Care Management Matters (CMM) Magazine July/August 2021 by Care Choices Ltd

JULY 2021

www.caremanagementmatters.co.uk

CREATIVE THINKING Pandemic projects supporting people in care settings

Navigating change

The impact of Brexit and COVID-19 on the workforce

Mindful future

Prioritising staff wellbeing for the long term

Leading the way

How is the world exploring technology integration?

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In this issue Inside CQC Debbie Ivanova, Deputy Chief Inspector for people with a learning disability and autistic people, updates on the new strategies and systems aimed to help devise care plans.

CMM News

Into Perspective Our contributors discuss the Delta variant and what the impact might be for care homes and the community if the Government imposes restrictions.

Celebrating Excellence We speak to the Barnsley Dementia Gateway Service, which won the Community Engagement Award at the Markel 3rd Sector Care Awards 2020.

Event Review Organised by CMM Insight, Lincolnshire Care Association (LinCA) hosted its care conference for 2021 virtually, bringing providers and decision makers together.

Straight Talk Samantha Allen, Chair of the Health & Care Women Leaders Network, discusses the new Women's Health Strategy.

FEATURES

REGULARS

Social Care Insights Simon Bottery of The King’s Fund says that, to make the biggest difference to workforce reform, better pay must lead to lower vacancies and higher quality care.

Creative thinking: How creative and cultural projects have supported social care during COVID-19 The Culture, Health & Wellbeing Alliance (CHWA) shares case study insights from pilot projects and explains why they have had a positive impact on the wellbeing of care home residents.

Navigating change: The impact of COVID-19 and Brexit on the workforce With the EU Settlement Scheme due to end on 30th June, Professor Shereen Hussein details the significance and importance of migrant care workers and the legal firm, Royds Withy King, outlines recruitment and pay changes as a result of immigration policy updates.

Taking control: Are you prepared to take proper care of your cyber risks? Markel UK offers steps to help providers devise a cyber strategy, defines the terminology on the topic and provides the latest statistics and findings relating to cyber risk in the sector.

Mindful future: How to devise a mentally healthy workplace for care staff The charity Samaritans shares findings from its helpline service and says to help care workers overcome the trauma experienced during the pandemic, providers must devise a longer-term mental health strategy.

Global innovations: How can technology be truly integrated into social care? Rafael Bengoa provides commentary on technology integration and refers to global models of practice, to present some of the different ways to achieve integration in social care. The article makes reference to the ADASS Commission report on technology and integration. CMM July 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

@blimeysimon

@CQCprof

@CHWAlliance

@DrShereeHussein

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

Debbie Ivanova Deputy Chief Inspector, Care Quality Commission

Victoria Hume Director, Culture, Health and Wellbeing Alliance (CHWA)

Shereen Hussein Professor of Health and Social Care Policy, London School of Hygiene and Tropical Medicine

@RoydsWithyKing

@ProfMartinGreen

@relresuk

@MarkelUK

Mike Thomson Litigation Executive, Employment, Royds Withy King

Professor Martin Green, OBE Chief Executive, Care England

Helen Wildbore Director, Relatives and Residents Association

Chris Burgess Head of Cyber, Markel UK

@samaritans

@rafabengoa

@MakingSpaceUK

@samanthallen

Keith Leslie Chair, Samaritans

Rafael Bengoa Chair, ADASS TSA Commission and Co-Director, The Institute for Health & Strategy in Bilbao

Cath Magee Peripatetic Service Manager, Making Space

Samantha Allen Chair, Health & Care Women Leaders Network and Chief Executive, Sussex Partnership NHS Foundation Trust

SUBSCRIPTIONS Non-care and support providers may be required to pay £50 per year. info@caremanagementmatters.co.uk 01223 207770 www.caremanagementmatters.co.uk

Care Management Matters is published by Care Choices Ltd who cannot be held responsible for views expressed by contributors. Care Management Matters © Care Choices Ltd 2021 CCL REF NO: CMM 18.5

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CMM July 2021

SOCIAL CARE

INSIGHTS From Simon Bottery

Simon Bottery of The King’s Fund discusses workforce reform and says that, to make the biggest difference, better pay must lead to lower vacancies and higher quality care. ‘We have some great people in social care, but we do not have enough of them ... we need more great people and, if we want that, we are going to have to pay for it.’ This contribution from Age UK Director, Caroline Abrahams, to the Health and Social Care Select Committee hearing on dementia in May 2021, demonstrates the extent to which workforce reform has become a priority for many in the sector. While this sentiment is clearly to be applauded, the Committee's Chair, Jeremy Hunt, was also right to ask his next question: ‘What would you do about it?’ Because here things start to get more difficult. For many, the key workforce

issue is pay. At one level, this is a simple matter of social justice. Care workers deserve to be paid more for carrying out a difficult and, during COVID-19, dangerous job. Only the hardest of hearts would disagree with this. Yet, better pay for staff may only help transform social care if it achieves two further goals – tackling the chronic workforce problems in social care and also improving the end result: the quality of social care that is delivered. On pay, the issue is not just the need for care work to be paid better but for it to be paid better than other, competing sectors. Care worker pay has, in fact, been rising faster than inflation for several years but vacancies have stayed

high because it has risen even faster in those other, competing sectors, such as retail and cleaning. This suggests to some that a form of national, sector-wide pay body is needed – setting a social care minimum wage, for example – though the practical difficulties of applying this in a sector that is much more complex and fragmented than the NHS should not be underestimated. However, if you could make this – or an alternative approach to increased pay – work, it should have an impact on vacancies. We know that low pay, and particularly the perception of low pay, is a key factor in recruitment difficulties. That would also help to ease the pressure

on the existing workforce. There is good evidence from the NHS that the sense of being able to do a job well is undermined by chronic workload pressures, which also of course impacts on the health and wellbeing of staff. All of this should improve quality, too, though in itself it may not be enough to be transformative. Broader issues such as quality of management, workplace culture and access to training and career progression will not necessarily improve just because careworkers earn more. And unless pay reforms are properly funded, they could even make the situation worse. One study found that the introduction of the national living wage was, in fact, associated with a fall in quality in some care homes. Though the study does not speculate about reasons, it seems plausible that it was because the cost of paying staff more meant corners had to be cut elsewhere. So, as with other areas of reform, a failure to properly fund changes could scupper them. This might seem an obvious point yet, in reality, workforce reform will have to compete with other required changes, for example to eligibility, which are also essential to reform. Distributing any available extra money between these different priorities is bound to be difficult. Untangling this complex web of workforce reform will take time. Even more important, then, that the Government gets on with it as quickly as possible.

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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CMM July 2021

In my last column, I shared my early thinking on our programme of work to transform the regulation of services for people with a learning disability and autistic people. Above all else, this programme focuses on making sure services for people with a learning disability and autistic people are safe and meet people's needs well, in a model of care that promotes choice, independence and control. In order to do that, we need to change the way we think about supporting people. We need to stop talking about people needing ‘complex care’ and vulnerable people, and shift to a focus on supporting people to lead the best lives they can.

KEY AREAS OF FOCUS We still have a lot to do, but I want to update you on where we are so far. Last time, I shared and explained our three key areas and what they should feel like to someone using a service, which are as follows: • Making sure we only register the right services — I use services that support me in the way I want to live and where I want to live. • Making sure we support services to improve and take the right action where they don’t — I will not be asked to move to a service that isn’t safe and I won’t be expected to continue to live in a service that doesn’t meet my needs. • Making sure we influence the improvement of pathways and wider healthcare of people with a learning disability and autistic people — I can access local services that meet my needs and get the right healthcare when I need it. Our inspectors are also using updated guidance to help identify signs of closed cultures. This guidance is underpinned by our policy Right Support, Right Care, Right Culture. This policy sets out our expectations of all providers and commissioners of care. Everyone in the system should know what to expect when it comes to our standards. If you are planning on opening a new service, we ask that you contact us first so that we can ensure it’s in line with our policy.

PILOT INSPECTIONS We have now completed three pilot inspections using our new methodology. I wanted to share

Inside CQC D E B B I E

I V A N O V A

Debbie Ivanova, Deputy Chief Inspector for people with learning disabilities and autistic people at the CQC, updates on the new strategies and systems aimed to help devise care plans for people with learning disabilities and autism.

firsthand experiences from our visits to help give a feel for what’s changed. My colleague Nathan, an Adult Social Care Inspector, shares his reflections below: ‘In the pilot, we’re inspecting through a new person-centred lens, which has a much greater focus on people using and living in these services. We’re also in multidisciplinary teams, which has been a real success. These inspections move away from the systems and processes a provider has in place and are much more about getting under the skin of what is really happening in these services, focusing on people and their outcomes. ‘We’re only one part of the system and can’t do this alone. My message to providers, commissioners, social workers, registered managers and others would be to collaborate and work towards a shared goal of helping people with disabilities who may need support to lead the lives they choose, in the places they want to be. We must all take accountability for our decisions and behaviours.’ On these visits, we’re inspecting at telling touch points in people's daily life, such as their time to eat, go to bed or when a staff handover is taking place. We’ve also increased observation and the amount of time we spend speaking to people in the service, as well as

using more Experts by Experience. Our teams are using new tools like the Quality of Life tool to better evaluate people’s care plans. The primary purpose of this tool is to improve CQC’s ability to consistently identify and take appropriate regulatory action in services that fail or are failing to meet the needs, aspirations and skills development of people with a learning disability and/or autistic people. We’re currently evaluating the pilot and hope to roll it out across more services in the next few months. We’re not accepting care that is not safe and doesn’t meet people’s needs. We’ve taken action on every inspection in the pilot, stopping admissions through urgent imposition of conditions in hospitals and cancelling the registration where care does not improve.

MY NEXT COLUMN Some autistic people can struggle to access health and social care services and many have negative interactions with the NHS because reasonable adjustments aren’t made. In my next update, I’ll focus on how important it is for there to be a good understanding of what it means to be autistic and explore our programme with a focus on autistic people.

Debbie Ivanova is Deputy Chief Inspector for people with learning disabilities and autistic people at the Care Quality Commission. Share your feedback and comments on Debbie’s column on the CMM website, www.caremanagementmatters.co.uk. CMM July 2021

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CMM July 2021

NEWS

APPOINTMENTS UNITED RESPONSE

DHSC confirms mandatory vaccination policy The Department of Health and Social Care (DHSC) has confirmed that people working in care homes will need to be fully vaccinated against COVID-19. The new legislation means from October – subject to parliamentary approval and a subsequent 16-week grace period – anyone working in a CQC-registered care home in England for residents requiring nursing or personal care must have two doses of a COVID-19 vaccine unless they have a medical exemption. The DHSC said the policy will apply to all workers employed directly by the care home or care home provider, those employed by an agency and deployed by the care home, and volunteers deployed in the care home. Those coming into care homes

to do other work, for example healthcare workers, tradespeople, hairdressers and beauticians and CQC inspectors will also have to follow the new regulations, unless they have a medical exemption. There will be exceptions for visiting family and friends, under 18s, emergency services and people undertaking urgent maintenance work. The Government will launch a further public consultation in due course on whether or not COVID-19 and flu vaccinations will be made a condition of deployment in health and care settings. John Godden MBE, CEO of Salutem Healthcare, said, ‘We adopted a policy of compulsory vaccination for our frontline staff with effect from 30th April. The Government’s proposals do not go nearly far enough. Vaccines must

be mandatory in all care settings, not just those providing care to the elderly. Adults and children with complex medical needs may be at even greater risk from coronavirus because they may not yet have met the vaccination criteria themselves.’ Karolina Gerlich, CEO of The Care Workers’ Charity, said, ‘We cannot discriminate against one part of the social care and health workforce, with a policy such as this it should either be compulsory for all or none, particularly with the set reasoning behind it which would be to protect people vulnerable to the virus. We are worried that this kind of compulsory vaccination will cause staff shortages if people feel discriminated against and want to leave the sector.’ Visit the CMM news pages for more comment and response.

