Care Management Matters (CMM) Magazine June 2021 by Care Choices Ltd

JUNE 2021

www.caremanagementmatters.co.uk

REFORMING CARE Building consumer sovereignty

Shared values

The recruitment approach you should take

Talking it through

Should vaccines become mandatory?

Resource finder Training

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In this issue 05

Inside CQC Kate Terroni, Chief Inspector of Adult Social Care at the Care Quality Commission (CQC), updates on the latest themes to be included in the CQC strategy.

CMM News

Into Perspective Our contributors discuss the Dilnot Cap and its place in the longer-term social care reform agenda.

Celebrating Excellence We speak to Project Collective, Options for Supported Living, who won the Collaboration (Integration) Award at the Markel 3rd Sector Care Awards 2020.

Event Preview What to expect from the ‘Community is the best medicine’ (virtual conference), hosted by The King’s Fund – 21st until 24th June.

Straight Talk Everyone has the right to good end of life care, but does this happen in reality? Claire Henry MBE, who specialises in end of life care, delves into the latest statistics and shares her analysis.

FEATURES

REGULARS

Social Care Insights Simon Bottery asks, if the Government is to devise a successful exit strategy out of the pandemic, how must their thinking and perceptions of social care change?

Breaking the cycle: Invest more time in recruitment and adopt a values-based approach Annette Baines and Neil Eastwood, of Care Friends, tell us more about the extraordinary power of values and offer practical advice on how to ensure your recruited members of staff develop into loyal members of the team.

Talking it through: Is mandating vaccines the right approach? A decision is expected in the summer regarding mandatory vaccinations for care workers. The National Care Forum share the results from its member survey and discuss sector opinion on the topic.

Raising the profile: Why the home care sector needs greater recognition The media has continued to highlight the impact of the pandemic on care homes, but does the home care sector feel forgotten? Raina Summerson, Group CEO of Agincare, calls for greater recognition of the sector.

People power: Building consumer sovereignty into social care Des Kelly and John Kennedy say that if social care is to happen, then there needs to be a transfer of power, control, and money. The authors define consumer sovereignty in relation to reforming social care.

Resource Finder CMM brings you information on some of the sector’s leading training providers. CMM June 2021

EDITORIAL editor@caremanagementmatters.co.uk Editor: Olivia Hubbard Content Editors: Aislinn Thompson, Henry Thornton

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

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@blimeysimon

@CQCprof

@CareFriendsApp

@NCF_Liz

Simon Bottery Senior Fellow in Social Care at The King's Fund

Kate Terroni Deputy Chief Inspector for Adult Social Care, Care Quality Commission

Annette Baines Head of Partnerships and Research at Care Friends

Liz Jones Policy Director at The National Care Forum

@CareFriendsApp

@CCNOffice

@AccessCharity1

@Agincare

Neil Eastwood Founder and CEO of Care Friends

Cllr David Fothergill Community Wellbeing Board Chairman, Local Government Association

Kari Gerstheimer Chief Executive and Founder of Access Social Care

Raina Summerson Group CEO of Agincare

@DesKellyOBE

@JohnnyCosmos

@proj_collective

@clairehenry_

Des Kelly OBE Chair at the Centre of Policy and Ageing

John Kennedy Independent consultant and commentator in adult social care

Christine Bithell Community Engagement Development Manager, Options for Supported Living

Claire Henry MBE Director of Claire Henry Associates

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 2021 CCL REF NO: CMM 18.4

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CMM June 2021

SOCIAL CARE

INSIGHTS From Simon Bottery

Simon Bottery of The King’s Fund asks, if the Government is to devise a successful exit strategy out of the pandemic, how must its thinking and perceptions of social care change? The American investor James Lampert was fond of saying that an ‘exit strategy’ is more important than an ‘entrance strategy’. You need to plan for leaving a business even more than for going into one. (The advice applies to other areas of life, of course, like house parties and wars.) That advice sprang to mind when the Labour MP Olivia Blake, during a recent Public Accounts Committee meeting, asked about the Government’s exit strategy for support to the social care sector during COVID-19. Would it stop and, if so, when? It’s a good question – and we’ll get to it in a moment – but it also begged one

about whether there had in fact been an ‘entrance strategy’ to the Government’s support to the sector as the COVID-19 pandemic began. You would have to say no. There was an initial phase of shock, confusion and bewilderment, followed by a flurry of policy and guidance, not all of which was fit for purpose and some of which – discharging people from hospitals without testing them for COVID-19 – was plainly mistaken. However, financial and other support did begin to emerge, taking on more coherent form with the social care taskforce recommendations. While some gaps and misjudgments have remained, guidance has become

clearer, the type of support has widened and the funding has increased – the Infection Control Fund alone has now provided over £1.1bn of support. A key objective of the financial support was to help care homes make often costly changes to their services that protected residents, and to avoid homes becoming financially unstable as a result. And, while causation is difficult to untangle from correlation, it looks like it has worked. There were far fewer excess deaths in care homes during the second wave of COVID-19 and we have not seen the wave of care home failures that some people feared. In fact, Ian Trenholme,

the chief executive of the Care Quality Commission, told the Public Accounts Committee that fewer care homes are leaving the market. Vaccination now offers hope that COVID-19 can be at least contained. Infection rates have fallen. Society has begun cautiously to reopen. Is Government now thinking about that exit strategy on financial support? Certainly Sir Chris Wormold, the permanent secretary at the Department of Health and Social Care, indicated there would eventually be a need to ‘step off the escalator’, albeit with ‘a degree of care’. But, as James Lampert might have predicted, it may prove harder to exit than to enter, for several reasons. First, COVID-19 will not disappear overnight and neither, presumably, will the extra costs of providers for measures like PPE and insurance. Second, we surely cannot return to the social care of endemic service failures and ‘care deserts’. Third, the relationship between Government and the sector has changed (as Sir Chris himself acknowledged). The Government has recognised – notably in its recent ‘Integration and Innovation‘ white paper – that local Government 'shaping’ of the market is not enough; national oversight has to be stepped up. So the Government cannot leave by the same door it entered. A new relationship with social care is inevitable. Only when – if – we see the promised social care reform white paper will we know exactly what it might look like.

Simon Bottery is a Senior Fellow in Social Care at The King's Fund. Email: S.Bottery@kingsfund.org.uk Twitter: @blimeysimon

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We’re all starting to take those first few tentative steps out of lockdown. As our communities begin to slowly open up, many of us will feel like our lives are returning to a familiar rhythm. I’m sure, like me, you’re looking towards the summer with hope. Hope for your loved ones, the people you care for and your colleagues. However, I recognise that you’re still facing daily challenges on areas such as workforce, visiting, occupancy and vaccination. The journey through COVID-19 recovery is just beginning and poses a number of challenges and opportunities for our sector. Everyone will need to continue adapting but I want to reassure you that we’ll be there to support you. I know you are working tirelessly to provide care and support during this time and my thoughts are with everyone who has lost someone through the COVID-19 pandemic. Our regulatory role and core purpose to keep people safe and ensure that they have highquality, person-centred care is at the heart of all decisions we make. COVID-19 has accelerated change across health and social care and, in this new world, we are changing too. So far, we’ve had over 20,000 structured monitoring calls with providers. These supportive conversations focus on specific key lines of enquiry and are an opportunity to raise any concerns you have with your inspector. Many of you will have experienced an infection prevention and control (IPC) inspection. We’ve now completed over 7,000 inspections since the start of the pandemic in adult social care locations, including IPC, risk and designated settings inspections. We’ve seen some fantastic IPC practice out there and over 90% of IPC inspections had an overall outcome of ‘assured’. This allows us to reassure the public about the good practice and safety of our services at a time when their concerns are high. We’ve adapted our care home IPC methodology to be used in community settings such as supported living and extra care. This tool has been developed as a way to seek and give assurance that, where providers have responsibility for IPC, they are following best practice guidance and working with other relevant agencies to keep people safe. This will be published on our website in the coming weeks. Through the COVID-19 pandemic we’ve received a number of requests to share the

Inside CQC K

A T

Kate Terroni, Chief Inspector of Adult Social Care at the Care Quality Commission (CQC), updates on the four key themes to feature in the new CQC strategy.

data we hold on deaths in care homes at a location level. We’ve kept our decision on whether to release this data under review. We already publish data on the total number of deaths in care homes in partnership with the Office for National Statistics (ONS) on a weekly basis; however, we’re now working towards sharing further data on this in the coming months and are in ongoing conversations with ONS about how best to release this. We know that on its own the number of deaths at a care home during this pandemic does not provide an accurate assessment of quality or safety. We’ll be working with your trade associations to release this information collaboratively and in context. Please continue to share clear, transparent and regular communications with families about any outbreaks and deaths at your service. Holistic, person-centred care has always been important, but the COVID-19 pandemic has shone a light on why. We’ve just published information about culturally appropriate care on our website. Culturally appropriate care is about being sensitive to people's cultural identity or heritage. It means being alert and responsive to feelings, beliefs or conventions that might be determined by a person’s culture. In these pages, you will find examples

and good practice to help you think about different ways culture might affect care. This has become even more important through the COVID-19 pandemic. I encourage you all to reflect on this information and think of some culturally appropriate care examples with your colleagues. Towards the end of May we’ll be launching our new strategy. Our strategy covers four key themes: people and communities, smarter regulation, safety through learning and accelerating improvement. Integrated throughout is an ambition to look at how the care provided in a local system is working to improve outcomes for people and reduce inequalities. This means looking at how services are working together within a system, as well as how individual systems are performing as a whole. We’ll be shaping the implementation of our strategy with you from the summer to help ensure our plans ultimately help people access better care. We have already heard your voice in response to our consultation on the strategy and this will help to shape our smarter, more responsive model of regulation for the future. Continue to engage through our digital participation platform and sign up to our newsletter to keep up to date. Thank you to everyone who has contributed so far.

Kate Terroni is Chief Inspector of Adult Social Care at the Care Quality Commission. Share your thoughts and feedback on Kate’s column on the CMM website, www.caremanagementmatters.co.uk. CMM June 2021

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NEWS

APPOINTMENTS NATIONAL CARE FORUM

Social care sector reacts to Queen’s Speech Leading organisations in the social care sector expressed their disappointment, following the lack of mention about social care in the Queen’s Speech. The State Opening of Parliament was viewed as a significant moment for the Government to set out its long-term agenda on social care reform and provide clarity on its manifesto promise to ‘fix social care’. The Queen’s Speech included the following reference: ‘Proposals on social care reform will be brought forward.’ Vic Rayner, Chief Executive at The National Care Forum, said, ‘We need to move forward from the place of (nine tiny) words to action – specific action that will propel the sector from the position of recovery to sustainability and growth. This Government can be the one that delivers for social care – but if it is to

fulfil its multiple commitments to do so; then now is the time for them to articulate in full the detail of that long-term ambition.’ Care England expressed its disappointment that meaningful social care reform has been ‘kicked into the long grass again’. Professor Martin Green OBE, Chief Executive of Care England, said, ‘We stand ready and willing to help the Government deliver its manifesto commitment, but the Health and Care Bill, which has a focus on the NHS, is not the vehicle to deliver this huge shift, as it will not produce the system change that is necessary to ensure the future sustainability of the sector.’ The Association of Directors of Adults Social Services (ADASS) shared a similar view. Stephen Chandler, ADASS President, said, ‘It is deeply frustrating that we did not hear any detail of how ministers

intend to make social care fit for purpose in the 21st century so that it can enable young disabled and older people and carers to realise their ambitions and maximise their independence.' Kirsty Matthews, CEO of Hft, the national charity supporting adults with learning disabilities, said, ‘While the Government has renewed their pledge to bring forward proposals for social care this year, there was a stark absence of concrete legislation outlining reform and a long-term funding settlement for the sector. As demonstrated by our Sector Pulse Check research, this is desperately needed, given that 56% of social care providers reported being either in deficit or having seen their surplus decline. These cost pressures have ultimately led to service closures, staff redundancies and care being offered to fewer people.’

