Care Management Matters November 2016 by Care Choices Ltd

NOVEMBER 2016 ÂŁ4.00 www.caremanagementmatters.co.uk

STEP UP YOUR CQC RATING Moving from Good to Outstanding

Breaking down barriers

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Marketing and recruitment

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Revolutionising social care

In this issue From the Editor

Is it just me…? Editor in Chief, Robert Chamberlain looks at the latest report on the impact of unsafe discharges from hospital.

CMM News

Business Clinic An innovative day, respite and training service for young people with autism and learning difficulties is discussed.

A View from the Top Paul Simic from Lancashire Care Association answers this month's questions.

3rd Sector Care Awards 2016 CMM announces this year's finalists.

Event review CMM reviews the CMM Insight Lancashire Care Conference.

What’s On?

Straight Talk Sylvie Silver asks what’s the link between sudden death and activity provision?

FEATURES

REGULARS

From ‘Good’ to ‘Outstanding’ – stepping up your CQC rating Karen Carter gives real examples of how providers have moved from a ‘Good’ to ‘Outstanding’ rating.

Breaking down barriers – healthcare for people with learning disabilities Rhidian Hughes explores the need for closer collaboration with health and how the Health Charter can break down barriers to good healthcare.

Marketing in social care recruitment Have you ever thought of using marketing to support your recruitment processes? David Huckerby explains why you should.

Challenging CQC’s factual accuracy – new developments Carlton Sadler delves into why a recent court case may change the process for seeking CQC factual accuracy corrections.

Resource Finder CMM draws together details of dedicated care sector financial services. CMM November 2016 3

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

@SkillsforCare

@RhidianHughes

@FitzRoyUK

@VickyMcDermott

Karen Carter Programme Head – Leadership and Management, Skills for Care

Professor Rhidian Hughes Chief Executive, Voluntary Organisations Disability Group

Anna Galliford Chief Executive, FitzRoy

Vicky McDermott Chief Executive, Papworth Trust

@changepeople_

@LancsCareAssoc

@GD_PR

@BevanBrittanLLP

Philipa Bragman Chief Executive, CHANGE

Paul Simic Chief Executive, Lancashire Care Association

David Huckerby Director, GD PR & Media Ltd

Carlton Sadler Senior Associate, Bevan Brittan LLP

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: 978-1-911437-18-5 CCL REF NO: CMM 13.8

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@activitiesNAPA ABC certified (Jan 2015-Dec 2015) Total average net circulation per issue 16,095

4 CMM November 2016

Sylvie Silver Executive Director, National Activity Providers Association

www.caremanagementmatters.co.uk

From the Editor I am writing this having just returned from our CMM Insight Lancashire Care Conference and preparing for our CMM Insight Berkshire Care Conference. I relish the opportunity to get out of the office and into regions such as Lancashire and Berkshire to hear what’s happening on a local level.

PARTNERSHIP AND COLLABORATION

Council. Louise was very open and honest about her role, the position of the council and how it is working with providers. Her aim was for the council to work better and more collaboratively with providers. She was clear that the independent sector is crucial to the local social care market as the council’s resources are being ‘exhausted’.

RHETORIC AND REALITY

In Lancashire, the theme was partnership working and collaboration. I heard a lot about how providers and the Lancashire Care Association are working together and with the wider system to implement changes, consider each other’s pressures and work together for solutions. I was particularly impressed with the presentation from Louise Taylor, Corporate Director of Operations and Delivery at Lancashire County

I know some will argue that there can be a big divide between rhetoric and reality. Louise even spoke about how it’s not easy to effect change. However, by putting herself on that platform and talking honestly to providers, calling for partnership working she has set the ball rolling. This was something delegates seemed to appreciate. I hope that other local authorities are taking the same approach. Without both sides reaching out, honestly

Editor, Emma Morriss shares her thoughts from the recent CMM Insight Lancashire Care Conference and how CMM can help you to deliver quality care.

and with the same objectives, the sector will not move forward.

LOCAL DEVELOPMENTS The conference also gave me an opportunity to see that what is happening nationally is also occurring locally. Conversations clearly touched on fees, recruitment, quality and specific pressures facing registered managers. These topics don’t go away easily; to help address them, this month we have features to assist.

SUPPORTING YOU We have some real examples of how providers have made the leap from ‘Good’ to ‘Outstanding’ quality ratings, as well as an article on how you can use marketing in recruitment to position your company and find the right staff. There's also a full write-up of the Lancashire Care Conference. Whatever your situation and whatever your region, CMM is here to support you to deliver quality care.

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

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Is it just me...?

so that its progress can be measured. • The Government explains what is happening in parts of the country where funding for the Better Care Fund from the New Homes Bonus does not materialise. • The Government sets out a route map demonstrating how arrangements for long-term, sufficient, sustainable and integrated funding for adult social care will be implemented, by March 2017. • The Government sets out a clear plan for implementing integrated health and social care plans across the country, as pledged in the 2015 Spending Review.

Editor in Chief, Robert Chamberlain looks at the latest report on the impact of unsafe discharges from hospital and evidence of ‘political maladministration’.

In May, the Parliamentary and Health Service Ombudsman (PHSO) published A report of investigations into unsafe discharge from hospital. It highlighted nine serious cases to demonstrate how best practice is far from what people experienced when leaving hospital. In a follow-up to this report, the Public Administration and Constitutional Affairs Committee (PACAC) describes the incidence of unsafe discharge from NHS hospitals as ‘unacceptably high’ and the separation between health and social care as ‘political maladministration’.

OBVIOUS PROBLEM The Committee makes itself quite clear where it sees the root cause of poor discharge outcomes, ‘A lack of integration between health and social care is preventing

seamless discharge processes, coordinated around the patient’s needs. The NHS must support local areas to adopt the best models of integration.’ ‘At a structural level, the historic split between health and social care means that interdependent services are being managed and funded separately. We consider this to be political maladministration.’ ‘The Government has developed promising plans to tackle this structural disconnect between health and social care, from the Discharge Programme Board to the Better Care Fund and long-term integration policy, but they are far from implemented.’ ‘Barriers to the implementation of best practice are prevalent both within hospitals and at the interface between health and social care. We heard that pressures on resources and capacity within hospitals are leading to worrying and unsafe

discharge practices. We call upon health and social care leaders to ensure that staff are operating in a culture where person-centred care is the undisputed priority’. I know that social care providers share huge frustrations around the apparent lack of willingness from health partners to embrace their services as a joint solution to improving outcomes for discharged patients. It seems obvious that separate funding and the pressures on NHS budgets are blinding decision-makers to what is best for those they serve. That leads me to ask, how can this cycle be broken?

RECOMMENDATIONS The PACAC recommends that: • The Secretary of State for Health establishes a clear set of objectives for the Discharge Programme Board, together with success measures and timelines,

Whilst these recommendations could, very well, go some way to unravelling this crisis, what is the likelihood of their adoption and implementation?

POINTLESS? I’m sure that we, in social care, can be forgiven for thinking, ‘here is another set of recommendations to be ignored’. Report after report make similar observations about how our sector is a crucial component in solving NHS issues, yet little seems to change. What bewilders me is why we have these important and necessary bodies, when the Government doesn’t appear to act on their recommendations. How can the discharge issue possibly continue to go unaddressed, when the PHSO and the PACAC jointly raise specific concerns and recommend remedial action? If these reports get confined to the filing cabinet like so many before, I question the worth of their existence.

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

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APPOINTMENTS COMMUNITY INTEGRATED CARE Community Integrated Care has appointed Phil Pegler as Interim Chief Executive.

BMI HEALTHCARE

Social care system is struggling The King’s Fund and the Nuffield Trust have published a joint report highlighting the impact of a growing funding gap in the care system. The gap will reach £2.8bn by 2019/20. The report paints a gloomy picture of the effect of six consecutive years of cuts to local authority budgets combined with a rising demand for care services. The report, Social care for older people: home truths found that the social care system in its current form is struggling to meet the needs of older people. It says that no one has a full picture of what is happening to older people who are no longer entitled to publicly-funded care; the human and financial costs to them and those who care for them are mounting. The most visible manifestation of current pressures

in health and social care budgets is seen in the rapid growth in delayed discharge from hospitals. There are also increased pressures on unpaid carers. The report also highlights the impact on providers and the social care market with a stark warning. It reports, ‘The possibility of large-scale provider failures is no longer a question of “if” but “when” and such a failure would jeopardise continuity of the care on which older people depend.’ Many providers were found to be surviving by relying increasingly on people who can fund their own care. The report concludes with three major strategic challenges. • Achieve more with less – continuing the policies of personalisation, better

Supported housing funding A new supported housing funding model has been announced by the Government. Supported housing will continue to be exempt from the Local Housing Allowance cap until 2019. From then, the new model will protect the sector from the cap, with a top-up of additional ring-fenced funding. The amount of top-up funding will be set on the basis of current projections of future need. The new model will mean Housing Benefit and the housing element of Universal Credit will focus on paying for core housing costs, while still ensuring the sector is protected from the Local Housing Allowance cap.

The Government says that the supported housing funding for local authorities in England will allow them to have a more co-ordinated approach to commissioning, funding and overseeing the support in this area, driving up quality and efficiency and ensuring the right support is in place where it is needed. Housing is a devolved matter and the appropriate funding will be allocated to the devolved administrations. The Government has also announced that benefit claimants in supported accommodation will be exempt from the lower shared accommodation rate, in recognition of the vulnerable nature of residents.

commissioning and integrated care but with bringing forward Better Care Fund monies to progress a single pooled budget for health and social care by 2020. • ‘A different offer’ – the Government should be honest with the public. This means being clear that the primary responsibility for funding care sits with individuals and families. It follows, therefore, that incentives will be needed for people to plan ahead. • ‘Longer term reform’ – because reliance on additional private funding will not be sufficient and is not equitable, a longer term strategy is needed. A frank and open debate is needed on how to fund health and social care on a sustainable basis into the future.

