Care Management Matters December 2016 by Care Choices Ltd

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

BALANCING THE RISKS

Debt financing in social care

Turning projects into reality Connecting innovation and practice

Supporting activities in the community Ways to overcome barriers

Changing the scope of learning disability care New framework for training

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Revolutionising social care

In this issue From the Editor

Is it just me…? 07 Editor in Chief, Robert Chamberlain looks at a joint think tank submission to ministers that warns of the need to address the critical state of social care. CMM News

Business Clinic Our panel considers WCS Care’s five ‘Outstanding’ quality ratings from the CQC.

A View from the Top Sara Livadeas, Strategy Director for The Orders of St John Care Trust (OSJCT) is the subject of this month’s interview.

Event reviews CMM reviews the Thrive conference on achieving competitive advantage in the healthcare market and CMM Insight Berkshire Care Conference.

What’s On?

REGULARS

FEATURES

Straight Talk 50 Dr Jane Martin looks at adult social care complaints in 2016 and what providers can do to improve practice.

Debt financing in social care: Balancing the risks Rachel Brown explores the debt financing model in social care and the risks associated with it.

You can get there from here: How to connect innovation with practice in social care and health Debbie Sorkin explains the steps you can take to help move innovation into practice.

Bringing the outside in to bring the inside out: Supporting activities outside the care setting Ben Benson-Breen shares ways to overcome barriers to activities outside the traditional care setting.

Unexpected happenings: Life in a Swedish care home Rosemary Hurtley gives an insight into life in a Swedish care home.

Changing the scope of learning disability care Colin Wright discusses core standards for learning disability education and training. CMM December 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

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Des Kelly OBE Chair, Centre for Policy on Ageing

Sara Livadeas Strategy Director, Orders of St John Care Trust

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Rosemary Hurtley Health and Social Care Consultant, 360 Forward

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: 978-1-911437-20-8 CCL REF NO: CMM 13.9

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From the Editor Editor, Emma Morriss considers the hard work that the sector is putting in to raising awareness of the funding crisis. It’s that time of year where all thoughts turn to the Autumn Statement and the dire financial situation facing health and social care. In Robert’s column, he explores a joint statement from three leading think tanks aimed at highlighting this situation, but their publication is one of many that have been released in the last month.

RAISING THE SECTOR’S PROFILE Policy professionals across the sector have been working tirelessly to pull together evidence, carefully construct their arguments and bring into clear view the financial situation the sector is facing. They are also highlighting the impact that this is having on the NHS – the element of health and social care that has more ability to tug on the heartstrings of the public.

STRONG WORDS I wanted to summarise some of the phrases that have been used in recent reports – many of which you’ll be able to read about in our news pages or on our CMM website news feed. These include: ‘terminal impact’ of funding cuts, ‘deepening social care crisis’, ‘perfect storm’, ‘significant pressures’, ‘fragile’ homecare market, ‘widespread and systematic underfunding of homecare’, and social care facing a ‘tipping point’. These remarks come from leading sector organisations, including the Care Quality Commission, United Kingdom Homecare Association, Care and Social Services Inspectorate Wales, Association of Directors of Adult Social Services, County Councils Network and Local Government Association. These are organisations that have a lot of

influence in the sector and who are speaking louder, more frequently and getting mainstream news coverage in an attempt to raise the profile of the sector’s struggles.

LONG, HARD WINTER This time last year, I wrote a very similar column and in it I discussed how ‘homecare was teetering on the brink’ and the sector was concerned about the ‘financial stability of Four Seasons Health Care’. One year on, and the sector is still hanging on, but

for how much longer? By the time you receive this issue of CMM, we will know the outcome of the Autumn Statement. With the colder months on the way, let’s hope the Government at least offers us some relief to what could be a long, hard winter. As this is the last issue of CMM this year, we will return in January with, hopefully, a better picture of what 2017 holds for social care and the vulnerable people we support. I hope it’s at least slightly better than it looks right now.

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

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Is it just me...?

fundamental reform – this will not be quick or easy and will require crossparty consensus’. Richard Humphries, Assistant Director for Policy at the King’s Fund, makes recognition of the struggle that councils face when trying to deliver their Care Act duties. He does, however, express concern about the potential for individuals to begin taking legal action against them for unmet care needs, based upon the rising number of complaints to the Local Government Ombudsman.

Editor in Chief, Robert Chamberlain looks at a joint think tank submission to ministers that warns of the need to address the critical state of social care.

IS IT JUST ME?

Joining forces initially in 2015, to provide an independent assessment of social care’s financial needs for last year’s Spending Review, the Nuffield Trust, King's Fund and Health Foundation have issued an updated review to ministers. In its joint statement on health and social care, the combined think tank states that, ‘the urgent priority for the Autumn Statement is to address the critical state of social care’. In reference to the prospect of a £1.9m shortfall in 2017, they call for the Government to recognise as a minimum ‘the immediate funding pressures facing the sector’ and call for promised additional funding to be brought forward.

KEY POINTS The briefing considers the Department of Health’s real-term funding increase of £4.2bn between 2015/16 and 2020/21 as inadequate

to maintain NHS care standards and deliver service transformation as outlined in the Five Year Forward View. It is anticipated that demand on NHS services ‘will peak in 2018/19 and 2019/20, when there is almost no planned growth in real-terms funding’. It goes on to state that the ‘pace of change required to deliver £22bn of savings by 2020/21 is unrealistic’. In direct reference to social care, the update makes a number of key points: • After six years of unprecedented budget reductions, the number of people over 65 accessing publiclyfunded social care has fallen by at least 26%, imposing significant human and financial costs on older people, their families and carers, and exacerbating pressures on the NHS. • Even if the vast majority of councils choose to use the new powers to levy the 2% precept on Council Tax

as they did this year, the publiclyfunded social care system faces a £1.9bn funding gap next year. • New measures announced in the last Spending Review to increase funding for social care are welcome, but will still leave a funding gap of at least £2.3bn by the end of this parliament.

It is, of course, imperative that social care’s funding crisis be addressed; the promise of additional money through the Better Care Fund, though deemed inadequate, at least eases the issue. This goes for the 2% Council Tax precept too. My concern is that the current avenues of funding have, historically, shown to be ineffective. Quoting the joint statement, ‘The existing Better Care Fund, which is largely composed of money transferred from the NHS, does not offer adequate protection to social care services, with just 33% of the fund

“Current avenues of funding have, historically, shown to be ineffective.” • Despite the ageing population and rising demand for services, UK public spending on social care is set to fall back to less than 1% of GDP by the end of this parliament, leaving thousands more older and disabled people without access to services. The joint statement is clear that, ‘the social care system needs

used for this purpose in 2015/16’. If social care’s dire financial situation is compounded by the fact that, when additional funding is made available, it isn’t all spent on its true purpose; surely we need to look at more effectively managed mechanisms to deliver the investment into our sector, not just pour more water into leaking buckets.

Do you agree with Robert? Join the debate and access the joint statement at www.caremanagementmatters.co.uk Twitter: @CMM_Magazine CMM December 2016 7

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SOMERSET CARE

State of Care is ‘fragile’ The adult social care sector is approaching a ‘tipping point’, according to the Care Quality Commission (CQC). The CQC’s annual The state of health care and adult social care in England 2015/16 report delivers a hard-hitting message about the fragile state of services and the market for care. In a seemingly unprecedentedly open stance by the regulator, the report makes clear the ways in which the adult social care market is now beginning to impact on people who rely on care and support services, as well as the performance of secondary care services, especially hospitals. In a letter setting out the report, Peter Wyman CBE DL, Chairman of CQC and David Behan CBE, Chief Executive said, ‘Our evidence

suggests that finance and quality are not necessarily opposing demands; many providers are delivering good quality care within the resources available, often by starting to transform the way they work through collaboration with other services and sectors. We cannot ignore the impact of tough financial conditions on providers – but our focus will always be on quality and we will always act in the interests of people who use services.’ The report also highlights the numbers of care providers exiting the market caused by a lack of profitability, and the impact that this can have on continuity of care, as well as the rise in unpaid care. There is good news in the report around improving quality by the majority of care providers. However,

the overwhelming sense from the analysis is of a fragile health and care sector on the brink of crisis. This is notwithstanding the fact that in social care there are still a quarter of care services rated as ‘Inadequate’ that had not improved on re-inspection. In adult social care, the report shows 71% (or 11,902 services) rated as ‘Good’ and 1% (156) rated ‘Outstanding’ with 26% (4,320) ‘Requires Improvement’ and 2% (386) rated ‘Inadequate’. Given the report is 149 pages long, there is a huge amount of data and analysis, including on a regional basis. Once again the variations in quality are clear and CQC put down a marker that they will have more to say on this next year when every service has been rated at least once.

Deepening crisis in social care The crisis in social care is further evidenced by a survey from the Association of Directors of Adult Social Services, which finds projected overspends of almost £0.5bn (£441m), further closures of residential and nursing homes and increased handing back of contracts, together with increased pressure from the NHS. The figures are revealed in a snapshot survey of 129 of the 152 directors of adult social services in England. The survey found that councils are planning to use their reserves and other one-off funding

to plug the huge gap. It also found that 62% of councils have had residential and nursing home closures, and 57% have had care providers hand back contracts in the last six months. The closure of services and handing back of contracts has affected an estimated 10,820 people using council-funded care with some of them having to move to a new home. Nearly four in five councils (79%) have quality concerns with one or more homecare and/or residential and nursing care providers (84%). The situation is made worse by

pressures from the NHS. Some projected overspends, particularly the larger amounts, reflect a reduction in funding from the NHS to social care. Other results include: • 68% of Directors having discussions about reductions to NHS-funded continuing healthcare. • 56% of Directors reporting increased demand for healthcare activity to be undertaken by social care staff. • 51% reporting increased demand from people with very high needs not being admitted to hospital.

Somerset Care has appointed Julie Cullis as its new Assistant Director for Residential Care.

SHADOW CABINET Barbara Keeley MP has been appointed as the Shadow Cabinet Member for Mental Health and Social Care. Julie Cooper is the Shadow Minister for Community Health.

DANSHELL HEALTHCARE GROUP Danshell Healthcare Group has appointed Carole Guy as Manager of Cedar Vale independent hospital in Nottingham.

COLTEN CARE Colten Care has appointed Kay Gibson as its first Admiral Nurse.

ST CAMILLUS CARE GROUP St Camillus Care Group has appointed have appointed Holly Kelleher as Centre Manager of The Vault.

NEW CARE New Care has appointed Dominic Kay as its Chairman.

DOCARE DoCare has appointed a new Field Manager, Kate Townsend.

CALVERT TRUST EXMOOR Heidi Watson has taken over the role of Chief Executive Officer at Calvert Trust Exmoor. CMM December 2016 9

NEWS

Crisis in homecare revealed A new report from the United Kingdom Homecare Association (UKHCA) The Homecare Deficit 2016 reveals that on average local authorities in the UK (as at April 2016) paid just £14.58 per hour. UKHCA’s calculated minimum price for homecare is £16.70. The information gained from Freedom of Information requests from across the UK, includes the dramatic differences that exist across the country. It is evident from the findings that there is widespread underfunding by many councils who are paying a rate for care that is contributing to the homecare sector’s instability and making it unsustainable. UKHCA also highlights the impact of the National Living Wage arguing that there is a £513m funding gap in state-funded homecare.

Social services’ expenditure and costs New official social services’ expenditure and costs figures have been published. They outline the total money spent by local authorities on adult social care. Personal Social Services: Expenditure and Unit Costs, England 2015-16 is published by NHS Digital and collects data from the 152 local authorities across England, which are responsible for adult social services. For the 2015-16 reporting period, the gross current expenditure of all Councils with Adult Social Service

Responsibilities (CASSRs) was £16.97bn, a slight decrease in cash terms from £17.04bn in 2014-15. Overall total gross current expenditure in cash terms in 201516 is 18% higher than in 2005-06 when the figure was £14.36bn, but 1.5% lower in real terms. £13.06bn was spent on longterm care (77% of gross current expenditure), £554m was spent on short-term care (3% of gross current expenditure) and the remaining £3.36bn was ‘other social care’ expenditure (20% of

gross current expenditure). In 2015-16, the average cost of care per adult, per week was £716 for long-term care in a care home and £596 for long-term care in a care home with nursing. The average cost of internally provided homecare was £30.75 per hour and externally provided homecare was £14.28 per hour. The detailed analysis, available on the NHS Digital website, includes a breakdown of each individual council’s social care spend.

