, and complemented with accommodation costs and living expenses for residential care settings, thereby facilitating support level and cost comparisons for similar levels of need, supported in different settings (eg to compare personal care costs at home or in a nursing home).

There has been much talk in recent years about the need to move away from talking about hours of support required, enabling individuals with personal budgets to spend the money allocated entirely as they wish. However, this misses the essential point that it is still necessary to use the hours-based approach as the best, only reliable way to calculate the level of personal budget required, coupled with expense estimates.

This approach has the added benefit (compared to existing resource allocation points systems) that the extent of free carer/family and other resource inputs are quantified, and can then be reviewed to ensure that these are not excessive.

Changes in levels of support, resource mix and costs can all readily be made, flexibly,

and the budget revised simply. Costing models are already available and in use which can probably be modified to achieve this by area.

It might be argued that the need to analyse support needs by area will prove too onerous, although it is already being done in home-based care, and through the care funding calculator, for learning disabilities. The suggested approach would not require anywhere near such detailed analysis, but can, nevertheless, be tested for practicability and refined, using tailored costing models. The benefits likely to be gained, in ensuring that all areas of need are addressed holistically, to ensure that all-round well-being is promoted, as well as in being able to compare different areas of outcome directly with relevant resource inputs, could be significant.

MAKING PROGRESS It is widely recognised that social care budgets are currently insufficient to meet all eligible needs but at least the new system could address the needs better, and more flexibly, enabling personalisation to proceed as planned, whilst meeting commissioner aims to promote the ‘more for less’ agenda, where progress can be made now.

CMM David Roe is a consultant with LaingBuisson Email: david.roe@btconnect.com

CMM JULY 2014 ÂŚ 33

FIRE SAFETY ADVICE FOR CARE HOME MANAGERS Tom Welland summarises best practice in fire safety.

34 | CMM JULY 2014

Care homes represent one of the most high-risk establishments when it comes to fire safety. The combination of the frailty of occupants and the age of buildings heightens the risk.

Care home residents often have difficulty with evacuation, in part due to slow responses to a fire alarm sounding and mobility challenges. The fire strategies for these buildings are, therefore, more complex than others.

FIRE SAFETY REGULATION Care home owners and managers need to be aware of the Fire Safety Order (FSO); the current law in England and Wales.

The FSO nominates one individual as the ‘Responsible Person’ for a building – generally deemed to be the owner, occupier or employer.

Quite often a care home manager can be the designated ‘Responsible Person’ without knowing it and without any fire safety knowledge or training. However, just because they are listed as the ‘Responsible Person’ doesn’t mean they need to know everything about fire safety; someone else can be nominated to be a ‘Competent Person’ for the premises and be sent on fire safety training courses accordingly.

The ‘Responsible Person’ has a duty to fulfil the requirements of the FSO. Those requirements all stem from having a suitable and sufficient fire risk assessment. The care home manger will need to prove that they have reduced fire risk as far as is reasonably practicable and show that they have taken precautions to protect its residents and employees.

ROSEPARK NURSING HOME Doors are one of the most important fire safety features in a building and also, sadly, the most commonly abused. Recent research carried out by Fireco found that 64 per cent of premises visited by the fire service found fire doors wedged open. A practice that can prove devastating as the case of the Rosepark Nursing Home in South Lanarkshire showed.

A fire broke out at Rosepark in a cupboard on 31st January 2004, it ripped through the building. The Fatal Accident Inquiry (FAI) conclusion for this case listed a catalogue of precautions that could have helped prevent the fire becoming as destructive.

One of these precautions was for all bedroom doors to have door closers and smoke seals fitted to them.

Simply put, the loss of life would have been significantly reduced had the bedroom doors been closed. It was also noted that a few of the bedroom doors had self closers but some had been removed or disconnected, or were intact but the doors had been wedged open.

Installing a free-swing door closer on each bedroom door will allow care home residents to safely keep their bedroom doors open, but rest assured that the door will automatically shut when a fire alarm sounds.

STAFF TRAINING Providing adequate training to care home staff on how to identify and report fire risks will give the owner or manager the power to reduce and remove those risks. Training should start as part of

an induction, with regular updates from then on.

Top tips: • Ensure that the fire risk assessment is kept as a live document, rather than a ‘tick-box’ exercise carried out once a year.

• Regular checks of the building need to be made, e.g. that fire doors are still closing properly and the means of escape routes are kept clear of any obstacles.

• Try to spread out fire training throughout the year. Regular training updates could involve evacuation drills, how to use a fire blanket, fire extinguisher training and how to change the lint filters in tumble dryers.

• Keep an online diary of fire safety training with a sign-off for employees.

• Make sure that everyone who comes into contact with the building is also trained in fire risks including agency staff, builders, cleaners and gardeners. They also need to understand the importance of keeping a fire door closed and not wedged open, and looking out for things like damage to fire doors, frayed wiring and blockages to means of escape routes.

