Care Management Matters February 2015 by Care Choices Ltd

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FACING A DROUGHT

The looming nursing crisis

Handling complaints effectively Best practice principles

Business Clinic

The future of local authority care homes

Resource Finder

Specialist legal firms

Includes 4-page Skills Academy insert: Focus on leadership – how adult social care organisations can develop positive caring cultures

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Believe in better *Pricing shown is ex VAT, for the Sky in-room package. Customers will be billed monthly and installation costs apply. **Over 65s Sky TV viewing statistics based on Sky IQ data, April 2014. ^Sky Box only free where Sky installs your equipment. Charge of £50 per box (plus VAT) if Sky does not install your equipment. Installation of equipment is not included, please call for more information. Free box offers not available if you have previously had such offers. 12 month minimum term for Sky TV and WiFi. Both in room and lounge packages available. Channels available dependant on chosen package and scheduling may be subject to change. Some content/channels unavailable in communal areas. As at the date of print, channels not available in communal areas are: Alibi, G.O.L.D., Watch, Star Gold, Star Life OK and Star Plus. #WiFi availability subject to location. WiFi pricing subject to survey. Set up fee applies. †Free £500 voucher for Oomph! is available as part of the Sky Lounge package. Further terms apply. See voucher for details. Calls cost 5.1p per minute (plus 15.97p connection fee) for BT customers. Calls from other providers may vary. Correct as at 11 December 2014. The Grand Budapest Hotel © 2014 TGBH LLC, Twentieth Century Fox Film Corporation and TSG Entertainment Finance LLC. All rights reserved. Artwork © 2014 Twentieth Century Fox Film Corporation. All rights reserved.

In this issue 05

Is it just me…? Editor in Chief, Robert Chamberlain takes a satirical look at the state of social care and progress towards integration.

CMM News

A View from the Top David Coull, Chief Executive of Coverage Care.

Business Clinic The panel considers the future of local authority in-house care provision.

Resource Finder Need a solicitor? CMM profiles some of the sector’s specialist law firms.

Event round up CMM reviews the Surrey Care Awards 2014 and Launch of Learning Disability Alliance England.

What’s On?

Straight Talk In the light of the Burstow Commission’s Key to Care report, Trevor Brocklebank argues that good care costs money – and it needs time.

FEATURES 40 CMM Insight 2015

REGULARS

From the Editor

The future nursing crisis Dr David Foster answers a killer question from the sector on the looming nursing crisis.

Handling complaints Michael King explores the role of the Local Government Ombudsmen in handling complaints and discusses best practice.

3rd Sector Care Awards 2014

The Homecare Gap Patrick Tate explores homecare geography and demographics whilst identifying opportunities for providers.

Managing grievances David Waters shares his top tips for handling grievances from former employees.

Achieving Gold in End of Life Care Maggie Stobbart-Rowlands explores the benefits of the Gold Standards Framework in End of Life Care.

Learning Disability Services: Current Developments and Future Opportunities – see page 42 to find out more. CMM February 2015 3

CONTRIBUTORS

EDITORIAL editor@caremanagementmatters.co.uk Editor in Chief: Robert Chamberlain Editor: Emma Morriss News Editor: Des Kelly Editorial Assistant: Amy Elizabeth Catlin

CONTRIBUTORS

PRODUCTION Lead Designer: Holly Cornell Director of Creative Operations: Lisa Werthmann Assistant Production Manager: Jamie Harvey Creative Artworker: Gemma Cook

ADVERTISING sales@caremanagementmatters.co.uk 01223 207770 Advertising Manager: Daniel Carpenter daniel.carpenter@carechoices.co.uk Director of Sales: David Werthmann david.werthmann@carechoices.co.uk National Sales Manager: Paul Leahy paul.leahy@carechoices.co.uk

Dr David Foster

Michael King Executive Director, Local Government Ombudsman

Andrew Sidwell Senior Director, GVA

Des Kelly OBE Executive Director, National Care Forum

Erica Lockhart Co-Chair, Care Association Alliance

Patrick Tate Director – Location Strategy and Analytics, CACI

David Coull Chief Executive, Coverage Care, Chair, National Care Forum

David Waters Managing Director, CHIS/PrimeCare Insurance

Maggie StobbartRowlands Lead Nurse, Gold Standard Framework Centre

Trevor Brocklebank Chief Executive, Home Instead Senior Care

Deputy Director of Nursing and Midwifery Advisor, Department of Health

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 2015 ISBN: 978-1-910362-33-4 CCL REF NO: CMM 12.0

CMM magazine is officially part of the membership entitlement of:

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

4 CMM February 2015

FROM THE EDITOR

From the Editor Editor, Emma Morriss welcomes you to the new-look CMM and shares her thoughts on the sector. NEW YEAR, NEW-LOOK It’s with great pleasure that I welcome you to the new-look CMM. I’ve been involved with CMM, in one capacity or another, for nearly a decade and have taken it through many incarnations. The sector has changed in that time and I hope that the magazine has evolved to reflect that. The CMM team has worked really hard to bring you a publication that meets your needs, gives you relevant and useful information to run a successful, quality business whilst keeping you up-to-date on sector developments. We hope we’ve achieved this. To coincide with the relaunch of CMM, we have a brand new website www.caremanagementmatters. co.uk. Designed to reflect the quality you’ve all come to expect from CMM, we have developed it as a as useful companion to the magazine. The website will grow

throughout 2015 and I encourage you to visit it regularly as we’re confident it will enhance the content you find within these pages. Subscribers to the website will find a growing amount of additional content too.

SHARING MY THOUGHTS Within this new column I intend to share my thoughts on aspects of the sector and one thing I’m really interested in is how our sector is represented in the wider media and major press. I think a fitting example for this first issue of 2015, and one that sums up how the sector can be negatively represented, is this story from The Times in early January. ‘One in three care homes is judged to be substandard’ ‘Almost a third of homes for the elderly have been judged as substandard under a new

inspection regime that has granted its top rating to just one residential care home in the three months since it was set up. The Care Quality Commission has so far examined 353 care homes and domiciliary services, which offer care to the elderly in their own homes. Of these, 24 were judged to be “Inadequate” and face closure if they do not improve swiftly, and 81 “Require Improvement”. Of the rest, 245 have been judged “Good”. Only three services have been given an “Outstanding” rating.’ Whilst completely accurate in its

reporting, I think the main story here is that nearly 70% of those providers inspected under the new regime have been judged as ‘Good’ with the first three receiving an ‘Outstanding’ rating. We are all aware that the quality of services can vary and agree that ‘Inadequate’ services need to improve, but when the minority figures are focused on for shock effect, it’s not helping the sector and its public perception. I hope you enjoy the new-look CMM. Emma Morriss

Email: editor@caremanagementmatters.co.uk Twitter: @CMM_Magazine Web: www.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

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Finding you t h e s o lu t i o n s s i n c e 2 003 .

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Ablution Revolution? BESPOKE EDITORIAL, NEWS, OPINION AND BEST PRACTICE INFORMATION

LNT’S INSTITUTIONAL INVESTOR THE FUTURE OF FINANCE?

Business Clinic

LNT GROUP

The LNT Group, chaired by British entrepreneur Lawrence Tomlinson, includes a number of different, and far-reaching companies including the care sector focused Ideal Carehomes, LNT Construction and LNT Software, plus LNT Solutions and Ginetta Cars. Ideal Carehomes is a care home operator, offering high quality services for older people without any third party top ups. Its homes are mainly across the UK and are designed and developed to be future-proof. LNT Construction designs and builds care homes, not only for Ideal Carehomes but for third parties too including Anchor, Avery, Sanctuary and Nugent Care. Having built 52 care homes since 2009, with 36 being run by Ideal Carehomes, it offers providers turnkey solutions and is currently working on developments in the south and Home Counties. The third care-focused company in

the Group is LNT Software, an integral care sector software package.

REFINANCING

In April 2013, the Group finalised a £100 million refinancing, though the process was not straight forward. At the time, Lawrence Tomlinson was quoted as saying the deal had taken two to three years to come together, involved four different banks and had ‘issues’. He named Santander and Yorkshire and Clydesdale Banks in the process, plus it’s reported that RBS and Bank Leumi were also involved. Mr Tomlinson went on to say that the amount of paperwork involved was ‘phenomenal’ and that the whole process was ‘complicated’. He has, however, given very positive feedback about several of the banking partners involved in the 2013 refinance. He told CMM, ‘Whilst there were complexities in the 2013 refinance which were costly, and at times challenging, it met our finance needs for 2013 to 14. I found Santander and Yorkshire Bank particularly helpful throughout the past year, and Leumi continue to be a key partner in enabling our care home developments.’ After all this, the deal would have needed to have been renegotiated in September 2014. With renegotiation on the horizon, LNT Group has just announced a £51 million debt refinancing with L&G Capital. L&G Capital is a new business line created by Legal and General to provide five key functions: direct investments; implementing the investment strategy across the balance sheet; managing the Group’s Shareholder Funds investments and managing the Group’s debt and liquidity. One of the drivers behind

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

L&G DEAL

Congratulations @DesKellyOBE @NCFCareForum for your continued support of @skillsforcare as a valuable Board member! Oct 17

HOME

Does a new 10-year deal between L&G Capital and LNT Group, owner of Ideal Carehomes, signal a change in care sector financing? The LNT Group’s Founding Chairman, Lawrence Tomlinson, has been a vocal advocate for the need for sensible financing in business since the credit crunch. As one of two Entrepreneurs in Residence at the Department for Business, Innovation and Skills, he published an independent report in November 2013 which looked into bank lending practices and how certain banks deal with businesses in distress. In April 2013, the Group had negotiated a £100 million refinancing of the business with a collective of banks. With that up for renewal in September 2014, the Group has announced a £51 million debt facility with L&G Capital. As the insurer looks to increase its involvement in the care sector, is this the future of financing?

The deal between LNT Group and L&G Capital, which was announced in mid- TARGET HEALTHCARE REIT May, is a £51 million debt facility, over On the same day as the L&G ten years, to LNT Group incorporating Capital announcement, Target all its subsidiaries. It is secured Healthcare REIT Ltd announced that against the Group’s portfolio of care it had acquired a portfolio of three homes and will give the company homes from Ideal Carehomes for the ability to move forward with approximately £13.9 million. These building a sustainable and growing have been leased back to the operator build pipeline of new care homes. for 35 years. The announcement Mr Tomlinson explained the drivers comes just a month after Target behind the deal with L&G Capital, ‘Our Healthcare REIT acquired two decision to take a debt facility from other Ideal Carehomes, the first for Legal and General was largely driven £3.8 million and another, due for by the offer of long-term finance and completion in summer 2014, for £5.1 their understanding of our business million. In 2013, Target Healthcare model which we believe paves the REIT also acquired homes from Ideal way for a fruitful partnership for the Carehomes in September for £4 future.’ million and £18 million for four homes Alex Gipson, Lending Manager at in March. CMM Legal and General, said, ‘Organisations OVER TO THE EXPERTS... that hold enduring business models and that, therefore, operate and Given the tough nature of the bank plan over medium- to long-term finance market, highlighted by the horizons are clearly better matched ‘issues’ faced by LNT in 2013, do to external capital that operates over these new financing options mark similar long-term durations. For this the future for care sector financing? reason, the financing needs of LNT’s Are more providers going to have to Ideal Carehome business provides a look farther afield than the traditional very natural fit with Legal & General’s banks to access finance? Will we long-dated pension and annuity see more organisations such as liabilities and we expect increasing L&G begin to meet the needs of the opportunities in sectors such as market, not necessarily being met the care home market, supporting by the traditional banks? Is this the organisations committed to delivery changing face of care sector finance? of long term solutions to meet What does our panel think? increasing demand.’

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It’s not L&G’s first investment in the care home sector. It acquired 13 care homes from MHA for just over £70 million in December 2013 and it forward funded and purchased five care homes in Suffolk with Care UK for £31 million. These were funded on behalf of Legal and General Property’s Managed Property Fund.

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Ablution Revolution?

Ablution Revolution? A Comprehensive Research Study into Wetroom Provision in UK Care Homes

Integration in practice

Ben Hartley analyses the provision of ensuites and wetrooms in UK care homes and draws some interesting conclusions.

Notes

It is said that, apart from death and taxes, the only certainty in life is change - a truism, for sure, but one that warrants some reflection when we consider how society thinks about the way we care for our older people, and particularly in relation to residential settings.

Maps

iTunes

Before launching into the research I’d like to draw comparisons with the hotel and guesthouse sector. It’s not that long ago that ensuite bathrooms in hotels and guesthouses were a dream for the future. Today, it’s as standard as the beds in the room. Residential care for older people though might not be keeping up with the ablution revolution, which was our starting point in deciding that there needed to be some in-depth work to establish the current position.

30 CMM February 2015

We embarked upon a thorough and extensive research project, carrying out a comprehensive survey over six months involving more than 6,000 telephone interviews. It reveals a very interesting picture. The research includes data from the whole of the UK and comprises information from private, not-for-profit, local authority and some NHS care homes.

Right to work

Where we were unable to contact a care home directly, we made a number of assumptions based on data from other sources including the A-Z Care Homes Guide and the Care Quality Commission. The principles of what we did and why are relatively easy to convey. The detail, however, is trickier and, unless you are a stats lover, a little less inspiring.

A view from the top

Definitions

Safari

For the purpose of this research, we describe an ensuite bedroom as one where there is at least a WC and wash hand basin. Such a room may also provide, though this is not a requirement for the purposes of our definition, a shower cubicle, bath or wetroom.

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By contrast, our definition of a bedroom with an ensuite wetroom is one where there is a full wetroom, i.e. a walk-in shower complete with level access as well as the WC and wash hand basin. In effect, this is a subset of the ensuite bedroom provision – simply characterised by a higher level of facility.

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Headline results We know that care homes aren’t keeping pace with the rate of change witnessed in hotel stock, however, although we knew that provision was more limited, the findings have shown an even bigger gap in provision than anticipated.

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IS IT JUST ME...?

Is it just me...? Editor in Chief, Robert Chamberlain takes a satirical look at the state of social care and its progress toward integration with health services.

