Care Management Matters December 2018 by Care Choices Ltd

DECEMBER 2018

www.caremanagementmatters.co.uk

THE INTEGRATION ISSUE Does it stand a chance?

Defying the rules

How CQC is changing regulation

Employees and workers Defining the difference

Medication management Are you getting it right?

Person Centred Software Interviews Alison Redhead, Registered Manager of Minster Grange Care Home, part of LifeStyle Care

Book a demo of MCM with us: Call: 01483 604108 or email hello@personcentredsoftware.com

In this issue 05

Inside CQC Andrea Sutcliffe CBE shares her parting thoughts and explains that the Mum test will still be at the heart of what CQC does after she leaves the organisation.

CMM News

Business Clinic CMM looks at Heathcotes’ new approach using ‘Pods’ to encourage independence.

Rising Stars 2018 Julie Veritiero is Home Manager at Borough Care’s Marbury House.

3rd Sector Care Awards Claire Thomas has made a huge impact in Wiltshire training dementia friends. CMM takes a closer look at her work.

Event Review A review of the CMM Insight Berkshire, Buckinghamshire and Oxfordshire Care Conference 2018.

What’s On?

Straight Talk Glen Garrod explores the recent Budget announcements and explains his reasons for saying we must take bigger steps.

FEATURES 37

REGULARS

From the Editor

Integration: a possibility or a pipe dream? Organisations across the sector are trying to work more closely with health partners, but without action from the top, does integration stand a chance? Professor Martin Green OBE shares his thoughts on whether this system change is achievable.

Key changes to CQC regulation: are we losing sight of the basics? Neil Grant from Gordons Solicitors highlights some of the key changes CQC has been making to policy and approach, and how these are increasingly defining how it regulates the sector.

Employment status explained: navigating the rules Melanie Stancliffe un-muddies the waters surrounding staff’s employment status, explaining the differences between employees and workers.

The safety and efficiency of medication management Medication management is an area where the slightest error can have severe consequences. Steve Sawyer explains how providers can improve efficiencies and ensure safety procedures are followed effectively. CMM December 2018

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

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

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CMM December 2018

Melanie Stancliffe Partner, Irwin Mitchell

From the Editor Editor, Angharad Burnham looks at this month's features and invites readers to attend the Markel 3rd Sector Care Awards in December. This month has seen several promising announcements from Government. The recruitment pilot taking place throughout November is a step in a positive direction – hopefully resulting in tried and tested methods to set the sector up for a successful campaign in 2019. Another positive is Mr Hancock’s commitment to prevention. While his speech was fairly NHS-centric, the potential behind the vision – supporting people with disabilities into work and encouraging social prescribing to reduce loneliness – could prove life-changing for many people. The questions we are asking now are, will we see these principles put into practice? After years of ongoing negative press, how easy will it be to change people’s perceptions of a career in social care? Will the vision for prevention yield results, or will it just be another document with grand intentions? October also saw the

Chancellor of the Exchequer give his Budget 2018. The social care sector deflated as more insufficient and temporary funding was offered. Though welcome, sector leaders agreed that the money made available just isn’t enough to support social care to sustain services. Glen Garrod has shared his views on the Chancellor’s announcements on page 50.

MAKING CHANGES Integration remains high on the agenda, and a joined-up system will be instrumental in seeing the Government’s prevention plan become a reality. However, the barriers are unavoidable and the truth is that, to be achievable, integration needs attention. In this edition, Professor Martin Green OBE discusses this issue and asks whether integration is really a possibility. Turning to the Care Quality Commission (CQC), this month we have Andrea Suttcliffe’s final

column as Chief Inspector of Adult Social Care. She shares her reflections on what has been achieved in her time with CQC and looks at what the future of the organisation might hold. I’d like to thank Andrea for her contributions to CMM and wish her all the best for the future. Delving into the changes CQC has been making, Neil Grant’s feature on page 25 highlights the ways in which the organisation has recently shifted its boundaries for inspection and regulation, examining what this means for providers and raising the question, does someone need to be regulating the regulators?

3RD SECTOR AWARDS This month, we have also had the pleasure of attending our Markel 3rd Sector Care Awards judging day. Our panel saw an incredibly high calibre of finalists this year and had a hard time deciding the deserving winners. I’d like to take this opportunity to let the finalists know that the judges were deeply impressed by their efforts and I wish them all the best of luck. Winners will be announced at the ceremony in London on 7th December. If you don’t have a ticket to attend, book your seat now via the CMM website – we hope to see you there.

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

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This is my final ‘Inside CQC’ column because, as you may have heard, I will be leaving the Care Quality Commission (CQC) at the end of 2018 to take up a new appointment as Chief Executive and Registrar of the Nursing and Midwifery Council. I want to start by saying a huge and heartfelt thank you to everyone who has written to and tweeted me with good wishes about my news. I have been overwhelmed by your kind words. When departures are announced, we like to look back at what has been achieved and wonder about what changes might come in the future. Reflecting on progress and improvements is important, and I am proud of how CQC has changed in the five years I have been Chief Inspector of Adult Social Care. We have cemented our commitment to ensuring people who use services are at the centre of everything we do and to working in co-production with everyone impacted by our work. We have completed and built on a full round of comprehensive inspections since launching our new approach to regulation in 2014 and this has allowed us to develop an unrivalled knowledge about quality in the sector. We have used our independent voice to talk about the importance of adult social care and speak honestly about the challenges facing the sector. We have matured as an organisation; building public confidence in our ability to carry out our role and encouraging providers to improve, as well as holding to them account for poor care. Of course, there is always more to do and I think I have left enough of that for my successor to get their teeth into! Looking to the future, there are big challenges ahead for adult social care and the role CQC plays in raising the profile of it; being a champion for quality and speaking truth to power about the state of the sector will continue to be vital. Some of you have been worried whether all this will continue after I have left. But please be assured, what we have built together is bigger than one person and I have a great team to carry on the good work. The progress we’ve made has been possible because we have worked in co-production with people who use services, their carers and families, providers, staff, commissioners and national bodies. CQC knows this is how to get things done – co-production not only helps us strengthen our relationships with our stakeholders, it’s a

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 explains that the Mum test will still be at the heart of what CQC does after she leaves the organisation at the end of the year.

common-sense approach to making sure that we’re doing the right thing for the people who matter most and that we understand how our decisions will impact on others. Being clear about standards and not compromising on quality for people who use services is something CQC will remain totally

“What we have built together is bigger than one person and I have a great team to carry on the good work.” committed to. Back in 2013, I first talked about the Mum test – asking ourselves ‘Is this service good enough for my Mum (or anyone else I love)?’ – and this human focus now threads through all our work. The new case studies in our Equally

outstanding resource show that quality improvement can and will be made when providers take a person-centred, human rights approach to care, and CQC has a crucial role in sharing this learning with the sector. There’s more to do in this space and I know the team at CQC are full of ideas for the future. The focus on person-centred care at CQC mirrors what’s happened across the sector. This rang true at the relaunch of Making it Real, a framework to support good personalised care. It ensures people who use services are squarely at the centre for everyone working in and using adult social care – just like the Mum test. Whatever challenges and change the future may bring, the Mum test is here to stay. It gets to the heart of why we’re all in this sector – to make a difference for people who use services, their carers and families. I’ll finish by adding that I won’t be saying goodbye to adult social care when I leave CQC – as the 42,000 nurses who work in adult social care will appreciate – and I will keep championing this sector and the dedicated, skilled people who work in it. Thank you for being a part of my CQC adventure.

