Care Management Matters July/August 2018 by Care Choices Ltd

JULY 2018

www.caremanagementmatters.co.uk

CREATING A POSITIVE ENVIRONMENT The role of managers

Becoming an effective leader Have you got what it takes?

End of life care best practice

Developments with Gold Standards Framework

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Driving Outstanding Care

In this issue 05

Inside CQC Deputy Chief Inspector of Adult Social Care, Debbie Westhead talks about CQC’s enforcement work.

CMM News

Business Clinic A recent pilot in London has uncovered a number of challenges and solutions to the success of Transforming Care.

A View from the Top Martin Farrow, Chief Executive of Optalis is this month’s interview subject.

Rising Stars Nick Rickwood, Registered Manager of Flowerdown House ‘Wings Breaks’ Hotel is the first of 2018’s Rising Stars.

Awards Preview CMM previews the categories for the Markel 3rd Sector Care Awards 2018.

What’s On?

Straight Talk Paula Webb asks whether people with Pathological Demand Avoidance are misunderstood or whether it’s a lack of awareness of the condition.

FEATURES

REGULARS

From the Editor

Becoming an effective care leader: attitudes, skills and techniques Jonathan Cunningham explores the features of effective care leadership and the essential skills that all care leaders need.

Best practice in end of life care: developments with Gold Standards Framework Professor Keri Thomas OBE updates on developments with the Gold Standards Framework for Social Care and the impact it can have on social care and health.

Bridging the gap through mental health research Andrew Molodynski and Professor Kathryn Abel discuss the value of research in terms of improving care and treatment for people with mental health conditions.

The role of managers in creating a positive environment Jenny Kartupelis shares recent learning about the way in which relationships in care homes affect wellbeing and considers the unique role of managers in creating a positive environment.

Resource Finder: property professionals CMM profiles specialist property professionals. CMM July 2018

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

CONTRIBUTORS

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Debbie Westhead Deputy Chief Inspector of Adult Social Care, Care Quality Commission

Jonathan Cunningham MBE Managing Director, STORM Consultancy

Professor Keri Thomas OBE Clinical Director, Gold Standards Framework Centre

Sarah Broadhurst Lead for Learning Disabilities and Autism, Institute of Public Care

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Steve Scown Chief Executive, Dimensions

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Martin Farrow Chief Executive, Optalis

Nick Rickwood Registered Manager, Flowerdown House

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Andrew Molodynski Consultant Psychiatrist, Oxford Health NHS Foundation Trust

Professor Kathryn Abel CRN National Specialty Lead for Mental Health, NIHR

Jenny Kartupelis MBE Director, Faith in Society Ltd

Paula Webb Chair and Adult Enquiry Line Lead, PDA Society

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 2018 ISBN: 978-1-911437-94-9 CCL REF NO: CMM 15.5

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ABC certified (Jan 2017-Dec 2017) Total average net circulation per issue 16,336

CMM July 2018

From the Editor Editor, Emma Morriss reflects on the last 13 years as she bids farewell to contacts, readers and the sector. As the standfirst suggests, this people with the highest levels is my last full issue of CMM. of need, meaning fewer were As I reflect on my time at the receiving the care required to live magazine, I have seen so many independently. Added to this, changes happen in the sector it said that support for carers since I started. was urgently needed and people My first full issue carried the faced a lack of information when headline, Granny Ghettos? Are looking for services. care villages set to revolutionise Oh, how times have changed… care? It also explored tackling staff or not. hesitancy around technology, new what it is, we have an article CMM, under the editorship of Common Induction Standards THE FUTURE on being an effective leader, as my successor, Angharad Jenkins and the hidden costs of staff leadership matters to quality and the wider team, will continue recruitment. The sector is only weeks away services, starting on page 22, to support you with quality Our news discussed a highlyfrom another Green Paper to and another on the role of content and expertly-developed anticipated White Paper set to address the issues it faces, many managers in creating positive care events as they stand alongside you influence policy for the next of which it was dealing with environments, starting on page into the future. 10 to 15 years. It also covered back in 2005 – but with even less 40. If organisations are well-led plans to merge the Healthcare money. Much of this month’s and positive places to be, good THANK YOU Commission and Commission for news looks at how the future care follows. Social Care Inspection (CSCI) and funding of adult social care and As my own career takes As I sign off for the final time, all the CSCI’s first State of Social the NHS could be reformed, as me away from social care on a that it leaves me to say is thank Care Report. The report identified, well as containing reports and daily basis, I will be watching you. I have made many wonderful amongst other things, continuing research which I hope will feed with interest to see how the contacts within the sector and and chronic difficulties in staff into the Government’s research Government addresses the muchwithout you and your hard work, recruitment and retention which for the Green Paper. needed reform and how the sector my job would have been much was impacting on care quality. Also, this month, knowing continues to cope, adapt and more difficult. Thanks for reading It also found that councils how much it’s the people in grow over the coming months and and supporting me, and CMM, were targeting resources on social care who make the sector years. over the years. R075 CMM_reports_ad_Layout 1 04/09/2017 15:25 Page 4 Email: editor@caremanagementmatters.co.uk Twitter: @CMM_Magazine Web: www.caremanagementmatters.co.uk

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It’s great to have the opportunity to write for readers of Care Management Matters. As this is my first column, I’ll begin by telling you a little about my role. I’m CQC’s Deputy Chief Inspector of Adult Social Care for the North region. This means I lead the inspection teams working everywhere from the Wirral up to Berwick-uponTweed. I’m also the strategic lead for CQC’s enforcement work, a vital part of our role. We register, monitor, inspect and rate all services that fall within our scope, so you will all be familiar with this part of our role. Although four out of five services in England are rated as Good or Outstanding, there is still too much poor care and where we find it we will use our enforcement powers to take action. I think of enforcement as a way of encouraging improvement – rather than a punishment – to make sure people receive safe, effective and high-quality care. Since we began our new approach to regulation in 2014, we have matured in how we use and learn from our enforcement powers. Our civil powers ensure people remain safe and our criminal powers ensure we hold providers to account when there are serious failings. We’re taking more enforcement action and we know more about the risks that providers are least likely to act on. I want to share the issues we’re seeing regularly and talk about our plans to inform providers about them. So, where have we been taking enforcement action in relation to the most serious incidents? Issues with documentation have been a key theme. In one case, we found errors with anti-coagulant medication that linked to wideranging documentation failures including: medication dosages and strengths, allergy information, and medication administration times not being accurately recorded, plus poor systems of stock management leading to the service running out of essential medicines. We’ve also seen problems with the quality and use of risk assessments. One care home was found to have no proper system for assessing the risks to the health and safety of people using the service, which shockingly included failing to prevent a person with visual impairments from repeatedly falling in their bedroom. Failure relating to equipment has come up frequently. In one very upsetting case, a person living with dementia suffered burns after falling against a radiator where the provider had failed to ensure effective radiator covers were in place

Inside CQC D E B B I E

W E S T H E A D

In this month’s Care Quality Commission column, Deputy Chief Inspector of Adult Social Care, Debbie Westhead talks about CQC’s enforcement work.

and pressure sensor mats were not used to alert staff to the person getting out of bed. The final theme we’ve seen across a lot of our enforcement work is problems with staff training. One provider failed to bring to the attention of staff a national safety alert about the importance of safety/posture belts and to

“I think of enforcement as a way of encouraging improvement to make sure people receive safe, effective and high-quality care.” ensure that staff understood how to fit chair straps safely, which led to a person falling out of a shower commode chair. Getting these things right are the basics of delivering good care; the impact when this doesn’t happen can have devastating consequences. It’s so important that we do all we can to protect people who use services from this type of harm. With this in mind, we are working to bring these issues to the attention

of providers so that action can be taken to mitigate any risks they find within their own services. How are we doing this? We’re currently developing a series of updates that will be shared via our newsletter and available on our website: Learning from safety incidents. We’ll share the risk, give an example of where we have taken enforcement action in this area, share how the provider has since taken steps to improve, and link this issue to our regulations and any relevant Medicines and Healthcare products Regulatory Agency safety alerts. The idea is to provide short, easy-to-digest summaries that providers can use to support their risk management, and stop other similar incidents happening in the future. We’re testing these updates with providers on our Online Community to make sure that the information and format is useful. When we’ve completed this testing and made any changes, we’ll share them in our newsletter later this year. I hope that gives you a taste of CQC’s enforcement work and how it enables us to encourage services to improve.

Debbie Westhead is Deputy Chief Inspector of Adult Social Care at the Care Quality Commission. Share your thoughts on Debbie’s column and suggest topics for future CQC columns on the CMM website www.caremanagementmatters.co.uk Not a member? Sign up today. CMM July 2018

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APPOINTMENTS WELSH GOVERNMENT Heléna Herklots has been appointed as Wales’ next Commissioner for Older People. She is stepping down as Chief Executive of Carers UK.

BRUNELCARE

Petition for Government to commit to long-term funding

Consumer law consultation

The NHS Confederation has launched a petition calling on the Government to commit to a funding plan for health and social care to 2035, in recognition of the crippling effects of rising demand, underfunding and workforce shortages. Following repeated warnings of services on the brink and an NHS gradually becoming unsustainable, the organisation has launched a public petition to secure a debate on the issue in Parliament. The petition, available on Parliament’s website, urges the Government to commit to a long-

The Competition and Markets Authority (CMA) is consulting on advice to help care homes meet their consumer law obligations. It follows the CMA’s year-long market study into the residential and nursing care home sector. The study found that there is a risk of residents being treated unfairly and that some care homes may be breaching consumer law. The draft advice sets out what the CMA considers care homes should do to comply with consumer law, including: • What upfront information they need to provide to prospective residents and their representatives to help them make informed choices. • What they need to do to ensure that their contract terms and the way they treat residents and their representatives are fair. • Their obligation to provide services to residents with reasonable care and skill. • What they need to do to ensure that their complaint-handling policies and procedures are easy to find, easy-to-use, and fair.

term funding plan that covers both health and social care to the year 2035. It comes after the Prime Minister in March announced plans to come forward with a multi-year settlement and long-term plan for the NHS. But the announcement lacked detail on what period the settlement would cover and whether it would include social care – 85% of healthcare leaders in England believe it should. The organisation aims to gather over 100,000 signatures, surpassing the threshold needed for the petition to be considered for debate in Parliament.

Economic value of social care A new report from Skills for Care on the economic value of adult social care has highlighted that employers in the sector contribute £38.5bn to the English economy. The Economic Value of the Adult Social Care Sector – England was commissioned by the Board of Skills for Care and Development who wanted to find out the extent of the economic impact of the sector. The first step in determining the sector’s economic contribution was identifying the Gross Value Added (GVA) directly generated by employers including wages. In addition to measuring the direct impact, two further measures were used to estimate the total GVA generated by the sector. The first

of these was the indirect approach, estimating the GVA created by the sector in its supply chain by purchasing services from other sectors of the economy. Next was the induced impact that results from those who are employed directly in the sector and those employed indirectly spending their wages in other sectors of the economy. These three measures of GVA – the direct, indirect and induced – were then combined to give a total spend of £38.5bn across England. As well as estimating the GVA created by the sector, the report also examines the numbers of job roles adult social care supports. This totals 1.5 million jobs, or 962,000 full-time equivalents.

The CMA is seeking views on the draft advice from care homes and their representative bodies, enforcers and regulators. The CMA also welcomes views from residents and families, charities representing the elderly and consumer groups. The consultation is on the CMA’s webpage on the GOV.UK website and closes on 12th July.

Brunelcare has made three senior appointments. Michelle Richards has been promoted to Property and Housing Director. Brian Whittaker has been appointed Human Resources and Organisational Development Director. Matthew Bell has been appointed Head of Marketing and Business Development.

CANFORD HEALTHCARE Canford Healthcare has appointed Stephen Bates to its Board as Company Secretary.

