Care Management Matters December 2015 by Care Choices Ltd

WWW.CAREMANAGEMENTMATTERS.CO.UK @CMM_Magazine

DECEMBER 2015 ÂŁ4.00

OPERATING IN AUSTERITY

Providers share their experiences

3rd Sector Care Awards

Time to celebrate

Driving up Quality Code

Client and business benefits

Supporting people with dementia Using empathy and understanding

Includes 4-page Skills for Care insert: Workforce integration

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In this issue From the Editor

Is it just me…? Editor in Chief, Robert Chamberlain, makes a Remembrance Day reflection on how today’s society holds its older citizens in regard.

CMM News

Business Clinic CMM explores the new Primary Care Home model and asks the panel for its thoughts.

A View from the Top John Kennedy, Director of Care at Joseph Rowntree Foundation answers CMM’s interview questions.

Event preview CMM previews the forthcoming 3rd Sector Care Awards.

What’s On?

Straight Talk Information Commissioner, Christopher Graham warns that personal data should be handled with care.

FEATURES 25

REGULARS

Operating in austerity How should care providers respond to the funding and commissioning pressures of austerity? Professor Rhidian Hughes shares experiences.

Driving Up Quality Peter Kinsey and Sarah Maguire introduce the Driving up Quality Code, its aims and benefits.

Engaging staff whilst maintaining quality Tom Owen and Jess Watson continue their series looking at how to maintain quality and engage staff in a climate of austerity.

Learning from complaints Dr Jane Martin explains how to realise the full benefits of the complaints system.

Supporting people with dementia Julia Pitkin and Rosemary Hurtley explore approaches for supporting those with dementia. CMM December 2015 3

CONTRIBUTORS

EDITORIAL editor@caremanagementmatters.co.uk Editor in Chief: Robert Chamberlain Editor: Emma Morriss News Editor: Des Kelly Content Editor: Emma Cooper

@RhidianHughes

@PeterKinseyCMG

@Choice_Support

@DebbieSorkin2

Rhidian Hughes Chief Executive, Voluntary Organisations Disability Group

Peter Kinsey Chief Executive, CMG

Sarah Maguire Director of Quality and Safeguarding, Choice Support

Debbie Sorkin National Director of Systems Leadership, The Leadership Centre

@JohnnyCosmos

@MyHomeLifeUK

PRODUCTION Lead Designer: Holly Cornell Director of Creative Operations: Lisa Werthmann Studio Manager: Jamie Harvey Creative Artworker: Gemma Barker

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

Ian R Smith Chairman, Four Seasons Health Care

Stephen K Smith Professor of Medicine

John Kennedy Director of Care, Joseph Rowntree Foundation

Tom Owen Director, My Home Life England

@MyHomeLifeUK

@LGOmbudsman

@360Fwd

@DementiaSense

Jess Watson Social Action Lead, My Home Life England

Dr Jane Martin Local Government Ombudsman

Rosemary Hurtley Health and Social Care Consultant, 360 Forward

Julia Pitkin Specialist Dementia Trainer

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: 978-1-910362-72-3 CCL REF NO: CMM 12.9

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4 CMM December 2015

Christopher Graham Information Commissioner, Information Commissioner’s Office

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From the Editor In her final column of the year, Editor, Emma Morriss is reflecting on the sector and the year. I am writing this knowing that by the time it gets to you, we’ll have had the Autumn Spending Review and will know more about what the future holds. It feels like everyone has called on the Government to recognise the pressures on the sector. But I don’t have a crystal ball so I can only hope the answer is favourable by the time you read this.

HOMECARE The sector is desperate. The Save our Homecare campaign has picked up speed recently. Homecare is teetering on the brink and the petition needs 100,000 signatures to be considered for debate in Parliament. If you’d like to back the campaign, search for the petition online.

FOUR SEASONS As well as pressures facing homecare, rumours are abound

regarding the financial stability of Four Seasons Health Care. The sector’s largest provider, it faces many of the problems that led to Southern Cross’ collapse in 2011. Rumours are that it is trying to sell off parts of the business. The Care Quality Commission has a duty to assess the financial sustainability of the most ‘difficult to replace’ major providers. Does it have anything up its sleeve? Will we see the provider broken up and sold on? Only time will tell.

experiences and ideas that should help you to operate in the current climate.

OPERATING IN AUSTERITY

3RD SECTOR CARE AWARDS

Everyone is operating in austerity, and has been doing so for many years. As a result, providers are developing techniques and approaches to working successfully. On page 22, Professor Rhidian Hughes has pulled together some really useful approaches,

Despite all the doom and gloom, there is some light; some reason to be proud and celebrate. I’m looking forward to attending the 3rd Sector Care Awards on 9th December. Hosted by Dame Esther Rantzen, I had the honour of facilitating the judging and all the finalists are proving that

fantastic work is out there. If you’d like to join me at the Awards, a few tickets are still available, www.3rdSectorCareAwards.co.uk

UNTIL NEXT YEAR And that’s it, the last issue of CMM until 2016. The next issue will be a year since we relaunched the magazine and website. Don’t forget there are lots of benefits for online subscribers and it’s free for care providers. Wishing you a wonderful winter. See you in January.

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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CMM December 2015 5

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Is it just me...?

of which could be avoided with more community health and social care services. The pattern of demand on primary services has intensified: the number of times an older person visits a GP practice has increased from seven to 13, on average, in just 13 years. • Rates of admission for ambulatory care-sensitive conditions such as pneumonia, UTIs and congestive heart failure are rising dramatically.

Editor in Chief, Robert Chamberlain, makes a Remembrance Day reflection on how society holds its older citizens in regard.

UNFATHOMABLE LOGIC

I’m sitting here on the 11th day of the 11th month writing my column and reflecting. Remembrance Day is such a wonderful institution. A time when society comes together to remember those who gave their lives during the First World War and in the line of duty thereafter. But this is not the only reason that I describe it as ‘wonderful’. Having attended the Remembrance Sunday parade in my hometown, I observed the crowds that came to pay their respects. Young and old standing side-by-side, coming together to join in common purpose. Several generations of

respect and remember. Strangers shoulder to shoulder regarding each other on this important day. On television, parades across the country are shown and we watch the Queen and Prime Minister lay wreaths.

FAILING OUR FOREFATHERS Through the emotion of the day, something struck me. What a pity that society doesn’t demonstrate this respect and care for our older population everyday, whether or not they served their country. The

“The atmosphere of Remembrance Day is almost juxtaposed with how we are allowing our elders to be treated in their later years.” families bowing their heads for the two minutes’ silence. Grandpa proudly wearing his medals, holding hands with his grandchildren to

atmosphere of Remembrance Day is almost juxtaposed with how we are allowing our elders to be treated in their later years.

Politicians, past and present, have ignored the importance of investing in a social care system that is fit-for-purpose. The crisis affecting our sector quite obviously results in a dramatic reduction in people’s quality of life. Yet little is being done to recognise the impact or address the issue. It’s quite the reverse. The key findings of Age UK’s The health and care of older people in England 2015 are a stark reminder of how we are failing our forefathers: • Almost £2bn has been cut from older people’s social care in the last 10 years. • The number of people with unmet care needs has increased from 800,000 in 2010 to over a million in 2015. • NHS funding has been mostly protected, but has not kept pace with demographic change and growing needs. A £20bn shortfall is expected by 2020. • The number of emergency admissions, and readmissions, to hospital are increasing, many

There is clearly more parliamentary focus on fixing the health service than social care currently, despite the talk of integration. Yet the impact of allowing care providers to crumble has an inevitable knock-on effect. The logic appears unfathomable. New research from think-tank ResPublica entitled, The Care Collapse: The imminent crisis in residential care and its impact on the NHS could not make it any clearer. It states that within five years residential care homes could lose a staggering 37,000 beds. This means that the NHS would have to find an extra £3bn to care for those patients who are no longer in care and can’t go elsewhere.

TAKE RESPONSIBILITY We continue to quietly question the mindset of our Government, but why is there no public uprising to force the necessary action? The very people being disrespected by our failing care system will be the very same people with whom we stood on Remembrance Day, many of them wearing medals. Shouldn’t we, the tax paying and voting public, take some responsibility for allowing this injustice and do more to effect change?

Do you agree with Robert? Join the debate. Twitter: @CMM_Magazine Web: www.caremanagementmatters.co.uk CMM December 2015 7

Consequences of injury

Consequences for the employer

Consequences to the worker

Patient falls are a regular part of the working day in a healthcare environment and performing a safe lift is vital for both the wellbeing of the fallen person and the EMS professionals. Injuries among EMS professionals can be costly not only to employers and employees but also can negatively impact the quality of care that a patient may receive.

When an employee is affected by a musculoskeletal injury the impact on the employer can be significant as skilled, experienced workers take time off to recover. Evidence suggests repeated manual lifting is a leading cause of musculoskeletal disorders in EMS professionals. Paramedics and EMT workers are valuable employees and should not be put at unnecessary risk. Manual lifting, however, is a regular part of their working day and evidence suggests it is a leading cause of musculoskeletal disorders

Financial implications such as compensation claims and human resource costs including:

• Recruitment - advertising, interviewing and background checks

• Enhanced fees for agency personnel

• Overtime payments

Consequences to the worker are:

• Ongoing pain suffered through a musculoskeletal disorder

• Time off required to recover and recuperate, often resulting in reduced earnings

• The loss of their ability to perform duties

• Reduced productivity as new workers learn the job

• No longer able to work in a healthcare or moving and handling environment and require new training

• Training of new workers

Using the appropriate equipment, such as a lifting cushion brings financial benefits:

8 CMM December 2015

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The patient becomes more dependent on others and less mobile, and begins to cut their daily activities. As the fear of falling increases and activity diminishes, muscle strength weakens causing more and more falls. Falls are often considered a contributing reason for admission to a nursing home.

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APPOINTMENTS NATIONAL ACTIVITY PROVIDERS ASSOCIATION

CQC fee consultation The Care Quality Commission (CQC) is asking providers and the organisations that represent them to give their views on the regulatory fees it’ll be charging from 1st April 2016. CQC has to change the fees it charges health and adult social care providers to be regulated. While the changes will differ across the different types of health and adult social care services, CQC is asking

providers to give their feedback on whether the rate of the changes to ‘full cost recovery’ should take place over two or four years. The United Kingdom Homecare Association (UKHCA) has commented that the proposed 313% increase in fees for homecare agencies, phased over the next two or four years, ‘flies in the face of gross underfunding of state-funded social care’.

Professor Rhidian Hughes, Chief Executive of the Voluntary Organisations Disability Group said, ‘We are enormously disappointed with CQC’s whole approach to fees. CQC has become an increasingly high cost organisation, and just last year the regulator raised fees by a staggering 9%’. For more information, see In Focus on page 15.

