Care Management Matters October 2016 by Care Choices Ltd

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Revolutionising social care

In this issue From the Editor

Is it just me…? 07 Editor in Chief, Robert Chamberlain, looks at the Health Select Committee’s report into public health. CMM News

Business Clinic Central Bedfordshire’s new project to encourage private sector investment in older people’s accommodation is discussed by the panel.

REGULARS

A View from the Top 31 Lynda Tarpey, Director of Think Local Act Personal is the subject of this month’s interview.

What’s On? Straight Talk Louise Pritchard asserts the importance of managing hearing loss amongst care home residents.

49 50

FEATURES

Event preview CMM previews the Care and Dementia Show 2016, being held in Birmingham.

This way out – preparing for sale If you’re thinking of exiting the market, John Lucas runs through what you need to consider.

Private prosecutions…is it only a matter of time? Is it a matter of time before private prosecutions happen in social care? Simon Lindsay and Ruth Atkinson-Wilks share their thoughts.

Invest in activities to transform lives Ben Benson explores how investing in residents’ wellbeing, through meaningful activities can achieve outstanding results.

Coming out from the shadows Lucy Hurst-Brown discusses why people with learning disabilities remain invisible to society and the sector’s role in changing this.

Resource Finder CMM draws together a selection of recruitment organisations to meet your staffing needs. CMM October 2016 3

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

CONTRIBUTORS

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

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John Lucas Corporate Finance Partner, Hazlewoods

Simon Lindsay Partner, Bevan Brittan LLP

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SUBSCRIPTIONS Non-care and support providers may be required to pay £50 per year. info@caremanagementmatters.co.uk 01223 207770 www.caremanagementmatters.co.uk Care Management Matters is published by Care Choices Ltd who cannot be held responsible for views expressed by contributors. Care Management Matters © Care Choices Ltd 2016 ISBN: 978-1-911437-13-0 CCL REF NO: CMM 13.7

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Michael Voges Executive Director, Associated Retirement Community Operators

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Lynda Tarpey Director, Think Local Act Personal

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Lucy Hurst-Brown Chief Executive, Brandon Trust

Louise Pritchard Executive Director of Services, Action on Hearing Loss

From the Editor Editor Emma Morriss looks at recruitment in social care. Putting together an issue of CMM in late August/early September can be tricky, people are on holiday and Parliament is in recess, so there are very few reports published. However, one thing that hasn’t disappeared for a couple of weeks’ break is the issue of recruitment and retention. Although it is said that social care workers are not as motivated by money as those in other industries, a couple of pieces of research this month have highlighted some interesting facts about salaries.

NATIONAL LIVING WAGE When considering pay, a new report from the Resolution Foundation explored the impact of the National Living Wage on the sector. Positively, it found that the rise in wages due to the National Living Wage has been passed

onto younger social care workers, even though there was only a duty for over 24s to receive the new minimum wage. Great news. But it’s not all great. Evidence suggests that there is now a ‘bunching’ of pay at the legal pay floor. With the extra costs of the National Living Wage for the sector predicted to reach £2.3bn by 2020, more money must be found to cover it. This is something the Resolution Foundation is calling on the Government to ensure. However, given the ongoing calls for additional funding in social care, it’s more of a case of wait and see.

DOMICILIARY CARE Also in the news is the story that domiciliary care managers earn less than their care home counterparts. The research from Croner also found that, unlike

managers, frontline care workers earn more in domiciliary care than care homes. I’d be interested to know if you agree with this, or whether you feel there is parity across the different provisions of care. Let me know on the website or via Twitter.

RECRUITMENT Whatever salaries you pay, there is a chance that you will have some recruitment needs. The Croner report found that staff turnover in domiciliary care sat at 17.5%. The National Care

Forum recently reported that its members, operating care homes and domiciliary care supporting older people, had an average staff turnover of 23%. If you are finding recruitment an issue, this month our Resource Finder profiles some of the leading care sector recruitment organisations. Whether you’re looking to fill vacancies or learn about values-based recruitment to get the right people for the job, the organisations in the feature, starting on page 43, should be able to help.

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

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Is it just me...?

to comparable, comprehensible and transparent information on local priorities and performance on public health. It notes that changes to local government funding, especially the removal of the ring-fencing around the public health grant, must be managed so as not to further disadvantage areas with high deprivation and poor health outcomes.

Editor in Chief, Robert Chamberlain, looks at the Health Select Committee’s report into public health and discusses how upfront cuts to funding and the confusing system are making things worse.

IS IT JUST ME?

The transfer of responsibility to local authorities for the funding of public health from 2013 was cautiously welcomed at the time. It made sense for this budget to be managed at a local level, but there were concerns about handing this additional responsibility to already cash-strapped councils. The latest report from the Health Select Committee, Public health post-2013, examines how effective this transition has been and recognises the challenges faced by local government amid budget cut pressures. It states, ‘Local authorities face a number of challenges and have had to cope rapidly with major system change. In addition, they face real-terms cuts to public health budgets, including last year’s in-year cut of £200 million. As a result, they are trying to deliver more with less. Whilst we have seen examples of innovative

practice, local authorities are now at the limit of the savings they can achieve without a detrimental impact on services and outcomes. There is a growing mismatch between spending on public health and the significance attached to prevention in the NHS Five Year Forward View.’ The Committee also recognises the importance of prevention in the wider system and the impact that these cuts to public health can have on health and social care further down the line. It states, ‘Cuts to public health and the services they deliver are a false economy as they not only add to the future costs of health and social care but risk widening health inequalities’. I find this short-sightedness and the upfront cuts to funding baffling. We can all see the impact it is having throughout the NHS and social care systems.

MODEST IMPACT Change is happening, in spite of the cuts and local authority pressures. The Committee found that some local authorities had made good progress in public health, seeing positive impact on public health outcomes. However, in other areas, less progress has been made. Due to the nature of public health needing to be delivered in communities, where people live and work, the new public health system has been designed to be locally driven, and therefore, a degree of variation between areas is to be expected. However, the Committee is concerned that, three years’ later, robust systems to address unacceptable variation are not yet in place. It says that the current system of sector-led improvement needs to be more clearly linked

The cuts to public health funding in cash-strapped local authorities, just after the funding was transferred are ridiculous. Even if you ignore the funding for a moment, the system is bogged down with complex processes of commissioning services, involving many different departments, and a lack of cohesion. I believe the need for a whole systems approach to address public health in its truest sense, including social care as a key proponent, is blindingly obvious. However, the continuum of a person’s health and care needs currently has to fit around a confusing system of differing budgets, commissioners and departmental objectives, rather than the system being designed around an individual’s needs. Pooled budgets spent proportionately on all aspects of prevention, support and care, leading to the cessation of social care as a poor relation, would surely have the most positive impact. Throwing the lion’s share of money to fire-fight the NHS crisis, at the other end of the system, while underfunding the very services that would ease the pressure, makes absolutely no sense at all.

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

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APPOINTMENTS TLAP

Think Local Act Personal (TLAP) has appointed Adam Webb as Market Development Policy Adviser to head up work to support local authorities with commissioning and market shaping.

Impact of the NLW The first indication of the implications of the National Living Wage (NLW) on social care have been highlighted in a report from the Resolution Foundation. The think-tank has published a research report Rising to the challenge: early evidence on the introduction of the NLW in the social care sector which appears to paint a positive account of the NLW process so far. The report found that most

social care employers have passed on the benefit of the new rate of £7.20 from April 2016 for the over 24s to all workers. As a consequence, many young social care workers have enjoyed a significant pay rise. In addition, there is no evidence that employers have handled the wage increase by cutting workers’ shifts. The Resolution Foundation report makes reference to bunching of pay in social care at the legal

Rise in care home costs Care home costs have risen ten times faster than pensioner incomes, according to new research from Prestige Nursing + Care. The annual cost of a care home has increased by £1,536 over the past year – almost ten times the average £156 income gains enjoyed by pensioners over the same period. Costs for an average single room have risen by 5.2% to £30,926. This

is more than double the average pensioner’s income of £14,456; while pensioner incomes grew by just 1.1% over the last year. The annual growth rate of care costs (5.2%) from 2015 to 2016 has more than doubled from the 2.5% growth rate from 2014 to 2015. This is far higher than the current rate of inflation (0.3%) and the fastest growth rate since Prestige began collecting data in 2012.

Guides for collaborating with health NHS England and partners have published a series of quick guides to support local health and care systems. The Guides, which they are keen to raise awareness of, provide practical tips, case studies and links to useful documents, which can be used to implement solutions to commonly experienced issues.

The Guides include: Managing care home closures; Supporting patients’ choices at discharge to avoid long hospital stays; Better use of care at home; Clinical input to care homes; Identifying local care home placements; Improving hospital discharge into the care sector; Sharing patient information and; Technology in care homes.