Integration can bring savings By focusing on the best care pathway for people using services significant benefits in outcomes, quality and financial savings can be made, according to the Local Government Association’s (LGA) Efficiency opportunities through health and social care integration. In the project report, the LGA

suggests that savings of 7-10% could be achieved that would equate to efficiency savings of £1bn nationally across health and social care. Furthermore, the study found a variation in frontline decision-making saying that up to 45% of pathway decisions could be improved. The single biggest area

for savings is through the avoidance of admissions to hospitals – missed opportunities to prevent admission were found in 26% of the cases reviewed. The study also found that discharge planning and the role of preventative services both have the potential for significant savings.

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Social care should receive greater funding Two thirds of people believe a greater share of the total health budget should be spent on care for the elderly and disabled provided by councils, according to a new national public poll published by the Local Government Association (LGA). Just 11% of the ÂŁ129bn health and care budget is spent by councils on adult social care, with the remainder on health services. The poll, carried out by Populus Data Solutions for the LGA, reveals nearly two thirds of respondents (62%) think adult social care

services should receive a much higher proportion of health and care funding. The LGA, which represents more than 370 councils in England and Wales, says the only way to deal with the significant pressures facing both adult social care and the NHS is to invest more in services that help to keep people out of hospital and to stay in their communities, which is what the vast majority of people want. This is at a time when record numbers of people find themselves unable to leave hospital due to

a lack of care in the community and increasing numbers of people unable to get care are having to turn to stretched A&E departments instead. The LGA says there is also a need to raise national awareness of the importance of adult social care services. It comes as the poll, published in the LGA's new State of the Nation report on the adult social care funding crisis reveals many people underestimate the scale of the problem. Councils spend approximately 35% of their budgets

on adult social care and are increasingly having to divert money away from other local services to plug gaps. Yet more than three quarters of respondents to the LGA's poll think councils spend a much smaller proportion of their budgets on adult social care. 60% of people polled also thought adult social care already received a higher proportion of the total health and care budget than 11%. The findings follow new analysis by the LGA which estimates adult social care services face a potential funding gap of at least ÂŁ2.6bn.

Consultation on CQC fee proposals The Care Quality Commission (CQC) has published its fee proposals for increases from April 2017. The CQC fee proposals follow the plans the regulator consulted on last year to meet the Treasuryâ&#x20AC;&#x2122;s requirement to recover

its chargeable costs in full from providers. The CQC proposes to increase fees for all sectors, except community social care and dental providers, as the second year of the two-year trajectory to reach full

chargeable cost recovery (FCCR); increase fees for community social care providers as the second year of the four-year trajectory to reach FCCR; iecrease fees for dental providers maintaining FCCR levels for this sector.

Full details of the proposed fee increases and other proposals are available on the consultation website and providers are encouraged to respond. The closing date is Wednesday 11th January 2017.

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Raising awareness of hate crime Wales to increase capital limit I’m with Sam is a campaign, led by Dimensions, which aims to tackle hate crime against people with learning disabilities. Some 73% of people with autism or learning disabilities have experienced hate crime. The campaign aims to raise awareness of this and is based around eight outcomes

intended to tackle the root causes of hate crime. The outcomes include raising awareness including amongst Government departments, changing the law and evaluating the campaign’s effectiveness. Resources and guidance have also been developed.

The Minister for Social Services and Public Health in Wales, Rebecca Evans, has announced that from 2017 it will start the process of increasing the capital limit for residential care. The Welsh Government’s fiveyear plan, Taking Wales Forward, committed to more than doubling the capital limit used in charging for residential social care, from £24,000 to £50,000. Following on from that, Rebecca Evans has announced that the new limit will be implemented in

phases, starting with an increase to £30,000 from April 2017. The decision to phase implementation reflects feedback from local authorities and care home providers and is designed to ensure they have sufficient time to adapt to the changes. It also takes into account independent research commissioned by the Welsh Government to obtain up-to-date costings for implementing the change.

Carterwood has undertaken a survey of its database to determine the impact of the Brexit decision on social care. Key questions included: how the sector voted, implications for trading and development. Most respondents (almost 60%) stated it had made no difference to their confidence in the sector, with a

similar proportion saying it made no difference to the cost of developing a care home. Although some 35% felt that the decision might make land a little less expensive. The 62% of respondents voted to remain, 27% voted to leave, 1% abstained and the final 10% were not willing to say.

Total transformation – creating a five year forward view for Implications of Brexit social care Adult social care will struggle to continue to provide good services that meet rising demand without significant transformation. Scaling up promising models could improve outcomes for individuals – and result in savings for both adult social care and the NHS. These conclusions are published by the Social Care Institute for Excellence (SCIE). Its paper, Total transformation of care and support explores the potential for scaling up some of the most promising examples of care and support services, using data from Birmingham City Council, to see what their impact would be on outcomes and costs. The paper indicates potential

improvements in outcomes for individuals, and potential savings of £6.6m to the adult social care budget, along with £1.4m to the NHS, per annum, if three promising models were fully scaled up in Birmingham. The paper, which is the first in a new SCIE series on the Future of Care, summarises the potential benefits of scaling up Shared Lives, Age UK’s Living Well scheme and Kent County Council’s hospital discharge project. The sector needs to have difficult, challenging and creative local conversations, which release ‘stuck’ systems and create space for moving forward together. The report includes a template for starting those conversations.

New care models: report on innovations The King’s Fund has published a report exploring new care models and the different approaches being taken. New care models: Emerging innovations in governance and organisational form explores the different approaches being taken by the 23 vanguard sites that were chosen to develop the multispecialty community provider (MCP) and primary and acute care system (PACS) new care models. It looks at differences in approaches around contracting, 12 CMM December 2016

governance and other organisational infrastructure. The vanguards have been working to pool budgets and integrate services more closely. Some are continuing to use informal partnerships, but others are opting for more formal governance arrangements. However, commissioners are grappling with how to contract for the new systems, while providers are exploring how to work together within emerging partnerships, how to allocate funding, and how to share risk and rewards.

Dying Matters launches photo competition The Dying Matters Coalition has launched a photographic competition with the theme Celebrating Life in the Face of Death. Although death is a universal experience, Dying Matters says that there is a lack of representative images of dying, death and bereavement. The competition seeks

to address this lack of images and the fact that the media either resorts to stereotypes or avoids the issue altogether. The competition closes on 18th December (with a top prize of £1,000 and the chance to observe a photoshoot with Rankin). Entries are welcome in two categories: student/amateur and professional.

Living through Landscapes brings innovation to dementia A pioneering project, which is the result of a partnership between Learning through Landscapes, Thrive (the horticultural charity), Groundwork, Age UK and the University of Kent, aims to transform outdoor spaces at 30 care homes across the UK. Initial research found that although most care homes for people with dementia have

outside spaces, they are seldom used because of fears they are unsafe or there is a lack of resources. The project will offer dementiafriendly consultation and engagement, landscape changes, training and support. The three-year project has been made possible through £1.3m of Big Lottery funding.

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NEWS

Brendoncare to develop care home for dementia couples Brendoncare is building a service to cater for people with dementia and their carers or partners in the form of ‘shared care’. The new care facility will be built to Stirling University gold dementia standards, with best practice

dementia design integral to the scheme. It is intended to keep couples together when one partner has dementia. The facility will have 64 care home places, plus 20 one- or twobedroom apartments.

SCIE adds dementia resources The Social Care Institute for Excellence (SCIE) has added new resources to support people with dementia from BME communities and LGBT communities to its

website. Both have been produced by the Dementia Intelligence Network in collaboration with the National End of Life Care Intelligence Network.

Homecare in Wales Most people are ‘happy’ with homecare in Wales, despite a ‘fragile’ market, according to a new report from Care and Social Services Inspectorate Wales (CSSIW). The review was prompted by concerns around homecare in Wales. The key findings include: care and support arranged for a set time with fixed tasks is more likely to be inflexible and rushed; care purchased at low prices tends to lead to problems with recruiting and keeping care workers; good domiciliary care is based on building relationships between care workers and people who receive care; most people, most of the time, are happy with and appreciate the

Engaging and empowering communities For the first time, care leaders are offering a clear way of making sure that community-centred approaches are embedded in health and social care services. The clear set of principles and actions have been launched by the Think Local Act Personal (TLAP) Partnership. Engaging and Empowering Communities: A Shared Commitment and Call to Action offers a compelling case for working collaboratively to create strong and empowered communities, and for this to be central to the

transformation of the health and care sector. It is co-authored by all national health and care system leaders, including the Association of Directors of Adult Social Services, Coalition for Collaborative Care, Local Government Association, Public Health England, Association of Directors of Public Health, the Department of Health and NHS England. The report was produced following a National Leaders’ Seminar on community and citizen empowerment, attended by NHS

care they receive. However, a small proportion of people experience poor care, especially regarding poor care worker continuity and unreliable visits; despite poor pay and working conditions, most care workers are very motivated and often go ‘above and beyond’, giving care in their own time. However, there is a lack of workforce capacity, and the market is very fragile. It says that current approaches are not sustainable. The CSSIW’s report is being used to inform the five-year domiciliary care strategy for Wales. It will also be used to strengthen new regulations, standards and inspection methods to be introduced in 2018.

Visiting rights in care homes

England Chief Executive, Simon Stevens, which called for national agencies to work together in realising the policy ambitions of the Care Act and Five Year Forward View. The report argues for the need to build strong and inclusive communities that can address persistent health and wellbeing inequalities. Key principles and broad actions are set out with a commitment from key partners to develop a detailed plan to support practical actions on the ground.

The Care Quality Commission has published information for people living in care homes, their family and friends clarifying visiting rights in care homes and the inspectorate’s expectations of providers who are responsible for ensuring people are supported to maintain relationships that are important to them. The regulator has developed this information to help people feel better informed and make sure providers are clear about their obligations.

rely more on family and friends for support. More than a quarter (27%) of respondents reported an increase or a significant increase in the amount of money they have to contribute towards the cost of their support. Roughly the same numbers of respondents rated the quality of their support as good or very good (41%) as rated it poor or very poor (40%). However, the amount of support was rated as poor or very poor by 44% of respondents compared to 30% saying the amount of support they had was good or very good.

86% of people reported that when their local authority had assessed their needs they had listened or partly listened to them. Of those respondents who said their support had been reviewed in the last 12 months, just under two thirds (63%) did not know how much money was available for their support. One in four people had been told their support would be reduced because of cuts/savings and/or there is a limit to the amount of money you can get for a particular service. The full report is available on the In Control website.

Independent Living Survey 2016 In Control has published a new report, on behalf of the Independent Living Strategy group. It presents the findings of an online survey looking at what impact the Care Act is having on the day-to-day lives of disabled people living in England. Regarding choice and control, just under half (48%) of all respondents reported that the choice and control they enjoyed over their support was poor or very poor. A third of respondents (33%) said that the level of choice and control they enjoyed over their support had reduced or reduced significantly. Significant

numbers of people reported a range of different restrictions being placed on how they could use the money available for their support. For example, 50% of respondents reported support was restricted to personal care tasks only. When it comes to quality of life and wellbeing, 58% of respondents reported that their quality of life had reduced or reduced significantly over the past 12 months. A quarter of respondents (25%) said the hours of work or volunteering they could do had reduced or reduced significantly. 38% reported they are having to

CMM December 2016 15

NEWS

HEE training places for nursing National Living Wage to rise slower than expected associates Over 1,000 nursing associates will begin training this year in a new role alongside nursing care support workers and fully-qualified registered nurses. Health Education England has announced that there will be a second wave of 1,000 nursing associate trainees following the

interest that has been shown in the role. The first wave of training starts in December and will run for two years. The initiative brings together a range of organisations, including higher education, care homes, community trusts and hospices.

Agincare Health and Social Care Academy Agincare and Weymouth College have announced the launch of a new training initiative – The Agincare Health and Social Care Academy. The initiative will see Agincare and Weymouth College working in partnership to offer a wide range of clear pathways for a rewarding long-term ‘career in care’ for the

students of Dorset. Both Weymouth College and Agincare believe that a strong partnership between business and education is a key way forward in developing the very best career opportunities for the people of Dorset. It is hoped that the academy will inspire those looking to follow a career in care.

The National Living Wage is likely to rise to around £7.50 an hour next year, which is 10p lower than expected in March, because of the weaker outlook for pay in the wake of the Brexit vote, according to a new report by the Resolution Foundation. The new forecast of £7.50 an hour comes as the Government prepares to announce the National

Living Wage rate for April 2017. This is expected around the time of the Autumn Statement on 23rd November. This rate is 10p down on the Office for Budget Responsibility (OBR) projection in March. However, it will still mean that a full-time worker on the National Living Wage will receive an annual pay rise of around £600.