Quality care at risk from NLW High quality care will be available only to those who can afford to pay for it, unless central Government covers the extra cost of paying all care home workers the National Living Wage (NLW), the Joseph Rowntree Foundation (JRF) has warned. The costs and benefits of paying all the lowest paid care home workers in the UK the Living Wage was commissioned by JRF and written by Lancaster University and the International Longevity Centre – UK. It found that introducing the NLW for

low-paid care home workers will cost £387m per year, which will need to be met by central and local Government as well as care providers. The new research is the first to examine the impact of the NLW in one of the most important sectors in the UK, and shows that half (50%) of all care workers, 300,000 people, will be eligible for a pay rise under it. Those who benefit will see their pay packets increase by an average of £462 per year, rising to £640 per year for the lowest paid.

The report also finds that over three quarters (77%) would benefit if their employer paid the voluntary, higher Living Wage (LW). Paying the LW would boost care workers’ pay packets by an average of £1,208, or £1,359 for the lowest paid. The extra costs will come at a time when many care homes are already under financial pressure. However, the report finds that care homes which have mainly self-funded residents will be most able to afford wage increases.

Greater recognition of frontline staff A determination to ensure frontline staff get better recognition for their dedicated work and praise for the CQC marked Association of Directors of Adult Social Services (ADASS) President, Ray James’ speech at the annual National Adults and Children’s Care conference. At the same time, he reminded central Government, in the midst of its 2015 Spending Review, that ADASS had recently joined leading sector representatives

to publish a joint submission to the spending review. This is a ‘chorus of voices speaking with unprecedented unanimity’ across the sector telling Government of the unquestionable need for a fair and sustainable funding settlement for adult social care. Imploring the Chancellor, ‘to do the right thing and give us a clean settlement to provide for both the growing funding gap for social care and the true cost of the living wage,’

he warned of what will happen if he doesn’t. Ray James also stressed his determination to play his part in ensuring that frontline social care staff get better recognition, and ‘unashamedly’ asked for delegates’ help in achieving that aim. He said, ‘Ultimately the quality of people’s lives will be determined by our ability to attract people with the right skills and behaviour into social care.’

National Activity Providers Association (NAPA) is delighted to announce the appointment of a new part-time Director. Jennifer Dudley will be supporting Sylvie Silver, who assumes the role of Executive Director.

CENTRE FOR AGEING BETTER Catherine Foot has joined the Centre for Ageing Better in the newly-created role of Director of Evidence. She joins from The King’s Fund, where she was Assistant Policy Director.

GREENSLEEVES HOMES TRUST Greensleeves Homes Trust has appointed Julie Clarges as Quality Manager to lead its growing Quality team. Julie joins from Mears Care, where she was National Quality Director.

HERITAGE CARE Mark Milton has started as the new Chief Executive of Heritage Care succeeding Kim Foo who retired at the end of October.

THE ROYAL STAR & GARTER HOMES The Royal Star & Garter Homes has appointed Andy Cole OBE as the new Chief Executive. He takes up his new position in January 2016. Andy is currently Director of Corporate Affairs at Leonard Cheshire Disability.

THINK LOCAL, ACT PERSONAL Lynda Tarpey has been appointed the new director of Think Local, Act Personal, replacing Dr Sam Bennett who has moved to NHS England. CMM December 2015 9

NEWS

APPOINTMENTS NEW CENTURY CARE Phil Smith has joined New Century Care as its Chief Operating Officer. Phil joins New Century Care after over 10 years at Sunrise, where he was Senior Director of Operations.

AUDLEY RETIREMENT VILLAGES Audley Retirement Villages has appointed Professor Alison While as Non-Executive Director of Audley Care.

ACCORD GROUP The Accord Group has appointed Maxine Espley as Executive Director of Health, Social Care and Support. Maxine joins the Accord Group from the Royal Wolverhampton NHS Trust.

NHS CONFEDERATION The NHS Confederation has appointed Stephen Dorrell as its new Chair.

40% cuts would devastate services A further 40% real terms reduction in local government grant funding in the Spending Review would deliver the £10.5bn knock-out blow to cherished local services, the Local Government Association has warned. Non-protected government

multiple conditions in the future, new guidance has been released to ensure care remains safe and of a high quality. The guideline by the National Institute for Health and Care Excellence (NICE) focuses on the group of people most likely to be living with more than one long-term condition – older people. It says health and social care services should work more closely together to deliver effective services and improve quality

State of Care

Ian Gordon has become Coverage Care Services’ new Chairman following Kenneth Bean stepping down.

The Care Quality Commission (CQC) has published its annual analysis of the quality of health and adult social care in England, reporting for the first time following the introduction of a new tough, rigorous ratings system. CQC reports, in State of Care 2014/15, that despite increasingly challenging circumstances, the majority of services across

United Kingdom Homecare Association has elected new board members. Mike Smith, Trinity Homecare Group Ltd, Jane Townson, Somerset Care Ltd, Richard Walker, Optimo Care Group Ltd and Fiona Williams, Bluebird Care Company Ltd. Max Wurr, Lynda Gardner and Trevor Brocklebank have all been re-elected. Steve Allen, Peter King and Wayne Reeves have all stepped down.

QCS Quality Compliance Systems (QCS) has appointed Ed Watkinson as Head of Care Quality and Compliance.

10 CMM December 2015

government funding would be worth £8.4bn. The same cut to separate local government grants would see a further £2.1bn lost from council budgets. This would mean local government losing 64% of its grant funding between 2010 and 2020.

Guideline to support older people Dementia: With millions of people in England of life for those they look after. through the living with more than one chronic Reports have previously said that health condition, and hundreds health and social care services for eyes of women older people can often be disjointed of thousands more set to develop

COVERAGE CARE SERVICES

UKHCA

departments have been ordered to draw up savings plans worth, in real terms, 25% and 40% of their budgets ahead of the Spending Review which will set out Government spending plans for the next four years. Analysis by the LGA reveals a 40% real terms reduction to core central

and hard to access. The new NICE guideline for older people with social care needs and multiple long-term conditions wants to help services from both sectors bridge this gap to achieve better, more effective ways of working. The guideline makes a series of recommendations for people who commission, manage and provide care for older people with social care needs and multiple long-term conditions.

health and social care have been rated as Good, with some rated Outstanding. However, there is significant variation in quality – and safety continues to be the biggest concern across all the sectors that CQC regulates. CQC also found that strong leadership and collaboration are emerging as more crucial than ever to delivering good care.

Increase in adult social care jobs A new report from Skills for Care has revealed that the number of adult social care jobs in England increased by around 40,000 between 2013 and 2014 taking the total to 1.55 million. The annual Size of Structure of the Adult Social Care Sector in England 2015 report, using data from Skills for Care’s National Minimum Data Set for Social Care (NMDS-SC), also shows 18,000 organisations are offering social care services in 39,500

establishments. Key findings include: • The number of full-time equivalent jobs was estimated at 1.18 million. • Around 234,000 people received direct payments. Approximately 70,000 of these recipients were now employing their own staff. • The proportion of jobs that were direct care providing increased from 74% in 2011 to 76% in 2014 (an increase of 130,000 jobs).

Dementia disproportionately affects women, but their experiences and voices are missing from research and literature. This project, published by JRF, aimed to inspire people to think differently about women and dementia by using stories and reflections from individual women to inform the debate in a unique, inspiring and insightful way. The report, Dementia: through the eyes of women, shows that there is often resistance to talking about dementia as a women’s issue. As a consequence, service provision should reflect the needs, skills and attributes of women with dementia, female carers and the female care workforce. The report is part of the final year of the Joseph Rowntree Foundation’s Dementia without Walls programme.

Sunderland care home In a deal worth £430,000, the Royal Bank of Scotland has restructured and provided finance facilities for Princess House in Sunderland to extend its residential care home to provide a further four bedrooms. Princess House has been owned and run by husband and wife team, John and Jennifer Young, since the late 1990s. Set on Sunderland’s seafront at Seaburn, the care home offers a scenic location for their 26 elderly residents.

CMM December 2015 11

NEWS

3rd Sector Care Awards The finalists have been announced in the 3rd Sector Care Awards. Finalists faced judging panels comprising leading names in social care, such as John Kennedy of Joseph Rowntree Foundation and Dr David Foster of the Department of Health as well as

Experts by Experience from Choice Support and The Royal Hospital Chelsea. Tickets are available for the event which will once again be hosted by Dame Esther Rantzen. Find out more at www.3rdsectorcareawards.co.uk

Social care budget cuts damaging the NHS Cuts in local authority social care budgets are adversely affecting health services, according to nearly 9 out of 10 (88%) NHS trust finance directors and 8 out of 10 (80%) clinical commissioning group finance leads surveyed for The King’s Fund’s latest quarterly monitoring report. These findings are reinforced by NHS performance data analysed for the report. This shows that more than 5,000 patients experienced delays in being discharged from hospital at the end of August – the highest level at this time of year since

2007. Further analysis for the report reveals that nearly a third of these delays were caused by problems accessing social care services – an increase of 21% in the past year. With cuts in local authority budgets now having a significant impact on health and social care services, The King’s Fund is calling on the Government to use the forthcoming Spending Review to protect social care from further budget cuts and reinvest the £6bn previously earmarked to implement the Dilnot reforms (now delayed).

Client Care Planning and personal details Billing and accounting systems integration Staff Files and HR Timesheets, Rotas and payroll integration Secure solution in the Cloud

12 CMM December 2015

Understanding the self-funding market – new toolkit A self-funder toolkit has been produced by the Institute for Public Care to help local authorities ensure that they comply with the requirements of the Care Act, helping them understand their selffunder population so that they can facilitate and shape their local care market to meet the needs of the whole population. The role of local authorities in providing and commissioning social care has changed significantly in the light of financial austerity and

the changes introduced by the Care Act. Local authorities are required to assess the needs of their whole population, to keep people active and to empower them to make choices about what types of care they receive, regardless of their financial position. Yet most local authorities have little knowledge of people who pay for their own care in their area, despite this group accessing a range of services and forming a significant part of the total care market.

Independent living in Shirley Solihull Care Housing Association (SCHA) has opened the doors of a new development in Shirley. The aim of the development is to provide independent living for over-55s. It has been built with the support of a £4.4m financial package from Lloyds Bank

Commercial Banking. Located within Shirley’s Parkgate leisure, retail and residential complex, the development, Trinity Apartments, comprises 33 one-bedroom apartments together with 18 twobed dwellings.

