Care Management Matters October 2018 by Care Choices Ltd

OCTOBER 2018

www.caremanagementmatters.co.uk

STAYING ON TRACK Securing the stability of your business

Busting the myths

Why should nurses choose social care?

Vision 2030

A drive for development

Resource Finder Specialist solicitors

In this issue 05

Inside CQC Chief Inspector of Adult Social Care, Andrea Sutcliffe, CBE talks about CQC's role in taking decisions about registration that protect people with learning disabilities.

CMM News

Business Clinic Our panel looks at Alive’s ‘Making Pals’ project, which aims to get homes interacting more with their communities.

Rising Stars 2018 Catherine Haycock is Support Manager at Belong’s Morris Feinmann Care Village.

3rd Sector Care Awards A look at Camphill Village Trust's Quality of Life Reviewers project, which won in the 3rd Sector Care Awards 2017.

Event Preview CMM previews the Care Show 2018.

What’s On?

Straight Talk Colin Angel, Policy Director at UKHCA shares his views on improving the stability of the state-funded homecare market.

FEATURES 27

REGULARS

From the Editor

Challenging the myths of a career in social care Nurses choosing between a career in social care or the NHS seem to continue to opt for the latter. Dr Charles Armitage looks at the benefits of working in the social care sector and how they outweigh the perks of working in the NHS.

Into the future: a new vision for retirement communities Retirement communities are becoming an ever more popular option with older people. With supply not keeping pace with demand, ARCO has launched Vision 2030 to tackle this issue. Michael Voges explores the Vision and how it will impact the future.

Staying on track: sustaining a care home Opening and running a care home is never easy, and the current climate in social care is stretching even the most seasoned operators. Sara Livadeas, Director of Social Care Works and author of Opening a New Care Home, shares her tips for ensuring success for both new and existing businesses.

Resource Finder CMM profiles specialist care sector solicitors for businesses that need advice or guidance. CMM October 2018

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

CONTRIBUTORS

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

ADVERTISING sales@caremanagementmatters.co.uk 01223 207770 Advertising Manager: Daniel Carpenter daniel.carpenter@carechoices.co.uk Director of Sales: David Werthmann david.werthmann@carechoices.co.uk Senior Sales Executive: Aaron Barber aaron.barber@carechoices.co.uk

@CQCProf

@DrCArmitage

@ARCOtweets

@activitiesNAPA

Andrea Sutcliffe CBE Chief Inspector of Adult Social Care, Care Quality Commission

Dr Charles Armitage Managing Director, Florence

Michael Voges Executive Director, ARCO UK

Sylvie Silver Executive Director, National Activity Providers Association

@skillsforcare

@Barchester_care

@BelongVillages

@saralivadeas

Jim Thomas Programme Head for Workforce Innovation, Skills for Care

Michael Butler Activities Champion, Barchester Healthcare

Catherine Haycock Support Manager, Belong’s Morris Feinmann Care Village

Sara Livadeas Director, Social Care Works Ltd

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 CCL REF NO: CMM 15.7

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CMM October 2018

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Philip Gibson Project Manager, Camphill Village Trust

Colin Angel Policy and Campaigns Director, UKHCA

From the Editor Editor, Angharad Jenkins takes a look at the features in this issue of CMM and considers the news from the last month. additional funding for the specialist housing sector. We are taking a look at ARCO UK’s Vision 2030 and its ten commitments to see what needs to be done to drive the retirement housing sector forward and provide more homes for older people. Michael Voges explores the Vision in the feature starting on Read the feature on page 46 to offer that the NHS doesn’t. page 27. find out more about their project For those operating a care 3RD SECTOR CARE with Quality of Life Reviewers. home, and those looking to open AWARDS a new home, Sara Livadeas shares BECOME A MEMBER the crucial elements you need to I’m also delighted to bring you consider to ensure your business is a new series starting this month The CMM website has a host of successful on page 37. showcasing the outstanding work additional content for social care Of course, while new that is happening in the voluntary providers. Find knowledge pieces, developments are vital to sector. extended features, the latest news the progression of the sector, We will be looking at the and more. recruitment remains a tough issue, winners of the 3rd Sector Care Membership is free for all particularly when looking for Awards, exploring the important providers and includes discounts nurses. work they have been doing and on CMM Insight events. On page 22, Dr Charles EXPANDING THE what it is they won for. Leave your feedback on the SECTOR Armitage considers why registered We are kicking off this series features in this issue and claim nurses continue to choose a career with the winners of the 2017 award CPD points for reading CMM at One thing we do know, is that in the NHS over social care and for citizenship, Camphill Village www.caremanagementmatters. Government has announced explores what social care has to Trust. co.uk. 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 Welcome to the October edition of CMM. We’ve got a packed issue this month with information for all areas of the sector. Over the last few weeks, we’ve seen reports flooding in about the state of social care, its future and what it needs to develop. Matt Hancock’s recent announcements about technology have given us a clear indication of his intentions for the sector, and the launch of the new digital platform for staff to influence policy suggests a genuine dedication to hearing the voice of the workforce. However, with no further developments on the Green Paper, and uncertainty still surrounding sleep-ins payments, we’re still left wondering what the future of social care will look like.

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Registration is the bedrock of what we do at the Care Quality Commission (CQC). It’s the first quality check we make. The decisions made by registration inspectors – informed by national and best practice guidance – are an important part of how we promote the health, safety and welfare of people who use services. This is why I’m proud of CQC for standing up for the rights of people who use services when making decisions in line with our policy, Registering the Right Support. Last month, the First-tier Tribunal upheld one of CQC’s decisions to refuse an application submitted by a provider to increase the number of people with a learning disability at one of its services, following an appeal by the provider. Registering the Right Support guides the assessments that registration inspectors make of providers of services for people with a learning disability and/or autism. It sets out that new services and variations to registrations within a campus or congregate setting should not be developed because this model of care is not in the best interests of people. Consistent with other national policy, it gives a clear message that people with a learning disability have as much right as anyone else to live fulfilling, ordinary lives in their communities. I acknowledge that, for some, Registering the Right Support has been controversial. There have been myths circulating that there are strict limits on the number of places a

“Our focus must be firmly on the rights, welfare and wellbeing of people with autism and learning disabilities.” service can have (for the avoidance of doubt, there are no rigid rules, just expectations that providers can demonstrate they follow the principles and values in the guidance) and we’ve heard concerns that promoting small services may impact on future capacity. I am very clear that standing by the policy and the principles that underpin it is the right thing to do.

Inside CQC A N D R E A S U T C L I F F E C B E In this month’s CQC column, Chief Inspector of Adult Social Care, Andrea Sutcliffe CBE talks about the role CQC has in taking decisions about registration that protect the interests of people with autism and learning disabilities.

Our focus must be firmly on the rights, welfare and wellbeing of people with autism and learning disabilities as determined by national best practice evidence. This evidence shows that smaller services are best placed to work with people, their families and carers to ensure care is truly person-centred and responsive to individual needs and wishes. Having said that, size is not considered in isolation from the other things that contribute to a service being able to deliver the best outcomes for people. We will always look at service size alongside the skills of staff; effectiveness of management; and the evidence base for the proposed service model. This is set out in Registering the Right Support, alongside clear examples of the types of applications that are likely to be approved and those that are likely to be refused. CQC has an important role in supporting national policy and best practice guidance. The registration decisions we make today will impact what services exist to support people in the future. We have a responsibility to ensure that those services deliver a model of care that is proven to lead to the best outcomes

for people and make a real difference to people’s lives. This means services that create environments where people have access to their local communities, the associated opportunities for independence, jobs and relationships, and the best conditions for a happy and successful life. Everyone deserves these opportunities. It’s right that at CQC we’re using our position to make this a reality for more people in future.

DID YOU KNOW? CQC has developed handy resources to support providers to improve. Learning from safety incidents are resources that describe a critical safety issue: what happened, what CQC and the provider have done about it, and the steps you can take to avoid it happening in your service. Adult social care medicines FAQs explore a wide range of medicines safety issues, answering the frequently asked questions put to CQC Pharmacist Specialists. You can find these on the Guidance for Providers section of www.cqc.org.uk

Andrea Sutcliffe CBE is Chief Inspector of Adult Social Care at the Care Quality Commission. Read the First-tier Tribunal judgements in full by following the link on the CMM website, www.caremanagementmatters.co.uk where you can also share your thoughts on Registering the Right Support. CMM October 2018

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APPOINTMENTS CARERS UK

Government seeks engagement from workforce The Government has announced a national digital platform to allow staff to feed back on five ‘key challenges’. The Secretary of State gave a speech to staff at Southmead Hospital Bristol setting out plans to give all health and care staff in England a voice in the day-to-day creation of policy. As part of his drive to bring health and care into the 21st century, he has launched a digital platform, ‘TalkHealthandCare’, which staff can use quickly and easily to post ideas, questions and challenges for Government. It is

available on phones and tablets, evolving and updating to reflect the views and ideas of staff in realtime. It will also be supported by other events, forums, and webinars for staff across the country. TalkHealthandCare has been launched following feedback from staff via surveys and other routes, that far too often staff aren’t feeling valued at work. Some of the issues that TalkHealthandCare will be seeking input on are improving shift patterns and juggling home and work lives, speeding up the use of technologies which cut out paperwork, and training and

development. The Department of Health and Social Care is also launching a Workforce Panel made up of a range of staff, which the Secretary of State will meet with as a personal sounding board on issues affecting health and care staff across the country. The Secretary of State added, 'Nobody knows what needs improving more than hard-working staff themselves, so my message is clear: we are listening to you, we want your views, and we will use them to ensure the long-term plan for the NHS helps you.'

Funding free support for all Independent Age is calling for free personal care for older people to help solve the social care crisis. Polling found that the majority of adults would support paying more in tax or a lump sum to fund free personal care and the charity is now urging Government to introduce a social care contribution aligned to a commitment to provide free personal care in its report, A Taxing Question. It suggests that this will make it easier for people to navigate the system, as well as reducing NHS spending and delayed transfers of care, and allowing more people to live at home independently for longer. It also suggests that free personal care for older people would mean no-one would have to sell their home to pay for care.

Over 2,000 working age adults were polled, finding that: • Almost three-quarters (74%) of adults support free personal care for everyone who needs it. • More than two-thirds of adults (69%) would be happy to pay more tax to provide free personal care for all. • 27% would be willing to pay a small increase in Income Tax. • 25% of adults would be willing to pay a small increase in National Insurance. • 11% would support a new small tax for people aged between 40 and retirement age. • 6% would prefer paying a lump sum of £30,000 on retirement. This support was found to be consistent across political leanings,

Carers UK has announced the appointment of Helen Walker as its new Chief Executive. Helen will start her new role on 3rd December 2018. She is replacing Heléna Herklots CBE, who stepped down to become the Older People’s Commissioner for Wales.

THE KING’S FUND Richard Murray, who is currently Director of Policy at The King’s Fund, has been appointed as its new Chief Executive. He succeeds Professor Sir Chris Ham, who will be stepping down at the end of 2018.

JEWISH CARE Angela Beerman has been appointed as Director of Human Resources and Organisational Development at Jewish Care.

WELLGATE CARE gender, age and region. However, according to the report, no single funding option delivers the level of reform that the public wants, and people need in 10 years’ time. Some options, including increasing business rates or Corporation Tax, increasing Council Tax or Inheritance Tax, or charging National Insurance for over-65s, fall short of addressing the social care funding gap. The report looks at the proposed funding mechanisms for both the Government’s proposed ‘cap and floor’ model and free personal care, concluding that the difference between the costs would be around £1bn in 2020/21, rising to £2bn in 2030/31, but that free personal care would result in significant benefits.

Wellgate Care has appointed Debbie Smith as Director of Care after acquiring Folkestone-based MNP Group in May. Debbie’s role will involve growing the business, identifying new opportunities and developing relationships with local authorities.