WHO report on community mental health The World Health Organization (WHO) has published a report: Guidance and technical packages on community mental health service: Promoting person-centred and rights-based approaches. The purpose of the report is to inform people responsible for the provision of mental health care at all levels of the benefits of community mental health services that are respectful of human rights and focused on recovery. The WHO said that human rights violations in mental healthcare services are still far too common in countries of all income levels. Examples include forced admission and forced treatment; manual, physical and

chemical restraint; physical, verbal, psychological and sexual abuse; and unsanitary living conditions. The WHO states that there is a need for: • Legal and policy frameworks that are respectful of human rights. • Political commitment to, and an increase in funding for, developing/scaling up community mental health services that are respectful of human rights. • Initial training and follow-up supervision provided to all staff involved in providing care to people with mental health conditions. It also called for Community-based

mental health services that: • Do not use coercive practices such as seclusion and restraint. • Do not accept any form of physical, verbal, psychological or sexual abuse. • Respect people’s choices and decisions about their treatment, care and support. • Provide directly or facilitate access to support with housing, education, professional opportunities and relationships. Karyn Kirkpatrick, CEO of KeyRing Living Support Networks, said, ‘We believe that everyone should have access to support that connects and inspires them to live the life they want.'

National disability charity, United Response, has appointed two new trustees to its Board. Satya Satal and Paul Marriner will both formally join United Response’s Board of Trustees from July 2021, as part of a wider commitment from the charity to strengthen the diversity of its leadership team. Satal and Marriner bring skills in digital technology and business systems to support the charity’s strategic intent, which will use its learnings from working through the pandemic as a blueprint for how it works in the future.

RADIS COMMUNITY CARE

Radis Community Care has welcomed a new Head of Nursing to its Management Team. Nicola Dale, who has a wealth of experience in complex care and nursing practice, will be responsible for overseeing and developing Complex Care Services, which offers clients with complex health needs clinical care within their own homes and under the supervision of qualified nurses.

CANFORD HEALTHCARE

Canford Healthcare, a leading provider of nursing, residential and dementia care services, is pleased to announce the appointment of Krystyna Bosko RN MSc as manager of Hampton Care Home. Krystyna is highly qualified, with an MSc in Nursing with Teaching, a PGCert in Hospital Management and Public Health, a PGDip in Quality Management/Internal Auditor and the NVQ Level 4 Registered Manager Award. She has been nursing for 35 years. CMM July 2021

NEWS

APPOINTMENTS HALLMARK CARE HOMES

Aneurin Brown, Regional Director for England of the multi-award-winning care provider Hallmark Care Homes, has been promoted to Group Operations Director. He will now oversee the operational direction of the group’s entire portfolio. In addition, he will drive consistency across the group, which currently provides residential, nursing and dementia care to over 1,000 residents across 20 locations in England and South Wales.

HALLMARK CARE HOMES FOUNDATION

The trustees of Hallmark Care Homes Foundation have appointed Stephen Burke as the charity’s first Chief Executive. Since the charity was established in 2020, the foundation has already backed several projects promoting the care workforce such as The Care Workers' Charity Emergency Coronavirus Fund and the Together with Music project.

LEONARD CHESHIRE

Marcus Missen is set to join Leonard Cheshire as its new Executive Director of Fundraising, Marketing and Communications. He moves to the international disability charity from WaterAid, where he has been Director of Communications and Fundraising.

Are you getting the benefit of the CMM website? Sign up today to start getting more from CMM. It’s FREE for care providers. www.caremanagementmatters.co.uk

CMM July 2021

CQC launches five-year strategy The Care Quality Commission (CQC) launched an ambitious new strategy in May, based on consultation with the public, providers of health and social care services, charities and partner organisations. The new strategy focuses on the following four themes: • People and communities: regulation that is driven by people’s needs and experiences, focusing on what is important to them as they access, use and move between services. • Smarter regulation: a more dynamic and flexible approach that provides up-to-date and high-quality information and ratings, easier ways of working with the CQC, and a more proportionate regulatory response. • Safety through learning: an

unremitting focus on safety, requiring a culture across health and care that enables people to speak up and in this way share learning and improvement opportunities. • Accelerating improvement: encouraging health and care services, and local systems, to access support to help improve the quality of care where it’s needed most. Running through each of these themes are two core ambitions: Assessing local systems: giving the public independent assurance about the quality of care in their area. Tackling inequalities in health and care: pushing for equality of access, experiences and outcomes from services. The CQC said that it will work to make a positive

impact on the experiences of everyone who receives care, while regulating in a targeted way, which supports services to improve and prioritise safety. Tim Coolican, Partner for Anthony Collins Solicitors LLP, said, 'While the CQC is right to focus on safety and devote resources to areas of greatest risk, they must keep in mind the fundamental role of a regulator to act fairly. Fairness will be essential if they are to regain the trust of providers, who may question what if any support the CQC has provided during the pandemic. The CQC will only be able to rebuild confidence in their role as a regulator if they can demonstrate in practice that their new approach to inspection and rating is as clear, open and transparent as the services they seek to promote.’

New report highlights workforce burnout The inquiry from the Department of Health and Social Care (DHSC) Committee examined workforce burnout across the NHS and social care in particular, the increased pressures brought about by COVID19, and the resilience of services to cope with high levels of staff stress. The key recommendations set out in the report are as follows: • Repeats call for Health Education England to publish objective, transparent and independently audited annual reports on workforce projections covering the next five, ten and 20 years, including assessment of whether sufficient numbers are being trained.

• Workforce projections should cover social care as well as the NHS. • DHSC should produce a People Plan for social care as a priority, aligned to the ambitions set out in the NHS People Plan. • The level of resources allocated to mental health support for health and care staff should be maintained as and when the NHS and social care return to ‘business as usual’ after the pandemic. • NHS England should review the role of targets across the NHS, which seeks to balance the operational grip they undoubtedly deliver to senior managers against the risks of

inadvertently creating a culture which deprioritises care of both staff and patients. Care England welcomed the report. Professor Martin Green OBE, Chief Executive of Care England, said, ‘Whilst the workforce is resilient it is only as resilient as the funding and support behind it hence the need for adequate long-term support for the sector. We want to work with the Prime Minister to ensure that his promise to reform social care is delivered upon and carries the views and experiences of those at the front line.’ Visit the UK Parliament website to read the report in full.

ADASS Activity Survey 2021 Adult social services are facing a surge of requests for care and support from older people and disabled people of working age, as society emerges out of the pandemic. Almost seven in 10 social services directors in England said they are dealing with growing

demand for help with mental health issues. Almost six in 10 say more people, with care and support needs, are seeking help to escape domestic violence or other abuse. Of responding directors, 48% said they were being asked to support more people

awaiting admission to hospital and 75% said they were dealing with more people being discharged and asking for help from their local council – 55% reporting a rise of more than 10% in numbers of requests following discharge over the six months.

CMM July 2021

NEWS

Charity applies for judicial review over 14-day isolation rule The charity John’s Campaign has applied for permission for judicial review of the Department of Health and Social Care (DHSC) guidance which includes the 14-day isolation requirement. In line with the DHSC’s guidance, care providers are required to ensure that care home residents self-isolate for 14 days following a visit out that would be deemed high risk through a risk assessment or after an

overnight stay at hospital. The DHSC has insisted in correspondence with John’s Campaign’s lawyers, Leigh Day, that the 14-day isolation requirement is not mandatory. However, the Care Quality Commission (CQC) has repeatedly stated that the regulator expects care homes to fully comply with Government guidance. The application for permission for judicial review was filed at the

High Court on Wednesday, 9th June. John’s Campaign says the guidance ‘makes it likely that care providers will falsely imprison care home residents contrary to Article 5 ECHR, either by not permitting them to make visits out of the care home at all or by imposing on them a 14-day isolation requirement on return without any legal basis.’ The charity also argues that the necessary individualised assessment

for admission or overnight visits will not be carried out by providers because the guidance appears to be received as mandatory. The grounds for the application have been submitted along with several case studies compiled by John’s Campaign. John’s Campaign is crowdfunding its legal case, and sales of its booklet are also helping to meet legal costs.

10 years on from Winterbourne, VODG response On the 10th anniversary of the Winterbourne View scandal, the Voluntary Organisations Disability Group (VODG) has published its calls to Government: • That the Secretary of State for Health and Social Care directs the Care Quality Commission to rate all assessment and treatment units as ‘Requiring Improvement’ if any person has been living there for more than

12 months. The rating should be downgraded to ‘Inadequate’ if anyone has been living there for more than 24 months and all new admissions halted until the rating has improved. • That HM Treasury establishes a community development fund of £400m over four years to prime the development of community facilities. • That the Secretary of State for

Health and Social Care requires the National Audit Office to publish an annual report to be presented to parliament on the progress of Transforming Care. Dr Rhidian Hughes, Chief Executive of the Voluntary Organisations Disability Group (VODG), said, ‘Ten years on and there are still more than 2,000 people with a learning disability and/or autism detained

in ATUs and the all-too-regular exposés about abusive practices demonstrates how little progress has been made. This is simply unacceptable.’ VODG has said that if the Government is truly committed to protecting and transforming the lives of people who are in the most vulnerable of circumstances, then it must put an end to this human rights scandal.

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CMM July 2021

NEWS

#GladtoCare Awareness Week returns in July Person Centred Software and Autumna are thrilled to announce that #GladtoCare Awareness Week is returning for a second year from 5th July to 9th July 2021. Following the great success of the 2020 inaugural event, which saw over 250 care homes take part and the #GladtoCare hashtag used over 25,000 times in just one week, it is hoped that this second-time celebration will become an annual awareness week.

Created in admiration of the care sector, #GladtoCare Awareness Week serves as a celebration to resilient care workers, following what has undeniably been a trying period for the industry. It shows appreciation for the extraordinary contributions that carers make to the lives of recipients of care, their families, and community members, reassuring families currently looking for care and in turn resulting in improving occupancy for providers.

Speaking of the initiative, Jonathan Papworth, co-founder of Person Centred Software, said, ‘We hope that as many care providers and care workers will get involved as possible to shine a light on all of the incredible work that’s been done, and continues to be done, within the industry, much of which often goes unnoticed and underappreciated.’ Various initiatives during the week will encourage carers to

highlight reasons why they are #GladtoCare. Through the sharing of stories, photos and videos on their social channels, participants will be asked to showcase milestone moments that have made them feel particularly proud to be caregivers, providing inspiration for people to consider careers within the industry. For more information on #GladtoCare Awareness Week and how to get involved, please visit www.gladtocare.com.

Older people badly let down by CQC, says R&RA The Relatives and Residents Association (R&RA) has expressed ‘disappointment and despair’, in relation to the role the Care Quality Commission (CQC) has taken during the pandemic. In a letter exchange with the CQC, the R&RA argued that older people needing care have been badly let down by the regulator. The letter said that ‘during the

most difficult period in generations and with a human rights crisis unfolding in care, CQC retreated to the side-lines’. The letter was accompanied by a number of examples from the R&RA Helpline. The R&RA said the response from the CQC is ‘unacceptable abdication of responsibility’ and that the letter fails to acknowledge the devastating

impact that the past 14 months have had on older people in care and the charity says the letter ignores R&RA’s main call for the CQC to take a proactive role in monitoring compliance with visiting guidance. In response to R&RA’s letter, Ian Trenholm, Chief Executive of the Care Quality Commission, said, ‘I cannot agree with the R&RA that

there has been lack of action by us, which, in turn, has left people who use adult social care services at risk. We have continued to monitor and inspect adult social care services during the pandemic. ‘If R&RA has evidence that people are unsafe or at risk of abuse, I think it is your duty to share this information with us and other relevant bodies.’

