Care Management Matters December 2014 by Care Choices Ltd

DECEMBER 2014 £4.00

STICK OR TWIST? Can you afford to gamble on LA funding?

What’s ahead? Our predictions for 2015

Business Clinic NHP and HC-One’s acquisition

Retaining staff Holding onto your most valuable asset

Includes 4-page Skills Academy insert: Focus on Leadership – Lead to Success Programme

Residential care delivery goes mobile Advanced Health & Care have launched a mobile working solution designed speciﬁcally to support care workers within residential care homes that allows data recording at the point of care.

Available on a range of devices to suit individual requirements, you can truly mobilise your business with the ability to view and update service user plans as care is being delivered.

To ﬁnd out how your care delivery can go mobile please contact us on 01233 722670 or visit advcs.co/tablet Advanced Health and Care Limited is part of Advanced Computer Software Group. Registered in England. Company number 02939302. Registered ofﬁce: Munro House, Portsmouth Road, Cobham, Surrey, KT11 1TF

CMM full page October 2014.indd 1

03/09/2014 16:30:53

in this issue

IN THIS ISSUE regulars 05

editor’s welcome

I s it just me...?

Editor, Emma Morriss examines the ‘shambles’ that was the planning for the Better Care Fund.

N ews

Property News

Corporate News

Local Authority and Planning News

60 Seconds with...

Business Clinic

Conference reviews

Ensuring a fair price for care

Nottingham City Council replies to CMM’s September Business Clinic with an explanation of its fair price for care model.

Welcome to the final CMM of 2014. I’ve been reflecting on the past year which, amongst other things, saw the Care Act receive Royal Assent, a new approach to inspection and regulation, the introduction of new quality ratings, increasing operating costs, another rise in the National Minimum Wage, further discussion around the living wage and more pressure on local authorities to save money, impacting on fee rates. After all that, it’d be great to wrap up the year thinking that, as we’ve been through so much in 2014, next year will be quieter. Unfortunately not. Amongst other things, 2015 will see the first part of the Care Act being implemented in April and a General Election in May. Given that, we’ve asked three industry experts their thoughts for 2015 and they’ve offered their predictions, starting on page 16. Also this month, Nottingham City Council has set out its approach to paying a fair price for care in the city, in response to the Business Clinic published in CMM’s September issue. Against a backdrop of immense pressures on social care budgets, Nottingham City Council explains how it has sought to pay providers a fair price for care. The feature starts on page 35. Finally, we also take a closer look at how you can retain your most valuable asset, your staff. According to the National Care Forum, nearly 40% of care staff leave an organisation within a year of joining and 65% leave within two years. It highlights that there’s a real need to retain staff and reduce this churn. Neil Eastwood shares some useful tips on page 29. All that is left for me to say is see you in 2015 when CMM will be looking rather different.

HMRC National Minimum Wage Investigations – prevention is better than cure

Emma Morriss Editor

Chris McGoff, Chief Executive of New Care Projects.

The panel considers market stability following the acquisition of NHP and HC-One.

CMM reviews the Berkshire Care Conference and Care Show Birmingham 2014.

What’s On?

Straight Talk

features 16

Rosemary Hurtley argues that equipping the workforce with a range of new skills must be a priority if we’re to put the needs of older people first.

2015: A Year of Immense Change?

Des Kelly, Roger Harcourt and David Pearson shed light on what we can expect to see in 2015.

Stick or Twist: Can you afford to sit still in a changing market?

With increasing pressure on local authority funded placements, Chris Tarry asks whether providers can afford to continue relying on this income.

Staff turnover rates in the care sector are averaging close to 20%, Neil Eastwood explores how to retain valuable employees.

Please don’t go! Retaining frontline care staff

Ian Hyde advises on how to avoid noncompliance with the National Minimum Wage.

Follow CMM on Twitter @cmm_magazine CMM DECEMBER 2014 | 3

contributors

CMM CAREMANAGEMENTMATTERS December 2014 EDITORIAL AND PRODUCTION editor@caremanagementmatters.co.uk Editor in Chief: Robert Chamberlain Editor: Emma Morriss News Editor: Des Kelly Editorial Assistant: Amy Elizabeth Catlin Design and Production: Holly Cornell, Lisa Werthmann, Jamie Harvey and 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: 978-1-910362-27-3 CCL REF NO: CMM 11.9

editorial panel Des Kelly OBE,

Mike Padgham,

Executive Director, National Care Forum

Chair, UKHCA

Professor Martin Green OBE,

David L Jones,

Chief Executive, Care England

Partner, Deloitte

Andrew Sidwell,

Paul Ridout,

Partner, GVA

Partner, Ridouts LLP

Andrew Barnsley,

Zoe Farrell,

Managing Partner, Nexus Corporate Finance LLP

Training Development Director, Catalyst for Care

contributors Chris McGoff, Chief Executive, New Care Projects Chris Tarry, Social Care Business and Marketing Consultant David Pearson, President, Association of Directors of Adult Social Services Derek Breingan BA (Acc) MCIBS, Head of Healthcare Sector UK - Corporate, Business & Private Bank, Clydesdale Bank Plc and Yorkshire Bank Plc Des Kelly OBE, Executive Director, National Care Forum Ian Hyde, Tax Partner, Pinsent Masons LLP John May, Managing Partner, Freeths LLP

Publications

CMM magazine is officially part of the membership entitlement of:

Neil Eastwood, Founder, Sticky People Ltd Nottingham City Council Roger Harcourt, Partner and Head of Healthcare, Shakespeares

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

4 | CMM DECEMBER 2014

Rosemary Hurtley, Founder, Elizabeth Care Tim Edghill, European Director and Head of UK M&A, JLL Corporate Finance Ltd

is it just me...?

Is it just me...? Editor, Emma Morriss examines the ‘shambles’ that was the planning for the Better Care Fund and asks whether this laissez-faire approach by Government was really appropriate. The Better Care Fund, or Integration Transformation Fund, as it was originally named, was announced by the Government in the June 2013 Spending Round. It was hailed as, ‘one of the most ambitious ever programmes across the NHS and local government, creating a local single pooled budget to incentivise the NHS and local government to work more closely together around people, placing their well-being as the focus of health and care services.’ It aimed to deliver better, more joined-up local services for older and disabled people, caring for them in the community, keeping them out of hospital, easing pressure on the NHS and improving people’s lives. I’ll admit, it was an exciting prospect. The concept of making integration a reality, of social care providers being in at the beginning and helping to drive, shape and deliver innovative solutions to ease the pressure on the NHS with money specifically for it, what’s not to get excited about?

plans had to be resubmitted. Although the Government’s early planning assumption was that the Fund would save the NHS £1 billion in 2015-16, current plans forecast at least £314 million of savings for the NHS. ‘It was agreed that local areas would develop plans for spending the Fund with minimal central prescription, in order to drive local innovation from the bottom up, and reflecting the fact that no savings target had been formally agreed for the Fund during Spending Round 2013. As a result, there was no central programme team, no programme director and limited risk management and no analysis of local planning capacity, capability, or where local areas would need additional support. In addition, the initial scheme guidance did not mention the scale of savings expected from the Fund.’ But there were expectations of savings, £1 billion of NHS savings.

but delays and changes to the Fund’s design have weakened its credibility with local bodies and lost goodwill. It is deeply disturbing that local government believes the changes to targets and how the Fund will be run move the integration agenda backward and not forward.’ ‘The Better Care Fund is a complex and challenging initiative that clearly requires strong leadership and effective crossgovernment working, both of which have been lacking. It is hard to believe that until recently there was no central management team or programme director and there were only limited attempts to identify and manage risks to successful delivery. Such incompetence from Departments is unacceptable at a time when the number of people most likely to need care is rising, and overall funding is falling.’

‘A SHAMBLES’

THE REALITY

Margaret Hodge MP, Chair of the Committee of Public Accounts has called it ‘a shambles’. In a statement she said, ‘The integration of health and social care is fundamental to delivering more efficient and effective NHS and social care services... So I am dismayed that planning for the Better Care Fund has been such a shambles. ‘The Fund will not now deliver the £1 billion savings originally expected – savings which local areas were not initially told they should collectively deliver.’ She continued, ‘Successful delivery depends on goodwill and joint commitment

All this has left me feeling rather deflated. Local area plans for the Fund didn’t meet expectations but expectations weren’t communicated. Surely it’s not surprising then that plans fell short. Whilst I appreciate the sentiment of the laissez-faire approach, with something this ambitious looking to patch a huge hole in the NHS - surely some central Government direction and clarification of expectations were essential? Where we go from here and what this means for integration and the future of health and social care, only time will tell.

However, planning has fallen short. A National Audit Office report into the Fund has concluded, ‘the quality of early preparation and planning did not match the scale of ambition’. The organisation which scrutinises public spending for Parliament reported that, ‘Early local plans for the Fund, which will pool £5.3 billion of existing NHS and local authority funding in 2015-16, did not meet Ministers’ expectations or generate the level of savings the Government expected and all

WHAT’S NEXT?

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

We buy and sell care businesses and land We provide consultancy and valuation advice We don’t do anything else Dedicated to the healthcare sector – dedicated to you For more information about Carterwood or to find out how we can help you please telephone 08458 690777 info@carterwood.co.uk

www.carterwood.co.uk

CMM DECEMBER 2014 | 5

APPOINTMENTS APPOINTMENTS SPRINGFIELD HEALTHCARE APPOINTMENT Springfield Healthcare Group has appointed Mark Beadle to the board of the company as non-executive chairman. Mark was previously Chief Operating Officer at Priory Healthcare Group, Chief Executive at Capio Nightingale - which operates the Florence Nightingale Hospital - and Managing Director at Aitch Care Homes (ACH) which was sold in April. EVERMORE APPOINTS CHIEF OPERATING OFFICER Evermore has announced the appointment of Jennie Azizi as Chief Operating Officer. The former Operations Director of Care UK was Regional Operations Director at Anchor and held senior managerial roles with Marks & Spencer, Asda and Esporta. TWO APPOINTMENTS AT GLEN CARE Glen Care has appointed Lee Houghton as its Chief Operating Officer. A qualified Occupational Therapist, Lee brings many years of experience in both clinical and managerial roles to the position. Lee re-joins Glen Care from Vista Healthcare Independent Hospital after previously working for Glen Care as Director of Therapeutic Services. Dr Kiriakos Xenitidis, MD, MSc, MRCPsych, Consultant Psychiatrist has also joined Glen Care’s clinical team at the London Autistic Spectrum Centre in Anerley. Dr Xenitidis is one of the UK’s leading clinical and academic experts in the fields of Learning Disabilities, Adult ADHD and Autism Spectrum Disorders. CARTERWOOD STRENGTHENS TEAM Carterwood has appointed Jessamy Venables to support both the agency and consultancy teams. Jessamy is a highly experienced chartered surveyor with significant knowledge of the sector and is a former Director at GVA, where she worked in the healthcare team.

6 | CMM DECEMBER 2014

NEWS

• Planning • Local authority • Corporate News editor - Des Kelly ‘Better pay and support for workers’ The Joseph Rowntree Foundation (JRF) has called for sweeping change to ‘inject humanity’ back into care homes, with personal relationships put at the heart of how they are run and regulated. The call follows a year-long personal inquiry by John Kennedy - Director of Care Services at JRF and the Joseph Rowntree Housing Trust. The current blame culture, bureaucracy and business model have contributed to the ‘permanent sense of crisis’, says Mr Kennedy. The inquiry argues that human relationships and caring must be central to services. The care home inquiry took a fresh approach to find out what people really thought of the sector, using social media to broaden the range of views and seek an honest and immediate response from those closest to care homes. He spoke to people being cared for and people shaping the delivery of services.