UNITED RESPONSE United Response has appointed Malcolm McCaig as its new Chair, effective immediately. Malcolm succeeds Maurice Rumbold who is retiring and stepping down from the role he has held for the past decade. CMM October 2018

NEWS

ADASS analysis of social care savings New analysis of social care savings by the Association of Directors of Adult Social Services (ADASS) reveals adult social care has saved the NHS almost £60m through reducing pressures. Since the introduction of annual cash injections, the number of delays to transfers of care attributable to social care has fallen by 41%, from a high of just over 74,000 last March to around 40,000 this June, according to ADASS’ analysis. The NHS’ calculations put the saving of having one extra bed available in hospital throughout 2016/17 at £313 per day. Over the last year, the number of delayed transfers of care days

attributable to adult social care has fallen by almost 188,000, meaning a reduction of nearly £60m in NHS costs as a result of improved adult social care performance when compared to the previous 12 months. As a proportion of delays to transfers of care, social care has only been attributable for 29.1% of all delays, with the NHS responsible for 62.6%. The improvement in social care delays demonstrates the impact social care can make with additional resources. Recently, stakeholders from across the sector have been putting forward plans which could address funding shortfalls

in adult social care, with the Local Government Association (LGA) publishing its own green paper, outlining a range of possible options Government should consider in order to place social care on a sustainable footing. The Association of Directors of Adult Social Services is now joining these calls with a renewed push for a green paper that delivers a long-term funding solution. With long-term funding plans and an emergency cash injection to shore up the sector, councils could make a real difference in creating the conditions for people to live as independently as possible for as long as possible,

says the Association of Directors of Adult Social Services. But, the Association of Directors of Adult Social Services suggests, without at least some short-term emergency funding, pressures on the NHS could increase. This could mean that increased funding for the health service could be throwing money at the symptoms of the problem rather than tackling the underlying causes of the situation. It suggests that, as a minimum, local authorities should have greater influence when it comes to determining how money is spent on primary, community and mental health services.

Debden Grange retirement village Work has begun on a new £24m retirement village near Saffron Walden, Essex as developers broke ground. Debden Grange is the latest

addition to Retirement Villages Group’s portfolio, which already boasts 16 luxury developments across the UK. The development will see the

completion of Debden Grange House, an on-site 40-bed care home, which will also offer a domiciliary care service to those who need it.

The village will also include around 80 retirement properties. Retirement Villages Group has used Castleoak to deliver this project.

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NEWS

Call for clarity on sleep-ins

Uptake of NHS Health Checks

Voluntary Organisations Disability Group (VODG) is once again urging Government to provide clarity on sleep-in payments as Parliament returns. Chair of VODG, Steve Scown has called for urgent action. He says, 'It is over seven weeks since the Court of Appeal judgement was handed down. 'Radio silence from Government is unacceptable. The continued uncertainty, for both social care staff and providers, helps no-one.' VODG has set out its main concerns that, without clarity on sleep-in payments from Government: • Local care markets may move in unpredictable ways, putting at

Recent analysis from Diabetes UK shows that uptake of NHS Health Checks is not increasing in all areas, with less than half of over 40s eligible for an NHS Health Check in the last five years having received one. The analysis found that there is a significant regional variation of uptake of NHS Health Checks across England. In the East of England, 50% of the eligible population attended the health check between 2013 and 2018, but in the South West, this figure was lower, at only 35%. On a local authority level, this variation is higher still, with the best performing local authorities having a five times greater attendance rate than the worst.

risk overnight support services for disabled people and their carers. • There could be a reduction of investment in future services, such as the challenges associated with delivering transforming care and moving people out of long-stay hospitals. • Providers might continue to seek legal advice, spending money which could be used elsewhere. The sector is still waiting to hear whether Unison will be granted leave to appeal to the Supreme Court, with an announcement hoped for before the end of the year.

Walsall is the only local authority in England where 99% of the eligible population received a health check, Bolton at 91.7% and Westminster at 91%. The worst performing areas are East Riding of Yorkshire and Croydon with 18%, followed closely by Surrey at 18.6%. Since 2013, local authorities have a legal duty to ‘seek continuous improvement’ in the uptake of NHS Health Checks in their area, with funding from Public Health England. However, only 55 local authorities delivered more NHS Health Checks in 2017-2018 than they did in 2015-2016, while the remaining 97 local authorities delivered fewer.

Audley Group acquires Cobham site Audley Group has exchanged contracts on its 19th Audley Villages site at Cobham, Surrey. Audley has been working

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NEWS

Risks in state-funded homecare The United Kingdom Homecare Association (UKHCA) has produced a report looking at the risks to the stability of the state-funded homecare market. It lays out the findings of its research project, aiming to identify and prioritise the biggest risks to the financial failure of provider organisations, or the risk to planned withdrawal from the provider market. The analysis has been collected based on the views of providers delivering homecare services. These providers spanned more than

500 locations across the UK, with views from providers in almost 300 further locations that provide services either entirely or mainly to state-funded services. The report into the stability of the state-funded homecare market includes detailed recommendations by UKHCA. It is calling for statutory sector commissioners to consider these findings carefully, encouraging them to act on any areas that have been highlighted which may place their own markets at a high level of risk.

A risk-register for state-funded homecare includes concerns around: • Fee levels. • Engagement between providers and local authorities. • Late payments. • Length of homecare visits. • Length of contracts. • Use of unregulated services. The full report is available on the UKHCA website and Colin Angel shares his views on the state of the homecare sector on page 50.

Safety of older people living at home An interim report from Age UK warns that the 'safety net' we expect for older people living at home has become dangerously weak. The report has found that older people living alone in declining health, without support from family and friends, are at particularly high risk. Age UK estimates that roughly half a million people aged over 65 in England are living with three or more significant health conditions and have personal care needs. However, the report suggests that around one in three receives care at home, with the remainder relying on family or managing without. Of those with support from family, nearly two in three depend on a partner who is often an older person with their own increasing health needs.

More broadly, Age UK says that nearly a third of those aged over 65 in the UK live alone, while around one in ten are ageing without children. These numbers are expected to rise as the population ages, and Age UK is calling on people to strengthen the support on offer to older people at home. The report argues that, while people assume that health and care professionals monitor the wellbeing of older people who live at home and whose health is of concern or in decline, this is not always the case. It explains that deficits within over-stretched health and care services, plus fragmentation between them, mean that a loved one needs to chase progress and join up services for the person who requires them. Age UK suggests that many

older people living at home do not have someone like this to help them and without this support they risk failing to get the treatment and support they need. The report shows that the end result is often an unplanned and avoidable admission to hospital, or worse. This latest analysis from Age UK shows the health and care system has failed to keep up with the ageing population, piling pressure on hospitals as the rate of avoidable emergency admissions of older people has more than doubled over the last 13 years. Overall, England has seen a 63% rise in the overall rate of these avoidable admissions since 2003. These rates have increased by 107% for those aged 65-69, and by 119% for people aged 75-79.

Risk of fewer adult social care workers by 2026 Ending freedom of movement after Brexit could mean more than 100,000 fewer adult social care workers by 2026, and a 26% increase in the ratio of over-75s to care workers, according to analysis by Global Future. The think tank's analysis suggests continuing free movement after Brexit for social care workers from the EU. The report shows: • Currently, 17% of care staff in England are from overseas. • Meanwhile, there are 90,000 12

CMM October 2018

unfilled social care vacancies and a vacancy rate of 6.6% compared to the labour market average of 2.5%, and the sector is adding a net 18,000 additional British workers a year. • If the UK applies similar immigration restrictions on European workers to those currently applied to those from outside the EU, Global Future’s analysis projects 115,000 fewer care staff in England by 2026 than if free movement were to continue.

At the same time, the Office for National Statistics projects that by 2026 there will be 1.5 million more people aged 75 or over. Without free movement, the UK would need to fill 380,000 additional social care jobs just to keep up with the needs of our ageing population. With new immigration restrictions and without a stepchange in social care recruitment, the care worker to over-75 ratio is set to rise from 3.4 in 2017 to 4.3 in 2026 – a 26% increase.

Accessible elections The Government has announced its plans to ensure accessible elections for disabled people. In September 2017, the Cabinet Office launched a Call for Evidence, asking people with disabilities and mental health issues for their views on, and experience of the voting process. In total, 256 responses were received, including comments from individuals, organisations, charities, NHS Foundation Trusts, sector representative bodies and local authority election teams. The Government has produced a document setting out the main findings. This includes actions to ensure accessible elections for disabled people in the future. These actions were produced with the Accessibility of Elections Working Group.

Hospital discharge in Wales Healthcare Inspectorate Wales has published a report into hospital discharge in Wales, following a Review of Patient Discharge from hospital to general practice. The way in which patients are discharged is critical to the effectiveness of their ongoing care in the community, says Healthcare Inspectorate Wales. It suggests that the quality and timeliness of discharge information provided by hospitals is of particular importance; this formed the focus of the Healthcare Inspectorate Wales review. The review suggests that it is clear that some parts of the NHS in Wales are making progress in the area of patient discharge but progress is variable across Wales. Where it saw increased usage of electronic discharge systems, the quality and timeliness of information received by GPs was clearly improving.

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NEWS / IN FOCUS

Applications for Teaching Care Homes Programme Care England has encouraged care homes to apply to be part of the Teaching Care Home Programme. Building on the success of the scheme over the last two years, the Foundation of Nursing Studies will recruit five care homes within England in the autumn. The focus of the programme will be on enhancing cross system partnership working, for example between care homes and acute

sector services, or between care homes, universities, GP practices, etc. The partnerships should intend to develop and strengthen crosssystem relationships by working together towards developing and achieving shared outcomes. The programme is open to all care homes in England. Visit www.fons.org for further information.

Target Healthcare Target Healthcare has acquired a development site and entered into a forward funding agreement in Wetherby, West Yorkshire. Having received planning consent, the development will be funded, under a capped

development contract, to create a 66-bedroomed residential care home. The development, which is due to complete in early 2019, will be undertaken by LNT Construction Limited.

Social care in other nations A new report, commissioned by Age UK, highlights the different social care systems in other nations in the developed world, their approaches to long-term care, and how they compare to the system in England. The Incisive Health report, An international comparison of long-term care funding and outcomes: insights for the social care green paper, explores the key characteristics and outcomes of social care systems operating in other advanced nations. It aimed to see what lessons could be learned and applied to the social care system in England. The other countries in the study were: • Italy. • Spain. • France. • Germany. • Japan. The findings suggest that creating a sustainable social care system fit for a rapidly ageing population is a challenge in every one of these countries, which none has completely overcome.

However, most of the social care systems in other nations have undergone significant reforms during the last 25 years. For example, Germany began to modify its system in 1995 and Japan began to make changes in 2000. According to the report, over the same period, despite two Government consultations, two official Commissions, five Green or White Papers and one Act of Parliament, the system in England is broadly unchanged. The report also notes that England has a stricter means test than the other countries examined. It found that other countries have more progressive systems, either providing a non-meanstested basic level of support as in Germany, capping the level of co-payment for all, which is at 10% in Japan, or using a more generous and gradual means test as in France. Furthermore, in recent years, England’s means test has become increasingly less generous, says the report.

IN FOCUS New model predicts rise in elderly care needs WHAT’S THE STORY?

Experts at Newcastle University have created a Population Ageing and Care Simulation (PACSim) model to estimate the number of older people in England who will require care in the future. A study conducted by the researchers has revealed a predicted rise in elderly care needs, suggesting that the number of adults aged 85 and older needing round-the-clock care will almost double to 446,000 over the next 20 years.

WHAT DID THE RESEARCH FIND?

The model accounts for multiple risk factors that contribute to increased dependence and disability, including education, smoking and physical activity. It also considers 12 chronic diseases and geriatric conditions. The study, which was funded by the Economic and Social Research Council and the National Institute for Health Research, used data from three nationally-representative studies. Future trends in social care needs were then estimated for the population aged 65 and older in England between 2015 and 2035. Adults who needed 24hour care were categorised as 'high dependency'; 'medium dependency' if they needed help at regular times daily; 'low dependency' if they didn't require care daily and were looked after in the community; or 'independent'. The research found that: • The total number of over-65s requiring 24-hour care will rise by more than a third to over one million in 2035. • The number of people aged 65

and older who are categorised 'independent' will rise to 8.9 million by 2035, from 5.5 million in 2015, with the upturn in independence seen primarily in men. • The number of people aged over 65 will increase by just under 50%. • Between 2015 and 2035, life expectancy of men aged 65 will rise by 3.5 years to 22.2 years, and the average number of years spent independent is expected to increase by 4.2 years, whilst time spent living with substantial care needs is likely to decline. • Average life expectancy for women at 65 will increase by 3 years. The average number of independent years is expected to rise by less than a year. • Women will spend almost half of their remaining life with low dependency needs, such as help with personal care, alongside a small increase in years requiring intensive 24-hour care.

