Care Management Matters (CMM) October 2021 by Care Choices Ltd

OCTOBER 2021

www.caremanagementmatters.co.uk

MANDATORY VACCINATION

Guidance for providers

Community lifeline

How to approach re-opening day services

Stuck in the spiral

How to avoid toxic workplace cultures

Green design

Sustainable development for the care sector

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In this issue Inside CQC Stefan Kallee, CQC’s North West Lead Inspection Manager for learning disabilities and autistic people, explains why support for autistic people is so important to him.

CMM News

Into Perspective This month, our experts consider how people with learning disabilities should be supported in the wake of COVID-19 restrictions easing.

Celebrating Excellence Demelza Hospice Care for Children won the Creative Arts Award at the Markel 3rd Sector Care Awards 2020.

Event Review CMM attended the National Care Forum (NCF) CEO Conference on 13-14th September. We share our round-up of the event’s key talking points.

Straight Talk What’s the reality of staff shortages for the home care sector? Dr Jane Townson, CEO of United Kingdom Home Care Association (UKHCA), tells us more.

FEATURES

REGULARS

Social Care Insights Simon Bottery of The King’s Fund explains why the social care sector should approach some digital innovations with caution.

Mandatory vaccination: Practical tips on thorny issues As the deadline for compulsory vaccination for care workers draws closer, James Sage of legal firm Royds Withy King shares his interpretations and the red flags to look out for.

Community lifeline: Re-opening day care services Becky Hamilton of Windward Day Services shares an honest account of delivering support during the pandemic and the Social Care Institute of Excellence (SCIE) offers advice on how to approach re-opening.

Intergenerational friendships: Spreading joy and understanding across the generations My Home Life England tells us more about Care Home Friends and Neighbours: Intergenerational Linking – a national social action project linking together young people with older people living in care homes – and we learn what the impact has been so far.

Stuck in the spiral: How to avoid toxic workplace cultures The pandemic has changed the way we assess workplace culture. HR specialist Cath Dixon devised her own HR model to explain why care workplaces are becoming increasingly toxic. Find out how to prevent it from happening.

Green design: Sustainable development for the care sector The COP26 Climate Summit takes place in November. Danny Sharpe, Co-founder and Director of Northstar, a specialist care home planning, design and project management consultancy, explains the benefits of sustainable design for the care sector. CMM October 2021

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

CONTRIBUTORS

PRODUCTION Lead Designer: Ruth Keating 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

@jamessage6

@SCIE_socialcare

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

Stefan Kallee CQC’s North West Lead Inspection Manager for people with learning disabilities and autism

James Sage Partner, Royds Withy King LLP

Kathryn Smith

@ARCEngDirector

@TurningPointUK

@MyHomeLifeUK

Clive Parry Director, ARC England

Julie Bass Chief Executive, Turning Point UK

Amy Simpkins Communications Officer, My Home Life England

@NStar_Projects

@DemelzaHospice

@drjanetownson

Danny Sharp Director, Northstar

Victoria Swan Senior Music Therapist, Demelza Hospice Care for Children

Jane Townson CEO, United Kingdom Homecare Association (UKHCA)

CEO, Social Care Institute of Excellence (SCIE)

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 18.7

CMM magazine is officially part of the membership entitlement of:

CMM October 2021

@Windwarddayservices – Facebook

Becky Hamilton Manager, Windward Day Services

Cath Dixon Independent HR Consultant

SOCIAL CARE

INSIGHTS From Simon Bottery

Many social care providers are embracing new technological change to improve their delivery, but which innovations hold the most value and why should the sector approach robots with caution? Simon Bottery tells us more. The computer that develops a mind of its own is a staple of science fiction. From 2001: A Space Odyssey (‘Open the pod bay doors, Hal’) to the Terminator series, it taps into a deep fear that one day technology will become more powerful than people. This is a harmless, enjoyable fiction, at least for the foreseeable future. However, the more neutral belief lying behind it – that technology, and robots in particular, will one day be able to do many of the tasks that people do – can be an unfortunate distraction for social care from the real, immediate benefits that technology can bring to the sector. That was illustrated recently by

the news that Pepper, the robot helper touted as – among other things – a future care worker, had been unplugged by its makers. The Japanese company SoftBank said that production been ‘paused for a while’ and would only be started ‘when it is needed’. That may well mean never. Despite intense publicity, the closest Pepper came to active service in social care was a brief trial as a ‘companion’ in a care home. I saw a demonstration of Pepper once, intended to show that it could lead exercise classes for older people, and thought it unwieldy and unconvincing. It took ages to set up and was not remotely a substitute for a real, living person. It was undoubtedly

cute, but so is a giant panda and I would not want one of those in a care home either. The more publicity that Pepper received, the more you felt we were missing out on coverage of the really exciting technological developments in social care. These make more efficient, analyse or enhance what people do rather than seek to replace them and so offer social care far more immediate, realistic opportunities than the likes of Pepper. You can see a list of some of them here, the products of an NHS-funded programme which ran from April 2016 to March 2021 and funded over 100 projects with a total investment of £22.8 million. These covered less glamorous but vital areas, such as information sharing between health and social care and technology to directly improve care, such as acoustic monitoring, circadian lighting, digital care planning and electronic medicines management. The programme claims it will have generated future benefits of £127m and, while this is a suspiciously specific number, there are surely benefits to be had. Why then does it not necessarily feel like change is happening at the speed it should? A report from Future Care Capital into the home care tech start-up market earlier in the year

adds weight to that feeling. It said that, while there were major opportunities to improve adult social care provision through the use of technology, there was only a ‘small niche of home care companies using technology in a truly innovative way’. A recent piece in Wired magazine, initially enthusiastic that ‘startups are scrambling to fix the social care system’, quickly concluded that the impact was, in fact, limited. It succinctly summed up the reasons why: ‘A system that is massively fragmented, underfunded and unable to serve millions of people in need, is not going to be noticeably changed by technological innovation.’ Although that remains the case, there is just a hint that some things are changing as a result of COVID-19. An audit of technological readiness of the sector found that fewer providers now regarded themselves as digital novices than before the pandemic and that around half of social care companies were using technology like digital care planning. One in five even see themselves as ‘digital experts’. So it may be that the future is already here, just – as the sci-fi writer William Gibson famously said – unevenly distributed. It does not involve a smiley robot taking exercise classes but, honestly, that’s for the best.

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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My mum has worked with people with a learning disability and autistic people since the 1970s. My mum’s view of the world inspired me to start my career in Supported Living, where I specialise in supporting autistic people. She and the people I have had the privilege of supporting and working in partnership with taught me everything I know.

SUPPORTING SERVICES TO BE PERSON CENTRED Autism impacts on very person uniquely. Describing a service as ‘autism friendly’ doesn’t mean it’s an environment fit for all autistic people. In my view, a person-centred service with knowledgeable, empowering support for autistic people always tailors that support to the individual. Language is so important. It isn’t person centred to define a person through a description of ‘incidents’ or ‘meltdowns’. Person-centred support means recognising that the person is communicating an unmet need. To empower the person, we must understand the person better and understand those needs before they become urgent or overwhelming. Working in partnership with the person means listening to and understanding their communication.

UNDERSTANDING LANGUAGE Rather than defining an autistic person by what they can’t do, I recognise every person as a unique individual. Too often, we hear the words ‘they’re non-verbal’ – a one-size-fits-all phrase. I spent my career understanding how those I cared for communicated. How do they let me know what they love and enjoy doing or if they’re scared, hungry or are in pain? Every person – whether they are autistic or not – is unique. I learnt the unique language of every person I had the privilege to support, whether that was through signing, sounds, words or symbols. I’d always echo back to them that I’d heard in their own language.

UNDERSTANDING QUALITY OF LIFE I spent time understanding what a good quality of life meant to different individuals. What were their wishes and dreams? My goal was to understand how I could empower that person to develop their own skills in a way they wanted to and that meant something to them,

Inside CQC S T E F A N

K A L L E E

Stefan Kallee is CQC’s North West Lead Inspection Manager for learning disabilities and autistic people and he explains why empowering support for autistic people is so important to him.

to achieve the quality of life they deserve. To do this, I tried to stand in the shoes of the person and see the world from their point of view. Many autistic people see, hear, taste, smell and experience the world very differently. It’s so important to understand and view the world through their eyes.

UNDERSTANDING COGNITIVE DIFFERENCES Something which is sometimes overlooked is an understanding of the unique way an autistic person thinks about the world. We can’t apply our own thinking patterns and expect autistic people we support to be the same. An example could be an autistic person responding to a situation they find frightening. How does the person think through what to do next? Does the person know that there are different choices they can make? What helps the person? Unless we make it explicit that there are different ways to respond, we’re assuming that people know.

CELEBRATING BEST PRACTICE As a regulator, we want to enable services for people with a learning disability and autistic

people to become more person-centred and tailored to individual needs. We want services to focus on understanding people and supporting them to live good lives, rather than only thinking about how to react in the best way to keep them safe. It starts with understanding what good outcomes look like for people and moving away from restrictive practices and the use of restraint. I have conversations with individuals who support autistic people and I try to encourage them to look at situations differently. There isn’t a one-size-fits-all approach. I work with inspectors to see where we can help drive improvement and, crucially, identify and celebrate good practice – shining a light on places that keep people safe and empower them to have choice and control. In our latest report: Home for Good, we share eight case studies of autistic people and people with a learning disability receiving high-quality care in the community. I encourage everyone to listen to the accompanying podcast with Alexis Quin from the Restraint Reduction Network. Alexis describes the labels often given to autistic people and shares the moment one member of staff gave her a reason to hope with the words: 'You’re not sick, you’re autistic.’