ALZHEIMER’S SOCIETY Alzheimer’s Society has appointed two new ambassadors: Former Government Minister, Hazel Blears and actor, Vicky McClure.

NORTH DEVON DISTRICT HOSPITAL North Devon District Hospital has appointed Angela Walter as Admiral Nurse.

ALDRINGHAM COURT NURSING HOME Aldringham Court has announced Tracey Cumby as its new Home Manager.

TANGLEWOOD Julie Wright has been appointed as Tanglewood Care Homes’ new Managing Director.

RUDDINGTON MANOR Kad Daffe has been appointed Centre Manager at Ruddington Manor. CMM July 2018

NEWS

Raise NI to secure NHS and social care The Government should raise National Insurance (NI) contributions by 1p in the pound from 2019 to secure the NHS and social care in this parliament, according to former ministers and the think-tank, IPPR. The change is part of a package of measures for a long-term funding settlement for the NHS and secure funding for social care. The plan comes from Professor Lord Darzi and Lord Prior, who are working with IPPR. The increase would be necessary to meet a new, long-term funding

settlement for the NHS. The former ministers and IPPR say that the NHS needs at least a 3.5% increase every year along with properly funded social care, if it is to provide good quality care, meet the demands of an ageing population, and embrace technological change. The plan would deliver more than £350m a week extra for the NHS by the time the UK’s transition out of the EU is complete, compared with funding at the time of the Brexit vote in 2016. However, this would be achieved through the

Driving Improvement The Care Quality Commission (CQC) has published a new resource for providers containing nine case studies telling the stories of adult social care services that have improved from a rating of Inadequate and/or enforcement action to a rating of Good. The case studies explore how the services reacted to the initial rating, what they did to turn things around and what they learnt through the process. In each case

study, the manager has shared their top tips for improvement – practical ideas that other services could implement themselves. Driving Improvement reflects the wide range of services and people involved in the adult social care sector. CQC visited homecare agencies, nursing homes and residential homes, with specialisms for supporting people with different needs.

Lack of CHC increase Care England has expressed its concern that a number of NHS bodies are failing to pay for the increased cost pressures of looking after vulnerable people in care homes with nursing. Under Government rules, the NHS is responsible for arranging and funding care for individuals who are not in hospital and have been assessed as having a primary health need via NHS Continuing Health Care (CHC). Many residents in care homes with nursing are eligible for CHC, but despite significant increases in NHS funding, combined with nursing homes offering better options and value for money than hospitals, some clinical commissioning groups (CCGs) have not increased their CHC funding for 2018/19. These decisions are adding further pressures upon an already fragile sector, with nursing 10

CMM July 2018

homes closing at an increasing rate piling even more pressures upon an over-stretched NHS. Professor Martin Green OBE, Chief Executive of Care England said, ‘Decisions by some CCGs make absolutely no sense at all. Zero percentage fee decisions result in vulnerable people at risk of ending up in hospital and not in care settings within their communities. This is exactly what the NHS is trying to avoid.’ In January, the Public Accounts Committee found that too often people’s care is compromised because no-one makes them aware that CHC funding is available, or helps them to navigate the process. This followed a National Audit Office investigation into CHC. A revised national framework for NHS CHC and NHS-funded nursing care will be implemented on 1st October 2018.

increase in NI contributions, rather than by redirecting existing UK contributions to the EU. Under their proposal, the NHS budget would be guaranteed to increase at least 1.54% over and above overall growth in the economy – the average rate it has grown at from 1960 to today. This would allow the NHS to plan long-term investments to improve quality and access to care. The plan would also address the crisis in social care by properly funding the current system.

Spending would increase from £17bn today to £21bn by the end of the parliament – a £4bn rise. This would prevent further deterioration in state-funded social care. Raising NI contributions by 1p in the pound from 2019 would raise an additional £12bn a year by 2021/22, matching the additional financing requirements of both the NHS and social care. The changes would be phased in, with a 1p rise for employers in 2019/20 followed by a 1p rise for employees in 2020/21.

Benefits of intergenerational homesharing Research has revealed how intergenerational homesharing can help reduce loneliness and isolation, improve wellbeing and address the lack of affordable housing options. The evaluation, conducted by the Social Care Institute for Excellence and Traverse, found that the Homeshare model reduces loneliness and improves wellbeing by offering companionship and facilitating inter-generational relationships. It also provides affordable housing for younger people who are often priced out of home ownership and even renting. The Homeshare model brings together older people with a spare room with younger people seeking affordable housing or an alternative to a traditional house share. In return for the accommodation, the younger person, homesharer, provides up

to 10 hours of support around the house as well as more informally being around for a chat. The report draws on evidence from a £2m Homeshare Partnership Programme, funded by Lloyds Bank Foundation for England and Wales and Big Lottery Fund, using money raised by National Lottery players. The programme was set up in 2015 to grow and develop the model and has funded eight pilot Homeshare schemes across the UK as well as the development of a national network in partnership with Shared Lives Plus. Other partners to the programme included Age UK and the Foyer Federation. The evaluation was based on reviewing a range of evidence and capturing the experiences of staff at eight schemes and from 28 matches across the two years of the programme.

Learning from Transforming Care pilots VODG (Voluntary Organisations Disability Group) has published a new report focusing on the key steps to help people move out of long-stay inpatient care. Transforming care – the challenges and solutions explores the challenges and solutions to achieving NHS England’s policy

ambition to enable people to move into their community and out of inpatient settings. The report offers a number of solutions to help support more people out of long-stay hospitals and into the community. The pilot is covered in more detail in Business Clinic on page 30.

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NEWS

Securing the future of health and social care The Institute for Fiscal Studies and The Health Foundation, in association with the NHS Confederation, have undertaken research to look at how much health spending would need to rise to continue to provide the level of service it does today and how much it would need to modernise and improve for the future. Securing the future: funding health and social care to the 2030s suggests that to keep the NHS

providing the level of service it does today will require spending to increase by an average of 3.3% a year for the next 15 years – with slightly bigger increases in the short term to address immediate funding problems. This would mean health spending rising faster than national income, from 7.3% of national income today to 8.9% of national income by 2033/34. To secure modest improvements in NHS services,

funding increases of nearer 4% a year would be required over the medium term, with 5% annual increases in the short term. This would take spending in 2033/34 to 9.9% of national income, an increase of 2.6% of national income relative to 2018/19. Pressures on social care spending are also increasing and adult social care spending is likely to have to rise by 3.9% a year over

the next 15 years, taking an extra 0.4% of national income relative to today. To meet these pressures would almost certainly require an increase in taxes, by between 1.6% and 2.6% of GDP – equivalent to between £1,200 and £2,000 per household (out of projected net income growth of about £8,500 per household). Any such increases would need to be phased in gradually over the next 15 years.

Health inequalities facing people with learning disabilities #MyGPandMe, published by Dimensions, exposes the health inequalities facing people with autism and learning disabilities. The report highlights that life expectancy for a man with a learning disability is 23 years lower than in the general population, and life expectancy for a woman with a learning disability is 29 years below average. Patients with autism and learning disabilities are also more

likely to experience a reduced quality of life, and for health issues to go undiagnosed and untreated. The research also reveals that only 19% of eligible women with learning disabilities and autism have undergone a cervical cancer screening, compared with 73% of the general population. They are also 10% less likely to have the recommended three-yearly breast screening than other women.

Added to this, as many as 30,000 to 35,000 people with learning disabilities and autism are at risk of being wrongly prescribed psychotropic medication. According to Dimensions, 80% of GPs recognise the problem and 48% said they would benefit from additional training on prescribing and assessing psychotropic medication. Half of the GPs surveyed also

said a lack of training on how to make reasonable adjustments was stopping them from meeting the individual needs of patients with autism and learning disabilities. #MyGPandMe aims to address these issues and more by providing training for all GP surgery staff, sharing information and resources with patients and support teams, and calling on policymakers to reduce health inequality.

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NEWS

More support needed for homecare workers Care workers who provide personal and domestic care to older people with dementia in their own homes are at risk of feeling under emotional strain and some don’t get as much support as they need, according to a new study. Researchers at Kingston University and King’s College London explored some of the pressures facing homecare workers in London and the South East of England. They found that,

while managers and homecare workers had clear ideas of what their professional boundaries should be, homecare workers sometimes found themselves crossing that line, or being asked to take on tasks beyond their job role. The combined impact of supporting older people with complex needs, alongside working in someone’s own home where typical workplace conventions may not exist, add to such

pressures the researchers found. Following interviews with 30 homecare workers and 13 managers, the researchers found that some workers find it difficult to refuse requests to carry out extra tasks from clients’ families, particularly if there is strong emotional attachment. Homecare workers also juggle a desire to be compassionate and helpful, with maintaining professional boundaries. A small number of those who

had looked after people with dementia also revealed that they sometimes felt vulnerable working in people’s own homes. While acknowledging policies are not able to reduce feelings of vulnerability completely, the researchers found some workers thought that more employer support could help reduce these risks. The research team recommends more discussion with workers and their managers about what can be done to support staff.

Research into emergency admissions New data is available which highlights issues around emergency admissions. An Alzheimer’s Society investigation has discovered tens of thousands of people with dementia are being admitted to A&E each year because inadequate social care is leaving them unprotected from falls and infections. The investigation, which involved Freedom of Information

requests to NHS Trusts in England and a survey of paramedics, revealed a sharp rise in emergency admissions for people with dementia over the last five years – up 70% since 2012, with more than 50,000 avoidable emergency admissions of over-65s with dementia in the last year alone. Frontline staff confirmed the rise, with 75% of paramedics

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surveyed reporting that the problem has become more common in recent years. Half reported dealing with instances every week, and one in five (21%) said they see the situation every day. Added to this, research from The Health Foundation has found that one in three patients admitted to hospital in England as

an emergency in 2015/16 had five or more health conditions. This is up from one in ten in 2006/07. The Health Foundation also identified opportunities to reduce emergency admissions, including timely and effective primary care for conditions such as asthma; and older patients seeing their regular GP two more times out of every ten consultations.

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NEWS / IN FOCUS

Advice on charging fees after death The Competition and Markets Authority (CMA) has published its final consumer law advice on the charging of fees after a resident’s death, following a public consultation earlier this year. It is aimed at residential care providers supporting people over 65 and relates to self-funded and part-funded residents. The purpose of the advice is to help care homes understand and comply with their responsibilities under consumer law following the death of a resident. It covers CMA’s approach to assessing the fairness of relevant terms in care home contracts;

length of usual payment period of residential care fees after the death of a self-funded resident; treatment of possessions; residential care fees payable by a third party after the death of a part-funded resident; fees payable to cover ‘shortfalls’ in any contributions which are no longer paid by the State upon (or shortly after) the death of the resident; and clear and transparent contract terms. It also includes a useful summary table. The full advice is available on the CMA’s pages on the GOV.UK website.

Rise of social care debt New Freedom of Information requests by the GMB union have found that more than 166,000 people have a level of social care debt. The requests, submitted to every local authority in Great Britain with responsibility for social care, show at least 1,178 people have been taken to court by local authorities for social care debts

during the past two years. Of the total of at least 166,835 people who are in arrears, more than 78,000 have debt management procedures started against them by their authority for non-payment of social care charges. GMB says that the true figure is likely to be higher as some authorities didn’t respond.

Belong raises £50m through Retail Charity Bond The Belong Limited Retail Charity Bond has raised £50m and closed early due to high demand from investors. The Bond, which was offered by Retail Charity Bonds PLC, was launched on 23rd May 2018 and closed early at 10.00 on 31st May 2018. The proceeds will be used to further Belong’s charitable objectives as well as to develop additional Belong villages. It offered an interest rate of

4.5% a year for a term of eight years. Within eight days, the offer was oversubscribed and orders from investors had to be reduced or turned away. Belong will borrow £35m initially, but a further £15m of ‘retained bonds’ will be created which can be sold and the extra money loaned to Belong at a later date. The lead manager for the bond issue was Peel Hunt LLP.