The report makes a series of recommendations, including: Better pay, conditions and support for care workers - Care workers need to be rewarded sufficiently for their work. The care sector is one of the worst paid: three quarters of care workers earn around £6.45 per hour, 14p higher than the 2013 National Minimum Wage. Opportunities for training and development are limited for this highly-skilled, high-commitment occupation. Cutting paperwork - Workers need to have more time to spend on caring for residents and developing relationships. The inquiry identified more than 100 separate items of paperwork that care homes must complete regularly. Some managers reported spending 20% of their time on paperwork, rather than leadership activities that could improve care. Better funding for the sector - The way care is funded has led to minimum staffing levels and

Early ratings of ‘Good’ adult social care 21 services out of 31 reports published so far under the Care Quality Commission’s (CQC) new rating system have been judged as providing ‘Good’ standards of care. These first reports follow the CQC’s introduction of a new, more rigorous and expert-led approach of inspecting that was launched in October.

This includes rating care homes and other adult social care services for the first time as ‘Outstanding’, ‘Good’, ‘Requires Improvement’ and ‘Inadequate’ to help the public make informed choices about their care. Of the first 31 ratings, 21 are rated as ‘Good’, seven as ‘Requires Improvement’ and three as ‘Inadequate’.

poor pay. The sector accounts for 1.8% of national expenditure (£12 billion), yet is inadequately funded for the vital service it provides. Care homes should be an essential partner of the NHS. Extend the remit of regulation - Regulation should be more than inspection. Regulation should look at pay and working conditions, staffing levels, mission, commissioning practices and transparency of tariffs, in order to improve the quality of care. Creating a professional body to represent care managers - Managers were identified as focal points in running good homes and need to be supported in the leadership and development they offer staff. Managers should be registered and have a license to practice. The proposed body should set professional standards, have disciplinary powers and provide a voice at a national policy level.

NHS vision The NHS is at a crossroads and needs to change: that is the message from NHS England’s Chief Executive Simon Stevens, who has launched a five-year forward view for the NHS. The document outlines a vision of an NHS that can deliver better care and a better experience for patients while meeting the ongoing financial challenge. www.england.nhs.uk/ ourwork/futurenhs

£4.3 billion funding ‘black hole’ New analysis reveals a £4.3 billion funding black hole by the end of this decade. The Local Government Association and the Association of Directors of Adult Social Services have joined together to highlight that these alarming figures are almost a third of current annual adult social care spending, revealing councils as the most stretched part of the health and social care system. Thousands of older and disabled adults could be left uncertain about their future care and access to vital services such as homecare and

meals on wheels. It is also a stark warning that successful integration of health and social care next year is vital to save the care system from collapsing. The shortfall is set to be caused by a combination of reduced government funding and rising demand on services, in particular from the country’s rapidly ageing population. Over the last year alone, councils were forced to divert £900 million funding from other budgets simply to maintain the current level of service - despite making efficiency savings and receiving

additional money from the 2010 spending round. The pressures are set to continue and by 2020 councils will have to find £4.3 billion just to manage care services at the current levels. In just six months adult social care services will reach a critical point in England, with the pooling of funding from councils and the health service through the Better Care Fund and the introduction of the Care Act. Councils are already warning that these changes could bring even more additional pressures.

State of Care report highlights variations in quality The Care Quality Commission (CQC) has published its fifth State of Care report. The report finds that there are many excellent services, but the variation in quality is unacceptably wide. The report offers a perspective across 40,000 services in 2013/14 and shows how strong leadership and a positive culture are the key to safe care. The CQC report identifies several key areas where action is needed, saying that the

public should be at the heart of good care and providers should accept where there are problems and use inspections to drive up quality. Inspectors found that care homes with a registered care manager performed better than those which had been lacking a manager for six months or more. Among care homes, the CQC found that homes with fewer beds tended to perform better than larger units. For specialist

Involve people in personal budgets A survey looking at the experiences of personal budget holders and their carers based on the Personal Outcomes Evaluation Tool shows that people who use services are more likely to report good ‘outcomes’ when their views are included in the process and they are helped to plan their support. Another significant finding is that personal budget holders who experience the process as easy are three

times more likely to report good outcomes with having their health and social care needs met. Published by Think Local Act Personal, In Control and Lancaster University, the Third National Personal Budget Survey is the largest survey to date with over 4,000 participants. The survey is intended to support council practitioners to improve the delivery of personal budgets by learning from other areas.

learning disability homes, small homes (those with up to 10 beds) met 94% of standards, whereas large homes (those with more than 50 beds) met 85% of standards. For care homes for older people, small homes hit 90% of standards while the figure for large homes was 82%. CQC will use its new approach to shine a light on poor care, highlight good and outstanding practice and encourage a learning culture.

Guidance on new CQC requirements Skills for Care has produced a new free online guide to help providers ensure their services are ready for changes to regulation and inspection. Skills for Care’s Recommendation for CQC Providers Guide links to resources to help providers prepare for and meet key areas of workforce requirements in CQC’s regulation.

APPOINTMENTS APPOINTMENTS SKILLS FOR CARE ANNOUNCES NEW BOARD MEMBERS Professor David CroisdaleAppleby has announced the new, 15 member Board of Skills for Care who take up their new duties in November. The Board will guide the work of Skills for Care and the National Skills Academy of Social Care who merged in June 2014. The 15 Skills for Care board members are: Dame Moira Gibb DBE (Chair Designate); Helen Wilcox (Vice-Chair); Anita Astle MBE; Peter Beresford OBE; Peter Hodkinson; Des Kelly OBE; Gary Kent; Deborah McKenzie; Frances Mills; Nina Osborne; Judith Salmon; Stephen Sloss; David Sutton; Frank Ursell and Brian Walsh. THE MENTAL HEALTH FOUNDATION The Mental Health Foundation appointed Isabella Goldie, who was Head of Scotland for the organisation from 20052014 to the role of Directory of Delivery and Development for the Foundation across the UK. She will be responsible for the Foundation’s research and policy programmes as well as developing new areas and will manage a staff team who are specialist in research, policy and a range of equality issues including learning disability in her new role. COOPER HEALTHCARE EXPANDS TEAM Cooper Healthcare has welcomed Ian Catterall to the team to strengthen the company’s presence locally and nationally. SEQUENCE CARE GROUP APPOINTS NEW CHIEF EXECUTIVE Chief Executive, Kit Doleman is set to leave Sequence Care Group. Ian Coldrick former Business Operations and Project Director at the Priory Group will become Sequence’s new Chief Executive. Sequence Care has also announced that it is changing its name from CuroCare.

CMM DECEMBER 2014 | 7

news / in focus

IN FOCUS Statutory guidance on Care Act published WHAT’S THE STORY? The Department of Health has published the statutory guidance to support implementation of Part One of the Care Act 2014. It comprises a full 506 pages, including an easy read summary of the guidance which stands at just 46 pages.

major reforms to the legal framework for adult social care in England with new duties for local authorities, new entitlements for people receiving care and their carers and new regulations and standards. It also introduces a new funding system for care and support.

WHY IS THIS IMPORTANT?

WHAT WILL IT MEAN FOR CARE PROVIDERS?

The Care Act brings together care and support legislation into a single act with a new well-being principle at its heart. It introduces

Implementation of the Care Act from April 2015 will have significant implications for care providers in England. These

changes mean that councils are likely to assess and commission care services differently. The statutory guidance published by the Department of Health sets out in detail how it is meant to work.

ARE YOU PREPARED? The statutory guidance is essential reading for care providers. The Department of Health has produced a series of factsheets covering the key themes of the Care Act. In addition, there are already a

range of free resources developed by bodies such as the Social Care Institute for Excellence and Skills for Care which will help providers to understand the implications and to be ready.

WHERE CAN I FIND THE GUIDANCE? The Department of Health’s guidance can be found on the Gov.uk website: www.gov.uk/ government/publications/careact-2014-statutory-guidance-forimplementation

CQC discuss surveillance CQC fees consultation The CQC Board has considered its approach to the use of surveillance to monitor care in health and social care settings.

A final paper to set out proposals for publishing information about the use of covert and overt surveillance is expected.

Modest fee rate increase seen in 2014 Key findings from Knight Frank’s Care Homes Trading Performance Review 2014 show that average fee rates have increased by 2.1% during 2013/14 - almost double the rise seen the previous year. However, this rise equates to a fourth successive year of falling fees in real terms, with the Retail Price Index, a standard measure of inflation, running at 2.5% for the period. Diverging fortunes were found between nursing and personal care. Overall, personal care homes have a higher occupancy rate and have seen a stronger rate of fee growth than care with nursing. The report also found that: • Occupancy rates increased marginally, although rising costs are putting margins 8 | CMM DECEMBER 2014

under pressure. • Rising staff costs are a pressing challenge for operators. • Staff costs have come to £19,531 per resident for the financial year 2013/14 – a like-for-like increase of 2.9% from last year. • Trading performance remains strongest in Greater London and the South East region. • Many providers are repositioning their existing care facilities towards personal care instead of nursing care. • Geographical polarisation remains an important theme, a challenge will be the replacement of poor quality stock in order to meet care demand in areas outside the South East.

The Care Quality Commission (CQC) has published a consultation about the fees that it proposes to charge registered providers in 2015/16. It includes proposals to increase annual fees for all registered providers except for the dental sector and amend the fee scheme for independent healthcare providers, whose fees increased due only to structural changes made in the

2013/14 fees scheme. With these increases included, the CQC expects providers will still typically pay 1% or less of their income in fees to CQC. The impact of the proposed fee increase on a typical care home would be £238. The consultation runs until noon on 9th January 2015 and is available at www.cqc.org.uk/ organisations-we-regulate/ registered-services/fees

Eden Futures’ acquisition Eden Futures has announced that Supported Homes Limited has joined the Eden Futures group. Supported Homes provides 24-hour support to over 40 vulnerable people with a range of mental health illnesses and/ or Asperger’s Syndrome at eight locations across the North West, West Midlands, and Welsh borders. Eden Futures and Supported Homes share a similar approach and culture. The combined team of approaching 2000 staff have a sector-leading depth of

experience and knowledge. By joining Eden Futures, Supported Homes further strengthens the capabilities of the group to provide the very best services to the people they support and their commissioners. The combined group now provides support and partnered housing solutions for over 800 people with a range of disabilities across England. Richard Clarke, former director/owner, will be joining the Eden Futures executive team as Head of Operations North West and Wales.

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CMM DECEMBER 2014 | 9

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Make the commitment to provide quality care. The Social Care Commitment is for all those working in adult social care. Signing up involves agreeing to statements and tasks that reflect good practice and will help with learning and development.

www.thesocialcarecommitment.org.uk

10 | CMM DECEMBER 2014

property news

North Star starts projects Work begins on four residential, nursing and specialist dementia healthcare projects across the UK as North Star gets on site to develop five star home from home environments. Totalling over £15 million, the projects will see the company’s professional team come together to deliver a total of

New £4.75m care home

220 beds, 17 studio apartments and 25 extra care bungalows. The projects, which are based in Gloucester, Glasgow, and Norfolk, will provide specialist residential, nursing and dementia care for elderly people in environments that have been designed to be as flexible as possible to meet a range of complex care needs.

Chronic lack of purposebuilt retirement housing Britain is not building enough retirement housing to cater for demand from a rapidly ageing population, according to property consultancy Knight Frank. The Retirement Housing report shows that such housing makes up only 2.8% of all new homes currently under construction in the UK. With the over 65s making up nearly 23% of the national population in the next 20 years, the lack of supply will compound a significant structural shortfall in purpose-built retirement homes. According to a survey conducted for the report, a

quarter of over 55s say they are likely to consider relocating to a retirement village in the future - suggesting that 4.4 million over-55s would consider buying or renting a purpose-built retirement property. The ‘retirement homes’ examined in the report include all developments designed with older people in mind, some with levels of care provided, but exclude care homes. With a clear undersupply on the horizon, there are signals that the appetite to build elderly housing (units built specifically for older people) may be set to pick up in the years to come.