BMI Healthcare has appointed Kevin Thomson as the Head of HealthFirst, the organisation’s UK corporate healthcare division.

DANSHELL Danshell Healthcare Group has appointed Clynt Hall as its new Finance Director. Helen Davidson joins as manager at its Thors Park hospital in Thorrington, Essex.

SURECARE RECRUITMENT Alison Dean is the newlyappointed SureCare Recruitment Manager responsible for the recruitment agency arm of the business.

SILK HEALTHCARE Silk Healthcare has appointed a new catering manager, Andrew Ford.

Castleoak and OSJCT development announcement

CARE AND SOCIAL SERVICES INSPECTORATE FOR WALES

An £8.8m development deal has been announced between Castleoak and The Orders of St John Care Trust, on the lease of a new state-of-the-art care home in South Gloucestershire. The new 70-bed care home is also designed and built by Castleoak. Construction work began in June 2016 and the home is scheduled to open in early 2018.

THE AURORA GROUP

The Welsh Government Permanent Secretary, Sir Derek Jones has appointed Gillian Baranski as Chief Inspector of the Care and Social Services Inspectorate for Wales.

The Aurora Group has appointed Kathryn Rudd OBE as Managing Director of Adult Services.

BADBY PARK GROUP Badby Park Group has appointed Diana Nash as Human Resources Director.

CMM November 2016 9

NEWS

Social Value Act – a vital tool for change A new report shows that the Social Value Act can be a vital tool in systemic healthcare change. The report published by Social Enterprise UK says that the Social Value Act can be used as a tool by commissioners to address local priorities and maximise value for every £1 spent. Social Value Difference in Health and Care Commissioning highlights how social value can be used as a lynchpin on which integration can be built, having the potential to transform health and social care services and deliver the joint-working at the heart of Sustainability and Transformation Plans. The report also calls for

time- and resource-strapped commissioners, both in clinical commissioning groups and councils, to be given more information and training on social value to help them take up the opportunities presented by the Act. The report details the findings of a three-year programme funded by the Department of Health, which brought together clinical commissioning groups, local authorities and health and wellbeing boards with charity and social enterprise providers in 12 areas across England, to explore how to use the Social Value Act to address local health and care priorities.

Coalition to champion care sector in Brexit process A coalition of 29 health and social care organisations has been established to ensure sustainable workforce supply and standards of care are maintained as the UK prepares to withdraw from the European Union. Called the Cavendish Coalition, it will offer

expertise, evidence and knowledge on health and social care issues to those leading the Brexit negotiations. The coalition includes the Care Provider Alliance, Association of Directors of Adult Social Services, NHS Employers, Royal College of Nursing and UNISON.

Dementia nursing: vision and strategy The Department of Health has refreshed Making a Difference in Dementia Nursing: Vision and Strategy. The 20-page policy document sets out the roles and responsibilities for nurses providing care and support for people with dementia. It explores how nurses can provide high quality compassionate care and support for people with dementia, so they can live well with dementia within all care settings, including a person’s own home. The strategy 10 CMM November 2016

aims to support all nurses to be responsive to the needs of people with dementia, continue to develop their skills and expertise, and achieve the best outcomes for people with dementia, their carers and families. It builds on the original strategy, published in March 2013. The document is aimed at registered nurses; directors of nursing; staff working in health and social care services; chairs and members of local safeguarding adult boards; lecturers and those who deliver professional training.

Research on anti-psychotics A research study has found that there was no significant drop in prescriptions for anti-psychotic drugs to care home patients in the four years following the Government’s 2009 National Dementia Strategy. The study by five universities, and published in the medical journal BMJ Open, describes inappropriate anti-psychotic prescription as a ‘marker of poor cares’. It also raises the issue of the frequent practice of

patients staying with their GPs (rather than one surgery supporting a care home and its residents) as a factor in not implementing a consistent prescribing practice across a care home. The Department of Health and NHS England have both restated a commitment to reducing the use of anti-psychotics within the Prime Ministers Challenge on Dementia 2020.

‘Ownership revolution’ for social care The Co-operative Party has called for an ownership revolution in social care. It states that carers, those who receive care, and their families should be represented on the company Boards of private social care providers, and given the right to own their firm when it changes hands. The report, Taking Care: A Cooperative Vision for Social Care argues that, given the dominance of private

providers and criticisms over low pay and standards of service, the care sector is the perfect place for such an ownership revolution to begin. The Co-operative Party proposes that employee and service user ownership is vital to tackling the growing crisis in social care, setting out a vision in which social care cooperatives – owned by their staff and social users – could take the place of private providers.

Hospital discharge assessments The Care Quality Commission (CQC) has issued guidance on needs assessments on hospital discharge, presumably designed to ease pressures on hospitals. CQC highlights the requirement for providers to undertake a needs assessment before providing a service and ‘to do so in collaboration with the person being

cared for or someone with the legal powers to make relevant decisions’. However, where it concerns an existing service user, CQC has indicated that it may not be necessary for ‘the provider to physically see the person’. The full guidance can be found on the CQC website.

DoLS pressures and problems New figures make explicit the pressures on local authorities by Deprivation of Liberty Safeguards (DoLS) applications. NHS Digital has released data showing that care homes and hospitals made 195,840 DoLS applications in 2015-16. This is a 30% increase on the previous year and 14 times the number made in 2013-14. Furthermore, 42% of applications made in 2015-16 were

not signed off by the end of the year. Only 29% of DoLS applications appear to have been completed within the 21-day limit. During 2015, the average duration of ‘urgent’ applications not signed off rose to 205 days. The Law Commission has been charged by the Government to bring forward recommendations to replace the DoLS scheme, which are expected by the end of the year.

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NEWS

Bupa UK acquisitions

The Abbeyfield Kent Society

Bupa UK has acquired The Lindsay and The Links care homes in Poole, from Primetower Care. The two homes are purposebuilt, designed to provide residential, nursing and dementia care. The purchase underlines Bupa’s continued commitment to providing high-quality facilities and services for the UK’s growing ageing population. Last year, Bupa acquired five care homes in the north of England

The Abbeyfield Kent Society has merged with The Abbeyfield Beckenham Society, acquiring three new supported homes in Greater London. With the merger, the Society has obtained three supported homes in

from Hadrian Healthcare with two development sites. Bupa also continues to expand its Richmond Villages business, with the completion of the first part of Richmond Witney this year bringing the portfolio to six villages. Two more villages are under construction. By the end of 2016, Bupa will also have completed refurbishing 20 more of its existing care homes and started to build four new care homes.

Care Home Open Day 2017 Care Home Open Day in 2016 attracted over 4,300 care homes to participate in the annual event which raises awareness about the role of care homes in their communities. The date for 2017 has now been confirmed as Friday 16th June. The theme will be ‘friendship’. Care Home Open Day 2017 will

be in conjunction with The Big Lunch, part of the Eden Project in Cornwall. The Big Lunch aims to get as many people as possible to share lunch together as an act of friendship. It encourages communities to connect and prevent isolation and therefore offers an ideal role for local care homes.

Shortlands Road, Bromley Road and Oakwood Avenue, in Beckenham and Bromley. In total, the homes provide en-suite rooms for up to 29 older people with shared communal areas and a house manager providing two daily meals.

Changes at TLAP The Think Local Act Personal (TLAP) Programme Board has announced that it cannot continue to fund a director after Lynda Tarpey’s contract ends in December. TLAP

will continue, however, as an independent partnership with some responsibilities being transferred to the Social Care Institute of Excellence.

Care coordination roles Skills for Care has published a summary report, Care Coordination Functions Scoping Research reviewing policy and guidance as well as job descriptions on this emerging role. It found that a number of different practice examples have been developed for

care coordination. Employers and staff agree that there is a lack of a framework detailing core functions and associated competencies for staff coordinating care. Furthermore, there continues to be a reliance on in-house training and on-the-job training.

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NEWS / POLL

Gracewell Healthcare

Carers and the NHS – Report reveals pressure points

Hamberley has unveiled the latest of a group of 10 new homes, which it is building for Gracewell Healthcare. The £10m care home in Newbury marks the next stage in the rapid roll-out of new buildings for the award-winning developer. The team behind Hamberley founded Gracewell Healthcare in 2011, and these new buildings are the first turnkey developments that Hamberley has built exclusively for the provider, since it was sold to Sunrise Senior Living and US healthcare real estate firm Welltower in August 2014, for £153m. The new care home in Newbury, on the site of a former guest house, will provide 66 en-suite premium rooms. This home will be swiftly followed by new openings in Adderbury, Bath, Bourneville, Lane End, Little Bookham, Sutton, Sutton Coldfield and Woking.

A lack of appropriate support in the community is leading to unpaid carers reluctantly taking their loved ones to A&E, according to Pressure points: carers and the NHS published by Carers UK. The report comes as the NHS prepares for its annual challenge of increased A&E visits and hospital admissions during the winter months. Carers identified serious difficulties accessing primary and community support services, with one in five saying they had no option but to take their loved one to A&E, because it was impossible to see a district nurse or a GP out of hours. One in 10 said they didn’t know where else to go. The report found that the majority of carers who have taken their loved one to A&E in the past 12 months believe their admission

could have been prevented with more (55%) or higher-quality support (50%) for the person they care for, more local support for them as a carer (32%) or access to a district nurse (25%). Over half of carers (58%) said that the person they care for had been discharged from hospital too early, with 12% saying their loved one had to be readmitted as a result. A lack of community health and care support is not only resulting in more people being admitted – or readmitted – to hospital, it is also leading to many people having to stay in hospital for longer than necessary as they wait for an appropriate care package to be put in place to enable them to go home. Pressure points: carers and the NHS is available to read on the Carers UK website.

POLL

Do you have good working relationships with your local hospitals? Yes No You can vote via: www.caremanagementmatters.co.uk

October’s results Are you considering exiting the market? NO 70%

YES 30%

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

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NEWS / IN FOCUS

NCPC boosts board

In focus

The National Council for Palliative Care (NCPC) has added five new trustees to its board. The five were confirmed at a meeting of the current board on 29th September. The five new members are: Ruston

The State of the Adult Social Care Sector and Workforce

Smith, Dr Carl Brookes, Kevin Orford, Mohamed Omer and Lord Shinkwin. Together with the existing board members, they will oversee the work of NCPC and the Dying Matters coalition.