EVACUATION STRATEGY There should be a personal emergency evacuation plan (PEEP) in place for each individual resident. This plan details the resident’s needs and requirements. It can be useful to set the fire alarm off and record each resident’s response and reaction to it.

In some cases, a loud continuous noise can provoke unexpected reactions including violent outbursts or even seizures. Care home managers also need to be aware if the resident doesn’t respond at all to the alarm, or has a very slow reaction to it. All staff should have access to, and be made aware of, these PEEPs. Employees also need to have faith that fire doors will actually resist fire for 30 minutes. In the event of a fire, they will have the hard task of going around and informing the residents. Faith in the doors can help instil a sense of calm and this will help to save lives.

REPERCUSSIONS The main enforcer of the FSO is the Fire and Rescue Service. If a care home is found to have something wrong with the premises, it may be issued with an enforcement notice. This notice will state that the law has been broken and this needs to be rectified within a certain timescale. There is a right to appeal the notice within 21 days.

If an enforcement notice is not complied with, penalties range from large fines, restrictions from the Care Quality Commission and possibly imprisonment. In a recent case, a hotel owner and the fire risk assessor were both sent to prison for 18 months for failure to comply with the FSO and subsequent enforcement notice.

Fires are, thankfully, rare occurrences but prevention is essential. The most important piece of advice to help avoid fire disasters is to ensure regular inspections are undertaken and to make fire safety part of everyday life for all staff.

Tom Welland is Conformance and Regulatory Affairs Manager at Fireco Ltd. www.firecoltd.com

CMM JULY 2014 | 35

Tailor made care systems With systems tailored to your individual needs, Aid Call wireless nurse call is the perfect fit. � � �

Efficient Reliable Flexible

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0800 052 3616 0 220 (20 30 0 7)

EN

www.aidcall.co.uk Quote Ref: CMM

Transformational Strategies in Health and Social Care 15th Annual Healthcare Conference To be held on the morning of Tuesday, 8th July 2014 | One Birdcage Walk, Westminster, London, SW1H 9JJ Organised by LCS International, in partnership with The Sunday Times, the theme of this year’s event is ‘Transformational Strategies in Health and Social Care’. The conference will debate the 2015-2020 agenda. It is held at a time of real impetus behind the integration of primary, secondary and community services; new partnerships between the NHS and the independent sector; NHS England’s Simon Steven’s views on the use of data and the role of patients and communities, and the Department of Health’s recent paper ‘Transforming Primary Care’.

Participants include: Lord Norman Warner, author of 2014 ‘Solving the NHS Care and Cash Crisis.’

Stephen Collier, CEO, General Healthcare

Dr Charles Alessi, Chair, NAPC.

Tom Wright, CEO, Age UK.

Rt Hon Stephen Dorrell MP, Chair, House of Commons Health Committee.

Dr Arvind Medan, CEO, Hurley Group.

Kingsley Manning, Chair, Health and Social Care Information Centre.

Sir John Oldham, Chair, Independent Commission on Whole Person Care.

Anita Charlesworth, Senior economist, The Health Foundation.

Sir Stephen Bubb, CEO, ACEVO.

Dr Matthew Patrick, CEO, SLAM. Rob Webster, CEO, NHS Confederation.

Delegate Price: £275 +VAT includes reception and lunch

To book please visit our website at www.lcsic.com,or call 0207 108 6323, or e-mail info@lcsic.com

36 | CMM JULY 2014

SPOTLIGHT ON...

CARE SECTOR SOFTWARE Whatever the type or size of organisation, there are now software systems to help your day-to-day business. Integrating software can have a huge impact on efficiency, reporting, management, quality and costs. If you’ve not embraced technology or are wanting to see what options are available to you, CMM brings you a selection of the leading providers on the market.

ABLYSS SYSTEMS

With the current media spotlight on care homes and the changes to legislation that will evolve, the care sector is facing a period of unprecedented change. You need to rest assured in the knowledge that your chosen care management software can cope with any changes as well as being easy enough to use for your daily support team.

The Care Management System (CMS) from Ablyss offers you one of the most intuitive and adaptable systems in the marketplace. It was developed in 2003 and Ablyss has been developing and supporting the system since then. CMS offers a range of cost-effective products, CMS Desktop, CMS Touch and CMS Tablet designed to give the end-user complete flexibility and it can be used in a large range of care home environments including nursing care, supported living and learning difficulties.

All of the CMS products have been designed with the end user in mind and offer user friendly features and a highly-customisable format and templates. The software is fullysupported and continually updated to comply with industry regulations and our support team is at hand to help with any queries you may have.

CMS covers all the areas you would expect from your management software such as care planning, risk assessments, training and employee reviews. However, some of the

key features and benefits of the system are more surprising. Homes have reportedly been able to complete compliance checks up to 66% faster and employees’ time can be released allowing a greater focus on actual care.