A new state of the art care home has opened in Brentwood. Howard Lodge II is a new 68 bedroom care home, located within Kelvendon Common, in Essex. The home is owned and run by St Michaels Homes Ltd who secured funding to support the project from The Royal Bank of Scotland (RBS) using the bank’s Funding for Lending Scheme (FLS). St Michaels Homes Ltd constructed the new facility in the grounds of its existing home Howard Lodge which will be demolished as a result of the completion of the new home. Incorporating fresh and up

to date design, Howard Lodge II will provide residents and staff with much improved and modern facilities and more accommodation than its predecessor. Bed capacity has been increased from 44 to 68 and all rooms have ensuite facilities. Howard Lodge II also offers its residents a hairdressers, sun terrace/ balconies, activity and training facility, day care centre, tea room, dining and living rooms on each wing and landscaped gardens. The new facilities will benefit existing residents as well as providing increased space for newcomers welcomed to the home.

Christie + Co to sell closed care home Christie + Co is selling the former Purbeck Care Home in Wareham, Dorset, on behalf of Joint Administrators, Duncan Swift, Miles Needham and Jeremy Willmont of Moore Stephens LLP. Located in the village of East Stoke, approximately four miles from Wareham, the site comprises a variety of buildings which

are set in 17 acres of grounds encompassing a main building, formerly known as Binnegar Hall, lawned area, paddock, walled garden and workshops. The business went into Administration on 15th July 2014 having previously been registered for 52 residents with learning disabilities.

Strong local demand for housing-with-care Carterwood has published new research in conjunction with Associated Retirement Community Operators (ARCO) and its members to determine patterns of those moving, retiring and downsizing into extra care housing. The research involved information from over 3,800 residents on the distances between the postcodes of their last homes and the postcodes of

the housing-with-care schemes where they currently reside. Responses were calculated and then cross-referenced to the data with a number of different variables, including the location of next of kin, tenure type and age profile. The influence of local geography is a strong determining factor for people moving into an extra care scheme and the research reveals

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the key factors affecting how geography impacts on supply and demand. Residents moved to schemes within their local area, where available. The average moving distance was just over three miles – very similar to the care home market. There were some differences between tenure, with local authority funded extra care schemes having lower moving distances (at under two miles), which can

be attributed to local authorities often having nomination rights. The research also showed that moving distances were equally low (at around five miles) in the leasehold market. There were some variations, with residents in ‘middle market’ schemes moving an average of 3.4 miles, while those in highend schemes moving much further on average, at just under 20 miles.

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CMM DECEMBER 2014 | 11

corporate news

Market hindered by falling fees NHP and HC-One acquired The UK healthcare market has experienced another consecutive increase in the number of residents in care homes for the third time in eighteen months according to Colliers International’s Care Homes Review. However, despite augmented demand, profit margins are on a downward trajectory due to limited public funding as operators increasingly struggle to absorb costs. The report, which focuses on the five key performance indicators including occupancy rates, average weekly fees, payroll costs, non-payroll costs and profit margins (EBITDAR), found that occupancy levels are continuing to rise and now exceed 90%. Despite stronger occupancy, profit margins are becoming tighter; falling fee levels and rising costs have meant profitability has fallen in both nursing and specialist care and have remained unchanged in the nursing home sector. Average weekly fees have been edging lower with real fees

(with inflation taken into account) tracking down in 2014, especially in the nursing sector. Nursing fees declined 3% in real terms to £637 per week and by 12.6% since 2009. Specialist care homes saw weekly fees fall further, by 6.7% in real terms, putting even greater pressure on profits. Personal care has fared better, maintaining its average fee but has seen a 1.3% decrease in real terms. Whilst analysis in H1 2014 has shown a small decline in nursing payroll costs, the challenge of staff recruitment continues. The recent National Minimum Wage increase was also an inevitable cost to be absorbed. Non-payroll costs across all sectors went up slightly in H1 2014. Rising costs in food and energy are further pressures. High quality care homes have been trading between 5% and 6% in the South East, but regional assets and portfolios that were trading between 7.5% and 8% last year are seeing transactional yields at 7% or better.

NHP has announced that Formation Capital in partnership with Safanad, a global investment principal firm, and Court Cavendish, the healthcare turnaround specialist and management team at HC-One, have signed a

binding commitment to acquire NHP. The deal is expected to complete in November 2014. The final deal sees NHP acquired for £477million. For more information on the acquisition, see Business Clinic on page 26.

Priory sale and leaseback properties Priory Group, the UK’s leading independent provider of specialist care has announced that it has reached an agreement with leading investment manager, M&G Investments, for the sale and leaseback of a portfolio of six acute psychiatric hospitals for £223million. All of the proceeds of the sale will be reinvested in the business to pay down debt. The six hospitals are located in Altrincham,

Bristol, Chelmsford, North London, Roehampton and Woking. Service users and commissioning arrangements at the six sites will be unaffected by the transaction. Priory has spent £127million on improving the quality of its estate since acquisition by Advent in March 2011 through to June 2014 and will continue to invest in its portfolio sites to drive future growth and improve service user experience.

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corporate news

Target Healthcare REIT acquisition Target Healthcare REIT Limited has acquired three purpose-built care homes in Yorkshire and Lancashire, for approximately £13.3million including acquisition costs. The homes are located in: Fleetwood, Lancashire; Rastrick, West Yorkshire; and Sutton-inCraven, North Yorkshire. They were acquired from Clerical Medical (part of Aberdeen Asset Management plc).

With a total of 201 rooms, the homes offer residential and nursing care. The homes will continue to be operated by Orchard Care Homes for a period of approximately 28 years. The transaction represents an initial yield of 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. This

transaction is the first following the company’s recent fundraising and is in line with the details published in the Prospectus of 5 September 2014. This will bring the total funds invested by the company to £129 million, through a combination of equity raised and the use of term loan and revolving credit facilities provided by the Royal Bank of Scotland plc.

Danshell’s 2014 and new service One year on from a major expansion, Danshell is on track to complete Phase One of its five year plan. The company acquired 20 new services in September 2013 following its buyout of Castlebeck from administration. Following a comprehensive review of its services and after detailed consultation with commissioners, bed managers and the NHS, a number of services have been reconfigured

to meet local requirements. The company has already worked with local commissioners in Essex and the North East to design ‘bespoke’ services and expects to continue this partnership working across the country. Its first bespoke service has opened in Hartlepool. Phase one of the plan also involved assessing the quality of care and ensuring regulatory compliance. Recruitment of caring, professional staff and the

appointment of a new team to assess and prioritise training and development was also a priority. Addressing occupancy levels followed once all systems were integrated across the services and the company was confident with the quality of the care. The improvements made and the renewed confidence in the services from commissioner has led to a considerably higher rate of referrals and admissions.

Sanctuary Supported Living Sanctuary Supported Living (SSL) has secured framework agreements for three new services in the north of the country. The organisation has reached agreements with local authorities in Sheffield, Stockton and the East Riding of Yorkshire. A framework agreement with East Riding of Yorkshire Council will see SSL providing housing support for young people in the county aged 16 to 25 leaving local authority care. Sanctuary Supported Living will also be on the framework to operate a learning disability and mental health service for Sheffield City Council. In addition, under a threeyear framework agreement with Stockton-on-Tees Borough Council, the organisation will provide floating support for clients with a range of needs.

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local authority and planning news

Barnsley care home opens The opening of a new care home in Barnsley, funded by Yorkshire Bank, will create more than 40 jobs and deliver much-needed care for the elderly and those with specialist needs. Ward Green Lodge Care Home, near Worsbrough, south of Barnsley, is a purpose-built care home able to cater for 64 residents and is being delivered by one of the UK’s

leading psychiatrists, Dr Darryl Britto. Ward Green Lodge Care Home, owned by the Britto family, opened in September, having been supported with a seven-figure funding package by Yorkshire Bank. The deal was delivered by Gail Fielding, Yorkshire Bank’s healthcare business development manager in the East of England.

New Care Projects With build well underway and the opening scheduled for March 2015, New Care Projects has exclusively unveiled plans for its £7million care facility in West Bridgford. The purpose-built 82 bed care home, located on Greythorne Drive, will be known as The Grand. The facility will benefit from an array of communal lounges and dining rooms, as well as boasting a cinema, a snoezelen room and retail coffee shop. Each well-

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appointed bedroom will enjoy spacious en-suite wet room facilities. The Grand will offer residential, nursing and dementia care services. Its team of qualified nurses, carers and in-house occupational therapist and physiotherapist will deliver New Care’s ‘enablement’ philosophy; working with the individual to maintain their health and well-being, as well as encourage independence for as long as possible.

Dorset County Council LATC Dorset County Council has voted to begin implementation of a Local Authority Trading Company (LATC) for its adult care services. The Council is facing increasing pressure from an ageing population and demand for services is rising. Councillors recently agreed that a LATC was the best way to ‘deliver and sustain high quality care for adults and communities, including older people, people with a learning disability and people with a disability, in the long term.’ The Council plans to

have the company launched and trading in the 2015/16 financial year. A further vote will be taken this year as to whether the LATC will incorporate Bournemouth and Poole. The following adult social care provider services will be within the scope of the LATC - care catering services; residential services; day services; reablement services; Shared Lives; and Oh Crumbs! a service offering people with a disability the chance to develop work skills and experience.

Anchor milestone in Surrey Anchor and construction partner Castleoak have moved another step closer to delivering a luxury £12.4million retirement apartment development in Weybridge, Surrey, with a ceremony to mark the completion of the building footprint. The new development,

named Austin Place, will have 65 one- and two-bedroom luxury apartments which will be offered exclusively for sale. Communal facilities will include a hair and beauty salon, treatment room, coffee shop, lounges, a reading room and landscaped gardens. Austin Place will open in 2016.

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local authority and planning news

Liverpool City Council considers adult social care Liverpool City Council is looking to approve plans which will see most of its day centres remain open, following a major review and consultation. The aim is to ensure the city council can continue to support people in the face of £156 million of central Government funding cuts over the next three years, while at the same time delivering £3million of savings per year. The plans were developed following informal consultation with service users, staff and carers and are designed to preserve the council’s skills and expertise in looking after some of the most vulnerable clients,

and make better use of some of the council’s buildings. In mental health, the city will continue to have two ‘hubs’, with more emphasis placed on recovery and reablement as well as offering longer term support. The council will continue to run the five centres, which provide specialist services for the most vulnerable and three centres, which mainly support older people, offering 24 hour reablement care as well as some day services. A further five centres will remain open but will be transferred to external organisations. Other services will be relocated, developed and changed.

Mental health support in Essex Metropolitan has been awarded the contract to implement a new mental health Intensive Enablement supported housing service across Essex. The three-year contract, which was awarded following a competitive tendering process, started in mid-September and has a twoyear extension option. Metropolitan is the sole support partner to Essex County Council for the new supported housing service, which will provide an alternative to residential care wherever possible, and will enable individuals to move on to more independent settings as appropriate. The service has been introduced to help adults who have enduring and

complex mental health needs, some of whom may have had long stays in residential or hospital-based services, and who, with support, will be able to achieve greater independence. Under the service, Metropolitan is delivering 18 months of high quality, recovery-focused intensive support designed around the needs of each individual. Metropolitan is responsible for sourcing 44 of a total of 79 accommodation units for the new contract, which is valued at £1.4million per annum, and will be delivered from schemes in North East, Mid, South and West Essex (excluding Southend and Thurrock).

The homes under consultation are: Brockhurst in Ottershaw, Cobgates in Farnham, Dormers in Caterham, Longfield in

Cranleigh, Park Hall in Reigate and Pinehurst in Camberley. Further information can be found at www.surreysays.co.uk.

Surrey consults on care homes Surrey County Council is consulting on the futures of six residential care homes owned and operated by the council in the

county. The consultation is due to run until 12th December 2014 and is open to anyone who wants to participate.

Planning permission granted for Cornwall Care Cornwall Care has been granted planning permission by Cornwall Council for a 72 bedroom care home with a 75 unit extra care scheme in Wadebridge. Carterwood, the chartered surveyor’s specialising in the long-term care sector, assisted Cornwall Care in the planning application by providing a needs assessment. Ben Hartley,

Director at Carterwood said, ‘Our analysis of the Wadebridge area indicated that there is a significant under-provision of specialist, dedicated dementia care beds which the subject scheme will be capable of providing. ‘Therefore we are delighted that Cornwall Council have granted this planning permission at committee stage.’

