Care Management Matters September 2014 Issue by Care Choices Ltd

SEPTEMBER 2014 £4.00

THE PREMIUM UNCOVERING CARE HOME THE TRUTH MARKET The Care Act and eligibility Analysing the trends

3rd Sector Care Awards Celebrating creativity and innovation

Medication management Is IT the answer?

Business Clinic

Recruiting the right people

Nottingham City’s minimum core pricing

Learning from the US

Business Clinic SureCare’s micro-franchises

The revolution will be improvised How leadership can drive integration

bulletin included featuring ‘top-tips on Community Engagement’

Includes 4-page Skills Academy insert: The Social Care Manager’s Handbook: Quality leadership at the heart of outstanding services

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07/08/2014 11:22

in this issue

IN THIS ISSUE regulars 05

editor s welcome

Is it just me...? Robert Chamberlain, Editor in Chief, considers the findings of the LGA s research into councils ability to pay for the Care Act s funding reforms.

News

Local Authority and Planning News

Property News

Corporate News

Business Clinic

Our panel discusses Nottingham City Council s minimum core price for care.

60 Seconds with... David Pearson, President of the Association of Directors of Adult Social Services.

Who s who...recruitment CMM profiles recruiters and organisations to help with your recruitment needs.

features 20

Conference review CMM reviews Health+Care and Commissioning 2014.

What s On?

Straight Talk

Clouds Yesterday, Sunshine Tomorrow? Amanda Nurse considers confusing economic signals and recent market activity to see what the future might hold.

John Burton looks at CQC s end of year report and declares that it requires improvement .

The Care Act and eligibility â&#x20AC;&#x2019; uncovering the truth of Government s plans Colin Slasberg analyses the reality of the Care Act s changes to eligibility in light of the Government s draft guidance.

The revolution will be improvised Debbie Sorkin looks at how new approaches to leadership are driving integration.

Counting the cost of social media Liz Mulvaney explains why it is important your staff are fully aware of their responsibilities when using social media.

The role of occupational therapy in care homes Victoria Elliot and Helen Martin discuss how occupational therapists can add value to a care home.

46 36

The 3rd Sector Care Awards CMM profiles the new Awards for operators within the not-for-profit care sector.

CMM returns after its summer break with a great issue for you. The summer months are usually quieter but I think it s a good indicator of everything happening in the sector that this summer hasn t been quiet at all. We ve increased our news pages to make sure you are up-to-date on all the important developments. Inside this issue we have a very interesting feature by Colin Slasberg on page 28. Colin explores the reality of the Government s planned changes to eligibility in light of new guidance. John Burton shares his opinion on the Care Quality Commission s end of year report and introduction of new quality ratings in October. He gives his thoughts in the Straight Talk on page 50. The subject of our 60 Seconds with... interview this month is David Pearson, President of the Association of Directors of Adult Social Services. He has taken on the role at a time of real change but believes the Care Act will be a platform for the future. With the Care Act and Better Care Fund moving forward, the drive to integrate services is picking up speed. On page 32, Debbie Sorkin reports on how systems leadership can be used to help organisations work together even if they have different views, or priorities. Finally, I m delighted to announce the launch of a new Awards for the not-for-profit care sector. Organised by CMM, the 3rd Sector Care Awards will champion creative and innovative ways to achieve excellence. Nominations are now open and you can find out more about the Award categories and how to enter on page 46. The ceremony will be hosted by Esther Rantzen on 3rd December in London. If you re a notfor-profit provider I urge you to enter and share the good work you do. Emma Morriss Editor

Follow CMM on Twitter @cmm_magazine

CMM SEPTEMBER 2014 ÂŚ 3

contributors

CMM CAREMANAGEMENTMATTERS

editorial panel Des Kelly OBE,

Mike Padgham,

Executive Director, National Care Forum

Chair, UKHCA

Professor Martin Green OBE,

David L Jones,

Chief Executive, 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

September 2014 EDITORIAL AND PRODUCTION editor@caremanagementmatters.co.uk Editor in Chief: Robert Chamberlain Editor: Emma Morriss News Editor: Des Kelly Editorial Assistant: Rebecca Northfield Design and Production: Holly Cornell, Lisa Werthmann, Jamie Harvey & Gemma Cook ADVERTISING sales@caremanagementmatters.co.uk 01223 207770 Advertising Manager: Daniel Carpenter daniel.carpenter@carechoices.co.uk National Sales Manager: Paul Leahy paul.leahy@carechoices.co.uk SUBSCRIPTIONS Non-care and support providers may be required to pay £50 per year. info@caremanagementmatters.co.uk 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: 978-1-910362-14-3 CCL REF NO: CMM 11.6

contributors Alan Pearce, Chairman, Nottinghamshire Care Association Amanda Nurse, Founding Director, Carterwood Colin Slasberg, Independent consultant in social care David Roe, Consultant, LaingBuisson Debbie Sorkin, National Director of Systems Leadership, Leadership Centre John Burton, Independent social care consultant and writer

Publications

John Roddy, Consultant, Shakespeares CMM magazine is officially part of the membership entitlement of:

Liz Mulvaney, National Head of Health, Healthcare, Freeths LLP Victoria Elliot, Principal Care Consultant (Research and Innovation), The Orders of St John Care Trust

ABC certified (Jan 2013 - Dec 2013) Total average net circulation per issue 15, 991

4 ¦ CMM SEPTEMBER 2014

Helen Martin M.Ed BA (Hons) Dip.COT Cert.Ed, Senior Lecturer and Admission Tutor, University of the West of England

is it just me...?

Is it just me...? Robert Chamberlain, Editor in Chief, discusses the findings of the LGA’s research into councils’ ability to pay for the Care Act’s funding reforms. According to the Local Government Association’s (LGA) latest research (7th August 2014) 90% of councils are concerned about the cost of implementing the forthcoming funding reforms. In the survey of 152 local authorities, 134 stated that additional funding would be required to fill the distinct possibility of a funding gap.

UNKNOWN DEMAND Of major concern is the uncertainty regarding the numbers of self-funders in each region that could request an assessment from a council to limit their expenditure on care costs under the new system. The unknown demands for new assessments and the costs of meeting additional care needs are clearly worrying for local authorities, whose budgets are already under tremendous pressure. Without adequate funding it is possible that councils will not be able to meet the increased demand for assessments. This issue threatens to impact on the benefit of the reforms for thousands who would qualify for funding.

WARNING SIGNS The LGA report states that, ‘local authorities are warning the Government that if further analysis being carried out between local government and the Department of Health in the coming weeks does uncover a funding gap, more money will be the only reasonable solution to carrying out these reforms – not delaying or making fewer changes.’ Katie Hall, Chair of the LGA’s Community Wellbeing Board, added, ‘Councils want to

help as many people who require support and care as possible, however, with only eight months to go until councils will have to start implementing these changes, the clock is ticking for Government to get the funding right so that these vital reforms do not face collapse before they have even begun. ‘The Care Act has the potential to bring about a once-in-a-lifetime opportunity to improve the lives of the most vulnerable people who rely on care and support. Some

‘Without adequate funding it is possible that councils will not be able to meet the increased demand for assessments.’ of the most vulnerable people who rely on care, their families and carers are expecting changes from April next year. Many of these people will have been anticipating the positive impact that some of these changes could have on their lives and now could be facing the very real possibility that the Government could have unfairly raised their expectations through a failure to properly fund the changes they have been waiting for.’

TROUBLED START Even if the reforms are implemented successfully, the diluted Dilnot recommendations are regarded with

scepticism over how limited the benefits will be to care seekers. For example, it would appear that care home residents would only benefit after two and a half years – way beyond the average stay in residential care according to sector statistics. If councils’ concerns, as highlighted by the LGA research, are proved grounded, it is questionable how further reduced any benefits from the reforms will be. It is difficult to understand how the Government has calculated the affordability of the new system, given the lack of information on the numbers of people potentially eligible. Is it possible that they have a handle on these figures while local authorities are scratching their heads? I do also wonder if the finances are calculated on additional care costs alone or take into account the cost of resources needed by councils to assess new claimants. I’m not surprised that councils have yet to determine the extent of potential selffunder assessments. In other recent research conducted by Independent Age almost 75% of councils admitted failing to even track the extent of top-up care fees. This is despite a consensus from those councils interviewed that they had a legal responsibility to do so. With such a short timeframe before the reforms impact there is an absolute and immediate need to address these fundamental issues on both sides of the fence. Let’s hope that Care Services Minister Norman Lamb’s response to the LGA’s findings heads off the potential of a troubled start. If you would like to comment please email robert. chamberlain@caremanagementmatters.co.uk

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CMM SEPTEMBER 2014 ¦ 5

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WiFi availability is subject to your premise’s location. The Knick SM under licence from Home Box Office, Inc. Scandal © ABC Studios. Thor: The Dark World © 2013 Marvel. The F1 logo, F1, FORMULA 1, FIA FORMULA ONE WORLD CHAMPIONSHIP, GRAND PRIX and related marks are trademarks of Formula One Licensing BV, a Formula One group company. All rights reserved. Source: Sky viewing figures. Sky IQ, 2014. Calls to Sky cost up to 5.1p per minute (plus 15p connection fee) for BT customers. Calls from other providers may vary. Correct at 18 July 2014.

news

APPOINTMENTS APPOINTMENTS DAME MOIRA GIBB Dame Moira Gibb has been appointed as Chair designate of Skills for Care. The organisation recently merged with the National Skills Academy. DANSHELL Danshell has announced that Steve Page is joining its board as a Strategic Adviser. Steve has held senior positions at Priory Healthcare, Nestor plc and Acorn Care and Education. YOUR CARE RATING Your Care Rating has appointed two high profile new members to its board. Professor Julienne Meyer from City University and Sylvie Silver from the National Association for Providers of Activities for Older People add considerable expertise. PRIORY APPOINTS TOM MUIR Tom Muir joins the Priory Group in the newly-created role of Group Director of Corporate Affairs. Tom joins from the Circle Partnership where he held the position of Head of Communications. COMMUNITY INTEGRATED CARE Community Integrated Care has appointed Martin McGuigan to its newly-created Director of Innovation post. This reflects the charity s strategic ambition to becoming the UK s leading health and social care charity by 2017. Martin joins the organisation s Executive Team, helping to shape and develop the charity s plans for transformation. AGINCARE Agincare, in conjunction with Dementia UK, have appointed Agincare s Jo Palmer as the UK s first Consultant Admiral Nurse to help raise standards of care for high dependency dementia care and clinical nursing care across the organisation. COLTEN CARE S NEW HR DIRECTOR Colten Care has appointed a new Director of Human Resources and Learning and Development. Andrew Arkinstall joins from FitzRoy, where he has been HR Director since 2006.

8 ¦ CMM SEPTEMBER 2014

NEWS • Planning • Local authority • Corporate News editor - Des Kelly Changes in the care home population The Office of National Statistics has released its analysis of changes in the older resident population between 2001 and 2011. This analysis focused on the changes in the over 65 resident care home population of England and Wales. This group represented 82.5% of the care home population in 2011. According to Changes in the Older Resident Care Home Population between 2001 and 2011: The care home resident

population for those aged 65 and over has remained almost unchanged since 2001 with an increase of only 0.3%, despite growth of 11.0% in the overall population at this age. Fewer women but more men aged 65 and over, were residents in care homes in 2011 compared to 2001; the population of women fell by around 9,000 (-4.2%) while the population of men increased by around 10,000 (15.2%).

The gender gap in the older resident care home population has, therefore, narrowed since 2001. In 2011, there were around 2.8 women for each man aged 65 and over compared to a ratio of 3.3 women for each man in 2001. The residential care home population is ageing: in 2011, people aged 85 and over represented 59.2% of the older care home population compared to 56.5% in 2001.

Care home market remains ‘fragile’ A new report from the Institute of Public Care (IPC) shows that significant problems continue for the care home market - three years on from the collapse of Southern Cross. In the wake of the demise of Southern Cross in 2011, and following the development of the Market Oversight regime in the Care Act, the Care Quality Commission (CQC) has published a major IPC report which reviews the state of the care market in England. IPC, which is part of Oxford Brookes University, found that recruiting a trained and well-paid

workforce is likely to be a major issue for the future, and that the older persons’ care market continues to be fragile. The report notes that ‘very few of the providers and financial advisers we interviewed ruled out the possibility of another Southern Cross style crisis.’ Debt, and the management of debt, remains a critical issue for a number of the larger care providers. Equally, a rise in property values alongside demands of regulation and lower levels of local authority funding may persuade some smaller care

home providers to cash in their assets and leave the market. Finally, the Care Act itself whilst welcomed by most providers, still creates a level of uncertainty in the market particularly between those who self-fund their care and those in receipt of state-funded care. The report suggests that the most likely characteristics of provider failure is that of a large care home provider which does not own the properties in which it operates, and where it has a concentration of homes in a limited number of authorities in less affluent areas.

CQC round up Care Quality Commission (CQC) has made a number of recent announcements. Firstly it published its Annual Report and accounts. In its 2013/14 business year, it appointed Chief Inspector of Adult Social Care, Andrea Sutcliffe and began to rate services on a four point scale of Outstanding, Good,

Requires Improvement, and Inadequate. CQC will begin to rate adult social care from October. Most of CQC’s inspections (68%) were of care homes and other adult social care services, as this is the largest sector that CQC regulates. The CQC also announced

it will work together with the adult social care sector to put together a new regime that will tackle failing care through special measures from April 2015. It is also consulting on how providers can meet new ‘fundamental standards’ of care. In Focus on page 11 explains this in more detail.

news

Grey Pride Manifesto Older people have backed calls for better representation as a new report reveals the devastating impact of failure to address demographic change. Neglect, loneliness and inadequate care funding are just some of the reasons why Anchor is issuing a rallying call to transform the way services are planned and designed for older people. The case for change is set out in its Grey Pride Manifesto, which supports growing calls for a Minister for Older People. Findings show 77% of over65s agree that one individual in the Cabinet should be dedicated to the needs of older people. 62% of 18 to 34 year olds also agree. The research commissioned by Anchor shows that young people and over-55s agree social care funding and adequate care for older patients in the NHS are the main concerns for later life.