WHAT DOES THE SECTOR SAY?

Councillor Nick Forbes, Senior Vice Chair of the Local Government Association, said, 'This report is a further warning of the crisis in adult social care and the urgent need to plug the immediate funding gap and find a long-term solution on how we pay for it and improve people’s independence and wellbeing. 'With people living longer, increases in costs, decreases in funding, care providers closing and contracts being returned to councils, the system is at breaking point, ramping up pressures on unpaid carers who are the backbone of the care system.' CMM October 2018

NEWS

Tribunal rules in favour of CQC A Tribunal has found the Care Quality Commission’s (CQC’s) decision to prevent a care provider from increasing its number of people with a learning disability 'fair, reasonable and proportionate.' The First-tier Tribunal has ruled in favour of CQC's decision to refuse an application submitted by Care Management Group Limited (CMG) to change a condition of its registration and increase the number of people with a learning disability at one of its services.

CMG – a care provider running several specialist support provisions across the country for people with learning disabilities and/or autism – applied to CQC in April 2017 to increase the maximum number of people at its Cherry Tree service in Essex from seven to ten. CQC refused CMG’s application to increase this number on the basis that it did not demonstrate it would comply with Registering the Right Support – as well as the underpinning national guidance.

Care UK CQC was also not assured that appropriate consultation had taken place with those who used the Lilliputs site, their families and advocates, or with local commissioners to identify local need. CMG appealed CQC’s decision which was heard by the Care Standards Tribunal over seven days. This concluded on 6th July and the Tribunal’s judgement has now been published, upholding CQC’s decision of refusal, meaning the appeal is now dismissed.

Retirement Village Group

Encore expands

The completion of 20 new luxury apartments at Retirement Village Group’s Elmbridge Village site in Cranleigh, Surrey marks the end of its extensive regeneration. The Retirement Villages Group now boasts 16 sites in its portfolio. £4.5m was invested in the redevelopment of the site and

Encore is expanding its portfolio into Poole, with support from Clydesdale Bank. Work has started on The Oakdale, Encore’s 84-bed facility on Kingsmill Road, which will be the fourth state-of-the-art care home it has designed, built and opened in the last five years. Encore is targeting the opening

communal facilities. The project took 15 months to complete, in conjunction with Castleoak. The apartments at Arun House comprise six one-bedroomed and fourteen two-bedroomed apartments including top floor penthouses.

Following the opening of new homes in Bromsgrove and Horndean earlier this year, local people in the West Midlands were recently invited to celebrate the grand launch of Care UK’s newest, luxurious, purpose-built care home. Mercia Grange in Sutton Coldfield is the third Care UK home to open this year. Another two homes in Windsor and Edinburgh respectively are on track to receive their first residents before Christmas.

of three care homes a year. The Oakdale is set to open next summer, while another property in Redhill will be ready in 2020. The business is also undergoing planning permission for sites in Pembury and Reading, as well as identifying other locations in the South.

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NEWS

Plan to reduce DToCs The British Healthcare Trades Association (BHTA) has produced a new paper in support of the NHS’ aim to reduce delayed transfers of care (DToCs). The BHTA says that procurement policies could be improved in order to speed up delivery of community equipment and enable people to leave hospital more quickly. It wants to see delayed discharges treated as an emergency, with needs for equipment quickly identified, and generally provided within five days. The principle of combining health and care budgets is strongly supported.

The paper points to examples of good practice in areas such as Manchester, Kent and Norfolk. In the cases cited, there is clear evidence that better integration provides better care and cuts costs. It is also suggested that tax incentives should be introduced to encourage people purchasing homes with a view to retirement to plan ahead and make their homes more accessible in anticipation of future care and support needs. Such homes could be adapted at purchase to provide, for example, for the introduction of a stairlift in future.

Prestige Care Group Prestige Care Group is set to open a new specialist facility for people with dementia in West Sussex, adding 80 rooms to its portfolio with the opening of Walberton

Place Nursing Home. Clydesdale and Yorkshire Bank has provided the funding package to support the build of the new home.

£76m a year for specialised housing Thousands of extra homes, specially designed for people with disabilities, mental health issues and older people who need extra support, will be created over the next three years with an additional £76m a year for specialised housing announced by Government. The fund is run in partnership with Homes England for schemes outside London, and the Mayor of London for London-based schemes, who implement the programme. Providers can bid for money through Homes England and the Mayor of London’s office to build these specially designed new homes. The Care and Support Specialised Housing Fund (CASSH) was announced in 2012 and has been extended until 2021. After two fixed bidding rounds were rolled out, housing

providers have applied for funding and already built around 3,300 specially designed new homes. To streamline the process and enable as many schemes to get off the ground as possible, local authorities and housing developers will now be able to apply on a rolling basis, until all the funding has been allocated for the year. The housing ensures people with disabilities and older people can live independently for longer in the community. Minister for Care Caroline Dinenage said, 'No one should have to go into a residential home or get stuck in hospital because of a lack of specialised housing adapted to suit their needs. This programme provides a vital lifeline for some of the most vulnerable people in society to live their own lives in a home that works for them.'

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CMM October 2018

NEWS

Autism and learning disabilities Mental Capacity (Amendment) a priority for NHS Bill: ‘flawed’ reforms NHS England has announced that autism and learning disabilities will be a priority in its plan to improve health services. The announcement has been welcomed across the sector. Jane Harris, Director of External Affairs at the National Autistic Society, said, 'This is fantastic news. Hundreds of thousands of autistic people and their families will be pleased to hear that their health and wellbeing will be a key priority for NHS England over the next 10 years.' Alicia Wood, Head of Public Affairs at Dimensions, said, 'NHS

England’s pledge to prioritise learning disabilities and autism is an important step in the right direction. For too long, people with learning disabilities and autism have experienced unacceptable health inequalities, particularly at the primary care level…We are calling for this pledge to be backed up with rigid measures that ensure all GPs receive mandatory training, co-led by people with learning disabilities, so GPs can better and more confidently communicate and diagnose health issues and identify risk factors.'

Consumers in social care Research by Which?, looking at consumer behaviour in the social care sector, suggests that one in 10 adults (12%) aged 55 or over have put aside money to pay for care needs as they get older. It found more than half (55%) of these adults are prioritising other things they want or need to do now over planning for care. Only a third (34%) had discussed their preferences for care in later life with a friend or relative, while a fifth (19%) said they did not even know where to look for information about care. People aged 55 and over were divided about whether they will get good quality care through the social care system. Three in 10 (30%) said they expected they would, while around a third (36%) said they thought it was unlikely. When asked what their first port of call would be when looking into care options for themselves or a relative, Google was the most popular option amongst adults – ahead of speaking to the local GP or friends and family. Overall, the top sources of information people said they would use to explore social care options were Google (46%), the GP (45%), a local authority website (45%),

SAVE THE DATE 18

CMM October 2018

family and friends (41%) and social care providers (39%). The GP is still the most trusted source of advice on care and support for older people, along with friends and family, according to the research – despite local authorities being responsible for providing advice on social care. Both the GP and friends and family were trusted to provide good advice by four in five people (81%). This was followed closely by a relevant charity in the sector (78%). Six in 10 said they trusted local authority social services staff. When asked to think about what changes they may make if their health and mobility did deteriorate, nine in 10 (92%) people aged 55 and over said they would be willing to make adaptations to their homes to aid mobility and a similar percentage (89%) said they would be willing to use mobility aids outside the home. More than eight in 10 (85%) said they would be willing to use a gardener, cleaner or handyperson. Which? is calling on the Government to take these insights into account and create a social care system that works for the people that will come to require support in later life.

The Mental Capacity (Amendment) Bill requires a radical rethink, says Voluntary Organisations Disability Group (VODG). VODG issued a warning as the Bill reached the committee stage. The Bill already included over 90 amendments from peers, reflecting the reservations that have met its passage through parliament. VODG states that mental capacity legislation reform is vital to safeguard people who need support; and it agrees with the Joint Committee on Human Rights report that the existing system is broken and needs urgent action. However, the charity is critical of the content, motive and ethos

of the Bill and the fact that the Department of Health and Social Care (DHSC) has failed to fully engage and consult with social care providers on the reforms. VODG is warning of the potential conflict of interest created by placing Liberty Protection Safeguards assessment responsibilities on care managers because the person responsible for maximising the use of the service will also be responsible for deciding if someone objects to being there. It also has concerns about the financial and practical impact of fulfilling this new responsibility when care providers are already under enormous strain.

Workplaces for all The Health and Work Unit is working towards inclusive workplaces for everyone. It is run by a cross-government team and is jointly sponsored by the Department for Work and Pensions and the Department of Health and Social Care. The unit is inviting employers from the voluntary, community,

social enterprise and public sectors to commit to being part of a pilot programme aimed at embedding positive attitudes towards employing and supporting people with long-term conditions and disabilities. The pilot aims to create a network of employers that are ‘Positive about Pathways to Work’.

Extension of local system reviews programme CQC has written to local system leaders in six local authority areas where it will be undertaking new or follow-up reviews exploring how older people move between health and adult care services. This further tranche follows on from CQC’s national report published in July.

The three new areas now being reviewed and reported on by December are Staffordshire, Leeds and Reading. CQC has also chosen three areas to follow up on progress made. These follow-up areas are Stoke-onTrent, York and Oxfordshire.

Hallmark Care Homes A major milestone has been marked at a new 77-bed care home in Banstead, which will provide residential and dementia care and be leased by Hallmark Care Homes.

Banstead Manor Care Home is being built at a cost of £8m across a one-acre site on Brighton Road by specialist care contractor, Lawrence Baker.

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CHALLENGING THE MYTHS of a career in social care Nurse recruitment is a huge issue for social care. Nurses choosing between a career in social care or the NHS seem to continue to opt for the latter. However, Dr Charles Armitage from Florence believes that the benefits of working in the social care sector far outweigh the perks of working in the NHS. Here, he explains why.

CMM October 2018

There was a brief moment earlier in the summer when the news coming out of the Department of Health and Social Care (DHSC) was good. Finally, unions and the DHSC had come to an agreement on a long-awaited pay rise for NHS nurses. This news was followed a few days later by the announcement that non-NHS nurses on the Agenda for Change contract would also be eligible for the uplift. However, the atmosphere soured with the arrival of Julyâ&#x20AC;&#x2122;s payslips and widespread complaints that the pay deal had been mis-sold.

Whatever the result of this debacle, the impact on the social care sector is undeniable. In May, Janet Davies, the Chief Executive of the Royal College of Nursing, wrote in a letter to the then Health and Social Care Secretary that the NHS pay deal risked drawing staff away from the social care sector. This fear is shared by providers across the country. The recruitment and retention crisis in adult social care significantly predates this summerâ&#x20AC;&#x2122;s NHS pay deal debate. Currently, 9% of nursing posts within the sector are long-term vacant and 32% of social care nurses leave their roles every year. This is a staggeringly difficult environment for providers to build and train a team for the long term. As the population ages, there is an inevitable increase of people living in the community with multiple chronic diseases. To prevent an untenable influx of increasingly sick patients to the nationâ&#x20AC;&#x2122;s A&E departments, it is essential that the social care frontline is adequately resourced and staffed. So how can care providers ensure that they are not losing their best nursing staff to the NHS? In order to reverse this exodus, it is important to tackle two key questions. What are the salient reasons a nurse might choose a career in the NHS over adult social care and, conversely, why might a nurse choose a career in adult social care over the NHS? Once we understand this, we can begin to think of how providers can push back against negative stereotypes and emphasise the positives to attract more nurses into the sector.

WHY WORK FOR THE NHS? The NHS has a global reputation for excellence. For many, especially those from overseas, working for the NHS comes with a strong social cachet. The opportunities for learning and professional development are extensive. Within the hospital setting, nurses are a bleep away from any multidisciplinary support that they require. Contrast this to the preconceptions about jobs in adult social care. A career in social care can be seen as the blunt edge of the wedge; that oneâ&#x20AC;&#x2122;s time is spent de-skilling and away from the action. Whilst the machination of a large hospital may give nurses the support and learning opportunities that they desire, it comes with its downsides. Frustration at supersize organisations is common. Workers are faced constantly with bureaucracy and inflexible systems. Patient care is often rushed, transactional and performed against a backdrop of management key performance indicators (KPIs). Staff can feel like very small cogs in the machine, unable to share their grievances and powerless to enact change.