Housing and technology fund People with learning disabilities are set to benefit from £25m of Government funding to help them live independently. This housing and technology fund builds on £20m already earmarked by NHS England as part of its Transforming Care programme, which will be used for schemes across the country in 2016/17, including new housing and services. The Department of Health has opened bidding for the £25m

fund, which is aimed at creating a range of housing and technology options for people with learning disabilities. Applications close on 28th October 2016. Only 15% of adults with learning disabilities have a secure long-term tenancy or their own home. The fund will enable more people to live as independently as possible with the best care and support, greatly improving their quality of life.

WCS Care opens home Show apartments at a state-of-theart care home in Kenilworth for people with dementia have been officially opened, as the £10.5m development nears completion. Run by Warwickshire-based charity, WCS Care, one of only two care home groups in England to have four homes recognised as ‘Outstanding’ by the Care Quality Commission, Castle Brook will be home to 84 people when it welcomes the first residents in December 2016. Castle Brook will include ensuite rooms throughout, including double apartments for residents wanting to live together, or to provide extra space for relatives

who are visiting. Castle Brook will include stateof-the-art technology, designed to enhance and integrate into daily life without being intrusive. Fingerprint recognition for visitors and staff, intelligent lifts that appear when someone stands in front of them, and advanced night-time monitoring software that contributes to a better night’s sleep, are among some of the advanced features being installed from the outset. In addition, there will be an internet-based care system, which includes a gateway for relatives to check their loved one’s care at any time, from anywhere with an internet connection.

Parkinson’s consultation The National Institute for Health and Care Excellence (NICE) has published, for public consultation, its draft updated clinical guideline on Parkinson’s disease. The draft guideline updates some aspects of NICE’s previous guideline on the treatment of Parkinson’s disease published in 2006. This includes the addition of a section on

managing and monitoring impulse control disorders that are sometimes the result of dopaminergic therapy, a common treatment for Parkinson’s disease. The draft guideline also includes new recommendations about managing Parkinson’s disease dementia and nutritional support for people with Parkinson’s disease.

WHAT’S THE STORY?

Skills for Care has published its latest report on the adult social care workforce in England, drawing primarily on the National Minimum Data Set for Social Care (NMDS-SC). The report is a vital source of robust and reliable information on key workforce issues, including: • Recruitment and retention rates. • The nationality of the workforce. • Prevalence of the Care Certificate.

AND?

The report is the most authoritative collection of data on the care sector workforce in England. It explores how many workers there are in the sector, the hours they work and the pay they receive. It also includes information on training and qualifications, turnover and vacancy rates. Such workforce information is absolutely essential for planning and commissioning.

WHAT DID THE REPORT FIND?

The report runs to 114 pages so there is a lot of information to read. Key findings include: • The adult social care sector is growing and now has some 1.55 million jobs and 23,000 employers. • Adult social care contributes an estimated £40.4bn per annum to the English economy and has an annual wage bill of £18.6bn. • Workers have an average of eight years’ experience. • 62% of direct care staff have achieved the Care Certificate or

are working towards it. • Average turnover rates are 27.3% which is an increase of 4.7% over the last five years. • 24% of the workforce are on zero-hours contracts.

HOW CAN PROVIDERS MAKE USE OF THE REPORT?

The report should be essential reading for providers, commissioners and policy-makers, not least because it offers valuable information to inform future planning. For care providers, the data is a useful source of benchmarking of key performance indicators. The trends in the report are illuminating, consider for example, the findings about the growth of the adult social care sector. The number of jobs in the sector has increased by 18% since 2009 – that is an astonishing 240,000 jobs. It is estimated that the workforce will grow by a further 18% by 2025. Providers will be competing for these workers – both amongst other care providers and other industries, especially for young people as our society ages. The trends on services are also illuminating. A 10% reduction in residential care since 2009, alongside a 7% increase in provision of care homes with nursing, and a dramatic 50% increase in non-residential care services. Adult social care, and its workforce, is changing. This report is the evidence of that change and the pace at which it is happening. The full report can be downloaded from the Skills for Care website. CMM November 2016 15

NEWS

Raft of reports explore implications of Brexit A number of new reports have been published which explore the potential implications of Brexit on different facets of social care. A report from Independent Age considers workforce issues surrounding Brexit. Brexit and the future of migrants in the social care workforce highlights the increase, over the last decade, in the proportion of European migrants in the social care workforce. In the first part of 2016, over 80% of all migrant care workers in England were from

European Union countries. Any restrictions to the migration of European citizens would, therefore, reduce the overall number of workers in social care. The report recommends a review of funding and efforts to make the sector more attractive to British-born workers. Voluntary Organisations Disability Group has published a report on key issues for third sector disability providers following the vote to leave the European Union. Post-Brexit: the impact for social care

provider organisations is a follow-up report, which examines so-called ‘hard Brexit’ and ‘soft Brexit’ options and the implications for care providers. It, too, argues that the position of European Union migrant workers is crucial to the stability and sustainability of the care sector. Finally, Papworth Trust has published new report on the impact of Brexit on disabled people highlighting concerns and opportunities. Brexit – What next for disabled people? was published

to coincide with party conference season and aims to raise awareness of the various issues coming out of the UK’s decision to leave the European Union. Social care, accessible housing, welfare and education are all debated, with the charity calling on the Department for Exiting the European Union to work closely with voluntary sector representatives to consider the wider implications for disabled people.

Shaping a new agenda for care at home

New all-female rehabilitation ward

The United Kingdom Homecare Association (UKHCA) has announced the theme of its 2016 England conference. Given the ongoing pressure facing the homecare sector, Shaping a new agenda for care at home will feature presentations from Andrea Sutcliffe, Chief Inspector for Adult Social Care at the Care Quality Commission, Alyson Scurfield, Chief Executive of Telecare Services Association

Increased demand for specialist care and a dedicated care pathway has led to Bramley Health opening a new all-female rehabilitation ward at The Langford Centre in Bexhill-on-Sea. Balmoral is an 11-bed facility providing specialist in-patient care for women with complex mental health needs. The facility is

and Mike Padgham, Chairman of UKHCA. Workshop topics include top tips for getting an Outstanding from the Care Quality Commission; Buurtzorg – can this or a similar approach be adopted in the UK?; and Effective employee engagement – what it looks like and why it’s important. The conference will take place at Leicester City Football Club on Friday 11th November.

New Manchester centre A specialised £4m treatment and recovery centre in Ardwick, Manchester has welcomed its first clients. Tesito House, commissioned by Alternative Futures Group exists to provide a recovery-

oriented therapeutic service and environment for vulnerable women who have suffered from the complex social, psychological, and physical consequences of overwhelming stress and adversity.

designed for women with long-term psychiatric conditions that are affecting their ability to function. The new service will enable people to have increased choice and independence enabling them to progress along their care pathway, living their lives as they would wish to.

Plans to cut red tape The Department of Health has announced that it is to challenge bureaucratic red tape on the health and social care frontline, to increase focus on patient contact and care. The Minister for Health, Lord Prior is setting up the Burden Reduction Challenge Panel in partnership with NHS Providers, NHS Confederation and Care England to look at red tape

in social care and health. The panel will look at evidence of both the burdens and benefits of current NHS and social care regulatory activity and will then challenge their use and necessity. Regulatory activity judged to be unnecessary by the panel and relevant officials will be amended or removed.

Parkinson’s Excellence Awards launched

Horizon Care

The UK Parkinson’s Excellence Network has launched the Excellence Network Awards to recognise the outstanding services that make a real difference to people affected by Parkinson’s. The Excellence Network launched in 2015 with the aim of revolutionising the way health and social care services are delivered to those with this degenerative, neurological condition.

Horizon Care has started work on Wood Hill Lodge in Sheffield, which is designed to support the needs of individuals with learning disabilities and complex care needs. Wood Hill Lodge will provide both short-term respite and long-term support. It forms part of a new care village developed by Horizon, designed to support a wide range of care needs.

16 CMM November 2016

A collaboration between health and social care professionals, Parkinson’s UK and people affected by Parkinson’s, the Network encourages professionals to work together for change, build an expert workforce, influence services and strengthen the voice of people affected. The 2015 UK Parkinson’s Audit shows that great care for people affected by Parkinson’s is

already happening. The Excellence Network want to celebrate it and make it standard for each and every person living with Parkinson’s across the UK. They want to hear from health and social care professionals who are delivering quality care that have made a real difference to people who are living with Parkinson’s. The entry stage closes on Friday 28th October.

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NEWS

Chatsworth Care acquired

Enhanced health in care homes

Learning disability provider, Chatsworth Care has been acquired by Heathcotes Group for an undisclosed sum. The Surrey-based group comprising five residential properties, with capacity for 36 residents, was formed in 2002 by Gabby and Graham Smith. Heathcotes will continue to

NHS England has published the framework for enhanced health in care homes. The model lays out a clear vision for providing joined-up primary, community and secondary social care to residents of care and nursing homes, via in-reach services. Seven key components and eighteen sub-components which define the care homes model are

provide high-quality residential services across Sutton, Carlshalton and Banstead. It will be expanding services in the South to provide person-centred specialist residential accommodation for adults with autism, learning disabilities and mental health conditions and associated challenging behaviours.

put forward, with practical guidance explaining how organisations and providers can make the transition and implement the whole model. The plans are designed to help transform the way care is delivered, with staff from across health and social care organisations working together as part of multidisciplinary teams – joining up care for residents.