Carterwood sells Beds care home Carterwood has successfully completed on the sale of a 66-bed care home in Bedfordshire.

The care home was purposebuilt in 2016 and has been acquired by Hamberley Care Homes.

IN FOCUS Government publishes Carers Action Plan to 2020 WHAT’S THE STORY?

The Government has published its Carers Action Plan 2018 to 2020, setting out how it will improve support for carers in England over the next two years. It details 64 actions across five key priorities. The actions focus on delivery and tangible progress that can be made in the near future, and give visibility to the work that is planned or underway across government to support carers, their families and those they care for.

WHAT DO CARERS WANT?

In 2016, the Government launched a carers’ Call for Evidence consultation. The responses informed the development of the plan and a summary of the responses is published with the action plan. Carers’ most frequent requests for improvement included providing more information and training for health, social care and education professionals; identifying carers as early as possible; giving carers access to consistent, goodquality respite care; and giving carers information about their eligibility for financial support.

WHAT’S IN THE PLAN?

Five primary themes emerged from the Government’s analysis of the responses and these are reflected in the structure and contents of the action plan. The themes are: • Services and systems that work for carers. • Employment and financial wellbeing. • Supporting young carers. • Recognising and supporting carers in the wider community.

• Building research and evidence to improve carers’ outcomes. The Government has said it will seek to understand the extent to which the actions outlined in the plan will: increase employers’ awareness of caring and the impact on workforce; support health and social care professionals to better identify, value and work with carers; improve access to support for carers, including respite and carers’ breaks; improve the evidence base on carers to inform future policy and decisions; and ensure carers’ needs are recognised in relevant government strategies.

WHAT DOES THE SECTOR SAY?

Heléna Herklots CBE, Chief Executive of Carers UK said, ‘[The plan] includes several measures that we have specifically called for, including: a review of dedicated employment rights for carers; an innovations fund to develop new ways to reach carers with information earlier; and training for NHS staff to better support carers. We will do all that we can to ensure that these positive measures are taken forward. ‘However, we are very disappointed that the Action Plan does not commit to further financial support for carers...The Plan raises greater expectations for more far-reaching proposals on the funding and support provided to families and friends who care as part of the forthcoming Green Paper on social care. We will continue to press the Government to make sure that the Green Paper brings the wider changes...carers need.’ CMM July 2018

NEWS

Local Health and Care Records project NHS England has announced funding for three Local Health and Care Record projects to support the integration of health and social care through more effective data sharing. New partnerships will be introduced giving health and care staff better and faster access to vital information about the person in their care, so they can determine the right action as quickly as

possible. The selected areas are Greater Manchester, Wessex and One London. Each new partnership will receive up to £7.5m over two years to put in place an electronic, shared local health and care record that makes the relevant information about people instantly available to everyone involved in their care and support. Each Local Health and Care

Record Exemplar will provide healthcare staff who need it access to the information they need for people’s individual care. Each Local Health and Care Record Exemplar is made up of either one or multiple Sustainability Transformation Partnerships. The new partnerships will also work to better understand demand for local services and to plan effectively for future demand.

Lack of progress on social care reform The Health Foundation and The King’s Fund have highlighted a worrying lack of progress on social care reform in analysis of funding pressures and options for change. A Fork in the Road: Next Steps for Social Care Funding Reform points to low public awareness and lack of agreement on what should be done as major barriers to progress, despite political consensus on the need for urgent action.

The report concludes that reforming the current system will be expensive, but that if reform is chosen, England must choose between a better means-tested system and one that is free at the point of use for those who need it. The report finds that the current system, which sees fewer people receiving publicly-funded care every year, will lead to a funding gap of £6bn by 2030/31. Returning to levels of access

and quality last seen in 2009/10, before the current period of austerity, would increase the gap to £15bn. More fundamental reforms would also significantly increase the cost of social care. Introducing free personal care for all older people with needs above the current threshold would cost an extra £14bn. Implementing a cap on the lifetime costs of care would require £12bn.

The strain of caring Eight national charities have come together to call for urgent support for unpaid carers to be healthy and connected, as new research released for Carers Week reveals the toll that caring can take on carers. Lack of sleep, performing care tasks and the impact on their finances were named as the top stressors by unpaid carers. Almost three quarters (72%) of carers in the UK said they had suffered mental ill-health as a result of caring, while well over half (61%) said their physical health had worsened. Carers were most likely to say that the impact of stress and anxiety on their own health was their main worry about the impact of caring on them. The Carers Week charities are calling on communities, healthcare professionals, employers, and the wider public to support carers to get connected to health and wellbeing services and support.

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CMM July 2018

NEWS

The reality of homecare cuts A new report from Age UK illustrates the misery being experienced by many older people and their families, as they try to get the care at home they need. Behind the Headlines – the battle to get care at home shows that the provision of homecare services has fallen by 3 million hours since 2015, which Age UK suggests highlights the crisis

facing older people who are in need of homecare services. The average spend per adult on social care fell 13% between 2009/10 and 2016/17. Over the same period, around 400,000 fewer older people received social care, as eligibility criteria were tightened by councils. Age UK says it is essential that the Government acts now to prop

up the system with substantial investment, as well as bringing forward proposals for placing care on a sustainable financial footing as it has promised to do in the forthcoming Green Paper. The report lists the most common reasons for people calling the Age UK helpline, including: long waits to get an assessment; care services that are

disjointed or simply unresponsive; social services declining to get involved; fundamental lack of capacity in the system; poor quality services and support; support and services being cut back; and vital help for families providing care being cut back. Without urgent action, the Charity says this situation will only get worse.

Prevention and early intervention in mental health Against a backdrop of increasing pressures on mental health services in England, a new report from the Royal College of Occupational Therapists (RCOT) highlights the importance of prevention and early intervention in tackling mental health issues. Current statistics show that 85% of people first disclose mental health issues to their GP – yet fewer than 5% of mental health professionals such as occupational

therapists work in GP services. This means that the majority of people with mental health needs have to reach crisis before they can access any kind of help. Getting My Life Back: Occupational therapy promoting health and wellbeing in England, the latest report from the RCOT’s Improving Lives, Saving Money Campaign, reveals a range of innovative occupational therapy services that focus on prevention

and early intervention in mental health services. The report shows that occupational therapy has lifechanging effects on people with mental health conditions. The Royal College recommends occupational therapy as one of the lead professions in designing and delivering services for the future, in four key areas. These are: • Helping young people to achieve

their full educational potential. • Supporting people into employment. • Be involved in plans to improve the physical health of people with serious mental health issues. • Incorporating and promoting healthy occupations and occupational therapists to lead innovative service delivery that improves access to mental health support in primary care.

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NEWS

Nursing pay and social care

FoI data on commissioning

In a letter to Health and Social Care Secretary, Jeremy Hunt MP, the Royal College of Nursing (RCN) has called for a nursing pay deal to apply to nursing staff in social care, general practice and the independent sector to avoid a ‘dangerous imbalance’ that is harming patients. RCN argues that the social care sector delivers more patient care than NHS hospitals and urges additional funding to ‘level the playing field’ to avoid people being ‘drawn away’ from where they are needed. RCN Chief Executive, Janet Davies said that improving terms and conditions of all nursing staff employed by contractors, but delivering publicly-funded services, would help employers to address recruitment and

Care England has initiated a series of Freedom of Information (FoI) requests across 152 councils to gather data on commissioning activity for 2018/19. This data is being collected on the themes of fees paid by councils for residential, nursing home and supported living care, as well as use of resources and placement activity across older people and learning disability care. Once collated, Care England will triangulate responses with other data such as quality ratings, projections on bed numbers and staffing, and analysis of councils’ spending plans to build up a comprehensive picture of how each council is responding to the challenges and opportunities of supporting a sustainable local care market. The data will build upon a

retention problems and improve standards. Janet Davies calls for a new and separate staff council to be established in England to negotiate for all nursing staff not directly employed by an NHS organisation. It would take a similar form to the current NHS council, made up of government, employers and trade unions. She said nursing staff ‘delivering NHS services but not employed by NHS organisations complain that they endure poorer working conditions and loss of career and education opportunities’. She said in her speech at RCN Congress, ‘If integrated health and care is going to succeed, we must lift up the pay, terms and conditions of nurses and care assistants working beyond the NHS.’

similar spreadsheet constructed by Care England for 2017/18, that was used to target councils where analysis indicated a combination of concerns based upon the relative positions of the particular council in comparison to other councils regionally or nationally. This targeted approach opened up a number of informed debates between commissioners and providers on how to respond to local concerns. The importance of Care England’s approach is that for the first-time, data from a range of sources has been pulled together in such a way that both commissioners and providers can recognise common issues and look at ways to take a more holistic view of actions that support a dynamic sustainable market.

Unprecedented pressure on the NHS A new report has highlighted unprecedented pressure on the NHS. Despite experiencing the worst winter in a decade, frontline NHS staff and managers have risen to the challenge and cared for more patients than ever before. Although, this surge in demand has affected the NHS’s performance in key areas, such as waiting times

and its reliance on temporary workers. The Quarter 4 2017/18 performance report states that more than 5.87 million people went to A&E in January, February and March 2018 – over 220,000 more than the same period last year. Of these, 1.1 million needed to be admitted for treatment – 70,000

People with autism risk being manipulated A study published in Autism Research shows that the ability to distinguish truth from lies is diminished in people with autism spectrum disorder (ASD), putting them at greater risk of manipulation. Researchers, led by Professor David Williams at the University of Kent, found that lie detection ability is ‘significantly diminished’ in those with a full ASD diagnosis. It is also related to how many ASD traits people in the general population have: the more traits, the poorer the deception detection. Professor Williams and researchers from the UK and 18

CMM July 2018

US conducted experiments with participants exhibiting varying degrees of ASD and compared them to those who were deemed ‘neurotypical’. The researchers suggest that limited social engagement may result in people having a failure to learn the social cues that indicate deceit. It is important to consider training individuals with ASD to detect behavioural indicators of lying. They conclude that ‘if such training were successful, it would represent a significant opportunity to enhance the lives of a group of people who...are clearly susceptible to exploitation.’

more than the same period last year. Despite these enormous pressures, 277,150 more patients were seen within four hours at A&Es in 2017-18 than in 2016-17. However, performance against this standard slipped nationally – 88.4% of patients were seen within four hours in A&E, compared to

89.1% the year before. The national target is 95%. Higher than planned levels of A&E activity meant that hospitals had to cancel operations and hire temporary staff to cover vacancies and sickness. At the end of March 2018, 2,647 patients were waiting over a year for elective treatment compared to 1,513 in March 2017.

Rise in care home insolvencies The number of care homes entering insolvency has risen by 83%, from 81 in 2016/17 to 148 in 2017/18, according to figures from the Insolvency Service, compiled by Moore Stephens. The sector has been struggling since the Government’s cuts to local authority funding and Moore Stephens says that times have been made harder still, as a number of recent high-profile and complex care home insolvencies have caused mainstream lenders to be more cautious of providing lowcost funding to the sector. Local authorities planned to make savings of £824m in their social care budgets in 2017/18, according to the Association of

Directors of Adult Social Services, despite demand increasing. However, the Local Government Association says that the care home sector faces a £2.3bn funding gap by 2020 and the Competition and Markets Authority highlighted a £1bn shortfall in the public-sector funding of care homes in 2017. The cost of providing quality care has also increased over the years. According to NatWest Care Home Benchmarking Report 2016/17, the average care home now spends 52% of its turnover on staff. The rising interest rates expected this year creates further costs for care homes, who will see any floating rate debts secured against their properties increase.