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NEWS / IN FOCUS

CMM announces return of Markel UK 3rd Sector Care Awards

IN FOCUS

CMM is thrilled to announce that the Markel UK 3rd Sector Care Awards will be returning. Nominations will open later this year, followed by the ceremony in 2022. It is hoped that 2022 will see the much-anticipated return of a face-to-face event which will now continue to take place annually in February. Preparations are well underway towards a provision ceremony date of Friday 11th February 2022*. Other important dates for your diary include nominations opening on Friday 23rd July* and closing on Friday 8th October 2021*, as well as the judging day falling on either Thursday 2nd* or Friday 3rd December 2021*. *Dates subject to change. Anyone can enter themselves or nominate someone else in one of the ceremony’s categories – irrespective of their position in an organisation. All entries will continue to be free to ensure that the event is accessible to all. The Awards focus on creative arts, community engagement, innovation, quality improvements, integration, technology and

Report published for Carers Week 2021

governance. These categories and the entry criteria have always been based on specific strategies – from Government and the sector – and have evolved over time to maintain relevance in an ever-changing landscape. Limited sponsorship and marketing opportunities are available for The Markel UK 3rd Sector Care Awards. Supporting the Awards in this manner is an excellent way of demonstrating your commitment to a sector underpinned by hard work and innovation. Increased awareness of your brand and extensive social media coverage are amongst the automatic benefits granted to those supporting the event. For more information on the Markel UK 3rd Sector Care Awards, please contact the Awards team on 01223 207770 or email lisa. werthmann@carechoices.co.uk The Markel UK 3rd Sector Care Awards celebrate the excellence, innovation and creativity in the voluntary care and support sector. Specialist insurer Markel is headline sponsor of the event.

Research project to explore COVID-19 infection control Researchers at the University of East Anglia (UEA) are launching a new project to investigate how people who live, visit and work in care homes have coped with COVID-19 infection control measures. The study, which has been funded by the National Institute of Health Research School of Social Care Research (NIHR SSCR), will help identify what more could be done in the future to support residents, families and care home staff cope with measures that aim to control and reduce infectious disease outbreaks. They will work with residents, families and care home staff to better understand their experience of measures such as mask-wearing, visiting restrictions

and social distancing. The team will work with more than 15 care homes across East Anglia in order to speak with care home residents, family members and friends of residents and care home staff. Lead researcher Dr Kathleen Lane, from UEA’s School of Health Sciences, said, ‘Right from the start of the COVID-19 pandemic, older people’s care homes put in place extra infection-control measures. These included restricting visitors, wearing additional protective equipment and changing how care is given. But we do not know how those who live and work in care homes have coped with these infection-control measures or whether they met their needs.’

WHAT’S THE STORY? Research released for Carers Week (7th – 13th June 2021) has found that carers lost, on average, 25 hours of support a month they previously had from services or family and friends before the pandemic. The six charities supporting Carers Week – Carers UK, Age UK, Carers Trust, Motor Neurone Disease Association, Oxfam GB and Rethink Mental Illness – are calling on the UK Government to provide £1.2 billion funding for unpaid carers’ breaks, so that those providing upwards of 50 hours of care are able to take time off for their own health and wellbeing. Carers UK carried out an online survey between 8th April and 25th April 2021. A total of 2,850 carers and former carers responded to the survey. This included 2,754 current carers and 96 former carers. Compared to the carer population, respondents to this survey were more likely to be female and caring for a high number of hours every week.

WHAT ARE THE FINDINGS? • More than a third (35%) of people caring unpaid for family members or friends feel unable to manage their caring role. • 72% of carers have not had any breaks from their caring role during the pandemic. • Fewer than one in five (14%) exhausted unpaid carers are confident that the support they receive with caring will continue following the COVID-19 pandemic.

• 69% of carers responding to the Carers Week survey reported poor mental health, while 64% said their physical health had deteriorated. • Almost two thirds of carers (63%) say they are worried about continuing to care without a break. • Carers are using their time off from caring to do essential things – 26% to go to a medical appointment, and 33% to complete practical tasks such as housework. • Fewer than one in five (14%) exhausted unpaid carers are confident that the support they receive with caring will continue following the COVID-19 pandemic.

WHAT DO EXPERTS SAY? On behalf of Carers Week charities Helen Walker, Chief Executive of Carers UK, said, ‘Without the right support, the stress and challenges of the last year could lead to far more carers breaking down. It is essential that the Government ensures that carers can take breaks and that those providing upwards of 50 hours of care each week get a funded break. Unpaid carers need hope and support in the future and they must be at the heart of the Government’s plans for social care reform.’ According to the King's Fund, unpaid carers – usually, but not always, family members – contribute the equivalent of four million paid care workers to the social care system. Visit the Carers Week website to read the report in full. CMM July 2021

NEWS

New award to recognise exceptional practice in adult social care The exceptional efforts of the social care workforce will be recognised through a new award launched by the Chief Nurse for Adult Social Care. Professor Deborah Sturdy has outlined her commitment to recognise the outstanding contribution made by social care workers and nurses in England and their enormous range of skills, expertise and enduring compassion.

The awards will mirror the Chief Nursing Officer Ruth May’s awards for the NHS and aim to celebrate nurses and care workers in adult social care who go above and beyond their everyday roles to provide excellent care, leadership and inspiration. Presented as gold and silver awards, they represent an important step towards bringing recognition in line with the NHS

workforce and recognise the extraordinary commitment of the adult social care workforce. Chief Nurse for Adult Social Care Professor Deborah Study, said, ‘The social care workforce more than ever continues to demonstrate unwavering compassion, professionalism, and dedication. Not only during the pandemic but every year. I am extremely proud to present these awards to colleagues

in social care which reflect those for colleagues in the NHS.’ Nominations will be considered by a panel of NHS and adult social care chief nursing officers and adult social care sector representatives. Applications are available as a form that should be supported by two signatories. Visit the Government website for more information and to download the forms.

‘Secure the social care sector now or risk its collapse’ Partner at Anthony Collins Solicitors, Matthew Wort, has said the Government’s failure to address the funding issues affecting the social care sector is having a major impact on UK care providers and those relying on their services. Matthew Wort told CMM, ‘Some care providers are having to assess the viability of their services following funding cuts from commissioning local authorities or failures to increase payments in line with rising costs. At Anthony Collins Solicitors, we’ve experienced providers receiving notifications

from local authorities, informing them of planned reductions to the rates paid for overnight shifts. ‘This follows the Supreme Court’s judgment for sleep-in shifts in March. While safeguarding care providers from a potentially catastrophic back-pay bill, the judgment is being seen by some local commissioners as a sign to reduce the rates paid for overnight shifts. ‘A recent report from Hft demonstrates the pressure currently facing care providers. The charity’s Sector Pulse Check revealed

that 56% are reporting declining surpluses or a deficit – driven by rising wages and a lack of fee income. The report also revealed that 62% of care providers have resorted to closing down parts of their organisation or handing back marginal contracts and services to local authorities. ‘The Health Foundation estimates that £11bn a year will need to be invested by 2023/24 to stabilise care services and improve pay and conditions for staff. Though the Government does not appear to want to recognise that immediate

financial investment is needed, the UK population must accept that increased taxes may be needed to help fund social care – services, that at some point, we may all rely on. ‘The Government was able to find the budget for a £37bn NHS Test and Trace system but continues to ignore the opportunity to invest in services that enable vulnerable people to be properly cared for and supported.’ To read Matthew Wort’s comment in full, visit the CMM news pages at www. caremanagementmatters.co.uk

Admissions from dementia care failures soaring During Dementia Action Week, 17th – 23rd May, Alzheimer’s Society urged governments to honour their promise to rebuild the broken social care system. An Alzheimer’s Society investigation, launched to mark Dementia Action Week, has revealed, even before the pandemic, tens of thousands of people with dementia were being rushed to hospital each year, up 27%, because, according

to Alzheimer's Society, inadequate social care left them unprotected from infections, falls and dehydration. The investigation, involving FOIs to NHS Trusts, found a 27% rise between 2015 and 2019 of people with dementia being sped to hospitals with avoidable emergencies. And in 2019, nearly two thirds (65%) of all emergency admissions of people with dementia were for avoidable illnesses and

injuries caused by failures in care. In a supporting survey of unpaid dementia carers, almost half (48%) reported that they had performed tasks they felt unqualified to carry out because of a lack of support, and as a result, they reported three-quarters (72%) of people with dementia having medical issues at home. It has also been reported by the charity that three in ten had experienced avoidable falls (29%),

one in six missed medication (16%), one in five hurt themselves in the house (22%) and one in nine (11%) reported their loved one being rushed to hospital in an avoidable emergency. Kate Lee, Chief Executive Officer at Alzheimer’s Society, said, 'Lack of time and dementia-specific training among the overworked and underpaid care workforce means people with dementia aren’t getting the support they need.'

Freemantle Trust care worker wins two awards Mandy Horne, Bedside Buddy at Icknield Court care home in Princes Risborough, scooped not just one but two awards at the recent Buckinghamshire Health and Social Care Awards. Mandy won both the Home Care Worker Award and the 16

CMM July 2021

Dementia Carer Award in recognition of her contribution to the care and support of people living at Icknield Court care home, one of the 11 Care Homes within The Fremantle Trust. The Bedside Buddy scheme was introduced by the Trust to

support residents who are alone in their rooms. The scheme includes providing companionship, one-toone stimulation and activities which are adapted to engage people in different ways. Bedside Buddies also help facilitate video calls, so people

can stay in touch with relatives who are unable to visit in person. Upon winning the awards, Mandy said, ‘I feel lucky to have found a role that is not only making a difference to people’s lives, but also one that I love.’

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CMM July 2021

NEWS

People with disabilities share climate change animation A new stop-motion animation created by people with learning disabilities and their support workers in Devon is hoping to raise awareness of climate change this summer. The animation was released as the G7 summit commenced in Cornwall and it aims to highlight how the impact of climate change can directly affect marginalised people – such as those with disabilities. Local people with learning

disabilities, many of whom are supported by the national charity United Response, worked with Devon-based creative groups to help shape the animation’s narrative and storyline. They were supported by staff to help decorate some of the animation’s set, while the fiveminute film itself is narrated by people whom the charity supports. Both the animation and a behind the scenes documentary are available on United Response’s YouTube channel.

The new climate change animation – titled Zack’s Story – is the third production from the Devon group over the past year. A recent United Nations survey found that nearly three quarters (72%) of disabled people have no personal preparedness for natural disasters and nearly 80% would not be able to easily evacuate their homes should disaster strike. The United Nations is pushing for true inclusion when it comes to

disaster response, especially in the face of ever-growing concerns over climate change. Kate Conroy, senior service manager for United Response’s Wellbeing Devon project, said, ‘We want the G7 to listen to the voices of people with learning disabilities and hope this animation will help disabled people realise they can make a difference too – we want to involve everyone in the fight against climate change.’

Care home residents to be granted wishes Staff at the charity run care centre, The Edensor in Essex, asked their residents to hang a handwritten note asking for something that they would really love to receive on a ‘Wish Tree’. Diane Groom, 72, placed her wish which said, ‘I would love to have a cat to love and care for’ and she was over the moon when ‘Dave’, a tiny little tabby kitten, arrived.

CMM July 2021

Lindsey Milliken, Deputy Manager, Edensor Care Centre, said, 'Dave has made a huge difference to the atmosphere in the Care Centre and seeing the residents' faces light up when he is about is magical.’ The staff also added a wish to the tree inspired by one of the residents, Simon Keyes, 34, who stayed at the centre for end-of-

life care. On the day before he died, he told a member of staff that he would love to go on the beach to feel the sand and be taken to the water’s edge to put his feet in the sea. Staff said not being able to do this for him was heart breaking and they knew that they needed to fundraise for a couple of beach wheelchairs to ensure that, in the future, they

would be able to take residents on to the sand. Other wishes on the tree include to go and see West Ham play and tour the stadium, to have a round of golf and to go ten pin bowling and one resident simply wanted to walk in the rain. The charity-run Care Centre hopes to make all the wishes happen by the end of the year.