CMM October 2018

CHALLENGING THE MYTHS OF A CAREER IN SOCIAL CARE

WHY WORK IN SOCIAL CARE?

Those making the choice to work in adult social care may be doing so for many reasons. Staff within a care home can develop long-lasting and deep relationships with the residents they care for. There is more scope for nurses to work in a person-centric model of care. Irrespective of whether a care home is an independent site or part of a larger company, working within a smaller organisation means that staff’s ideas and concerns can be heard. Organisations can be nimble enough to listen to these ideas and make change quickly. The demographic of those working in adult social care is different to the NHS. Nurses tend to be older and have different priorities for their work. This represents a challenge in itself, with 30% of the nursing workforce predicted to retire in the next decade. This older demographic comes with different priorities and cite increased flexibility as a key driver for working in the sector. Being a slave to NHS rotas becomes less tenable as personal and family commitments become more rigid.

CHALLENGING THE NEGATIVE STEREOTYPES Tackling the negative stereotypes around social care nursing must be worked on from the ground up. Having worked as an A&E doctor, I have seen first-hand (and indeed been guilty of) the condemnation of what can be perceived as ‘inappropriate’ midnight admissions from the community. In the bright lights of A&E and surrounded by limitless potential investigations and interventions, it is easy to deem a late-night admission from the community as unnecessary. It is not until you have seen the realities of nursing within a care home that you realise the challenges of managing an unwell resident with little clinical support and no tangible interventions up your sleeve. There is an endemic attitude of ‘us and them’ within the NHS which must be tackled if we are to reset the stereotypes that exist. By making community nursing a compulsory part of undergraduate education and encouraging preceptorships within the community, nurses can be better placed to understand the unique challenges faced by those working in social care. Everywhere, commissioners and legislators are pushing to join together health and social care. Encouraging collaboration and crossfertilisation of ideas at a grass-roots level will lead to greater synergy between the sectors.

Not only will this benefit service users as they transition between hospital and the community, but it will do great things to tackle the incorrectly-held preconceptions about social care.

EMPHASISING THE POSITIVES To begin challenging these stereotypes, we must identify and share the positives of working in social care. Continuous learning The care sector offers a unique opportunity for learning and professional development. Nurses can follow a resident over months and years and chart the complex interplay of how their life is affected by chronic disease. Nurses are able to provide ongoing, person-centred care on a framework of specialist knowledge in their subject areas. As the population ages and more people live with complex pathologies in the community, upskilling and training of nurses will no longer be a luxury but a necessity. Continuous learning should be an ingrained culture within an organisation. Nurses should be encouraged to become clinical specialists and lead the team in providing evidence-based best practice support. Culture and the workplace environment Care home managers have the unique opportunity to interact with their staff every day and reinforce the organisation’s cultural values. When making hiring decisions, cultural compatibility should come top of the list. Whilst the blue lights of the operating room may suit some, there is a distinct pleasure of working alongside a close-knit team in a resident’s home environment. Whilst nursing in a care home is undeniably busy, there is still the opportunity for nurses to lead a team that focuses on the individual and develops deep relationships with those for whom they care. The greatest advantage that social care providers have over large NHS organisations is their ability to be nimble and enact change. Care providers can talk to their staff and identify their likes and dislikes in the workplace. Enacting positive change may feel difficult in a 100-bed care home, but it is certainly easier than in a 1,000-bed hospital. Career development There is a perception that nursing in social care comes without a recognised route of progression. This could not be further from the

truth, as staff can develop into specialist clinical practitioners, managers or educators. The potential for progression and the development of new skills outside of the core nursing competencies should be emphasised to nurses thinking of working in the sector. Nurses currently working in adult social care should have clear professional development plans and regular meetings with supervisors to chart progress against their plans. Flexibility We are seeing a period of radical change in the population’s working patterns. In many industries, there has been an explosion in the proportion of those demanding flexible working. Within the care sector, there is a continuous leakage of nurses from full-time employment into the arms of agencies. Whilst the current dogma is that these nurses’ motivations are purely financial, the reality is that the desire for flexibility is a huge driver. Traditional rotas leave little scope for nurses to visit overseas family members for extended periods of time. Those juggling family commitments (especially around school holidays) can find it difficult to commit to inflexible rostering. Being able to instigate this kind of change and support modern working practices is an ask too many for most NHS trusts. This is an area where social care providers can have first-mover advantage and use it to attract talent. Enabling flexible working within a care home comes with its own challenges. It goes without saying that attempts must never lead to unsafe staffing levels or jeopardise continuity of care. Judicious use of technology can help managers enable flexible working within their homes without adding to management burden.

ACTION IS NEEDED A career in social care is fulfilling and varied. Work must be done to tackle the negative stereotypes that surround the sector whilst the positive aspects of the career should be emphasised. For those already working in social care, the priority should be on creating a workplace that encourages staff retention. Change may seem painful and, at times, inconvenient. But the headwinds that are impacting the sector are due to strengthen over the coming years. Legislators and providers that don’t take active steps to offset these headwinds risk letting the nursing crisis lead the entire sector into the grave. CMM

Dr Charles Armitage is Managing Director at Florence. Email: charles@florenceapp.co.uk Twitter: @DrCArmitage What do you think the sector needs to do to combat the nursing staff shortage? Share your thoughts, feedback and ideas on the CMM website www.caremanagementmatters.co.uk 24

CMM October 2018

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Into the future: a new vision for retirement communities

Retirement communities are becoming ever more popular amongst the older population. However, the supply is not keeping up with the demand. ARCO has launched its Vision 2030 to tackle this issue. Michael Voges explains the Vision and what it means for the future here.

The UK is among the world leaders in its provision of retirement living, but we are not keeping up with demand. With retirement communities becoming an increasingly popular option for older people and their families, the sector needs to do more to provide the supply. This will benefit older people and our health and social care systems, as well as freeing up larger family homes for those who need them. This is the thinking behind Vision 2030 â&#x20AC;&#x201C; our shared ambitions to grow and deliver ever-improving services to residents and to have a positive impact throughout the UK.

CMM October 2018

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INTO THE FUTURE: A NEW VISION FOR RETIREMENT COMMUNITIES the UK live in retirement communities, while the countries mentioned above all have 5-6% of their older population living in retirement housing. This represents a massive missed opportunity and one we are determined to put right. Vision 2030 gives us the blueprint and the foundations for how we will do this. We will also be campaigning to raise the profile of these issues and will be relentless in highlighting the importance of taking the actions necessary.

PRIORITIES FOR CHANGE We’ve developed ten pledges to make our Vision a reality. These outline our priorities for the sector, to help it drive forward and expand. 1. Clear customer proposition We know we have a communications challenge in front of us. We must explain what we are, what we are not, and what benefits retirement communities can offer older people and wider society. This is the first of our priorities, as it starts with our residents and we know that the test for each of our following priorities must be how they serve older people.

By 2030, we will have designed, built and started operating retirement community housing for 250,000 people. That’s equivalent to a city the size of Southampton. At the moment, our sector is the size of Crewe.

CURRENT MARKET Retirement communities allow people to keep their independence for longer, access care and support if they need it and to have access to a good range of on-site facilities. Whilst residents have their own houses or apartments, they can also get involved in the community through a range of clubs, activities and communal facilities. Currently, more than 60% of retirement community units are for people with moderate means. However, we are starting to see particularly fast growth in the private sector, which is meeting the desires of middle-income and wealthier older people to live their later lives in active, independent and supportive communities. At the Vision’s heart is our goal to house 250,000 older people in retirement communities by 2030. This would represent the greatest ever expansion of our sector – and yet would still leave the UK with roughly half the provision that comparable countries such as New Zealand, Australia and the USA have. The Vision is specifically designed to address those issues which our members and retirement community operators around the world tell us are standing in the way of this sector growing and meeting its potential. Only 70,000 (0.5%) people aged over 65 in

2. Effective self-regulation When moving to a retirement community, residents have the right to full transparency on what to expect and what it will cost them. Our Consumer Code is already in place, backed up by a robust standards and compliance framework which includes rigorous external assessments. We will keep reviewing our code to make sure that the fair treatment of our consumers continues to be put first.

“By 2030, we will have designed, built and started operating retirement community housing for 250,000 people.” 3. Enhanced health and wellbeing When people move in to a retirement community, they are choosing more than just a building – they want opportunities to stay active and to get care and support if and when they need it. Another of our key priorities will therefore be to maintain and improve this offer over time, continually staying ahead of the curve and sharing our best practice. 4. Intelligent use of technology This doesn’t mean implementing the latest expensive gimmick, but carefully considering the interests and needs of residents and staff. We will continue to explore how technology such as robotics can help us to deliver services such as personal care in a way which protects individual dignity and privacy and

CMM October 2018

INTO THE FUTURE: A NEW VISION FOR RETIREMENT COMMUNITIES

allows carers to focus on caring.

5. Highly trained workforce The indispensable element in delivering good services and care is good people. With the care sector already facing skills shortages, we want to encourage people to see working in a retirement community as an exciting and rewarding career, one in which they will develop and be able to take pride in what they do. 6. Flexible model of tenure We need to respond to changing circumstances, including moving away from what have been described as ‘feudal’ leasehold practices. We are clear that we do not need ground-rents for future expansion. A flexible model of tenure would protect the rights of residents. It will assure residents that they will always receive the services and support that they expected when they moved into their new home. 7. Sustainable funding streams Our population is dramatically ageing, with the number of people over the age of 80 expected to double in the next 30 years. The current patchwork of funding arrangements around the country is not up to the task of providing for this increase. Whoever pays, whether it be the individual or their council, we will work with them to ensure that funding is in place. 8. Clarity in the planning system One of the most challenging obstacles we have faced to-date is in getting more retirement communities built – largely because we are not yet fully understood by the planning system, with our holistic offer not fitting into existing boxes. We want to make our contribution to local communities – both in terms of development contributions and ongoing community engagement. This should also be accompanied by recognition of the important health and social care role that our communities play. 9. Sector specific legislation All of the changes we want to make will be much more achievable if we can help Government to recognise the role we play in retirement living and care. We want consumers to know their rights and to be able to enforce them. Currently, this is extremely difficult with a confusing labyrinth of over 100 intertwined pieces of legislation applying to our sector – and a number of gaps and contradictions frustrating attempts to build for the future with any certainty. 10. Comprehensive and robust data We know that people need, and increasingly expect, to be able to see how we’re performing and what impact retirement communities are having. Producing this data will help us put consumers first by better

understanding who they are, what they want, and how our sector can help to meet their needs. This data is equally important for potential investors, lenders, regulators and operators.

BUILDING FOR THE FUTURE Surveying the above, it seems like an ambitious project. But we believe these goals are also realistic, desirable and exciting. We also know that we can’t do it without working in partnership – both as a sector and more broadly. For too long the narrative around housing and care for older people in the UK has been one of doom and gloom – but we are genuinely excited about the bright future we’re already building; one which we can all build together. CMM

Michael Voges is Executive Director of ARCO UK. Email: michaelvoges@arcouk.org Twitter: @ARCOtweets Have you signed up to Vision 2030? Share your thoughts and feedback on the project on the CMM website www.caremanagementmatters.co.uk 30

CMM October 2018

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MAKING PALS – ENCOURAGING COMMUNITY INTEGRATION Activities in care homes should be engaging, personalised and inclusive, but putting together a schedule can be hard. This, coupled with the drive to get homes interacting more with their communities, has led to Alive’s ‘Making Pals’ project. Through its work, Alive had seen the positive impact that social connections can have on care home residents and knew that connecting homes with their communities could have a significant influence on wellbeing. Funded by The Henry Smith Charitable Foundation, Alive’s three-year Making Pals project was designed to help homes build long-lasting and meaningful relationships with their communities across parts of Somerset, Bristol and Gloucestershire. This included encouraging homes to find new ways to engage their residents with people and spaces outside of the home and building the homes’ capacity to carry on the relationships beyond the project.