Andrea Sutcliffe CBE is Chief Inspector of Adult Social Care at the Care Quality Commission. Share your thoughts and feedback on Andrea’s column on the CMM website www.caremanagementmatters.co.uk Not a member? Sign up today. CMM December 2018

APPOINTMENTS HC-ONE

Sector responds to Budget 2018 The sector has responded to Philip Hammond's Budget 2018, after he announced an additional £650m for social care for 2019/20. In the Budget, the Chancellor said, 'We will shortly publish our Green Paper on the future of social care, setting out the choices, some of them difficult, for making our social care system sustainable into the future. But I recognise the immediate pressures local authorities face in respect of social care. 'So today, building on the £240m for social care winter pressures announced earlier this month, I will make available a further £650m of grant funding for English authorities for 2019/20 and an additional £45m for the Disabled Facilities Grant in England in 2018/19.' Leaders in the sector have

since shared their views on the announcements in the Budget 2018. Vic Rayner, Executive Director of National Care Forum, said, 'The Chancellor had a golden opportunity to meet the shortterm funding requirements of the adult social care sector, which have been highlighted multiple times by both parliamentary bodies and sector specialists. The limited additional funding is, of course, welcome. However, it does nothing to address the immediate needs of the social care sector.' George McNamara, Director of Policy and Influencing at Independent Age said, ‘The Chancellor’s commitment for an additional £650m towards social care will only provide a short-lived breathing space to a social care system that is already on its knees.

'…We urge the Government to address the vital need for a fullyfunded system. We believe this can be achieved by introducing free personal care in England, ensuring many older people are able to get the care and support they need to live independent lives.' Lord Porter, Chairman of the Local Government Association (LGA) commented, 'While this funding will ease some of the immediate financial pressure facing councils and our local services, it is clear that this cannot be a one-off. This funding is a start, but the real test will come in the Spending Review next year.’ The Chancellor's full speech can be read on the GOV.UK website and Glen Garrod has shared his thoughts on the Chancellor’s Budget in this month’s Straight Talk on page 50.

Leaders react to mental capacity proposals Ministers must eliminate the conflict of interest within the ‘troubled’ mental capacity proposals, according to leaders in the social care sector. Sector leaders have already set out their position that managers with a controlling interest over care and support businesses should not be in charge of processes and decisions to deprive people of their liberty. Further concerns about the Bill have now been raised by the Joint Select Committee. Judy Downey, Chair of the

Relatives & Residents Association said, 'The Joint Committee on Human Rights has joined the chorus of disapproval about this Bill. It has highlighted the fact that the Bill does not meet the requirements of the European Convention on Human Rights. Let’s hope that the Government takes notice and urgently redrafts the Bill accordingly.' The Mental Capacity (Amendment) Bill was introduced to the House of Lords on 3rd July 2018. Sector leaders welcomed the

very first discussion with senior officials and Ministers on 25th October 2018 – a meeting that was held with provider, commissioner and charity representatives. Professor Martin Green OBE, Chief Executive of Care England, said, 'We want to work jointly with the DHSC and Ministers and we welcome the interest shown by them…We hope the many detailed items which were discussed have been captured by officials and will now be actioned in terms of government amendments to the Bill.'

HC-One has announced that former Care Quality Commission Chief Executive, Sir David Behan CBE has joined the company board as a NonExecutive Director. Sir David will be working to ensure the company continues to develop its strong quality record and build on existing work to develop industry-leading career opportunities for staff.

CARE SOUTH Simon Bird has been appointed Chief Executive of Care South. Simon has been with Care South since 2011, most recently in the role of Deputy Chief Executive.

SKILLS FOR CARE Skills for Care has announced that Dimensions Chief Executive Officer, Steve Scown and Suzie Bailey from The King’s Fund have joined their board of trustees.

SANCTUARY GROUP Sanctuary Group has announced David Bennett’s decision to retire as Group Chief Executive at the end of the year, having joined the organisation in 1986 and led it since 1991. The Board has appointed Craig Moule, Sanctuary’s Chief Financial Officer, as Group Chief Executive with effect from 1st January 2019.

CAREMARK Caremark has strengthened its core team for the second time in 2018 with the formal appointment of Managing Director, David Glover, and a duo of Compliance Managers, Alan Frew and Sharon Kemp. CMM December 2018

NEWS

APPOINTMENTS CORNWALL CARE Cornwall Care has appointed Anne Thomas as its new Chief Executive Officer.

CAREWATCH CARE SERVICES LTD Carewatch Care Services Ltd has appointed Mark Stephenson, a healthcare professional with more than 15 years of leadership experience, as its new Chief Executive Officer to drive growth and service excellence.

HEATHCOTES GROUP Heathcotes Group has appointed Hocine Benhafsi as Head of Recruitment to support its nationwide expansion. He will be overseeing recruitment for over 62 specialist services for adults with learning disabilities, mental illness and associated challenging behaviours.

DFN CHARITABLE FOUNDATION The DFN Charitable Foundation has announced the appointment of a new Chief Executive Officer, Kevin Horne. Kevin joins after 21 years heading a multi-million pound business services enterprise, through which he actively developed employability initiatives to support those with learning disabilities.

CHRISTCHURCH GROUP Christchurch Group has announced the appointment of Sheila Manisier to the position of Business Development Director. Sheila has extensive experience of the sector with a particular interest in specialist services for people with complex needs and brain injury rehabilitation. 10

CMM December 2018

Social care recruitment pilot The Department of Health and Social Care (DHSC) has been conducting a care worker recruitment pilot throughout November to inform a national campaign due to start in 2019. The month-long programme aimed to promote jobs in the adult

social care sector in Gloucestershire and Tyne and Wear. The care worker recruitment pilot started on October 31st and has been testing various marketing methods in each region to identify the best channels in different areas. Working with local providers,

DHSC is looking to convey a positive message about care work – that it is different every day – and is highlighting the sorts of roles and tasks that people working in the care sector carry out, as well as the difference they can make to others.