NEWS / POLL

Homes not hospitals NHS England, along with the Local Government Association and the Association of Directors of Adult Social Services, has published a national plan called Building the right support: A national implementation plan to develop community services and close inpatient facilities. This is a plan for changing the way people

Caring Homes acquires new homes Caring Homes Group has recently acquired three homes, located in Suffolk, Aberdeen and the Isle of Man, to add to its portfolio. Caring Homes now has more than 60 elderly care homes, with Cotman House and Lodge in Felixstowe, Hawkhill House in Aberdeen and Castle View on the Isle of Man, joining the company in September 2015.

with a learning disability or autism are supported, particularly if they have challenging behaviour. Local NHS and councils are working together to change the way services are delivered. They want more people to get support in the community instead of in hospitals. When people do have to go to hospital, they want it to be

POLL near where the person lives and for as short a time as possible. People who are in hospital, or about to go into hospital, will have Care and Treatment Reviews to help plan to move out when they are ready. Local areas will also be able to design bespoke services with those who use them.

LACE Housing disposal by Carterwood Carterwood has disposed of three, purpose-built elderly care homes in Lincolnshire on behalf of LACE Housing. The homes have a total effective capacity of 134 beds, all of which benefit from en-suite wetroom facilities. LACE Housing is a leading social housing provider in Lincolnshire. A decision to divest the three care homes will allow the association to concentrate on providing additional

supported housing; and extra care accommodation for the elderly population of Lincolnshire. All three homes have been sold to Country Court Care, which operates a total of 19 elderly care homes across the country. Carterwood was able to work with LACE Housing and Country Court Care, as well as a number of third parties to successfully manage a complex transaction through to completion.

Do you feel that social care is in crisis? Yes No You can vote via: www.caremanagementmatters.co.uk

Novemberâ&#x20AC;&#x2122;s results Will you be able to afford to pay the National Living Wage? NO 42%

YES 29%

DONâ&#x20AC;&#x2122;T KNOW 29%

Source: www.caremanagementmatters.co.uk Figures correct at time of print.

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CMM December 2015 13

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Rota hell? Why you should think about moving to a computerised rota system Timetabling the complex schedules of staff can be a problem for many care homes. Ashly Sarsons, Registered Manager at The Bevern Trust, a charity dedicated to helping people with profound disabilities, explains why she took the plunge with computerised rota system, OmniRota. Rotas really shouldn’t be this hard Scheduling the large care team, housekeepers, specialist staff and admin team at Bevern House is no picnic. With a team of 58 staff members, each shift not only needs to have the right number of staff including a shift leader and a senior, but also requisite numbers of female staff and those appropriately trained for medication, driving, lifeguard duties, epilepsy care etc. Add in specialist activities, the constantly changing needs of the residents and staff turnover and you soon have a real headache coordinating staffing levels and ensuring that the service is covered at all times. Oh and you need to make sure that everyone is given their fair share of weekends off. Ugh.

The short straw Pity the manager who’s been given this daunting task. For The Bevern Trust, this fell to Ashly Sarsons, the Registered Manager, and it was taking her 10 hours every two weeks for two weeks’ worth of a rolling six week rota.

We looked for rota software because we wanted to save time and reduce the amount of mistakes made. Ashly Sarsons, Registered Manager

A personal pressure Ashly can now take comfort from the fact that all the complex rules are no longer stored only in her head and that she alone doesn’t have to try to remember them all whenever she draws up a rota; a big personal advantage of having the software and avoiding a key man dependency for the service. It also makes planning much easier. Whilst changes are inevitable (and are almost daily), the fact that the changes can be processed using OmniRota means that all of the impacts of a change can be considered and planned for.

Taking the plunge Ashly believes that people often shy away from taking the plunge into rota software because they can’t quite believe that it’s capable of doing the job. I think OmniRota is brilliant. Both myself and the staff have adapted well to it. It is better than I expected as I couldn’t imagine a bit of software being able to take so many different variables and make it work. Ashly Sarsons, The Bevern Trust

OmniRota - A new rota system OmniRota takes just minutes to work out the best, fairest rota that meets your ‘rota rules’ and flags any exceptions: where the home is under-staffed or if your pre-agreed guidelines are not being met. And it’s simple to adjust for last minute changes. It also provides reports to show the parity of allocations and can send individuals’ rotas to their phones, emails or to Intradoc247 to be distributed easily to staff.

Getting started “Basically they help you to work through it to come up with your rota rules”, Ashly explains. “The set up process was hard for me as a lot of the rules were in my head and writing it all down and remembering everything took a few times to get right but the service was brilliant and I was really supported to get it right.” It has saved so much time which in turn relieves the stress and pressure from the manager to get the rota out on time. Ashly Sarsons, The Bevern Trust

OmniRota software has been developed specifically for use by GP surgeries, hospitals and care homes. It has been bought by almost 100 organisations throughout the UK and Australia, managing rotas from 5 to over 50 staff. Find out today how your practice could save time and effort and ensure fair rotas for less than you might think. We’re so confident that you’ll be impressed by OmniRota that we’re offering a free, no obligation, 30 day trial. Visit www.omnihrs.co.uk to take a virtual tour

Ashly Sarsons is Registered Manager for The Bevern Trust, a charity dedicated to helping people with profound disabilities to get more from life. 14 CMM December 2015

NEWS / IN FOCUS

In focus

Homecare and dementia

CQC opens consultation on fee rates WHAT’S THE STORY? The Care Quality Commission (CQC) has opened a consultation asking for views on the regulatory fees it intends to charge from 1st April 2016. All health and adult social care services regulated by CQC must pay an annual fee. The amount that CQC charges is set out every year in its fees scheme. When these charges change, CQC carries out a consultation to make sure that care providers, organisations that represent them and the public have an opportunity to comment on what changes it is proposing.

WHY IS IT DIFFERENT THIS YEAR? Government policy for fee-setting regulators is that their chargeable costs must be fully covered through their fees income. This means that CQC must increase the fees it charges to providers and reduce reliance on grants it receives from Government. As a consequence the increases (which vary across different services) represent a significant uplift.

WHAT DOES THE CQC SAY? David Behan, Chief Executive of the Care Quality Commission said, ‘Our commitment is to make sure that people receive safe, effective, compassionate and high-quality care and we can see that our new inspection model is allowing us to support providers to do exactly that. ‘The fees providers pay enables this important work to happen. ‘We recognise the financial pressures faced by many providers, and do not underestimate the impact of any changes to their fees. We developed our proposals with an expert panel; including representatives from the providers we regulate.’

WHAT HAS BEEN THE SECTOR REACTION? Sector representative bodies have been strongly critical of the proposals to increase the fee rates by such significant amounts at the present time and on top of a range of other increasing costs.

WHAT IS CQC PROPOSING?

WHAT HAPPENS NEXT – HAVE YOUR SAY

CQC is seeking views on two options to move to a position where it recovers full chargeable costs: • Over two years between 2016 and 2018. • Over four years between 2016 and 2020.

The consultation paper is 46 pages and contains a lot of detail on the rationale for the two proposals. It is available on the CQC website at: www.cqc.org.uk/ content/health-and-social-carefees-consultation

Nine actions to improve dementia care in the community have been developed. A new report that demonstrates how skilled homecare can play a pivotal role in enabling people living with dementia and their family to live well at home. United Kingdom Homecare Association released the report Dementia and Homecare: Driving Quality and Innovation, as part of the Prime Minister’s Challenge on Dementia. The report seeks to provide clear, practical guidance and examples of innovative practice to further dementia care in the

community, and what is required to spread these examples across the sector. The nine actions for change include: • Delivering a personalised approach focused on outcomes for the individual and their family. • Ensuring sufficient time to deliver the care people living with dementia need, in the way they want. • Giving greater flexibility for homecare providers to innovate and shape care with and for the individual.

Who will care after I’m gone? Parents of people with a learning disability are so anxious about the future that many hope their sons or daughters will die before they do, according to a new report. The research, by the national charity FitzRoy, reveals the profound anguish of families of children with learning disabilities about their future in the face of ongoing funding cuts to budgets and services that support them. They live in fear of the dire consequences of incorrect assessments and the lack of

consistent and quality care available. FitzRoy is making recommendations for change, including a demand for local authorities to fulfill their duty of care by making provision for the potential lifetime needs that include education, housing, employment and medical care. Other key recommendations include improving the status of care work to improve retention and morale in the sector and embedding adult placements in communities.

Specialist dementia care A new specialist care facility designed specifically for individuals of working age with dementia has opened in Bedworth, creating over 50 new jobs. Supported with funding from Royal Bank of Scotland, Sole End House is a purpose-built nursing home focused on the notion of creating calm and tranquillity for its residents. The bank has supported the development with a seven figure loan. Developed by the owners of Cow

Lees Care Home, the building follows a new concept in design. The house has been built in an ‘E’ shape so that all corridors lead onto each other and are easily accessible for residents to walk around. The property has natural light and all living space benefits from floor-toceiling windows. Situated on Astley Lane in Bedworth, Sole End House has been constructed alongside two existing facilities.

Developing resilience Skills for Care has produced a new resource for managers and staff who work in adult social care. Greater resilience better care offers practical guidance to adult social care employers on how to develop

resilience within their workforce. Developing the resilience of staff helps protect their mental and physical health and wellbeing. It also helps them to deliver quality services consistently. CMM December 2015 15

NEWS

Flu fighter campaign Jane Ellison MP, Minister for Public Health and Alistair Burt MP, Minister for Community and Social Care, hosted a summit to launch the Flu Fighter Residential Care campaign. The new campaign is intended to raise awareness, offer support, advice and guidance and share good practice. NHS Employers, working in partnership with Public Health England and supported by the Department of Health, is leading the national seasonal

flu campaign for staff working in health and care settings. The campaign provides employers with tools and resources that will help them run an effective flu fighter campaign and support resilience plans for winter pressures. Flu fighter has a strong success record within the NHS, with uptake rates increasing year-on-year, and they are aiming to replicate achievements with the Flu Fighter Residential Care Programme.

New dementia core skills Skills for Health, Health Education England and Skills for Care have launched a comprehensive new resource to support health and social care staff and educators in England who work with people living with dementia and their carers. The Dementia Core Skills Education and Training Framework sets out the essential skills and knowledge necessary for all staff involved in dementia care and will

enable organisations to: • Standardise the interpretation of dementia education and training. • Guide the focus and aims of dementia education and training delivery through key learning outcomes. • Ensure the educational relevance of dementia training. • Improve the quality and consistency of education and training provision.

St George Healthcare Group A leading care provider in the North West has agreed a £33m loan facility which includes a £5m development loan to build a new hospital in Liverpool supported by Barclays. St George Healthcare Group provides care and rehabilitation for people with a brain injury, autistic spectrum conditions, deafness and mental health conditions, in addition to a wide range of neurological conditions. The group currently provides over 100 beds across three facilities in the

North West, including Warrington, Oldham and Chester, fulfilling an important and much-needed role in society, supporting service users with complex conditions whilst seeking to rehabilitate them. There are plans to extend two of the existing hospitals to add an additional 17 beds. In the next 12 months, St George Healthcare Group will also commence work on an existing site in Huyton, Liverpool that they already own to build a new 36bed hospital at a cost of £6.5m.