Sutton Coldfield scheme achieves planning Brassington Avenue, a 240 unit development designed for older people in Sutton Coldfield has won planning permission. The scheme is designed to deliver a pioneering approach to retirement housing, conceived by specialist developer PegasusLife. The site at Brassington Avenue, designed by Glenn Howells Architects in

collaboration with Camlins Landscape Architects, will deliver five residential towers set around a central two-storey podium core. Each tower will be ‘rotated’ in response to views and infiltration of sunlight and the towers are thoughtfully distributed to allow plenty of space and light into the residencies.

CMM DECEMBER 2014 | 15

A YEAR OF IMMENSE CHANGE? As 2014 draws to an end, CMM has asked Des Kelly, Roger Harcourt and David Pearson to give their thoughts on what 2015 will bring for the sector. With so much happening, is it time to face the change head on?

16 | CMM DECEMBER 2014

Looking to 2015: The experience of quality will become paramount Des Kelly OBE, Executive Director, National Care Forum

I predict that 2015 will be a landmark year for the care sector. Why? There are so many competing priorities to be addressed. They include, in no particular order, future funding; demographic pressures; public sector cuts and continuing austerity measures; dementia and other long-term conditions; quality concerns; reform of regulation; commissioning for outcomes; transformation; integrating health and care. Take your pick - they are all challenging. 2015 will bring the implementation of the Care Act and with it changes to fundamental standards, regulation and inspection, scrutiny and overview. There are three particular features to consider simultaneously. The first is that these radical reforms to social care are taking place following at least five years of austerity, resulting in substantial reductions in public sector funding. The context, therefore, is a sector suffering the pressures of underfunding. Secondly, future funding remains uncertain until the Department of Health consults on its proposals and plans (and the Governments interpretation of the Dilnot Commission recommendations are not due to commence until April 2016). The third, and most pressing factor, is the fact that in May 2015 there will be a General Election. There could be a change in policy direction. That said, it seems there is already evidence to suggest that health and care will be a key election issue. We can, therefore, expect a lot of media coverage of pressures on the NHS. It is to be hoped that social care providers can use the opportunity to emphasise

the importance of the relationship between health and social care. Integration of health and social care is starting to happen, but it still has so much more potential. We are only just beginning to appreciate how social media will affect the provision of care services. It has already brought a new dimension to notions of openness, transparency and accountability. Information gets into the public domain so quickly and comprehensively; social media has the power to undermine reputations that have taken a long time to build. I believe that the provision of care and support services, and their quality, will increasingly be subject to such public scrutiny with opinions aired before there has been a chance to investigate and form a judgement. How providers react will be in the spotlight… And watched by the media. Add this to the mix of a duty of candour, fitness of purpose for management and corporate accountability: robust governance systems will be necessary. Don’t get me wrong, I welcome these different ways to improve quality of care and support services and taken together they will strengthen inspection and regulation. Quality, however, cannot be inspected into a service. Quality cannot be commissioned into a service. Clearly they are both important, but it is the experience of quality that has primary significance – that is the outcome defined by the person receiving the service and the responsibility of the provider. Let’s hope that the New Year progresses our understanding of these vital elements.

CMM DECEMBER 2014 | 17

2015 – a year of immense change?

2015 – A year of immense change? Undoubtedly ‘yes’ Roger Harcourt, Partner and Head of Healthcare, Shakespeares

The title poses a question to which the answer is undoubtedly ‘yes’ and the medium-term outlook suggests that the only constant is change. Some changes impacting in 2015 are generated by improvements that have inbuilt implications for the future. The first stage of the Care Act 2014 comes into force, to be followed in 2016 by the second stage. The first part (effective April 2015) deals with care and support reform. It focuses, amongst many other things, on ‘wellbeing’ along with duties and powers to ‘meet needs’ which replace previous entitlements to services. There is a focus also on the prevention, reduction and delay of needs arising. What is less well appreciated is that the Care Quality Commission (CQC) will be bringing in its oversight regime of the financial health of ‘difficult to replace’ providers. This cannot just apply to large national operators, as it needs to look at the local landscape. Are you a medium-sized local provider, with high borrowing relative to the value and profitability of your homes? Will the CQC ‘control’ the lending and sales market by indicating what the sensible levels for bank leverage and debt service cover are? The second stage of the Care Act comes into force in April 2016 and includes the cap on care costs. This will require education of the general public, the majority of who still think that this means all care costs and not just the care element. Once the care element cost has been quantified by local authorities, this will create transparency in the level of ‘hotel costs’ included within a fee and perhaps some interesting discussions between families and care home operators. Will this create a transfer to lower cost providers, or will the family take the view that they will still pay the fees because they want ‘the best’ for Mum and/or Dad? The Better Care Fund moves into the mandatory phase for local authorities and Clinical Commissioning Groups to pool budgets from 2015. The driver is to deliver more integrated commissioning of health

and social care and reduce pressure on NHS hospitals. The single pooled fund across the country for 2015/16 is set at £3.8 billion, with £3 billion of this coming from the NHS budget. Examples of targeted activity include reductions in avoidable emergency admissions, reductions in non-elective length of stay, and a reduction in the delayed transfer of care. These provide clear opportunities for the market to respond with provision of step up/step down care, reablement/ rehabilitation services, together with respite and outreach provision. There will undoubtedly be further pressures on local authority budgets in 2015 and beyond. These fee pressures have led to newbuild care homes mainly being built in areas where there is a greater proportion of self-funders and top-ups available. There has been a North/South divide in new-build activity in the sector for a few years now and the difference in the trading performance of homes across the UK is clearly evident in the recently released Knight Frank 2014 Care Homes Trading Performance Review. With land prices south of the A14 corridor now heating up, providers are looking to the Midlands and North with greater focus, but generally only the affluent areas. Quality ratings are being re-introduced by the CQC, at the same time as what appears to be much more rigorous testing of providers and less tolerance of poor provision across the various areas inspected. So long as we see consistency from the CQC, this will provide the public with an independent ratings system which they clearly value. Oh and finally, there is a General Election in 2015 to boot, which if it results in the election of a Labour Government, brings with it the intention to repeal the Care Act 2014 – but how quickly will this happen and what will the intention to provide social care linked to the NHS bring with it in terms of large scale structural change and opportunities? 2015 – A year of immense change? I think so!

2015 – A wide range of issues and challenges to be addressed David Pearson, President, Association of Directors of Adult Social Services

The view of what 2015 will bring was acutely highlighted at the recent National Adults and Children’s Services Conference. The hunger for local councillors, members, providers and advocacy groups working with government departments to seek solutions and innovation was evidenced by the fact that the delegate list had to be closed a week before the conference. The mood was positive about the opportunities and authentic about the challenges. Ministers and shadow ministers were all in attendance. There was a wide range of issues covered. Announcements included the approval of the overwhelming majority of Better Care Fund Plans; new Standards for Commissioning by local authorities in adult social care; a joint paper on integration by the Royal College of GPs and the college of social workers, and a myriad other developments and contributions about the Care Act. These are all principled ways of saving money and how to progress the personalisation of services. The recently-published Barker Commission report also produces a forward look at how a more joined-up health and care service may develop. However, it emphasises that integration is not going to be a silver bullet for the problem of how to sustain health and social care as needs rise. A major challenge to continue into 2015 is the need to save 26 per cent of £3.5billion in social care over the last few years. This has 18 | CMM DECEMBER 2014

prompted leaders, service users and colleagues up and down the country to dig deep to find creative solutions and mitigate, as far as possible, the impact. Reductions, savings and efficiencies of that magnitude can easily blunt enthusiasm, deaden creativity and frustrate the urge in social care to make a better world. The conference also saw the publication of a joint document between the Association of Directors of Adult Social Services and the Local Government Association on adult social care funding. We have had a thorough exploration over recent weeks of the £30billion gap in the health service budget over the next few years, the paper highlights that by the end of the decade the equivalent gap is £4.3billion in adult social care. Directors fear that people who need services may not be able to access them; the quality of care may deteriorate and that it may not be possible to deal effectively with the pressures from the health service to ensure that people get the right care at the right time. There is a culture of ‘can-do’ in social care. A future of personcentred, co-ordinated care, and personal budgets as part of a system of integrated care built on promoting wellbeing is being explored with enthusiasm. To realise the aspirations of the Care Act, we will need this determination and resolve in pushing forward with innovation. At the same time, we must ensure that there is no let-up in explaining the need for this resolve to be supported by sustainable funding for social care as well as health. CMM

CMM DECEMBER 2014 | 19

There are many adult social care professionals who believe that parts of the care home sector are on the brink of collapse, and that current levels of provision cannot possibly be maintained, given static, or falling, levels of income into the system.

PRESSURE ON THE SECTOR A combination of social policy shift and economic conditions has led to a situation where many private owners face a bleak future, in particular those with a large reliance on publiclyfunded placement. For these owners there is the constant struggle to balance a high level of fixed cost (necessary in order to provide even minimum levels of care) against diminishing incomes. In many cases, this is exacerbated by a significant debt burden. The pre-2008 boom period left behind a legacy of debt that is fast becoming unsustainable in an era of austerity. Local authority referrals, always a significant revenue stream for the sector, have declined in number and value. The overarching strategy for public social care no longer involves large block placements. The development of new technologies and new services, along with a determination on the part of central Government and social services departments, across the country, to produce a real shift in the way care is commissioned and delivered, has led to real change in the adult social care landscape. There are those who have been able to survive and adapt, and there is still a flourishing high-end market. But even giants of the sector, such as Southern Cross, found the new economic reality impossible to stand up to. At the lower end of the market, where publicly-funded beds make up a significant proportion of, or in some cases all, income, the situation is becoming bleaker, and this has led to an increasing number of closures. The tragic story of two Lincolnshire care home owners committing suicide before they had been due to tell staff that their home was to shut underlines the desperation that some will inevitably feel. The knock-on effect is the pain and anguish suffered by residents, through the uncertainty and upheaval that closure, or the threat of it, brings. 20 | CMM DECEMBER 2014

STICK or TWIST

The situation can be summed up as follows: • Owners of homes with a significant reliance on local authority funded placement have broadly seen reductions in profitability, and in many cases, occupancy. • Profit margins have decreased or been eradicated by year-on-year baseline rates losing ground on inflation and costs within the sector. • Wages in the sector are low, attracting a limited staff pool, and consequently quality of care can suffer due to lack of motivation. • Wholly publicly-funded residents now make up less than 30 per cent of the total market. • The gap between wholly privatelyfunded homes and those reliant on publicly-funded placement is growing fast, leading to a two-tier system evolving. • New developments are concentrating on future-proofed schemes, further exacerbating the gap in provision quality. Debbie Le Quesne, Chair of the West Midlands Care Association, which represents several hundred owners, sums up the dilemma for her members when she says, ‘Many have developed businesses based on their local authority placing people into their homes at adequate rates. However, the industry has now changed, and local authorities aren’t placing in the way they did. On top of this, the rates they are now paying are no longer even adequate. Many owners are struggling to make ends meet, but at the same time they need to change the way their business works and appeals to the market. It is difficult for many to come to terms with.’