Funding announced for social care research Social care research in England will get up to £20m in new funding through the National Institute for Health Research (NIHR), boosting research to improve adult social care across the country. The investment by the Department of Health and Social Care will fund the next five years of the NIHR School for Social Care Research. The School funds adult social care research and training for research staff. It brings together leading academic centres for social care research in England, and supports world-class research by social care professionals and academics to improve the way social care is delivered. The new funding will allow the School’s partner organisations to

build on their work in areas such as mental health, dementia, and care homes. Two new partners have joined the School – Kings College London and the University of Birmingham – bringing the total number of partners to seven. The School will launch a call for research proposals in Summer 2019. The Government is committed to improving the evidence around social care so that people are provided with better and more effective services in the future. The NIHR has already invested £30m into the School for Social Care Research, which celebrates its 10 year anniversary in 2019. Thanks to the new investment, the School will continue to build the evidence

base and develop capacity in social care research in England over the next five years. Ongoing research projects include investigating how staff in supported accommodation can support people with challenging behaviours, looking at whether providing adaptations to bathing facilities in people’s homes can improve quality of life and relieve pressure on other services, and studying how hearing dogs can affect people’s wellbeing and mental health. The £20m investment into social care also includes £1.8m investment for training researchers through the new NIHR Academy, which will be co-ordinated through the School.

Latest on sleep-ins Following months of campaigning and nearly four months after the Court of Appeal judgement the Government has revised its guidance on sleep-in payments. The announcement follows a cross-sector letter signed by care, health and education organisations urging the government to clarify how sleepins should be remunerated. The guidance reflects the law in paying for sleep-in work as determined by the Court of Appeal’s judgment in the joined cases of Mencap v Tomlinson-Blake and Shannon v Rampersad. But it neither helps anyone nor goes far enough, says Voluntary Organisations Disability Group (VODG), which has been calling on Government to resolve these issues since 2014. The official guidance notes that

further court judgements may again change the circumstances under which the national minimum wage is paid. Unison has already lodged an appeal to the Supreme Court, creating renewed uncertainty for employers over retrospective and ongoing costs. Government is therefore avoiding real action until this potential legal action concludes, effectively imposing a state of uncertainty, probably until 2020, says VODG. The ongoing lack of clarity not only affects care provider organisations but also individuals using personal budgets or direct payments to employ and manage support staff. VODG is now calling on Government to: • Introduce through a statutory

instrument regulatory clarity on pay rates for sleep-in shifts. • Work with providers and local government on a sustainable funding solution that will ensure care workers are valued and fairly paid. • Provide clarity on the Social Care Compliance Scheme in the light of new guidance. • Confirm that the current legal position means employers will not face potential HMRC retrospective action to recover underpayment of national minimum wage for sleep-in work – now or in the future. • Work with organisations to produce information so that people who use services and their families, the workforce, employers and commissioners understand how sleep-in shifts should be remunerated.

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CQC consultation on fees The Care Quality Commission (CQC) has published its consultation on the fees it proposes to charge providers in 2019/20. The proposals follow the plans CQC set out to continue to meet the Treasury’s requirement to recover its ‘chargeable costs’ in full from providers. CQC will analyse the feedback from this consultation to prepare a response and a final fees scheme to recommend to the Secretary of

State, whose consent is required to implement the scheme from 1st April 2019. CQC has promised to continue to look carefully at its costs. It has also promised to continue to demonstrate that it is fair, efficient, effective and proportionate. CQC’s budget, in relation to the overall spending on health and adult social care in England, remains at 0.16%. The regulator is estimating

National Care Group

that: • Community social care locations supporting up to 22 service users will see a fee increase of no more than £144 per annum. This represents half of all locations. • The average residential social care provider with 26-30 beds at one location would see a fee reduction of £64 under the new proposals. The consultation on fees runs until midday on 17 January 2019.

National Care Group (NCG) has announced the acquisition of Atlantic Support (Devon) Ltd (Atlantic). Financial details of the deal were not disclosed. Atlantic currently cares for 13 people with mental health needs. The acquisition of the Atlantic business continues NCG’s growth nationwide, becoming the company’s first site in Devon.

Millions are underestimating the cost of care Millions of people are underestimating the cost of a care home place, according to Which? research. When the consumer champion asked people to estimate the cost of a private nursing home place in their region, more than half (55%) came up with a figure that fell short of the average cost. On average, people are

underestimating the cost of care in a care home in England by £237 per week – the equivalent of £12,000 a year. One in 10 people underestimated the true cost by more than £757 per week – the equivalent of £39,000 a year. A quarter gave a figure that was too low by more than £507 per week, the equivalent of

£26,000 a year. Three in 10 people admitted that they simply did not know the weekly cost of a care home with nursing in their region, while only one in seven people (15%) got the answer right or overestimated the cost. Londoners had the most unrealistic expectations overall, underestimating the cost of care

in a care home with nursing by an average of £540 a week – the equivalent of £28,080 a year. People in the East Midlands were the closest to giving an accurate figure, underestimating the true cost of care at £721 a week – just £74 short of the real figure. But this was still the equivalent of a £3,848 a year shortfall.

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What a no-deal Brexit would mean for social care

Markel 3rd Sector Care Awards finalists 2018

Care England has submitted evidence to the Health and Social Care Select Committee’s inquiry into the impact of a ‘no deal Brexit’ on health and social care. The impact largely has to do with recruitment and retention, an area in social care which can already prove difficult to get right and have long term successes in. Professor Martin Green OBE, Chief Executive of Care England says, ‘The prospect of a no deal Brexit only accentuates the fragility within the social care sector. ‘It magnifies potential uncertainties in the recruitment and retention of foreign workers upon which many independent community care providers depend. ‘Currently the sector includes 233,000 employees that have a foreign nationality. With vacancy rates running at around 90,000

The Markel 3rd Sector Care Awards finalists have been announced, with a selection of nominees from a range of voluntary sector care providers. Recognising achievements in a range of settings, the Markel 3rd Sector Care Awards uncovers the person, care provider or community group that is going above and beyond on a daily basis. Hosted by Dame Esther

at any one time, this dependency is significantly important to the sustainability of the sector – particularly as it is predicted that by 2035 an extra 650,000 social care jobs will be required to keep pace with rising demand.’ Care England has recently produced a briefing for its members regarding Brexit. The main focus is the recruitment and retention of foreign workers, including registered nurses, with particular reference to areas of the country that may be most at risk. For example, in the South East of England, 23% of the social care workforce is non-British, with regional unemployment at 3.7%. This is compared with the picture in the North East of England, which has only a 4% dependency on non-British social care workers and has an unemployment rate of 4.4%.

Rantzen and her daughter, Rebecca Wilcox, this year’s ceremony will take place on Friday 7th December at the London Marriott Hotel, Grosvenor Square. As well as announcing the well-deserved winners, there will be a three-course lunch and entertainment to capture the spirit of the day. A full list of finalists can be found on the CMM website.

Crown Care Group Crown Care is set to add to its portfolio by opening a state of the art care home, with support from Yorkshire Bank. The £4m in funding will assist with the development of a luxury 78-bed care home, due to open in Hucknall in 2019, designed to accommodate those living with dementia. The home will create a minimum of 40 full-time jobs, plus

a further 20 roles once the site is fully operational. Crown Care currently operates 14 care homes across the North East and Yorkshire. It is undertaking an ambitious expansion plan, involving investment in excess of £115m to create care villages and care homes across the UK, providing 700 jobs in the process.