Stefan Kallee is CQC’s North West Lead Inspection Manager for learning disabilities and autistic people. Share your thoughts and views on Stefan’s column on the CMM website. Visit www.caremanagementmatters.co.uk CMM October 2021

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NEWS

APPOINTMENTS BELONG

Sector responds to funding proposals MPs voted to approve the NHS and social care tax rise to help fund health and social care. The Government has proposed to introduce a UK-wide 1.25% Health and Social Care Levy based on National Insurance contributions (NICs). The levy will make available around an additional £12bn per year on average for health and social care across the UK. A cap will be introduced on care costs in England from October 2023 of £86,000 over a person's lifetime. Vic Rayner OBE, CEO of the National Care Forum (NCF), said, ‘This has been a long time coming – and it is a giant leap forward to get the parliamentary focus on social care, and importantly what it can deliver for each and every citizen. The litmus test for this announcement is the difference it

will make to people’s lives.’ However, NCF said the announcement does nothing to address the immediate crisis impacting on social care, especially the enormous workforce challenges facing the sector. The Care Workers’ Charity is very worried about the ambiguity of the Prime Minister’s statement and is unsure as to how much of the money raised by the levy he proposed will go directly to front-line social care. The United Kingdom Homecare Association (UKHCA) has criticised the Government’s focus. Jane Townson, CEO of UKHCA, said, ‘Once again, the Government’s focus is on the 0.5 million people in institutional care, rather than the 15 million needing support and care at home. Home-based support and care play a vital role in enabling us all to live well at home and flourish

in our communities.’ There has been some concern from organisations and charities, who support working-age disabled adults. Dr Rhidian Hughes, Chief Executive of the Voluntary Organisations Disability Group (VODG), said, ‘We are concerned that Government’s approach to policy making could continue to leave disabled people living in England behind, as it has done so throughout the coronavirus pandemic, and we would encourage Government to prioritise solutions that work for everyone and enable older and disabled people to lead independent and fulfilling lives, in their local communities.’ To read more, visit www. caremanagementmatters.co.uk/ sector-responds-to-social-care-taxrise/ to read more comment.

New mandatory vaccination consultation The Government is seeking views on plans for staff in health and care settings in England to be required to have COVID-19 and flu vaccines to protect vulnerable people. A six-week consultation launched on 9th September, looking at whether requirements should apply for health and wider social care workers: those in contact with patients and people receiving care. It would mean only those who are fully vaccinated, unless medically exempt, could be deployed to deliver health and care services. The consultation will also seek views on whether flu vaccines should be a requirement for health and care workers. Flu vaccination has been

recommended for staff and vulnerable groups in the UK since the late 1960s, with the average number of estimated deaths in England for the five seasons 2015 to 2020 at over 11,000 deaths annually. During the 2019/2020 winter season, 86% of deaths associated with flu were people aged 65 and over. The Joint Committee of Vaccination and Immunisation (JCVI) has advised this winter will be the first in the UK when SARS-CoV-2 is expected to co-circulate alongside other respiratory viruses such as flu. This could significantly contribute to the NHS’s winter pressures, with more vulnerable people expected to be admitted to hospital over the

coming months. The consultation will seek views on the proposal, its scope, and any potential impact it could have on staffing and safety such as reducing staff sickness absence. Findings will then help inform decision-making around how the change could be implemented and who could be exempt – if a decision is taken to introduce this requirement. Staff, healthcare providers, stakeholders, patients and their families are being urged to take part to have their views heard, with a final decision expected this winter. Visit the UK Government website to find out more about the consultation.

Dementia care specialist, Belong, has appointed Ali Gopaul to its operations team, with oversight of the organisation’s Greater Manchester care villages, as well as the group’s health and fitness provision across all locations. In his new role as Operations Manager, Ali will work closely with teams in Atherton, Wigan and Didsbury, all of which hold Outstanding or Good ratings with the Care Quality Commission (CQC).

HOLMES CARE GROUP

Holmes Care Group has named Alex Wilson as its new Managing Director, following former Managing Director Sharifa Lakhani’s promotion to Chief Executive Officer. Alex brings with him a wealth of experience in social care, having previously served as an Executive Director for the trade organisation Scottish Care, Managing Director at Four Seasons and Divisional Director at Barchester Healthcare. His appointment comes as Holmes Care Group seeks to make new acquisitions in Scotland, with the goal of increasing its portfolio by 50% over the next two years.

PRECIOUS HOMES

Precious Homes, provider of supported living and residential support services for autistic adults and those with learning disabilities, has strengthened its Board with the appointment of Paul Callander as non-executive chairman. Mitesh Dhanak, who founded the business more than 25 years ago, will step back from his current role as Chairman but continue to be involved with the Board.

AMBIENT SUPPORT

Ambient Support has appointed Will Thornton as its new Regional Manager for Lincolnshire and the Midlands. Will’s appointment promises to expertly drive the charity forward to further develop its services across the region. CMM October 2021

NEWS

#Remembersocialcare campaign launches Social care organisations across England have joined together to launch #RememberSocialCare – a campaign to honour the work of the adult social care workforce during the pandemic and those we sadly lost. A total of 21 organisations, supported by the Department of Health and Social Care and Minister of State for Social Care Helen Whately, have come together to launch the Memorial Day dedicated

to the adult social care workforce in England. The Remembrance Day itself will be held in March 2022. An estimated 922 social care workers in England tragically lost their lives between March 2020 and May 2021. A Memorial Wall and Thank You Wall has been launched on The Care Workers’ Charity website, where people can share tributes to care workers lost during the pandemic and say thank you to those who

provided vital support. Those behind the Social Care Day of Remembrance and Reflection request people to add their stories to the walls in the lead-up to the day in March. Other ways include planting a tree in honour of a lost care worker, having a minute’s silence or creating a piece of art. Karolina Gerlich, CEO of The Care Workers’ Charity, said, ‘The sacrifices made by the social care workforce

during the pandemic must be acknowledged and the sector must be respected and recognised properly. We hope that this day will ensure people remember the skill and dedication of social care workers as the professional front-line workers that they are.’ Be involved with the day on social media using #RememberSocialCare. Visit The Care Workers' Charity website for more information.

JCVI issues advice on third dose vaccination The Joint Committee on Vaccination and Immunisation (JCVI) is advising that people with severely weakened immune systems should have a third vaccine dose as part of their primary COVID-19 vaccination schedule. According to the JCVI, this third dose should be offered to people over 12 years old who were severely immunosuppressed at the time of their first or second dose, including those with leukaemia, advanced HIV and recent organ

transplants. The JCVI has said that these people may not mount a full response to vaccination and therefore may be less protected than the wider population. This offer is separate from any potential booster programme. The JCVI is still deliberating on the potential benefits of booster vaccines for the rest of the population and is awaiting further evidence to inform this decision. Immunosuppression varies widely in

severity and duration. Many people who are immunosuppressed have lower levels of antibodies after coronavirus (COVID-19) vaccination, as some studies have shown. Preliminary data from the OCTAVE trial showed that almost everyone who was immunosuppressed mounted an immune response after two doses, as indicated by either antibodies or T cells. However, in around 40% of people, the levels

of antibodies were low. It is not clear how much this may affect protection against COVID-19 as antibodies represent only part of a person’s immune response. Studies are ongoing to see how effective a third dose is for immunosuppressed people, but it is very unlikely to cause any harm. Therefore, on balance, the JCVI’s view is that a third dose can be safely offered as it may increase their protection.

Charities unite to tackle health inequalities The Government has welcomed new members to the Voluntary Community and Social Enterprise (VCSE) Health and Wellbeing Alliance. Backed by £2m a year, members including Age UK, Barnardo’s, Homeless Link, Hospice UK, National Autistic Society and Samaritans, will work together to promote good health and tackle inequalities across the

UK. The Government said people’s voices and lived experiences will continue to be at the centre of health policy development and work to level up the UK. Membership to the alliance is awarded through a competitive tendering process. Members receive grant funding on an annual basis of up to £100,000 for their core work. The refreshed 19 alliance

members will represent the views of social care workers and older people, people bereaved by suicide, children and young people, people with learning disabilities and autism, those with mental health conditions, LGBTQ+ communities and minority communities, including refugees and Gypsy, traveller and Roma communities. The new Office for Health Promotion will also launch later

this year and will spearhead national efforts to level up the health of the nation and close the gap on disparities. The Government said the Health and Wellbeing Alliance is a key element of the Health and Wellbeing Programme and the alliance has already helped to shape policymaking. Visit the NHS website to read more about the alliance.

Music for Dementia launches #powerof30 campaign Music for Dementia asked the UK to make time to listen to music with a loved one for 30 minutes a week, to mark World Alzheimer’s Month. Its #powerof30 campaign, supported by actor Christopher Eccleston, aims to get people benefitting from the power that music has to promote and support 10

CMM October 2021

wellbeing, which for many is at a critical low after lockdown. Music can help reduce isolation and support communication for people with the condition and those who care for them. Twenty years of academic research indicate it can even reduce the need for medication. In the UK, dementia affects one in 14 people over the

age of 65 and one in six over 80. Grace Meadows, Campaign Director at Music for Dementia, said, ‘Our #powerof30 campaign aims to help people make connections again. Musical services have been severely impacted in the last 18 months, meaning many people living with dementia and their carers have lost those important

connections and special moments that music, uniquely, provides – but we can all use music to help create those connections and make a difference to people’s lives.' Visit the Music for Dementia website to download the Five Ways to Use Music leaflet for handy tips on how to make music part of the day in your care setting.