The current situation, outlined in Anchor’s manifesto, suggests why social care funding has been cut by over a quarter in the past four years while nurse to patient ratios in hospitals are lower for older people. These issues would be tackled more effectively by one individual in Government having responsibility for ensuring we are better prepared for our ageing society. At the same time, an Older People’s Commissioner should be appointed to investigate issues and hold Government to account. The appointment of a commissioner was backed by 73% of over-65s. Such a role is already in place in Wales and Northern Ireland. Some of these issues outlined in Anchor’s manifesto include: • Institutional ageism in health Older people’s hospital wards regularly have one nurse for

APPOINTMENTS APPOINTMENTS 10.3 patients on average, well below Royal College of Nursing recommendations for safe care. • Lack of appropriate retirement housing - 58% of over 60s who want to move say they can’t because of a lack of retirement properties. • Care in crisis - Over the past four years, social care budgets have been cut by 26% despite a 14% increase in demand for support. • The dysfunctional relationship between health, social care and housing - In 2012-13, patients spent 833,000 days longer in hospital than necessary because of delayed transfers. • Retirement, older workers and the workplace - Ageism in the workplace if widespread - 41% of young people say there are not enough jobs for older people to be in work.

DoLS in supported living The Law Commission, independent law reform adviser to the Government, has announced that it will review the law with a view to extending Deprivation of Liberty Safeguards (DoLS) to people receiving care in supported living arrangements or, potentially, in other settings. The existing rules protect people in hospitals and care homes, however people receiving treatment outside of these settings are not protected by DoLS. The Law Commissions review will consider how

deprivation of liberty should be authorised and supervised in other settings where the human rights of vulnerable people might be infringed. The aim of the project will be to create a new legal framework that protects individuals’ rights and is clear and straightforward to use. The Commission will also consider what the implications of this work are for DoLS. Nicholas Paines QC, Law Commissioner for public law, said, ‘The law in this area is highly problematic and leaves vulnerable people at risk. People

who live in supported living arrangements have limited protection in situations where they need to be provided with care and treatment which is in their best interests but do not have the capacity to consent. ‘Our review will extend the protection available to vulnerable people, while making the rules clearer and easier to apply. We also intend to provide the Government with insight in order to improve existing safeguards under the Deprivation of Liberty Safeguards.’

Councils face £5.8bn funding crisis Local authorities will need to make huge savings before next April, equivalent to 12.5% of their total budgets. The Local Government Association said the figures provide a stark warning that the successful integration of health and social care next year is vital to save the care system from collapsing. The £5.8bn shortfall

in council budgets will be caused by a combination of reduced government funding and rising demand on services, in particular from growing numbers of elderly people. The funding gap in adult social care alone already amounts to £1.9bn by 2015/16 – based on council adult social care budgets in 2013/14. April 2015

will mark a critical point for adult social care in England with the pooling of £5.4bn from councils and the health service. The scale of savings which need to be found next year illustrate the urgent need for the Better Care Fund to quickly succeed in radically improving the way public money is spent to support elderly people.

GLEN CARE APPOINTS OPERATIONS DIRECTOR Qualified nurse, Clare Armstrong joins Glen Care as Operations Director. Her focus will be on supporting hospital directors and service managers to maintain high quality care and ensure that all services achieve and exceed the standards demanded by the Care Quality Commission. EASTGATE CARE Sharon Green is Eastgate Care s new Compliance Manager providing support to home managers to drive assessment procedures and assure full compliance. COVERAGE CARE SERVICES Coverage Care Services has appointed Stan Meiklem as HR manager to look after the needs of its almost 1000-strong workforce. CZAJKA APPOINTMENT Janet Wood has been appointed as Financial Controller at Bradford-based Czajka Care Group. Janet is responsible for producing Czajka s management accounts and overseeing the company s finance team. RADIAN SUPPORT Bridget Phelps has been appointed Chair of Radian Support, the adult care and support arm of Radian. Bridget joined the Radian Support board on 1st August 2014 and will assume the role of Chair from 1st September 2014 when the current Chair Richard Barritt steps down. LGA APPOINTS NEW TEASC DIRECTOR The Local Government Association, with the support of the Association of Directors of Adult Social Services, has appointed Sarah Mitchell as director of the Towards Excellence in Adult Social Care (TEASC) improvement programme. THE FREMANTLE TRUST The Fremantle Trust has appointed Steve Flanagan as Chief Executive. He joins in September. Steve has held senior positions at British Airways and Bupa.

CMM SEPTEMBER 2014 ¦ 9

8'!ŕŚ§=' & -223=!ŕŚ§=' ways to achieve excellence

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Social care ‘unsustainable’ Adult social care services in England will soon be ‘unsustainable’ if current budgetary pressures continue, and significant measures are not taken to inject new money into local social care economies. This is the message of Association of Directors of Adult Social Services (ADASS) annual budget survey. Based on returns from 95% of adult social services departments, it shows that despite the ‘very welcome help adult social care has received from central Government, and the faith and finance that local councillors have invested in us as well’ the cash invested in services will reduce by a further 1.9% in 2014/15: a sum equivalent to £266 million. ADASS President David Pearson said, ‘This is

the third year of continuing cash reductions and the fifth year of real terms reductions in spending.’ The survey also shows that directors feel gloomy about the future, with the pace of adult social care savings projected to continue at an accelerated trajectory for 2015/16. This will create further significant instability at the crucial time when the Care Act reforms and the Better Care Fund plans are due to be implemented. Nearly 50% think that fewer people will be able to access care services; an equal number believe that people will get smaller personal budgets; over a half think care providers are facing financial difficulty, and nearly 60% think there will be increased costly legal challenges.

Social care activity figures Among adults who receive social services, 44% say that they have as much social contact as they want with people they like. The figures are part of a collection of statistics on social care in England in three provisional reports published by the Health and Social Care Information Centre (HSCIC). This is the first year that a measure on social contact for adult users of social care and carers has been included in the Adult Social Care Outcomes Framework (ASCOF). ASCOF is a set of indicators defined by the Department of Health to benchmark the performance of local councils on their delivery of adult social care. Alongside the provisional ASCOF data, the HSCIC has released data on social care activity (including details of the numbers of adults being assessed

for and receiving social services) and the results of an annual survey assessing how far users of social services are satisfied with the support they receive. Key 2013-14 statistics from the three reports include: • Among adults receiving social services, 44% said they had as much social contact as they wanted with people they like, for 34% the amount of social contact was adequate, 16% had some but not enough, and 6% felt socially isolated. • The percentage of people using social care who receive selfdirected support increased to 62% in 2013-14, from 56% in 2012-13, 43% in 2011-12 and 29% in 2010-11. • The number of people receiving social services in 2013-14 was 1,267,000, down 5% on 2012-13 (1,328,000).

A Better Life Two new films from the Social Care Institute for Excellence highlight what makes a better life for older people with high support needs. Based on the findings of

the Joseph Rowntree Foundation’s A Better Life programme, the films explore what makes a difference both in the community and in residential care settings.

IN FOCUS CQC consults on guidance to help services meet new regulations WHAT’S THE STORY? On 25th July the Care Quality Commission (CQC) launched its consultation on proposed guidance for providers on meeting the new health and social care regulations and the proposed guidance on how it will use its enforcement powers.

WHAT DOES THE CONSULTATION COVER? New regulations setting out fundamental standards of quality and safety were laid before Parliament as part of the new Care Act. The regulations also introduce a new ‘duty of candour’ and a ‘fit and proper person’ requirement for directors, which will enable greater accountability of directors.

WHEN WILL THEY BECOME EFFECTIVE? The ‘duty of candour’ and the ‘fit and proper person’ requirement will come into force for NHS bodies in October 2014 (NHS bodies means NHS trusts, NHS foundation trusts and special health authorities) at the same time as the new ratings system starts for all registered adult social care providers. The full regulations (including the fit and proper person requirement and duty of candour) come into force for all health and social care services in April 2015.

WHAT HAPPENS NEXT?

The consultation sets out the proposed guidance for health and social care providers on meeting the requirements of AND? the new regulations. It will lead to the complete These are significant changes which enable the CQC to move replacement, from April 2015, of CQC’s current Guidance to the next stage of developing and Enforcement policy. the way it regulates health and The consultation will run social care services. It needs until Friday 17th October. A to be seen in the context of major developments which will link to the consultation can be change the inspection processes found on the CQC’s website. and introduce a new quality www.cqc.org.uk ratings system.

Manager’s Handbook The National Skills Academy for Social Care has published a practical guide for Registered Managers and other leaders in social care services. It brings together everything the Registered Manager needs to know to deliver good quality care and support services complete with handy summaries and references to other sources of information.

The Handbook is divided into eleven sections with up to date and relevant information, and is mapped to Care Quality Commission regulations, the Leadership Qualities Framework, current legislation and the Manager Induction Standards. It is designed to be the ‘go to’ guide for Registered Managers (and other service leaders). CMM SEPTEMBER 2014 ¦ 11

news

New LD steering group Sir Stephen Bubb, Head of the charity chief executives body Acevo, has been appointed by NHS England to chair a steering group to develop a new national guide on care for people with learning disabilities. Sir Bubb will lead a group to develop funding models for new services, identifying potential sources of social investment and creating models for local implementation to meet the needs of people with

learning disabilities and autism. The steering group will include the chief executives of charities working in these areas, including Jan Tregelles of Mencap, Robert Longley-Cook of HFT, Mark Lever of the National Autistic Society and Su Sayer of United Response. The announcement has been criticised by user and family groups who were not consulted on the initiative and not initially involved in it.

Quality barometer for new CQC ratings 360 forward has released a new survey to help providers measure the quality of their service and prepare them to become outstanding in the new CQC ratings. Surveys are designed to measure outcomes, based on what matters most to people living, working and visiting a care home, telling providers what people really think. The survey gathers views of residents, visiting relatives, staff and managers on a number of key aspects of living in, working in and visiting the care home. The surveys ask the same questions of

each group and give the service a triangulated set of results discussing areas for improvement and areas where high quality care is being delivered. The results will provide a traffic light indication of the areas for improvement to focus on, with easy-to-follow instructions and a ‘road map’. This will help providers to get started actively involving residents, relatives and staff in a continuous quality improvement programme including planning, implementation and on-going management and monitoring.

Health and safety in care homes HSE has launched the revised second edition of Health and safety in care homes (HSG220). This guidance is intended to help those providing and managing care homes – to give them a better understanding of the real risks and how to manage them effectively. It has a number of new topics, and brings together key messages on risks to both workers and residents. It will also be of interest to others working in social care. At the time of publication, HSE and local authorities investigate serious worker and

resident incidents. Under the Enforcing Authority Regulations, HSE regulates homes with nursing and local authority owned or run care homes. Other homes are regulated by local authorities. It is anticipated, however, that the Care Quality Commission (CQC) in England will soon become the lead investigator of incidents where residents have been harmed because of unsafe or poor quality care. These, and any other changes in regulation across Great Britain, will be reflected in future editions.

John Adams leaves VODG John Adams OBE steps down as VODG General Secretary at the 12 ¦ CMM SEPTEMBER 2014

end of August after more than 10 years in the role.

Free social care at the end of life Commissioned by leading charities, How could free social care at the end of life work in practice? is written by OPM and commissioned by Macmillan Cancer Support, the Motor Neurone Disease Association and Sue Ryder. It shows the success of integrated health and social care services in some areas and recommends further roll-out. It highlights examples of joined-up working between health and social care services, such as STARS Care Liverpool, and makes the case for extending this nationwide. The report notes an absence of national guidance on

implementation and a lack of understanding on how the current system operates, which leads to restricted choice for people at the end of life. The charities are urging health and social care commissioners to adopt the recommendations in the report, which include: improving access to high quality free social care services for people at the end of life and collaborating with local partners to deliver integrated health and social care services. The coalition calls on the Government to make non-means tested, personal care available to everyone at the end of life.

New eligibility criteria in Wales A new national eligibility criteria for social care in Wales will replace the current system where people receive services only when they cross a threshold, rather than when they cannot meet their own needs, Deputy Minister for Social Services Gwenda Thomas has announced. The new system will be introduced as part of the biggest overhaul of social care legislation in Wales for 60 years when a new law comes into force in 2016. It means people will become eligible for social care when they cannot meet their own well-being needs without a care and support plan. The Deputy Minister said that well-being is everyone’s right and everyone’s responsibility. The Social Services and Well-being

(Wales) Act 2014 will require the promotion of well-being and new arrangements for assessment and eligibility when it is implemented in April 2016. The Deputy Minister also published the national outcomes framework, which will support the delivery of person centred care and support and set the foundation for the eligibility model. The new national eligibility criteria for social care will replace the current criteria based on definitions of ‘low’, ‘moderate’, ‘significant’ and ‘critical’ levels. The new model will base decisions on a discussion about ‘what matters’ and what the person wants to be able to do in life and whether they need managed care and support to achieve this.

Castleoak welcomes Greensleeves Castleoak has announced the development of a £5.3m care home for new customer Greensleeves Homes Trust in Norfolk. The new 60-bed care home is a Castleoak development project with funding

provided by the CarePlaces Fund – a partnership between Castleoak and Bridges Ventures. A 35-year lease agreement has been reached with Greensleeves Homes Trust and construction is now underway.