The CMS Touch and Tablet have been designed with care assistants in mind to simplify and speed up the process of recording care notes. Built in templates guide the user through common routines such as getting up and dressed, eating patterns and night checks. You can also add your own templates or adapt those that are provided. The great advantage here is that the templates are quick and easy to use as they eradicate the need to type and can help with language barrier difficulties and written reports.

One final advantage of the CMS Tablet is that the device can work offline which can be a distinct advantage in homes where the networking range is limited. Simply view and complete your record and the data resynchronises when you come back into range.

We are so confident that you’ll find CMS invaluable to your business that we offer a free 30 day trial of CMS which you can arrange from our website. Why not give it a try?

Telephone: 01625 535685 • Email: sales@ablyss.co.uk • www.ablyss.co.uk

CMM JULY 2014 | 37

Our products, Mobile Care Monitoring (MCM) and Interactive Care Planning (ICP), provide a cost-effective, easy to use and reliable method of care planning and evidencing care interventions.

Mobile Care Monitoring incorporates handheld devices to collect evidence of care at the point of delivery, giving efficiency, accuracy, transparency and team-working for everyone involved in care. MCM focuses on enhancing the working life of care staff, owners, care managers, service users and services users’ family and friends.

Integrated Care Planning joins the circle between care planning and care delivery, so all care staff have care plans in their hands. Through joining together all aspects of care, care managers are better informed and can write care plans that are most appropriate for the service user, and measure the positive or negative impact of actual care against planned care.

Please contact us for more information.

38 | CMM JULY 2014

Person Centred Software specialises in creating innovative products to improve the lives of everyone involved in social care.

T: 01483 604108 W: www.personcentredsoftware.com E: care@personcentredsoftware.com @PersonCentredSW

spotlight on…care sector software

ADVANCED HEALTH & CARE

As more and more care organisations are choosing to invest in better IT solutions in order to improve efficiency and cut costs while improving quality of care, Caresys from Advanced Health & Care is one solution which is becoming increasingly popular within the care sector because of its ease of use.

It has also been specifically designed to add value to care organisations. Caresys is used by more than 3,000 residential, nursing and specialist care homes across the UK, catering for all types and sizes of care organisations and offers a fully-tailored solution and licencing options depending on the users’ needs. The solution has been implemented in some of the largest care home groups, specialist care and learning disability organisations in the country.

correct reporting and compliance; therefore securing better outcomes for service users.

The fully-integrated software application is available as a complete package or as individual modules, allowing information to be shared cost effectively amongst any number of different people at different locations. By eliminating time consuming and disconnected manual processes across different systems, Caresys allows care staff to focus on delivering joined-up care, whilst managerial and administration staff can ensure

The Advanced Health & Care suite of products includes: Adastra, Advanced Community, Advanced Mobile Communications, Carenotes, Caresys, Crosscare, iConnect, iNurse, Odyssey, Pathfinder and Staffplan.

Caresys enables care organisations’ staff to focus on delivering high quality care, rather than spending that time on cumbersome administrative processes. Modules available include: • Time and Attendance, • Care Planning, • Staff HR, • Finance, • Care Scheduling, • Equipment Maintenance, • Behaviour Support, • Enquiries and Marketing, • Income and Billing.

Advanced Health & Care also provides market leading software for homecare agencies, supported living providers and local authorities. Advanced Health & Care uses innovative technology to allow organisations of all sizes to increase efficiency and compliance, giving them more time to deliver great care.

Telephone: 01233 722700 • Email: ahcmarketing@advancedcomputersoftware.com • www.advancedcomputersoftware.com/ahc

ASPIRICO

iplanit is a unique approach for social care and mental health service providers in learning disabilities, mental health, older people and/or supported housing services. iplanit is a secure, cloud (or on-premises) web-based service that: • Puts action into person-centred support planning.

• Evidences outcomes creating transparency, accountability for funders, providers and end customers/carers.

• Enables service users take control of their care plans.

• Supports risk management and drives up quality.

• Informs strategy for management and funders through dashboards and reports based on KPI linked to people’s outcomes.

• Promotes inclusion, cost reduction and co-production.

• Supports collaboration and mobile working for carers/supporters. iplanit uses data entered at the level of individual support to create a cross service/location dashboard for tracking and reporting on the impact and value of what a provider does, and planning the future development of services.

Telephone: 0203 239 1033 • Email: enquiry@aspirico.com • www.aspirico.com

CAREDOCS

CareDocs is a complete care-planning and home management system. The system uses a unique, three-step process to create care plans.

Step 1 – the user completes an easy-to-follow assessment, which covers all areas required for a full, compliant assessment of the resident.

Step 2 - using the information gathered in the assessment, CareDocs automatically generates a draft care plan, saving hours of work.