During the festive break the headlines regarding the crisis in A&E departments have come thick and fast – almost on a daily basis. Hospitals are at breaking point with unprecedented demand especially from older people with complex needs. Waiting times are at an all time high and government targets have gone out of the window. I’m sure that there are many contributing factors that have impacted on this crisis but the cuts to social care services, intervention and rehabilitation must be key contributors. Building a more robust social care sector is part of the solution it seems clear to me. I am currently studying towards an MBA and have discovered an interesting idea generation tool that I feel could be put to good use to unravel the current social and health care crisis. Known as ‘negative (or reverse) brainstorming’ the concept in simple terms is to look at the worst way to approach the achievement of objectives. One

that is likely to result in their failure. Having identified these negatives, the theory is to then to look at the reverse of these points to discover the best way forward. So I thought I’d apply it to our sector and see what I came up with. I pondered the worst possible way to develop social care in order to meet the needs of a growing population and reduce the impact on health services. Here is what I came up with. • Ignore the fact that social care is being under-funded. Reduce available budgets year on year even though the demand for services is rising. Promote personalisation, control, independence and choice as the right of all individuals when requiring care but provide budgets that make these ‘rights’ aspirational. • Publicly push the intention to integrate health and social care but continue to make budgeting and planning decisions in silos. Fail to see the bigger picture of social care’s potential contribution

to reducing the demands on the health service at a time when A&E departments are reaching ‘breaking point’. Throw more money at the

• Increase social care eligibility criteria to benefit only the most vulnerable in society and commission brief home care visits for the majority of older people. Place reliance on families or neighbours to fill the voids where possible. Accept chronic loneliness and social isolation as collateral damage from budget cuts and society’s problem. • Tender for contracts from providers that promise quality home care but provide the service at a price that does not afford the minimum wage for care workers. • Consider care homes and nursing homes as a last resort that form no part in resolving the issues of growing pressure on NHS admissions or discharges. Fund such placements at a sub-market level that affords minimum wage for their employees to make recruitment and staff retention problematic. Ignore the

‘I’m sure that there are many contributing factors that have impacted on this crisis but the cuts to social care services, intervention and rehabilitation must be key contributors.’ NHS to resolve the resultant crisis rather than investing in social care services that could intervene much earlier in the demise of an individual’s health. • Continue to leave social care budgets without a ring-fence including new potential funding streams, for example the NHS Transfer money. Ensure that complicated financial systems prevent the tracking of how and where such funds are spent and how efficient or effective the expenditure has been.

fact that the fee levels and the consequences of such have the potential to impact on the quality of care provided. So now all that I need to do is to look at the reverse of these points and that should provide me with a pathway to understanding how to achieve the set objectives. But hang on a moment…. is it just me or do these ‘negative’ points sound familiar? Perhaps the powers that be forgot to carry out the second part of the exercise! CMM

Join the debate on the CMM website www.caremanagementmatters.co.uk. Comment, create a debate and move the conversation forward. CMM February 2015 7

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8 CMM February 2015

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NEWS First ‘Outstanding’ ratings The Chief Inspector of Adult Social Care at the Care Quality Commission (CQC), Andrea Sutcliffe, has congratulated England’s first three adult social care services which have achieved the highest possible rating in providing safe, high-quality and compassionate care. CQC has named Prince of Wales House (Ipswich) along with two homecare companies – Home Instead Senior Care (West Lancashire and Chorley) and Domiciliary Care East Devon (Exeter) – as having services judged to be ‘Outstanding’. The top ratings follow on from the launch of the regulator’s new style inspections and ratings system in October 2014 inspecting whether services are safe, caring, effective, responsive and well-led. Since then, 350 adult social care services nationally have so far been awarded a CQC rating. Around 70% of these are rated as ‘Good’. Chief Inspector of Adult Social Care at the CQC, Andrea Sutcliffe

said, ‘I am tremendously pleased to be able to congratulate our very first ‘Outstanding’ adult social care services in England. Each one has demonstrated that excellent care is being provided by dedicated and committed staff who are passionate about making a difference for the people they support. ‘The launch of our new approach to inspecting and rating services last October set out clear and important criteria on how providers can demonstrate they are delivering good or better care and effectively tackling any problems. Through performance ratings, we will continue to celebrate the very best services and shine a spotlight on those providers that fail to do the right thing to help people when it comes to choosing care. ‘Everyone using adult social care services deserves to experience really great care. I am determined that we use regulation to drive forward rapid improvement and help make the ‘Mum Test’ real.’

APPOINTMENTS CARE UK Care UK has appointed Phil Whitecross as Chief Financial Officer. Phil has worked with Care UK as Group Commercial Director since December.

8.8% less funding for LAs The Local Government Finance Settlement confirms that councils across England will receive 8.8% less funding from Government to run local services in April 2015. Initial analysis by the Local Government Association (LGA), which represents councils, shows that: savings of £2.6 billion will need to be found from council budgets for 2015/16; the cut brings the total reduction in core government funding to councils since 2010 to 40%. Over this period councils will have made £20bn worth of savings. Research carried out by the LGA earlier this year found 60% of councils said they were considering stopping at least some services in 2015 because efficiency savings are fast running out. This was based on the expected cut for 2015/16 set out in last year’s Local Government Finance Settlement.

‘Time to act’ on homecare The Local Government Information Unit (LGiU) has published its final report of the Burstow Commission on the future of the homecare workforce Key to Care saying ‘it is time to act’. The report highlights that there are more people needing care and there is less money to pay for it and not enough people willing to do the work. Homecare services are not organised nearly as well as they

could be and appears designed to keep caring professional relationships from forming between workers and those they care for, it warns. It concludes that if homecare in the UK is not yet in crisis, it soon will be – as a result of downward pressure on the cost of care and a workforce that is devalued by employers. The report outlines recommendations on what needs

to change to have a professional, well-paid, well-trained and properly regulated workforce who can provide the quality of care at home that people need. It features stories of care workers, in their own powerful words, on what needs to change and what could be the future of care. Trevor Brocklebank of Home Instead gives his thoughts on the report and the future of homecare in Straight Talk on page 50.

GLEN CARE Glen Care has appointed Julian Wenman as Director of Hospitals. Peter Gilroy OBE and Dr Andres Fonseca have also joined as nonexecutive directors.

BROOKDALE CARE Brookdale Care has appointed Mark Goldsborough as Chief Operating Officer.

DANSHELL Danshell has appointed Amanda Smith as Director of Finance. A Chartered Accountant, Amanda has a wealth of experience working in learning disability, mental health and CAMHS services.

HC-ONE Dr Chai Patel has taken on the role of Acting Chief Executive at HC-One, whilst retaining his role as Chair. David Spruzen has stepped down as Chief Executive.

CARTERWOOD Carterwood has announced two new promotions. Tom Hartley has been promoted to Senior Agent and Sadie Havens has become Sales Administrator.

ALTERNATIVE FUTURES Alternative Futures Group has appointed four new trustees. Experienced healthcare professional Mary Burrows MBE; Daniel Chaffer, a chartered accountant at BBC North; government adviser Michael Parkinson CBE and Mike Clarke, a business development specialist all join the board.

CMM February 2015 9

NEWS

APPOINTMENTS SEVACARE Sevacare has made senior management changes. Founder and current Chairman, Ravi Bains is to reassume the role of Chief Executive, while Darren Stapelberg becomes Chief Operating Officer. This follows the departure of former Chief Executive Roger Booker.

AVANTE Avante Care and Support has appointed Heather Brimm as Regional Care Director for Bexley. Heather previously worked with Avante as a consultant.

CHOICE Estelle Christmas has joined Choice as part of the Referrals Team. The Operations Team has welcomed Mark Luce as Area Director of Operational Resources. Three new directors have joined the management team; Gareth Williams, joins as Finance Director, Dr. Peter Oaks is Clinical Director and Andy Knowles joins as Estates Director.

TOGETHER TRUST Together Trust has appointed Larry Waller as Head of Business Development to support its future plans for expansion.

NEW CARE PROJECTS Kay Johnson has joined New Care Projects as Group Hospitality and Client Experience Manager. Kay has a wealth of experience in the hospitality industry.

SANTANDER Santander Corporate and Commercial has strengthened its healthcare team with the appointments of Graham McKean as Head of SME Healthcare and Mark Pavis as Head of Corporate Healthcare.

10 CMM February 2015

CQC partners The future for learning with The Silver disability provision The leading names in learning Inspector for the North – The Care Line Quality Commission’s presentation disability provision are meeting in The Care Quality Commission (CQC) has partnered with The Silver Line helpline. Through CQC’s ‘tell us about your care’ partnership, anyone can share their concerns – and anonymously if preferred – if they feel they are not being listened to, or might not feel able to speak directly to those responsible for delivering safe, caring, effective, responsive and well-led services that CQC expects. The partnership is also an opportunity to help identify best practice examples where high quality and compassionate care is being provided.

Harrogate home sold HPC has announced the sale of Alexander Court Nursing Home in Harrogate. The property has been acquired by Hadrian Healthcare, which intends to completely redevelop the site. Director of HPC Ian Wilkie commented, ‘The 85 bed home attracted strong interest from a variety of developers and care home operators. After interviewing a shortlist of potential purchasers, we were delighted to agree a deal with Hadrian Healthcare.’

Manchester in February to debate the current status of learning disability services and explore future opportunities. CMM Insight 2015 Learning Disability Services: Current Developments and Future Opportunities will once again bring together providers, policymakers and leading advisers to debate this important sector. Delegates will benefit from Deborah Westhead, Deputy Chief

on the proposed regulation of supported living. This is a subject that all providers need to understand. Also speaking are Zandrea Stewart and Stephen Taylor – Principal Advisers for Winterbourne View Joint Improvement Programme, Amanda Nurse, Director, Carterwood and Roger Harcourt, Partner, Shakespeares. To book, visit www.caremanagementmatters.co.uk

Time for Change A report on the future of services for people with learning disabilities has been published by the Association of Chief Executives of Voluntary Organisations (ACEVO). In 2011, Panorama’s exposé of Winterbourne View led to the Government pledge to move all people with learning disabilities and/or autism inappropriately placed in such institutions into community care by June 2014. Three years on, not only has that movement not been achieved, but there are still more people being admitted to these institutions than discharged. Sir Stephen Bubb, Chief Executive of ACEVO, led a review exploring how a new national framework of support might be delivered locally, in order to allow the growth of community

provision required to move people out of inappropriate institutional care. Winterbourne View – Time for Change gives a roadmap for action. The recommendations includes a Charter of Rights for people with learning disabilities and/or autism and their families; to give people with learning disabilities and their families a ‘right to challenge’ decisions and the right to request a personal budget; and a requirement for local decision-makers to follow a mandatory framework that sets out who is responsible, for which services and how they will be held to account, including improved data collection and publication. The report also recommends improved training and education for NHS, local government and provider staff.

GMB’s tests for cameras in care settings Cameras can never be a substitute for good care and the money could be better spent elsewhere says GMB. The union responded to the Care Quality Commission’s announcement that it is publishing information on the use of CCTV cameras in care settings. Justin Bowden, GMB National Officer said, ‘More than 2,000 GMB members working for HC-One responded to a recent survey of their views on the possible introduction of visible cameras into care homes. Whilst 40%

were opposed to their introduction, a majority were relaxed about it and believed in the right circumstances it could provide some degree of protection to them and residents. The main reasons for opposition and concern were about the dignity and privacy of the residents; that cameras could never be a substitute for good care and money could be better spent elsewhere. GMB recognises there is a degree of inevitably about cameras in care but five tests should be applied:

1. What would be the purpose of each camera being introduced? 2. Has the prior consent and views of the residents been obtained? 3. How is the system regulated? 4. Who will have access to the footage and when? How will it be kept secure? 5. Could the money be better spent elsewhere? See In Focus on page 15 regarding the CQC’s guidance on cameras in care homes.

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NEWS

L&G acquires homes Legal & General Property (LGP), on behalf of its Legal & General UK Property Fund, has acquired a portfolio of three care homes from the Careplaces Fund, the specialist healthcare property fund managed by Bridges Ventures in partnership with care home developer Castleoak. Purchased for a total consideration of £25.2m, the deal represents a net initial yield of 5.5%. Located in Stratford-upon-Avon, Kidderminster and Stansted, the properties are all let to Care UK on 30year leases. The three homes provide 187 registered care beds. Having only recently been developed, the properties are purpose-built to the highest standards.

Complaints matter

Continuing to participate in a growing range of housing and social infrastructure activities, the deal brings L&G’s investment into the care home sector to around £220m. Previous deals include the acquisition of 15 care homes let to Methodist Homes, the forward-funding and purchase of a portfolio of five care homes let to Care UK, as well as another existing Care UK-operated asset, and a £51m, 10-year debt facility to the LNT Group, the parent company to Ideal Carehomes. The sale represents the first realisations from Careplaces, which was established in 2011 to focus specifically on building a portfolio of pre-let care home investments.

RBS supports Eminence Care Eminence Care, provider of Rose Lodge in Exmouth, has received a loan from The Royal Bank of Scotland to extend its existing care home by creating a new community for people

living with dementia. This will further its dementia care provision in East Devon, taking its total bed count to 33 to meet local demands. Rose Lodge specialises in dementia care.

According to the Care Quality Commission (CQC), people could be being put off from making complaints about health and adult social care, which is leading to concerns not being identified and providers missing out on opportunities to improve their services. In its Complaints Matter report, the CQC has found that there is wide variation in the way complaints are handled across the NHS, primary care and adult social care services in England, with complainants being met too often with a defensive

culture rather than one that listens and is willing to learn. Although the regulator has found examples of good practice, more needs to be done to encourage people to come forward with their complaints, to keep them informed on the progress, to reassure them that action will be taken as a result, and to assess that whether they are satisfied with how it has been resolved. This in turn will lead to improvements in the quality of care. For more information on handling complaints, see our feature on page 25.

New care centre in Warminster The Orders of St John Care Trust has officially opened Ashwood Care Centre in Warminster. Developed as a state-of-the-art care home for older people, Ashwood provides person-centred care, including a combination of specialist nursing and dementia care, along with short-

term respite care for those who may only require a short stay. Equipped with 82 beds, the £7.5m care facility is divided into six separate household units, each self-contained with its own communal dining and lounge areas, as well as specialist assisted bathing facilities.

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Cambian acquires Woodleigh Cambian Group has acquired Woodleigh Community Care for an enterprise value of £63m, funded from the Group’s bank facilities. Woodleigh operates 152 beds, across 13 residential homes and supported living units plus one hospital in the Yorkshire and Humber region. It provides a full pathway for specialist, community-based, high severity care for adults with complex needs, challenging behaviours and learning disabilities. In the 12 months to September 2014, Woodleigh recorded revenue of £18.2m, EBITDA of £6.8m and operating profit of £5.4m. At 30th September 2014, the gross assets employed in Woodleigh were £13.5m. The properties in the Woodleigh portfolio are freehold, with three further freehold sites owned for development.