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CMM July 2018

NEWS

Hanover and Anchor in talks to merge

Most deprived more likely to develop dementia

Hanover and Anchor are in talks about merging. Under the proposals, the two organisations would come together as the Anchor Hanover Group. Anchor Chief Executive, Jane Ashcroft CBE would become Chief Executive Designate of the new organisation. The Chair Designate would be Dr Stuart Burgess CBE, currently Chair of Hanover. Anchor Chair, Pamela Chesters

Older adults in England with fewer financial resources are more likely to develop dementia, according to new research from University College London. Researchers analysed data from over 6,000 adults born between 1902 and 1943 and found that the 20% most deprived adults were 50% more likely to develop

CBE had already announced her intention to stand down from Anchor’s Board. In addition to its housing to rent and to buy and extra care services, the new organisation would continue to be a major provider of residential care to older people. The organisations are seeking feedback from customers and stakeholders and hope to report back later in the year.

Quality Care Campaign The Quality Care Campaign (QCC) initiative has launched with a mission to improve the quality of care received by people who use social care services. Run as a collaboration between Care England, recognised social care experts and a leading care

home inspector, QCC aims to recognise and highlight instances of exceptional care whilst simultaneously challenging local commissioners and policy-makers to deliver high-quality care services in line with the Care Act 2012.

Trafalgar updates on progress Trafalgar Property Group plc has provided an update on its progress. Trafalgar’s subsidiary, Trafalgar Retirement has continued to research and pursue potential properties for acquisition, seeking neighbouring properties that can be consolidated into one larger site for redevelopment into ‘extra care’ living developments. A number of new option agreements to acquire properties have been agreed recently over a total of 14 individual properties across three sites for possible redevelopment. The intention is that the three new sites in Frimley, Wokingham and Maidstone would

be developed into extra care once the options are exercised and the properties purchased by the Group, subject to obtaining the relevant planning permissions for each development. Trafalgar’s other subsidiary, Trafalgar New Homes Limited has reached the final stages in the application process for planning permission on its site in Staplehurst, Kent. The Group has submitted plans for the development of a retirement village, which would comprise 48 one and two-bedroom apartments and a further 32 two and threebedroom cottages.

dementia than the 20% least deprived adults. The study, published in JAMA Psychiatry, is the first of its kind to determine which socio-economic factors influence the development of dementia and found limited wealth in late life is associated with increased risk of dementia, independent of education.

Downing exits five care homes Investment manager, Downing LLP has announced the successful exit by its funds from a group of five trading care homes, which comprise over 390 beds, managed by Care Concern Group. Downing has worked closely with Care Concern since 2012, investing £65m across nine care home projects, including newbuilds, operational improvement

projects, extensions and repositioning of existing homes. Downing’s exit from the five care homes to an undisclosed real estate investor will see the successful repayment of Downing funds’ capital and will generate an attractive return to Downing’s investors across both the debt and equity provided. Care Concern will continue to operate the homes.

New recommendations for Carer’s Allowance The Work and Pensions Committee has published Employment support for carers, calling on Government to remove the ‘cliffedge’ in benefit calculation that sees Carer’s Allowance withdrawn in full as soon as carers earn more than £120 a week. This means that working additional hours can leave carers worse off – which, the report states, is, ‘contrary to the Government’s objective of ensuring work always pays’. A pay rise can also leave parents facing

the choice between losing Carer’s Allowance or losing free childcare for their three or four-year-old, which requires them to work 16 hours a week. Employment support for carers recommends withdrawing Carer’s Allowance gradually as income rises, in line with the Universal Credit taper system; allowing carers to request flexible working from day one of their employment; and when resources allow, introducing a statutory five days paid carer’s leave.

Funding for digital adult social care pilots NHS Digital and the Local Government Association (LGA) have announced funding for innovative digital adult social care pilots. A share of the £1m funding, provided by NHS Digital and managed by the LGA, with support from the Association of Directors of Adult Social Services (ADASS),

will be awarded to local authorities that put forward projects that support innovative uses of digital technology in the design and delivery of adult social care. 12 authorities will receive £20,000 to design a digital solution to address a specific issue with their service, with six receiving up

to a further £80,000 to support its implementation. This year, local authority bids should focus on: efficiency and strengths-based approaches; managing marketing and commission; or sustainable and integrated social care and health systems.

Now called the Social Care Digital Innovation Programme (SCDIP), it encourages the adult social care sector to use technology to respond to challenges in their local area. It is intended to support direct practice, improve information sharing and enable integration. CMM July 2018

BECOMING AN EFFECTIVE CARE LEADER: attitudes, skills and techniques Jonathan Cunningham explores the features of effective care leadership and the essential skills that all care leaders need to develop.

CMM July 2018

The social care sector is in perpetual crisis and under increasing pressure to deliver a higher quality of care. Yet, as we all search for the ‘silver bullet’ to put it right, the solution may be under our noses in the development of effective leaders.

IT’S TIME TO LEAD Social care, its employees and clients crave effective leadership. The Care Quality Commission has identified that visible, top-down leadership is the most defining factor on the quality rating of care provision. This comes down to investment in quality recruitment, selection, training and nurturing of senior leadership teams.

To survive and thrive in today’s environment, it’s time to take leadership development seriously.

LEADERS OR MANAGERS: THAT IS THE QUESTION Put simply, you can differentiate between managers and leaders because, ‘managers do things right, whilst leaders do the right things’. Managers tend to implement processes and systems provided to them. They can be highly-effective and efficient, but this isn’t care leadership. Leaders are different, they show people another way, another route. Leaders present a vision of an exciting new world, they inspire,

enthuse and motivate; they are driven, innovative and on a continuous journey of learning. Leaders can infuriate and irritate as they attempt to turn their organisation to a new direction. But they are courageous and brave risktakers that don’t shy away from difficult decisionmaking. Leaders are not managers, yet leaders need managers in the way a car’s steering wheel needs an engine to get it to its destination.

ATTRIBUTES OF AN EFFECTIVE LEADER What are the attributes of an effective leader? Vision Leaders see a new place that isn’t where they are now. They identify when the status quo is not acceptable and will not deliver the desired outcomes. Leaders describe their vision in detail and set the pathway and project management to reach it. This is the start of transformational change. Integrity A leader lives and dies by their integrity. Integrity is a beautiful quality that may never be compromised. It builds trust in the team that, come what may, they will do the right thing. A leader’s integrity may be tested but their moral compass will see them through. However, be warned, once a leader’s

CMM July 2018

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BECOMING AN EFFECTIVE CARE LEADER: ATTITUDES, SKILLS AND TECHNIQUES

integrity has been damaged, tainted or soiled, they lose their license to lead. Passion Staff will not buy into a new vision without a leader full of passion. This is the fire in the belly, the fuel that will sustain the drive to achieve the goal. Teams have to become enthused and this will only happen through a passionately driven leader. Energy Leaders need a lot of energy because sustaining effective leadership demands physical, emotional and mental energy. Leaders need to be fully aware of this and take time to maintain high energy levels, setting in place effective strategies to achieve and maintain the required level of energy.

“Like all skills and talents in life, effective leadership is something that can be taught but must be continuously practised in order to improve.” Resilience Leadership is not easy and the leadership journey is frequently lonely and challenging. Having resilience is a critical feature of an effective leader. To maintain high resilience, leaders require high levels of self-belief, the ability to remain positive, maintain a healthy perspective and use positive references, such as ‘well, we’ve faced these challenges before and we’ve always done well’. The ability to switch off is also an important characteristic, plus leaders need to allow their brains to wander to remain strong. Values and standards Effective leaders are driven by an inner compass of moral courage that upholds their values and standards. These values and standards run through them and should never be compromised. Good leaders involve their whole organisation in the creation of these essential foundation stones of standards. Ultimately, the standards you are prepared to walk past are the standards you accept. Consistency Effective leaders consistently display the same effective behaviours. They are

emotionally intelligent, recognise best practice and establish an internal heartbeat within their organisation that delivers quality care. They are also predictable, reliable and consistently effective in all that they accomplish.

SKILLS AND TECHNIQUES OF EFFECTIVE LEADERS The inherent qualities of an effective care leader can only go so far. In addition, they require a powerful toolkit of techniques and skills that allow them to achieve what they do. Effective morning routine It may not seem obvious but successful leaders from all walks of life share one thing in common: a ‘super-charged’ morning. A quick internet search can bring up the morning routines of highly-successful people, but they commonly include: • Getting up early and working, eg. emails/ reports. • Exercise. • Eating a good (low sugar) breakfast. • Meditating and allowing ideas time to develop. Maximising productivity We all need to squeeze every bit of value out of the day. Efficient care leaders recognise this and have powerful techniques to get more out of the same 24-hours we all have available. Five productive steps to get more of your day can include: • Make a to-do list of no more than five things. • Ruthlessly tackle one thing at a time. • Switch off from the internet. Avoid distraction. • Exercise, eat well and get sleep. • Day dream and allow your subconscious time to soak. The power of delegation We all struggle to delegate, but this is the single greatest area that needs to be mastered. Realise that you can’t do it all yourself and consider these five steps. • Select the task to delegate. Are you delegating down (routine easy tasks) or delegating up (more complex projects)? • Take time out to explain the task to the selected member of staff. • Explain the context of the task. Why are

they doing it – for what reason? • Define how often you will both meet to discuss progress. • Define the desired outcome and performance metrics. Reducing procrastination We all put off the things we don’t wish to do, it’s human nature. However, by recognising the power of taking action, you will be more effective as a leader. Consider these steps to reducing procrastination. • Stop over-thinking. • Make a list of a maximum of five things. • Set a date/time in your diary to achieve certain tasks. • Set a deadline and inform someone to hold you accountable. • If it’s a particularly difficult task, or one you’ve been avoiding for a while, consider rewarding yourself for completing it. Defusing conflict We all have to deal with conflict. Those who are in-touch with their own emotions, keep their ego in check and learn to consider the other person’s view will be more successful at dealing with conflict situations. Consider these powerful phrases used in succession to defuse most conflict situations: • First, acknowledge the other person’s view by saying ‘I respect that’. • ‘I appreciate where you are coming from’. • ‘I agree with you’. • ‘How can we resolve that?’. • ‘Let’s move this ahead, how can I help you?’.

SOCIAL CARE NEEDS MORE LEADERS Effective leaders are nurtured, not born. Like all skills and talents in life, effective leadership is something that can be taught but must be continuously practised in order to improve. An inspirational leader can have an immeasurable effect on their organisation. More importantly, residents and clients receive quality, personalised care, delivered by an effective team. All organisations, big or small, must recognise that they need to continually invest in the leadership development of their care team. Outstanding leaders create more leaders. As social care struggles with the challenges of shrinking resources, it is time to expand the leadership pool and maybe this is the ‘silver bullet’ we all seek. CMM

Jonathan Cunningham MBE is the owner of Rosebank Care Home, Registered Manager of Birkdale Park Nursing Home and Managing Director of STORM Consultancy. Email: jonathan@stormconsultancyuk.com Twitter: @JCGlobalSpeaker What attributes do you think effective leaders need in social care? CMM members can share them on the CMM website, where you can also comment and feedback on this article. www.caremanagementmatters.co.uk. Not a member? Sign up today. 24

CMM July 2018

We’re supporting

leaders and managers Over 90% of services rated good or outstanding for being well-led by the Care Quality Commission (CQC) were also rated good or outstanding overall. If you’re working in a leadership or management role in social care you’re not only responsible for supporting those who need care and support, but for taking care of your staff and influencing the quality of care across the sector. That’s why we’ve created a variety of development programmes, tools and resources to help leaders and managers at all levels, feel supported in their roles. You can also become a registered manager member of Skills for Care and join a community of managers dedicated to improving the quality of adult social care. Find out more at www.skillsforcare.org.uk/leadershipandmanagement

CMM July 2018

Best practice in end of life care Developments with Gold Standards Framework Professor Keri Thomas OBE updates on developments with the Gold Standards Framework for Social Care and the impact it can have on social care and health.