NEWS

NCF #9wordsforcare campaign The campaign, #9wordsforcare, was launched following the frustration felt by the sector after the Queen’s Speech included just nine words about social care and with no detail on longer-term reform. The NCF made a call out to those who work in the sector, those who receive care and support, relatives and friends, providers, commissioners, local Government, parliamentarians and the wider public to find out what they would have said about how

important social care was – if they only had nine words. In 48 hours, from Wednesday 12th May until Friday 14th May, NCF received over 400 submissions and hundreds more who engaged and commented on the ambition for social care. NCF said that the responses were angry, inspiring, emotional, sardonic, symbolic and most of all they showed that people care. Here are just some of the

submissions shared: ‘We do not want proposals, we need action.’ ‘Social care needs total reform not sticking plaster solutions.’ ‘Ambitious reform backed by appropriate investment is needed now.’ ‘Sustainable and equal access to care and support services.’ ‘9 words said a lot, neglecting #care must stop.’ Vic Rayner OBE, Chief Executive

of the National Care Forum, said, ‘The underlying message is clearly that nine words was definitely not enough and seriously undermines the muchrepeated commitment that this Government will ‘fix social care’. If all the Government is going to allocate to social care is nine words – there are literally hundreds and hundreds of alternative nine words which have made much more impact and giving people a sense of hope, purpose and ambition for the future.’

impact on the lives of older adults. The charity’s vision is to improve the quality of life for underserved ageing adults. Speaking about the rebrand, the charity’s Executive Director, Penny Hamer, said, ‘The new brand positioning will help to connect us with the Home Instead network of franchise offices around a common

cause, for the good of our communities. ‘It also makes us part of a global collective of Home Instead Charities around the world who are working to influence and change the future for so many lonely and isolated ageing adults. We are looking to fearlessly create a world today that we want to grow old in tomorrow.’

Home Instead relaunches charity Home care provider, Home Instead, has announced a rebrand of its charity to align it with the company’s global social purpose mission and emphasise the charity’s connection to the Home Instead brand. The relaunch, as Home Instead Charities, took place at a virtual event, attended by the company’s UK franchise network

and national office team as well as Home Instead founders Paul and Lori Hogan along with colleagues and franchisees from the US, Canada, Germany and Ireland. The charity was previously known as the Bring Joy Foundation. Whilst its name has changed, its work will remain focused on making a positive

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: g n i k n i th Creative How creative and cultural projects have supported social care during COVID-19

There has been so much loss, trauma and sadness during the pandemic, but there has been some hope and positivity. Victoria Hume, director of the Culture, Health and Wellbeing Alliance (CHWA), shares how culture and creativity have helped people in care settings during COVID-19.

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In recent years, there has been a growing understanding of the impact that creative or cultural activity can have on our health and wellbeing. The arts, creativity and what we sometimes call ‘cultural assets’, like our museums and heritage sites, are all agents of wellness; through supporting us to use our imaginations and develop our sense of agency, they help build our resilience, aid recovery and foster community. Despite the strain the cultural and creative sector has faced during the pandemic, organisations and freelancers have made a huge collective effort to focus on supporting those around them and turn towards partnerships with health and social care, to reach both the workforce and those most vulnerable. As we all know, COVID19 exacerbated the loneliness and isolation already at crisis point in the UK and has affected mental health and wellbeing. Frontline health and care staff have been particularly vulnerable, both physically and psychologically, and as early research indicates, other keyworkers have had the least opportunity to access creative practice to support their own health1.

THE ROLE OF CULTURE The Culture of Health and Wellbeing Alliance (CHWA) is a free-to-join membership organisation that supports everyone invested in the relationship between creativity, culture, health and wellbeing. It also works to build partnerships across culture, creative practice, health, social care and local Government. Our latest report reveals the pivotal role that culture and creativity have played in supporting health and social care organisations throughout the pandemic, produced in partnership with seven national organisations, including Live Music Now, Music for Dementia, Music in Hospitals and Care, The National Criminal Justice Arts Alliance, The National Performance Advisory Group for Arts, Design and Heritage in Healthcare, Paintings in Hospitals and Performing Medicine. A collection of more than 40 innovative projects from across the UK are illustrated, which in total reached around 50,000 people. The largest proportion were designed for older adults in residential care. Other key groups included people living with dementia, adults in mental health institutions, NHS staff, adults and young people in

hospitals, people serving sentences and care home staff. Many of the projects adopted digital approaches using online workshops, attracting high levels of engagement and reaching thousands of individuals. At a time when face-to-face work was not an option, a wonderful and wide selection of approaches emerged from pre-recorded, live online and outdoor performances to activity packs, exhibitions, artworks, phone-based workshops and radio programmes.

FIVE STEPS TO WELLBEING The common outcome was to improve participant wellbeing, tackle loneliness and isolation, and support social connections. The projects can be universally related to the Five Steps to Wellbeing: connect with other people, be physically active, learn new skills, give to others, and pay attention to the present moment (mindfulness). Much of this could be described as early intervention to prevent the onset of apathy and depression – to build a sense of feeling able to contribute actively to one’s own life and community.

CMM July 2021

CREATIVE THINKING: HOW CREATIVE AND CULTURAL PROJECTS HAVE SUPPORTED SOCIAL CARE DURING COVID-19

Here is a snapshot of some of the fantastic projects that have taken place: Key Changes works with musicians facing inequalities and barriers as a result of their racial background or mental health disability. Weekly online sessions were designed for people living in high-risk settings, such as care homes and hospitals, throughout the pandemic. In an independent survey by MIND/ DoH, 85% of artists reported increased wellbeing and 100% would recommend Key Changes to a friend. Oxford Playhouse’s Tea Talks project worked with socially isolated participants aged 60+ who were living independently or in a care home. Participants were encouraged to share stories about their lives via phone calls, in which the creative interests of each participant were identified and nurtured through conversations and memories. A radio play was subsequently created using the stories and talents shared by participants. Dance and Time with the Museum by University of Cambridge Museums provided support for older adults in residential homes. Copies of museum paintings were distributed with written information for care home staff to share with residents, describing the artwork and inviting participants to travel through the painting, and to share their ideas, thoughts, memories and feelings. Art boxes were provided containing good-quality art materials and activities relating to the museum’s collection to extend engagement. Postcards of the collections were included, so residents could correspond with family and friends who could no longer visit. This contributed to the psychosocial wellbeing of older people, particularly those affected by loneliness and social isolation. Love Through Double Glazing by Vamos Theatre in the West Midlands

was staged entirely outside, but viewed by people in care homes inside where it’s warm and safe. Love Through Double Glazing is funny, cheeky and unashamedly silly. It brings clowning, music, food fights, bubbles and ballet – even a real-life dog. The benefits included: encouraging a re-engagement with culture; encouraging participation to improve mental and physical heath; encouraging attention and communication, wellbeing and contentment; and giving people living with dementia the opportunity to connect in alternative ways. A care home resident said, ‘Love Through Double Glazing made me realise how long it’s been since we laughed so much.’ The Box on the Box, run by The Box, a museum, art gallery and archive for Plymouth and the South West, screened archive film and images to residents in care homes across the region. Drawing on 10,000 hours of footage available in the archive film collection, a series of collaborative episodes were designed to cover interest areas including: Blitz and Reconstruction; Dockyard Traditions; Plymouth After Dark; and Seaside and Holidays. This enabled residents to reminisce together and learn about the area. Participants Annie and Nick said, ‘This is a godsend. We are trapped at home and now we have something wonderful to look forward to each week and talk about. The films are wonderful. More please!’ The History of Ashford in 100 Buildings, run by Funder Films CIC, reached out to care homes. Photographs were taken of buildings in the Ashford area and organised sequentially in films. Activities were provided based on watching the films, poetry and writing associated with the buildings, and more. This created a sense of one big community with an amazing local history in common. Arts Together for Care Homes by Arts Together/Opera North

took place across Leeds to make art accessible to all. It ran outside performances by a range of artists, from opera singers to jazz, to classical guitar, to poets, for care homes to entertain staff and residents. The outcomes included improvements in mental health, wellbeing, happiness, togetherness, relief from boredom, a break for staff, and an opportunity for staff and residents to enjoy something together.

HOPE FOR MORE TO COME We not only want to ensure this level of work can continue in the future, but that these examples can be built on to create a more level playing field. Jo McLean, Executive Director at Performing Medicine, which worked in partnership on the report and is one of the projects that released a suite of resources to support health and social care professionals when wearing PPE, said, ‘CHWA’s report showcases the huge variety of innovative cultural and creative projects that have taken place over the past year. It is fantastic to be involved in such a vital report and to share best practice to encourage a better understanding of how and where this type of work is happening.’ To ensure we have continued support from organisations in the future, we have made a series of recommendations, directed primarily at funders, commissioners and policymakers. These include the importance of investing not just in projects like these, but in the longer work of building the partnerships that underpin it, and supporting the huge numbers of freelancers who provide this critical work. It is clear from the case studies that partnerships across culture, health and social care, along with the skills, experience and dedication of creative practitioners, were two key enablers allowing organisations to rapidly pivot to support communities in entirely

new circumstances. The flexibility and trust demonstrated by funders (mostly Trusts and Foundations) in the early days of the pandemic was also critically important, but there remains a gap between statutory sector’s willingness to partner with community arts organisations and its willingness to invest at a higher level. Filling this gap and supporting local and regional infrastructure across culture that better matches Integrated Care Systems will also help support the cultural sector to better address health inequalities, and to align itself with local health priorities and the need to level up.

CELEBRATING, ACKNOWLEDGING AND LEARNING FROM THE PROJECTS Our recommendation is to celebrate, acknowledge and learn from this work. Lockdown has increased our appreciation of cultural and creative work. The ‘moral commitment’, as one organisation described it, has brought meaning and hope to people dealing with the harshest impacts of the pandemic – whether residents, staff or creative professionals. At the moment, this work is happening in pockets around the country, often thanks to the energy and commitment of small organisations and freelancers deeply rooted in their communities. Our work as an alliance is to join these dots on the map together and help spread the ideas and innovation they represent. CMM Reference 1. Mak HW, Fluharty M & Fancourt D (2020). Predictors and impact of arts engagement during the COVID19 pandemic: analyses of data from 19,384 adults in the COVID-19 Social Study. Preprint at www.doi. org/10.31234/osf.io/rckp5 Read the full report, at: www. culturehealthandwellbeing.org.uk

Victoria Hume is Executive Director of the Culture, Health & Wellbeing Alliance. Email: info@culturehealthandwellbeing.org.uk Twitter: @CHWAlliance In what ways has your organisation incorporated culture and creativity to help support the people you care for? Which of these case studies could you adapt and run in the future? Share your opinion on the website, visit www.caremanagementmatters.co.uk 22

CMM July 2021

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NAVIGATING CHANGE: The impact of COVID-19 and Brexit on the workforce

With the ever-changing COVID-19 guidance and updates to immigration policy, providers are constantly learning how best they can support their workforce. In this article, Shereen Hussein, Professor of Health and Social Care Policy at the London School of Hygiene and Tropical Medicine, shares evidence examining the impact. Brexit and COVID-19 combined have undoubtedly tested the social care sector, its workforce and providers to the limit. On the one hand, Brexit challenges the ability of the sector to maintain drawing on EU migrants who were able to exercise their free-mobility rights to move to the UK and become a vital part of the British labour force. COVID19, on the other hand, has closed borders, caused many UK-based workers to lose their jobs and become suddenly available to take up social care work either as paid workers or volunteers, thus, providing a sudden, yet temporary, supply of willing hands and bodies ready to support the sector during its most challenging times. The sector has been dealing with confusing guidelines, restrictions, fragmented advice and

CMM July 2021

NAVIGATING CHANGE: THE IMPACT OF COVID-19 AND BREXIT ON THE WORKFORCE

considerable grief associated with a significant death toll among the older population in general and those who use care services in particular. The sector has shown resilience in the face of such a sea of change but at what cost? The burden on care providers and care workers has been enormous, yet hardly recognised nor acknowledged by adequate financial support or policy reforms.