Safeguarding adults – annual report NHS Digital has published Safeguarding Adults, Annual Report, England 2015-16, Experimental Statistics. The report provides the key findings from the Safeguarding Adults Collection (SAC) data collection for 1st April 2015 to 31st March 2016. It presents information about adults at risk for whom safeguarding concerns or enquiries were opened during the reporting period, and case details for safeguarding enquiries which concluded during

the reporting period. A safeguarding concern is where a council is notified about a risk of abuse, which instigates an investigation (enquiry) under the local safeguarding procedures. This is the first reporting year since safeguarding adults became a statutory duty for councils on 1st April 2015. The SAC data collection only includes cases of suspected abuse where a council safeguarding service has been notified and has

entered details onto their system. It does not include cases where partner agencies have dealt with the allegation and not shared the information with the council. It is likely that there are cases of abuse that have not been reported to councils. For the 2015/16 reporting year, there were 102,970 individuals with enquiries under Section 42 of the Care Act. Of these enquiries, 60% were for females and 63% of individuals at risk were aged 65 or

over. For Section 42 enquiries which concluded during the reporting year, there were 124,940 risks recorded by type of risk (one enquiry can include multiple risks). Of these, the most common type was neglect and acts of omission, which accounted for 34% of risks, followed by physical abuse with 26%. There were 110,095 risks recorded by location of risk. The location of risk was most frequently the home of the adult at risk (43% of enquiries) or in a care home (36%).

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18 CMM November 2016

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NEWS

The future of adult social care in Kent

Report on the social care activity of councils

Kent County Council (KCC) has launched a consultation on its new vision and strategy for adult social care – Your life, your well-being. The five-year plan aims to continue the redesign of social care to create an effective, sustainable and personcentred service, which can meet the challenges of the future. Kent, like local authorities around the country, is facing increasing demand from an ageing

Community Care Statistics, Social Services Activity, England – 2015-16 has been published by NHS Digital. The report looks at the social care activity of Councils with Adult Social Services Responsibilities (CASSRs) in England between 1st April 2015 and 31st March 2016. There were 1,811,000 requests for support from new clients. 28% of these were from clients aged 18 to 64, with the remaining 72% from clients aged 65 and over. There were 245,000 completed instances of Short Term Support to Maximise Independence, for new and existing clients during the reporting period. The report also found that there were 873,000 clients receiving long-term support during the reporting period. Simon Bottery, Director of Policy at Independent Age, commented on the report, ‘Today’s figures reveal the real consequences of a care and support system in crisis. Around

population with long-term, complex needs alongside severely reduced national funding, which is not keeping up with this rising demand. Over the past five years, KCC has delivered £433m of savings and the total budget of adult social care continues to rise. KCC says that, ‘These challenges must be met by redesigning how care and support is delivered and passing funding to frontline services.’

Finding and keeping workers Skills for Care would like to find out workforce issues. more about the effectiveness and It aims to be the first place impact of its Finding and Keeping providers visit for recruitment and Workers online resource, and how retention information and includes it has helped providers with their a range of useful videos, case studies recruitment and retention challenges. and websites. Finding and Keeping Workers The survey closes on 11th supports health and social care November and can be found at providers of all sizes with their www.surveymonkey.co.uk/r/FKW16

350,000 people, that’s 26% of people over 65 who asked for help from their council received no assistance at all. Of these, nearly 100,000 are older people who were discharged from hospital and asked for help but received none. While some people with low-level needs may not need formal care and support, many do. We hear regularly from those left struggling to cope on their own despite facing really serious needs. ‘What we are now seeing are the undeniable consequences of a care system that can’t manage the demands being placed on it. Budgets have been repeatedly cut, and there is a growing workforce gap in the sector. It is vital that people get the right support when they need it. Without facing up to the reality of the cost of social care, this situation will get worse, and it is older and disabled people who will suffer the most.’

CMM November 2016 19

From ‘Good’ to ‘Outstanding’

STEPPING UP YOUR CQC RATING 20 CMM November 2016

I currently have a ‘Good’ CQC rating. How do I improve on that to become ‘Outstanding’?

Karen Carter, Programme Head – Leadership and Management, Skills for Care

If you’re a business owner or registered manager, ‘How do I get an Outstanding rating?’ is a question you probably ask yourself fairly often. Following the hard work and dedication it takes to achieve a ‘Good’ Care Quality Commission (CQC) inspection rating, many leadership teams then turn their attention to achieving ‘Outstanding’. ‘Good’ is what people expect from a service. ‘Outstanding’ separates out those who are exceptional. At Skills for Care, we’re asked for advice on attaining ‘Outstanding’ so frequently that we’re embedding it into our programmes, products and services to set others on a similar path to success. Examples of how other providers have moved from ‘Good’ to ‘Outstanding’ can form a good basis for an organisation’s own approaches.

AN OPEN, BLAME-FREE CULTURE Sonnet Care Homes’ The New Deanery and St Mary’s Court were rated ‘Good’ overall and ‘Outstanding’ for leadership by the CQC in 2016. Things were very different in 2014, when one site was the subject of a Panorama documentary focusing on abuse of older people in care settings. At the time, Sonnet had just become new operators of the care homes. They acted quickly, suspending staff, reviewing their management structure, increasing their training and improving their auditing and oversight services. Julia Clinton, Chief Executive of Sonnet Care

Homes, said there was a culture in the homes that was corrosive, describing it as ‘in the brickwork’. ‘Everyone felt powerless, like they had no voice – frontline workers, relatives and, most importantly of all, residents.’ Since then, this atmosphere has been transformed by improving communication between staff, residents and relatives. Leaders are now present at all new staff inductions and make time to talk to all staff, including those working nights and at the weekend. Suggestion boxes have been installed and surveys of residents’ views are regularly conducted. Monthly meetings are also held between residents and staff. Julia continued, ‘Sweeping away all barriers to communication creates a culture of openness that has to be present if you want care to be the best that it can be. It’s the thousand little things that happen every day that make the difference.’

REGISTERED MANAGERS WHO ARE VISIBLE CQC inspection reports have revealed that there are organisations providing care in which leadership teams are practically invisible to staff, residents and relatives. It’s vitally important that leaders and managers are accessible and regularly visible in day-to-day operation. This is not just about care homes, as managers within community services should equally be known by the people who use the service and their family members. When the CQC awards an ‘Outstanding’ rating in any category, it needs to evidence why it has done so. Often, this is demonstrated by what people receiving care describe as ‘the extra effort’ leaders and managers make in supporting their day-to-day care provision. For example, a resident of one ‘Outstanding’ care

CMM November 2016 21

FROM ‘GOOD’ TO ‘OUTSTANDING’ – STEPPING UP YOUR CQC RATING

provider said it gives them happiness to see the registered manager on a regular basis. ‘The registered manager is always walking around the service asking us how things are going. They join in with all the activities, and really care about the staff.’ Another resident described the extra input by the leadership teams across the festive period as particularly heart-warming. ‘The management team and the owner can be found talking and sharing a laugh with all who live there, as well as being found cooking the Christmas dinner!’ Visible registered managers promote a culture of teamwork and a strong work ethic through their presence. This inspires and encourages frontline care staff. One care worker from an ‘Outstanding’ rated provider said it means she enjoys her job. ‘You know that they will go to the ends of the earth to make just one small difference to improve people’s lives. It makes me happy to come to work.’

A COMMITTED MANAGEMENT TEAM Management teams are there to support their staff, so that staff can support those who need their services. Ineffective management teams can leave staff feeling stressed and disenchanted. Julia Clinton from Sonnet Care Homes explained that their commitment to overhauling their services is responsible for their success. Julia and her colleagues committed themselves to an ambitious culture change strategy and then set about embedding it in their organisation. ‘Our first step was to develop a set of values for the homes that would be at the core of everything that came next. Kindness, comfort and respect became our mantra. We worked with staff so that they knew what kind, comforting and respectful care looked like in practice, not just in theory.’

HIGH RECRUITMENT STANDARDS Recruiting the right people is key to the success of any ‘Good’ or ‘Outstanding’ rated care provider. It is rare to find an inspection report from such an organisation that does not mention effective recruitment practices. Kevin Hewlett, Director and Registered Manager of ‘Outstanding’ rated Hale Place Farmhouse, said, ‘If we were to drop recruitment standards to fill vacancies, our person-centred culture would become a part-time objective and an enormous burden on the registered manager and person

in charge of each shift. We take time to recruit care workers who smile and have a humanistic approach to care.’ He also mentioned their commitment to retention and the happiness of their staff as a factor in their ‘Outstanding’ rating. ‘We look at our staff objectives, aims and goals and support them to achieve, even if that means developing them into roles outside our organisation. The benefits are wide-ranging – they feel valued, supported and are happier.’

STRONG LINKS TO THE LOCAL COMMUNITY Working in social care is so busy, it’s easy to stick within your own little bubble, but ‘Outstanding’ rated organisations tend to have strong links with healthcare professionals, other care organisations and other experts. Vida Healthcare, an ‘Outstanding’ rated organisation in Harrogate, regularly appears on its local radio station to talk about social care issues facing the local community and promote quality care. Some of the best ways to stay connected with the local community is to invite people into your premises, arrange events and use local media. You can also invite people to social events or meetings on a more regular basis. One provider explained that ‘Relatives and family members are warmly welcomed and frequently attend our social events. Here, barriers are broken down, relationships are developed and trust is cemented.’

CELEBRATE ACHIEVEMENTS Everybody likes to be celebrated – to be told that the work they are doing and the effort they put in means something. No matter what the rating of your organisation, it’s important that you continue to applaud and reward staff who are working hard and in the way that you want them to. There is nothing to stop you celebrating your achievements locally, too. If you receive a ‘Good’ or ‘Outstanding’ rating or you have turned your service around, why not contact your local media and sing the praises of your staff? A news story would promote your services, provide you with evidence of celebration for the CQC and make your staff proud. One care home we spoke to said praise from outsiders was special to their team. ‘It always holds more weight when

praise comes from outside observers. Staff could not quite comprehend the small percentage of homes that had achieved “Outstanding” – it made them more proud to be part of it.’ When Vida Healthcare won a Skills for Care Accolade in 2016, the management team contacted their local press and received a letter from their local MP. ‘We plastered it all over our website. We plastered it all over Twitter. Our local newspaper put it on their Twitter account. We were in the Guardian. We were congratulated personally by the CQC and the Head of Skills for Care. I had a member of staff come up to me to talk to me about how they felt and she said, “I am so proud to be part of this company”.’