SOMERSET CARE GROUP wage floor as a cause for future concern. This ‘bunching’ means limited opportunities to progress within the sector. The extra costs of the NLW for social care are predicted to reach £2.3bn by 2020 and the think-tank uses the report to call on the Government to ensure that there are sufficient funds for providers to continue to implement the NLW without adverse consequences for workers.

Voluntary sector and NHS VODG members are calling for the voluntary sector to be recognised as central to the NHS and health system. The message is outlined in a new publication that describes the reasons for closer partnership. In the paper – What can the voluntary sector do to encourage greater engagement and collaboration with the health system? – the latest in a thought-leadership series, VODG describes the challenges and solutions to more joined-up approaches to health and care. Among the challenges is the relationship with health commissioners, many of whom often regard the voluntary organisations as a fragmented group. Health commissioners, the paper notes, are also inclined to focus on the traditional ‘medical model’ of support rather than consider community-based provision.

The Somerset Care Group has appointed three non-executive directors: Richard Ring, Roger Davies and Sarah Hicks.

ST LEONARD’S COURT

St Leonard’s Court in Mundford, Norfolk has appointed Shelley Jarred as its new home manager.

NACC

Sophie Murray, Head of Nutrition and Hydration at Sunrise Senior Living, has been confirmed as the new Deputy Chair of the National Association of Care Catering (NACC).

MENTAL HEALTH NETWORK

Mental Health Network has appointed Sean Duggan as its new Chief Executive.

HOME MEADOW

Home Meadow care home in Toft, Cambridgeshire has welcomed Sabine Pietsch as its new home manager.

PRESTIGE NURSING + CARE

Prestige Nursing + Care has appointed Steve Francis as a non-executive director.

HALLMARK CARE HOMES Debbie Sharples-Kirkbride has been appointed Group Lifestyle Manager for Hallmark Care Homes.

MALHOTRA GROUP

Malhotra Group has recruited Norman Mackenzie as Executive Chef. CMM October 2016 9

NEWS

Major project from SCIE on integrating health and care The Social Care Institute for Excellence (SCIE) has been commissioned by the Government to undertake a programme of research and engagement with people who use services, carers, families, local areas and national stakeholders to understand what successful integration of health and social care should look like in 2020.

SCIE is planning a co-production approach to the work, which will be informed by an Expert Advisory Group. It will be chaired by Lord Bichard, who is the Chair of SCIE. SCIE intends to research emerging practice on the integration of care and health in a number of local areas to produce good practice guidance.

Apprenticeship levy guide Skills for Care has produced a guide on the new plans for the introduction of the Apprenticeship Levy.

It includes details of the new banding system and incentives for offering apprenticeships for 16-18 year olds.

Briefing on end of life care The National Council for Palliative Care (NCPC) has produced a briefing document on the Government’s national commitment to end of life care.

The briefing document highlights the six commitments, how they will be delivered and how they fit with other strategies and reports on end of life care.

Hill Care Group secures funding Learning disabilities training Derbyshire care business, Hill Operating homes across the framework Care Group has secured funding North of England, Hill Care will from Barclays to consolidate its banking with one provider and refinance for growth with a £26m term loan. Established in 2001 and headquartered at St Mary’s Gate, Chesterfield, Derbyshire, the business provides care to over 1,000 residents.

10 CMM October 2016

now move ahead with plans to acquire and build new facilities in communities with a need for firstclass care services. The funding deal with Barclays is the largest the bank has agreed with any care operator in the north of England this year.

A comprehensive resource to support health and social care staff and educators working with people living with a learning disability has been launched by Skills for Health. The Learning Disabilities Core Skills Education and Training Framework sets out the essential

skills and knowledge necessary for all staff. Commissioned and funded by the Department of Health, the framework is intended to standardise learning disability education and training and to improve quality and consistency in training provision.

NEWS / POLL

Arts in Care gets boost

Target Healthcare REIT acquisitions

Spotlight on Arts in Care is a resource developed by the Care Inspectorate in Scotland, through a partnership with Luminate creative ageing festival. It celebrates the importance of creativity in care settings. The resource pack includes a film featuring three care homes sharing their experience of participating in the arts. In addition, cards covering five different arts forms have been created by artists for care staff, with tried and tested methods, ideas, hints and tips. There are also useful links to other resources and organisations.

Target Healthcare REIT Limited has acquired two modern, purpose-built care homes located in Dundee, Scotland and Sandiacre, Derbyshire for approximately £14m, including acquisition costs. The homes will continue to be operated by the incumbent operator, Hudson Healthcare who will become the 14th tenant of the Group. The properties comprise a total of 151 bedrooms with full en-suite bathrooms, including wetrooms, and opened in 2007 and 2015. A refurbishment programme on the older property will be completed imminently with both properties due to reach operational maturity

by the year end. Each home is located in areas with strong demographics and provide a high level of amenities, lounges and good sized bedrooms as well as access to pleasant secure outdoor areas. Target Healthcare REIT has also acquired a modern, purposebuilt care home in Mytchett near Camberley, Surrey, for approximately £6.5m including acquisition costs. Kingsmead House was completed in 2015 and offers luxurious accommodation with bedrooms looking onto peaceful landscaped gardens. The home has 40 bedrooms over three floors, each with full en-suite wetroom facilities.

POLL

Are you considering exiting the market? Yes No You can vote via: www.caremanagementmatters.co.uk

September’s results Do you have recruitment and/or retention issues? Yes 44% No 56%

CMM Insight Learning Disability & Mental Health Services SAVE THE DATE The Renaissance, Manchester 2nd March 2017

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

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NEWS

District nursing services District nursing services will be key to the success of policies that aim to provide more care closer to home according to a new report by The King’s Fund. Understanding quality in district nursing services investigates what ‘good’ district nursing care looks like from the perspective of people receiving this care, unpaid carers and district nursing staff. It puts forward a framework for understanding the

components involved. It also looks at the growing demand–capacity gap in district nursing and the worrying impact that this is having on services, the workforce and the quality and safety of patient care. The report makes recommendations to policymakers, regulators, commissioners and provider organisations as to how to start to address these pressures.

Health Charter in practice Voluntary Organisations Disability Group and National Development Team for Inclusion have published the second edition of a guide which explains how the Health Charter can be used by social care providers. This practical new resource supports the wellbeing of people with learning disabilities and aims to reduce inequalities

in healthcare, which were highlighted in a recent report. The resource includes practical steps on providing staff training on health and on promoting access to screening tests. The new edition sets out key outcomes and advice from organisations already using the practical support.

Interactive dementia map The Government has launched an online Dementia Atlas. It is an interactive map of England, which enables comparisons about the quality of dementia care in local areas, including diagnosis and ongoing support. The Dementia Atlas enables

local comparisons to be made on a number of factors relating to dementia, including dementia prevalence, annual reviews of dementia, number of Dementia Friends per area, the location of Dementia Friendly Communities, as well as death in usual place of residence.

Lilian Faithfull Herefordshire Homes Care Homes Herefordshire Care Homes acquires Royal The group has added to its nursing home portfolio with the Court acquisition of Hazelhurst Nursing Lilian Faithfull Homes celebrated its 70th year of operation with the acquisition of Royal Court in Cheltenham. This latest acquisition, with 44 assisted living/extra care apartments, makes the not-forprofit provider the largest in Cheltenham. 12 CMM October 2016

Home in Bishopswood, Ross on Wye. This acquisition brings the total number of homes in the group to six. Hazelhurst Nursing Home is set in 18 acres of land and is currently registered for 42, with outline planning for another 13 rooms and a separate specialist dementia care unit.

Research shows care home construction on track to reach five-year high The care home market is an attractive source of investment, with the value of construction contracts forecast to reach a fiveyear high, according to research for the Care & Dementia Show. The Outlook for the UK Residential Care Construction Market 2016 research, conducted by Barbour ABI, revealed the total

value of residential care contracts is set to reach £2.3bn for 2016. South West England is leading the way for developments, with 26% of the market share, followed by the West Midlands which accounts for 15% of contract values. The top project in 2016 (based on construction contract value) is Kidbrook Village Care Apartments, London.

New framework to help communities adapt to ageing population The fact that we are living longer is a real and growing issue for many governments and community providers, placing increased demands on areas such as healthcare and safety. A new International Workshop Agreement aims to provide the foundation on which more solutions can be built to support the world's ageing population. Experts from government, public health, product manufacturers and health research were brought together in a workshop to discuss and develop a framework of the fundamental principles that should be addressed when providing community-based, integrated health and care services for aged societies.

This discussion resulted in a new ISO International Workshop Agreement – IWA 18:2016, Framework for integrated community-based life-long health and care services in aged societies – developed to help address the challenges posed by an ageing population, such as healthcare, wellbeing and isolation. IWA 18 gives guidance on the key principles identified as essential for future investment, and covers areas such as the medical needs of older people, personal care, daily living tasks, maintaining relationships and community involvement and keeping safe. The workshop and agreement were led by the British Standards Institution, ISO’s member for the UK.