STICK OR TWIST? The situation begs two questions. Firstly, can those home owners, who have been traditionally heavily reliant on publicly-funded placement, begin to alter their business model? And secondly, are they willing to make the mindset leap needed to accomplish the sort of changes that may be required? Common sense alone suggests that the status quo cannot remain, without resulting in a downward spiral of

CMM DECEMBER 2014 | 21

22 | CMM DECEMBER 2014

stick or twist: can you afford to sit still in a changing market?

care. The ‘do nothing’ model will lead to slow decline. We are now faced with an industry where, unless there is a radical shift of emphasis by some owners, there will be a rash of business failures over the coming years. Much of the problem lies in the fact that the sector is not traditionally marketing-led. Owner and operator focus has traditionally been inward, not outward, looking. The provision of care, and the logistical demands it imposes on a business have been the core business driver, rather than a desire to ‘sell’ to the marketplace. Many owners who thought their income stream was guaranteed and who borrowed pre-recession to develop their business on the back of that assumption are now facing a difficult future. Ill-equipped and poorly-resourced to cope with an industry where less and less is ‘guaranteed’ there is a desperate need for fresh impetus. Of course, change is difficult and often slow to achieve an impact, particularly on the bottom line. However, we now have an industry where unless there is a radical shift of emphasis by some owners, there will be a rash of business failures over the coming years. For many the problem will become a lack of clear thinking as they concentrate on fire-fighting. The crucial first question that owners should ask themselves is, ‘am I willing to change things?’ If the answer is ‘no’ then there are different routes for an ailing business to consider including closure, sale or merger. For those answering ‘yes’ it might be useful to illustrate one way the thought process might flow from that decision (Figure 1).

SIGNIFICANT CONSIDERATIONS The seven areas along the bottom of the figure can all seem daunting to an owner not used to thinking about the impact they make on the potential resident or their relatives, ie the marketplace. Within each of them there are many follow-on considerations that will impact towards the regeneration of a business. However, not only are economic pressures making this necessary, but public expectation and regulatory change are also driving forces.

HOW IS MY BUSINESS INCOME DERIVED? What has happened to that income in the last five years?

Is my business model sustainable given current trends?

WHO AM I AIMING TO ATTRACT TO MY HOME? Existing local authority placement, where possible

New, partly or wholly, privately-funded residents

WHAT AREAS DO I NEED TO LOOK AT TO CHANGE MY HOME? Capital expenditure

Staffing

Training

Marketing

Pricing

Competition New regulatory activity inspections

Figure 1 – Thought processes when deciding how to adapt your business In recent years, the public has been bombarded with care home abuse scandals, a sector in crisis, large scale closures and the like. They are more aware, informed and their demands are growing. The decision they make about placement of a relative is highly stressful; there is a natural desire to get it right. That pressure transfers onto homes to deliver more than just minimum standards. Complacency is no longer an option; making the right impression is of paramount importance if an owner is looking to attract revenue from new sources. This is also true in relation to the regulatory change that is coming. The CQC has announced its new criteria for judging a homes’ performance, and a new rating system to go along with it. When it is fully rolled out there is bound to be considerable fanfare that the public will take notice of. It is crucial that owners take on board the shifts in emphasis that the new inspections will bring. Five key questions form the bedrock of the new system: Is the service safe? Is the service effective? Is the service caring? Is the service responsive to people’s needs? Is the service well led? In order to reach these conclusions there is going to be much greater interaction with the public experience. There is clearly a desire to move away from a system with a ‘tick the box’ process driven mentality, towards one that takes into account real experiences

and real views. There are now to be four gradings, with nothing between ‘good’ and ‘needs improvement’. In other words, if you’re not good, then you need to change. Home owners will need to shift their focus accordingly. Andrea Sutcliffe, Chief Inspector of Adult Social Care, has said, ‘To make sure that our regulatory approach is truly personalised I want us to consider for every service we look at – is this good enough for my Mum (or any other member of my family)? If it is, that is fantastic. If it’s not then we need to do something about it.’

OBJECTIVE EVALUATION Making an objective evaluation of your own business is often difficult. It requires a detachment that, very often, is hard to achieve. Debbie Le Quesne from West Midlands Care Association summed it up, ‘Many of our owners don’t know where to start to make change. Our job is to stimulate the thought process. We as a care association need to help them achieve those changes that will hopefully ensure their businesses continue, despite the rapidly shifting social care landscape.’ This is not the time for an ostrich, head in the sand, mentality. Commissioning strategy for adult social care has changed massively over the past decade. Owners who ignore that change, and who don’t make changes of their own, face a very uncertain future. CMM Chris Tarry is a social care business and marketing consultant. Email: chris.tarry@icloud.com

CMM DECEMBER 2014 | 23

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I graduated from Nottingham Trent University with a degree in Residential Development. I then worked at McCarthy & Stone as an Assistant Land Buyer before joining Linden Homes as Senior Land Manager so my background and expertise is in land; sourcing suitable sites for development. In 2001, I founded Villafont Homes, a luxury housebuilder, and started to build in the North West. In 2008, I joined the board at McGoff & Byrne, our privatelyowned construction business. In 2009, I established New Care Projects. I identify sites for development, negotiate contracts, manage the planning and technical process, de-risk the construction process, and explore funding solutions. I am heavily involved in every stage of the process from concept and innovation to physical construction delivery. Our construction and development expertise make us a unique ‘derisked’ delivery offering in the care space. Our facilities are located in areas where there is an identified need for our ‘New Generation’ product, where there is a strong bias for private fee pay and where an identified deficiency in a care/ clinical offering is evident.

HOW DOES IT FIT WITH CARE?

My background with a bias in property and construction is ideally suited to the care sector as both industries are heavily regulated and diverse in terms of characteristics and people you have to deal with.

WHAT ARE YOUR THOUGHTS ON SOCIAL CARE’S FUTURE?

There is no silver bullet for the future of social care, but providers from all areas of the spectrum need to be appropriately paid a fair price

for the service they provide. Cost pressures are increasing and too many commissioning authorities don’t want to recognise this fact against the backdrop of rising pressures associated with an increasingly elderly demographic. I also think providers need to grasp the local healthcare economy and future commissioning expectations. We are one of only a handful of care home operators to employ in-house occupational therapists and physiotherapists, whose focus is primarily to reduce the risk of falls and take forward our philosophy of ‘enablement’. The health and wellbeing of our residents is paramount and we want all of our residents to remain as independent as possible for as long as possible. Having this multidisciplinary approach ensures we offer our residents the best levels of care to suit their individual needs. It also reduces the need for costly secondary care services.

WHAT OPPORTUNITIES DOES IT POSE FOR PROVIDERS?

Better buildings create a platform for better care and there is a desperate need to drive operational efficiencies to raise standards for less money and this can often only be achieved via the creation of new generation facilities. Our care homes are purpose-built, specifically designed to provide a comprehensive range of high standard care options and cater for the rising aspirations of the older generation. As we are a uniquely positioned developmentled care home operator, we are well placed to take advantage of this growing need.

WHAT’S THE BEST PIECE OF ADVICE YOU’VE BEEN GIVEN?

The ‘p’ in property stands for patience. CMM CMM DECEMBER 2014 | 25

business clinic

HC-ONE ACQUISITION – STABILITY FOR THE MARKET? Care home landlord, NHP Group and HC-One have announced that they are being acquired. With rumours circulating around the future of the companies for the majority of this year, the final announcement sees a US investment partnership enter the UK market. Does this finally mean stability for the company that took on the majority of Southern Cross’ stock and the wider market? In CMM’s February 2014 issue, the Business Clinic explored speculation around the sale of HC-One to Four Seasons Health Care and whether we would see the return of a huge, marketdominating provider like Southern Cross before its collapse. Speaking to CMM in December 2013 about any potential sale, an HC-One spokesperson said that, ‘We do not expect this process to conclude for several months.’ Eleven months later and a deal has finally been announced although it has not been a smooth process.

A BUMPY RIDE Sky News reported in August 2014, that the sale of NHP and HC-One was

on the verge of collapse with a potential legal threat from Credit Suisse which was trying to protect its investment and secure repayments to bondholders. Bondholders make up a large proportion of NHP’s financial backing and there have been legal challenges over the potential sale and the level of repayment to bondholders. It appears that the companies resolved the issues surrounding the potential sale as at the beginning of November, NHP announced that a binding agreement to acquire the company had been signed by Formation Capital in partnership with global investment firm, Safanad and Court Cavendish which is the management team of HC-One. The deal is expected to complete in November but was still

progressing at time of print. It was well-documented that NHP had been dealing with its debt and the action taken by bondholders to ensure their return on investment had halted the sale throughout the year. However, all parties must have been acutely aware of the Care Quality Commission’s increased responsibilities under the Care Act to ensure financial stability in the market. From the 6th April 2015, the regulator will have the responsibility to ensure the financial health of the ‘difficult to replace’ adult social care providers. The final deal involving Formation Capital, Safanad and Court Cavendish sees NHP, which comprises 275

The shadow of Southern Cross will remain

The concern is to ensure stability

Derek Breingan BA (Acc) MCIBS Head of Healthcare Sector UK Clydesdale Bank Plc and Yorkshire Bank Plc

John May Managing Partner Freeths LLP

This transaction, thankfully, ends months of speculation about the future and wellbeing of HC-One and, hopefully, will allow the new investors to focus on the core business and continue to invest and improve the portfolio it has acquired. Residents and families will expect to see early evidence of the intentions of the new owners. The rescue of Southern Cross remains a remarkable achievement by those involved given the size and geographical spread of the group, and indeed its financial position at that time. The size and structure was, in some ways, the source of the problems it faced, but could also be argued as a catalyst to its ultimate successful rescue. Whilst this deal does bring a welcome level of stability, and removes a degree of uncertainty to those involved in HC-One, the shadow of Southern Cross will remain over the sector for some time. The Care Quality Commission (CQC) seeking to judge the financial

26 | CMM DECEMBER 2014

well-being of the main providers in the industry provides tangible evidence of this. This will put significant pressure on the CQC to ensure it audits as robustly and thoroughly as possible. The financial pressures on the sector remain in relation to occupancy levels, average fees, rising costs, including staff and utilities, and in many cases ongoing debt obligations. However, this has not prevented continued investment from overseas funds, with heightened deal activity an ongoing feature of the market. That does bring confidence to the sector and large groups will remain an attractive investment. The outlook for the care home sector is broadly a positive one, but there is no question that the Government and regulator will be monitoring the care landscape carefully as it tries to prevent another Southern Cross sized collapse, which would damage an important industry which is steadily recovering.

Any step towards certainty about the future has to be positive for investors, local authorities, employees, care home residents and their relatives alike. We hope this acquisition has a wider calming economic impact. The collapse of Southern Cross after rapid expansion highlights that income growth assumptions require regular checks; particularly at a time when the NHS and other public sector bodies are under pressure to make year on year efficiencies. As envisaged by the Care Act, efficiencies and service quality improvements are achievable through integrating care pathways. The market needs to be competitive and open to new entrants. With an ageing population there is real growth potential and opportunities as the NHS rationalises its estate. Fundamentally, the concern is to ensure stability, avoiding short-term gains for bondholders potentially at the expense of the tax-payer and the vulnerable. Competitive

pricing must not lead to lowering of standards. This is a market where attention to the delivery of high standards of care, by well-trained staff, knowledgeable about their responsibilities is critical. Particularly with new CQC standards, a statutory duty of candour and duty to meet fit and proper person requirements. We recognise the concerns of our colleagues in the health and care sector of the costs of ensuring compliance with the CQC and other regulatory standards, alongside managing the damage to the sector’s reputation caused by the collapse of Southern Cross and others; and the revelations of the Mid Staffordshire and Winterbourne enquiries. In my opinion, the way forward has to focus on using lawyers with knowledge of the risk management regulatory compliance issues to reduce likelihood of future crisis and collapse. This is how we are working to support our clients: it is a case of looking to be wise before the event.

business clinic

properties, including those operated by HC-One, acquired for £477million. The company announced that this brings total recoveries to its creditors to £507million over the last five years. NHP stated that, ‘The sale of the portfolio and underlying business brings to an end one of the most difficult business rescues and turnarounds in the history of the UK health and social care sector.’

THE PARTNERSHIP The new partnership comprises Formation Capital, Safanad and Court Cavendish. Only one of these names will be familiar to the majority of the sector in the UK, Court Cavendish. Owned and operated by Dr Chai Patel, formerly owner of the Priory Group, Court Cavendish was re-established to deliver operational and financial turnarounds of multi-site social care and health care organisations. It joined up with care home landlord NHP in 2011 to operate the majority of the NHP-owned Southern Cross portfolio when the provider collapsed. Together with a very experienced management team the companies formed HC-One and set about turning around the portfolio.