WORKFORCE DEMAND As part of our research on the care workforce retention and sustainability1, we conducted a recent survey2 to understand the impact of COVID-19 on care workers. In summer 2020, more than half of respondents to the survey indicated that they increased their working hours, with 18% needing to self-isolate. As this was before the Government ‘infection-control’ fund became available, 18% of those who had to self-isolate reported not receiving any pay during that time. One of the main findings of that survey was the significant impact of the pandemic on workers’ wellbeing and mental health. For example, over 80% of respondents indicated that the amount of time their job made them feel ‘tense, unease or worried’ has either increased a little or a lot since the start of the pandemic.

A ROLE OF SIGNIFICANCE Migrant workers have consistently contributed to the adult social care sector across all settings over several decades. At an average of a fifth of nearly one and a half million jobs, such contribution has been consistent over the last couple of decades. They continued to support the sector despite several immigration policy changes from earlier expansions of the EU to restrictions on the numbers of non-EU migrants and, more recently, with the Brexit referendum3. Migrant workers play even more prominent roles in some geographical regions, such as London and large cities, and in the provision of certain types of care, such as live-in care. While they continue to play a crucial role within the sector, what has changed over the past 20-year period was their profile rather than their significance. This was directly related to the groups allowed to move to the UK and be recruited to the sector governed by changing immigration rules. Recent workforce data shows an almost equal share of workers who have arrived from within or outside the EU. Furthermore, the two groups of workers (EU and non-EU) are now more evenly distributed across various care settings, in comparison to a higher prevalence of non-EU migrants working more proportionally in nursing and residential care homes observed at the turn of the 21st century.

PERCEPTION OF SOCIAL CARE There are myriad reasons why the sector continues to rely on migrant workers. Among these is the relatively unattractive employment package care work can offer to potential workers compounded with generally low unemployment rates among the British population. Care work is emotionally demanding and requires a high level of resilience and self-reliance while paradoxically considered a ‘low-skilled’ and low-paid sector with no career progression 26

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pathways. The causes of this weak labour market position are well connected both to social care funding and the value the society places on this type of work, whether purposefully or unwittingly. Before the end of the free-labour mobility within the European Union (EU), social care providers relied on recruiting from the UK, attracting migrants available within the UK labour market with no active overseas recruitment. However, recruitment and intermediary agencies played an active role in positioning social care work as a promising option for potential EU migrants, mainly from Eastern and Central Europe, while in their home countries.

MANAGING RISK With Brexit and the new immigration points-based system, there does not seem to be a straightforward replacement route for the sector to maintain the necessary supply of migrant workers. As part of the Sustainable Care Programme4 of research, we conducted a two-round Delphi survey of 30 UK policy and social care experts in 2020 and 2021. Respondents emphasised the potential detrimental effect of these changes on the ability of the social care sector to meet escalating demands on services, especially in the short to medium term. Furthermore, experts warned these adverse effects would be most pronounced in large cities, among smaller care providers with limited HR functions, those providing home and live-in care, and who primarily provide services to people with complex needs. Over two thirds of them recommended introducing a sectoral visa with the possibility of long-term settlement to ensure a sufficient number of recruits to the sector. While most respondents shared the latter opinion, a small group warned against the potential impact of sector-specific work visas. Their concerns were linked to a potentially increased risk of exploitation of migrant workers if they needed to continue accepting unfair working conditions, fearing losing their work visas. These experts felt this would negatively affect both workers and social care users. The second round of this survey took place in February 2021. Participants recommended social care workers be included on the list of shortage occupations, a step taken later by the Government in March 20215. However, experts recommended further actions to ensure the social care sector can meet demand, including lowering the salary threshold and considering a sectorspecific work visa scheme.

LONGER-TERM STRATEGY The findings from these different projects present some concerning messages about an overwhelmed workforce operating within a sector faced with severe challenges and unclear pathways to new recruitment channels. The immediate influx of workers facilitated by the unfortunate events of the pandemic did not seem to be sufficient to address the sector's needs for a continued supply chain of workers. Participants in our expert surveys and interviews felt that the only way forward is to prioritise investing in creating better jobs within the sector that can attract local workers in the longer term. The end of the Brexit transition period (and free

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CMM July 2021

NAVIGATING CHANGE: THE IMPACT OF COVID-19 AND BREXIT ON THE WORKFORCE

movement of EU workers) coincided with the second wave of the COVID-19 pandemic impacting the labour market, international migration and the social care sector in diverse and significant ways. Despite the impact of the pandemic on other sectors – resulting in higher numbers of people losing their jobs or being furloughed – and Government campaigns to attract people to work in social care, vacancies and staffing pressures remain significant6. These shortages are likely to increase as now the hospitality sector is re-opening and the temporary surplus of workers will drain. Furthermore, there are concerns that these events will impact on the structure of the social care market. For example, there are some early indications of an increased market share of live-in care due to fears associated with the experience of care homes at the onset of the pandemic. There are also questions around the potential growth of a grey market of care and an increase in the share of private/domestic arrangements between users and workers. The key message is that the priority should be to improve care work jobs and conditions as part of broader social care reforms. However, such reforms have been seeing considerable delays. Further measures are needed to promote making the sector attractive for various workers across age groups and with different backgrounds while acknowledging the role of migrant workers. CMM References 1. Retention and Sustainability of Social Care Workforce (RESSCW) is part of the Health Foundation’s Efficiency Research Programme. Principle Investigators Professor Shereen Hussein & Dr Florin Vadean www.pssru.ac.uk/resscw/frontpage 2. www.pssru.ac.uk/resscw/files/2020/12/COVID19and-the-UK-Care-Workers_FINAL_01dec20.pdf 3. www.circle.group.shef.ac.uk/wp-content/ uploads/2020/06/SC-PB_June-2020_Migrantworkers-in-England’s-homecare-sector.pdf 4. Sustainable Care Programme: Funded by Economic and Social Research Council (award ES/P009255/1, Sustainable Care: connecting people and systems, Principal Investigator Sue Yeandle, University of Sheffield): 2017-21. www.circle.group.shef.ac.uk/ sustainable-care/ 5. www.gov.uk/government/news/rule-changes-tomake-it-easier-to-recruit-health-and-care-staff 6. Skills for Care COVID-19 recruitment and retention monthly tracking www.skillsforcare.org.uk/ adult-social-care-workforce-data/Workforceintelligence/publications/Topics/COVID-19/ Recruitment-and-retention.aspx

Mike Thomson, Litigation Executive for Employment at Royds Withy King, shares his legal advice for providers.

SENIOR CARE WORKER • On 6th April 2021, the role of ‘Senior Care Worker’ was added to the Shortage Occupation List (SOL), which reduces the requirements for recruiting migrants from overseas into the role. • The minimum salary is now £20,480 per annum or 80% of the going rate for the role, whichever is higher. The going rate for the role is £16,900 per annum based on a 39-hour week and 80% of that salary is £13,520. The minimum amount a Senior Care Worker can be paid is therefore £20,480 as this is higher than 80% of the going rate. • Due to the lower going rate for the role, you could offer contracts with more than 39 hours per week and reduce the hourly rate until the salary either meets £20,480 or the current National Minimum Wage depending on the age of the migrant. As the salary must be at least £20,480, there is very limited scope for recruiting part-time workers. • Note that the worker will need to actually be working the number of hours that they are contracted to work and the duties need to clearly relate to a Senior Care Worker as opposed to a Care Worker (which isn’t an eligible role). You will need to demonstrate this to the Home Office in the event of a compliance visit.

RIGHT TO WORK CHECKS • In order to complete a valid right to work check, you should review the individual’s identity documents (passport/biometric residence permit) to verify that they are who they say they are. Normally this needs to be conducted face to face, but it can currently be carried out over a video call. Employers will not be required to carry out a physical check once the position reverts back. • If you fail to carry out a proper right to work check you could be liable to a fine of up to £20,000 per illegal worker plus criminal sanctions. You could also have your sponsor licence revoked.

EU SETTLEMENT SCHEME • The EU Settlement Scheme is due to close on 30th June, at which point EEA nationals will no longer be able to use their passports as valid identification for a right to work check. Employers should send communications out to staff to remind those who need to apply to do so, and that if they don’t, they may lose their right to work in the UK.

Shereen Hussein is a Professor of Health and Social Care Policy at the London School of Hygiene and Tropical Medicine. Email: Shereen.hussein@LSHTM.ac.uk Twitter: @DrShereeHussein What impact will the changes to immigration policy have on your organisation? Do you feel equipped to navigate the change? Share your comments relating to workforce challenges and policy. Visit www.caremanagementmatters.co.uk CMM July 2021

INTO PERSPECTIVE

IF THE GOVERNMENT IMPOSES RESTRICTIONS DUE TO THE DELTA VARIANT, WHAT MIGHT THE IMPACT BE? LOCAL LOCKDOWN LIMITS

At the time of writing, it is known that the Delta variant of coronavirus is approximately 40% more transmissible than other strains. Whilst a startling figure, the latest data available indicates that only 2% of the people who have been hospitalised in England as a result of the Delta variant had received both doses of a vaccine. Coupled with the fact that Public Health England’s estimation that 13,200 deaths have been averted in people aged 60 years or older in England (up to 13th May 2021) as a direct effect of being vaccinated, this suggests that vaccines are having their desired effect. Despite this, in areas worst affected by the Delta variant, namely Bolton, Blackburn and Bedford, the Health and Social Care Secretary has not ruled out re-introducing local lockdowns. What might the impact be of re-introducing such measures? 30

CMM July 2021

The effectiveness of local lockdowns has been scrutinised since the introduction of the three-tier system in England last October. The Guardian reported in September 2020 that COVID-19 cases doubled in most major English towns and cities where long-term lockdowns were in place. In the case of care homes and their residents, there are clear limitations to re-introducing local lockdowns. Healthwatch UK outlines five key examples drawn from provider experiences – confusing Government guidance, additional costs associated with PPE, reduced admissions and covering staff absences, removing access to face-to-face healthcare appointments, increased delays in conducting routine assessments and revised access for visiting residents. Government must step up and provide adequate guidance and support to care providers.

MENTAL HEALTH CONCERNS There are clear lessons to be learned from the last 12 months. Extended periods of isolation in residents’ own rooms, limited opportunities to interact socially with staff and other residents, and removing access to visits from friends and relatives have all contributed to widespread feelings of loneliness, boredom and distress. The impact of visiting restrictions has been particularly pertinent in the reported decline of residents’ mental health during lockdown. Visits from friends and family are integral to life in a care home and should local lockdowns be re-introduced, suitable provisions must be put in

place to facilitate social contact of this kind, wherever it is safe to do so. Whilst the use of technology, such as making a video call, has served as a compromise for some homes in the last 12 months, many have suffered from poor internet connection and residents with sensory and/or cognitive impairments have struggled to get to grips with this method of communication.

DON’T FORGET THE STAFF For many care home staff, especially those providing end of life care to residents and their families, typical working days can provoke feelings of sadness and stress, and this is without the lingering threat of COVID-19 to contend with. Since the beginning of the pandemic and subsequent lockdowns, care home staff have had to endure a rapid increase in the volume and intensity of their workloads, all whilst balancing evolving guidance and protocols from Government. Circling back to visiting restrictions as a fundamental consequence of re-introducing local lockdowns, it is understood that care home staff have, in some cases, had to carry out additional caring responsibilities that may have previously been undertaken by visiting relatives. In addition, it has not been unheard of for staff to take up temporary residence in the care home, out of fear of spreading the virus to their loved ones. Often leading to round-the-clock working, residential care providers must be supported to introduce initiatives designed to protect the physical and mental wellbeing of their staff should the Delta variant continue to pose a threat to the lifting of restrictions in England.