Step 3 – the draft care plan is personalised but every section can be edited or supplemented with other information enabling it to become a truly person-centred document.

The ongoing maintenance and update of the care plans is a simple and straightforward process. All text and content can be amended to reflect changes in circumstance. All previous content is saved for future reference creating an invaluable record of care history.

The care plan, in conjunction with daily occurrence notes and forms, gives you comprehensive guidance and evidence which will encourage best practice and support good care provision. Daily occurrence notes are categorised as different event types; using our system you can filter this information allowing you to produce a precise historical event log when you need it. Also, the system prompts you to record all resident experiences (eg doctor visits and hairdresser appointments) and indicate their mood. You can filter these events to analyse patterns in resident behaviour. You can then use this to make the necessary adjustments to the provision of their care.

CareDocs can monitor residents’ and staff records and ensure that equipment servicing schedules and daily checks are completed on time. All information can be stored and retrieved with ease.

CareDocs is supplied installed on desktop or laptop computers – no programmes to install or download. If you want more than one system, we provide a server system and additional computers to meet your needs. All our subscription packages include unlimited technical support and regular updates. We also provide you with initial training when we install the system so that you get the most from CareDocs right from the start.

CareDocs covers all the areas of recording and record-keeping that a care home requires.

As well as maintaining residents’ records, care plans and progress notes, CareDocs will also record staff training records and supervisions. Users can also maintain home maintenance records with a facility to keep daily recordings of equipment performance and maintenance schedules. CareDocs Mobile enables care workers to add daily progress notes remotely using any internet-enabled device through a secure website.

CareDocs is supplied ready-to-run on our own hardware and is a complete system; there is nothing more to buy or more modules to gain full access to all the features.

Customers benefit from all future upgrades to the programme without any fee. It is suitable for residential care homes, nursing homes and domiciliary care.

Free initial training with ongoing support plus distance and telephone training are available. Further, on-site visits can be arranged. User training videos are built into the product. There is unlimited technical support (UK-based) on all hardware. Over 600 systems are currently in use across the UK. First systems (including hardware) £150.00+vat per month (minimum 12 month subscription). Subsequent systems £95.00+vat per month.

Telephone: 0333 500 5115 • Email: info@caredocs.co.uk • www.caredocs.co.uk

CMM JULY 2014 | 39

spotlight on…care sector software

CAREPLANNER

CarePlanner has been developed in partnership with several homecare agencies with the sole purpose of tackling the issues they face. It isn’t a general purpose rostering solution or staff management product. We live and breathe homecare and have built a software solution to match.

Planner

Cloud based - You don’t have to maintain expensive servers, software and backup solutions etc. We do all the work for you.

Unbeatable value - Pay as you go with no long-term contracts, no ‘upgrade’ fees and no additional charge for core features.

Top Notch Support - You can call us as much as you like and you will get straight through to someone who can help.

Saves you time - Save days of manual tasks every week. CarePlanner automates dozens of administrative tasks.

Uses the latest technology - No ‘virtual desktops’, no leaving your office PC running, no multiple passwords. CarePlanner is a technological breath of fresh air.

Easy to use - CarePlanner is very user-friendly and you don’t need to be trained to use it. You can call our support team at any time if you have any questions or just want to discuss the best way of doing something.

CarePlanner doesn’t stand still. Based on customer feedback, we continually add new features to the system that are made available to all our customers, free-of-

charge, as soon as they are ready. Here are just some of the features the system offers.

Easy, intuitive rota planning - Rota planning that anyone can use - no need to memorise information. It will all be on the screen.

Record-keeping - Keep track of staff training, service user requirements and dayto-day incidents with CarePlanner’s thorough record-keeping system.

Automated texting and emailing - Text, email or print your rotas for all staff with just a few clicks of the mouse.

Secure, cloud-based system - 256 bit, online banking-grade security; accessible to your staff from anywhere on virtually any device.

Professional invoices and timesheets - Printed or emailed, CarePlanner generates smart, customisable invoices and staff timesheets.

Integration with third-party systems - No more piles of invoices, transfer all your invoice data to Sage Line 50 with ease.

Automatic mileage calculations - Choose how and when to pay/bill for mileage, at what rate and based on exact distances.

Call monitoring - Know for certain that a care assistant has attended an appointment and receive a warning if they have been delayed.

Mobile Apps - Care staff can use their phones to view their rosters and you can include any information required to clients and appointments.

Customisation - CarePlanner is infinitely customisable. If it doesn’t do something you need, get in touch and we can discuss your requirements.

Telephone: 0117 214 0585 • Email: info@care-planner.co.uk • www.care-planner.co.uk

iCAREHEALTH

iCareHealth’s Electronic Medication Management software is the only software to integrate seamlessly with your choice of pharmacy, to create a safe and efficient flow of information between the pharmacy and care home. The comprehensive electronic medication administration record promotes significant safety gains by ensuring staff only ever view the medications intended for administration during a certain round, and that the administration of these medications meets compliance and more importantly the needs of the resident.