Calling time on Inadequate care Adult social care services in England that fail to improve within a year of being rated as ‘Inadequate’ overall will face closure as part of plans to tackle failing care according to the Care Quality Commission’s (CQC) Public Board Meeting. The update follows the announcement from the Secretary of State for Health in July 2014 asking the CQC to develop a special measures regime for adult social care in England. Since then, the CQC has been

developing what this could look like with people using services and their carers, providers and their representatives, commissioners, staff and national partners. CQC is now seeking further views from anyone who wishes to have their say on the latest special measures proposals before the final policy is published in March 2015. Learn more and have your say on the CQC website www.cqc.org.uk. The deadline for feedback is Friday 30th January.

POLL

Are you ready for the forthcoming Care Act changes? Yes No You can vote via: www.caremanagementmatters.co.uk editor@caremanagementmatters.co.uk

Lexicon Healthcare opens £7.5m care home in Exeter

SureCare acquired

Angela Rippon OBE has opened Green Tree Court care home in Exeter. Developed, designed and built by Castleoak, the home is owned and run by Lexicon Healthcare, which specialises in providing exceptional care home environments with the very best

The managing director of Chesterbased care company SureCare has acquired the business from Housing & Care 21. Gary Farrer, who has been SureCare’s Managing Director for two years, has completed a deal to buy the franchise company.

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NEWS / IN FOCUS

Ashtonleigh Homes expands

In focus

Ashtonleigh Homes is to expand its portfolio with the purchase of a 91-bed care home in Haywards Heath, following £6.5 million in funding from Santander Corporate and Commercial. AHL currently has three care homes in the south east of England: 38-bed Avalon Nursing Home in Eastbourne and

CQC guidance on the use of surveillance

43-bed Ashtonleigh Residential Care Home and 31-bed Ashton Grange in Horsham. The acquisition of this latest facility, Ashton House in Haywards Heath will allow the group to significantly extend its presence in the region and provide a quality service to even more residents.

New film from SCIE and NCPC The Social Care Institute for Excellence (SCIE) and the National Council for Palliative Care (NCPC) have developed a new film, Thinking about the words we use. The film looks at the words that care and health staff often use when someone has been given a terminal diagnosis or is dying. It explores how people are first confronted with this terminology. It might be when a professional speaks to them; or it might be on signs in hospitals and other care settings. This, at a time when people - and their relatives -

might be confused, angry and in the dark about what to expect. It makes the case for practitioners to communicate how much they care about the person who is dying; as well as being clear about what they’re doing to help and support the person, and their friends and relatives. Practitioners need to ask themselves whether the words they use convey this compassion. They also need to check with those they are caring for, that the information they are providing is clear as well as compassionate.

Acquisition of Hastings home Target Healthcare REIT Limited has exchanged contracts to acquire a new, purpose-built care home in Hastings, East Sussex. As the property has now reached practical completion and been registered with the Care Quality Commission,

the Company confirms that it has acquired the property for a total consideration of approximately £8m including acquisition costs. The care home will be leased to operator Hastings Court for 35 years.

Partnerships in Care

Carterwood assists Frontier with planning

Partnerships in Care has acquired a 50-bed service at Melton Mowbray, Leicestershire from The Danshell Group. The service, which is based across three sites (Warwick Lodge, Croxton Lodge and The Dalby Unit) cares for patients diagnosed with acquired brain injury and learning disability. Joy Chamberlain, Group Chief Executive said, ‘The expansion of our care pathways supports our aim and commitment to provide access to high quality and caring services.’

Runnymede Borough Council has granted full planning approval for the demolition of existing buildings at Parklands in Chertsey and its redevelopment into a 70-bed care home with 50 extra care apartments. Specialist chartered surveyors, Carterwood was asked by Frontier Estates, the landowners, to prepare a needs assessment in support of the planning application.

WHAT’S THE STORY? The Care Quality Commission (CQC) published guidance on the use of surveillance, such as CCTV cameras, to monitor health and social care services in December 2014 following extensive consultation and discussions. The guidance refers to the use of covert surveillance (such as hidden cameras or audio recording equipment) and overt surveillance (such as visible CCTV cameras).

WHY IS THIS IMPORTANT? The protection of privacy and treating people with dignity and respect are fundamental to providing quality care and support services. CQC has concluded that there may be occasions when the use of surveillance may be considered as a means of supporting ‘the delivery of safe, effective, compassionate and high-quality care’. However the CQC guidance highlights the importance of capable and confident staff with the right mix of skills; an open culture for raising concerns; and systems of supervision and appraisal to develop and motivate staff as likely to be the best way to ensure that care is high quality and safe. There will also be training issues for staff as well as a need for clear policies and procedures including how requests for access to recorded information would be handled and issues of storage and security to consider.

WHAT WILL IT MEAN FOR CARE PROVIDERS? Please note that any use of surveillance must comply with the law. CQC points out that its guidance, ‘does not constitute legal advice’ and providers are advised to obtain expert legal opinion when considering its use. Case examples are helpfully used to illustrate the way providers might approach the sensitive issue of surveillance. The guidance is fair and balanced. It is proportionate and does an excellent job in balancing the interests of different parties likely to be involved. CQC indicates that it would not routinely access information collected through overt or covert surveillance systems. The guidance also lists useful reference material.

ARE YOU PREPARED? The CQC guidance emphasises the importance of consulting with people who use services, their families and friends as well as staff when considering the use of surveillance systems - wherever this is possible. It also covers critical matters of consent, capacity and implications for the Data Protection Act 1998, and the need to keep appropriate records that can be viewed by inspectors. There is a helpful note that CQC would be concerned by an over-reliance on surveillance to deliver key elements of care. In addition, the guidance reflects on the importance of the trust between staff and the employer/ employee relationship. CMM February 2015 15

NEWS

Mansfield care home opens

Signature’s approval in Reigate

A new state of the art care home, Baily House in Mansfield, has opened its doors thanks to a funding provided by The Royal Bank of Scotland (RBS). Baily House in Mansfield is one of LNT Group’s recently completed ‘Turn of Key Plus’ projects. It has now been handed over to John Walton, Managing Director of Woodleigh Care, who already runs the highly

Reigate and Banstead Borough Council has granted full planning approval for the development of an 87-bed care home in Reigate, which will include a 24-bedroom dementia community. The care home will provide specialist care within a

successful Woodleigh Christian Care Home in Mansfield. LNT’s unique package and service means that Woodleigh Care has benefited from not only a fullyequipped brand new state-of-the-art care home but also the support of staff selection and recruitment, CQC commissioning and a pre-opening marketing programme leading up to two highly successful open days.

Revolution in learning disability care A state-of-the-art residential support service in Hartlepool is leading a revolution in learning disability care by enabling people with complex needs to live semiindependently in the community. The £4.5m Mariner Care service has been created to meet a national requirement for people with learning disabilities and autism to move from inappropriate

and unsuitable environments – including hospitals – and out of homes not considered fit for purpose. Moving into one of the Mariner homes will allow service users to access specialist community-based services. The four specially designed bungalows in Hartlepool will provide therapeutic care for up to 12 vulnerable adults.

dedicated environment, specifically designed to care for older people living with dementia. Carterwood were asked by Signature Senior Lifestyle to prepare a needs assessment in support of the planning application.

NorthStar to upgrade facilities in Worthing NorthStar has been given the goahead to redevelop the Priory care home in Worthing into a brand new, 21st century care facility. The proposed redevelopment of a site in Worthing was granted planning consent at a meeting of

the Adur and Worthing Planning Committee in December. Currently the Priory Nursing Home offers 42 beds. Under the new development the existing building will be demolished and a new, 64bed care home put in its place.

Executive Care Group acquired Deloitte has sold Executive Care Group to Conduit Street Holdings 1 Limited, an organisation linked to Monarch Alternative Capital.

Executive Care Group, which operates 25 care homes in the North East of England was in administration at the time of sale.

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Countering the critics of residential care Residential care has been much criticised over the years. Some of the criticisms have been justified, but many are overstated or unfair. Countless reports have been written about residential care but few have been followed up. As a result, residential care services have become accustomed to receiving

criticism from many quarters, argues the charity The Residential Forum. As a consequence the residential care sector has appeared to staff and the public to be passive in accepting and not challenging such criticism. The Residential Forum has produced a paper based on

a workshop which seeks to take the debate forward with commissioners, regulators, provider organisations, government officials and other stakeholders. The workshop discussions raised issues about the need for better informed media and public debate about residential care.

Care home development report catalyst for growth. Knight Frank has published its 2014 Care Home Development report. Key • Increased levels of overseas highlights indicate that demand investment has increased additional funds for development to a range of for new care home development is major healthcare providers. expected to improve going forward, driven by strong population growth • The demand for new care home prospects and as current stock development is expected to approaches obsolescence. improve going forward, driven by strong growth prospects in The analysis reveals that more the UK’s population of over 65s than half of the top 12 counties in and as current stock approaches England and Wales are located in obsolescence. the UK’s southern regions. Greater London climbs to the top spot. • Greater London is current number • Care home development realised via one hot spot for care home forward funding continues to be a development, edging ahead of

Buckinghamshire – South East region market will remain strong where self-funding market remains at a high. • Highlands and Islands has replaced the Borders as top ranked Scottish counties for care home development. Disposal of public sector land for care-led development will continue, however high alternative use values could encourage land being sold for residential development rather than care homes.

Dignity workshops

Graham Care plans further expansion Graham Care has announced plans for further expansion following the completion of an additional £15 million funding package with Clydesdale and Yorkshire Bank. Graham Care, which already operates seven care homes in Kent, Surrey and Sussex, will open a new facility at Hawkhurst, Turnbridge Wells. It will also complete a major redevelopment of its existing care home at Rodwell Farm in Surrey. Construction work on both developments is scheduled for completion by the beginning of 2016, and will create around 150 new jobs across the two facilities. On opening, overall capacity at Graham Care’s homes will increase from 520 to around 650 places. The company employs around 600 people and its annual turnover is approaching £25 million.

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NEWS

YouGov reports on care home catering New research from YouGov Reports suggests that while most people with relatives/friends in care homes are satisfied with the standard of food and drink provided to their loved ones, there is room for improvement. The Care Home Catering 2014 report examined the experience and views of people with a relative or friend currently residing in a care

home, and people who have had a loved one in a care home within the last five years. It included both publically and privately funded homes. Amongst people with relatives/ friends currently in care homes, a significant proportion (32%) believe that care home meals are to some degree better than the meals their

relative/friend ate at home. When compared to NHS hospitals meals this rises to 55%. Considering hot meals that are delivered at home, 37% say the care home food is better. There is room for improvement however. 37% of people with relatives/friends currently in care homes and 35% of people with relatives/friends who were in care

homes would like to see more fresh fruit on the menu. There is also a demand for more home-cooked meals (31%/26%). There is also a desire to consult with residents/ patients on menus and to be careful not to use too much processed foods. Significantly, many would be willing to pay extra to improve the quality of meals (32%/36%).

Care home opens in Essex

Dementia in diverse communities

A new care home in Manningtree has officially opened after funding from Clydesdale Bank. Operated by Stour Valley Care Group, the 60-bed Mistley Manor will employ 100 people. The company received a seven figure funding package from Clydesdale Bank to complete the new home.

The University of Salford’s Institute for Dementia has found that more needs to be done to support people from diverse communities living with dementia, including Black Minority Ethnic (BME) and deaf people. It is estimated there are currently 25,000 people with dementia from BME communities in

The new home has been built on the site of a former eight-bed care home in Manningtree. It will include 48 en-suite bedrooms and 12 penthouse suites. Four supportedcare bungalows are also opening next to the home and will operate as Mistley Grove.

Sheffcare end of life care Sheffcare has been awarded a major new contract with Sheffield Clinical Commissioning Group. The contract will see the Sheffcare Home Care team provide dignified, safe and personalised end of life care, enabling patients to remain living in their own home if they choose to do so. The service will provide practical care, reassurance and support to patients

and their families with scheduled visits throughout a 24 hour period, seven days a week, providing care on a flexible, rapid and occasionally crisis basis in order to accommodate the changing needs of the patient. The service will be provided in conjunction with other NHS mainstream services and voluntary providers.

Final phase of healthcare village Work begins on the final phase of a £10m tailor-made healthcare village in the Norfolk as the NorthStar team oversee the development of 25 independent living retirement bungalows. Called Woodgate Park, the development is owned and managed by Castlemeadow Care,

GMB: ‘Minority will benefit from funding cap’ Only a tiny minority of elderly care home residents paying for their own care will live long enough to benefit from cost of care cap of £72,000 from April 2016, according to the union, GMB. The union says that about 90% of those who go into a care home will die before they reach the cap limit so only a very small minority of elderly residents who pay for their own residential care will live long enough to benefit from the cap on care costs due to start in April 2016. The Government is introducing a cap on eligible care costs for people in England of state pension age or over who have to pay for their own care. Individuals will pay all costs 18 CMM February 2015

before the cap. The Government has set the cap at £72,000. Top-up fees are excluded from the cap, so too are ‘ hotel costs’ of around £230 per week. According to the GMB, based on current trends, when the new system comes into force local authorities will be paying on average £522 a week in England for a residential care bed. After deducting the £230 per week, the union says the balance counting towards the cap will be £292 per week on average. There is significant variation in local authority rates and this will affect the time taken to reach the cap. The union goes on to say that

England and Wales and this figure is expected to grow to 50,000 by 2026 and 172,000 by 2051. Certain types of dementia may be more prevalent among BME communities for example, as risk factors, including high blood pressure, diabetes, hypertension and high cholesterol, may be more common.

it would take four years and nine months for an average resident in England to reach the cap and that residents can expect to spend around twice the official level of the cap to get to that point. They also state that there is just above a one in 10 chance of a resident reaching the cap before they die. Justin Bowden, GMB National Officer said, ‘The complete inadequacy of the Government’s cap on eligible care fees is laid bare for all to see… ‘Does this government policy really represent the full value as a society we place on our elderly and vulnerable?’

who contracted NorthStar to deliver a unique vision of what elderly care will look like, now and in the future. Woodgate Park is a development of 25 two-bed retirement bungalows which will be built to a high specification offering safe and secure independent living.

3AB Care 3AB Care Limited has secured funding from The Royal Bank of Scotland (RBS) to help the growth of the business and finance the expansion and renovation of one of its care homes. 3AB Care owns and operates five care and nursing homes throughout the UK. The funding is to be used primarily to help finance work at Brook House. Plans for the development include the construction of 12 new en-suite bedrooms as well as extensive renovation work to the home’s existing facilities. Development work has already started with completion estimated by Spring 2015.