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One of the lessons that has to be learned from the pandemic is that social care, including care homes, needs to be involved in the planning both at national and local level. If local lockdowns are imposed as a result of the Delta variant, or future crises, care homes need to be supported locally and have the confidence to act in the best interests of those whom they strive to look after. There must be a clear national framework in place if local lockdowns are to be reinstated. Evidence from previous local lockdowns demonstrated that adult social care providers were often disadvantaged by the local variance in approaches from commissioners and local directors of services. Indeed, decisions and actions must continue to be made in the best interests of those in receipt of care. It is vital to ensure that these individuals are enabled to enjoy their rights to live purposeful lives as active members of families and communities. I am really proud of adult social care staff, our best resource, who have worked tirelessly throughout this pandemic with very little let up.

It is high time that this cohort is regarded as the professionals that they are and this needs to be harnessed into a ten-year plan for the workforce akin to that of the NHS. Care homes want to reclaim their role as hubs of the community, a notion which has been very hard over the last year or so. Care England, as the largest representative body for independent providers of adult social care, is determined to ensure that the much-heralded reform is actually delivered upon. The political consensus is in existence but political will is lacking. The omission of social care reform from the Queen’s Speech was a hugely missed opportunity by the Prime Minister; however, he is in keeping with a swathe of former leaders who similarly dodged the issue. The pandemic has shone a spotlight on social care and I believe that reform is within touching distance; therefore, frustration aside, let’s harness the political consensus and ensure that reform becomes a buzz word associated with the 2021 parliament – our 2021 moment.

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People living in care have now faced 15 months of restrictions on their movement and contact with those most important to them. These controls have been stricter and longer lasting for care home residents than for any other group in society. Whether national or regional lockdowns, or local closures of homes, the impact of isolation on physical and mental health has been devastating. Our helpline hears of increased distress, anxiety and depression of residents who think they have been abandoned, who have stopped eating, drinking or taking medication and given up on life. Since visiting guidance was changed on the 8th of March many residents have been able to have more meaningful contact with their relatives and friends. This led to heart-warming stories of families being reunited. The fear now is that a local lockdown could bring an end to this contact, so vital for the health and wellbeing of residents. For those with dementia, suddenly losing access to their family again would lead to yet more confusion and distress. There is concern about how much more some older people can take. Local lockdowns may seem the fairest way to deal with local surges in coronavirus cases.

Otherwise, how do you explain to a resident with dementia in Norfolk why her husband down the road can no longer visit because of high case rates in Blackburn? In reality, regional restrictions have been confusing, leading to a complicated series of different rules for different areas. They have been particularly bewildering for those who have to travel some distance and cross boundaries to see relatives. Lockdowns – national and regional – have led to blanket approaches which fail to take individuals into account. Many people visiting care homes are older, and have been shielding and doing everything they can to keep themselves and their relative/s safe. Throughout the pandemic, relatives and friends of those in care have too often been seen as an optional extra. They are more than just ‘visitors’. They are an essential part of residents’ lives. The love and support they provide is vital for residents’ wellbeing and quality of life. Our ongoing management of the virus must recognise access to family as fundamental. Using the tools for good infection control, we can end the damaging impact of isolation in care.

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CMM July 2021

TAKING CONTROL: ARE YOU PREPARED TO TAKE PROPER CARE OF YOUR CYBER RISKS?

Chris Burgess, Cyber Manager at Markel UK, explains how COVID-19 has not only changed the way we work but also created new opportunities for cybercriminals.

It goes without saying that COVID-19 has had a far-reaching impact on many aspects of our working and private lives. For many organisations, new restrictions quickly forced them to change the way they operate with an increased reliance on technology, particularly remote working. Our reliance on technology has increased to the extent that, according to a survey by McKinsey released in October 2020, COVID-19 has advanced the use of digital technologies by several years.

CMM July 2021

TAKING CONTROL: ARE YOU PREPARED TO TAKE PROPER CARE OF YOUR CYBER RISKS?

The care sector has been no exception. Staff, who work in administration and officebased roles, were forced to work remotely unless it was imperative they needed to see clients face-to-face.

INCREASED RISK While robust digital security systems may exist within the office environment, COVID-19 has forced staff to, not only work from home, but also access company systems using their own computers, laptops and mobiles. This potentially leaves the employer at a greater security risk, as they are unable to fully control the quality of security systems in place. This has created a new dynamic for cyber risks and increased the types and levels of cyber-attack during the pandemic. Firms must assess the level of reputational damage should their system be compromised. How would an attack affect their clients and

“Almost half of businesses (46%) and a quarter of charities (26%) have reported cyber security breaches.” their families? Could client, employee and supplier information be compromised? How much would it cost to put things right? What protection is in place should any breach occur? While lockdown is easing, remote working for many businesses is here for the foreseeable future and this threat will continue. It may be time to review not only your security but also the cover in place should you require it. Whilst there will always be a risk, being prepared should anything go wrong can help. Seeking advice – and discussing what is right for your organisation’s specific needs – is advised. A cyber threat will have different outcomes, depending on your size, the services you provide and the sector of care industry you operate in. The growth in digitalisation has been accompanied by a rise in online fraud, scams, intrusions and security breaches across a wide range of organisations and Government bodies.

EVIDENCE OF THREAT To cybercriminals, the size of their victim’s organisation does not matter. According to UK

Government statistics almost half of businesses (46%) and a quarter of charities (26%) have reported cyber security breaches. Amongst the businesses which formed part of the survey 32% are experiencing breaches or attacks once a week and a fifth of charities (22%) say they experience breaches at least once a week. Defending your network and data against malware, ransomware, phishing, and other threats has never been more important. The Government’s statistics show that businesses are experiencing a rise in phishing attacks (86%) and while viruses or other malware attacks have fallen in number, they still pose a significant threat to businesses of all sizes. Cyber criminals are constantly working to find new ways to access systems.

UNDERSTAND THE LAW In the UK, laws relating to data breaches that arise from cyber-attacks have been enhanced. They place the onus on the organisation to react in a way that limits the impact on clients, with increasing penalties for failure to take every effort to mitigate any impact. Understanding your risks is vital; only then can you instigate steps to protect your systems and address the weaknesses you have identified. Begin by asking how secure you consider your data availability, confidentiality and integrity to be. Rate whether you consider them to be very secure, secure or not secure.

DEVISE YOUR STRATEGY Here are seven steps that need to be part and parcel of your cyber strategy: 1. Implement regular checks. GDPR rules require regular tests to check whether effective security measures are in place. This helps to ensure you are ahead of the game when it comes to a cyber security issue. 2. Ensure an emergency plan is in place. Create a plan which ensures that any breaches are dealt with efficiently and effectively. Responsibilities should be given and senior team members should lead when it comes to a response plan. Ensure all staff members are aware of the plan. 3. Ensure any security incidents are reported and acted on as soon as possible. Make sure all staff are aware of the importance of reporting problems and to whom they should report them within the organisation.

4. Review how a breach occurred. Once the problem has been solved, investigate how it happened. Make sure you immediately put in place any necessary changes to protect you in the future. Records must be kept – this is particularly crucial if you need legal support as a result of a breach. 5. Seek legal advice. It is well worth seeking a lawyer’s view. They would be able to inform you if you might be in a litigious situation. You may also need to report any incident to the authorities, including the police and Information Commissioner’s Office (ICO). 6. Make sure you protect your reputation. Be prepared to deal with possible media interest and client/customer questions. Allocate a spokesperson and ensure a clear and consistent message is given. 7. Ensure you are able to recover assets if needed. If data is lost through malicious actions, you may be asked to recover it so ensure you have backups in place. Make sure this is possible and inform any legal advisers you have. These risk management suggestions, of course, will not eliminate the risk altogether. Organisations still need appropriate cyber insurance cover in place to add that additional protection for when things go wrong. CMM What are you up against? A brief explanation of the main types of breaches according to the UK National Cyber Security Centre. Phishing Untargeted, mass emails sent to many people asking for sensitive information (such as bank details) or encouraging them to visit a fake website. Malware Derived from ‘malicious software’, malware includes viruses, Trojans, worms or any code or content that can damage computer systems, networks or devices. Ransomware A type of malware that makes data or systems unusable until the victim makes a payment.

Chris Burgess is Cyber Manager at Markel UK. Twitter: @MarkelUK How robust is your cyber strategy and do you think you have faced greater cyber threats recently? Share your feedback on the article and visit www.caremanagementmatters.co.uk 34

CMM July 2021

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CMM July 2021

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Mindful future: How to devise a mentally healthy workplace for care staff

Aimed at providing emotional support to anyone feeling overwhelmed or struggling to cope, the registered charity Samaritans has helped care for our front line during the pandemic. In this article, Keith Leslie, Chair of Samaritans, shares the reality behind the helpline and explains the importance of creating a longer-term mental health support strategy for your staff.

For the first time since the Second World War, we have all gone through a shared experience of crisis, loss, fear, and helplessness. But for some of us, the impact has been more severe. Whilst the physical health risks of potentially being exposed to COVID-19 are well known, the mental health impact is harder to qualify, and the extent may not be known for some time. The social care workforce is one that has been under immense

CMM July 2021

MINDFUL FUTURE: HOW TO DEVISE A MENTALLY HEALTHY WORKPLACE FOR CARE STAFF

pressure over the past 15 months. The social care sector must address mental health support for its staff both now and in the future. This is because the mental health impact of working through the pandemic is something we shall live with for many years to come.

SUPPORT FROM SAMARITANS When the need to support health and social care workers became apparent in the first days of the pandemic, Samaritans launched a free dedicated helpline that offered confidential and emotional support from trained Samaritans volunteers, seven days a week, between 7.00am and 11.00pm. We also joined forces with Mind, Shout, and Hospice UK to launch Our Frontline. Our Frontline is a collaborative partnership between the four charities to support the mental health of those working on the front line against coronavirus. Through the platform of Our Frontline, we collectively provide round-the-clock, one-to-one support,

resources and advice for key workers all in one place. In fact, Our Frontline recently launched a new campaign aimed at health and social care workers, encouraging them to take a breath and check on themselves. Through Samaritans’ dedicated NHS and social care helpline, we hear firsthand about the challenges social care and health workers are experiencing. All calls are confidential and anonymous; but certain overarching themes and trends emerge over time. So, what are we hearing about people’s experiences of the pandemic as health and social care workers? A lot of health and social care staff are feeling stressed, anxious, lonely, frightened, overwhelmed and frustrated. Many are feeling guilty, for example, if they’ve taken time off, have caught COVID-19 and are shielding, or if they’re working hard and don’t have the energy to contribute to family time. Some callers are not initially open to seeking emotional support, in part due to the nature of their professions. We’ve found some workers like to call before

a shift so they can share their fears with someone, or after a shift so they can offload without bringing it home to their families. A number of care workers said sharing their feelings after a shift, before bed, makes them feel they will be able to sleep easier.

HOW TIME ALTERED EMOTIONS So, what has changed since the pandemic started? We’ve noticed there was a sense of callers ‘running on adrenaline’ during the early peak in April 2020. During the first wave, calls would be more about what was going on in the here and now, such as a shift they had just been on. At the beginning of the pandemic, dealing with the unknown and so much rapid change meant callers were very overwhelmed and would look to ‘offload’ about the situation they found themselves in. For many, this was dealing with the high levels of death amongst COVID-19 patients. As the crisis continued, callers seemed to be more reflective rather than talking about acute experiences. Stronger emotions emerged once callers had a little more time and space to reflect. The longerterm impact of the pandemic built up. For example, some callers would discuss having flashbacks of working on COVID-19 wards and share fears of another wave. And there is a trend amongst callers who are exhausted and unsure they have the physical or emotional capacity or the energy to keep working at this rate. Of course, everyone is different and there cannot be a single snapshot of people’s pandemic experience. However, linking our understanding of the mental health impact of the pandemic with the themes and trends we’ve seen from our dedicated helpline enables us to anticipate what support is needed over the coming months and years for health and social care workers.