DO EVERYTHING WELL There is no instruction manual for ‘Outstanding’ ratings. Organisations that are rated ‘Outstanding’ are most likely doing everything well, including learning from mistakes to improve their practice. It seems like an overwhelming task in a sector that is struggling with financial difficulties and a bad reputation, but it’s achievable. Although it’s incredibly rare for an organisation to be rated as ‘Outstanding’ across all five categories, it does happen. The important thing to remember is that you should be trying to provide the highest quality care for those using your services, at all times. If you’re working towards that with a strong team, you’re probably on your way. Registered managers can have a direct impact on the rating of your service. The ‘Well-led’ category is the most closely aligned to all other categories. Those organisations rated highest for being ‘Well-led’ tend to get higher ratings overall. Skills for Care is embedding the knowledge we’ve learned from ‘Outstanding’ care providers into a leadership programme beginning this autumn. The Skills for Care Well-Led Programme is grounded in the reality of social care delivery. It provides the opportunity to develop leadership skills, make valuable advances in the service and have real impact in the workplace. It includes details of what ‘Well-led’ organisations do to achieve and sustain high standards of leadership and how to apply these examples across your own organisation to deliver high-quality, person-centred care. Although there can be a big leap from ‘Good’ to ‘Outstanding’, by learning from others, you have tried and tested approaches to try. CMM

Karen Carter, Programme Head – Leadership and Management at Skills for Care. Email: karen.carter@skillsforcare.org.uk Twitter: @SkillsforCare Are you striving to achieve ‘Outstanding’? Share your methods at www.caremanagementmatters.co.uk Subscription required. For more information, visit www.skillsforcare.org.uk/developyourself 22 CMM November 2016

PROTECTING YOUR CARE BUSINESS BETTER THAN EVER BEFORE CHIS (care home insurance) and PrimeCare Insurance (domiciliary care insurance), two specialist services under one roof. It is this recognised market expertise that sets us apart from others, enabling care providers to benefit from the very best value for money insurance and advice on risk-related matters. Call us now on 01273 645 928 or email simon@chis.net for your free no obligation quotation for your insurance needs.

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BREAKING DOWN BARRIERS Healthcare for people with learning disabilities

24 CMM November 2016

The health of people with learning disabilities is affected by problems accessing healthcare, or by issues such as poor housing and unemployment. A 2013 Confidential Inquiry into Premature Deaths of People with Learning Disabilities showed that, on average, men with learning disabilities die 13 years earlier than the rest of the population and women die 20 years earlier. Added to that, in early September, NHS England data revealed that 92% of health organisations need to improve

how they treat people with learning disabilities. However, these inequalities are preventable and the health sector is developing work on this issue. Take, for example, the 2015 launch of NHS England’s first National Learning Disability Mortality Review Programme to review – and ultimately reduce – the premature deaths of people with learning disabilities. Then, there is its work to improve take-up of routine health checks. However, alongside health, there is also a major role for social care providers to help people access good healthcare and lead a healthy lifestyle. A recent Voluntary Organisations Disability Group (VODG) debate, for example, reinforced the need for closer collaboration between health and voluntary sector care organisations in supporting people with learning disabilities. As part of the work in this area, VODG and the National Development Team for Inclusion (NDTi) have published the second edition of detailed guidance for social care providers on how to use a sectorwide Health Charter.

THE HEALTH CHARTER

People with learning disabilities experience poorer health and die younger than people in the general population. Rhidian Hughes explores the need for closer collaboration with health and the role of the updated Health Charter in breaking down barriers to good healthcare.

The Health Charter itself was originally co-produced in 2012 with providers, commissioners, selfadvocates, carers and health staff. It is designed to be a practical resource to help improve the wellbeing of people with learning disabilities. Organisations sign-up to the Charter and outline what they will do to boost people’s health; there is a selfassessment framework and guidance to build practice upon. The requirements of the Care Act, combined with the compelling evidence of health inequalities, mean that providers – and commissioners – must prioritise the individual health and wellbeing needs of people with learning disabilities. This makes the Health Charter, funded through a voluntary sector strategic partner

CMM November 2016 25

BREAKING DOWN BARRIERS – HEALTHCARE FOR PEOPLE WITH LEARNING DISABILITIES

programme between VODG and the National Care Forum, backed by the Department of Health, NHS England and Public Health England, more relevant than ever for social care professionals. More than 100 adult social care employers have signed up to the guidance, which covers issues such as: • How to ensure all staff understand and apply the principles of mental capacity laws. • How to listen to, respect and involve family carers. The resource includes practical steps on how to provide staff training on health and how to promote access to screening tests. Those already on board say the approach offers a clear commitment to addressing health inequalities, and sends an important message to commissioners. The Charter has also been used to help with regulatory compliance, for example, organisations that have embedded it into their strategies find that it drives improvements in services. For Michaela Hopps, Tees Esk Wear Valley NHS Foundation Trust Team Lead, Specialist Health Team, the benefits are clear, ‘The Care Act firmly places the emphasis on wellbeing, and care providers have a legal duty to anticipate health needs and act accordingly, to avoid delays in care and treatment. The Health Charter is an invaluable tool for us to identify gaps in service through selfassessment and determine priorities for care delivery.’

IMPLEMENTING THE HEALTH CHARTER Durham County Council, commissioning in partnership with Tees Esk and Wear Valley NHS Trust Learning Disability Health Facilitation Team, hosted an event to promote the Charter. The aim was to raise awareness about it and encourage

providers to sign up. The focus was on ‘we’re all in it together’, underlining the responsibility that both commissioners and providers have in playing a vital role in improving health outcomes for people with learning disabilities locally. The event reinforced the importance of an integrated approach and coproductive partnerships. The event included talks from guest speakers and a range of market stalls from health and social care agencies, as well as the Care Quality Commission. Such agencies provided information and practical resources to support organisations to implement the Charter. Providers also received a resource pack with additional information about the Charter, as well as all the presentations and contacts. By doing this, Durham County Council has delivered a clear message calling for action. It is asking providers to familiarise themselves with the Charter, sign-up and identify three key priorities. This call to action has been followed up with training and awareness-raising, as well as signposting to specialist support. Most providers of supported living and residential care in County Durham, alongside some day care providers, are now signed up to the Charter. Its implementation has also enabled commissioners to identify gaps in health services and prioritise resources. It has helped target those providers who most require support, particularly organisations supporting people with complex health needs. Social care charity, Vibrance was a member of the focus group that originally supported the development of the Charter. Vibrance staff are trained to challenge barriers to healthcare, so the introduction of the Charter underlined the importance of supporting people to access mainstream healthcare. Jean Jay, Director of Development said, ‘Vibrance believes

the introduction of the Health Charter offers the opportunity to underpin practice that is already expected from our own staff, providing a tool and reference point for staff to use when speaking to healthcare partners. We have been able to present our experiences to local authority partnership boards, giving the opportunity to raise the profile of the Health Charter for wider impact.’ Vibrance held a series of presentations for managers and staff, sharing research and data about the inequalities experienced by people with learning disabilities. Staff highlighted the importance of the annual health check, and the need to monitor the take up of annual health checks across all services. As well as using case studies to stress how to use existing safeguarding processes to challenge inequalities, Vibrance circulated accessible information on health issues and contact details for different liaison nurses at acute hospitals and in community teams. Crucially, the organisation amended the annual audit for each service to include a check on how mental capacity is assessed, encouraging staff to see whether best-interest decision-making processes were used.

noticed that some of Margaret’s treatments for her chest infection had been stopped. She found that there was a do-not-resuscitate order on her profile. The doctor in charge of Margaret’s care informed her that the team did not feel that Margaret’s quality of life was good enough and, therefore, they did not think it was in her best interests to be treated. However, there had been no assessment or record of Margaret’s mental capacity, no multi-disciplinary best interests meeting, and – of greater concern – no discussion with the family. Vibrance arranged for a meeting with the ward staff and Margaret’s family the next day, but unfortunately none of the clinical team attended. Vibrance spoke with the community learning disability team, who put them in touch with the local safeguarding adults team. The safeguarding team then took control of the situation, involving Margaret and her family at every stage to challenge the hospital’s processes. The do-not-resuscitate order was removed, Margaret’s treatment resumed, her health improved and she was able to return home. Her family made a formal complaint to the hospital, who have since said they have reviewed their processes.

IMPACT OF THE HEALTH CHARTER

IMPROVING GOOD PRACTICE

This type of work impacted on the life of Margaret, who lives in shared, supported accommodation. Margaret has severe epilepsy and a history of chest infections. Although she has very complex physical and learning disabilities, and very little verbal communication, she clearly expresses her mood, likes, dislikes and wishes. Margaret has had many hospital admissions, and these have been of varying quality. On one occasion, a Vibrance member of staff went to visit and

It is encouraging that some good practice exists in the health sector to specifically support the treatment of people with learning disabilities, but Margaret’s experience proves that this is currently the exception, not the rule. If we are to speed-up progress on reducing health inequalities of people who need support, many more must adopt a far more proactive approach in this area. The second edition of the Health Charter in Practice is available to download at www.vodg.org.uk CMM

Professor Rhidian Hughes is Chief Executive of Voluntary Organisations Disability Group. Email: rhidian.hughes@vodg.org.uk Twitter: @RhidianHughes Visit www.caremanagementmatters.co.uk for more information on the reports mentioned. Subscription required. 26 CMM November 2016

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Barclays is a trading name of Barclays Bank PLC and its subsidiaries. Barclays Bank PLC is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority (Financial Services No. 122702). Registered in England. Registered number is 1026167 with registered office at 1 Churchill Place, London E14 5HP. *Please note: this is a mobile phone number and calls will be charged in accordance with your mobile tariff.