Measuring social value The Office of Civil Society has launched a series of case studies showing how providers apply social value. The Office of Civil Society has funded a total of £30,000, to eight different external providers with expertise in social value and/ or impact management, to work with commissioners in practically applying the Public Services (Social

Value Act) 2012. Each provider has documented its experience through a case study. The case studies range from an adult social care provider to forums supporting voluntary organisations, the first two case studies have been published. The remaining case studies will be rolled out between October and December 2016.

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NEWS / IN FOCUS

In focus

SCIE and QCS Quality Compliance Systems (QCS) is teaming up with the Social Care Institute for Excellence (SCIE) to support care providers to move beyond compliance and create

real improvement. The new partnership will support providers in building on their achievements to date and drive improvement across the sector.

New guidance and resources on market shaping

Abbeyfield Kent Society The Abbeyfield Kent Society’s new care home for older people has officially opened. After 18 months of construction, Barnes Lodge welcomed its first new residents who made their way across to their new home from the Society’s former care home next door, Woodgate.

Comprising 101 spacious en-suite bedrooms over three storeys, Barnes Lodge will provide care and companionship for people with a variety of care needs, including frailty, dementia and end of life care, as well as shortterm care.

Reducing falls in East Midlands A new initiative has been helping to reduce the number of falls among older people in parts of the East Midlands. A series of exercise classes focusing on improving strength and balance for over 65s have been taking place across the city. The Falls Management Exercise programme (FaME) includes

balance, endurance and strength exercises as well as techniques for getting down and up from the floor. The research behind the initiative was conducted by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands.

Adept Care Homes Adept Care Homes based in Hinckley, Leicestershire has been handed the keys to its latest project – a brand-new £7.8m care home on Coleman Street in Derby which was built by Nottinghamshirebased specialist care home builder, Wynbrook Care Homes. Residents of Kiwi House will live in one of six suites, occupied by up to 13 people. Each suite has its own

lounge, dining room and lifestyle kitchen. Outside there are carefully landscaped gardens which overlook Kiwi Park. The total value of the home is now £7.8m of which Adept Care Homes secured a £4.65m loan from the Royal Bank of Scotland. Building works commenced in April and completed on time and within budget in July 2016.

Silvercrest investment in dementia Silvercrest Group has announced expansion plans starting with a £1m investment into the opening of a new bespoke dementia care home in Wales. Established in 2014 by Dr Bikram Choudhary, Silvercrest

operates homes across South Wales, from Pontypridd to the Swansea Valley. Its latest addition will be the 33-bed Ty Nant care home in Williamstown, which will generate 50 new jobs this autumn.

WHAT’S THE STORY?

The Institute for Public Care at Oxford Brookes University has published new and updated guidance and resources to assist both commissioners and providers in meeting the Care Act 2014 responsibilities on market shaping. The guidance was commissioned by the Department of Health, the Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS). It is designed to assist commissioners and care providers to work together as well as highlight best market-shaping practice around the country.

WHY?

The Care Act makes it a duty of local authorities to publish a Market Position Statement and to involve care providers. However, there are long-standing concerns about the time it has taken to develop good practice in this area. Arguably, some difficulties have been exacerbated by providers’ concerns about fee levels and the extent to which local authorities have recognised the additional impact of the new National Living Wage.

WHAT HAS BEEN DEVELOPED?

The Institute for Public Care, working with the Care Provider Alliance, LGA and ADASS, has devised a set of tools and resources under the title ‘Market Share’. The six tools include: guidance on ‘what is market

shaping?’; a fully searchable Market Position Statement database, including all published Market Position Statements in England; Market Position Statement guidance, with a checklist to assess the quality of Market Position Statements; papers on market shaping and individual purchasing of care, including personal budgets and self-funders; local co-ordination of health and social care; cross local authority; and regional working.

HOW CAN PROVIDERS GET INVOLVED?

The guidance and resources developed by the Institute for Public Care are intended to support commissioners and providers working together. This is the purpose of the legislation and a core aspect of the Care Act 2014. It is vital that care providers have a good understanding of these duties and responsibilities and are working in partnership with local authorities. Local care associations may be working with their local authority on implementing market shaping responsibilities, but this is certainly worth checking. It makes absolute sense for care providers to be aware of the resources and tools being developed to support commissioning. Further details on market shaping and a link to all the resources and guidance can be found on the IPC website www.ipc.brookes.ac.uk CMM October 2016 15

NEWS

Adara Group acquisitions Northampton-based Adara Group has acquired two care homes: Burlington Hall in Woburn Sands and The Shrubbery in Higham Ferrers. An undisclosed funding package has been provided by the Royal Bank of Scotland to support the deal. Adara Group was established in January 2016, by experienced

care home operator Sue Hanspaul, alongside her husband, Mike and son, Sandy Hanspaul. Sue has been involved with the running of both Burlington Hall and The Shrubbery since their inception and this deal sees her acquire full ownership of both homes under the Adara Group. Burlington Hall is located on Station Road in Woburn Sands and

delivers professional care to older people with physical disability and dementia. It has capacity for 53 residents with 51 single rooms and one double. The Shrubbery is situated on College Street in Higham Ferrers and also specialises in the same kind of care. It accommodates 45 residents with single rooms including en-suite facilities.

Mental health fund The Government has announced successful bids to the first wave of the £15m mental health fund. It has also opened bidding for the remaining funding. Forty-one projects have been awarded a share of the funding to improve provision of mental health places of safety for people in crisis. The Department of Health mental health fund is supporting the creation of new places of safety and the refurbishment of

existing sites to prevent people experiencing a mental health crisis, who have committed no crime, from being placed in a police cell. The Government wants to see an end to the unacceptable situation in which hundreds of people in crisis are being lockedup in police cells each year, because health services are not available in time. When a person is experiencing a mental health crisis, they need the right care, in

the right place and too often the only safe place available is a police cell – somewhere which often exacerbates the crisis. The first wave of bids, totalling £6.1m, have been awarded to 15 NHS trusts and partnership organisations covering 11 police force areas. They have been focused where use of police cells as a place of safety has previously been amongst the highest in the country.

Luxury Care Group acquisition Birds Hill Nursing Home in Poole has been acquired by Luxury Care Group for an undisclosed sum. The new owners plan to spend £600,000 on improvements to the 75-bed home over the next two years. The work will include new bathrooms and updating the furniture as well as purchasing leading equipment to take the home from ‘Good’ to ‘Outstanding’. The acquisition of Birds Hill brings the number of homes owned by Luxury Care Group to four. The company also owns Aranlaw House in Branksome Park, Poole; Regency Manor in Lower Parkstone, Poole; and Seabourne House in Southbourne, Bournemouth. Ellis Jones Solicitors acted as legal advisers for the purchase of Birds Hill.

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16 CMM October 2016

09/09/2016 12:52:15

NEWS

Sanctuary Supported Living Sanctuary Supported Living (SSL) has secured a three-year contract to deliver tailored support for the residents of a new supported living scheme in Redcar and Cleveland. Under the contract with Redcar and Cleveland Borough Council, SSL will be working alongside landlord Thirteen Homes to provide flexible and personalised CQC-registered support to 17 residents at Romanby Crescent, who have learning disabilities and mental health needs. The new-build property is part of the larger Eston Community Village, which will provide 51

homes for people with dementia, mental health needs and learning disabilities. Romanby Crescent is SSL’s fifth supported living service in the Teesside area and the latest in a growing set of services commissioned by the borough council. The contract comes soon after the launch of The Shore, a learning disability supported housing scheme also located in Redcar, which opened its doors earlier this year and sees SSL providing 24-hour on-site support to its 12 residents.

Southern Care Group Alison Taylor, Regional Director of DC Care, has completed the sale of Southern Care Group Ltd (in administration) on behalf of the joint administrators BDO LLP. The sale includes the last

two homes in the group, Coed Duon Nursing Home and Maes Elwy Care Home based in North Wales. The other homes have already been sold over a period of time.

Hear to Care The charity, Action on Hearing Loss has rolled out a new project in mainstream care homes across the North of England designed to improve the care and support provided to older people with hearing loss and reduce social isolation. With 71% of over-70 year olds

living with hearing loss in the UK, the project titled Hear to Care will pilot and test out changes or improvements which can be made in mainstream longer-term care settings to improve the diagnosis and management of hearing loss. For more information on the project, see Straight Talk on page 50.

Public health post-2013 – Health Select Committee report A new report into public health by the Health Select Committee explores the situation with public health since the transfer of responsibility to local authorities in 2013. It has found that, after taking on responsibility for public health, local authorities were dealt an in-year cut of £200m last year and now face further real-terms cuts to

public health budgets. It says that these cuts are ‘a false economy as they not only add to the future costs of health and social care but risk widening health inequalities’. The Committee wants to see a Cabinet Office minister given specific responsibility for embedding health across all areas of Government policy.