West Yorkshire development A former West Yorkshire pub has been transformed into a luxury care home, creating 100 jobs. Crown Care’s 85-bed home, called Holyrood House, in

Wakefield is due to open in August. It will be the company’s eighth home in Yorkshire having opened Osborne House in Selby last December.

local authority and planning news

Abbeyfield v Newcastle A High Court Judgement has been passed down which will have profound implications for the funding of care home residents throughout the UK. Abbeyfield Society’s Newcastle branch took Newcastle City Council to court for not paying a fair rate for the care provided to older people at two of Abbeyfield’s care homes in the City (Gosforth House and the Grove). Abbeyfield is claiming victory in what it believes is the first judgement of its kind where a court has been prepared to fix a reasonable rate for care rather than tell a

local authority to go away and fix a lawful rate. ‘We were forced to take a stand because Newcastle wasn’t paying a fair rate for the care we were providing’, said John Kilner, Chairman of the Abbeyfield Newcastle Society. ‘We are very relieved and pleased at the High Court ruling. Other care home providers up and down the country will be looking to this Judgement to ensure that they too can continue to provide the quality of care that elderly people deserve, regardless of their financial circumstances.’

Craegmoor in Lincolnshire Craegmoor has invested £150,000 to create a new residential facility in Lincolnshire to support people with mental health conditions including personality disorders. Middlegate Lodge, which is close to Caistor and is set in

extensive grounds, will provide high quality accommodation for service users who no longer need hospital care. Middlegate Lodge has five bedrooms and one studio apartment. The new service will create up to 10 new jobs.

Oxfordshire Sanctuary Home Care care home’s dementia wing secures Westgate House run by Devon the Orders of St John Care Trust has unveiled its newlycontract refurbished dementia wing. The £150,000 project, mostly funded by a Department of Health grant secured by Oxfordshire County Council (OCC), began during late 2013 and has resulted in major upgrades to the home’s 20-bed dementia household, in addition to the creation of a themed destination area within the heart of the home. Nearly £119,000 of the renovation cost was funded through OCC’s Oxfordshire Dignity Plus Programme – a joint bid for Department of Health funding that aims to improve the lives of people living with dementia by enhancing the environments within care homes, community hospitals and the acute sector.

National provider Sanctuary Home Care has secured a contract with Devon County Council to deliver its services to people with care needs. The organisation will be delivering up to 400 hours a week of homecare services to people across the Dartmouth area of the South Hams district over the course of the following year. Dartmouth’s location, in the south-east area of the district, means a number of clients live in rural, and traditionally more isolated, locations. The one-year contract will see Sanctuary Home Care expand its presence in Devon from its closest branch in Torbay.

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local authority and planning news

Local authority fee uplifts Analysis of elderly residential care fees carried out by specialist healthcare property advisers HPC indicates an average uplift of 1.7%. Whilst a number of councils have yet to complete the consultation process, this level of uplift at least seeks to give parity with rising costs. Having fallen significantly behind the Consumer Prices Index (CPI) over recent years, this average review level is broadly in line with the April 2014 CPI of 1.8%. Unfortunately, what the uplift fails to reflect is the forthcoming 3% uplift in National Minimum Wage (October 2014) coupled with a rising pension

liability for many operators. The research, carried out by HPC, is detailed in full on the consultant’s website. It involved enquiry of all 152 English local authorities with responsibility for elderly care provision/placement and, with only a handful of local authorities failing to respond, the analysis reflects the fees set across 124 of the local authority areas. Councils not reflected in the survey results include those currently out to consultation, those negotiating each fee on an individual basis and a limited number of local authorities who review annually in the autumn.

Construction in Canterbury Sanctuary Group has begun work on a new state-of-the art care home in Canterbury. Sanctuary is developing the 60-bedroom care home in Hersden in a £6 million project due for completion in the summer of 2015. The new home will be built by Sanctuary’s construction partner Castleoak

and will offer high quality care for older people. It will also include a range of communal facilities to enhance the quality of life of future residents, with shared lounges and dining areas, a garden room and terrace on the first floor as well as landscaped gardens.

McCarthy & Stone McCarthy & Stone has announced 31 planning consents in the five months from January to May 2014. The new consents will deliver a total of 1,102 units with a forward sales value of £250 million and set a record for the company since it built its first retirement development in 1977. The latest consents include sites in Chichester, Walton-onThames, Kidlington, Drayton, Letchworth, Wendover,

Upminster and Old Stevenage for the company’s South East region, Romsey, Bridgewater and Tetbury in the South West and Walsall, Dorridge and Cromer in the Midlands. In the North, new consents include Morecambe, Hexham, Harrogate and Gosforth, and Bishopbriggs, North Berwick and Paisley in Scotland. For the South-East region, one week saw seven new planning consents alone.

Windsor retirement village Construction is due to start on a new 130 home retirement village in Windsor by spring 2015. Castle Retirement Living will commence building work on the £30 million Castle View project early in 2015, with most of the funding now in place, the entire project could be completed in one phase within approximately 20 months. The development for those over 55, will comprise 58

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property news

Target Healthcare REIT acquisitions Target Healthcare REIT has acquired 10 care properties. The specialist investor has acquired three purpose-built care homes and four specialist care bungalows from Zest Investment Group for approximately £20.4m including acquisition costs. Located in Norfolk and Northern Ireland, each of the care homes offers a combination of residential, nursing and dementia care. One of the homes also provides specialist care for individuals with learning disabilities, autism and complex physical disabilities. The care homes will continue to be leased to the existing operator, Priory Group, for a period of up to 28 years. The transaction represents an initial yield in excess of 7% and the rents payable under the leases are subject to fixed annual rental uplifts. The selling agents on this transaction were Vector Property Group and Knight Frank. The investor has also acquired a new purposebuilt care home in Hinckley, Leicestershire. The home was acquired for approximately £6m including acquisition costs in

RBS’ recent funding

July 2014, when it was due to be completed and opened. The care home will be leased to Care Concern Group for a period of 35 years and the transaction represents an initial yield in excess of 7%. The rent payable under the lease is subject to an annual uplift in line with the retail prices index subject to a cap and collar. Finally, Target has acquired two purpose-built care homes Bromford Lane and Beechdale Manor in the Midlands, for approximately £14.3m including acquisition costs. Both properties are modern, purpose-built homes and were acquired under a sale and leaseback arrangement from Bondcare, who will continue to operate them. The care homes will continue to be leased to Bondcare for a period of approximately 21 years at Bromford Lane and 35 years at Beechdale Manor, and the transaction represents an initial yield in excess of 7%. The rent payable under the lease is subject to an annual uplift in line with the retail prices index subject to a cap and collar.

Berkley Care Group expands Christie + Co has sold a 0.67 acre site on behalf of clients Berkley Care Group. The site is in Ryefield Avenue, Hillingdon, West London, and planning consent has been granted for a purpose-built 58-bedroom care home. Berkley Care Group

acquired the site within nine weeks of making its initial offer, emerging victorious following a fiercely competitive sale process. Berkley Care Group currently operates four care homes. Albion Ventures LLP provided the funding for Berkley Care Group.

Carterwood wins award Carterwood recently won the ‘UK Property Consultancy Firm of the Year’ award from

global M&A magazine, ACQ. The award winners are chosen by ACQ’s readership.

Building Construction Partnership ltd Excellence In Construction

The construction and renovation of a new care home in Newcastle has reached the final stages of development with the completion of a funding deal from The Royal Bank of Scotland (RBS). Solehawk Limited has spent the last twelve months working on the project which has seen them demolish their existing care home, Ashton Court, to begin construction and redevelopment work on a larger capacity facility which is expected to cost in the region of £3m. It is hoped that the new property, which has been increased from a 30 to a 45 ensuite bedroom care home, will be ready for residents to move in to this October, creating 60 new jobs. RBS has agreed a fee free loan under the Government backed Funding for Lending Scheme (FLS), specifically designed to offer more support

to small and medium enterprises by making borrowing more affordable. Under the scheme, businesses can take advantage of loans with lower interest rates and no arrangement fees. Peterborough Care has opened a purpose-built 50-bed care home with funding from RBS. The bank provided a seven-figure funding package via the Governmentbacked FLS to support financially Peterborough Care’s latest investment. The Maltings nursing and elderly care home is located in a prestigious area of Peterborough just off Thorpe Road and has allowed for unrivalled facilities including spacious rooms – all with en-suite, a hairdressing salon, gymnasium, games room and a cinema room. In addition, 80 full and part time jobs will be created in the area to staff the new care home.

Buyer for The Meadows DC Care has found a purchaser for The Meadows Nursing Home, now called Highcroft Manor, in Northamptonshire after instructions

from the administrators Moorfields Corporate Recovery to find a purchaser. There was a high level of interest in the 30-bed home.

Bromson Hill sale Bromson Hill Nursing Home, a 34-bed care home in Warwickshire has been sold by Christie + Co, concluding a process which has seen ten care homes sold by the company on

behalf of Alpha Health Care Ltd. Bromson Hill is registered for nursing, residential and respite care although the majority of residents require nursing care.

Holyrood House in East Yorkshire sold DC Care has announced the sale of Holyrood House in Hedon. The home is the first of a series of sales due to complete on behalf of HICA. Holyrood House has been sold to Tony

Proudfoot, a local operator who is keen to expand his portfolio. The home was originally a residential property but was converted to a care home and extended some years ago.

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corporate news

Hazlewoods advises on Chosen Care sale Hazlewoods Corporate Finance has advised on the sale of Chosen Care Limited to Access Housing Limited. Chosen Care Limited is a residential home provider for individuals with physical and learning disabilities and also provides care at home in a supported living environment in Gloucestershire. Iqbal Ismail, a director of Access Housing Limited, said, ‘The deal has provided us with

a platform that will allow us to expand our provision of care services in Gloucestershire and the surrounding areas, which is an exciting prospect for us.’ The Hazlewoods team was led by John Lucas. The transaction was funded by private funding and Allied Irish Bank. Legal services were provided to the vendor by Graham Guthrie and the corporate team at Okells with Francis Law LLP.

Alina Homecare completes second acquisition Alina Homecare one of Bridges Ventures’ portfolio companies, has acquired a high quality homecare provider in the Midlands. This is Alina’s second deal and follows the acquisition of a Hertfordshire homecare provider Hertfordshire in May. Alina is continuing to invest in ‘greenfield’ branches and, in

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addition to the first branch that it opened on the South Coast in March, it is now opening a further two ‘greenfield’ branches in the region. Bridges announced its backing of Alina in May 2014 as the latest investment of the Bridges Sustainable Growth Fund III.

Clydesdale Bank backs Tracscare acquisition Clydesdale Bank has provided funding worth £16.75m, as part of a three bank senior debt package, to support the management buyout of specialist care provider Tracscare Group. The purchase of Tracscare by its management team was supported by panEuropean private equity firm

G Square and funded through Clydesdale Bank’s Acquisition Finance team and two other club partners. Tracscare provides specialist healthcare to a range of service users with learning disabilities, acquired brain injuries, mental health or autistic spectrum disorders.

Albion Ventures invests £16m in new care homes Funds managed by venture capital investors Albion Ventures have committed up to £16m for the development of two purpose-built residential care homes for the elderly. The new facilities will be located in Cumnor Hill, Oxford and Hillingdon, Greater London and will cater for a total of 130 elderly residents, providing hotel style accommodation including a bistro, private

dining room, library and spa. Construction on both facilities will start in September 2014 and they will be open to residents in the autumn of 2015. Berkley Care Group will operate the two new facilities. Albion and Berkley have already established a successful partnership through owning and operating Bayfield Court, a 46-bed facility in Chingford.

corporate news

Mencap charity bond to be listed The first charity bond to be listed on the London Stock Exchange’s Order Book for Retail Bonds will buy houses for people with a learning disability and allow investors to help create the accommodation needed by people with a learning disability. The proceeds of the bond will enable learning disability charity Mencap’s housing arm, Golden Lane Housing (GLH), to invest in buying and adapting much-

needed housing for people with a learning disability in their local communities. These community-based houses and bungalows will provide a lasting legacy for future generations of people with a learning disability. The bond has been launched via Retail Charity Bonds Plc, an independent non-profit special purpose vehicle. Retail Charity Bonds Plc is an initiative of Allia, a community benefit society with exempt charity status, and

established in association with Canaccord Genuity. The 2014 Retail Charity Bond follows on from GLH’s previous £10m corporate bond issue which closed in July 2013, which has now been invested in buying and adapting 27 high quality houses and bungalows in community settings across the country which have become home to 99 tenants with a learning disability.

Care UK’s new First Evermore development East Lancashire will be home to the attractive property with support £7.5m home Care UK has begun construction of a new £7.5m care in Norfolk. Upon completion the new 80-bed home is set to create 100 jobs. The home is set to open in summer 2015 and will offer residential, nursing and specialist dementia care, as well as palliative, respite and end of life care.

first Evermore village development. The village is being developed by Pendle Enterprise and Regeneration Limited (PEARL), a joint venture development company between Barnfield Investment Properties and Pendle Borough Council, on behalf of Evermore Wellbeing Limited. The Evermore housing and lifestyle approach combines

services to help older people retain independence and control. Founded by Sara McKee, it will radically change the housing choices available for people in later life and tackle social isolation among older people living alone. The village in Brierfield will feature a five storey building with 60 one-bed, self-contained apartments for sale. Each

Agincare’s growth Agincare has opened its new headquarters in Portland after it has shown sustained growth, with over £25m of new local authority contracts awarded across the country in the first quarter of 2014. To cope with this growth, it has consolidated head office functions. The move will bring 75 staff to the newly refurbished building, which has now had significant investment of well over £1m.

apartment will have a doublebedroom and en-suite, living room, kitchenette and balcony. The apartments will be clustered into households of 12 with each household sharing communal living area and hearth including an open-plan kitchen and large dining table. It is expected that construction will begin in autumn 2014 with sales commencing in spring 2015.

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CLOUDS YESTERDAY, SUNSHINE TOMORROW? Amanda Nurse tries to make sense of some confusing economic signals and asks what all this might mean for the sector.