Further restrictions eased for care homes The Department of Health and Social Care (DHSC) further relaxed restrictions for care homes on Monday 17th May. Care home residents are now able to have more named visitors and more opportunities to make visits out, with no need to selfisolate when they return. As part of step three of the roadmap, the number of named family members or friends able to visit their loved ones in care homes has increased from two to five, as the visiting restrictions continue to ease. A maximum of two visitors will be allowed at any one time or on any given day. This follows a reduction in COVID-19 cases and

the ongoing successful vaccine rollout with 95% of older care home residents receiving their first jab. Residents will also be able to go to medical appointments, a workplace, educational setting, and day centres without having to self-isolate on their return. The period when a COVID-19 outbreak in a care home can be declared, will also change from 28 days to 14 days after the last positive case assuming there are no Variants of Concern (VOCs) identified. This means visits can resume sooner following an outbreak, once the relevant testing has been completed and provided all staff and residents tested receive a

negative result. Chief Nurse for Adult Social Care, Professor Deborah Sturdy, said, 'I know this change to the guidance will be a huge boost to so many, giving more people the chance to reunite with more of their friends and family.' Helen Wildbore, Director of The Relatives and Residents Association, said, 'Some of the changes are not even a step forward at all, but merely bring an end to terrible policies which have been imposed only on care users – like dropping the two-week quarantine after medical appointments, which has prevented many older people from accessing vital healthcare.'

The National Care Forum (NCF) has announced the appointment of Andy Cole OBE, as the new Chair of its board. Andy succeeds Maria Ball, CEO of Quantum Care, who has held this post since 2017. Maria will remain on the board of directors. Andy is Chief Executive of Royal Star and Garter, a long-standing member of NCF and a NCF board member himself since 2017.

COUNTY COUNCILS NETWORK

The County Councils Network (CCN) has announced that Cllr David Fothergill will be CCN’s Acting Chairman until a permanent candidate is elected later this year. Cllr Fothergill will stay in place until July, when a permanent CCN Chairman-Elect will be appointed following elections within the largest political party, the Conservatives.

NHS DIGITAL

NHS Digital has announced today that Simon Bolton has been appointed as its interim CEO. Simon joins the organisation from Test and Trace where he has been Chief Information Officer since August 2020.

CORNERSTONE HEALTHCARE

Complex care provider, Cornerstone Healthcare, has appointed Deborah Bailey as Commercial Director and a key member of their Senior Management Team. Deborah will play a pivotal role in the next stage of the company’s ambitious growth plan.

SHEFFCARE

Sheffield charity, Sheffcare has appointed Claire Rintoul as its new Chief Executive. CMM June 2021

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NEWS

Council leaders urge ministers to ‘fix’ social care A cross-party group of council leaders said failure to act on securing the future of adult social care, as we emerge from the pandemic, will be a ‘bitter blow’ to the millions of people who rely on and work in these vital services. The letter, copied to Health and Social Care Secretary Matt Hancock, Communities Secretary Robert Jenrick and Care Minister Helen Whately, also said the approach of one-off Government grants and the social care council tax precept are only ‘sticking plaster solutions’ which prevent longer-term planning. The signatories state that for

the Government to finally make good on its promise to ‘fix social care’, three things are needed: • Investment – move away from a model of wellbeing based on care homes and hospitalisation, to a broader offer that enables people to live their own lives independently in their own homes and communities, in appropriate accommodation and with the right level of support. This preventative approach would be better for people and for the NHS by preventing or delaying the need for someone to go into hospital. As a significant employer, investment in social

care is also an investment in local economies. • No more sticking plasters – it must be confined to history the approach of additional one-off grants and, in particular, the adult social care precept to fund social care. While helpful, they are only ever sticking plaster solutions which are unsustainable, and depending on council tax is not the solution. • Long-term funding – a solution is needed for bringing more money into social care which matches the level of ambition needed to have for the future of care and support, beyond

just protecting people from having to sell their home to pay for care, as important as that is. The case should be made for increases in national taxation and/or a social care premium based on universal risk-pooling. Cllr James Jamieson, Chairman of the Local Government Association, said, ‘The decisions on social care funding and reform in the coming weeks will potentially impact both the millions of people who draw on or work in care and support now and the many millions more who will do so in the decades ahead.’

30 projects to receive share of charity music fund Following one of 2020’s standout television moments – when Paul Harvey, former concert pianist, composer, music teacher and person living with dementia, played his Four Notes composition on BBC Breakfast – some 30 projects across the UK, providing musical services for people with dementia, are receiving a share of Music for Dementia’s £500,000 Paul & Nick Harvey Fund. In just six weeks over 170 organisations applied to the fund, which was launched by the Music for Dementia campaign,

backed by The Utley Foundation, in January this year. Grants of between £5,000 and £50,000 have been awarded to a diverse range of projects from dementia choirs to music therapy services. Successful grantees such as Lifesize CIC in England, Forget Me Notes in Scotland, Musical Memories Choir in Wales and Ulster Orchestra Limited Society in Northern Ireland, are overjoyed to receive support for their work in enhancing the lives of people living with dementia in their communities through music. Not only will those living with

dementia benefit, the ripple effect of the fund will also touch carers, family and friends who support them in the community, care home settings and at home. For example, Wishing Well for Music in Surrey and Sussex, usually takes musicians to the bedside of people with dementia in hospital, but its grant will enable it to continue and extend its bedside music programme, where hospital staff will connect the patient with the musicians via Zoom. In addition, Elders Voice in Brent, which has a diverse

population, will use its grant to bring musicians from a variety of cultures to make a positive impact on people with dementia from BAME communities, with music that reflects their specific cultural background. Grace Meadows, Campaign Director, Music for Dementia, said, ‘Musical services have been severely impacted in the last year, meaning many people living with dementia and their carers have lost those important connections and special moments that music, uniquely, provides.’

innovation and permanent reform. Kathy Roberts, Chair of the Care Provider Alliance (CPA), said, ‘Although short term Governmental support during the pandemic has been very welcome, flexible negotiation for change going forward is essential. The CPA will work alongside our colleagues to focus on outcomes for people, families and communities who draw on care services. Employment within adult social care must also be as highly regarded and attractive as it is in other areas of the public sector

with steps taken to make it so. 'Government policy and guidance has also regularly lagged behind that of the NHS, and early access to enhanced infection prevention and control including PCR testing and PPE was limited. But this is not about care providers complaining of playing ‘second fiddle’ to our NHS colleagues. It’s about recognising our incredible workforce, and in reinforcing the outstanding quality care offered to millions who rely on social care every day.'

ADASS Spring Seminar The 2021 ADASS Spring Seminar took place between Wednesday 27th – 30th April. The new President of the Association of Directors of Adult Social Services (ADASS), Stephen Chandler, reflected on the lessons of the last year, called on the Government to urgently set out its plans for the future of care and support and asked for everyone to come together to speak up for change. Stephen Chandler said, ‘I want everyone with personal experience and who is passionate about care

and support to come together, to be confident, to be ambitious, and to help us make the change happen. Together we can ensure that all of us have access to the care and support we want for ourselves and our families, today and for years to come.’ The Care Provider Alliance believes central and local Government must use the expertise, knowledge and experience available to them in strategically delivering care support appropriate for everyone. CPA said It’s about debate,

CMM June 2021

NEWS

Women with learning disabilities urged to make voices heard Women with learning disabilities are being urged to respond to the call for evidence that will shape the first-ever Governmentled Women’s Health Strategy, to ensure health services are meeting the needs of women. The six core themes included in the call for evidence are: • Placing women’s voices at the centre of their health and care: How the health and care system engages with and listens to women at the individual level as well as at the system level.

• Improving the quality and accessibility of information and education on women’s health: Women having access to high-quality information when they need to make a decision, increasing health literacy, as well as increasing awareness and understanding of women’s health conditions among clinicians. • Ensuring the health and care system understands and is responsive to women’s health and care needs across the life course: Supporting women to

maximise their health across their lives, and ensuring services are designed to maximise benefits for women. • Maximising women’s health in the workplace: Deepening our understanding of how women’s health issues can affect their workforce participation and outcomes, both with regards to female-specific issues such as the menopause, but also conditions that are more prevalent in women such as musculoskeletal conditions, depression or anxiety.

• Ensuring research, evidence and data support improvements in women’s health: Inclusion of women and women’s health in research and data collection and how that information is used and driving participation in clinical trials to support improvements in women’s health. There are approximately 1.2 million people with a learning disability in England. On average women with a learning disability die 27 years earlier than those without.

MacIntyre secures funding for ground-breaking project MacIntyre, a national learning disability charity, has secured almost £170,000 of National Lottery funding, for a new project to test solutions to break down the barriers people with a learning disability experience regarding end of life care, dying and death. The funding will enable the

‘Dying to Talk’ pilot project to help people the charity supports, their families and MacIntyre staff, understand and feel supported talking about death and dying. Through the delivery of their three-year Department of Health funded Dementia Project it became apparent that many people with a

learning disability are not spoken to when it comes to end of life care, dying and making decisions regarding their death. Working with people with a learning disability, support workers, family members and the wider sector MacIntyre will deliver workshops, provide information and create resources

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NEWS

NCF launches Kickstart support scheme The National Care Forum (NCF) is pleased to announce that the first applications have been submitted to the DWP to recruit 30 young people into roles within the adult social care sector at NCF member organisations. The Kickstart Scheme provides funding to create new job placements for 16 to 24 year olds on Universal Credit, who are at risk of long-term employment. In conjunction with Pathway

CTM (a dedicated Social Enterprise that supports young people with employability skills and employment opportunities) and long-term NCF partners Cohesion Recruitment, NCF has put together a unique package of support to offer NCF members the best possible Kickstart experience. A programme of monthly, themed webinars has been created in conjunction with Cohesion Recruitment to support workplace mentors and employers

on a variety of topics. The scheme offers a package of support, not just for young people employed through the Kickstart Programme, but also to care provider members of NCF taking part in the scheme, and their existing employees who are acting as mentors for their new colleagues. Brian Whittaker, HR and OD Director of Brunelcare, who has been operating its own Kickstart

scheme for a number of months, said of Kickstart, ‘So far, we have 22 Kickstart colleagues working across the charity including within the IT team, Finance, HR and Property Services. We also have a number working in our various care homes. They are brilliant people doing a great job and enjoying the opportunity. This is a real win-win as we are in reality training people who can then apply for permanent vacancies.’