HEADER

CMM February 2015 19

CMM is offering readers the opportunity to put their questions to senior decision-makers. Is there something affecting your business that youâ&#x20AC;&#x2122;d like an answer to? Are you facing specific pressures youâ&#x20AC;&#x2122;d like to know how to tackle? Send your questions to CMM.

The future nursing

CRISIS

20 CMM February 2015

29% of nurses will retire in the next 10 years. This comes at a time when the Care Act encourages keeping people at home for longer but the availability of district nurses and community psychiatric nurses is reducing and the demand increasing. It is also increasingly difficult to recruit nurses to the care home sector together with registered nurse managers as a result of the national shortage and the increasing responsibilities being placed on them in this setting. How is the Department of Health planning to redress this major looming crisis? Roger Wharton, Executive Officer, Registered Care Providers Association Ltd

Dr David Foster, Deputy Director of Nursing and Midwifery Adviser, Department of Health responds.

The demand for nursing, care and support is increasing. It’s really a great success story because we are living longer, remaining independent for longer and taking more responsibility for managing our health than ever before. It’s also a cause of great concern that those who are living longer and want to stay independent but need nursing, care and support should not have to worry about who is going to provide it. Whichever way you look at it, the demand is outstripping the supply. Whatever the statistics we know the nursing and caring workforce is ageing, significant numbers will wish to retire in the next decade and the supply of newly-qualified nurses is skewed towards staffing NHS hospitals.

The Francis inquiry into Mid Staffordshire NHS Foundation Trust shone a spotlight on the quality of nursing care in acute hospitals which undoubtedly has influenced the increase in supply of nurses to the NHS. This has left, unfortunately and unintentionally, the impact of Winterbourne View and the staffing of the independent sector in the shadows. Given this context it is easy to become negative about nursing, its pressures and demands and nursing older people generally. My introduction to nursing was as a nursing auxiliary in, what was then called, a geriatric hospital. It was a fantastic experience and fired my love of nursing. My exposure to older people recovering, rehabilitating or having a respectful and dignified death kept me going through my student nurse training. Images of that superb care still live with me but that was an ‘illness’ model. Now I am exposed to nursing in settings where the care of older people is more personcentred, people are helped to stay as independent as possible, manage their health and wellbeing and avoid hospital admissions. The breadth, value and autonomy of nursing older people in this way is something that we should make more obvious and celebrate as an incredibly meaningful and worthwhile career choice.

GETTING A CLEARER PICTURE Policy intentions suggest care should be closer to home and therefore, more care in the community where we have decreasing numbers of district nurses, community psychiatric nurses and learning disabilities nurses particularly. However, there remain a number of gaps in our data which currently impede our ability to understand the current picture clearly or to plan effectively

CMM February 2015 21

THE FUTURE NURSING CRISIS

for the future. We need to understand better health and social care vacancy rates, the movement of staff between organisations and sectors and how students make career choices about where to work when they qualify. All health and social care employers share the same supply of nurses: they are either trained by the NHS or are recruited from overseas. We recognise that, valuable and experienced though overseas recruits are, this source of nurses cannot be an enduring solution. The diversity of where staff trained by the NHS work is vast with 1,000 different public, private and voluntary sector organisations. There are 676,547 nurses and midwives in the UK on the Nursing and Midwifery Council (NMC) register and Skills for Care estimates there are 50,000 registered nurses employed in care homes (about the same number as are in Wales and Northern Ireland combined) and there are 30,000 to 50,000 nurses in the private and independent sector. The NMC says that 60 per cent of its registrants work outside the NHS. This is a huge number spread across independent sector healthcare organisations, social care, education, research, the armed forces and others. This sheer scale and complexity makes workforce planning a real challenge. The Department is looking closely at the evidence base to see what the collected data tells us about the issues in nursing. The Skills for Care National Data Set for Social Care is invaluable and to improve future decision-making we have asked the Centre for Workforce Intelligence to look at the future supply and demand situation.

Education England (HEE) was created under the Health and Social Care Act 2012 which has responsibility for delivering a better health and healthcare workforce for England. They are responsible for the education, training and personal development of every member of NHS staff, and making sure staff are recruited for their values as well as their abilities. They are governed by a mandate given to them by the Department of Health. The supply of nurses nationally is, therefore, from the health sector and there needs to be greater recognition and focus on a whole system approach to care including adult social care. The mandate from the Government to HEE recognises that health and social care will change over the coming years with increased focus on managing complex comorbidities which will place greater emphasis on the skills of generalist staff as care moves closer to home. Over time, the boundaries between health and social care will become blurred. Although HEE does not have responsibility for the social care workforce, it will be expected to work closely with the social care sector at local and national level to support the transition to integrated care. HEE will need to work with partners across health and care to develop common standards and portable qualifications and skills. The mechanism for doing this is through HEE’s Local Education and Training Boards (LETB). Their core purpose is to lead planning and education commissioning; ensure security of supply of the local health and care workforce; and support national workforce priorities set by HEE.

WORKFORCE PLANNING

Their functions include: • Ensuring security of supply of the local health and care workforce. • Workforce planning and prioritisation of local education and training. • Holding and allocating funding for education and training. • Commissioning education and training and securing quality and value from education and training providers. • Securing effective partnerships with clinicians, Clinical Commissioning Groups, local authorities, health and wellbeing boards, universities and the other providers of education, research and innovation.

In my early days of being a director of nursing, I was very diligent about workforce planning and getting the right number of students for my organisation so I would have a regular supply of the newly-qualified to replace those who left. My numbers were signed off to the nearest tenth of a whole time equivalent to be aggregated into the regional pot. As I grew to understand the system better I realised it’s not an exact science and the precision of my calculations was unwarranted when it emerged that to create a supply of nurses for the independent sector the planners just added 10 per cent to the sum total of the NHS requirement. At least it was there. Now the workforce planning landscape is much changed. Health

They are a significant development in the redesigned structures. As can be seen from their functions their local reach in forging partnerships will mean including social care providers in their discussions. These partnerships

The key issue for the independent and third sector is capturing their requirements for the large number of clinical professionals they need. 22 CMM February 2015

THE FUTURE NURSING CRISIS

might already exist between social care and local authorities, health and wellbeing boards and clinical commissioning groups to a degree of maturity that influencing LETBs will be possible. Challenging though this might be, LETBs will need to capture the future needs and expectations of independent and third sector employers who are providing NHS commissioned care. The key issue for the independent and third sector is capturing their requirements for the large number of clinical professionals they need. This has not been done systematically so far yet, but it is crucial to develop ways of doing this. As Andrea Sutcliffe identified in the Care Quality Commission’s State of Care report there is a current shortage of nurses in adult social care. With one in five nursing homes not having enough staff on duty to ensure care is good and safe, the supply of registered nurses to this sector has to be understood and driven by the new HEE mechanisms. This also means the sector having a voice at the LETB tables in the same way they have a voice on the national HEE Nursing and Midwifery Advisory Board.

SHAPE OF CARING Another development which will help this situation is the Shape of Caring review chaired by Lord Willis of Knaresborough which is a joint initiative by the NMC and HEE. Its objective is to ensure that nurses and care assistants receive high quality education and training, which supports high quality care. It will bring together findings and expertise from recent major reviews such as Francis, Cavendish, Willis and Berwick and make recommendations for the reform of nursing and care assistant education and training in England. The review has sought evidence about the type of workforce required to meet the needs of the population as care patterns and delivery change over the next 15 years. Evidence to this review has very helpfully been provided from the independent sector to highlight that the supply of registered nurses needs to be addressed across the whole health and social care system. It is also clear from the discussions amongst the review’s steering group members that the integration of health and care is a crucial development in streamlining services in the future. The nature of this transition is also clear from NHS England’s Five

Year Forward View. This important document sets the direction for NHS England as a commissioner of services and incorporates an intention to work more closely with social care providers. Similarly, the mandate between the Government and NHS England sets an objective about transforming care so that it is more joined up right across GP surgeries, district nurses and midwives, care homes and hospitals.

DEPARTMENT OF HEALTH’S ACTIONS As can be seen, the situation is complex. There are a number of new national bodies who are turning some attention to this situation and there are initiatives which will help change the situation for the future, but immediacy is also needed in tackling this problem. For this reason, the Department of Health, in its reformed role of as ‘system steward’, is hosting a symposium to work out some quick solutions to the supply of registered nurses to the sector. In the reformed and dispersed healthcare system, the Department does not run or manage the system, but does have a function to stimulate national and local action to help solve this problem. For this reason the Department of Health: • is hosting a symposium on this subject in February 2015 so that we can understand from stakeholders what they propose as solutions and what they are adopting as good practice to improve the image, recruitment and retention of nurses; • will use its membership of the national HEE Advisory Group to influence the commissioning of student nurse numbers to reflect the demands of the sector; and • will keep this on the agenda of the Department’s Independent Sector Nursing Advisory Forum so that stakeholders and partners can sustain pressure and momentum to reach solutions. There is no easy answer to the shortage of nurses in social care, or the supply of newly-registered nurses from NHS-funded education and training programmes, but this is high on the national agenda. It needs sector-led solutions and also needs to be high on local agendas so that those providing NHS care in the independent sector can be involved in working through solutions for their communities, service users and the vulnerable people who need nursing, care and support. CMM

Dr David Foster is Deputy Director of Nursing and Midwifery Advisor at the Department of Health. What are your thoughts on the future of nursing? Join the debate on the CMM website www.caremanagementmatters.co.uk If you would like to put your question to senior decision-makers, email editor@caremanagementmatters.co.uk CMM February 2015 23

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HEADER

HANDLING COMPLAINTS With a Care Quality Commission report on complaints handling in social care, Michael King explores the role of the Local Government Ombudsman (LGO) in handling complaints and discusses best practice for providers. Everyone makes mistakes. The big question for any organisation is how willing you are to admit that, put things right and learn lessons to avoid similar problems in future. We know from experience that the best service providers are not afraid to get service complaints, and instead, welcome every contact they receive as a way to improve their services. The Care Quality Commission’s

(CQC) report Complaints Matter, shared that view, and found that more needs to be done to encourage people to come forward with their complaints. The care regulator has said that it will be making complaints handling central to its inspections and will feed this into its regulatory judgements about how responsive a provider is to people’s needs. As the social care ombudsman, we welcome the CQC’s report, and have been working with the regulator to provide a seamless process when people first contact us allowing easy transfer of calls if they have come to the wrong organisation. We’ve also been working with the Parliamentary and Health Services Ombudsman (PHSO) and Healthwatch England, listening to people who use

public services to understand what they want from an effective complaints system. This research has led to our ground-breaking joint report, My expectations for raising concerns and complaints. The report presents the vision that was created and the findings of the primary research with patients, service users, frontline staff and stakeholders that lay behind it. The vision lays out a comprehensive guide to what good outcomes for patients and service users look like if complaints are handled well. It does this by presenting a series of ‘I statements’ laid out across a complaint journey. The ‘I statements’ are expressions of what patients and service users might say if their experience of making

CMM February 2015 25

HANDLING COMPLAINTS

a complaint was a good one. The journey describes the different stages that patients and service users must go through when making a complaint, from initial consideration, through the communications with staff and institutions, to final reflection on the experience. We believe that the commonsense principles set out in this report should be at the heart of every care provider’s process.

EFFECTIVE COMPLAINTS HANDLING Across all areas, we heard that people wanted to know that they have a right to complain, they wanted to know where to complain, to be kept informed and feel their complaint makes a difference and they want to feel confident they can complain again if the need arises. A person-centred complaints procedure needs to take this into account – and, while we would never advocate a ‘one-size-fits-all’ blueprint for complaints handling, a good process needs to be accessible, effective and accountable. It needs to be transparent and people need to know who to turn to if they have a problem, with no barriers placed in their way. People want to know that they are being heard. Sadly, in many of the cases we investigate, organisations could have sorted out the problem at an early stage by simply acknowledging concerns and apologising. From our own research we also know that people get frustrated when the complaints process appears to be taking too long. We know that communication is the key to helping the process run smoothly. People want to be kept informed and updated regularly, and

want to have a personal point of contact for their complaint.

THE FINAL STAGE In our role as the social care ombudsman, the LGO provides the final stage of the care complaints process. Where a service user remains dissatisfied with the provider’s response to a complaint, we can conduct a free, fair and independent review of the matter. We investigate complaints about all types of social care. If we find fault we will recommend a remedy to put things right for the person who has complained. If we don’t, we’ll bring the issue to a clear conclusion. Our enquiries, recommendations and remedies also aim to help prevent similar problems in future. Last year we registered 2,456 complaints and enquiries about adult social care. Just nine per cent of those (213) were about privately-funded care - a share that has remained constant since our remit was widened nearly five years ago. We’d like to understand a bit more about why we receive so few complaints about private care. It may be that the sector has high levels of satisfaction and does a really good job of handling complaints before they reach us, or it could be that customers do not have a clear idea about where they can take their complaints if they have not been resolved to their satisfaction. In all likelihood, there will be a mix of different factors in different parts of the private care market. In our 2014 annual review of adult social care complaints, we recommended a number of ways that the complaints process could be improved nationally. While these are not statutory requirements, many care providers are looking at how they can implement some of them as a means of improving the transparency of

their own complaints processes. In the report, we suggested that there should be better signposting to ensure that service users, their families and representatives understand how to complain, and understand that there is an independent avenue for redress through the LGO when things go wrong. To that end, we suggested that every care setting should have appropriate, but prominent, signs, posters and leaflets outlining how a person can make a complaint or raise a concern, who they can turn to for independent support and that they have the right to go to an independent ombudsman if they remain dissatisfied. We also suggested that all social care providers and commissioners should have an annual review of complaints, which would increase the ownership and understanding of complaints, as well as driving the improvement of services.

LGO RESOURCES The LGO offers practical, one-day training sessions specifically for groups of people who deal with adult social care complaints. We have been running these courses for local authority complaints handlers for a number of years, and we will soon be launching courses aimed at supervisory and frontline staff in the private care sector too. A pilot of the private provider course received excellent feedback. All our decisions are published on our website, and complaints handlers can look at our online statements to find out how we have recommended other authorities or providers can remedy similar complaints. People who specifically deal with adult social care complaints can also receive the ASC Matters newsletter. CMM

Michael King, Executive Director at the Local Government Ombudsman. www.lgo.org.uk To read any of the reports mentioned in this article, visit www.caremanagementmatters.co.uk

26 CMM February 2015

A VIEW FROM THE TOP

D A V I D

C O U L L

David Coull is Chief Executive of Coverage Care, and Chair of the National Care Forum.