Mental Health Act detentions Detentions under the Mental Health Act rose by 9.8% (5,220) to 58,400 in 2014/15 compared to the previous year, according to official statistics published by the Health and Social Care Information Centre. The 9.8% rise during 2014/15 compares to a 5.5% rise during 2013/14 and a 3.7% rise during 2012/13. The report, Inpatients formally detained in hospitals under the Mental Health Act 1983, and patients subject to supervised community treatment, England 2014/15 looks at detentions under the Mental Health Act 1983, which defines how and

when a person can be detained in hospital without consent for assessment and/or treatment. The report also shows that during 2014/15: • Detentions in NHS hospitals increased by 4,000 (8.2%) from the year before to reach 51,970 and in independent sector hospitals by 1,270 (24.6%) to 6,430. • The instances where section 1364 of the Act was used to make a short-term detention to a hospital as a ‘place of safety’ increased by 2,400 (14.1%) to 19,400, compared to the year before.

Supporting those with complex needs More than four in five (82%) respondents to a poll of senior health and care professionals believe that support worker pay is the biggest barrier to delivering appropriate support for people with complex needs. The survey, conducted by Dimensions, also reveals strong support for Positive Behaviour

Support approaches, with 94% of respondents agreeing that instances of challenging behaviour can be at least halved through the use of the technique. However, the majority (60%) also believe that most current support for people with behaviour that challenges is based on outdated and often inappropriate approaches.

£50m care home investment Castleoak and Pramerica Real Estate Investors have agreed to collaborate on the development of UK care homes. Pramerica, the real estate investment arm of Prudential Financial, will invest an initial £50m into the programme on behalf of an institutional investor. The care homes

developed will be leased to both forprofit and not-for-profit providers. Castleoak has also secured a £13m contract to deliver independent living apartments for Anchor. The deal will deliver a retirement village in Haywards Heath, Sussex.

Ideal Carehomes

NICE standard for behaviour that challenges

Ideal Carehomes has announced that it will be paying all its staff above living wage, despite inflation being near 0% for the past year.

The National Institute for Health and Care Excellence (NICE) has issued a new quality standard to help people with a learning disability and behaviour that challenges, and their families and carers, receive

SureCare’s new franchisees

16 CMM December 2015

the personalised care and support they need, where they need it, when they need it. The quality standard includes eight statements aimed at staff who support people with learning disabilities.

SureCare has welcomed on board two new franchisees. Sami Haider is the new franchisee for SureCare

The lowest paid in the organisation will now be paid £7.50p/h. This represents a 15% increase on Ideal’s current lowest wage.

Southend while Dean Bush has taken on the territory of Merton and Wandsworth.

NEWS

CMM December 2015 17

NEWS

Integration requires significant extra funding Greater integration of health and social care services across England will need to be backed up by ‘significant’ upfront investment and cannot, in itself, be relied upon to make savings in the short-term, a major report by public finance experts warns. The Chartered Institute of Public Finance and Accountancy (CIPFA) said the Government must recognise that combining two ‘financially-challenged systems’ will need additional funding or changes to the regime for charging. It also said that any benefits of integration may take some years to

come through in full. CIPFA said that the Government should set aside invest-to-save funding to enable costs of change and transition to be met without undermining the short-term position. The Government also needs to move quickly to address the financial and policy framework for integration in 2016 to 2017 and beyond. The report, Let’s Get Together: Integrating Health and Social Care is the result of a nationwide consultation with 200 leading public finance experts.

It calls for a streamlining of services, with a much greater effort towards creating wellness and not just treating ill health. CIPFA said that there has been a promising start. This is represented by the Government’s £5.3bn Better Care Fund to join up the NHS and council-run social care systems, the Greater Manchester and Cornwall devolution initiatives and pilots linked to the Five Year Forward Plan for the NHS. However this will be ‘dissipated’ unless local health and social care providers are able to budget effectively for the medium term.

CIPFA said, for their part, central and local health and social care leaders must take the right local actions to facilitate successful integration. This will involve them concentrating on frontline practice and ensuring that their staff have the right attitudes, skills and knowledge to be able to work collaboratively across organisational boundaries. Central and local health and social care leaders also need to invest in prevention and encourage people to take responsibility for looking after their own health.

disabilities, physical disabilities and substance abuse. Holy Cross Care Homes is now expanding this 101-bedroom residential care home to provide 14 two-bedroom properties within its seven acres of land.

This development will create a community feel, with the advantage of nursing staff on hand at Bradeney House, as well as being fully alarmed in case of need. This development will complete in February 2016.

Assisted living in Shropshire The Royal Bank of Scotland has implemented a refinance facility for care home operator, Holy Cross Care Homes Ltd. In addition, the bank has released working capital to allow an independent living development of

18 CMM December 2015

14 bungalows to commence in the grounds of their existing care home, Bradeney House, in Shropshire. Bradeney House in Bridgnorth was established in 2006 to provide residential care to the elderly, those suffering with dementia, learning

NEWS

Save our homecare Older and vulnerable adults receiving the care they need in their own home have been let down by successive governments, a sector leader told homecare providers. Speaking at the annual conference of the United Kingdom Homecare Association (UKHCA), chairman Mike Padgham warned that the Government’s autumn spending review would be ‘make or break time’ for many providing homecare. ‘Thousands of people are going without the care they need in their own home – breaking the promises not just of this government, but of successive governments, of every political colour,’ he said.

His words came as Age UK revealed figures that showed a million people aged over 65 with a care need were not getting the help they needed. The UKHCA has launched a Save Our Homecare campaign, including a petition calling on the Government to address an expected £750m shortfall in homecare spending, in the autumn spending review. The petition is well on track to reaching its 10,000 target to provoke a Government response. Homecare providers fear the new National Living Wage could result in a loss of providers to care for older and vulnerable adults unless it is supported by extra money.

Increase in health and social care apprenticeships There has been a 20% leap in the numbers of health and social care apprenticeships to 84,300 up from 70,080 the year before. The provisional numbers from the Government’s Statistical First Release for 2014/15 also revealed that the numbers of higher apprenticeships in care leadership and management had more than doubled to 8,300 compared to 3,450 last year. Higher apprenticeships in the social care sector will now make up 43% of all higher apprenticeship starts across all sectors and, since

this framework first started three years ago, it has generated 14,720 starts out of 38,120. The 20% year-on-year increase for health and social care and 140% in care leadership and management were greater than the year-on-year 12% change for all frameworks. It means health and social care is still the largest framework, almost twice as large as the second largest in terms of starts, and the gap to the second largest framework widened by almost 10,000 starts since last year.

with Waltham Forest Council, the contractor Hill, architects Metropolitan Workshop and with £450,873 of funding provided by the Greater London Authority. For its eight new residents,

Everall Court is the next stage in their recovery from mental illness and their journey to living independently. Several of its residents have moved to the scheme from secure hospital units.

New support living scheme East Thames has launched a brand new supported living scheme for adults with high mental health support needs in Chingford. Everall Court provides eight brand new, high quality, self-

contained apartments, plus 24-hour on-site support, for adults with high mental health support needs. Everall Court is part of the East Thames’ May Road development, which was built in partnership

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06/11/2015 14:26

CMM December 2015 19

PA CK AG ES

FO R

12 M

NG O E

20 Y OF % LO F U

HEADER

Sky TV packages In Lounge from £55.20 a week (ex VAT)

With themed movie sessions and inspirational documentaries, Sky TV brings your residents together, stimulates their senses and enhances their wellbeing. Get 20% off our Sky Lounge Package for 12 months when you sign-up by December 31st 2015. Sky Lounge Package price shown above includes the 20% discount. Packages billed monthly. Sky TV minimum term is 12 months. Standard cost of the Sky Lounge Package is £299 per month(ex VAT). Standard cost of Sky In room is £40 per room, per month (ex VAT). Installation of equipment is not included, please call for more information. Charge of £50 per box (ex VAT) applies if Sky does not install your equipment. Channels available dependant on chosen package and scheduling may be subject to change. Please visit www.sky.com/business for full channel details. 20% discount: Available to customers subscribing to the Care Homes Sky Lounge Package on a Sky Business DTH UK/ROI Agreement up until 31 December 2015

20 CMM December 2015

for your Care Homes

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In Room from £9.23 a week (ex VAT)

To find the right package for your residents and your business call

08442 414 660

Believe in better

(you must not have subscribed to Sky in the last six months). You’ll receive 20% off the Sky Lounge Package only for 12 months. Standard prices apply thereafter. If you change your package your 20% discount will end and you must pay the then current full price for your package. Offer excludes Stand Alone channels, Sky Box Office and pay-per-view services. You must pay via Direct Debit to receive your offer. Caught in the Act 6 Luangwa, Zambia, Africa :Elephants in water. (Photo Credit: Aquavision TV Productions). Angela Lansbury and David Tomlinson in Bedknobs & Broomsticks ©Disney. Calls to Sky cost up to 7p per minute plus your provider’s access charge. Correct at the time of supply 11.11.15.

CMM December 2015 21

OPERATING IN AUSTERITY Q

How should care providers respond to the funding and commissioning pressures of austerity?

Professor Rhidian Hughes, Chief Executive, Voluntary Organisations Disability Group

There are clearly challenges and barriers to social care funding and commissioning. Within the context of unremitting demographic change, demand is rising. This year, directors of adult social services in England plan on making very significant cuts. These equate to: • Physically disabled people and people with learning disabilities using residential and home care – £53m. • Older people supported through home care or in residential care – £67m. • People using mental health services – £14m. By the end of the decade, the Local Government Association and Association of Directors of Adult Social Services estimate a £4.3bn funding gap in adult social care. Against this backdrop, how should care providers respond to funding and commissioning pressures? Voluntary Organisations Disability Group (VODG) members recently discussed such challenges 22 CMM December 2015

at a roundtable event held at the Group’s 2015 annual conference in London. The debate was attended by senior directors and chief executives. The impact of austerity was acknowledged by all but it was clear that discussions had to be around more than cuts. As one participant said, social care needs more funding but ‘let’s just take it as read there is not enough money…demand is growing, people are living longer with more complex needs and resources are reducing – all of which is a fairly grim financial picture’. The general consensus was that the difficult financial context should encourage providers to adopt a more proactive approach. ‘In the worst of times, it is the best environment to enable inspiration and innovation. So we can either continue to be in this place we’re in – and there are those in the wider sector who are at risk of going under in the next five to ten years – or we can think about that in a different way.’ This rings true for all providers, not just those in the third sector.