UNDERSTANDING DISPARITY We know that the impact of COVID-19 and working on the front line is greater for people marginalised in our society by low income or ethnic heritage. Quite simply, they have been hit harder and the recovery process will be correspondingly longer. For some, ‘long COVID’ or bereavement or the long-term impact of intensive treatment will last years. Even the ‘return to normality’ will trigger fears and divisions between

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CMM July 2021

MINDFUL FUTURE: HOW TO DEVISE A MENTALLY HEALTHY WORKPLACE FOR CARE STAFF

groups who did not share the same experience – those furloughed versus those at work, those working from home versus those at the worksite. As the pandemic ebbs and economic insecurities ease, people will need time and space to process everything they have been through during the past 18 months. This decompression stage is likely to be similar to what we see with patients discharged from intensive care units or military veterans or other trauma victims who can present – sometimes years later – with symptoms of post-traumatic stress disorder (PTSD). While mental health support from the voluntary sector is being relied upon to help those struggling with the pandemic, it is everybody’s business to take care of those who’ve been caring for us over the past 15 months. I’m pleased to say that the health and social care sector is seeming to respond to the needs of its workforce – I have lost count of the number of talks I have given to management groups about leaders’ roles in promoting mentally healthy workplaces.

LEADING THE WAY Legally and morally, employers are already obligated to protect their employees’ health and safety at work. No one would argue that leaders should not take seriously their impact on physical health at work and organisations are prosecuted for failures around physical health at work. But mental health also needs to be protected at work – and slowly the law is expanding into this area. For example, stigmatising mental ill health can lead to lawsuits alleging discrimination on grounds of disability under the Equality Act. Fending off the lawyers is one thing – leaders need to ask themselves: How different would our organisation look if we applied the same right to mental health at work? Tackling stress at work should be a major priority, as should be creating a supportive workplace culture that promotes mental health. Organisational culture can be enhanced by offering effective leadership, line management training, and interventions to reduce stress and improve mental health at work.

A mentally healthy workplace in the care sector would: • Demonstrate compassionate leadership This is how it was for me – how was it for you? Having open conversations like this can break down the stigma particular to the health and care sector of not seeking help. • Recognise the challenges of ‘returning to normal’ For the many people living with the impact of long COVID, post-treatment stress, bereavement, financial worries, family worries and other concerns, demonstrating an understanding of the individual impact and allowing time for recovery is paramount. • Invest in personal resilience and peer support at the level of the individual There is a hunger for advice about techniques to manage anxiety and depression. This is more than one-sizefits-all ‘wellbeing’ practices around good sleeping-eating-exercise patterns. What is needed is a series of tailored interventions for target populations, reflecting the challenges and stresses of their particular work situations. Peer support is vital – a Mental Health Foundation report1 found 49% of employees surveyed would not discuss their mental health with their line manager. In many workplaces, people are particularly susceptible to overworking and self-stressing – and peer support is essential to maintain balance. • Invest in equipping managers from front-line supervisory level to senior managers Line managers need practice in productive conversations to moderate the frequency and the severity of many of the incidents of anxiety and depression that are the most frequent evidence of mental ill health in the workplace. They need to address the 51% of employees willing to talk with their line manager and win over the 49% currently unwilling to1. • Promote leaders as allies for mental health in the organisation The power of personal example and apprenticeship is the most powerful signal of leadership commitment to ‘what matters around here’. Instead

of ‘managing’ people struggling with mental health, ‘allies’ invite people to contribute, share career goals, push to get people on projects, speak up when stereotypes are being invoked – and talk about them as fellow humans, not ‘problems’. • Appraise the impact of senior leaders, front-line leaders and management teams Leaders need to think about the impact of their decisions on their organisation’s and people’s mental health. They need to avoid game-playing and instead engage in real conversation with their people. • Educate your leaders and staff in other emotional support and mental health advice If you are worried about someone and are not sure your workplace wellbeing initiatives will be enough, you can encourage them to reach out for help in other ways. They may benefit from spending time with their friends and family, or support offered through Our Frontline or Samaritans, or they may need to see their GP. When we look longer term, this shared experience of crisis across the entire population of the UK and Ireland creates an opportunity for a fresh start with issues that governments have acknowledged, but not acted upon. This must include investing in mental health and proper funding for social care. Samaritans and others are keeping these lessons from the pandemic in front of governments. Recently we have seen the launch of the Archbishops Commission on the future of social care. It is everyone’s responsibility to advance the mental health agenda – and especially for leadership at all levels to promote mentally healthy workplaces. For anyone struggling to cope, reach out to Samaritans on 0800 069 6222 or visit www.ourfrontline.org for free emotional support. CMM Reference 1. ’Stress: Are we coping?’ Mental Health Foundation, May 2018 p11 available at www.mentalhealth.org. uk/publications/stress-are-we-coping

Keith Leslie is Chair of Samaritans in the UK & Ireland and Chair of Mental Health At Work CIC, and was Chair of the Mental Health Foundation 2014-20. Email: keith.leslie@samaritans.org Twitter: @KeithLeslie19 Have you devised a longer-term support strategy for your workplace? What does a mentally healthy workplace look like to you? Share your feedback and comments on this article, visit www.caremanagementmatters.co.uk. CMM July 2021

GLOBAL INNOVATIONS: How can technology be truly integrated into social care?

The social care sector has called for a greater integration of care, but what role does technology play and what can we learn from countries across the globe and their models of care? Rafael Bengoa, Co-Director of the Institute for Health and Strategy (SI-Health) in Bilbao, investigates and tells us more.

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Here in Spain, like so many countries across the world, the impact of COVID-19 has been devastating. Many of our care homes, home care organisations and wider social care services have been on the brink of collapse, heaving under the strain of surging demand. Over the past 15 months, I’ve witnessed similar situations unfold in the UK, Europe and beyond, and a question comes to mind: could the COVID-19 death toll have been lessened through stronger, smarter and more collaborative social care? The answer, I fear, is yes. In my work as a doctor, practising in hospital and primary care and then as health minister for the Basque Government, and as director of health system policies for the World Health Organization, I’ve seen over and over again how social care continues to be treated as separate from health, right across the world.

CRACKS IN THE SYSTEM This siloed working has contributed to the shocking COVID-19 death figures we have seen, particularly in the UK and Europe. A lack of integration between health and social care, poor data sharing and isolated commissioning has meant that services are anything but seamless and many people have fallen through the cracks or, at times, the gaping holes. This is partly down to the inequalities between health and social care, something that is sharply evident when it comes to digital. Despite pockets of good practice, all European countries seem to share one trend: that healthcare is way ahead of social care on the digital agenda. Whether that is down to a lack of leadership, clear responsibility or investment, digital has not yet been normalised in social care as it has, to a greater extent, in health. This is despite COVID-19 accelerating the use of technology in so many elements of our lives.

ADASS COMMISSION Last October I began chairing a Commission to address this problem in the UK. Set up by the Association of Directors of Adult Social Services (ADASS) and the TEC Services Association (TSA), our goal was to explore how technology can be truly integrated into adult social care. Over a period of six months we spoke to almost 60 people, including senior leaders in adult social care, housing and health, as well as frontline care workers and individuals, families and carers accessing support. We wanted to identify the barriers to mainstreaming digital within adult social care and the levers that could prompt large-scale adoption. Our findings and recommendations focus on four key themes. The first is that

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GLOBAL INNOVATIONS: HOW CAN TECHNOLOGY BE TRULY INTEGRATED INTO SOCIAL CARE?

digital social care services must be proactive and co-produced with people, their families and carers. We also found that digital infrastructure, skills and approaches in social care must be improved if individuals and the care workforce are going to maximise digital opportunities.

GRANTING OWNERSHIP Giving people ownership and control over their health and social care data is also vital, enabling access by the right people at the right time. We also believe that greater collaboration across care and support at all levels is critical, so services and policies are joined-up and focus on boosting not just health, but the wider wellbeing of people, their families and carers. A central element of this is making sure that Integrated Care Systems (ICS) consider digital social care provision as well as digital health provision. With the Government’s recent health and social care white paper seeking to create ICSs in every part of the country, it is vital they become welcoming places for social care, with an equal balance of power. This will help to create the conditions for health and social care to advance together and provide local communities with co-ordinated digital care.

GLOBAL PRACTICE However, it is not just the UK that has begun to create place-based care partnerships. In New Zealand, major reforms to the health system are helping to provide a smoother transition between services so individuals receive more integrated health, care and social welfare support in their local communities. In America, accountable care organisations (ACOs) now take responsibility for providing all health and care services for specific populations, with the goal of offering a more continuous approach to care. In Sweden, the ‘chains of care’ model focuses less on provider-centred care and more on care designed around a patient's needs. A multi-disciplinary team of doctors, nurses, social workers and other professionals work together across different local geographies to support individuals. Spain, too, is moving towards place-based care systems with the deployment of integrated health organisations (IHOs) in the Basque Country. These IHOs seek to deliver more joined-up, person-centred care for patients, especially those living with chronic conditions.

DIGITAL INNOVATIONS For example, in 2010 the Basque Government launched Southern Europe’s first strategy to prevent and manage chronic disease. Among other projects, it implemented digital health and care services across a population of 2.3 million. The services shared data across electronic medical records in primary healthcare and hospitals, giving the entire population digital access to their health and care data and launching electronic prescriptions with all pharmacies. This set the scene for increasing digital connectedness in Spanish social care, something that has been invaluable during the pandemic. Patients have been able to access medicines without having to physically go to their doctor and health professionals have had the tools and skills to quickly organise virtual consultations. This digital route to integrated care is also being seen in the Netherlands, within the Buurtzorg model. ‘Buurtzorg’ is the Dutch word for ‘neighbourhood care’ and this system sees small teams of community nurses providing a range of personal, social and clinical care to people in their own homes in a particular local area. Nursing teams are connected through the ‘Buurtzorg web’ – an intranet they helped to design. It enables nurses to share knowledge, support and manage business processes such as online scheduling and documentation. The Buurtzorg web is accessible through desktop and mobile apps and it is estimated that using it for admin functions saves approximately 20% of the costs of a typical home care agency. Importantly, the tool can also be accessed by patients themselves. Another example of digital solutions ‘gelling’ health and social care provision is the GERI toolbox. Used in Denmark, this mobile kit helps home care nurses – in collaboration with GPs – to offer proactive care to older people. The aim is to catch deterioration in health before an acute admission to hospital becomes necessary. During a home visit, a home care nurse brings their GERI test kit and takes clinical readings based on the symptoms of the patient. The data recorded during the visit is transferred to a joint IT platform that can be accessed by the home care nurses, GP and hospital clinicians. The goal of sharing the information is to reduce the risk of misunderstandings and provide a better basis for decision-making for further treatment.

In France, there are also several pioneering examples of technology being used in social care. But, like many of the projects I have cited, they are nearly always ad hoc initiatives, isolated pockets of good practice as opposed to national systems, rolled out at scale.