It may not be much of a revelation but I’d like to start with a small confession. Amid the hurly burly of everyday activity, I occasionally permit myself something of a flight of fancy. I imagine myself, twenty years from now, sitting on a beach sipping a bitter lemon as I don’t drink alcohol, and looking back at what I hope I will be able to regard as having been a successful career. There’s one thing about the exercise that I’m sure about, even now; I will always be grateful that we started our business just in time to coincide with the worst recession since the 1920s. I believe there’s no better environment for learning what really matters, and for keeping you absolutely focused on business fundamentals – client service, cash management and good planning. It’s all too easy, in dynamic and positive economic periods, for new businesses to gain a false impression of why they may be doing well. The inevitable tendency being

that they are all too ready to ascribe their successes to their own capabilities rather than to the prevailing strength of the economy. Such self-delusion can have dire consequences when the conditions change. While it can’t be described as fun, starting a business in difficult times has the advantage of not building any false impressions. I’m as happy as anyone that the economic data seems to be improving, unemployment is down, output is up and credit is starting to flow again. Of course, we have the London housing bubble to contend with and uncertainty over interest rates, but all in all there does seem to be some more confidence. That said, there is a school of thought that sees the recovery as fragile, with the deficit still a dark cloud sitting over the economy. What sense can we make of all this as far as the care sector is concerned? The honest response to that rhetorical question is that there is no short, simple or

clear answer. As ever, changing conditions present opportunities for some, threats for others and question marks for all of us.

RECENT MARKET ACTIVITY We should take a look at what’s been happening in the sector in recent months. For starters, we’ve seen the entry of the American Real Estate Investment Trusts (REITs), who have made some significant investments. Deals have been done, amongst others, with Caring Homes, Avery Healthcare and Sunrise Senior Living. The REITs may have restricted their interest to the elderly care sector, rather than to specialist care, but we think that their entry will have a ripple effect because their intervention has the impact of reducing the volume of high quality stock available for those seeking acquisitions. As opportunities for acquirers reduce, the natural impetus towards new development as a means of driving growth is obvious. However, this

CMM SEPTEMBER 2014 ¦ 21

clouds yesterday, sunshine tomorrow?

comes with its own complications. The land market has moved significantly and the renewed confidence within the residential property sector means that the national housebuilders are, if you’ll pardon the pun, dominating the landscape. The net result is that land prices have risen significantly and this alone has a major impact on the financial feasibility of new build schemes for care operators and developers alike. Add into this particular equation a recovering construction sector which, after having been one of the most badly affected sectors of the past few years, is desperate to recover lost ground and to rebuild itself. As contract opportunities increase, confidence grows and build prices rise. It’s the unholiest of trinities. I can’t point to empirical data to substantiate my point, but anecdotal evidence confirms it. I’ve been talking to contractors who are turning down work, who are only prepared to negotiate contracts and are steadfastly refusing to tender. How different from just eighteen months ago. If limited stock, rising land and construction prices are bad news, something of a counterbalance can be found in the fact that there has been a reduction

in the number of care homes falling into receivership. This is less to do with any improvement in trading and more about the quality of those operations left in the market after the ravages of the past few years. Many of the businesses that went to the wall did so largely because of their financial situation. They were overborrowed and would probably have been vulnerable to any negative change in trading conditions – not just a severe recession. Those remaining are characterised by much lower borrowings and by a commitment to the delivery of very high quality care. Those owners or operators who might have considered a sale in the recent past, for reasons of age or expediency, are now recognising that they can achieve positive returns and are considering alternative means of exit – via good succession planning, for example.

CURRENT MARKET TRENDS Looking over the site feasibility studies for proposed elderly care homes that we’ve completed in the last three years [Figure 1], it is interesting to see how the emphasis of operators and developers has changed over

Percentage distribution of Carterwood client work by region 2010 and 2013

that period. In 2010, there was a clear focus towards the South East of England, and this area still remains a focal point for many operators. However, areas such as East Anglia and central London are now seeing increased interest. The majority of interest in central London has arisen from increased attention from overseas investors, who have better financial resources and who are less concerned by the price of land in this area. East Anglia has historically suffered from poor quality provision even though there are some excellent pockets of wealth in counties such as Cambridgeshire. There are also other pockets of improved activity, such as Sutton Coldfield, north of Birmingham, which have seen increased interest over the period. As anticipated, the focus of care home development broadly follows the wealth profile of the country. This is not surprising as the majority of operators remain focused upon the private fee paying market. Site values are increasing, with a growing number of sites transacting at over £50,000 per bedspace and this figure can be much higher in central London. Land values outside the M25 vary much more, ranging from £15,000 to £35,000 per bedspace. Fees, of course, remain a sticking point and this is one issue that’s not going to go away any time soon. The conundrum for those delivering in the state-funded sector is how to balance fees that are controlled by the continuing austerity programme, with the demand from residents and relatives for improved facilities in order to keep pace with what’s on offer for private payers.

WHAT DOES THE FUTURE HOLD?

Fig. 1

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Based on the work we have carried out, we remain convinced that organisations will become increasingly focused on

local demographics. If you draw parallels with the hotel sector, no developer would seriously acquire land believing they could create an opportunity that would suit Hilton or Premier Inn. Yes, both brands deliver overnight accommodation for paying guests but that’s where the similarity in their offering ends. They have different business models and different target audiences. The same is true in the care sector. Detailed demographics provide the business case and give clear answers about the levels and the nature of demand. It sounds utterly obvious, and it is, but knowing the market is everything. There will also be a focus on closer relationships with the health sector which will be driven by operators. The need for greater cohesion and integration between health and social care has long been a call made by operators, clinicians, relatives and politicians alike. It has been a slow train coming but to some extent it is now on the tracks and we are seeing care operators deliver services for increasingly high needs. Change is there to be embraced and maintaining the current status quo for all of us working in the care sector is not really an option. The economy may be showing signs of recovery, the sector might be wrestling with the need to resolve the long-term funding question and to achieve clarity about the services needed, but change is inevitable. One thing that won’t change, however, is the extent of the demand and the challenge it presents to everyone connected with the sector. Somehow that bitter lemon on the beach still feels like it might be a little way off. CMM

Amanda Nurse is Founding Director of Carterwood. Email: amanda.nurse@ carterwood.co.uk

CMM SEPTEMBER 2014 ¦ 23

business clinic

NOTTINGHAM S MINIMUM CORE PRICE FOR CARE Nottingham City Council has reviewed its pricing for residential and nursing care in the city. This has seen it move from a banded system for residential and nursing care to a minimum core price for all services. Is this the future for local authorities paying for care services? The pressures on social care budgets are immense, against a backdrop of austerity, changes to eligibility and paying for care as set out in the Care Act, there is a real need for local authorities to look at budgets, costs and the services they commission. In light of this, Nottingham City Council has implemented a minimum core price for residential and nursing care in the city. Its aim was to move towards a fair price for care whilst ensuring that the council was aware of the actual cost of care that it commissioned, considered this cost when setting its pricing structures and managing the budget implications of moving to a fair price for care. The council stated that the process was expected to, ‘ensure that Nottingham City citizens can receive the best quality of care from the council and provide resilience in the number of providers available within the city.’

Of course, all local authorities need to be paying a fair price for care, one that meets the budgetary constraints whilst ensuring that those people it is obligated to support receive a quality service.

THE PROCESS The council commissioned a Fair Price for Care review by Valuing Care Financial Management (VCFM) which included a ‘sample costing exercise of placements in a cross-section of services and analysis with reference to a national comparator database of rates’. It also engaged with local providers. The report’s findings suggested a reasonable minimum price for care services in the city. The figure of £494 was concluded as ‘an indicative fair price for a core package of care in any service.’ This was, ‘based on the “Value for Money Rate” cited in the

VCFM report for residential care for older people with dementia which “represents a reasonable mid-point (between standard residential and nursing dementia services), on which to base a generic fee”.’ Many details of the research and proposals aren’t open to the public, however the council is, ‘moving towards a proposed minimum “core” price over a planned period. It is proposed to implement the transition to the indicative “fair price” through a staged approach in order to manage the financial impact to the council and allow a number of years to identify funding options to cover increase costs.’ The transition will take place over a four year period, which started in April 2014.

INCREMENTAL CHANGES As of April 2014, the council is paying a core

Interesting to see how operators respond

Seems neither wise nor ethical

John Roddy Consultant Shakespeares

Alan Pearce Chairman Nottinghamshire Care Association

Increasing the minimum fee by the highest percentages for lower band operators, may sustain supply which could otherwise have ceased due to the viability issues of existing low fee levels. This could provide resilience in the number of providers available within the City . However, paying more for services currently in the lower quality banded homes will need to be accompanied by the robust improvement programme promised. High fees don t always produce high quality care, this relies on owners, managers and staff. Higher fees only assist with improved standards if deployed effectively. Operators who don t improve quality will presumably go out of business and supply will be reduced. It will be interesting to see how operators respond to receiving no differential fee for providing nursing and/or dementia care. The Funded Nursing Care payment of £110.89, really only covers a modest amount of nursing time. Other additional costs i.e. specialist beds

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and mattresses aren t covered and now won t be by the council. Good quality dementia care requires a recommended staffing ratio of 1:4, 1:1 at times; environmental adaption may be required, extra night staff and resources for regular purposeful activity, plus the cost of dementia care mapping. By offering no extra payments, there is a risk that operators will turn away more complex residents in favour those with lower level needs. Then who will care for those with higher needs? Will they block hospital beds? How does this all fit with person-centred care? Whether it improves quality depends: on the current lower band homes achieving the robust improvement programme required; higher band operators delivering a higher standard of care than the minimum without additional reward. Location may also influence because if the catchment has a low affluence level, there will be less opportunity to benefit from delivering a higher quality service than is required.

I do not believe this is sustainable although in the short-term we might expect previous Band 1 and Band 2 city homes to improve quality of service as they have financially benefited by the implementation of the minimum core price, however in my opinion there will be a levelling off of said improvements up to the minimum standards required and as such overall quality across the previous Bands will inevitably reduce quality over time. One core price seems neither wise nor ethical. It is clear that actual cost of high needs dementia care and nursing care is much more than the imposed core price even when taking into consideration the £15.30 differential for the higher banded nursing homes, there is certainly an equality issue to be addressed. I feel it may well lead to a two-tier system with those who can afford to pay for the high quality privately and those who cannot. Nottingham City Council clearly

believes that its one-price-fits-all approach will enable the lower banded homes to improve their quality far more quickly than if they continue to be funded at the lower rate. However, the financial incentive to improve quality through a banding system in the county of Nottinghamshire has proved highly successful, year on year there has been a steady rise in homes achieving the higher quality band awards. We are concerned that without the smart goals defined for providers in the quality audit guidance, providers will no longer have a focus around what changes need to be made to improve overall quality in their care settings. Equally, it may well be the case that the quality achieved by the higher banded homes will at best be maintained rather than improved as again the focus on improving quality is being removed and replaced with the ethos that everyone should expect homes to meet minimum quality standards .

business clinic

minimum price for services across the city, irrespective of the price the service charged in 2013/14. This means that, ‘A higher percentage increase is allocated to lower cost placements than those already paid at a higher level, based on the rationale that the lower cost services are currently furthest from the indicative minimum “core” price and therefore need to increase at a faster rate.’ The council is, as a result, removing its previously held banding based on quality as it expects all services to meet minimum quality standards. The council says that moving to a single fee, ‘is based on the principle that a minimum price based on the actual cost of service provision should be paid equally for all services. All services will be expected to deliver to the required minimum quality standards and this will be managed robustly through a consistent contract compliance process, with sanctions applied for poor performance. This approach is expected to ensure that Nottingham City citizens can receive the best quality of care from the council and provide resilience in the number of providers available within the city.’ Specifically, the proposals see fees for residential and nursing care in the city set at £441.66 across the board in 2014/15,

rising incrementally to the minimum core price of £494.00 in 2017/18. According to the previous banding systems this sees large increases for lower banded homes and smaller increases for those which received higher fees. In residential care, there was a rise from 2013/14 rates of £396.36 for Band 1 (the lowest band). For Band 5 (the highest band), this remains at the 2013/14 rate of £441.66 in 2014/15. For nursing care, the Band 1 home saw the rate rise from £417.90, whereas Band 4 (highest band) homes have reportedly had their rate held at £456.96. Fees were implemented from 1st April 2014 with a proposal to review inflation on an annual basis.

care providers to ‘aspire to the highest standards of care…to earn higher fee levels.’ The consultation response goes on to argue that, ‘a flat rate one-size-fits-all approach actually rewards poor practice at the expense of homes who deliver the highest standards of care.’ It calls this ‘a race to the bottom’. It also raises concerns about extra costs incurred by caring for those with dementia, those requiring nursing care, whether the fee excludes the NHS Funded Nursing Care contribution. It also felt that the market could be destabilised and, ‘put dementia and nursing residents at risk of falling standards of care and/or the loss of their homes…if a home is no longer viable and forced to close.’ CMM

PROVIDER RESPONSE The council consulted on the changes which yielded a response rate of 22.5 per cent, however, the Nottinghamshire Care Association, which represents a large proportion of providers in the region, set out a detailed reply. It feels that, ‘the current and proposed fee levels… are substantially below the actual cost.’ It is also ‘dismayed’ that the council has removed the five bands which incentivises

Over to the experts... There is no doubt that local authorities need to innovate to meet their obligations within limited ﬁnancial resources whilst still paying a fair price for care. Nottingham City Council has developed one approach with its minimum core pricing. Is this the future of care pricing? Is it sustainable? Will it drive up quality? What does our panel think?