BARRIERS However, there are obvious barriers to this approach. ‘At the moment,’ one participant explained, ‘commissioners are finding it hard to be innovative and helpful or inspiring and

they’re quite risk averse’. Several commentators agreed that it was often difficult to even secure a meeting with those who hold the local authority purse strings. ‘They [local authorities] cancel, they send us holding letters…I’m getting held at assistant director stage; until I can get above that to someone who can make a decision, we’re never going to turn the ship.’ The debate heard examples of lack of engagement from councils. This included meetings being frequently cancelled and local authority staff attending meetings ‘totally unprepared’. One participant added that, ‘they sent four senior staff to speak to us about the care funding calculator – we had to give them the password to use it’. There was concern that commissioners favour large providers of generic adult social care services ‘who can provide everything they want’ over smaller, more specialist, local organisations. However, one

CMM December 2015 23

OPERATING IN AUSTERITY

commentator warned that commissioners who buy services from only one care provider will contravene the Care Act, which encourages choice from a variety of providers. The roundtable heard that the result of such challenges arising from funding and commissioning pressures was an increase in risk; risk to quality for people needing care, and to the reputation of the providers delivering it.

SOLUTIONS There was agreement that much can be done to the way providers present themselves to and communicate with commissioners. Given that, as one participant said, ‘the language that local authorities are being told to learn is health’, even something as simple as tweaking vocabulary can help. With reference to a meeting with health commissioners, one person said, ‘We may not be speaking the same language, we may not be presenting things in a way they [councils or health commissioners] understand…Let’s establish a need first off – for example, articulate people as “patients” rather than “customers” when dealing with the NHS.’ Another contributor explained the importance of adapting arguments for different stakeholders. ‘At a meeting with chief executives of local hospital trusts, I said “you’ve got an issue with bed blocking…when patients stay for a long time, you get bashed on key performance indicators, and this costs you money so I think I have a solution”.’ The same provider also insisted the trusts brought their clinical directors into meetings and ‘we spent time articulating how this [our services] would benefit them.’ Next, it was important to explain the benefits to the local clinical commissioning group. ‘We began pitching the same product, but pitched it as saving money on the continuing healthcare budget.’ Finally, ‘we went to the local authority… [persuading them of the service’s benefits] as part of the reablement agenda’. Four months later, after a series of persuasive and tailor-made discussions, ‘each found a niche they wanted for their own purpose’ and the provider won the contract. One controversial area of discussion was how articulating the threat of a service closing can reengage commissioners. They went on to explain how they informed local commissioners there was ‘approval from the board [to warn about a service closing] – this wasn’t just a negotiating stance’.

Another speaker said invoking the dispute resolution process, complete with legal advice, had made commissioners take the provider’s concerns seriously and force dialogue. A third contributor recalled an experience with commissioners, ‘We gave notice; we were running at a loss. We had nothing to reinvent – if you go bust you put lives of service users at risk. We did give notice and they went to get someone else to pick up work [then] they came back to us asking “could you just tweak it a little bit”.’ The service was re-commissioned. Participants agreed, however, that it was important to ‘come to the table with positivity and solutions’, rather than empty threats to use as a bargaining tool. Discussion about solutions moved to changing how care providers are perceived by the public, policymakers and politicians. Health and Government bodies, said one speaker, seem to only see a homogeneous ‘social care’ or ‘voluntary sector’ (or as another put it, all about ‘corduroy and sandals’). But it is vital to convey that ‘we’ve all got decent business skills’. In terms of the sector’s image, ‘it’s about that respect for us as businesses and as a sector’. One contributor suggested there is a need to change the stereotyped image of providers ‘to not just being caring, but being caring and commercial’. Another argued that positive case studies and examples of individuals in the media would help, ‘It’s like social work – you only ever hear about bad social workers’. The sector could do with what one commentator described as ‘a savvy PR approach as to how we improve our image’. Others agreed, ‘The public doesn’t understand [disability]… they don’t approach it from a human rights perspective, but from a charitable perspective… we have to say people have human rights for proper services, it’s not from a charitable patronising perspective’. Ultimately, as the debate heard, ‘it’s about the value of social care and how we get on the same footing as health’. There were suggestions of more collaboration and sharing of information – on commissioning processes or about service contracts, for example – between individual providers. ‘No single organisation can solve this [the pressures on social care] as the future is so bleak.’ There was debate over the practicalities of sharing data, ‘There will be instances where we compete

against each other…we must be clear about when we collaborate and compete.’

BE POSITIVE AND INNOVATIVE As the debate ended, contributors at the roundtable stressed the need to remain positive and continually create and offer solutions amid the unprecedented challenges facing the sector. They also emphasised the importance of standing up for the people being supported and to not compromise on quality, and that means not accepting tenders for services at the lowest price. Putting people who use services first needs to be the driving force. ‘The challenge to us is to actually stand up for the people we are supporting and say it takes this much money to do a quality job… Are we prepared to do it at any price? Most of us are not.’ As one speaker at the event concluded, ‘It’s a tough place and it’s going to get tougher,’ and another speaker said, ‘but we’ve got an incredible staff and value base and we’ve got to make that work better for us by producing more innovative approaches – and maybe a more fiery message.’ CMM

Key points to operating in the current climate • Adopt a more proactive approach. • Learn to speak the language of health and present things in a way health partners will understand. • Adapt arguments for different stakeholders. • Articulate how your services will benefit stakeholders – including savings to budgets, policy requirements and patient outcomes. • Be honest about the threat of service closure. • Invoke dispute resolution, complete with legal advice if necessary. • Come to the table with positivity and solutions, not empty threats. • Collaborate and share information on commissioning processes or service contracts with other providers, with clear definition of when to collaborate and when to compete. • Remain positive and continually create and offer solutions. • Don’t compromise on quality. • Stand up for people who use services. • Innovate.

Professor Rhidian Hughes is Chief Executive of the Voluntary Organisations Disability Group. Email: rhidian.hughes@vodg.org.uk Twitter: @rhidianhughes How do you think the sector should respond to funding and commissioning issues? Visit the CMM website www.caremanagementmatters.co.uk to share your thoughts and access video content from the roundtable event discussed here. Subscription required. 24 CMM December 2015

Workforce integration Integration has many meanings. For Skills for Care, home of the National Skills Academy for Social Care, we’ve focused on workforce integration and how people working together in a person centred way doesn’t require everyone to work for the same organisation. Workforce integration can be about how workers in housing and social care work together in projects that change how people live. For example, Calderdale Council has trained housing officers to be able to assess appropriate adaptations and order resources to support people and promote independence in their own home. Workforce integration can also be about different ways of commissioning care and health and the skills people need to commission in an integrated way (such as Norfolk’s integrated commissioning team). It can also be about person centred transitions (such as the Black Country Partnership’s work on developing the skills and resources in its workforce to improve transitions between hospital and home). It is about making sure that each worker in the transition process has knowledge about how others work,

as well as the skills to successfully support change. Over the last two years, we’ve developed our understanding of workforce integration into the Principles of workforce integration. Developed in partnership with Skills for Health, Association of Directors of Adult Social Services (ADASS), Local Government Association, NHS Employers, Think Local Act Personal and Centre for Workforce Intelligence, the principles underpin work we are currently doing with housing and with the new models of care Vanguard programme.

Sharon Allen

(NMDS-SC). Using person centred outcomes rather than organisation specific creates a focussed culture, which supports staff to work beyond traditional boundaries.

Using our knowledge and resources, we’ve been able to help projects understand how making integration work isn’t just about team structures. It’s also about culture, values, By working with pioneer sites and respect and a mutual understanding Vanguards supporting leadership of what each member of the development and offering intensive workforce brings. Working in an support, we are providing expertise integrated way requires us to trust in the development and delivery of each other and value difference, with integrated workforce strategies and the focus at all times being on better supporting sites to develop their local outcomes for people with care and workforce profiles using the National support needs. Integration – it’s all Minimum Data Set for Social Care about people.

Read more inside about workforce integration best practice.

Service integration and workforce integration – it’s not the same Leaders and managers must look to integrate their workforce as well as their services to provide the best care. Integration is a much-used term that seems to have many meanings. The most common understanding of integration is bringing health (NHS) and social care (local government) services together. This definition of integration misses out service integration with housing, fire services, police, arts, sports and leisure, the retail sector and the wider social care world in which most adult social care workers work. Additionally, service integration can be about bringing departments in one organisation together and bringing parts of different organisations together to offer shared services. If we think only about integrating services, we miss out on the most important element of successful integration projects – people. When your biggest cost is your workforce, it makes sense that workforce integration should be just as (if not more) important than service integration. Workforce integration is about how people

work together, regardless of whom they are employed by, to deliver the outcomes that people with care and support needs require. This can be about workers sharing skills and knowledge and being prepared to ‘give up’ sole responsibly for certain tasks. It can also be about new roles, changing working practices so that people have joined up care and acknowledging that different training schemes create different perspectives on what constitutes the right care and support. Integrating some of those values,

beliefs and cultures might be the first step in being more integrated in how someone’s care and support is offered. Whilst service integration is more commonly talked about and understood, workforce integration is less often discussed. Yet workforce integration is what will bring about real change and it applies to all of us. In your workplace, how integrated is the way people work and what barriers are there to successful workforce integration?

Stockport Council and integration Stockport Council’s in-house Reablement and Community Home Support (REaCH) was the winner of the 2015 Skills for Care Accolade for integration. REaCH works co-productively with Stockport’s district nursing teams and Macmillan nurses to enhance and combine social care and clinical support offered to people at the end of their life. This approach has enabled the numbers of people able to die at home to increase and reduced the number of hospital admissions at times of crisis. Relationships are a key part of making integration in the REaCH service work. Bringing diverse teams together; with shared values, high levels of communication with the joint aim of providing person centred, personalised care. Ensuring the person is at the centre of the care planning process; their wishes, needs and wants, unpin REaCH’s methodology. By creating a holistic joint care plan which combines and captures best practice from both disciplines, REaCH workers are able to provide high-level social care support alongside clinical tasks. Individuals are supported to maintain their quality of life and their chosen level of independence for as long as possible. This is done by ensuring prompt access to aids and adaptations, reordering

of medication and pain relief, and by working with GPs and community nurses. By protecting people’s dignity and treating them with respect at a difficult time, their wishes are at the heart of everything the REaCH team can offer to meet the holistic needs and choices of the individual, enabling people to die in their place of choice which,

for many, is their own home. The REaCH service embodies the principles of workforce integration by putting the person with care and support needs at the centre of the how workforce integration is achieved. Workers in the REaCH service are immensely proud of the care and support they are giving people at the end of their lives.

Social Care Commitment Week 7–13 December 2015

Join us for Social Care Commitment Week to hear why 3,000 social care employers have already signed up. Follow @CareCommitment on Twitter to find out how you can get involved or visit www.skillsforcare.org.uk.

The Social Care Commitment is the sector’s promise to deliver high quality social care. You should sign the Social Care Commitment because:  It is a free tool and easy to access  It can help you improve the quality of care provided  It endorses what you already do well

#SCCWeek

The Driving Up Quality Code was developed to drive out poor quality in learning disability services. In the first in a series of articles, Peter Kinsey and Sarah Maguire introduce the Code, its aims and benefits.