Call to establish sustainable future for social care A signed open letter has been sent to the Prime Minister, calling for a ‘1948 moment’ for adult social care and to establish a long-term and sustainable future for the sector. The letter was signed by more than 28 co-signatories. Organisations and charities including Care England, Age UK, The Relatives and Residents’ Association (R&RA), UKHCA, Carers UK and

Independent Age, backed the call for a ‘desperate need of reform’. The body of the letter highlights how the adult social care workforce has demonstrated tremendous commitment and resilience during this time; however, the letter states that the sector is on its knees and is in desperate need of reform so that it can craft a long-term social care future that will protect citizens,

reduce the burden on the NHS and establish good careers in social care. Dr Jane Townson, UKHCA's CEO, said, ‘Regardless of whether people are funding their own care, or are supported by the State, strong leadership from central Government, based on cross-party consensus, is vital to ensure that people’s preferences are at the heart of our care and health system.’

Caroline Abrahams, Charity Director at Age UK, said, ‘The disaster that has struck social care this year illustrates what happens when you consistently neglect a crucial service that millions rely on every day. We have seen the countless problems first-hand, with care homes bearing the brunt, care at home struggling to meet older people's needs and family members often forced to pitch in.’

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NEWS / IN FOCUS

Adult social care across the nations The Institute for Government, a London-based think tank, has published a new report: Devolved Public Services: The NHS, schools and social care in the four nations. Some of the key findings from the report, relating to adult social care, are as follows: • The UK Government spent £308 per head on adult social care in England in 2018/19 – as opposed to £423 per head in Wales, £443 in Scotland and £491 in Northern Ireland. • The Scottish Government was the only Government which spent more on community than residential care in 2018/19. • The proportion of the English population receiving state-funded social care fell by over a third between 2006/07 and 2013/14. • Scotland loses more bed days per person to delayed discharges than England and Wales combined. • The Welsh Government spends more per head on social care for working age people than

the Scottish Government, but significantly less per head on older people. Grant Dalton, author of the social care-based chapters in the report, said, ‘Building on previous work from Skills for Care, and the Nuffield Trust, we found that static or declining budgets have meant that the Government is providing care to fewer people than it was a decade ago in England, Scotland and Wales. Spending in Northern Ireland has increased rapidly over the past five years, but even their provision has not kept up with rising demand.’ Dalton concludes, ‘The four nations rarely release data in the same way as each other, and often do not agree on how comparable the data they do publish is. Better data is vital to understanding the performance of services. The four Governments must improve the evidence on social care performance to analyse what has – and has not – worked.’

Care homes could save millions in VAT A Supreme Court ruling could mean that organisations, such as care homes that have used leaseback arrangements, will not be subject to retrospective VAT charges and could now save millions, say leading tax and advisory firm, Blick Rothenberg. Alan Pearce, VAT partner at the firm, said, ‘This is great news for owners and operators of new relevant residential properties (such as care homes and student accommodation) and certain properties used for a relevant charitable purpose. When these properties are first constructed, they qualify for zero rating. This is normally an absolute saving for the owners or operators as they are unlikely to be entitled to recover most of the VAT they incur.’ He added, ‘However, where the construction costs have been zerorated, there is a self-supply charge

that can be can retrospectively be applied where there is a dispose or change of use of the zero-rated building within ten years of its completion. This can effectively reverse some or all the VAT savings and result in a significant payment of VAT to HMRC. This is long-awaited good news for those organisations that have used leaseback arrangements to finance new residential or charitable buildings. As this is now settled case law, HMRC cannot appeal further.' Alan Pearce concluded, ‘HMRC has not yet commented on the practical implications of this decision. However, charities, care homes other organisations in similar circumstances should be reviewing their arrangement to ensure they fall into line with the Balhousie decision and are not susceptible to challenge by HMRC.’

IN FOCUS Care Workers’ union warns of mental health crisis

WHAT’S THE STORY? The month of May marked mental health awareness month. GMB, the care workers’ union, has warned of a looming care workers’ crisis as new research found that threequarters of care workers have experienced worsened mental health, as a result of their work during the pandemic. The survey included findings from 1,200 social care workers and 75% of respondents reported that pandemic work has caused worsened mental health and a sharp increase in anxiety. The union has said the Government must ‘step up' and address the mental health crisis in social care.

WHAT ARE THE FINDINGS? • 75% of care workers say that their work during the COVID-19 pandemic has had a serious negative impact on their mental health. • Care workers report anxiety levels are almost half as high (44% higher) than all employees in the wider economy. • Care workers’ mental health declined throughout the second wave: care workers reported poorer mental health in December/January than at the start of the second wave in September/October.

• Some groups of care workers were more likely to report poor mental health: women, disabled, residential, and care workers who were only entitled to statutory sick pay all reported lower mental health scores. • Worryingly, the new survey found that care workers’ mental health had declined since the summer. Survey respondents’ scores for happiness had fallen by 12% and self-reported anxiety levels had risen by 6%.

WHAT DID THE EXPERTS SAY? Karolina Gerlich, CEO, The Care Workers’ Charity, said, 'Care workers across the country have shown remarkable bravery and sacrifice in putting their lives at risk, in order to care for others. Many are working in unfamiliar roles and workplaces and face unprecedented stress and trauma. Despite rising rates of anxiety, stress, PTSD and depression, many social care workers are not eligible for bespoke therapy, and those that are, are unable to afford its cost. Without existing support structures in place, they are forced to cope alone.’ To bridge this gap, the Care Workers’ Charity is providing ten hours of free mental health support through its partner Red Umbrella. CMM June 2021

NEWS

Social care perception survey The social care special interest group at the Institute of Health and Social Care Management (IHSCM) has carried out a survey, to gauge current perceptions of the sector. 225 people, split equally between those working in and outside of social care took part in the survey. Key survey insights (March 2021): • 64% of all respondents would consider a career in social care, while those with first-hand experience (54%) are much more likely than those with limited or

no knowledge (19%). • Most respondents believe that social care exists to support and care for the most vulnerable in our society, in particular the elderly. • Respondents were most aware of care homes (97%) and home care (92%) and least aware of Extra Care Housing (54%), especially those with limited or no knowledge of social care. • 75% of respondents said they were aware of NHS services in

the care sector which suggests a level of misunderstanding between healthcare and social care services. • Respondents cited the CQC or equivalent (86%) and word of mouth (74%) as the best ways to find out the quality of a care organisation, with the media (23%) scoring the lowest. • 86% of all respondents stated that care workers didn’t receive the recognition they deserved, rising to 90% from those working

in social care. Jane Brightman, General Manager of Social Care at IHSCM, said, ‘It’s revealing to see that those people who have had some first-hand experiences of social care are three times more likely to want to work in our sector. This is a positive finding and demonstrates a greater need to introduce social care as a career option to young people, graduates and those in careers with transferable skills.’

Elder and Co-op legal announce partnership Provider of live-in care services, Elder, has announced a new partnership with Co-op Legal Services, in a bid to empower customers with the knowledge they need to take charge of their later life finances and care arrangements. A new virtual hub will provide legal guidance on a range of estate planning issues such as wills, Lasting

CMM June 2021

Power of Attorney and inheritance tax along with support on live-in care options. The move follows research conducted by Co-op Legal Services in 2020 that showed a large number of people had given no thought to their legal affairs. Almost four fifths (83%) of over 50s and two thirds (66%) of those aged 75 and over

did not have a Lasting Power of Attorney in place. Research conducted by Elder shows that 60% of people aged over 60 have limited or no knowledge about elderly care and support services. Peter Dowds, CEO of Elder, said, ‘There is still a knowledge gap when it comes to planning for care needs in later life. And it is

often a decision delayed until one unfortunate incident triggers an urgency to arrange additional care support for a loved one. However, if we, as a society, move towards a mindset where we’re considering potential care needs ahead of when they are actually required, we can collectively move towards a more personalised care model.’

NEWS

Housing with care sector’s pandemic response The RE-COV study was led by the St Monica Trust, funded by the Dunhill Medical Trust and supported by Housing LIN. The aim of the research project was to better understand the experiences of Retirement Villages and Extra Care Housing during the pandemic, including the effectiveness of measures taken to protect the health and wellbeing of residents and staff. The study highlighted the favourable experience of many

residents living in Retirement Villages and Extra Care Housing during the pandemic. Positive outcomes for residents included high levels of feeling safe, supported and comforted, knowing other people were around, plus enjoyment from organised outdoor activities. Rachael Dutton, St Monica Trust’s COVID National Research Project Lead, said, ‘0.97% of Retirement Village and housing scheme residents died from

confirmed COVID-19 from March to December 2020. ‘This was less than the 1.09% of people with the same age profiles who died from COVID-19 living in the general population in England and residents of Retirement Village only operators also had the lowest COVID-19 death rate of 0.51%.’ Michael Voges, Executive Director of The Associated Retirement Community Operators (ARCO), said, ‘Despite the huge challenges presented by the

pandemic, Housing with Care has performed brilliantly in keeping their residents safe, supporting them to stay active and independent and in supporting the wider health and social care system. ‘The past year has seen an overwhelming vindication of the Housing with Care model. It is time for more older people to have the opportunity to benefit from the safety, security and supported independence which Housing with Care provides.’

South East care group takes on cohort of nurses A South East care group has welcomed a cohort of 24 registered nurses from its Indian training centre to work across its homes after passing their Objective Structured Clinical Exam (OSCE). Nellsar, a family-run group of 13 care homes throughout Kent, Surrey and Essex, recently took

on the nurses from its overseas training centre in Kerala, India – with the programme achieving a 100% pass rate since it was set-up last year. Driven by a shortage of nurses in the UK, the highly successful programme was formulated in late 2020 to enable carers from overseas to gain their Nursing

and Midwifery Council (NMC) registration to work in the UK. After passing two exams in India, the nurses took part in OSCE training at Nellsar’s Princess Christian Care Centre in Surrey, and Hengist Field Care Centre in Kent, under the stewardship of Paula Persaud, Registered Nurse Development

Manager at Nellsar. Paula said, 'The OSCE nurses are supported in passing their exams with the NMC, before continuing their registered nurse induction with us. It’s a practice that incorporates more futuristic development and support to recruitment in the social care sector.’

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Virtual holidays for care home residents Advinia Healthcare, who manage Roseacres, and live-streaming travel platform Heygo, have teamed up to provide interactive adventures as a way of addressing the isolation and boredom that many residents have felt over the past year and to help them find meaningful ways to connect with friends and family who are unable to visit. Heygo's live tours allow groups

to tune in via a shared screen in a care home living room or join from the privacy of their own room. Travellers are able to invite others to join remotely and to communicate with other tourists and their guide. The platform, which was launched during the pandemic, offers over 50 tours a day in over 60 countries around the world. Dennis, an 84 year old resident at Roseacres, said,

‘I used to travel with my wife all the time, but after she passed away, I felt as though that part of my life was over. Last week, we did an hourlong tour of Venice and watching the men singing on the Gondola suddenly transported me back to a holiday I took with her many years ago. It was really special to be able to share this memory with my son who had joined from his home.’

Hertfordshire care home opens new activity hub Foxholes Care Home is intent on keeping spirits high after some long-awaited reunions with family members, by launching a brand new indoor activity centre. A scheme which promotes exercise, social interaction and entertainment, the recreation hub includes a cinema room, library, bar, communications booth, and pool table, providing residents with an array of activities to boost their physical and mental wellbeing.