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NEWS

Care worker pay petition The #BetterPay4SocialCare Action Week took place from Monday 6th to Friday 10th September. To help raise awareness of care worker pay, 28 social care organisations across the country urged people to sign the petition. The petition will be delivered this week (21st September) on the steps of HM Treasury. The organisations behind the campaign are petitioning Government to ensure care

workers receive a minimum of the Real Living Wage. Autism at Kingwood currently pays support workers an £8.91 hourly rate and would like to pay workers £9.50, which is the Real Living Wage hourly rate. Local authority hourly payments to Autism at Kingwood range between £16.39 and £18.40. The petition will be shared by MP and Labour Deputy Leader Angela Rayner, a former care

worker herself. On Tuesday 8th September, Liz Kendall MP, Shadow Minister for Health and Social Care, showed her support at a special panel on social care pay, organised by The Care Workers' Charity and #BetterPay4SocialCare. Beth, a social care worker who will be delivering the petition, said, ‘I am a single parent and my eldest has autism and a few other conditions which leave him with a weaker immune system. Not

working isn’t a financial option. ‘I’m highly trained and have a lot of experience behind me. The job I do is intricate, but I don’t get paid enough for the responsibilities I undertake. It’s kind of soul destroying. This is my chosen career because I want to help others, but the wage is not enough, and I struggle financially. It’s not fair.’ Visit the #BetterPay4SocialCare website for more information.

‘Critical moment’ for housing with care ARCO has led calls for a crossGovernment housing with care task force to be established, so the sector can be expanded and its benefits brought to hundreds of thousands more older people. Following an open letter to the Prime Minister in March, calling for the 2020s to be the ‘decade of housing with care’, signed by over 40 politicians, academics,

charity and private sector leaders, Ministers have confirmed they are considering the proposals for a new task force. ARCO’s 5th Annual Conference, due to be held from 3rd-4th November 2021 in London, will provide a platform for bringing together the leading voices on housing with care and debate on how to take the sector forward.

Michael Voges, Executive Director of ARCO, said, ‘At this critical moment for housing with care and with Government action to spur the sector imminent, we’re delighted to have some great organisations with wide-ranging expertise sponsoring this year’s ARCO conference. It is more important than ever that we bring people

together from different sectors, including law, planning, real estate, social care and technology, so we can lay the best path ahead for the housing with care sector and help bring its benefits to many more older people.’ Visit the ARCO website for more information relating to the ARCO conference.

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NEWS

DHSC urges care workforce to seek wellbeing support The Secretary of Health and Social Care, Sajid Javid, issued a wellbeing message to the care workforce and signposted to support resources. Care workers were reminded of the ‘Every Care Counts’ campaign – which is based on the concept ‘because I care’ originally created by NHS England. The short film not only highlights the importance of Infection Prevention Control (IPC) but also celebrates the

compassion of care staff across the country. Sajid Javid took the opportunity to reference the Skills for Care Workforce Wellbeing resource finder and said there are many resources available to colleagues for support. The care workforce heard the news that the Samaritans’ confidential emotional staff support line has been extended to all

social care staff, who might be feeling stressed, anxious or overwhelmed. Hospice UK has also extended its bereavement and trauma line to social care staff. This service offers a safe space to talk to professionals in the event of bereavement, trauma or anxiety as a result of the pandemic. The wellbeing message also included mention of the ‘Our

Frontline’ service, a collaboration between Samaritans, Shout, Hospice UK and Mind which offers information, emotional support and access to a crisis text service for all those working on the frontline. Care workers can call Samaritans’ free, confidential emotional support line dedicated to NHS and social care staff seven days a week, between 7am and 11pm on 0800 0696222.

Care costs increase for vulnerable adults According to BBC research, some adults with learning disabilities are paying thousands of pounds extra a year for care. In half of 83 areas that responded to a BBC request, bills across all users have risen at least 10% over two years. Research concluded that there was a 13% increase in how much disabled and frail people were

asked to contribute, in two years. In total, 83 councils responded to the BBC request for information (151 were asked). This is equivalent to a £500 rise per person with learning disabilities, in 22 of those councils. (Source: BBC Freedom of Information requests, comparing 2018/19 with 2020/21.) Richard Kramer, Chief Executive of national disability

charity Sense, said, ‘Many disabled adults are having to pay significantly more towards their care than they did two years ago. The pandemic has increased the demand for social care and pressures on a system that is already in crisis. ‘National long-term funding and reforms are urgently needed to ensure disabled people are

no longer forgotten. Disabled people and their families should not be required to make up for the lack of funding in order to receive the right care and support. The social care system must be affordable and work for those who need it.’ Visit the ADASS website to access the Learning Disabilities Network.

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NEWS / IN FOCUS

Skills for Care shines spotlight on recruitment Skills for Care is highlighting its comprehensive selection of tools, resources and information to support recruitment. The campaign, #RecruitmentReady ran throughout August and will close at the end of September. The activity ties into the organisation’s ‘recruit’ work, which aims to provide ‘support to find and keep the right people.’ Resources include videos, templates, best practice guidelines, training support, and more. New blogs and articles sharing expert insights, advice and interviews from people within the Skills for Care team and those working within the sector will also be added to the website throughout August

and September. The recruitment spotlight comes shortly after the release of Skills for Care’s annual ‘Size and structure of the adult social care sector and workforce in England' data. The monthly workforce trackers also monitor the impact of COVID-19, detailing data on days lost to sickness and current vacancy rates. The national vacancy rate in the sector is currently 7.4%. Skills for Care’s newly released three-year strategy also highlights the importance to Skills for Care of supporting recruitment within the sector. All of Skills for Care’s #RecruitmentReady support, information, and resources are available on its website.

Research highlights care worker challenges New research from Keele University highlights some of the key challenges that workers in the social care sector faced during the first wave of COVID-19. The research led by Dr Tom Kingstone, with Professors Lisa Dikomitis and Christian Mallen, from Keele University's School of Medicine, found stories of resilience and rapid adaptation among social care workers. The study explored experiences and perceptions of social workers responding to the first wave (April–July 2020) of COVID-19, in England Interviews with 13 social workers, all working in the West Midlands region, were conducted via telephone or online video. Transcripts were analysed using reflexive thematic analysis. Researchers use ‘managing uncertainty’ as a central concept underpinning the four themes identified after analysis: (1) providing social

care at a physical distance, (2) negotiating home/work boundaries, (3) managing emerging risks and (4) long-term implications for social work. Social care workers shared concerns about how to provide effective care while maintaining social distancing. They were also concerned about balancing their home and work lives, particularly how to maintain professional boundaries and practices when having to resort to video calling. Social care workers confronted new risks to manage and new kit (Personal Protective Equipment – PPE) to get used to. They also spoke of either making compromises or putting themselves at greater risk to maintain business as usual and the authors have said future research is needed to keep track of these changes in the long term, post-pandemic. The findings have been published in the British Journal of Social Work.

IN FOCUS New ADASS snap survey findings WHAT’S THE STORY? A new rapid survey of ADASS members shows that whilst councils are delivering more care and support in people’s homes, people are waiting longer for vital care assessments and reviews. It suggests that the number of people waiting for assessments and reviews has increased over the last three months. It also highlights the impact of growing requests for care in people’s homes and concerns about the recruitment and retention of care staff. It also paints a stark picture of the impact for those of us who have care and support needs, or support others who do; with people waiting longer, receiving less care, or the wrong type of care and support. ADASS said the report should be read alongside the ADASS Activity Survey (June 2021) and ADASS Spring Survey 2021 (July 2021). Together they underline why the sector needs short-term investment in services for older people, disabled people, carers and others.

WHAT WERE THE FINDINGS? The report suggests that: • Nearly 300,000 people (294,353) are awaiting social care assessments, care and support or reviews. This figure has increased by just over a quarter (26%) over the last three months. • 70,000 people are waiting for care assessments (up from 55,000 at the time of the ADASS Spring Survey 2021). • 11,000 people have been waiting for more than six months (compared to 7,000 at

the time of the ADASS Spring Survey). • Up to 184,062 are waiting for reviews of existing care and support plans, which is up 15.6% (24,971) from 159,271 at the time of the ADASS Spring Survey*. Under the Care Act 2014’s statutory guidance, councils should review care plans no later than every 12 months. • 13% of people are being offered care and support such as residential care that they would not have chosen, due to recruitment and retention issues. • There has been a significant increase in the number of home care hours delivered in local authority areas. This has increased from 13,835,304 hours from 1st February to 30th April 2021, compared to 14,425,882 hours from 1st May to 31st July 2021, an increase of 4%. • The number of hours of care that are needed locally but that there is not the capacity to deliver has doubled over the last six-month period.

WHAT WERE THE FINDINGS? Reflecting on the findings of the survey, Stephen Chandler, ADASS President, said, ‘Having heard the Government's initial thinking about the longer-term future, this survey is a stark reminder of why we need investment in care and support now. It is neither fair nor acceptable that people are waiting longer and getting less care. People need care and support to live a good life now. They cannot and should not be made to wait.’ Visit www.adass.org.uk/media to download reports in full. CMM October 2021

NEWS

Resource to advise on suicide prevention The SHARE Guide, prepared by the Zero Suicide Alliance (ZSA), with support from the Department of Health and Social Care (DHSC) and NHS England/Improvement (NHSE/I), is designed to expand upon and enhance the DHSC Consensus Statement. The 2014 Department of Health and Social Care (DHSC) Information Sharing and Suicide Prevention – Consensus Statement,

prepared in collaboration with multiple organisations and the National Suicide Prevention Strategy Advisory Group (NSPSAG), sought to highlight the theme of information sharing and strengthen its associated guidelines, both for those at risk from self harm and suicide and those close to them. The new SHARE resource is designed to support health and

social care staff on: • How to use the Department of Health and Social Care’s (DHSC) Consensus Statement for information sharing and suicide prevention. • How to engage with patients when discussing confidentiality and consent to share information. Steve Mallen, Co-Founder, Zero

Suicide Alliance, said, ‘This SHARE Guide is designed to assist all healthcare practitioners and service user facing personnel in adopting best practice within the limitations of the appropriate legislation, rules and regulations. Properly applied, this Guide will produce better patient outcomes and save lives.’ Visit the UK Government website to read the SHARE resource in full.