Up Driving Quality The provider-led Driving Up Quality Alliance developed the Driving Up Quality Code in response to the abuse of people with learning disabilities at Winterbourne View. The Code was launched in 2013 at the Houses of Parliament and was endorsed by the then Care Services Minister, Norman Lamb MP with the express aim to ensure this situation could never happen again. The Code asks health and social care providers to make a public

> CMM December 2015 25

DRIVING UP QUALITY

commitment to improve the quality of their service provision and welcome scrutiny of their progress by people who use services, their families and professionals. By signing up to the Code, health and social care providers create a culture of openness and transparency. This is essential to ensure that good organisations flourish and poor provision is exposed and addressed. The Code is unique as it was developed by the voluntary, independent and statutory sectors in consultation with people who use services, their families as well as the Care Quality Commission (CQC) and commissioners. There was a real desire to listen to the people receiving support, their families and other stakeholders and a real commitment to build lives that have meaning.

“The Code is about providers showing a willingness to commit their time and resources to demonstrate that they are delivering good quality services, have the buy-in from relevant stakeholders and are open and transparent in their operations.”

FIVE AIMS The Code has a particular focus on people with challenging behaviour who have longstanding and complex support needs. However, it can be, and is, readily applied to services supporting all people with learning disabilities, including those who have autism. The Code has five simple aims which are to: 1. Drive up quality in services for people with learning disabilities. 2. Create and build passion in the learning disability sector to provide high quality, values-led services. 3. Provide a clear message to the sector and the wider population about what is, and what is not, acceptable practice. 4. Promote a culture of openness and honesty in organisations. 5. Promote the celebration and sharing of the good work that is already out there. The Code was deliberately devised as a voluntary process as there is already plenty of statutory and regulatory ‘assessment’ in the sector. The Code is about providers showing a willingness to commit their time and resources to demonstrate that they are delivering good quality services, have the buy-in from relevant stakeholders and are open and transparent in their operations. It is not intended as a quality measurement tool or to replace other codes and frameworks, but is a process

26 CMM December 2015

that can enable organisations to think more deeply about what they are trying to achieve and how their behaviour impacts on this. Providers sign up to the Code publically and are asked to evidence how they meet, or are working towards meeting, the Code. Commissioners are also asked to sign up to the Code and to commit to using it in their commissioning process to improve the quality of services.

SELF-ASSESSMENT Signing up to the Code is great, however that isn’t enough. The most important aspect is the self-assessment process. This encourages people to come together, take a deep breath and spend some time reflecting on how they work. This means asking people who often spend little time together – people being supported, senior managers, support staff, families, housing providers, commissioners, finance and human resource teams – to listen to each other, recognise the good things, acknowledge the bad and find new ways to drive up the quality of what everyone does. The self-assessments are then posted on the Driving Up Quality website so everyone can see how they are working towards meeting the Code. It is hoped that providers will go that extra mile and use Experts by Experience and/or other mechanisms to independently verify their self-assessments. Having the self-assessment documents publically available means that people are encouraged to challenge them if they feel they differ from the service being received. These challenges could be from service users, their families, staff, commissioners or members of the public. Self-assessment is not a ‘tick box’ exercise. Neither is it about services being told what to do by Government, commissioners or regulators. It is about providers wanting to listen, learn and share their stories about what makes good support and striving to ensure they are delivering it.

BENEFITS OF THE CODE Apart from being the ‘right thing to do’, implementing the code and selfassessment process brings additional

DRIVING UP QUALITY

benefits for providers. Carrying out a self-assessment process involving listening to families, people who are supported by the service and external stakeholders means providers get a good understanding what they do well and what they could improve upon. This kind of feedback is critical to service development but it can also help in achieving a rating of ‘Outstanding’ for the ‘Well-led’ aspect of the CQC inspection process. The CQC has, in fact, produced inspection reports specifically referring to the Driving Up Quality Code under the ‘Well-led’ section. As well as whole organisations carrying out self-assessments, there are a number of excellent examples of individual services carrying out their own self-assessment process. This shows the eagerness of individual services and staff in being open, understanding how they are performing and hearing honest feedback from everyone involved in the service. The self-assessment process is all about openness and transparency. This means that it is can be used as evidence that a provider organisation is meeting the requirements of the ‘Duty of Candour’ regulation. The CQC sets out that the ‘aim of this [Duty of Candour] regulation is to ensure that providers are open and transparent with people who use services and other “relevant persons” (people acting lawfully on their behalf) in relation to care and treatment.’ It is also important that Board members actively engage in the selfassessment process. By listening to the views of people who use services, families and external stakeholders and acting on their feedback, this aspect of the Code provides strong evidence that Board members meet the requirement to be a ‘fit and proper person’. The ‘fit and proper persons test’ aims ‘to ensure that people who have director level responsibility for the quality and safety of care, and for meeting the fundamental standards are

fit and proper to carry out this important role.’ Commissioners are encouraged to refer to the Code in their tenders and this is happening. Evidencing that they have signed up to the Code and are undertaking the self-assessment process could improve a provider’s chance of obtaining a contract. When families are looking to place their relatives in the care of a provider organisation, they want to know about the quality of the services they are visiting. Providers who have signed up to the Code, undertaken the full self-assessment and produced a self-assessment report will have good evidence of the quality of the care and support they deliver. If families don’t know to ask whether a provider has signed up to the Code, providers can be forthcoming with the information and a copy of the selfassessment report. The report can give an honest understanding of what families, people being supported and other stakeholders say about the quality of care. Not only that, but it will also set out what the organisation is doing to address any shortfall.

DRIVE UP QUALITY The Driving Up Quality Code gives providers an openness and transparency about the service they offer. It enables organisations to assess critically the level and quality of services as experienced by everyone involved, from clients to families, staff and commissioners. Since the Code was launched in November 2013, over 200 providers and 17 local authorities and clinical commissioning groups have signed up. In the next edition of Care Management Matters, we will be exploring in more detail, how the self-assessment process can be carried out, giving specific examples from organisations that have implemented it successfully involving a range of stakeholders. CMM

Peter Kinsey is Chief Executive of CMG. Email: peter.kinsey@cmg.co.uk Twitter: @PeterKinseyCMG Sarah Maguire is Director of Quality and Safeguarding at Choice Support. Email: sarah.maguire@choicesupport.org.uk Twitter: @Choice_Support You can find out more about Driving Up Quality at www.drivingupquality.org.uk Twitter: @DrivingUpQualit CMM December 2015 27

PRIMARY CARE HOME MODEL – IS IT THE ANSWER? The National Association of Primary Care has announced pilots of a new Primary Care Home model to bring comprehensive and personalised care to people in their communities. What does it mean for social care and is there a role for this sector? The need to support more people outside acute hospitals is evident. It can relieve pressure on the system and enable people to receive treatment closer to home. There is a need and political drive for new models of care including integrating services. The recently announced Primary Care Home model is one of a number of options.

THE PRIMARY CARE HOME MODEL The Primary Care Home model is defined as, ‘the complete clinical community meeting the health and social care needs of a registered population through a multispecialty community provider model’. It was launched by the National Association of Primary Care (NAPC), which represents and supports the interests of all primary care professionals including general practitioners, nurses, practice staff, pharmacists, opticians and dentists. The aim of the model is to support the strengthening of primary care in line with the new care models as outlined in the NHS Five Year Forward View. Endorsed by NHS England, it builds on NAPC’s Primary Care Home initiative and is tailored to meet the health and social care needs of a community of up to 50,000 people in a location, improving their health, wellbeing and care. The NAPC has developed a briefing paper and FAQs document to explore the model.

CARE DELIVERY Care will be provided by ‘a complete clinical community’, an integrated 28 CMM December 2015

workforce from hospitals, primary care, community health services, social care and the voluntary sector. It builds on the model of multispecialty community providers. These providers are already moving forward with developing local health and care services to keep people well, and bring home care, mental health and community nursing, GP services and hospitals together. By moving a lot of care and support out of hospitals and into the community, patients will be offered more personalised, co-ordinated and responsive care nearer to their home. It is hoped that it will improve care for people with long-term conditions and patients needing rehabilitation. Specifically, those patients who don’t need to be supported in an acute environment. The key features of the Primary Care Home model will be: • Provision of care to a defined, registered population of between 30,000 and 50,000. • Aligned clinical financial drivers through a unified, capitated budget with appropriate shared risks and rewards. • An integrated workforce, with a strong focus on partnerships spanning primary, secondary and social care. • A combined focus on personalisation of care with improvements in population health outcomes.

MAKING IT WORK It has been designed to allow primary care, community health and social care professionals to work together with specialists to

provide care out of hospital settings. However, to make the model work it will need buy-in from all health, community and social care partners including clinical commissioning groups, GPs, patient groups, local authorities, care providers and health trusts. The business vehicle behind the clinical partnership model has a few options which could include an equity stake in the organisation. This could be through a partnership model with stakeholders being jointly incentivised. It will also require a population-based capitated budget which will require providers to achieve enhanced value. It will require careful planning of the workforce to create a single, integrated, multidisciplinary workforce of clinical and social care professionals who are able to meet the needs of the population they will serve. The new ways of collaborative working will require roles to develop and could include cross-skilling of staff and will require change management. It will also separate out the roles of GPs and specialists who can focus their skills where they are most needed. There will also be premises requirements, with the model championing a campus approach which will be using any existing health, social care and community premises and facilities where appropriate. There will also be a role for technology. Expressions of interest for potential rapid test sites are due to be announced by NAPC soon and could be by the time this issue goes to print. It is intended that the test

sites will work from November 2015 to March 2016, to prepare to go live from 1st April 2016.

BENEFITS NAPC feels that the main benefits for patients will be the single, integrated, multidisciplinary team, working to provide comprehensive and personalised care. It is hoped that by working together in this way the team are able to ensure the patients receive a consistent experience of care. It should enable services to be holistic, with staff having a common purpose and clear understanding of the role of each aspect of the care pathway. It should also ensure that costly acute care is delivered in acute settings for those needing it. Patients requiring non-acute care will be served by the more cost-effective, community-based Primary Care Home model. CMM

OVER TO THE EXPERTS... This move to create a communitybased primary care home model will involve many different disciplines coming together. Vanguard sites announced in March have been moving towards this on a smaller scale and appear to be a precursor to the roll out of the Primary Care Home model. Is this model a good solution for the NHS? What is the role of social care? How can social care providers ensure they are involved from the start? If social care doesn’t become involved, will it miss its chance to be integral to such new ways of working?