Any common core price needs to be sufficient

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David Roe Consultant LaingBuisson It is essential that the basis by which commissioners arrive at estimates of actual costs of care be totally transparent, including an analysis of the key component costs, the underlying assumptions and data sources. There s also an urgent need for a consistent approach to calculating the costs of care reliably and objectively, nationally, which is accepted by all as fair; otherwise, there will continue to be turmoil, with significant time and costs wasted. Local authorities, the NHS and providers need to agree on what levels of support are required to meet different levels of need, for different conditions, what it costs to provide good quality support and what constitutes an efficient and economic service in different settings; and, importantly, to work together in effective partnership to promote high quality, cost-effective services. Using some sort of arbitrary midpoint core price for residential care with dementia is a backward

OR GAS TOO DEAR? step, when it s vital that there s clear calibration of the different staffing ratios required to support people with different categories of need. If a common core price is to be used for each category of care, then this needs to be sufficient to meet the actual costs necessary to provide quality care. Fees proposed by Nottingham are simply too low, based on latest LaingBuisson fair prices, which reflect the costs of meeting CQC essential standards of quality and safety, based on the lower costs of efficient operators. If the fee level is sufficient, then there s only a need to reduce that fee for homes where either the physical standards fall short of the original national minimum standards, or if quality falls short of CQC standards. Local authorities can devise their own quality bandings, but if the fair price for care is used, these would essentially only need to represent penalties for not meeting standards, rather than there being bonuses for higher quality than standards.

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CMM SEPTEMBER 2014 ¦ 25

60 seconds with...

SECONDS WITH...

DAVID PEARSON David Pearson is President of the Association of Directors of Adult Social Services (ADASS).

WHAT S YOUR BACKGROUND? I qualiﬁed as a social worker in 1982, I ve worked for Nottinghamshire County Council for 32 years and became a Director in 2005. I ve held varied roles: managing a team in a multi-disciplinary mental health setting ‒ which was an interface between health and social care (h&sc); Board member of a Clinical Commissioning Group; and have a Master s degree in Integrating Health and Social Care. I ve managed most types of services - provider and commissioning and undertaken a lot of change management.

HOW ARE YOU FINDING THE ROLE?

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It s an incredible time in social care. It s a huge privilege to represent my colleagues and do my best for social care alongside partners and providers to make a difference. People ask me if the funding challenge and need to join-up services makes it difficult, but what better time to try to make a difference. I ve hit the ground running, being Vice-President was a great introduction plus I ve worked with an h&sc transformation group which helped with implementing the Health and Social Care Act, and has had a role in the Better Care Fund (BCF) work.

HOW DO YOU FEEL ABOUT THE CARE ACT AND BCF? The Care Act must be the most collaborative piece of legislation. The Government has shared responsibility with the Local Government Association and ADASS for implementation. It s genuinely collaborative including providers, the community and voluntary sectors too. Its focus on prevention, early intervention, carers, consistent assessments and eligibility nationwide, health and wellbeing information and advice,

personalisation and joined-up services is supported sector-wide. The consultation on the statutory guidance is so significant, people need to read it and contribute. It comes in tough times with the funding challenges and social care needs a sustainable financial system. It s very important legislation, starting in tough times but a platform for the future. The BCF is the right thing to put into place, though joined-up services is a better term than integration . I prefer the National Voices definition, person-centred, coordinated care , it takes the service user perspective. If it increases choice and helps to keep older people out of hospital then it must be right. People are working together to get the best outcomes. It s important for Health and Wellbeing Boards to oversee plans as it involves housing and community, needs can t be compartmentalised. It s about co-providing and coproducing; looking at how we spend all the money around people and the services they need, not just the BCF. We need to see success stories as it s a major challenge to keep people at home and integrate services.

WHAT ARE THE CHALLENGES? Suﬃcient resources to be able to do it all, even with creativity and innovation. Having an h&sc workforce with greater parity of esteem, training, pay, status and value. Having diﬀerent leadership skills to work across systems in new ways and changing culture. Dealing with the number and scale of initiatives all at once.

WHAT S THE BEST PIECE OF ADVICE YOU VE RECEIVED? It was a realisation when I ﬁrst became a Director ‒ the most important thing in leadership is not what you know or your technical expertise, but the values you espouse and live up to. CMM

CMM SEPTEMBER 2014 ¦ 27

THE CARE ACT AND ELIGIBILITY – uncovering the truth of Government’s plans Colin Slasberg gives his analysis of the reality of the Care Act’s changes to eligibility in light of the Government’s draft guidance.

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In May’s issue of CMM, Jamie Balbes introduced the new Care Act. The article correctly pointed out that, potentially, one of the most significant changes is that the Act opens up the possibility of needs assessments becoming holistic, meaning they identify the whole of a person’s needs calling for public funding, notwithstanding affordability. This has the potential to be a game-changer. It would expose the funding gap between needs and the resources to meet them. This would have a major impact on the politics of social care funding. However, since Jamie’s article the Government has published its draft guidance in relation to the Act.

This makes it clear the Government has no intention of going down this route, and will seek to make sure there is no change to the core processes in the way needs are assessed and funded. This article explains this view.

THE ECONOMIC REALITIES OF SOCIAL CARE Social care needs, properly understood, come in highly variable and unpredictable shapes and sizes that are unique to the individual. They arise from the complex interplay of many factors: the nature and severity of the person’s impairment; how long they have

lived with it; the personal resources and attitudes they bring to it; the attitudes and resources of people in their personal network; their physical living environment; their physical community space; the attitudes and resources of their local community; and the attitude and resources of universal services. Just as needs are unique, so is the cost of meeting them. The guidance recognises this when it says that needs are ‘different and personal’ for each person. However, social care is delivered within a cash-limited budget. Rule number one for councils is they cannot overspend. With demand so unpredictable, how can the service decide which needs will be funded and which will not whilst also being fair and equitable?

FAIR ACCESS TO CARE SERVICES The prevailing approach is based on the idea of dividing needs into groups, predicting the costs of meeting each group, and then deciding how many of the groups there are in the resource to meet. This becomes the ‘eligibility threshold’. Needs in the groups above it are called ‘eligible’ and will be met. Fair Access to Care Services (FACS) has four groups, or bands, of needs – ‘critical’, ‘substantial’, ‘moderate’ and ‘low’. Against its declared objectives, the strategy has proved little short of disastrous. A thorough review by the former Commission for Social Care Inspection (CSCI) in 2008 found that FACS has led to practices that were ‘standardised’,

‘service-led’ and based on ‘deficits’. This is the antithesis of the practices which FACS claimed it supported and characterises what we would not describe as the vision of a personalised system. No less concerning, work by the Audit Commission for the review found that different eligibility thresholds actually made no difference to spending levels. The bands were effectively meaningless. With the FACS bands meaningless, the strategy is not capable of delivering consistency or equity.

WHY HAS FACS FAILED SO BADLY? The notion of precisely matching spend to budget by grouping needs is, of course, mathematically impossible given the huge variability of the costs of social care needs. This is addressed in two ways. The first is to blunt the uniqueness of needs by standardising them. Assessment processes are used that categorise and score needs. Secondly, the FACS bands are defined in a way that allows the widest possible interpretation. This is achieved by distinguishing the bands by use of highly elastic concepts such as ‘significant’ and ‘vital’. Councils interpret them as they see fit. The evidence makes clear that resource availability is the dominant factor. The highest spending council spends twice the amount per head as the lowest spending council with the same threshold. Working age people have three times more spent on them than older people, with a much greater range of needs met, yet

have the same threshold. In effect, a circular process is created whereby ‘need’ is defined by resource availability.

RESPONSE TO CSCI’S FINDINGS The Government acknowledged the CSCI’s work and reviewed FACS in 2010. However, no substantive changes were made. This was in the light of an expectation that Resource Allocation Systems would change the landscape by allocating any given council budget to individuals in a fair and transparent way through ‘up-front’ allocations. We now know that promise has failed to materialise. The Care Act is clear that resources cannot be allocated ‘up-front’. Although ‘personal budgets’ are introduced, they are defined as no more than the actual and precise cost of meeting needs the council has decided it will meet. A notional ‘up-front’ figure plays no part in that decision. This means we are back to square one.

THE GOVERNMENT’S PLANS The plan is to replace FACS with a National Minimum Guarantee (NMG). However, this is simply a rose by another name. It is built on the same principles as FACS. The Government says the NMG will be the equivalent of the current FACS bands, ‘critical’ and ‘substantial’. The notion that spend can be controlled by grouping needs and precisely predicting the cost of meeting them is retained. It is expected

g CMM SEPTEMBER 2014 ¦ 29

the care act and eligibility – uncovering the truth of government’s plans

the NMG will form the core business of publicly-funded social care. While councils will have the power to meet needs beyond the NMG, the guidance is clear that it will be optional and of no concern to central Government, certainly not in the terms of providing funding to meet such needs. Finally, needs will meet the NMG if they have a ‘significant impact’ on the person’s wellbeing. It is for councils to decide when the impact is ‘significant’. It is a recipe for no change.

WHY HAS THE GOVERNMENT ACTED IN THIS WAY? It seems perverse that the Government should be persisting with essentially the same strategy. It claims to want an approach to eligibility that supports personalisation whilst removing the ‘postcode lottery’, which it ascribes to councils being able to decide their own threshold. This completely ignores the lessons from 2008. Is this a matter of incompetence, or is it wilful? It may well be the latter. Whilst from the perspective of the service, the strategy of allowing councils to define ‘need’ by availability of resource has been disastrous. From the perspective of political leaders, it has had four major, albeit undeclared, benefits: • It has helped to ensure spending has more or less remained within budget, no matter how small or diminishing the budget. • At the same time, it has allowed political leaders to claim that ‘eligible needs’ are always met. • It has given an appearance of equity within a national framework, albeit entirely spurious. • It has allowed political leaders to say they do not recognise there is a funding gap as there is no record of any unmet need. Needs that will not be funded are not recognised. This claim was made by the then Minister of State for Care Services, Paul Burstow MP, when pressed on the funding gap by the Health Select Committee in 2011. Social care is a major financial risk. It is not known how great the

30 ¦ CMM SEPTEMBER 2014

funding gap is but estimates between £5 billion and £10 billion are enough to make political leaders not want to know. The guidance to the Care Act is full of appeals to practitioners to be person-centred and empowering in their practice. Yet at the same time, it is encouraging the perpetuation of a system that makes such practice impossible.

DOES IT HAVE TO BE THIS WAY? As Jamie Balbes pointed out, it doesn’t have to be this way. The Act’s distinction between the needs a council has a duty to meet and those it has a power to meet is key. Not meeting a need in the latter group because it is unaffordable removes the fear of legal challenge if an assessed need is not met. However, it does not remove the political risk of exposing the funding gap. Indeed, it looks it square in the face. This need not – indeed, should not – be the end of the story. Councils who authentically put service users first can negotiate their way around the guidance and refer directly to the primary legislation in setting out their policies

and practices. Service users, their advocates and allies can also refer directly to the primary legislation and, through legal precedent, use the Care Act to establish a right to a holistic and costed assessment of needs. How else can a council decide which needs, over and above the floor set by the NMG, it can afford to meet and which it cannot? This will create pressure on the system to address the funding gap in both the short and long term. If the guidance has been crafted in full knowledge of its implications, it points to a level of cynicism and indifference to the service and the people who rely on it that will make the fight to create a system that is truly person-centred a tough one. However, the Act has created a legal context that makes the fight winnable. It is likely it will happen despite, not because of, Government intentions. For more information on the Government’s draft regulations visit: http://careandsupportregs.dh.gov.uk/ CMM Colin Slasberg is an independent consultant in social care. Email: colin.slasberg@gmail.com

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THE

REVOLUTION WILL BE IMPROVISED If you’re a provider of social care services, and you are in receipt of funding from a local authority, then whether you work with older people, people with learning disabilities, people with physical disabilities or people with mental health issues, you’re likely to have had battles over funding in recent years. In its latest Budget Survey Report 2014, the Association of Directors of Adult Social Services estimated that since 2010, local authority adult social care 32 ¦ CMM SEPTEMBER 2014

departments have had to make savings of 26 per cent in their budgets – the equivalent of £3.53 billion over the last four years. Aside from leading to a radical reduction in the number of people eligible for local authority care funding – the National Audit Office estimated in its Adult Social Care in England: Overview in March 2014 that 87 per cent of the adult population lived in local authorities that only provided care services to those with substantial

needs or higher. The last four years have also seen fee levels for providers being significantly cut back, in some cases to the extent that providers have walked away from local authority contracts. The funding cuts have coincided with a much greater emphasis on service integration and redesign: integrated services, based around the person using care and support, are at the heart of the Care Act, and the evidence for integrated services

providing better outcomes for people has been clear from recent studies including the European Observatory’s Policy Study, What is the evidence on the economic impacts of integrated care?. But there are major structural, cultural and financial barriers to integrating social care and health. Financial incentives and funding mechanisms are different. Healthcare is free at the point of delivery, and costs for acute care are calculated on a tariff, or

HOW NEW APPROACHES TO LEADERSHIP ARE DRIVING INTEGRATION Debbie Sorkin reports on how systems leadership projects around the country are bringing together care providers, commissioners and service users in order to integrate services. episode, basis. Social care is not free and for local authorities, is effectively means-tested. Many providers will have first-hand experience of the structural divides that make them feel they are often on the outside looking in as far as decision-making around integration is concerned, even though it is the independent sector that is best-placed, through local knowledge and sector expertise, to ease the pressures on the acute hospitals in their area.

There are a number of ways in which health and social care have been piloting new ways of working, to bring services together for the benefit of service users and to support more efficient, and effective, use of resources.

SYSTEMS LEADERSHIP One of these ways has been through using systems leadership approaches.