Report outlines community care approaches The British Geriatrics Society (BGS) launched Right time, right place: Urgent community-based care for older people – a new report that aims to help health professionals to navigate the options for providing urgent care to older people which can be delivered at home, avoiding unnecessary emergency hospital admissions. The report explains that there are times when hospital is the right

place for treatment. However, for many older people living with frailty and complex long-term conditions, a spell in hospital can result in worsening frailty, delirium and deconditioning, particularly if discharge is delayed. Once they return home, they are likely to require rehabilitation and other support to help them recover. Right time, right place sets out an alternative to this scenario: a

rapid response to the initial crisis delivered in someone’s home by a multidisciplinary team, providing timely assessment, diagnosis and treatment. Right time, right place shows some of the emerging ways in which community teams are able to deliver care quickly, safely and effectively to older people living at home or in care homes. The BGS believes that developing

a consistent, co-ordinated approach to such delivery across the country will bring benefits in terms of older people’s wellbeing and health outcomes, and in the longer term reduce the costs of acute care by minimising avoidable hospital admissions. Visit the British Geriatrics website to read the report in full and more insights into communitybased care.

New integrated health and care hub An event took place on Monday 23rd August to celebrate a £43m development that will see the construction of a new integrated health and care hub in Dunstable, Bedfordshire. The project has been funded by the council with a contribution from the £6.2m Housing Infrastructure Fund for Dunstable. The hub will comprise 98 apartments for the over-55s built right in the heart of the town. Planning was approved

in 2020 and work on site commenced three months ago, but due to the pandemic the ceremony had been delayed. The Dunstable integrated health and care hub is the first of its kind to be built across Central Bedfordshire and a realisation of an ambitious vision created ten years ago between the council and its NHS partners. When complete, developers say the hub will transform the way health and care services

are provided so local people can be better supported in the community, with access to more joined-up working between hospitals and community-based services. It is being built on the site behind GO Bowling off Court Drive. Chief Executive of Bedfordshire Hospitals NHS Foundation Trust, David Carter, said, ‘This hub represents a major step forward in providing the infrastructure to allow us

to change the way in which we care for people’s health and wellbeing. Working together in one building will allow us to be proactive in supporting our population’s heath, more resilient and more accessible. It is incredibly exciting for us to play a part in developing a hub which will be a model for how we provide integrated primary and community services.’ The development is scheduled for completion in Spring 2023.

The Care Workers' Charity partners with RCH Care Homes RCH Care Homes and The Care Workers' Charity (CWC) announced that they are committed to supporting the social care workforce and The CWC is ‘grateful’ that RCH has chosen to join them as a partner to work towards ensuring every care worker in the UK can access support. 16

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Karolina Gerlich, CEO of The CWC, said, ‘We are thrilled to be working with RCH Care Homes to raise awareness of the work and impact of The CWC amongst the social care sector and its workforce. This partnership represents a collective commitment to

building a stronger, more resilient sector; a sector that values and supports its employees so that they can deliver the highest levels of care. Myself, and the team, look forward to working with them.’ RCH Care Homes said, ‘RCH are proud to partner with The

Care Workers’ Charity who have been instrumental in supporting so many carers in the care sector. By partnering with The Care Workers' Charity, we aim to be an additional resource of support for our own team members in addition to our own internal initiatives.’

CMM October 2021

NEWS

Care UK launches new buddy programme Care home provider Care UK launched its Buddy programme for new starters during Professional Care Workers’ Week. The Buddy programme was piloted by Care UK last year with a target to recruit 125 buddies across the organisation. It has been widely embraced, resulting in the recruitment of 590 Buddies by the end of August 2021. Care UK has given the Buddy function a structure with training

and mentoring, opportunities for buddies to interact with others from across the organisation and the potential for career development. The organisation introduced the Buddy programme at the same time as a relaunch of its induction programme so that the two could work hand in hand. The aim of the programme is to match each new colleague with an experienced Buddy within their care home. This ensures that

they feel part of the organisation with the support to build their confidence from the word go. While a new starter and their Buddy are officially paired for 12 weeks, the Buddy remains a friendly face beyond that timescale. As well as assisting a new starter with early appointment needs such as induction, making introductions and finding their way around the home, a Buddy is also an ambassador for Care UK with

a remit to instil the organisation’s values and beliefs. Think Tank sessions provide Buddies with the chance to network and exchange ideas and best practice. This was especially welcome during the worst of the pandemic restrictions, reducing feelings of isolation and increasing opportunities to support each other while they themselves supported new starters in difficult circumstances.

Resident enjoys day to remember One resident at the Gracewell of Weymouth care home has recently enjoyed a trip out to sea in a day to remember. Despite joining Gracewell of Weymouth just days prior, Roy Ricketts, 101, headed out on his first trip with the care home on 17th August. After noting how he enjoyed seeing the cruise ships in the bay

from his flat in Poole during the lockdown period, the team at Gracewell of Weymouth decided to treat their new resident with a fantastic trip out to sea. Roy is no stranger to the coast, with Bournemouth being his hometown since childhood. However, during the Second World War, he was called up to serve in the RAF’s Medical Branch.

During this time, he went away to Castle Camps and Burma, where he served for 12 months, receiving the Burma Star for his service. Eager to embrace new opportunities at the age of 101, Roy and several other residents at Gracewell of Weymouth boarded the FM Freedom boat for a day of fantastic sights, where they enjoyed watching the cruise ships

out at sea. Reflecting on the trip out, Roy said, ‘I never thought I would be able to do this within a care home. I really enjoyed the day, it was windy but not too cold, and it was lovely to be out at sea with the sea air. If there are spaces on any trips I would like to go. You have to take opportunities in life.’

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CMM October 2021

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National care charity announces four-day week One of the UK’s social care charities, Community Integrated Care, has embarked on an overhaul of its working practices by introducing a four-day working week for more than 300 of its employees. The new plan, which sees the charity become the first social care provider in the UK to introduce the four-day week, allows head office and support

function employees to condense their normal working hours into four days, rather than five – having either the Monday or Friday as a non-working day. These flexible working measures come in response to feedback from colleagues in a series of recent surveys, with 82% of colleagues feeling positive about the move towards a four-day working week and 81%

expressing a desire to reduce the numbers of days in the office post-pandemic. The move has been introduced across the charity’s support function teams initially, including departments such as finance, HR and quality, but the aim is that this will be rolled out further later in the year, with operational teams having the chance to take part in the scheme too.

End of life care conference On Thursday 14th October 2021, St Christopher’s Hospice will be hosting a one-day conference on frailty at its brand-new Centre for Awareness and Response to End of Life (St Christopher’s CARE). Speakers at the conference include CEO of British Geriatrics Society, Sarah Mistry, acclaimed Geriatrician and author, Dr Lucy Pollock, author and former Guardian columnist, Madeline

Bunting, and current AGE UK Director, Caroline Abrahams. The conference will be delivered through a blend of provocations from industry experts, leading to round table discussions, exhibitions and interactive lived experience sessions. Attendees will be able to listen to and take part in conversations with experts in their field and learn more about what

frailty is and how it impacts on people living and dying with it. Participants will also have a unique chance to learn more about the significant challenges facing wider society, which impact on our health and social care provision and reduce opportunities for people to live and die well. Visit www.stchristophers.org. uk/frailtyconference for tickets and information.

Royal Star and Garter wins award Royal Star and Garter in High Wycombe has been awarded a national Gold Standards Framework (GSF) Quality Hallmark Award for its delivery of end of life care. It was given as part of the GSF Virtual Awards, which recognise health and social care providers delivering quality care in the final year of life. The Hughenden Avenue home provides compassionate care to veterans and their partners living with disability or dementia. It is one of a cohort of 59 GP practices, care homes, retirement villages, and hospital wards which will receive the prestigious GSF quality hallmark across the country during the virtual ceremony. The GSF Centre, in association with Hospice UK, provides expert training for front-line staff in health and social care.

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MANDATORY VACCINATION: Practical tips on thorny issues

At time of writing, social care providers still await detailed Government guidance on some aspects relating to mandatory vaccination. In this article, James Sage of Royds Withy King offers his interpretation of the facts so far and flags the priority areas for providers to consider.

CMM October 2021

From 11th November 2021, all care home staff in England must be fully vaccinated against COVID-19, unless they are exempt. The Government is currently consulting on extending the scope of the vaccination requirement to the remainder of the health and social care sector, including domiciliary care and supported living services. The Government estimates that 35,000 – 70,000 care home staff face dismissal for refusing to be vaccinated. Surprisingly, this didn’t make the Government think twice about introducing the requirement given the impact it will have on residents and care providers, who are already in the midst of a workforce crisis, with over 100,000 vacancies and poor staff retention rates which have not been helped by Brexit and the pandemic. Many care providers and recruitment agencies are reporting the most challenging recruitment environment they have ever seen. The Government has been threatened with judicial review action against its decision to introduce mandatory vaccination, but it is undeterred. Care providers are getting to grips with implementing the new requirement but unfortunately they have not been assisted by the Department of Health and Social Care's (DHSC) failure to publish complete and comprehensive guidance on mandatory vaccination in a timely way.