The use of alerts and warnings aid care staff to help ensure they comply with the highest standard of medication administration procedures.

Medication reports can be generated instantly, based on the most up-to-date resident information to provide greater transparency across medication management processes and trends within your facility. Standard and customisable medication reports highlight medication errors, medications not administered, administered PRN medications and more, to helps safeguard against risks and ensure compliance of your medication management procedures.

Telephone: 01440 766400 • Email: solutions@icarehealth.com • www.icarehealth.co.uk

LNT SOFTWARE

LNT Software truly understands the care sector. We are committed to providing the highest quality software solutions to help your business. We have been designing and delivering care home management software for nearly 15 years, providing our CoolCare system to care homes throughout the UK and Ireland.

paid for the right job role. Being able to export your client payments and payroll to your accounting packages with peace of mind and in a few minutes, will also greatly ease your administration overhead.

CoolCare3 has been built by care home owners for care home owners. Our goal with CoolCare is to offer an affordable, practical package that will be easy-to-use and grow with our clients. With our low cost of entry in to Coolcare3, your £90 monthly subscription includes all Coolcare3 elements plus support, maintenance and, of course, training. We do not believe in modules or extra bolt-ons. There are no software add-ons or modules required - everything is included in our package, ready for you to choose to use as you grow.

Company analysis With CoolCare’s Operational Analysis, you can simply click a button and access the realtime data whenever you wish, including in great detail how a home had performed over the last four quarters. Complete with average weekly fees, occupancy and the fill rate.

Time and attendance This is an often over-looked benefit of CoolCare. Being able to manage staff in an efficient, fast and intelligent way can help you significantly improve your care facility in terms of its productivity and, ultimately, profitability. One way to ensure you are getting the most from your team, and to discover better ways to manage your team’s working hours, is to integrate employee time and attendance systems into the business.

CoolCare works by letting your employees clock in to work using our iButton clocking in systems that automatically puts them on the right shift at the right time and being Telephone: 0113 385 3853 • info@LNTSoftware.com • www.lntsoftware.com

40 | CMM JULY 2014

Care planning Being able to appropriately and correctly care for those people living with you should form the very ethos for which you operate. CoolCare helps by giving you the medium to collate all this information in a compliant and easily-accessible manner.

Recruitment and staff HR Maintaining your staff records can be a lengthy task, updating next of kin details, monitoring when a Visa expires or when a member of staff is sick yet booked on a course. All of these things can be managed by our in-depth HR Management system.

And much, much more including Document Management, Messaging Centre, Enquiry Management, Training, Virtual Notice Boards.

Ever wished that all your business requirements were in one system?

Caresys from Advanced Health & Care is the complete care home management system offering an extensive range of integrated modules to simplify the running of your care home. Easy to use and cost effective, Caresys is trusted by over 3,000 organisations across the UK. To find out how your organisation can have all of it’s business requirements in one place with Caresys, please contact us on 01233 722670 or visit

www.advancedcomputersoftware.com/link

Advanced Health and Care Limited is part of Advanced Computer Software Group. Registered in England, company number 02939302. Registered office: Munro House, Portsmouth Road, Cobham, Surrey, KT11 1TF

spotlight on…care sector software

W NE

CT-CLOUD allows anytime and anywhere access to all your ‘08 Nurse Call System’ data* Quickly view operating performance of individual or multiple homes Accessible on tablet, smartphone or desktop* All reports delivered by email when you want them No more manual or paper back-up of nurse call data – secure daily uploads are standard Clean and simple display information – needs no training CT-CLOUD is our unique, cloud based, nurse call data reporting and storage service. Get key performance information and much more when and wherever you need it at your fingertips.

To find out more or to arrange a demonstration,

*

call 0800 068 7419 or visit www.c-t.co.uk Works in conjunction with CT-TOUCH

Technology for those who care

42 | CMM JULY 2014

Internet connection required.

spotlight on…care sector software

PERSON CENTRED SOFTWARE

Mobile Care Monitoring by Person Centred Software provides an innovative solution for evidencing care and electronic care planning that is focused on improving the quality of life for service users and care staff. In social care, the primary objective has to be to improve the quality of life. Care workers do their job because they love caring for people, so we start by helping to remove their routine tasks of writing daily records and make record-keeping fit in with their care duties. We also want service users to feel comfortable, safe and, above all, happy so we’ve made this objective the core of our product by measuring their happiness during each care interaction.

Mobile Care Monitoring incorporates handheld devices to collect evidence of care at the point of delivery, with processes built-in to provide protection to service users and staff.