REFLECTIONS ON THE LAST DECADE Social care: We are seeing significant changes in the sector that have been anticipated at least 10 years. Especially changes to residential care commissioning. There is more focus on discretionary and non-discretionary spend by local authorities. Within the difficult financial circumstances, where they can delay spending money they will. Providers unprepared to respond and adapt their service offering are experiencing obsolescence as key funders aren’t supporting traditional residential care. Organisation: We spotted these changes. When we took over the original Shropshire, Telford and Wrekin local authority care homes, much of the contract was unsustainable: day services and meals on wheels. We refocused, invested in specialist staff training and development and developed state of the art nursing homes providing a fuller continuum of care including dementia. Over the last decade we have doubled in size, modernised the organisational structure and developed a fully-integrated governance structure we can be proud of. We have the best of both ‘worlds’ (voluntary and independent sector), while retaining all of the ethics and objectives of a not-for-profit. Career: This is my 40th year in the sector. I started in a long-stay psychiatric hospital and trained as a nurse when I realised I couldn’t be a marine. I worked in

the NHS for 20 years leaving as Corporate Director of a community trust. I worked as an executive director in care, housing and health organisations until I joined Coverage Care as Chief Executive in 2003. PROJECTIONS FOR THE NEXT DECADE If sense rather than other interests prevail we should move further towards integration. The driver has to be managing long-term conditions, starting with integrating personal budgets (PBs) and personal health budgets. This could impact quickly. However existing barriers, including professional attitudes and costs to individuals must be addressed. NHS commissioning can make efficiencies and economies. We must stop restructuring commissioning ‘agencies’. It costs a fortune, loses quality individuals and distracts organisations. Services delivered via PBs must be directed by or exclusively on behalf of the individual. We must be more creative about developing, deploying and sharing scarce or difficult to recruit staff. We are often desperately trying to outbid competing providers, constructing false boundaries and constraining the innovation we need. I’m positive about the future. Austerity is an impetus for change. Increases in health funding in the 1990s showed additional money doesn’t always drive innovation. People want services delivered differently. Less of the same won’t do.

INSIGHT Honesty counts. Personal and professional integrity is essential. I’m really proud of our organisation. The privilege of operating a not-for-profit enables us to have open discussions with our communities and stakeholders. We don’t have infinite choice but we have added flexibilities which we’re committed to using in the interests of current or future, service users. INFLUENCES My old senior nursing officer, who before coaching and mentoring programmes were so common (in the late 70s) spotted in me something and ‘sponsored’ my career development. We can all identify rising stars and shouldn’t feel threatened by them. They are our future. LESSONS Don’t spend your time making yourself busy. There is rarely any correlation between speed of conversation and busyness and quality output. Reflect and focus on what you’re trying to achieve as you’ll have more chance of achieving it. ADVICE Apply a simple logic test. If it looks too good to be true, it probably is. If it doesn’t look right, it probably isn’t. If you don’t understand you are probably not alone. If it can’t be explained clearly it is unlikely to be actioned wisely, keep asking questions. CMM

An extended version of this interview can be found on our website. www.caremanagementmatters.co.uk CMM February 2015 27

CALLING TIME ON LOCAL AUTHORITY HOMES? The end of 2014 saw a number of local authorities consulting on the future of council-run care homes. Is time finally being called on in-house care home provision? Council-run care homes were once the main provision of care within individual counties. As time, legislation and successive Governments have passed, provision has been outsourced or closed. Now council-run care homes are a minority. Local authorities face further budgetary cuts, having to make vast savings over recent years; A proportion of existing in-house provision is ageing and will cost to bring up to standard. As a result, 2014 saw more local authorities consulting on their care homes. Although individual councils are taking different approaches from outsourcing to closures. More specifically, consultations are happening in Devon, Doncaster, Leeds, Leicester, Nottinghamshire and Surrey.

DEVON

In Devon, plans were revealed to close 20 homes over a 18 months. The council only provides places to 10 per cent of the county’s residents, with 90 per cent of places outsourced to the independent sector. However, the costs involved meant that it was spending nearly 30 per cent of its residential care budget on these 10 per cent of people. With a need to make financial savings, it proposed to close 20 of its 22 care homes. Two dementia care homes were to remain open. However, the decision was met with legal action which put it on hold until November when the challenge was withdrawn. The Council said in a statement to CMM, ‘Devon County Council is now continuing to implement its phased closure programme. The 28 CMM February 2015

number of residents has already been reduced from 260 to fewer than 150 and several homes are now empty. Throughout the process, all concerned are being reassured that there has been no change to the existing eligibility criteria for access to County Council care services and that the authority is fully committed to supporting residents and their families to identify and secure the best possible alternative care in the independent sector.’

DONCASTER

Doncaster Metropolitan Borough Council had agreed in late 2013 to close the last of its seven care homes from June 2014. This was mainly due to ageing stock and the costs involved in bringing them up to standard. However, a decision was then taken to find alternative providers. In a Statement Ros Jones, Mayor of Doncaster said, ‘In June Cabinet requested that officers seek to identify potential alternative providers for the council’s seven care homes. I am pleased that this process has identified enough interest to commence a formal procurement process which, if successful, would mean the care homes will not close. ‘The procurement process to transfer the care homes has started and is being designed to ensure high quality of care for our residents. Staff would continue to be protected not just in legislative terms, through such things as TUPE, but also through our expectations on an incumbent provider to maintain a skilled and effective workforce. Staff will be fully consulted on the proposals and the implications for them and the service, in light of these planned changes.’

LEEDS

In Leeds, the City Council has taken the decision to ‘move away from directly owned and operated long-stay care homes to support the development of Extra Care housing… in those areas where there is currently an undersupply.’ The Council is also looking to work closely with the independent sector to ensure future provision of nursing and end of life care facilities across the city is modern, up-to-date and fits the needs of local residents. The Council is discussing whether to consult on the closure of three of its 15 remaining homes, stop admissions to two more and look at the possibility of community transfers for another two. The council has closed seven homes since 2010 due to budgetary pressures.

LEICESTER

Leicester City Council has sold two of its former care home properties. In a statement it said it had, ‘put the former elderly people’s homes of Nuffield House and Elizabeth House up for sale following their closure earlier this year [2014]. Both buildings have now been purchased by two nationally-established private care home providers, with a view to running them as care homes’. The council has also agreed the sale of two homes as going concerns. Abbey House and Cooper House are due to transfer to Leicestershire County Care Ltd on 2nd February 2015.

NOTTINGHAMSHIRE

Nottinghamshire County Council is consulting on the future of its six remaining care homes in its Budget

consultation. These homes according to the consultation document, ‘are not modern and do not have the benefit of en-suite facilities for long-term care residents.’ The Council is investing £12.65million in more extra care schemes across the county as one alternative to the care homes, which are proposed to close. Residents in the care homes proposed to close will be given priority for a place in a new build extra care scheme where appropriate.

SURREY

Finally, Surrey County Council is consulting on the future of six of its residential care homes. In its consultation document the council said, ‘We want to make sure Surrey residents have access to high quality care and support... These six homes – built between 1970 and 1990 – are not designed to meet changing needs and new standards of accommodation. The homes are all currently under-utilised.’ The consultation ran until the 19th December with recommendations expected in 2015. CMM

OVER TO THE EXPERTS... Local authorities across the country are consulting on the future of some or all of their care provision. With a need to make financial savings, ageing stock and rising costs of delivering care, is time being called, once and for all, on in-house residential care? Do these consultations pose opportunities for private providers? Will we see a completely independent care market within the next five years?

DIVESTMENT IS ADVISABLE AND INEVITABLE We live in an age of ever-increasing care home standards, driven by expectations of users and relentless regulation. I seriously question local authorities’ (LA) ability to compete, and even their future provider role. Over the longer term will the available care and accommodation across any given district improve or deteriorate by keeping care homes in the hands of LAs? Or might overall sector standards improve by allowing the homes to pass into private or charitable sector ownership, or close? Key to this is the ability to invest in redeveloping and improving ageing stock, for hugely less-dependent clients than today. We cannot be confident that LAs have the resources to re-provide stock to create appropriate, fit-for-purpose environments. Successive governments have given social care funding a low priority. Combine with the LA budget squeeze and the continuing austerity agenda and divestment is not only

advisable, it is inevitable. The undisputed need for statefunded residential care beds is largely taken up elsewhere by charities, housing associations and the many excellent not-for-profit trusts founded to takeover LA homes. Much of this supply is of high quality, higher than many surviving LA homes. Development of sheltered/extracare housing continues, sometimes in ambitious and attractive care villages. Homecare services expand. So there’s little room for struggling, inefficient and increasingly obsolete LA homes. Many stand on sites with viable alternative uses, even in low value areas. The best use of scarce resources no longer lies in persevering with LA care homes. Will LAs still provide residential care facilities? Probably, but substantially fewer and more aligned to wider choices of accommodation and care.

Andrew Sidwell Senior Director, GVA

PUBLIC SECTOR PROVISION WILL CONTINUE TO SHRINK The transfer of care home services from the public sector which began in the 1980s is almost complete in that there is estimated to be only about 6 per cent of care provision now operated by local authorities. As the summary of consultations currently taking place highlights very well, the phased closure of care homes appears to be intensifying as councils deal with rising demands and a continuing squeeze on their budgets. Local authorities are different, supply and demand characteristics vary as does the availability of alternative support services and, as a consequence, the ‘market’ for care also differs. Whether or not a council decides to continue to operate some care home services on an in-house basis will need to be informed by these, and other relevant, local factors. I don’t believe that public sector provision will disappear altogether but I do think it will continue to shrink as it seeks to specialise in such areas as dementia care or forms of integrated

service such as intermediate care or rehabilitation. Of course, this is mirroring developments that are occurring amongst for-profit and notfor-profit care home providers. The biggest difficulty that council-run care homes face is the disproportionately high cost of staffing. Herein is a significant dilemma as reducing costs has primarily been achieved through cuts to staff wages and conditions. Given the current calls for commissioning arrangements to recognise the professional role of care workers and cover the cost of paying the Living Wage it is ironic that the same financial pressures experienced by all providers has resulted in this situation. I believe that any opportunities will simply result from the continued sector consolidation but worry that the cost of improved quality will ultimately mean less choice.

Des Kelly OBE Executive Director, National Care Forum

SURREY’S SITUATION IS ECHOED ELSEWHERE Anyone who reads the consultation document on the potential closure of Surrey County Council’s last remaining care homes would ask, ‘why has it taken this long to address this issue?’ It highlights low occupancy, poor building infrastructure and probably the worst element, poor environment – with no en-suite facilities, corridor and toilets not suitable for today’s frailer residents. That is before you consider the overhead costs at a time when LA budgets are under such pressure, how can such low occupancy levels be sustained? No private or voluntary sector provider could have stayed in business. Nor would the Care Quality Commission have been so tolerant of the lack of modern facilities. Although there will no doubt be local concern at these homes closing, not least for the current residents but as a community resource the residents, when moved to alternative more suitable premises, will flourish. The key question for the LA will be, can they buy alternative beds in the

independent market for the current low fees they pay. Surrey has been sheltered from some of the market forces by its long-term block contracts from over 20 years ago when it outsourced homes to two large providers. There will be capacity in the market fortese residents but I’m concerned about the high numbers of respite beds that will be lost. It’s a problem for independent providers to make available advance respite bookings for carers. If there are vacancies virtually all providers will assist but to keep beds open ‘in case’ doesn’t make financial sense. The council will need to consider some block contract beds to meet this need. It’s time to take stock, for providers to respond with innovative solutions and continue to build public confidence in the quality of care the private sector can offer.

Erica Lockhart Co-Chair, Care Association Alliance CMM February 2015 29

Organised by:

The inaugural 3rd Sector Care Awards, organised by CMM was held in Central London on December 3rd 2014. The event was hosted by Esther Rantzen and was supported by The National Care Forum.

Already looking to 2015, the excellence, innovation and goodwill the event generated will raise the bar for the sector. The event truly gave care and support 3rd Sector the recognition it deserves.

The Awards celebrate and showcase the innovation and care excellence of the not-for-profit care and support sector. The Awards aim to reward examples of outstanding achievement and performance in this dynamic sector.

CMM is proud to announce that the 3rd Sector Care Awards will return in 2015. Nominations will open in due course however to explore the categories, find out how to enter, attend or support the 3rd Sector Care Awards 2015 visit www.3rdSectorCareAwards.co.uk. Alternatively you can email lisa.werthmann@carechoices.co.uk for more information.

All winners and finalists were thoroughly deserving in the ways they make a difference to the people they support and the wider community. However, the show was stolen by the Certitude Community Choir, The Inclusions from Ealing and The Brixton Harmonies. Made up of service users and members of the wider community, their performance had the audience on its feet and finished with the largest standing ovation of the day.

Supported by:

30 CMM February 2015

It was great to see so many talented and modest people be recognised – most of them seemed to have no idea how influential they have been. David Foster, Department of Health Member of the Awards’ judging panel

The Compassion Award Sponsored by CHIS – www.chis.net WINNER: Morenike (Renie) Dada, Support Worker, Amethyst Road, Outlook Care The Innovative Quality Outcomes Award Sponsored by Ladder to the Moon – www.laddertothemoon.co.uk WINNER: Tenant Involvement Team, Progress Housing Group – Supported Living Creative Arts Award Sponsored by The Baring Foundation – www.baringfoundation.org.uk WINNER: Alison Sayer, Chief Executive, Halas Homes Community Engagement Award Sponsored by Social Care Institute for Excellence – www.scie.org.uk WINNER: Jo Boddington, Director, Bodster Equine Assisted Learning Community Interest Company Citizenship Award Sponsored by Care Choices – www.carechoices.co.uk WINNER: Allan Finn, Volunteer Project Advisor, The Jigsaw Project, mcch Leadership Award Sponsored by Carterwood – www.carterwood.co.uk WINNER: Neil Matthewman, Community Integrated Care Collaboration (Integration) Award Sponsored by Bollington Insurance – www.bollington.com WINNER: Maresa Ness, Chief Executive, Mosaic Clubhouse

Contribution to Sector Development Award Sponsored by Freeths LLP – www.freeths.co.uk WINNER: David Russell, Head of Health and Social Care, Spice Innovations Board Member/Trustee of the Year Award Sponsored by Sky – www.sky.com/business WINNER: Beverley Aldridge, Operations Director and Board Member, Coverage Care Services

Sponsors:

CMM February 2015 31

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32 CMM February 2015

THE HOMECARE

GAP HOMECARE DRIVERS

Patrick Tate highlights the extent to which local authority and self-funded homecare differ, not only geographically but also demographically whilst identifying where opportunities may lie for providers.