WHAT CARE PROVIDERS NEED TO KNOW: 1. Evidence of vaccination It is essential to obtain evidence of vaccination in a compliant way and CQC will inspect against this. Vaccination status must be demonstrated through the NHS app, NHS website or an NHS COVID-19 pass letter. Nothing else will suffice and the vaccination appointment card is not valid evidence and cannot be used. Having reviewed the evidence, you must accurately record the vaccination status and the date on which it was reviewed. Vaccination status is special category data; it must be processed and stored in a manner that is compliant with data protection laws. A Data Impact Assessment should be undertaken; the ICO website has some templates that can be used for this purpose. 2. Vaccines administered outside the UK Workers must have a vaccine that is authorised in the UK, namely: Moderna, Oxford/AstraZeneca, Pfizer/BioNTech and Janssen and problems may arise where staff have been vaccinated outside the UK. Even if their vaccine is authorised in the UK, there is currently no means of evidencing their vaccination status through any of the required methods set out above. Where the worker’s vaccine is not authorised in the UK, they will CMM October 2021

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MANDATORY VACCINATION: PRACTICAL TIPS ON THORNY ISSUES

not be eligible to enter a care home from 11th November. On 15th September, the DHSC issued exemption guidance which included a temporary exemption for care workers who have been vaccinated outside the UK. A template form has been provided for the worker to self-certify that they have been vaccinated outside the UK and they will be able to continue working in a care home for now. It is not clear whether the exemption is intended to cover care workers who have been vaccinated outside the UK with UK-approved and non-UK-approved vaccines, and further guidance is required. 3. Exemptions On 15th September, the DHSC finally issued exemption guidance. The content was a surprise, to say the least. Essentially, a temporary exemption process has been

“Clear, objective and fair criteria must be used to avoid the risk of discrimination and unfair dismissal claims.” introduced allowing workers asserting a medical exemption to self-certify that they meet the medical exemption criteria in the guidance. A template form for staff to complete has been provided. It will only be in place until the NHS COVID Pass system is launched, following which care workers will need to apply for a formal medical exemption through that system and their asserted medical exemption will be subject to clinical review. Self-certification will expire 12 weeks after the NHS COVID Pass system is launched. The DHSC has provided a 'non-exhaustive' list of medical conditions including what appears to be an exemption for needle phobia. Expressly stating that the list is non-exhaustive appears to leave broad discretion for care workers to self-certify themselves as medically exempt. Surprisingly, there is also an exemption for pregnant workers, despite the DHSC previously stating that this would not be grounds for an exemption. This is likely to be welcomed by

providers but it is frustrating that this has not been communicated sooner as many pregnant care workers have already been told that they are not exempt, based on DHSC guidance. 4. Consultation The guidance provides little information about the requirement to collectively consult about mandatory vaccination. Section 188 of the Trade Union and Labour Relations (Consolidation) Act 1992 (‘TULRCA’) requires collective consultation with a trade union or employee representatives, where there is a proposal to dismiss 20 or more employees as ‘redundant’ at one establishment within 90 days. Dismissal of a worker who is not fully vaccinated will not amount to a redundancy situation under the Employment Rights Act 1996 (‘ERA’), so redundancy will not be the reason for dismissal and there will be no entitlement to statutory redundancy pay. However, for collective consultation purposes, TULRCA defines ‘redundant’ broadly and it includes dismissal for any reason not related to the individual. In our view, this is likely to include dismissal for not meeting the statutory requirement to be vaccinated. Failing to comply with collective consultation obligations could lead to Employment Tribunal claims and awards of 90 days’ pay per employee. Specific advice should be sought on whether these enhanced consultation obligations apply to your circumstances. 5. Fair reason for dismissal The DHSC guidance states that a potentially fair reason for dismissal for refusing to be vaccinated could be: • That the employee cannot continue to work in their position without the employer contravening a duty or restriction imposed by or under an enactment (‘Statutory Restriction’), or • Some other substantial reason of a kind as to justify the dismissal of an employee holding the position which the employee held (‘SOSR’). Both are potentially fair reasons for dismissal; however, no guidance is provided on which applies in what circumstances. Statutory restriction would only apply if you dismissed staff who are in scope for mandatory vaccination under the regulations. If you are applying the requirement to be vaccinated more broadly (e.g., to head office staff who are not required to enter the care home), you could not rely on statutory restriction and

SOSR would be more appropriate. We are not aware of any providers seeking to extend the scope of the vaccination requirement in this way, but if you are you should take specialist advice on the risks. 6. Redeployment The guidance states that redeployment should be considered as an alternative to dismissal for unvaccinated staff. This is key to a fair dismissal process. Many providers will not have any roles where there is no requirement to enter the care home and for which there is no requirement to be vaccinated. However, some will. Currently, domiciliary care and supported living services are not in scope for mandatory vaccination, so if you operate those services alongside care home services, any vacancies should be considered before dismissal. Where there are more unvaccinated staff at risk of dismissal than there are vacancies, care is needed when deciding which staff to select for the available roles. Clear, objective and fair criteria must be used to avoid the risk of discrimination and unfair dismissal claims. 7. Timescales It is important that you proactively manage the information and consultation process with workers because the timescales for implementation are tight, particularly when taking account of the need to give notice, which for some staff could be as much as 12 weeks. If there is insufficient time for them to work their entire notice period before 11th November, you will be faced with costly payments in lieu of notice (i.e., pay for no work). 8. Planning is key Planning the process, and identifying potential issues in advance, will ensure it runs smoothly. We are also seeing that it is possible for some workers to overcome vaccine hesitancy, with good numbers of workers changing their decision not to be vaccinated during the consultation process. Every worker is valuable to the sector so continued consultation and support remains critical. CMM Want to know more? Royds Withy King will be contributing to the CMM website if further Government guidance is published. Visit www.caremanagementmatters.co.uk to read the latest news updates.

James Sage is an Employment Partner and Head of Health & Social Care at Royds Withy King. Email: james.sage@roydswithyking.com Twitter: @jamessage6 Which areas relating to the mandatory vaccination concern you the most? Visit www.caremanagementmatters.co.uk and share your views on the topic. 22

CMM October 2021

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Re-opening day care services

The loss of, or reduction in, day care services during the COVID-19 crisis has been hugely challenging for people. In this article, Kathryn Smith of the Social Care Institute for Excellence (SCIE) shares advice on re-opening and Becky Hamilton, Manager at Windward Day Care Services, reflects on its response to the pandemic.

During a webinar we held in March 2021, we heard about all of the challenges thrown at day service providers during the pandemic. At SCIE, we have developed a guide that supports day care managers, social workers, commissioners and providers to restart or continue activities. It’s focused on community-based day services and day centres (with and without personal care), including specialised day centre environments and

CMM October 2021

COMMUNITY LIFELINE: RE-OPENING DAY CARE SERVICES

those with outdoor spaces. The SCIE Guide was developed in conjunction with Public Health England, the Department for Health and Social Care, the Local Government Association and King’s College London. It has been recently updated to reflect the changing COVID-19 landscape and policies.

CONSIDERATIONS FOR PROVIDERS Some services might have been able to provide very limited, or no, day care support during the pandemic. It is highly likely that things can’t just revert to the way they were pre-COVID. During lockdown, there may have been changes to contracts, re-deployment of staff and/ or an increase in the use of technology and home-based one-to-one support. Communication and engagement are key. For example, a communication plan can be agreed on, to ensure all people using services and their families are informed of what will be happening in the weeks and months ahead. It is important to make sure that staff and volunteers feel safe and supported when services resume and that their concerns and needs are considered when re-opening or expanding face-to-face support. Managers will need a plan to respond to the trauma of COVID-19 experienced by people who draw on services, staff, volunteers and others.

GET CREATIVE One county council has been identifying people most in need of face-to-face day care using a red,

CMM October 2021

amber and green system. ‘Red’ means there is an immediate risk for the person or carer. This could be that a safeguarding concern has been raised. ‘Amber’ suggests the person or carer is experiencing difficulties but is not at immediate risk. One indicator here is that the existing care arrangements could be at risk. ‘Green’ suggests there are minimal concerns regarding a person’s or carer’s wellbeing; for instance, the carer isn’t expressing concerns and there were no welfare concerns prior to isolation in March 2020.

NEW WAYS OF WORKING Despite the vaccination programme being much further on compared to March 2021 when we held the webinar, infection and control measures in the workplace should be robustly implemented and adhered to. This includes limiting close contact, optimising ventilation, PPE and hand and respiratory hygiene. Staff (including kitchen staff, cleaning staff and transport staff) and volunteer training is needed to embrace new ways of working, along with how to cover COVID19 etiquette. It is important that staff understand why new systems and protocols are in place and how they can help to minimise risk. This includes infection prevention and control, safe systems of working, limiting close contact, correct use of PPE and local training on measures to be taken in different environments or service locations.

LEGAL FACTORS Depending on the service, a range of agencies and contractors

“Day care offers improves the quality of lifefor participants and their carers. It is a central component of social citizenship for many.” may need to be involved in the safe re-opening or expansion of face-to-face services. This includes insurance providers, facilities that are open to the public and transport providers. When it comes to building landlords and management groups, providers must ensure relevant health and safety checks have been undertaken for buildings that have been closed or, indeed, new spaces. It’s best to be clear about who has responsibility for deep cleaning and regular cleaning. It is important to be aware of other users of the building and know who is responsible for handing over and cleaning between user groups.

ESSENTIAL SERVICE Day care offers an essential service and improves the quality of life for participants and their carers. It is a central component of social citizenship for many. It is essential that participants and carers continue to receive the support they need. There is also clearly the need for day services to be as safe as possible.