CMM October 2016 17

NEWS

Audley’s record first half results £600m to invest over the next five years, from a combination of equity, development income and investment debt. Audley currently owns 12 villages and manages two more providing over 1,000 properties and intends to double this number over the next five years by completing its current villages as well as new site acquisitions. The first half of 2016 also saw Audley launch its new mid-market proposition, Mayfield.

The combination of demographic trends, including longevity as well as increased consumer wealth, have helped luxury retirement village operator, Audley Retirement produce record results for the first half of 2016. Audley’s revenues reached £31.6m for the first half of the year, up 511% year-on-year, driven by a combination of new village developments and growing service income across the existing estate.

Earnings rose to £2.7m, compared to a loss of £2.7m in the previous year. Net profit reached £1.9m for the period, with the comparable figure a £3.2m loss for 2015. In total, more than 2,000 new units are planned to be completed within the next five years with turnover forecast to reach £100m in 2016, having grown more than tenfold between 2009 and 2015, from £4.2m to £42.9m. Audley now has a war chest of over

Target’s debt facilities extended

Next chapter for Home Instead

The Board of Target Healthcare REIT Limited has announced that it has agreed with The Royal Bank of Scotland (RBS) to amend and restate the terms of its existing £30m committed term loan and £20m revolving credit facility. The term of the facilities has been extended from June 2019 to August 2021. In addition, the amendment also provides an option of two further one-year extensions thereafter, subject to the consent of RBS.

Accessible housing demand New Freedom of Information evidence from housing association Habinteg, shows that councils lack plans to meet future accessible housing demand. A Freedom of Information request (with an 82% response rate from English local authorities) found just 3% of local authorities outside London have policies to deliver and monitor the number of accessible homes built. 18 CMM October 2016

Home Instead Senior Care, the UK’s leading provider of high quality homecare, has announced that the UK master franchise has been acquired by its US founding franchisor Home Instead, Inc. On 1st September 2016, ownership of the UK master franchise transferred from husband and wife team Trevor and Sam Brocklebank, who brought the model from the US to the UK in 2005, back to the original US founders, husband and wife Paul and Lori Hogan. The award-winning network of

UK offices will continue under the leadership of Managing Director Martin Jones (formerly UK Chief Operating Officer), working closely with the US. Trevor has accepted a new role as CEO Emeritus, in which he will focus on influencing policies in social care that contribute to Home Instead’s mission to change the face of ageing. Sam Brocklebank is taking this opportunity to spend more time with the couple’s young family and will no longer be involved with the business.

Domiciliary care managers earn less Managers in domiciliary care earn up to 30% less than their care home counterparts, according to new research by Croner. The findings come from Croner’s latest salary survey report on pay and benefits within the care sector. The

report also highlights that unlike managers, pay at care worker level is higher for those working within domiciliary care. The survey also found that staff turnover continues to be a problem across the sector at 17.5%.

New Meallmore care home Mearns House, Meallmore’s newest care home, is has opened and welcomed its first residents. The home opened in July and welcomed four residents in its first week, with more expected in the

coming months. It offers 24-hour nursing care and support for up to 68 people, as well as providing expert care for people experiencing the symptoms of dementia.

Hica Group restructures Hica Group has restructured and strengthened its operational management team to develop and build the Hull-based organisation. The changes follow a review of operations by Terry Peel, Operations Director, and Penni Brown, Chief Executive, to reshape the organisation to provide the best direct support to all services and managers across Hica, which operates a portfolio of 20 residential care homes. Kay Ling has been internally seconded as Regional Director for the South and West Region. She will take up the direct line management and support of The Lodge care home in Lancashire in the West alongside her current care home portfolio in the South. Heidi Dugdale Dawes continues as Hica’s Regional Director for the East and Central Areas as well as being the group-wide safeguard lead. Salma Keles has been internally seconded as Operations Manager for Homecare across the Hica Group. She will support Terry Peel in the continued shaping of homecare and extra care provision across the group. Salma will remain based at Grimsby homecare branch.

Kare Plus Rugby The Rugby branch of national care personnel provider, Kare Plus is launching its own domiciliary service, providing quality care to individuals in their own homes. Established in January 2016 by husband and wife Richard and Amy Hardy, with funding support from The Royal Bank of Scotland, Kare Plus Rugby provides staffing solutions to private health, care and nursing facilities. It is part of the nationwide Kare Plus franchise, which now has over 60 branches across the UK.

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THIS WAY OUT

PREPARING FOR SALE

20 CMM October 2016

Q A

What process do I need to go through to exit the market? The sector is becoming increasingly tough to operate in and I’d like to know my options. John Lucas, Corporate Finance Partner, Hazlewoods

Many business owners will have an ‘exit plan’, or at least an idea of how long they would like to run their business. For some, recent developments such as the introduction of the National Living Wage, auto-enrolment and fee pressures, means they are considering an exit plan earlier than expected. If you are considering selling your business, either now or in the next few years, it is important to know whether you and your business are prepared for a disposal and, if not, what can be done to get it ready.

THE BUYERS There are three main types of buyers in the market: trade buyers, private equity investors and charities or not-for-profit organisations. Each has their own distinctive approach to acquisitions. Trade buyers are businesses already operating in the care sector, who are perhaps looking to expand, move into a new geographical area or service type. They would often prefer to acquire an existing business with established relationships with local authorities or private clients than build from scratch. One of the key benefits of selling a business to trade buyers is that it is often possible to find someone who you think would be a good ‘fit’ for your business. Private equity or ‘PE’ buyers are professional investors looking to

acquire a profitable business that can be grown and then be sold at a profit, within a reasonably short period of time. PE buyers are experienced acquirers and so their approach is usually efficient and professional. A key attraction of PE buyers is that they may be willing to offer a premium for your business, if they are keen to gain a platform in your particular market. Charities and not-for-profit organisations, in comparison, are less likely to prioritise profitability. Selling to a charity or not-for-profit organisation can mean that the process is slower than if selling to trade or PE buyers. However, they are often considered to be good ‘homes’ for staff and service users.

THE PROCESS Whichever group you might sell to, broadly the same acquisition process will be involved and this consists of three core stages. 1. Finding a buyer and Indicative Offers. 2. Due diligence. 3. Legal documentation and completion. The first phase involves confidentially marketing the business to potential buyers who will undertake an initial assessment of summarised financial and operational information about the business. If the buyer likes your business, then they will make an Indicative Offer. Once the Indicative Offer has been accepted, lawyers will

CMM October 2016 21

The perfect remedy for healthy business Strategic business planning including acquisition and disposal With over 20 years of health and social care experience, Hazlewoods can help you to build a solid business strategy, allowing you to plan for the future and grow your business. Our dedicated and enthusiastic team can advise you on how to increase your profits year on year, ensuring your business is worth its maximum value when you come to exit. To find out more, please contact Andrew Brookes andrew.brookes@hazlewoods.co.uk John Lucas john.lucas@hazlewoods.co.uk Rachael Anstee rachael.anstee@hazlewoods.co.uk or 01242 246670 www.hazlewoods.co.uk @HazlewoodsCare Hazlewoods LLP is a Limited Liability Partnership registered in England and Wales with number OC311817. Registered office: Staverton Court, Staverton, Cheltenham, Glos, GL51 0UX. A list of LLP partners is available for inspection at each office. Hazlewoods LLP is registered to carry on audit work in the UK and Ireland and regulated for a range of investment business activities by the institute of Chartered Accountants in England & Wales.

THIS WAY OUT – PREPARING FOR SALE

prepare Heads of Agreement, a document setting out the terms of the initial offer agreed and a timetable for completion. This will all be subject to due diligence. Due diligence is often split into two main types: financial and legal. Larger businesses will also look at expanding the process to include commercial, human resources, and even IT due diligence, but for the average small to medium-sized care business, the legal and financial due diligence is often enough. The buyer’s solicitors will perform the legal due diligence, looking at all legal aspects of contracts, ownership of assets, compliance and litigation. The financial due diligence is normally undertaken by a team of accountants who specialise in this process. It will involve a range of tasks including looking at historic and current trading results, the

see how the business has performed over a period of time, so making sure your accounts are accurate and up-to-date is imperative. These financial records will form an important part of a buyer’s financial due diligence work. As accounts are prepared just once a year and reflect a period in the past, a buyer will also want to assess the trading results since your last year-end date. If you do not already prepare monthly or quarterly management accounts, then it is a good idea to start.

OTHER RECORDS Legal due diligence will require copies of all contracts with staff and local authorities to be sent to the buyer’s lawyers, so make sure you have copies of all signed contracts on file. If fee reviews have taken place since the contracts were put in

“The market for care businesses has changed quite significantly over the past couple of years.” working capital and cash required to run the business, historic trends and company debt. All of this is intended to make sure the buyers know what the underlying and sustainable profitability of your business is. The process of due diligence can often feel a bit invasive as the professionals look in detail at your business. It is important to ensure that records are complete and operations are working as efficiently as possible before you start down this route.

