Care Management Matters September 2016 by Care Choices Ltd

SEPTEMBER 2016 £4.00 www.caremanagementmatters.co.uk

INTO THE UNKNOWN Social care post-Brexit

Health and safety CQC’s new powers

Manager Induction Standards Revised, refreshed, relaunched

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Revolutionising social care

In this issue From the Editor

Is it just me…? 07 Vic Rayner reflects on her first few months at the National Care Forum and how the sector needs to engage with the wider world. CMM News

REGULARS

Business Clinic 32 The panel looks at Hampshire County Council’s consultation on social care charging. A View from the Top 35 Bradley Phillips, Director at Bramley Health is the subject of our interview. Event preview CMM previews the 3rd Sector Care Awards 2016.

What’s On?

Straight Talk Jill Parker explores how volunteering can act as a force for inclusion.

FEATURES

EU Referendum – What next for the sector? Three industry experts, including the late Harold Bodmer, share their thoughts on the likely impact of Brexit on social care.

Regulator shows sharper teeth Sarah Knight and Stuart Marchant summarise the first prosecution under the new Care Quality Commission regime for regulating health and safety.

Getting IT right Simon Bentley and Claire Ferrari discuss advances in technology and the improvements they can make.

Feeling refreshed: Manager Induction Standards 2016 Skills for Care is launching revised Manager Induction Standards. Sue Johnson looks at what’s changing.

NLP – A unique approach to management Peter Kinsey explores the impact that neuro-linguistic programming has had on his senior management team and how it could work for other organisations. CMM September 2016 3

CONTRIBUTORS

@VicRayner

@PHallKF

@SharonAllenSFC

Vic Rayner Executive Director, National Care Forum

Harold Bodmer late President, Association of Directors of Adult Social Services

Patrick Hall Fellow, Social Care Policy, The King's Fund

Sharon Allen Chief Executive, Skills for Care

@BevanBrittanLLP

@CCNOffice

@JanetMorrisonIA

Sarah Knight Associate, Bevan Brittan

Stuart Marchant Partner, Bevan Brittan

Cllr Colin Noble

Janet Morrison Chief Executive, Independent Age

Non-care and support providers may be required to pay £50 per year. info@caremanagementmatters.co.uk 01223 207770 www.caremanagementmatters.co.uk

@ColinTWAngel

@BramleyHealth

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 2016 ISBN: 978-1-911437-09-3 CCL REF NO: CMM 13.6

Colin Angel Policy Director, United Kingdom Homecare Association

Bradley Phillips Director, Bramley Health

Simon Bentley Divisional Director, Howden's Care Division

@SkillsforCare

@PeterKinseyCMG

@VODGMembership

Sue Johnson Project Manager for Standards, Learning and Qualifications, Skills for Care

Peter Kinsey Chief Executive, CMG

Jill Parker Senior Policy Advisor, Voluntary Organisations Disability Group

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

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

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

Spokesman for Health and Social Care, County Councils Network and Leader, Suffolk County Council

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From the Editor Editor Emma Morriss pays tribute to Harold Bodmer. It was with great sadness that we heard of the sudden death of Association of Directors of Adult Social Services’ (ADASS) President, Harold Bodmer in July. Having only taken up his role as ADASS President in April, his sudden death was a shock to all. I had liaised with him a few times for the magazine and he struck me as an honest, hard-working advocate for the sector and the people it supports. He knew what needed to be done, and wanted to use his year as President to make the most of this.

CLEAR VISION Delivering his presidential speech back in April, Harold did not wash over the pressures facing the sector and the impact on the public. He said, ‘Money is urgent and real and immediate. There may be more cash coming but even that is not enough and the problems are now.

We have made the savings that were comparatively easy to make (if any savings are easy to make). Now what we save will impact on people. Let’s not deceive ourselves about this. The key is how we do it, how we have an honest debate with the public about the resources we have available and what this means. How we build community assets, family assets and find alternative ways of meeting needs, including the need we all have for positive human contact.’ He had clear vision of what needed to be done, ‘We need a social movement about social care, a campaign that starts now and reaches out over the next few years. We need to go into the next comprehensive spending review with it being an absolute given that social care needs to be properly funded. So I think this is a clear task for my Presidency, to make sure that ball is rolling.’

To those who knew him well, this characterised who he was, his ethos, his honesty and his genuine caring nature. In his A View from the Top interview in CMM June, Harold was very honest in his answers to our questions. He openly admitted that his role as President was not something he could do in isolation; he needed to, and was, leaning on his director colleagues for support. He described it as being similar to a relay race, doing as much as he could with the baton, for the short time he had it, then handing it on. Early in the summer, CMM

commissioned Harold to give his thoughts on the potential impact of the EU Referendum on the sector. This month, we publish his comments in the article starting on page 24. I spoke to his colleagues at ADASS who felt to include his piece in the feature would be very fitting, as the issues raised were all close to Harold’s heart. I hope that his passion, vision and honesty are carried through the sector and his legacy lives on. CMM sends its condolences to Harold’s family, friends and colleagues.

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

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Is it just me...?

leaving a gaping hole. However, over and above the calls for young blood, there has to be an absolute recognition that unless we nurture and develop this experienced workforce, there is going to be a much more immediate recruitment crisis.

Vic Rayner, Executive Director of the National Care Forum reflects on the sector, three months after taking up her role.

OPPOSING MESSAGES

Is it just me...? Or are we letting the fact that there are ‘two sides to every story’ tie the care sector in knots? We live in interesting times, which seems at one level the most over used and yet the most appropriate mantra for this unique point in UK history. It is at this moment in time that I have taken up the helm at the National Care Forum (NCF), and I certainly have not found myself twiddling my thumbs and wondering what to do. Three months into the role is a good moment to reflect – the initial frenzied round of meetings is in abeyance, and I have got my teeth stuck into some of the key challenges impacting on the sector. However, coming from outside of social care, this perhaps is a good opportunity for me to reflect on what I see in terms of ‘the sector’ – before I become so immersed in it that it becomes difficult to see the wood for the trees.

QUALITY AND INNOVATION Quality and innovation dominate the agenda of almost every discussion that I have been involved in. This discussion plays out in a number of different ways and is, I suspect, indicative of the broader challenge impacting the sector. Critical to this debate, and that of many others, is the audience. Quality and innovation is excellent in many parts of the sector, and NCF members and other providers are rightly proud of the ongoing efforts to raise the bar of services to meet the changing needs of those receiving care. However, quality and innovation are also under threat, because of the squeeze on funding and the rising costs of provision, through the introduction of the National Living Wage, amongst other areas. So how do you represent that dichotomy when we have

excellent services that are under threat? Or we need more funding to provide innovative solutions in services of the future? If you are a purchaser of care, you will need the first message, if you are a commissioner, you will need to respond to the second part of the equation. A healthy dose of realism is important for everyone, and adult social care is perfectly capable of ‘telling it like it is’. However, once again, the question of ‘who’ it is telling can lead to mixed messages. This is aptly indicated in the whole debate around the workforce. In a recent personnel survey carried out by NCF, the standout figure for me was that 93% of the registered managers in the workforce were 45 and over. How does the messaging around that work? On the one hand, there is a clear understanding that at some point in the not too distant future, large chunks of that workforce may consider retirement,

How is it possible that these often opposing messages are allowed to co-exist within the sector? Why is it that we haven’t plumped for one set of messages that portray a clear image of what is happening on a day-to-day basis? My reflection on this conundrum would be that we are still largely intent on talking to ourselves and, therefore, presenting almost in one breath, a seemingly Janus-faced response to the key issues does not feel out of line. Because, of course, there are two sides to a story, but if you want to build a narrative to share with anyone not immersed in your day-to-day world, you have to be absolutely clear about your goals, and distil your energy into telling the side of the story that will get you closest to your target. This is not cynical marketing, this is engagement. As long as we continue to offer a two-sided representation of our world, we will find that people will only hear what they want to hear, if, that is, they hear anything at all.

CHALLENGE AHEAD My challenge for the months ahead is to get those goals clear and help shape the words and pictures that tell the wider world what is great about the services that we currently offer, and what is needed to make them greater still.

Do you agree with Vic? Join the debate. Twitter: @CMM_Magazine Web: www.caremanagementmatters.co.uk CMM September 2016 7

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APPOINTMENTS BEN BEN has announced the appointment of Zara Ross as its new Chief Executive Officer.

BUPA Bupa has appointed Evelyn Bourke as Chief Executive and Joy Linton as Chief Financial Officer.