The library, in particular, will include a mobile book trolley and see the launch of the Foxholes Library Club, which will be run by the residents themselves. In addition to the new activity hub, the Hitchin home has also built outdoor pods; The Foxholes Oval and The Foxholes Wheelhouse, which have been developed specifically for outdoor visitation and staff breaks. Neil Gandecha, Estate Manager

at Foxholes, said, ‘We’re excited to be opening a new activities room and outdoor visitation area at a time where we’re gradually moving away from restrictions. They are our way of saying thank you to our wonderful residents, who have been absolutely fantastic during these unprecedented times. Residents can now spend quality and meaningful time with their family and friends while taking up some exciting new activities, too.’

Staff urged to shape Women’s Health Strategy The social care workforce is being urged to respond to a call for evidence that will help shape a new Women’s Health Strategy. The Minister for Care, Helen Whately, and Chief Nurse for Adult Social Care, Professor Deborah Sturdy, met with women working in social care to discuss the health issues affecting them in the sector. Government is urging women who are care workers to talk about their own personal experiences

of the health and care sector and encouraging all social care workers regardless of gender to feed in about women they have looked after. Mental health support and help with anxiety were raised as key challenges for the workforce, as well as the physical demands of caring, particularly as staff get older. Participants also raised issues around irregular shift patterns and healthy eating, with many

having to buy unhealthy meals for convenience. Shift times during the pandemic and working extra hours meant that going to the shops and trying to get healthy food became a challenge for some women and their families. The Women’s Health Strategy will be guided by the experiences of women from all walks of life, and by sharing their views in the call to evidence they are helping create a health and care system that works for them.

R&RA express disappointment in letter to CQC The Relatives & Residents Association (R&RA) has expressed continued disappointment with the role the Care Quality Commission has taken during the pandemic. In a letter to the regulator, R&RA’s chair, Judy Downey, outlines how older people needing care have been ‘badly let down by CQC’. Downey says, ‘As a human rights crisis unfolded in care – with 18

CMM June 2021

isolation infringing people’s rights to liberty, family life and wellbeing – CQC retreated to the sidelines. Their lack of voice and leadership has left the sector vulnerable. Their failure to adapt to the changing world has left care users and their families feeling bereft.’ The letter calls on CQC to take urgent action to remedy these failings and earn the trust and respect of those

it exists to represent. R&RA has repeatedly called for CQC to take a proactive role in monitoring compliance with the Government guidance on visiting, to end isolation in care. The letter is accompanied by a summary of insights and evidence from the R&RA Helpline of the barriers older people and their families continue to face.

East Sussex planning development Christie & Co has brought to market a 74-bedroom care home development opportunity (C2) with planning consent in Uckfield, East Sussex. The site measures circa one acre and comprises a cleared brownfield site which previously accommodated a former care home and day care centre. Planning consent was granted in May 2016 for the ‘erection of a new part two/part three-storey C2 care home’ with 74 generously sized en-suite bedrooms which all exceed the CQC’s ‘Essential Standards of Quality and Care’.

Care south staff go paperless A not-for-profit charity in the South of England is the latest UK care provider to invest in technology to boost operational efficiency, reduce errors and improve care delivery. Care South, which provides residential, nursing and dementia care to residents across its 16 care homes, also help people to live independently in their own homes. Care South's latest investment will see staff go paperless, using Person Centred Software’s Mobile Care Monitoring to evidence and monitor care interactions in real-time, in a move that is said to save each carer up to three days per month on paperwork. The gradual rollout will see Care South’s Sussexdown care home receive the software first, with the wider plan being to onboard up to two locations per month until all services are fully equipped with the software.

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: E L C Y C E H T G N I K BREA Invest more time in recruitment and adopt a values-based approach

CMM June 2021

What has the pandemic taught us about recruitment and retention? Annette Baines and Neil Eastwood of Care Friends tell us more about the extraordinary power of values and offer practical advice on how to ensure your recruited members of staff develop into loyal members of the team.

Adult Social Care’s vacancy rate, as reported by employers, dropped 18% in the first six months of the pandemic, and, when the latest stats are released, we anticipate they will show this positive trend continued into the first weeks of 2021. But not everything is always as it seems, and, in this article, we look behind the headline figures, uncovering a looming threat and a significant learning opportunity for employers.

RETENTION RATES Most readers are all too familiar with the impact the pandemic has had on their own care workforce. One published measure of the organisational impact is the almost tripling of days lost to sickness. But this statistic doesn’t address tens of thousands of personal stories of care workers struggling with illness, stress, guilt and concern for loved ones. Or how these lost days were covered by exhausted colleagues maintaining support to residents and clients. It doesn’t capture the familial love that care managers have for both those in their care and their teams, or how much the burden of responsibility to keep everyone safe weighed on them. And it certainly doesn’t reflect the tragedy of care staff dying as a result of their commitment to caring for others. Given these extraordinary emotional and physical factors on top of the general challenges of working in a frontline care role, why did

retention levels seemingly improve? Two main themes cited by employers in a recent poll help us untangle this: firstly, loyalty and dedication of staff not wanting to abandon those in their care, and secondly, lack of alternative employment options. We believe this short-term combination of factors may have simply propped up retention rates by temporarily delaying staff resignations, rather than preventing them. Now vaccinations are almost universal among the vulnerable and the economy is bouncing back, props may fall away quickly, leaving our sector dangerously exposed to a widespread staffing exodus. At the same time, and at the worst possible moment, the door is closing to a potential EU migrant care workforce that mostly doesn’t meet current immigration criteria (always an ill-judged policy in our opinion). Where does that leave social care employers? We need to uncover and examine the biggest workforce lesson to come out of the pandemic before we can chart a course to improve both recruitment and retention for any employer of care staff.

THE EXTRAORDINARY POWER OF VALUES It has long been our belief that, if adult social care characteristics – the low pay, emotional and physical pressures, unsociable hours, escalating demand and long overdue need

CMM June 2021

BREAKING THE CYCLE: INVEST MORE TIME IN RECRUITMENT AND ADOPT A VALUES-BASED APPROACH

for structural reform – were apparent in any other human services, a catastrophic collapse would have occurred long ago. Workers would simply vote with their feet and exit the sector for higher paid local work in substitute industries. Whilst a major concern, our sector vacancy rate is surely much lower than supply and demand economics would predict. So, what is going on? The answer? We benefit from the extraordinary goodwill of the majority of the workforce and this is the invisible glue that holds social care together. What care workers themselves often describe as ‘a calling for care’ is actually a powerful alignment of their personal values with those of the job role. Something no other hourly paid job offers. This could be considered social care’s superpower: the ability to match the specific beliefs, values and aspirations of a large subset of people from all walks of life, simultaneously offsetting the significant downsides of the job. Could we go as far as saying that the bigger the social care crisis, the higher the sector’s dependency on care workers’ goodwill and generosity of spirit? The pandemic has certainly made this clear: the values of our workforce are fundamental to the provision of good care. Nothing matters more.

THE CASE FOR VALUES-BASED RECRUITMENT It’s not difficult to make a compelling argument for prioritising values when reviewing applicants for frontline care roles. We know that people selected for their values tend to stay longer, perform better and have fewer absence days. We also know that employers clearly see a return on investment and, more importantly, the continuity and experience of care improves for the person receiving it. Whilst there isn't an official ‘list’ of social care values for all organisations in the sector, many employers adopt very similar ones, such as dignity and respect or working together. One of the first steps and perhaps most important step to adopting a values-based approach is for that employer to determine what their organisational values should be and why these are important. This is usually done in consultation with staff, and people who use the services, and includes their families, friends, carers and/or advocates. We predict that, over the coming months and years, the only way to build any kind of solid foundation for our care workforce will be to select candidates for their values. As unemployment rates fall away, memories of

social care’s contribution to the greater good fades, staff retention weakens and demand for care continues to rise, we desperately need a North Star to guide our recruitment. Our proposal is this: break the negative cycle of replacing leavers in haste, instead recruiting for values above all else, thus lessoning retention challenges. Using our existing employees to select the people they consider to have the right values through employee referral is a great way of doing this. The result is a significant improvement in staff turnover in the first 90 days of employment. In addition, when managers are asked to identify the highest performing members of the team, those selected by employees are two and a half times more likely to be chosen than those recruited by the next most popular method. And there is no shortage of people in the local community who hold the beliefs we seek. A great illustration of this is the reaction of many displaced workers, often hesitant entrants to our sector from the arts, hospitality, travel and leisure, who have discovered and perhaps been surprised by just how rewarding caring for others can be. When workers’ values and the role align, wonderful things happen.

referrals are their strongest source, usually there is no measurement. Those employers who do analyse it can then go on to confidently realign their recruitment and retention approach entirely around values.

PRACTICAL STEPS

5. The job offer is only the beginning However well you have selected new starters, the hardest part is converting them into loyal members of the team who grow and stay. Try these approaches: • Provide pre-planned induction and support from day one, ideally via a ‘buddy’ or peer mentor. • Have open, values-led communication channels. • Offer reassurance and timely information. • Listen to and encourage feedback. • Give regular recognition and appreciation. • Ensure leaders and managers at all levels embrace a values-based culture and recognise how this impacts on the organisation’s recruitment and retention success, because, as the old saying goes: people quit a manager, not a job – so lead by example. • Be an employer of choice in your community – word will soon spread and your reputation will create a flow of those attracted by shared values.

Skills for Care provides a lot of support to employers around recruiting and retaining for values, and this has been reinforced by successive national recruitment campaigns to reach a wider public. Ultimately, though, it is the responsibility of the employer to use local methods to attract, select and hire, drawing from the community whilst focusing on values throughout the process. Here are some simple tips to help employers do just that: 1. Reduce your dependency on active job seekers It’s important not to rely on a single channel to recruit. The majority of recruiters list internet job boards as their primary recruitment source, and this severely limits the available candidate pool, since active job seekers represent less than 25% of the potential new recruits for any provider. This means limited choice of those with the values you seek. 2. Measure results to find out what is working Less than a third of employers monitor whether their hiring practices equal suitable employees with the right values. We’ve found that, whilst most managers intuitively know that employee

3. C raft an offer that doesn’t insist on experience … or a CV We know that people from all walks of life can be successful in a care role, so don’t infer prior experience is needed but always describe the values you require. For example, family care experience is a great predictor of success and a reliable indicator of suitable values. Such experience is rarely on a CV and transcends a candidate’s current or prior occupation. 4. Demonstrate your organisational values With very few entry barriers to social care beyond the right to work, the ability to reach the care setting daily and a willingness to fulfil the required hours, recruiters can become tired of processing high volumes of half-hearted enquiries, leading to dismissive and slow responses to new applications. Make sure your candidates ‘feel’ your values with timely replies and a genuine interest in why they are considering a care role.

We face an existential challenge to not only maintain our current workforce, but to backfill our vacancies and recruit fast enough to keep up with the demand for care. But, by putting values at the centre of our workforce strategy, everything becomes an awful lot more achievable, don’t you think? CMM

Annette Baines is Head of Partnerships and Research at Care Friends and was, until recently, Head of Recruitment and Retention at Skills for Care. Neil Eastwood is the author of Saving Social Care and Founder and CEO of Care Friends. Email: neil@carefriends.co.uk Twitter: @CareFriendsApp How has your organisation approached recruitment during the pandemic? Have you successfully implemented values-based recruitment? Share your comments and thoughts on this article. Visit: www.caremanagementmatters.co.uk 22

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for People Who Care My Learning Cloud are the blended and e-Learning specialists for Health and Social Care. Our tailored Learning Environments and accredited content empower organisations to confidently manage and deliver compliant, higher standards of care. We were born out of a passion for delivering excellent and innovative learning solutions for the Health and Social Care Sector. Our vision is to support organisations with a blended learning approach, maximising their ability to assist all staff in becoming competent and confident in areas necessary for their role.Our experience within the Health and Social Care sector has also inspired the creation of our Learning Environment, armed with a Sharpie pen and a blank piece of paper, our Chief Cloud, Steven Embleton created a learning environment that would break the mould and revolutionise training in the industry with engaging, informative and interactive learning. As an endorsed learning provider for Skills for Care and as a recognised Skills for Care Centre of Excellence, we supported over 5,000 individual learners across 400 organisations with their COVID-19 funded Rapid Induction Training.