Systems leadership describes the kind of leadership you use when you’re seeking to lead across organisational boundaries – so when you go beyond your own service or organisation and interact with others, often with very different priorities and points of view. It describes the way you need to work when you face large, complex, difficult and seemingly intractable problems where you need to juggle multiple

uncertainties, where no person or organisation can find or organise the solution on their own, where everyone is grappling with how to make resources meet demand which is outstripping them, and where the way forward therefore lies in involving as many people’s energies, ideas, talents and expertise as possible. It recognises that leadership isn’t vested in people simply because of their title or position; that it is possible – indeed,

CMM SEPTEMBER 2014 ¦ 33

the revolution will be improvised

necessary – for leadership to be shared and ceded, and that you can come together on the basis of a shared ambition, and accept partial or clumsy solutions on the way to getting there. Working with uncertainty, and ambiguity, is a given, and it’s expected that people will experiment with different methods and processes as a result. Systems leadership is, therefore, particularly useful when you’re looking to integrate services, and to redesign them around the person, at a time when you have less money than you need and more expectations than you can cope with. In other words, it’s leadership for our times. Alongside identifying a research base, a group of national organisations – spanning social care, health care and public health – have put a new initiative in place to try systems leadership approaches in practice. This initiative, which is already involving social care providers, is called Systems Leadership – Local Vision. Systems Leadership – Local Vision is currently funding 25 projects around the country. The aim of these projects – each of which looks to create change in a difficult or ‘breakthrough’ issue across a locality – is to develop systems leadership at local level, to create new ways of working in support of delivering integrated services, and to achieve measurable improvements in health, care and wellbeing. Progress on an issue needs to involve a number of different sectors. The projects commit to applying what they learn about systems leadership to other issues, and to sharing that learning so that other areas can benefit.

SYSTEMS LEADERSHIP IN ACTION The current projects cover a broad range of issues. In Kent, social care providers have come together with the local authority and NHS Trusts to develop 34 ¦ CMM SEPTEMBER 2014

new approaches to integrated commissioning, with large-scale ‘open space’ events bringing providers, commissioners, service users and carers together to shape what future services should look like. In the London Borough of Merton, they have created a pilot approach to integrated health and social care for people with two or more serious long-term conditions, putting service users at the centre and building up strong links with service users, carers and the voluntary sector. Birmingham has used a community asset-based approach, working with the independent and voluntary sectors to identify how localities across the city – ‘healthy villages’ – can support people and ease the demand on public services. Across Dorset, Bournemouth and Poole, senior figures from across health and social care have come together to develop a coherent local system to deliver integrated health and social care, pooling budgets and working with a range of delivery partners. Other projects have covered broader issues around long-term health and wellbeing. In Cornwall and on The Wirral, systems leadership programmes have looked at how to alleviate the rise in food poverty (use of food banks in Birkenhead, for example, had increased by 47 per cent over four months in 2013-14, from 9,000 to over 13,000). Outcomes have included more local markets and food networks, building better systems between local farmers and local consumers, so there is more use of surplus food and less waste; more community cafes; and a development of skills-based food curriculum for schools. Finally, in Plymouth, representatives from health, public health, the local council, the voluntary and third sectors, the police and the local university have been working together on reducing late-night street drinking in order to benefit health, reduce demands on A&E and reduce ‘streetscene’ costs: the systems

leadership programme has led to joint decisions on where funding should best be invested to achieve better outcomes.

THE REVOLUTION WILL BE IMPROVISED Initial findings from the projects have been published in a recent report, The Revolution will be Improvised. Although the projects have proceeded at different speeds, and some have made stronger progress than others, there is emerging evidence of providers being involved earlier in discussions around integration, and becoming centrally involved, rather than being consulted late in the day or not at all. There are also encouraging signs of real co-production and co-design with service users and carers. Where the projects are working, even if there isn’t an immediate payoff, relationships between commissioners, providers and others involved have improved to the extent that they are in a much better position to have difficult conversations – for example, around funding – than they previously were. What are the lessons about what makes collaboration a success? A number of key messages have emerged repeatedly: • Service users, not organisations and services, must be at the centre. This is constantly claimed and rarely delivered, but when it happens, the results are transformational. • Systems need to recognise that co-producing services with users is hard. It is a different way of working and needs skills and strategy to make it happen. • Leaders need to see themselves as part of the collective leadership of the system, as well as leaders in their own services and organisations. • Collaborative skills are now essential to success. Organisations should make the ability to collaborate a key requirement for employment, development and promotion at every level.

• Key abilities include being able to operate in networks without clear rules; instinctively making connections; building shared values and trust; and building coalitions of support. • Getting things done depends on relationships, trust and commitment, not formal structures. • Organisations and staff need to think and act strategically: the squeeze on resources makes long-term thinking imperative. The greater the pressures, the more important strategic thinking becomes. Increasingly, providers are finding themselves in a position where they need to work alongside others such as the local authority, Clinical Commissioning Group, Health and Wellbeing Boards. In these circumstances systems leadership may be the key to enabling everyone to work together to achieve the best outcomes.

FURTHER READING Systems Leadership: Exceptional leadership for exceptional times. Synthesis Paper www.virtualstaffcollege.co.uk/ wp-content/uploads/VSC_ Synthesis_complete.pdf The Revolution will be Improvised www.localleadership.gov. uk/docs/Revolution%20 will%20be%20improvised%20 publication%20v3.pdf More information about systems leadership and the systems leadership programmes, can be found at www.localleadership.gov.uk. Details of how to apply for funding for new Systems Leadership – Local Vision projects can be found at www.localleadership.gov.uk/ place/lvinvitation/ CMM Debbie Sorkin is National Director of Systems Leadership at the Leadership Centre. Email: debbie. Sorkin@localleadership.gov.uk

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CMM SEPTEMBER 2014 ¦ 35

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Counting the cost of

Social Media

Social media is an integral part of modern life but a coherent social media policy is essential to manage risks. Liz Mulvaney explains why it is important your staff are fully aware of their responsibilities.

36 ÂŚ CMM SEPTEMBER 2014

Most of us make use of social media daily. It is accepted that use of social media sites benefits communication, enabling active engagement with others about activities, services and events. Organisations like the Care Quality Commission use social media sites to share information and to gain ‘intelligence’ feeding risk profile scorings which in turn inform inspection decisions. Where would we be now without these sites, we might well ask? However, as much as social media use may be good for marketing, improving staff relations and boosting reputations, uncontrolled use can also threaten disrepute and the well-being of individuals and businesses. Some comments may breach professional codes of practice, such as the British Association of Social Workers’ guidance which warns against ‘accepting service users and their carers as online “friends”.’ Apart from attracting ‘trolls’ (persons wanting to vent anger at a service or individual online) unguarded comments might well be libellous, discriminatory, breach confidentiality or disclose sensitive information. Sites have been used to cause harassment, threaten harm and make obscene, grossly offensive or false remarks. At least half of the calls received by the Police about nuisance crimes have been reported to relate to social media site comments; prompting the Director of Public Prosecutions to issue guidelines as to when the Police and Crown Prosecution Service should be involved.

THINK BEFORE YOU ACT Active use of sites may be encouraged by all means but to ‘show personality not genitalia’ and with the clear caveat to engage brain and think about the consequences (both personal and professional) before making any posting. An example of brain not being engaged in considering consequences is provided by the case of Taggart v TeleTech UK. Mr Taggart posted the comment, ‘Quick question who in TeleTech has ‘A’ not tried to f***? She does get around.’ TeleTech took the view that this was gross misconduct and the Tribunal agreed, costing Mr Taggart his job. In Young v Argos the employee succeeded with an unfair dismissal claim having been sacked for ‘liking’ a comment on Facebook by a former employee which

said that their manager was, ‘as much use as a chocolate teapot’. Ms Young added, ‘that this was the worst year in 15 years of working for Argos’ and it is reasonable to speculate that at some level it wasn’t a good year either for Argos. Notably in the High Court, freedom of speech has triumphed to allow expression of views albeit at odds with upholding equality and diversity policies aimed at ensuring good relations in the workplace. In Smith v Trafford Housing Trust, Senior Manager, Mr Smith, posted links to news articles about gay marriages in church on Facebook adding comment ‘an equality too far’. Consequently, he was demoted, but the High Court found the employer in breach of contract for imposing this sanction. This was because the Court considered that Mr Smith had used the site clearly for personal and not work-related purposes. Accordingly, even though Mr Smith had offended workplace colleagues holding different views, he was found to be entitled to express his lawful personal opinions without being subject to sanction at work. Freedom of speech is, of course, not just the freedom to say agreeable things. Nevertheless, strongly held contentious views made public (via friends) do have the potential to reflect adversely upon individuals, their workplace organisation and overall sour workplace relations. Each case will turn on its own facts as to whether work-related and going beyond silly banter to the point of warranting sanction. The cases mentioned highlight difficulties with maintaining boundaries between working and private life and between preserving freedom of speech whilst avoiding defamation and malicious injury. Costs for all are never neutral especially those related to bringing and defending cases which can be high.

PROTECTING YOUR BUSINESS Protecting your business and your staff is a ‘must’. Access to websites can be blocked on work computers but ban on private use outside of the workplace, and outside of work-time, cannot be imposed. An employer can, though, make clear the boundaries of acceptable use. Consider taking the following four steps: 1. Implement a social media use policy laying down the ground rules, and

boundaries, making clear the sanctions to be imposed for acting contrary to the policy; 2. Raise awareness within the policy about Human Rights and Equality legislation; 3. Issue the policy to all staff, and provide training, drawing attention to the type of comments that will be considered to amount to misconduct whether occurring inside or outside of work; 4. Secure proof that staff are aware of the policy and associated sanctions for abuse of its terms. The consequences of not having implemented a social media policy were made clear in Lerwill v Aston Villa FC. Mr Lerwill won his unfair dismissal claim because he was not given clear guidance about acceptable media use or the consequences of sanction in respect of his actions. We see many cases where employers struggle to prove that the employee was aware of any restrictions on social medial use. Without a policy, and evidence of completed staff awareness training, the employer faces an uphill battle to satisfy an employment tribunal that it was fair to discipline an employee for any concerns about social media use. Speak with an HR adviser or employment lawyer about devising and implementing a social media policy to ensure you’re protected.

FURTHER RESOURCES Guidelines on prosecuting cases involving communications sent via social media: www.cps.gov.uk/legal/a_to_c/ communications_sent_via_social_media/ Social care meets social media – what’s holding the sector back? Guardian www.theguardian.com/social-carenetwork/2014/jul/10/social-care-socialmedia-digital-tools www.freeths.co.uk/publications/countingthe-cost-of-social-media-the-four-keysteps-employers-must-make CMM Liz Mulvaney is National Head of Health, Healthcare at Freeths LLP. Email: liz.mulvaney@freeths.co.uk

CMM SEPTEMBER 2014 ¦ 37

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L A N O I T A P U C C O THERAPY Victoria Elliot and Helen Martin discuss the value of employing occupational therapists and how they fit into a care home environment.

CA RE HO M ES

F O E L HE RO

BENEFITS OF OCCUPATIONAL THERAPISTS IN CARE SETTINGS

According to recent statistics from Age UK, the number of older people living in residential care has reached over 430,000 throughout the UK, with 27 per cent of these remaining in a care home setting for more than three years. Karin Tancock Professional Affairs Officer at the College of Occupational Therapists was quoted as saying that, ‘Activities, daily tasks roles and routines that are key to our identity are particularly important for older people in care homes who are at risk from health complications if left with nothing to do.’ There are over 34,000 occupational therapists (OTs) in the UK; however, the number of these working within the care sector is sparse. This is despite their ability to provide unique skills and expertise to support care teams, while improving the quality of life and wellbeing of the residents they care for.

With a knowledge base established on the belief that occupation and engagement in activities that have personal meaning is necessary for the health and wellbeing of all individuals. OTs in care home settings work to incorporate significant daily activities and meaningful roles into the lives of residents, providing an important feeling of identity that empowers older people and gives a sense of purpose. From helping staff tidy after a meal to watering plants in the garden, purposeful activities like these are life-enhancing and can help lift someone’s mood, give meaning to their life, provide a reason to get up, develop a sense of identity and independence, and may even, according to the College of Occupational Therapists, reduce hospital admissions. Not only can OTs provide meaningful ways for residents to occupy time, but they can also offer insight and training to care teams that can augment overall communication with residents, as well as improve a home’s physical and social environment and layout.

g CMM SEPTEMBER 2014 ¦ 39

the role of occupational therapy in care homes

INVOLVING OCCUPATIONAL THERAPY STUDENTS As part of a Trust-wide initiative to improve care quality, increase research and innovation, and heighten the lived experience of care teams and residents, two third-year OT students from the University of the West of England (UWE) were selected to undertake a placement at one of the Orders of Saint John Care Trust’s (OSJCT) Wiltshire homes during autumn 2013. The home selected was residential caring, for individuals with a dementia. Prior to welcoming these students, OSJCT had never worked directly with OTs; however, the benefits these young experts brought to the Trust was invaluable. As part of their time in the home, the students worked on a variety of projects to enhance the lives of residents, along with the level of care and engagement in appropriate activities provided by staff.

DEVELOPING ACTIVITIES TO ENRICH EVERYDAY LIFE The OT students initially supported residents to complete activity checklists to understand better their individual interests and preferred daily occupations. Completion of the checklists highlighted that some residents were not taking part in activities, due to disinterest and/or selfperceived inability to participate. As a result, the students worked with the activities coordinators to implement two new groups into the home’s weekly routine in order to get more residents involved – a gardening group and crochet club. By developing new activities tailored specifically to the wishes and aspirations of individual residents, everyday lives were improved by providing those living in the home with an opportunity to get involved in the activities and occupations they previously enjoyed doing.

OCCUPATION TO RESOLVE ANXIETY AND DISTRESS The students also assisted staff in problem-solving and managing one resident’s ongoing episodes of distress and anxiety. The students observed the resident to detect any triggers or patterns behind the behaviour, which included calling out and becoming tearful at the same time each day. After analysing their findings, the students developed a ‘keep busy’ session that outlined a meaningful set of daily activities and occupations for the resident to undertake, including laying tables, folding laundry and general cleaning around the home. By implementing familiar tasks and activities to occupy this resident each day, the students were able to break the cycle of anxiety and distress reactions that had been occurring on a regular basis both within this home and in her previous residential home placement.