GOVERNMENT RECOMMENDATIONS This links back to the ADASS TSA Commission. One of our recommendations is that the UK Government funds the creation of a ‘Personalised Care Innovation Programme’, with stage one of development involving work with people and care practitioners to capture the most effective proactive services and technologies. Running in parallel, stage two would pursue a ‘topdown’ approach, using regional data to confirm priority needs and determine how support organisations will embed digital technologies into their care practices. An assessment of these local initiatives will help to develop a business case for stage three, the creation of a two-year programme of 10 social care innovation projects. Stage four will see national deployment of all learnings. But it is only the work in those early stages – implementing and evaluating local services – that will enable proof of impact and cost effectiveness to come through. This evidence, and the business case it creates, will give technology suppliers and social care commissioners strategic direction so they can specify and develop digital solutions that offer the most value to individuals in the future. I believe that this innovation-led, business case process would be of real value across Europe. I would like to see the UK setting up an international social care technology ‘knowledge network’ to share its approach so other countries can take inspiration and the UK can be inspired by others. But ultimately, if technology is ever going to be truly mainstreamed in adult social care, there needs to be a significant policy intervention to give it an organised push. This isn’t just about funding a few trailblazers or exemplars here and there. Instead, we need major funding for a nationwide implementation programme, including partnership arrangements with the private technology sector. If there is ever going to be a right time, surely this post-COVID moment is it. CMM

Rafael Bengoa is Chair of the ADASS TSA Commission and Co-Director of The Institute for Health & Strategy in Bilbao. Email: rafa.bengoa@sihealth.es Twitter: @rafabengoa To download the ADASS TSA Commission report on integrating technology into social care, visit www.tsa-voice.org.uk. What do you think of these models of practice and in what ways should the UK improve their integration of care? Visit www.caremanagementmatters.co.uk to share your comments and feedback. CMM July 2021

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CELEBRATING EXCELLENCE Markel 3rd Sector Care Awards

IN COMMUNITY ENGAGEMENT Barnsley Dementia Gateway Service won the Community Engagement Award at the Markel 3rd Sector Care Awards 2020.

Barnsley Dementia Gateway Service, working as part of the Barnsley 3rd Sector Dementia Group, was recognised in this category for achieving what often seems an impossible task. Pulling together multiple providers and forming a strong relationship with the local authority, the service has closed many of the gaps that people had previously fallen through and has ensured consistent service delivery across the local area. Continuing in a series of features celebrating 2020’s winners, we caught up with Cath Magee from Barnsley Dementia Gateway Service, who proudly accepted the Community Engagement Award on behalf of the service at the Markel 3rd Sector Care Awards 2020.

A NEW VISION In 2019, Barnsley Council took the bold decision to create the Barnsley Dementia Gateway Service. Barnsley Council had spent years working with a range of small and large local providers of services for people living with dementia and their carers. Barnsley Council knew the care market in Barnsley and appreciated the services on offer for these groups of people, but the council was frustrated with the lack of cohesion between these providers. The council was also convinced that closer working would make for a more co-ordinated service for people living with dementia and their carers. Barnsley Council worked with Making Space, a national health and social care provider, to bring these charities together. Barnsley Council made resources available to enable this group to meet regularly. Each charity willingly came 46

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to the table because they wanted to make a difference, but they were already working to capacity and could do no more. Barnsley Council, through the Dementia Gateway Service, provided the resources to service these regular meetings and to follow up on all the decisions taken at each meeting. The Barnsley 3rd Sector Dementia Group is made up of the following organisations: Age UK Barnsley, Alzheimer’s Society Barnsley, Barnsley Independent Alzheimer’s and Dementia Support (BIADS), Butterflies Dementia Support and Activities Group, Crossroads Barnsley Ltd (Caring for Carers) and Making Space. Leaders of these six charities could quickly see that attending the Barnsley 3rd Sector Dementia Group was not a burden, stretching their time and their energies further. These meetings offered personal and professional support to each member organisation, and it became clear that by working together, this group could create new services and events by pooling resources, sharing the risk and making a greater difference.

CELEBRATING EXCELLENCE TOGETHER Following fortnightly meetings from April 2019, the group wanted to concentrate on three areas – reaching more people living with dementia, reaching more carers of people living with dementia and attracting increased resources and funding to grow new services and sustain existing services. This group decided to hold the Best of

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Barnsley Dementia Care Awards 2020 in January 2020. It was a magnificent all-day event. The morning welcomed national and local speakers who were able to provide insights into the national and local prevalence relating to dementia, the innovations in research and practice and the gaps in services. The event informed 19,000 readers of The Barnsley Chronicle and many more on social media. At lunchtime, the Dementia Friendly Unity Choir entertained everyone and welcomed new members. The afternoon was devoted exclusively to celebrating people nominated for 13 awards. 62 people, who were nominated by staff, volunteers and carers across all health and social care sectors, were praised for their own person-centred practice. They were praised for going above and beyond expectation to make a real difference in care homes, hospitals, home care services, day centres and in the community through carer support services and churches. It was a glitzy event, with formal table settings, matching balloons and wonderful food. This was important, because it was vital that people nominated knew that this was a special event, publicly recognising their skills, knowledge and commitment and valuing their kind and sensitive approach in their varying roles.

PRIORITISING GROWTH This event was a huge success and this gave the Barnsley 3rd Sector Dementia Group the confidence to move forward with other projects. This group went on to create DISC – Dementia Information and Support for Carers. DISC is an eight-week course (two hours each week) for carers of people living with dementia. Two charities offer this training and have secured additional funding to continue this offer for the rest of 2021/22.

OVERCOMING LOCKDOWN COVID-19 presented the Barnsley 3rd Sector Dementia Group with the greatest challenge in 2020, but also the greatest opportunities. Timely meetings and shared local intelligence helped the group to adapt their services and avoid duplicating them, so that people living with dementia and their carers had a very specific lockdown offer. Most organisations moved to remote working in March 2020. The impact of lockdown was felt most severely in local care homes and for people living with dementia in their own homes. Within the first month it became obvious that carers were really struggling with the lack of access to

their loved ones in care homes. It was also becoming clearer that people living with dementia were deteriorating as their usual social routines came to a halt. This affected them mentally and physically and this was an added burden for their carers. The Barnsley 3rd Sector Dementia Group quickly mobilised to ensure emergency supplies were getting to people in their homes – welfare and befriending telephone calls were made by all six local charities. Those carers who wanted tablets so that they could connect to peer support groups on Zoom, were given them and showed how to use them. The 3rd Sector Dementia Group realised that there was a need for a freephone Barnsley Dementia Helpline and extra resources were secured to enable four of the six charities to staff this helpline from 8.00pm to midnight each evening from May 2020 to March 2021. Extra funding was secured to create and distribute food parcels, carer pamper packs and treats for those people connected to all services that were struggling the most.

MARKEL 3RD SECTOR CARE AWARDS

INVALUABLE EXPERIENCES The Barnsley 3rd Sector Dementia Group is now the Barnsley Third Sector Dementia Alliance. Barnsley Council has seen what has been achieved in the first two years and has the confidence to fund this group for the next three years. This will help it to reach more people living with dementia and their carers in Barnsley. Dementia awareness in Barnsley has increased through events like the Best of Barnsley Dementia Care Awards and through the publicity generated with new services like the Barnsley Dementia Helpline and DISC. Services across the health and social care sectors are now working more closely with each other and with the third sector charities to listen to the voices of people living with dementia and their carers. This is uncomfortable at times but has been an invaluable process and is really helping us all to realise that just because we all think we are doing great things for people living with dementia and their carers, does not mean that we are doing so all the time. We are listening more than ever, and we are committed to making significant changes to offer a smoother journey through the services for people affected by dementia in Barnsley. CMM Cath Magee is Peripatetic Service Manager at Making Space. Email: Cath.Magee@makingspace.co.uk Twitter: @MakingSpaceUK

Headline Sponsor The Markel UK 3rd Sector Care Awards is run specifically for the voluntary care and support sector. Visit www.3rdsectorcareawards.co.uk to view the 2020 event winners and find out more about next year’s event. Sponsorship opportunities are available. With thanks to our supporting organisations: National Care Forum, Learning Disability England, The Care Provider Alliance, Association of Mental Health Providers and VODG. CMM July 2021

EVENT REVIEW

LINCOLNSHIRE CARE ASSOCIATION (LINCA) CONFERENCE Thursday 3rd June 2021 Organised by CMM Insight, Lincolnshire Care Association (LinCA) hosted its annual care conference virtually for 2021, bringing local and national providers and decision makers together to communicate the latest updates, guidance and knowledge concerning the adult social care sector. The aim of the event was to acknowledge the unity and collaboration demonstrated by the sector during the pandemic and look ahead to the future on how the sector can continue to work together to ensure strength and governance beyond COVID-19. Melanie Weatherley MBE, Chair of LinCA, welcomed delegates and said that, despite these times of great uncertainty and enormous challenge, the adult social care workforce has shown and continues to show tremendous mental resilience.

MAKING THE HEADLINES As can be expected, the well-documented topics of reform and COVID-19 dominated the conference’s most frequently discussed talking points. The panel of expert speakers relished the opportunity to discuss their insights from the past 12 months and share their recommendations to kickstart a brighter future for social care. Simon Bottery, of The King’s Fund, shared what the 12 key trends have been in social care over the past few years, how COVID-19 has affected the trends and what can be done about it. A few of these trends included: councils are paying more for care; more carers are receiving support but it’s mainly ‘advice’; and fewer people are receiving long-term care. Simon Bottery then tried to predict the future, although, admittedly, he acknowledged that’s a difficult task. The presentation ended with six immediate actions, outlining what the Government must prioritise if we are to strengthen the social care system. Chief Executive of Care England, Professor Martin Green OBE, presented on ‘the new vision for social care’ and said how true integration is about how a person experiences care. He told 48

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the delegates, ‘Good social care enables people to live well.’ The Care England Chief Executive said the Government must not simply ‘amend’ the current system – but it must be new and reflect the current picture and meet the needs of the people. One delegate described the presentation as ‘positive’ and ‘empowering’.

A BIG THANK YOU Despite the enormous hurdles the sector has had to overcome since the start of the pandemic, sentiments of unity and shared values have manifested themselves in the continued

“The adult social care workforce has shown and continues to show tremendous mental resilience.” delivery of services placing people at the heart of care. The panel were eager to reinforce their thanks to all key workers and rally together to challenge the Government to take appropriate action to recognise the true value of the adult social care workforce. Vic Rayner OBE, CEO at the National Care Forum, shared timely analysis detailing the most significant challenges facing the workforce now and post COVID-19, as well as suggestions for how employers can minimise the adverse effects of the virus’ lasting impact amongst the workforce. Open discussions also took place about mandatory vaccines for health and social care staff, including feedback from care workers about the steps employers could take to encourage universal uptake of vaccinations amongst their entire workforce.

ENHANCING LOCAL FUTURES Like almost all local authorities in England, Lincolnshire’s social care landscape has

changed dramatically during the pandemic, and the County Council has had to adapt its relationships with providers to ensure the maintenance of person-centred outcomes. COVID-19 has acted as a catalyst for several local developments, such as digital solutions to address isolation. Glen Garrod, Executive Director of Adult Care and Community Wellbeing at Lincolnshire County Council, summarised that the local authority wishes to build upon using technology not only in communities but also across health, social care and housing. Glen also spoke about recruitment and highlighted the importance of hiring a younger workforce and devising clear career pathways to help aid retention. The final speaker of the day was Anne Trotter, Assistant Director: Education and Standards at the Nursing and Midwifery Council. Anne outlined updates relating to post registration standards and emphasised the skills needed to help equip the next generation of community and public health nurses working in health and social care.

PLAYING CATCH UP? If you would like more information about the conference, or didn’t manage to catch all of the speakers, you can watch back recordings and download the delegate guide on the CMM website. You can also explore the CMM Marketplace, tailormade for the Lincolnshire Care Conference. Here, you’ll find a host of exhibitors aiming to offer you solutions to everyday concerns. With thanks to the conference’s sponsors, Scott-Moncrieff & Associates Ltd, Blue Stream Academy, CarePlanner, PainChek and our exhibitors who made this day possible. CMM For LinCA membership enquiries, contact Sue Lovelock susannalovelock@linca.org.uk To find out more about LinCA visit www.linca.org.uk

WELLBEING AREA SUPPORT FOR REGISTERED MANAGERS The registered manager role is difficult at the best of times, but in today’s climate the stresses of the job are bound to be taking their toll on many. CMM’s dedicated Wellbeing Area provides articles, resources and support to help those who might be finding things tougher than usual.

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