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BREAKING THE MOULD – FROM DAY SERVICE TO EMPLOYMENT A new, innovative day service and respite for young people with autism and learning difficulties is to open in the North-East. The Vault will offer respite as well as on-site training opportunities for clients and individuals in the wider community. Its aim is to get people into employment. St Camillus Care Group is a relatively new social care organisation. Based in Gateshead, it is establishing itself as a provider of day services, respite care, training programmes and work-based internships for people with learning disabilities or autism. The company was set up to try to meet the growing needs of local people with learning disabilities or autism. It is striving for its services to meet the high expectations of clients and carers; enabling people to gain skills, build confidence and, ultimately, find paid employment. With their new project, the senior management of St Camillus have set out to co-design day provision and residential accommodation, to make sure that clients have bespoke services to meet their specific needs. Its aim is to offer more than day services and respite. They want to offer meaningful opportunities for the people who attend, as well as the wider community, with the intention to enable clients to be fully-trained to join the local workforce, wherever possible.

MAXIMISING POTENTIAL The management believe that everybody has a right to maximise their potential and they declare that anything short of this aim would mean they have failed their service users. As a result, they are designing their day provision to have a meaningful, strong, outcome-based curriculum that is built around the needs and wishes of the clients and their carers. 28 CMM November 2016

St Camillus Managing Director, John Heron knows first-hand the benefit of good opportunities for people with learning disabilities or autism. John has learning difficulties and his personal understanding of what young people may struggle with is the driving force behind the company. He wants to help others by providing a route to employment in a safe and fun environment in which the students can grow in confidence and really find themselves.

THE VAULT This ethos is reflected in Camillus Care’s new, innovated day service and respite, The Vault. Set on the banks of the River Tyne, on the site of the former Rivers Edge Hotel, The Vault will offer respite care and day opportunities for young people with learning disabilities. It is intended to equip clients with the necessary skills to work in the hospitality industry. Planning permission was granted in August and refurbishment work is underway to transform the 28 bedrooms of the former hotel, to make them suitable for respite care. It is hoped that these works will be completed by the end of November. The Vault will not only provide day services and respite care to young people, but, true to the company’s ethos, it will also train them to work in the hospitality industry. St Camillus wants the Vault to be the first of its kind in the area, and provide users with a truly unique

and tailored experience. John explained more about the project, ‘There are very few opportunities for people with learning disabilities or autism. ‘At the Vault, we offer an internship and a traineeship within the hospitality industry. The main contributing factor behind choosing hospitality is that we feel that our learners have an extra eye for detail which would benefit hotel operators. ‘We firmly believe that breaking the mould on existing provision, and allowing the service user to develop their own package of care, is the key to not only the happiness of the service user and carers but also helps to make sure that the user can enjoy an active lifestyle and social life.’

TRAINING AND EMPLOYMENT To provide people with autism and learning disabilities with the tools and support to have a full life, Camillus Care is offering full training and employment within the Vault, with real links to employers outside of the building. The ground floor has been transformed into an American-style diner, which is currently being used by clients. The intention is to open it to the public in due course. Training has started on giving young people with autism or learning disabilities the opportunity to work in the Vault alongside trained staff. The venue also has a function room, which is currently being used by clients; however, as with the diner, the intention is to open

it up to the wider community for business meetings and celebrations. John commented on how young people can get involved, ‘People can book onto our course through the job centre, Gateshead college, or self-referral. We also offer out-ofborough learners the opportunity to stay with us in one of our newlyrefurbished rooms for the duration of their course. In conjunction with the hospitality qualifications gained, clients will also learn the necessary life skills readying them for their own independence. ‘We have been open to our learners since May and we have placed three into employment already. We aim to place as many learners as possible into employment and help them transition into their role. Our commitment to them is that we will always be there for them going forward.’ CMM

OVER TO THE EXPERTS... Combining respite, day services, training and employment offers young people a complete pathway to work, with the necessary support to assist them. Is this approach one that could be emulated elsewhere? Is this kind of pathway needed to support young people into employment? Does it offer opportunities for young people to find their role in the wider society? Is it an option for diversification amongst specialist care providers? What does the panel think?

APPLAUDED FOR MEETING THE CHALLENGE HEAD-ON I have an abiding memory of someone we support telling me how he’d stopped claiming benefits because he’d started working. He was full of pride at his new found independence, as well as loving the opportunity to make new friends. Such independence is an aspiration we have for ourselves and our families, and one we should have for people with learning disabilities. This is why it is fantastic to hear about an organisation delivering change through employment training for people with learning disabilities. By providing this pathway, The Vault will be bringing about opportunities that help people connect with their communities, overcome loneliness, and develop the skills and self-confidence necessary to find work and friendships. Without such schemes, people with learning disabilities can become lonely, and are unlikely to have the resources they need to find work and

employment. FitzRoy continually looks for ways to break down frontiers for those with learning disabilities to achieve full integration in their communities. This approach was strengthened last year when, through our research Who will care after I’ve gone? with families and parents of adult children with learning disabilities, we learnt that many live in fear for their children’s futures. Parents told us that they are often so worried about what will happen to their son or daughter after they’ve died, they hoped their child died before them. This is a call to arms to all of us to seek ways to stop vulnerable adults falling through the gaps in social care provision and provide the support they need to live fulfilling lives, and I applaud the Vault for meeting this challenge headon.

Anna Galliford Chief Executive, FitzRoy

AN INNOVATIVE AND TAILORED APPROACH Anything that increases opportunities for disabled people – whilst ensuring they are the right opportunities – should be welcomed. The Vault looks like an innovative and tailored approach by St Camillus Care Group. It is clear that they have not just stopped at providing excellent respite care for local people in the North East with learning disabilities or autism. By providing the right level of support for people, they will also be using the former hotel as a platform for suitable work opportunities and training. The fact St Camillus Care Group is using its services to provide training to young people with learning disabilities, so that they can have the necessary skills to work in the hospitality industry is also heartening. It is clear that innovation is happening right across the social

care sector. I believe that the third sector is leading the way and it is great to see projects all over the country that are ensuring disabled people aren’t left behind. As a leading disability charity, Papworth Trust prioritises social care and employment, along with housing, and this is a perfect marriage of that. From Newcastle to Newmarket, our needs as individuals aren’t so different. We want a home, support and employment opportunities. As we all know in social care, the Government has set an ambitious and welcome target of halving the disability employment gap by 2020. As a sector, we must work together with the local economy. This will help to break down any perceived barriers and challenges that occur when it comes to employing disabled people.

Vicky McDermott Chief Executive, Papworth Trust

GOING AGAINST INCLUSION AND INTEGRATION In 2016, we are looking at full inclusion of disabled people into society, at every level, as in Article 19 of the UN Convention on the Rights of Persons with Disabilities, the right to live and integrate into the community. To set up a day service that also includes a respite service and onsite training opportunities services seems like it is going against the principle of inclusion and integration. The best way for people with autism and learning disabilities to gain employment skills is to be in the workplace, alongside the rest of the non-learning disabled workforce on internships and work experience. Not in a segregated separate service. Young people need to attend college not day services, if they are learning about the hospitality industry, why aren’t they in college alongside other non-learning disabled students and having

internships in local hotels? Why open a separate American diner, rather than support existing restaurants to become inclusive employers? I would have concerns that a 28-bed respite care unit could constitute an institution. Would you want to go somewhere for a break with 27 other people you don’t know? I know I wouldn’t. We shouldn’t be building new institutions in 2016 and trying to convince ourselves that these will give people with learning disabilities a ‘unique and tailored experience’. If we are really committed to supporting people with learning disabilities to fulfil their dreams and be treated with the dignity and respect that we want for ourselves, then I don’t believe that this is the way to do it.

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A VIEW FROM THE TOP

P A U L S I M I C Paul Simic, Chief Executive, Lancashire Care Association.

I interpret the ‘view from the top’ as being more about an overview analysis than pronouncements from someone who feels they occupy a royally-elevated position, so, with that Corbyn-esque democratisation of leadership, I'll begin. REFLECTIONS ON THE LAST DECADE At LCA, we have been trying to work effectively with local authority and health colleagues at a strategic level since about 2005. That’s about a decade, isn’t it? What comes most to mind as I reflect on that period from the threshold where we stand now, at the eve of the ‘integration’ era? Er...Jackanory. While fees and funding dominate the sector discourse, and shock-horror headlines the sector’s image, it is really about the story. The NHS has one and it is revered. Talking of the NHS can bring a tremulous note to the speaker’s voice and the expression you see in those Russian posters that showed the conquering proletariat staring steely-eyed to a new dawn. The immense positive regard is also a much-needed sustaining force. However, when we refer to the independent care sector, in many ways indistinguishable from the NHS, it causes no such swelling breast. The template precedes and frames the reality. The worst of the NHS, when it comes to light, has no impact on its overall positive narrative; while the best of the independent sector doesn’t make a mark on its critical template.

These templates are not the reality, which is fantastically more complex – nor is the debate framed in the same way across the third and private sectors – but the filters shape thought, perspective and attitude amongst even the most sophisticated of professionals and policy-makers. It is, oddly enough, these intangibles – barriers arising from the ways people think – that feature largest in my reflection on the last decade. I didn’t know I was going to say that here. Perhaps I’ll rephrase it. A decade of under-funding and a longstanding workforce crisis leaves the independent sector fragile. It is struggling to meet the overwhelming demand, increased expectations and needs, and overregulation that characterises the sector. It has been a decade where we have seen ever-greater resources going to an army of regulators and overseers, who have questionable impact on ultimate care outcomes and are not regulated properly, while frontline care struggles for air. PROJECTIONS FOR THE NEXT DECADE Integration and workforce are the watchwords. Integration is the next big thing. It means different things to different people. One thing I hold true: independent care providers need to have an effective voice in shaping integrated care. Also, without addressing the workforce crisis, it’s just putting new wine in old bottles. The absence of a sustaining

narrative and affective attachment for the independent sector weakens that voice. The challenge for us is to develop that narrative and workforce self-esteem. In Lancashire, we are having some ‘blue-sky’ thinking about a care academy – working with schools, further education and higher education – to help make care the source of pride we want it to be. INSIGHT I'm a chief executive in the not-for-profit sector, facing the big-small challenges anyone in a similar position faces. How do you do the big things well, the aspirational aims, and also make sure you’re on top of all the detail, not least your finances? INFLUENCES My biggest musical influence is Jeff Lynne. But I don’t think that’s relevant. My wife is my biggest influence. Honestly! She is organised, pragmatic, has clear standards and has drive. She helped me find direction and focus. She’s an occupational therapist! She won’t read this, so I’m not just saying it for effect. ADVICE One thing I’ve learned – oh, no, I said that phrase – is there’s always a danger in being influenced by people or ideas you like or who make you feel comfortable. The challenge is to learn from people you don't like and learn from situations you wouldn't choose to be in. I’ve also learned, it’s much easier to say than do. CMM CMM November 2016 31

Marketing in social care recruitment What role does marketing play in social care recruitment? David Huckerby explains all.