ENHANCING COMMUNICATION While spending time with a resident who had suffered a brain injury, the OT students recognised patterns of 40 ¦ CMM SEPTEMBER 2014

behaviour that showed a favouring of communication from the left-hand side. Testing this finding by speaking to the person from both sides and noting differences, specifically a dramatic drop in response and interaction when speaking from the right-hand side, the students concluded that the resident had limited awareness on their right. This information was passed to the care team, who then used it to improve the way they engaged with the resident, leading to more meaningful and productive communication.

ENVIRONMENT DEVELOPMENT The OT students also provided valuable input about the care home’s environment. They recommended that elements from the home’s reminiscence and destination areas should be incorporated into the home’s communal sitting areas. They also noted that the overall ambience of the home was more feminine than masculine, so using information gathered in the activity checklists, the students worked with male residents to design and construct a bar area – something desired by a majority of men living there.

BENEFITS OF OT STUDENT PLACEMENTS All the staff within the home noted the benefits of the OT student placement. Feedback included, ‘The students’ input has encouraged us to think about things in a different way and helped us to improve how we engage with residents on a daily basis.’ Following the success of its first two OT placement students, the Trust is now looking forward to welcoming placement students from both UWE and Coventry University during autumn 2014. The unique skills and expertise of the OT students enhanced and developed the knowledge base of the care teams working in the home. Through their role-modelling, they were able to demonstrate a more focused and effective relationship-centred approach to care teams and, in consequence, improve the lived experience of residents. CMM Victoria Elliot is Principal Care Consultant (Research and Innovation) at The Orders of St John Care Trust. Helen Martin M.Ed BA (Hons) Dip.COT Cert.Ed is a Senior Lecturer and Admission Tutor for the BSc (Hons) Occupational Therapy programme within the School of Health and Social Care at the University of the West of England.

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INCLUDING

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who’s who…

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who’s who…

Who’s who...

RECRUITMENT

Recruitment can feel like an ongoing concern but there are many different facets to it beyond the need to find care staff. CMM looks at issues surrounding recruitment and brings you details of organisations focusing on executive recruitment, care staff or ensuring you’re recruiting the right people.

According to Skills for Care, ‘The demand for adult social care is set to rise due to the ageing population. The size of the adult social care workforce will have to increase significantly to meet this demand. By 2025 we may need up to a million extra workers. To meet this challenge employers will need to have good recruitment plans that can help lead to higher rates of retention.’ The care sector is under constant pressure to deliver high quality services, for more people, with higher needs in a changing political landscape. This means that organisations need the right people in the right roles from Board level down to care assistant and everything in between. Having the right Board and senior management team can help an organisation to focus on moving forward. There is a rising

market for senior posts with many executive recruiters offering discreet services to locate and attract leading figures into high level posts. Alongside the process of recruiting at all levels, it’s important to ensure that the people you recruit are the best fit for the role, the organisation and the rest of the team. As such there are now tools, organisations and testing methods to profile candidates verifying their values as well as their credentials. CMM brings you a selection of care sector organisations focusing on different aspects of recruitment. There is a real benefit to using an organisation specialising in social care, they will understand the nuances of the sector, the sort of personality needed to deliver care and for those at the executive end of the spectrum, they will have great contacts to find you the right person to take your business forward. CMM SEPTEMBER 2014 ¦ 43

who’s who…

RESOURCES TO AID RECRUITMENT There are also a range of resources to help you with the recruitment process.

CARTER SCHWARTZ WWW.CARTERSCHWARTZ.CO.UK

With significant market exposure, Adam Carter is widely-recognised as one of the most knowledgeable executive recruiters within the independent care sector. As a trusted adviser he has consistently addressed the management and leadership challenges at Chief Executive, Chief Operating Officer and Financial Director level for major providers, emerging corporates, not-for-profits and investors across a diverse range of health and social care niches. Having spent eighteen years developing this sector focus for another respected consultancy, Adam recently founded Carter Schwartz – a boutique search and selection consultancy exclusively focused on care and education. Telephone: 07778 464653 • Email: adam@carterschwartz.co.uk • www.carterschwartz.co.uk Differentiated by knowledge and networks, Carter Schwartz has created an innovative range of Managing Director human capital solutions for the independent care and education markets. Moving away from the transactional style of business offered by traditional recruiters, we adopt a value add proposition, that is uniquely positioned with true relationship partnering in mind and creates real intrinsic value for our clients.

ADAM CARTER

Listening to our clients over an eighteen year period, it’s clear that the human capital challenge isn’t just about hiring new recruits - it’s much broader than that. So Carter Schwartz addresses both traditional recruitment requirements alongside additional services that meet client need by simply reacting to their wider commercial challenges – it’s about addressing those thorny issues that a lack of appropriate people resource can effect across all companies, irrelevant of scale, in the highly regulated care and education sectors.

COLLINGWOOD EXECUTIVE RECRUITMENT

Ben Westcott is Head of Healthcare Services at Collingwood Executive Recruitment. Our ethos of acting with integrity and accountability drives everything we do. From this comes our true differentiator for which we are very proud. Coupled with deep industry knowledge and genuine passion for what we do, we have successfully delivered numerous executive level assignments within the care sector. We work proactively with our clients, rigorously headhunting within their chosen markets to find the highest calibre talent. Our approach is advice driven, not sales focused. Our proven methodology includes face to face interviews, competency-based assessments and behavioural profiling. We have been fortunate enough to develop long-term partnerships with many leading care providers and become their true trusted adviser.

BEN WESTCOTT Head of Healthcare Services Telephone: 07738 874316 • Email: ben.westcott@collingwoodsearch.co.uk • www.collingwoodsearch.co.uk

COMPASS ASSOCIATES - WWW.COMPASSLTD.CO.UK

SAM LEIGHTONSMITH Director

Sam, a founding Director, is responsible for Compass Associates group financial performance, growth strategy and business generation. He oversees the Specialist Services Division in tandem with Compass Executives, a search and selection firm operating out of London. Sam specialises in board level appointments that add long-term value to organisations and regularly acts in an advisory capacity to our closest clients in relation to succession planning, industry trends and salary benchmarking. Sam holds a Law and Politics degree BA (Hons), LLB from the University of Kent as well as additional qualifications in the practice of recruitment.

MIKE JEFFREYS

Mike is a founding partner and current Director of Compass Associates, he heads up the Care Home Division and assumes responsibility for all things IT related. Mike is also responsible for the operational direction of the business. CertRP qualified under the Recruitment and Employment Confederation (REC), Mike has many years’ experience working within the recruitment industry and an in-depth knowledge of the health care sector.

Director

Telephone: South 02392 384 555 or North 0161 209 3680 • Email: info@compassltd.co.uk • www.compassltd.co.uk • www.compassexecs.co.uk Compass Associates is one of the UK’s leading healthcare recruitment consultancies providing tailored, high quality services for all permanent and fixed-term vacancies. Focusing extensively in niche sectors such as care home, general healthcare and specialist services we are able, and proud, to provide an in-depth, knowledgeable and professional service at all times. Established by three experienced founding partners, Compass Associates provide permanent and fixed-term recruitment solutions on a national scale. Our divisions are deliberately divided into geographical regions ensuring our consultants are ideally placed with localised knowledge at their disposal to understand what our clients and candidates expectations really are. At Compass Associates our consultants and management team take pride in aiming to provide both our clients and candidates alike with a dynamic service incorporating all of our core values. We are passionate and proud of both our values and accredited processes striving to be transparent at all times.

44 ¦ CMM SEPTEMBER 2014

Compass Associates has developed strong relationships with a range of private, independent and third sector providers throughout the UK, and are acutely aware that to maintain these it is paramount that we employ the right personnel and create the right work environment for this to be sustained. We take pride in mentoring our consultants to endeavour to be the best, providing ongoing training and accreditations, support and incentivised benefits aligned to performance. In 2013 Compass Associates opened an office in Manchester headed up by Director Geoff Flavell-Matts. Geoff has over 15 years’ experience in recruitment managing multiple offices and is a Fellow of the Institute of Sales and Marketing Management in addition to his Fellowship of the Institute of Recruitment Professionals. Furthermore, Compass Associates also has a General Healthcare Division which is led by founding partner and Director Chris Russell. Having established two of the four divisions in Compass Associates, Chris has over 10 years’ experience specifically within health care recruitment and has an expert knowledge of the industry.

who’s who… Social Care Institute for Excellence (SCIE)

Skills for Care

SCIE has information dedicated to helping employers recruit and retain their staff. It has many different resources to help you attract and retain the right staff with good strategies, equality and fairness, and human resource planning. For example, there is a recruitment and retention audit tool that has eight questions assessing your administration and records, which is vital in managing effective employment, accurate workforce statistics and workforce planning. www.scie.org.uk/workforce/peoplemanagement

Skills for Care offers resources on the latest employment initiatives and free practical toolkits. It has its own recruitment strategy, detailed in full, which identifies barriers to finding and keeping staff, solutions to these barriers, how to develop new career pathways and examples of good practice. There is also a guide on the sector-route way for social care, which gives you support regarding the recruitment of unemployed people. www.skillsforcare.org.uk/Finding-and-keeping-workers

NATIONAL SKILLS ACADEMY FOR SOCIAL CARE - WWW.NSASOCIALCARE.CO.UK

The National Skills Academy for Social Care is for everyone committed to excellent adult social care in England. It is an employer-led membership organisation, created by social care employers to transform the quality of leadership, management, and commissioning. We are also dedicated to supporting and promoting excellent learning and training. As part of our drive for excellence in adult social care, our website features a Jobs Board which forms part of our offer to Members, where they can post vacancies free of charge. It profiles your organisation, the people you support, the role you are advertising and its main tasks, along with the skills and experience required of applicants, along with any conditions of service, salary and details of how to apply. The website also has useful tools for recruiting and retaining staff including an online

values-based recruitment toolkit. It’s been designed to help employers of all sizes to recruit the right people, with the right social care values, whom you can trust to do the right thing and who will stay with you to develop their careers in social care and add value to your service. The values-based model gives employers, especially smaller or micro-employers that may be unfamiliar with the approach, an opportunity to try it out and gauge the effect on their workforce and their service. To find out more about Membership of the National Skills Academy for Social Care’s Job Board visit www.nsasocialcare.co.uk/jobs or you can find out more about the valuesbased recruitment toolkit www.nsasocialcare.co.uk/ values-based-recruitment-toolkit.

Email: contactus@nsasocialcare.co.uk • jobsboard@nsasocialcare.co.uk • www.nsasocialcare.co.uk

PULSE COMMUNITY HEALTHCARE

Pulse Community Healthcare provide staff that deliver a range of healthcare services to adults and children across the UK. Our reputation is built on effective management of care packages for those with often very complex needs. By assigning only the most compliant and highly competent healthcare professionals, our staff enable clients to live as independently as possible at home, whilst still accessing their wider communities. We guarantee a responsive and reliable recruitment service around the clock. We instil confidence in the expertise and ability of our team by employing only industry and niche specialists trained in the delivery of complex care. We commit to open and honest communication, fast response times and providing the highest quality care and

standards of service. We recruit and, most importantly, train the appropriate nurses and support workers to manage our clients’ specific requirements. By providing a fantastic benefits scheme, ongoing career progression and support from a dedicated case manager, you can rest assured that we only work with the best. Our network of 16 offices across the UK means we can deliver the benefits of our national service, in a package tailored locally to you. Contact us for more information or to arrange an interview with your local office.

Telephone: 0845 459 7417 • Email: pch@pulsestaffing.co.uk • www.pulsecommunityhealthcare.co.uk

STICKY PEOPLE - WWW.STICKYPEOPLE.CO.UK

Neil Eastwood founded Sticky People after experiencing the challenges of recruiting quality frontline care staff at a national care provider. He then began a quest to find practical and proven recruitment and retention tools and techniques used by social care employers in other countries. This led to the creation of Sticky People, which holds the UK licence for the popular US care recruitment screening tool PeopleClues. As well as building a client-base of care providers who now use PeopleClues to inform their hiring choice, Neil provides free global best practice advice on all aspects of care recruitment and retention through articles, presentations and webinars.

NEIL EASTWOOD Founder

Neil said, ‘Finding and keeping care staff is becoming the major issue for all care providers, so it makes sense that we look around the world for the very best techniques and tools. I have spent five years collecting this together, so busy employers don’t have to.’ Telephone: 0845 604 8064 • Email: neil@stickypeople.co.uk • www.stickypeople.co.uk

Sticky People provides the Staff-Sure PeopleClues recruitment screening tool to care sector employers of all sizes. Staff-Sure is a simple, very low cost, award-winning online personality and attitude assessment system that quickly and accurately identifies the applicants that are likely to deliver quality care and stay in the job long-term. It has been developed and tested over many years in the US social care and healthcare sectors and validated for the UK market. It works by comparing each applicant’s personality profile with the benchmarked ‘best’ personality for the specific care job they are applying for, as well as assessing their workplace attitude to help employers spot individuals with potentially high risk behaviours. Candidates can either take the assessments in the office prior to interview or at home via an emailed link sent to them. The two most commonly used assessments are Job Fit and Attitude. Each takes around 10 minutes to complete and the results are available instantly to the interviewer via

their secure web portal. The in-built benchmark profiles for assessing Job Fit include care worker, live-in care worker, registered manager, head cook, ancillary staff, support worker, nurse and 13 more. Our clients usually report one or more of these: 1. Consistently improved hiring decisions; 2. A demonstrable method of identifying Safeguarding risk; 3. Reduced staff turnover; 4. Improved consistency and quality of care; 5. A quality mark for social services, clients and their families; 6. A reduced risk of disciplinary action and business disruption; 7. Protection of their reputation. Care employers can try Staff-Sure for free for 30 days with full training and support provided. The tool is sold on an annual licence basis and is affordable for care settings of all sizes who recruit regularly.

CMM SEPTEMBER 2014 ¦ 45

the 3rd sector care awards

Wednesday 3rd December 2014 London Marriott Hotel, Grosvenor Square

The new 3rd Sector Care Awards, organised by Care Management Matters (CMM), have been launched to celebrate and showcase innovation and care excellence in the dynamic not-for-profit care sector.

Organised by:

Supported by:

Confirmed sponsor:

Hosting this worthwhile event will be Esther Rantzen CBE, who is deeply involved in various charitable causes. She is the founder of Childline and The Silver Line, the only free confidential helpline designed to combat loneliness amongst older people. The Award categories are: • Compassion Award, • Innovative Quality Outcomes Award, • Creative Arts Award, • Community Engagement (over 65s care) Award, • Community Engagement (under 65s care) Award, • Citizenship Award, • Leadership Award, • Collaboration (integration) Award, • Contribution to sector development Award, • Board Member/Trustee of the Year Award. The Awards are open to any individual, team or organisation who have excelled in their services in the not-for-profit care sector and the judging process will involve ‘experts by experience’ alongside independent experts from the field. Nominations for the Awards must be submitted by Friday 12th September 2014, and all will be treated as confidential. Interviews for the three shortlisted candidates from each category will be held on 21st or 23rd October 2014. Nominees must be available to attend. The winners will be announced at the Awards ceremony on 3rd December 2014, and all three finalists from each category will be invited to the ceremony, along with two guests.

How to Enter Online • Choose the category that you would like to enter or put forward a nomination for. • Read the criteria for your chosen Award carefully and click on the relevant Award category on the left, where the online entry forms can be found. Complete the online entry

46 ¦ CMM SEPTEMBER 2014

form in full, print, sign, date and return either by email, fax or post. • Answer the questions outlining how you or your nominee meet the criteria for the Award and why you feel you or your nominee should be considered. Answers to questions should be 200 words each with an additional 250 words for any supporting statements. Statements are additional and not compulsory to entries. Please ensure that your name, organisation and the category is included on the nomination and on any supporting information. This should then be emailed to lisa.werthmann@carechoices.co.uk. By post Please get in touch for a copy of the nomination pack. Alternatively, download the relevant PDF for your chosen category, which is available online, and post it free of charge to: The 3rd Sector Care Awards, FREEPOST, CB398, Royston SG8 0BR. You can also fax back the form to 01223 207108.

Supporters The 3rd Sector Care Awards 2014 is proudly supported by The National Care Forum (NCF), The Care Provider Alliance (CPA), the Housing and Support Alliance (H&SA), the Mental Health Providers Forum (MHPF) and the Voluntary Organisations Disability Group (VODG).

Get in touch For further information on the 3rd Sector Care Awards and details of how to get involved, please contact: Lisa Werthmann, Director of Creative Operations, Care Choices Ltd Email: lisa.werthmann@carechoices.co.uk Tel: 01223 206952 Or visit www.3rdsectorcareawards.co.uk Sponsorship opportunities are also available. Contact: David Werthmann, Director of Sales, Care Choices Ltd Email: david.werthmann@carechoices.co.uk Tel: 01223 206955.

Unrivalled Health & Care expertise Our experienced team shows real commitment to delivering the right quality of service at the best price. Liz Mulvaney liz.mulvaney@freeths.co.uk 0845 050 3689 07790 407992 www.freeths.co.uk

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Pre-register for FREE ENTRY into the CaterCare Expo or book from a choice of delegate packages by visiting www.mcculloughmoore.co.uk/nacc or calling 0870 748 0180

CMM SEPTEMBER 2014 ÂŚ 47

conference review

HEALTH+CARE AND COMMISSIONING 2014

25/26 June London

More than 7600 healthcare professionals congregated from all over the country to hear the latest political developments and educational and business updates in two packed days at Health+Care and The Commissioning Show 2014. Over 350 speakers in 14 theatres, at the ExCel London, delivered informed legislation and policy lectures, live debates, case studies and keynote sessions on issues ranging from integrated care, Clinical Commissioning Group (CCG) business and long-term conditions to care commissioning, home care and residential care business. Some 400 exhibitors were on hand to demonstrate the latest services, products, equipment and innovations on the market and to network with delegates. The move towards a more integrated and collaborative health and care system was a key theme of the event. This year 97 per cent of CCGs were represented at the event. More than half the audience was made up of CCGs and 97 per cent of health and wellbeing boards were also represented. Commissioning Show and Health+Care attendees browsing the exhibition were responsible for spending more than £57 billion of the NHS budget and nearly £1.5 billion on social care. ‘When I spoke at the conference here last year we were in the planning stages of what this more integrated service would look like,’ Care and Support Minister Normal Lamb MP told delegates. ‘At the time we were sifting through a remarkable 99 applications from all over the country to become integrated care pioneers. To me, the level of interest in wanting to become a pioneer when the Government was not offering a single penny of support demonstrated the pent up energy in the system to do things differently, to take control and show what you could do without being dictated to from on high.’

Mr Lamb went on to say that the 14 pilots chosen to pioneer integrated care pioneers were already having an impact by leading change and improving care. ‘What is really exciting is the innovation and experimentation that is going on all over the place,’ he concluded. Health Secretary Jeremy Hunt MP told a packed lecture theatre that the second key innovation in the last year had been the launch of the Better Care Fund, which gave CCGs and local authorities a leadership role in jointly commissioning care. ‘We are seeing discussions happening as a result of the Better Care Fund which have never happened before.’ Mr Hunt also spoke about the new opportunity for CCGs to co-commission primary care with NHS England. He told health and care commissioning leaders, ‘You are now in the driving seat to deliver a completely new vision for integrated care in your areas and you have the powers, freedoms and the clinical leadership, in the way that people at local levels have never had before, to break down barriers. Many of you are already starting to use those freedoms and I want to support you to do it.’ CMM supported Health+Care 2014 and the show will return to Excel on the 24th and 25th June 2015.

48 | CMM SEPTEMBER 2014

layout on? one what’s

WHAT’S ON? British Association for Supported Employment Annual Conference 2014 Date/Location: 10th - 11th September, Leicester British Association for Supported Employment, Contact: Web: base-uk.org/conference Event:

REHACARE INTERNATIONAL 2014 Event: Date/Location: 24th – 27th September, Dusseldorf Messe Düsseldorf, www.rehacare.de Contact: National Association of Care Catering Training and Development Forum 2014 Date/Location: 1st – 3rd October, Nottingham McCullough Moore, Contact: Web: www.mcculloughmoore.co.uk/nacc Event:

Annual Mental Health Law Conference Event: Date/Location: 2nd October, London RadcliffesLeBrasseur, Tel: 0207 227 6782 Contact: ICG Conference and Exhibition 2014 Event: Date/Location: 7th October, York McCullough Moore, Tel: 01293 851869 Contact: Safeguarding Adults Event: Date/Location: 24th October, London Capita Conferences, Tel: 0207 202 0593 Contact: Tackling Long-Term Conditions Event: Date/Location: 29th October, London Open Forum Events, Tel: 0161 376 9007 Contact:

! VE TE SA A ED TH

CMM CAREMANAGEMENTMATTERS

Media Partners of ICG

7 October 2014 at York Race Course Topics will include: The changes you need to know about rated inspections – October 2014 and beyond Delivering social care in North Yorkshire and the City of York Dementia – THE SPECAL METHOD and three golden rules of contented dementia care Infection control – unannounced visits! Homecare – making it work The burden of paperwork in social care Customer care and treating people with respect Social care’s national position

Speakers will include: Andrea Sutcliffe, Chief Inspector of Adult Social Care, Care Quality Commission Chair for the day Harry Gration, BBC Look North

Care Show Birmingham Event: Date/Location: 4th – 5th November, Birmingham Care Show, www.careshow.co.uk/birmingham Contact: Care England Conference: The Road to Integration Date/Location: 13th November, London Care England, Tel: 0207 492 4846 Contact: Event:

CMM EVENTS

Richard Webb, DHASS, North Yorkshire Paul Edmondson-Jones, Deputy CE and DHASS, City of York Penny Garner, Contended Dementia Trust John Kennedy, Director, Joseph Rowntree Foundation David Pearson, President ADASS Ian Donaghy, Director of Training, Training for Carers

Berkshire Care Conference 2014 Event: Date/Location: 16th October, Reading McCullough Moore, Tel: 01293 854401 Contact: CMM Insight: The Future of Learning Disability Care Date/Location: 26th February, Manchester Care Choices, Tel: 01223 207770 Contact: Event:

BOOK NOW!

Call Jacki Brailey on 01293 851869, or visit www.mcculloughmoore.co.uk/icg If you are interested in exhibiting at the ICG exhibition, please call Jacki Brailey on 01293 851869

SUA1991 ICG2014 Save the Date Qtr Page Ad_FINAL.indd 1

North West Care Conference 2014 Event: Date/Location: 18th September, Clayton-le-Moors McCullough Moore, Tel: 01293 854401 Contact:

Please mention CMM when booking your place.

07/08/2014 15:21

CMM SEPTEMBER SEPTEMBER2014 2014 || 49 CMM 49

straight talk

straight talk John Burton looks at CQC’s end of year report and declares that it ‘requires improvement’.

JOHN BURTON INDEPENDENT SOCIAL CARE CONSULTANT AND WRITER After three disastrous years of the previous regime, the new guard at the Care Quality Commission (CQC) spent its first year trying to clean up the mess that was left behind. This time last year, CQC was front-page news - cock-ups and cover-ups. Unfortunately there are still skeletons in the cupboards and dirt lingering under the carpets. Why can’t people who are so experienced in organisational cultures and change, understand that it takes years to achieve deep change in any organisation, whether it’s a national regulator or a care home? That question and its answer point to what is wrong. CQC is still reliant on concepts that are alien to social care which is based on relationships. CQC’s culture is one of compliance, quality assurance, performance and delivery. It’s how they run the organisation and how they make their judgements about social care services. They appear to have little idea of whole system change and of what lies beneath the surface of organisations. They believe it’s possible for a care home to change from inadequate to good in six months: just appoint a new manager and follow an improvement plan. (And you may need to engage a consultant to ‘ensure’ that everything appears to be in compliant order.) So, in their annual report for 2013/14, CQC measures itself by ‘key numbers’. The Commission costs nearly £200 million a year. Adult social care had 22,066 inspections, nearly 200 less than in the previous year, yet the headline figure in the report is the 6 per cent overall increase due to introducing the inspection of GP practices. 238,621 calls were received by the National Customer Services Centre (NCSC) and there were 9,473 ‘whistleblowing contacts’. When making any observation about any service, CQC inspectors are trained to ask themselves the question, ‘So what?’ So, what are we to make of the 9,473 whistleblowing contacts? And why were there fewer social care inspections? And what were the 238,621 calls to the NCSC about? The annual report does attempt to explain but fails to make a systemic analysis. For example, why aren’t most of these phone calls and whistleblowing ‘contacts’ going directly to inspectors? Surely, if you need information, or help, or there is something worrying you about a social care service, you should contact the person who knows the service and is responsible for checking that it’s caring and safe. And this points to the fundamental error in the design of a

national care regulator. Social care services are local and they should have local inspectors, accountable to the people who rely on them, to check whether to a service is good enough. Instead, CQC maintains costly central systems that distance the relationships between public, providers and inspectors. ‘Special measures’ and ratings Linked with the reintroduction of ratings in October is the announcement that from April 2015, care services that are rated as ‘inadequate’ will be put into ‘special measures’ if they don’t improve sufficiently within a specified time-scale (usually six months), and if they fail again they will be closed. I don’t support the ratings scheme because no one, not even CQC inspectors, can draw precise, fair, and consistent lines between the levels, nor can anyone say for sure whether a service is 100 per cent safe. (No service is or should be.) CQC is setting itself up for embarrassment and failure as soon as the first service with a ‘good’ or even an ‘outstanding’ rating is exposed publicly and tragically as neglectful or abusive. This happened with the old Commission for Social Care Inspection (CSCI) ratings and continued when CQC maintained the same scheme. We can be 100 per cent sure that it will happen again with the new ratings. However, CQC’s five broad and imprecise questions - Safe? Effective? Caring? Responsive? Well-led? - are a sensible basis on which to inspect. Add Andrea Sutcliffe’s ‘Is it good enough for my mum?’ and we have the essence of what inspection should be about. If a service is not good enough, it needs improving and, depending on how far it falls short of being good enough, the local inspector must keep a very close eye on whether it is getting better, with residents and clients, relatives and staff communicating any concerns they have directly to the inspector. If the home shows no sign of improvement in a reasonable time, CQC should remove registration and the service should close. The use of the term ‘special measures’ is merely a political ploy to signify that the Government is ‘cracking down’ on poor care. I don’t think it really changes anything. If inspectors were individually accountable for the services on their patch, they would be more likely to step in well before ‘special measures’ were needed. Make inspection simple, direct and local; adding to the superstructure is in danger of capsizing the ship. CMM

DO YOU AGREE WITH JOHN? PLEASE EMAIL YOUR THOUGHTS TO EDITOR@CAREMANAGEMENTMATTERS.CO.UK 50 | CMM SEPTEMBER 2014

Care Conference

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FOR YOUR 2014/15 MARKETING SCHEDULE! Focusing on the future of care and commissioning 2014 2014 SEPTEMBER SEPTEMBER

Save the dates! 2014 2014 OCTOBER OCTOBER

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Lancashire Care Conference Incl. Blackpool & Blackburn with Darwen

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June 2015

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06/05/2014 10:56