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The Homecare Deficit 2018 A report from the United Kingdom Homecare Association (UKHCA), The Homecare Deficit 2018, suggests that councils in Great Britain and Northern Ireland’s Health and Social Care Trusts are continuing to exploit their purchasing power. The report's author claims that, 'Councils are buying homecare services for older people on the

cheap'. The Homecare Deficit 2018 exposes the scale of underfunding of a fragile state-funded sector across each of England’s nine government regions and in Wales, Scotland and Northern Ireland. Using data obtained under Freedom of Information legislation, UKHCA found the average price paid for homecare in the UK is

£16.12 per hour, almost £2 per hour less than UKHCA’s Minimum Price for Homecare of £18.01 per hour. UKHCA calculates that the UK’s homecare sector needs at least £402m per year to ensure that homecare workers receive the statutory National Living Wage, while also ensuring that homecare providers can meet their statutory obligations.

However, the size of the deficit this year would be £921m if national governments and local councils were to commit to raising the status of the homecare workforce to at least the independently calculated Real Living Wage. Neither of these figures account for the additional costs of people currently going without care and support.

expenditure (£14bn) was spent on long-term care (residential, nursing or community care), an increase of £369m or 2.7% on 2016/17 (£13.6bn). • Overall, the number of people receiving long-term care provided or arranged by local authorities has decreased each year since 2015-16, down 14,750 (1.7%) to 857,770 in 2017-18. The number of 18-64 year olds in receipt of long-term support has increased for the second year in

a row, up 7,360 (2.6%) to 292,380 since 2015-16, while the numbers of 65 and over in receipt of long-term support has fallen for the second year in a row, down 22,110 (3.8%) to 565,385 since 2015-16. • 58.6% of all people receiving long-term support are female. This increases further for those supported in a care home (61.9%) and further still when considering those in a care home with nursing (63.4%).

Requests for adult social care A report from NHS Digital has revealed that local authorities receive 5,100 new requests for adult social care assistance every day. The new figures from Adult Social Care Activity and Finance, England 2017-18 show that local authorities received 1.8m new requests for adult social care support in 2017-18, an increase of 1.6% on 2016-17. These requests were received from 1.3 million people; those

aged 65 and over accounted for 71.6% of the requests. Similar to previous years, 77.1% of the requests originated from the community and 20.1% originated from a discharge from hospital. Other findings in the report include: • Gross current expenditure by local authorities on adult social care was £17.9bn in 2017-18, an increase of £0.4bn or 2.3% in cash terms on 2016-17 (£17.5bn). • 77.9% of total gross current

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Government loneliness strategy

Interface between health and social care

The Prime Minister has launched the first cross-Government strategy to tackle loneliness, and has confirmed all GPs in England will be able to refer patients experiencing loneliness to community activities and voluntary services by 2023. The practice, known as ‘social prescribing’, will allow GPs to direct patients to community workers offering tailored support to help people improve their health and wellbeing, instead of defaulting to medicine. As part of the long-term plan for the NHS, funding will be provided to connect patients to a variety of activities, such as cookery classes, walking clubs and art groups, reducing demand on the NHS and improving patients’ quality of life. Up to a fifth of all UK adults feel lonely most or all of the time and with evidence showing

The Public Accounts Committee has published its report into the integration of health and social care. Interface between health and social care says that Government ‘lacks an effective overall strategy or plan to achieve its long-held aim to integrate these two sectors’. It recommends: • The government should set out a costed 10-year plan for social care to go alongside its 10-year plan for the NHS. • The Department of Health and Social Care (DHSC) and the Ministry of Housing, Communities and Local Government should ensure their 10-year plans and the green paper address the challenges of fragmented funding and separate means-testing, including consideration of any legislative change needed. • NHS England should set out how it will support the national rollout of new care models, including

loneliness can be as bad for health as obesity or smoking, the Prime Minister has also announced the first ever ‘Employer Pledge’ to tackle loneliness issues in the workplace. Government will also partner with the Royal Mail on a new scheme in Liverpool, New Malden and Whitby which will see postal workers check up on lonely people as part of their usual delivery rounds. Postal workers will be speaking with isolated people to help link them up with support from families or communities if required. The Prime Minister also confirmed £1.8m to increase the number of community spaces available – the funding will be used to transform underutilised areas, such as creating new community cafes, art spaces or gardens.

specialist healthcare business agents

how it will accelerate slow uptake. • The DHSC, Ministry and NHS England should set out how accountability will work under a new integrated care system, and how the public can find out about the progress and performance of health and social care locally. • The DHSC, Ministry and NHS England should write to the Committee by December 2018 to set out how they will develop and support local leadership consistently. • DHSC should ensure its workforce plan addresses the previous criticisms made by the Committee and make sure it tackles the barriers between health and social care, particularly disparity in pay and conditions and the transfer of pension arrangements. Professor Martin Green OBE shares his thoughts on the future of integration in his article on page 20.

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NEWS / IN FOCUS

Capacity to deliver social care A quarterly survey of council leaders and chief executives has revealed a steep decline in the capacity of councils to deliver social care. The New Local Government Network Leadership Index found that since March, the confidence of council leadership that they have sufficient powers and resources to deliver social care for adults has fallen by 21%. This figure is taken from the 150 councils responsible for delivering social care. 57% of council leaderships identified cuts to central

government funding as the main cause of their financial problems, while 31% also identified the rise in demand for social care – both adults and children – as the cause. To tackle these financial pressures, 97% of respondents are planning to increase Council Tax from March 2019. The survey also found that 46% of council leaderships expect adult social care costs to rise more than any other local public service if a deal is not struck with the EU prior to Brexit.

Westgate Healthcare Westgate Healthcare has expanded its portfolio with the opening of Riverdale Care Home, a 32-bed property in Essex. The development has been supported

by Clydesdale Bank and has been designed with features including a sensory garden, potting shed, spa salon, cinema room, fine dining room and café.

Talking to patients about dying The Royal College of Physicians (RCP) latest report, Talking about dying: How to begin honest conversations about what lies ahead, explores the reasons that doctors and other healthcare professionals find it hard to talk to patients about dying. Based on conversations with doctors, patients, carers and medical organisations, the report reveals the barriers that stand in the way and offers solutions and resources to help. Barriers include: • Culture – Some physicians felt that death could be perceived as a failure and that modern medicine is expected to cure all ailments. However, the evidence from patients and carers is that many people do want to talk about death and planning helps patients feel more empowered about care and decision making. • Confidence – From medical students to consultants, there were many doctors who felt uncomfortable initiating conversations about the future with patients; medical students and junior doctors had little practice with real patients; training doesn’t prioritise the

‘soft’ skills needed; and diagnostic uncertainty was often an issue. • Practicalities – Confusion over whether hospital doctors or the patient’s GP should be having the conversation; reluctance to begin conversations when the doctor was not going to be responsible for the patient’s care going forward; workforce pressures; lack of privacy; lack of prioritised clinic or ward time to have the conversations; and the challenges of being sensitive to different cultural and religious beliefs. One of the major issues identified is that professionals need to begin conversations about planning for end-of-life care nearer the time that patients are given a terminal diagnosis, as early conversations allow patients choice and control over the remainder of their lives. The evidence shows that patients who have had these conversations and have end-oflife care plans put in place have a better experience than those for whom the conversations come in the final days or hours of life when they can seem unexpected to patients and carers.

IN FOCUS Social care’s post-Brexit workforce WHAT’S THE STORY?

A report has been published examining the potential state of the health and social care workforce after Brexit. Commissioned by the Cavendish Coalition, Brexit and the Health and Social Care Workforce in the UK – put together by the National Institute of Economic and Social Research (NIESR) – highlights the increasingly crucial role European Economic Area nationals are playing in UK social care services.

WHAT DID THE REPORT FIND?

The NIESR report forecasts a potential shortfall of around 5,000 to 10,000 nurses in the NHS in England by 2021. That is on top of existing vacancies, which stood at 41,722 (11.8%) at the end of June. Between 2011 and 2016, the number of European Economic Area nationals employed in social care grew by 68%, or 30,600 people. There were 42,000 registered nurses working in adult social care in England in 2017, with almost a third of registered nurses (32.4%) estimated to have left their role within the past 12 months, meaning a vacancy rate of 12.3%, equivalent to around 5,000 vacancies. While it is anticipated there will be provision for doctors and nurses coming to the UK after Brexit, if Government follows the guidance of this autumn’s Migration Advisory Committee report, as it has indicated it will, there could be particularly significant implications for social care's workforce after Brexit. The

sector relies on lower-paid colleagues who would be effectively cut off by a salary threshold of £30,000 and with no special allowance like that recommended for seasonal agricultural workers. The Cavendish Coalition is warning that the future immigration system must enable the health and social care system to continue to attract the brightest and best from the EU and the rest of the world.

WHAT ARE THE RECOMMENDATIONS?

The report recommends that any future immigration system needs to be uncomplicated, transparent and cost effective for applicants. It also suggests that the system should be responsive to the changing health needs of the population. As well as this, NIESR says in the report that the UK and devolved governments must review their workforce planning approaches across the social care sector, incorporating international recruitment into the costed strategy. The report also notes that, while all levels of Government should work together to review career routes within social care, the Home Office in particular should guarantee that its settled status programme for EU nationals will be honoured in the event of a no-deal Brexit. Lastly, Brexit and the Health and Social Care Workforce in the UK states that professional regulators should frequently review their processes for registering international professionals. CMM December 2018

NEWS

Final consumer law advice

Cuts to council-funded care

Following a public consultation and feedback from the industry, the Competition and Markets Authority (CMA) is publishing its final advice for care homes on their responsibilities and obligations under consumer law. This includes advice on what upfront information care homes must give to prospective residents and their families when they are making a decision about which care home to move into, as well as when to give this information and how. It also covers other areas where care homes need to be compliant, including how they

The Care and Support Alliance (CSA) has found that more than a quarter (29%) of disabled 18 to 64-year-olds who rely on council funding have had their care cut over the last year. Respondents to the survey often reported that there had been no change in their needs and the CSA is suggesting that disabled people’s legal rights to care are being breached. In the most worrying cases, people’s health, safety and wellbeing was being jeopardised as a result. An estimated £6.3bn has been taken out of adult social care in real terms since 2010 and overall council budgets were cut by 49% in real terms over the same period. Meanwhile, need has steadily increased because of a rise in the numbers of older and disabled people, creating an ever bigger gap between the demand for and supply of care. It would

handle complaints and the use of certain terms and conditions that are likely to be unfair. This latest publication incorporates CMA’s advice for care homes on charging fees after death, which it consulted on separately and published earlier this year. To help care home providers digest the full advice, CMA is also publishing a short introductory guide that summarises the key points they need to know, as well as short advice for residents on what their rights are. All of this information is available on the CMA website.

Studley care home investment Runwood Homes Senior Living has invested £6m to rebuild former Warwickshire County Council owned care home, Four Acres, turning it into a modernised and

expanded version of the former home. The home has 66 beds and supports older people, including those living with dementia.

not be surprising therefore if cash strapped councils had been forced down a path of restricting the care they provide – but any such move would be in clear breach of the law under The Care Act and in defiance of disabled people’s rights, says CSA. In 2017, CSA research showed that the majority of professionals who undertake care assessments felt that their managers expected them to reduce the help on offer to people in need of social care. Social workers also revealed their experiences, with one saying, ‘We are being encouraged to write care plans that do not include any form of social interaction’, and another saying, ‘The view within the council is that only 20% of all those assessed should be receiving formalised care packages from the local authority and that 80% should only receive information and advice.’

Delivering home adaptations

Effective complaints processes

A report from the Centre for Ageing Better, Adapting for ageing, jointly published with Care and Repair England, identifies examples of good practice on providing life-changing adaptations in the home. The report reveals innovative approaches and calls for other councils and service providers to learn from it. Examples include proactively raising awareness of available support and how to access it, delivering home adaptations quickly and without means-testing, linking adaptation services with vital home improvements and working with handyperson services. More than 90% of people over the age of 65 live in mainstream housing, rather than specialist

As part of Voluntary Organisations Disability Group’s (VODG’s) commitment to the NHS England Ask, Listen, Do campaign, the body for disability organisations is hosting a roundtable on the importance of listening to and acting on the views of the people they support. It says an effective complaints system not only allows people

retirement accommodation. Only 7% of UK homes meet basic national accessibility requirements. As older people increasingly want to stay in their own homes for as long as possible, it is clear that something needs to be done to enable this. The report highlights the benefits of a proactive, preventionfocused approach to providing adaptations in older people's homes, while improving the information and advice offered on the options available. Previous research shows that investment in adaptations is highly costeffective, helping to improve wellbeing, keep people out of hospital, prevent or delay moves into residential care, and reduce the need for carers.

Octopus Healthcare Octopus Healthcare, part of the Octopus Group and leading investor in healthcare facilities throughout the UK and Ireland, has announced Sefton Council’s 18

CMM December 2018

approval of a major redevelopment of the former Birkdale School for Hearing Impaired Children in Southport into an extra care accommodation site.

to feel valued and listened to, it can also improve outcomes and bring about positive change. The NHS England initiative encourages providers of health, social care and education services to learn from and improve the experience of people with learning disabilities, autism or both and family carers when they give feedback, raise a concern or make a complaint.

Call for better products for older people Minister of State for Care, Caroline Dinenage has called on businesses to develop more products and services that meet the needs and aspirations of older people. The Minister said more inclusive, innovative and attractive products should play an important role in helping people to remain healthy, active and independent for longer, whilst also offering opportunities for growth to businesses. These could be anything from home appliances like eye-level ovens

and walk-in showers, to the use of new technologies such as AI and robotics – for example, Amazon Alexa is being used in some cases as a memory aid. Much of the support equipment currently marketed to older age groups, such as grab rails, ramps and bathing aids, is unattractive and clinical-looking, which research shows can put people off making vital changes to their homes that would keep them safe and living independently.

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INTEGRATION: a

possibility or a pipe dream?

Integration is a hot topic, and has been for some time. Organisations across the sector are doing what they can to work more closely with health partners and thereâ&#x20AC;&#x2122;s pilots-a-plenty experimenting with how health and social care can support each other. But without real action from the top, does integration stand a chance? Professor Martin Green OBE shares his thoughts on whether this system change is achievable in the current market.

CMM December 2018

Over the past few years, there has been a concerted attempt to talk about integration. Recently, this culminated in the Department of Health becoming the Department of Health and Social Care, but sadly we have discovered a change of name does not deliver an integrated system. We need to examine to what extent all the rhetoric about integration has been translated into practice. In relation to the Department of Health and Social Care, the evidence is clear. They may have changed their name, but they have certainly not changed their spots. Since the announcement of a new title on the headed paper, we have seen the old practices rear their heads. Several announcements have been made of huge amounts of money being offered to support the NHS, while social care received the announcement that the Green Paper was to be postponed. A few weeks ago, we had a ‘crumb from the table’ of an extra £241m for social care, but only on the condition that we can help the NHS deal with the self-induced delayed transfer of care crisis.

THE HOSPITAL ISSUE It was very interesting to watch the BBC documentary, Hospital, about the Queen’s Medical Centre in Nottingham, which was dealing with significant issues around delayed discharge. In the programme, they never once reached out to residential care providers to see what they could deliver. Incidentally, Nottingham champions itself as a beacon of integration, but the documentary clearly showed that there was no sense of what could be delivered outside the NHS that could solve the problem. Finally, there was a scene where the

CMM December 2018

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INTEGRATION: A POSSIBILITY OR A PIPE DREAM?

room was packed with expensive managers, one of whom hung their head in their hands and issued the words, ‘We might even have to bring in the private sector’. There was little evidence of an approach to integration in that hospital, only a focus on dogma and organisational myopia. One of the major problems which faces the NHS, is that its staff are often so blinkered that they think the only solution to anything is an NHS service, or more taxpayers’ money going into existing services.

MAKING IT PERSONCENTRED Whenever I go to events and meetings that are about integration, there is much talk about organisations, systems, local authorities and very occasionally a word about the providers who deliver care, but I think this completely misses the point. True integration has nothing to do with organisations and systems, but it should be judged by the experience of people who use services. The problem with our current approach to integration is that it is always defined by organisational goals and it is as if the organisation, rather than the citizen, is the objective. The attempt to deliver integrated services is a very well-worn path, and I am old enough to remember many abortive attempts at integration. We had local and health authorities delivering joint appointments, in the expectation that this would deliver better outcomes, more efficiencies and seamless services. There was also a move towards co-location of services, with the expectation that this would deliver better communication and more integrated outcomes. However, this too failed to live up to its anticipated success because, once participating organisations faced funding challenges, they retreated into their silos, rather than crafting an integrated and joint solution that would have been better for citizens and delivered more positive outcomes and efficiencies. It is my view that we need to re-claim the word integration and set it firmly in the context of the experience of people

who use services.

LEARNING FROM OTHERS There are many examples of services which are delivered by a range of different organisations, yet are completely seamless when it comes to the experience of the customer. The airline industry is a really good example of this. I do not know when I leave Austrian airspace and go into German airspace, despite the fact that there is an enormous technical and managerial shift going on behind the scenes. What I experience is a flight from A to B, and I neither know, nor care, who is doing what in the background. The experience of the citizen has to be the ‘holy grail’ of an integrated service,

of some obsolete services, as well as a massive cultural change in the NHS and social care.

WHAT ABOUT THE POLITICIANS? We are seeing a number of areas, such as Greater Manchester, attempting new approaches to integrated services across their respective cities. What is interesting to note is that, in all the discussions about reconfiguration and joint working, one area has been left completely untouched, and that is the local politicians. It is frankly ridiculous to have layer after layer of local politicians who do not have the same outcome measures. We see it in London with local authorities,

“True integration has nothing to do with organisations and systems, but it should be judged by the experience of people who use services.” and we must judge every service’s success not on its structure, or whether it is public, private or voluntary, but solely on its outcomes. If we were really going to deliver integration, we would align the success measures of the whole system, focus them on the experience of the person who uses the service and, I think, we need to start using three high-level measures for success. The first measure should be person experience; the second should focus on the outcomes that are achieved; and for the third I think we need to question whether we are using our resources, both financial and human, in the most effective way. To ensure we have a truly and wholly integrated service, we would inevitably have to start thinking differently across the whole of both sectors, and this would require some re-configuration of the current system and the decommissioning

CCGs and the London Assembly, all working to different outcome measures and often in conflict with one another. We need to align these measures so that everyone is working together, towards the same goals.

RHETORIC OR REALITY? I do not believe that this rhetoric about integration will be delivered. What we will see is what we have always seen: tinkering around the edges, changes to the headed paper, endless amounts of money spent to move staff from one employer to the other. And in the midst of it all, citizens getting fragmented and un-co-ordinated services from two systems that work on hugely different resource levels, completely disconnected outcome measures, and have no operational plan that will turn rhetoric to reality. CMM

Professor Martin Green OBE is Chief Executive of Care England. Email: MGreen@careengland.org.uk Twitter: @ProfMartinGreen What are your thoughts on integration? Do you agree with Martin that much more needs to be done before it can be considered possible? Share your thoughts and experiences on the CMM website where you can also feed-back on this article www.caremanagementmatters.co.uk CMM December 2018

Good luck! With your next CQC inspection!

Gordons Solicitors wish all CMM readers a very Merry Christmas and a Happy New Year!

neil@gordonsols.co.uk | 01483 451900 | www.gordonsols.co.uk

KEY CHANGES TO CQC REGULATION: are we losing sight of the basics? The way in which the Care Quality Commission (CQC) regulates providers is constantly evolving. While some of the changes follow on from consultation with the sector, others are introduced without any public scrutiny. At most, they may have been raised at meetings with the various trade associations. Neil Grant from Gordons highlights some of the key changes of policy and approach that increasingly define how CQC regulates the sector.

I am concerned that there appears to be a growing tendency within CQC to change the way it registers and regulates the sector by introducing new guidance or revising existing guidance without due regard to the statutory framework or the need for proper consultation. The risk of this is that CQC comes to make up its own rules without proper accountability, either by way of parliamentary scrutiny or public consultation, potentially leading to arbitrary decision-making.