Hospital dementia training Dementia Action Alliance has launched a programme of immersive training workshops, with an aim to improve hospital care for people living with dementia. The hospital dementia training will help participating hospitals demonstrate good practice as well as seek feedback from the

expertise of dementia leads in attendance. The first workshop – to be held at University of London College Hospitals – will see attendees interacting with actors who have experience playing roles of people living with dementia, carrying out a series of challenging scenarios that may arise on a hospital ward.

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NEWS

Make personal budgets dementia friendly Deep-seated misconception of personal budgets and dementia is preventing local authorities from delivering person-centred care according to Alzheimer’s Society. The charity is calling on all local authorities in England to urgently breakdown the barriers preventing people with dementia accessing personal budgets. Fewer than a third of people receiving social care support for issues with memory and cognition have a personal budget, despite

the Government’s aspirations for a person-centred care and support system. The Care Act gives everyone who is receiving support from social services the legal right to a personal budget, offering them greater choice and control over their care and support. An Alzheimer’s Society audit of local authorities’ personal budgets processes has highlighted how the majority are falling at the first hurdle, with many failing to make people with dementia aware of

their entitlement to a personal budget. Alzheimer’s Society has produced a personal budgets guide of easy and cost-effective actions councils can take to improve the personal budgets process for people with dementia and their carers. The charity is urging all local authorities with adult social care responsibilities to sign the Dementia-Friendly Personal Budgets Charter to demonstrate their commitment.

Social value is key to reducing inequalities The Voluntary Organisations Disability Group (VODG) has launched a practical resource that supports the delivery of social value in the commissioning of social care. The VODG Social Value Toolkit promotes increased cooperation between social care commissioners and providers.

The guidance has been created in response to the fact that while there are resources to support commissioners to implement the Social Value Act, less guidance exists for social care providers. The new toolkit reflects an approach to commissioning, which creates maximum value for money from public spending by realising

additional benefits from providers – at no extra cost to the public purse. Harnessing social value is an essential route to tackling inequalities. VODG’s Social Value Toolkit guides social care providers on how to demonstrate the added value that not-for-profit organisations deliver.

POLL

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

November’s results Do you have good working relationships with your local hospitals? No 62% Yes 38% 0

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

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CMM December 2016 17

NEWS

RMBI opens new dementia service

HC-One People Development receives Centre of Excellence status

Hallmark care home unveils refurbishment

RMBI care home Zetland Court in Bournemouth has opened a new dementia service, which can support up to 18 people with specialist dementia care. Residents living in Red Admiral View, which opened in summer 2016, can enjoy a variety of stimulating activities at the home’s new dementia support house, benefiting from a bar area, kitchen, own bus stop and a range of communal spaces.

HC-One’s People Development programmes have been awarded Centre of Excellence status by Skills for Care. This award recognises that they demonstrate exemplary learning and development for their staff.

Hallmark Care Homes’ facility in Merthyr, Wales has unveiled its £800,000 refurbishment. Greenhill Manor, which provides dementia, nursing and young physical disability care, offered tours for over 50 inquisitive guests and revealed its new facilities for its 120 residents at an official grand launch event.

Greensleeves Care starts work Greensleeves Care has begun the construction of its latest new care home in Seal, Kent. Due to open in late 2017, the home will provide nursing and residential care to 75 older people.

There are only six other Skills for Care Centres of Excellence in the UK, and the HC-One People Development Team is only one of two in-house training providers, the other being The Royal Mencap Society.

Funding for Pendlebury Care Homes Pendlebury Care Homes Ltd has announced its third care home in the group, Regency Hall, has opened its doors in Hadfield, Derbyshire, offering specialist care and support for up to 68 people with dementia or frailty. Six-figure funding has been provided by Royal Bank of Scotland to support this latest acquisition. Previously a nursing home, Regency Hall has been transformed into a modern, luxurious and comfortable environment.

Particular attention and consideration has been paid to the layout, colour schemes, orientation, furnishings and use of space which are all important factors for the needs of the residents. Since the year 2000, Pendlebury Care Homes Ltd has operated Lyme Green Hall in Macclesfield, Cheshire, and Pendlebury Court in Glossop, making Regency Hall the second home to open in the High Peak.

Funding cuts could have ‘terminal impact’ on services Care funding cuts could lead to a ‘terminal’ impact on services and hold back integration, a new report warns. Just one in ten adult social care directors believe their budgets are now manageable, as the Government is warned care funding cuts in county areas could soon be ‘terminal’. The County Councils Network’s Delivering Adult Social Care in Challenging Times, outlines the issues and funding pressures facing county authorities in delivering this key frontline service, potentially leaving thousands of vulnerable people without the care and support to maintain their independence. The results of a survey contained in the report from county 18 CMM December 2016

directors of adult social care (ASC) reveals that 88% believe their budgets to be either ‘severe’ or ‘critical’, and only 12% say current funding levels are ‘manageable’. It is yet more evidence ahead of the Autumn Statement on the brittle nature of the social care system in England. The survey also reveals that just one in five ASC directors believe Sustainability and Transformation Plans (STPs) will fulfil their objective to ensure services are sustainable in the coming years. They cite insufficient funding, as well as conflicting targets and incentives, as impeding health and social care integration. The report shows that social care pressures are most acute

in county areas – CCN member councils have the oldest and fastest-growing elderly populations, yet funding has proportionately reduced for counties at a higher rate than any other local authority type. As a consequence, overspend in social care means that some county authorities will struggle to deliver a balanced budget before the end of this Parliament. The impact of this rising demand and falling budgets in county areas has a knock-on effect within the public sector. CCN members have seen a 68% increase in the number of delayed discharges within the month from April 2014 to July 2016, higher than in any other local authority area – costing the NHS millions.

Almond Case Management Almond Care has launched a new case management division, Almond Case Management to meet a need for integrated case management for people with the most complex care needs. The firm’s case managers can assist clients living with a wide range of conditions, including spinal cord injuries, cerebral palsy, birth injuries, amputation, complex orthopaedics and psychological trauma. The range of interventions that can be managed by the firm include setting up care or support packages, private medical interventions, sourcing adapted vehicles and setting up bespoke rehabilitation programmes.

Avery celebrates topping out Avery Healthcare has commemorated a special event with contractor NATTA to mark the completion of the shell and core of Astbury Manor. Standing in a prominent position close the town centre in Bracknell, Astbury Manor is a three-storey, 64-bed new care home.

NEWS

Audley acquires Buckinghamshire home care company Audley Retirement has completed its acquisition of Red Kite Home Care, a Buckinghamshire-based care provider, for an undisclosed sum. This acquisition will see all 22 personal care assistants currently employed by Red Kite Home Care transfer across to Audley Care, with the business’ footprint ideally

located to serve customers at Audley Chalfont Dene, as well as the future Audley village at Englefield Green. Red Kite Home Care was established in May 2011, by two homecare professionals, both of whom previously worked for Buckinghamshire County Council’s care team.

Target Healthcare acquisition in Kent Target Healthcare REIT has completed the acquisition of a purpose-built care home in Tonbridge, Kent for approximately £12.2m, including acquisition costs. The Group had previously entered into a forward commitment to acquire this property. This is a purpose-built home which was completed in early October 2016. It comprises 101 bedrooms with full en-suite bathrooms, including wetrooms

over three floors. Each floor has its own lounge and the home also benefits from quiet rooms, a hairdressing salon and a therapy room. There is generous outdoor space which includes an attractive landscaped garden as well as balconies for the upper floors. The home is let to the Abbeyfield Kent Society, for a 30-year term. Abbeyfield Kent is the Group's 15th tenant and further diversifies the Group's tenant base.

Fit for Future review of palliative care A major review into the future provision of palliative care in the county has concluded its formal consultation and will now consider recommendations. Fit for Future is being led by St Margaret’s Hospice and has brought together a range of people, including leading healthcare experts, carers, national cancer charities, families, patient representatives, church leaders, politicians and the local authority. It is one of the largest community engagement programmes in the country on the issue and will provide a blueprint for better and more efficient palliative care throughout the UK. The review has identified five key 20 CMM December 2016

areas for action: finance and funding; rising demand; maintaining quality; fractured services; accessibility and equity of care; and maintaining and growing the care community. Maintaining and developing the workforce, including volunteers, is also high on the agenda. It has also already resulted in a number of pilot projects, taking the first steps towards addressing some of these challenges. These include an initiative to develop an ‘end of life’ volunteer workforce in the county and providing expert training to micro providers who deliver personal care, domestic support and companionship directly to those who need it.

Consultation on the State Pension age A consultation has been launched seeking the public and representative bodies’ views on the State Pension system of the future. John Cridland CBE, the State Pension age independent reviewer, has called on the public and representative bodies to have their say as he publishes an interim report on ensuring the State Pension age remains affordable and fair for all beyond 2028. The consultation looks at the key drivers of State Pension age like life expectancy, including in the different nations and regions and for different occupational groups. It also asks about the challenges faced by those who rely most on the State Pension and are, therefore, most likely to be affected by any future changes. These groups include carers, people with poor

health or disability in later life, the self-employed, women and ethnic minorities. The report puts forward the view that there is value, in a clear point in time, when the state will offer retirement income. It also opens a discussion on alternatives to a universal State Pension age, recognising that the nature of work and retirement is changing, as people move from the old model of a fixed retirement age and a defined period of retirement to a more flexible approach where they may work part-time or change career in later life. It also considers options such as supporting individuals to work longer and more direct interventions, such as early access after a long working life to either a full or a reduced pension.

Nominations open for NCPC Awards The National Council for Palliative Care (NCPC) is seeking nominations for the second year of its annual awards. Over 50 entries were received for the 2016 Awards, and the NCPC is hoping to beat this total. Awards are given in four categories: Bereavement Project of the Year; Dying Matters Initiative of

the Year; End of Life Care Champion of the Year (sponsored by the Royal College of Nursing); and Effective Coordination of Care Award. Nominations close on Friday 16th December, and the winners will be announced at an event at the House of Lords on 22nd February 2017.

Black Swan International Birketts has advised Black Swan International on the purchase of its third care home in Norwich, and another facility near Colchester, as the care homes provider continues to expand within the region.

The Norwich-based group has been involved in the care sector since 1991 and now has 15 sites, which includes a mixture of homes for older people and those with physical and/or learning disabilities.

Dovercourt House sold Dovercourt House, registered for 27 has been sold by DC Care for an undisclosed sum. Located close to the seafront in

Dovercourt, Essex, the home had been owned since 2002 by Mr and Mrs Tibbles. It has been purchased by Jayman Patel.

NEWS NEWS / IN FOCUS

Hamberley, Gracewell and Bournville Village Trust Hamberley has unveiled its most ambitious project to date at the heart of the historic Bournville community in Birmingham. The award-winning developer worked in partnership with Gracewell Healthcare Ltd and Bournville Village Trust (BVT) to build a £9m state-of-the-art luxury care home. The 80-bedroom home is integral to Bournville’s new care village, College Green, which is being

developed by BVT, the ExtraCare Charitable Trust and Gracewell Healthcare Ltd, and will feature a retirement village, nursing and care home, 16 independent living homes and a health and wellbeing centre once complete. This home will be swiftly followed by new Hamberley developments in Adderbury, Bath, Lane End, Little Bookham, Sutton, Sutton Coldfield and Woking.

Skills for Care Skills for Care has announced that five new members have joined their board, bringing with them extensive experience in the social care and health sectors. The new board members are Sam Jones, who is the lead executive at NHS England supporting the delivery of the New Care Models; Sue McMillan, who has recently retired from the Deputy Chief Inspector role at the Care Quality Commission;

Munira Thobani, Independent Executive Coach and Organisational Development Consultant; Paul Snell, Chief Executive of Walsingham Support; and Paul Kingston who is a Professor of Ageing and Mental Health at the University of Chester. They join as Professor Peter Beresford, Judith Salmon, Frank Ursell and Deborah McKenzie step down after completing their terms on the Skills for Care board.

Acquisition of Priory and Partnerships in Care facilities Funds advised by BC Partners, a leading European private equity firm, have entered into an agreement to acquire a portfolio of 22 mental health facilities from Acadia Healthcare. The transaction is subject to approval by the Competition and Markets Authority. The hospitals are based across the UK and offer a wide variety of tailored programmes to suit patients’ specific behavioural care needs. The facilities were part of

either Priory Group or Partnerships in Care and will be formed into a new company led by Joy Chamberlain, former Group Chief Executive of Partnerships in Care and an experienced figure in the UK’s independent healthcare sector. Once formed, the new company will have more than 2,000 employees and offer approximately 1,000 beds across the 22 hospitals. BC Partners was advised by PJT Partners, KPMG and Candesic.

Audley Care contracts As part of its commitment to being at the forefront of care provision, Audley Care has offered enhanced contracts to all its care staff.

It has offered all 231 personal care assistants permanent contracts, which includes a contributory pension and benefits.

In focus The introduction of Sustainability and Transformation Plans WHAT ARE STPS?

STP is a new acronym for the health and care sector. STPs, or Sustainability and Transformation Plans are being published and are set to reorganise health and care at a local level.

WHAT'S THE STORY?

STPs were launched by NHS England in December 2015, with the intention of ensuring that health and social care services are built around the needs of local populations and developed as local plans, which take account of natural communities. Draft plans were submitted in June 2016 with final plans due from the end of October. England has been divided in 44 areas (with an average population of 1.4m people) for the purposes of producing STPs which will apparently join up health and care services in these local areas. The scope of STPs is very broad and includes improving quality and efficiency of services, health and wellbeing and developing new models of care. The STP will include the key health and care priorities for the local area. Although to date, the guidance has mostly focused on the NHS, the STPs must cover integration with local authorities.

AND?

The so-called 'place-based plans' will determine the future of health and care in their area. They are, therefore, a significant change, and represent a real shift in the way in which the NHS plans services. There appears to be consensus across the health and care sectors

that integrated models of care are necessary for the future.

WHY SHOULD CARE PROVIDERS BE INTERESTED?

From April 2017, STPs will become the single application and approval process for accessing NHS transformation funding. They are intended to be part of the way in which the objectives of NHS England's Five Year Forward View gets implemented. Although the incentives are considered to be weak, they are likely to prove influential as a means of commissioning services. It is vital that care providers (almost all of which are in the independent sector) are being involved by local authorities in the planning process as this will be the key to implementation.

WHAT HAPPENS NEXT?

STPs are now being published. They indicate the merging of services, including hospitals, and the merging of clinical commissioning groups, as well as shared back-office services and efforts to reduce duplication of roles. Probably one of the biggest challenges for the emerging STPs is that of balancing rising demand and the pressure of regulation with continued austerity and the need to make savings for the NHS. Local social care markets are already fragile with growing calls for Better Care Fund money to be brought forward to help ensure some sustainability of the market for care services. CMM December 2016 21

Debt financing in social care

Balancing the

risks Q

Thereâ&#x20AC;&#x2122;s lots of talk about debt financing within the sector (specifically term loans) and the risks associated with this method of finance. What can I do to protect against these risks? Rachel Brown, Senior Associate, Druces.

It has recently been reported that Britainâ&#x20AC;&#x2122;s care home sector is under threat due to mounting financial pressures. Several reports have focused on the use of debt financing within the sector (particularly term loans) and concern about the high levels of debt carried by businesses.

WHAT IS DEBT FINANCE? The concept of debt finance is relatively simple. The business seeks external finance from a third 22 CMM December 2016

party (normally a bank) and agrees to repay the loaned sum, together with interest, within a specified period of time. The loan will typically be secured against an asset (normally a property). Debt finance is an attractive method of finance for businesses of all sizes and it can be used for a variety of purposes. One of the key benefits of debt finance is that it does not affect ownership of the business. It is also a flexible method of raising finance and can be tailored to meet both shortand long-term funding needs. Most businesses require some method of finance during their lifetime and debt finance can provide a solution for a variety of funding needs. For example, a business may require additional funds to cover capital expenditure, to make an acquisition, or to grow its market share. Additional finance may also be required to resolve a shortterm cash flow issue. Added to this, the overall cost of obtaining debt finance is, typically, less than the overall cost of equity finance.

WHY IS IT CRITICISED? Since the financial crisis in 2007, there has been criticism of certain lending practices, particularly where money has been lent to smaller businesses and the finance for a business has been underpinned by security on physical assets. The care sector has been a particular point of focus because some businesses have used debt finance as a way of raising additional funds. Those debts have been secured against properties, often homing vulnerable people. The collapse of Southern Cross, which many attributed to its business model and the fact that it was carrying high levels of debt, has also attracted the mediaâ&#x20AC;&#x2122;s attention and led the Care Quality Commission to take on responsibility for market oversight of large providers in the sector to prevent a similar situation arising. However, despite recent criticism, debt finance remains an accessible and flexible method of finance for care businesses.

CMM December 2016 23

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DEBT FINANCING IN SOCIAL CARE: BALANCING THE RISKS

WHAT ARE THE RISKS?

Using debt finance exposes a business to a number of risks. The main disadvantage of debt finance is the business’s obligation to repay the loan, together with interest. The business is in effect borrowing money against its future profits. This leaves the business exposed to risks that its future profits may not be sufficient to enable it to meet the required repayments on the debt and it may not be able to pay its debts as and when they fall due. If the terms of the loan provide for variable interest, the business will also be exposed to increases in interest rates. Using debt finance may also place restrictions on the business’s future activities and impact on its future planning. Lenders often require borrowers to enter into covenants which restrict the business’s operations and its ability to materially alter its business model during the loan period. These covenants are designed to protect the interests of the lender and can be extensive. The borrower may be asked to enter into negative covenants restricting it from doing certain things (often related to assets, cash flow, control of the business and liabilities). Equally, the borrower may also be asked to enter into positive covenants, which require it to take positive steps to comply with the terms of the loan (for example, reporting to the lender on performance of the business, or any changes within the business). ‘Overuse’ of debt finance can also expose a business to several additional risks. If a business is carrying high levels of debt, it may find that high repayment obligations negatively impact on its cash flow and increase its vulnerability to adverse economic conditions. If repayments are too high, the business may struggle to maintain a sufficient level of working capital to meet its debts as and when they fall due. It may also find its growth is stifled. Owners and operators should be mindful of these risks when reviewing existing arrangements and considering new finance options.

WHAT STEPS CAN BE TAKEN TO PROTECT AGAINST THESE RISKS? There are a number of steps that owners and operators can take to manage a business’s debt levels and to protect against some of the risks associated with debt finance. Providers should make sure they understand, and are familiar with, the terms of any loan.

Particular attention should be given to the covenants section. Owners and operators should also keep compliance with these covenants under regular review. If, for any reason, it becomes apparent that the business will not be able to comply with the covenants, legal advice should be sought promptly. The lender should also be notified promptly and, ideally, before a default occurs, so that the business may be able to renegotiate terms with the lender (such as lengthening the loan period to reduce the amount paid, or negotiating a repayment holiday). Make sure the business has a good debt recovery policy and debts are chased promptly. This will assist with cash flow. It will also enable providers to identify potential bad debtors and take appropriate action. Debt collection methods vary depending on whether the outstanding fees relate to privately funded residents or local authority funded residents. Legal advice should be sought on the most appropriate method of collecting debts, if required. Make sure the business has an efficient costs management system in place. A good costs management system enables operators to plan ahead and stop the business from overspending. It also allows providers to monitor revenue, profit and the overall performance of the business. In turn, this enables them to identify what steps can be taken to increase revenue and profit for the business, as well as identifying potential opportunities for growth and expansion. If the business experiences cash flow difficulties, prompt action is required. Most businesses experience cash flow difficulties at some point during their lifetime and, generally, the quicker it is acted upon, the easier it will be to resolve those issues. Revisit the business strategy and make sure it is realistic. Particular attention should be given to cash flow forecasts and the business’s repayment obligations. Review the business’s finance model and make sure it is suitable. Businesses within the care sector often have complicated, multi-level finance models. In some cases, this is appropriate; however, an overly complicated finance model can act as a hindrance and make it difficult for providers to effectively manage costs. A range of different finance models is available and it is advisable to seek professional advice on the suitability of existing models. Review the business’s property portfolio.

Businesses owning property will find it easier to raise finance and may be offered better terms. Providers should also be mindful of the fact that lenders are increasingly concerned about the age and condition of any property offered for security. Businesses with older, non-purpose-built properties may find it harder to obtain finance because lenders tend to be more willing to lend to businesses that can offer security against a good quality, purpose-built asset. Keep abreast of any changes in the market. Providers should also ensure that the business is adequately prepared for any upcoming changes which are likely to affect cash flow. Particular attention should be given to changes affecting staff costs (such as the National Living Wage), which tend to make up a large proportion of a business’s costs in the sector. Ensure that the business is achieving high levels of regulatory compliance. Businesses achieving this will be able to charge high fees, increasing cash flow and profits within the business. Lenders are also increasingly concerned about compliance issues. Businesses with compliance issues may find it harder to obtain finance, or negotiate terms with lenders on existing term loans. Providers who embrace regulation and achieve high levels of compliance will, generally, find it easier to obtain finance and obtain an advantage over competitors.

WHAT IS THE FUTURE OF DEBT FINANCE? Businesses within the care sector have faced a number of challenges over the last few years, including cuts to local authority funding, increased competition and increased regulation. Some businesses may have found it a challenge to maintain cash flow and profitability levels. Recent criticism of debt financing within the sector has led to changes within the lending market and this creates an additional challenge for businesses. However, the healthcare sector remains one of the largest in the country and it continues to attract high levels of private investment. Many lenders are looking to increase lending within the sector over the next few years, albeit subject to stricter lending criteria. Debt finance will remain an attractive method of finance for many within the sector and businesses who adapt their model to respond to these changes will, inevitably, find it easier to use debt finance effectively. CMM

Rachel Brown is Senior Associate at Druces LLP. Email: r.brown@druces.com Twitter: @DrucesLLP Have you used debt financing for your business? Share your thoughts online at www.caremanagementmatters.co.uk Subscription required. CMM December 2016 25

YOU CAN GET THERE FROM HERE 26 CMM December 2016

How to connect innovation with practice in social care and health Debbie Sorkin explains the steps you can take to help move innovation into practice.

In putting together its New Models of Care programme, through what were termed ‘Vanguard’ sites, NHS England had ‘replicability’ as one of its assessment criteria. There was no point in having a national programme if what you were doing in your area couldn’t be applied somewhere else. At the same time, this has always proven tricky in practice. Plus, it’s not just an issue in healthcare. Many social care providers are aware of pockets of good practice happening around integration or more joinedup services, but to find out about what’s going on, or to be able to do something with the information, is hard-going. It takes time and attention, when people are already over-burdened and services are under-resourced. Even if they’re worthwhile, innovations can sometimes be temporary, stopping when the funding runs out. This means that by the time you hear about them, there’s no-one left in-post to ask. Also, if you haven’t been directly involved in a new development – and independent sector social care providers are often last on the list to be included – it can feel difficult to apply something that was constructed to fit different circumstances or geographies. If you’ve found yourself in this position, there are things you can do to learn about, and apply, what’s happening elsewhere. The starting point is to get away from ‘magical thinking’: stop hoping for the ‘one big thing’ – a website, person or organisation – that is going to wave a magic wand and explain everything to you (and, ideally, apply it for you). Then – and this is the beauty of this approach – there are lots of small steps that you and people in your organisations can take.

YOU MAKE IT EVERYBODY’S BUSINESS Finding out what’s happening, with a view to continuous improvement, is part and parcel of social care leadership. The Leadership Qualities

Framework for Adult Social Care has ‘Improving Services’ as one of its seven key Dimensions, and this includes critically evaluating services to identify improvements and create solutions; actively encouraging improvement and innovation; and facilitating transformation. Leadership is for everyone, no matter what their level or role – it’s about how they behave in everyday situations. If you’re a frontline worker, good leadership means being actively engaged with improving the lives of the people you support and promoting change. At operational or strategic level, it means creating a culture of continuous improvement, championing excellent care and ensuring that good practice is adopted. It also means empowering your staff to seek out opportunities for change and innovation. As such, looking for innovation, and thinking about how to apply it, can be built into everyone’s role. It doesn’t have to be purely down to a single individual at the head of the organisation, or someone with the word ‘Development’ in their job title. Myron Rogers, who writes extensively on systems thinking and change, has two sayings, ‘Real change takes place in real work’; and ‘The people who do the work make the change’. Giving your frontline staff explicit permission to think about change, some ‘fail-safe’ areas in which to try out new things, and – importantly – permission to fail (because not all innovation is going to work) is a great way to improve opportunities for learning about, and applying, new ways of working.

THIS MEANS BUILDING, AND USING, NETWORKS AND RELATIONSHIPS Leadership, in this context, means systems leadership: how you lead, with other people, when you need to reach across organisational and sector boundaries. This means thinking in terms of using networks, and building relationships and trust. If you want to be a change agent, your position in an

CMM December 2016 27

YOU CAN GET THERE FROM HERE

informal network is much more important than your position in a formal hierarchy. There is research evidence that people who are highly-connected have twice as much power to influence change as people with hierarchical power. Social connection, and discussion, has been calculated to be 14 times more effective than written reporting or toolkits in supporting change. So the thing to do is to start using the networks you have, or that your staff have, and use them to learn, ideally face-to-face, about what’s happening elsewhere, and think together about what this might mean for you. If you have a local care association, or you’re a member of an organisation like Care England, the National Care Forum or Voluntary Organisations Disability Group, they’re a good place to start. Many have networks for specific groups such as HR and finance directors, and chief executives. Skills for Care and the National Skills Academy have Registered Manager Networks that can be a valuable source of emerging good practice and insights too. It’s also worth becoming a part of online networks like the Academy of Fabulous Stuff – for health and social care – which has a wealth of information and garners thousands of views alongside direct queries.

IT’S FINE TO START SMALL There’s a tendency to feel you should know everything, or have thought through all potential implications, before starting to do anything new. This is not the case. This doesn’t mean that you hare off down a new path without thinking through how you want it to work: of course, you need to think things through, get all the information you can and get as many people as possible in the room to think through the consequences

with you. But it does mean that you don’t have to wait for perfection. You just need to make a start. Start anywhere, follow it everywhere and don’t feel you need to ask permission.

AT THE SAME TIME, BE AWARE OF SOME OF THE BIGGER INITIATIVES AND WHAT THEY CAN OFFER There are national initiatives, particularly the Enhanced Care in Care Homes Vanguards, that are making major strides in joining up health and social care for the benefit of service users. They have a wealth of experience and evidence, and are happy to share what they’re doing and how they’ve done it. The Wakefield Connecting Care Vanguard has set up a number of network hubs, looking at different service mixes and trying out new ways of operating. One network focuses on working with a community geriatrician, with weekly GP visits to residents with complex neurological problems in specific homes. Two others involve advanced nurse practitioners acting as care co-ordinators for residents identified as high-risk, with regular pro-active care visits and better links with GP practices. A fourth is prioritising better collaboration between primary and secondary care, and Age UK, with better use of video links and access to shared care records. As a corollary, there has been more emphasis on skills development for care home staff, funded through the Vanguard, so that staff can deal with more complex medical needs and prevent emergency call-outs. They have moved towards using multidisciplinary teams across health and social care, often with the registered manager being the pivotal figure, and working with a range of health and social care practitioners,

including district nurses, social care staff, pharmacists and specialists in palliative care. The teams use a screening process to identify care needs which, if not met, may lead to residents needing to be admitted to hospital unnecessarily. The team can then support the care home to meet these needs to reduce reliance on hospital admission and improve people’s quality of life. It’s having a really positive effect. Outcomes from the pilots include a 25% reduction in ambulance calls; 30% reduction in A&E attendances, and at least 50 weekly visits to care homes by GPs – a significant increase. As a result of care reviews, 53% of residents saw changes in their medication, often with less medication required. Similarly, in the Sutton Homes of Care Vanguard, providers working alongside local GPs, Age UK and Alzheimer’s Society, are involved in building a provider network to support training across local care homes, as well as a new model of care that enables people to get specialist support at home rather than having to go into hospital. Again, this is translating into enhanced education and training for care home staff, with specialist modules in dementia, diet and nutrition, falls prevention and management, diabetes and working with challenging behaviour. A care co-ordinator role has been developed to bolster nursing leadership within care homes and maximise the input they have into the way GPs review care. The Vanguards have recently published an enhanced health in care homes framework, setting out what they’ve been doing, and how they’ve got started, along with contact details. They have ‘spread’ their work across the country as a core aim, and are a great source of insight and support.

GO BEYOND THE USUAL CONTACTS Alongside seeking information and insights from local health and social care contacts, and from those involved in national initiatives, it’s worth making links with other organisations involved in the delivery of services, particularly local voluntary and community sector organisations and housing associations. There are many examples of how just making these links has fostered innovation. In Dudley, the Council for Voluntary Services (CVS) has joined local multi-disciplinary teams and now delivers an ‘Integrated Plus’ service, using specialist link workers, to join up health, care and other sectors. In the West Midlands, domiciliary care provider, New Outlook made connections with Nehemiah Housing Association that have now developed into a formal partnership to deliver services, with outcomes that have included better satisfaction levels, more take-up of services and calls to ambulance services dropping by 66% over the last two years.

TAKE UP YOUR LEADERSHIP ROLE As many of the examples have illustrated, these innovations often happen because social care providers – owners, managers and staff – have stepped up to the plate and taken up their leadership role, both in their own organisations and working collaboratively with others, as true systems leaders. Learning about innovation, and getting in on the ground floor to influence development, can be difficult, but it can be done. Plus, it’s much better when social care gets involved. The thing to do is to start somewhere, and show how it’s social care leadership that makes all the difference. CMM

Debbie Sorkin is National Director of Systems Leadership at The Leadership Centre Email: Debbie.sorkin@leadershipcentre.org.uk Twitter: @DebbieSorkin2 Will you take the lead in connecting innovation to practice? Share your thoughts at www.caremanagementmatters.co.uk where you can also access this article’s references. Subscription required. 28 CMM December 2016

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5 OUTSTANDING…AND COUNTING WCS Care is the first care home provider in England to achieve five ‘Outstanding’ quality ratings from the Care Quality Commission (CQC). How has it achieved this and can others follow in its footsteps? WCS Care is a not-for-profit care provider operating 12 care homes across Warwickshire. Ten homes offer day care, long-term residential and short-term respite care for older people and people living with dementia or a range of different needs – three of which have now been recognised as ‘Outstanding’. The other two homes provide rehabilitation, respite and residential care for younger adults with physical disabilities or long-term conditions – both are also recognised as ‘Outstanding’.

OUTSTANDING HOMES The first WCS Care home to be recognised as ‘Outstanding’ was Drayton Court in Nuneaton. It was rated ‘Outstanding’ in the ‘Responsive’ and ‘Well-led’ categories, and ‘Good’ in the other three categories: ‘Safe’, ‘Effective’ and ‘Caring’. Commenting on the ‘Outstanding’ areas, the inspectors said, ‘The registered manager and staff were flexible and responsive to people’s individual needs and preferences and ensured people were enabled to live as full a life as possible. ‘People were encouraged to build and maintain links with their community by taking part in local events and by inviting people and organisations to visit. The registered manager had been interviewed by a local newspaper and had taken the opportunity to explain the vision and values of the home, and to invite volunteers to get involved. ‘Relatives and staff told us the managers were approachable and supportive and the registered manager operated an open and listening culture. A visitor told us, “This is great, really impressive. It’s a nice place to be. I enjoy visiting.” A member of care staff told us, “The manager is very approachable, I love 30 CMM December 2016

working here, we are a very close-knit team.” The provider’s vision and values were imaginative and personcentred and put people at the heart of the service.’ Dewar Close in Rugby also received an ‘Outstanding’ rating in ‘Responsive’ and ‘Well-led’ leading to an overall rating of ‘Outstanding’ (with ‘Safe’, ‘Effective’ and ‘Caring’ rated as ‘Good’). Commenting on the ‘Outstanding’ areas, the inspectors said that ‘people’s preferences, likes and dislikes were understood by the staff from the person’s point of view’ and that WCS Care’s ‘philosophy, vision and values were shared by all the staff, which resulted in a culture that valued people’s individual experiences and abilities’. Attleborough Grange followed Drayton Court with its ‘Outstanding’ rating on 7th May. This home received ‘Outstanding’ in the ‘Caring’ and ‘Well-led’ categories and ‘Good’ in the rest. The inspectors said of the ‘Caring’ category, ‘The service was very caring. People and relatives told us there was “something” in the atmosphere that made them feel welcome and truly “at home”. People, relatives and a visitor told us the care and support they received exceeded their expectations. They told us they were surprised and delighted at the level of kindness, thoughtfulness and compassion shown by staff.’ Mill Green in Rugby became the charity’s fourth home to be recognised as ‘Outstanding’ by the CQC. The home provides rehabilitation, respite and residential care for people with physical disabilities or long-term conditions. Mill Green achieved ‘Outstanding’ in ‘Effective’, ‘Caring’ and ‘Responsive’. The CQC report said residents at ‘were at the heart of the service’ and that the team ‘understood the importance of being partners-in-care with people who lived at the home’. It also recognised that the team ‘took

time to understand people’s histories and dreams and encouraged them to be ambitious in making decisions about their day-to-day lives’, and how they treated ‘people’s right to choose how to live their lives’ among the highest priorities. One resident told the inspector that they were initially anxious about moving into a care home but were ‘overwhelmed’ by the team’s ‘understanding, thoughtfulness and willingness to support them to regain control of their day-to-day life’. The CQC also highlighted the positive impact activities like Oomph! Wellness and gardening had on the lives of people living at the home and stated ‘people and staff share the moment of fun together, which develops trust and positive relationships’.

FIFTH OUTSTANDING The final home to be recognised as ‘Outstanding’ was Newlands in Kenilworth. This was achieved in October. Again, a home for people under 65, it offers rehabilitation, respite and residential care for people with physical disabilities or long-term conditions. Its ‘Outstanding’ categories were ‘Caring’, ‘Responsive’ and ‘Well-led’. Residents told the inspector that ‘their lives had improved and their horizons had broadened since coming to Newlands’. The report included examples of how the team encouraged independence at Newlands, so that people could ‘carry on with their working lives or continue their education’, including a resident who works for a local car company and another who works for a recycling charity. Jason Saunders, who has lived at Newlands for over 10 years, said, ‘Newlands is an outstanding place to live because it is my home. I’m able to live my life how I want to and do

the things I want to do – anything from working in the garden to fixing a bike or going to the pub with friends. ‘The team here are great and are very supportive – they help make it a fun, caring place to live and I’m really pleased that my home has been recognised.’ The CQC also highlighted the use of ‘creative communication techniques’ including an electronic touch and voice activation system designed to be used alongside other signs and gestures, as well as encouraging the use of other technology, such as digital screens and social media, to keep in touch with relatives around the world.

GOING THE EXTRA MILE Commenting on the company’s fifth ‘Outstanding’, WCS Care Chief Executive, Christine Asbury said, ‘In every WCS Care home, our teams always go the extra mile to provide the highest quality care because that is the way we think it should be done…we won’t be resting on our laurels – we’re always keen to push the boundaries of innovation and find new ways of responding to the ambitions of residents, so that every day is a day well lived.’ CMM

OVER TO THE EXPERTS... What WCS Care has achieved is ground-breaking. To be awarded five ‘Outstanding’ quality ratings must be commended. However, is this achievement only possible for the larger providers with economies of scale? Or does that make it harder to achieve consistency with more homes to manage? Is it easier for not-for-profit providers to achieve ‘Outstanding’? Can other providers learn from WCS Care? What does the panel think?

DIFFICULT, BUT NOT IMPOSSIBLE TO ACHIEVE So far, only about 1% of services have received an ‘Outstanding’ rating from the Care Quality Commission (CQC), so the achievement of WCS Care in having five of its services awarded this accolade is pretty amazing. It is a real credit to the way in which the organisation has transmitted its core values and made sure that these are being delivered across its services. I think it's important to remember that whether you are part of a large group, or an individual service, the CQC will rate you on the basis of what each individual service delivers to the people who use it. However, I think there are some common themes which come through all of the services that have been rated ‘Outstanding’. First, there is a rigorous focus on the needs of the people who use care, and their families. This focus manifests itself in services that are responsive and flexible and give people a good-

GOING BACK TO THE ROOTS OF CARE

quality life, rather than just a service. There has been a lot of talk as to whether or not some services are more likely to be rated as ‘Outstanding’ than others, and I have seen commentators suggesting that voluntary sector services, or small units, are the ones most likely to receive an ‘Outstanding’ rating. Care England is supporting an ‘Outstanding’ Group of providers and this has got a mixture of charitable and commercial providers, larger and smaller services; services for older people, as well as those for people with learning difficulties. The diversity of this group shows clearly that with the right values, highly-motivated staff, and a rigorous commitment to delivering high-quality lives for the people who use services, any service should be able to aspire to, and achieve, and ‘Outstanding’ rating.

Professor Martin Green OBE Chief Executive, Care England

WCS Care’s recurring ‘Outstanding’ themes focus on involving people in their own support, promoting independence, respect for choices, involvement in the local community, the stability of the staff team and a leadership focused on improvement. Judgements are focused on the care being delivered and relationships that are built; going back to the roots of care. It is rarely about paperwork, meeting regulations or systems. WCS Care also supports younger people and transferring this model to older people’s services increases chances of an improved rating, as highly-developed person-centred care is the norm for younger adults. Although, in some cases this model is ‘finding its feet’ and a challenge in some isolated older people’s services. If providers want an ‘Outstanding’ rating, they need to ‘sell themselves’ during an inspection. They need to be upfront, prepared, proactive, engaged and change the dynamic; treat the inspector as a potential

client. The regulator also needs to be more proactive and seek evidence to support really good practice, and not be afraid of rating services accordingly. Published figures show that the percentage of ‘Inadequate’ services is significantly reducing, the number ‘Requiring improvement’ is also reducing and ‘Good’ services are increasing. However, services rated ‘Outstanding’ appear to be fixed at around 1%. This may lead to it being seen as unachievable and a disincentive for improvement. I believe that more than 1% of services are ‘Outstanding’, and if so, then it must lie with how evidence is presented, looked for, judged or included in inspection reports. This 1% figure is a block for inspectors too. As it is so ‘rare’ it is in danger of overriding the judgement process, which should be objective and based on evidence.