We are a preferred partner of the UKHCA and solely focused on the Health and Social Care Sector. Our amazing 100+ CPD certified e-Learning courses are inclusive and relatable by all organisations within the Industry. Last year alone saw industry learners complete more than 1.5million e-Learning courses using our Learning Environment and 250,000 completed workshops with our management tools. We are constantly working to create new and innovative ways of learning in line with the ever-changing needs and requirements of organisations within the Health and Social Care Sector. We currently support a number of organisations within all areas of the industry, from Housing Associations to Care in the community, Eating Disorder services to Fertility Clinics, and we’re growing every day.

CMM June 2021

Supporting Ariya Neuro Care to Increase and Maintain Compliance Ariya Neuro Care first approached My Learning Cloud in 2018 as they were looking for a new Learning Management System and course provider to bring a fresh approach to their learning and development. They also wanted to implement a new system that would support their Management Team to track learner compliance, instead of the basic Excel Spreadsheet that they were using. We were able to provide a Learning Management System that not only tracked their overall compliance and non-compliance with an easy-to-read dashboard, but also gave their individual learners their own learning portal. In comparison to their previous Learning Management System, My Learning Cloud delivered interactive and relevant courses and the new Learning Environment now allows them to upload and direct policies, training resources, and workshops to their leaners efficiently and in a timely manner. Since working with My Learning Cloud to deliver Learning and Development, they have seen a significant increase to their overall compliance, at 97%+, as their Management Team can now identify the key non-compliance areas and their learners can also view in advance any learning that is due to expire and pro-actively work in renewing these courses.

CMM June 2021

Ariya Neuro Care now have a training portal where monitoring their compliance is straightforward and one that their learners actively and regularly engage with. The Learning Management System, provided by My Learning Cloud, has given them the desired outcome of delivering the right knowledge, in an engaging format. As an additional benefit, they can now also easily demonstrate compliance to both their internal and external audience, in particular the Care Quality Commission (CQC) and Local Authority Compliance Teams. Commenting on the new Learning Management System, Paul Constable, Owner and Managing Director at Ariya Neuro Care said:

We have a well-trained staff team, delivering excellent outcomes for the people we support. This helps us achieve 95% occupancy and staff turnover is less than 2% – which is sector leading.

Why is it Important to Invest in a Learning Management System for your Organisation and what makes My Learning Cloud Different? Investing in a Learning Management System can be a very comprehensive project in time with resources and energy. However, it is critical to any organisation making this investment that they make the right choice and get it correct first time.

One of the key benefits of our Learning Management System for your organisation, is the opportunity to allow the technology to take the strain and the administration of Learning and Development challenges away from you.

At My Learning Cloud we believe that good design and User Experience facilitates good experience and user engagement. Your Learning Management System needs to understand that there will be different user types such as Administrators, Managers, and Learners and each screen needs to deliver the correct information for them. A Learning Management System needs to and must allow your staff to access their learning whenever they like, on any device they like, seamlessly. An innovative, intuitive and responsive Learning Management System, such as ours, can provide your team with the tools to take ownership of their learning by letting them choose a time that suits them and can be really powerful tool with-in your Learning and Development.

Our Learning Management System allows the technology to take the strain and the administration of Learning and Development challenges away from you. CMM June 2021

It is important to note that the benefits will be different for each organisation; but there is no doubt that your employees will feel empowered as they progress on their learning journey, with full visibility of any learning they have completed, what learning they need to complete, and ability to track their own compliance.

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CMM June 2021

TALKIN

G IT TH

ROUGH Is mand : a t i n g vaccine the righ s t appro ach?

As we await the confirmed decision on mandatory vaccinations for care staff, Liz Jones, Policy Director at The National Care Forum asks whether compulsory vaccination for care staff is pragmatic policy making or a policy sledgehammer?

Was the care sector surprised when the Government announced its consultation on mandating vaccination for care staff in older people’s care homes? Not really – the mood music around this was changing as the vaccination data from the Capacity Tracker was flowing in and indicating that, for some parts of the country, vaccine uptake rates in care staff were not accelerating as quickly as the Government would like. Despite a promise from Prime Minister Boris

CMM June 2021

TALKING IT THROUGH: IS MANDATING VACCINES THE RIGHT APPROACH?

Johnson in November 2020 that COVID-19 vaccination would not become compulsory, it was clear that the ministerial position was changing. It’s worth reflecting for a moment on the ultimate aim here, and one which all of us involved in any way with the care sector want to see, which is the highest possible vaccine uptake in both staff and the people we support. The key question then, which is unfortunately missing from the Government’s consultation, is ‘will compulsory vaccination be the best way to achieve this aim?’ And what may be the unintended consequences of implementing such a policy?

DIVIDED OPINION At the National Care Forum, we represent the views of not-for-profit care providers, which are some of the many organisations and employers which will have to implement this policy if it goes ahead. We conducted our own survey to inform our consultation response: we asked our whole membership to consider the questions, not just those operating older people’s care homes, because there are such important principles in this debate. The survey ran for ten days with a 64% response rate, with respondents employing nearly 52,000 staff and supporting over 85,000 people. Views are clearly divided. The following quotes illustrate the range of perspectives, from ‘The staff have a responsibility to protect the people they support’ to ‘We do not think mandating vaccination is necessary and believe staff, through gentle persuasion and educated discussion, can be encouraged to take up the vaccine. 89% of colleagues in our care homes have been vaccinated. Mandating vaccination would result in a loss of good staff.’ Some respondents support this policy, especially if it provides absolute clarity in terms of employers’ duties under the relevant regulations; for others, it is fundamentally not the right approach and is a step too far. It is important to take a moment also to reflect that all our members have been working very hard to promote vaccine uptake across their staff and have used a whole range of techniques to do so. We heard from members about what had been working: ‘Education over vaccine, staff briefings/forums/ one-to-ones, wellbeing champions, onsite vaccinations’; ‘Providing information from trusted and accredited NHS/ 28

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medical/faith sources and combatting myths. Running Zoom Q&A sessions with health professionals where staff could send in specific questions in advance. Publishing videos of colleagues talking about their vaccination’; and ‘Paid transport to get people to hospital sites or vaccination hubs.’ Many of our members have very high rates of staff uptake, across all their services, including care homes for older people, so they are rightly asking why a blanket policy is being mooted. Some 77% of members running care homes for older people have over 75% vaccination rates among staff; 47% have more than 85% vaccination rates.

SINGLED OUT Our membership is united in the belief that targeting this particular subset of care staff (those who work in care homes that support anyone over 65) is fundamentally unfair and illogical. There is an important issue of fairness and equity across different groups of the workforce who work closely with vulnerable people over 65. If the key risk is close, frequent and prolonged contact with the most vulnerable Joint Committee on Vaccination and Immunisation (JCVI) priority group one, then many other settings involve this, so why are those workforces not included, such as NHS staff? In our survey, 65% of respondents felt that this subset of care staff should not be singled out for compulsory vaccination and 76% felt that this should also be applied to health professionals. 80% also told us that they thought their staff would feel unfairly treated if the policy only applied to those working in older adult care homes. Thinking about health staff then, let’s consider a point often made in this debate, which is the view that compulsory vaccination already applies to some jobs, notably some health professionals, and therefore what’s the issue? It feels a little disingenuous to make such a direct comparison here. The vaccines that some health staff are required to have as a condition of employment generally have been around for a long time, are well understood and well accepted by the vast majority of the population. Side effects and risks have been thoroughly researched and there is a significant amount of support and resource within the NHS to help people access

TALKING IT THROUGH: IS MANDATING VACCINES THE RIGHT APPROACH? the necessary vaccines and address any hesitancy. If, for any reason, staff cannot have the particular vaccine, the NHS is a large employer with other options to deploy staff. None of this is true for the COVID-19 vaccines and the care sector. In addition, in health organisations, mandatory vaccination requirements have in general been introduced to new appointees to a role, rather than mandated across all the existing workforce.

PROFESSIONAL RECOGNITION The professional duty of care argument has also been made by some, with an apparent amnesia about the dedication and commitment of care staff over the last 15 months, who have been the stalwarts of the COVID19 front line, 24 hours a day, seven days a week, continuing to provide care under the most challenging of circumstance. They have done this with compassion, providing a lifeline for the most vulnerable across all our communities. It is time to back up that call for professionalism with real action to invest in the social care workforce to create a professionally skilled, recognised workforce – properly valued, better paid, with more training and development. Any exhortation to take the COVID19 vaccine would be much more credible to frontline care staff if it were accompanied by a proper package of professional recognition and reward. If this policy is implemented, it is very clear that the sector will need an enormous amount of infrastructure resource and support to implement it, in the same way that the NHS receives significant infrastructure support for its vaccine uptake work. The Government’s consultation is silent on the practicalities of implementation, bar one rather bland question.

REQUIRED SUPPORT We have a long list of the things our members will need to support compulsory vaccination of care staff. They start with the very practical issue of guaranteed access to free COVID-19 vaccines and boosters for as long as

“While it is impossible to know at this point how many staff will decide to leave the sector if they face compulsory vaccination, can the sector and the people we support cope with that? ”

needed. This would be an important step change, as at present each year we have the unhelpful flu vaccine debate as to whether it will be free or not for social care. Meanwhile, there is never any debate that it will be free for the NHS. If compulsory vaccination for any number of care staff is implemented, then the Government must guarantee that the COVID-19 vaccine now and in the future is free and prioritised for social care. This is crucially important given the high turnover of care staff (30% according to Skills for Care 2020 data; 22% in our NCF Personnel Survey 2020). We must be able to vaccinate new staff immediately. Insurance and litigation also loom large here; this is already a huge challenge across the care sector, with eye watering increases in costs and worryingly low levels of COVID-related cover. Remember that the Government indemnified the NHS against COVID related claims in 2020 but, as yet, has failed to offer any help for the care sector, despite huge evidence of the ongoing problems and failure of the insurance market for social care. This policy cannot be implemented without Government indemnification of the care sector or absolute clarity that any associated litigation by staff during effective implementation must be addressed by the Government, not the providers. The sector also needs practical resources and support, such as HR support and occupational health support to implement this policy, as employers will have to work it through with existing staff, help them to make the decision about the vaccine, look to renegotiate

existing employment contracts and/or consider redeployment options if that is a possibility, and support to identify the medically exempt workforce and determine how that will work within this policy.

HURDLES TO JUMP Despite the relatively high level of concurrence with the principle of the policy, 70% of our respondents told us that a compulsory vaccination policy would be difficult to implement and one fifth told us it would be extremely difficult. It is clear that the sector is going to need significant infrastructure help from the Government to monitor ongoing vaccine status of staff, especially as presumably this will have to be tracked at individual care home level, with each care home with any adult over 65 needing to show all their staff are up-to-date with the COVID-19 vaccine or have an up-to-date medical exemption. Some respondents told us ‘keeping track of status is very challenging’ and a clear mechanism for evidencing vaccinations needs to be created’. Finally, it is not yet clear about the impact of potential loss of care staff if this policy is implemented: just over a third of our respondents think up to 5% of their staff could leave; 23% think more than 10% of their staff could leave. While it is impossible to know at this point how many staff will decide to leave the sector if they face compulsory vaccination, can the sector and the people we support cope with that? Given that the sector already has 112,000 vacancies, is mandating vaccines the right approach? CMM

Liz Jones is the Policy Director of the National Care Forum. Email: liz.jones@nationalcareforum.org.uk Twitter: @NCFCareForum @NCF_Liz What is your opinion and view on this much spoken about topic? Share your feedback and visit www.caremanagematters.co.uk CMM June 2021

INTO PERSPECTIVE

WHAT REFORM IS NEEDED TO THE DILNOT CAP, IF IT'S TO BENEFIT WIDER SOCIETY? THE BASICS

On Monday 4th July 2011, the Commission on Funding of Care and Support (the Dilnot Commission), chaired by economist Andrew Dilnot, shared its recommendations on the future funding of care and support. Proposals including a more generous means-testing threshold and a lifetime cap on care costs were warmly welcomed across the political spectrum at the time, but ultimately failed to spark much needed reform. Today, the sector is still waiting for such reform and the once prized ‘Dilnot cap’ has become increasingly criticised for serving mainly wealthy older people in practice. Social care craves reform, but what must change for the Dilnot cap to become our best foot forward? 30

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The Dilnot Commission proposed four recommendations to reform the funding of care and support in England, two of which have gained the most notoriety. The first involved increasing the threshold at which older people would become responsible for paying their care costs themselves, from £23,250 to £100,000. On paper, this means that more people would become eligible for state support – those with savings between £14,250 and £100,000 would contribute an amount towards the cost of care, with the state also contributing. People who have more than £100,000 would have to pay for their care in full up to a limit, or until their funds deplete below the means test threshold. The second proposal relates to a lifetime cap on care costs, specifically £35,000. Once someone has contributed this much of their own money towards the cost of their care, the state will step in and cover all ongoing care costs. For people already living in residential care, their ongoing living costs would be capped at an amount between £7,000 and £10,000 per year.

THE PROBLEM The main issue damaging the universal benefits proposed by the Dilnot cap involves money, as is so often the case when social care reform is on the table. In the current climate, many consider the proposals to be ‘hugely costly, highly inequitable, and would do little to address the current difficulties faced by older people in accessing publicly funded social care’, according to the London School of Economics. Furthermore,

it has been known since the birth of the Dilnot cap that in order for the changes to the funding system to be implemented (cap on individual contributions to be set at £35,000), £1.7bn in additional public expenditure would be required, escalating to £3.6bn by 2025/26, according to The King’s Fund. In addition, there is the widely held understanding that further public funding would be necessary to ensure that the current means-tested system is up to speed alongside the Dilnot Commission’s new proposals. Given Government’s historically ineffective approach to much-needed financial support for the existing system, it is understandable that scepticism within the sector is continuing to halt the development of the proposals towards benefitting wider society and invite criticism of its makers and Government.

THE SOLUTION? As each day passes the need for social care reform grows more urgent. While most would endorse the fundamental purpose of the Dilton Commission’s proposals, to cap the amount people pay towards their lifetime care costs and introduce more standardised eligibility for social care, there are clear weaknesses that prevent the proposal from benefitting wider society at this time, particularly those relating to the sector’s increasing funding gap. Some have suggested increasing the lifetime care cost cap from £35,000 to £50,000 – arguing that greater public spending on ensuring publicly funded social care eligibility for the least well off in society is as wide as possible, is a starting point.

We must be bold to reform social care

Current system is deeply unfair

Cllr David Fothergill, Chairman of the Local Government Association’s Community Wellbeing Board

Kari Gerstheimer, CEO and Founder of Access Social Care

The Queen’s Speech last month confirmed the Government will bring forward its proposals on the future of adult social care this year. It will be interesting to see how Government define the scope of ‘reform’. In our own work, and that of partners, several key priorities surface time and again. Action on these would help deliver on a vision of care and support that is more preventative, person-centred, accessible and high quality, all underpinned by a properly resourced and valued care workforce that works in a way which complements people’s own skills and abilities. Alongside these changes, there is also a need to prevent people from facing ‘catastrophic costs.’ Part two of the Care Act, otherwise known as the ‘Dilnot reforms’, seek to address this by capping the costs of care people face. These reforms would help tackle one dimension of the ‘fairness’ issue, but they do not deliver extra resources to meet unmet or under-met need or realise the legislation’s ambition on prevention. This, of course, carries a cost. It is clear that more funding is needed to achieve our ambition, as outlined above. The current

system draws funding mostly from council tax and business rates, as well as other sources such as Government grants and people’s own contributions. Council tax and business rates are not the right taxes to meet the forward growth in adult social care needs and costs – these are national-level entitlements that shouldn’t be funded by local taxes. The system is also means tested, which does not allow for the pooling of the risk to individuals of having to fund very high-cost care. Designed carefully and over a period of time, a new or supplementary system of funding which pools risk could address both the issue of the funding shortfall and provide people with certainty that they would not face catastrophic costs of care by sharing that risk across the population. A new source of funding that incorporates risk pooling is vital to the reform agenda. That is why we suggest the Government should make the case for increases in national taxation and/or a social care premium. We need to be bold in redesigning the function, form and funding of adult social care and support.

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Boris Johnson’s pledge to ‘fix social care once and for all’ in 2019 was universally welcomed. However, introducing the decade old Dilnot Cap without addressing wider social care reform and chronic underfunding poses yet another existential threat to social care. Social care is a neglected policy area and the funding crisis is getting worse each year. Local authority resources have not grown at the same rate as the ageing population; more people are requesting social care and less are receiving it. The cap alone promises no extra funds for social care. It is expensive, inequitable, does not help those who struggle to access social care, nor does it improve the quality of care or enhance lives. This regressive policy will protect the inheritance of the wealthy, whilst leaving thousands of British people without substantial savings in the same position they are in today: having to sell their homes to pay for social care. The cap will take money out of the social care system, posing a risk to quality and potentially

causing a further restriction in eligibility for state funded care increasing injustice for working-age disabled people and older people. Rather than injecting extra funds to address the social care crisis – Dilnot argues that private insurance providers will step in with citizens buying insurance products to cover themselves for the risk of accruing social care costs up to the level of the cap. But again, it is the people who need it the most that are least able to afford private insurance. It is true that the current system is deeply unfair, but as a country we must do better than this. This affects all of us as we, or our loved ones, will likely need social care at some point. Without additional reform, the cap will benefit the wealthy, disadvantage the poor and do nothing to promote better quality care through better training, pay, and conditions for staff. An injection of additional public funding is urgently needed if Johnson is to keep his promise. Fixing social care is not the same as not having to sell your home to pay for it.

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CMM June 2021

Raising the profile: WHY THE HOME CARE SECTOR NEEDS GREATER RECOGNITION Has the home care sector been the forgotten front line during the pandemic? Raina Summerson, Group CEO of Agincare, shares her insights and calls for greater recognition of the sector.

Whilst the profile of social care has been highlighted through the COVID-19 pandemic, there are also deep feelings amongst many parts of the sector that this increased awareness has been limited and that the level of understanding around home care has remained poor. Government guidance and media coverage has most often placed the emphasis on those living in care homes. The ongoing stories relating to risk, support and rights in care homes have left other parts of the sector, both providers and people using other care and support, feeling left behind. For home care, it is not only the challenges faced by providers and those using services that have not been given the same attention, but that the multitude of positive stories across the home care

sector about resilience, innovation, commitment and care have been largely ignored.

ONGOING BATTLE With a career spanning different areas of social care since 1989, I am used to viewing the sector from different angles. Agincare is relatively unusual in having such a wide range of services and gives me an interesting oversight of differences in approach and understanding. Whilst the NHS and Community Care Act 1990 may have started to shift focus from ‘institutional care settings’ into a more varied range of communitybased services, including home care, here now in 2021 it still seems to remain a relatively unknown

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RAISING THE PROFILE: WHY THE HOME CARE SECTOR NEEDS GREATER RECOGNITION

and unclear provision despite its scale. Care homes remain easier for the Government, for investors, for the public and for communities to understand; care delivered in buildings one sees in the locality, bed-placed care provision, solid assets for funding and investment purposes. There have been years of lobbying from many people and organisations across social care, including numerous papers on the subject and research showing how people want to remain in their own homes for as long as possible. According to the United Kingdom Homecare Association (UKHCA) around nine in ten people would prefer to be cared for in their own homes if the need arose, with around just 8% expressing a preference for residential care. There is also evidence about workforce issues, funding issues and the volume of people both in receipt of care and support and large workforce numbers – still the battle for recognition goes on. Associations such as UKHCA work hard to raise the profile, with much success and in strong partnership with large providers across the country, but still wider recognition is scarce.

THE CHALLENGES It has been well documented that, when the pandemic started, the focus was on the NHS. Slogans such as ‘Protect the NHS’ and the ‘Clap for Carers’ started for NHS workers, before being widened to include other key workers, including social care workers. But even during this time, our frontline home care teams were receiving (at best) a lack of the same attention, direction and care for the work they undertook; at worst, they were receiving abuse from members of the public who simply failed to understand their roles and saw their movement out and about in the community as a risk of wider transmission of COVID19. In giving evidence to the Health and Select Committee in 2020, alongside Mel Cairnduff, part of our

brilliant home care team in Dorset, I recall the MPs being shocked in hearing that home care workers felt ‘under-valued’ and ‘at risk’ in their daily work during a time that they were giving so much for others. Recognition of social care came late but, for home care, it always seemed a step behind care homes. Forgotten and misunderstood. Guidance was often much later than Government announcements, causing concern and confusion, PPE came late causing high levels of stress for providers and the social care workforce, and recognition of home care workers came too late. Other social care agencies retreated to the periphery and families and usual social networks diminished with each lockdown. Home care workers faced new challenges, often being the only support network for people in need of care and support, increasingly lonely and scared by the events taking place across society. Vaccine rollout for home care workers proved more problematic, especially in services such as live-in care. Gabby Duval, who works for an Agincare home care team in Bristol, said, ‘A lot of the people we support are vulnerable and they weren’t allowed outside contact, certainly at the start of the pandemic. Their families didn’t want to put them at risk and asked us to report back about how they were doing, as we were not only their only point of contact but also company to talk to.’ Care providers found ways to manage, often with whole teams focused on securing and distributing PPE, whilst managing the expectations, anxieties and queries of our teams and people using our services. However, it often felt like a battle to get our teams recognised alongside NHS colleagues and other keyworkers. Even areas such as protected time for shopping in supermarkets and discounted offers were problematic. The emotional impact on the workforce and managers was immense and this remains an

area we must not forget as things become seemingly more stable.

LESSONS LEARNED Despite these challenges, home care has shown its true worth through the pandemic. Structurally, 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. Home care responded quickly, offered flexible, innovative services, showed great resilience and great solutions. Providers, largely independently owned and managed, stepped up and have shown that they really are an essential part of the UK’s health infrastructure. Our care teams excelled amidst all the unknowns and despite all the fears and teamwork has been brilliant. Their care and commitment to making a difference to people’s lives has never been stronger. New ways of working have been developed and many of these will stay with home care organisations and make them stronger: improved digital communications, workforce recruitment, training and development, family and team communication and interaction, partnership projects with NHS and Local Authority teams and, indeed for us, better working across Agincare’s own diverse range of services.

HOME CARE FUTURE For many home care providers across the country, whilst times have been tough and social care reform is urgently needed, there is also a confidence in the future. This is due to the commitment to home-based care, initiatives such as ‘Home First’ taking shape, closer working with NHS colleagues and an increased awareness of the scope of home care potential. Live-in care is one area that has flourished and become more widely used as a solution for independent living. However,

for others, the uncertainty around funding and commissioning strategy continues, the increasing cost of delivery, workforce challenges and the sheer emotional legacy of the past year is leading to an exit from the sector. There are increasing areas of the country where home care is difficult to source and multiple reports from a huge range of professionals and organisations, with Age UK, National Audit Office NHS Confederation and Local Government Association to name but a few, all highlighting issues around strategy, funding, capacity, unmet need and wider societal impact. The Care and Support Alliance recently said that a lack of social care ’undermines’ people’s health, heaps pressure on the NHS and makes it ’difficult or impossible’ for people and their carers to live fulfilling lives.

SOCIAL CARE REFORM So, what can we hope will change now? We had hoped that the calls for social care reform – real, proper system change – wouldn’t fade away as they have so many times in the past. But several missed opportunities from Government to give the sector what it so wanted to hear has made us doubt again. Government must now offer social care some meaningful reform, something that goes beyond financial protection of homes that people don’t want to sell to pay for their care. Funding and how we pay for it is key but there is so much more needed. We must stop social care being seen as – and used as – a support prop for the NHS; we must recognise and reward the valuable contribution, skills and professionalism of its workforce, and we must involve and engage working with – and for – local communities and with those in need of care and support as partners in it all. The future need is there for home care to thrive, but we need the strategy, funding and workforce to make sure it can. CMM

Raina Summerson is Group CEO of Agincare. Email: digital@agincare.com Twitter: @Agincare Do you agree with Raina’s comments that the homecare sector needs more recognition? Visit www.caremanagementmatters.co.uk and share your comments on the article. 34

CMM June 2021

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HEADER

: R E W O P E L P O E P BUILDING CONSUMER SOVEREIGNTY INTO SOCIAL CARE Social care’s ‘moment’ needs nothing short of the transfer of power, control and money to transform social care, argue John Kennedy and Des Kelly.

The ‘Brave New World’ that may emerge from the crisis caused by COVID-19 is yet to be truly known. One thing that feels more likely than ever before though is that attention may finally be given to the pressing need for reform of adult social care. Social care (especially care homes) has been thrust into the media spotlight in the last year and, therefore, the cracks in the system have been well and truly exposed. There seems to be universal support for the urgency for reform … but will it be radical enough?

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FlorenceFlex

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PEOPLE POWER: BUILDING CONSUMER SOVEREIGNTY INTO SOCIAL CARE

SOCIAL CARE CRISIS

Across our working lives, social care has often been described as in crisis – arguably a permanent state of crisis. Crisis is an interesting word, defined by Wikipedia as: ‘A crisis (plural: ‘crises’; adjectival form: ‘critical’) is any event or period that will lead, or may lead, to an unstable and dangerous situation affecting an individual, group, or all of society. Crises are negative changes in the human or environmental affairs, especially when they occur abruptly, with little or no warning. More loosely, a crisis is a testing time or an emergency. ‘The noun is derived from the verb κρίνω krinō, which means 'distinguish, choose, decide'.’ So, a crisis is essentially the decision point. The point where there is no option but to choose a path. Social care may well be in a permanent state of crisis; but the krino moment never seems to come. Perhaps it has now. The pandemic has certainly been a ‘crisis’, forcing uncomfortable choices between public health and the economy. Decisions to lock down, restrict liberties and freedoms, protect the NHS. Many decisions: some well made, others not. All forced by circumstances and made in order to avoid a catastrophe to health and health services. There does appear to be a head of steam building for reform of social care. Every interest group within the sector is girding themselves for the debate. Thinktanks and Commissions are publishing reports setting out new visions. Green papers and grey papers, thinkpieces and blogs – take your pick. At the same time there is a fear that the current Government sees social care in narrow terms, just about care homes and the fear of needing to sell your house to pay the cost. This lack of fundamental understanding could be a significant barrier to meaningful and effective reform.

“Despite transformational changes in many markets driven by an expert generation of post-war consumers, social care’s offer has remained broadly the same.”

COMMUNITY APPROACH #socialcarefuture, who so often nail it, describe the experience of social care as: ’When organised well, social care acts as the glue that binds together relationships and support in our local communities that we can draw on to live our lives in the way that we want to, whatever our age or stage of life.’ This very eloquently places social care where it should be. A fundamental part of our economic and social infrastructure. It can support people to stay well, stay engaged, stay employed. It is as important as a good rail infrastructure and road network. Well organised social care can be an enabler to support a fair, secure and compassionate society which drives a dynamic economy. When we produced our report: ‘Power To People: Proposals to reboot adult social care in Northern Ireland’ in 2017, we argued in the introduction ’Social care is personal – and about all of us. A good system of social care can transform lives – it’s that simple. Not just for those who receive social care services but their families, friends and communities too.’ Since our report was published, there have been many more. One of the more recent – ‘The Lives we want to Lead’ – is from the Local Government Association (LGA). The LGA’s headline message is that until the value of social care is fully recognised, the ‘krino’ moment may never arrive. The report also highlights the need to create a much more diverse and dynamic social care world. A world where quality support is personalised and community based. A social care world that has citizens’ wellbeing at its heart and that endows the conditions to truly enact the aspirations of the Care Act. In short, to create a system that, it seems to us, allows this vision. Again from #socialcarefuture: ’Don’t we all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing the things that matter to us?’

POWER TO THE CITIZENS Of course, social care needs more money, too. But money is not the only answer to the challenge of social care. It is necessary but not sufficient. Who holds the power that the money bestows is just as important for reform. Local authorities have, for 30 years, had a market shaping responsibility. The sovereignty in the market has primarily been theirs. The rate set for care has, in turn, kept staff on the minimum wage. Despite transformational changes in many markets driven by an expert generation of post-war consumers, social care’s offer has remained broadly the same. That’s not to say there aren’t individuals and organisations striving to innovate, striving to do new things in different ways who are, in many cases, succeeding. But you can’t ignore the dominance of time and task homecare and care homes in the market mix. If we don’t change the levers in the market, we are just going to get the same limited choices, larger care homes and shorter care visits. Way back in 2005 the Joseph Rowntree Foundation (JRF) CMM June 2021

PEOPLE POWER: BUILDING CONSUMER SOVEREIGNTY INTO SOCIAL CARE

undertook ’The Older People’s Enquiry’ and one of the outcomes was ’that little bit of help’ which set out the baker’s dozen of services that people valued most. It is well worth revisiting as it is exactly the kind of menu we should be looking to create. If we want to aspire to a new vision, a future of community-based, preventative and highly personalised support, then we must question whether commissioning, as currently organised, is going to achieve it. This vision for a social care reform isn’t new, we’ve been talking about it for years. If commissioning worked, why are we where we are? Isn’t it time we introduced some real consumer sovereignty? Take the power from commissioners and give it to the citizens? Consumer sovereignty was first defined by the economist William Harold Hutt (1936) as: ‘The controlling power exercised by free individuals, in choosing between ends, over the custodians of the community's resources, when the resources by which those ends can be served are scarce.’ Ah but, you say, we’ve had direct payments for years, most of the care home market is now self-funders! They aren’t shaping the market. This is true but consumer power has more facets than just the cash. In order to have effective demand, the consumer needs to have the cash but also knowledge of the market and there must be meaningful choice. Direct payments have been around a long time. But without a diverse market of services and knowledge about the possibilities they haven’t been able to energise the market. If individuals were given the power to buy whatever met their needs, then initially they would continue to buy what was on offer. But over time providers would offer new services, alternatives to existing models. Some will be popular, and others get no takers. Choice, though, would grow. Some existing models or services may also fall away as people embrace alternatives. This crucial dynamic is missing from the market as commissioner purchasing is embedding existing models and restricting new approaches. There may be efforts at co-production, but nothing beats holding the purse strings for being in control.

RADICAL CHANGE If adult social care is to use the crisis to bring about reform – it needs to be radical. The sector needs to be disrupted in the way other parts of the economy have had to make way for the ‘game changers’ such as Netflix, Uber, Airbnb, Deliveroo or Purple Bricks, which have brought new consumer control to home entertainment, travel, holidays, take-away food or selling your house. Every one of us is different. Our families, friends and neighbourhood structures are different. Our housing, our outlook on life and risk appetite are different. No two people's social care journey is the same. Which is

why the market’s dynamic drivers must come directly from those who draw the services. In order to create the dynamic and diverse smorgasbord of services we need, it’s crucial that the customer and the money are put together. There needs to be real choice. Every neighbourhood needs a good care home, a good home care service, a good community connector, handyperson service, community transport and who knows what new offers and innovations may follow. Obviously, we need a framework for the systems necessary to stimulate change. There will need to be standards, procedures to regulate and monitor. Perhaps we need a new profession of neighbourhood navigators. Perhaps a sort of Independent Well-being Adviser or care concierges. Experts in what a neighbourhood offers and how to guide someone to the services that meet their needs. But crucially as servants – not gatekeepers. We acknowledge that enabling consumer sovereignty is not a panacea. It should be seen as part of an approach to radically energise the social care offer. In order for consumer sovereignty to stimulate the creation of a vibrant social care market, other aspects of the system need to be addressed. It needs to be properly personalised, simpler to use and navigate, it needs to be fairer and universal, it needs to be sustainable. Reform cannot be done in a piecemeal way. A sustainable funding settlement is vital with some market oversight to protect the consumer and the public purse. Only when our choices are under our control, only when we have true consumer sovereignty, will the market be freed to meet our needs. All our futures depend on it. CMM

John Kennedy is an Independent Consultant and Commentator in adult social care and Des Kelly OBE is Chair at the Centre for Policy and Ageing. Email: jpkennedy366@gmail.com Twitter: @JohnnyCosmos Email: des.kelly@btinternet.com Twitter: @DesKellyOBE What does ‘radical’ social care reform look like to you? Share your thoughts and views on the article and on social care reform. Visit: www.caremanagementmatters.co.uk 40

CMM June 2021

eMAR

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CMM June 2021

RESOURCE FINDER

TRAINING

There are so many training platforms, technologies and courses within the social care sector to help advance your workforce and organisation. This resource finder gives you information on some of the sector’s leading providers, to help with planning your next training objectives.

CMM June 2021

Access eLearning for You

Blue Stream Academy Ltd

Tel: 01206 322575 Email: elfy.sales@theaccessgroup.com Website: www.theaccessgroup.com/hsc

Tel: 01773 822549 Email: nch@bluestreamacademy.com Website: www.bluestreamacademy.com

SECTORS

• Domiciliary care. • Residential care. • Nursing care. • Local Authority care. • Supported living. • Learning disability homes. • Hospice care. • Complex care.

PRODUCTS • Industry-leading learning management system. • Mobile app. • Range of training courses.

MANDATORY COURSES • Care Certificate courses. • Managerial courses. • Clinical courses. • Ancillary courses. • eCompetency for care.

COMPANY PROFILE Access eLearning for You delivers over 70 courses, designed, and approved by NCFE to meet the needs of your care organisation in core training areas, as well as offering additional learning to support your carers' career progression, which is proven to improve your staff retention. All these courses are approved by regulators and are made easily available through the eLearning for You mobile app. All courses come in a range of different languages to cater for every carer within an organisation. With our Dyslexia Aid, the courses can also be set to support your learners who are dyslexic, giving your carers the freedom to learn by themselves without limited or zero assistance. eLearning for You

courses are also purchased as an 'allowance for learners' meaning that if a carer leaves, their licence can pass to the next carer that replaces them, so you don't lose access to the courses you have already paid for. Introducing eCompetency for Care into the market. eCompetency helps you to test the skills of your carers. Designed by social care experts, eCompetency uses gamification to create a virtual interactive environment, combined with industry standard assessment methods, complementing training with the ability to test knowledge in a realistic assessment environment. Upon successful completion of an eCompetency module, staff can access a comprehensive report which is integrated into the Access learning management system.

• Care homes. • Domiciliary/home care. • Social care. • Assisted/supported living. • Specialist residential homes.

SERVICES • 100+ CPD-certified eLearning modules. • Management of Information System (MIS). • Paperless Care Certificate Solution. • Blue People – HR System. • Blue Pay – Payroll System. • Blue Check – DBS Checking System. • Complimentary account set-up and system training with every purchase.

COMPANY PROFILE Blue Stream Academy Ltd is the leading provider of eLearning to healthcare professionals throughout the UK, currently supporting over a quarter of a million trainees nationwide whilst improving compliance and training outcomes throughout over 5,000 organisations. The Nursing and Care Home eLearning suite consists of 100+ CPD-certified eLearning modules, suitable to train any member of staff within an organisation. Unlike other providers, Blue Stream Academy is proud to have an in-house team of content specialists who work alongside Subject Matter Experts (SMEs), regularly delivering new hot topic modules and continuing to review current content across the site. Every purchase includes complimentary account set-up and access to the market-leading Management

of Information System with multiple department and site access levels. This includes 15+ automated management reports and a paperless solution to add and store external training, alongside an electronic policy sign and track system. Managers also have access to the Blue Recruit vacancy system to easily advertise for available positions within their organisation at no additional cost. An integrated video conferencing and diary management feature is available to all users, with the added peace of mind that every aspect of the system is ISO 27001 certified. The fully integrated Blue People HR system equips managers with the tools required to easily organise rotas, leave and absences, with custom settings to forecast minimum staffing levels and contracted staff hours available at the touch of a button. The Blue Pay payroll add-on provides managers with the power to easily run pay schedules and take control of one-off changes, whilst still ensuring their compliance and HMRC submissions remain a priority. With Blue Check managers can easily create and submit DBS applications, automatically check for correct formatting or incomplete fields, and receive rapid application results direct to an address of choice.

CMM June 2021

Community is the best medicine This virtual conference will explore how to create sustainable, community-based health and care. Join us to hear from projects that are innovative, scaleable and have evidence of impact on the health and wellbeing of the communities they serve. We’ll share case studies about: l strengthening community resilience l health and care organisations ‘working with’ communities rather than ‘doing to’ l sharing power and resources with communities to drive better health l working with diverse communities to tackle inequalities in health.

Don’t miss sessions with:

Helen Goulden Chief Executive Officer, The Young Foundation

The virtual conference platform will be open for four weeks:

Mohammed Khan Community Development Officer, Blackburn with Darwen Healthy Living

Kiran Kenth

Jane South

Director of National and Regional Programmes, Royal Society for Public Health

National Adviser on Communities, Health Equity and Mental Health, Public Health England

l Exhibition opens on Monday 14 June l Sessions will go live over four half-days on Monday 21–Thursday 24 June l Catch up on demand until Sunday 11 July, when the event closes.

Find out more at www.kingsfund.org.uk/virtual-events 44 CMM June 2021

RESOURCE FINDER: TRAINING

Carers Coaching Academy Ltd

Eden Alternative CIC

Tel: 07860 432568 Email: sales@carerscoachingacademy.co.uk Website: www.carerscoachingacademy.co.uk

Tel: 01626 868192 Email: admin@eden-alternative.co.uk Website: www.eden-alternative.co.uk

SECTORS

• Care homes focusing on Dementia and Alzheimer’s disease. • Care at home sector especially for Dementia and Alzheimer’s.

PRODUCTS • Emotional Support Tools for the Alzheimer’s and Dementia Marketplace. • Online Accredited Master Coaching Courses – Induction Emotional Coaching for Professional Carers. • Online Accredited Master Coaching Courses, specific to Personal Carers. • Online Crisis Emotional Support Coaching for Professional and Personal Carers – a short sharp Master Coaching course for that ‘help!’ situation. • DVDs of video tips for carers from the founders’ personal experience. • Publications offering Alzheimer’s and Dementia Emotional Support. • A Book Trilogy of the founders’ personal Alzheimer’s journey with her husband. • Online FREE emotional support tools.

COMPANY PROFILE We are passionate about helping carers with emotional challenges and our goal is to provide solutions that will create inner peace, confidence, and the ability to deal with challenges both in the workplace and in the home

environment. We understand the intensity of an ‘emotional rollercoaster ride’ of emotions for all those involved in caring within the Dementia sector. Our Founder, Sylvia Stock, has her own experience as a carer for her husband who was diagnosed with young-onset Alzheimer's Disease in 2010. Her background in Nursing and Nurse counselling, Care Management, Accredited Master Coaching, and deep spiritual beliefs could not fully prepare her for the journey. There was an awareness of the need for a way to increase emotional health and stability with carers. COVID-19 has certainly brought emotional and mental health to the forefront. This triggered the development of Accredited Master Emotional Coaching programmes and other emotional support tools for both professional and homebased carers. ‘I was always looking outside for strength and confidence, but it comes from within. It is there all the time’ – Anna Freud.

• Care homes and groups. • Domiciliary care providers and groups. • Community care organisations, Housing Associations. • Healthcare providers. • Organisations who have an interest in eradicating loneliness, helplessness and boredom occurring in care settings. • Organisations who are committed to the wellbeing of older people receiving care and support and the people providing such care and support.

COURSES • Three-day (or seven-day session online) flagship ‘Eden Associate Training’ course. • Eden Trainer course. • Eden Fellowship course.

COMPANY PROFILE The Eden Alternative CIC (UK) is a ‘not for profit’ training provider for the Eden Alternative model of care. It has operated in the UK since 2005 and Eden itself has operated since 1992. It’s an ‘Alternative’ because it drives forward the culture of care with its members, building care environments that are different from most people’s experience, understanding or perception. Its programme has many elements, many of which are common sense and often what people in the sector are already aspiring to. However, its detailed

body of material focuses on developing a progressive vision, applies theory to practice and makes vision a reality. The reason why people adopt the Eden Alternative is to enhance the wellbeing of residents, the essential workforce, and residents’ families. It also makes very good business sense. It has plenty of material, principles, and ways of enhancing wellbeing; put together in a way that delivers a Home's ambitions. The model has been tried and tested over 30 years and suits Homes already likely running ambitious training programmes. Whilst Eden dovetails with most programmes it also stands alone and gets results. The UK board consists of Geoffrey Cox, Margot Whittaker and June Burgess, all with extensive professional hands-on experience in Health and Social Care. Geoffrey Cox, the CEO, has a group of four Nursing Homes which adopted Eden 10 years ago, having come across this work in New Zealand. Margot Whittaker, RGN, Director of Nursing is its development officer. June Burgess, RGN, brought Eden to the UK in 2005. Eden operates in 20 countries: the UK, USA, Canada, Australia, New Zealand, Germany, Austria, Denmark, Switzerland, Spain, Iceland, Mauritius, Singapore and many other regions with different cultures and languages. Its regional leaders meet frequently, and its membership is growing steadily worldwide.

CMM June 2021

RESOURCE FINDER: TRAINING

My Learning Cloud

Solicitude Training Ltd

Tel: 0800 088 6109 Email: enquiries@mylearningcloud.org.uk Website: www.mylearningcloud.org.uk

Tel: 01256 242272 Email: info@solicitudetraining.co.uk Website: www.solicitudetraining.co.uk

SECTORS

• Care homes. • Domiciliary care providers. • Hospices. • Clinics. • Nursing homes & supported living. • Housing Associations.

PRODUCTS • e-Learning. • Learning Management Systems. • Online Training and Development.

COMPANY PROFILE We were born out of a passion for delivering excellent and innovative learning solutions for the Health and Social Care Sector. Our vision is to support organisations with a blended learning approach, to maximise their ability to assist all staff in becoming competent and confident in the areas necessary for their role. Our user-friendly technology and the resources we create, aid best practice and management control, giving full transparency and saving administration time. Your carers acquire skills and knowledge quickly through engaging and accessible courses and all our solutions are backed-

CMM June 2021

up with expert support from our experienced team. Our experience within the Health and Social Care sector has also inspired the creation of our Learning Environment, and the amazing features within it are tailored to the demands of the sector and the necessary requirements. We’re solely focused on the Health and Social Care Sector, our amazing CPD certified e-Learning courses are inclusive and relatable, by all organisations within the Industry. My Learning Cloud is constantly working to improve and create new and innovative ways of learning in line with the ever-changing needs and requirements of organisations within the sector. We currently support a number of organisations within all areas of the industry, from Housing Associations to Care in the Community, Eating Disorder services to Fertility Clinics, and we’re growing every day. As a Skills for Care Centre of Excellence and as an endorsed provider, we are the blended and e-Learning specialists for the Health and Social Care sector. Our bespoke Learning Environments and accredited content empower organisations to confidently manage and deliver compliant, higher standards of care.

• Care homes. • Domiciliary care. • Hospitals. • Local authorities. • Nursing homes and schools.

SERVICES • Care certificate training. • Mandatory training. • Other training not deemed as mandatory for care staff. • Clinical skills, e.g., male catheterisation, venepuncture etc. • First aid qualifications (adult and paediatric). • Management training.

COMPANY PROFILE Solicitude Training was founded 10 years ago, with a view of providing high-quality, cost-effective, and engaging training. Jenny and her team are passionate about providing bespoke training that is relevant to the individual service. All trainers come from a clinical background and, therefore, can

relate to the staff in a meaningful manner and are able to offer constructive support throughout the training when practice questions and issues are raised. Due to the nature of care work, training can be provided to meet the needs of shift workers and this includes delivering training on an evening or weekend, at no additional cost to the service. During 2020, Solicitude Training adapted to meet the needs of the sector and now offers training, not only face to face but also virtually and via e-learning. As a result of this, we have seen a large take up in the blended learning approach, where staff will gain the theoretical knowledge via e-learning; but this is then re-enforced and applied to practice during face-to-face delivery. Solicitude Training would be very happy to undertake a training needs analysis for your service and submit a report, along with a proposed training plan. To discuss this in more detail, please do not hesitate to contact us.

IT’

JOIN OUR ONLINE EVENT

Lincolnshire Care Association Conference Thursday 3rd June 2021

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Agenda topics include: � Social Care beyond COVID-19 � Lincolnshire County Council: Looking to the future � What do we want from social care reforms? � Supporting the workforce

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