YOUR FINANCIAL RECORDS Annual accounts are an easy way to

place, then ensure that a paper trail exists so that you have evidence to support the new rates. Ensuring that the business is compliant with various governing bodies is a large part of legal due diligence. As a result, you should make sure that your Care Quality Commission registration is correct, managers are registered, and DBS checks are complete and filed. The legal due diligence team is also likely to request copies of documents, such as employee handbooks and health and safety certificates. Any delays in providing due diligence information will make the process longer, and it can already feel tiring. By making the

appropriate preparations, you will help to ensure it goes as smoothly as possible.

TAX IMPLICATIONS When you sell your business, you will become subject to capital gains tax, which is payable at between 10% and 20%. The capital gains tax annual exemption is a one-off, tax free allowance which can be applied to capital gains each year. You will be entitled to an allowance of £11,100 providing you have not received other capital gains during the tax year of sale. Entrepreneur’s Relief reduces the amount of Capital Gains Tax when you sell a business. It is available for the sale of shares where certain conditions are met. It means that each shareholder in the business may qualify to pay tax at the 10% rate for up to £10 million of gains. The conditions are: • You must own at least 5% of the issued share capital (and have voting rights). • You must be an employee or director of the company. • These conditions must have been satisfied for 12 months prior to the sale. If you are a sole trader or your business is a partnership, then Entrepreneur’s Relief is still available, provided you have owned all or part of the business for 12 months. There are no restrictions on applying Entrepreneur’s Relief to spousal shareholdings. This means that if your wife, husband or partner is not currently a shareholder or business partner, and you are expecting to sell the business more than 12 months down the line, then you have the option to transfer them at least 5% of your shares or stake in the business. One key area to review is

property ownership. Historical tax planning of holding properties outside of the operating company may mean that Entrepreneur’s Relief is not obtained on the property element of the sale – which can mean an extra 10% tax charge. This should be reviewed prior to sale.

THE MARKET The market for care businesses has changed quite significantly over the past couple of years. At the moment, uncertainty due to implications of National Living Wage, the exceptionally hardnosed approach to fees by the local authorities, and electronic call monitoring for the domiciliary care and supported living sector, means that buyers are often paying lower multiples of profits than just two years ago. The multiples paid for businesses which are not necessarily considered ‘corporate’ are particularly affected. This includes sub-scale business – those with less than £500,000 profit, homes with limited en-suites, or low-margin domiciliary care. In some cases, sellers are having to find alternative strategies for sale, such as closing the home and selling for ‘alternative use’ value. This is particularly common for period conversions, or where a ‘site’ has greater value as a new build development. However, as ever, there is a silver lining for higher acuity and high quality care businesses. Buyers are more willing to pay higher multiples if they are acquiring a business with a strong Care Quality Commission inspection history and low service user and staff turnovers. If you are well prepared, then it is possible that you and the buyer can come to an agreement that both sides are happy with – but setting reasonable expectations of current value at the outset is key. CMM

John Lucas is Corporate Finance Partner at Hazlewoods. Email: john.lucas@hazlewoods.co.uk Twitter: @HazlewoodsCare Are you planning to exit the market? Share your thoughts at www.caremanagementmatters.co.uk. Subscription required. CMM October 2016 23

PRIVATE PROSECUTIONS â&#x20AC;Śis it only a matter of time? High profile private prosecutions have raised questions about whether it would be possible for cases to be brought against health and social care providers. Simon Lindsay and Ruth Atkinson-Wilks share their thoughts on the likelihood, what offenses could be brought and what providers should do if it happens to them.

24 CMM October 2016

The thought of being sued strikes fear into the heart of many providers. But what about the possibility of being criminally prosecuted? Traditionally, the decision on whether to pursue criminal proceedings has been left to the State, which is required to adhere to strict guidelines on when a prosecution should or should not be undertaken. In particular, there must be sufficient evidence and any prosecution must be in the public interest. The number of investigations by the police, and subsequent prosecutions by the Crown Prosecution Service (CPS) (or in some cases the Health and Safety Executive or Care Quality Commission) for offences such as corporate manslaughter, gross negligence manslaughter, wilful neglect and offences under the health and safety legislation has

notably increased, with everincreasing public scrutiny. Not only this, but in recent years the use of private prosecutions has seen a resurgence. In 2014, there was the successful private conviction of businessman Ketan Somai for nine counts of fraud after swindling investors out of ÂŁ13.5m. In August 2015, the fatal accident inquiry into the tragic 2014 Glasgow bin lorry crash was adjourned to allow the parties to consider a private prosecution. We have also seen private prosecutions in relation to the Hillsborough football disaster and the Stephen Lawrence murder. The growing trend and expanding remit of private prosecutions means that it may only be a matter of time before someone attempts a private prosecution of an offence by a health or social care professional.

HEALTH AND SOCIAL CARE CONTEXT What are the offences in the health and social care context that could be subject to a private criminal prosecution, (ie a prosecution that is not brought by or on behalf of the CPS but by an individual or body, acting in a private capacity)? They fall into two categories – those that must be brought against the organisation (ie a care provider or NHS trust) and those that can be brought against individuals. The three most prominent offences are: (a) Corporate manslaughter An organisation such as a care

provider or health trust will be guilty of corporate manslaughter ‘if the way in which its activities are managed or organised causes a person’s death and amounts to a gross breach of a relevant duty of care owed by the organisation to the deceased’. A breach of a duty of care will be considered ‘gross’ if the alleged conduct falls far below what can reasonably be expected of the organisation in the circumstances. Punishment can include a significant fine, a remedial order (requiring the organisation to take steps to remedy the management failure) and a publicity order (to name and shame). The prospect of a private prosecution for corporate manslaughter is perhaps less likely than the other offences discussed below as permission from the

Director of Public Prosecutions (DPP) is required before a private prosecution of corporate manslaughter can begin. (b) Gross negligence manslaughter Gross negligence manslaughter is a common law offence, where death is as a result of a grossly negligent act. It has a four-stage test: 1. The defendant owed the deceased a duty of care. 2. The defendant breached the duty of care. 3. That breach caused (or significantly contributed to) the death. 4. The breach was grossly negligent. Gross negligence manslaughter can be brought against

individuals. The defendant’s act or omission (which amounts to a breach of the duty of care) has to be so bad that, taking into account all of the circumstances, it should amount to a criminal offence. It’s what is sometimes described as ‘reprehensible’ behaviour. We are not, at present, aware of any private prosecutions for gross negligence manslaughter in England and Wales, however such a private prosecution would be possible as the private prosecution of gross negligence manslaughter does not require the consent of the DPP. The maximum penalty is life imprisonment. A successful prosecutor would be able to recover costs from central funds for this type of prosecution.

CMM October 2016 25

PRIVATE PROSECUTIONS…IS IT ONLY A MATTER OF TIME?

The offence of ill-treatment or wilful neglect can be brought against both individuals and organisations (eg care providers) in health and social care. An individual commits the offence if, as a care worker, they ill-treat or wilfully neglect a person in their care. An organisation commits the offence if (i) an individual commits the offence, (ii) the management or organisation employing that individual, or the care provider’s activities, amount to a gross breach of a relevant duty of care owed by the care provider to the person who is ill-treated or neglected; and (iii) in the absence of the breach, the ill-treatment

defendant may be liable for the costs of the prosecution, subject to means. It is possible for a private prosecution for wilful neglect to be commenced without first obtaining consent from the DPP.

POTENTIAL IMPACT OF A PRIVATE PROSECUTION A growth in private prosecutions in health and social care could have a huge impact on resources for organisations. It may also impact upon the insurance arena for organisations, who – going forwards – may need to have greater policy coverage. As the private prosecutor will be relying on private investigators

“A growth in private prosecutions in health and social care could have a huge impact on resources for organisations. It may also impact upon insurance.” or wilful neglect would not have occurred or would have been less likely to occur. The offence for individuals can result in a prison term of up to five years or a fine or both. The penalties for organisations may include a fine, a remedial order and a publicity order. Depending upon the sentence, the private prosecutor may be able to recover costs from central funds. In some circumstances, the

or unqualified individuals, as opposed to the police, to collate evidence and put together their cases, they are likely to require extra assistance from the defendant organisation. Whereas the police, and other organisations, such as Health and Safety Executive and Care Quality Commission, have statutory powers to require disclosure and the production of items/documentation from a

defendant, private prosecutors and their investigators will not have these powers. Whilst this can be beneficial in some respects, it can also mean that the defendant organisation has to give greater consideration and deliberation as to whether it is obliged to provide disclosure in specific circumstances. Ultimately, this can cause greater resource to be required than simply complying with a warrant or court order.