Ed Watkinson Director of Care Quality, Quality Compliance Systems

ALL PROVIDERS SHOULD BE STUDYING ‘THE BEST’ There can be no doubt that an organisation having five care services rated by Care Quality Commission as ‘Outstanding’ is an outstanding achievement in itself. Also, achieving ‘Outstanding’ in five out of 12 care services is tremendous and must be a great fillip to all involved at WCS Care. It seems likely that many variables will have contributed to such consistent demonstrations of ‘Outstanding’ quality. These variables include, but aren’t limited to, genuinely listening to what people who receive the service have to say about it, along with their families and staff; leaders who maintain the high standards through the way they work; a culture of openness and transparency; investing in training and development to support and motivate frontline staff; and meaningful activities for people living within care settings. There is probably also

something to consider around assisting staff in how they evidence what they do to meet the needs of the people they support. In other words, taking the inspection and assessment of a care service seriously. Such factors are not, in my view, the preserve of bigger providers or not-for-profit care providers per se. I believe that a commercial approach is necessary for reinvestment and sustainability. Shared learning is certainly the key to increasing the number of providers achieving an ‘Outstanding’ rating. All care providers with an interest in delivering quality improvement, whatever their size, approach and type of service, should be studying other ‘Outstanding’ providers, ‘the best’, to learn what they can do better.

Des Kelly OBE Chair, Centre for Policy on Ageing

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Health and safety is a key training area. According to HSE, there are over 6000 reported injuries in a year to employees in social care. This new DVD explains health and safety procedures relating to all aspects of the topic within the care home, covering not only service users but also staff, contractors and visitors, making your home a safe place to work and live.

CARE HOME - HEALTH & SAFETY

• • • • • • • • •

Infection Prevention and Control (IPC) is a key element in social care and is vital to the well-being of people that we support and care for. Good IPC practices must be consistently applied by all staff to best prevent and control infection, and to ensure the safety of residents in a care home environment.

INFECTION PREVENTION & CONTROL IN THE CARE HOME

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Training Pack Infection Prevention and Control in the Care Home

HANDOUT 5

CARE HOME HEALTH & SAFETY

WASTe MANAGeMeNT - UNDerSTANDiNG SeGreGATiON Training Pack reFereNce GUiDe TO cOlOUr cODiNG Infection Prevention and Control in the CareQUicK Home WASTE MANAGEMENT Understanding segregation Quick reference guide to colour coding

Contents

Description

Colour

Care Certificate Workbook Care Certificate – Certificate INFECTION PREVENTION & CONTROL Assessment Quizzes IN THE CARE HOME Care Certificate Assessor Document Care Certificate Guidance Document Care Certificate Mapping Document Care Certificate Framework Care Assistant Self-Assessment Tool Deliver your training in-house • Cost effective • High quality • Easy to manage and record CPD Training Certificate CPD accredited and certificated • Over 70 individual courses also available on DVD or to download This care home based DVD aims to provide substantial support in making sure your staff fully understand and comply with legal obligations as well as significantly improving their skills/knowledge in the area of infection prevention and control. This DVD explains important topics such as: • Chain of Infection • Legislation and Guidance • Systems to Manage and Monitor IPC • Cleaning Equipment • Adopting Good Practice • Effective Hand Hygiene • Use of Personal Protective Equipment

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Subjects include but not limited to:

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www.bvs.co.uk

• • • • • • • • • • • • • • • • • •

Legal Duties Competent Person Contractors Medication Fire Safety Security within the Home Who is at Risk? RIDDOR Dangerous Occurencies Diseases Missing Clients First Aid Infection Control COSHH Managing Waste The National Colour Coding System Sharps Disposal Clinical Waste

• • • • • • • • • • • • • • • • •

Blood Borne Infections Water Temperatures Legionella Safe Handling of Food Manual Handling Lifting Techniques Floors and Stairs Lighting Windows and Ventilation Lifts Smoking Electrical Safety Kitchen Safety Laundry Safety Stress Management Challenging Behaviour Health and Safety Check List

Duration: (Approx.) 45 Minute DVD in 38 sections.

The BVS Range Includes: Care Home Series, Domiciliary Care Series, Childcare Series, Dementia Care and Learning Disabilities.

BVS Training

Page 1 Page 1 Pages 1-2 Page 2 Page 2 Page 3 Page 3 Pages 3-8 Page 8

How to use this Training Pack Trainer Introduction Notes Bibliography and Websites Tools Aims and Objectives Compatibility with Induction and QCF Units CPD Accreditation Lesson Plan Training Evaluation

Waste requiring disposal by incineration in a suitably licensed facility.

Waste which may be ‘treated’ or ‘rendered’ safe in a suitably licensed facility. May also be disposed of by incineration.

How to use this Training Pack

Cytotoxic and cytostatic waste requiring disposal by incineration in a licensed facility.

This Training Pack, containing a Lesson Plan and supporting material, has been designed to help you prepare and run an effective training session.

Offensive hygiene waste requiring disposal to a licensed landfill site. This waste should not be compacted.

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.

Page 1

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32 CMM December 2016

A VIEW FROM THE TOP

S A R A LIVADEAS Sara Livadeas is Strategy Director for The Orders of St John Care Trust (OSJCT).

REFLECTIONS ON THE LAST DECADE Since I started my career in social care over 20 years ago, I have seen a huge improvement in the support available to people. We have moved from a onesize-fits-all approach, with the majority of services delivered by councils, to a vibrant care market underpinned by notions of individual entitlements and choice. While I still see variability, the progress we have made in creating a more personcentred approach to care is a real success. We need care homes to become smaller and more intimate, perhaps along the lines of the Greenhouse model. What older people really need is love and intimacy – and that can’t be delivered in a large institution, however hard we try. PROJECTIONS FOR THE NEXT DECADE We aren’t doing enough to help individuals plan for the challenges that come with ageing. By the time people accept they need care, it’s often too late to influence the type of services that are available to them personally. There is a surprising lack of debate about the sort of help people should receive when they are old. It seems that politicians are just as likely to stick their heads in the sand when it comes to planning for an ageing society. The fact that people with dementia, which is an illness, have to pay for their own care, is

a national scandal. I wonder if the fear of dementia itself stops us from having the debate. I hope housing with care on-site will play a bigger role in the future. Someone needs to bang heads together to make more land available for retirement housing in the locations where people want to live. I’m thinking of the size of the NHS estate and other institutions like the Church and universities where they own land. This generation of older people has benefitted hugely from policies that favour home ownership. If we can make equity release easier so people can fund their own care and downsize, releasing family housing for the next generation, then everyone is a winner. Making the UK a great place to live when you are old is not the responsibility of any one agency. INSIGHT During my time working as a commissioner for Oxfordshire, I saw local authorities making a lot of efficiencies and they rightly expect providers to do the same. I hear a lot about underfunding in the sector, but less about cutting costs. I know commissioners are busy people but, since changing roles, I am surprised by how difficult it is to get them to talk to you about anything other than their own concerns. If only they realised that providers hold the solution to many of the challenges facing health and social care.

INFLUENCES I’ve recently met Muir Gray, Director of the NHS National Knowledge Service, who is raising awareness of the influence we have over our own health and wellbeing as we age. His basic message is ‘don’t mistake loss of fitness for ageing’. In essence, it’s so empowering. Small changes make all the difference. LESSONS The real joy in this job is that I am learning all the time and I find that so exciting. I felt pretty daunted when I took on the development role at The Orders of St John Care Trust as I had never even directly managed a capital project. However, now I can confidently talk to you about any aspect of healthcare development, from the return on investment for a new-build care home to the price of bricks. ADVICE My advice is to keep trying new things. I’ve recently taken on the role of nonexecutive Trustee on the Board of the Disabilities Trust – another great organisation. I think that voluntary trustees do an amazing job running these big charities. Knowing that you are improving people's day-to-day experience is so motivating, and I challenge anyone to find a more rewarding occupation. CMM

Read about Sara’s typical day on the website www.caremanagementmatters.co.uk Subscription required. CMM December 2016 33

BRINGING THE OUTSIDE

TO BRING THE INSIDE

OUT

Ben Benson-Breen explores ways to overcome barriers to activities outside the traditional care setting. How often do you find yourself beginning the week by asking your colleagues what they got up to over the weekend? Most Monday mornings in the Oomph! offices you’ll find people catching up over a coffee, swapping stories and sharing general chit chat as people ease back into the working week. Though a very simple question, asking ‘what have you been up to?’ can be harder to ask when visiting a care home, as often we already know the answer. Care homes can sometimes represent closed loops as care schedules and programmes of activity can seem repetitive, so the question of ‘what have you been up to?’ can serve to reinforce that repetition. This is the reason why running activities away from the care environment can have such a constructive impact; not only for the

34 CMM December 2016

Supporting activities outside the care setting

CMM December 2016 35

BRINGING THE OUTSIDE IN TO BRING THE INSIDE OUT

individuals attending the trips but also on the staff, family members and residents staying at home, who will now get to ask that very simple question, but get a very different answer in return. In my last article for CMM, I wrote of the importance of developing the community within the home, and the need for harnessing the relationships between staff and resident to create a communal ethic that distinguishes each setting from any other by that within. Here, I discuss the need for maintaining links with the wider world, the importance of getting out and about and the need for bringing the outside in. By developing a programme that links people living within a care setting not only to each other but also to those further afield, we can expect to see a deeper level of care that nurtures individuality and supports responsive and effective interactions. In my experience, I have found that activity co-ordinators are often good at utilising their local resources to support activities in the home, whether it is bringing in school choirs for Christmas or managing to arrange a donation from the local butchers for the summer BBQ, it seems that there are ready-made partners out there who are willing to support care homes in their area. However, it should be noted that all too often these are singular events that don’t result in an ongoing and regular relationship. When talking to these same activity leaders, there is often an expression for the need to run further activities outside of the care setting. There is a ready acceptance that if residents could get out of the home more they would better maintain a sense of identity and personhood through opportunities to relive past experiences and the freedom to take on new challenges.

WHAT DO WE LOSE BY LIVING IN CARE? To better understand what we could gain from running activities away from the home, it is worth considering what we might potentially lose when moving into care. The core elements to our identity are primarily built up through our relationships with the people and spaces around us. It is losing access to these things that people associate with coming to the end of life. Whether it is the fear of a diminished connection to family, friends and social groups, or losing our position within society in which we are relied upon to fulfil a function, for many people

36 CMM December 2016

“To set up the care home as a welcoming environment, there are some immediate factors that should be considered.” moving into care can raise mixed emotions. This is especially true as anxiety grows around the thought that by losing our sphere of influence, we may become less of ourselves. For this reason, the act of moving into care can be a shock to the system. It is normally seen as a last resort. Therefore, to set up the care home as a welcoming environment, there are some immediate factors that should be considered and included as part of a person’s induction process. Identifying what a person might be leaving behind and then moving to mitigate against as many of those losses as possible is one of the ways we can move to a more creative course of person-led care. This should result in a list of proactive actions that can be taken once the individual has become a resident of the home.

BARRIERS TO GETTING OUT AND ABOUT Why is it that, although we are aware of a clear need, and often have willing external bodies, we still have such a large gap between our care home population who are isolated from their local communities and achieving relationships that we know would be beneficial to all parties concerned? What are the barriers facing us? There are, of course, many factors that influence whether a care home can successfully connect with the community around it. However, they broadly fall into two categories. Do they have the means necessary to access the community? And, do they have staff with the inclination to do so?

THE MEANS TO DO IT The first category is the one we are presented with most often and is probably the more difficult to solve. Many activity co-ordinators complain of a lack of transport options as homes often don’t have their own minibus.

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BRINGING THE OUTSIDE IN TO BRING THE INSIDE OUT

This is understandable as they are a very expensive asset to maintain. When a home does have a minibus, we often find that other issues arise, such as the lack of trained staff or available persons who are insured to drive the bus. This means that outings are infrequent and, as such, activities outside the home become ad-hoc. To draw any significant benefit from doing activities outside the home, there needs to be an element of routine. The success of a trip away from the home is often prefaced by the anticipation or the knowledge of what is going to happen, when this is stripped away a sense of anxiety can build and people who would otherwise have benefitted are now uncertain that they want to go at all. As this is an issue that we have come across so regularly that we have taken direct steps

costs and introducing a reliable consistent service that residents can look forward to.