Since the start of the millennium, there has been a radical transformation in the way nursing and residential homes care for their residents as they approach the last stage of their life. While pockets of good practice undoubtedly existed then, the standards of care in some homes and investment in staff training and support left much to be desired. Iâ&#x20AC;&#x2122;ll never forget a conversation with one manager of a residential home in London who said they have no deaths in their home â&#x20AC;&#x201C; they just sent them all to hospital to die. There is increasing recognition of the vital importance of this sector within the integrated care context, and the impact that low investment in social care has on the rest of the system, particularly affecting hospital admissions, deaths of residents in hospitals and delayed transfer of care.

CMM July 2018

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In 2018, the profile of a typical care home resident has changed significantly, with an estimated eight out of ten likely to die within a year (this figure is higher in nursing homes) and one in five deaths in the UK now occurring in a care home. But still too many residents are admitted to hospitals in crisis, especially in their last weeks or days of life. This is despite the fact that, through planning and better staff training, many such admissions could be avoided, up to half in fact, according to a National Audit Office report in 2009.

I MPROVEMENTS IN END OF LIFE CARE Meanwhile, many improvements in care homes have been made over this time. This period of progress in delivering improved care for people in the later stages of their life coincides with 3,000 homes having completed the Gold Standards Framework (GSF) Care Homes Training Programme since its launch in 2004. Hundreds of those homes have also progressed a stage further to complete accreditation and many of these have gone on to be reaccredited multiple times. For a considerable number of those homes, the training and accreditation was the launchpad for a new way of thinking about the way they cared for their residents, not just in the final weeks and days, but for their entire stay – from the day they moved in. Many homes used GSF as a way of standardising and systemising the already good quality care they provided and as a catalyst for further improvement. They’ve embedded that good practice and continued to adapt and grow even stronger. At September’s National GSF Awards in London, several homes will be receiving their award for the fourth time, 12 years since starting GSF – this is a truly significant milestone and a demonstration of its long-term sustainability and their enduring commitment to do more and go further to provide the best possible care for their residents right up until the end of their lives. There are countless stories of extraordinary transformation and wholesale culture change amongst these 3,000 homes, catalysed by the use of GSF. Many say that GSF continues to be the bedrock of the ongoing positive change they’re achieving as well as a key factor in their attainment of Outstanding Care Quality Commission (CQC) reports.

GSF IN PRACTICE At Kineton Manor Nursing Home in

Worcestershire, for example, Dr Paul du Rand said, ‘I really think it was GSF that helped us get the Outstanding rating. All the principles you implement when doing GSF are principles that help you to get an Outstanding inspection from CQC. Inspectors mentioned that our care for people who are dying is like a hospice.’ The 2017 winner of the GSF Care Home of the Year award, Cholwell House, in Somerset, is an excellent example of a home that has transformed the way it cares for residents, particularly as they approach the end of life. Fiona Trezise, Manager of the 46-bed home which specialises in care for people with dementia, said, ‘When I started at Cholwell House in 2008, we had no clear way of looking after people at the end of life. They were really dark days. The staff here truly do give themselves and are so motivated and passionate about providing the best care they can.’ Fiona invites every resident and their family to a meeting, soon after admission, to discuss how and where they would like to be cared for in the form of an Advance Care Plan. In line with their wishes, all residents at Cholwell House who died in the last year, did so at the home. There have also been no crisis admissions to hospital from the home since 2010 – an outstanding achievement in the context of the daily traumas for patients and staff in A&Es all over the country. While Cholwell House is an exemplar, its approach is now far from unique. Advance care planning has become a routine function in many homes, laying the foundations for compassionate, personalised care, dramatically reduced admissions and a major increase in residents fulfilling their wish to die at home.

MAKING EXCELLENT APPROACHES THE NORM How then can these excellent exemplars of care become the norm rather than the exception? GSF has spent the last year taking soundings from the industry. This has culminated in the launch of a revised care homes training programme which is updated to include all the latest developments, shorter and more affordable – designed to be accessible for all homes, delivering on the mission to mainstream gold standard care across the whole sector. The new programme draws on the learning from the Vanguards, the experience of our multi-accredited homes and includes lessons from the shorter Six-Steps programme that developed from GSF some years ago.

The training has been streamlined to focus on seven key tasks and is delivered across just three and half days over six months, with homework and a starter-kit portfolio preparing homes for accreditation, which is now achievable within a year. The shorter nature of the new programme is reflected in the lower cost, helping more homes, smaller ones in particular, become a part of this national momentum of best practice, for the price of one resident’s bed for a week. The ever-expanding network of GSF regional training centres around the UK ensures homes can access the programme easily too.

BENEFITS OF GSF FOR HEALTH AND SOCIAL CARE Aligning with the seven key principles announced by Jeremy Hunt, Secretary of State for Health and Social Care, in March this year, the revised GSF Care Homes Programme retains its focus on quality. Mr Hunt highlighted the postcode lottery endured by many residents, with a 90-fold difference in hospital admission rates for over75s between the highest and lowest performing areas. On average, nationally, GSF-accredited homes halve the number of residents’ admissions and improve delayed transfers of care. GSF Homes experience closer working relationships with GPs, specialists and hospitals through better integrated care in line with Mr Hunt’s second key principle of whole-person, integrated care. The new GSF programme helps homes implement another of the Health and Social Care Secretary’s principles – to respect and nurture the social care workforce – the ‘modern-day heroes’ as he rightly calls them. Staff in GSF homes report increased job satisfaction, with many describing being reminded of the reasons why they entered the profession in the first place. As Fiona Trezise of Cholwell House said, ‘Caring for someone at the end of their life is a privilege and doing it well provides those that excel at it with a huge sense of satisfaction. That in turn, improves morale and decreases staff turnover. By embedding co-ordinated, compassionate and personalised end of life care, homes will experience better outcomes for them and their residents, helping them to stand out in this vital area of care, preparing them for the next decade, at the end of which it’s predicted considerably more than the current 20% of deaths will occur in care homes.’ CMM

Professor Keri Thomas OBE is Clinical Director at GSF Centre. Email: keri.thomas@gsfcentre.co.uk Twitter: @GSFCentre Members can access more information on the GSF Care Homes Programme on the CMM website www.caremanagementmatters.co.uk or at www.goldstandardsframework.org.uk Not a member? Sign up today. CMM July 2018

TRANSFORMING CARE – LEARNING FROM PROVIDERS A recent pilot by members of Voluntary Organisations Disability Group (VODG) in London has uncovered a number of challenges and solutions to the success of Transforming Care. Building the right support is NHS England’s plan to move people out of long-stay inpatient facilities and into appropriate housing with support in the community. It involves improving services so that more people can live in the community, with the right support, and close to home. To move it forward, VODG’s Provider Taskforce has undertaken a London Demonstrator to support 27 people originally from London who have been in inpatient settings for longer than five years into the community.

DEMONSTRATOR The Taskforce comprises care and support providers for people with a learning disability, autism or both. It offers statutory organisations, government departments and sector agencies a single point of contact to engage and work with voluntary sector organisations to deliver the transforming care agenda. Providers support commissioners to develop their approaches and work together to facilitate and co-ordinate support assessments and proposals. As well as supporting people into the community, the Taskforce also aimed to identify learning around challenges and barriers to successful community support and actions to enable positive change. The Taskforce met with four of the six London transforming care partnerships (TCPs) including clinical commissioning groups, NHS England’s specialised commissioners and local authorities. Panel meetings for each TCP area were used to discuss individuals’ support needs. Shared action and outcomes were agreed with the clinical and social work leads and providers 30

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were identified for each person. Referrals were then made by the Taskforce to appropriate providers and contact established between the provider, commissioner and funding agencies to take forward the planning process. A key element of the pilot was to identify and locate appropriate housing and support for the individuals. The Taskforce identified three patterns: bespoke accommodation and support for people to live alone; bespoke accommodation and support within a core and cluster model; and shared housing and support. These also require a specific skilled workforce to enable the transition and tailor support.

CHALLENGES The pilot faced a number of challenges to discharging people and barriers to developing appropriate support plans. These included: delays in discharge plans, including a lack of knowledge about potential community support options; negative attitudes and aspirations towards people supported (eg referring to people by patient identity number); confusion about costs, with commissioners and funders underestimating the cost of initial support immediately after discharge and/or therapeutic support; a lack of support to families, despite it being critical to the sustainability of support to their loved one.

SOLUTIONS As the Demonstrator progressed, the Taskforce developed solutions. As opposed to funding authorities viewing housing and support needs in isolation, which

makes it harder to identify people who can live together, the project started mapping people across the TCP, including a cross-borough information sharing to help to identify people with similar needs across wider areas. Specific structures and differing timescales within the system delayed progress, so a stronger understanding of the impact of this along with accountability were found to help. Different professionals involved in the process have different drivers for an individual’s discharge which are not always shared. The Taskforce concluded that shared meetings at the beginning of the process with all relevant professionals to discuss and agree the way forward for a group of people was helpful in agreeing a shared understanding. This included what has not worked to-date and the important issues for different stakeholders. They also found meetings helpful in refocusing on the person rather than cases to manage and process. The Taskforce found it critical to be realistic about the financial costs of supporting people in the community. They concluded that there’s a need to establish a wider, shared understanding of the financial costs of community support packages. Housing was described as one of the biggest challenges. The Taskforce found that the earlier the provider is identified in the discharge process, the quicker the housing solution can be agreed and sourced. Recognising and agreeing the need for additional support through specialist organisations is important to achieving successful, sustainable, community support.

RECOMMENDATIONS From these solutions, the Taskforce went on to identify next steps for wider implementation. Firstly, they identified that a strategic regional pathway is needed to move people out of hospital and/or prevent readmission including demand and supply mapping with a detailed analysis of costs and funding arrangements. A sustainable care, support and housing market needs to be developed to support the current and future needs of people. Also, a provider network should be created which dynamically maps organisations’ capacity, skillsets and infrastructures to identify an appropriate provider for each person. This could include regular TCP panel meetings with providers to strengthen shared working and to maintain momentum. Regional work is required with providers to develop shared and standardised approaches as appropriate, to develop joint approaches to shared challenges. An enhanced brokerage programme should also be created to facilitate people’s discharge and a therapeutic support programme should be piloted to understand the demand and impact of this CMM type of support.

OVER TO THE EXPERTS... How can the learning from this report help to increase the numbers of people moving from inpatient settings into community services and their own homes? How can the findings be used for wider implementation? How easy will it be for other areas to replicate?

GREAT RELATIONSHIP-BASED COMMISSIONING The project is a great example of relationship-based commissioning, which needs to be widely embedded if the TCP is to be successful. IPC has been working for over 25 years in health and social care commissioning and our work over the years has taught us the importance of good relationships. Our model for relationship-based commissioning is based on our original commissioning cycle – Analyse, Plan, Do and Review, but emphasises what needs to happen in each quadrant to achieve good relationships. Analyse: Commissioners and providers need to understand each other’s context, drivers and business relationship needs. Plan: Both need to schedule time to build the relationship. Do: Both need to actively listen to the other, value each other and behave in a solution-focused way (it’s all about people skills). Review: Both need to regularly reflect on what’s working

and what’s not working in terms of their relationship. The project is a good example of relationship-based commissioning because commissioners and providers took the time to understand each other’s needs and how they could best support each other. They prioritised finding time to meet, discuss and build their relationships. They actively listened and problem-solved together and when something wasn’t working they were honest about it which empowered them to move forward. Enabling people to move out of long-stay inpatient facilities depends upon the willingness and ability of commissioners and providers to focus on improving their relationships and engaging in relationship-based commissioning as is so wonderfully demonstrated in this project from the VODG Taskforce.