Through efficiency, accuracy, transparency and team-working, the system provides time savings for everyone involved in care, allowing more one to one time with service users, and also provides increased profitability through reduced staff induction costs and increased income.

The system is easy to use, fast and icon driven with limited need for typing. Visibility and transparency ensures that information is managed across the organisation. Care worker

to nurse workflow is through automated escalation of certain care interventions; nurse to care worker with care plans, planned care routines and shift handover notes; and care worker to care worker workflow with service user preferences, flags for overdue care and happiness indicators. All this added together makes a unique solution to a very simple objective: to improve the life of everyone involved in social care.

The benefits of Mobile Care Monitoring include: Care workers get more time for care because they spend less time on administration and are better informed. Service users have less stressed care staff caring for them, and the system audits how happy service users are. Care managers get an holistic overview of care, presented in ways that helps them quickly identify potential problems, and know that all service users are being well cared for. A service user’s family and friends can know instantly that their loved one is receiving the care they need and is happy.

Mobile Care Monitoring is in use by customers providing elderly nursing and residential care; supported living; learning disability and domiciliary care. The system is available for £15 per full-time equivalent (FTE) user per month, based on one device per two FTE users. All prices are fully inclusive, covering software, devices, support and taxes.

Telephone: 01483 604108 • care@personcentredsoftware.com • www.personcentredsoftware.com

QUALITY COMPLIANCE SYSTEMS

Across the care sector Quality Compliance Systems (QCS) is a widely trusted and respected brand with over 7,000 users nationwide. The management system software and paper manuals are specifically designed to conform to the CQC standards. Quality Compliance Systems provides a high quality bespoke Care Quality Commission (CQC) management service for a range of services: domiciliary care, residential care, nursing care, learning disabilities, Mental health, supported living, dental and GP practices. No matter whether you are a business start-up or an established provider, we can help ensure that you adhere to the CQC’s planning and standards in all areas.

Access to our instant software updates and constant flow of information through paper updates, makes it easier to meet and exceed the CQC standards of quality and safety.

Highlights of the QCS System: Comprehensive Care Planning covers all aspects of care planning, from initial contact and first assessment through to admission and continuous review. Interactive Risk Assessment Centre, this tool has been developed to assist you with completing, creating and scheduling your assessments as well as

action plans that will be sent directly to your Registered Manager. Mock Inspection Toolkit, step into the shoes of your inspector and find out what to improve on before your inspection. Up to 2,300 pages with 200+ easy to follow policies and procedures available on any computer or smart device with internet access. Support from a dedicated customer care executive. Easy to use, we’ve designed the system in a way that is intuitive and efficient for everyone to use. And so much more.

Best of all, you don’t have to take our word for it. Our compliance advisers will be happy to give you a free trial. Contact us on 0207 138 3078 option 1 or complete a free trial request at ukqcs.co.uk and experience for yourself the peace of mind of knowing you’re compliant and up to date.

What our clients are saying…‘With QCS, managing compliance is now easier than it has ever been.’

‘QCS makes compliance user-friendly.’ ‘Effectively we have offloaded responsibility for updating our policies to QCS. It’s the first place to go when a compliance matter comes up.’

Telephone: 0333 405 33 33 • info@ukqcs.co.uk • www.ukqcs.co.uk

WEBROSTER.NET

Webroster.net is an online rostering and monitoring system that can be used anywhere, at any time. It focuses on streamlining manual processes, leaving you time to concentrate on running your business. It works by matching staff to client requirements based on a range of user-defined criteria such as specific health needs, continuity of care or location. It will then generate timesheets, invoices and payroll whilst also taking the pain out of everyday communications between clients and staff. The efficiency and accuracy of the system allows you provide the highest possible service quality.

Webroster.net is a highly-flexible system ideal for providers of all sizes; the basic functionality can be enhanced at any time by a wide range of additional modules, all designed to save you time and money. These include three electronic call monitoring options, Travel, MIS, Document Management, Staff and Client Portals, Audit plus the re-launched ‘Bee’ app and the new Real Time Mapping module.

Bee is an Android app designed to give field staff all the information they need to carry out their working day, including their daily schedule, appointment details and the ability to check in and out of visits for proof of service delivery. New ‘Real Time Mapping’ allows you to track the location of your field staff in real time improving

your quality of service by ensuring that field staff are where they should be. It also allows you to react quickly to any issues that may arise, by diverting routes that staff members are due to take or re-scheduling another staff member to a requirement.

Webroster is proud to have been providing web-based software solutions for nearly 12 years and we are delighted to see customers and staff who have been with us since day one! We value the relationship that we have with each of our customers and provide an individual and personal service at all times. New customers are welcomed on board with a bespoke implementation and training programme provided by PRINCE2 qualified consultants. All customers are fully supported through our SDI accredited customer support service and have access to an online suite of help guides. In addition, annual user open days provide best practice guidance to system users. Strategic roadshows are also held annually for customers to hear about and give feedback on planned developments.