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CMM October 2021

COMMUNITY LIFELINE: RE-OPENING DAY CARE SERVICES

> Becky Hamilton, Manager at Windward Day Care Services, reflects on how her team responded to the pandemic and outlines some of the biggest challenges they had to overcome, so they could continue to support people.

The impact of COVID-19 has affected every part of Windward Day Services. We are a team of 70 people, who support 170 adults with a learning disability and who may also be autistic. We have been offering day opportunities for 20 years in small community-based buildings in Hampshire and Dorset. We support our clients to have a good day undertaking activities, including physical activity in the community such as using gyms, outdoor gyms, swimming pools, sailing and golf. We also offer more focused sessions like dance, drama, cooking, self-care, singing, Makaton and recycling. We are developing a shop and showroom where people can gain employment skills. When we closed in March 2020, we were thrown into shock. Fortunately, we quickly adopted zoom to communicate within our managers’ group. We then started to meet throughout the day and developed new systems to support people. Windward is an outward-looking organisation and we maintain links with other similar providers to enable us to share knowledge. The biggest game changer was when we threw everything into our new breakout digital service called Click. Click offers a full timetable of meaningful activities throughout the day, evening and weekends. We fostered a culture of staff creativity and co-production. Click is accessed by existing people who use our service and also new members. We were in weekly contact with everyone linked to our service, which helped us to keep up to date with how people were coping. After we had to close, we quickly began

to offer hands-on critical support for people who were struggling and we were supported by the councils to do this. Following a request by one council, we released our staff to work in local Supported Living provisions. The staff involved felt they were really helping out and good links were formed. Windward opened in July 2020 on a trial basis and then fully opened on 1st August for people in need. The local authority and Windward assessed those people most in need (60% of the community became eligible). We didn’t close fully again throughout all following lockdowns. To ensure safety, we performed full risk assessments and then communicated our measures to our clients and their circles of care through easy-read docs, on Facebook and via email. We produced videos of walk throughs of the new services, which were available on YouTube.

READING BETWEEN THE LINES The Government released good information for residential homes, Supported Living, domiciliary care providers and education. However, those of us involved in day opportunities had to read between the lines of all this information to find a way forward. Day services are not regulated by CQC and so are often misunderstood by Governments. Our biggest challenges throughout the whole period were to: • Understand constant changes in guidance and regulation. • Help support people with anxiety. • Advocate on behalf of people whose voices are seldom heard by decision makers. At times, we have been disappointed by the speed with which paternalistic attitudes have returned towards people who have

care and support needs. People we support have been unable to make their own decisions about many aspects of their life. Others have decided how, when and what services they can access. We are driven by the desire to provide a safe service but it has often been forgotten that we are working with adults who are used to having some agency in their own lives.

A HELPING HAND One of our clients, Steve*, is autistic and lives with his mum in a flat near to one of our centres. He really struggled from the beginning of lockdown one. He has considerable support needs with processing and communication and was becoming increasingly frustrated. When his lack of routine became so hard that his mum was being physically harmed, we opened part of one centre just for him and a small team of key people. This support enabled him to stay living at home and avoid moving to emergency respite, which would have been difficult for both of them. What has helped us to flourish through the pandemic is being open to others – we have received support from other services and offered support in return. In preparation for another pandemic, we would always want to be keeping up to date with technology and to not be afraid of thinking of new ways to approach challenges. Day service provision has been seen by some people as unfashionable in the last few years, with the focus coming away from buildings-based support. What we have clearly seen throughout this period is that a day service is a place where people know and are known. It’s a place where friendships form and sustain. It is a hub for many types of support. Without services like ours, many people would struggle with deep isolation and a loss of friendship, fun and support. CMM

Kathryn Smith is the Chief Executive of the Social Care Institute for Excellence (SCIE). Email: media@scie.org.uk Twitter: @SCIE_socialcare Becky Hamilton is Manager at Windward Day Care Services. Email: becky@windward-dayservices.co.uk How did you adapt and respond to day care service closure during the pandemic? Have you devised creative ways to re-open services? Visit www.caremanagementmatters.co.uk to comment. CMM October 2021

INTO PERSPECTIVE HOW SHOULD PEOPLE WITH LEARNING DISABILITIES BE SUPPORTED IN THE WAKE OF COVID-19 RESTRICTIONS EASING? THE STORY SO FAR

Whilst the easing of almost all COVID-19 restrictions in England has been a momentous occasion for most, it is unlikely that the most vulnerable in society will have shared the same sentiment. In particular, people with learning disabilities, who have recently been identified as being eight times more likely to die from COVID-19 than the general population, may be burdened by feelings of uncertainty and trepidation as they settle back into everyday life, with limited reassurance about whether their health and wellbeing will be prioritised in the wake of COVID-19 restrictions easing.

CMM October 2021

For people with Down’s syndrome, who, according to the London School of Hygiene & Tropical Medicine, Oxford University and Public Health England are 36 times more likely to die from COVID-19 than the general population, there is hope. This being access to the approved booster programme, which will see select groups of people most susceptible to COVID-19 receive a third vaccine with winter looming. People with Down’s syndrome have been categorised as clinically extremely vulnerable by Government and are therefore eligible to be offered a booster dose once the programme is underway by the end of September, estimates the Health and Social Care Secretary, Sajid Javid. The JCVI had outlined several complex and ethical barriers to rolling out the booster programme, which was expanded upon by Professor Dame Sarah Gilbert, a leading figure in the development of the Oxford AstraZeneca jab, who suggested that extra vaccines should be directed to low-uptake countries. While the booster programme is a step in the right direction, the lack of urgency in its current form to prioritise people with profound learning disabilities is difficult to overlook. But what about people living with other learning disabilities? In response to the findings that people with learning disabilities are five times more likely to be hospitalised after infection than the general population, some in the sector have called for Government to extend the scope of the booster programme to offer a third vaccine to all people living with a learning disability, not just those with Down’s syndrome. Dan Scorer, Head of Policy and Public Affairs at Mencap, has also urged

Government and the NHS to ‘raise awareness of the Learning Disability register and the benefits of being on it amongst people with a learning disability and their families.’

MAKING THE CASE FOR YOUNG PEOPLE Monday 13th September saw the announcement that people aged 12 to 15 in England will be offered one dose of the Pfizer/BioNTech COVID-19 vaccine, following advice from the four UK Chief Medical Officers. In the case of young people with learning disabilities, it seems that they have also been overlooked for prioritisation despite the evidence cited in this article and two recent opportunities for vaccination. The first involves the JCVI initially explaining its decision to not approve universal vaccination of 12- to 15-year-olds, recommending that extra doses would be better placed serving older children with health conditions, such as heart disease, type 1 diabetes and severe asthma. Secondly, the Health and Social Care Secretary has insisted that offering a third COVID-19 vaccine to half a million people aged 12 and up with severely weakened immune systems is part of the ongoing primary vaccination schedule. Eligible people include those with particular diseases such as HIV and blood cancer, and people on medication that damps down the immunity supplied by the first two vaccines. Despite the unquestionable need to ensure the safety of both vulnerable groups discussed in these instances, the case remains for the adult social care sector to argue that people with learning disabilities, of all ages, are without certainty of prioritisation in the wake of COVID-19 restrictions easing in England.

Everyone with a learning disability ought to have been vaccinated sooner

Choice and control in the new normal

Clive Parry, Director, ARC England

Julie Bass, Chief Executive, Turning Point

Recent reports suggest that if you have a learning disability, you are six times more likely to die from COVID-19 than someone who does not. NHS data from 17 million health records puts this figure even higher at an eight times increased risk. People with a ‘severe and profound learning disability’ including those with Down’s Syndrome were part of the sixth group to receive their COVID-19 vaccine, but people with moderate learning disabilities, autism or both were prioritised on the basis of their age along with the rest of the UK population. It was always the view of ARC England’s members that the largely age-based Joint Committee on Vaccination and Immunisation (JCVI) prioritisation model (published 30th December 2020) did not accurately reflect either the additional clinical needs of people with a learning disability or the social and psychological impacts of the restrictions placed upon them last year. The July 2020 Learning Disability Mortality Review (LeDeR) confirmed that COVID-19 was the cause of death in only

4% of people aged 85 or over with learning disabilities, versus 47% in the general population. It also showed that 65% of people with a learning disability who died from COVID-19 in the first wave had a mild or moderate learning disability and were in much younger age categories. Whichever statistics you read, the information now suggests everyone with a learning disability ought to have been vaccinated sooner than they were. In addition, because there is no comprehensive learning disability register, reaching everyone who was eligible was far from straightforward when their turn to be vaccinated eventually came. I believe that if the JCVI, which advises UK health departments on immunisation, works with the support of the social care sector, we can learn from what happened when COVID-19 deaths were at their highest. If we are serious about tackling the long-standing health inequalities that affect people with a learning disability, autism or both, they should be prioritised and receive their boosters along with the other people in the JCVI group one.

People with a learning disability have suffered more than most through the pandemic. According to research conducted by the British Medical Journal (BMJ), people with learning disabilities are eight times more likely to die from COVID-19, therefore strict infection control measures have been the priority. But for many of the people we support, the combination of staff decked out in PPE, not being allowed visitors and normal activities being curtailed has been a stressful and bewildering experience. Over the summer, restrictions eased and many support services re-opened. For many of us, it feels like life is beginning to get back to normal and long may that continue. However, the sector continues to face a number of challenges. From November 11th, all care home workers in England must be double jabbed, unless exempt. Inevitably, some members of staff will take the decision to leave. This is hard for the people we support and intensifies the recruitment challenges that we were already facing.