THE DESIRE TO DO IT The second category is more concerning, but is potentially more straightforward to solve. When staff in a care setting see activities as a ring-fenced responsibility, they are unlikely to contribute either their opinion on what could be done or the resultant action to do it. Activity co-ordinators often perform an admirable service to ensure that all residents are included and catered for, but how can we expect one individual to maintain links with the community for all the residents in a home? The truth is we cannot, something must give, and the solution to this is simple.

“When considering what excellent care should look like, we shouldn’t just think about the controllable space of our immediate surroundings, we should also include the spaces away from our homes.” to help homes overcome it. We have recently launched a service to work with homes who are facing these issues. Oomph! Out & About runs outings and trips on a home’s behalf, with our own buses, staff and timetable of activities that mean we can keep people in regular contact with their local areas. In my last article, I wrote about how we had supported a lady living in Hereford to start horse riding again after many years. The home now regularly sends a small group of residents to the stables to feed and groom the horses and spend time with the stable hands. The value of building connections with people who are otherwise unconnected to the care home has proved to be of massive benefit to this group of residents, teaching them new skills and providing a chance for friendships to grow. Part of the success of this relationship has hinged on the home’s ability to travel. For homes that don’t have this freedom, the service accounts for all the barriers that frequently prevent successful outings by bringing down

The introduction of a befriending system built on shared interests will support meaningful engagement within the home as well as outside it. I was recently running a workshop for managers on the benefits of activity to an individual’s wellbeing when I was told a story which supports this idea. One of the managers had recently employed a young male member of staff into his care team. The young man had never worked in care before and so had spent the first couple of weeks finding his feet and learning his duties. During this short period, he had connected with a gentleman in the home and they bonded immediately over their mutual love of the local football club. Without hesitation, the young care worker called the club to see if he could arrange a ticket for the gentlemen who used a wheelchair and hadn’t been to a game in years. The club were more than happy to give both men a ticket and the care worker came in on the day of the game, which was also his day off, to pick up the

gentleman and they went out together. This is not a unique case and I’m sure many of us can recall similar instances where bonds have been formed in this way. However, what struck me as different here was that this young care worker had never been educated away from the fact that this was a natural, caring thing to do that formed part of his role. If we want to replicate anything here it is the ease with which this interaction occurred, and the sense of personal benefit for both parties. A 2013 study called Greening Dementia looked at the benefits and the barriers that people living with dementia face when getting out and about. One of the things it found was that only 20% of the people living with dementia considered that their condition was a barrier to using outdoor spaces, whereas 83% of care staff believed that dementia limited the person’s ability to do so. What this means is that most of the barriers to accessing space away from the care setting are barriers of our own making. Whether it is the expectation of what’s possible, or the lack of accountability to do it, there are things we could do to expand the tangible areas in which we can attend to people’s needs.

BREAKING DOWN THE FOURTH WALL In the theatre, there is a term ‘bringing down the fourth wall’, the idea here is to let the audience in so that they can better interact with the story-telling. When we think about the story of care, maybe breaking down the forth wall could mean that that story could be told just as well in numerous other settings. When considering what excellent care should look like, we shouldn’t just think about the controllable space of our immediate surroundings, we should also include the spaces away from our homes. This could mean dropping into a museum or gallery exhibition to learn something new, frequenting a local café with a book club or simply getting out into the fresh air for a short period to feel the touch of the elements. These moments enrich the whole care experience by broadening the perspective of both care staff and residents. When this balance happens, we find we are providing more than just a care home, it becomes a more encompassing habitat of care. CMM

Ben Benson-Breen is Head of Activities and Wellbeing at Oomph! Email: benjamin@oomph-wellness.org Twitter: @OomphWellness How do you help your residents get out into the community? Share your thoughts at www.caremanagementmatters.co.uk Subscription required. CMM December 2016 39

UNEXPECTED HAPPENINGS

Life in a Swedish care home 40 CMM December 2016

Sweden is twice the size of the UK, with a population the size of London. Care homes in Sweden are mostly owned and managed through local government structures and fees are subsidised by the State. The care home I visited, Harakarrsgarden in Akarp, a leafy suburb comprising 8,000 people with enviable infrastructure. Harakarrsgarden is a 34-bed home for people with dementia. It is separated into four units and each resident has their own apartment with small kitchenette, sitting area and bedroom. The rooms all have overhead track hoists and easy-opening bathroom doors. All bedrooms are individual and personalised. There is a courtyard garden with hens, rabbits, a pond with ducks and fish, plus plenty of small sitting areas in the shade.

STAFFING AND STAFF DEVELOPMENT

Rosemary Hurtley explores life in a Swedish care home and finds some unexpected happenings.

Harakarrsgarden is run by the manager, Eva, with nursing assistants known as ‘under nurses’. The under nurses whom I re-named ‘wonder nurses’, due to their emphasis on quality of life and their enhanced education, are neither registered nurses nor care assistants. In training for their role, they can undergo a three-year further education course with different placements. Alternatively, they can undertake 40-week online training with practice learning on the job. Under nurses change their roles as the day progresses. Firstly, they are assisting with activities of daily living and care, then they may become activity assistants or dining assistants. They also act as a key contact for the resident and their family. The care home has very little turnover of staff and I was interested in their continuous development and whether this was a contributing factor in their retention. The emphasis in the home is on the caring culture and how much fun it is to live in the workplace. This means that staff need ongoing support

CMM December 2016 41

UNEXPECTED HAPPENINGS: LIFE IN A SWEDISH CARE HOME

and a sense of pride in their job. It is important that staff have flexible ways of working to enable them to deliver spontaneous activity in the daily flow of the day. This is creatively enabled with the use of life story work and approaches have been developed that have been designed to lift mood and alter energy levels amongst residents. The manager is keen to be seen out and about on the floors, encouraging and reinforcing positive approaches to care and support through modelling or coaching. Staff appraisals focus on staff development and the support the company can give them, as well as feedback on any improvements the company can make. There is no minimum wage. Due to recent changes to nursing there is only one nurse to 70 residents in the region. They are stationed in regional offices and work in district formation. The care home manager admitted that she was is not happy with this as it affects the continuity of nursing care on site.

THE DAILY ORGANISATION OF CARE The manager empowers her staff to be spontaneous and creative in how they build relationships with residents. The manager ensures that there is a higher ratio of staff on duty in the afternoons. This is the time she wants them to use their initiative to help residents enjoy their day, build relationships and make sure residents are able to get outside every day. Mealtimes offer a graded service to accommodate different needs; these can be met in separate environments. There is a pub/ restaurant service on open days for relatives to join and eat together. There are additional day care spaces for up to seven

local community members with dementia. They arrive by subsidised transport and are supported by an under nurse. Adopting a communitybuilding approach, the manager works closely with the activity co-ordinator to integrate these local residents into the home’s community.

ACTIVITY ACTIVATION Although there is only one activity co-ordinator for the home, all staff stay with a group of residents and work together as a community supporting the activities in the morning. The under nurses work independently on a one-to-one basis, using their creativity in the afternoon, reporting to the manager who encourages her staff to be person-centred and use life stories. The under nurses participate in and support group activity. This enables them to really get to know the resident as a person, which the manager explained is an important part of their role enrichment. It also builds relationships and residents are more likely to be treasured rather than managed. Caroline, the activity co-ordinator, is also an experienced under nurse. Her role is to both co-ordinate the activities within the home and deliver some. She regularly links up with the nursing home next door for inter-home activities. The formal activities are delivered between 8am and 4pm. Spontaneous daily activity also occurs, led by the other under nurses with whom she has a good working relationship. The range of activities include singing together, weekly community church activities with a coffee morning (run by volunteers), a library visit with short story readings, slide shows and films. Some residents also enjoy Bingo and residents select the prizes weekly. Baking and flower craft is popular alongside the

multi-sensory themed activities. Discussions include history and traditions, and there are exercise sessions too. Outings include fishing trips, with cold beer, shrimps and meat, and a range of cultural excursions. The home also has a London cab to take residents out on trips in small groups. There are also drama and dressing-up sessions plus sensory

team, including a physiotherapist, occupational therapist and specialist nurse. There is no boundary to the discussions and ideas are facilitated in an open environment, focusing on the quality of the care experience. There is also a domiciliary agency attached to the care home. There is an annual two-day holiday for some residents where staff share a room with a resident

“The manager empowers her staff to be spontaneous and creative in how they build relationships with residents.” boxes. The garden is full of things to see and do with several shaded sitting and walking areas. One-to-one activities include individualised music with personalised earphones to suit different tastes, outdoor walks, bike rides and an indoor sensory relaxation chair. The use of the arts is evident in the home with murals and themed displays. Corridors are wide and generous, broken up with the themed displays and an old sweet shop.

COMMUNITY BUILDING AND SHARING BEST PRACTICE The care home offers respite services for one week each month to help eligible carers. This is common practice in Sweden. There are formal relatives’ meetings with the manager, activity co-ordinators and contact person twice a year, any other meetings are informal. There is a weekly review meeting with the multi-disciplinary

and a family member. The manager said that her staff are committed to this and that it is life-changing for them.

LIFE IN A SWEDISH CARE HOME There are a number of points that can be drawn from the care home I visited for consideration by UK care providers. There is a learning environment led by the manager who models and supports her staff. Staff are encouraged to be creative with structures, including time and job profiles to reflect their flexible roles. Daily activity is everybody’s business and built into the flexible job functions. There is a strong emphasis on education for nurse assistant roles as the primary workforce and the nursing role is seen as important. Although it is not organised to deliver the optimal health and wellbeing outcomes. Use of the arts is encouraged in the indoor and outdoor environment and forms part of the community building. CMM

Rosemary Hurtley is a health and social care consultant at 360 Forward. Email: rosemary@360fwd.com Twitter: @360Fwd Have you visited any overseas care providers? What can we learn from other countries? Share your thoughts at www.caremanagementmatters.co.uk Subscription required. 42 CMM December 2016

Colin Wright discusses core standards for learning disability education and training. Department of Health figures suggest that around 1.5 million people have a learning disability. This is 2.5% of the UK population. Of these people, 57,608 were in contact with learning disability services in January 2016, according to Mental Health Services Data Set (MHSDS) collection. The Department of Health statistics also suggest that the number of people with learning disabilities is expected to rise by around 1% per year, for the next ten years, and to grow overall by over 10% by 2020. I believe that now, more than ever, it is important for the sector to review its learning disability education and training, to ensure all staff and organisations meet the standard needed to offer an efficient and effective service.

RECOGNISING THE GAPS Along with the Government, healthcare organisations, and others across the system, are committed to transforming care for people with learning disabilities, who have a mental illness or with behaviours that challenge. A lot of progress has been made so far, but much more still needs to be done. In 2014,

Changing the scope of learning disability care CMM December 2016 43

CHANGING THE SCOPE OF LEARNING DISABILITY CARE

NHS England commissioned Sir Stephen Bubb to produce a report on his recommendations to accelerate the transformation of care for people with learning disabilities. As Sir Stephen Bubb said in his report, ‘We make it too hard for stakeholders across the system to make change happen, and too easy to continue with the status quo. And we do not give enough power or support to the people most eager and best placed to make things change – starting with people with learning disabilities and/or autism themselves and their families.’ The report made it clear that there was a great need to develop the workforce to equip it to provide person-centred care and fully support people with a learning disability in their communities. It also highlighted that the workforce needs to become more needs-led, local and accessible.

LEARNING DISABILITY FRAMEWORK Skills for Health was commissioned by the Department of Health to develop a Core Skills Education and Training Framework for the learning disability workforce to help improve care. We worked with Health Education England and Skills for Care, to develop core learning outcomes aimed at changing the way the workforce cares for people with learning disabilities. After 10 months of development and consultation, the Framework launched in July.

MEETING CROSS-SECTOR NEEDS When developing the Framework, the first phase of the project was a scoping report to identify key resources and stakeholders. The project steering group included

representatives of key stakeholders such as the relevant royal colleges, health, social care and education sector organisations. The steering group was supported by a reference group, who were involved in the consultation process to ensure the new Framework met the requirements of health and social care. The Framework builds upon previous activity to develop standards and existing frameworks, including Health Education England’s Generic Service Interventions Pathway (2015). The Framework had to meet sector needs, build on what existed previously and encompassed the core requirements and standards required.