Sarah Broadhurst Lead for Learning Disabilities and Autism, IPC

A TIMELY REMINDER THAT THE JOB IS JUST BEGINNING As the end of Transforming Care looms large, this report is a timely reminder that the job to support people out of long-stay hospitals is still just beginning. We’re pleased that the report is clear that each of the people assessed would have been able to live independently were it not for systemic barriers. Time and again, Dimensions has to persuade the professionals around a person that a better life outside of a long-stay hospital is absolutely possible. Even if an individual has a history of failed placements in the community, the failure is of the plan, not of the person. Challenging behaviour must be seen simply as how a person has learned to communicate that things are wrong. It is not an indivisible part of his or her personality. By starting from this point, taking the time to get to know the person, and employing suitable levels of professional support, in particular

using positive behaviour support techniques, almost anyone can emerge successfully from long-term stays in assessment and treatment units (ATU). Our experience also shows that in the long-term, living in a community setting is usually much cheaper too. However, as the report indicates, funding suitable levels of support at the outset is key. Everyone around the individual must have realistic expectations of the support needed initially. Get that right, a person’s support needs can reduce significantly over time. There has been no indication from Government as to what happens beyond the end of the TCP in March 2019. I have an unsettling fear that the end of the programme will bring the end of targets and of any meaningful efforts to help people stuck in ATUs. I hope I’m wrong.

Steve Scown Chief Executive, Dimensions

YET MORE EVIDENCE OF SYSTEMIC CHALLENGES This report provides yet more evidence of the systemic challenges to delivering the transformation of care, a transformation that is long overdue. The issues described are familiar to the families the Challenging Behaviour Foundation (CBF) supports – the report identifies solutions to these issues and examples of driving change to get people the lives they have a right to. It shows it can be done, but for too many people it isn’t. The families we support live through the consequences of the system not working and this has a devastating and lasting impact on their loved ones. It means that people are kept in inpatient provision that doesn’t meet their needs, often long distances from their families and friends for long periods (the average length of stay in inpatient services is now 5.5 years). The report highlights that the people responsible for Transforming Care fail to even think

about the people they support. Our experience at CBF is that families can clearly describe the support their relative needs to live a good quality of life. Where families are engaged and their knowledge and experience is valued and listened to, their loved one is more likely to live a good quality of life with the right support. Yet lack of support for families was highlighted as a challenge in the report with a call to involve and invest in families. Families articulate what is needed very clearly, what would it take to address the issues? To a parent, it doesn’t seem like rocket science. It just needs adequate ring-fenced funding, and government-level scrutiny and accountability. This demonstrator contributes to a range of voices and evidence that we all have a responsibility to use to make change happen.

Vivien Cooper OBE Founder, Challenging Behaviour Foundation

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A VIEW FROM THE TOP

MARTINFA R R O W Martin Farrow, Chief Executive of Optalis

REFLECTIONS ON THE LAST DECADE The last decade has seen a paradigm shift in our sector. 2008 saw the start of a period of uncertainty and fiscal challenge that I’d not seen before; the landscape was undergoing seismic change, driven by fundamental reform, challenging economics, and a realignment of commissioning routes and procurement methodology. Ten years on and the challenges remain. The sector continues to re-think how it balances increasing customer complexities and demand, with depleted central government settlements. However, in a sector where the only constant appears to be change, one thing remains the same: the hard work, dedication and support of care staff across the sector in making sure customers experience the best care and support we can give them. PROJECTIONS FOR THE NEXT DECADE Challenging times often provide the catalyst for positive change which drives innovation and momentum. When I look at technology, I see a progressive outlook. When I look at our teams, I see a continued focus on doing what is right for our customers. As an organisation owned by two local authorities, we have seen the emergence of this business model, and I see this continuing, particularly where scale can bring resilience for customers and colleagues. The traditional view of these models delivering services such

as reablement, day care and homecare will change. Optalis began in 2011 with a similar portfolio of services. Today, we offer those same services but also, uniquely, we also provide statutory services where the council remains strong and at the heart of current practice, but there are opportunities for refinement and innovation. Integration with health will also drive the future. Whilst the policy-makers plan the journey, innovative pilots will help forge the future, supported by the right culture within organisations to let that innovation thrive. Finally, the explosion in technology will have a profound effect on our sector, although we have some way to go to understand how we move from data to information to guide and inform. Overarching all this is a desperate need to look at how we can finance this future, and critically how we look outside of parliamentary terms and set a health and social care strategy that spans forty years not four. INSIGHT Our job at Optalis is to fulfil the potential of every customer, colleague and community we work with. In my role, I have three things to achieve. Firstly, to establish (with customers and colleagues) a strategy that can be articulated and delivered. Secondly, to have great people who are inspired to do great things, and

thirdly, to ensure we have the right culture: the organisation’s ‘personality’. Interestingly, if you can achieve the right culture, you will attract great people who will be inspired to bring the strategy to life. INFLUENCES I have been lucky to work with some inspirational people but also experienced organisations where the culture hasn’t been so good. That has helped me shape what I think is important in leadership. When I think of the people I admire, I associate them with words like authenticity, respect, courage, integrity, honesty and passion. LESSONS Keep it simple and clear, keep close to the important things and be true to your values. I was told once that if you don’t start something or don’t finish something then you are in trouble. That’s good advice. ADVICE Choose your boss and have a constant appetite to listen and learn. Work with great people and recognise that your job as a leader is about fulfilling the potential of those around you to be the best they can be. Build the strategy together so everyone is involved and don’t give up or be a friend of phrase ‘the problem is’. Finally, try every day to be inspired and be inspiring. CMM

Read about Martin’s typical day on the CMM website www.caremanagementmatters.co.uk. Sign up today. CMM July 2018

RISING STARS

Nick Rickwood is Registered Manager of Flowerdown House ‘Wings Breaks’ Hotel, a Royal Air Forces Association (RAFA) hotel in Somerset.

CMM July 2018

CAREER HISTORY My career started when I was 21, I had left formal education at 18 and travelled a little. I was deciding what I wanted to do, when one day I missed a bus and by chance saw an advert for a role at a private learning disability provider. I started as a support worker and met Trevor who has shaped my whole career and approach to working. Trevor came to the service from a long-stay setting and taught me to see beyond people’s behaviours to who they are. He taught me exactly what it meant to be person-centred in all aspects of life. Trevor still sits on my shoulder and reminds me of who I am and how I should approach all relationships in work and life. My first years in health and social care helped me to build up my ideals and working practices, but I wanted to develop my skills. I supported Trevor to visit a drama therapist and this opened a door for me. Seeing how the process worked and having had a background in drama I signed up to a degree in drama therapy with the University of Derby. After graduating, I got a job at a day service, applying my newly acquired skills alongside my existing practices. I enjoyed it and was happy applying my key principles. I then began working for Derbyshire County Council looking at the philosophy and structure of supporting people with behaviours that may be described as challenging. I worked on engaging people in the philosophy of proactive, active and reactive support and recognising how behaviour is used to communicate. During that time, I completed my adult teaching certificates and developed my role as a staff development officer, delivering staff training across a range of topics. My training as a therapist was complemented and enhanced by my training as an adult teacher and the key principles of both are embedded in my working practice and are the core values I uphold as a manager today. One day, whilst in Somerset visiting family, I decided to have a look at management jobs in the area and discovered a role for a registered manager for Somerset County Council’s inhouse learning disability services and applied. I was successful and went on to hold a number of management roles across a range of services before taking on a temporary role as a senior service manager supporting other managers and services. I enjoyed the role and felt that I did it well, fulfilling all its outcomes but the role required a high level of time and investment so when it was offered to me permanently I chose to step down, so I could focus on the needs of my wife and sons, who are hugely important to me. Now my sons are adults I began looking for my next career step, which is when I heard about the role at Flowerdown House. I’d been supporting learning disability services for 26 years and wanted to try something new. Everything clicked when I went for the interview – I’d visited to get an idea of the organisation, I’d undertaken thorough research about the RAFA, and everything just fell into place. I started in January 2018, right at the beginning of the RAF’s 100 years celebrations.

ORGANISATION The RAFA is a membership-based charity made up of a number of branches run and supported by members. The aim is to offer welfare support to current and ex air force personnel and their partners. The charity offers a range of welfare support from befriending services to financial assistance and part of this welfare support is provided through its subsidised holiday breaks in any of their three ‘Wings Break’ hotels - Flowerdown, Rothbury and Richard Peck. These hotels offer a holiday break experience to their guests and can offer support to individuals, where required, to enable their access of these services. Flowerdown House ‘Wings Breaks’ Hotel is an 18-bed hotel. Eight bedrooms have been registered with the Care Quality Commission to enable us to provide personal care and support. The hotel stay includes full board, three excursions into the community and surrounding area and live entertainment on three evenings a week. We also provide mobility scooters for our guests to use so they can independently explore what Weston-super-Mare, with its beautiful pier and beach, has to offer.

CURRENT ROLE I’ve been here for nearly six months now and I think the hardest part for me was to step out of my comfort zone and into a completely new service to explore my skills, abilities and potential. I was nervous to step into the role, but have found myself in a very special setting, working for and supporting a hugely valued charity. Flowerdown House, like all three hotels, has a strong and loyal staff base, so it’s been great getting to know them, becoming part of their team and starting to help in building and growing the service.

RISING STARS Rising Stars was the perfect opportunity for RAFA to put forward a member of the team to benefit from such a wonderful initiative and to work more closely with the National Care Forum. Being new to the organisation and role, I fit the criteria, although I am not new to social care or management. That being said, I’m a great believer in lifelong learning and the opportunities which come along with the Rising Stars initiative. As an older Rising Star with some experience under my belt, I want to use it to help me explore my next step in the sector – aspirationally I’d like to move into a director or chief executive role in time, so having the mentoring experience and access to other experienced individuals, I believe will help me to get there and provide me insight into these roles and what’s involved in taking these steps. Irrespective of age or experience, I think the programme has the potential to support all Rising Stars wherever they are on their pathway.

Johnny Johnson of Squadron 617 – The DamBusters, pictured with hotel guest, Derick Coombs who served as part of the RAF Instrument, Mechanical and Photography division.

ADVICE I think my success is down to having a knowledgeable and experienced manager to work alongside for the first six months of my career. I think having that support mechanism as you move into a leadership or management role is very important. It helps you to look at your own approaches and align them with others. Peer support is hugely important too. Having an opportunity to share, discuss and develop through common interest with your peers enables you to grow in areas you wouldn’t alone and gives a safe platform to explore your developing practice with another who shares and understands your role, with all its rewards and challenges. It can be isolating being a manager, so having people on your level who you can contact for advice and support can help. It’s also important to recognise the type of peer support you may need, whether practical, emotional, or something else and approaching the right peer to help. I guess ultimately, though, I have to go back to Trevor. He taught me to be person-centred in all aspects of life, not just service delivery. Actively listen, be part of a team, respond, invest, encourage and support. Whoever they may be and whatever you may be doing together, you need to see the person you are with and keep them at the front of all that you do. CMM Nick is part of the second cohort of Rising Stars. This innovative programme, developed by National Care Forum and supported by Carterwood is designed to identify leading lights within organisations who will shape and form the care sector in the future. More information about the programme, the candidates and future opportunities can be found at www.nationalcareforum.org.uk

CMM July 2018

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BRIDGING THE GAP THROUGH MENTAL HEALTH RESEARCH Despite an increase in NHS mental health funding last year, the gap in spending between NHS acute hospitals and mental health providers continues to rise. Andrew Molodynski and Professor Kathryn Abel from the National Institute for Health Research (NIHR) discuss the value of research in terms of improving care and treatment for people with mental health conditions.