Despite this, vaccination is clearly the best tool to keep the people we support safe. The dedication and resilience demonstrated by our staff through the pandemic has been remarkable. Staff who feel happy and supported is the key to delivering high quality support. At Turning Point, all staff have access to health and wellbeing support – interactive online health and wellbeing support and therapy, from Rightsteps. As restrictions have eased, the number of staff accessing this support has increased significantly which suggests to me that the impact of the pandemic on the social care workforce will be felt for some time to come. PPE and vaccinations for staff are here to stay, but this must not distract us in our efforts to ensure quality. James, a resident at one of our learning disability care homes in Salford, answered the door to a CQC inspector recently and demanded to see proof that she had been double vaccinated – an example of what choice and control looks like in the ‘new normal’.

Note: The statistics mentioned in this article were correct at the time of publication.

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Intergenerational links:

Spreading joy and understanding across the generations

Amy Simpkins of My Home Life England tells us more about England’s largest-scale intergenerational project and explains why My Home Life has been championing the social action of linking younger and older members of society together.

Ellie from Bristol is one of many hundreds of children who, over the past year, has been connecting with older people living in a nearby care home. The children are all involved in Care Home Friends and Neighbours: Intergenerational Linking – a national social action project linking together young people aged five to 14 from schools and youth organisations in less socio-economically advantaged areas of England with older people living in care homes. On why she decided to become involved with the project, Ellie said, ‘I wanted to take part because I wanted the older generation in our community

to know that we care about them.’ The project is led by a partnership between us at My Home Life England (MHLE) and The Linking Network (TLN), a venture that combines MHLE’s expertise with older people and care homes with TLN’s expertise working with young people and schools to create meaningful intergenerational friendships that are mutually beneficial and strengthen community connection.

THINKING BIG As a partnership, we’re supporting a network of local CMM October 2021

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INTERGENERATIONAL LINKS: SPREADING JOY AND UNDERSTANDING ACROSS THE GENERATIONS

charities and organisations to lead the project in different areas of England and make a real difference to the lives of younger and older people and their communities. Alive in Bristol and The Linking Network in Bradford first piloted the project in early 2020 and there are now 11 active projects ranging right across the country, from the North East down to the South West. The organisations bring a wealth of their own experiences with younger and older people, as well as understanding of their local landscape, and are using this knowledge to support the creation of intergenerational connections. As a national project, we’re forging an exciting path too – this is the first time that a group of charities and organisations have been funded to start intergenerational linking in different parts of England at the same time, making Care Home Friends and Neighbours: Intergenerational Linking England’s largest-scale intergenerational project! We hope that over 4,000 participants from schools, youth groups and care homes will take part in intergenerational linking over the next 12 months, made possible by funding from The Dunhill Medical Trust and the #iwill Fund from The National Lottery Community Fund and the Department of Digital, Culture, Media & Sport.

BUILDING FRIENDSHIPS With the support of a local ‘community broker’ who leads the project in their area, a school or youth group is supported to link with a nearby care home over a period of 18 months. Starting with introductions, younger and older people spend time getting to know one other. As Jasmine, a Year 5 pupil, put it, ‘It’s really fun to write letters and pass them back and forth.’ With the majority of contact so far taking place during a time of COVID-19 lockdowns and social

distancing, interestingly some projects reported that their links were preferring traditional means of communication such as letters and artwork, rather than more time spent in front of screens. Classroom displays have also been created to support children’s learning and pupils have discussed topics such as memories and ageing to help them connect with their new friends and deepen their understanding of topics such as dementia and ‘what does it mean to be old?’ Once relationships are established, individual links have the freedom to continue linking in a way that fulfils the interests of their participating younger and older people. In line with the aims of the #iwill campaign (supported by the #iwill Fund) young people are empowered to develop their leadership skills and take ownership of activities, with the hope of helping to inspire a long-term habit of engaging with social action and making a positive difference in their local communities. Equally, older people’s voices are an integral element too, empowering them to participate in the lives of younger generations, including through knowledge sharing, as well as the project helping to boost wellbeing and reduce feelings of isolation.

THE PERSONAL TOUCH The project’s ethos has led to some really thoughtful, person-centred work. In a virtual session between a school and care home in the North East, participants noticed one resident, Pat, kept mentioning how much she liked bubbles. Inspired by her joy, the class visited the care home garden a few weeks later and tied baubles to the trees with messages inside, giving the effect of floating bubbles. Pat’s eyes lit up. Back in Bristol, Ellie and her classmates recorded themselves singing Let it Be by the Beatles, after people living in their linked care home shared that it was one of their favourite songs. Care home staff recorded their reactions so

the children could see the impact of their actions, even though COVID-19 meant they couldn’t be there in person. Betty, who lives at the home, said, ‘It was a lovely performance; I saw it in my room. I have a granddaughter your age and it reminded me of her. Your singing made me smile.’ Maxine, an Activities Co-ordinator, added, ‘This heartfelt song really lifted all our spirits – children you are wonderful and again, thank you from the bottom of our hearts.’ The young people themselves expressed empathy and kindness towards their older friends: ‘We wanted to do something to let them know that they weren't alone,’ said Christopher. ‘It made my day knowing it would make someone else's day,’ added Sam. We’ve also seen groups ‘rewild the classroom and care home’ by creating beautiful flower and garden artwork, with others decorating pebbles to brighten up care home gardens. In another link, children devised their own word searches and sent them through to their care home friends. Not only did the older people have a fun and personalised activity to complete, but it had the additional cognitive benefit of helping to keep their brains active and engaged.

CAPTURING THE LEARNING Importantly, alongside the project, we are also conducting a research study hosted by My Home Life England at City, University of London, which is led by Dr Ali Somers, expert in intergenerational work and programme design. The study is focused on what happens when intergenerational linking begins between schools, youth groups and care homes. We regularly collect reflective learning from our local community brokers and capture insight at our collaborative ‘Sharing Network’, where successes, challenges and insights are shared to benefit the

project as a whole. Dr Somers is also exploring how each intergenerational linking project shapes and changes its local community over the 18-month period. Our hope is that, by capturing the learning in all of the areas taking place at the same time, we can create a body of knowledge to share with those interested in intergenerational studies.

SUSTAINABILITY For a long time, we at My Home Life England have recognised and championed the value of community involvement in supporting quality of life for older people living in care homes. Care homes are structurally part of communities, yet they don’t always feel that way. This intergenerational project grew out of our Care Home Friends and Neighbours (Care Home FaNs) work connecting care homes to their local communities and we know just how important it is for older people to be connected to the people, places and passions that matter to them. Through creating projects that are receptive to the local landscape and designed to best suit those participating, we hope the links will sustain into the future and that participating schools, youth groups and care homes will continue to connect and support one another. My Home Life England has a wealth of community engagement resources supporting care homes to connect with their local communities – and vice versa, for communities to reach out to care homes. Visit www.myhomelife.org. uk/resources If you know of a young person who would like to connect with older people living in a care home, we have a series of stepby-step activities that could be a great place to start. Visit www. carehomefans.org/remoteintergenerational-linking CMM

Amy Simpkins is a Communications Officer at My Home Life England. Email: mhl@city.ac.uk Twitter: @MyHomeLifeUK @IntergenLinking In what ways has your care setting been creating opportunities for older people to connect with young people in the community? Will you be planning more projects and support ideas after the pandemic? Visit www.caremanagementmatters.co.uk and share your feedback on the feature. 34

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STUCK IN THE SPIRAL: HOW TO AVOID TOXIC WORKPLACE CULTURES 36

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With staff vacancy rates rocketing and burnout becoming increasingly common, human resources (HR) specialist Cath Dixon created a model to explain how the culture of our care workplaces is changing and shares her advice on how to combat toxic cultures. Until three years ago, I was the only HR professional supporting approximately 700 staff for a charity with ten care homes. The ten homes had initially been run as ten different businesses but, following several changes in the leadership team, we started working towards having one single, corporate approach. To begin with all went well, but then we noticed that new documentation, new processes and ways of working just weren’t sticking and people were referring back to what they had always done. We started performance-managing people, telling them what they had to do and checking that they did it. Around the same time, we started to notice that staff turnover was increasing and it was becoming harder to recruit new staff; a few months on, we noticed that turnover among new starters was a large part of our turnover problem and, in the homes where staff turnover was at its worst, we were also increasingly having problems with occupancy too. It was then that I started to join the dots and created the first draft of what became my Care Culture Spiral model.

PEOPLE PROFILES Let’s start by looking at the type of people who are drawn to working in care; none of us is here for the money! People are drawn to care as a vocation – they work in care because they care; they’re also probably caring for children, older parents and/or neighbours as well as being the go-to person for tea and sympathy amongst their friends and family. Very simply, they are prone to put themselves last. They’re also likely to be a Green personality type on the Insights Colour Wheel, who want to be

liked, to maintain harmony and who fear confrontation. If this isn’t true for you, then it’s likely to be true for the majority of people who form your senior team. When under pressure, these people tend to just work harder or longer because they don’t want to let anyone down and, because they put themselves last, they end up on the road to burnout. The road to burnout can be long and winding and, if you don’t stop and take care of yourself, the destination is inevitable. As a manager on that road, it’s very easy to slip into the parent/child ego state rather than adult/adult (Transactional Analysis, Eric Berne), which leads to a range of communication problems including the Drama Triangle (Stephen Karpman), where we switch between the roles of persecutor, victim and rescuer. Before we realise it, we’ve developed a dictatorial leadership style that relies on employees following instructions and, without realising, we’re disempowering staff from making their own decisions – what did you want me to do with Mrs Smith? Do I need to do this with Mr Jones? Ever felt like your staff don’t think for themselves? Maybe we’ve left them with no alternative but to ask questions; remember, these are Green people who want to please you by getting it right. They want to avoid the conflict that occurs when they get it wrong and they don’t want to be blamed. If this doesn’t sound like somewhere you’d want to work, then it’s no surprise that some staff won’t stay. Some will stay, though, and they’ll fit into two groups: your best staff who are staying because they love the people they are caring for and are staying for

CMM October 2021

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STUCK IN THE SPIRAL: HOW TO AVOID TOXIC WORKPLACE CULTURES

them, and your worst staff who are staying because it’s less hassle than trying to get a new job. However, you have been able to recruit, so I’m sure it will be OK, except those new recruits are being pulled from pillar to post working the shifts your existing staff don’t want to cover. Or they’re being pushed from household to household and not getting the chance to form relationships with people, staff and residents alike. Or they’re working alongside your worst staff who are watching your new recruits implement their learning from induction training only to tell them, ‘That’s not how we do it here!’ So, your new Green recruits who want to be liked and want to do the right thing have a choice: 1) conform to bad habits, 2) report their new team mates, 3) get their head down and ignore it or 4) leave. You’re now seeing an increase in new staff turnover, too.