SELECTING THE HOMES Alive began by choosing ten care homes to be part of an intensive pilot. The homes were selected to ensure that the results were applicable to care homes across the board. They were chosen based on their CQC rating, their location (a mix of urban and rural), their size and whether their residents were living with dementia. The project also worked with a further 50 care homes to signpost and connect them to their communities.

CO-PRODUCING COMMUNITY ACTIVITIES Alive developed a co-production process to understand how residents in the pilot homes wanted to engage with their communities and what activities they wanted to take part in. A combination of group discussion, reminiscence, 32

CMM October 2018

suggestion boxes, one-to-ones, handling items and sensory stimulation revealed potential avenues for activities. Alive compiled the results of these interactions and reported back to care homes, creating activity plans and recommendations. The charity then supported the homes to create new, and utilise existing, opportunities in the local area. For example, fishing was identified as something several residents wanted to take part in, so the team organised accessible fishing days. The homes could also use the co-produced information in their day-to-day caring; they could make small changes, tailoring their support to enable someone to go out for half a pint or stay in to watch the cricket. The project also encourages care homes to play a bigger role in their communities. Alive supports homes to run events for the public and to offer space for community activities, allowing the public to spend time there and enabling residents to socialise with people from the community. Alive has also brokered relationships with local organisations like gardening clubs, youth groups and universities to encourage long-term collaboration. To help more homes with their community engagement, Alive has developed volunteer management training for care staff, supporting them to find and manage volunteers who can assist residents with skilled or specific hobbies. One home in the project has a volunteer who visits regularly to build model planes with a resident. Making Pals offers this volunteer management training to up to four staff from each home it is working with.

CHALLENGES Anxiety and a loss of confidence among residents in going outside of the care home, combined with staff concerns about health and safety has been a significant barrier. However, Alive has found that by documenting the successful outings (through photography and case studies) and sharing these stories with staff and residents, this barrier can be overcome. Emma Dyer, Making Pals Project Manager said, ‘At the first fishing trip we ran, all five men dropped out, with care staff citing anxiety and unease about going to do something they’d not done in a long time as the main reason. However, once those involved had seen photos of other people successfully enjoying trips out, they became more confident. We’ve had particular success with our men’s fishing trips; now there are a number of men confident enough to come along without carers, giving them a huge amount of independence that they did not have before.’ Access to suitable transport has also proved an issue, with many homes that have a minibus not able to recruit a regular driver. To combat this, Alive is training a bank of drivers for homes to call upon and is working with community transport charities to offer trips that are affordable for residents and profitable for the charities.

SEEING RESULTS Making Pals is in its second year and is seeing positive results. Residents’ wellbeing has improved, there is a better understanding of residents’ needs, and staff are better

equipped to respond to anxiety or distress. The increased level of community engagement enables residents to feel more included in their community, less lonely and less isolated. Looking to the future, Alive’s Chief Executive, Simon Bernstein said, ‘Making Pals proves that these kinds of community partnerships, events and trips out are hugely beneficial for care homes and their residents. Low budgets, limited staff capacity and perceived risks, need not be barriers if some creativity, ingenuity and enthusiasm can be injected into care home activity planning. For 2019 we’re producing a series of ‘how-to’ training courses and toolkits for care homes to gain the skills they need and try the process for themselves. ‘In the final year of the project, and beyond, we would love to see care homes using our resources to develop their activity plans directly with residents, as well as making those all-important connections with their local communities. We hope Alive’s Making Pals project will not only transform the way the general public perceive care homes but will encourage care home residents and their care staff to believe they can make important contributions to community life too.’ CMM

OVER TO THE EXPERTS... How can Making Pals be adapted to suit the wider market? How easy will it be to replicate the support and training care homes are offered? Can this change the way communities view care homes?

A POSITIVE ‘CAN DO’ APPROACH It struck me that the article refers, directly or indirectly, to ‘confidence’ or the lack of it. It is relevant to both the residents and to the staff. What the Alive project team seem to bring is a ‘can do’ approach that recognises potential barriers and looks for creative solutions. In the process they are building the confidence to do things differently which can be hard for many residents to embrace and seen as a step too far for some staff. In our experience, once you can persuade and motivate a care team to look for innovative ways of doing things, you can step back and watch a significant culture shift take place. But it does take some skill to achieve this and often needs the enthusiasm of an ‘outsider’ to get it going. In some care settings, the activity team can motivate and inspire but they too can be defeated by policies that seem to be insurmountable. It is sensible to share Alive’s

learning through a ‘How to guide’ but I believe it will take more than that to spread this effective initiative. On-site, face-to-face training encourages questioning and gives the opportunity to break down myths and taboos about what can and can’t be done in a way that no other medium can. I believe that changing the perceptions of care by the community will only come about when most people have made a positive connection with care. It might be by meeting residents fishing on a river bank, or the man running the model shop that the activity co-ordinator buys the kits from spreading the word. Either way, it will be about the relationships forged that make a difference in the long term. All credit to Alive and the Henry Smith Foundation for getting the ball rolling.

Sylvie Silver Executive Director, NAPA

BRINGS COMMUNITIES CLOSER TOGETHER Being involved in your local community is a great way to improve the health and wellbeing of people with care and support needs. For care homes, enabling people who live there to stay engaged in their local community can be a challenge. Maintaining relationships with local groups is an important part of meeting this challenge. The Making Pals project is a great example of what can be achieved by engaging with people beyond the walls of the care home. As with most things in life, it’s how personalised things are that makes the difference. ‘Likes going out’ is not enough if someone’s interpretation of that means an individual goes to a place they don’t like, with no way of leaving by themselves. Projects like Making Pals have an important role to play in enabling people living and working in a care home to be more than a ‘client’ or

a ‘care worker’ and stay in touch with who they really are and what matters to them outside the home in the community they live in. Skills for Care has worked on developing community skills itself, and our work showed that community involvement in a care home can impact positively on everyone – the workforce, people with care and support needs, and people in the local community. Projects like this also change the way that communities see care homes. Realising that the local care home for older people is actually full of retired accountants, librarians and dress makers for example, who could, in different ways, share their knowledge and skills with local people, changes perceptions and can even bring communities closer together.

Jim Thomas Programme Head for Workforce Innovation, Skills for Care

THE EXTRA SUPPORT THE CARE SECTOR NEEDS A charity project like Making Pals can really make a difference to the lives of older people living in care homes. We know that activities that are designed bespoke for the individual, from young to old, contribute to well-rounded, fulfilling lives where people are seen and heard, and for older people, especially those who require long term nursing care or have various stages of dementia. For care homes who don’t have the capacity to provide the activities calendars and facilities as thoroughly as bigger brands, the support from Making Pals can help more individuals by connecting them to new friends in their neighbourhood, and connecting the home itself to its community. It will be challenging to train and monitor all of the volunteers necessary to make Making Pals nationwide and keep its quality of care consistent; as with all types of care we want to make sure our

loved ones are in safe hands. It can also be quite costly to support all residents who would benefit from a volunteer friend. But if there is enough support, Making Pals could really become a care institution which can upgrade the quality of care across the country. Each older person deserves a good quality of life, and a project like Making Pals has great potential to provide the extra support the sector needs. Providing activities for the elderly can be a hugely rewarding career, and can truly support residents to live well-rounded lives. Community activities, such as those the Making Pals project organises, support personal interests of residents with their personal hobbies, which can help maintain their independence, as well as boost social interaction so they don’t become isolated.

Michael Butler Activities Champion, Barchester Healthcare CMM October 2018

RISING STARS

Catherine Haycock is Support Manager at Belong’s Morris Feinmann Care Village.

CAREER HISTORY I started my career in this sector as a care assistant in a care home. I wanted a job that would fit around my life and my family, but that would also keep me engaged. I soon became really passionate about the work I was doing and was keen to progress. I got promoted to Team Leader which I loved, and which propelled me to move forward again. My next position was in domiciliary care services. From there, I transitioned to a service which was aiming to develop the offering for the Chinese community in Manchester. I was given a translator and an admin team and was involved in setting up this service – the skills I learnt there have gone a long way in helping me in my current role. Although I enjoyed the domiciliary care sector, my passion remained with residential care. I liked having more time with the clients and developing those relationships. I started working as Registered Manager at a care home for Age Concern Manchester. I had a passionate and committed team and led the home to become accredited with Manchester City Council’s Gold Award and the Gold Standards Framework. I am really proud of what I achieved there. After eight years, I was keen to further my career again. I moved to a larger care provider where I managed the dementia neighbourhood and then the Assisted Living neighbourhood, but I was still looking for a group with a larger portfolio where I could be involved in more services. That’s when I came across Belong. It seemed perfect, as it was local and a great organisation. I discovered they were commissioning a new care village nearby, which was looking to predominantly support Jewish people. This offered me the opportunity for learning and I liked the idea and challenge of the diversity of people’s needs. I’d never been involved in commissioning a new residential service before and have loved being a part of it – it made me feel a real sense of ownership and belonging, even before our first resident moved in.

ORGANISATION Our care village has 74 beds and provides residential, nursing and dementia care predominantly to the Jewish community. We also have independent living apartments, an award-winning bespoke domiciliary care service and offer experience day care services. The idea is to offer support at all stages of life and through people’s journeys. Our service is all about the people. We have six ‘households’ where our residents live in groups of 12 people. The decision about who lives in which house is not based on needs, but rather on personality and interests. Two ladies in one of our houses have completely different levels of needs but they are now best friends.

CMM October 2018

In other circumstances, they might never have met, however because we have matched them by their personalities, they have had the chance to form this bond which enhances their lives. Our households are designed to be as homely as possible. There are no uniforms and our teams enjoy working within their own particular households, so continuity of care is ensured for our residents. We also have lots of village facilities, such as an exercise studio, a kosher bistro, a synagogue, a library, internet café, salon and a therapy suite. These are all open to the public as well as our residents and those living in our independent living apartments. The public also uses the space to host community groups – a weekly bridge club attracts around 20-30 people from our local community, As well as this, we have a weekly debate club with a different speaker each time, and we have an eclectic and vibrant social calendar for our residents and the community to enjoy.

CURRENT ROLE I originally found this role due to driving past the site and seeing the Belong signs. I researched the company and saw that it was definitely the sort of organisation I wanted to work for. It was so exciting to be involved from the very beginning, with the ability to shape and mould the service. Residential care is where my heart is – I love the hands-on aspect of the work and the satisfaction derived from developing my team. Initially, it was challenging opening a new service. Whilst it was great having a completely new service, with brandnew buildings and equipment, it also took time for us all to gel together as a team. I found that teamwork and having a common aim really helped here. It’s safe to say that the village has surpassed what I thought it would be, having a great team has been a huge part of this. The best part of my job is the people. Meeting some amazing customers and seeing my team progress over the last 12 months, supporting people to grow and develop brings me so much joy and I feel overwhelmingly proud of the care and support that our residents receive. The greatest challenge is sometimes the speed at which things change – everything happens so fast; you can have just a few days off and come back to find the needs of a resident are completely different to when you left. You come into work on any given day expecting to do a, b and c, and end the day having not done any of them but having done several other things instead. The way I deal with this is to prioritise, recognise that you are part of a team, that the team can support you, and you can work together to achieve your aims.

RISING STARS My line manager wanted to nominate me for the Rising Stars programme. I felt honoured and fortunate to have the opportunity to be recognised in this way. I’m enjoying going to the events, meeting new people, including industry leaders, and learning from them. My mentor has also been fantastic and a huge support. She has already helped me to focus on my goals and think about my career. She has also given me support to progress my service and encourage my team. I see Rising Stars as a learning opportunity and am grasping all opportunities to educate myself – from sessions and workshops to speaking to other Rising Stars in the group. I’m taking everything I learn and passing it down to my team – it might be me who was nominated but I want to share the gain with whoever I can.