CMM December 2018

KEY CHANGES TO CQC REGULATION: ARE WE LOSING SIGHT OF THE BASICS?

THE NEW RATINGS LIMITER

CQC has a number of rules that limit the rating that can apply at overall provider level or at key question level to adult social care services. The original overall provider level rating limiter, linked to compliance, came out in October 2014 when ratings were first introduced for adult social care. It stated that, ‘the overall rating for a service would not normally be better than ‘requires improvement’ if enforcement action is being taken.’ In January 2017, the internal CQC guidance for inspection staff was strengthened with the inclusion of a new limiter, which stated, ‘In addition, the overall rating of a service cannot normally be better than ‘requires improvement’ if there is a breach of regulations’ and this is included in the latest internal CQC guidance document, Inspection guidance – judgements and ratings. Inspectors are required to follow CQC’s inspection methodology in the interests of consistency. This new limiter was never the subject of any formal consultation exercise and it is only being applied to adult social care services, not the NHS or GP practices. However, the main problem is that this ratings limiter appears to be being applied in a blunt and arbitrary manner, with no regard to proportionality or professional judgement. As an example, CQC inspected a care home and awarded ‘good’ ratings for safe, effective, caring and responsive. The inspection report commented that the service remained well-led but awarded ‘requires improvement’ for that key question because of a failure to display the previous rating on the provider’s website. The provider had, however, displayed the old rating in the entrance to the home, so the omission was not willful but still amounted to a breach of regulations. Ordinarily, four ‘goods’ and a ‘requires improvement’ would generate an overall rating of ‘good’, but here, because there was a breach of regulation, the overall rating was downgraded to ‘requires improvement’. This was a simple error, capable of easy and 26

CMM December 2018

swift resolution. It was completely disproportionate and unreasonable to describe this highly-successful service as requiring improvement and the inspector should have been allowed to exercise professional judgement rather than be bound by

“It would be better for CQC to abandon this ratings limiter and allow inspectors to exercise professional judgment.”

a strict rule of this nature. The other area causing services that otherwise would be ‘good’ overall to be downgraded is in relation to failures to notify CQC of incidents or authorisations of Deprivations of Liberty. A service may be ‘good’ across four key questions, but if a couple of notifications are not sent to CQC, it will be rated as overall requires improvement. The above points are in no way intended to minimise the importance of displaying ratings or making the necessary notifications to CQC, but are made to highlight the importance of putting such matters in context. It would be better for CQC to abandon this ratings limiter and allow inspectors to exercise professional judgment. It is also unfair to apply it to adult social care but not the NHS or GP practices. Ironically, although CQC adopted the Ofsted ratings model, the latter applies far greater flexibility in how it awards good ratings. Ofsted may identify compliance issues but still rate a service as ‘good’ if, overall, it is performing to that standard. This issue is all the more important given that CQC is going to be increasing its focus

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KEY CHANGES TO CQC REGULATION: ARE WE LOSING SIGHT OF THE BASICS?

on services that are repeatedly rated ‘requires improvement’.

COMPLIANCE CONDITIONS When taking enforcement action against NHS hospitals, CQC has often had to regulate using conditions of registration or warning notices, as it is not feasible to deploy cancellation or suspension powers on them. However, regulation via ‘compliance’ or ‘positive’ conditions is now increasingly being used in the adult social care arena. An example of a compliance condition that has become quite common is one that requires the registered person to undertake monthly care planning reviews on all the service users, with a monthly report to CQC on the outcomes of the reviews and any changes made to care plans. Such a condition can be unduly onerous on a service and is likely to take the manager off the floor to carry out this work, given the obvious fear that a breach of a condition, without reasonable excuse, is a statutory offence with an unlimited fine. CQC will say that conditions should not performancemanage a provider or manager, so why are conditions being deployed in this way, in the first place? I have argued successfully that, on legal and factual grounds, such conditions should not be imposed and that a more proportionate approach could be available. For example, CQC could ask the provider to voluntarily supply reasonable amounts of information or it can request information under sections 64 and 65 of the Health and Social Care Act 2008. A further weakness in CQC’s use of compliance conditions is that they are taken from CQC’s ‘Conditions Bank’ so standard wording is being used which may not cover the situation in a particular service. Furthermore, there can be issues about the clarity of compliance conditions and whether they are reasonably achievable. CQC says

that conditions must not include reference to the date when the condition will take effect or the length of time for which it will continue to have effect. This calls into question the reasonableness of the condition. Its duration should be clear; it should not be open-ended.

DEFINITION OF A PROVIDER Finally, there is one major change in the offing. Currently, CQC regulates organisations that directly provide the service to the client. However, it has indicated that it wants to register and inspect any related organisations that may direct and/or control systems of care, such as parent companies and care management companies. CQC says it doesn’t need a change to legislation to register these associated organisations – it is enough for it to apply a new interpretation to ‘carrying on a regulated activity’ and widen the scope of provider registration. As I set out in my article, Cats, Dogs and CQC registration, which is available on the CMM website, I believe that if CQC wants to widen the definition of a provider, it should lobby the Government with clear reasons as to why it is necessary, as such an important change should be introduced via legislation. After all, CQC is not a lawmaker. There is a hint that CQC is starting to listen to the sector on this particular issue. The latest I have heard is that CQC is planning to go back to first principles as part of a broader piece of work looking at future provider assessment. It is hoped that that there will be a far greater degree of engagement with the sector on any future proposals than has so far been the case and that it will seek legislative change if it wishes to widen the scope of registration.

OPERATING WITHIN OBLIGATIONS CQC carries out an essential public

function and much of its work is of a commendable standard. However, it needs to ensure that it operates in accordance with its statutory duties and obligations at all times. Ratings decisions should be reasonable and proportionate, and CQC needs to move away from applying rules in a blanket fashion without regard to the facts and circumstances of the case. My main fear is that it will lose sight of the importance of getting the basics right, namely registration, inspection, compliance and enforcement. Only time will tell, and I wish the new Chief Executive, Ian Trenholm, every success in his stewardship of the inspectorate. CMM

Neil Grant is Partner at Gordons Partnership LLP. Email: neil@gordonsols.co.uk What do you think of CQC’s changes to the way it inspects and regulates services? Does there need to be more legislation around CQC’s powers? Share your thoughts on the CMM website and feed-back on this feature www.caremanagementmatters.co.uk CMM December 2018

STEPPING DOWN – SUPPORTING PEOPLE BACK INTO THEIR COMMUNITY Supporting adults with learning disabilities to have equal opportunities, understand their rights and be in control of their own lives is on everyone’s agenda. But for individuals, providers and families, it can be hard to know whether someone is ready to move back into the community. As a potential solution, Heathcotes is using ‘Pods’ as a step-down service from their care homes. Heathcotes operates a number of residential services for people with learning disabilities. Many of these homes have large gardens that often go partly unused. Some of these gardens have been fenced-off to create a more manageable space, but the organisation had long been looking for a solution to make these areas into practical, usable parts of the service.

