Care Management Matters COVID-19 Special Edition July 2020 by Care Choices Ltd

SPECIAL EDITION JULY 2020

www.caremanagementmatters.co.uk

LEADING THROUGH CRISIS

What are the qualities you need?

Continual development

Keeping the workforce current

Changing the past

What if weâ&#x20AC;&#x2122;d reformed social care?

Government update

Helen Whately shares where we have got to

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In this issue REGULARS From the Editor

Inside CQC Debbie Ivanova, Deputy Chief Inspector of Adult Social Care looks at data collected by the regulator around people with learning disabilities.

CMM News

FEATURES 14

Leadership through a crisis Rob Coulthard from Judgement Index examines the qualities of a strong leader, and how leadership should and can be adapted to support staff and services through a crisis.

Making ends meet: Short-term funding support A huge part of coronavirus’ impact on the care sector has been financial, but opportunities for short-term financial support are available. Jeremy Huband from HSBC UK shares details of what these are.

Adapting to change: Supporting the social care workforce Oonagh Smyth of Skills for Care details the work they’ve been doing to ensure training and development doesn’t take a backseat during this pandemic, including how resources can still be accessed.

What if…? A different social care What would have happened if we’d come into coronavirus having tackled social care reform years ago? What might have made a difference? John Kennedy asks, what if?

Engagement, activity and social distancing The benefits of people engaging in activities are welldocumented, but social distancing and lockdown have limited our options. Hilary Woodhead offers ideas and insight into activities that even isolated people can take part in.

Where we’ve got to: Government’s response to COVID-19 so far Helen Whately, Minister of State for Care gives us a round-up of what the Government has put in place so far to support social care providers, and how it plans to tackle the future.

Reflections on management during COVID-19 As the sector comes to terms with its new ways of working, space for reflection opens up. Raina Summerson, Chief Executive of Agincare, looks back on how far we’ve come and what we need for the future.

A changing landscape for digital solutions in social care Digital has never been so vital or widespread in social care. Daniel Casson from Care England looks at the rapid uptake of digital tools during COVID-19 and suggests how this could impact the next few years.

CMM July 2020

EDITORIAL editor@caremanagementmatters.co.uk Editor: Angharad Burnham Content Editor: Emma Cooper

CONTRIBUTORS

PRODUCTION Lead Designer: Ruth Clarry 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 Assistant Advertising Manager: Aaron Barber aaron.barber@carechoices.co.uk Director of Sales: David Werthmann david.werthmann@carechoices.co.uk

@CQCProf

@judgementindex

@HSBCUKBusiness

@oonaghsmyth

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

Rob Coulthard Managing Director, Judgement Index UK Ltd

Jeremy Huband Head of Healthcare – UK Corporate Banking, HSBC UK

Oonagh Smyth Chief Executive, Skills for Care

@JohnnyCosmos

@HilaryWoodhead

@Helen_Whately

@Agincare

John Kennedy Independent Social Care Consultant

Hilary Woodhead Executive Director, National Activity Providers Association

Helen Whately Minister of State (Minister for Care), Department of Health and Social Care

Raina Summerson Group Chief Executive, Agincare

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 2020 CCL REF NO: CMM 17.5

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CMM July 2020

Daniel Casson Digital Development Executive, Care England

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From the Editor After months of work to keep people as safe and well as possible, it is finally starting to feel like things are beginning to slow down. For many, this has been a trying time of rapidly implementing new policies, keeping staff levels up, and anticipating what lies around the corner, and that isn’t about to change. But a sort of settling seems to have occurred for some, getting used to a new way of working and a different environment with an additional set of priorities.

MOVING ON The public is returning to the high street and to work, measures are in place to help protect those who use public transport, and the number of deaths is continuing to drop. Despite the PPE and queues, you could be forgiven for thinking things are returning to normal. But the nation must not forget social care. The care workers they clapped and sparkled for are still putting themselves at risk for the sake of others, care providers are

still taking strict precautions, and care is costing more to provide with very little, if any, increase in fees. Managers face round-theclock concerns about whether their services are safe, what other measures might need to be put in place and how they can get some normalcy back without compromising on the protection of their clients. The people the sector supports have been classed as some of the most at risk from the deadly virus, causing concern for them, their relatives and the people who are supporting them. And for those services that have sadly lost people to COVID-19, there is a fear that staff and the people they support might begin to suffer from post-traumatic stress.

RETURNING TO REFORM Just before the outbreak, Government was looking to start cross-party talks on social care – we were about to have some movement on what reform

Editor, Angharad Burnham talks about why it's so important that social care isn't forgotten as England moves further out of lockdown.

the sector wanted and needed. Murmurings about this have picked up again and people are starting to look ahead at what might be next, what this sector could look like and how it could be valued. These talks must now include the ways that coronavirus has changed things, and what more needs to be put in place to support providers not just to carry on as they were, but to never have to face a pandemic unprepared again. It is not and was never enough to offer more money or a new funding model – though of course these would be appreciated. The sector needs, more than ever, a way to form closer relationships with

services and offer better support for its staff.

MOMENTS OF POSITIVITY In the face of this pandemic, the sector has come together and offered some fantastic care and support. We are delighted to be able to celebrate some of these moments with our Markel 3rd Sector Care Awards this year. Nominations have opened and are free to enter. We are hoping to see many entries showcasing examples of outstanding care throughout and in spite of COVID-19. Enter yourself or a deserving team or colleague at www.3rdsectorcareawards.co.uk.

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

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In this month’s column, I want to talk about the impact of COVID-19 on people with a learning disability and the data that we published relating to this at the beginning of June. Many of you will know that each week care homes submit data to the Care Quality Commission (CQC), which then forms part of the information on deaths which is published weekly by the Office for National Statistics (ONS). What is not clear from this information is how COVID-19 has impacted the lives of people with a learning disability, some of whom may also have autism, therefore we have looked at this in more detail. We have been supported by ONS to look at all of the deaths we were notified of from providers registered with us who care for people with a learning disability and/or autism, between 10th April and 15th May, and where the person who died was indicated as having a learning disability on the death notification form. This includes providers of adult social care, independent hospitals and services in the community. What we found is not easy to hear. The data showed that between 10th April and 15th May this year, 386 people with a learning disability who were receiving care from one of the providers mentioned above died. Out of the 386, 206 were as a result of suspected or confirmed COVID-19 as notified by the provider.

“It is important that services think about how they can make sure their more closed environments do not lead to a closed culture.” There are limitations with this data, but what it shows is a significant increase in deaths of people with a learning disability as a result of COVID-19. People with a learning disability are at higher risk of respiratory illnesses, so access to testing is vital to reduce infection and save lives. For more detail on the data, read the news story on our website. We welcome the decision of the Department of Health and Social care to roll

Inside CQC D E B B I E

I V A N O V A

This month, Debbie Ivanova looks at the data on COVID-19 deaths of people with learning disabilities.

out testing to all care homes, including those where younger people live. Our data showed that as well as a significant increase in deaths of people with a learning disability, the impact is being felt at a younger age range than in the wider population. We now need to think about how services in the community, particularly supported living, can have access to testing to support best practice in infection control in all services for people with learning disabilities. COVID-19 has led to us suspending routine inspections, stopped visitors going into services, and meant thousands of people are isolated and alone. It is important that services think about how they can make sure their more closed environments do not lead to a closed culture, and keep open as many channels with

the outside world as possible. We will be talking more about this in future columns. It has been great to hear about some imaginative ways of doing this – from drivethrough visits, to family ‘get togethers’ on FaceTime. We have had an overwhelming number of positive examples showing how providers have adapted and responded to the pandemic, and you can find a whole range of these on our website. In future columns, I hope to reflect on how we have responded to the pandemic as a sector, as well as looking at how COVID-19 has affected other groups, such as the black and minority ethnic (BAME) community. In the meantime, I hope everyone is taking care of themselves as well as others.

Debbie Ivanova is Deputy Chief Inspector of Adult Social Care at the Care Quality Commission. Share your thoughts and feedback on Debbie’s column on the CMM website, www.caremanagementmatters.co.uk CMM July 2020

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CMM July 2020

NEWS

ADASS COVID-19 Budget Survey The Association of Directors of Adult Social Services (ADASS) has published the first part of its annual Budget Survey, this year focusing on COVID-19, offering insight into the response from adult social care to the coronavirus pandemic. It states that, 'Adult social care was rendered ill-equipped and underresourced to deal with the COVID-19 pandemic by the failure of successive

governments of all political colours... to put the people who need and work in it at the forefront.' It argues that the focus on freeing-up hospital beds came at a huge cost, saying that prioritising PPE and testing for hospitals and treating care homes as 'an afterthought' was 'not right', continuing, ‘We must change our approach.’

James Bullion, President of ADASS, said, ‘The results of the survey paint a vivid picture of the devastating effect of COVID-19 upon millions of us… ‘The Government must ensure that social care is never again left exposed to a pandemic. This starts by protecting those of us with care and support needs from the current and subsequent waves of COVID-19

Challenging ‘do not resuscitate’ orders A checklist to support disabled people, their families and care staff with challenging illegal ‘do not resuscitate’ orders from doctors has been published as part of a campaign by Turning Point and Learning Disability England (LDE). The organisations say the document will help protect the rights of people with a learning disability if they become sick with coronavirus. It has been drawn up in response to a rise in GPs and hospital staff issuing ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) forms without consulting people or their

families. In a recent survey of its members, LDE found that one in five (20%) organisations had seen DNACPRs placed in people’s medical records without consultation in March and April this year. Julie Bass, Chief Executive at Turning Point, said, 'It is not only illegal but outrageous that a doctor would decide not to save someone just because they have a learning disability. They have the same right to life as anyone else. 'We hope our campaign and the checklist will help support families

and care staff in challenging these orders.' Scott Watkin, LDE Representative Body Co-chair, said, 'Decisions on people’s treatment that are based on someone having a learning disability are never OK – even one is too many. 'We’re pleased this guide has been made so people can understand their rights and speak up for themselves or their family member. It’s an important step in helping people challenge poor or illegal decisions. Enough is enough.' The checklist is available to download on the LDE website.

Visitation for learning disability services Highlighting the need for more guidance for care settings in managing the easing of lockdown, Care England has provided a statement on visitation for learning disability services. The guidelines focus on the potential benefits of fresh air, exercise and carefully managed

meetings with family or friends, stating that it is important to find ways of supporting increased contact with families and friends; however it is equally important that this is approached in a way that is safe, sensible and does not undo all of the efforts so many care providers have made to date.

Care England warns that decisions will need to be revisited as necessary in light of what is likely to be fast-changing guidance in response to the numbers infected and whether these are rising or continue to fall. Such decisions will be vital in mitigating the probability and severity of a second peak.

and extends to ensuring social care is at the centre of all future emergency planning and preparation… ‘Learning the lessons from the COVID-19 pandemic, the Government must seize the opportunity to reform and reset social care as part of the wider post COVID-19 recovery.' The full survey can be viewed on the ADASS website.

Social care taskforce A new social care COVID-19 taskforce has been set up, with representatives from across both government and the care sector. This includes representatives from Public Health England (PHE), Care Quality Commission (CQC), Care Provider Alliance (CPA), Local Government Association (LGA), Association of Directors of Adult Social Services (ADASS), Healthwatch England, Ministry of Housing, Communities and Local Government, Cabinet Office and the Department of Health and Social Care (DHSC). It will be chaired by David Pearson, Social Care COVID-19 Lead for the NHS and past President of ADASS. The new taskforce will help oversee the implementation of the government’s social care action plan and care home support package to help end transmission of the virus in the community and will advise on a plan to support the sector through the next year. CMM July 2020

NEWS

Data and cyber security Digital Social Care has worked alongside the Local Government Association, NHS Digital and NHSX to produce guidance on data and cyber security. This comes as the organisations joined efforts to investigate the best ways to help care providers benefit from the increased use of digital technology while also

keeping safe and secure. Over the last year, 24 local projects and 57 individual care providers have been exploring practical solutions to the challenges of data and cyber security. Nine of the projects were led by local care associations, nine by local councils, four by national

trade associations and two by individual care providers. The full programme report can be found on the Institute of Public Care at Oxford Brookes University website, while the Digital Social Care website hosts additional information, including videos and material for staff training.

view their video interviews before starting DBS checks and training processes and make conditional offers. This all aims to make recruitment more streamlined during and after the coronavirus pandemic. Free online induction training for candidates is provided by Skills for Care-endorsed learning providers and will include infection prevention and control, basic

life support and first aid and safeguarding adults training. As part of the recruitment process, candidates will undertake pre-employment checks to help fast-track recruitment processes for employers. Providers can start the DBS checking process as soon as they have identified a potential employee on the Join Social Care platform and looked at their video interview.

Join Social Care An online platform has been launched to fast-track recruitment into the adult social care sector. Join Social Care makes it easier for care providers to reach potential employees in their local area. Candidates can record a video interview and access free training supported by Skills for Care before starting employment, while registered providers are able to search for candidates in their area,

Markel 3rd Sector Care Awards open for nominations Nominations are now open for the Markel 3rd Sector Care Awards 2020, and as the Awards enter their seventh consecutive year it is more important than ever to recognise and reward the sector’s dedication. The awards are free to enter and are for all those working in the not-for-profit support sector, including charities, community interest companies, and informal community groups. Applications can be made online with simple forms to fill out for each category. For more information on how to enter, visit www.3rdsectorcareawards.co.uk.

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CMM July 2020

NEWS

CQC publishes first insight document The Care Quality Commission (CQC) has published its first insight document, which will form part of a regular series to highlight COVID19 related pressures on the sectors that it regulates. This document draws on information gathered through direct feedback from staff

and people receiving care, the regulator's new regular data collection from services who provide care for people in their own homes, and insight from regular conversations with providers and partners. It focuses on adult social care, reviewing data on outbreaks,

deaths and availability of PPE, and highlighting the impact of COVID-19 on staff wellbeing and the financial viability of adult social care services. It concludes that, up to 10th May 2020, more than a third (36%) of care homes had been affected by COVID-19.

COVID-19 deaths of people with learning disabilities The Care Quality Commission (CQC) has published data on COVID-19 deaths amongst people with a learning disability and/or autism. This follows targeted work to analyse the impact of coronavirus on people with a learning disability or autism and how the number of deaths during this period compares to the number of deaths last year. The analysis looked at all deaths notified to CQC between 10th

April and 15th May from registered providers who offer care to people with a learning disability and/or autism (including providers of adult social care, independent hospitals and in the community), and where the person who died was indicated to have a learning disability on the death notification form. During this period, 386 people with a learning disability and/ or autism died. This is a 134%

increase in the number of death notifications compared to the same period in 2019 (165 deaths). This data should be considered when decisions are being made about the prioritisation of testing at a national and local level, says CQC. Of the 386 people who have died this year, 206 were as a result of suspected or confirmed COVID-19 as notified by the provider and 180 were not related to COVID-19.

New portal for emergency PPE Healthcare providers, including providers of social care and primary care providers, can order additional personal protective equipment (PPE) through a dedicated online portal to top up their existing supplies for COVID19 in an emergency. The Department of Health and Social Care (DHSC) has partnered with eBay, Clipper Logistics and Royal Mail to develop this service. Orders will be managed in line with Public Health England (PHE) guidance and wider availability from the NHS Supply Chainâ&#x20AC;&#x2122;s central PPE logistic operations. All PPE ordered from the portal is free of charge and meets UK government quality standards. For more information and access to the portal, visit the government website.

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CMM July 2020

NEWS

Do all care home residents face an equal risk of dying from COVID-19? Following analysis of deaths among care home residents in England and Wales, The Health Foundation has found the COVID-19 pandemic has disproportionately affected care homes in different regions across England. The highest number of deaths among care home

residents occurred in the southeast of England. However, once the number of care home beds in each region are taken into account, it appears that care homes in northern England and London have had more deaths relative to the number of care home beds than

other areas. More granular and up-to-date data is needed to fully understand the impact of COVID-19 on care home residents and staff across different regions and to inform decisions on how to allocate resources where they are most needed.

NHS Confederation chief executive to step down Niall Dickson, Chief Executive of the NHS Confederation, is to step down from his role in October, having been in post for almost four years. During this time, he steered the Confederation through a challenging period as it supported its members in coping with the impact of a decade of austerity, rapidly rising demand, Brexit and now the unprecedented impact of

the pandemic. Niall has been clear about the need to support social care and was responsible for setting up and leading the Health for Care coalition, which has brought together 15 national organisations in health to campaign for social care reform. He has also brought together organisations from across the health and care system

on issues of common concern, establishing both the Brexit Health Alliance and the Cavendish Coalition. Recruitment for his replacement is underway and his deputy, Danny Mortimer, who is also Chief Executive of NHS Employers, will take over on an interim basis. Interim arrangements for NHS Employers will be confirmed shortly.

Joint statement on communications during COVID-19 The Relatives & Residents Association and the National Care Forum (NCF) have released a joint statement on communications during COVID-19. The statement, endorsed by the Care Provider Alliance (CPA), the Care Quality Commission (CQC) and Skills for Care, focuses on the importance of clear, open, transparent and regular

communications during the COVID-19 pandemic. It includes examples of good practice and guidance on why communication is so vital at this time. Vic Rayner, Executive Director of the NCF, said, ‘The COVID-19 crisis has created huge challenges for the people who live in care homes, their friends and families and care providers. Given all the

uncertainty and anxiety that we are all facing, it is more important than ever that there is a culture of clear, open, transparent and regular communications during the COVID-19 crisis between care providers and the families of their residents.’ The statement can be found on the Relatives & Residents Association website.

Dementia Support UK: Connect, Consult A new service, Dementia Support UK: Connect, Consult has been set up to provide immediate expert support for staff who are caring for those living with dementia. The service has been funded by Innovate UK. It is provided by HammondCare and is now available to every care home in England. The service provides care home managers and their staff with access to a trained 12

CMM July 2020

consultant at no cost to provide personal, non-pharmacological support through video conferencing and telephone consultation. It addresses an urgent need to help people living with dementia in care homes, their families and staff. Dementia Support UK: Connect, Consult has been adapted from a tried and tested

approach developed in Australia through a programme led by the Dementia Centre, HammondCare. Since the start of that programme in 2016, the partnership has supported over 25,000 people with dementia in care homes, domestic homes and hospitals. Care homes can access Dementia Support UK: Connect, Consult in the first instance by visiting the website.

The Help Hub launches across the UK Initially a concept that began as an online community counselling scheme, the Help Hub has since been rolled out across the UK. Over 600 volunteer therapists are now remotely helping people who are struggling emotionally because of lockdown and the uncertainty around the current pandemic. People who are experiencing loneliness, distress, fear and anxiety due to the challenges brought about by COVID-19, can now book a free 20-minute slot to speak with a qualified therapist over the telephone or by video call. Visit the website for more details.

Care Home of the Future Four leading technology providers have launched a Care Home of the Future campaign to help the care home sector use more digital services. The aim is to support a move towards a stronger future post-COVID-19. Ascom UK, Person Centred Software, ATLAS eMAR and PainChek are joining together to help care home owners and staff embrace more digital technology, saying that digital is proven to increase cost-effectiveness of care, improve outcomes and help with workforce issues. The group will also raise awareness of the benefits of putting technology at the heart of care. The campaign launches at an exceptionally challenging time for the sector – with high PPE costs, reduced occupancy levels and increased barriers to the outside world. Care Home of the Future is backed by Vic Rayner, Executive Director of the National Care Forum, and Professor Martin Green OBE, Chief Executive of Care England, who will be part of the launch event in a webinar on 24th June.

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CMM July 2020

LEADERSHIP THROUGH A CRISIS

Strong leadership is vital to providing highquality care, at all times. With COVID-19 testing leaders and managers across the sector, Rob Coulthard from Judgement Index reflects on the qualities of a great leader in crisis situations.

CMM July 2020

I doubt if there are many care leaders and managers that have ever faced a crisis such as COVID-19 and the subsequent fight to keep their staff and clients safe. With such an unprecedented scenario, there have also come many demands and pressure points that people have had to react to, sometimes with barely a moment to plan and think about it. This demand for fast change and action makes leading an organisation and team far more challenging than in normal times. Let’s face it, demands on care leaders and managers are normally quite high, so this extra challenge has required people to do things they may not naturally do. From our experience, the typical performance areas that are sometimes side-lined are those that are critical to survival in a crisis and I would like to explore a few things that – if nothing else – will raise a conscious awareness and hopefully have you reflecting on your own leadership.

THE PLACE TO START We are being stretched to the limit in all aspects, physically, mentally and emotionally. Without doubt, you and your people will have faced levels of confusion, uncertainty, and moments where confidence seemed to ebb away. I have spoken with many managers and leaders during the COVID-19 crisis who have commented on certain staff members unexpectedly stepping

up and showing a side not seen before, but unfortunately, some have not coped. Reflecting on my military career, I have known leaders who operate more successfully in peacetime training environments than on an operational tour and vice versa, but the great leaders are those who can perform in both arenas. Our research on Outstanding Care Managers in 2018 found that outstanding managers/ leaders have remarkably similar qualities to highperforming leaders from other sectors, such as the military, and all that seems to change is the landscape and environment; the crisis, threat and risk need to be approached with similar considerations from a leadership perspective. What might be useful is to reflect against a few of the things that great leaders will do in a crisis, so you can adjust and adopt those behaviours to give yourself the best chance of successfully leading your people in this time. However, you must start first with ‘leading yourself’. You need to be especially strong in areas such as emotional stability and resilience. The first thing to do is take a good look in the mirror and consider where you are right now, physically, mentally and emotionally. I’m not just restricting this to work either – consider your personal life and other subtle things that impact on you. And, whatever you do, don’t come out with the old saying, ‘Work is work and home is home and I can separate the two’, because you won’t when things get really pressurised and this is when you will make mistakes. The data on outstanding managers illustrated great stress control and resilience in both work and one’s personal life. Is this you? Let’s agree that you have looked in the mirror and are putting some things in place to support your personal anchors, wellbeing and resilience; if you need any more advice on this there’s a lot on our website. Just remember if you are knackered and burned out you will fail to be intuitive, strategic and problem solve effectively. The consequence is you will potentially fail. So, regarding you, make it a priority and ‘Just do it’, to quote Nike.

THE BIGGER PICTURE Now, on to the heart of what you should consider, reflect on, and take action on if needed. Always remember that apart from when you’re leading you, when it comes to leading others it’s never about you. Leadership is about being flexible and adapting to what is in front of you, especially if you have not seen the scenario coming already, so you need to be a chameleon. Whenever I hear a leader say, ‘It’s my way or the highway’ I immediately see a lack of flexibility and pending failure to succeed or take the team with them. We have written

CMM July 2020

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CMM July 2020

LEADERSHIP THROUGH A CRISIS

a book on the subject (The Care Leaders Handbook), but here I’m going to just look at a few key things. We know situations in a crisis happen quickly, requiring fundamental qualities from leaders, managers, and team players to stay in front of the curve of change and demands of the crisis. Key words you might consider to help stay ahead are: • Vison and strategy. • Change and empower. • Emotion and support. There are obviously lots of linked factors that go with these words and key will be your capacity as a leader to control the positive mental attitude and emotions of yourself and your people.

SEEING THE FUTURE You must take time to plan and look beyond what is in front of you and, literally speaking, become a Jedi Knight, anticipating potential changes that require action. To see around corners and over the horizon effectively, you need a high energy level and the time set aside to look outwards and strategically plan. This will allow you to see potential threats and create a contingency plan if they happen. This could be anything from staff absences, a lack of resources, or a COVID-19 outbreak. These things need to be brainstormed and solutions written and detailed. You also need to consider carefully who will cope and is best to step into certain situations, including a contingency if you are not there. Is all your knowledge and planning in your head or could someone simply pick up the plan and get stuck in? Again, think as laterally as you can so you can act quickly and not lose precious time in the moment. The other factor is that when something happens, your emotions are heightened and you may not think as effectively as you could when the threat is just a potential. I’ve heard this type of contingency called a few things in the past such as emergency operating procedures or ambush drills. When strategically planning, here are a few things that could add to the quality of what you do: • Invite staff from various departments and levels to join conversations. This will give a sense of ownership and trust and they are likely to step up if a situation occurs as they will have visualised and hopefully pre-set the emotional response and behaviour needed. • Inform staff of what you are doing and when

a meeting will happen. Pre-warn staff so they can start to think about contingency themselves. • Make the environment safe by creating a simple, open and transparent communication pathway without comeback (make a rule of no egos in these sessions). This is especially important after an incident, where meetings need to be focused on performance not just the result of what happened. Don’t blame, just deal with performance when things go wrong and if there is time to coach and train then consider the long-term benefits of this style. • Encourage staff to practice, and make strategic thinking a task for everyone throughout the entire workforce. Encourage innovation and risk management from everyone. Make it safe to speak out and do not rely on being told things. Those who are shy or lack confidence might not volunteer their thoughts so engage and ask, using open questions.

THE FLEXIBLE CHAMELEON Back to being a flexible chameleon. When we run a Leadership Academy, this subject is always a point when delegates go quiet and reflect. A sense of awareness seems to happen of how being a leader is never about you. It’s about your ability to influence others, considering in the process their skills, motivation and coping capacity as well as the severity of threat and the outcome you want. The sum should allow you to adopt the appropriate style of leadership, and work out how best to communicate to get the desired result. The style of leadership you adopt will be based on the words you use and, according to the great Daniel Golman, there are six typical styles: • Command. • Pace setting. • Democratic. • Coaching. • Affiliative. • Visionary. We wrote a whole chapter on this topic in the book along with an assessment to give you a sense of your current dominance in each style. During a crisis, leaders often shift to a command and tell style, but this doesn’t mean other considerations should not be made, especially if the scenario gives space and time or people need you to behave in a particular way. For instance, if people are panicking, you may have to step in closer and be amongst them, letting them know you are one of them

and all in it together (affiliative). If you have highly experienced staff who deal well with pressure, maybe have a democratic approach if time allows. You will probably find yourself using several styles at once and typically they are a visionary style of ‘that’s where we are going’ and command style of ‘and this is how we are going to get there’. Note, command does not necessarily mean being a bossy, loud type; it’s the words you use, not the tone and temperament, that dictate the style.

KNOW YOUR TEAM In everything we have discussed so far, the most important thing as a leader is to manage your own mindset and emotions and those of your staff. If you or your people lose it emotionally you will probably fail. It’s therefore so important to really understand your people and be able to read them. Ask yourself, to what extent do you really know every member of your team? What are their emotional trigger points, what are their current worries? As I highlighted before, having a solid foundation in your own world will support you to get the best from your working world. Go ask and don’t just guess because you never know what is going on behind the eyes of some of your people and it might just be they need you. To summarise a few take-home points for reflection: • You need to be rock solid and energised yourself to be as effective a leader as you can. • Plan and engage in regular strategic sessions to offset threat and risk. • Have contingency plans drawn up for as many eventualities as possible. • Be prepared and start becoming that flexible chameleon so you can adopt the appropriate situational leadership style. • Develop your emotional intelligence and coping mechanisms for both supporting yourself and influencing others. It’s about awareness and management of emotions. The more movement required from people, the more emotion you will need to create. • Be prepared to be tough and ruthless if needed. It’s better to feel bad for being a bit tough on someone rather than conscious of a serious incident because you didn’t want to hurt someone’s feelings. Finally, if you do have staff who may be suffering with traumatic stress from recent incidents, we have produced some material and support documents which can be freely downloaded from our website. CMM

Rob Coulthard is Managing Director of Judgement Index UK Ltd. Email: gabby@judgementindex.co.uk Twitter: @judgementindex How are you working on your leadership during this pandemic? What have you learnt about yourself and how has that helped you lead your teams? Share your experiences and give feedback on this article on the CMM website, www.caremanagementmatters.co.uk CMM July 2020

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Making ends meet: ORT

SHORT-TERM FUNDING SUPP

There are any number of reasons that providers might be facing problems with cashflow at the moment. To help, Jeremy Huband of HSBC UK writes about the Government coronavirus-related loan schemes and more widely about what finance options are available, giving a feel of what your options are when you approach your bank and what they might ask.

As an introduction, I am Head of Healthcare for HSBC UK; my role is to support commercial customers in the healthcare industry across the UK. This involves working with customers, frontline staff and various offices within the bank. We work alongside businesses in both the social care and primary care space, including care homes, homecare providers, community pharmacies, dentists and GPs. Every day, we are either talking to customers in the sector or to people within the industry. What we hear is that many of our customers have been impacted by COVID-19 and we are working hard to ensure that all of our customers have the guidance and support they need at

CMM July 2020

MAKING ENDS MEET: SHORT-TERM FUNDING SUPPORT

this time. This may include considering amendments to existing facilities, additional finance, or to assist with access to various Government COVID-19 finance schemes, such as the Coronavirus Business Interruption Loan Scheme, Coronavirus Large Business Interruption Loan Scheme and the Bounce Back Loan Scheme, which I will describe later.

THE SITUATION SO FAR During April and early May we saw operators furlough staff who were sick or needed to be isolated due to underlying health issues. This has placed pressure on staffing for some care providers, in some cases requiring agency staff to cover shifts. Agency staff are more expensive, which can impact on profitability, and where agency staff work in different homes there comes a greater risk of spreading the virus. We saw occupancy in care homes for older people dip in late April, as most hospitals by this point had transferred out those who they could. In addition, many potential privatepay residents, having seen the negative news

“We have seen all our care home customers continue to trade strongly with minimal access to the coronavirus Government-backed schemes.” coverage, continued to self-isolate at home as they either didn’t want to go into a home or felt unable to due to the national lockdown. Providers have also had to protect staff and clients with Personal Protective Equipment (PPE) which comes at a price and needs to be paid for out of existing budgets.

FINDING HELP Where providers have suffered short-term

cash flow issues – whether caused by falling occupancy/contracts, agency costs, increased staffing hours, PPE or any of the other cost increases we have seen – they may need some financial assistance. This assistance may be a short-term overdraft as occupancy levels recover and/or fee rates are adjusted to cover the new cost of care. Another option, if you are borrowing money and this is repayable via regular capital and interest repayments, is to ask the bank for a capital holiday. In this way, you continue to pay the interest, but your repayments are lower for the agreed period, helping your cash flow. They are then adjusted as agreed to repay the debt.

GOVERNMENT SCHEMES The Government schemes start with the Business Bounce Back Loans (BBLS). Here, the Government provides accredited lenders with a 100% guarantee. Please note, the borrower remains 100% liable for the debt. Any business can apply for loans worth up to 25% of business turnover, with a maximum limit of £50,000. The aim is to help businesses access cash so they can keep operating. Banks should have a straightforward online application, typically via a website. This is a simple product, a term loan with a six-year term, without early repayment fees. No repayment of capital is required during the period of 12 months from drawdown, and the Government pays the fees and interest for the first 12 months. The interest rate is fixed at 2.5%. The second scheme is the Coronavirus Business Interruption Loan scheme (CBILS), a Government guarantee which secures bank loans to any viable business with a sound borrowing proposal. No fee is required for Government guarantee and there’s no loan arrangement fee or loan repayment fee, should you wish to repay early. These are available

for sums of £50,001 to £5m. There is a variable interest rate with the option to fix. An interestfree period of 12 months will apply, after which you will be charged: • 3.49% over Bank of England Base Rate for loans up to and including three years. • 3.99% over Bank of England Base Rate for loans over three years. There is no repayment of capital required during the period of 12 months from drawdown and the loan can be repaid over any period up to six years. The third scheme is the Coronavirus Large Business Interruption Loan Scheme (CLBILS) which is designed to support customers who would be considered viable were it not for the COVID-19 pandemic and who have a borrowing need. Here, the Government guarantees secure bank loans to any viable business with a sound borrowing proposal. CLBILS has commercial rates of interests, security requirements on a case-by-case basis and a term between three months and three years. For businesses with an annual turnover of between £45m and £250m, sums up to £25m are available, and, where turnover is in excess of £250m, up to £50m could be available.

WE WILL RECOVER We have seen all our care home customers continue to trade strongly with minimal access to the coronavirus Government-backed schemes. This is probably because, across the country, healthcare provision broadly reflects demand, with care homes typically 90% full year-on-year. Looking forward, we can see some care homes for older people facing a short-term fall in occupancy, having lost residents to COVID19, but we believe well-managed providers will recover and continue to successfully serve our communities in the years to come. CMM

Jeremy Huband is Head of Healthcare – UK Corporate Banking at HSBC UK. Email: jeremy.d.huband@hsbc.com Twitter: @HSBCUKBusiness Have you used any of the Government-backed coronavirus loan schemes? Are you facing cashflow issues? Share your experiences on the CMM website, www.caremanagementmatters.co.uk 20

CMM July 2020

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Adapting to change:

E SUPPORTING TOH RCE SOCIAL CARE WORKF

In times of crisis, staff need support – and this includes managers. Skills for Care has been working to ensure that help is available for not just maintaining the workforce but developing people too. Here, Oonagh Smyth shares details of this work and how you can access it. 22

CMM July 2020

One of things that became very clear as I joined the ‘Clap for Care’ communal gathering on my street is that people were showing their appreciation for both care workers and their NHS colleagues. As a result of the crisis, and for very sad reasons, social care has been prominent. I hope that it means people understand more about what the 1.49 million care workers do and are prepared to do to risk their lives to keep people safe and well. There is a greater understanding

HEADER of the depth of skills of people who work in social care, their motivation and dedication which I know all of social care is keen to build on. One of the strengths of Skills for Care is our insight into the sector. We have 54% coverage of the sector in our workforce intelligence work through Adult Social Care Workforce Data Set (ASC-WDS) and we are grateful to the thousands of employers who supply their data. It’s a big ask but we need them to keep doing that so we can make sense of what happened during the crisis so we can make coherent workforce

planning decisions post pandemic.

VACANCY AND ABSENCE Before the virus, we already had a vacancy rate of around 7.8% – equivalent to around 122,000 vacancies on any given day – with turnover running at 38%. The latest research from our Workforce Intelligence analysts found the percentage of days that have been lost to sickness has almost tripled from 3% to 8% in March/April compared to usual levels. If we apply that figure to the whole workforce it equates to

around 2.3 million more days lost to sickness than would usually be expected. These overall figures, however, mask some of the differences within the sector. Some employers are successfully recruiting and retaining staff and are not experiencing increased absence rates, whereas others are struggling. Skills for Care already had a safe and fair recruitment guide to encourage considerate, inclusive and safe recruitment practices when hiring new staff. We worked quickly to develop a supplement to help employers recruit key staff and volunteers safely and rapidly to COVID-19 eligible roles. The supplement contains downloadable resources, including a COVID-19 safer recruitment checklist, criminal record self-declaration form and risk assessment templates. Despite the pressures, it was important that the safety and wellbeing of people using care services remained a priority. Employers of all sizes are able to access COVID-19: Safe and rapid recruitment principles that can help them address their additional workforce recruitment challenges.

INDUCTION Once employers have recruited people they feel are the right fit for them, with the core values needed to become great care workers, then it is critical they can access high-quality, rapid induction training. We worked with the Department of Health and Social Care and the Care Quality Commission (CQC) to quickly train new recruits and volunteers and to give existing staff new training. Employers are able to find all the information, and can access funding to support with training needs, on the dedicated Essential Training webpage.

MANAGERS NEED SUPPORT The response to COVID-19 has confirmed what we already knew, that the 22,500

CMM July 2020

ADAPTING TO CHANGE: SUPPORTING THE SOCIAL CARE WORKFORCE

registered managers across the country were critical to the sector dealing with, and then coming out of, the crisis. Their flexibility, leadership, resilience, creativity, and problem solving based on their experience has made a huge difference on the ground. Skills for Care has already begun work to understand the needs of existing managers, to support their ongoing wellbeing and resilience, and to understand what skills and resources they need to cope with new challenges and what will be a changing market. Supporting managers in the crisis Weâ&#x20AC;&#x2122;ve offered a series of COVID-19 webinars to support managers and their services during the pandemic, ranging from human resources and recruitment topics through to essential training and keeping the team motivated. They are delivered live to participants and posted to our website for further viewing. We knew from the intelligence we were gathering that employers were dealing with emotionally draining situations at work, supporting people through lockdown and losing people they had long-standing relationships with. We worked with a range of employers to create a self-support tool to help staff with aspects of feelings and communication at work, mapping out practical steps to help staff manage their own reactions, or the reactions of others, during difficult moments at work. Supporting managers in the future In the future, managers will need to be supported to continue to deliver high standards of care. For the owners and directors of care services, this will mean providing continued development, professional supervision, timely mentoring and the ability to engage with their peers across

both social care and health. To support that, we have expanded our support to registered managers and other frontline managers combining opportunities for bite-size learning, peer support, advice and guidance and action learning. We are targeting new managers with support and reaching out to those struggling in services falling below CQC standards. Supporting organisations to succession plan There remains a growing need for managers across the sector. Even before COVID-19, there was a 22% annual turnover of registered managers across England, with many leaving the sector. An 11% vacancy rate of registered managers across our sector means that thousands of services will have gone into the pandemic without a person in this post. Regulated services need a highquality registered manager, but they also need to have in mind where their next managers are coming from. Succession planning remains important and every service, regardless of size, should be identifying and developing emerging talent into future senior care workers, team leaders, deputy managers and beyond. Our Developing new managers and deputies guide helps employers to identify such talent, recommends practical ways to develop them through delegating tasks and providing new opportunities to upskill them, and suggests the nationally recognised qualifications and courses that can help. To complement this, a new Time to manage guide has been produced focusing on the benefits of empowering the workforce and effective delegation. Supporting managers to support each other Many managers have drawn on peer support over the years, helping them to share good practice, sense check ideas,

problem solve together or share costs. Skills for Careâ&#x20AC;&#x2122;s Registered Manager Network has connected thousands of managers with local services and these relationships have proved especially important during the pandemic. With face-toface meetings no longer possible, a swift shift to WhatsApp groups meant managers could support one another on a daily basis throughout the emergency. In April, Skills for Care opened the registered manager members Facebook group to non-members and other managers, and that group has grown rapidly. This is providing real-time peer support where it is needed most and comments from managers have highlighted the added value this brings to their role. Maintaining these new links and the use of technology to look beyond services will continue to be critical over the coming months. We have seen the value of connecting peers at other levels together in the development process as part of programmes such as the interactive Lead to Succeed for aspiring managers, which often brings together emerging talent from multiple organisations. Skills for Care is now helping to establish Deputy Manager Networks across the country so deputies can build relationships with other services and grow their own community of peer support.

TECHNOLOGY The use of technology has exploded across the sector over the past few months. We have created guidance around the technology needed for effective virtual interviewing including the preparation you can do, the support you can give to help a potential candidate, how to run the interview and the steps after the interview to support a successful new recruit. But we also know this was new

territory for many employers so we developed our communication and collaboration tools to provide a snapshot of the different digital products, like Microsoft Teams and Zoom, to support socially-distanced recruitment activities. We also included tips for communicating and collaborating with colleagues remotely as employers were telling us this was happening much, much more.

THE FUTURE The future is uncertain in terms of when lockdown will end and different approaches for people who are shielded, which will impact those accessing and working in social care. The sector will continue to need support, particularly around recruitment and retention, development, technology and leadership. In a post-COVID-19 world, leaders and managers will need to keep a close eye on resources and advice as it becomes available; all our updates are available on www. skillsforcare.org.uk. I would also encourage all registered managers to join one of the local networks that have been so effective during the crisis www.skillsforcare.org.uk/ registeredmanagers. Speak to our locality managers to let them know what you are seeing on the ground and make sure you complete your ASC-WDS returns so that we know what is happening and can feed that into Government and other partners. We know evidence based on quality data is one of the most effective ways we can influence change. The challenge for all of us is to make sure that the sacrifices of our workforce lead to better access to career-long learning and development that meets their needs. Most importantly, we want to play our part in ensuring the role social care has in supporting people is recognised and valued. CMM

Oonagh Smyth is Chief Executive of of Skills for Care. marketing@skillsforcare.org.uk Twitter: @oonaghsmyth Sharon Allen OBE is Chief Executive Arthur RankEmail: Hospice Trust. Email: sharon.allen@arhc.org.uk Twitter: @sharonallenarhc How have What new you wayskept are ayou focus finding on your to cope staffwith in this end pandemic? of life care? Have Have you you been spoken able to to your identify local talent hospice? and start Feed-back thinking on about this article upskilling individuals? Share and share your experiences your thoughts on the CMM on the website, CMM website, www.caremanagementmatters.co.uk www.caremanagementmatters.co.uk CMM July 2020

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CMM July 2020

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What ifâ&#x20AC;Ś? A different social care

Social care reform has been put on the backburner for years, and nothing has shown the damage this has done like the COVID-19 pandemic. Here, John Kennedy asks, what if weâ&#x20AC;&#x2122;d invested in reform before it was direly needed?

CMM July 2020

No doubt you are now well used to reading the litanies of pain that have accompanied social care through the coronavirus pandemic. The PPE, the testing, the abandonment. You will no doubt have also noted the daily stories of resilience, heroism and sheer kindness and selflessness that have filled our newspapers and news broadcasts. I trust too that, like me, you haven’t been surprised. You won’t have been surprised by the abandonment; those purporting to ensure, support and improve conspicuous by their absence. You’ve shrugged maybe, and if, like me, you occasionally fall prey to a touch of pomposity, a mutter of ‘plus ça change, plus c'est la même chose’. If not, then just a weary ‘same old, same old’. You won’t have been surprised by the response from the people working in social care. Because you know them. Whilst others fled the field, they got stuck in for they ‘are but warriors for the working day’, despite the abandonment, despite the decades of neglect, despite the exploitative pay, despite their ‘low skill’. No, you won’t have been surprised. Of course, the crisis and pain are not yet over and the full history is yet to be written. I don’t often quote the Queen, but her words earlier in the year, ‘I hope in the years to come everyone will be able to take pride in how they responded to this challenge,’ struck me. There is no doubt that the 1.5 million working on the ground in social care will ‘stand a tip toe when this day is named’. Despite the heroism, the people working in care are stretched to the limit, physically, mentally and emotionally. The death and loss is starkly disproportionate for people receiving and giving care and you have to ask, has our archaic model of social care contributed? Has the system got harm designed in? What if we’d done things differently?

DEALING WITH THE DISPARITIES Whilst the hospitality industry is coproducing guidance on how pubs and restaurants may open safely, social care receives no such engagement. Crucial guidance on correct use of PPE, safe hospital discharge, isolation etc is curtly issued only to be met with cries of anguish at its

CMM July 2020

WHAT IF…? A DIFFERENT SOCIAL CARE

impracticality and ability to utterly confound. Obviously written by people with very little knowledge or understanding of the realities on the ground. ‘Please, please, involve us in the design of guidance’, cries the sector, ‘We know the reality! Let us write it!’ Whilst every other sector is able to access substantial financial support with a few clicks on Government Gateway, social care is conspicuously singled out as different. Instead of support being swiftly allocated to the front line, financial support is channelled through the byzantine bureaucracy that is local authorities. Trickled out, richly decorated with detailed criteria, claw back clauses, caveats. Why? Why can golf clubs, bookies, tanning salons and pubs get immediate support and the care sector has to beg?

A DIFFERENT STORY? What if, years ago, we’d recognised the true value of social care and truly put the citizen at the heart? What if we’d recognised that ‘commissioning’ had become a straitjacket that was binding us into the creation and sustenance of service models people increasingly don’t want? A downward, spiralling race to the bottom, creating bigger and bigger care homes, pizza delivery homecare models and stifling imagination. Further entrenching poverty pay, industrialising care into piecework packages and attracting short-term, impatient profitmaximising finance. What if we’d realised that the very best services often come from organisations with purpose, patient profit and not-for-profit? From people who get out of bed each morning with those they provide care for first on their minds. What if we’d driven consumer sovereignty into social care? What if ‘the desires and needs of consumers controlled the output of producers’? What if we’d invested in supporting consumers to have economic power in the market? What if we’d allowed a sector to bloom that was able to offer a wide continuum of services responding to the desires and needs of individuals?

What might have been different? Would you want a stranger to do your supermarket shop? With their list? What if the power in the market was in the hands of the people receiving the care? What if we’d invested in and celebrated neighbourhoods? What if we’d not waited for a crisis to mobilise the immense potential of volunteering? What if we’d recognised, cherished and supported carers – the bedrock of social care? What if every neighbourhood had a navigator, connecting and empowering? What if there were no ‘service users’ but instead a network of reciprocal support? What if the first point of attention was a person, and not a criteria assessment but a conversation about what they want and what they can give? What if we’d regulated for success and not for failure? What if we’d been inquisitive about the attributes of Outstanding services? What if we’d recognised that all Outstanding services have adequate and sufficient resources and that desperately few Outstanding services are wholly in the shoestring commissioned market? What if we’d been inquisitive about the underlying fundamentals of quality and safety? What if we’d used that to demand reform? What if instead of nurturing a ‘critical parent – reactive child’ relationship, we’d coproduced a SMART regulatory framework? What if efficiently collected data had made random subjective ‘whack a mole’ inspections redundant? What if staff and managers in social care had been empowered by regulation and not cowed? What if we’d actually known how many people lived in care homes, why they were there and what if the reporting of the crisis had been accurate and timely? What if we’d banned the word ‘integration’? The magic Holy Grail forever just out of grasp. Do we really want integration? Don’t we want people to just work together? Surely, we want a medical model in our hospitals but not in our homes? What if social care had the same respect as Health? What if it was seen as just as important, but different, just as

“Why can golf clubs, bookies, tanning salons and pubs get immediate support and the care sector has to beg?” much an essential part of our societal and economic infrastructure? What if Health knew the care providers in their patch? What if they worked together as partners? What if they met, talked, explored, planned and did things together? Perhaps then social care may have been able to really support the NHS in a way that kept both safe. The NHS may have paused and considered before it put those receiving and giving care at risk. What if we’d acknowledged the skilled nature of social care staff? What if their pay reflected their skill and responsibility, and was complementary to and comparable with Health? What if they shared the same competencies and accreditation? What if they were professionally registered and could show an ID that was immediately recognisable and respected? Perhaps they wouldn’t have felt panic at having to stay away from work and lose pay. Perhaps they wouldn’t have needed to work multiple sites to feed their children and pay their rent. Perhaps they wouldn’t have had to shout and plead to be recognised as essential workers.

TIME FOR CHANGE Despite the systemic injustice and contempt towards social care, its people have been magnificent, but they shouldn’t have been treated the way they have been. Is it time to stop the stifling overparenting and give social care the respect and attention it deserves? It’s a fundamental part of our lives and is of primary national strategic importance. CMM

John Kennedy is an Independent Social Care Consultant. Email: jpkennedy366@gmail.com Twitter: @JohnnyCosmos What are your ‘what ifs’ of this crisis? How do you think things could have been different? Share your thoughts on the CMM website, www.caremanagementmatters.co.uk 30

CMM July 2020

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Engagement, activity and social distancing

The emotional and physical wellbeing of those with care and support needs and those who care for them must be our absolute priority at this time. Hilary Woodhead from National Activity Providers Association shares ways that lockdown and isolation activities can support wellness.

Making the decision to apply social distancing was not an easy one for care homes, not least because physical visits from family members had to be restricted, but also because it might have involved restricting people’s movement around the home. This has created challenges for resident engagement and inclusion. There is significant risk of loneliness and distress and all staff across the setting must therefore ensure that residents are engaged, encouraged and safe and that emotional wellbeing is prioritised alongside physical wellbeing.

ENABLING WELLBEING Having something to do can make people feel useful and valued. Simple things like talking, laughing, singing and just being together can help improve wellbeing and reduce loneliness. Here are some ideas that could be useful for ensuring activity is embedded in the support your organisation offers: • Use existing care and support plans to develop individual engagement plans for each resident in your care. • Include opportunities for activities over a 24-hour period. These should not depend on the presence of a member of staff to initiate engagement. • Keep plans in each residents’ room for easy access by all staff members (make sure these do not share sensitive information). • Identify a staff member to be responsible for 32

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maintaining contact between residents and their loved ones. • Encourage and enable family contact through the means of technology if you can’t offer outdoor, socially distant meetings safely. • Offer support and encouragement through one-to-one interaction with residents, in accordance with the required COVID-19 restrictions. Remember, the provision of activity is not the sole responsibility of one person; the whole home can be fully involved in an engagement-based model of care. • Discard or sanitise activity supplies according to the care home’s infection control policy. • Ensure items are not shared between residents. • Organise the necessary supplies for each residents’ room to promote engagement and activity.

SUGGESTIONS FOR ACTIVITIES As discussed, for many, keeping in touch with relatives is vital. As soon as it is safe to do so, homes can now invite family members to visit in the garden. Until then, ask relatives to send in photos of family and friends, from days gone by or more recent. You can use these to create a photo album, frame photos or make a collage together. Greetings can be recorded either by or for family, or you can help with letter writing. You could also help to write or record an autobiography or diary, or help to keep in touch with pen pals. Reading together can also be a fun pastime.

ENGAGEMENT, ACTIVITY AND SOCIAL DISTANCING As well as novels and poetry, think about reading newspapers aloud to keep people in touch with current affairs (don’t skip any astrology sections which can make a good discussion topic). Read letters from family and friends, or religious or inspirational texts if that is appropriate. Some residents might be comforted by helping with daily tasks in the home and might be finding it difficult if they’re not able to do this at the moment. You could look at dusting their bedroom together, shining shoes, creating a toolbox, button box or sewing basket that can then be organised or planting and taking care of plants in the bedroom together. You could also organise drawers and wardrobes. For those who find music entertaining or even relaxing, you could sing together (nursery rhymes can be comforting), use a tablet for karaoke or talk about your favourite kinds of music. If any care workers play an instrument, you could organise a concert, or you could use small rhythm instruments to make your own music with a resident. Arts and crafts is usually a very popular activity and this doesn’t need to stop if residents are isolated. Winding wool is calming for many, and drawing and painting, writing a journal, stories or poetry, and creating memory or ‘joy’ boxes can all still be done. Card-making can be done in advance of holidays such as Christmas, and you can draw portraits of each other or create personalised decorations. You could even try making potpourri and placing it around the room. Other activities could include playing games, like word games, noughts and crosses or charades or playing along with TV gameshows, looking through catalogues, bird watching from the window, watching TV, clips on YouTube or soaps together, an online shopping spree, or doing a seated physical activity. For those who

might be less able to engage, you could do a guided meditation, have a pamper session, combing hair, applying perfume, offering a hand massage with aromatherapy oils or doing a manicure, you could touch different fabrics or smell different scents together, or take paintings down from other areas of the home and look at them together. We have also been asked about hall and doorway activities and many of our members have shared the following ideas: • Any type of exercise – yoga, tai chi, noodles, scarf, stretchy band exercise. • Joke hour – everyone takes turns telling prepared and printed jokes. • Remote control cars or devices in and out of the rooms (if appropriate). • Alexa/Dot: use for music, trivia, quiz. • Singing between staff and residents. • Worship via TV, radio, livestream or recorded, Prayer CDs. • Bread machine for aroma and then snacking. • Hallway choir. • Doorway bingo. • Doorway football.

WORKING TOGETHER There are more activity ideas on the NAPA website where you can access free resources to download, full of ideas of things to do. You can also contact the NAPA Helpline on 0207 078 9375 or email helpline@napa-activities.co.uk for free support and information. Despite the lockdown, we can all do our part to ensure that people stay emotionally, mentally and physically engaged, whether that needs to be on a one-to-one basis because of infection control, or as a group within the home’s boundaries until lockdown measures are eased. CMM

Useful supplies – suggestions from our members • Contact details of friends and loved ones. • Mobile phone or tablet. • Decks of cards. • Large print books. • Spiral notebooks. • Colouring pencils and other stationery. • Watercolours/paints. • Notice board to display work or messages. • Adult-appropriate colouring. • Craft supplies and kits. • Word searches and crosswords. • Wool. • Trivia books. • Hand-held video games. • Magazines and newspapers. • Small pots of flowers. • Life like dolls. • Robotic pets. • Essential oils and diffusers. • Music players and headphones. • Song sheets.

Hilary Woodhead is Executive Director of NAPA. Email: hilary@napa-activitities.co.uk Twitter: @HilaryWoodhead What activities have been successful in your home? Share your knowledge on the CMM website where you can also feed-back on this article and find useful resources, www.caremanagementmatters.co.uk. To become a NAPA member and receive a comprehensive benefits package email membership@napa-activities.co.uk – quote ‘Care Management Introductory offer’ for three free months on subscription for new members.

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CMM July 2020

WHERE WE’VE GOT TO:

GOVERNMENT’S RESPONSE TO COVID-19 SO FAR The social care sector has been battling COVID-19 for months now and support from Government has been trickling through to shore up providers and staff. Helen Whately MP, Minister of State for Care gives us a round-up of what the Government has put in place so far, and how it plans to tackle the future.

It’s been a persistent worry for all of us – not just our dedicated health and social care professionals – how can we better protect ourselves against a threat we cannot see, smell or touch? How can we know who has coronavirus, including whether we do ourselves? For those working tirelessly in the nation’s care homes, where social distancing has its own unique challenges, this concern has loomed large since the earliest days of lockdown. There’s no way of stopping all of our worries, but

CMM July 2020

WHERE WE’VE GOT TO: GOVERNMENT’S RESPONSE TO COVID-19 SO FAR

we know that one way to help is through the continual expansion of our testing capability. The more health and care staff we can test for COVID-19 – and who come up negative – the greater their peace of mind and the sooner they can return to caring for others safely. For those testing positive, they can isolate sooner to reduce the spread and receive the treatment and support they need to recover. That’s why it’s so important that the Government is now rolling out whole care home testing to all adult care homes in England. From the beginning, we have prioritised those groups most at risk from infection. Now that we’ve met the 6th June target of offering tests to every care home caring for over65s, and those with dementia, we can significantly expand provision. Since the launch of whole care home testing, we have provided over one million test kits to more than 9,000 care homes, and now have distribution networks in place to send out more than 50,000 test kits a day. This service will benefit residents and staff in over 6,000 more care homes. We are continuing to explore how we can support other parts of the sector, such as those in supported living settings, extra care settings and domiciliary care, and of course anyone with suspected coronavirus symptoms in these settings can now access testing by self-referral. Opening up whole care home testing to all homes, regardless of whether people there are displaying symptoms, means we can prevent and control outbreaks and protect the most vulnerable. We are confident this also means more staff can resume normal family lives and get back to the work they love.

SETTING THE SECTOR UP FOR THE FUTURE But it’s not only about testing – coronavirus is a challenge being tackled on multiple fronts. We continue to provide support to the whole social care sector, which is why we have set up a new taskforce,

with representatives from across government and the care sector, headed up by Chair, David Pearson. This taskforce will help oversee the implementation of the government’s social care action plan and care home support package. Its priority mission is to help end transmission of the disease in our communities and plan robust next steps to support the sector through the next year. Care homes, like the NHS, have been on the frontline from the beginning. We are determined that managers and staff have everything they need to keep themselves and their residents safe. And across the wider care home sector, I believe we can be cautiously optimistic. The frequency of new outbreaks and deaths continues to decline thanks to the dedication, expertise and compassion of staff throughout the country. However, the virus remains a clear and present risk to residents. That’s why the government has maintained its focus on protecting both residents and care workers with a comprehensive package of targeted support. In April, we released the Adult Social Care Action Plan which set out how we will help people receiving adult social care through this current health crisis. We have now provided £3.2bn to local councils to help them manage the pandemic’s impact, an unprecedented level of additional financial support in recent times. In a further boost to the care sector, last month we issued a new Care Homes Support Package, supported by a £600m Infection Control Fund, setting out the steps needed to keep residents safe. We also explained how national and local government would collaborate to help care home managers put the plan into practice as quickly and efficiently as possible. Named NHS clinical support leads have been assigned to every care home, part of the additional clinical resource pledged for residential care. New digital portals for care managers to order testing kits and PPE supplies for staff and residents are already coming online to help speed, delivery and use. In terms of day-to-day care home

activities, the package includes advice on limiting staff movement to reduce infection risk further – although care homes have already been adapting brilliantly to this new way of working. Additional staff training is also being given on the use of personal protective equipment (PPE), infection control and testing advice. This all adds up to a comprehensive, person-centred and responsive support programme designed to protect and provide peace of mind to all care home staff, residents and families, wherever and whoever they are.

TAKING CARE OF STAFF Peace of mind will often be preceded by time off work for staff who do have the misfortune to test positive. This creates potential problems with staffing levels. To offset staff shortages, a re-energised adult social care recruitment campaign, Care for others; make a difference, is running across TV and radio right now, to attract newlytrained staff into the sector to support the existing workforce. Fully staffed or not, these are difficult times for health and care workers, and we know how vital it is to maintain their mental, as well as physical, health. The Samaritans have extended their helpline service to all care workers. Anyone feeling the strain can speak to a trained adviser and be signposted to support services. Hospice UK is also extending its bereavement and trauma support hotline to those working in the care sector, with specialist counsellors available to support staff who have experienced stress or anxiety through their work. The recently launched CARE app features additional support links. This is the hardest thing many of us have ever lived through, but I also know so many people have been doing the most extraordinary and wonderful things. The compassion and commitment of care workers goes above and beyond. On my part, I want there to be all the possible support for care workers and care providers that there can be, so no one feels they have been left to cope alone. Together, we will get through this. CMM

Helen Whately is Minister of State (Minister for Care) at the Department of Health and Social Care. Twitter: @Helen_Whately What are your views on how the Government is supporting the sector? Share your opinion on the CMM website where you can also leave feedback on this feature, www.caremanagementmatters.co.uk 36

CMM July 2020

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R E F L E CT I O N S ON MANAGEMENT DURING COVID-19

The battle against coronavirus has just about taken all the energy the sector has. As breathing space begins to edge slowly in, Raina Summerson reflects on what has happened, where we are now and what we can hope for in the future.

Since March and the start of the COVID-19 pandemic, life in social care has become even more challenging than usual. Many times in the past weeks, my colleagues and I have asked ourselves what we did before ‘the crisis’, as every part of our days, like many others’, have been overwhelmed with managing the management of coronavirus. Three months in, there is finally some space for reflection and

CMM July 2020

consideration of the issues raised for the social care sector and how it might change the future for us. Could it be the catalyst for the major social care reform that has been so long awaited? Or will we go back to being on the side-lines, an area just too big and complex to address? Underlying system issues have certainly been brought to the fore during the pandemic. A lack of

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understanding of the sector, a lack of funding and ongoing struggles to communicate effectively with the sector have all been evident. Alongside this, there has been some increased recognition of the key workers playing an essential role in frontline care delivery, we have seen the sector react fantastically to fast-paced and emerging needs with the innovation, responsiveness and positive attitude it is known for by those who understand it, and we have seen amazing personal commitment from many people who work within it.

RECOGNISING THE IMPACT For those of us who live and breathe social care and the ups and downs that come with it, none of the above was a surprise. However, the start of the crisis changed our working days into structured routines of daily director briefings, endless conference and video calls with internal teams and external networks, lobbying on essential issues, communication pieces with our teams and visits to our locations â&#x20AC;&#x201C; to stand outside offering moral support whilst feeling pretty useless compared to the activity going on inside, being dealt with so admirably by our direct care team members. Remote working was introduced quickly where possible, whilst maintaining daily support processes, which meant IT resources and support needed deploying rapidly and new systems needed setting up. A full-time team focused on securing PPE, and we had daily realities of juggling rapidly escalating costs with unknown and unreliable funding streams, whilst managing the expectations, anxieties and queries of our teams and people using our services. Daily-changing government guidance, often issued at five oâ&#x20AC;&#x2122;clock and with the really gamechanging issues often on a Friday, meant little rest as interpretation and communication of this was needed immediately. The issues and unknowns contributed to many sleepless nights,

CMM July 2020

The National Care Forum (NCF) COVID-19 resources – for members and non-members. Make sure you are aware of all the latest guidance, thinking and intelligence in response to the fast changing situation with COVID-19 Visit the NCF website: www.nationalcareforum.org.uk • The latest from PHE, DHSC & NHS England • PPE guidance, Infection Prevention & Control • Hospital Discharge, Critical Care guidance & Commissioning • Information Governance & using Technology & Data

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CMM July 2020

REFLECTIONS ON MANAGEMENT DURING COVID-19

mostly caused by concern for our teams out there working and how we could best support them to keep themselves, and those we provide care and support to, safe. The weekly calls and updates provided by the United Kingdom Homecare Association (UKHCA) were invaluable as a sounding board with other homecare leaders, but also gave critical and timely insight from the wider Care Provider Alliance perspective and enabled us to give direct and key data provision back into central government, the Local Government Association and the Association of Directors of Adult Social Services (ADASS).

NEW WAYS OF WORKING Some great projects emerged to support communities, reminding me of how nimble and responsive our social care teams are at all levels. Homecare operations put together dedicated teams and working processes to help with hospital discharge into people’s own homes as well as ‘care hotels’, working closely with health colleagues. They adapted and expanded ‘welfare calls’ for people who were worried about visits or frequency of visits and they used their community links to support in multiple ways. Our existing live-in care project work developed to flex with our health colleagues’ demands, whilst also seeing fantastic commitment from team members who remained in one-toone placements with those they support in order to give continuity of care and minimise risk of crossinfection. Complex care services for younger adults continued to provide a safe haven for those we support, though with added flexibility to accommodate a wider range of needs and support critical situations caused by the pandemic. As reflected in the media coverage, our care homes have been impacted the most of all our services in this time, with

changed working practices, often to aid both hospital discharges and prevention of people into hospital. In some cases, this required rapid changes to registration, installation of new equipment and new ways of working; not least in the essential communication and daily support of people with a dementia while wearing enhanced PPE and with a lockdown on visits from families and friends. The way the teams have responded to this, managing outbreaks of COVID-19, whilst dealing with all of the usual care, reassuring and supporting people, managing visitors for end of life care and using different ways of ensuring social connection and activity, has been amazing. Our support functions have also responded brilliantly, dealing with rapid implementation of new commercial agreements, local authority payment queries and new processes, tracking costs to each location for local authority funding purposes, and the frustrating world of PPE procurement and distribution. Training and recruitment had to adapt overnight, implementing processes to accommodate increased recruitment interest and ensure robust processes for interviewing, starting and inducting within streamlined procedures. Human resources, quality and marketing have dealt admirably with increased communications, support and information flow. New things have been tried across all of our services and teams and with some great learning and outcomes to take forward beyond COVID-19 times. From a wider perspective, teams across social care have seen recognition of their roles beyond anything we have seen before. ‘Clap for our carers’ every Thursday and thoughtful donations and communications from local communities into so many care locations have meant so much in keeping up morale, and seeing this recognition and resulting pride shine through our teams, amidst

anxieties and tiredness, has been one of the joys of this time for me. At times, it has still felt like a battle to get our teams recognised along NHS colleagues; supermarkets and discounted offers being one area that was far more problematic than it should have been.

WILL THE FUTURE BE BRIGHT? In terms of impact on the future of social care, what can we hope will change? We can hope that the calls for social care reform – real, proper system change, not just tweaks – don’t fade away as they have so many times in the past. Proper long-term funding has to be a key part of that. We can hope that the collective recognition and appreciation of our social care workforce, and indeed of the range of organisations who employ them across the sector, will continue and gain momentum. We can hope that the adults and children who require social care support at times in their lives will get the support and care they need from a more joined up system that recognises the value of both social and health care, and that working together is more effective. Structurally, we can hope that society and organisations have learned that streamlining processes, focusing on essentials and minimising red tape procedures can make ‘the system’ flow so much better and enhance the experience for all of those in it. Questions are rightly being raised about the support afforded to older people, the protection of people living in care homes, and the range and depth of our homecare provision to do so much more, as well as how as a society we want to pay for and receive support when needed. Whilst we wait to see if we get a second spike of outbreaks, we are already talking about ‘normal things’ again: winter pressures, perennial funding issues, local authorities who have still not given uplifts for this financial year and,

of course, social care workforce terms and conditions. However, these conversations are happening against the backdrop of a severely challenged economic background and a world of enhanced infection control and PPE use, COVID-19 testing, higher levels of team absences and increased costs for the foreseeable future. The ‘new normal’, as people like to refer to it. Beyond the end of June, most providers who work with local authorities and clinical commissioning groups have no idea about where any additional support for these inflated costs of providing care are to come from. The fall out of this, in particular for smaller providers, is likely to hit in coming months. Expressed support for the sector from central government, local government, NHS, the public and the media has been welcomed during this period, despite some fundamental failures in the actual ‘on the ground’, practical delivery of some of the rhetoric. However, we are already starting to see the usual business strains emerging. Less mention of social care in daily briefings, a lack of trust and partnership in dealings with local authorities, vagueness in future planning and worst of all the finger of blame being pointed at the sector for perceived deficiencies or judgments made, often in the absence of knowledge about the realities of managing care at any time, let alone through a global pandemic. Issues remain with points-based immigration, with quarantine requirements not covering social care professionals and off-the-cuff comments about ‘unskilled’ workforce still being made by senior politicians and the media. Let’s hope for all of our sakes that the commitment and care shown by our teams during this time is not forgotten and that we see this extraordinary time as one that impacted real and positive change for the sector. CMM

Raina Summerson is Group Chief Executive of Agincare. Email: raina.summerson@agincare.com Twitter: @Agincare How have you coped with managing a service through COVID-19? What do you think the future holds? Let us know on the CMM website, where you can also leave feedback on this article, www.caremanagementmatters.co.uk CMM July 2020

A CHANGING LANDSCAPE FOR DIGITAL SOLUTIONS IN SOCIAL CARE

COVID-19 has undoubtedly caused many to rapidly uptake technologies they otherwise might not have done. Daniel Casson from Care England shares how the use of digital tools in social care has been impacted by COVID-19 and what the future looks like.

Over the past three months, digital solutions have become the normal way of life for many people working in care, and for the people being supported. The pressures of working in a COVID-19 world have mobilised people into action in a way not previously witnessed, and people have been emboldened to question the way care interacts with health and the statutory bodies (NHS, Department of Health and Social Care and the Care Quality Commission). The scales have fallen from people’s eyes due to the intense and urgent need for: • New ways to connect with families and health and care professionals. • Ways to record data to inform the situation inside a care organisation, as well as the situation in the local area and nationally.

CMM July 2020

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A CHANGING LANDSCAPE FOR DIGITAL SOLUTIONS IN SOCIAL CARE

• Integrated remote monitoring solutions.

We are still in the relatively early days of COVID-19, and so there is still time to learn from the experience of the past three months, to improve the current situation and to inform current and future best practice.

CONNECTING PEOPLE The first realisation in lockdown was that people would not be able to have visitors, and so care homes had to mobilise digitally to help

effort to ensure care homes are included in the health and social care continuum. This is an example of a situation where COVID-19 has been the key to unlocking digital engagement.

VITAL DATA People working in health and care have realised that lack of data and poor data systems have cost lives. There are many accounts of people being discharged from health facilities into social care without full disclosure of the situation, whether the person is new to a care

“The glaring lack of interconnectedness between care homes and health facilities has been laid bare, and it has become all too apparent that this lack of interconnectedness has cost lives.” people keep in touch. The digital contribution has been immense, with IT managers becoming urgent hardware procurement specialists, purchasing tablets, iPads and laptops to ensure residents can at least be seen by their families. Many care home operators have mobilised non-care staff to work as liaison officers supporting stretched care staff. The NHS has opened NHSmail to all care providers, and, in residential care, 11,000 of the 15,000 care homes in England now have access to secure email, which in turn gives them access to Microsoft Teams. This has allowed two of the most important interactions in a residential care setting to happen online: medication instruction from pharmacists and GP consultations. This means that many of the obstacles in the pathway between health and care have now been cleared. What we in the sector have been trying to achieve for the past three years has happened overnight, due to a collective

home or a returning resident. When the scale of the pandemic became apparent the initial focus was on clearing hospital beds to create extra capacity, and a typical report from a care home in March or April states: “Resident AA admitted to BB hospital with symptoms unrelated to COVID-19, tested positive whilst in hospital. We were not informed, consequently the home remained open putting other residents at risk.” The glaring lack of interconnectedness between care homes and health facilities has been laid bare, and it has become all too apparent that this lack of interconnectedness has cost lives. So, what is happening? The NHS has realised the scale of the problem, and NHSX is now fully focused on ensuring care homes and social care have recourse to the digital infrastructure, hardware and training to ensure that care and health have the opportunity to be connected.

EMERGING TECHNOLOGIES The next area which has seen a great leap forward is remote monitoring. There is a plethora of remote monitoring tools in the market, and those being used in healthcare and homecare are now being mobilised in residential care. The pace of uptake has been breath-taking, and new technologies which have had trouble gaining a foothold have become commonplace. For example, the Norwegian company, Hepro is working with Graham Care Group to integrate the following functions in one platform: remote patient care, alerting and alarms, GPS localisation, video supervision and communication, online visits, fall detection, acoustic monitoring, medicine dispensing, nurse call/ alarm and integration with electronic care planning modules. Moreover, in COVID-19 times, the system can be installed from a remote location. This last point has been a revelation: the costly mobilisation of engineers and installers to a location has been minimised, empowering local operators to take control of their own systems. Another forward-looking company, Ally Cares is working with care home providers across the UK to remotely install their AI-powered monitoring system. Using their system, staff are alerted via the Ally app on their smartphones to when residents are in need of care. This removes the need to carry out regular checks giving staff back 40% of their valuable time, whilst also significantly reducing the number of falls and hospital admissions. They are notably involved in an NHS Digital Pathfinders project, aimed at promoting widescale adoption of digital solutions. The project, with Friends of the Elderly and care planning software provider, KareInn, delivers an interoperable, integrated solution

to further improve staff ability to give outstanding care at the right time. Friends of the Elderly’s Chief Executive, Steve Allen said, ‘The ability to monitor remotely day and night via Ally Cares’ integrated solution is a huge benefit to our teams who are under additional pressure due to COVID-19. The integrated systems are a solid asset which helps them to continue to safeguard the health and wellbeing of our residents.’ These examples are just two of many in the care sector where the power of remote monitoring is becoming apparent.

WORK IS UNDERWAY As well as the individual items above, the NHS has really shifted gear in promoting digital engagement in care. NHSX had started its work with the care sector before COVID-19 hit, and it has redoubled and accelerated its engagement. It has sourced Wi-Fi deals for care operators, started sourcing hardware and validating tech solutions and shown a willingness to listen to the sector as never before. Its realisation of its duty to provide the infrastructure, and potentially the curated ecosystem, into which tech solutions can fit will have a real impact. The need for guidance and standards is being co-ordinated with the Professional Record Standards Body (PRSB) and the work of setting standards and ensuring the person is at the centre of all developments is starting to take shape. The last three months have seen an acceleration in digital adoption, and, in spite of the very tough situation in care, there is real hope that out of adversity is coming a new, valuable way of working. The challenge now is to maintain the momentum and ensure traction for these new solutions to change the care and health landscape. CMM

Daniel Casson is Digital Development Executive at Care England. Email: dcasson@careengland.org.uk Twitter: @CareEngDigital How have you used digital solutions to help you through COVID-19? Let us know by commenting on the CMM website, where you can also leave feedback on this article, www.caremanagementmatters.co.uk 44

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Care Management Matters COVID-19 Special Edition July 2020

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Reflections on management during COVID-19

From the Editor