Recruitment is a word on everyone’s lips at the moment, whether talking about the effect of Brexit on the status of thousands of EU workers, the perennial shortage of nurses or the impact of continued underfunding from the Government, the conversation never veers far from the dreaded ‘R’ word. As a public relations specialist, you may wonder why I am writing about recruitment. We work with care providers to raise their profile, improve occupancy and grow their businesses. Recently, clients have asked us to work with their HR teams to support their recruitment initiatives. The reason for this is simple. Organisations are starting to understand that their reputation, as an employer, can have a substantial impact on their ability to attract high-quality staff. Staff that are critical to the sustainability of their business. Whether you like it or not, your organisation will already have a reputation as an employer, be that a good one or a bad one. Recruitment is rarely a cheap exercise. By putting some time into building a positive ‘employer brand’, you could attract great talent, saving yourself a significant amount of time and money.

32 CMM November 2016

CHALLENGES TO EFFECTIVE RECRUITMENT Much has been written recently about the challenges facing care providers, but it is worth reiterating the factors that are having a direct impact on providers’ ability to recruit effectively. The social care sector may need to fill an extra one million jobs by 2025 to cope with the increasing demand for services. This demand comes from, among other causes, a growing ageing population. Ongoing underfunding continues to constrain providers’ abilities to compete in the jobs market. Providers are reliant on the rewarding aspect of increasingly challenging roles. However, this can only go so far when prospective candidates consider the potential strain on their health, personal lives and bank balances. There is also much that social care needs to do to make itself attractive to young people when mapping out their study and career choices. Whether that’s a more structured career path, more understanding of the opportunities, or merely a sector-wide push to ensure that its workforce is valued, nurtured and treasured as the undoubted heroes they are.

WHY RECRUITMENT AND MARKETING HAVE GROWN CLOSER With so many options for recruiting people, it is very easy to burn through a recruitment budget quickly. This places a strong emphasis on effective targeting, which is where marketing and PR teams come into their own. They have spent years getting to know specific audiences, how to reach them and how to carefully package and deliver key organisational messages that will resonate with them. Positioning your organisation as an employer of choice can be a careful process. However, it is not always the most direct and obvious routes that are effective. Good PR teams can highlight the benefits of choosing a particular company in a more measured, subtle way, cutting through much of the traditional, hard-edged recruitment messages. Neil Eastwood, founder of Sticky People, summed this up particularly well recently, saying, ‘Marketing and PR is an increasingly important aspect of care recruitment, because employers now have to work much harder to find and attract

CMM November 2016 33

quality candidates against a backdrop of increasing competition. ‘These disciplines play a major role in raising local awareness, driving traffic to your website, differentiating your employment offer, engaging audiences on social media as well as communicating the culture and values of your organisation. ‘I don’t see how providers can compete in today’s jobs market without a marketing-led approach to recruitment.’ Social care talks a lot about the need to be honest and authentic when communicating with key stakeholders. Essentially, you want to let people know what makes your organisation

“Just as when you market your business to potential customers, the messaging and branding you choose for recruitment is crucial. It needs to be consistent, authentic and memorable.” unique and what makes it a great place to work. If, as a company, you are there for the right reasons and honest about your shortcomings, it can create an authenticity. This is often easier for smaller providers to achieve, coming across as personal and engaged employers.

MAKING BEST USE OF ALL MARKETING AND RECRUITMENT CHANNELS Print advertising, job boards and recruitment companies are all viable solutions to meet shortterm recruiting needs. However, to continue to attract real talent, organisations need to develop a strong brand that is synonymous with being a good employer. Each time you come into contact with a potential candidate is an opportunity to engage and enthuse them. Don’t ignore certain ways of recruiting people. Don’t continuously churn out one-dimensional recruitment pleas. This risks alienating potential recruits and creating a

negative lasting impression on them. You could be seen as old-fashioned or inflexible, none of which are great traits in a would-be employer. Just as when you market your business to potential customers, the messaging and branding you choose for recruitment is crucial. It needs to be consistent, authentic and memorable. It is also far more effective to adopt a drip-feed approach towards marketing-led recruitment, rather than a blast campaign as and when you need to bolster your staff numbers. Recruitment should not be turned on or off depending on the needs of the business. It should be a consistent effort to communicate with the best talent for your business and build a desire to join your company in their minds. To put this into some context, finding a care provider for a relative is something that the average person may do two or three times in their lifetime. They are certainly not on the lookout all the time. However, if they have read good things about a particular provider in their local paper, met them at a local community event and read a helpful online article they have written about choosing care, they are far more likely to pick up the phone and talk to them when the time does come to source care. This is just the same for potential employees – very few people regard a job as being for life anymore. You need to be in their minds when they are either in a period of unemployment, unhappy with an existing job or merely looking for a fresh challenge. The beauty of effective marketing-led recruitment is to turn the process on its head and develop a situation where people want to be part of your organisation. It is equally important to use social media effectively to promote open opportunities and share engaging content about the culture of your organisation. Social media has a place in generating sales. It also has a place in the recruitment-marketing mix. Social media offers a great opportunity for small companies to compete with the big players. This is certainly true with recruitment. Small providers naturally come across as more personal and closer to the frontline. For this reason, it is crucial that, if you are a larger provider, you establish a personality for your business. To do this, imagine this personality in human form (someone famous is normally easier). This can give you a feeling of what your business might say and how it would say it. Share this with your colleagues and even put a picture of the person

Top tips for developing a marketing-led recruitment strategy 1. Develop a marketing-led recruitment strategy that sets out: • Your target audience. • Where you are likely to reach them. • The key messages that will build your ‘employer brand’ effectively.

2. Ensure your messaging and branding is consistent with the actual experience of working for your organisation. • Invite feedback from your existing workforce, you may be surprised how positive they are about you as an employer. • Even if they’re not, they will be an invaluable source of ideas about what you do well and what you could be doing better.

3. Review every place you come into contact with a potential candidate. Each one is an opportunity to attract talent, try not to waste it. • Website. • Social media. • Local press. • Events. you have in mind on the wall. I believe that, over time, the company with the more compelling story will attract the best talent. As with every other aspect of marketing and communications, if you stand still and stick to tried and tested methods, your competitors will be innovating and you could be left behind. CMM

David Huckerby is Director of GD PR & Media Ltd. Email: david@gd-pr.co.uk Twitter: @GD_PR Have you considered using marketing in this way? Share your thoughts at www.caremanagementmatters.co.uk Subscription required. 34 CMM November 2016

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The Lesson Plan outlines a suggested running order for the session which incorporates the use of this training DVD and also optional pause points where the trainer may wish to stop the DVD. This may be to facilitate a group discussion on a particular issue or carry out an exercise or activity to improve trainees’ understanding and retention of key learning points. The supporting materials referred to in the Lesson Plan could include case studies, group and/or individual exercises and information handouts. Handouts that can be photocopied are listed in the Handouts folder on the CD-Rom.

Domestic waste or municipal waste requiring disposal to a licensed landfill site. Recyclable components should be removed through segregation. Clear/opaque containers may also be used for domestic waste. Safe management of healthcare waste 7658:1.8: England (2011) http://www.spaceforhealth.nhs.uk/sites/www.spaceforhealth.nhs.uk/files/7658-England-7658%3A1.8%3AEngland.pdf

As you prepare for your session you may also wish to carry out your own independent research into the subject matter. Those that have limited training experience may also find it useful to refer to the Trainer’s Guide held on the CD-ROM. This aims to help develop an awareness of training issues and how to get the most benefit out of a training session.

Trainer Introduction Notes The supporting materials provide the trainer with a variety of activities including discussions, quizzes, case studies and practical demonstrations that help to emphasise the use of safe systems at work and the necessary guidelines to achieve best practice for infection prevention and control. Depending upon the number of individuals attending the training session, it is recommended that sufficient time is given to the session so that topics raised in the DVD can be discussed and subsequently reference made to local policies can be examined. Alternatively, trainers can conduct shorter sessions of 30 minutes and concentrate on one individual topic area at a time, e.g., hand hygiene.

Bibliography and Websites Bibliography DH (2009) Health and Social Care Act 2008 DH (2008) Health Care Act 2006: Code of Practice DH (2007) Essential Steps to safe, clean care NICE (2003) Infection control: prevention of healthcare-associated infection in primary and community care. Available on line at: http://www.nice.org.uk © BVS Training Ltd. Permission is given to photocopy for training purposes only when product is purchased.

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Challenging CQC's fac t u a l a ccu ra cy

new developments The process of seeking factual accuracy corrections to the Care Quality Commission’s (CQC) draft inspection reports can be cumbersome and extremely frustrating for care providers. However, a recent court case may change the process for the better. Carlton Sadler explains.

There are a number of ways that providers can challenge the factual accuracy of draft inspection reports. They can include: • Correcting clear factual inaccuracies. • Seeking amendment of statements which, though factually correct, give a misleading impression. • Seeking clarification of the true extent of concerns lying behind phrases like ‘People said there were insufficient activities to occupy them in the day.’ For instance, how many people? • Seeking the inclusion of additional information, which may have been omitted, in order to provide balance.