The call for ‘parity of esteem’ implies that mental health and physical health should be valued equally – both as outcomes in the commissioning of health services and also by investors in health research. Worryingly then, in spite of an increase in NHS mental health funding last year, the gap between funding for NHS acute trusts dealing primarily with physical health needs and funding for mental health providers continues to grow. Funding for mental health services is around 11% of overall spend, yet it is widely accepted that approximately 23% of NHS activity is directly related to mental health care. This disparity is acknowledged

> CMM July 2018

BRIDGING THE GAP THROUGH MENTAL HEALTH RESEARCH

by many but has yet to be tackled effectively. The funding gap is also present in research about mental health – with approximately 7% of total research funding allocated to mental health studies. This gap in funding affecting mental health services and research has had an important influence on people’s ability to access excellent, evidence-based psychiatric services. It also means that increasingly stretched clinical teams are limited in their capacity to support research in clinical practice. This limits the availability and ease of access to important mental health studies for people who need them most, or may wish to take part. People in mental health services are already far less likely to be involved in research than patients in other health specialities. Moreover, the incentives for health professionals to get involved in research are few and we risk losing valuable expertise and experience which allow clinical teams to promote and support research actively in their practice.

ADDRESSING THE SHORTFALL The need to increase spend on mental health services and research is put into context by an independent review commissioned by the Government in 2017. This reported that around 300,000 people leave their jobs each year because of mental illness – costing employers and the UK economy an estimated £42bn annually. Delivering high-quality, wellresourced clinical research is key if we are to improve care and outcomes for people. Improving mental health for individuals conveys far wider benefits on society and the economy. We must do more both to facilitate existing studies and ‘grow’ new

ones to help the many people whose lives are affected by poor mental health. The need for high-quality evidence has also never been greater: mental health services across the country are undergoing significant change during austerity and important clinical evidence gleaned through research studies can optimise the chances that such changes are positive. Key publications such as NHS England’s Five Year Forward View (FYFV) and Department of Health and Social Care’s Framework for Mental Health Research recognise these concerns. Both highlight the importance of more high-quality research and, crucially, the need for more strategic planning and co-ordination of studies to meet the gaps in our knowledge. Achieving these goals from the current situation will be a challenge. Clinical and academic workforces are critically depleted. Both are over-stretched and the pipeline for clinical academics in psychiatry is low in numbers and some areas of the field are unrepresented. This means there is a lack of researchers available to undertake work in priority areas for the mental health workforce and for the population – such as addictions, or children and young people’s services. Other major shortfalls include the medical focus of much psychiatric research and the small service user research community.

THE VALUE OF MENTAL HEALTH RESEARCH The majority of mental health care is evidence-based and increasingly so. However, stigma pervades mental health research as well as practice. Within medical disciplines, there is an enduring and common perception that psychiatry is a lesser discipline and represents an ‘art’ rather than a ‘science’.

There are also perceptions that mental health research is not as ‘good’ as research into, say, cancer or heart disease. This persists in spite of the fact that mental health research funding confers 37p benefit for every £1 spent, exactly the same as the ‘big two’. However, there are reasons for optimism. The UK produced nearly 8% of the global mental health research output in 2015 according to Mapping UK Mental Health Research Funding and its Contribution to Global Funding – so we ‘punch well above our weight’. We also know that people with mental ill health overwhelmingly support research and would take part in studies if offered, with figures from an international study indicating this could be as high as 98%. Staff in services need to be discouraged from ‘gatekeeping’ clients in psychiatric services from taking part in research. This is a challenge the NIHR Clinical Research Network (CRN) is particularly well-placed to address. We need to work with clinical staff to reassure them that research improves lives and improves patient outcomes.

Conversely, we need to work with research teams to understand competing perspectives and pressures that mean research is not seen as a priority. Embedding research staff from the CRN within clinical services is one approach and offers additional staff time for the day-to-day clinical work with patients, while facilitating participation for clients who want to get involved in research. Digital platforms such as Joint Dementia Research, MQ’s patient portal, and NHS Research Scotland’s ‘SHARE’ initiative increasingly allow people to find out about research opportunities and take part directly. However, we must remain aware that clients with mental illness may (or may not) need additional support to access such portals. The greater prominence of research and increasing awareness of its value by policymakers, inspectorates, and funders is very welcome. Combined with more patient choice, it provides a valuable opportunity to usher in a new era of discovery with the possibility for improved outcomes and healthier, happier lives. Our challenge is to rise to this. CMM

Andrew Molodynski, Consultant Psychiatrist at Oxford Health NHS Foundation Trust and NIHR CRN Deputy National Speciality Lead for Mental Health Twitter: @Andrewmolodyns1 Professor Kathryn Abel, NIHR CRN National Specialty Lead for Mental Health. Email: crnspecialtyclusterc@nihr.ac.uk Twitter: @NIHRCRN Would you support research in mental health settings? CMM members, share your thoughts and feedback on the article on the CMM website www.caremanagementmatters.co.uk where you can also access the reports mentioned in this article. Not a member? Sign up today. 38

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THE ROLE OF MANAGERS IN CREATING A POSITIVE ENVIRONMENT Jenny Kartupelis shares recent learning about the way in which relationships in care homes affect wellbeing and considers the unique role of managers in creating a positive environment.

In 2015, I concluded a study commissioned by the Abbeyfield Society to investigate the nature of spiritual life in its homes. One of the factors that distinguished this study was the decision to explore the responses and hence care of everyone in the community of the home, rather than to focus on the residents alone. Another was the extent of the study, with over 100 people interviewed during its course, in a variety of geographical locations and different settings, from supported housing to care homes. The intention was to listen carefully to the voices of all involved and draw out common factors that appeared to lead to feelings of security, being known and valued, and being enabled to live life as fully as possible. There is a current policy emphasis on helping older people to remain living in their ‘own’ home as long as possible, equating this with independence. However, being alone in a house that may no longer be suitable and with care possibly being delivered in short visits, 40

CMM July 2018

risks the person not moving into a more suitable care setting until they reach a point of frailty. A move at this point may be so disruptive that wellbeing is severely compromised.

FAMILY LIFE IN CARE SETTINGS To help tackle this, there needs to be greater awareness amongst the wider public that it is possible for people to rebuild a version of ‘family life’ in a new home. This is especially so if it is a community where they feel rooted, their isolation is addressed, and their critical needs met. Of course, there are challenges in meeting such apparently simple demands, but these are surmountable, and more than that, the financial and societal savings in providing what really matters to older people, as opposed to what others think they want, are potentially life-changing for us all as a society. I discovered people primarily want

a safe, secure environment that fosters good relationships, recognition and being valued as a unique person; enjoyable nourishing food in the company of others; and personal care relevant to the individualâ&#x20AC;&#x2122;s needs. The model that favours such provision is that of the â&#x20AC;&#x2DC;familyâ&#x20AC;&#x2122;. Families range from the highlysupportive to the dysfunctional, but in their essence, they are based on interactions whereby members are known to one another, and provide a model for two-way relationships, rather than a one-way process of giving and receiving care. A shift from unidirectional care engenders respect and a way of treating people with compassion but without patronising them. This observation arises from talking to staff and residents, and hearing from them about how they view their

CMM July 2018

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NCF is the strongest voice for the not-for-profit care sector Join us!

0345 644 2866

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NCF supports its members to improve social care provision and enhance the quality of life, choice, control and wellbeing of people who use care services. We work directly with not for profit providers of care and support services across the UK offering: • Expert response to government consultations and engagement with senior politicians and staff • Innovation focus - influencing the future of the health and social care sector • Direct support for individual members and their senior teams • Regular specialist and general forums – bringing together practitioners from across the UK • Weekly policy and information briefings • National events spread throughout the year – offering expertise, collaboration and knowledge exchange • Regular benchmarking surveys on key sector issues • Opportunities for national and international networking

www.nationalcareforum.org.uk @NCFCareForum info@nationalcareforum.org.uk 02476 243 619

CMM July 2018

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THE ROLE OF MANAGERS IN CREATING A POSITIVE ENVIRONMENT

interactions. In their own words, these include comments about their homes such as, ‘It feels like a family – they’re supportive of one another’ (manager) and, ‘The family bond is part of the home’ (staff). In these descriptions, there is a recognition of mutual support. Managers may help staff through difficult times, but residents can also do this for one another and for care staff; the burden does not fall solely on managers to ‘carry’ everyone because they themselves can feel known and valued by the community of staff and residents.

NURTURING RELATIONSHIPS There appears to be a constellation of factors that nurture relationships, and they need to work together to be effective in creating a favourable environment for wellbeing. Continuity is critical: it takes time for interpersonal trust and knowledge to develop. This demands a high level of staff retention, which in turn argues for investment in training, a living wage, and ways of recognising the value of individuals who are not interchangeable units. The assumption that it also demands scheduling-in more time for resident/ staff interactions may not be valid: relationships can be built during the giving of care and the sharing of meals. Although, this does not apply in the same way where people with dementia are concerned, as there is a need for staff and residents to pause during tasks for full interaction. Good nutrition, delivered through hot food cooked on the premises is transformative, and meals bring people together, providing a structure to life. Again, using actual words from the study this can be put into context, ‘They sit down together for meals, and it makes them like a family again’ (member of staff); ‘I love joining in with the meals’ (resident). Feeling safe and secure is critical and associated with long-term, settled relationships and the knowledge that there is ‘someone there for them’. A sense of real security grows with time, as residents learn to build trust in staff, and is essential to an environment in which people can flourish.

PHYSICAL ENVIRONMENT It also became clear that the physical environment strongly influences feelings of dignity, security and belonging. Noone in the study wanted to be in a home that looked like a hospital or hotel, people wanted somewhere to belong. Whilst only a few managers may be in a position to influence the design of a new-build, relatively small alterations can make a big difference. It is wellrecognised that certain design features are essential in homes supporting people with dementia, such as avoiding dead-end corridors, having a variety of communal rooms and waymarking to minimise confusion. However, in residential homes that don’t support people with dementia, there are equally desirable features. These can include having at least two lounges, one without a TV (or at the last resort, dividing a large lounge); making sure chairs are grouped for easy conversation; having focal and talking points; and enabling residents to display their books, paintings and ornaments in communal areas if they wish.

VOLUNTEERS AND TRUSTEES Volunteers and trustees are also great assets to the manager, as they can take some burden off her/him and be with staff and residents, joining in conversation and discreetly monitoring. They can and should also join in the ‘family’ of the home, by offering to help out and taking part in outings and meals.

ROLE OF MANAGERS Managers of homes have several vital roles to play in creating the ‘relational home’ and in effect are the catalyst that brings it into being or ensures its continuation. Residents and staff talk about managers as the ‘hub’ or the ‘soul’ of the home. They can, in many respects, prioritise the factors that nurture relationships, although in others, such as wage levels, they may only be able to put a case to the owners or trustees. Critically, managers can influence the atmosphere profoundly, in practical ways such as scheduling rotas to enable

continuity of care; organising tea and cakes around a focal point such as a fire, rather than by a trolley service; ensuring lounges are not dominated by a TV; and by setting an example of listening and being there. This may mean reserving paperwork to be handled unobtrusively or seeking an assistant from amongst the volunteers to look after some of the routine administration. It will certainly mean knowing staff and residents well enough to be sensitive to changes in mood or signs of discord.

BENEFITS OF RELATIONAL CARE The ‘returns on investment’ of this selfcommitment and time are considerable. For the manager, a supportive and ‘bonded’ environment is invaluable; for example, in the study a resident commented, ‘We are aware how badly affected managers can be by a death and are concerned for them.’ Put simply, the manager is no longer alone in a controlling or isolated position but becomes part of a group endeavour with mutual care between staff, residents, volunteers and trustees. For the organisation running the home, there are the benefits of improved health of residents, with lower demands on staff time, and reduced management stress, staff sickness and possible adverse care incidents. For the public purse, in particular the NHS and housing provision, there are benefits from better use of limited resources. Finally, for society as a whole, the value, wisdom and presence of older people CMM can be optimised.