The Better Care Fund, announced by the Coalition Government in June 2013, is aimed at joining up NHS and local authority (LA) run services to ensure people receive better, more appropriate care in locations most suited to them. More recently, there has been a pledge to ease the pressure on hospitals by shifting the support element of care into peopleâ&#x20AC;&#x2122;s homes.

CMM February 2015 33

THE HOMECARE GAP

According to the Local Government Association, the gap between demand and funding for social care is projected to stand at £1.9billion in 2015/16. This means that many people who would benefit from LA provided home-care will have to turn to family, friends and voluntary groups to provide care in the home or, for self-funders that have the means, the private home-care provider. The Personal Social Services Research Unit (PSSRU) estimated that for older people, LA-funded homecare users will rise 71 per cent between 2010 and 2030 and those who fund their care privately will rise by 106 per cent. This is based on Office for National Statistics (ONS) projections of age and gender and assuming prevalence rates of disability household structure (e.g. marital status, lone person households) remain unchanged. CACI has previously reported on population growth and that by 2024 there is expected to be a 14 per cent rise in the numbers in the elderly population (aged 65+), compared to a 5 per cent rise in the overall population of Great Britain. Both studies highlight the immediate need and the growing expectation for domiciliary care. LAs including their newly-formed Public Health teams are under increasing pressure to improve their services while reducing costs by efficiently delivering transformation programmes and appropriate, person-centric amenities. These types of efficiencies can only be achieved through migrating the right people towards the right level of supported services. This provides opportunities for LAs to be more effective and for private enterprise to fulfil a growing need in a market which is currently worth over £1billion per year in England and Wales alone.

It is interesting to note the regional variations, with the South West being approximately 9 per cent more expensive than the average and the North West almost 10 per cent less. Self-Funders Market Size Up to £5,500,000 £5,500,00 to £7,500,00 £7,500,00 to £9,500,00 £9,500,00 to £14,000,000 Over £14,000,000 0

Miles

REGIONAL DEMAND FOR SELF-FUNDED HOMECARE A separate study based on data from the English Longitudinal Survey of Ageing estimates the proportion of older people who currently fully fund their homecare is 1.96 per cent. To understand the size of the market we used our 2014 population forecasts combined with the above study’s age and gender cohorts. Table one shows the top 10 postcode areas by annual self-funding market size. It can be seen that Birmingham (Postcode Area B) with its high population also has the highest number of elderly people who are likely to pay for their own domiciliary care, with Brighton (BN) having the greatest proportion. Although not shown on the table, Milton Keynes (MK) is set to have the biggest increase, 29 per cent, in self-funders within ten years (given constant propensities by age). Rank

Postcode Area

Postcode Area Name

Total Population 65+

Population 65+ SelfFunders

SelfFunders %

Self-Funders Annual Market Size

Birmingham

302,383

6,216

2.06

£29,607,000

Sheffield

249,352

4,918

1.97

£24,580,000

Nottingham

208,616

4,137

1.98

£21,586,000

Newcastle-upon-Tyne

216,912

4,341

£20,773,000

Brighton

171,918

3,818

2.22

£19,629,000

Peterborough

189,465

3,731

1.97

£19,547,000

Portsmouth

180,104

3,762

2.09

£19,343,000

Bristol

166,994

3,454

2.07

£18,757,000

Norwich

171,333

3,471

2.03

£18,181,000

Leicester

171,107

3,443

2.01

£17,965,000

Combining the results of a research piece by PSSRU and recent data releases in National Adult Social Care Intelligence Service (NASCIS) enables us to ascertain the value of self-funders at very small area level, averaging at around £5,000 per user per year. In England and Wales alone, this equates to more than £1billion. This is in contrast to the cost to English LAs, which average £10,000 per person or over £2billion in total. 34 CMM February 2015

The map shows where the market for self-funded domiciliary care is likely to be high, according to the proportions of age cohorts amongst elderly people and their respective regions. Whilst some areas may seem obvious in that they either have a large overall population, such as Birmingham, or that they contain many elderly people as is the case along the south coast, there is a concentration of likely spend across the East Midlands and down into south Wales.

REGIONAL DEMAND FOR LA-FUNDED HOMECARE Data published by the Health and Social Care Information Centre’s (HSCIC) National Adult Social Care Intelligence Service (NASCIS) gives the number of people aged 65+ who are in receipt of LA-funded homecare and the associated cost. As mentioned above, the average cost to an English LA is about £10,000 per year per user, with approximately 2.2 per cent of the 65+ population using their services. The range of usage across the country is fairly wide, from less than 1 per cent in places like Cheshire East to over 5 per cent in Newham, Lambeth and Tower Hamlets. The question remains, however, that with the introduction of the Better Care Fund and the diminishing funding of care home places, which of these current users of LA services can be converted to funding their own homecare? Any funding formula provided to each area will inevitably be interpreted differently by each LA, as such the answer may lie in the demographics of those using homecare and whether or not they self-fund.

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THE HOMECARE GAP

DEMOGRAPHIC DEMAND FOR SELF-FUNDED HOMECARE As the calculation for self-funded homecare spend is based on age cohorts, we are able to assign a value at full postcode level (ie W14 8TT). Using a postcode level geo-demographic classification of the UK population that highlights social factors like wealth, consumer habits and digital behaviour, known as Acorn groups, we can estimate which Acorn groups and types are most likely to self-fund their homecare and how much they are likely to spend. We can also estimate the number of LA service users by Acorn group. When considering the number of people aged 65 and over who are likely to be self-funders, it is expected that those neighbourhoods with many elderly people would be prevalent. When looking at the Acorn groups, the group classified as ‘Poorer Pensioners’ (older people living in social housing with traditional attitudes) and the ‘Comfortable Seniors’ group (empty nester couples in owner-occupied housing) are commonly considered to be potential self-funders. However, these two groups only represent 12 per cent of self-funders and, therefore, only offer limited opportunity. When looking for opportunities to provide services to self-funders, the larger groups are ‘Executive Wealth’ (families and retired couples in larger properties with above average incomes) and ‘Mature Money’ (suburban and rural neighbourhoods of older empty nesters in high value, high income homes). These alone make up over 25 per cent of self-funders and when applying our spend calculation, the table below shows that their likely spend on homecare is over £268million per year. Acorn Group Description

Total Spend

Base

Average Spend

£14,521,083 £125,917,482 £142,317,596

1.4 12.3 13.9

2,884 24,934 28,175

1.4 12.2 13.8

£5,036 £5,050 £5,051

£17,430,111 £35,085,882

1.7 3.4

3,410 6,877

1.7 3.4

£5,111 £5,102

£66,542,715 £61,621,553 £78,708,745 £56,959,696 £28,764,656

6.5 6.0 7.7 5.6 2.8

13,038 12,155 15,737 11,324 5,694

6.4 6.0 7.7 5.6 2.8

£5,104 £5,070 £5,001 £5,030 £5,051

£8,334,325 £63,055,946 £75,779,921 £69,489,036

0.8 6.1 7.4 6.8

1,647 12,653 15,058 13,876

0.8 6.2 7.4 6.8

£5,060 £4,984 £5,033 £5,008

£38,308,850 £47,675,490 £36,409,594

3.7 4.6 3.5

7,705 9,537 7,352

3.8 4.7 3.6

£4,972 £4,999 £4,952

1. Affluent Achievers 1. A Lavish Lifestyles 1. B Executive Wealth 1. C Mature Money 2. Rising Prosperity 2. D City Sophisticates 2. E Career Climbers 3. Comfortable Communities 3. F Countryside Communities 3. G Successful Suburbs 3. H Steady Neighbourhoods 3. I Comfortable Seniors 3. J Starting Out 4. Financially Stretched 4. K Student Life 4. L Modest Means 4. M Striving Families 4. N Poorer Pensioners 5. Urban Adversity 5. O Young Hardship 5. P Struggling Estates 5. Q Difficult Circumstances Total

£1,025,936,696

203,787

£5,034

DEMOGRAPHIC DEMAND FOR LOCAL AUTHORITY FUNDED HOMECARE The English data from NASCIS allows us to estimate the distribution of those in receipt of LA-funded homecare by spreading the values across the population of those aged 65 and over. The resultant Acorn profile shows that those in urban and metropolitan areas are more likely to have their homecare funded by their LA.

Just under two per cent of the overall English elderly population live in ‘City Sophisticates’ neighbourhoods (these are neighbourhoods of generally affluent city dwellers living in areas of relatively young professionals), whereas those in receipt of LA-funded homecare in these neighbourhoods are over represented by 50 per cent. The volume of people, however, isn’t particularly high. Those in the ‘Student Life’ group (areas dominated by students and young people) also over index, containing 24% more elderly LA funded homecare users than one would expect to find given the distribution of the population aged over 65. This also applies to the ‘Urban Adversity’ category which contain some of the most deprived areas of large and small towns across the country and contains over 14 per cent of the elderly population in receipt of LA funded homecare compared to just 12 per cent of all over 65 population. However, given the deprived nature of people in these categories, the over representation is to be expected. It’s interesting to note that the average household income of retired households in the ‘City Sophisticates’ group is £31,300 compared to £19,500 in the ‘Urban Adversity’ category. As well as being disproportionately over-represented in their usage of LA-funded homecare, the City Sophisticates group also appear to cost more per person than any other Acorn group at over £10,750 per person, whereas the overall average is less than £9,800, a difference of almost £1,000. With an estimate of nearly 5,500 elderly people being funded by their LA, this equates to £5.5million in additional funds being spent in this group alone.

OPPORTUNITIES The introduction of the Better Care Fund should allow more people to make their own decisions about their health and social care. However, the Government’s pledge to have more older people remain in their own homes for as long as possible and the diminishing funding for care home places means there are opportunities for LAs to manage their integrated care resources better and for private elderly care businesses to direct their commercial activities to those that are able to self-fund. The Acorn analysis presented here shows a clear opportunity for LAs to allocate funding to those who are most in need. The elderly population within the ‘City Sophisticates’ Acorn group costs a disproportionate amount of money to LAs. Even though it only represents approximately 5,500 people, the total cost for homecare is estimated to be in excess of £59million. Similarly the ‘Executive Wealth’ and ‘Mature Money’ groups between them are estimated to cost over £500million. These particular groups make up some of the wealthiest neighbourhoods in the country and represent a significant opportunity for private enterprise to provide alternative, selffunded homecare. A simple comparison of the Acorn profiles of those in receipt of LAfunded homecare and those who self-fund shows how over represented the ‘City Sophisticates’ group are in the LA-funded cohort. At the same time, ‘Poorer Pensioners’ are tending to self-fund, but to a lesser degree. Identifying these neighbourhoods and ascertaining the appropriate funding for their homecare will not only save money within the integrated care provided through the Better Care Fund, but also provide commercial opportunities for private enterprise. For more information on this and Acorn visit: http://acorn.caci.co.uk CMM

Patrick Tate is Director – Location Strategy and Analytics at CACI. ptate@caci.co.uk For more graphs and tables relating to this feature – visit www.caremanagementmatters.co.uk CMM February 2015 37

Every care provider must have breathed a sigh of relief when, back in July 2013, regulations came into force requiring claimants to pay towards the costs of bringing an unfair dismissal claim before an employment tribunal. Vexatious claims made by disgruntled former employees are surely the stuff of nightmares for employers and nowhere more so in the care sector. Yet, while no one could argue that the decline in number of tribunal claims made over the last 18 months has been dramatic, is there a danger that care homes may be resting on their laurels?

CURRENT SITUATION

David Waters shares his top tips for handling grievances from former employees.

It has been widely reported that the number of single claims brought to employment tribunal has reduced by 70 per cent year-on-year, during the period of April to June 2014, with potential claimants deterred by typical fees of up to ÂŁ1,200. However, Acas figures suggest that while the overall claims have fallen considerably there has actually been a significant increase, 9.2 per cent, in the number of claims that reach the stage of being heard. Meanwhile, there have been numerous legal challenges to the system and Labour even outlined its intention this autumn to reform the employment system if elected so that â&#x20AC;&#x2DC;income is not a barrier to justiceâ&#x20AC;&#x2122;. Against this background, care providers can ill afford to be complacent. After all, we can be sure those former employees who are not deterred by the introduction of fees are unlikely to be bringing frivolous claims. Having parted with a substantial amount of money, these claimants will surely be bitterly determined to pursue their claim to the very end. Every year CHIS/PrimeCare Insurance works on claims for its insurance partners, which are made by care providers to cover the cost

Managing grievances 38 CMM February 2015

of employment tribunals brought by disgruntled former employees. While perfectly legitimate under the terms of our insurance policy, these claims naturally can cause premiums to rise at renewal. Disgruntled former workers may complain that they were unfairly treated, that their employer did not follow its own policies or that they were the subject of discrimination. However providers can take heart that, whatever the nature of the grievance, employment tribunals are usually avoidable in all but the most extreme (and often groundless) circumstances. Robust and transparent management procedures together with effective staff communication and professional, timely responses to any complaints can often resolve the matter before it escalates.

TOP TIPS FOR PREVENTING GRIEVANCE CLAIMS Consider Investors in People (IIP) accreditation The most straightforward way to minimise the risk of having to defend an employment tribunal claim is to ensure that your staff are content, well-trained and loyal. Gaining Investors in People accreditation is an excellent means to help develop towards this goal. Develop complaints procedures It is important to pre-empt complaints, considering how to deal with them before it reaches that stage. The proper response to an aggrieved former employee begins even before the complaint is made. Now considered good business practice, it is vital to establish well-drafted complaints procedures that aim to resolve issues quickly, fairly and confidently; it may be advisable to consult, possibly via your insurance policy, a lawyer for assistance. Put these procedures in writing, distribute to all members of staff

and follow them consistently and to the letter when a complaint is filed. This way, if the employeremployee relationship breaks down and a member of staff leaves acrimoniously, a process is in place for dealing with any disputes.

conclusion. This information must be retained in the personnel file of the complainant. This means giving both the former employee and the employer a chance to put their cases forward, talking to witnesses and reviewing all evidence.

Identify genuine grievance issues If any employee, especially a recent leaver, makes a complaint through the proper procedures, identify whether it is a genuine grievance. If so, remember that by carrying out an investigation, you will be viewed favourably if the issue does eventually lead to an employment tribunal. If you decide not to investigate a grievance, the ex-employee may take matters further, their first point of redress of course being Acas. It may be possible to resolve the dispute through that process of early conciliation. If not, and there is merit in the complaint, this is a suitable stage at which to negotiate a settlement â&#x20AC;&#x201C; before the claimant needs to pay the tribunal fee and side-stepping the risk of substantial legal costs to the employer of defending a claim. It goes without saying that complaints relating to discrimination of any kind must be treated seriously. If the complaint eventually leads to an employment tribunal, it is far better to be able to prove that you took action.

Communicate Communication is a key skill when dealing with disgruntled former employees. Keep claimants regularly updated with investigation results and be as detailed as possible in the findings, explaining the steps taken and reasons for coming to any conclusions. When employees make contact reply promptly; do not close down the channels of communication. Take care not to adopt an angry tone, stay calm and professional at all times.

Conduct thorough investigations If an ex-employee makes a complaint through the proper channels and the issue is deemed worthy of investigation, a designated investigator should be appointed. It is essential that this individual is considered to be fair and is trusted both by other employees and by management. The investigator should conduct a thorough investigation in accordance with the complaints procedures, interviewing other appropriate interested parties and witnesses to come to an unbiased

Resolve If the investigation finds the complaint has merit, detail what you intend to do to rectify the situation and prevent the same issue from recurring. It can be beneficial to offer a settlement since this will almost always cost less out of court than through an employment tribunal. In some circumstances, tribunals have the power to increase the compensation paid to a claimant by as much as 25 per cent, should they rule against the employer. Even if the investigation finds that a complaint is unsubstantiated, do consider offering a small gesture. In this way the disgruntled former member of staff will have a small victory and it may be enough to placate them without the risk of any further backlash. In these straitened times, it is imperative that care providers take all possible steps to mitigate any financial risk to their business. Despite the downward trend in employment tribunal claims, the horizon is not clear by any means. Care homes would be wise to shore up their defences, rather than risk being set adrift. CMM

David Waters is Managing Director of CHIS/PrimeCare Insurance. david@chis.net CMM February 2015 39

HEADER

Achieving Gold

in End of Life Care

Itâ&#x20AC;&#x2122;s now 10 years since the Gold Standards Framework in End of Life Care was launched. Maggie Stobbart-Rowlands explores the benefits it can have on residents, care providers and the wider health economy. 40 CMM February 2015

When Otto Frederick Rohwedder started selling sliced bread to his customers in Davenport, Iowa, in 1928, it was hailed as a huge step forward in domestic life. When you think about, it really wasn’t rocket science, but was one of those genius moments that married two simple things – a loaf of bread and a machine to cut it – to create something which improves our quality of life. Improving the quality of life in a care home needn’t be a job for rocket scientists either. In fact, while the impact is far greater than that of sliced bread, the ‘magic’ required really is not much more sophisticated. It does require a framework, commitment and dedication. But the rewards are potentially great. The National Gold Standards Framework (GSF) in End of Life Care recently celebrated a decade of delivering its Care Homes Training Programme at a parliamentary reception hosted by former Care Services Minister, Paul Burstow MP. Rather than resting on its laurels, the GSF Centre took the opportunity to launch a number of new, flexible ways in which care homes can benefit from the ten years of experience it has gleaned, working with more than 2,500 across the UK. During that time, more than a million care home residents and their families have felt the benefit of improved care, in line with their preferences, and almost a quarter of a million care home staff have enjoyed a sustained boost to their confidence, a new set of skills and a sense of satisfaction in being able to deliver the care their residents want and deserve. Many care homes feel daunted at the prospect of undertaking an end of life care training programme, fearing it will involve considerable increased work and issues they are reluctant to tackle. But, this is where the sliced bread analogy comes in. Break down the GSF Care Homes programme into its simple core elements (or slices, if you prefer) and the fear factor can quickly be dissipated.

IDENTIFY, ASSESS, PLAN Identify, assess, plan. Now, that doesn’t sound too taxing does it? But those are the three core elements on which the GSF programme is built. By implementing them, with the help of a portfolio of resources and tools, those 2,500

homes that have completed the training have undergone a transformation, not just for the residents and their families but for the staff and indeed the local health economy. The vast majority of GSF accredited homes (up to 200 apply for accreditation every year and around 100 are being reaccredited annually too) endeavour to start the process within days of a new resident’s admission. By instigating open lines of communication at the earliest possible opportunity, staff are immediately creating a sense of trust with residents and their family upon which they can build throughout the resident’s time in the home. These conversations form the basis of an Advance Care Plan which will inform how the resident wishes to be cared for and where. This helps both parties feel more empowered and drastically increases the chances of avoiding crises. It also means that for the vast majority of care home residents who express a preference to be cared for in their care home, their wishes are met and their care is planned, right up until the end of their lives. GSF accredited homes have demonstrated a halving of avoidable hospital admissions and doubled the number of residents dying in the home rather than in hospital. This has the added benefit of relieving pressure on over-stretched hospitals and reducing costs for the local healthy economy. GSF accredited care homes are a hallmark of excellence in the area, recognised by the Care Quality Commission, NHS Choices, commissioners and other indications of quality provision, endorsed by all of the major care home organisations and the National Skills Academy for Social Care – providing relatives with the assurance they crave when looking for a home.

BREAKING DOWN THE BARRIERS Recognising that there are barriers to participating in its full programme, most notably cost and time, the GSF Centre has responded with a variety of more accessible and economical ways of engaging. The GSF Centre has been piloting a Silver Foundation level programme, with homes in Nottingham and Northampton with great success.

This version of the programme is designed for homes that are keen to start adopting the GSF principles but don’t yet feel ready to attempt the whole Premium Gold Programme. A number of the homes in the Nottingham phase are now moving on to the full Gold programme. The original Premium Gold Programme is built around six workshops and has now been developed to include a filmed version to support the cascading of training throughout the whole home. Six months after completing the training, giving time to embed the new practices, homes can apply for accreditation. This process involves rigorous assessment against 20 standards, using objective independent assessors. The award is valid for three years, before the home must apply for reaccreditation.

COMPASSIONATE CARE IS ACHIEVABLE The Care Quality Commission’s Chief Inspector of Adult Social Care, Andrea Sutcliffe, said recently, ‘Making sure care homes are places I would be happy for my mum, or anybody else’s mum or loved one, to call home depends on them providing services that are safe, caring, effective, responsive and well-led. By being creative and focusing on continuous improvement and innovation, staff and managers can deliver good and outstanding care, which everyone has the right to expect. ‘Over the past 10 years, the work of the National Gold Standards Framework Centre has helped to raise standards of care for many thousands of people in the final stages of their life, which we know is so important. Schemes like the Gold Standards Framework show that the delivery of high-quality and compassionate care is achievable.’ Achieving a Gold Standard in end of life care for all residents is not only achievable, but flexible too. Planning a person’s care from the time they come into a care home right up until the end of their life will help them and their family to have comfort that their wishes will be followed at all times. This has the added benefit of avoiding unnecessary hospital admissions, meaning care homes can also help to reduce pressure on the NHS. CMM

Maggie Stobbart-Rowlands is Gold Standards Framework Lead Nurse at the Gold Standard Framework Centre. Email: info@gsfcentre.co.uk To read about GSF in practice visit the CMM website www.caremanagementmatters.co.uk CMM February 2015 41

CONFERENCE AND EXHIBITION 2015

ying damain taoces re oekw pl BLoast f

HEADER

@CMM_Magazine #CMMInsight

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

JUST CONFIRMED Amanda Nurse Carterwood • Neil Matthewman Community Integrated Care • Robin Miller University of Birmingham 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.

SPEAKERS

Delegates will also have access to a choice of practical workshops and a comprehensive exhibition.

Roger Harcourt, Partner at Shakespeares Legal LLP will update delegates on trends and opportunities in the market.

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.

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.

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.

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 £275 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 42 CMM February 2015

bevan brittan Tel: 0870 194 1000 Email: stuart.marchant@bevanbrittan.com Website: www.bevanbrittan.com

Resource Finder

Solicitors Solicitors play an integral role in the care sector. They can assist with operational issues, regulation, dealings with local authorities, employment law, corporate considerations and much more. Specialist social care solicitors have specific knowledge and experience that may benefit your organisation. CMM’s Resource Finder offers you details of specialist social care solicitors with essential and expanded profiles to help you find the right legal representation for your business.

SECTORS • Independent health and social care providers; • Acute and emergency care; • Community health; • Mental health; and • Primary care.

SERVICES • CQC regulation; • Serious incidents, safeguarding and health and safety investigations; • Commercial dispute resolution; • Care support – from capacity and consent to deprivation of liberty; • Contracting; • Procurement and competition; • Employment; • Property and construction; and • Commercial structuring and finance.

LEAD INDIVIDUALS Stuart and Carlton are responsible for Bevan Brittan’s independent health and social care team with extensive experience in assisting all kinds of care provider. They say ‘Most of our clients are providers of care services, either in the private and not-for-profit sectors or the NHS. We work with small and large organisations on quality, compliance, commissioning

and strategy issues which are often testing and difficult, and our colleagues work closely to provide other types of support for providers. ‘We give sensible and practical advice on technical legal issues and regulation which are part of delivering care services. Importantly, the team’s advice and representation is always centred round our clients’ best interests, being mindful of their legal responsibilities, commercial interest and the value of their reputation. It speaks volumes that our clients genuinely like working with us and we are always happy to speak to care providers who may just need a quick conversation to provide reassurance or guidance.’

COMPANY INFORMATION As a firm, Bevan Brittan is uniquely set up to advise organisations who work in health and social care because of its broad client base across public service delivery. The firm draws on this experience to help independent sector social care providers on all aspects of their business, from commissioning and procurement issues and challenges to specialist advice and support on care and regulation. Offices are located in Bristol, Birmingham and London, with national coverage.

Stuart Marchant Tel: 0870 194 7712 Email: stuart.marchant@bevanbrittan.com

Carlton Sadler Tel: 0870 194 1633 Email: carlton.sadler@bevanbrittan.com CMM February 2015 43

RESOURCE FINDER: SOLICITORS

Brunswicks

Freeths

Tel: 0845 519 0690 Tel: Crisis Helpline 0785 585 5588 – 24-hour, 365 days Email: keith.lewin@brunswicks.eu Website: www.brunswicks-web.co.uk

Tel: 0845 050 3689 Email: postmaster@freeths.co.uk Website: www.freeths.co.uk/home

SECTORS • Adult Placement schemes; • Boarding schools; • Care homes with nursing; • Care homes for older people, EMI and reminiscence units; • Care homes for younger adults; • Children’s homes; • Domiciliary care; • Learning disabled provision; • Private hospitals; and • Psychiatric hospitals, including secure and medium secure units.

SERVICES • Registration guidance and help; • Compliance and enforcement; • Regulation - Care Quality Commission (CQC), police, environmental health;

• Challenging inspection reports; • Challenging CQC investigations; • Opposing notices of cancellation including urgent cancellation applications to the courts; • Dealings with local authorities – including contract compliance, proposed termination and fees; • Safeguarding – adult and children; • Inquests; • Commercial; • Contractual – commissioners and suppliers; • Crisis management; • Debt recovery; • Reputation management; • Employment; • Fee negotiation; • Due diligence; and • Free weekly newsletter – Brunswicks’ Healthcare Review.

Charles Russell Speechlys Tel: 0207 427 6518 Email: william.nash@crsblaw.com Website: www.charlesrussellspeechlys.com

SECTORS • Social care; • Primary care; • Pharmacy; and • Dental.

SERVICES • Corporate; • Regulatory;

44 CMM February 2015

• Real estate; • Development projects; • Commercial; • Disputes; • Employment; • Pensions; • Immigration; • Intellectual property; • Competition law; • Public procurement; and • Tax - corporate and personal.

SECTORS • Health • Housing associations; • Care home associations; • Providers; • Property developers; • Construction contractors; • Suppliers; • Regulators; • Commissioners; and • Charitable organisations.

SERVICES • Banking and Finance; • Business Structures; • Commercial Contracts; • Debt Recovery; • Dispute Resolution Mediators; • Employment; • Environment; • Infrastructure Project Finance; • Immigration; • Insurance; • Intellectual Property; • IT and Data; • Licensing and Regulatory; • Notary Services; • Planning and Environment; • Real Estate; • Restructuring and Insolvency; and • Taxation.

LEAD INDIVIDUALS Liz is a total all-rounder with a strong commitment to providing practical cost-effective solutions for clients. She has extensive practical

experience of dealing with dispute resolution particularly related to consent, mental capacity, best interests, safeguarding, Deprivation of Liberty and end of life care management. Her main areas of work include NHS Governance, Public Law, Healthcare Law and Mental Health Law. National Head of Care, Jon Smart operates in care, health and real estate. His services include banking and finance, occupiers, real estate and real estate finance. Jon has recently been involved with a £80million refinancing of a major care homes group.

COMPANY INFORMATION ‘Thinking Differently, Delivering Results and Building Trust’ Freeths Solicitors is a leading national law firm with 11 offices providing a strong local presence covering all types of work. Credited with ensuring ‘outstanding outcomes in a range of highpressure negotiating situations’, Freeths has an enviable track record for providing ‘market first’ solutions to support achievement of cost efficiencies. A Chambers UK commentator said, ‘Clients are particularly impressed by the firm’s value for money: one told us about how they are “working with us to reduce our legal spend, which I find pretty unique for a law firm”.’

Liz Mulvaney Tel: +44(0)845 050 3689 Email: liz.mulvaney@freeths.co.uk Jon Smart National Head of Care Tel: +44(0)845 050 3650 Email: jon.smart@freeths.co.uk

RESOURCE FINDER: SOLICITORS

Geldards

Lester Aldridge

Tel: 0844 736 0006 Email: info@geldards.com Website: www.geldards.com

Tel: 01202 786135 Email: info@LA-law.com Website: www.lesteraldridge.com

SECTORS

SERVICES

SECTORS

• Care homes for older people; • Children’s day nurseries; • Domiciliary care providers; • GP and dental practices; • Learning disability units; • Mental health residential homes; • Opticians; • Pharmacies; and • Residential schools for children with social, emotional and behavioural difficulties.

• Acquisitions and disposals of businesses; • Commercial dispute resolution; • Commercial structuring and finance; • Contracting; • Employment issues; • Procurement; and • Property and construction.

• Adult care homes; • Supported living; • Independent hospitals; • Children’s homes; • Schools; and • Fostering services.

rhw solicitors Tel: 01483 302000 Email: guildford@rhw.co.uk Website: www.rhw.co.uk

SECTORS

SERVICES

• Care homes for older people; • Children’s homes; • Children’s nurseries; • Dental practices; • Doctors; • Home care; • Learning disabled homes; • Nursing homes; and • Rehabilitation units.

• Commercial property; • Corporate law; • Dispute resolution; • Employment law; • Family law; • Intellectual property rights; • Residential conveyancing; and • Wills, trusts and estates.

Next month...

Resource Finder: Assistive Technology and Nurse Call Systems

SERVICES • Assisting clients in relation to enforcement action by the Care Quality Commission (CQC); • Safeguarding investigations; • Contractual disputes with local authorities or Clinical Commissioning Groups; • Drafting contracts between the home and service users; • Debt recovery for non-payment of care fees; • Inquests; • Employment problems; • Care home sales and purchases; • Health, safety and environment health; and • Professional misconduct.

LEAD PARTNER The LA Healthcare Team is headed by Peter Grose. Peter enjoys a national reputation, specialising in the law regulating health and social care for over 20 years. He acts for care home and supported living providers, in addition to independent hospital and specialist children’s care and education providers. He is particularly specialised in advising on the compliance of supported living services with regulatory requirements.

Peter negotiates firmly with the CQC on behalf of clients facing enforcement action, and also with local authorities in relation to contracting disputes. He also specialises in dealing with local authorities in relation to safeguarding investigations. Peter is a regular lecturer and writer for the care press. Peter is appointed solicitor to the Registered Nursing Home Association and the National Care Association.

COMPANY INFORMATION The Team’s other regulatory specialists include Laura Guntrip, Jeremy Allin and Michael Rourke. The Team specialises in dealing with conflict with the local authorities and CQC, and negotiating to achieve the best possible outcome. The Team has considerable experience in handling more serious cases involving appeals to the First Tier Tribunal and emergency cancellation of registration proceedings before a Magistrate. LA is also experienced in dealing with contract disputes with social services and frequently advises on what to do when things go wrong. The Team provides on-going assistance and representation through the safeguarding process, especially any action which may need to be taken against employees as a result of the safeguarding matters. The Team also has a strong reputation in the field of supported living.

Peter Grose Head of Team Tel: 01202 786163 Email: peter.grose@LA-law.com CMM February 2015 45

RESOURCE FINDER: SOLICITORS

RadcliffesLeBrasseur

Shakespeares

Tel: 0207 222 7040 Email: info@rlb-law.com Website: www.rlb-law.com

Tel: 0845 630 8833 Email: roger.harcourt@shakespeares.co.uk Website: www.shakespeares.co.uk

SECTORS • Medical defence organisations; • PLCs; • National institutions; • Charities; • NHS and private healthcare; • Entrepreneurs; • Private clients; and • Professionals.

SERVICES • Healthcare; • Business; • Property and Tax; and • Private Client Services.

LEAD PARTNER Andrew advises in all areas of healthcare law; he has extensive experience of advising on issues arising from CQC inspections, adult safeguarding, police investigations following serious incidents and advising on Deprivation of Liberty Safeguards. He acts for a large number of care home operators as well as NHS clients. Andrew regularly advises on care homes law, mental health law, public law and judicial review and personal injury matters. He has been involved in many of the most important mental health cases in recent years and is seen as a leading practitioner in this field. He also has experience of large clinical negligence claims particularly obstetric, paediatric and psychiatric cases. Andrew has extensive advocacy experience including attending inquests on behalf of clients.

Andrew acts as adviser on regulatory matters involving the Care Quality Commission (CQC), the Health and Safety Executive (HSE) and the Police. Andrew is a regular lecturer and contributor of articles to the health and legal press, and provides an educational programme to clients and others, especially relating to mental health, care homes and human rights. Andrew is recognised by both Chambers and Partners and the Legal 500 as a Leading Individual.

COMPANY INFORMATION RadcliffesLeBrasseur is proud of its reputation as one of the leading UK law firms for the care homes sector. The firm has many years of experience advising care homes, both private and public sector. Our lawyers are skilled in advising on specialist issues, such as CQC registration issues and other regulatory matters, adult safeguarding investigations and Deprivation of Liberty Safeguards, inquests, complaints and HSE prosecutions. Problems can arise at any time, so the firm operates a 24-hour helpline to provide advice, often on matters requiring an urgent application to the Court. The firm also assists with employment, corporate and property matters. The firm provides educational lectures, seminars and briefings to enable clients to keep up to date with developments. We also offer a free monthly care home bulletin on news, guidance and legislation.

Mr Andrew Parsons Head of Healthcare Tel: 0207 227 7282 Email: andrew.parsons@rlb-law.com 46 CMM February 2015

SECTORS • Care homes with nursing; • Care homes for older people; • Children’s homes; • Domiciliary care; • Supported living; • Learning disabled provision; • Mental health; • Social housing; • Charities; • Education; • Local authorities; and • Not-for-profit organisations.

SERVICES • Registration and commissioning; • Regulatory compliance; • Safeguarding and health & safety interventions; • Mental health and capacity issues, including deprivation of liberty; • Court of Protection and deputyships; • Business improvement; • Quality assurance system and care plan reviews; • Fee analysis and renegotiation; • Family and children’s matters; • Dispute resolution and litigation; • Employment and HR; • Commercial property sales and acquisition; • Property construction/ development; • Planning; • Corporate and partnership law; • Business sales and acquisition and private equity investments; • Commercial contracts (public and private sector) and procurement; • Intellectual Property; • Residential conveyancing;

• Wills and probate; • Tax, trusts and inheritance; • Debt recovery; and • Structuring/re-financing debt.

LEAD PARTNER Roger heads up our innovative healthcare team, advising providers on legal issues, operational matters and funding as well. Roger also leads much of Shakespeares’ healthcare-related banking work. He’s recognised in the leading legal directories as ‘efficient and knowledgeable’, ‘thoroughly professional’ and ‘committed to working in the best interests of his client’. If you’re setting up, developing, buying, selling or refinancing, Roger can help. He is a corporate lawyer with many years’ experience of helping providers to structure and develop their businesses. Roger has advised clients providing residential, supported living, domiciliary and extra care to young people and the elderly, through the acuity spectrum.

COMPANY INFORMATION Shakespeares Healthcare is a multidisciplinary team of lawyers and non-legal healthcare specialists, bringing together a broad spectrum of expertise, tailored to this dynamic sector. We share our clients’ passion for achieving excellent outcomes for those they support. With nine offices across the country, we aim to meet the full range of needs required by providers and their service users to develop and sustain high quality care pathways.

Roger Harcourt Head of Healthcare Tel: 0115 945 4629 Email: roger.harcourt@shakespeares.co.uk

HEADER

CMM February 2015 47

EVENT ROUND UP

THE SURREY CARE AWARDS 2014 21st November, Epsom Downs Racecourse Now in its sixth year, The Surrey Care Awards is the county’s most prestigious awards ceremony for care workers. Over 370 care employers and staff celebrated 2014’s Awards. The Awards were presented by distinguished performer and writer Sir Richard Stilgoe OBE, who founded the Orpheus Centre in 1997. He continues to direct courses there in music theatre and song-writing. In recognition of his achievements in the care sector, Sir Richard was presented with an honorary award by the Chairman of Surrey Care Association, Richard Williams. Organised by Surrey Care Association, the Awards recognise the dedication of people working in a wide variety of roles in adult social care including dementia care, caring for people in their own homes and caring for adults with learning disabilities. This year there were 16 Award categories open to care providers and their staff.

Categories included Dementia Care Team, which was awarded to Broome Park Nursing Home; Beyond the Call of Duty in both care homes and care at home, which was won by Julio Costa and Debi Parker of Ashcroft Care Services respectively; Care Newcomer in both care homes and care at home which went to Lisa Smith of the Queen Elizabeth’s Foundation’s Independent Living Services and Steven Robinson of The Avenues Group respectively; and Care Provider of the Year, which was given to Abbeyfield Wey Valley Society. The 64 finalists were nominated by their colleagues, with glowing and often very moving testimonials from service users and their families. The Surrey Care Awards 2014 were supported by Care Choices, Care Management Matters, Lloyds Bank, Signature, SmartCare, TLC Group and many others.

LAUNCH OF LEARNING DISABILITY ALLIANCE ENGLAND 21st November, Manchester Learning Disability Alliance England (LDA England) is an alliance of all those committed to the rights of people with learning disabilities. On Friday 21st November, the LDA England was launched at an event in Manchester where people with learning disabilities, family members and professionals explained why the Alliance is important to them. LDA England brings together the four main umbrella organisations for people with learning disabilities – the National Forum of People with Learning Disabilities (representing self-advocacy groups); National Valuing Families Forum (representing 150 service providers); Association 48 CMM February 2015

for Real Change (representing 150 service providers); and the Housing and Support Alliance (representing 150 service and housing providers). In just a few weeks over 90 further organisations also joined the campaign – making LDA England the first effective alliance to bring together people with learning disabilities, families and their allies on the basis of equality and respect. LDA England aims to review all Government policy that affects people with learning disabilities; challenge bad laws and policies; give each political party a mark out of ten in advance of the General Election in May; and encourage people, families

and allies to use their vote wisely. There were many messages of support from politicians at the LDA England launch including a film that shared people’s experiences and feelings. LDA members publically pledged to end these injustices and discuss the next steps for the Alliance. LDA England was formed for the direct purpose of campaigning and lobbying – offering individuals, organisations and charities a way to express their support for the rights of people with learning disabilities – firmly, objectively and without fear.

WHAT’S ON? Event:

National Development Team for Inclusion Conference Date/Location: 27th January, London Contact: National Development Team for Inclusion, Tel: 01225 789135

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Event: Dementias 2015 Date/Location: 5th/6th February, London Contact: MA Healthcare Limited, Tel: 0207 501 6762



Event:

Nursing Homes, Care Homes, Assisted Living, Domiciliary Care Services and Third Age Housing Date/Location: 11th February, London Contact: Henry Stewart Conference Studies, Tel: 0207 092 3494

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or visit our website at www..co.uk

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The Gold Standards Framework Centre ‘Celebrating Best Practice’ Conference and Awards Ceremony Date/Location: 27th March, London Contact: Gold Standards Framework Central Team, Tel: 01743 291892 Event: NICE Annual Conference Date/Location: 12th/13th May, Birmingham Contact: NICE, Tel: 0845 056 8339

CMM EVENTS

Facebook Social Media

Success

Quality

Business Plans

Facebook

Proﬁts

Twitter

Marketing Plans

Social Media

Search Engine Optimisation

Advertising

Care Home Marketing Internet

Event:

Event: Health+Care 2015 Date/Location: 24th/25th June, London Contact: CloserStill Media, Tel: 0207 348 5261

Higher Occupancy

Website design

Care Showcase 2015 – Challenges and Opportunities of Working Together Date/Location: 18th March, Brighton Contact: Contact: Lisa Mack, Event Coordinator, Tel: 07779 584397 Event: Care Show Bournemouth Date/Location: 25/26 March, Bournemouth Contact: Contact: The Care Show, Web: www.careshow.co.uk/bournemouth

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E. info@carehomemarketeers.co.uk

Event: Date/Location: Contact:

CMM Insight: Learning Disability Services: Current Developments and Future Opportunities 26th February, Manchester Care Choices, Tel: 01223 207770

Event: Date/Location: Contact:

3rd Sector Care Awards December, London Care Choices, Tel: 01223 207770

Please mention CMM when booking your place. CMM’s regional care conferences will return in 2015. Visit the events page at www.caremanagementmatters.co.uk to keep updated on developments. CMM February 2015 49

TREVOR BROCKLEBANK • CHIEF EXECUTIVE • HOME INSTEAD SENIOR CARE

STRAIGHT

talk In the light of the Burstow Commission’s Key to Care report, Trevor Brocklebank argues that good care costs money – and it needs time.

I welcomed the publication at the end of last year of the Burstow Commission report, Key to Care which looks at the future of the homecare workforce. While it did not make happy reading – generating shock national headlines about a crisis in elderly care – it pinpointed a key issue that those of us in the sector are only too aware of. How do you train and motivate a high quality homecare workforce when the system they work in is under immense budget strain? We are all very aware that there is no silver bullet. Ingrid Koehler, Senior Policy Researcher at the Local Government Information Unit who authored the report, highlights the ‘complexity and interdependency of problems’ and that is, of course, the nub of the issue. The care system is currently experiencing a perfect storm. While the ageing population is growing at an 50 CMM February 2015

exponential rate, along with increased expectations for more personalised care, providers are frustrated by a system which is currently focused on time and task care plans and low hourly rates. Local authorities, the main commissioners of care, are themselves frustrated by shrinking budgets and rising demand. And in the middle of all that sits the care worker. In the vast majority of cases they are good people, keen to provide good care, but how can they if the local authority who commissioned their employer has driven the hourly rates down to such an extent that the only way to make it pay is by scheduling short-duration calls? As with many things it comes down to budgets. The Secretary of State for Health, Jeremy Hunt MP, has told Parliament that he wants Britain to become the best place in the world in which to grow old. But while the Government is putting extra money into the NHS (an extra £2billion announced in December), budgets for social care continue to be under threat as the vast majority of this care is organised by local councils who are having to reduce the amount they spend on care. In many local authority areas, there is also a

care systems and there is no doubt that we simply need to move more money into social care as the current budgets are unsustainable. Investing more in better social care will reduce costs for the wider health service, by enabling more elderly people to live independent lives at home and preventing them entering the more costly health system. At Home Instead, our solution has been to pursue our own distinct model of care. We operate outside the arena of volume contracts with local authorities as we believe they can drive down the quality of care and prevent carers from providing a quality service. We respect and value our frontline CAREGivers, who enjoy above average terms and conditions and specialist training. Most of all, we give them the time to care and to build lasting relationships with their clients. This has meant making brave business decisions, for example, refusing contracts that specify 15-minute slots of care, but it has paid off. Our business is succeeding and our CAREGivers enjoy working for us; many describe joining Home Instead as a ‘relief’. In concluding, I would echo Paul Burstow’s important comment in the Key to Care report. We must ensure that

Ultimately, for me the solution lies in the integration of our health and social care systems and there is no doubt that we simply need to move more money into social care as the current budgets are unsustainable. lack of knowledge about the wider care provider landscape, with potentially affordable and beneficial providers simply not ‘on the radar’. The new Care Act should change this, giving councils a new responsibility to better understand the whole social care ‘market’, not just what they commission. Ultimately, for me the solution lies in the integration of our health and social

pressure on budgets does not mean that good care providers are driven out and those who profit from exploiting their workers thrive. It’s time to invest in good quality care. CMM Do you agree with Trevor? Add your voice to the debate on the CMM website www.caremanagementmatters.co.uk

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