> CMM November 2016 37

CHALLENGING CQC’S FACTUAL ACCURACY – NEW DEVELOPMENTS

At times, it can seem that CQC will adamantly seek to maintain wording in the draft report in the face of cogent evidence to the contrary. However, a recent Administrative Court case offers some encouragement for providers that CQC's processes for dealing with factual accuracy challenges may be fairer and more objective in the future.

WHAT ARE THE FACTS? The case concerned CQC’s inspection of a GP surgery operated by SSP Health Limited (SSP) in November 2014. Following the inspection, CQC sent the provider a draft inspection report in February 2015 which gave the practice a rating of ‘Inadequate' for the domains of ‘Safe’ and ‘Well-led’, with the other domains being rated ‘Requires Improvement’, leading to an overall rating of ‘Inadequate’. SSP submitted a factual accuracy comments log setting out eight points of challenge to the draft report. These comments were considered by the lead inspector from the inspection team who accepted two of the proposed changes, but made no amendment in respect of the other six challenges. The inspection report was finalised, maintaining the overall rating of ‘Inadequate’ and the practice was placed into ‘Special Measures’. Following publication of the report, SSP submitted a quality rating review request. This request, amongst other things, repeated and elaborated on some of the points SSP had made in its factual accuracy log. However, the request did not allege any failure by CQC to follow its stated process, in the provider handbook, for awarding and aggregating ratings. Due to this, CQC notified SSP in June 2015 that its request for a review of the rating would not proceed.

JUDICIAL REVIEW Following this, SSP brought a judicial review challenge of CQC’s June 2015 decision to refuse the quality rating review. In strict terms, this challenge was unsuccessful. Mrs Justice Andrews held that the CQC had acted correctly in deciding not to carry out a quality rating review, on the basis that its processes made it clear that such reviews would only be carried out on the grounds of an alleged failure by CQC to follow its processes for making and aggregating ratings decisions. However, the nature of the argument advanced by SSP changed during the course of the judicial review proceedings. Helpfully, the Court spent some time considering SSP’s concerns regarding CQC’s handling of the earlier factual accuracy process.

FACTUAL ACCURACY CONCERNS It is informative to look at some of the formal factual accuracy challenges that SSP raised regarding the draft 38 CMM November 2016

report and CQC’s response to those challenges at the factual accuracy stage. Providers may find some of the themes familiar: 1. Register of older people – the draft report stated, ‘The practice did not keep a register of all older people to help plan for the regular review of care and treatment.’ In the factual accuracy log, SSP pointed out this was incorrect and that there was such a register. In rejecting this challenge at the factual accuracy stage, CQC stated, ‘There was a lengthy discussion with the practice manager about how the practice ensures the needs of older people were met. We talked specifically about registers and practice profiling and he was not aware that this took place or that registers were kept. No evidence was presented for this during the day, including the one referred to here, and ample opportunity was given for this during our visit.’ However, the Court pointed out that none of these points provided any justification for CQC to maintain an assertion that the register of older people did not exist. Mrs Justice Andrews went on to state that the

“The case is an important step forward in terms of ensuring more rigour in the factual accuracy process, which should provide greater safeguards for providers when responding to draft inspection reports.” existence of the register was something that could easily have been ascertained by CQC and, although the practice manager’s lack of awareness of the register was a legitimate cause for concern, it was a different type of concern from the one which would arise if the practice did not keep a register of older patients in the first place. Clearly, a change could have been made to the draft report to clarify the precise nature of CQC’s concern. 2. Systems for dealing with national safety alerts – similarly, the draft report commented that the practice did not have a system in place for notifying relevant staff of alerts from national safety bodies. In the factual accuracy log, SSP rejected this and described the

CHALLENGING CQC’S FACTUAL ACCURACY – NEW DEVELOPMENTS

system which was in place. However, in considering the factual accuracy response, CQC stated it was not prepared to make any change to the draft report as, ‘we did not see evidence of this during our visit and staff did not discuss this with the inspection team’. As Mrs Justice Andrews pointed out in her judgment, however, there was nothing in CQC’s response to indicate whether staff had actually been asked about this system during the inspection. 3. DBS Checks – the draft inspection report commented that, ‘staff recruitment policies were in place but not all staff, including those with chaperoning responsibilities had undertaken a DBS check’. This statement was literally correct, but the natural inference to be drawn from it was that there was a regulatory requirement that such a check should be carried out on all staff, including those with chaperoning duties. In fact, SSP had carried out risk assessments (which had been seen by CQC) and concluded that staff involved in chaperoning duties did not need to undertake a DBS check as long as they only did so under the supervision of a person who had been checked. Mrs Justice Andrews commented that CQC’s concern appeared to be the lack of information in the risk assessments explaining the rationale behind why staff, who occasionally undertook chaperoning duties, did not need to have a DBS check. However, Mrs Justice Andrews stated that if, indeed, this was the real nature of CQC’s concern, then CQC could and should have made that clearer in the report, rather than implying that there was a legal requirement to carry out DBS checks on all staff, regardless of their responsibilities. In summary, Mrs Justice Andrews stated that despite SSP having made a number of valid points, these had not resulted in changes to aspects of the draft report which: • Were factually inaccurate. • In one instance (whilst factually accurate) was misleading in a way that gave rise to unjustified criticism. • Obscured the real concern that might have been the subject of legitimate criticism.

CQC’S PROCESS FOR FACTUAL ACCURACY CHALLENGES Mrs Justice Andrews stated that factual accuracy challenges can only be made at the pre-publication stage and are not challenges which can be brought as grounds for the subsequent post-publication quality rating review requests. She also commented that it is understandable that CQC should ask the lead inspector to deal with factual accuracy challenges in the first instance; they are best placed to evaluate the criticisms of the draft report by reference to their contemporaneous notes and/or recollection of the

CMM November 2016 39

CHALLENGING CQC’S FACTUAL ACCURACY – NEW DEVELOPMENTS

inspection. However, importantly, the Court concluded that it is not fair that the lead inspector should be the sole arbiter of whether any changes should be made. CQC’s processes are that, if providers are unhappy with the way in which CQC deals with their factual accuracy challenges, they can commence proceedings for judicial review. However, Mrs Justice Andrews felt this placed a disproportionate burden on providers. She said that fairness required there to be a process within CQC to deal with providers’ legitimate complaints regarding the handling of their factual accuracy challenges, before the report is finalised and published. Mrs Justice Andrews stated that, whilst a further review stage might result in a short delay in publication of the report, this was justified due to the ‘otherwise irreversible damage’ which might be done to the reputation of the provider by publication of an inaccurate report.

INDEPENDENT REVIEW Mrs Justice Andrews concluded by declaring that, ‘there is an obligation on the CQC to carry out an independent review of a decision made in response to comments in the factual accuracy comments log, on a request to do so by the inspected entity, if the ground of complaint is that a fact-finding maintained in the draft report is demonstrably wrong or misleading.’ It is important to recognise that this only requires CQC to carry out a review of its decision upon factual accuracy challenges in cases where the provider can show that CQC’s decision is ‘demonstrably wrong or misleading’, and not in relation to all comments in the draft report with which they may disagree. Nevertheless, the case is an important step forward in terms of ensuring more rigour in the factual accuracy process, which should provide greater safeguards for providers when responding to draft inspection reports.

CQC’S RESPONSE It is hoped that Mrs Justice Andrews’ ruling will result in greater independence and rigour being brought into CQC’s handling of factual accuracy challenges. However, CQC’s initial press release response to the Judgment is not encouraging. Firstly, CQC’s response focuses primarily on Mrs Justice Andrews’ finding that CQC was justified in refusing to review the rating and presented the judgment as an endorsement of CQC’s processes. In contrast, the press release presented the Judge’s declaration on its factual accuracy process

(which Mrs Justice Andrews referred to as ‘the real issue’ in the case on which she found in SSP’s favour) as a ‘suggested amendment’. In the context of a ruling regarding an inspection report being misleading, this representation of the outcome by CQC is perhaps surprising. Secondly, Mrs Justice Andrews’ declaration was that CQC should carry out (if requested to do so) an independent review of its factual accuracy decision-making (ie a re-consideration), giving providers a ‘second bite at the cherry’. However, CQC states that, from now on, all factual accuracy responses will be reviewed by someone independent of the original inspection visit. The judgment does not require this to be done in all cases, merely when the provider remains dissatisfied that the report is ‘demonstrably wrong’. As such, it is not clear whether CQC is planning to hold just a single initial consideration of factual accuracy requests (albeit with independent input), or (as the Court ordered) to allow providers to request a review of that initial handling to give a ‘second bite at the cherry’ in cases where the draft report is demonstrably wrong or misleading.

ACTION FOR PROVIDERS To give themselves the best chance of ensuring their inspection reports properly reflect the position at their services, providers should: • Consider asking for copies of the inspectors’ contemporaneous notes at the time of the inspection; these might provide useful information to be referred to in a factual accuracy challenge to the draft report. • Provide any additional information CQC requests at the time of the inspection as quickly as possible. • Take time to submit a detailed factual accuracy comments log, clearly challenging any points in the draft report with which they disagree. • Supply, or offer to supply, further documents along with the factual accuracy comments log, if these counter any points in the draft report which are ‘demonstrably wrong or misleading’. • Consider asking for a pre-publication review by an independent person in CQC if the Lead Inspector refuses to change points in the draft report, which are demonstrably wrong or misleading. Clearly, this is an ongoing development which providers need to monitor. It is hoped that the case will form an important step in the factual accuracy process, giving more safeguards to providers. CMM

Carlton Sadler is Senior Associate at Bevan Brittan LLP. Email: carlton.sadler@bevanbrittan.com Twitter: @BevanBrittanLLP Have you challenged factual accuracy? Do you think this case will change the process? Share your thoughts on the CMM website www.caremanagementmatters.co.uk Subscription required. 40 CMM November 2016

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