Formation Capital is an experienced investor in the US market, specialising in ‘seniors housing and care, post-acute and health care real estate investments’. It is chaired by Arnold Whitman who has an extensive career in investing in the elderly housing and care market in the US. The company actively acquires health and care properties in the US and has an ongoing partnership with Safanad, the third player in the NHP acquisition partnership. Safanad is a global principal investment firm that invests in real estate, private equity and public markets. It has a specific focus on healthcare investments along with education, financial services and retail. Safanad and Formation Capital have acquired over $3billion in elderly care assets since it began its strategic partnership in 2009.

THE FUTURE The partnership between Formation Capital, Safanad and Court Cavendish intends to consolidate HC-One’s transformation of the business, which is now reported to have above average occupancy levels. Plans for HC-One include acquisition of further homes and to diversify the portfolio further to offer the full range of

There is no question that it is good news Tim Edghill European Director and UK Head of M&A JLL Corporate Finance Ltd As a member of the seven man restructure committee of Southern Cross, the impact of what was a very public and emotive process for residents and families, the sector, Government, media and the general public was plain to see. The sale of NHP/ HC-One, almost exactly three years after the business took back control of its homes from the beleaguered Southern Cross, is an important step forward, lifting its debt burden and providing vital funding for the future. This joint venture by Formation Capital and Safanad, entering the UK market for the first time, brings another exciting new source of capital. Furthermore the involvement of HCP, the US specialist healthcare REIT, who has provided debt to the transaction, further demonstrates the breadth of new sources and types of capital helping to revitalise and develop the sector. As a third of the portfolio, this recapitalisation is a major step in laying to rest the impact of Southern

Cross’ failure, however a broader legacy remains in the elderly care sector as a whole. A significant debt burden remains in many portfolios or corporately with owner/operator businesses at a time of reducing margins driven by economic, legislative and regulatory pressures. There is no question that this transaction is good news for HCOne and its employees, its residents and their families and for the sector. Healthcare as a sector (and elderly care in particular) still has challenges ahead in an age of continued funding shortages and increasing demand and acuity. Nevertheless, transactions such as this and the significant amount of funding and recapitalisation work we are involved with will continue to benefit and have a positive impact on the sector. As innovation increases and more capital flows are realised, the potential for the sector to provide for the care needs of tomorrow also increases, which is an exciting prospect for the next few years.

social care services including retirement villages, care and nursing homes plus home care. It is hoped this will make the company, ‘an integrated health and social care provider working in collaboration with public sector commissioners to deliver high quality and cost-effective services.’ With the deal and the end of the uncertainty over the future funding of HCOne, it is hoped that residents and their families will be experiencing ‘a new era’ as the new owners focus on investing further to continue driving the business forward. Also this new financial stability should help to stabilise the market further. CMM

Over to the experts... With the sale of NHP and HC-One having been lengthy, challenging and, at times, embroiled in legal challenges, there must be a sense of relief at this final acquisition. With it due to complete this in November, does this draw to an end the hangover of the Southern Cross collapse? What does the acquisition mean for the market, HC-One and its residents? With the Care Act bringing with it regulatory responsibilities to ensure the financial health of larger providers will this deal bring much-needed stability to the market?

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Neil Eastwood gives his perspective on how to address issues of staff turnover, drawing on examples from US care settings.

Please don’t go! Retaining frontline care staff

‘I’m leaving’. It’s a phrase that’s not easy to be told in any situation, but according to recent surveys, such as the National Care Forum’s 2014 Personnel Statistics Report, if you are an employer in the care sector, you have been hearing it more frequently in the past year. The National Care Forum’s survey on members provides a snapshot staff of turnover, vacancy rates, age, qualifications, sickness absence, reasons for leaving, agency spend, zero hour contracts and recruitment from outside the UK. According to the findings, turnover rates continue to average close to 20 per cent although some improvement seems to have occurred. However, worryingly, the ‘churn’ rate is up for the third consecutive year, with 38.8 per cent of staff leaving within one year of appointment and 65.5 per cent within two years. In homecare, the figures are even higher with 47.4 per cent leaving within one year and a staggering 73.5 per cent within two years.

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please don’t go! retaining frontline care staff

UNDERSTANDING THE SITUATION

Figure 1 – Causal factors for why care staff stay or leave

If you are like most employers, you will wonder what could have been done differently each time a valued member of staff tells you they are leaving. A similar question will be in your mind when you have to undertake a dismissal. Of course, workforce departures can seem like a series of isolated disappointments, each with its own seemingly unique circumstances. There is rarely time to explore underlying causes before you have to move on to dealing with the consequences – the potential impact on clients, recruiting to replace them and adjusting rotas. No wonder it’s easier to simply accept it and move on. Managing a care workforce is a messy business. It’s not possible to ever get it completely ‘right’. Despite the seeming complexities, ambiguities and unknowns associated with the unexpected ending of an individual’s employment, I have discovered through my research of the US care sector that there are common themes and measurably successful interventions. I want to bring you some fresh retention perspectives based on studies of what US providers are doing. That is not to say that the resources already available to you here through respected organisations such as Skills for Care are not effective, rather that I will assume you will already be familiar with them. I hope to add to the debate.

P e rs on a l fa c tors - Ou ts ide w or k

WHY DO CARE STAFF STAY OR LEAVE?

Workplace attitude

As a starting point, it is helpful to understand the range of factors that influence whether a frontline care worker stays or leaves you. If you haven’t done this exercise yourself, let me tell you it leaves you wondering how your turnover can be so low. Figure 1 shows some of the contributing factors which US managers cite. I have adapted certain elements for a UK audience, see figure 1. This process of mapping potential causes of staff loss allows you to identify the factors that are fully or partially within your control and those that are not. This enables you to focus on the things you could do to improve staff retention. In addition, you may start to see patterns that apply to your organisation based on considering your recent leavers against these triggers.

Demographics Health Transport Financial Relocation Values Aspirations Motivation Family Education level

P e rs on a l fa c tors - in w ork Job stress Physical requirements Personality fit

Relationships with colleagues at all levels Engagement Workplace injury Changing responsibilities

W orkp l a c e fa c tors Pay and benefits Training Hours, location Communications

US RETENTION FINDINGS

Culture There are real similarities between the UK and the US care sectors and there are some key retention findings from a number of US sources and studies that can be easily applied to UK care businesses. The starting point for much of my work was to study the recruitment process in the US. Recruitment is so important to care providers and good recruitment can lead to good retention. • Best practice recruitment is a fundamental driver of retention. If you select mainly suitable and reliable staff, that is, in my view, the single biggest contributor to long job tenure. New sectorspecific candidate screening tools can play a role along with values-based interviewing, for example. • The first 90 days of employment are critically important. Norms are set and impressions are made particularly in the first few weeks of the job. This is when the implied promise made to the candidate needs to be honoured. Exemplar care providers in the US ensure that during this period their management are regularly visible to new starters, that their opinion is

30 | CMM DECEMBER 2014

Recruitment Policy Leadership Ownership Employment Practices

E x te rn a l fa c tors Alternative employment opportunities Competitors Government Policy Economy Public perception/Media Societal norms

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please don’t go! retaining frontline care staff

g actively sought and each new member of staff is assigned a mentor. • Caring attracts them, a lack of respect pushes them away. The adage ‘people don’t leave their jobs, they leave their bosses’ holds doubly true in social care. The best care staff are relationship-centric people. Pay is not their biggest motivator. In the pressure of a busy care setting it is too easy for supervisors to communicate poorly or show a lack of humility or empathy towards team members. This would be damaging to any workplace relationship but for those who care for a living, it is toxic. A number of studies in the US have demonstrated the positive impact of communication training to instil a culture of respect. The impact on retention levels has been dramatic. • Factors that drive retention are not always the same as those that drive staff turnover. The reasons that keep care staff in a job can be different to those that push them to leave, so when considering interventions it is important to be clear what you are attempting to address.

‘To improve retention, it is important that you minimise the recruitment of unsuitable staff through poor attraction and selection.’ • Job satisfaction is not enough. Many care businesses poll their staff to measure job satisfaction but a recent study into the determinants of job tenure in homecare workers in Maine found that this measure was actually very similar between leavers and stayers. Job engagement is a much more valuable metric. • Age is a predictor of employment tenure. US experience seems to suggest that older workers are more likely to stay longer, particularly if there is uncertainty over a consistent income. Younger staff may be more reliant on a minimum earnings level whilst those without dependent children and perhaps with other sources of income can be more flexible. This is particularly noticeable in homecare settings. There was also evidence of younger staff seeking career progression to a much greater extent than those later in life. • Some attempts at staff motivation can actually be detrimental. There are distinct differences between recognition and appreciation. For genuinely caring staff, appreciation (a personal communication that they are valued within the organisation) can be a more effective engagement tool than recognition (praising their ‘external’ performance often to other staff) because they are relationship-centric individuals. In many cases, attempts at recognition can actually be damaging. For example, you may operate an ‘Employee of the Month’ scheme but often high quality care is delivered away from direct supervision so

awards based solely on acts that were observed by other staff can be seen as arbitrary and unfair. Perhaps your employee recognition effort is actually motivating only one employee whilst demotivating the others.

SOME PRACTICAL INTERVENTIONS Much of what has been covered here will be of relevance and interest but it is one thing to be interesting and quite another to be of actual material value. For that to happen then work practices have to be changed. That is not a trivial thing to do in a busy care setting. I have suggested below a few interventions to consider, from the relatively simple to implement, to the more ambitious.

QUICK FIXES 1. Ensure you stay in touch with ‘good leavers’. In US tests, three out of ten leavers returned to their employer because there was ongoing communication. 2. Be sure to send a personal note of appreciation home to all ‘good’ staff at least once a year. This will not only be motivating to them but will also be seen by a spouse or partner who can often be the one encouraging them to leave. 3. Involve frontline staff in a taskforce or some aspect of your operation outside of their core duties. A great example is to get them to meet prospective new staff and answer questions about the work. This will make them feel valued and empowered and differentiate your company to applicants.

MEDIUM-TERM ACTIONS 1. Put your supervisory staff and schedulers on a communication and active listening course. This will help to reduce disputes, conflict and lower turnover of both frontline care staff and supervisors. 2. Review your incentives and motivation schemes. If you have an Employee of the Month award, get staff feedback on whether it is doing what you intended. Consider introducing more personal appreciation mechanisms. 3. Upgrade your recruitment process. To improve retention, it is important that you minimise the recruitment of unsuitable staff through poor attraction and selection. In many cases, weak attraction leads to a limited choice of candidates and pressure to offer a job to the only applicant.

LONGER-TERM STRATEGIES It may be necessary to consider a fundamental culture change towards one of mutual respect and empowerment. This would include reviewing leadership, workplace practices and communication methods. Whilst this is a big commitment, it may be the right approach for some organisations. High staff turnover is a cycle that can be broken. Consistency of care staff is crucial to the people you support. Although it may feel that there isn’t time to step back and analyse the situation, by doing so and taking steps to recruit the right people, motivate your staff and build on their reasons for working with you in the first place, you can build a good team that you can retain for years to come. CMM Neil Eastwood is Founder of Sticky People Ltd. Email: neil@stickypeople.co.uk

CMM DECEMBER 2014 | 33

CONFERENCE AND EXHIBITION 2015 @CMM_Magazine #CMMInsight

Learning Disability Services: Current Developments and Future Opportunities Thursday 26th February 2015 9am-4.30pm The Renaissance Hotel, Manchester M3 2EQ

CMM Insight 2015 offers delegates a day of two halves. The morning focuses on recent developments in the learning disability sector. The afternoon then looks to the future, exploring opportunities for providers. Delegates will also have access to a choice of practical workshops and a comprehensive exhibition. For those wanting to engage further, a Themed Panel Discussion offers that opportunity. Delegates can tap into the expertise of the panel and get answers to any questions they may have.

CONFIRMED SPEAKERS Deborah Westhead, Deputy Chief Inspector for the North at the Care Quality Commission will discuss the new proposed regulation of supported living and the quality ratings. Roger Harcourt, Partner at Shakespeares Legal LLP will update delegates on trends and opportunities in the market. Zandrea Stewart and Stephen Taylor, Principal Advisers for the Joint Improvement Programme will explore developments in moving people from long-stay institutions into the community.

For further information, to request a media pack or booking form, contact: Cheryl Yardley E: cheryl.yardley@carechoices.co.uk T: 01223 206953 Alternatively, visit www.cmminsight.eventbrite.co.uk for online booking options. Tickets cost ÂŁ275 plus VAT.

S P O N S O R S H I P A N D E X H I B I T I N G O P P O R T U N I T I E S AVA I L A B L E 34 | CMM DECEMBER 2014

ENSURING A FAIR PRICE FOR CARE Putting a fair price on care services is a complex task. Against a backdrop of immense pressures on social care budgets Nottingham City Council explains how it has sought to pay providers a fair price for care and ensure citizens receive a quality service.

In 2012, Nottingham City Council identified that in order to discharge its statutory duty to provide residential accommodation to adults with an assessed need the Council needed to consider the fees it pays to providers, whilst bearing in mind the limited funds available. In this context the Council agreed to commission external independent specialist support to undertake a review to identify an appropriate price for residential and

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ensuring a fair price for care

nursing care services in the City. Valuing Care Financial Management (VCFM) were appointed to carry out this work which comprised a sample costing exercise of placements in a cross section of services and analysis with reference to a national comparator database of rates. The process included local provider engagement with VCFM. The report of the review findings was completed in March 2013 and formed the basis for the Council’s pricing structure from 2013 onwards. The report entitled Fair Price for Care Review outlined the findings of the review and prices that were suggested to represent a reasonable price for care for services in the City.

CONSULTATION The local care home providers were consulted on a number of occasions in relation to the findings and the proposed pricing arrangements. Initially, the consultation was on the pricing for 2013 to 2014 and subsequently for the proposed pricing structure from 2014 to 2017. During the first consultation the review information was supplied to providers to ensure transparency of process. This information was anonymised as some information would have been commercially sensitive to individual providers. In subsequent consultations, the longer term pricing structure was published and views sought from providers. The Council recognised the importance of getting a broad range of providers’ views and at one point extended the consultation following discussions with providers to enable further comments to be included. Following the consultation, the recommendations were agreed by the Council in April 2014. These recommendations were informed by a range of evidence including the consultation responses, the report of VCFM and by an Equality Impact Assessment. Throughout the process the Council has been clear that the pricing structure is based upon a core cost of providing residential care. Citizens with needs over and above the core elements would be considered by the Council and additional funding provided where appropriate.

PRICING STRUCTURE The proposed core price would be the minimum price for residential and nursing care, payable for those packages where the identified care needs can be met through the minimum ‘core’ level of service. The Core Elements of Care document accompanied the pricing proposals during the consultation to define the core elements of service to be covered by the minimum core price. For citizens with higher levels of need that cannot be met through the core package, additional support/staffing/hours assessed to be needed over and above the core price will continue to be paid for on top of the minimum core price. This will include citizens with dementia and other complex needs. This would ensure those citizens with higher levels of need would have the appropriate level of care funded and enable Nottingham City Council to fulfil its statutory duty to meet assessed needs. 36 | CMM DECEMBER 2014

QUALITY During the review of pricing it became clear that there needed to be further consideration of the previous pricing structure, which for older people’s services was based upon five quality bands. It was important to the Council that to ensure all services are able to meet the required service standards on a sustainable basis, all should be paid equally the price needed to deliver care to an acceptable standard. This should enable lower banded homes to make improvements. The Council made clear its intention to manage quality standards robustly through the contract compliance process and to apply sanctions for poor performance. Quality monitoring visits are undertaken with a RAG (red, amber, green) rating system and the ratings are made publicly available to citizens to support them in their choice of home. Through contract compliance and market development Nottingham City Council aims to shape the local residential market to improve quality across all residential and nursing care homes. Performance managing providers against the contract terms and conditions is important but is only one element of the work to improve quality in Nottingham City. The Council has also worked with a number of local suppliers around measures to improve quality of provision as well as providing advice on making their business sustainable in the longer term against a backdrop of a move towards increasing more home-based provision and reducing demand for residential care.

CONCLUSION Nottingham City Council is committed to commissioning quality residential and nursing home provision at a level of pricing that is fair and sustainable and is based upon robust evidence of the cost of delivery. The Council continues to be driven by the priority of ensuring its citizens receive quality care with the limited funds available. CMM With thanks to Nottingham City Council.

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HMRC National Minimum Wage INVESTIGATIONS

PREVENTION IS BETTER THAN CURE Non-compliance with National Minimum Wage can be inadvertent in the care sector, however, the impact can affect your organisations’ reputation. Ian Hyde explores common pitfalls for providers when it comes to underpayment of NMW and advises on how to avoid them.

Her Majesty’s Revenue and Customs’ (HMRC) increasing attention on National Minimum Wage (NMW) compliance means that providers of residential and domiciliary care must be sure their pay accords with relevant NMW requirements. The change in October last year introducing compulsory ‘naming and shaming’ for those who breach

NMW requirements creates a serious reputational risk for noncompliant businesses. It is recognised (for example in the Low Pay Commission Report of March 2014) that public sector funding cuts have put pressure on providers, making it more difficult to ensure NMW is paid to employees. Further, with pay levels close to the NMW

CMM DECEMBER 2014 | 39

HMRC national minimum wage investigations

mark, and its often complex pay structures, the care sector is more susceptible to inadvertently contravening with the complex and sometimes irrational calculation methods in the NMW legislation. However, in the world of NMW, funding pressures and complex legislation are not excuses. Indeed, in its November 2013 report, National Minimum Wage compliance in the social care sector, HMRC found, ‘increasing levels of non-compliance’ in the care sector. Of the 183 NMW investigations HMRC conducted and completed in the social care sector over the two year period from 1st April 2011 to 31st March 2013, 48 per cent of businesses had NMW errors but there was 58 per cent non-compliance in 2012/13 compared to 28 per cent in 2008/09. HMRC, therefore, believes the position is getting worse and its targeting of NMW in the care sector can be expected to continue.

NON-COMPLIANCE All employers know about NMW and most, it is assumed, want to comply. However, noncompliance is often inadvertent, particularly with the increase in the use of zero-hours contracts or agency workers. The problem

is that even when inadvertent, whilst such breaches will not trigger a prosecution, a failure to comply will now result in public naming and shaming. It is important then to know the most common ways in which employers inadvertently fail to comply: • Travelling time is a particular cause of concern for domiciliary care providers. A recent case has confirmed that travel time between each place of care counts as working time when calculating whether pay is within NMW law. • Other unpaid work-related time can breach the NMW regulations, for example, training or team meetings which start just before or after the employee’s paid hours. • Employers in this sector should also be careful to ensure that any deductions from workers’ pay are accounted for in determining NMW compliance. If an employer pays the NMW rate but makes deductions from pay, for example for uniforms, training or provided meals, the pay for calculating NMW compliance will be after taking those deductions. • Employers also commonly fail to disregard premium rates, for example for weekend working. NMW is calculated only by reference to basic pay rates. • Problems also arise on correct application of reduced rates, for example for apprentices, and when NMW rates change.

• Overnight work is also a common cause of noncompliance. Where a care worker is required to ‘sleep-in’ to provide care, it had been common for some employers to pay only for those hours when the employee was awake or providing care. This is not correct as a recent tribunal case has confirmed. The time when the care worker is asleep should be paid at least at NMW levels.

PROSECUTION For exceptional cases HMRC can prosecute. However, this power is reserved for the most serious cases and, in particular, where HMRC wishes to make an example to encourage others to comply. Typical factors that will tend to result in prosecution are repeated failure to comply, falsifying NMW records and obstruction of an NMW enquiry.

WHAT IT MEANS FOR THE CARE SECTOR If HMRC commences a NMW investigation into a care service provider, the consequences are wide-ranging. First, the very fact of an HMRC investigation is very disruptive, even if no errors are found. HMRC will not only review records but also interview payroll staff and sample workers. Failure to maintain adequate records, for example for travel time, make it very difficult to demonstrate compliance. In addition, HMRC take a very detailed and technical approach to compliance, for example late payments will trigger a breach in the relevant pay reference period even though over the year wages at the NMW rate have

been paid. If errors are found, the employer must immediately pay the employee the shortfall. As a point of detail, if the current rate is higher than the rate when the pay should have been paid, then the current rate is used. In addition, penalties - increased in March 2014 to a maximum in some circumstances of £20,000 per worker - may be due. For the future, a noncompliant employer would need to reassess its business model to ensure that its profitability can be protected. It will be necessary for residential care providers, who have inadvertently failed to meet NMW standards, to review pay structures to ensure compliance for the future and consider how the additional cost is passed on to the final consumer. Importantly, care providers that are investigated by HMRC face significant reputational risks if they are issued with a Notice of Underpayment. For investigations commenced after 1st October 2013 (even if the underpayment relates to earlier periods), once a notice has been issued, if it is not successfully challenged, HMRC is automatically required to pass on the name of the employer to the Government’s Business Innovation and Skills (BIS) department. BIS will automatically ‘name and shame’ employers unless exceptional circumstances apply.

PREVENTION IS BETTER THAN CURE Automatic naming and shaming, and with it the threat of negative public scrutiny in today’s climate, means that residential and domiciliary care providers should review their pay structures and, vitally, their record-keeping before HMRC issues a notice. CMM Ian Hyde is Tax Partner at Pinsent Masons LLP. Email: Ian.Hyde@pinsentmasons.com

40 | CMM DECEMBER 2014

Alzheimer’s Society launches new training course portfolio and consultancy service Courses can be delivered within the workplace or as part of our country wide open course schedule. Courses and dates 2014-15

Alzheimer’s Society training combines a person centred approach with up-to date research and evidence-led design, to provide high quality and innovative training. We put people with dementia at the heart of everything we do. So our outcome based solutions enable compassionate and high quality support to people affected by dementia, which increases staff confidence and realises their potential.

Meaningful Occupation Sheffield Horsham Birmingham Newcastle Cardiff York

04/11/2014 11/11/2014 12/11/2014 13/11/2014 19/11/2014 27/11/2014

Responsive Behaviours Newcastle York Sheffield Birmingham London Cardiff

02/12/2014 03/12/2014 04/12/2014 09/12/2014 10/12/2014 17/12/2014

Improving pain assessment and management for people with dementia Newcastle 08/01/2015 Sheffield 13/01/2015 York 14/01/2015 London 15/01/2015 Birmingham 20/01/2015 Cardiff 29/01/2015

Training and Consultancy Person Centred Relationships Birmingham 03/02/2015 Newcastle 05/02/2015 Sheffield 10/02/2015 York 11/02/2015 Cardiff 18/02/2015 London 19/02/2015 Understanding Dementia New Level 2 Award to be launched soon Alzheimer’s Society and Royal Society for Public Health (RSPH) have joined forces to create a new qualification open to anyone who has an interest in broadening their knowledge about dementia including the many people who have signed up to the widely publicised Alzheimer’s Society initiative, Dementia Friends.

For more details about the courses and how to book, please contact us on: T: 01904 567 909 E: dementiatraining@alzheimers.org.uk Or visit our website www.alzheimers.org.uk/training

Alzheimer’s Society operates in England, Wales and Northern Ireland. Registered charity number 296645.

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CMM DECEMBER 2014 | 41

42 | CMM DECEMBER 2014

conference review

BERKSHIRE CARE CONFERENCE AND EXHIBITION 2014

The Berkshire Care Conference 2014, in conjunction with the Berkshire Care Association set out to offer providers in Berkshire and the surrounding areas a forum for debate and discussion about pressure on their services in this changing market. Paul Leahy of Care Management Matters opened the conference before handing over to Fidelma Tinneny, Chair of the Berkshire Care Association, who welcomed delegates to the event. The Care Act has now received Royal Assent and with phase one of implementation happening in April 2015 there will be significant change for the sector. Keynote speaker Professor Martin Green OBE, Chief Executive of Care England, summarised the main points of the Act in his presentation, The Care Act – Implementation and impact on care providers. He discussed what providers need to know and what it means for them and the impact of the changes on the relationship with local authorities. Following Martin, Alan Rosenbach, Special Strategy Lead of the Care Quality Commission (CQC), explained the CQC’s changes to the inspectorate and regulations in The Future of Regulation. He explored why things have changed and what impact it has on care providers. Alan also covered the new quality ratings system. In the current property market, what makes a good care home is always a hot topic. Amanda Nurse, Director of Carterwood, talked to delegates about the Berkshire market, typical fill and fee rates for new build care homes, as well as comparing local authority fee rates and wealth profiles. Risks and how to avoid them in the opportunistic elderly care sector were highlighted, as well as the changing hot spot locations. A panel debate discussing The Changing Landscape – Care Act, Regulation and Market Pressures followed and it gave delegates the opportunity to discuss what was affecting them in the current climate. Chaired by Professor Martin Green OBE, the stage included Fidelma Tinneny, Alan Rosenbach, Amanda Nurse and Liz Mulvaney, Head of National Healthcare at Freeths LLP.

Thursday 16th October, Reading

WORKSHOPS Two workshops were available to delegates. In the main conference room, Maureen Hinds, Head of Programmes at the National Skills Academy for Social Care, presented Better Leadership, Better Care – How to strengthen leadership and drive quality in your organisation. She delivered practical and affordable ways to improve leadership capacity, helping providers to boost their organisations and train people to work in social care. Alex Rook, Partner at Irwin Mitchell Solicitors LLP held his workshop on The Deprivation of Liberty Safeguards (DoLS). The Government has recently rejected a claim by the House of Lords that the DoLS are ‘not fit for purpose’. The workshop explored the current situation with DoLS and how they can be improved.

AFTERNOON SESSION The afternoon session returned to the main conference room, where Liz Mulvaney presented Risk Management – safeguarding taking account of the new statutory duty of candour. She discussed the changes expected when a statutory duty of candour comes into force. Business Communication Consultant, Jonathan Smith then concluded the day’s the presentations with Innovations in Marketing, discussing digital advances in the care sector, debating whether newer technologies are better than the tried and tested. The day was closed by Fildelma Tinneny. An exhibition showcasing more than 30 sector-specific providers ran alongside the conference, with stands from product and services providers, training organisations, lawyers, solicitors, mobility vehicles and many others. The conference was sponsored by Hazlewoods, produced by McCullough Moore, in association with the Berkshire Care Association and supported by Care Choices.

CMM CAREMANAGEMENTMATTERS

CMM DECEMBER 2014 | 43

conference review

THE CARE SHOW BIRMINGHAM 2014

4th & 5th November 2014, Birmingham

On the 4th and 5th November, The Care Show was held in Birmingham. The UK care market is said to be worth in excess of £55 billion to the general economy, and The Care Show offers a vital platform for industry (and Government) to meet, network and deliberate on the issues that face the sector. Prior to the event, The Care Show undertook a survey of 22,000 care home owners and managers, home care agencies, NHS staff and other industry contributors, which revealed that recruitment, training and retention of staff are among the key issues in the strained sector. Funding cuts in the care industry was also highlighted as a key concern by respondents of the survey. Therefore the Care Show and its seminar theatres offered an opportunity to help move the sector forward. The Dementia Care Show ran concurrently with The Care Show and proved popular, as the Dementia Design Academy showed how outdoor spaces and bright colours can really benefit people with Alzheimer’s and cognitive impairments. This year, The Care Show attracted over 260 exhibitors, offering practical support, advice and products for those operating in the long-term care sector. Visitors from care homes, home care agencies, the NHS and associations across the country attended the Care Show 2014 to identify new products and services, learn from and be inspired by the topical educational programme and network with industry peers.

INFORMATIVE PROGRAMMES Delegates were able to attend a range of activities and seminars, as well as group discussions. The focus of day one was The Big Debate.

The Big Debate: State of care in the UK: how can we fix the broken system? was chaired by Mrs Nadra Ahmed, Chair of the National Care Association. The panel discussion featured: the Rt Hon Stephen Dorrell MP; John Telling, Group Corporate Affairs Director at MiTie; Sara McKee, Founder of Evermore; Jane Ashcroft CBE, Chief Executive of Anchor; Andrew Cannon, Managing Director of Bupa Care Services, Bupa UK; and David L Jones, Partner at Deloitte. Delegates were able to pose questions to the panel and probe for answers. Other seminars included: • CMM Presents: The Care Act: Implications for Providers - Des Kelly, Executive Director of the National Care Forum, National Care Forum. 44 | CMM DECEMBER 2014

• CMM Presents: The New Adult Social Care Workforce Recruitment and Retention Strategy with practical examples for providers - Dave Williams, Area Officer and Jeanine Willoughby, Project Manager Recruitment and Retention at Skills for Care. • The Virtual Dementia Hospital – Jilly Polson, Lead Associate of Dementia Services Development Centre (DSDC). • Best Practice Programme for improving Dementia care in hospitals - Amanda Leitch, Programme Director of Northern Ireland DSDC. • The Future of Dementia Care: Care in 2050 - Professor June Andrews, Director, DSDC. • Developing Dementia Friendly Communities; Collaboration and engagement with people with dementia and their carers Amanda Leitch, Programme Director, Northern Ireland DSDC. • CQC: A fresh start - a new approach - Sue Howard, Interim Deputy Chief Inspector, Care Quality Commission. The Care Show was a successful event with many visitors and exhibitors leaving the show reporting a burgeoning care market and significant business success from the event. Event organisers UBM also announced that The Care Show 2015, taking place on the 3rd and 4th November 2015, will introduce a simultaneous, high profile, two-day International Dementia Conference in partnership with Dementia Services Design Centre (DSDC) at the University of Stirling. CMM was the Official Media Partner for The Care Show Birmingham, which was organised by UBM and supported by Care England. The National CAREMANAGEMENTMATTERS Association for Providers of Activities for Older People (NAPA) was the event’s official charity.

CMM

layout on? one what’s

WHAT’S ON? Transforming Support for Disabled Children and Young People Conference Date/Location: 25th November, Central London Capita Conferences, Tel: 0870 400 1020 Contact: Event:

Safeguarding Adults in Care Homes and Hospitals Event: Date/Location: 2nd December, London Community Care Conferences, Tel: 020 8652 4659 Contact: Assessing the Impact of the Care Act Event: Date/Location: 4th December, Central London Policy Knowledge, Tel: 0845 647 7000 Contact: 9th Annual Conference on Dementia and End of Life Date/Location: 10th December, London The National Council for Palliative Care, Contact: Tel: 0207 697 1520 Event:

2014 LCS and Adam Smith Institute Health and Social Care Winter Event Date/Location: 20th January, London LCS, Tel: 0207 108 6323 Contact: Event:

Learning Disabilities Conference Event: Date/Location: 26th January, Central London Capita Conferences, Tel: 0870 400 1020 Contact: Latest Developments in Primary Healthcare Property Date/Location: 29th January, London Henry Stewart Conference Studies, Contact: Tel: 0207 092 3494 Event:

Dementias 2015 Event: Date/Location: 5th-6th February, London MA Healthcare Limited, Tel: 0207 7501 6762 Contact: Nursing Homes, Care Homes, Assisted Living, Domiciliary Care Services and Third Age Housing Date/Location: 11th February, London Henry Stewart Conference Studies, Contact: Tel: 0207 092 3494 Event:

Health Care Conference 2015 Event: Date/Location: 13th-15th April, Liverpool UNISON, Tel: 020 7121 5123 Contact:

CMM EVENTS 3rd Sector Care Awards Event: Date/Location: 3rd December, London Care Choices, Tel: 01223 207770 Contact: CMM Insight: Learning Disability Services: Current Developments and Future Opportunities Date/Location: 26th February, Manchester Care Choices, Tel: 01223 207770 Contact: Event:

Please mention CMM when booking your place. CMMDECEMBER DECEMBER2014 2014 || 45 CMM 45

straight talk

straight talk Rosemary Hurtley argues that we need a new mix of skills to deliver a workforce fit for the future.

ROSEMARY HURTLEY

FOUNDER

Are we putting the needs of older people first when equipping the workforce to deliver best practice for people with long-term conditions? Receiving person-centred care is a fundamental feature of healthy cultures in health and social care organisations. A key contributing factor is education and its fitness for purpose in the workplace in which we now live, move and ‘have our being’. Sustainable good organisational cultures are made from striving to achieve the shared purpose to deliver person-centred outcomes to the individual, from their perspective. I am talking about work-based learning, based on what older people in our care homes need. Clinical Commissioning Groups (CCGs) are realising the need to upskill care home nurses (and care assistants). Anxiety about health domination has affected people’s experiences of care. It’s left many providers with an underdeveloped workforce, missing out on developed understanding of how to deliver personcentred socio-therapeutic, complex care; an essential prerequisite. For example, CCGs are expecting care homes to deliver ‘enhanced’ medical or technical skills to help increase early discharge and reduce hospital admissions. Without staff offering a good experience, we will return to a medical model of delivering tasks without relationship-activated principles. Staff need opportunities to learn on the job, supported with coaching and work-based supervision. It need not require more resources but a different way of thinking and behaving. It enables exponential acquisition of skills and behaviours and the attitudes that people have a right to expect. A person-centred philosophy integrated into an organisation is the best way of ensuring that neither a medical model nor a social model dominates. Sociotherapeutic care requires a multi-disciplinary and integrated collaboration and co-operation that focuses on what older people with long-term conditions must have. Doctors are knowledgeable about medical intervention but not necessarily about caring. Nursing is about professional caring for the whole person and, despite exemplary practice in many care homes, professional practice has been underdeveloped. A fear of the medical model taking over, however legitimate, has unfortunately played down healthcare needs in many social care settings, diminishing the nurse’s role. In some cases, healthcare professionals’ decision-making is undermined by other social care professionals who have limited understanding and education on the healthcare needs of older people with complex conditions.

ELIZABETH CARE

When health and social care was split - it was about money, and we were left with no clear definition. Social care felt it didn’t need to know much about healthcare and vice versa. It was thought that, for example, in a residential home we can just call in someone when we decide it is needed. But who takes responsibility for this decision and for the ‘patient’ when the health professional leaves? People are left vulnerable as care staff can’t always recognise early signs or determine when health needs arise, change or need to be responded to differently. We need more knowledge, critical thinking and skills in-house. To combat the pressure, we can’t afford care assistants to be treated as nurses or treat nurses as enhanced care assistants. We need clarity about roles, levels of legitimate authority, responsibility and accountability to deliver care in a socio-therapeutic way. This must involve the individual, their families and access to a wider range of specialists across health and social care. Programmes, such as Elizabeth Care®, are emerging to provide a more multidisciplinary and evidence-based picture of what is needed, worked into a carefully thought out, enriched role for nurses, other registered professionals and ‘carer practitioners’ with enhanced roles in socio-therapeutic gerontology practice that is not ‘medicalised’. They can lead to foundation and work-based degrees giving a clear career pathway. An alternative to taking the most promising staff down the management route. A workand skills-based education would deliver the care needs fit for a growing, ageing population and develop experts and specialists in caring for older people. Staff need an innovative mix of knowledge, skills and practice that currently sit in a range of disciplines. Development at senior level must be offered at the care delivery end to provide the right care experience for residents and relatives and equip staff properly. Care homes are understandably defensive and justify themselves about the quality of their care as they are unfairly targeted, underdeveloped and misunderstood. We must take the initiative to be seen as equal partners along the care journey. We must take strategic ownership and drive our own future to equip our workforce and provide a worthwhile career pathway, creating our care homes as centres of learning, attracting people to work with us. We must also have a larger share of resources from Health Education England as older people in ‘social care’ settings have the same rights for quality care as the rest of the population. CMM

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

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