NO SHORTAGE OF PROGRAMMES FOR INTEGRATION With Vanguards – both the multispecialty community providers and those focusing on enhanced care in care homes; health and social care integration pioneers; and now the National Association of Primary Care model, there is no shortage of programmes to encourage more integrated working. If you’re a social care provider, the plethora of initiatives can be confusing, especially if you have more than one going on in your local area. Also, chasing them can be a diversion of time and attention. From a systems point of view, rather than ‘chasing the model’, I’d recommend that providers start with the question, ‘what do we want services for older people, or people with disabilities, or people using mental health services to be like?’. Then, once you’re clear in your own mind, start approaching potential partners, such as local clinical commissioning groups and GP federations, to hear their views

VITAL PART OF A SYSTEM THAT NEEDS TO DEVELOP

and have conversations about how you might work together in practice. The mechanism for this might be the National Association of Primary Care model or one of the NHS England new models of care. Or it might be none of these. And it may take time. But the key thing is to have a vision around quality of care, and to develop a shared ambition to deliver it with others, whether they sit in primary care, allied health professions, the voluntary sector or elsewhere. There are many examples of social care providers working successfully with primary care, keeping people out of hospital and leading healthy lives. CMM’s March and July issues have articles on these. So now is the time to share your vision for care, and look to be a leader in your local system.

Debbie Sorkin National Director of Systems Leadership, The Leadership Centre

PROPOSALS ARE HEADING IN THE RIGHT DIRECTION I appreciate that ideas are forming but this proposal needs expanding. Three obvious issues arise. Firstly, from the patient’s perspective, the biggest complaint is that they do not know who to turn to, who knows them as a person, who is co-ordinating their care. We have all had the ‘bank experience’ – hundreds of perfectly nice, smiling people but no-one in charge and no-one to advocate. The GP did this, of sorts, but here there’s an opportunity to outline a way in which something can be achieved. For example, a named team assigned to the patient. Having yet another anonymous team, especially to older patients, is not a great advance. Secondly, the thorny question of governance. The proposals would benefit from consideration of whether you want consensus or collaborative leadership. This goes to the heart of the historical problems as to ‘Who is in charge?’.

Should health, as in the acute specialist or GP generalist, lead, or should social care? As with the first argument, it is about the interpersonal relationships. In the former, it’s about the patient and the system. In this case it’s between the members of the system. I don’t think you need an answer, but a recognition that it needs to be resolved. Finally, there is a huge opportunity around technology, building a system on paper records is not going to work. The digital health revolution that we medics know as ‘precision or personalised medicine’ has huge opportunities here. Elderly care lends itself very well to this kind of learning healthcare system, of course delivered in a caring and personal way.

Since the announcement of new models of care in the NHS Five Year Forward View there have been a number of different pilots and models developed. The Primary Care Home model could become an essential model within the health and social care systems. The model detailed here outlines a vital part of the out-of-hospital system that needs to develop. That development and evolution is needed in order to serve patients better. It is also needed to avert the gathering crisis that is developing as traditional NHS systems, including GP surgeries, acute hospitals and the ambulance service, become overwhelmed. It is well-documented that acute settings, especially for frail older people, are very dangerous and expensive. By establishing a multispecialty, community-based model such as this, it will reduce the need for older people with long-term conditions to enter the acute system

unless completely necessary. The integrated and co-ordinated services should better meet their needs in a holistic way. The phrase ‘Primary Care Home model’ in this instance is ambiguous and it could be that it evolves with the different test sites and as it is rolled-out for different regions for different populations. It could be applied to residents in care homes. In these settings, and for this group of people, the Primary Care Home model would be able to deliver higher-complexity care, allowing more rapid discharge of older people from hospitals and also greater ‘hospital avoidance’. As mentioned above, this would have a great impact on the lives of those who currently get caught-up in the acute system unnecessarily, and reduce the costs associated with traditional ‘bedblocking’.

Ian R Smith Chairman, Four Seasons Health Care

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CMM December 2015 29

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A VIEW FROM THE TOP

JOHN K E N N E DY John Kennedy is Director of Care at Joseph Rowntree Foundation.

REFLECTIONS ON THE LAST DECADE ‘Disappointing’. We’ve known about our ageing population and the challenges it will bring for a long time. But still we’ve not settled on our response. There’s always a sense of permanent crisis. We cannot continue to put social care in the ‘too difficult to deal with’ box. We need a functional sector. We need it for the economy, the workforce and, most importantly, for ourselves. Social care is part of the infrastructure, we can’t ignore such a fundamental thing. It needs to be permanently a higher priority. I have been with JRF for 14 years, the challenges set out when it was founded 100 years ago are still as relevant today. We are an independent organisation working to inspire social change through research, policy and practice. Tackling poverty in society is especially important. We have evolved and modernised over the past decade. We’re constantly trying to mould ourselves to reflect the current world, whilst also preparing for the future. We endeavour to try to understand the ‘underlying causes’ and address our challenges with sustainable long-term solutions. I’m currently taking a sabbatical to continue with my care home inquiry. I’m visiting care homes with ‘Outstanding’ ratings to find their secret and see how it can be translated. It’s a fairly simple formula – a good manager, adequate

resources, vocationally-orientated organisation. Though remarkably difficult to replicate within the current system. Getting social care right for ourselves and our families isn’t just about more resources, although more resources are required. It’s also about our attitudes to care and how we value those who care for us. We need to accept the fundamental change that needs to take place to allow our social care sector to be ‘good’, commonly and consistently. PROJECTIONS FOR THE NEXT DECADE We need to be realistic about the challenges and get solutions in place. The current situation isn’t sustainable. It will impact on society, and put greater pressure on the NHS. Cheap social care doesn’t work. We need to fundamentally review social care. If we don’t, I fear the consequences. I hope we will finally embrace social care and agree a long-term workable future. I hope so as there are not many decades left before it will be my turn. INSIGHT It seems clear to me that everyone wants good social care. But we don’t seem to be able to create the conditions for it to flourish. Perhaps we all need to think about ourselves, our own wishes for the care we might one day need. Personalise our thinking. Putting ourselves in the shoes of the cared-for might help us accept

the fundamental changes needed. We need valued staff with sufficient time for interactions, relaxed enough to chat and banter. Social care is about interactions, it’s not a factory. We need to nurture the relationships, they are the key. Kind, caring people thrive in kind, caring systems. INFLUENCES I’m not a dogmatist, or at least I don’t think I am. I am open to changing my point of view if persuaded. Many people have influenced me. I’ve been privileged to work with some incredible people and, of course, going home in the evening to family always brings you down a peg or two. As a teenager, Jack Kerouac influenced me to hitchhike the world and today, Dr Bill Thomas of the Eden Alternative, always makes me think. LESSONS Don’t think you know it all. You need to have confident humility. But I also think it’s a weakness not to say what you actually think, even if you may feel stupid sometimes. There are a lot of naked emperors around. ADVICE Be yourself. Trying to be someone else or what you think other people think you should be doesn’t work, it’s also very stressful. CMM

An extended version of this interview can be found at www.caremanagementmatters.co.uk Subscription required. The John Kennedy Care Home Inquiry is available online www.jrf.org.uk/report/john-kennedys-care-home-inquiry CMM December 2015 31

Tom Owen and Jess Watson continue their series looking at how to maintain quality and engage staff in a climate of austerity.

In our last article, we shared our learning about leadership and positive culture from nearly ten years immersed in the care home sector. At My Home Life (MHL), we’re always interested in hearing what works well in delivering a good quality of life for those living, dying, visiting and working in care homes. This month, we look at care homes’ approaches to keeping staff supported, valued and engaged in continuing to deliver quality care in the difficult financial circumstances we are all working in.

STAFF AT THE HEART OF QUALITY SERVICE At the heart of delivering quality care are the staff and their relationships with the people they care for. Potential customers, when looking around a care home, look at how staff ‘are’ with the residents and it forms a large part of what attracts them to a particular home. The importance of relationships means that at MHL we make relationshipcentred care our focus. In relationship-centred care, everyone in the care home community needs to have six senses fulfilled. These are described in the Senses Framework, from Mike Nolan and colleagues, and are a sense of: • Security (feeling safe). 32 CMM December 2015

• Belonging (feeling part of things). • Continuity (experiencing links and connections). • Purpose (having goals to aspire to). • Achievement (making progress towards these goals). • Significance (feeling you matter as a person). These are the building blocks for great relationships. When we talk to older people living in care homes and staff working there, their words tell the story of these beautiful moments of connection in their relationships. For example: • ‘They reassure me if I am scared, listen and show me I am a valued human being.’ Resident. • ‘They love us and I love them. It’s the little things that matter.’ Resident. • ‘We are all like family; we laugh with them and we cry when they are down, but we are always here for our residents.’ Staff member. While such sentiments are not uncommon in care homes, the complex, emotional role can make it difficult for staff to focus on their relationships with residents and relatives. Additionally, working in a society that doesn’t value

care work takes its toll, so it’s understandable that sometimes staff can switch off their emotions and, as one manager described it, ‘drag residents through the tasks of the day’. Organisations need to understand the underlying motivations that staff have for their work, what’s important to them and create an organisational culture that supports this. With this in place, staff will be better able to nurture those beautiful relationship moments. These moments then become part and parcel of everyday practice, enhance people’s quality of life and attract customers to your business.

if rules and policies are changing all the time, or if paperwork is pulling them away from care-giving, this can demotivate staff. • They feel the organisation truly values the interests of the people being cared for. For example, when the power of decision-making is given to residents, staff feel they are delivering a service that residents truly want. • The organisation shows it values high-quality relationships as an employer. For example, through modelling relationship-centred approaches with staff, helping create a sense of commitment of the organisation to its people and vice versa.

WHAT DO WE KNOW ABOUT STAFF MOTIVATION?

As a result, there’s value in investing time and energy to help staff connect more strongly with the primary aim of the care home: positive relationships with residents.

As you might expect, despite a range of motivating factors for care staff, most agree that their relationships with residents and the rewarding nature of this part of their job is a big motivator. When it comes to their relationship with their employer, staff are often motivated by a commitment of the organisation to allow them to do their job – to care. Our learning suggests that staff feel more motivated when: • There is less interference or change at an organisational level. For example,

IS PAY THE BOTTOM LINE? How can the organisation create the conditions that support staff to focus on their relationships with residents and relatives? It may be a relief to hear that MHL research into pay and quality of care showed that the evidence

CMM December 2015 33

ENGAGING STAFF WHILST MAINTAINING QUALITY

was inconclusive about a direct connection between the level of pay offered to staff and the quality of the service being delivered. However, other indicators suggest that pay levels do have an indirect impact on quality. Within an organisation with a general culture of support, improving pay is one of the ways staff feel that commitment to them. This recognition can improve general levels of motivation and wellbeing, which in turn appear to have a positive impact upon the quality of care being delivered. Additionally, increased staff pay may lead to: • Greater ability to retain care staff, particularly if the organisation is losing good staff to the NHS, local supermarkets or other competitors paying more. • Some staff feeling less worried about their finances, and so are more able to ‘give more of themselves’ to the complex emotional role they play. • The organisation being able to recruit from a wider pool of candidates with the right skills and attitudes. This, in turn, may help the organisation feel more confident in taking action to ask more from those staff already in post that may not be performing well. At the moment, and with the significant increase in the minimum wage to meet the National Living Wage coming into force in April, pay increases are off the cards for the majority of the sector. However, investment in staff isn’t only about finances. There are other ways homes can promote a culture that allows staff to build the relationships, leading to both quality as well as meeting their own motivations for working in care.

CREATING A CULTURE THAT VALUES AND SUPPORTS STAFF Care homes have identified a range of ways to help staff feel valued through the organisation’s culture. Their overall approach is well summed up by one provider that we interviewed who admitted that he was not paying staff particularly well, yet continued to recruit good people who stayed with the organisation. He felt that the culture was about communicating that, ‘while you stay with us, we will support you, and try to make your work interesting and meaningful’. With this in mind, organisations need to consider how they can create an environment where staff feel they are given the time and autonomy to develop and ‘own’ the relationship with the resident. Care home colleagues have shared ways they’ve sought to value and motivate their teams, which they felt helped to retain good staff and improve or sustain quality. Some also felt that this had reduced the costs associated with staff sickness and staff recruitment. These include: • Providing supervision, induction and opportunities for safe and open reflection. • Helping to create connections between the personal interests and lives of individual staff and the lives of the people they are supporting. • Tailoring the work to be flexible to the needs and motivations of staff (eg having key workers, altering rotas or flexible working hours). • Helping staff feel connected to the ‘heart’ of the organisation, sharing and shaping its values and vision, making the plans and goals meaningful to staff. There are also other options which require some financial input. These include: • Investing in training and personal or professional development options as

requested or valued by staff. • Offering staff benefits (eg access to staff discounts, access to the local gym, parties, games room, staff awards, hardship fund, childcare vouchers or debt counselling services). Overall, there was a real sense that the relationship that the organisation has with the individual staff member impacts greatly on the way staff feel about themselves and their work. This, in turn, impacts upon their quality of work. Much can be achieved through little things, like how managers communicate and connect with staff. One example shared with us from a care home was that each member of staff receives a personal letter each year from the director in which they are individually recognised for their contribution. A simple gesture that can go a long way.

THE VITAL IMPORTANCE OF A GREAT MANAGER As always, the manager role is pivotal to quality. Where managers are enabled by their organisation to spend proper time supporting staff to reflect and develop their practice, this provides significant value and motivation to staff. It also helps staff to better understand the behaviours expected of them and their role in strengthening relationships with residents and relatives. As we discussed in our last article, don’t underestimate the value of professional support to managers to take on this complex role.

INVESTMENT IS MORE THAN JUST FINANCIAL There is no doubt that recruiting, retaining and developing care staff remains a significant challenge and we work in a context where opportunities for financial investment are drastically limited. Although pay can be a motivating factor, investment in staff is about more than pay cheques. Listening and responding to your staff’s motivations and development needs is one of many ways to keep them engaged whilst demonstrating that you see their value to your organisation. Central to this is the relationship-centred approach to care, where positive relationships across the whole organisation need to aim to provide everyone, including staff, with a sense of security, belonging, continuity, purpose, achievement and significance. Such a culture can grow a well-motivated community that is committed to its members and through this, delivers the quality of care that will attract business. CMM

REFERENCES Relationship-centred care and the Senses Framework http://shura.shu.ac.uk/280/1/PDF_Senses_Framework_Report.pdf Pay, conditions and care quality in residential, nursing and domiciliary services www.jrf.org.uk/report/pay-conditions-and-care-qualityresidential-nursing-and-domiciliary-services What motivates care workers and how organisations can strengthen the psychological contract with their staff? www.nationalcareforum.org.uk/ documentLibraryDownload.asp?documentID=455

Tom Owen is Director and Jess Watson is Social Action Lead at My Home Life England, based at City University London. Email: mhl@city.ac.uk Twitter: @MyHomeLifeUK How do you invest in your staff to deliver quality, relationship-centred care? Share your thoughts and read the references that accompany this article on the CMM website www.caremanagementmatters.co.uk Subscription required. 34 CMM December 2015

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LEARNING FROM COMPLAINTS Following its latest review of adult social care complaints, Dr Jane Martin explains the Local Government Ombudsmanâ&#x20AC;&#x2122;s role in the care sector and how to realise the full benefits of the complaints system.

36 CMM December 2015

Winston Churchill said that all men make mistakes, but only wise men learn from them. This saying gets to the heart of why we, the Local Government Ombudsman, in our role as social care ombudsman, publish all of our social care complaints statistics on an annual basis. In 2010, our powers were extended to look at complaints about all social care providers that can be registered with the Care Quality Commission. So we look at care complaints regardless of how the care is funded or who it is provided by, giving us a unique oversight of the whole market. We recently published our second Annual Review of Adult Social Care Complaints to present the national picture of social care complaints.

OPENNESS AND TRANSPARENCY The reason we release our data is to support openness and transparency across the whole complaints system. I encourage care providers to use

this data, alongside any other information they have, to scrutinise their own complaints system and to inform their conclusions on the quality of care and support given. Our report builds on other work across the health and social care sector to ensure that complaints are welcomed and lessons are learned to improve standards of service.

PROBLEMS WITH SIGNPOSTING Complaints to us about adult social care are on the rise. We received just over 2,800 complaints and enquiries last year. This is an 18% increase on the previous yearâ&#x20AC;&#x2122;s total. While the amount we receive is small in comparison with the many thousands of social care users in England, each complaint and enquiry represents a story of an individual whose needs were not met by the local complaints process. We know that the best way to resolve a problem is for the body responsible to put things right. We are the last port of call in the complaints process. Last year, we referred 37% of our complaints and enquiries back to the local council or care provider because they had not been given the chance to respond. This indicates to me that more

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38 CMM December 2015

LEARNING FROM COMPLAINTS

could be done to help service users understand how they can raise their concerns locally. We would recommend that: • Information is given in all care settings about how to raise a concern. • A complaints procedure is in place that sets out clear stages with timely responses. • Any information has a clear explanation of the Local Government Ombudsman’s role and details of how to signpost people to us.

TYPES OF COMPLAINT In the report, we distinguish between complaints about how a council carried out its duty to arrange care and complaints about quality of the care provided. The greatest number of complaints about the quality of care provided relates to residential care. Some of the common issues include: • A lack of proper consideration of individual needs. • Poor communication with residents and family members; • Inconsistent and ineffective liaison with other agencies, including health providers. • Incorrect administration of medication. • Incomplete or inaccurate care records. In one of the stories we highlight in the report, Stephen was asked to find another care home for his father who had dementia. His father had lived there for some years but staff could no longer cope with his deteriorating behaviour. The manager at a new care home expressed concerns that the medical administration records for Stephen’s father, which had been passed to her, had substantial gaps in them. Stephen complained to us on behalf of his father.

We found that a medication prescribed for problems with behaviour was frequently marked as not given, either because Stephen’s father was sleeping or refused it. There was no record that this had been raised with his GP or that other approaches had been considered, such as giving the medication before he went to bed. As a result of our investigation, the care home reviewed and updated its policy on medications, apologised to Stephen and offered £500 for the distress caused by moving his father to another home. The story demonstrates the importance of properly understanding and meeting people’s individual needs to administer medication. It is possible that with a more systematic approach Stephen’s father may not have had to move home.

We also always look at whether procedural changes are warranted to encourage learning from the complaint and to avoid the same issue recurring. We know that one of the most common reasons for people deciding to complain is to hear somebody take responsibility for the issue and ensure others do not suffer. As such, a full apology is usually the first step to putting something right. We have also published our staff guidance on recommended remedies. By doing this we hope that it will help those dealing with complaints to understand what we would consider a suitable remedy for different situations. Providers may also want to take a look at the published decisions of our investigations on our website to see examples of our decision making in specific situations.

PUTTING THINGS RIGHT

TIP OF THE ICEBERG

The Local Government Ombudsman has the powers of the High Court to investigate complaints. We are independent and impartial. If we find fault that has caused an injustice, we will recommend ways to remedy the situation. If we don’t find fault, we can help bring the matter to a conclusion. We made recommendations in more than 500 adult social care cases last year. Our recommendations always aim to put the people raising the complaint back in the situation they were in before the problem occurred, rather than ‘penalise’ the organisation at fault. If we recommend a remedy payment, it could relate to a specific service that was missed or costs that were incurred because of a fault. Sometimes a payment will be recommended to reflect the distress caused and time and trouble somebody has gone to in pursuing their complaint.

It is worth remembering that complaint numbers alone are not an indication of good or poor service. On the contrary, high volumes may show an open attitude and accessible procedure. I would be more concerned about a service provider with little or no complaints than one that welcomes complaints as an opportunity to improve. Where we carried out a detailed investigation, we upheld on average 55% of complaints, which means we found fault in how the council or care provider acted. It is important that the public understand that they can come to us with any complaint about social care. The number of complaints we receive about self-funded care continues to rise year-on-year, but remains just over 10% of our total adult care caseload. The self-funded market exceeded £10bn in 2011, so it is likely that we are only seeing a small proportion of independent

care complaints. We know that not enough people are being advised of their right to access the Ombudsman if they cannot resolve their problem. Our customer research shows that nearly half of people using our service were not signposted to us. Care providers and councils need to ensure they provide clear information about complaints, including the right to access the Local Government Ombudsman.

GOOD PRACTICE We use our annual review of complaints to make a number of proposals for the sector. Many partners are involved in arranging and providing social care. The end user should not be expected to navigate a complex maze. Care providers ought to take a ‘no wrong door’ approach to the complaints they receive and take responsibility for ensuring the right organisation receives the complaint. If providers have contracts commissioned by councils, it is important that they check that those contracts clearly set out processes and responsibilities for responding to complaints and concerns. Last year, alongside the Parliamentary and Health Ombudsman and Healthwatch England, we published My Expectations. This framework was produced with health and social care users and describes people’s own expectations of what good complaint handling looks like. We recommend adopting this personcentred structure as the framework by which to receive and respond to complaints. Things go wrong. There’s no getting away from it. But only by welcoming feedback and reflecting on what can be learnt will we see the benefits of the complaints system realised for everybody. CMM

Dr Jane Martin is the Local Government Ombudsman. Web: www.lgo.org.uk Twitter: @LGOmbudsman Do you have a clear complaints policy? Share your thoughts on the CMM website www.caremanagementmatters.co.uk You can also access the reports mentioned in this article. Subscription required. CMM December 2015 39

Final few tickets remaining. There’s still time to be involved. In a sector facing unprecedented pressure, there’s never been a better time to celebrate the creativity and innovation of the third sector. Hosted by Dame Esther Rantzen, the 3rd Sector Care Awards offer you an opportunity to network, celebrate and raise your profile.

Contact: Lisa Werthmann Telephone: 01223 207770 Email: lisa.werthmann@carechoices.co.uk www.3rdsectorcareawards.co.uk/book-now

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40 CMM December 2015