ADVICE My advice is to treat each day as a learning opportunity, whether it has been a successful day or not. Listen to the people around you and take away something from everyone you speak to – positive or negative. I find that I can always come away from a conversation with a thought like, ‘I wouldn’t have approached it like that’ or ‘I like the way they handled that’. Also, invest in your teams. Without the right people you can’t have a great service. I am only where I am now because of the support I have received. I have learnt to to be strategic rather than reactive, and to always reflect on my actions and consider them carefully before I take them. I think senior management teams should never underestimate the responsibilities that sit behind being a registered manager. They should make sure everyone in the organisation is aware of this and offer guidance and support. I’m an ambitious person, so I think that career development should always be on offer too. More also needs to be done to promote caring as a career; we need to encourage people to aspire to be part of the work we do. CMM Catherine is part of the second cohort of Rising Stars. This innovative programme, developed by National Care Forum and supported by Carterwood and apetito, 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

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Opening and running a care home is challenging at the best of times, but the current climate in social care is stretching even the most seasoned care home operators. Sara Livadeas, Director of Social Care Works and author of Opening a New Care Home, explores what providers need to do to ensure success.

It’s no secret that the social care sector is operating in a difficult market – and things aren’t set to get better. The population in the UK continues to age and demand for care home places is expected to rise exponentially, with a predicted shortfall of 71,000 places by 2025. However, LaingBuisson recently adjusted their demand supply analysis, suggesting that occupancy across the care home sector is closer to 85%, not 90% as previously reported. This means more availability and more choice for discerning customers, and care homes having

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STAYING ON TRACK: SUSTAINING A CARE HOME

to work a little bit harder to attract residents. A greater supply of vacant places than previously thought will encourage local authorities to continue to push down fee rates, and the potential impact of Brexit on an already precious pool of staff will only intensify the challenge of operating a care home. With all of this in mind, the importance of getting both new and established care homes right in terms of quality, occupancy and staffing is more important than ever. But once the basics are taken care of – registration, health and safety and training – what can care homes do to ensure they succeed, and where can they look for support?

CULTURE The right culture is essential. Opening a new home gives a unique opportunity to set a person-centred culture from the outset, but even established homes can improve the way they involve residents and families in decisions. These can be decisions about their own support as well as choices that might influence the running of the home. Providers should encourage meaningful involvement of residents in, for example, staff training, menu planning, cooking or sharing recipes with the chef, and hosting open days or show-rounds. Enlisting residents in the recruitment process is great for residents and gives a strong signal to potential employees that the service is person-centred right from the start. Make sure that residents understand company recruitment policies as well as the rest of the interview panel so that they are able to contribute. When seeking staff, remember that recruitment of all employees, including ancillary staff, should be values based; training can be provided but attitudes are harder to change. Values-based recruitment will also contribute to staff retention, which is just as important as recruitment. Another important retention tool is to know that, once hired, employees need support that goes well beyond on-boarding and induction. Operators should think about how employees are invested in the success of the home. Spend as much

time on team-building and promoting shared values as on training for care quality. If you can promote a positive culture that is person-centred, open, inclusive and empowering, you are on the road to outstanding.

IT’S A PROJECT A new home needs to be run as a project for at least 12 months postopening to ensure its success. It is all too easy to get distracted by new projects once the home is open. Regularly monitoring care quality ensures that everything is running properly. This is especially important in the early days of operation, when both staff and systems are settling down. Seeking feedback from residents, families and staff means that issues can be picked up and dealt with early. For smaller organisations, there are specialist agencies who will carry out mock CQC inspections. However, this is only going to be effective if remedial action is taken promptly, and preferably written up in a plan. For new homes, Key Performance Indicators should be reported and monitored at the right level in the organisation.

OCCUPANCY Residents’ needs are increasing and length of stay is getting shorter. On average, new homes take at least 18 months to fill, so be prepared that some residents may have passed away before the home is at capacity. This can put pressure on processes like admissions, assessment and care planning, helping residents to settle in and getting to know the relatives. With more people choosing to die outside of hospital, care staff are also administering more end of life care, so supporting all employees with bereavement is a must. Shortened length of stay also means marketing departments are having to work twice as hard to maintain occupancy. Bear in mind that however good the demographics, people cannot move into the home if they do not know that it is there, so a properly researched and resourced marketing plan is essential. Care homes operate in a micro-market, with most residents

coming from within a five-mile radius, but employees should be prepared to travel long distances, sometimes at short notice, to assess, for example, someone who is moving to be closer to their family. Being open about this from the start could help to maintain occupancy and staff levels. Don’t underestimate the importance of both staff and residents needing to understand why marketing is required. They will experience a succession of visitors, show-rounds and open events. This can put a lot of pressure on the home, especially the manager but also the residents, who can all feel exposed, particularly when the home is newly-opened and everyone, including the media and local dignitaries, wants to visit. Explain why it’s important to showcase the home and encourage residents to engage with those looking around.

FINDING HELP Support is available for providers who are running both new and established facilities. Many local authorities operate care home support teams that can provide advice. Consider primary care services, which can also be a source of moral support for providers. National trade bodies and local provider forums and associations are a great place to network, seek support and training. Surprisingly, considering the level of investment involved, there is very little written about the ‘how’ when operating a care home. Issac Theophilos has written on how to create an outstanding service and Skills for Care produces both training and handbooks for managers and employees alike. Neil Eastwood has also covered every aspect of recruitment and retention with lots of hints and tips in his book.

OVERCOMING OBSTACLES Despite the challenges, it is more than possible for care home operators to continue to provide good and outstanding care to an increasingly frail and demanding older population. Follow a few key principles, seek help when you need it and your care home will thrive. CMM

Sara Livadeas is Director of Social Care Works Ltd. Email: s.livadeas@socialcareworks.org.uk Twitter: @saralivadeas What are your tips to keeping a care business flourishing? Share what’s worked for you and feed-back on this feature on the CMM website www.caremanagementmatters.co.uk CMM October 2018

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Lloyd works from both Attwells’ London office in St Johns Wood, and our Head Office in Ipswich. He specialises in providing advice and support to the health and social care sectors. Over the past 10 years or so, Lloyd has acted for care homes, care agencies, charities, support housing associations, GP practices, dentists and childcare providers. Lloyd’s clients value his tenacity, attention to detail and supportive approach to all of his client relationships. He is also a qualified workplace mediator and works with both the Suffolk and Essex

Care Associations, regularly delivering talks and workshops to their members. Lloyd has also recently delivered a talk on the sleep-ins crisis at a national event held at the ExCel Centre in London and is a member of the Employment Lawyers Association. Lloyd has a key understanding of the sector and the difficulties faced by health and social care providers and is committed to providing plain English, pragmatic and commercially-minded advice to providers so that they can deal with issues cost-effectively and quickly.

COMPANY INFORMATION With its head office in Ipswich, and a boutique London office serving clients in the capital, Attwells Solicitors is the leading property firm in East Anglia. Attwells specialises in health and social care, headed up by Senior Associate, Lloyd Clarke, and the property sector, headed up by Managing Partner, Nick Attwell. Attwells offers all clients (new or existing) an initial no-charge chat on new projects or issues; it believes in only charging for work done, and not for initially scoping out what’s required. It also tries to agree transparent fixed fees for all their services wherever possible, to minimise the costs people often associate with legal advice.

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SECTORS

• Care homes, domiciliary care. • Supported living. • Extra care, retirement living. • Community healthcare services. • Primary care. • Independent hospitals and clinics.

SERVICES • Healthcare regulation. • Incidents, safeguarding and health and safety investigations. • Court of Protection, mental health and capacity (and DoLS) issues. • Corporate compliance and information governance. • Commercial – contracting, partnering and competition. • Property and construction. • Corporate transactions. • Finance and funding. • Procurement and commercial disputes. • Employment, pensions and business immigration. • Inquests, clinical negligence claims, employer's/public liability and insurance.

LEAD INDIVIDUALS Stuart and Carlton lead Bevan Brittan’s regulatory support. They say, ‘Most of our clients are care providers. We work with small and large organisations on quality, compliance, commissioning and strategic commercial issues. We work

hard to develop an in-depth understanding of our clients and the challenges they face both on a daily basis, and strategically. We believe this is vital to providing the best support, whether on operational matters, disputes and challenges from regulators, commissioners, or suppliers, or on strategic issues, such as governance arrangements, partnering, and optimising delivery and use of resources.’

COMPANY INFORMATION As a firm, Bevan Brittan specialises in advising health and social care providers. We support providers to: grow their business, deliver quality services; and respond to challenges and disputes. Our ‘one stop shop’ provides advice on all issues clients encounter including: • Regulatory advice on: restructuring, due diligence in transactions, CQC registration, inspection preparation, responding to reports and enforcement action. • Commercial advice on: contracting and partnering, including New Models of Care and STPs and related structuring and commercial transactional and property arrangements. The firm has a wide range of specialists across all legal areas and experienced external health and social care consultants.

Stuart Marchant Tel: 0370 194 7712 Email: stuart.marchant@bevanbrittan.com Carlton Sadler Tel: 0370 194 1633 Email: carlton.sadler@bevanbrittan.com

CMM October 2018

• Care homes. • Domiciliary care. • Supported living and extra care. • Learning disability services. • Independent hospitals.

SERVICES • Regulatory action. • Responding to civil and criminal enforcement action, and draft inspection reports. • Safeguarding enquiries. • Contract disputes (including fees and embargoes). • Police investigations and prosecutions. • Mental health, mental capacity and DoLS. • Health and safety. • Inquests. • Employment law. • Corporate finance and banking. • Sales and acquisitions. • Property related matters. • Commercial law advice. • Commercial litigation.

LEAD INDIVIDUALS Neil Grant heads our Health and Social Care Provider Team, based in Guildford. Neil is an expert in the regulation and funding of care services and only acts for providers. He has a wealth of experience, having acted for inspectorates and other public bodies at a senior level. Neil has an interest in Regulatory Policy and its impact on the sector. He offers a unique perspective on regulatory and commercial issues.

James Gordon is the firm’s founder. He is a corporate and banking lawyer based in London. James has expertise, knowledge and experience, along with an ability to match the service provided by the ‘bigger guns’ of the corporate world. Timely and informed legal advice is essential to the successful running of any operation but particularly in the care sector. Our approach is strategic and commercial, working in partnership with the client. We aim to resolve and improve matters through dialogue in the interests of service users, the provider and other stakeholders. However, we are assertive in defending our clients’ rights. The firm only acts for providers. As a result, we offer truly independent advice and defend providers without worrying about conflicts of interest.

COMPANY INFORMATION Gordons Partnership LLP is a respected and growing law firm and is a recognised leader in the healthcare field. It was formed in 1994 by three lawyers from leading practices who were fed up with the ‘factory’ approach to law. Their philosophy was to provide high-quality, practical and affordable advice, in a professional and friendly environment. Throughout Gordons’ growth, we have not lost sight of that philosophy.

Neil Grant Tel: 07968 861242 Email: neil@gordonsols.co.uk James Gordon Tel: 0207 421 9425 Email: james@gordonsols.co.uk

RESOURCE FINDER

Lester Aldridge LLP

Ridouts

Tel: 01202 786135 Email: Peter.Grose@LA-Law.com Website: www.lesteraldridge.com/business/healthcare

Tel: 0207 317 0341 Email: paul@ridout-law.com Website: www.ridout-law.com

SECTORS

• Care homes/nursing homes. • Domiciliary care agencies. • Supported living services. • Independent hospitals/NHS Trusts. • GPs and dental practices. • Charities and third sector.

SERVICES • Regulatory advice, disputes with CQC, Ofsted or other regulators. • Challenging inspection reports and ratings, defending enforcement action. • Safeguarding investigations. • Supported living arrangements. • Disputes with councils/CCGs. • Recovering unpaid care fees. • Contractual disputes. • Coroner’s inquests. • Court of Protection cases. • Health and safety. • Police investigations. • Sales and acquisitions. • Professional misconduct issues. • Employment advice. • Corporate and partnership matters.

LEAD INDIVIDUALS Peter Grose is Head of the Healthcare Team, supported by Laura Guntrip in overseeing the firm’s team specialising in health and social care. Peter has specialised in this sector for over 20 years and, combined, the team boasts of over 100 years’ expertise in the sector. Members often write for care sector publications and are regularly asked to speak

at conferences, recognising their specialist expertise and reputation. The team acts for providers and is the first choice for many, from small operators to national providers. The team has also been the solicitors to the National Care Association and RNHA for over 20 years, as well as acting for other regional care associations. ‘We act in relation to a variety of matters, from contract disputes to safeguarding investigations and helping providers challenge CQC reports and ratings or defend enforcement action,’ explains Peter. ‘We understand how care services operate and the difficulties they face. We provide clear, practical solutions.’ ‘We offer a one-stop shop to assist providers in all matters stemming from an incident: CQC action and safeguarding investigations, but also police investigations, employment issues and professional misconduct proceedings, offering consistency in representation,’ adds Laura.