Harold Bodmer The sector has paid tribute to the President of the Association of Directors of Adult Social Services (ADASS) and Executive Director of Adult Social Services at Norfolk County Council, Harold Bodmer, who passed away suddenly. In a statement, ADASS VicePresident, Margaret Wilcox and Immediate Past-President, Ray James said, ‘It is with great sadness that we announce the sad passing of our President, Harold Bodmer, yesterday. Many people today have used the words “such a lovely, honourable man” capturing how, in addition to his professionalism and expertise, his values, integrity, compassion, humility and warmth meant Harold was not only deeply respected but also held in great affection by so many people. ‘Harold has made an enormous contribution to the people of Norfolk, to our Association and to the wider health and care sector. He has served ADASS as Regional Chair, then Vice President before becoming President in April this year. His

opening speech will be remembered by everyone who had the privilege to be there. Harold will be greatly missed, most of all, our thoughts and warmest wishes are with his wife and family at this very sad time. May he rest in peace.’ David Behan, Chief Executive and Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission said, ‘We are shocked and deeply saddened by the news of Harold Bodmer’s untimely death. He was an honourable and decent man who cared deeply about people, especially those in need of support. In his too-short months as ADASS President he had gained a reputation for straight-talking about the challenges facing social care and social work and only last week was highlighting the financial pressures affecting the sector. He will be sorely missed and our thoughts and sympathy are with his family, friends, colleagues and all who loved him.’ Councillor Cliff Jordan, Leader of Norfolk County Council said, ‘I cannot think of a single man who

has risen to the top of his profession as Harold did this year and been so universally liked. He was the very epitome of public service and of the caring professions. It goes without saying that our thoughts are with his family at this very distressing time.’ Deputy Chief Executive of the LGA, and former ADASS President, Sarah Pickup, said, ‘I am devastated by the news of Harold’s death. Having known Harold for many years, he was not just a colleague but a close friend as well. I respected and admired Harold enormously for his unwavering commitment and dedication to social care, which was second to none. He had already made a major impact in his short time as ADASS President and the biggest tribute we can now all pay is to build on his legacy to strive for the vision of social care he articulated so passionately. ‘He was a wonderful, kind and gentle man and my thoughts and condolences are with his wife and children at this deeply distressing time.’

Improving homecare A new quality standard from the National Institute for Health and Care Excellence aims to improve homecare for older people. It states that services need to prioritise older people’s needs and wishes so they are treated with dignity. The standard Home Care for Older People highlights how providers can help older people maintain their independence for as long as possible. It encourages providers to

ditch the ‘one-size-fits-all’ approach and says that homecare plans should describe what each person wants and how their needs will be met. Family members and carers should be involved in the decision process, if possible. It says that enough time should be given so that what people want can be achieved in a way that does not compromise their dignity and wellbeing. Missed visits can have serious

implications for older people. The standard says providers should ensure a back-up plan is in place so that the older person stays safe and their carers are kept informed. Continuity of homecare workers is another priority for delivering person-centred care. Staff should get to know the person they are caring for, understand them and their needs. This builds confidence in the service and instils a sense of safety.

BADBY PARK GROUP Complex care provider Badby Park Group, has appointed Paul Hill as its new Chief Executive.

ORCHARD CARE HOMES Orchard Care Homes has appointed Robbie Burns as the new Non-Executive Chair of the Board. Dr Tony Felton joins as a Non-Executive Director.

AUDLEY RETIREMENT Audley Retirement has strengthened its team with the appointment of Jon Austen, who joins as Chief Financial Officer.

LEONARD CHESHIRE DISABILITY Leonard Cheshire Disability announced that Neil Heslop OBE is joining the charity as Chief Executive on 1st October.

HEALTHCARE HOMES Healthcare Homes Group has announced the internal promotion of its new Finance Director, Mathew King.

TLAP Think Local, Act Personal (TLAP) has appointed Martin Walker as new Policy Adviser.

COMMUNITY INTEGRATED CARE Neil Matthewman has stepped down as Chief Executive of Community Integrated Care. CMM September 2016 9

NEWS

The Care Act one year on

Ministerial changes

One year on from the implementation of the Care Act 2014, TLAP wants to hear about the experiences of people with care and support needs to find out what difference the Act is making. Is it easy to get information and advice? Do people feel they have choice and control of their care and support? These will be some of the questions asked in the TLAP survey.

Jeremy Hunt, Secretary of State for Health, was one of few Cabinet Ministers who has stayed in post following the departure of former Prime Minister, David Cameron. However, his team has changed. Alistair Burt announced that he would be leaving the post of Minister of State for Community and Social Care. He has been replaced by David Mowat, who is Parliamentary Under Secretary of State for Community Health and Care. This is effectively a downgrading of the post to junior minister. Philip Dunne joins the

The results of the survey will be used, alongside information from councils and others, to help the Department of Health identify problems and workable solutions to inform future work on the Care Act. The survey will be launched in early September for one month. Visit the TLAP website for more information.

Health Select Committee report on Spending Review The Health Select Committee has published a report following an inquiry into the impact of the Spending Review on health and social care. The report comments on the promise of integration of health and social care, although progress to date is patchy. The report highlights costs to the NHS of cuts to social

care funding and will monitor the extent to which the social care precept for Council Tax is successful in raising revenue to fund care. The Committee noted concerns about additional funding not actually being available until later in the Parliament and the impact that this will have in the meantime.

CQC reviews integrated care for older people A new report from the Care Quality Commission (CQC), Building bridges, breaking barriers: integrated care for older people reviews evidence from several sources on how integration impacts on the experience of care. CQC reports that it found considerable variation. Although

there is a strong commitment to integration, the report highlights that there are still too many barriers, especially in situations of unplanned emergency admissions to hospital. Examples of good joint-working were found, but they are inconsistent, short-term

Department as Minister of State for Health and Nicola Blackwood as the Parliamentary Under Secretary of State for Public Health and Innovation. There have been comments of concern and disappointment from the sector about the downgrading of the Ministerial post for social care, at the same time as the loss of the Director General for Social Care, Local Government and Care Partnerships post at the Department of Health. Jon Rouse has left the post to join the Greater Manchester Health and Social Care Partnership and is not being replaced.

and often reliant on temporary funding. Furthermore, monitoring and evaluation was found to be insufficient. CQC recommends that shared understanding and definitions of what integration means, especially at a local level, are necessary.

at commissioners and service providers. It offers advice and case study examples to show how housing can be tailored to be person-centred and focused on outcomes.

NICE guideline on oral health NICE has produced new guidelines on oral health for adults in care homes. It calls for oral health and access to dental treatments to be given the same priority as general health for all adults in care homes.

New dementia toolkit

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The National Council for Palliative Care (NCPC) has just published a new guide on end of life care for older LGBT people. The publication, Being Accepted Being Me: Understanding the end of life care needs for older LGBT people is intended to help health and social care staff and volunteers to learn more about listening, understanding and responding to the unique needs of LGBT people. It has been jointly-produced and written by Kathryn Almack of

setting, outcome measured, type of intervention and country of study or authors. The unique dementia toolkit provides easy access to scientific evidence on dementia care and treatment. It gives clear, evidence-based information to people living with dementia, family and other unpaid carers, staff working in health and social care sectors, local and strategic decision-makers and researchers.

the University of Nottingham and NCPC. It can be seen as a complement to the Marie Curie resource, Hiding Who I Am, released earlier this year, as well as NCPC’s previous publication and DVD. This follows the CQC’s report, A Different Ending published earlier this year, which found that discrimination continues to have an adverse impact on LGBT people’s access, needs and experience of services.

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NEWS

Staffing survey highlights workforce challenges Once again, the annual National Care Forum Personnel Survey has highlighted the age profile of the social care workforce as a major concern. 93% of Registered Managers in the personnel survey were found to be aged over 45 and 38% aged 55 and over. Amongst the 68,000 staff in the survey, 50% were aged over 45. Amongst the other findings is

a slight increase in the average turnover rates, with staff turnover in care homes for older people rising to 23%. Clearly, staff stability remains a key challenge for the sector. One of the most striking findings is the number of staff leaving within the first 12 months, which appears to have risen from 32% in 2015 to an alarming 47.9% in the current survey.

Inadequate supply of specialist housing The supply of specialist housing is set to worsen, according to a new report from think-tank, International Longevity Centre-UK (ILC-UK). The report estimates that there will be a shortage of

160,000 retirement housing units by 2030. Although it concludes that specialist housing is only a part of the solution, this report indicates that a continuing lack of adaptations means that homes are not fit for many older people.

Changes needed to housing The All Party Parliamentary Group on Housing and Care for Older People has published its latest report. Housing our Ageing Population: Positive Ideas calls on policymakers to address issues that deter people from moving to

specialist housing. Importantly, the report explores how older people can be given more control over the management and delivery of services. It argues that it is imperative people are encouraged to move while still fit and healthy.

NHS-funded nursing care The Department of Health has released the figures for NHS-funded nursing care for 2016 to 17. The NHS contribution towards the costs of a place in a care home with nursing is increasing on an interim basis. Standard rate will be increased to £156.25 per week; higher rate will be increased to £215.04 per week (this is only relevant for those people who were already on the higher rate in 2007 when the single band was introduced). The increase follows an independent review of NHSfunded nursing care. The review recommends that the rate should

increase by 40% to £156.25. The Government accepts the recommendation, which means that clinical commissioning groups will now pay a national rate of £156.25. The increase will be backdated to 1st April 2016 for individuals who were in receipt of NHS-funded nursing care from that time. The new rate is being paid on an interim basis while further work is done to review the element of the rate for agency nursing staff (which could lead to a reduction to the rate from 1st January 2017) and to consult on introducing regional variation from April 2017.