SUBJECTS AND PRINCIPLES The Framework sets out the expected learning outcomes and minimum standards for the delivery of education and trainingrelated core skills. This includes common and transferable skills and knowledge that can be applied across different types of services. There are 19 subjects in the Framework: • Learning disability awareness. • Communication. • Identification and assessment of learning disabilities. • Person-centred care and support. • Healthcare. • Wellbeing and independence. • Relationships, sexuality and sexual health. • Supporting children and young people. • Preparing young people for adulthood. • Supporting people with profound and multiple learning disabilities. • Families and carers as partners. • Supporting people at risk of behaviours that challenge. • Supporting people with a learning

disability and a mental health condition. • Supporting people with a learning disability and autism. • Supporting older people with learning disabilities. • Equality, diversity and inclusion. • Law, ethics and safeguarding. • Research and evidence-based practice. • Leadership and management in learning disability care and support settings. These 19 subjects will help standardise the interpretation of learning disabilities education and training, and support the ongoing assessment of staff competence. However, we did not set out to prescribe the training or teaching methods, as this is down to the education and training providers. Providing care and support for people with learning disabilities requires commitment to strong principles and a firm value base. Within the Framework, there are four key principles that underpin all subjects. These are taken from Valuing People: A New Strategy for Learning Disability for the 21st Century: • Rights – People with learning disabilities and their families have the same human rights as everyone else. • Independent living – All disabled people should have greater choice and control over the support they need to go about their daily lives. • Control – People should have information and support to understand different options, their implications and consequences, so people can make informed decisions about their own lives. • Inclusion – Being able to participate in all the aspects of community – to work, learn, get about, meet people, be part of social networks and access goods and services – and to have the

support to do so. In addition to the four principles, care and support for people with learning disabilities should be delivered in line with health and social care values. Values influence the way people in the sector work and guide approaches to those being supported. Values underpin good care practice. In health and social care, values include individuality and identity, rights, dignity, respect, privacy and partnership.

BUILDING A COMMITTED WORKFORCE The new Framework applies to all health and social care employers, as well as to educational organisations that train students. Learning disabilities services need a workforce that is extensive and diverse. Many different levels of staff support people with learning disabilities meaning that all workers must understand an individual’s needs and be able to deal with individual cases. The key to a person’s wellbeing is the quality of care and commitment provided by those who work with them. Having a common standard ensures a sustainable and committed workforce. The Framework outlines the core education and training that has been created by the sector, for the sector, and will allow health and care professionals to ensure they are working professionally, according to conduct and an agreed minimum standard. Employers and commissioners of education are encouraged to use the new Framework as guidance for the development and delivery of appropriate and consistent education. We strongly believe that use of the framework will result in an increased quality of care for people and their families. CMM

Colin Wright is Skills Framework Manager at Skills for Health. Email: colin.wright@skillsforhealth.org.uk Twitter: @SkillsforHealth More information on the Framework and other resources referenced in this article are available at www.caremanagementmatters.co.uk Subscription required. 44 CMM December 2016

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EVENT REVIEW

THRIVE: ACHIEVING COMPETITIVE ADVANTAGE IN THE HEALTHCARE MARKET 29th September, London

Prominent healthcare companies hosted an exclusive director-level event in September exploring current and future challenges in the market. Thrive: Achieving Competitive Advantage in the Healthcare Market was produced in partnership between Liquid Healthcare, eLearning For You and Affinity Training, Advanced and Person Centred Software.

PRESENTATIONS Des Kelly OBE, Chair of the Centre for Policy on Ageing, delivered the morning’s keynote speech, providing an overview of the changing state of the sector. His talk focused on quality of care and changes to the revalidation process. Des Kelly was followed by Liquid Healthcare’s Managing Director, Alison Humphries. Humphries

suggested recruitment managers should consider behaviours equally with experience at interview to avoid high attrition rates. She encouraged attendees to invest in their company’s brand so they can track high-quality, developing candidates who may be suitable for future posts. Finally, Alison highlighted the importance of board-level sponsorship to successful recruitment. Paul Blane of eLearning For You and Affinity Training presented next, focusing on the skillset modern care home managers need. He argued that sourcing exceptional managers and adopting effective management training programmes is integral. He advocated that through supporting and transforming workforce thinking, good managers can help achieve best quality and profitability. Jane Orr-Campbell of Orr-Campbell Consultancy focused on Care Quality Commission (CQC) compliance. Her presentation encouraged attendees to instigate compliance processes, emphasising quality control and assurance. She also suggested managers adopt a collaborative, not adversarial, relationship with CQC inspectors to improve standards. Speaking on behalf of Advanced, Dr. Alex Yeates discussed information governance and the material obligations and business risk it presents for providers. Providing an overview on laws surrounding the topic, Yeates also examined upcoming information governance legislation and offered actions and precautions providers should take. Person Centred Software Director Jonathan Papworth gave the final presentation of the day, Media Partner

arguing that paperwork burdens prevent care staff from going beyond task-based care. To prevent consequent lost working hours and mass document duplication, Jonathan suggested using innovative systems to evidence care, alongside further use of mobile technology.

DISCUSSIONS Discussions at the event focused on sector changes over the past year, highlighting staff shortages and funding concerns. With 45% of nursing staff retiring within five years, attendees agreed that immigration will become increasingly important. Healthcare market growth correlates with the number of immigrants entering the workforce, resulting in a highly-diverse and international profession. Furthermore, the combination of an older British and younger immigrant staff means many workers are at different stages of their career. Attendees concurred that these situations meant future strategies and market approaches needed to be more flexible. The use of the International English Language Test System (IELTS) when screening migrant staff for language proficiency concerned many attendees. They felt the IELTS is too difficult and contains content irrelevant to the sector, preventing high-quality professionals from working in healthcare. The event followed on from the ‘Recruitment Excellence’ event held in February, and all participating companies look forward to organising similar events in 2017.

Partners

CMM December 2016 47

EVENT REVIEW

BERKSHIRE CARE CONFERENCE 2016

In association with

20th October 2016

CMM Insight – The Future of Care and Commissioning returned to Berkshire to tackle the pressure faced by providers in the region. Fidelma Tinneny of Berkshire Care Association chaired the event and opened the day with a very rousing speech. She gave a stark warning of what providers face, but also argued that social care staff are equal to those in the NHS, not different. Patrick Hall, Fellow, Social Care Policy at the King’s Fund followed with a slide showing a varied picture of the pressures that providers face. His statistics showed the homecare market in real distress, with providers reliant on local authority funding being at greater risk. Patrick predicted that more will fail in the next five years. Shortterm solutions, however, included changes in the commissioning processes, commissioners and providers working together and really valuing care staff. Sue Burn, Inspection Manager for the Bristol and BaNES Inspection Team, Care Quality Commission discussed the State of Care report and delivered some interesting statistics. Ed Watkinson, Director of Care Quality at Quality Compliance Systems followed Sue. Ed offered techniques to achieve an ‘Outstanding’ rating including suggesting providers mimic the best practice of others.

PANEL DISCUSSION The panel discussion followed straight afterwards, with delegates keen to put their own questions to the experts. The struggle to achieve an ‘Outstanding’ rating from the CQC was hotlydebated. Chair, Fidelma Tinneny asked the panel if they think that the criteria is still just too vague. Corporate sponsor

48 CMM December 2016

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Sue Burn also answered a question around the role of the regulator in health and safety issues, saying that providers should be more aware of avoidable harm. Talk quickly shifted from regulation to workforce and the benefits of developing career progression to make staff feel valued.

PACKED WORKSHOPS As always, the workshops proved extremely popular. Tom Owen, Co-Director of My Home Life placed a huge emphasis on the role of quality in increasing occupancy. Tom advised delegates that personalisation fed into quality. Investing in staff and relationships, where beautiful moments of connection between staff and residents could flourish, should be a continual focus. Colin Angel, Policy and Campaigns Director of United Kingdom Homecare Association, also had an impressive turnout for his workshop on the challenge of homecare. Armed with some alarming statistics, Colin highlighted the homecare funding gap and council contracts being returned. Colin’s was a powerful presentation, so much so that one delegate commented that ‘homecare was lucky to have such an authoritative voice.’ The third workshop from James Calvert and Lynne Omar explored the role of technology in social care and created a lot of discussion amongst the attendees.

SHARED PRESSURES The exhibition rooms allowed time in-between the presentations for delegates to explore services Organised by

and products, which could further enhance their business. With plenty of opportunity for delegates to network and share experiences, it was apparent that the topics discussed throughout the day were common pressures faced by all. Thanks go to our corporate sponsor, Quality Compliance Systems, the exhibitors and all those who attended on the day.

WHAT’S ON? Event:

Enhanced care in care homes – Lessons from the vanguards on integration in practice Date/Location: 6th December, London Contact: The King’s Fund, Tel: 0207 307 2409 Event: Recruiting for values in adult social care Date/Location: 12th December, London Contact: Skills for Care, Tel: 0113 241 0977 Event: Adult social care workforce conference Date/Location: 16th January, London Contact: Capita Conferences, Tel: 0870 400 1020 Event: Self-neglect and adult safeguarding Date/Location: 27th January, London Contact: Social Care Conferences UK, Tel: 01932 429933 Event: Governance and accountability in new care models Date/Location: 8th February, London Contact: The King’s Fund, Tel: 0207 307 2409 Event: Health + Care 2017 Date/Location: 28th-29th June, London Contact: Health + Care, Tel: 0207 348 5777

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3rd Sector Care Awards 2016 7th December, London Care Choices, Tel: 01223 207770

Event: Date/Location: Contact:

CMM Insight – Dorset Care Conference 2nd February, Bournemouth Care Choices, Tel: 01223 207770

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CMM Insight 2017 – Learning Disability and Mental Health Services 2nd March, Manchester Care Choices, Tel: 01223 207770

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12/02/2015 10:50

CMM December 2016 49

DR JANE MARTIN â&#x20AC;˘ LOCAL GOVERNMENT OMBUDSMAN

Dr Jane Martin looks at adult social care complaints in 2016 and what providers can do to improve practice.

As the local government and social care ombudsman, earlier this month we issued our annual review of adult social care complaints; and we believe many of the findings within the report should make interesting reading for the care sector. We are in the unique position of being able to investigate complaints about all adult social care regardless of how the care has been arranged or funded. Over the past year, we received 2,969 complaints and enquiries about

adult social care â&#x20AC;&#x201C; a 6% increase on the previous period. Now in its sixth operating year, our jurisdiction over care arranged privately with independent providers saw a 21% increase in the number of complaints and enquiries, and a 19% rise in the number of independent providers about whom we have received a complaint. In some respects, we welcome this upturn in complaints and enquiries received as it indicates more people coming forward to raise their concerns. We believe this is, in part, due to the good work of the sector to approach complaints maturely, improve the visibility of their complaints procedures and signpost people to the Ombudsman. However, this figure still only amounts to around 13% of our caseload within the adult care sector. If our statistics were to reflect the care spectrum as a whole, we would be expecting to receive even more complaints. Our report not only examines where things have gone wrong, but also highlights the steps we have recommended to councils and providers to put things right. Last year, we made 943 recommendations to remedy injustice for individuals â&#x20AC;&#x201C; this might be anything from a simple apology to financial redress and the provision of a service. More than 200 of our recommendations (222) involved preventing a similar issue affecting other people, and this included staff training or procedural change. Of the 1,188 recommendations we made, 23 acknowledged and provided reassurance to the service provider that they had already remedied the problem satisfactorily. What we really want is for services to

Dr Jane Martin is the Local Government Ombudsman. Twitter: @LGOmbudsman For more information about the Local Government Ombudsman, visit www.lgo.org.uk 50 CMM December 2016

be improved for all users. The learning points from complaints are a very useful way of identifying where practices need to be improved for the benefit of all clients. Clients and their families should not have to worry that raising a concern may lead to a deterioration of their care, or their relationship with staff. We believe a good complaints service should support people to make their complaint. Good quality social care relies on staff and managers having a positive attitude and response to hearing and resolving feedback, concerns and complaints. Staff should be open to identifying complaints and learning from them to drive service improvements. Care homes can have detailed and soundly reasoned policies, but unless managers are clear with staff about complaints handling, and staff are aware of those policies, understand and are empowered to follow them and then learn from any complaints that might arise, the true benefit will not be felt. Complaints about other providers are a good source of knowledge too. All our decisions can be found on our website. These offer a wealth of information about the complaints we receive, the faults we have found and the kind of remedies we recommend when we do find fault. If you think your staff may benefit from further guidance in the area of complaints, we offer training for care providers. These courses have been specially designed to take people through the complaints process from start to finish and identify ways in which complaints can better be resolved, and the learning used to improve services. Our website also includes template complaints letters and procedures for care providers that are free to download and adapt. CMM