USING UNUSED SPACE The idea for the Pods came about when a remote office was required at one of the care homes. The only space available to build this was in a corner of the garden. Heathcotes worked with architects to design a building that suited the garden setting without making it look spoilt, but which was also practical and functional. The outcome was a success, with an office that suited the service’s needs. It occurred to Heathcotes at this point that the design they’d used could be adapted to provide living accommodation in the unused garden spaces, and the concept for the Pods was born.

WHAT IS A POD? Pods are designed as independent living spaces, where residents who are thinking of moving back into the community can live for a time until they are confident about managing outside of the home. The Pods enable Heathcotes 30

CMM December 2018

to provide a full care pathway and are used as a stepping stone to enable further independence. The resident is still a part of the home and has as much support as required, but lives in the Pod which has its own bedroom, bathroom, living space and kitchen. The person is then supported to build their independent living skills in this environment while they prepare to move into the community. The Pods are either registered as supported living or as a variation on the home’s original registration, depending on the commissioning need in the local area. The idea is that the amount of support the person receives and the amount of time they live in the Pod for can vary according to each individual’s needs. For some, this can be intense support, lowered over a period of time; for others, this may be minimal support before furthering their independence.

EXPANDING QUICKLY Seeing the potential in the project, Heathcotes conducted a full assessment of all its garden spaces to identify where Pods could be matched with a need for this type of accommodation. It has now begun to build them across those services in which they can be used. One Pod has been completed and is currently in use and another three are already under development.

Heathcotes is also working with operational teams, families and external professionals, including social workers, commissioners and community nurses, to identify individual service users who may benefit from the Pods setting. This will only include people whose long-term goal it is to step down into the community. Individuals for whom it is suitable and appealing will be supported through transition from the current service into the Pods and will likely live there on a time-limited basis. Where possible, Heathcotes is aiming for individuals in a service to move into a Pod on the same site, or at a nearby service, to allow familiarity with staff and the local area to continue. So far, the project has been smooth-sailing. There have not been any issues with planning permission to date and staff, service users and families have all been receptive to the initiative.

OUTCOMES The Pods are still in their very early stages, with one individual currently residing in the first Pod, but they are seeing positive results. Rebecca Wright, Senior Commissioning Manager at Heathcotes said, ‘The service user currently residing in the Pod has settled in very well and has continued to build on independent living skills whilst still benefiting from the social aspect of living in

the home, with the Pod being in close proximity of the residential service.’ Rebecca went on to comment on the outcomes they have seen in this case, saying, ‘This has been a very positive step which has been evidenced by a significant reduction in previous behaviours. For this individual, living in the Pod has had a notable positive impact on their self-confidence, independence skills, drive, determination and their general happiness and wellbeing.’

FUTURE ASPIRATIONS Although it is a new project, Heathcotes has established the outcomes it is hoping to see overall from the use of Pods. The organisation is anticipating that people will leave their services with increased independent living skills and that people who are using the Pods can be supported in a less restrictive setting. Heathcotes is also hoping that the Pods will support people to live happy and meaningful lives as independently as they are able. CMM

OVER TO THE EXPERTS... What are the potential risks and barriers with this project? Is it replicable and can the outcomes already seen be reflected elsewhere? How can the project be developed to support more people?

JUMP THE EXTRA STEP What strikes me about this project is, who would really choose to live in a temporary structure in the garden of a residential service? And why? Faced with the opportunity of space and resources, you have to ask who the Pod idea is really serving? Heathcotes’ Pod initiative seems to talk about separation and segregation as acceptable norms. Worryingly, Heathcotes suggests the Pods are only for those who are thinking about moving back into the community. Who is commissioning Heathcotes services to keep people out of communities? What is society missing out on because of their exclusion? Everyone has potential for connection, contribution and control – relationships, work and real lives. The focus of the Pod claims to be on building towards independent living skills and a transition to where people actually

A GREAT AND INNOVATIVE INITIATIVE want to be. Why not jump the extra step (after all, change is hard) and go straight to what people want? Why not support people to consider what’s important to them, where they would like to be, what skills, attributes and personalities they would like to see in their staff team and build a home and support around what someone wants, rather than what is available? There remains real concern about the emergence of on-site supported living services. They risk taking the same approaches of residential institutions and hospitals, but with reduced regulation and regulatory oversight. There is a real danger that people will be ‘placed’ temporarily to build skills or independence but will never move on. As the saying goes, ‘a house is not a home’. A shed in the garden is not independent living.

Jill Corbyn Development Lead – Learning Disabilities, NDTi

The barriers for any project will always be funding and support of the local funding bodies, local authority and clinical commissioning groups, which, in my experience, will often believe they can deliver cheaper care – and more effectively. However, we know that they are too disjointed to offer a full continuing support solution. The Pods are a great and innovative initiative to promote independence in the learning disability community and offer a one stop support solution, including for young people going through transition. In my experience at The GROW Project, the smallest change in circumstances can be enormously difficult for someone with a learning disability. The outcomes of the Pods can only be achieved if the correct level of support is provided, which of course would come at a cost.

The GROW Project has been successful in providing members with opportunities that promote independence, but the support required is too costly for funding and therefore can result in a loss of choice and opportunity. Whilst the Pods would work for those that are able to be more independent, my concern would be the outside world once the person has left the relative ‘safety net’ of the pod. There is no question that the Pod initiative will work for the majority, and independent living could be achieved; the failing would be in the community, where people are often ignorant to inclusion, and support requirements rather than promotion of equality. Maybe the way forward is Pod villages, offering a safe environment to people who have the ability and desire to live independently.

Maria Harris Owner, The GROW Project

ARE THEY NECESSARY FOR THE INDIVIDUAL? Pathways to independence can be difficult to construct and must be tailored to the individual to give them the best possible prospects for leading a full, independent life centred on choice and control. There are so many variables, not least the property markets in which the ideal homes for people who need support must be found. It can be incredibly difficult to help someone secure the home that they want and need, and any new property options must be welcomed. The challenge is to make sure that each individual gets to the right living environment for them. Temporary/staged moves may be right for some people but not for others and greater ambition for the person is almost invariably rewarded. However, it is hard to give a really robust response to Pods without knowing more about the model. For example, I want

to know if the Pods come with different fundamentals, such as a fresh staff team, positive behaviour support or changed approaches to communication and family engagement. And what’s the policy on restraint? If Pods are to be used carefully and conscientiously as part of a constructed pathway on a temporary basis where someone can see their next step, then they may prove to be an innovative use of suitable land and building technology. However, my real question would be whether they are necessary for the individual. The risk with such devices is that they become the norm and another step in an already complicated, protracted pathway that, for many, could be sidestepped in order that community living can be achieved.

Steph Thompson Managing Director, Waymarks and Director, Dimensions CMM December 2018

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