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NEWS / POLL

Local government complaints The Local Government Ombudsman (LGO) has published its annual complaint statistics for local authorities. The LGO’s Annual Review of Local Government Complaints shows that it upheld 51% of detailed investigations in 2015/16 – up from 46% the previous year. The LGO received 19,702 complaints and enquiries about local authorities for the year ending 31st March 2016. Regarding adult social care complaints, the LGO registered 278 complaints and enquiries about charging for care, and upheld 62% of detailed investigations. Regarding homecare specifically, the LGO experienced a 29% increase in the number of complaints and enquiries received about councils’ provision of homecare from 218 the previous year to 281 this year.

Social care charities call for central role in NHS Social care providers have called for the voluntary sector to be recognised as central to the NHS and health system. The message is outlined in a new publication from the Voluntary Organisations Disability Group (VODG). What can the voluntary sector do to encourage greater engagement and collaboration with the health system? is the latest in a thoughtleadership series. It describes the challenges and solutions to more joined-up approaches to health and care. The publication is based on a recent VODG debate between chief executive and senior directors and NHS leaders, which investigated opportunities for partnership between health and voluntary groups. The need for such alignment is the subject of the recent joint review of partnerships and investment relating to voluntary organisations

in the health and social care sector. The paper notes that collaboration is even more vital amid ongoing funding cuts and post-Brexit-related uncertainties relating to workforce, funding, policy and legislation. In addition, the vanguard sites under NHS England’s five year forward view aim to deliver more integrated services, while Greater Manchester and Cornwall are among the first areas to win devolution and the chance to reshape local and regional health, care and support. Among the challenges to closer working is the relationship with health commissioners, many of whom often regard the voluntary organisations as a fragmented group. The paper notes that health commissioners are also inclined to focus on the traditional ‘medical model’ of support rather than consider community-based provision.

POLL

Do you have recruitment and/or retention issues? Yes No You can vote via: www.caremanagementmatters.co.uk

July’s results Did you participate in Care Home Open Day 2016? NO 75%

YES 25%

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

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NEWS / IN FOCUS

3rd Sector Care Awards – nominations are closing Nominations for the 3rd Sector Care Awards close on 2nd September. Don’t miss out on your chance to be recognised and celebrated. Hosted by Dame Esther Rantzen, the Awards are a chance to network and celebrate some of the best work in the industry. Nominations are open to outstanding employees of all levels in the not-for-profit care and support sector. The judging panel

will once again include Experts by Experience. Categories and how to nominate are online at www.3rdsectorcareawards.co.uk/ categories. Shortlisted nominees must be available to attend interviews on Wednesday 2nd November. The Awards Ceremony will be held on Wednesday 7th December in London.

Runwood Homes in Northern Ireland Runwood Homes has acquired three care homes in Northern Ireland: Ashbrooke Care Home in Enniskillen, Ard Mhacha Care Home in Armagh and Geanann Care Home in Dungannon. The three care homes are registered with the Regulation and Quality Improvement Authority to provide 192 places for the care

of older people with varying care needs. This expansion brings Runwood Homes’ portfolio of nursing and residential beds in Northern Ireland to 812 across the province. Later this year, this will increase to almost 900 beds with the completion of a new state-of-the-art care facility in Glengormley in Belfast.

Guidance for difficult conversations Independent Age has developed a toolkit of guidance to enable people to discuss difficult and sensitive subjects, such as housing, making a will, and end of life care

with relatives. The guidance has been developed from discussions with a range of people and covers information and the need for support.

Managing care home closures A new good practice guide, Managing care home closures has been published to help minimise the impact on people, and their families and carers, in the event of a care home closing. The Care Quality Commission has worked with NHS England, the Association of Directors of Adult Social Services, the Local Government Association and the Care Provider Alliance to agree the guide. Managing care home closures

sets out how local and national organisations should work together in order to co-ordinate action, avoid duplication and prevent confusion when facing a care home closure. When a care home closure situation arises, organisations including local authorities, clinical commissioning groups, NHS England, Care Quality Commission, providers and partners will be expected to use an appropriate and detailed checklist to ensure the process is co-ordinated well.

In focus The implications of Brexit for the care sector WHAT’S THE STORY?

The outcome of the referendum vote on 23rd June 2016 to leave the European Union was arguably one of the major surprises of the summer (at least for around 50% of the population). There has already been considerable political fall-out from the Brexit vote, including a new Prime Minister, a new cabinet and several new political positions to oversee the negotiations. It is expected that once the process of exit starts; the negotiations will take quite a while with the outcome less likely to deliver the promises that were made in the run up to the vote. However, it is now clear that the implications for the economy and for different service sectors are expected to remain uncertain for some time.

WHY DOES IT MATTER?

There are a number of issues relevant to the social care sector that relate to the decision for Britain to leave the EU. The key areas include: the state of the wider economy; funding (particularly of the public sector); workforce matters; future costs; research, development and training.

WHAT HAPPENS NEXT? As ever the devil is in the detail. We don't yet know when the Government will trigger the formal process and we don't know how long it will take. At this stage, the only thing we can be confident about is that the period of economic and

political uncertainly that Brexit has unleashed will continue for some time. This uncertainty comes at a time when the care and health sectors are already experiencing significant, unprecedented, operational and financial pressures.

HOW HAS THE CARE SECTOR REACTED?

Fair to say it is still very early days. One of the first organisations to consult with its members was the Voluntary Organisations Disability Group and its report on reactions from providers in its membership appears to reinforce the challenges care providers are already facing. There is widespread concern that post-Brexit, the social care sector will experience a deeper crisis. This is because significant infrastructure funding, as well as research and development, have been sourced from the EU. Furthermore, issues relating to human rights for people receiving services and for workers have also been raised as a potential worry, particularly if rights are unprotected in the future. In fact, the biggest concern has been the possible implications for staffing. There are questions about future recruitment, as well as the effects on retention for staff already working here and whether they will be able to continue. For more information on the potential impact of the EU Referendum on social care, see page 24. CMM September 2016 15

NEWS

Unviable homecare contracts Recent public statements from providers withdrawing from local authority homecare contracts has raised concerns about the commercial viability of such contracts. The statements by Mears Group and Warren Care for contracts in the Wirral and Liverpool demonstrate the increasing fragility of social care markets. The United Kingdom Homecare Association (UKHCA) has released a clear statement on the situation. It notes that many more withdrawals

from contracts have happened without media coverage, and are already in progress. Something which ITV’s Tonight programme covered in October 2015. Councils (and the health and social care trusts in Northern Ireland) have legal obligations to meet people’s needs. To do so, they require stable, functioning care markets in the independent and voluntary sector. The UKHCA has repeatedly warned governments in all four UK administrations and individual

Accessible Information Standard New requirements have come into force, ensuring that people who receive health and publiclyfunded adult social care have easily accessible information and support. The Accessible Information Standard aims to ensure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand with

support, so they can communicate effectively with services. Examples of the types of support that might be required include large print, braille or using a British Sign Language (BSL) interpreter. All organisations that provide NHS care or publicly-funded adult social care are required to follow the new standard, including NHS Trusts and Foundation Trusts and GP practices.

ADASS Budget Survey In one of the gloomiest annual budget surveys from the Association of Directors of Adult Social Services (ADASS), the association makes clear that funding does not match increased need for, and costs of, care for older and disabled people. Directors report that they are less clear about where future funding will come from and as a consequence the continuity of the care market is under threat,

with investment in prevention continuing to be squeezed. The survey shows the negative effects of the budget cuts, with a pessimistic account of the issues facing the care sector. In the survey, 85% of directors thought that care providers were facing quality challenges and 84% thought that care providers were facing financial difficulties. There are stark predictions of the shortfall in care funding in 2017-18 and beyond.

councils that homecare agencies cannot continue to accept unsustainable fees. Until now, most councils have been able to re-let contracts to alternative providers. However, the UKHCA says that with significant increases from the National Living Wage this year, and for the next two years, providers will be unable to take on larger volumes of uneconomic business, unless they can see this bringing in additional revenue at no more than a marginal increase in costs.

Supported housing guide A new Making it Real guide for supported housing has been published by Think Local Act Personal (TLAP) and Sitra, part of Homeless Link. Making it Real for Supported Housing is aimed at commissioners and service providers. It offers advice and case study examples to show how housing can be tailored to be person-centred and focused on outcomes.

Revalidation success Data published by the Nursing and Midwifery Council (NMC) shows that over 35,000 (91%) nurses and midwives due to renew their registration have now completed the revalidation process. The first report from the NMC examines data for the first three months of revalidation, which shows that renewal rates are in line with expectations and there is no evidence of revalidation having an

adverse effect on the register. Across the four UK countries, revalidation rates are very similar, ranging from 91% to 94%. The number of those revalidating varied in line with the size of the geographical areas, with nurses and midwives in England representing the largest group (80%); followed by Scotland (9%); Wales (5%); Northern Ireland (4%), and the remaining 2% from those living outside the UK.

Changes to apprenticeships Due to changes in apprenticeships, Skills for Care has produced a number of documents detailing the

changes. These include details of the new standards, and a ‘Frequently Asked Questions’ document.

Carterwood report on wetroom provision Carterwood has updated its 2014 report on the provision of en-suite wetrooms in care homes in the UK. The research shows a modest improvement in facilities, which have increased from 13.8% in 2014

to 17% in 2016. The provision of ensuites was also found to have risen slightly from 62% in 2014 to 67% in 2016 – revealing that, amongst care homes, around a third still don't offer this facility.

New hotel for people with learning disabilities An innovative £2m scheme to create the UK’s first hotel for young people with autism and learning disabilities has been given the green light by Gateshead Council. The St Camillus Care Group has 16 CMM September 2016

been granted planning permission to transform the former Rivers Edge Hotel at Gateshead into The Vault. It will not only provide respite care for young people with a range of learning disabilities but will also

train them to work within the hospitality industry. Work will now begin on transforming the 28 bedrooms to make them suitable for respite care, while training has already begun on

giving young people with autism and learning disabilities the opportunity to work alongside trained staff. St Camillus Care Group has partnered with Gateshead College and its Project Choice scheme.

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Elder abuse must be made a crime Action on Elder Abuse (AEA) has launched a UK-wide campaign calling for elder abuse to be made an aggravated criminal offence, similar to offences that are racially or religiously motivated. Research by the charity has shown that the Criminal Justice system is consistently failing to deliver justice to older people. Following a series of Freedom of

Information requests, AEA learned that most agencies, including the police, the courts system, and the Ministry of Justice, fail to keep any significant records of the experiences of older people. One force who did provide information, admitted that it investigated 76 cases in a year. It issued a police caution in each case.

Castleoak hands over keys to Abbeyfield Society The Abbeyfield Society has picked up the keys to its innovatively-built dementia care home in Winnersh. The charity has spent three years designing and developing the pioneering site just outside Reading, working in partnership with Castleoak. The 60-bed home boasts an abundance of unique features created to enhance the quality of

18 CMM September 2016

life for those living with dementia. The home’s innovative design, which is not dissimilar to the GCHQ building in Cheltenham, is the first circular care home in the UK. A very common symptom of dementia is the urge to wander or walk with purpose, and the cyclical corridors allow for this without residents ever coming to a definite ‘end point’.

Not one case reached court, so none of the perpetrators received a criminal conviction. In its report, published to coincide with World Elder Abuse Awareness Day, the charity catalogues 23 cases of elder abuse. None of the perpetrators received a custodial sentence, despite the horrendous circumstances of the abuse.

Carterwood sale Carterwood has sold a parcel of land with planning permission for a retirement scheme comprising 28 bungalows, 58 apartments and communal facilities in Titchfield, Hampshire on behalf of the Minton Group. It was purchased by Oak Retirement, who will develop and operate the scheme.

Leading group targets growth Midlands-based St Philip’s Care Group is targeting growth and new recruitment following agreement on a new £27m refinancing package with Yorkshire Bank. St Philip’s Care Group has more than 30 homes across the UK and has enjoyed ongoing growth via regular redevelopment of its portfolio. Its business strategy focuses on continually modernising, refurbishing and adding new

features to its homes. St Philip’s Care Group currently has full planning permission across 25 of its properties to add capacity of another 150 beds. This is via a major refurbishment programme. St Philip’s Care Group anticipates adding around 20-25 beds per annum to homes across the portfolio and expects to recruit approximately 60 new staff each year to service the increased capacity.

NEWS

New 'must read' report on activity provision from NAPA NAPA has published Sudden Death and Activity Provision – What’s the link? a ‘must read’ report funded by a Winston Churchill Memorial Trust, Travelling Fellowship. Sylvie Silver, the executive Director of NAPA travelled to Australia and the USA to see how activity staff in those countries are trained and developed in comparison with what happens in the UK. The report documents her observations and makes recommendations for how NAPA and the care sector should progress this much neglected but vital element of care in the future.

Sylvie Silver said, ‘The Churchill Fellowship allowed me the time and space to observe, discuss and crystallise my beliefs. I hope that the title of my report will inspire people to read on and see if they agree with my assertion that everyone deserves a sudden death. My aim, in brief, was to compare what two other nations are doing to provide training and support for activity providers and creative artists with what happens in the UK.’ The full report is available to read on the NAPA website.

Skills for Care Accolades Nominations are open for Skills for Care’s national Accolades awards and local adult social care organisations who deliver high quality care are being urged to enter.

The Accolades recognise excellence and innovation offered by adult social care providers in 10 different categories reflecting the diversity of the sector.

The Need for Community A report by the influential thinktank, the Centre for Social Justice (CSJ) has singled out the historic community of Camphill Newton Dee for praise saying it provides ‘many lessons for care in a communal setting’ for those with learning disabilities. The CSJ’s report entitled The Need for Community is a

wide-ranging review of care and accommodation for those with a learning disability. Its emphasis on communities, such as Camphill, where people feel safe and yet connected to the wider world, will be welcomed by many in the care sector who have long argued that such communities should be seen as a frontline model of care.

Who will care? – New research from Bupa Research from Bupa reveals that a fifth of the nation (20%) don’t know who will look after them if they have care needs in old age. Nearly three quarters (73%) think they will have care needs in older age, but only around half (51%) expect their family to care for them. The survey of more than 2,000 people reveals that old age is a regular consideration, with 24% of

respondents thinking about what life will be like in old age a few times a week – 17% think about it every day. The research reveals that under a quarter (24%) of the population feel older people are valued by society, illustrating the need to change perceptions of ageing and ensure older people are appreciated and treated as individuals.

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NEWS

New Care confirms £50m deal bonanza Manchester-based New Care has completed on a series of deals worth £50m with regards to four individual care homes, located in Sale, Lytham, Chester and Nottingham. The various deals have seen two new-build projects hit site, detailed planning permission granted for a third new care facility, and a sale and leaseback arrangement entered into on a recently completed home. Build is well-advanced in

Sale, South Manchester, where construction has commenced on a £10m, 57-bed care facility, known as Ashland Manor, with funding secured from HCP, an institutional fund based in USA. In Lytham, New Care has signed a forward funding agreement with Octopus Healthcare for the development of a 76-bed care facility, with construction now underway. Completing the trio of new care

Target Healthcare REIT Target Healthcare REIT has exchanged contracts to acquire a purpose-built care home in Kirby Cross near Frinton-on-Sea, Essex. The home will be acquired for approximately £9.2m including acquisition costs, once works have been undertaken to complete the home to the Group’s specification. Completion of the transaction is expected in January 2017. The home will have 82 bedrooms over two floors and will be leased to existing tenant Care Concern group. This

will be the fourth home with Care Concern as tenant, following the completion of renovation works on Tapton Court in Sheffield. It has also completed the acquisition of a modern, purposebuilt care home in Cheltenham, Gloucestershire for approximately £7.9m including acquisition costs. The home comprises 66 bedrooms over four floors. Upon acquisition it was let to a subsidiary of Caring Homes group. Caring Homes becomes Target’s 13th tenant.

Bupa Home Healthcare sold The sale of Bupa Home Healthcare to Celesio has been completed. The sale follows approval from the Competition and Markets Authority in the UK.

Bupa Home Healthcare is a leading provider of high-quality, home healthcare services supporting over 35,000 patients across the UK.

homes is Chester, where planning consent has been granted for a £15m, 77-bed care facility. Funded by bank debt, construction started in July. The deal bonanza culminated with a £12.5m sale and leaseback arrangement to Octopus Healthcare of the company’s recently completed 82-bed, flagship care home, known as The Grand, located in West Bridgford in Nottingham.

The Old Vicarage in Cumbria DC Care has completed the sale of The Old Vicarage Care Home, in Askam in Furness, Cumbria. The home, which had been in the owners’ family for over 30 years, is registered for 30 residents and is set in ample grounds.

Castleoak and One Housing Castleoak has announced a £6m turnkey care home development in Chelmsford. The deal is Castleoak’s first with leading housing association, One Housing. The home will be marketed under One Housing’s new luxury senior living brand, Baycroft.

The new 64-bed care home, designed and built by Castleoak will include pre-fabricated timber frame manufactured at Castleoak’s in-house ISO9001 standard factory. The home will open in autumn 2017, offering nursing and specialist dementia care.

Sanctuary Supported Living in Birmingham Sanctuary Supported Living (SSL) is expanding its services in Birmingham under a new agreement with the city council to deliver supported housing for 35 people with learning disabilities. Ten clients will be living in Sandwood House, a newly-

refurbished property in Edgbaston. The remaining 20 units will be based across a number of other SSL supported housing properties across the city. The agreement marks a major expansion of SSL’s learning disability supported housing provision in Birmingham.

Important role of Disabled Facilities Grant The often confusing array of home support services that help vulnerable people live more independently, via a key government grant, should be combined to create a one-stop shop, according to a new report. Some 40,000 people a year receive a Disabled Facilities Grant (DFG). This is set to rise to 85,000 by the end of the decade thanks to increases in government funding. It should pave the way to greater use of the cost-effective grant that can help to reduce hospital admissions, cut care costs, delay the move into residential care and speed up hospital discharge. However,

awareness of DFGs is still low and provision is fragmented. The findings come in a new report, commissioned by Foundations, examining how the DFG has developed since it was introduced in the early 1990s. The report highlights areas at the cutting edge of provision where services have been joined-up to great effect. By pulling together support from home improvement agencies (HIAs), occupational therapists and other health and care professionals, potentially in the form of new arm’s length management organisations, the report suggests support will

achieve a higher profile and be delivered more efficiently. It will also build greater capacity to support those not eligible for DFGs, relieving the pressure on hospitals and social care. DFGs are awarded by local authorities and are predominantly delivered by home improvement agencies. After being in what report authors Sheila Mackintosh and Philip Leather describe as a ‘policy vacuum’ since its inception, ‘not really belonging to housing, health or social care’, the DFG became part of the Better Care Fund in 2014. The report highlights this as

an important breakthrough, ‘The accessibility of the home is finally being recognised as important for successful hospital discharge, to enable care to take place at home, and to allow people to live independent lives…it is possible to join up the previously disjointed pathways and link the DFG to other related health and care services in a way that will make much more sense to customers. Rather than standing alone as a single solution, it can be part of a more holistic range of interventions to help older and disabled people remain independent at home.’ CMM September 2016 21

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EU REFERENDUM

What next for the sector? 24 CMM September 2016

What impact, if any, will the decision to leave the European Union have on social care?

Harold Bodmer, late President, Association of Directors of Adult Social Services, Patrick Hall, Fellow, Social Care Policy, The King’s Fund and Sharon Allen, Chief Executive, Skills for Care.

PEOPLE’S NEEDS FOR CARE WON’T STOP

Harold Bodmer, late President, Association of Directors of Adult Social Services The political turmoil that has followed the vote for the UK to leave the European Union cannot fail to have affected all of us working in the public sector, and there are many questions currently unanswered about how many services will be affected in the future – including adult social care. Is it worth remembering that hundreds of thousands of people continue to be cared for and supported by adult social care services – so our role remains crucial regardless of what’s going on around us. Also, the people that work for, and receive services from, adult social services will be just as worried about what’s happening as we are, and it’s part of our role to help deal with that. The Association of Directors of Adult Social Services (ADASS) will monitor the unfolding events closely and seek to take part in relevant discussions. We expect some of the main issues to affect our sector to include staffing, the potential for discrimination, and of course, the potential impact on the economy and funding for adult social care. Skills for Care estimates that staff with EU nationality made up 6% of the adult social care workforce in England in 2015 – some 80,000 jobs. Its figures show that the loss of nonBritish EU workers would be felt far more in some regions than in others. The proportion of the social care

workforce doubles from the average 6% to 12% (20,000 jobs) in London and rises to 10% (21,000) in the rest of the South-East, but is as low as 1% (1,000) in the North-East. There is no doubt that for a sector already under pressure, the loss of any of this valuable workforce would have a profound effect. Vacancy rates are already at 5%. We want to strongly convey our support to the 80,000 EU staff and other colleagues from outside of the EU who may be concerned. Every minute of every day, while we continue to analyse and understand the impact of the referendum and current events on this vital public service, millions of people are receiving a service from adult social care thanks to the contribution of those staff. We will, of course, be ensuring our safeguarding processes support people who may be victims of the recent rise in hate crime, and working to support communities to come together. This includes giving support to employers of social care staff who have experienced discrimination in recent weeks. Of course, it’s normal to feel unsettled at times of great change, but while we wait for negotiations to begin, and for more detail to emerge on everything from public sector funding to the employment of EU nationals, the most important thing to remember is that people’s needs for care won’t stop.

CMM September 2016 25

EU REFERENDUM – WHAT NEXT FOR THE SECTOR?

IT IS VITAL THAT SOCIAL CARE COMES TOGETHER

Patrick Hall, Fellow, Social Care Policy, The King’s Fund Simon Stevens recently claimed that ‘when the economy sneezes, the NHS catches a cold’. If this is true, then social care is in danger of a much more life-threatening infection if the social and economic risks of Brexit crystallise in the coming months and years. It is vital that social care comes together as a system to think through how it will adapt to the new environment. Leaders across the constituent parts of the sector will have to fight to ensure that progress toward a fairer and more sustainable future for care is not pushed off the national agenda. The first task is to reassure the migrant workforce on which social care in the UK heavily relies. Providers should demonstrate that they value their contribution. The atmosphere after the result has been a worrying one for EU and non-EU migrants alike. Frankly, the sector depends on migrant labour and should be open and clear about the potential impact of ending free movement within the EU and any moves to reduce nonEU immigration. It will also be important for the sector to act collectively to influence the British withdrawal process. Vic Rayner of the National Care Forum has acted quickly to draw together the views of leaders and has produced a number of resources to help providers think through the implications. This collaboration should be turned into a more permanent coalition to make the case for social care during negotiations. The system is already approaching crisis. The homecare market is at real risk

due to a combination of fee pressure, recruitment problems and an overly-transactional commissioning approach. Commissioners themselves face a potential shift in market power in the care home sector; as smaller providers exit, supply becomes scarcer and the remaining firms will begin to gain leverage over public purchasers. The worry is that if local authorities are forced to make even deeper cuts to expenditure, due to a renewed austerity drive, they will fail to meet their statutory obligations. This is reflected in the Association of Directors of Adult Social Services’ Budget Survey 2016, with only 2% of directors confident in their ability to meet savings targets by 2020. It could be argued that they are already struggling to meet their obligations, particularly with regard to the broad and aspirational opening clauses of the Care Act, relating to the promotion of wellbeing and the reorientation to preventing need rather than providing care only at crisis point. Leaders across the system must continue to make the case for social care (in terms of welfare and economic contribution) and the need for a new financial settlement, coupled with longterm reform. This will require clearthinking about influencing political decision-making when the policy and news agenda are full. For the new Prime Minister and her team of negotiators, addressing the approaching crisis in social care will be a key test of her promise of ‘a country that works for everyone’.

THE ANSWERS WE SEEK WILL TAKE TIME Sharon Allen, Chief Executive, Skills for Care To the 90,000 EU nationals working in social care – we value you and what you do. As the postReferendum arguments continue to rage, my main concern is that we find answers to some pretty fundamental questions, including what will be the impact on the social care workforce? Why does this matter so much to me? It’s simple – ours is a rapidlygrowing sector, in which the number one issue is how we can attract, keep and develop a high-quality workforce. Without enough people working in our sector, it follows we simply cannot ensure that our citizens can be supported to live independent and fulfilling lives. It matters that we debate what a post-Brexit, social care world will look like, because we know from our National Minimum Data Set for Adult Social Care that approximately 6% of our current workforce, of some 1.5 million people, are EU nationals. To all of them and their colleagues working hard to support people, day and night, I say, ‘we value you and what you do’. We also know that our sector will need to recruit an additional 400,000 people by 2030. How can we find those workers to ensure that people in our communities can have choice and control, and to support our health system, so that people are not, for example, delayed waiting to be discharged from hospital, but can get home? The social care workforce is as diverse as our society. It includes many from the EU and all corners of the globe. The workforce reflects, and supports, our local communities and the people who need care and support. Many nurses (and nursing

is a critical need) have joined us recently, following international recruitment drives, and we all know that outstanding care of any kind depends on those delivering the care feeling appreciated and valued. We need to continue to value all members of the workforce, wherever they come from, for their commitment and dedication – we’ve tweeted about this using #loveourEUstaff which has been such a popular tag across both social care and health services. It’s also why we shared our workforce data and our range of workforce development resources with the National Care Forum to help create the #unitedwecare hashtag, which has been enthusiastically supported by employers and their teams. The answers we seek will take time, but in the meantime, there are resources available for employers to help with the challenges of getting and keeping good quality staff. Our Finders Keepers toolkit is an interactive resource to take employers through from preemployment through to how to keep a motivated team. I Care... Ambassadors are a great way to promote different roles in our sector, to develop staff skills and confidence and to promote your organisation. Core values like humanity, inclusion, dignity, and celebrating and promoting diversity are the bedrock of good, person-centred social care. They are offered daily to millions of people by our diverse workforce. We must all work together to ensure this message is included in the debates over the coming months and, even more so in times of insecurity, we must be certain of this.

Harold Bodmer was the late President of Association of Directors of Adult Social Services. Twitter: @1ADASS Patrick Hall is Fellow, Social Care Policy at The King's Fund. Email: P.Hall@kingsfund.org.uk Twitter: @PHallKF Sharon Allen is Chief Executive of Skills for Care. Email: sharon.allen@skillsforcare.org.uk Twitter: @sharonallensfc What are your thoughts on the EU Referendum? What impact could Brexit have on the sector? Share your thoughts and access the reports mentioned at www.caremanagementmatters.co.uk. Subscription required. 26 CMM September 2016

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REGULATOR SHOWS

SHARPER TEETH A recent prosecution by the CQC has highlighted how the inspectorate is responding to new Regulations and that the sector needs to be fully aware. Sarah Knight and Stuart Marchant explain more. In June 2016, a not-for-profit care provider was fined £190,000 under the new Sentencing Council’s Guideline on Health and Safety Offences, Corporate Manslaughter and Food Safety and Hygiene Offences that took effect on 1st February 2016. The prosecutor was the Care Quality Commission (CQC); whose costs came to an additional £16,000. The individual care home at the heart of the prosecution had an excellent reputation with service users and their families and was well thought of by local healthcare professionals. There

CMM September 2016 29

REGULATOR SHOWS SHARPER TEETH

were (and remain) no safeguarding issues. Nevertheless, the fine imposed was substantial. The story acts as a salutary warning to all care providers. We each know that accidents can happen when you aren’t expecting them. Now more than ever, the penalty imposed by the CQC when accidents happen can drastically impact on a business.

WHAT WENT WRONG? On 30th April 2015, whilst two healthcare assistants who were preparing him for a shower, a service user fell forward onto the floor after tipping out of his chair. He sustained a broken neck. Very sadly, he died despite attempts at resuscitation. The care provider was charged with a single offence of failing to discharge its duty under Regulation 12(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the Regulations). These Regulations took effect on 1st April 2015 and coincided with a transfer of enforcement responsibility for health and safety incidents in the health and social care sector from the Health and Safety Executive (HSE) to the CQC. The allegation was that, whilst carrying out a regulated activity of providing accommodation for persons requiring nursing or personal care, the service provider failed to provide safe care and treatment resulting in avoidable harm or a significant risk of exposure to avoidable harm to a service user. The failure to discharge the duty imposed under Regulation 12(1) is a criminal offence pursuant to Regulation 22(2) and is liable to a penalty under Regulation 23 of the Regulations.

CQC’S APPROACH TO THE INVESTIGATION The prosecutor reiterated that the reason for the criminal status of the allegation was that the duty to provide safe care and treatment is a fundamental and minimum standard expected of care providers under the new Regulations. It is one of a series of fundamental standards introduced following the Mid Staffordshire NHS Foundation Trust inquiry. To give ‘bite’ to this submission the Prosecutor referred to the new sentencing guidelines under which there is an unlimited fine for the most serious cases. The offences are summary only. The category of fine in this case was between £300,000 and £1.3m. The CQC adopted the approach taken by the Health and Safety Executive in such cases. A thorough investigation was undertaken. Despite positive reporting by the CQC itself on previous inspections in relation to care provision, the HSE-style investigation included considerable scrutiny of many peripheral issues relating to the service provider’s systems and practices. During the course of its investigation, the CQC considered that a restriction should be imposed on the service provider’s registration. After lengthy submissions and the provision of copious documents to the CQC, that proposal was not upheld. In addition to its own investigation, a report was requested from the Health and Safety Executive which was relied upon in court. The report confirmed that the man had not been seated far enough back in the shower chair and that the lap belt used was not fastened securely. Furthermore, the castors of the chair were in the ‘push’ position. Despite having two care staff with him, it was 30 CMM September 2016

not clear how the service user came to lean forward. However, the care home had been waiting for a formal assessment of the man’s needs and had asked for him to be seen by a physiotherapist who, in turn, had referred the matter to an occupational therapist. Naturally, there was scrutiny of the relevant records going back over many years. The CQC also submitted that falls from chairs resulting in serious or fatal injuries are not uncommon in the health and social care sector. Because of this, the Medicines and Healthcare Products Regulatory Agency (MHRA) issued safety alerts, warning the sector to be alert to the need for the correct use of posture/safety belts. The provider was able to show that it, indeed, received the alerts and had sent them to all relevant care homes. However, it was unable to show what happened to the alerts after that.

THE PROSECUTION This case was the first prosecution under the new CQC regime for regulating health and safety in care and hospital settings. The case took over a year to come to fruition. During that time, the service provider did not take on any new clients, had spent many hours providing documentation, had been involved in lengthy Police and Criminal Evidence (PACE) interviews and liaison with solicitors. The District Judge accepted that there were no aggravating features and he accepted the strong mitigation on behalf of the service, not least the service provider was able to reassure the District Judge that it had spent over £100,000 on improvement to its governance systems. A new team had also been appointed to focus on these issues. However, despite the fact that this was a not-for-profit, charitable service, the District Judge confirmed that there was a need to ensure that a strong message was sent out to other providers.

THE FINE The new Regulations introduce higher maximum penalties on conviction compared to those previously in place. Under the 2010 Regulations, the maximum fine upon conviction for noncompliance with the regulations was £50,000. However, under the 2014 Regulations, the maximum fine is now unlimited, with the courts applying guidance from the Sentencing Council. The new Sentencing Guidelines in question relate to the new Health and Safety Offences, Corporate Manslaughter and Food Safety and Hygiene Offences – Definitive Guideline issued by the Sentencing Council. This Guideline, in broad terms, recommends a sentencing range and, within that, a ‘starting point’ for the court to consider based on: • The level of culpability of the provider. • The seriousness, and likelihood, of the harm risked – note it is not necessary for harm to have actually occurred. • The offender’s turnover. • The Guidelines establish how the Court should interpret culpability as follows: Very high Deliberate breach of or flagrant disregard for the law.

REGULATOR SHOWS SHARPER TEETH

“There are a number of points that the sector should take away from this case. Firstly, the CQC has taken over from the HSE as investigator and prosecutor of health and safety incidents in the care sector.”

High (a) Offender fell far short of the appropriate standard; for example, by: • Failing to put in place measures that are recognised standards in the industry. • Ignoring concerns raised by employees or others. • Failing to make appropriate changes following prior incident(s) exposing risks to health and safety. • Allowing breaches to subsist over a long period of time. (b) Serious and/or systemic failure within the organisation to address risks to health and safety. Medium (a) Offender fell short of the appropriate standard in a manner that falls between descriptions in ‘high’ and ‘low’ culpability categories. (b) Systems were in place but these were not sufficiently adhered to or implemented. Low (a) Offender did not fall far short of the appropriate standard; for example, because: • Significant efforts were made to address the risk although they were inadequate on this occasion. • There was no warning/circumstance indicating a risk to health and safety. (b) Failings were minor and occurred as an isolated incident. Having decided on the appropriate level of fine using these factors and taking into account the particular aggravating and mitigating factors of the individual case, the Guidelines require the court to take a step back and check whether the proposed

fine is proportionate to the offender’s overall means or otherwise requires some adjustment, before giving any further reductions to reflect any assistance provided to the prosecution and/or for guilty pleas.

LESSONS LEARNED There are a number of points that the sector should take away from this case. Firstly, the CQC has taken over from the HSE as investigator and prosecutor of health and safety incidents in the care sector. This was an important outcome of the regulatory changes and reflects negative findings in the Francis report into Mid Staffordshire NHS Foundation Trust. Also, there are new sentencing guidelines for these offences, which are scarily high by most standards. The CQC has said that there are many more of these types of prosecutions to come and more are being currently investigated. Strategy for providers in such cases is incredibly important and having good legal advice is key. A lot can be done by providers to mitigate the huge fines but providers need to act quickly in response to incidents. The ability to effectively respond to the CQC, and ultimately the Court, is rooted in a need to learn and take action from incidents, and also to avoid incidents in the first place by having effective risk assessments and training in place. CQC’s health and safety powers cross over with other investigations including safeguarding, commissioning suspensions, inquests, police powers to investigate corporate manslaughter and neglect, and indeed the CQC’s other powers. Providers need to take incidents very seriously. CMM

Sarah Knight is an Associate at Bevan Brittan. Sarah acted for St Anne’s Community Services sarah.knight@bevanbrittan.com Stuart Marchant is a Partner at Bevan Brittan stuart.marchant@bevanbrittan.com Twitter: @BevanBrittanLLP Are you aware of the CQC’s role in prosecutions such as this? Share your thoughts on the CMM website at www.caremanagementmatters.co.uk Subscription required. CMM September 2016 31

HAMPSHIRE CONSULTS ON SOCIAL CARE CHARGING In response to continued budgetary pressures, local authorities are having to find ways to meet demand and funding shortfalls. Hampshire County Council is consulting on its plans to change the way it charges for certain aspects of care and support. All councils are under significant pressure to meet their budgetary obligations. They have a legal duty to balance their budget but, with funding shortfalls, it is leading them to make difficult decisions. Hampshire County Council must meet a funding shortfall of £98m by April 2017. Of that, £43.1m must be met from the Council’s Adult Services budget. This year, it took the opportunity to increase Council Tax by the full 3.99% permissible without public referendum. That increase included the 2% social care precept. The Council calculates the precept will bring in approximately £10.2m per year. However, this isn’t sufficient and still leaves the Council needing to find significant savings. Research published by the Association of Directors of Adult Social Services (ADASS) in July found that the precept will generate less than two thirds of the more than £600m local authorities need to cover the costs of the National Living Wage this year; let alone address the huge funding shortfall councils face from increasing demand. In light of this and the pressure to make increased savings, Hampshire County Council is consulting on changes to its paying for care policy.

DIFFICULT DECISIONS In its consultation document, the Council explained its situation. ‘The amount of funding the County Council receives from central Government has more than halved in recent years. With public sector budgets expected to remain under pressure in the future, it is no longer 32 CMM September 2016

feasible to deliver the same services, and in the same way. Therefore, the County Council is faced with having to make some difficult decisions to be able to deliver a balanced budget – as it is legally required to do – and provide vital public services to the people of Hampshire.’

DISCOUNTED OPTIONS The Council considered a number of options alongside those that it is consulting on. These were ruled out, however they included: • Do nothing. • Charge unpaid carers for services that meet their eligible needs as a carer in their own right. • Charge for early intervention and prevention services.

CONSULTATION The Council has put forward four areas where it is proposing to change its paying for care policy. It states that the changes may affect the amount some people contribute towards the cost of their care. However, it asserts that no-one will be asked to pay towards the cost of their care, if they have been assessed as not being able to do so. Proposal one is charging new applicants for the cost of two care workers, where they are assessed as needing, and being able to pay for, two care workers at the same time to meet their care and support needs. Hampshire County Council currently has a ‘second-carer waiver’, which means that if the Council is organising the care, people can ask the Council to meet the cost of the

second care worker, even though they have been assessed as being able to afford the full cost of their care. The Council calculates that this currently costs £1.34m per year. It says that with increased demand, the second-carer waiver, if not closed to new clients, would make the subsidy unsustainable in the future. Proposal two is considering 100% of an individual’s disposable income in their financial assessment. At present, the Council considers 95% of a person’s disposable income in their financial assessment. The Council cites neighbouring authorities, including Portsmouth, Southampton and West Sussex that already take into account 100% of a person’s disposable income in the financial assessment. It proposes that this change, if agreed, will affect around 4,000 clients who would pay on average £2.22 extra per week towards their care. It’s calculated to raise additional income of around £420,000 per year. Proposal three relates to charging clients that are in Councilrun care homes and care homes with nursing if they are away from the home. This would bring policy in-line with the independent sector, which charges clients whilst they are in hospital or away from the home. The council says that this has the potential to affect 891 people who live in council-run homes. It is estimated that it could save around £160,000 per year. The fourth proposal focuses on rental income in Deferred Payment financial assessments. At present, during a financial assessment, the

Council only takes into account someone’s rental income from their property that is subject to a Deferred Payment Agreement if the individual requests it. The Care Act allowed councils to take rental income into account when assessing a client’s contribution towards their care costs. The consultation document says that on average, other authorities take into account 80% to 90% of rental income in the financial assessment. Hampshire County Council proposes to introduce this for new clients. It states that in 2015/16, it arranged three to four new Deferred Payment Agreements per month, so the change would not affect large numbers of people. It would also mean that the debt and interest charges people had to pay when their property was eventually sold would be lower. The consultation opened in June and closes on 26th August, with a decision due in October 2016. The Council encouraged views from clients, their families, residents and other stakeholders to inform its decision-making process. CMM

OVER TO THE EXPERTS... Hampshire County Council is consulting on a number of changes to its policies, many of which are already in place in other areas or in the independent sector. Is this the future for local authorities to help meet their budget shortfalls? Are these proposals the most ideal for Hampshire? What other savings can be or are being made by authorities across the country?

FACED WITH DIFFICULT DECISIONS As a very emotive, life critical service, councils will not increase social care charges with no good reason. County authorities are responsible for 47% of the total spend on adult social care in the whole country, some £6.6bn in 2015/16, virtually half their budgets. Faced with having to make unprecedented efficiencies, a mixture of historic Government underfunding and rising demand, county authorities have been faced with difficult decisions, such as the one Hampshire is consulting on. Indeed, County Councils Network (CCN) member councils will see their over-65 population grow by 2% per year until 2020, faster than any other local authority type. To compound this, the Local Government Finance Settlement did not pinpoint funding to the areas with the most pressing need. Over the last two years, adult social care funding for county authorities has declined by 22%. As the recent ADASS survey

THE REAL SOLUTION IS CENTRAL GOVERNMENT FUNDING

pointed out, the Better Care Fund (BCF) and social care precept do not even cover the extra costs of the new National Living Wage. The King’s Fund estimates that there will be a funding gap of £2.8bn by the end of this Parliament, while CCN’s analysis with LaingBuisson last year revealed how unstable this market currently is. That’s why CCN has argued for more sustainable funding, with the BCF being frontloaded now. The Government’s needs-based review of local authority funding, plus the move towards full business rate retention, needs to ensure that funding follows need and addresses the shortfalls in areas with the greatest demand. Until then, local authorities could be faced with more difficult decisions to ensure that public services continue to deliver for our most vulnerable residents.

Cllr Colin Noble Spokesman for Health and Social Care, County Councils Network and Leader, Suffolk County Council

HAMPSHIRE HAS SOME PARTICULAR CHALLENGES Hampshire’s consultation reflects one of a range of possible options to reduce pressure on increasingly stretched budgets. It is still news to many that social care is means-tested and it is deeply regrettable that central Government has largely avoided informing the public that, over time, even people of moderate financial means will increasingly need to fund their own care. Three particular issues are pressing heavily on the minds of councils’ social care services: meeting the needs of an ageing population; the significant impact of the National Living Wage on providers; and the additional costs of the Care Act (in England). Hampshire has some particular, if not unique, challenges: careworker recruitment is difficult, especially in rural parts; the local homecare market is increasingly fragile (to my knowledge, at least three of the 11 lead providers in the council’s main homecare contract have already served notice); and delayed transfers

from hospital have rocketed, with an 82% increase in the number of people experiencing a delay in 2015-16, according to NHS England data. Hampshire’s proposals for increasing fees to people using care and support are, therefore, just one part of the task facing them and many other councils. A radical rethink about how to manage the increasing demand for services is also needed. Outcome-Based Commissioning (OBC) is likely to have a more significant impact than moderate fee increases to users’ contributions. OBC uses ‘payment-by-results’ to incentivise providers to deliver short-term intensive support and reablement. Hampshire is beginning to engage with its provider market on its future plans; my recommendation is that they actively explore OBC, and continue talking to those councils who are the early adopters.

I’m not at all surprised that Hampshire County Council has had to consider other ways to address its huge budget shortfall as detailed in this article. Unfortunately, this is a situation which I fear will be repeated in many local authorities across the country who are struggling to balance the books. Even with the additional income from the Council Tax precept, the reality is that there is insufficient funding for social care at a national level – and this desperately needs to be addressed. If we do not address it quickly, it is elderly and disabled people who will the pay the price. It is good that Hampshire County Council is consulting on the changes before they’re implemented them. However, what strikes me about these proposals is that even if the residents of Hampshire agree to every one, they will not save the council anywhere

near the required £43m. Clearly, significant questions remain over how Hampshire will meet its Care Act duties and make these savings. It is important to also remember the people who will now be contributing more to their care costs as a result of the need to address this budget shortfall. The social care means-test is not generous, and the policies that Hampshire is now abandoning have helped maintain the standard of life for some of the poorest people, with the highest needs, in the country. However, the real solution to these problems is more central Government funding for social care and more integration with the NHS. That’s why we’re calling for a commission on health and social care to address these challenging issues and benefit the lives of older people.

Janet Morrison Chief Executive, Independent Age

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A VIEW FROM THE TOP

BRADLEYPHILLIPS Bradley Phillips is Director at Bramley Health.

REFLECTIONS ON THE LAST DECADE Expectations of service delivery have been dramatically increasing. On shrinking local authority budgets, we are expected to do more with less, and many smaller providers are beginning to fall by the wayside – unable to sustain the demands of the Care Quality Commission (CQC) and commissioners. The focus has also changed to accountability and compliance, everything has to be evidenced, which is running the risk of stripping the compassion out of care and reducing it to a box-ticking exercise. It’s incredibly resource intensive and many small providers can’t sustain the number-crunching, in addition to their principal responsibilities. At Bramley Health, when we were Glen Care, we ran a range of care homes and mental health services. In response to increasing pressure and the resultant homogenisation of the sector, we have focused on specialist provision in learning disabilities, neurocognitive disorders and for women with complex needs. PROJECTIONS FOR THE NEXT DECADE The next few years look to hold more challenges, especially for small providers, around 40% of which are non-compliant under the new Key Lines of Enquiry framework. Many will disappear, and care will be increasingly provided by large, national organisations, offering magnolia services in a more consolidated market.

At Bramley Health, we will continue to develop our business model, continuing to focus on complex care provision and developing our position as a high cost, low volume niche provider. INSIGHT I look on my role at Bramley Health as being a supportive one. I’m not a fan of top-down management, I believe in talking to staff and service users, finding out what hurdles they face and working with them to generate solutions. Of course, it’s my role to mitigate risk to the business through the rigorous governance framework, but I put the human element of the business first – and use it to guide and form the company’s strategic planning. INFLUENCES I would have to say, renowned neuropsychiatrist Dr Andres Fonseca, the Medical Director at Bramley Health has been a great influence. He has been invaluable to my learning and development, providing insights into the daily issues faced by clinicians and staff and the detailed workings of a healthcare provider. Another key influence on me, although not a person, was the experience I gained when Glen Care encountered some issues with the CQC. The whole process changed me and the company for the better as we worked through the quality improvement

processes. It instilled in me the importance of deep scrutiny, the central function of governance and prepared me for high-stress situations in the future. Whilst trust remains an integral part of an organisation’s ethos, it is equally important to have verification as a key principal of good governance. LESSON The best lesson I have ever learned is to put service users first. Equally, I don’t believe that you should be totally driven by profit. Of course, Bramley Health is a business and, as such, it has to be sustainable, but profit will come naturally if you get the other fundamentals right and put the quality of service users’ care as the principal aim. ADVICE Respect and understand your responsibilities. Be accountable for what happens – right or wrong. Take responsibility when things do go wrong, don’t blame others and don’t hide. Also, make sure that you’ve got the right systems in place, so that you can sleep at night. You see a lot of negative management, including people barking orders. It doesn’t really work. It’s far better to lead from the front and to deliver creativity together, so that everybody in the organisation buys into the objectives and gets behind delivering them.

Read about Bradley’s typical day on the website www.caremanagementmatters.co.uk Subscription required. CMM September 2016 35

Technological change is inevitable, and care providers should view it in a positive light and embrace it. Technology has potential to minimise the risk of errors and increase efficiency, improving the quality of care provided while maximising one-on-one time care staff spend with clients. This is particularly useful in domiciliary care, where care assistants need the right information at their fingertips in order to deliver the right care and also to be able to get to their next appointment as quickly as possible.

PRACTICAL BENEFITS The proliferation of digital technology brings with it a wealth of practical benefits for providers. Ultimately, it helps them to deliver a better service to customers and to mitigate risks. Such practical benefits may include: • Improvements in planning and co-ordinating care, such as scheduling domiciliary care appointments, to improve efficiency and reduce the risk of missed visits. • Simplification of day-to-day processes, triggering automatic referrals to external practitioners, such as doctors, where necessary. • Tracking and recording service delivery and administration of medicines. • Reduction in time-consuming, handwritten paperwork. IT systems can help providers to reduce the risk of falling foul of industry pitfalls, such as incorrect medication administration, which can impact on the business, clients and staff. Aside from the detrimental impact on clients, quality of care, reputational damage and the risk of litigation, providers also need to consider how such failings can impact on insurance claims. This is increasingly important because the number of insurers in the care sector has dwindled, partly due to high numbers of claims. Those insurers remaining in the sector scrutinise the way care businesses manage and mitigate risks, and this can affect premiums or even, in some cases, the ability to secure insurance cover at all. An active policy is, of course, a prerequisite for compliance with the Care Quality Commission (CQC): no insurance, no business. Staying at the forefront of technology helps providers to minimise risk and claims. 36 CMM September 2016

MANAGEMENT SYSTEMS Good examples of technology used on a practical level are technology packages to streamline back office and care delivery. These can create real efficiencies and provide documented evidence of procedures and processes. Management systems are becoming increasingly popular in the care industry. Some offer comprehensive solutions for achieving CQC compliance and enable businesses to exert strong management control over every aspect of providing high-quality and consistent care.

Getting IT right

Simon Bentley and Claire Ferrari discuss how advances in the technology behind mobile devices, networks and cloud computing are helping to drive improvements and efficiencies across the care sector.

CMM September 2016 37

GETTING IT RIGHT

They can provide policies and procedures, written and maintained by experts, as well as care plan templates, service user and staff handbooks and forms for areas such as risk assessments, managing health and safety and medications. Management systems and other software can play a big part in helping business run effectively and carry out care audits. These may bring vast improvements to the quality of service delivered and effectively help mitigate the day-to-day risks they face.

APPS AND SENSORS An increasing choice of smartphone and tablet apps make it easier for care staff to track what care has been delivered by whom and when. There has also been an increasing use of in-home sensors, radio frequency identification (RFID) technology and mobile devices for care homes and people receiving domiciliary care. These systems proactively monitor movement, temperature and even specifics such as how many times a medicine cabinet has been opened. They track expected parameters and, if an anomaly is detected, trigger an alert to care staff or the individual. The aim is to facilitate proactive social care.

BENEFITS FOR CLIENTS Aside from the practical benefits for providers, IT may benefit clients by empowering people to live as independently as possible, allowing them to be actively involved in making decisions about their own care. Care providers can use mobile devices and software packages to work with clients, assisting them with goal setting and making plans, whilst tracking progress made towards these goals for review on a monthly basis. This type of system can also be useful when recording information for care planning and advance care planning, as well as providing information on individual preferences in regard to pre-emptive best-interest decision-making. Providers can assist clients with the use of mobile devices to help promote independence, enabling and encouraging them to connect with friends and family, via email and social media, as well as surf the internet to research hobbies,

community activities and other areas of interest. Involving and empowering clients and encouraging communication with the outside world is an enormously positive, forwardthinking approach to care. It is an approach that can drastically improve lives. Everyone knows that happy clients make for better-run care services and this helps to reduce risks.

IT CHALLENGES Developing and using IT systems can have a wide range of benefits, however, they also pose challenges, including: • Compliance with data protection laws, including privacy and storage of data. • Data breaches (cybercrime). • Data loss. • Permissions. • Training staff. • Technology failure. • Rigidity and lack of personalisation (in some cases). These challenges create additional risks, which are very real indeed and, if not properly assessed and mitigated, they can undermine any benefits gained. You only have to look at the data breaches involving large companies such as Carphone Warehouse and TalkTalk to see this is a very serious problem and one that needs to be dealt with properly. It is imperative that providers, who store data connected with vulnerable individuals, obtain the relevant permissions and take steps to keep it safe and secure. Failure to do this means they run the risk of lawsuits for breach of data protection, not to mention reputation damage. Taking legal advice is essential, especially when it comes to contracts agreed with cloud-based IT service providers. Training staff to use technology can be costly, but there are efficiencies to be gained once everyone is using it properly. Also, it is important to consider what happens if technology fails. Providers must have a contingency plan for this scenario, otherwise their entire business could grind to a halt, putting clients at risk.

THE FUTURE IT is an ever-changing sector with new

innovations being developed all the time. It’s difficult to predict what could be available in the future. It’s likely that voice-activated recording software may have useful applications in the future. Recording the delivery of care is hugely important, but when care staff have to make handwritten notes and reports, this can create issues. Such issues could include legibility of handwriting, language barriers, literacy, learning difficulties such as dyslexia, or sometimes staff

“Care providers that utilise developing technologies, while properly assessing and mitigating the inevitable challenges, could be onto a winner.” may be called away quickly to assist another client and not have the opportunity to record the care, or forget to record it altogether. If delivery of care is not recorded, or not recorded well, it can put a business at risk, especially if there is a need to provide evidence of care provision. A far quicker method may involve care staff simply pressing a button on their smartphone and recording themselves talking. This could, with permission, include obtaining input or consent from the client. These sound bites could be automatically converted into text, using sophisticated voice recognition software, and logged in the system.

A BRIGHTER FUTURE Care providers that utilise developing technologies, while properly assessing and mitigating the inevitable challenges, could be onto a winner. They may experience significant improvements when it comes to efficiencies, quality assurance and mitigating risk. Ultimately, this leads to happy, well cared for clients. CMM

Simon Bentley is Divisional Director of Howden’s Care Division (formerly CHIS and PrimeCare). Email: simon.bentley@howdengroup.com Claire Ferrari is Director of ProRisk Care Consultancy. Email: claire@proriskcare.co.uk Twitter: @ProRiskCare What are your thoughts on IT? Do you face any particular challenges? Share your experiences at www.caremanagementmatters.co.uk. Subscription required. 38 CMM September 2016

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