‘Using Webroster.net allows our managers to spend more time managing the services and less time doing administrative tasks such as verifying timesheets. Since using Webroster.net we have saved eight hours per day and more than £36,000 per year.’ Shirley Harris, Future Home Care.

Telephone: 01733 311599 • info@webroster.com • www.webroster.co.uk

CMM JULY 2014 | 43

conference review

DERBYSHIRE AND NOTTINGHAMSHIRE CARE CONFERENCE 2014

4 June Nottingham

The second Derbyshire and Nottinghamshire Care Conference, supported and organised by Care Management Matters, in association with the Derbyshire Care Homes Association and Nottinghamshire Care Association, took place in the Nottingham Belfry.

Bringing the quality of a national conference to a regional platform, the programme focused on issues specific to providers within the two counties, as well as overarching themes facing the sector as a whole.

Chaired by Robert Chamberlain, Editor-in-Chief of Care Management Matters, the day comprised main stage presentations, a panel discussion and interactive workshops.

Delegates from across Derbyshire and Nottinghamshire were welcomed to the event by Alan Pearce, Chairman of Nottinghamshire Care Association and Brian Rosenberg, Chairman of Derbyshire Care Homes Association.

The keynote presentation focused on the biggest piece of legislation to affect the sector for many years, the Care Act and its implementation and impact on care providers. Des Kelly OBE, Executive Director of the National Care Forum informed delegates of the main points of the Act and how they would affect providers’ businesses.

This was followed by a panel discussion on the Care Act, its implementation and local authorities’ approach to implementation. The panel was chaired by Des Kelly OBE and he was joined by Paul McKay, Service Director Access and Public Protection at Nottinghamshire County Council; Alan Pearce, Chairman of Nottinghamshire Care Association and Brian Rosenberg, Chairman of Derbyshire Care Homes Association.

This gave delegates an opportunity to ask questions of the panel and hear directly from the local authority representative about their approach to implementing the Act in the region.

Market and finance Given the impact of the credit crunch on the sector, there is always a real appetite for information on financing. Andy Brookes, Partner, Head of Healthcare at Hazlewoods LLP gave delegates a summary of financing and whether banks are open for business. Coming from an accountant’s point of view, rather than a bank’s, meant he was able to give an overarching

view of the financing situation with information on lending requirements and other sources of funding.

The finance presentation fed neatly into a market outlook, delivered by Roger Harcourt, Partner, Shakespeares Legal LLP. Roger looked at the specifics of the market in the Derbyshire and Nottinghamshire regions, sharing his views on whether there was an under-supply or over-supply of provisions and what is happening with the market in the region.

Workshops A series of interactive workshops ran in the morning and afternoon. Assistive living technology in adult social care was delivered by Dave Williams and Christine Collymore from Skills for Care. An employment law overview was delivered by Liz Mulvaney and Alan Lewis of Freeths Solicitors LLP. A medication handling workshop also ran, drawing on the expertise of Adam Meakin of Protomed.

Afternoon session The afternoon plenary explored the future of regulation with an interesting and comprehensive presentation by Malcolm Bower-Brown, Deputy Chief Inspector of Adult Social Care Central Region at the Care Quality Commission. With so much happening around inspection, delegates were very interested to hear what Malcolm had to say.

The final presentation of the day was by Ben Troke, Partner at Browne Jacobson Solicitors. Ben explored safeguarding with a focus on Deprivation of Liberty Safeguards. This important topic is subject to much debate at the moment and Ben covered recent cases as well as sharing his expertise on ensuring safeguarding is implemented correctly.

The day wouldn’t have been made possible without the sponsors, Hazlewoods LLP, Shakespeares Legal LLP and Tektroniks. Also, thanks must go to the exhibitors who offered delegates a widerange of services CAREMANAGEMENTMATTERS and products to ensure they keep moving their businesses forward.

CMM

44 | CMM JULY 2014

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CMM JULY 2014 | 45

straight talk

straight talk Martin Green raises concerns about financial constraints and local authority commissioning practices on the Care Act.

MARTIN GREEN CHIEF EXECUTIVE CARE ENGLAND Now is a pivotal moment for the sector. The Care Bill has finally become the Care Act, the most significant piece of social care legislation in decades that aims to overhaul the system and create an affordable and adaptable system for all.

I think that many of those working in the sector, myself included, are united in support for such a change. The care sector is under strain. An ageing population will only add further pressure, we need reform now if we are to ensure sufficient, safe and wellstaffed care is available for future generations. Yet for all its benefits and promises of progress, the Act doesn’t inspire me with confidence. Nor does it assuage many of the concerns we have.