COMPANY INFORMATION The firm has an enviable reputation with a national following. As well as expertise acting for adult social care providers, the Healthcare Team also advises NHS Trusts and GP practices. The team have been finalists in the Legal Advisor category of the LaingBuisson Awards in recent years, and the Health Investor Awards annually since 2013.

Peter Grose Tel: 01202 786135 Email: Peter.Grose@LA-Law.com Laura Guntrip Tel: 01202 786135 Email: Laura.Guntrip@LA-Law.com

• Care homes/nursing homes. • Domiciliary care agencies. • Mental health and independent hospitals/NHS Trusts. • Learning disability services. • GPs and dental practices. • Substance misuse providers.

SERVICES • Challenging inspection reports, ratings, notices to suspend, cancel or vary registration and warning notices, fixed penalty notices and prosecutions. • Appeals to the First-Tier Tribunal. • Health and safety investigations and prosecutions. • Registration advice and challenges to refuse. • Mental health and DoLS. • Safeguarding investigations and Safeguarding Adults Reviews. • Commissioner fee and contract disputes and embargos. • Coroner’s inquests. • Police investigations. • Regulatory due diligence. • Operational consultancy.

LEAD INDIVIDUALS Paul Ridout, Managing Director has been providing advice to the sector for over 40 years. Throughout his career, Paul has been instructed in matters relating to the operation, regulation and funding of care service businesses. Paul has a unique knowledge of how regulation has changed and is regarded as one of the most experienced advisers in the sector.

Caroline Barker, Director has specialised in health and social care law since 2005. Caroline strives to achieve the best for clients and is careful to ensure that strategy and process within the organisation remain client focused with a bespoke feel. The unique client relationship has always formed the basis of Ridouts’ offering, ensuring that Ridouts is regarded as an operational partner rather than just an academic legal adviser.

COMPANY INFORMATION Ridouts offers legal, operational and strategic advice to health and social care providers. We have the single purpose of delivering time-sensitive, effective and results-driven advice. We only act for providers, enabling us to provide robust advice without compromise. We get to the heart of clients' issues to find solutions. We provide advice, training and consultancy services to build lasting relationships with clients. The combination of staff skill, knowledge and experience means our clients receive an intuitive and bespoke service, whilst we provide reassurance and navigation through often complex situations. We believe we have the largest and most experienced team of lawyers in the sector, with unrivalled knowledge and understanding of the issues facing providers. We have a strong track record in achieving good outcomes for clients.

Paul Ridout Managing Director Tel: 0207 317 0341 Email: paul@ridout-law.com Caroline Barker Director Tel: 0207 317 0348 Email: caroline@ridout-law.com CMM October 2018

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the new CQC assessment framework

Ben Hartley analyses the provision of ensuites and wetrooms in UK care homes and draws some interesting conclusions.

Notes

It is said that, apart from death and taxes, the only certainty in life is change - a truism, for sure, but one that warrants some reflection when we consider how society thinks about the way we care for our older people, and particularly in relation to residential settings. Before launching into the research I’d like to draw comparisons with the hotel and guesthouse sector. It’s not that long ago that ensuite bathrooms in hotels and guesthouses were a dream for the future. Today, it’s as standard as the beds in the room.

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Residential care for older people though might not be keeping up with the ablution revolution, which was our starting point in deciding that there needed to be some in-depth work to establish the current position. We embarked upon a thorough and extensive research project, carrying out a comprehensive survey over six months involving more than 6,000 telephone interviews. It reveals a very interesting picture. The research includes data from the whole of the UK and comprises information from private, not-for-profit, local authority and some NHS care homes.

overview of the UK’s dementia bed provision

Where we were unable to contact a care home directly, we made a number of assumptions based on data from other sources including the A-Z Care Homes Guide and the Care Quality Commission. The principles of what we did and why are relatively easy to convey. The detail, however, is trickier and, unless you are a stats lover, a little less inspiring. Definitions For the purpose of this research, we describe an ensuite bedroom as one where there is at least a WC and wash hand basin. Such a room may also provide, though this is not a requirement for the purposes of our definition, a shower cubicle, bath or wetroom.

Outstanding managers

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By contrast, our definition of a bedroom with an ensuite wetroom is one where there is a full wetroom, i.e. a walk-in shower complete with level access as well as the WC and wash hand basin. In effect, this is a subset of the ensuite bedroom provision – simply characterised by a higher level of facility. Headline results

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We know that care homes aren’t keeping pace with the rate of change witnessed in hotel stock, however, although we knew that provision was more limited, the findings have shown an even bigger gap in provision than anticipated.

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Non-care providers receive a three month free trial, £50 per year thereafter. *Cannot be used in conjunction with any other offer.

RESOURCE FINDER

Royds Withy King Tel: 0800 051 8058 Email: james.sage@roydswithyking.com Website: www.roydswithyking.com

SECTORS • Care homes/nursing homes. • Learning disability and specialist homes. • Domiciliary care. • Supported living. • Extra care/retirement villages. • Hospices. • Housing and support associations. • Charities.

SERVICES • CQC registration, challenging inspection reports, enforcement action and ratings. • Challenging notices to suspend or cancel registration. • Fees, tenders and commissioning contracts, challenging embargos. • Safeguarding investigations. • Inquests. • Buying and selling, leases, development and construction. • Commercial structuring and finance. • HR and employment law. • Mental capacity and DOLS. • Service user contracts. • Dispute resolution, debt recovery. • Intellectual property. • All aspects of charity law. • Free e-bulletins.

LEAD INDIVIDUALS The Health and Social Care team is a multi-disciplinary group of

specialist lawyers led by partners James Sage and Hazel Phillips. They have substantial experience advising care providers on legal and regulatory issues and regularly share their expertise at regional and national care conferences. They say, ‘We offer clients a complete legal service, giving them peace of mind that they are fully compliant so they can concentrate on doing what they do best – running successful businesses delivering the highest levels of care. We also advise a large number of providers who are registered charities, assisted by our charity law specialists. Our team’s in-depth knowledge of the challenges facing care providers and the fact we take the time to fully understand our clients' needs, means that we can provide a personal approach and become part of their trusted team.’ The Health and Social Care team are the recommended lawyers for a number of regional care associations.

COMPANY INFORMATION Royds Withy King is a UK Top 100 law firm, providing a national service to care providers from offices in London, Bath, Wiltshire and Oxford. The firm uses the breadth and depth of its expertise to provide practical, commercial and cost-effective advice.

James Sage Tel: 07508 297597 Email: james.sage@roydswithyking.com

Hazel Phillips Tel: 07776 241235 Email: hazel.phillips@roydswithyking.com

Scott Moncrieff & Associates Ltd Tel: 0207 129 7961 Email: errol.archer@scomo.com Website: www.scomo.com/errol-archer

SECTORS • Care homes/nursing homes. • Domiciliary care agencies. • Independent hospitals. • Learning disability services. • Mental health services.

SERVICES • Advice on and defence against CQC, Ofsted and HSE enforcement action. • Appeals to the First-Tier Tribunal. • Challenging inspection reports and ratings. • Coroners’ inquests. • Safeguarding investigations. • Mental Health Act and Mental Capacity Act compliance. • Contractual disputes with local authorities. • Employment advice. • Commercial contracts. • Business and property transactions.

LEAD INDIVIDUAL For over 20 years, Errol Archer has successfully acted for businesses, clients, regulators and central government, including advising senior civil servants and government ministers. He has worked both in-house and in private practice. Having successfully set up, run and managed a highly regulated business himself, he is keenly aware of the need to protect his clients’ ‘bottom line’ and business reputation. Errol is a health and social care law expert in dealing with CQC, Ofsted, HSE and other regulators.

He has: • Won appeals at tribunal against CQC and Ofsted Notices of Decision. • Successfully challenged Notices of Proposal. • Persuaded regulators to withdraw Fixed Penalty Notices. • Successfully defended and mitigated Health and Safety Prosecutions. • Guided providers through local authority safeguarding matters. Errol is a Solicitor-Advocate (Civil) and is authorised by the Solicitors Regulation Authority to exercise ‘higher rights of audience’ in courts and tribunals. He has represented clients in hundreds of hearings at courts and tribunals, including at the First-Tier Tribunal (Care Standards) and at Coroners’ Court Inquests. As a former Law Society Mental Health Tribunal Panel Member for 10 years, Errol is very well placed to work with staff to provide advice, guidance and legal assurance that they are acting lawfully; within the Mental Health Act, Mental Capacity Act and their Codes of Practice.

COMPANY INFORMATION For over 30 years Scott-Moncrieff has been providing innovative legal solutions. As we’ve grown, our nationwide network of over 40 lawyers remain committed to delivering skilled and affordable legal services, on employment law, contracts, dispute resolution, company law and more.

Errol Archer Consultant Solicitor Advocate (Civil) Tel: 07729 421836 Email: errol.archer@scomo.com CMM October 2018

3rd Sector Care Awards

Camphill Village Trust – Quality of Life

Camphill Village Trust won the Citizenship Award in the 3rd Sector Care Awards 2017 for its innovative project on Quality of Life Reviewers. Camphill Village Trust (CVT) is a national charity supporting adults with learning disabilities to live as independently as possible in their homes within community settings. Providing a wide range of supported skills-development activities, which are open to people living both within, and external to, our community settings. The activities provide opportunities for people to develop vocational and life skills, as well as having therapeutic benefits. In 2015, CVT began working with Changing Our Lives, an independent, rights-based organisation. The aim was to introduce a ‘Quality of Life’ (QOL) review approach into CVT settings. This approach is led by people who use the services (‘reviewers’) who visit people in communities other than their own. The reviewers spend time looking at how people are supported to have those life experiences we all recognise as part of ‘ordinary’ life. The result is a comprehensive review based on the QOL standards. These reviews include recommendations to improve outcomes as well as the way our support enables people to live as 46

CMM October 2018

independently as possible, contributing to society as equal citizens. The QOL review approach is consistent with a wider commitment across the charity to engage the people we support co-productively. The QOL review programme involves people with disabilities developing different skills and taking ownership and increased responsibility over what they would like to achieve. It also ensures that people are having real influence over how they interact with and contribute to their community. At the core of the Quality of Life programme are the partnerships built between the reviewer and their partner within each review team. The reviewer is the person with lived experience and it is their role to lead the whole process. They are supported by a partner, usually a support worker who knows the reviewer well. The role of the partner is to take notes when requested, help to construct the report following the review and ensure that the reviewer has everything they need. The programme aims to support reviewers to develop the skills to recognise and gather facts, listen to and balance opinions and gain a deeper understanding of what will be a positive outcome for every person. This process of gathering review ‘evidence’ is done through speaking with people, observation of interactions, awareness of environmental factors (especially when visiting people in their own homes) and the ability to think about and then ask the right questions. The reviewers develop their own listening skills, sense of empathy and ability to read body language, as well as increasing their understanding of how people can express their emotions in different ways and what this may mean. It is also important for the reviewers to recognise when something is to be treated as confidential, what rights people have and how to ensure that people feel safe and not overwhelmed or intimidated. The review teams know when they need to alert someone, and who this should be, if they are concerned about someone’s wellbeing or that something is not right. These skills do not come easily and need to be developed and encouraged. The programme is underpinned by a comprehensive training plan. The initial training is two days. It challenges and inspires the prospective review teams to trust their instinct and experience, and recognise their own abilities. This is followed up with additional training days once they have undertaken their first review. The reviewers are encouraged to reflect on their own practice and identify their own skills and abilities, whilst also looking at areas that they need to work on for their own personal development. Some reflections from reviewers include:

• ‘The opportunity to be a reviewer has filled me with confidence and self-worth.’ • ‘I feel I can inspire others to achieve their goals.’ • ‘It does not matter what your abilities are, you are seen as an individual person in your own right.’ Perhaps the most rewarding aspect of any review is when the recommendations result in actions that improve the quality of life for others. Some of the developments we have seen include: • Changes to accommodation to enable increased independence. • Increased access to different employment opportunities. • Changes to support delivery method and timings, reducing dependency on paid support. • Improved accessibility throughout the community for people with physical disabilities. The work that the review teams have undertaken so far is summarised by Jayne Leeson (MBE), Chief Executive of Changing Our Lives. She comments, ‘The CVT Quality of Life reviewers take a rights-based approach to their work, arguing all disabled people have a right to an ‘ordinary life’, where they decide who supports them, where they live, who they live with… in short, how they live their life. The Quality of Life reviewers are championing these rights, exposing myths and, in many cases, finding some of the most genuine and positive interactions between people with learning disabilities and staff that we have seen in a long time. They really are making a difference.’ The most exciting prospect for CVT is that this is just the beginning. New opportunities continue to open up for people we support to be involved with and influence the delivery of the charity’s services. The QOL reviews are directly influencing CVT community development plans and, at a wider level, strategic planning. To ensure that this project continues to grow, the new role of a Quality of Life ambassador has been created. These are people with learning difficulties who take responsibility for ensuring that reviews and reports are shared, actions are recorded, and outcomes are monitored. Recognition of the work of the CVT Quality of Life teams culminated in winning the 3rd Sector Care Awards Citizenship Award in December 2017. Huw John, CVT Chief Executive said, ‘This award is a reward for the hard work which teams from all our communities have put in over the last twelve months. Thank you to all of them. It represents a significant change in how we review quality and further strengthens our resolve to enable the people we support to have a stronger voice in the charity’s direction and governance.’ The members of the review team say that receiving the award has given them even more confidence and enthusiasm for doing more reviews, saying, ‘Knowing that other people respect our work makes us really happy and proud.’ The foundations have been built for a positive future. CMM Philip Gibson is Project Manager at Camphill Village Trust. Email: trustoffice@cvt.org.uk Twitter: @CamphillVillag1

The Markel 3rd Sector Care Awards is run specifically for the voluntary care and support sector. Book your ticket today to hear the inspiring stories and innovative work of this year’s nominees. Tables and sponsorship opportunities are also available. Visit www.caremanagementmatters.co.uk/3rd-sectorcare-awards With thanks to our supporters: National Care Forum, Learning Disability England, The Care Provider Alliance, Association of Mental Health Providers and Voluntary Organisations Disability Group.

CMM October 2018

EVENT PREVIEW

THE CARE SHOW 17th-18th October 2018, Birmingham

The Care Show returns in October, following 20 years of providing guidance and education dedicated to the social care sector. This year, it brings the same information-packed sessions, hands-on exhibition and an injection of something new.

CELEBRATION The Care Show is celebrating its 20th year with Home Care Awards, prizes, acknowledgments, a Carer of the Year award, live music, entertainment and, to thank everyone who’s been to a Care Show over its history, there will be a party for all to enjoy, with food, drinks and a live band. Delegates will also receive a welcome pack with a voucher booklet full of show discounts and offers.

LEARNING The Show promises to offer engagement, learning and opportunities to network. This year, there is a focus on providing a stronger, more practical training programme, delivered for free across education hubs on the show floor. The inspiring presentations have been developed to support providers in boosting levels of care, motivating teams and driving efficiency. The sessions have been divided into 6 care streams for people to filter what it is they are interested in learning about. A business stream will be offering practical advice and ideas to cover key business

CMM October 2018

Building a better future for care

functions such as finance, customer service, marketing and HR. Sessions aim to help providers to innovate, become Outstanding and develop their leadership. The people stream provides information for operators and homecare service providers to navigate the key areas of recruitment and retention of staff, training and up-skilling, the impact of Brexit and managing agencies. With dementia featuring on the majority of agendas, Care Show’s dementia stream promises sessions on everything from sensory, to technology. This stream brings together innovation and inspiration to equip care businesses with the knowledge they need to understand best practice in dementia care. An assets stream offers a series of seminars looking at the future growth of the care sector. Seminars will give knowledge on funding and finance, working with investors, effective procurement strategies and design and construction ideas. Compliance is a key part of operating a care business – how can providers ensure those all-important positive CQC reports and ratings and what more can be done to keep people safe? A series of practical seminars and workshops aims to answer these questions, giving providers the information they need to know to navigate their way through safeguarding, health and safety and successful CQC inspections. The final stream is excellence in care. Experts will share expertise and success stories from some of the UK’s most innovative care

home operators and service providers. These case studies will focus on technology and innovation, personalised care programmes, successful integration with GPs and the rest of the primary care landscape, including medication management and specialist care programmes.

CARER OF THE YEAR The Care Show celebrates outstanding work within the sector and, in January 2018, it introduced The Care Show’s Carer of the Month. This new award has uncovered moving stories of work that has gone above and beyond and has shown the care community more of the positive work it carries out. Carer of the Year will be decided from the winners of Carer of the Month and will receive an award from an exciting special guest at The Care Show.

ATTEND To attend The Care Show 2018 and celebrate the event’s 20th anniversary, visit www. careshow.co.uk or call the delegate booking line on 0207 013 4671. Keep up-to-date on the latest sector and event updates by following The Care Show on Twitter (@CareShow), joining discussion using the official event hashtag #CareShow. You can also connect on Facebook (facebook.com/careshows) and LinkedIn in the ‘Care Show Discussion Space’.

WHAT’S ON? Event: The Gold Standards Framework Annual Conference Date/Location: 28th September, London Contact: GSF Centre, Tel: 01743 291891 Event: UKHCA England Conference and AGM Date/Location: 9th October, London Contact: UKHCA, Web: www.ukhca.co.uk Event:

Care Show: Building a Better Future for Care Date/Location: 17th-18th October, Birmingham Contact: Care Show, Web: www.careshow.co.uk

Media Partner

Event: NCF Managers Conference Date/Location: 12th-13th November, Warwick Contact: National Care Forum, Web: www.nationalcareforum.org.uk Event:

Logging On: Care England 2018 Conference and Exhibition Date/Location: 14th November, London Contact: Care England, Web: www.careengland.org.uk

INTRODUCING THE STUNNING

Event: National Children and Adult Services Conference Date/Location: 14th-16th November, Manchester Contact: Local Government Association, Association of Directors of Social Services and Association of Directors of Children’s Services, Web: www.ncasc.info Event: The Future of Ageing 2018 Date/Location: 29th November, London Contact: ILC-UK, Email: events@ilcuk.org.uk

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CMM EVENTS Event: Date/Location: Contact:

CMM Insight Berkshire, Buckinghamshire and Oxfordshire Care Conference 11th October, Slough Care Choices, Tel: 01223 207770

Event: Date/Location: Contact:

The Transition Event East 2018 15th November, Newmarket Care Choices, Tel: 01223 207770

Event: Date/Location: Contact:

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

Event: Date/Location: Contact:

CMM Insight Dorset Care Conference 7th February 2019, Poole Care Choices, Tel: 01223 207770

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C O L I N A N G E L • P O L I C Y D I R E C T O R • U N I T E D K I N G D O M H O M E C A R E A S S O C I AT I O N

Colin Angel, Policy and Campaigns Director at UKHCA discusses ways of improving the stability of the statefunded homecare market.

There has been a growing awareness that the stability of the state-funded homecare market has been undermined by significant underfunding and poor procurement practices. The 2018 ADASS Budget Survey rightly acknowledges the presence of market failure in some parts of the country and fragility elsewhere. The report suggests that directors of adult social services also believe that they have a role in increasing the wages of care workers, ranking it as the most important factor in solving recruitment and retention pressures1. While I hear directors of adult social services repeatedly stating that the stability of the homecare market is their greatest anxiety, we are not seeing much evidence it is being addressed at a local level through practical action. Although there are a few isolated examples of

councils making some serious attempts to improve fees paid to providers, the majority have just about managed to maintain the status quo. Forgive a focus on financial matters but the greatest risks to the stability of the provider market (and the terms and conditions of the workforce) are financial, borne out by a recent survey of over 500 providers, who stated that inadequate fee levels, below-inflation increases and low direct payments rates are at the top of the list2. There appears to be a significant change in providers’ willingness to undertake state-funded homecare. It is not just providers handing-back contracts or unsustainable packages, but adopting a far more cautious approach to contracts being offered for tender. Providers’ risk assessments of new contracts increasingly suggest there are ambitious specifications but little understanding of the associated costs. Some contracts have also contained clauses which are now deal-breakers, including: requiring a single price for 3-5 years; councils reserving a unilateral right to vary contract terms after award; and vague references to the council changing its purchasing intentions during the life of the contract. Many of these contracts effectively require providers to sign-up to a contract which could change into something very different from what is described in the draft. While we’ve seen an increase in the number of tender processes abandoned before awards are made (with associated costs for both the tax-payer and provider), a number of directors of adult social services tell me they have had no shortage of prospective tenderers. If this is the case, we have to hope they have managed to secure not just a sufficient number of bids, but providers who can deliver the required volume at the right quality for the life of the contract. Our message to providers is that they should not sign up to unsustainable contracts where they would have to compromise on quality or safety.

Many providers themselves are taking a hard look at which customers they are willing to supply to. There is a perceptible shift towards providers who intend solely or mainly supplying to people who fund their own care. UKHCA has used freedom of information legislation to establish whether councils have undertaken a cost of care exercise with their local providers. UKHCA’s Minimum Price for Homecare3 provides a template and councils are directed to take notice of our methodology in Statutory Guidance4. Whilst the majority of councils claimed to have done some form of cost of care exercise, most were unable to provide evidence of their calculations. Avoiding such a calculation may be a way of conveniently hiding from stark realities. Unless I’m wrong, many authorities seem prepared to play Russian roulette with the stability of their care market. We certainly haven’t been able to find any part of the system which is effectively policing the market-shaping responsibilities councils have under the Care Act 2014. The Department of Health and Social Care and the bodies representing commissioners have each told us they do not do it. However, effective independent oversight of how councils discharge their duties is urgently needed. Logically, this would be the Care Quality Commission in England. It already assesses the quality of care delivered by providers, but is not empowered to assess commissioning practices of councils without specific permission by Government. Government has suggested that such a national oversight regime could be included as part of the forthcoming Green Paper consultation5 and the Local Government Association has already indicated its opposition6. It is hard to see why such scrutiny would not be in the public interest. It could certainly play a role in improving the fragility of the state-funded sector in the short term, before whatever solution to longer-term funding is agreed and effective. CMM

Colin Angel is Policy and Campaigns Director at United Kingdom Homecare Association. Email: colin.angel@ukhca.co.uk Twitter: @colintwangel Full references are available on the CMM website www.caremanagementmatters.co.uk 50

CMM October 2018

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Our theme for our Managers Conference this year is Health and Wellbeing and we are approaching this from the perspective of both the people that you provide care and support for, for you and your teams. Hear from key inspirational speakers including the Care Minister, Caroline Dinenage, MP; Sharon Allen OBE, CEO, Skills for Care; Sue Howard, Deputy Chief Inspector, CQC; Sam Monaghan, CEO, MHA • Visit the wonderful Festival of Health and Wellbeing, sponsored by HUR, experience the latest in health and wellbeing opportunities for staff and people who use care and support services • Take part in the wide range of Workshops to learn new skills and put key legislation and policy changes into practice • Meet with managers from across the country to network and build peer connections and support • Take time out from the hectic work schedule to reflect on your practice and build ideas and energy

Caroline Dinenage, MP, Minister DHSC

Sharon Allen OBE, CEO, Skills for Care

Sponsors of the conference drinks reception

Jill Parker, STOMP

Sponsors of the NCF Rising Stars

Sam Monaghan, CEO, MHA

*10% Early Bird rate available for member & non-members until 31 August 2018 (full delegate packag e

only)

• Full member: £306.00 +VAT (inc ludes all accommodation costs, refresh ments & access to the full conference pro gramme) • Non-member: £401.25 +VAT (inc ludes all accommodation costs, refresh ments & access to the full conference pro gramme)

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only) Other options available - more info rmation contact info@nationalcareforum .org.uk (*only 1 promotion per booking)

Ian Donaghy, Training for Carers

Prof Dawn Skelton, Professor in Ageing and Health

Sponsors of the Festival of Health and Wellbeing

Sue Howard, CQC, DCI of Adult Social Care, Central Region

NCF MANAGERS CONFERENCE 12 - 13 NOVEMBER 2018 Chesford Grange, Kenilworth, Warwick CV8 2LD