IN THE PUBLIC EYE It should also be remembered that private prosecutions are not only used to seek justice. They are also a useful campaigning tool for raising awareness of perceived injustice and keeping an issue in the public eye. This was demonstrated by the unsuccessful, yet high-profile private prosecutions brought by the families of Hillsborough victims against police officers involved in the disaster, and those initiated by the family of Stephen Lawrence against the suspects of his murder during the 1990s. Such press interest is likely to be a significant factor in the workload and pressures on organisations as they deal with private prosecutions. Private prosecutions are also likely to lead to interest from other regulators and may trigger further investigations. They may also lead the police or CPS to reconsider opening previously closed or discontinued investigations or prosecutions.

WHAT CAN PROVIDERS DO? It is imperative that any actual

or potential private prosecutions are addressed rapidly and proactively by defendant organisations. Early intervention and action could prevent an escalation – or at least put the organisation in the best possible position to successfully defend a prosecution. If faced with the prospect of a private prosecution, an organisation would be welladvised to seek legal advice immediately. This should be done without delay, as time is of the essence, to protect staff members and minimise the impact with regards to publicity and the involvement of other regulatory bodies. Furthermore, it may be possible to make a request to the DPP to take over and discontinue proceedings – something that a legal representative would be able to advise on.

IS IT A MATTER OF TIME? This is only a brief overview of private prosecutions with a focus on how they might be utilised to prosecute health and social care offences. Although the public interest element in health and social care offences provides a strong justification for most prosecutions being undertaken by the CPS (or at least taken over by the DPP), an under-resourced and over-burdened CPS means that the situation is ripe for cases being overlooked and picked up by private prosecutors instead. It really does look like only a matter of time before we see our first high profile private prosecution in health and social care. CMM

Simon Lindsay is a Partner at Bevan Brittan LLP. Email: simon.lindsay@bevanbrittan.com Ruth Atkinson-Wilks is a Solicitor at Bevan Brittan LLP. Email: ruth.atkinson-wilks@bevanbrittan.com Twitter: @BevanBrittanLLP Are you aware of the likelihood of private prosecutions? Share your thoughts at www.caremanagementmatters.co.uk. Subscription required. 26 CMM October 2016

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CENTRAL BEDFORDSHIRE’S HOUSING AMBITIONS Central Bedfordshire Council has launched a new project and an investment prospectus of opportunities for the private sector, to help it meet the accommodation needs of its ageing population. The forward-thinking document sets out in detail the Council’s ambitions and objectives for development of provision in the area. The prospectus, launched at a recent conference, is looking to bring together developers, architects, investors, providers and housing associations to help boost accommodation provision for older people in Central Bedfordshire. It sets out the area’s current situation regarding housing, care and housing with care in the locality and the likely demand up to 2020. It sets out a number of opportunities that it is opening up to the private sector. It also contains a detailed breakdown of each locality, with demographics, supply and demand requirements and more. The ambitions see it wanting to deliver a range of accommodation for the older residents of Central Bedfordshire to enable people to retain a good quality of life and health, in attractive homes that meet their needs and support their independence. It also wants provision to reflect the tenure wishes of residents in its four localities: Chiltern Vale, Leighton Buzzard, West Mid-Beds and Ivel Valley. Julie Ogley, Director of Social Care, Health and Housing at Central Bedfordshire Council said, ‘I know how important the private sector is in delivering specialist accommodation and care for older people and we are keen to engage with organisations across the sector. We know that organisations who may not already be active in Central Bedfordshire can find it difficult to get the information they need about demand and site availability along with an understanding of what the local council’s approach is. The Investment Prospectus aims to cover many of these areas, but 28 CMM October 2016

we are aware that we need to better understand the requirements of the sector so this is just that start of what we intend to be an open and productive conversation.’

HOUSING WITH CARE The Council has identified a lack of extra care housing in the region and wants to see increased provision available with a mix of tenure. Its plans set out the development of six affordable extra care schemes by the end of 2020. Its aim is that there is one scheme of 80 apartments or more in each locality area, plus two more schemes in areas of high demand. The Council is offering opportunities for registered providers to work with it to make this a reality. The Council specifically notes the lack of open market extra care provision in the region, and it is actively pursuing the development of sites with full extra care facilities and services, including the availability of 24/7 care. It is keen to connect with providers in this sector and to help them explore opportunities.

CARE HOMES The Council currently owns seven care homes with a capacity of 249 beds. It would like the capacity in these homes to be reprovided by the end of 2020 in homes with modern design standards. Again, it is offering opportunities for providers to work with the Council on this. It also wants to work with existing providers in the area who are looking to renovate or remodel their existing homes. During its detailed research, the

Council has also identified a lack of care home provision in the north of the area. As part of its prospectus it is encouraging new developments in the north, that specifically meet the expectations of older people.

MAINSTREAM HOUSING Central Bedfordshire, like many regions, is also seeing a large amount of housing development. As part of this, the Council is looking to encourage developers to build mainstream homes that are suitable for older people as part of their new developments. It is also looking for open market providers to develop innovative housing and small scale housing solutions in smaller towns and villages, town centres and neighbourhood centres. It states that older people prefer to live in more established communities and close to amenities and services.

WIDER OPPORTUNITIES The Council is also looking for more dementia-friendly buildings with a view to making Central Bedfordshire dementia-friendly. It would also like more open-market housing that is suitable for older people who are likely to be owner-occupiers. It states that there are models of openmarket housing for older people, some of which include care, however there are few providers active in the local market.

ADDITIONAL INFORMATION For interested parties, the Council has also put together a detailed

breakdown of the region’s four localities. This includes data on population, housing tenure, existing developments, wider regional development plans, supply and demand for care homes and extra care housing. It also sets out market opportunities for each locality. Added to this, the prospectus summarises design characteristics that the Council considers important for each type of housing and housing with care. Central Bedfordshire Council is keen to make connections and open dialogue with those organisations interested in helping it meet its objectives for the accommodation needs of older people in the area. It has set up a dedicated team to offer a wealth of support for interested organisations. This ranges from market intelligence and community engagement to planning, land management, procurement, building control, business support and business grants. CMM

OVER TO THE EXPERTS... This is a very detailed, open and forward-thinking prospectus from Central Bedfordshire Council. It has compiled a lot of the information that potential partners would require when considering the area for investment and development. Are its commerciality and awareness of wider role of private sector in meeting its objectives unique? Should other local authorities adopt this principle? Is this likely to achieve the Council’s ambitions for 2016 to 2020?

A CLEAR, ACCESSIBLE CALL TO ARMS The prospectus is a clear, accessible call to arms. It is making a coherent ‘business case’ for investment in a range of specialist and mainstream housing that meets the needs and aspirations of the area’s ageing population. It is interesting that while the prospectus talks about meeting short-term challenges – addressing a projected shortfall up to 2020 – it quite rightly provides much data on the projected significant growth in demand by 2030. The council is sensibly inviting prospective partners and stakeholders to meet identified gaps in the market over the long term, and to meet a more pressing need for up to six affordable extra care housing schemes. To ensure interest from as wide an audience as possible, the prospectus succinctly draws together much of the key detail that the Housing LIN’s tool for predicting and meeting future local

DEMONSTRATING STRONG LEADERSHIP

demand suggests parties require. In developing SHOP@, we urged councils and their partners to take the sort of clear-headed look at their local specialist housing markets, demand and opportunities that Central Bedfordshire has done here. I was also pleased to see that the document includes two pages on ‘important design characteristics’, but, as someone involved in the three Housing our Ageing Population: Panel for Innovation (HAPPI) reports over the last decade or so, it would be good to see interested parties directed towards what many now see as the ‘Bible’ of quality design for older people’s housing. I will watch with interest the impact this document and approach has in meeting the needs and choices of the older people of Central Bedfordshire over the next 5 to 15 years and beyond.

Jeremy Porteus Director of the Housing Learning and Improvement Network (LIN)

needs, but committing to ‘actively facilitate and support’ innovative developers. Birmingham City Council took this approach, and a close partnership between the council and The ExtraCare Charitable Trust, has led to the development of five mixed-tenure retirement villages (with care services) since 2007. Given the challenges of competitively bidding for land, help to secure sites is especially important, and Central Bedfordshire and other interested councils may want to look at the Birmingham model more closely. Whilst the tide is changing, Central Bedfordshire is still part of a minority really demonstrating strong leadership in relation to older people’s housing and care, and we encourage other councils (and public bodies such as NHS Trusts) to follow suit and tip that balance.

Michael Voges Executive Director, Associated Retirement Community Operators (ARCO)

UNABLE TO OFFER THE CERTAINTY ABOUT FUNDING Come on in – the water’s warm. Central Bedfordshire Council is pushing the door wide open on its thinking about how to address the future needs of its community. Its prospectus contains many of the key elements for a community embracing the future requirements of an ageing population. It is very positive that the council is including the care sector in its profile of future accommodation requirements for the community, recognising that, for many, access to high-quality care provision is an essential part of their future. What Central Bedfordshire Council may also need to understand is that engagement with care providers will also bring benefits in terms of determining ongoing access to effective homecare to sustain its vision of independent living. There are huge numbers of generalisations made about

This is extremely welcome. It identifies the vital role of extra care and retirement villages in contributing to local priorities, and specifically schemes with services such as on-site care, and 24/7 staffing. This is significant and demonstrates a forward-thinking approach. All too often, councils don't distinguish between different types of older people’s housing. Clearly, acknowledging that ‘housing- with-care’ is distinct from sheltered/retirement housing is a step in the right direction. Similarly, the prospectus is right to consider specifically self-funders – many councils focus too narrowly on local authority supported extra care places. Whilst provision needs to increase across the board, at present the ‘middle market’ catering for ‘average’ homeowners is the most under-served. Importantly, Central Bedfordshire Council is not just highlighting

older people’s housing and care needs, and Central Bedfordshire Council’s analysis of the need for the housing solutions to reflect the identities of the local communities is refreshing. Is its approach unique? No. Might it have early adopter status? Yes – but I think there will be plenty more who adopt this approach. The challenge for Central Bedfordshire Council, and indeed localities around the country, is that whilst it can and should be very clear about future needs, it is unable to offer the certainty about funding the services it requires. This is a challenge for both the provision of supported housing, including extra care and funded care, and unfortunately this level of uncertainty will make even the most welcome of partners reluctant to dip their toe in the river Great Ouse in Bedford.

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A VIEW FROM THE TOP

L Y N D A TA R P E Y Lynda Tarpey is the Director of Think Local Act Personal.

REFLECTIONS ON THE LAST DECADE In the last decade, we have had significant changes in legislation, which created opportunities to put wellbeing, prevention, personalisation and integration at the centre of the way the health and care sector works. This is a great move away from the wholesale approach of care management to something more personal. However, putting policy aspirations into practice in the face of austerity is proving really difficult. It seems austerity has overshadowed supporting people to have a better life. For example 28 years ago, as a local authority manager, I was paying care workers more per hour than most are paid in actual terms today. As a sector we have literally devalued our workforce. PROJECTIONS FOR THE NEXT DECADE I don’t think anyone needs a crystal ball to make headline projections for social care over the next decade. Doing things the way we do them now will not be sustainable with more demand and limited resources, which many people who use services would say is a potential opportunity. At Think Local Act Personal (TLAP) we support a new approach. We see the solution as one of enabling people to work with their support providers and community to make best use of available resources. For example, the take up of individual service funds as a good alternative for those who do not want to

manage a direct payment. Personalisation is also gaining momentum in health through personal health budgets. I believe this is the way to achieve integration driven by the needs of the individuals with lived experience. INSIGHT TLAP as a partnership has existed for eight years. I became Director in December 2015 and since I have been here, I have been incredibly impressed by what can be achieved when the whole sector works together. The challenges in the sector are now so great that no one party has the answer. This brings the opportunity for providers, people and communities to have more influence both locally and nationally. At TLAP, we work co-productively so everyone is around the table from the start. Working this way saves a lot of wasted time and energy. INFLUENCES In my life, it’s my fantastic, long-suffering, supportive family. In my career, the amazing people who work in the sector and use services with their mix of compassion, good humour and determination. LESSON The most important lesson I’ve learned is that we all need to listen to people who

use services, their families and carers and build good relationships with them. Whenever I have been involved in reviews of untoward incidents or read reports from high profile enquiries, there were always individuals who tried to tell the professionals or organisations that there was something wrong, but they were ignored. The best advice I received was in the form of a challenge. When I worked for Ian Winter CBE at the London Joint Improvement Partnership, he always challenged our plans and proposals with the words, ‘and what difference is that going to make to people who use services?’ It’s what we should all ask ourselves. ADVICE Organisational values and culture flow from its leaders. If the culture in your organisation is great, then share the credit with everyone involved. If it’s not, take a long hard look at yourself! The notion of ‘us and them’ is, for me, the single most corrosive attitude in health and social care, whether that is between organisations, leaders and staff, or professionals and the individuals we all serve. People who use services, families and carers are the ones who have the greatest investment in us all succeeding. See them as a resource and support. At TLAP, they are my constant inspiration and source of constructive challenge. CMM

Read about Lynda’s typical day on the website www.caremanagementmatters.co.uk Subscription required. CMM October 2016 31

Invest in activities to transform lives Ben Benson explores how investing in the wellbeing of residents, through meaningful activities can achieve outstanding results.

32 CMM October 2016

What does a meaningful and engaging programme of activity look like? To give ourselves some context, let’s try to remember five things that we have done over the past 24 hours; these may be both obscure and mundane, but try it anyway. Personally, I have driven a good distance across the country to get to a meeting, bathed my baby and put her to bed, cooked dinner for myself and my wife and been for a short run. All of these things are rather unremarkable in themselves, but when brought together they become a set of activities that have stimulated me mentally, physically and emotionally. By considering activities in this way, as the beings, doings and general goings-on of life, we can start to plan our activities accordingly, including ideas that stimulate wellbeing and celebrate the uniqueness of the residents we work for.

“The best strategies for success always involve looking at the care setting as a community in which everyone is a potential contributor.”

PUTTING ACTIVITIES AT THE CENTRE OF CARE At Oomph! we work with staff from a wide range of care settings to develop the skills, strategies and confidence to ensure their activity programmes perform a central role in improving quality of life. This is vital, as when the full value of activities to address the health and wellbeing of residents is appreciated, it creates an atmosphere in which wider teams are more willing and interested to contribute. This invariably enriches what’s on offer and leads to wider participation. The best strategies for success always involve looking at the care setting as a community in which everyone is a potential contributor. Creating this ‘activities’ culture will have the biggest impact on service users and care staff. Training and supporting someone as the activity lead and nurturing their skills in this way is essential for promoting and harnessing this shared responsibility. It is also statistically proven to increase job satisfaction and reduce staff attrition rates. All too often, we find that those taking on the mantle of activity co-ordinator are left to their own devices, often only finding success when they have the personal tenacity and talent to carve out a varied and creative programme for the home.

CMM October 2016 33

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INVEST IN ACTIVITIES TO TRANSFORM LIVES

CREATE PROJECTS TO BRING PEOPLE TOGETHER Creating projects that everyone in the home can contribute to, is a really positive way of building a community culture and is a great way to improve everyone’s job satisfaction. A home that we work closely with ran such a project with the objective of bringing the whole home closer together. They purchased an old doll’s house, which they then went on to decorate and refurbish as an extension of their care home. Residents worked together to design and furnish the house and each room represented a different decade. It is now proudly displayed in their reception area, so that everyone visiting the home can take a look. It stimulates great conversations between residents and staff as they reminisce about the homes they grew up in and how much they changed by the time they were bringing up their own children. When activities take on a life of their own, as this one did, the activity lead’s responsibility is to keep the plates spinning, enabling everyone to participate in a way that suits them and to support thorough inclusion throughout the home.

can engage and add to the programme that is already on offer. Having such a broad selection of resources enables anyone to deliver an activity whether they have an hour to commit or just a spare five minutes.

USE LIFE STORIES Using life stories as a way to get to know a resident is not a revolutionary idea, but it can often be underutilised as a tool for creating activities. Not only do they provide us with a way of seeing beyond the symptoms of a condition to the person beyond, but they also contribute

“Another way to embed activities throughout a service is by providing self-service resources that anyone can access in order to run an activity.”

SELF-SERVICE RESOURCES Another way to embed activities throughout a service is by providing self-service resources that anyone can access in order to run an activity. Over time, these resources will naturally accumulate and a ‘library of activity’ will develop. However, to ensure it is regularly engaged with, and added to, there does need to be an element of curation. To support this approach at homes Oomph! works with, we provide a daily international event calendar, weekly newspaper and radio show as inspiration. This means that anyone in the home

rich material to the activity planning process. On our activity leadership training, we work with life stories to discover life goals that are yet to be achieved, help maintain highly valued skills and also uncover common interests between residents and staff. Such common interests can help to build relationships and develop the community in the care setting. Collating this information makes it far more possible to be responsive to the needs of an individual and is also a great way of integrating ‘interest-based activity’ into the care regime.

Having said all this, approaching somebody living in a care home and asking them whether they have an unfulfilled ambition, or if there is something that they would like to achieve, is a very difficult thing to do. If asked directly, it rarely yields an actionable response. If you think about the last time you were asked what you wanted as a birthday gift, your mind probably went blank. It is often far more satisfying when you are presented with something unexpectedly that you can see some generous thought has gone into. Gifts given like this bring about feelings of delight, self-worth, and that you are understood by those around you. We should endeavour to create activities in this way.

CONNECT TO PAST AND PRESENT PASSIONS We worked with an activity co-ordinator who discovered, through a conversation, that a resident had been a lifelong Burnley Football Club fan. He had regularly visited the ground from a young age and the co-ordinator had found out that he had fears that he would never be able to go again. Unbeknownst, to the resident, she reached out to the club with this story and they responded with the offer of hosting him and his grandson for the day, so they could watch a game, have a tour of the ground and receive a meal in the hospitality suite. When the plans for the day were revealed, he was naturally taken aback; in his own words this was something ‘unexpected, out of the blue, and greatly appreciated’. He went on to say to the co-ordinator that, although he has had many good days throughout his life, this was a truly great day and a stand out occasion. It doesn’t take a great leap to see that the value of this day wasn’t only in the activities that were carried out, but that it was arranged by taking into account what was important to this man.

CMM October 2016 35

INVEST IN ACTIVITIES TO TRANSFORM LIVES

Another activity co-ordinator who trained with us used life story planning to unlock a lady’s passion for horses. When completing the lady’s life story, she discovered, through conversations with family members, that her client had been an avid horse rider from a young age. This wasn’t something that this lady could remember through conversation, but, with support and after a little time, they visited a local stable to spend some time with the horses there. As soon as she had stepped foot out of the car, she took her care worker’s arm and said, ‘I know that smell’. From that

“Activity programmes that are implemented with imagination, and integrated alongside other care pathways, bring immediate improvements to quality of life.” moment on, from seeing the horses, to being able to mount and ride on one, the whole experience became one of reconnecting with both emotional and physical memories. This experience has been repeated a number of times since as it has her boosted confidence

and increased her social interaction. We hear of many similar successes, whereby activities have enabled residents to exercise control over their lives in this way, regaining a part of their identity and increasing feelings of selfworth. We have also been inspired by the activity co-ordinators we have worked with that have discovered specialist skills held by residents, which are in danger of being forgotten. When these discoveries are made, often through life story work, we open up a new and therapeutic avenue of activity for the resident in question. Providing an opportunity to maintain skills, whatever they may be, allows the person practising it to be lifted into a position of authority, a feeling which can often be elusive when living in receipt of care.

course. Care staff are used to recording care interventions as part of reporting procedures. By applying these procedures to the activity programme, we can obtain a measure of the benefits to both those living in or using the setting and also those working there. Having this information is essential when creating a responsive environment that is self-aware; we found that homes within pilots at two major care groups we have been working with saw an increase in their Activities Net Promoter Score – the measure of whether users would recommend a product or service to others – by residents, relatives and staff by 40 points over a three-month period. This was a strong indication that these homes had implemented successful changes and were reacting to the needs of those using their services.

EVALUATING THE IMPACT

THREE-DIMENSIONAL CARE

Over the past five years, we have delivered hundreds of courses to thousands of people. Time and again we have seen how activity programmes that are implemented with imagination, and integrated alongside other care pathways, bring immediate improvements to quality of life. We partner with 40 leading care home groups to put person-centred activities at the heart of their offering and ensure care home residents have something to look forward to every day of the year. Intrinsic to our approach is the collection of impact data with the homes on the success of their activities. The methods of how to gather this evidence forms a key part of our training

Where in the past there has often been a general understanding of activities as a means of entertainment, we are now seeing a gentle shift in focus toward the therapeutic outcomes of activity provision. Success in this field requires strong leadership with a vision for inclusion so that a community culture can develop, but it also relies on all others in the care setting, contributing and sharing their skills and passions in a way that engenders continued personal growth. Personal care is no longer limited to maintaining bodily health, it is about nourishing the mind and reviving the spirit. Through the provision of vibrant and ambitious activity programmes, we can deliver truly three-dimensional care. CMM

Ben Benson is Activity Leadership Development Manager at Oomph! Email: benjamin@oomph-wellness.org Twitter: @OomphWellness How do you support your residents’ wellbeing? Share your examples and read the Oomph! 2016 Annual Impact Report at www.caremanagementmatters.co.uk. Subscription required. 36 CMM October 2016

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COMING OUT from the

SHADOWS Lucy Hurst-Brown shares her thoughts on why people with learning disabilities remain invisible to society and the sector’s role in changing this.

The system in the UK got it wrong once and failed badly many thousands of people with learning disabilities. But now I worry deeply that we may have got it wrong again. I’ve had a career spanning the period ushered in by community care. In my 20s, I was ‘bright-eyed and bushytailed’ championing the end of the big institutions brought in by the 1990 Community Care Act. I naively thought that small scale community-based support would automatically lead to integration and connectedness for people with learning disabilities. Now, I agree that there are some excellent examples of where this has become a reality, but I realise how wrong I have been in terms of the extent to which this has become the norm.

> CMM October 2016 39

COMING OUT FROM THE SHADOWS

Soon after I left university, my job was preparing people with learning disabilities to leave long-stay hospitals and move into ordinary homes in local communities with support. Although I saw so many shocking and often inhumane scenes within the hospitals, I was confident about the active and rich lives people would, in time, have. Thankfully, this confidence was regularly rewarded with heart-warming personal tales of independence and lifestyles that matched those of society, from the mundane to the complex. But where is this now?

INVISIBLE PEOPLE We like to believe that everybody is valued and involved in life, that our society is enlightened, modern and democratic. But some members of society still have no voice. People with learning disabilities in the UK are invisible; 93 out of every 100 have no job, many experience ‘hate and mate crime’ and over 3,000 are still ‘lockedup’ within ‘Assessment and Treatment Units’. Our limited exposure to people with learning disabilities has led to most of us not even knowing what a learning disability is. What’s worse is people are still filling in the gaps with a range of unhelpful, ill-informed and negative stereotypes. When our paths do cross, we feel uncomfortable and all too often categorise them as ‘the other’.

LONELINESS At Brandon Trust, we brought together 300 people with learning disabilities to ask them about their achievements,

the quality of their support and what they hoped to achieve in the future. Many hopes were expressed about the future that did not surprise us. These included the desire to work. However, the biggest issue was the desire to develop relationships and friendships beyond paid staff and families. People want to be truly connected to society, to mean something to people in their communities. This is a basic human need. We now have extensive and ongoing conversations with those we support about relationships, exploring people’s sense of loneliness and how we can support them to genuinely connect with people. This loneliness and isolation perpetuates the ignorance that is so rife in society and deprives our communities of the valuable contributions of people with learning disabilities. Many people with learning disabilities only interact with those paid to care for them. These relationships are important and rewarding, but they aren’t enough. We all need to see and know people who are interested in us, for us, not because they are paid to look after us. Reflecting on myself and my career, are we, the people and organisations providing social care, and the sector itself part of the problem? In stepping in to provide support, however well-meaning, much of this support becomes an end in itself. Support should act as a catalyst, connecting people on to other nonpaid people in the community. Are we creating a form of dependence and furthering isolation? I am a passionate supporter of

the principles of the Welfare State and creating a fairer society. But I wonder whether, in its own way, it too has created a dependence on formal support, has contributed to the eating away of communities and personal responsibility towards others. To add to that, how often do we hear people who care for family or friends talk about the money they are saving the Government? The last coalition Government’s short-lived and mistrusted Big Society agenda touched on some of these ideas and held the principle of a strong community as the bedrock of a healthy and integrated society.

RETHINK OUR PRIORITIES It’s time to re-think our priorities; we must respond to people’s deep cries for relationships. We must find ways to enable people to genuinely connect with others in their communities; people who can see beyond their disability, share common interests and recognise their shared humanity. At Brandon Trust, we are establishing a range of volunteering programmes aiming to connect people to buddies. With the motto, ‘Live Free’, we are looking to support people with disabilities to take their proper place in life. However, if these ideals are to work, society needs to be ready to change, ready to welcome people into their communities. Providers can offer opportunities for people to get involved and even training. However, as citizens, neighbours, family and friends we all need to do more. We need to play our part. CMM

Lucy Hurst-Brown is Chief Executive of Brandon Trust. Email: communications@brandontrust.org Twitter: @LucyHurstBrown What are your thoughts on the invisibility of people with learning disabilities? Share your thoughts at www.caremanagementmatters.co.uk Subscription required. 40 CMM October 2016

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Tel: 0330 363 9996 Email: info@profiles4care.com Website: www.profiles4care.com

Tel: 0845 241 9591 Email: nursing@liquidhc.com Website: www.liquidhc.com

SECTORS • Home care. • Residential care. • Education. • Community services. • Housing associations. • Local authority. • NHS trusts. • Nursing. • Supported living. • Training. • University/college.

JOB LEVEL/SERVICES • All job levels. • Values-based recruitment assessments. • Values-based benchmarking. • Leadership assessments. • Team building. • Employee appraisal. • Recruitment and development. • Decision-making assessments. • Language assessments. • Numeracy assessments. • Staff retention. • Staff development. • Reducing sickness and absence. • Improving staff performance. • Improving consistency of care. • Risk mitigation in health and social care devolution. • Multi-site and divisions solution. • Employee development. • Employee training identification.

LEAD INDIVIDUALS Marc and Harriet are Profiles4Care’s primary contacts. They both have extensive experience in championing

values-based recruitment across and beyond adult health and social care, ensuring that employers have access to cost-effective tools enabling the recruitment, retention and development of the right staff for our sector.

SECTORS