CRACKS BEGIN TO SHOW With gaps in the roster, you have no choice but to fill with agency staff unless you ask your best Green staff to work harder and longer, which they will do of course because they love the people they care for and want to please you. However, they can’t cover everything and so standards start to become inconsistent. Because our senior people are predominately Green too, they avoid having difficult conversations with the staff who are responsible for poorer standards and, by default, the team has started to tolerate the poorer standards, as they feel there is no point in reporting them as nothing gets done, unless it’s something that can’t be ignored. Inevitably, a medication error or other omission will be identified. You’ll investigate and it is everyone's fault but no one will take personal accountability for their part. We’ve now got a not insignificant number of staff who have fallen into bad habits; who don’t like working with new staff because they are too slow; who form cliques and gossip; who don’t take personal responsibility and

who stay with you because they get to have a laugh with their mates (because somehow, they are always rostered and allocated together). They are supported by a group of Green followers, who want to be liked by their colleagues so tolerate their bitching and bad habits. Maybe they’ve been tolerating other undesirable behaviours too, because now you’ve had an increase in reportable incidents, potential safeguarding issues and disciplinaries. Meanwhile, your best staff continue to work harder and longer.

RECOGNISING THE SIGNS And so starts the spiral, with standards, tolerance and behaviours becoming increasingly toxic. And that’s before COVID-19. Because of the nature of people who choose to work in care, combined with chronic underfunding and the lack of leadership development, I believe the sector has always been a ripe breeding ground for overwhelmed home managers and a propensity to spiral towards a toxic culture. COVID-19 has just sped up the process.

STUCK IN THE SPIRAL? Here are some steps you can take to reverse it: 1. Go back and get some organisational clarity – revisit and review your mission, vision, values and behaviours. Ensure that your business strategy outlines the steps you are taking towards the vision, when and how, and support this with organisational objectives and goals that measure your progress in delivering your strategy. 2. Ensure your key people are aligned behind this strategy, that they all agree that the priorities you are working on are absolutely the right priorities to be focusing on now to take you the next step closer to your vision. You need to be confident that your key people will give the same response, regardless of whether you are within earshot or not.

3. Create safe places using some team conditions – your staff know what the problems are and how to resolve them; ensure they have the opportunity to tell you (and others who need to know) by creating some rules around how you will communicate with each other. Some examples of team conditions include: a. Listen openly. b. Speak honestly. c. Trust the intent. d. One team, one goal. e. If you say it, do it. It’s up to you and your teams to agree what conditions you need in your workplace, what those conditions look like in practice and how you will hold each other to account when the conditions aren’t being adhered to. A great place to start for team conditions is The Collaborative Way. 4. Identify and address hot spots – bring your mixed teams together to discuss what works and what doesn’t within the home. It’s essential to practise the team conditions during these discussions, to role model the behaviours and values you expect and to support, encourage and remind those who don’t. 5. Invest in leadership and personal development – your leaders are not always people in a position of authority but they will always be role models. Focus your leadership development on softer skills like communication, having a growth mindset and role-modelling behaviours that are aligned with values. Create sessions on a sliding scale for everyone, from yourself through to front-line staff. Don’t underestimate the importance of following the steps in order; you can’t align your key people behind a strategy that is not clear and you can’t expect your team to engage in constructive debate if you’ve not set some ground rules. CMM

Cath Dixon is an independent HR specialist working in the social care sector. If you think your home has spiralled into a toxic culture, then Cath is available to support you with a culture change programme to reverse the spiral. Email: cath@valueinpeople.co.uk Do you recognise some of the behaviours and cultures discussed? Visit www.caremanagementmatters.co.uk and share your feedback on the article. CMM October 2021

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GREEN DESIGN: Sustainable development for the care sector We are living in a climate emergency. What action should care providers take? Danny Sharpe, Co-founder and Director of Northstar, a Specialist Care Home Planning, Design and Project Management consultancy, explains the benefits of sustainable design for the care sector.

The care home industry has traditionally been fairly good at embracing new technologies, including those designed to reduce energy consumption. This has historically been due, in equal part, to the financial benefits on the one hand and statutory requirements on the other: so, part carrot and part stick. As might be expected of the owner of any building which needs to be kept warm and well lit, care home operators have sought ways to reduce their heating and

CMM October 2021

GREEN DESIGN: SUSTAINABLE DEVELOPMENT FOR THE CARE SECTOR

lighting bills while, at the same time, local planning authorities have insisted that all large, new developments must provide at least 15% of their energy needs from renewable sources. In the past, we have been able to satisfy both drivers by, for example, designing in heat recovery systems which capture the excess heat from en-suite showers, using this to warm fresh air from the outside and then re-circulating it along communal corridors. This meant less energy was required to heat the home and a constant stream of warm, fresh air circulated throughout the building. By adding a couple of solar panels to the roof to help heat the water to the assisted baths, we comfortably met the 15% requirement and everyone was happy. The care operators could see the benefit because their heating bills were reduced and the planners were happy that it generated some renewable energy.

CLIMATE CRISIS However, now that we understand the scale of the climate change crisis facing us, this 15% renewables target looks woefully inadequate. The World Green Building Council (WorldGBC) reports that buildings are currently responsible for 39% of all global carbon emissions.

“Anyone now looking to commission a new care home building needs to take account of these targets and make sure their building will be ‘future proofed.” 11% of these emissions come from so-called ‘embodied carbon’ – that is the emissions which result from the manufacturing, transportation, construction and end of life phases of a building. The remaining 28% is made up of ‘operational carbon’ or emissions due to heating, lighting and powering our buildings. These emissions trap heat in the atmosphere and prevent it from leaking out into space as part of the earth’s natural cooling system. As the planet heats up, climate change brings more floods, rising sea levels, coastal erosion, forest fires, drought and crop failures leading to food shortages. The UK Government has made a commitment to tackling climate change and is hosting the COP 26 Summit in November of this year. The Government has also announced a target for net zero carbon emissions by 2050 and plans a 68% reduction in greenhouse gas emissions by 2030, when compared to 1990 levels – a rate faster than any other major economy. Anyone now looking to commission a new care home building needs to take account of these targets and make sure their building will be ‘future proofed’ and in line with both embodied carbon emissions during construction and operational carbon emissions during the running of the building. The problem comes in that meeting these new 42

CMM October 2021

standards will require care home developers and operators to buy into a longer ‘payback’ time. What Bill Gates refers to as the ‘Green Premium’ in his book How to Avoid a Climate Disaster is the difference between the cost of carbon-emitting processes and those of zero-carbon alternatives. For example, it is much more expensive initially to install an air source heat pump (ASHP), as opposed to a traditional gas boiler running off mains gas. However, the ASHP will pay for itself after about seven or eight years due to its lower running costs. So, in the long run, it is cheaper to have this cleaner energy source. In the same way, it might take up to 17 or 18 years for solar panels to pay for themselves but, in an industry where the normal commercial lease term is 35 years, this still works out eventually. It needs a change of mindset on the part of those procuring new buildings to realise that this is no longer an ‘either/or’ debate. Fossil fuels, which took millions of years to form, have been used so extensively over the past 200 years that they are due to run out within the next 40 or so years.

INVESTOR APPEAL The smart care home operators and developers are already taking this into account when commissioning new buildings. Whilst capital costs will be higher initially, the payback period is getting shorter, as evidenced through lower running costs and lower maintenance bills. Having a future-proofed building also gives peace of mind, as these new targets for lower emissions get nearer and nearer. Investors are increasingly looking for buildings that have solid green credentials to enable them to get into new, emerging technologies but also to invest in the type of socially responsible projects their shareholders are increasingly demanding – the added commercial benefit being that they will also meet future standards without a lot of retro-fitting being needed as legislation tightens up.

LEADING THE WAY We recently designed an 80-bed care home for Cornerstone Healthcare Group in Bristol, which has been designed to the highest standard set by the Building Research Establishment Environmental Assessment Method (BREEAM). At concept design stage, we began by orientating the new building to maximise sunlight and daylight to reduce the amount of energy needed for heating during the day. The day rooms and majority of bedrooms have a south and west aspect, whilst the car parking and back of house functions are located on the north-facing side. In developing the designs, we set high standards for the thermal efficiency of the building far in excess of building regulation standards. In other words, the building would use less energy as it would retain heat in the winter and stay cool in the summer for longer. Once we had reduced the amount of non-renewable, fossil fuel energy needed to heat and cool the building, we looked at installing Solar Photovoltaics on the roof to generate electricity, as well as installing ASHPs to work alongside a high-efficiency, gas-fired boiler plant. We then had a Materials Life Cycle assessment carried out. This looked at a range of options for the superstructure

CMM October 2021

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