Primarily, the Act has side-stepped the thorny issue of finance and local authority (LA) commissioning practices. Arguably, this is the area most in need of reform, but due to the inevitable complications and fiscal challenges, it’s one that slipped through the net. Few LAs pay care placement fees which accurately reflect the true cost of providing care. This creates a shortfall in funding which is placing providers, both private and not-for-profit, under increasing strain. To date, the ‘sticking plaster’ solution has been cross-subsidisation; private funders, providers and more generous LAs covering the shortfall. The Act looks to stop this practice, but fails to provide a viable solution for the fundamental problem, a lack of available funds going into the system.

LAs have seen budgets slashed whilst facing increasing costs of providing services. They are operating on a knife-edge too.

However, providers cannot invest in services, improve training, pay staff a living wage and ensure top quality care without proper financing. We cannot ensure ever-improving quality whilst accepting ever-dwindling rates. Commissioning is becoming a ‘race to the bottom’, with the main criteria being who can accept the lowest price and still function. If we are to avoid another Southern Cross scale collapse, or the collapse of any provider for that matter, the structures of care provision must adapt so that providers are offered rates which tally with costs. This will, of course, be more expensive but surely it’s worth it if it means better care for all.

Such reform was not provisioned for within the Care Act, but not for want of trying. Various parties pushed the agenda of commissioning reform. During the committee stages several MPs voiced their concerns, former Care Minister Paul Burstow MP, commented, ‘Commissioning has, in practice, turned out to be crude procurement’, and he quoted a 2013 Office of Fair Trading report which found, ‘that providers felt there was a lack of clear strategic

direction from local authorities, and a lack of commissioning and procurement skills - which was leading to market inefficiencies and difficulties in planning’.

We’ve been campaigning to raise awareness of this issue. Protect Care, Pay Fair got the issue discussed in the House of Commons, with two amendments reviewed by MPs. The amendments called for the introduction of a ‘fair funding formula’, which LAs would utilise when tendering contracts, to ensure reasonable costs were met. This would keep the market healthy and drive up standards. These amendments didn’t make it on to the Bill; the cost implications are understandably something the Government is keen to steer clear of if it can. However, we can’t keep hoping that these damaging commissioning practices will change by themselves.

Those in power accept the arguments behind these concerns, Care and Support Minister Norman Lamb MP acknowledged the issues in the Committee Stages of the Bill and the House of Commons.

However, until there is a groundswell of public opinion calling for LA funding reform, this acceptance is unlikely to translate into action. I fear this may only come if there’s more serious financial care provider collapse, something we all want to avoid.

Mr Lamb assured MPs that any LA that doesn’t consider the actual cost of care when setting fee levels is unlikely to be fulfilling its statutory duties, and that this will be addressed fully in the Act’s accompanying guidance. We’re currently awaiting the draft guidance and its consultation. We’ll be reviewing it carefully and submitting a detailed response. It’s a huge opportunity to ensure commissioning practices are addressed and that real incentives (or penalties) are in place to ensure change happens on the ground.

A recent announcement from Jon Rouse, Director General for Social Care, Local Government and Care Partnerships at the Department of Health confirmed that councils won’t receive any more money. The £470 million pot is what LAs are relying on to implement the Act’s reforms. If, or perhaps more realistically, when, this runs out, there is no back-up plan to ensure that the new laws are adhered to, no provisions to ensure councils will see the Act translated into action.

At this junction in the journey of social care, I don’t want to see all the good of the Care Act overshadowed by a slow progression towards an untenable market place and the inability for providers to invest in services. Current and future generations need and deserve quality care. We shouldn’t be avoiding reform purely for the sake of shortterm financial ease.

CMM

DO YOU AGREE WITH MARTIN? PLEASE EMAIL YOUR THOUGHTS TO EDITOR@CAREMANAGEMENTMATTERS.CO.UK 46 | CMM JULY 2014

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Care Conference

Supported and organised by Care Management Matters

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THE FUTURE OF CARE & COMMISSIONING Mercure Dunkenhalgh, 18 September 2014

June 2015

Hilton Reading, 16 October 2014

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What to expect from these events

Delegate profile

• The day will include presentations from high-level sector representatives, along with an exhibition and a choice of workshops

wners/Directors/Senior Management from the O Independent Care Sector within Residential and Domiciliary Care and other sector professionals

• An agenda that has been put together in partnership with the relevant local care associations, providers and opinion leaders in the region meaning that it totally reflects their needs • Networking opportunities with high-level decision makers and like-minded colleagues from within the independent sector

• 94% of delegates said the event had fulfilled their needs and expectations • 93% of delegates said they would be returning to next year’s event • 90% of delegates scored the speaker presentations as ‘good or excellent’

For exhibitor enquiries please call Paul on 01223 206965 or Jacki on 01293 854401 For delegate enquiries please call Denise Woodhatch on 01293 854401 SUA1713 CMM2015 Full Page Ad_FINAL.indd 1

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