BOOK OFFER Jenny Kartupelis is co-author of Developing a Relational Model of Care for Older People: Creating environments for shared living (Woodward & Kartupelis, 2018, Jessica Kingsley Publishers). CMM readers can receive 10% off online purchases of the book thanks to Jessica Kingsley Publishers. Visit https://www.jkp.com/uk/newstructures-for-care-2.html and enter: MCP at the checkout.

Jenny Kartupelis MBE MPhil is an author and researcher involved in issues of spirituality, older people and interfaith; she is Director of Faith in Society Ltd, and Development Officer for the World Congress of Faiths. Email: jenny@cambcatalyst.co.uk Twitter: @Jenny33K CMM July 2018

In association with

The Lancashire Care Conference

BOOK NOW 27th September 2018 Mercure Blackburn Dunkenhalgh

AGENDA TOPICS

Early Bird Discount for LCA members

› The Role of Digital Technology in Care Delivery

10% Discount for CMM members

› NHS View of Independent Sector

Book online at

› Future Models of Care www.lancashirecare.org.uk Corporate sponsor

@LancsCareAssoc Sponsor

www.caremanagementmatters.co.uk www.caremanagementmatters.co.uk Organised by

Supported by

@CMM_Magazine #CMMInsight *Discounts cannot be used in conjunction with each other. Agenda subject to change.

SPONSORSHIP AND EXHIBITING OPPORTUNITIES AVAILABLE T: 01223 206965 E: daniel.carpenter@carechoices.co.uk

E C R U RESO FINDER

PROPERTY PROFESSIONALS A specialist property professional has the skills and contacts to help your business. Whatever your business aim, from expansion to exit, site-finding or development opportunities, they have the skills and knowledge to assist you. The following property professionals will work with you to help achieve your vision for the future.

CMM July 2018

RESOURCE FINDER

BUYACAREHOME

CARTERWOOD LTD

Email: info@buyacarehome.com Website: www.buyacarehome.com

Tel: 08458 690777 Email: info@carterwood.co.uk Website: www.carterwood.co.uk

SECTORS • Care homes. • Nursing homes. • Specialist care homes. • Vacant/turnkey opportunities. • Development sites.

SERVICES • Care opportunities listed for sale. • Exclusive access to promotions for care home operators. • Market knowledge and ‘inside’ news. • Care sector industry experts: • Commercial mortgages. • Business loans. • Legal services. • Accountancy. • Capital allowances. • Architectural services. • Construction services. • Chartered surveyors. • Business insurance. • Compliance consultancy. • Specialist suppliers.

COMPANY INFORMATION The Buyacarehome group is the UK’s one-stop-shop for people buying and operating care homes. The website offers a complete range of integrated services to help you acquire and

run your care business. Whether you are buying, selling or improving your care business, you can find the right team of experienced experts to help you. The website features listings from a wide number of independent specialist business transfer agents and users can browse and find care homes for sale throughout the UK. Users of the site can register to be the first to see new properties posted and filter their search criteria to suit their preferences. Ownacarehome is a section exclusively for care home operators, featuring tried and tested suppliers and where Buyacarehome users can access exclusive promotions offered by group members. Buyacarehome is sponsored by specialist finance advisers and consultants, Chandler & Co, who are well-known in the sector. Chandler & Co can provide impartial advice whether you are considering an acquisition, refinance, development, expansion or financial restructuring with your existing lender. Working with Chandler & Co will give you access to some of the most competitive funding available in the market.

Anna Read Group Coordinator Tel: 01622 815925 Email: anna@buyacarehome.com

SECTORS • Elderly care homes. • Specialist dementia care. • Older people’s housing. • Care villages/Assisted living/ Extra care. • Development and investment. • Children’s nurseries. • Specialist care inc. mental health.

SERVICES • Consultancy. • Agency; disposal and acquisition. • Bespoke advisory projects.

LEAD INDIVIDUALS Carterwood was established in 2008 by directors Amanda Nurse and Ben Hartley. With the business celebrating its 10th trading anniversary this year and another year of record growth, it has made a number of promotions to its senior management team. Alex Taylor, who oversees Carterwood’s operations and product delivery, is now a director, while Tom Hartley and Matthew Drysdale are now associate directors. Tom is responsible for Carterwood’s agency and consultancy divisions. Matthew specialises in investment and development transactions across the care home and older people’s housing sectors. Amanda and Ben remain integral to Carterwood, with Amanda responsible for Carterwood’s strategic

direction and performance. Alongside his consultancy work, Ben is responsible for driving Carterwood’s innovation, including its older people’s housing and care home staffing reports.

COMPANY INFORMATION Carterwood is a multi-awardwinning property consultancy dedicated to social care. It provides advice across both the care home and older people’s housing sectors, for more than 70% of the top 20 care providers, advising on the majority of care home development in the UK. Recognised for its bespoke, personal and specialist service, for the last two years Carterwood has been named ‘Property consultants of the year – property services’, at the HealthInvestor Awards. It has also recently been named as finalist in the same category for the 2018 awards. In addition, in February 2018, Carterwood was honoured as one of the ‘Best Places to Work in Property’, at the national Property Week awards. It won two of the eight award categories: ‘leadership and planning’ and ‘relationship with supervisor’. Since its inception, Carterwood has enjoyed excellent client loyalty and satisfaction; 85% of clients in 2017 were returning customers. Carterwood has also worked with the majority of its top 10 clients for more than five years.

Amanda Nurse Managing Director Tel: 08458 690777 Email: amanda.nurse@carterwood.co.uk Ben Hartley Director Tel: 08458 690777 Email: ben.hartley@carterwood.co.uk

CMM July 2018

RESOURCE FINDER

The Frontida Group

DC Care Tel: 01937 849268 Email: sales@dccare.co.uk Website: www.dccare.co.uk

SECTORS • Elderly care and nursing homes. • Learning and physical disabilities. • Mental health. • Vacant care homes. • Care home groups and sites. • Care homes in administration or receivership. • Charities and not-for-profit. • Local authorities.

SERVICES • Sales and acquisitions. • Care business appraisals. • Marketing reports.

LEAD INDIVIDUALS As a Member of the Institute of Commercial and Business Agents, Alison Willoughby has over a decade of specialist healthcare experience. Alison joined DC Care in 2010 and has concluded sales of a range of businesses, from closed care homes and homes in administration, to well-performing operational groups. Her extensive transactional, appraisal and relationship management experience enables her to quickly grasp the very individual facets of any sale. Alison provides lenders with marketing reports, enabling decisions to be made on the future of businesses showing early signs of distress and also advises on portfolio development matters. Andrew Sandel has a wealth of experience in business transfer having been in the industry for

over 20 years. Prior to this, a background in internal auditing provided the accounting experience required to provide owners an accurate appraisal of their business. Since joining in January 2010, Andrew has built an excellent network of contacts in all aspects of care. A hands-on and personal approach to the entire process has resulted in DC Care significantly increasing its presence in the South, making it one of the most active specialist agents in the sector.

COMPANY INFORMATION DC Care has concluded over 500 transactions, with a total value in excess of £0.5bn. Our goal is to maximise the outcome for every client. The team focuses on service and acts for vendors or purchasers buying or selling businesses, development sites and empty units for redevelopment. We provide assistance on exit strategy planning, portfolio realignment, targeted acquisitions and administrations, liaising closely with carefully chosen partners to build a due diligence team where appropriate. Each member of the team has hands-on, specialist experience, gained over many years. This expertise and the wider commercial experience of the team means we offer practical, relevant and commercial advice. DC Care is the trading name of The Franklyn (Developments) Ltd.

Alison Willoughby MICBA Regional Director (North) Tel: 07825 353748 Email: awilloughby@dccare.co.uk

Tel: 0121 270 5854 Email: contact@frontidagroup.co.uk Website: www.frontidagroup.co.uk

SECTORS • Supported living. • Residential care. • Nursing care. • Extra care. • Supported accommodation. • Domiciliary care. • Social housing.

SERVICES • Compliance. • Sales and acquisitions. • Housing development. • Investments. • Property management.

LEAD INDIVIDUAL Robert has 15 years’ experience within the social care and housing markets specifically in supported and assisted living for adults with learning disabilities, autism and mental health conditions. His background has included being responsible for the development and acquisition of various real estate for the supported living market. His sincere passion throughout the last 15 years within social care has always been focused on the result to the service user ensuring successful outcomes. Robert has been involved in large business acquisitions and

sales, social housing investment and acquisitions, supported living and residential care strategic management, HR recruitment and compliance for various organisations since 2002.

COMPANY INFORMATION Our vision at The Frontida Group is to provide quality-based services to the social care and housing sectors. We offer extensive guidance and support through various arms of the group; each individual arm has a team of experienced professionals on hand to provide the very best support. You are at the centre of everything that we do. We work with you to make sure that we consider our clients’ needs in providing a quality service. We use involvement and active participation to promote personalisation within our specialist services. The Frontida Group is focused on exceptional service and support, always being actively involved in quality feedback and continuous improvement strategies. This involves clients, their services, tenants, health professionals, investors, inspectors, social services and the local community.

Robert Antcliff Director Tel: 07716 479878 Email: robert@frontidagroup.co.uk

Andrew Sandel Regional Director (South) Tel: 07825 206777 Email: asandel@dccare.co.uk CMM July 2018

EVENT PREVIEW

MARKEL 3RD SECTOR CARE AWARDS 2018 Organised by:

Corporate sponsor:

7th December, London

Nominations are open Nominations have opened for the Markel 3rd Sector Care Awards 2018. Now is your chance to nominate yourself, a colleague or contact in one of the 12 award categories. The Awards are open to any not-for-profit care and support organisation that is making an impact through innovation and excellence. Nominations opened on 15th June and there are 12 categories meaning thereâ&#x20AC;&#x2122;s something for everyone.

THE AWARD CATEGORIES The Leading Change Adding Value Award for Compassion celebrates a team or individual that consistently demonstrates compassion to those they support. The Innovative Quality Outcomes Award recognises those organisations achieving quality outcomes that make a difference to the lives of people using services. The Creative Arts Award celebrates organisations that use creative arts to engage with clients and demonstrate the positive impact to their quality of life. The Community Engagement Award focuses on the contribution an individual or a service makes to the local community. The Citizenship Award celebrates an individual or organisation that enables the people they support to contribute to their community. The Leadership Award recognises a person who has a leadership role at any level who demonstrates outstanding leadership which has significantly contributed to care and service excellence within a culture that puts people and quality first. The Collaboration (Integration) Award focuses on ways of working collaboratively and achieving outcomes for people using services that otherwise would not have been achieved. The Making a Difference Award is for an outstanding person effectively leading 48

CMM July 2018

an organisation for which they have sole responsibility who have significantly influenced outcomes for clients, families and staff. The Beyond Governance Award is for a Board Member, Trustee or Non-Executive Director who has made an outstanding and sustainable contribution to their organisation. The End of Life Care Award celebrates an individual or team that recognises how choices made by the person being cared for and their family are central to the service and care that is delivered. This involves reflecting fully on what is important to the person at the end of their life. The Technology Award recognises an individual, team or organisation that uses technology in an innovative and person-centred way to enhance lives.

NOMINATE TODAY The nomination process is easy. Head to the Events page on the CMM website and click on the Awards. Pick your chosen category (or categories), fill out the form, answering the questions and give as much detail as you can. Nominations will be shortlisted by the Awardsâ&#x20AC;&#x2122; judges. Shortlisted finalists will then be invited to a panel interview on 1st November in London. Nominees must be able to attend the interview. The winners will be announced at the Awards Ceremony on Friday 7th December at the London Marriott Hotel, Grosvenor Square. Tables and tickets are available for the Awards Ceremony on the Markel 3rd Sector Care Awards event page on the CMM website. Organisations wanting to sponsor an award and network with leading innovators in the market should call Daniel on 01223 206965. Supported by: