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

NOVEMBER 2021

www.caremanagementmatters.co.uk

DIGITAL DISCOVERIES

The role of technology in dementia care

People first

Why we must continue to deliver engaging activities

Attracting talent

Why age is no barrier to a career in care

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In this issue 05

Skills for Care Oonagh Smith steps in for CQC this month and outlines the findings from Skills for Care's latest report.

CMM News

Into Perspective Our experts comment on the easing of visiting restrictions for care home residents and the changing guidance during the pandemic.

Celebrating Excellence Music for Dementia won the Dementia Care Award at the Markel 3rd Sector Care Awards 2020.

Event Review CMM reviews the Institute of Health and Social Care Management (IHSCM) virtual conference. We share a round-up of the event’s key themes.

Straight Talk The Associated Retirement Community Operators (ARCO) outlines its latest calls to Government and explains why the housing with care sector must be clearly defined in what it stands for.

FEATURES

REGULARS

Social Care Insights Simon Bottery of The King’s Fund says the Government’s reform proposals, while worthwhile, largely ignore the lessons of COVID-19 for adult social care.

Digital discoveries: Reshaping the future of dementia care Jonathan Papworth of Person Centred Software shares how the sector is embracing digital innovation to support people living with dementia in care and Imperial College London signposts to latest research.

Attracting talent: Why age is no barrier to a career in care The care sector is facing monumental workforce pressures. Paterson recruitment offers its tips for attracting generation Z and notes what else providers should be considering.

Close inspection: Has CQC been giving lower ratings? Mike Short, Director of CSI Intelligence, has been collating reports on CQC inspections for some time. In this article, Mike shares his analysis on the latest inspections and offers his interpretation of the findings.

Resource finder CMM brings you information on some of the leading organisations to help you with your legal matters.

People first: Why we must continue to deliver experiences and activities Restrictions may have eased outside of care homes but some providers are reviewing their approach to activities cautiously. Geoffrey Cox, Managing Director at Southern Healthcare, explains why we must continue to offer engaging experiences. CMM November 2021

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

CONTRIBUTORS

PRODUCTION Lead Designer: Ruth Keating Graphic Designer: Kieran Bitten 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

@oonaghsmyth

@jonpapworth

@patersonhc

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

Oonagh Smyth CEO, Skills for Care

Jonathan Papworth Co-Founder and Director, Person Centred Software

Julia O’Connor

@AnchorLaterLife

@relresuk

@CSIMarketIntel

@geoffreydcox

Cath Holmes Director of Care Quality, Anchor

Judy Downey Chair, The Relatives & Residents Association

Mike Short Director, CSI Intelligence

Geoffrey Cox MD, Southern Healthcare

Managing Director, Patterson Recruitment

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 18.8

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Grace Meadows Programme Director, Music for Dementia

Michael Voges Executive Director, ARCO

SOCIAL CARE

INSIGHTS From Simon Bottery

Simon Bottery says the Government’s reform proposals, while worthwhile, largely ignore the lessons of COVID-19 for adult social care. Around 2BC (that is, two years before COVID-19), The King’s Fund published some analysis of the state of social care under the relatively provocative title ‘What’s your problem, social care?’. It concluded that there were eight fundamental problems: a restrictive means test; catastrophic costs (people selling their homes to pay for care); unmet need for care; uneven quality of care; the workforce (poor pay and high vacancies); provider market fragility; lack of integration with health and other partners; and variation in local authority provision (the ‘postcode lottery’). When COVID-19 struck, we updated the analysis to consider

the impact of the pandemic on those problems. In most cases, we argued, the pandemic had made things worse. The two main exceptions were the means test and catastrophic costs: though these remained problems, COVID-19 had made little difference to them. Scroll forward to September and the Government outlined its proposals for reform of adult social care. With a roll of drums, the reforms were revealed to focus on ... the means test and catastrophic costs. It was almost as if COVID-19 hadn’t happened. ‘Almost.’ To be fair to the Government, there were nods to other issues in the reforms.

The biggest of these was around workforce, where £500m was pledged over three years for wellbeing support and training. Yet there was nothing about workforce pay and, indeed, the immediate impact of the new health and care National Insurance levy will make many care workers worse off, not better. You could also, at a push, argue that, in making the means test more generous, the Government was tackling unmet need. Yet the promise that 75,000 might benefit from this measure – when estimates of unmet need for older people alone stand at 1.6 million – suggests that its impact will be modest.

The Government might also point to the money it has channelled to social care providers through the Infection Control Fund as evidence of its intent to improve provider fragility. Yet, while this has worked in the short term, the longer-term reform proposals announced in September actually run the risk of destablising the market even further. That’s because a mooted ‘fair price of care’ reform would reduce or eliminate the self-funder subsidy that many care home providers rely on to survive. It is true that the Government has begun to address two of the other problems on our initial list – variation in local authority provision and lack of integration – through the health and care bill currently working its way through parliament. This will give the CQC oversight of local authority social care commissioning and, through the formalisation of integrated care systems, aims to join up health and care provision more effectively. Still, when you consider the overall balance sheet, it’s clear that the reforms are rooted in the urge to deliver on the promise of the 2019 manifesto – that no one needing care has to sell their home to pay for it – rather than the realities of social care in the wake of the pandemic. That’s a gaping omission that will need tackling in the promised social care white paper by the end of this year and in the long-term financial settlement for local Government.

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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I write this column as our Workforce Intelligence Team crosses the t’s and dots the i’s on the release of our 2021 ‘The State of the Adult Social Care Sector and Workforce in England’ report. Our annual report provides a deep insight into the current state of the adult social care workforce, looking at vacancy rates, job roles, demographics, trends and forecasts. This year’s report has found that the number of filled job posts within the sector has fallen for the first time on record. At the same time, vacancy rates are increasing; our data shows we have an average of 105,000 jobs advertised in the sector on any given day. As of August 2021, vacancy rates are now higher than pre-pandemic levels. Turnover rates also remain high at 28.5%. While turnover decreased during the pandemic, employers tell us that, as of March this year, retention has become increasingly challenging in a very competitive employment market. To help the sector address this issue, we are spotlighting information and resources for retaining staff with our #RetainToGain activity throughout October and November. While an increase in vacancy rates may appear disheartening, it is also an opportunity for the sector – an opportunity for new people to build a fulfilling career within our sector and bring their skills and passion to support people to live the lives they want in our communities. That is why we must focus on attracting new people to the sector. We need to showcase the opportunity to build a long-term career in social care, to become a part of a skilled workforce, and to provide personalised care to the people who draw on it. We must also work to increase public recognition and appreciation for the skills of the social care workforce and the vital support they provide. And we must ensure our social care workforce is valued, supported and compensated accordingly for the important work that it does. That’s part of our three-year strategy, which we launched recently. Another opportunity presented from the latest report is to make the social care a sector committed to equality for people from diverse backgrounds. Our data shows us that 21% of the social care workforce is from diverse backgrounds, yet only 15% hold senior roles.

SKILLS FOR CARE REFLECTS ON WORKFORCE Oonagh Smyth, CEO of Skills for Care, says its latest report shows critical opportunity to value, develop and reward our social care workforce.

We must continue to strive to make the sector an inclusive place to work at all levels and we need to take proactive steps to increase diversity at the top level, like our Moving Up programme for leaders with diverse backgrounds. We can see that the way in which people draw on care is continuing to shift towards home care. Job roles in domiciliary care services increased by 7.4% – or 40,000 jobs – in 2020/21. People who draw on care services say they want to live in a place they call home and we need to ensure the promised reform of social care recognises this desire, enabling people to draw on care in the way that works best for them. The national living wage (NLW) has meant a 6% increase in the median nominal care worker hourly rate from March 2020 to March 2021. However, our data also shows care workers with at least five years’ experience in the sector are paid just 6p more per hour than care workers with less than one year of experience. Our recent ‘Value of Adult Social Care

in England’ report found that social care is a growing market, currently contributing £50.3 billion to the English economy. One of its recommendations was that we need to properly reward and value care workers for their high skill levels and dedication. This latest version of our annual ‘The State of the Adult Social Care Sector and Workforce’ report has highlighted the pressures our social care workforce is currently facing and how this has been exacerbated by the pandemic. It also shows us how we can grow, and what is needed to reward and recognise our dedicated workforce and to attract new talent to the sector, to allow people to live their lives in the way that they want now and in the future. And none of this would be possible without the 20,000 social care organisations that share their data with our Adult Social Care Workforce Data Set (ASCWDS) to make this report and the insights it offers possible, and we thank them for continuing to do so right through the worst of the pandemic.

Oonagh Smyth is CEO of Skills for Care. Email: information.team@skillsforcare.org.uk Twitter: @oonaghsmyth

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NEWS

APPOINTMENTS HOUSING SECRETARY

COVID-19 lessons learnt report published The House of Commons and Science and Technology Committee and Health and Social Care Committee have published their report, ‘Coronavirus: Lessons learned to date, examining the initial UK response to the COVID pandemic’. The 150-page report contains 38 recommendations to the Government and public bodies and draws on evidence from over 50 witnesses. The inquiry concluded that some initiatives were examples of global best practice but others represented mistakes. Both must be reflected on to ensure that lessons are applied to better inform future responses to emergencies. In particular: • The forward-planning, agility and decisive organisation of

the vaccine development and deployment effort will save millions of lives globally and should be a guide to future Government practice. • The delays in establishing an adequate test, trace and isolate system hampered efforts to understand and contain the outbreak and it failed in its stated purpose to avoid lockdowns. The initial decision to delay a comprehensive lockdown – despite practice elsewhere in the world – reflected a fatalism about the spread of COVID that should have been robustly challenged at the time. • Social care was not given sufficient priority in the early stages of the pandemic. • The experience of the COVID pandemic underlines the need for

an urgent and long-term strategy to tackle health inequalities. • The UK’s preparedness for a pandemic had been widely acclaimed in advance but performed less well than many other countries in practice. Helen Wildbore, Director of the Relatives and Residents Association, said, ‘The damning report confirms what care users and their families have known all along – the care sector was an afterthought. Older people needing care were failed by the very systems designed to protect them. They were abandoned in the early stages of the pandemic and continue to be left behind today, as the only group still subject to stringent restrictions on their contact with family and friends.'

Additional winter funding for social care The Department of Health and Social Care (DHSC) has announced that it will be extending its financial support for the adult social care sector this winter. The Health and Social Care Secretary Sajid Javid announced that an additional £388.3m will be given to the sector to prevent the spread of infection in social care settings. This additional funding includes £25m to support care workers to access COVID-19 and flu vaccines over the winter months. The DHSC said this will ensure social care staff who need to travel to receive their COVID-19 or flu vaccinations are paid their usual wages to do so and can be supported with travel costs. Continued funding to prevent infection spreading and provide

testing will be delivered through the Infection Control and Testing Fund (ICTF), which was first introduced in May 2020 with an investment of £600m. This funding announcement includes £237m for Infection Control measures and £126.3m for testing costs. To boost flu vaccine uptake among social care staff, GP practices will be able to vaccinate care home staff that are not registered at their practice. The Government will also extend the use of designated settings for people discharged from hospital to a care home with a positive COVID-19 test. The Government has also launched a consultation on extending free PPE beyond March 2022 for health and social care.

Vic Rayner OBE, CEO of the National Care Forum, said, 'At the eleventh hour, the Government has finally announced an extension to the funding for adult social care to support the delivery of care services in a COVID-safe environment. How it expects providers of care to plan and sustain services with the last-minute nature of this extension is a mystery. 'Whilst the £388m funding is welcome, it should be noted that this represents a 23% reduction of equivalent funding provided by the Government in only July of this year, and only a 44% reduction of that provided in April of this year. Yet for care services, nothing has changed in terms of the areas that the fund is intended to support.’

ARCO (The Associated Retirement Community Operators) has welcome Michael Gove as the new Secretary of State for Housing, Community and Local Government. Michael Voges, Executive Director of ARCO, said, ‘Mr Gove will need to draw on all of his reforming instincts to bring about the radical change needed in UK housing delivery.’

IHSCM

The Institute of Health & Social Care (IHSCM) is delighted to announce that Adam Purnell will join the Institute as its new Director of Social Care with effect from 1st November. Adam Purnell has spent his entire working career in social care, starting as a care assistant and working his way up to registered manager. During the last 10 years, he has built strong working relationships both at a local and national level.

ORBIS EDUCATION AND CARE

Orbis Education and Care has appointed Kris Davies in a new role for the organisation, as its Head of Academy Living. Orbis is one of the UK’s leading providers of specialist schools and homes, supporting children and adults with complex needs associated with autism. Kris’s new role will see the organisation build on its existing work to create personal development pathways for young people and adults to identify and progress in vocational and employment opportunities.

GREENSLEEVES CARE

Greensleeves Care has appointed Wendy Westbury to its senior leadership team as Director of Business Development. Wendy will head up a new, broader business development function. CMM November 2021

NEWS

Lockdowns trigger surge in disability hate crime Online disability hate crime soared by more than 50% across England and Wales during 2020/21, according to new figures. This latest police data, gathered by leading disability charities Leonard Cheshire and United Response ahead of Hate Crime Awareness Week, shows a huge spike during a period when much of the population was forced to stay at home during national and regional lockdowns. While there were more than 9,200 individual cases reported to police across England and Wales

in 2020/21, equating to around 25 disability hate crimes a day, just 1% of cases were referred to the Crown Prosecution Service (CPS) or charged. Given these outcomes, it is perhaps little wonder that repeat offender rates for disability hate crime are up by 89% on the previous year's rates. The latest findings also show in-person hate crime still plagued many disabled people’s lives during lockdown. Worryingly, almost half of the disability hate crimes reported last year were ‘violent’ (44%). These included assault and crimes

involving weapons. The charities conducted in-depth consultation with a range of disabled people to find out more about individual experiences of disability hate crime. Cassie from London told the charities, ‘Disability hate crime is uniquely isolating. When a woman pushed me off a ramp and out of my wheelchair, I had no idea what to do. I barely realised my experience was a disability hate crime and, when I did, I had no idea where to turn to for support, if it was worth reporting to the police,

and how the people in my life would react when I told them.’ Leonard Cheshire and United Response said, ‘The Government has a role to play in preventing hate crimes altogether. One of the most important steps in tackling hate crime is creating a more accepting society where differences are tolerated. The Government’s National Disability Strategy promised a disability awareness raising campaign. That should be an opportunity to educate everyone, including young people and those in school, about disability hate crime.’

Right at Home launches campaign to grant residents’ wishes Right at Home, a home care provider that supports adults to live safely and independently in their own homes, has launched a campaign that will see them grant the wishes of ten inspiring home care clients over 12 months. The campaign has been launched

in celebration of Right at Home’s ten-year anniversary and has been nicknamed ‘a tin-full of wishes’. Over the course of a year, caregivers from franchises across the UK will be given the honour of nominating home care clients to be granted a wish.

Working with franchisees, local communities and businesses, Right at Home’s National Office will then choose ten clients to receive an experience that will be remembered forever. Ken Deary, Founder and CEO of Right at Home UK, said, ‘After an

exceptionally difficult year, where many clients have been forced to shield from their loved ones for months on end, we hope this will be an initiative that brings a smile to people’s faces and inspires communities to come together to make dreams come true.’

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Five Nations Care Forum calls for workforce investment In October, the Five Nations Care Forum leaders met for the first time since before the pandemic and reflected on the invaluable role of our care workforce. In Scotland and Wales, care workers have each been given bonuses of £500 or more in recognition of their outstanding commitment during the COVID-19 pandemic. In Northern Ireland, there is a commitment to do the same.

News of the Scottish Government’s announcement on 5th October 2021 that wages of care workers in Scotland will rise from £9.50 per hour to £10.02 per hour, equivalent to Band 2 healthcare assistants in the NHS, was warmly welcomed and heralded as a lead other governments in the UK and Ireland should follow. The Five Nations Care Forum calls on the governments of the UK and Ireland to:

• Fund social care adequately so that care workers are paid fairly for the skilled roles they perform, and at least on a par with equivalent public sector roles. • Support development of an expert-led workforce strategy for social care and a 10-year workforce plan, aligned with the NHS People Plan in the UK. • Recognise current national needs and regional variation in demography and workforce and

explore placing social care on the Shortage Occupation List. • Create a professional register for care workers in England, in line with Scotland, Wales and Northern Ireland. Registration of care workers needs to be adequately funded and carefully implemented. In Ireland, regulation of home care must remain a Government priority and bring better state resourcing for home care workers.

Royal College of Nursing launches wellbeing campaign The Royal College of Nursing (RCN) has launched a winter wellbeing campaign to encourage members to prioritise their own physical and mental health this winter. Winter often sees an increase in a range of infectious diseases – colds and flu, alongside other respiratory infections and gastrointestinal infections including noroviruses. The #winterwellbeing campaign

aims to support members in keeping healthy during the winter months, as new RCN analysis shows NHS staff in England are now more at risk of mental health problems, chest and respiratory problems and migraines than before the pandemic. The range of resources includes advice about the COVID-19 and flu vaccines, as well as mindfulness and

healthy eating guides to support members’ physical and mental wellbeing. Helen Donovan, RCN Professional Lead for Public Health, said, ‘It’s important to take time for yourself and look after your own health this winter. One of the key ways to do that is by having the vaccines you’re eligible for – both for flu and COVID-19. With the

double threat they pose this year, this message is more important than ever. ‘As well as following the campaign’s advice, we’re asking members to please support it, both at work or university, and using social media. Together we can make a real difference that will save lives and protect ourselves, our patients and our families this winter.’

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DHSC publishes mandatory vaccination guidance The Department of Health and Social Care (DHSC) has confirmed that staff asserting a medical exemption can self-certify that they meet the medical exemption criteria and has provided template forms for staff to use. The Government launched a new NHS COVID Pass System on 8th October, which employees are expected to use to evidence their COVID-19 status and apply for a permanent medical exemption.

Who is exempt? While this list is not exhaustive, examples of medical exemptions from COVID-19 vaccination could include individuals: • Receiving end-of-life care where vaccination is not in the individual’s interests. • With learning disabilities or autistic individuals, or with a combination of impairments that result in the same distress, who find vaccination and

testing distressing because of their condition and cannot be achieved through reasonable adjustments such as the provision of an accessible environment. • With medical contraindications to the vaccines, such as severe allergy to all COVID-19 vaccines or their constituents. • Who have had adverse reactions to the first dose (e.g. myocarditis).

Time-limited exemptions will also be available for those with short-term medical conditions (e.g. people receiving hospital care or receiving medication that may interact with the vaccination). A time-limited exemption is also available for pregnant women should they choose to take it. Visit the Government website for the latest updates on the vaccine exemption guidance.

Care worker pay coalition visits Treasury The #BetterPay4SocialCare coalition visited the steps of the HM Treasury on 21st September to shine a light on the rates of pay for care workers. Care workers, people supported by care workers, social care organisations and advocates attended to promote the cause. The recent Government announcement that National Insurance contributions will rise by 1.25% to contribute to social

care could mean that social care workers’ wage packets could be hit even harder. The coalition argues that this makes the need for a fairer wage for social care workers even more pressing. At the time of CMM going to press, 10,000 members of the public have signed the petition calling on Government to ensure all social care workers receive a minimum of the Real Living Wage of £9.50 (£10.85 in London).

#BetterPay4SocialCare coalition members from the Association for Real Change, Mencap Heart of England, SeeAbility, Dimensions, the Brandon Trust and Autism at Kingwood, as well as people supported by these organisations, met on the Treasury steps with banners and other promotional items, including a giant cheque stating the Real Living Wage, to draw attention to the low

salaries of social care workers and drive even more support to the #BetterPay4SocialCare petition. Kate Allen CEO and Philippa Stannard, Fundraising and Communications Manager of Autism at Kingwood, delivered the petition at the Tory Party Conference on Tuesday 5th October. Visit the Kingwood website for more information about the #BetterPay4SocialCare petition.

VODG survey reveals workforce challenges A survey of Voluntary Organisations Disability Group (VODG) members has unearthed stark findings in relation to workforce challenges. Summary of key findings: • Across the 53 organisations that responded to the survey, there were a total of 3,500 first line vacancies – an average of 69 per organisation. • 20% of organisations had more than 100 vacancies. • Workforce was the top priority

for 62% of organisations who responded; for a further 28%, it was a high priority. This means 91% of organisations identified workforce as either their top or a high priority. • More organisations were finding it difficult to recruit than to retain staff. 81% reported finding it difficult or very difficult to recruit staff, compared to 44% who found it difficult or very difficult to retain staff. • 61% of organisations found that

recruitment had got worse since the emergency of the pandemic, while 42% felt staff retention had got worse. When asked whether they were confident in having sufficient staff to deliver current and planned future services, the most common response (43%) was ‘fairly confident’. A further 28% were unsure and 24% were either not very confident or not at all confident.

Dr Rhidian Hughes, Chief Executive of VODG, said, ‘Government’s reform agenda must go a lot further and must include a stronger focus on long-term sustainability of services to meet growing demand, supported by investment in helping the sector to secure a high-quality workforce – one that is grounded in the perception that a career in social care is fulfilling, inspiring and well rewarded.’

Oakland Care commits to going green Local care home provider Oakland Care spent September committing itself to ‘going green’ by hosting multiple events aimed at protecting the environment. On 23rd September, three of

Oakland Care’s homes mobilised volunteers, residents, staff and the public to three different locations for actions aimed at promoting sustainability and protecting the environment.

At Broomfield Park, 10 volunteers from Elsyng House, as well as the Chief Executive and members of Head Office from Oakland Care, came together on a mission to plant trees: 100 trees

were planted in total across the park’s boundaries. An ‘oak tree nursery’ was also established, allowing residents and the public the opportunity to enjoy the growth of the trees. CMM November 2021

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NEWS / IN FOCUS

Not enough psychiatrists to meet demand Record numbers of people need mental health treatment but there aren’t enough psychiatrists to meet demand, the Royal College of Psychiatrists’ 2021 census has revealed. At least 1.5 million people in England are waiting for treatment but a tenth of consultant psychiatrist posts (568 out of 5,317) are not filled. The vacancies are causing some patients to wait 18 weeks or longer for treatment. Official NHS workforce data shows that there are 4,500 full-time consultant psychiatrists for 56.5 million people: one consultant per 12,567. Addictions, eating disorders and child and adolescent psychiatry have the highest

vacancy rates, even though the numbers of those needing support from these specialties are overwhelmingly high. The Royal College of Psychiatrists is calling for an extra 7,000 medical school places on top of the existing 8,000 by 2029 at a total annual cost of £1.73bn. The Royal College of Psychiatrists is also calling on the Government to invest in a further 120 core psychiatry training posts in 2022, to help build a sustainable supply of psychiatrists. It says a long-term plan for growing the psychiatric workforce is needed alongside a multi-year settlement for training and education in order to address the mental health crisis.

Co-production key theme at Housing 21 conference Housing 21’s annual conference took place at the International Convention Centre (ICC) in Birmingham on 9th October. The key question asked at the conference was: ‘Is housing responding to the diverse needs of older people?’ It saw leaders from Stonewall, Birmingham City Council, Sheffield Hallam University and University of Worcester address the issue, as well as housing associations, architects and other organisations from across the sector. Keynote Lord Richard Best OBE, Co-Chair of the All-Party Parliamentary Group (APPG) on Housing and Care for Older People and Affordable Housing Commission Chair, estimated a huge 100k of the 300k new homes target from Government would need to be provided for this age group. Housing 21 Chief Executive Dr Bruce Moore said, ‘As providers, we can no longer assume what people want – and build it – but instead, listen and engage to co-produce. By asking different

communities what they want and working with them, they get peace of mind, safety and security and it means as providers we can prevent problems which can cause real distress, such as loss of dignity, lack of space, disrespect and antisocial behaviour. ‘Inclusivity has to be our goal, because our current and future generations of residents are asking for more – more distinction in the retirement and extra care homes they choose and a better quality of life in the communities in which they live.’ Stonewall Housing Director of Education and Engagement, Tina Wathern, reiterated results from the 2018 HouseProud ‘There’s no place like home’ research, revealing just 1% of more than 600 LGBT people surveyed said they would consider a general needs housing scheme. Putting this in context, up to 75% of older LGBT people live on their own in later life, while 33% of those surveyed had experienced homo-, bi- or transphobia from carers.

IN FOCUS ADASS Survey on care and support

WHAT’S THE STORY? A new rapid survey of Association of Directors of Adult Social Services (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. 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 ARE 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, 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 DID THE EXPERTS SAY? 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.’ CMM November 2021

NEWS

New interactive digital care home game launches A new immersive online game is set to bring home the daily realities of life for elderly people in care. The Digital Home allows players to experience a care home setting from the inside and confronts questions about the state of care in the UK. The experience sees users explore 12 different rooms in a digital care home where they discover films, text information, interactive quizzes and mini

games that immerse the user in the heart of the social care system. In the manager’s office, users find out how care is funded, in the common room they understand how care is delivered, a resident’s room experience gives users an idea of how care feels, the garden gives an insight into the future for care and care in crisis is presented in the first aid room. The Digital Home game is a

collaboration between artists and theatres in the UK and Japan, showing different approaches to social care in the context of care systems ravaged by COVID-19. Christopher Green, the creator of The Digital Home, is an awardwinning writer, experiential theatre maker and performer. Commenting on the new online game, Christopher said, ‘My intention with The Digital Home is to place the audience at the heart of their experience of

being vulnerable. 'We can all use our intellect to comment on how care should be provided in our society, but theatre (and now theatrical gaming, as I’m calling The Digital Home) can get us to experience the tensions between care and control and between care and capitalism through our own fragility. 'It’s that which I hope will urge people to take action on care provision.’

NCF takes over Care Innovation Hub After pausing operations due to COVID-19, the Care Innovation Hub (CIH) was approached by the National Care Forum (NCF) to take over the running of the CIH and the annual challenge on behalf of the whole sector. NCF is dedicated to developing innovation in the

social care and support sector and this is a natural home to drive the CIH into the future. Founded by Alex Ramamurthy (Mirthy), Ben Wilkins (Good Boost), Ashish Goyal (Principle Care Homes) and Ben Allen (Oomph Wellness), and later led by Navin Mayani as

CEO, the Care Innovation Hub was established in 2018 to create a platform for exploration and innovation in the social care sector. NCF Chief Executive Vic Rayner OBE said, ‘This is a great opportunity for NCF. 'We are an organisation

that has shown leadership in transformation across the care and support sector as Co-Chair of the Government Digital Advisory Group, strategic leaders in Digital Social Care and engaged in a range of transformation agendas around data, housing, workforce, and wellbeing.’

“Changing the Culture of Care” The Eden Alternative is a training & culture development programme, designed to eradicate loneliness, helplessness and boredom in care homes, through building loving companionship, developing care ‘partnerships’ and enhancing wellbeing – through maintaining vibrancy, spontaneous meaningful activity & close relationships. Eden’s flagship programme runs online over 7 x 1 hr weekly sessions, aiming to train and develop 10% or more of a Home’s staff – some of whom will likely become Eden in-house trainers themselves. The programme is designed to enhance the fulfilment of the Home’s staff, the team ethic and underpin the Home’s values. It is also designed to empower residents, support residents own family members and build the Homes reputation.

It’s common sense • It’s empowering people • It’s focussed on leadership

Call today on 01626 868192 or visit www.eden-alternative.co.uk 16

CMM November 2021

NEWS

Home care MD launches app for wellbeing of carers

Wheelchair user to complete charity marathon

Dan Archer, Managing Director of Visiting Angels UK, has utilised his years of experience to launch a new initiative that promises to relieve the emotional pressure felt by care workers in the wake of the pandemic. AngelCare is a caregiver welfare programme that equips care workers with unlimited access to counselling, wellbeing and peer-to-peer resources. The new resource has been devised with the support of Psychiatric Consultant and Mental Health Specialist Ishbel Straker. Caregivers can access the free resources at any time, which range from group therapy sessions to unlimited access to grief therapy – following the loss of a client – and advice on living a healthy and balanced lifestyle. AngelCare also encompasses a smartphone app that allows caregivers to anonymously speak with other

Chris Long, a wheelchair user with cerebral palsy and a customer of Bluebird Care Exeter, is spending October fundraising for Hospiscare, by partaking in its marathon in a month event. He was inspired to take part after seeing a poster on Exeter’s Quayside during one of his regular outings with his Bluebird Care Exeter Care Assistant. He told the Care Assistant that he would love to take part and signed up. Chris’s mission is a challenging one. During October, participants must cover 26.2 miles, in their own way and at their own pace. Everyone who completes the marathon will receive a zero-waste Hospiscare medal and each participant is asked to raise a minimum fee of £60 in sponsorship to support the care

caregivers around the nation about their own experiences, sharing a virtual hug and words of encouragement and support. The new initiative, exclusive to Visiting Angels, was unveiled at the brand’s national conference in August and is currently being piloted at the first UK office, based in Sheffield. The smartphone app and supportive materials will then be made available to all 20 offices from December this year. Dan said, ‘What’s crucial to us is that the people within our network, whether that’s our franchisees, support staff or caregivers, feel supported during what is still proving to be an unsettling period. We’re very much looking forward to receiving feedback from our network and to witnessing the positive change AngelCare will make for years to come.’

of people living with a terminal illness across Devon. Talking about his inspiration, Chris said, ‘Five years ago, I lost my mother to cancer. Although she did not use the Hospiscare service, I am grateful that the service was there had she needed it. 'So, for my Mum and all the people like her, I am undertaking this marathon in a month to ensure that Hospiscare remains available in the south west.’ His greatest challenge? The weather, he thinks. 'I don’t like the rain', said Chris. 'The wind and the rain. However, I am looking forward to future fundraising opportunities and getting more people involved each day. 'One day, I would like to create a huge conga line for Hospiscare and get more and more people involved every day!'

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NEWS

LGSCO publishes annual review of complaints The Local Government and Social Care Ombudsman (LGSCO) has published its annual review of adult social care complaints. The LGSCO outlines the following emerging trends in its report: • Delayed assessments preventing timely discharge from hospital and moves between providers. • Poor communication between hospitals and care homes both working in crisis conditions. • Care settings and councils being inflexible and failing to

properly communicate access to and availability of services, particularly when lockdown rules changed. • Care providers failing to manage risk appropriately, for example, around the use of PPE and with symptomatic staff. • Prolonged delays in accessing occupational therapy services and assessment and provision of aides and adaptations. In general, LGSCO found care homes applied visiting rules

appropriately. The Ombudsman’s Annual Review of Adult Social Care Complaints has revealed the following key findings: • In 2020-21, the Ombudsman received 2,033 complaints and enquiries about adult social care. • This included 270 about independent care providers, where the person arranged and paid for their own care. • That it is investigating a greater proportion of complaints than previous years

– and finding fault on average in 66% of cases. • In some casework areas – including those about fees and charging for care – the Ombudsman has upheld nearly three quarters of investigations (73%). • The uphold rate has increased from 43% to 66%. Despite this, the volume of complaints the Ombudsman received from people who pay for their care is still lower than the LGSCO would expect.

New supported living service opens A new service that will help to nurture the independence of up to seven individuals with additional needs has opened in Liverpool. The service was opened by Affinity Supporting People in collaboration with private equity firm Henley, First Priority Housing Association (FPHA) and Liverpool City Council Commissioning Team. Affinity Supporting People

is a National Care Group service that provides care and support to vulnerable adults with learning difficulties, in environments tailored to help them unlock their potential and live fulfilling lives. The leafy suburban property has benefitted from a complete renovation across three floors with modern and accessible communal areas. Two of the supported living

units have kitchenettes to afford the individuals living there some additional independence. The new facility in Brompton Avenue will provide a space for the people it supports to gain skills in living independently with the help of an expert caring team. Mike Ranson, Commercial Director at National Care Group said, ‘Many adults with learning

disabilities, autism and mental health problems are struggling to access services that meet their needs, remaining on long waiting lists with limited access to housing options. 'Therefore, we’re proud to be able to provide an answer to this crisis and care for individuals with a range of needs in a tailored environment that will help them to unlock their full potential.’

Care workers star in recruitment campaign Care workers are the stars of an exciting new ‘You care, so do we’ recruitment and retention campaign for leading independent care provider Agincare. Agincare developed the campaign after listening and learning from its teams as part

of a comprehensive review into how it hires, develops and cares for its people. It comes against the backdrop of the COVID-19 pandemic and care worker shortage and focuses on recruitment plus support, development and recognition

of Agincare’s incredible workforce across the country. The plan launches with a major recruitment marketing campaign which saw care workers come together at a studio in Bournemouth to film a promotional video, which features online and as an advert

on Sky TV. Head of Customer Relations Jamie Powell, said, ‘We want to not only welcome lots of new recruits with a passion for caring, but continue to build a great workplace experience where every team member can flourish and grow their career.’

First graduates complete Sanctuary Care’s Nursing Apprenticeship The first apprentices have graduated through Sanctuary Care’s Nursing Associate Apprenticeship Programme. The apprentices have been studying for their qualifications 18

CMM November 2021

for two years while gaining work experience at Sanctuary Care’s Greenslades Nursing Home in Exeter and Furzehatt Residential and Nursing Home in Plymouth. Educational modules completed

by the trio as part of their qualifications include medicines management, promoting public health and preventing ill health, team working and leadership, improving patient safety and

quality of care through research. The graduates will now be registered with the Nursing and Midwifery Council and will move into permanent roles as nursing associates at their care homes.

CMM November 2021

HEADER

DIGITAL DISCOVERIES:

Reshaping the future of dementia care

In this article, Jonathan Papworth of Person Centred Software explains how continually evolving technological advancements are reshaping the future of social care for people with dementia.

According to the Alzheimer’s Society, there are currently around 850,000 people living with dementia in the UK. However, this is projected to rise to 1.6 million by 2040. With about 70% of care home residents living with dementia, care providers are continuously looking for ways to adapt to the expected rise in numbers, so that caregivers can continue delivering the best dementia care possible. One solution is technology. After all, technology is constantly improving, making it one of many reasons why care providers continue to implement innovative solutions to 20

CMM November 2021

improve their quality of care. For example, digital care technology that can be integrated into care homes and utilised to help support dementia care is a key technological area of development. Personcentred digital solutions, which detail what is important to each individual and their preferred care plan, are proving to be a powerful tool for staff when caring for those living with dementia. By utilising these agile and innovative advancements, care environments have been able to implement and integrate software that empowers staff to provide a more responsive

HEADER and personalised quality of dementia care to improve residents’ quality of life.

DIGITAL COMFORT By empowering caregivers with information on a person’s past life story, hobbies and fears, they have the tools to draw upon and address crucial situations to adequately comfort someone living with dementia. For example, if a care home resident with dementia experiences anxiety, there are digital tools that can provide information, such as that person’s favourite song/book, which can be used as a tool to help calm them and aid with reminiscing – a core focus for someone with dementia. Agitation in people with dementia can be due to many reasons, such as pain or discomfort, medical reasons such as side effects of a medicine, communication problems and environment. Researchers at Imperial College London published research1 that discusses a model for analysing the risk of agitation in people with dementia and how in-home monitoring data can support them. Researchers proposed a semi-supervised model which combines a self-supervised learning model and a Bayesian ensemble classification. Digital care management systems are also becoming the hub of all information that disparate technologies create, informing care providers of everything they need in a single application. Caregivers are now able to access an array of information about a resident living with dementia from the palm of their hand, as well as evidence assessments at the point of delivery. Specialist functions, such as our ‘Who I Am’ feature, can utilise an assessment plan, capturing all kinds of information about the resident. For example, whether they have any cognitive impairments. This allows care staff to provide a person-centred care plan and pathway. It notifies care staff and those in a social care setting who interact with individuals living with dementia how they should treat and communicate with them. Of course, dementia is a complex condition and no two people living with dementia are the same.

PERSONALISATION IS KEY Therefore, care homes should provide staff with personalised insight into each individual's condition and care needs, rather than putting everyone in the same dementia ‘box’, which isn’t helpful, practical or ethical. These care documents contain a great deal of information that makes up an individual and, more importantly, should include key elements about a person’s life such as hobbies, fears, past careers and even what they like to talk about.

CMM November 2021

OVER 2.1 MILLION ISSUED IN GRANTS DURING 2020 TO CARE WORKERS IN NEED! Knowing someone is there to help can be just the lifeline needed. This is why we will never stop. We are now raising funds for our new Mental Health Grants appeal. Research shows that the mental health of care and support workers was suffering before the coronavirus existed. Since then, social care workers have experienced challenges that most of us cannot even imagine. The toll on mental health is massive. THIS IS WHY THE CARE WORKERS’ CHARITY IS WORKING ON CREATING A MENTAL HEALTH GRANT STREAM AND WE NEED YOUR HELP TO RAISE FUNDS FOR IT.

HELP US, PLEASE DONATE TO MAKE A DIFFERENCE TODAY.

https://thecareworkerscharity.enthuse.com/cf/mental-health-appeal Anyone looking to learn more why not book an information session about the work we do and the grants available. Email to book your session here info@thecwc.org.uk 22

CMM November 2021

DIGITAL DISCOVERIES: RESHAPING THE FUTURE OF DEMENTIA CARE

Good digital dementia care technology serves as a portal into the life of the individual, allowing care staff to extract information to connect with the person on a meaningful level and offer the utmost care they require. Care staff no longer need to waste time physically searching for information about an individual that has been filed away in a cupboard somewhere. The information is always and instantly accessible, helping to improve the quality of care through saved time and boosted productivity. Ultimately, when on-boarding a resident with dementia and even those without, you want to capture their life story to identify what makes them unique. By using technology to document their life events, mental state and wishes for future care, digital care plans will naturally be more comprehensive and therefore instrumental to both the individual and the care provider.

PROFILE-BUILDING SOFTWARE Care technology can also be used to build a profile on someone’s life that care staff can use to help interact with residents in a way that is comfortable and person-centred to them. Similar to the Alzheimer Society’s ‘This is Me’ tool, profile-building software can be utilised to improve the quality of information about a person’s life while also making it possible to easily access critical information when it is most needed. Features around personal behavioural support plans are also beneficial, providing a greater understanding for the carer to determine how the resident behaves on a good day and, in contrast, what makes them feel sad or anxious. Keeping a record of these behaviours empowers care staff to make swift and better interventions. The simple advantage of having access to a person’s favourite poem, for instance, could make all the difference in calming them down or cheering them up when they are agitated or upset. Furthermore, when individuals with dementia start to experience cognitive decline, they may struggle to express themselves. This is where digital care systems can also provide the carer with access to any wishes or concerns the individual may have noted when first joining the care environment. These could be anything from religious beliefs to culture to wishes for the future. Jasmine McFetters, a carer at Bernhard

Baron Cottages, has embraced technology in her approach and said, ‘We have a resident that has mental health issues and suffers with anxiety. There’s a prayer that she likes to read when she’s anxious. It’s really good to have that information available for all staff under the “What makes me feel better if I’m anxious or upset?” section of the “Who I Am” feature.’ It is now possible for carers to interact with residents living with dementia without needing to try and extract information from them. This can be an uncomfortable and daunting experience for the individual if they cannot recognise the face in front of them.

CQC COMPLIANT Subsequently, by creating a holistic, person-centred profile that gives staff immediate insight into how best to support people with dementia, they are also complying with CQC’s Key Lines of Enquiry (KLOEs): notably, the KLOEs C1.4 which asks, ‘Do staff know and respect the people they are caring for and supporting, including their preferences, personal histories, backgrounds, and potential?’, and R1.2 which asks, ‘How does the service make sure that a person’s care plan fully reflects their physical, mental, emotional and social needs …?’.

JOINED-UP CARE In the short term, digital care management systems have only had around a 30% uptake in the industry. Innovative digital care systems that evidence care at the point of delivery are going to be the one thing that picks up in the next year before IOT solutions become more widely available. Furthermore, digital care plans align with joined-up care, or interoperability, helping to connect health and social care in the interests of individuals’ quality of care. We are transferring that information digitally now with the NHS National Record Locator and this means that someone in an ambulance service or someone in hospital will see the ‘Who I Am’ function as part of that hospital case file, to help them know and understand that individual.

RESEARCH PROJECTS Payam Barnaghi is Chair in Machine Intelligence Applied to Medicine in the Department of Brain Sciences at Imperial College London. Payam’s

team has developed a digital platform to collect and analyse in-home data to support people with dementia. People with dementia are at increased risk of adverse medical events (e.g., infections and falls). These often cause clinical deterioration and potentially preventable admissions. Remote home monitoring of vital signs using internet-ofthings technology can identify risk factors for these events – something particularly pertinent during the COVID-19 pandemic.2 Further afield, there is a product in France that is worn as a watch but contains technology that can detect if the wearer has had a fall, with its primary benefit being to allow people to have more freedom. Another company based in Australia is using AI technology to identify the level of pain someone living with dementia is in. The aim is to reduce behavioural suppressant medication for people who are showing signs of challenging behaviour when it is caused by pain they cannot communicate. Cognetivity Neurosciences' five-minute test – the Integrated Cognitive Assessment or ICA – asks patients to respond to 100 images as the images appear on an iPad in rapid succession and to then select each image that contains an animal. The speed and accuracy data of responses is then analysed via an AI and the user's risk of having early signs of cognitive decline is established with a previously unattainable level of accuracy. Cognetivity’s iPad-administered test has recently been validated via a peer-reviewed paper as being exceptionally sensitive to elusive early-stage dementia, which allows care teams to identify when certain interventions may be needed and ensure members receive an appropriate, best-in-class care plan at the earliest possible stage. The ICA supports the whole patient journey, from the screening of atrisk individuals and assessment during the diagnostic process to longer-term monitoring. Ultimately, if we are to raise awareness and reduce the stigma that has persisted around dementia for far too long, then the adoption of technology is a necessary step to achieving such a utopia. CMM References 1. https://arxiv.org/abs/2105.10398 2. https://alz.confex.com/alz/2021/ meetingapp.cgi/Paper/55151

Jonathan Papworth is the Co-Founder and Director of Person Centred Software. Email: hello@personcentredsoftware.com Web: www.personcentredsoftware.com Twitter: @PersonCentredSW Which apps and types of technology has your care setting implemented? Visit www.caremanagementmatters.co.uk and share your feedback on the feature. CMM November 2021

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: T N E L A T G N ATTRACTI

a re c n i r e e r a c a i e r to r r a b o n s i e g W hy a The care sector is in the midst of a serious staffing crisis. Julia O’Connor, a recruitment specialist at Paterson Group, explains how you should keep an open mind in your recruitment process.

Looking ahead to what’s on the horizon, it feels as though things are going to get worse before they get better. One factor is the Government’s furlough scheme ending in September. The ending of the scheme will mean workers who had taken up social care roles while their long-term careers were on hold, are likely to leave the industry and return to their previous jobs. On top of that, from 11th November 2021, all care home staff in England must be fully vaccinated against COVID-19 (unless they are exempt). The Government predicts that the number of care home staff who face dismissal for refusing to be vaccinated is between 35,000 and 70,000, which puts care providers in a precarious position.

CMM November 2021

ATTRACTING TALENT: WHY AGE IS NO BARRIER TO A CAREER IN CARE

Not only will the cost of replacing these workers be astronomical and a hugely demanding task, but the shortfall of care workers poses huge risks to residents who potentially face substandard care in the meantime. Collectively, we need to create long-term solutions for a thriving workforce and part of this involves changing perceptions, developing routes for career progression and reinforcing the fact that opportunities in the social care sector are accessible regardless of age.

REMOVING BARRIERS Something that employers and agencies need to be better at is becoming more inclusive when it comes to their hiring processes. So many employers state a minimum amount of experience on their job descriptions, which could deter many applicants. According to Age UK, there are now over 15 million people in the UK aged 60+ and over one million of those are in either paid or voluntary work. This is a huge talent pool, with vast life experience that businesses across the care sector could be tapping into. Former qualified engineer Harry Seward smashed societal expectations by becoming a domiciliary care worker at the age of 65 at Respectful Care, a care home in Nottinghamshire. Now, five years later, Harry (70) says it is the most rewarding thing he has ever done and that he ‘wouldn't change a thing’. Sharing his experience with CMM, Harry said, ‘I like meeting new people and you do become friends with a lot of residents. As long as you are physically fit and mentally fit to cope with this, there is no reason why elderly people cannot also be carers. If I keep myself fit, I could probably carry on doing this for another ten years!’ In times of crisis, out-of-the-box thinking is required and that includes considering people of all ages, backgrounds and abilities.

GENERATION Z The kickstart scheme is a fantastic opportunity to engage with younger people, giving them access to on-the-job training and learning and setting them up for a long-term career in care. Attracting and engaging people at the start of their career into the social care sector, can help to inspire 26

CMM November 2021

“Employers and agencies need to place greater emphasis on values and soft skills over qualifications to encourage a wider talent pool.” their future career paths and starts to build a pipeline of talent for the sector. Tara Currie, Registered Care Manager at 8 Acres care home in Attleborough, part of the National Care Group, made the decision to start a career in care. Reflecting on her decision, she said, ‘Aged 18, I left college with a job application in each hand – one for the police force, the other for the care sector – and becoming a carer was definitely the right decision. I’ve never had a single regret. I have progressed from a support worker to management. I can’t wait to see what the future holds both for my own career and for those starting out in the sector.’ Social media is a fantastic tool for connecting with generation Z. Care providers can utilise social media by: • Giving an insight into different types of roles. • Showcasing positive messages from team members. • Interacting with audiences. • Promoting jobs. • Hosting virtual career days.

APPLICANT MISCONCEPTIONS A major misconception, which could be preventing people from applying for roles in care, is that candidates need specific qualifications. However, for most entry-level roles, key skills and behaviours are much more important than qualifications. Initial training is typically provided in the first few weeks of employment and then further skills, experiences and even specialisms are developed over time.

A career in social care is perfectly suited to anyone who is compassionate, people focused and wants to make a difference. A Carers Week report, published in June 2020, found an estimated 4.5 million additional people had taken on caring responsibilities during the pandemic. A huge proportion of these people were young people caring for a family member. Employers and agencies need to place greater emphasis on values and soft skills over qualifications. This will encourage a wider talent pool to engage with the application process.

PROMOTE OPPORTUNITIES There is a huge lack of awareness around the wider career opportunities offered by a career in care. Many people think being a carer means working in a care home and they don’t know about the opportunities in domiciliary care, disability care or the scope for progression to management level. We have been connecting with local colleges in Oxfordshire to help to change the perception of care amongst college students. Getting in front of this demographic and talking openly about the different types of roles, the training opportunities and ability to progress has been a great starting point and something we would recommend to other care providers and agencies. Raising awareness of the other benefits that come with a career in care is also important. We know that it’s a demanding job choice; however, the reward that comes from making a real difference to people’s lives is invaluable. It’s also a very flexible

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ATTRACTING TALENT: WHY AGE IS NO BARRIER TO A CAREER IN CARE

career choice and flexibility is something that people want now more than ever before. Having the option to work flexible hours and days to work around other commitments makes care a fantastic career choice for people of all ages and at all stages in their lives.

CHANGING CAREERS The pandemic has caused a real shift in what people want from a career, with purpose becoming a key driver for people. We also saw the ‘nightingale effect’, with record numbers of people applying to become nurses, despite knowing how demanding the role is. The sector has been in the spotlight for the last 18 months, creating a newfound respect for those who work in it. As an industry, we need to be engaging with people who are looking to change direction in their careers and those starting out in their career journey. Part of this involves highlighting key attributes and life experiences that people can bring to a career in the care sector, rather than focusing on qualifications.

WHAT CAN EMPLOYERS BE DOING? Employers have a big role to play when it comes to attracting and retaining staff in careers within the sector. Part of this involves addressing issues that may have previously put people off and ensuring they can offer secure work, with reasonable pay and good working conditions. Adopting a

values-driven recruitment approach also means demonstrating how staff are valued. Outlining a clear pathway to progression, opportunities for personal development and training, as well as prioritising mental health and wellbeing, will all help to boost job satisfaction and increase staff retention in the long term. Other ways to engage with people who may be considering a career in care include hosting taster sessions on site, so they can see first-hand the type of roles they could be involved in and how they will be impacting on someone’s life for the better. Sending ambassadors of the company to community and college career days and putting on workshops to raise awareness about social care work are other proactive steps to take.

WORKING WITH AGENCIES Recruitment agencies have a lot more to offer than just covering short-term requirements or filling current roles. Agencies can work with care providers on succession planning, provide guidance on salary, benefits and wellbeing packages, and often have affiliations with other local businesses and education providers that can be useful to connect with. Care providers need to be focused on both short- and long-term recruitment strategies; the more trends they can identify ahead of time, the longer they will have to source the best possible candidates for the roles. Regular communication between staff and managers will help businesses to

understand the needs, goals, aspirations and future plans of their employees and adapt accordingly. Not only will this help to identify any potential staffing gaps, but it will also improve the relationship between care workers and their managers and help to increase retention by resolving any issues before they escalate and prioritising wellbeing and job satisfaction. Perceptions of the care sector are changing for the better, partly thanks to the influence of the media. A recent docu-drama called Help, which aired on Channel 4, followed the story of a Liverpool care home and how they reacted and worked with the onset of the pandemic. It really shone a spotlight on the impact on the staff working through those challenging times and reinforced the importance of the role of care workers.

THE KEY TAKE-HOMES • Raise awareness of the diverse range of careers on offer. • Share real-life examples of people of all ages in the workplace. • Emphasise a values-driven approach over qualifications. • Reinforce how rewarding a career in care is. • Highlight the flexibility of many roles. There is no better time for care providers, agencies and industry bodies to connect with people of all demographics. Now is the time to capitalise on this changed perception of social care and build a quality workforce for the future. CMM

Julia O’Connor is a recruitment specialist at Paterson Health and Social Care. Email: j.oconnor@patersongroup.co.uk Twitter: @patersonhc How are you aiming to change the perception of social care and attract new talent? Visit www.caremanagementmatters.co.uk and share your comments.

CMM November 2021

INTO PERSPECTIVE

CAN COVID-19 RESTRICTIONS BE SAFELY EASED FOR PEOPLE IN RESIDENTIAL CARE? RIGHTFUL RESTRICTIONS?

People living in residential care have been amongst those who have suffered most from COVID-19. Due to heightened vulnerability, residents have been subject to far tighter restrictions since the pandemic began than the rest of the public. Naturally, maintaining residents’ safety has been the motivation throughout and few would question their necessity in the darkest days of lockdown. However, as society begins to return to normal life, free from almost all restrictions, people living in residential care are not currently being afforded the same opportunities. Whilst many limitations have been eased, a crucial few remain which some argue is placing unnecessary burden on residents, their families and carers. Protecting people living in residential care from COVID-19 continues to be a priority for all those concerned, that much is clear. Simultaneously interpreting guidance and keeping residents’ wellbeing in mind remains a challenge for care providers. 30

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Since Government published its updated guidance on care home visiting in August, residents have been able to enjoy much-needed relief from certain restrictions, such as unlimited ‘named visitors’ who can now visit as many times as they would like to on a single day. Residents can also benefit from nominating an essential caregiver. These people can attend care homes to support residents practically, emotionally or mentally and may be known personally to residents, providing further reassurance. However, parity with the rest of the population is yet to be seen, as residents and their named visitors are advised to keep physical contact to a minimum and maintain strict infection control measures, such as wearing PPE. Furthermore, non-named visitors will have to conduct social contact outdoors, in a pod or behind a screen. Given that, as of July, 93.5% of residents in older adult care homes have received both doses of a COVID-19 vaccine, championed as the strongest form of protection against COVID-19, and that people over 50 will be offered a booster jab, it is difficult not to question why such limitations remain in place for residents in care homes seemingly uniquely.

OPEN TO INTERPRETATION The language of Government’s latest COVID-19 guidance for residential care homes encourages providers to take the initiative and form their own policies for visiting and other everyday activities. As a

result, there is plenty of room for interpretation and residents and their families may have different experiences from home to home. Whilst we all wish for a swift return to life before lockdown for all care home residents, providers may, for example, consider the collective needs of their residents first and be wary of the possibility of further breakouts in the event of restrictions easing too much, too soon. Despite this, it remains crucially important that care providers create individual risk assessments based on the rights and needs of individual residents. Residents, their families and friends must also be involved in decision-making, along with other relevant professionals if necessary. This balancing act places pressure on already stretched care providers to make decisions based on input from multiple fronts – that being the welfare of residents who may be growing tired of restrictions, the frustrations from friends and families who may argue that their loved ones are being left behind on the road out of lockdown and Government which, at this time, is not lifting the limits for residents. There has also been questions raised about the fairness of the continued requirement for care home residents to isolate in their rooms for 14 days following an admission for emergency hospital care, regardless of vaccination status. As well as the detrimental impact on the individual’s wellbeing, it is recommended that all other residents in the home should also isolate under these circumstances. Campaigners argue that this blanket approach to isolation risks jeopardising the delivery of person-centered care.

Unique challenges call for a cautious approach

It’s time to make life worth living again

Cath Holmes, Director of Care Quality, Anchor

Judy Downey, Chair, The Relatives &

The happiness, health and wellbeing of our residents is our primary concern, so we will continue to follow guidance around keeping residents and colleagues safe. Our colleagues have done and continue to do a fantastic job caring for some of society’s most vulnerable people, while supporting each other, residents’ families and their own families throughout the pandemic. I’m proud to say that we’ve managed to keep life as normal as possible for residents, using innovative ways to enable people to stay connected to the people who are important to them, as well as using technology to keep families in touch with one another and our homes connected to each other with virtual competitions and events. Last year, we launched our Summer of Sport campaign, where our residents took part in fun sporting activities, complete with medals and opening and closing ceremonies, in homage to the Olympic Games. This year, we launched Anchor’s Get Set, Cycle campaign, which saw residents in all of Anchor’s 114 care homes virtually travelling the length of Britain via Memoride machines, ensuring that our residents are

physically and mentally active. While restrictions have been lifted for the general public, the unique challenges faced by the care sector call for a more cautious approach and we continue to follow guidance around visiting, lateral flow tests for visitors on arrival and continued use of PPE to ensure the health, safety and wellbeing of our residents and colleagues. In the short term, the current COVID-19 policies in care homes are prudent given the onset of winter, flu season and the need for our residents to have a COVID-19 booster jab to ensure they have maximum immunity against the virus. Even with these uncertainties, we shall continue to keep our residents safe and happy. We have plenty of fun activities planned with our upcoming Christmas celebrations. Watch this space for some more wonderful winter-themed activities from our residents! We’re confident that restrictions can and should be safely eased in due course. In the meantime, we will continue to act swiftly to implement these welcome changes safely and effectively and maintain our drive to provide high-quality care for our residents.

Residents Association Of course, care homes must now ease restrictions for people in residential care. The R&RA Helpline hears daily from families desperately worried about the deterioration of their parents, partners or siblings. They feel blocked at every turn trying to gain meaningful visits to support them. According to Government guidance, each resident is supposed to have access to ‘one essential caregiver’. But even this concession can be denied to residents. A confusing barrage of differing advice from all sides bedevils care homes, including from public health departments, the Department of Health and Social Care (DHSC), the Care Quality Commission (CQC) and adult social care departments. As a result, overly restrictive and risk-averse practices ride roughshod over human rights and other legal protections. Closed cultures and institutional practices have taken root in many care homes. These inhumane restrictions ignore people’s basic needs for familial contact and relationships. Instead, relatives are perceived as potential sources of infection, which seemingly justifies seeing families and friends as superfluous, regardless of the resident’s wellbeing.

Consequently, many care home residents have become withdrawn, depressed, unresponsive or simply given up due to excessive controls. This can mean 20-minute supervised, fortnightly visits, with PPE but without touching and in a strange room. In the last 18 months, relatives have witnessed new residents being placed in isolation, older residents deteriorating quickly, often unable to communicate or comprehend due to dementia and sensory disabilities. All taking place with minimal or no contact with their families. At the same time, staff shortages and an over reliance on agency staff have taken their toll on the quality of care. We can and must protect our most vulnerable without imprisoning them, especially with access to tests, vaccinations and PPE – the very same that care workers use to protect them. We need relatives to be seen as essential to the wellbeing of residents and staff and as intrinsic to residents’ lives, to prevent these closed cultures from becoming the norm. We need commissioners and regulators to put residents’ needs and wellbeing at the top of their agendas if we are to make life in care homes worth living again.

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CMM November 2021

HEADER

CLOSE INSPECTION: Has CQC been giving lower ratings?

During the COVID-19 pandemic, CQC halted most of its inspections. Now the regulator has resumed its practices, Mike Short, Director at CSI Market Intelligence, reviews to see whether CQC has been giving out ‘poorer’ inspection ratings over the last four years.

In 2017, I started monitoring published CQC inspections and the ratings they handed out to care homes for older people, taking a snapshot at the end of each quarter to analyse the results of those published during those three months.

WHY? I had noticed that the share of Requires Improvement and Inadequate ‘non-compliant’

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ratings was much higher than those given in total to all inspected homes across the country, and I was concerned about why this was happening. I continued with my analysis each quarter until the end of 2019, and each time I was seeing higher than normal shares across the bottom two ratings. Then COVID-19 arrived and all care homes went into lockdown, so my analysis paused, as did the majority of CQC inspections.

But, with a new CQC strategy recently introduced, to which I refer later, I thought it would be a good idea to provide an update on the situation and so publish here a full analysis of my findings since the start of 2017.

KEY FINDINGS • Out of 20,000 inspections undertaken and published between January 2017 and June 2021, 1,426 (7% or one in 14) were

given an Inadequate rating, despite only 1.7% (one in 58) of all homes currently tarnished with that rating. • Around 38% of ratings were Requires Improvement, which was twice as high as the 19% of homes currently rated this way. The analysis covers 20,000 inspections against around a total of 9,800 care homes in England, which means that, on average, every care home should have

CLOSE INSPECTION: HAS CQC BEEN GIVING LOWER RATINGS? been inspected twice over that period. Chart 1 shows how different the ratings handed out over the last 18 quarters are to those currently displayed across all inspected care homes. CHART 1 Share of CQC ratings 2017 to 2021 versus all care homes for older people June 2021 7.1%

1.7% 19.5%

37.8% 74.4% 52.6% 2.6%

4.4%

18 Quarters

June 2021

Inadequate Requires improvement Good Outstanding Whilst around three quarters of all care homes can boast a Good rating, only just over half of all ratings since the beginning of 2017 attained that level. Requires Improvement ratings all but doubled their share and, most worryingly, the dreaded Inadequate ratings have been more than four times that of their 1.7% overall share.

the dreaded virus just to go through protocol. Quite rightly, the average number of quarterly inspections dropped from around 1,400 pre-COVID to 460 during the pandemic, so during this period the CQC was `fire-fighting’. But has it also been fire fighting over the last four and a half years? The results over the period since the start of 2017 suggest one or more of three rationales: 1. Care standards are getting poorer. 2. The CQC is getting stricter with the ratings it is handing out. 3. The CQC has been primarily focusing on its inspections on those with lower ratings. The first rationale is doubtful, as the CQC has stated in its State of Care 2019/20 report that, ‘while quality was largely maintained compared with the previous year, there was no improvement overall.’ And, in fact, overall, the shares of each rating have not changed that much between 2017 and now, despite the fact that we have seen a repeated drop in ratings since. I imagine that care homes would definitely cite the second rationale as being the reason why they have not received the Good (or even Outstanding) rating they were striving for or had hoped to maintain.

COVID-19 RESPONSE

INSPECTION FREQUENCY

During the COVID-19 period between April 2020 and June 2021, the ‘non-compliant shares’ were even higher – Requires Improvement at around 50% and Inadequate at around 16% – but one can understand this because the CQC focused on those homes with which it had concerns. It would have been wrong for the CQC to enter a care home it was happy with and risk introducing

Rationale three was certainly the case during COVID-19, but was this also the CQC’s strategy over the three previous years? A good indicator as to the choice of homes to inspect depending on their existing rating, is shown when we compare the published dates of the last inspection for both Good and Requires Improvement care homes.

I understand that the higher the rating, the less the frequency of re-inspection, so where on the same day a home is rated Good and another is rated Requires Improvement, the latter home can expect the CQC knocking on its door earlier than the former. This in itself makes sense, as the home needing improvement will want another chance to prove that it is Good, whereas a Good home should be allowed to get on with its work without further interruption for a longer period – save for the CQC picking up something negative on its radar. However, we can see from Chart 2 that there is a massive variance in the last inspection dates between the two categories. CHART 2 Last Publication Date of Good and Requires Improvement ratings (June 21) 2021 2017

2020 7% 8% 16%

2018 30%

2019 39%

Good 2021 24%

2019 41%

2020 35%

Requires Improvement All existing Requires Improvements have been handed out within the last two and a half years – a quarter in the first six months of this year – whereas nearly 40% of homes

currently rated Good have not been re-inspected since 2018, which predates all Requires Improvement ratings. Another interesting statistic, and one of my key outtakes, is with regard to Inadequates, where the CQC has handed out 1,426 such ratings. Obviously, these will not all be to 1,426 different homes, as a number of these will be to the same homes that are trying but failing to get out of the predicament. However, currently there are just 163 that still have this rating.

CARE HOME CLOSURES So, perhaps there were massive closures within all those Inadequate homes, hence they don’t appear anymore? No, during that time only 296 have closed, so that means that quite a number of homes that had this burden have managed to get out of that dubious situation and have subsequently received a better rating and kept closure at bay. Well done to them. The CQC has recently outlined its new strategy which includes accelerating improvement, stating: ‘We’ll empower services to help themselves, while retaining our strong regulatory role. The key to this is by collaborating and strengthening our relationships with services, the people who use them and our partners across health and care’.

FUTURE APPROACH If the CQC is, in fact, going to accelerate improvement, then its strategy on whom it inspects and how those inspections will help to meet that objective will need to change drastically from what has been happening over the last four years. Will it? I will be keeping my quarterly eye on the situation and will let you know. CMM

Mike Short is Director at CSI Market Intelligence Ltd. Email: mike@csimarketintelligence.co.uk Twitter: @CSIMarketInte What’s your reaction to Mike’s analysis? Visit www.caremanagementmatters.co.uk and share your feedback. CMM November 2021

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Leecare’s comprehensive software suite encompasses all clinical and managerial requirements on one platform, assisting with the management of clinical risk and freeing up more time for staff to spend with residents all whilst exceeding CQC requirements. Years of collective experience working in, consulting to, & managing care organisations led our Senior Team to develop the P5 suite. Designed specifically for the aged care sector, P5 delivers an unparalleled clinical, care, lifestyle, medication, operations, and financial management software solution.

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CMM November 2021

RESOURCE FINDER

LEGAL

Every provider will need legal help from time to time. Here, CMM profiles some of the leading firms in the industry to help with your needs, whether that’s challenging inspection reports, advice on safeguarding issues or guidance on mandatory vaccination.

Gordons Partnership Tel: 01483 451900 Email: neil@gordonsols.co.uk Website: www.gordonsols.co.uk

SECTORS • Care homes. • Domiciliary care. • Supported living and extra care. • Learning disability services. • Independent hospitals.

SERVICES • Regulatory action. • Responding to civil and criminal enforcement action, and draft inspection reports. • Safeguarding enquiries. • Contract disputes (including fees and embargoes). • Police investigations and prosecutions. • Mental health, mental capacity and DoLS. • Health and safety. • Inquests. • Employment law. • Corporate finance and banking. • Sales and acquisitions. • Property related matters. • Commercial law advice. • Commercial litigation.

LEAD INDIVIDUALS Neil Grant heads our Health and Social Care Provider Team based in Guildford. Neil is an expert in the regulation and funding of health and social care services. He has a wealth of experience, having acted for inspectorates and other public bodies at a senior level. Nowadays, Neil only acts for providers, not regulators or commissioners, thus avoiding conflicts of interest. His motivation in working at Gordons Partnership is to offer the sector a full-service legal offering at competitive rates.

Susan Hunneyball works alongside Neil and has significant experience in advising clients in the health and social care sector. She has assisted providers with appeals against CQC decisions and, relevantly during the pandemic, on issues arising from compliance with infection control. She has helped providers obtain good outcomes following CQC urgent action. In addition, a large part of the work she does is advising clients who are involved in inquests or have Fitness to Practise issues, particularly in the pharmacy sector where Susan has a national reputation. Timely and informed legal advice is essential to the successful running of any operation but particularly in the care sector. Our approach is strategic and commercial, working in partnership with the client. We aim to resolve and improve matters through dialogue in the interests of service users, the provider and other stakeholders. However, we are assertive in defending our clients’ rights.

COMPANY INFORMATION Gordons Partnership LLP is a respected and growing law firm and is a recognised leader in the healthcare field. It was formed in 1994 by three lawyers from leading practices who were fed up with the ‘factory’ approach to law. Their philosophy was to provide highquality, practical and affordable advice, in a professional and friendly environment. Throughout Gordons’ growth, we have not lost sight of that philosophy.

Neil Grant Tel: 07968 861242 Email: neil@gordonsols.co.uk Susan Hunneyball Tel: 01483 451900 Email: susan@gordonsols.co.uk CMM November 2021

RESOURCE FINDER: LEGAL

Lester Aldridge LLP

Ridouts Professional Services Ltd

Tel: 01202 786187 Email: Laura.Guntrip@LA-Law.com Website: www.lesteraldridge.com/for-business/healthcare/

Tel: 0207 317 0340 Email: info@ridout-law.com Website: www.ridout-law.com

SECTORS

• Care homes/nursing homes. • Domiciliary care agencies. • Supported living services. • Independent hospitals. • Charities and third sector. • Learning disability services.

SERVICES • Regulatory advice, disputes with CQC or other regulators. • Challenging inspection reports and ratings. • Defending enforcement action and challenging notices of proposal. • Defending CQC criminal investigations and prosecutions. • Regulatory due diligence. • Safeguarding investigations. • Supported living arrangements. • Disputes with councils/CCGs. • Contractual disputes. • Coroner’s inquests. • Court of Protection cases. • Health and safety. • Police investigations. • Sales and acquisitions. • Professional misconduct issues. • Employment advice.

LEAD INDIVIDUAL Laura Guntrip is Head of the Healthcare Team which specialises in health and social care. Laura has specialised in this sector for 12 years. Members often write for care sector publications and are regularly

asked to speak at conferences, recognising their niche expertise and reputation. The team acts for providers and is the first choice for many, from small operators to national providers. The team has been solicitors to the RHNA for over 25 years, as well as acting for other regional care associations. ‘We act in relation to a variety of matters, from contract disputes to safeguarding investigations and helping providers challenge CQC reports and ratings or defend enforcement action,’ explains Laura. ‘We understand how care services operate and the difficulties they face. We provide clear, practical solutions and offer a one-stop shop to assist providers in all matters stemming from an incident: CQC action and safeguarding investigations, but also police investigations, employment issues and professional misconduct proceedings, offering consistency in representation,’ adds Laura.

COMPANY INFORMATION The firm has an enviable reputation with a national following. The team has been a finalist in the Legal Advisor category of the LaingBuisson Awards in recent years and the Health Investor Awards annually since 2013.

Laura Guntrip Tel: 01202 786187 Email: Laura.Guntrip@LA-Law.com

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• Care homes. • Home care agencies. • Independent hospitals. • Learning disabled care homes. • Children’s homes and residential special schools. • NHS Trusts. • GPs. • Dentists.

SERVICES • Challenging inspection reports and ratings. • Challenging notices to suspend, cancel or vary registration. • Challenging warning notices, fixed penalty notices and prosecutions. • Appeals to the First-Tier Tribunal. • Registration advice and challenges to refuse. • Safeguarding investigations. • Commissioner fee, contract disputes and embargoes. • Inquests. • Police investigations. • Regulatory due diligence.

LEAD INDIVIDUAL Paul Ridout, Managing Director, has been providing advice to the sector for over 40 years. Throughout his career, Paul has been actively and constantly instructed in matters relating to the operation, regulation and funding of care service businesses. Paul has a unique knowledge from previous

experience of how regulation has changed and is regarded as one of the most experienced advisers in the sector.

COMPANY INFORMATION At Ridouts, we know the health and social care sector and the details that can make the difference to your business. We provide legal, operational and strategic advice to providers who are faced with matters that could negatively impact on their businesses. We help our clients to find defences and positive outcomes to, often, commercially damaging situations. We work with you to manage and reduce risks presented to your business which, in turn, preserves business value. At Ridouts we only act for providers. Our specialism means that, not only do we know the law that governs the sector, we also know the nuances that come into play. There is no textbook way of operating a care business, so you need solicitors who don’t just know the regulations but who know how to interpret them in the context of multi-faceted pressures, conflicting stakeholder input and what the day job looks like for you. The team at Ridouts is on hand to help navigate you through the complexities that can arise.

Paul Ridout Managing Director Tel: 0207 317 0341 Email: paul@ridout-law.com

RESOURCE FINDER: LEGAL

Royds Withy King Tel: 07508 297597 Email: james.sage@roydswithyking.com Website: www.roydswithyking.com

SECTORS • Care homes/nursing homes. • Learning disability and specialist homes. • Domiciliary care. • Supported living. • Extra care/retirement villages. • Hospices. • Housing and support associations. • Charities.

SERVICES • CQC registration, challenging inspection reports, enforcement action and ratings. • Fees, tenders and commissioning contracts; challenging embargoes. • Safeguarding investigation. • Inquests. • Buying and selling, leases, development and construction. • Commercial structuring and finance. • Employment law. • Mental capacity and DoLS. • Service user contracts. • Dispute resolution, debt recovery. • Intellectual property. • All aspects of charity law.

LEAD INDIVIDUALS Royds Withy King is highly regarded by stakeholders in the sector, including being recommended lawyers for the Care Association Alliance and a commercial partner of Care

England. Leading practitioners include: • Hazel Phillips (Corporate) – has advised on social care transactions totalling over £100m in the last 12 months, including the £21m sale of five nursing homes and extra care apartments. • James Sage (Employment) – provides strategic legal advice on HR and employment law issues and manages our HELP service. • Mei-Ling Huang (Regulatory) – advises care providers on their CQC obligations, inspections and other crisis management responses. • Paul Daniels (Real Estate) – advises in all settings, including retirement villages, and on transactional matters. They say, 'Our Health & Social Care team is regularly instructed on social care matters across a variety of operators. The depth of knowledge in our team enables us to foresee, understand and resolve sector-specific issues that can arise for our clients.'

COMPANY INFORMATION Royds Withy King is a Top 100 law firm with over 480 employees across a network of offices. The firm uses the breadth and depth of its expertise to provide practical, commercial and cost-effective advice.

James Sage Tel: 07508 297597 Email: james.sage@roydswithyking.com

Hazel Phillips Tel: 07776 241235 Email: hazel.phillips@roydswithyking.com

Scott Moncrieff & Associates Ltd Tel: 020 3972 9011 Email: errol.archer@scomo.com Website: www.scomo.com

SECTORS • Care homes, home care. • GPs and dental practices. • Independent hospitals, clinics. • Supported living and extra care. • Learning disability. • Mental health.

SERVICES • CQC Appeals to the First-Tier Tribunal. • CQC registration advice. • CQC notices to refuse, cancel or vary registration, warning notices and fixed penalty notices. • Buying and selling. • Commercial law advice. • Commercial litigation. • Commissioner fee and contract disputes. • Contract drafting. • Employment. • GP disputes with CCGs. • GP referrals to NHS Resolution. • Health and safety. • Inquests and judicial review. • MCA, safeguarding. • Police investigations. • Property development and construction.

LEAD INDIVIDUALS Errol Archer leads on regulatory work for Health and Social Care providers. His experienced team work with small and large providers, delivering commercially focused solutions. He brings valuable regulatory and policy

insights from many years of advising business owners, regulatory bodies, central Government departments and Government ministers. As a specialist Solicitor-Advocate, he has represented clients at hundreds of court and tribunal hearings, including the First-Tier Tribunal (Care Standards), the Coroners’ Court and the High Court. Tom Woodward is a specialist employment lawyer and provides expert advice to employers via a fast-response, cost-effective service on an ‘as required’ basis.

COMPANY INFORMATION Scott-Moncrief is a leading firm, established over 30 years ago and known for its commitment to delivering high-quality legal services at an affordable cost. The firm provides a national service through recognised leaders in their fields, across all legal areas. It has a national reputation and particular expertise in the health and social care sectors. Its co-founder, Lucy Scott-Moncrieff CBE, describes the firm as userfriendly and approachable and emphasises that every client gets a personal service. The firm is known for standing up for clients when the going gets tough. We also work closely with specialist health and social care consultants and other business advisers.

Errol Archer Tel: 07729 421836 Email: errol.archer@scomo.com Tom Woodward Tel: 07917 835134 Email: twoodward@scomo.com CMM November 2021

PEOPLE FIRST:

Why we must continue to deliver experiences and activities

If we are to truly put people first, we must create memorable experiences and deliver activities to support residents’ wellbeing. Geoffrey Cox of Southern Healthcare and The Eden Alternative UK explains what providers must consider if they are to deliver activities in a changing world. The impact of the pandemic on care homes has been widely commented on and does not need repeating here. However, it is true that, whilst much of society is returning to a ‘new normal’, the care sector still faces various restrictions. The sector is constantly checking the latest updates related to Infection Prevention Control (IPC) measures and Personal Protective Equipment (PPE) requirements and, whilst some guidance has been updated, such as visiting rules, some has not. So, what have providers been doing and what should they be doing at this dichotomous juncture?

HUMAN CONTACT It is fully appreciated that, as

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the close input, support and contribution of loving family and friends has been so dramatically curtailed, this has significantly impacted on the wellbeing of many residents (and relatives). Each resident (and relative) is unique and will respond differently to any given situation but, overall, there can be no substitute for the love of a caring spouse, child, close relative or contact.

TEAM UNITY One positive take away has been the extent to which this void has been improved by the significant, selfless and driven contribution of the workforce. Teams of dedicated staff, whose holistic approach during these times has been significant, have been greatly appreciated by residents, families

and friends. This appreciation for a united workforce approach is likely to continue.

QUALITY OF RELATIONSHIPS This ‘loving companionship’, ‘family orientation’ and/or ‘partnership approach’ is within a very special set of skills that has been significant, but also honed, recognised and appreciated throughout the pandemic. This has been particularly important over the last 18 months but, furthermore, will always be and this is probably amongst the key learnings moving forward.

QUALITY OF LIFE Whilst there will be differences from one home to another, and

one organisation to another, there has also been something of a critical cultural evolution of homes and their staff towards a quality-of-life focus in partnership with families and loved ones. This shift has been critically important. This work has accelerated during the pandemic and, predominantly, in the worst of times we have seen the very best in our teams, often taking on more responsibility, covering for others and still delivering on a quality-of-life focus.

‘MEANINGFUL ACTIVITY’ MINDSET By way of illustration, increasingly care homes are not just focused on running ‘activities’ as an optional extra but more in terms of developing

a vibrant, engaging and joyous environment where activities are just one component of a culture that abounds with fun, meaning and spontaneity. This is another trend that will not change.

OPENING UP Beyond internally generated activities, which most homes have accelerated over the last 18 months, the bringing in of professional entertainers during the pandemic has been severely limited due to restrictions on access. However, for a combination of reasons, such as the success of the IPC measures and the vaccination programme, the current evolving circumstances have brought gradual changes in approach.

EXTERNAL ENTERTAINERS Although there is no specific guidance for (external) activities in the current circumstances, it is clear that providers are now considered best placed to assess the risks presented to a home, such as with an entertainer attending, and many are now bringing entertainers in.

REGULATION EXCEPTIONS The regulator, Care Quality Commission (CQC), has expected to see meaningful occupation of residents and to see the increased entry of visitors (which had previously been tightly prescribed). Providers are sharing their approaches

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PEOPLE FIRST: WHY WE MUST CONTINUE TO DELIVER EXPERIENCES AND ACTIVITIES

with inspectors and it is clear that a different approach is now expected by the regulator, which is particularly important as the options for meaningful occupation in the safer fresh air of the outdoors will largely no longer be the option it was in summer.

WINTER PLANNING Providers and commentators are still concerned over this coming winter and emerging statistics and expert opinions are observed closely. Yet, despite this, providers are not seeing the infection rates leading to serious illness that we saw in the first and second waves of the pandemic. This suggests the vaccination, IPC, testing and PPE regimes are working. Typically, entertainers are increasingly deployed but are expected to be double vaccinated, undertake LFT tests, wear a surgical facemask and maintain social distancing. (Some, but not many, are unable/unwilling to comply with this as of the 11th November deadline.)

OFFER VARIETY In terms of other things homes can do, even without going outside (often, older people are reluctant unless the weather is ideal), there are still plenty of options. Music is extremely important. It is unwise to assume what people like or may like; experience suggests trial and error is the best way, as different artists capture emotion differently at different times. Music can be a lifelong joy, be it live, on screen, on DVD, listening to professional singing (with singers wearing masks currently) or participating in karaoke, etc. Many providers will bring in a band regularly and, when COVID-19 was in its second wave, our band recorded favourite songs onto video/YouTube to be played at will.

Here are some other ways to connect people and enhance wellbeing through activity: • Arts and crafts – painting, drawing, making cards, etc., are still as popular as ever. • Games/quizzes – from bingo to snakes and ladders, the list is endless. • Indoor hospitality – many homes have additional facilities, such as bars or cafés, and these have been popular to create a more diverse environment. Staff at Wood Hill Lodge care home in Sheffield transformed their daytime seating area into an all-singing and dancing café and bar during the pandemic and some care homes are considering private dining spaces for residents to enjoy a meal with visitors. • Sports, games and wacky races – whether it’s a (safe) wheelchair race, soft ball games, gentle exercise or something more adventurous, the key is having fun, building laughter and being spontaneous. There are some great initiatives – Motitech’s annual cycling competition for older people and people with dementia saw the largest ever number of people virtually cycle more than 156,000km. This year’s oldest competitor was 106-year-old Irene Sewlyn from North London’s Mornington Hall. Also, Oakham Grange in Rutland has created an artificial putting green for residents to enjoy all year round. • Spontaneity – historically, activities have always been scheduled. It can help to schedule an activity and let residents decide what they want. It can be wonderful to find the different ideas that come up, from music and films to reminiscence, people or place. Learning about each other is something we rarely get to do and opens up a new dimension.

• Bringing the outside in – Planting from seed, growing plants and arranging flowers. Growing Support, a not-forprofit community interest group, based in the south west, creates gardening clubs and activities in care homes. The founders began the concept after visiting older relatives living in residential care and finding them lonely and bored, despite being surrounded by people. Residents and carers at Townend Close care home in Keighley were able to use their green thumbs planting flowers, herbs and beebombs in the walled gardens of the home for this year’s national gardening week. Residents who didn’t want to get their hands dirty still participated in the fun by decorating planting pots, gnomes and bird boxes with unique designs to use in the care home’s garden. • Making outside activities an option – Every January for the past five years, residents and team members in Care UK homes have run events to celebrate birds. Activities include making care home gardens more wildlife-friendly, creating and decorating nest boxes, bird song reminiscence sessions, talks from bird experts and visits from rescued birds of prey and owls. Some intrepid care home residents have even braved the chill of January to visit their local nature reserves. • Keeping an eye on upcoming community events – Harvest festival, Hallowe’en, firework displays on YouTube that are projected onto a big screen with a reasonable sound system, the build-up to Christmas, going to the Christmas lights, making cards, celebrating famous birthdays (these can happen most days). Keeping connected with the wider world is critically important these days.

FEELS LIKE HOME Providers should aim to build an environment of loving companionship and of a partnership or inclusive culture with everyone, especially with family and loved ones. I would encourage providers to develop a quality-of-life mindset, where care is delivered around the individual, as opposed to the individual being forced to comply with the care regimes and routines.It’s also about keeping an activity mindset for everything, from helping to get dressed, to developing engaging meal-time experiences, to something to help occupy the mornings, afternoons and evenings, seven days a week (and yes, this is quite a stretch). Maximising opportunities means recalling individual life moments, special dates, likes, dislikes, hopes and dreams, and planning things, maintaining a degree of spontaneity and wrapping this around an environment with heart, loving companionship and partnership working, encouraging people to participate in their care, their choices and decisions.

ENDLESS OPPORTUNITIES It seems there is a yawning gap between the perception and reality of residential care today, particularly over the last 18 months. Perhaps that is historic; it will take time and is understandable. What we must do now is continue the excellent work of our workforce and be dynamic in our approach to activities, to give those we care for the best possible opportunities which they truly deserve. The opportunities are endless – let’s not allow the pandemic to halt our delivery and commitment to ensuring people in care have access to memorable experiences. CMM

Geoffrey Cox is Managing Director at Southern Healthcare (West Sussex) and The Eden Alternative UK. Email: Geoffrey.cox@southernhealthcare.co.uk Twitter: @geoffreydcox How are you delivering activities in a changing COVID-19 world? Visit www.caremanagementmatters.co.uk and share your feedback. 40

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CMM November 2021

Markel 3rd Sector Care Awards

CELEBRATING EXCELLENCE IN DEMENTIA CARE Music for Dementia won the Dementia Care Award at the Markel 3rd Sector Care Awards 2020.

The Dementia Care Award celebrates organisations that have provided outstanding dementia care. Due to its wide-reaching impact, Music for Dementia was recognised for championing the power of music to support people living with dementia. The campaign was singled out for the creation of its accessible radio station, M4D Radio, which filled the gap left by the inability of musicians and music therapists to access care settings during the COVID-19 pandemic. Continuing in a series of features celebrating 2020’s winners, Grace Meadows, Programme Director at Music for Dementia, reflects on the impressive momentum that the campaign has gathered since its inception.

LAYING THE GROUNDWORK Receiving a £500,000 donation live on air was not something I or the team at Music for Dementia expected last autumn, as we celebrated the joy Paul and Nick Harvey had brought into people’s lives during the pandemic with their music. Knowingly or not, this moment of recognition for the campaign had come about as a result of years of work in developing Music for Dementia, a national campaign to make music an integral part of dementia care. Rewind to 2014. The Utley Foundation, the charitable family foundation which backs the campaign, began laying the groundwork. It had ignited conversations with stakeholders from across various sectors and had itself been funding organisations working in the music and dementia space, asking along the way, ‘Why is music not 42

CMM November 2021

an integral part of dementia care and how do we make it an integral part?’ What became apparent as a result of these conversations was just how fragmented the music and dementia space was, and whilst there were pockets of excellent work taking place across the country, it was often isolated and with no communication. There was no golden thread tying the work together.

BRINGING PEOPLE TOGETHER The foundation was aware of its role – it couldn’t be another player in the space, it needed to offer something different. The more we learnt about why music was not already embedded in care, the more we understood that we could not just act as a funder, but had to bring people together, act as a catalyst and build creative partnerships. To do this, we needed to establish trust. We did this by establishing a commission and gathering high-quality and accurate data from over 1,500 leaders and experts from across sectors – health, social care, music, dementia, academic, the third sector, and most importantly people with lived experience. This enabled us to understand the existing landscape, gather the latest evidence, better understand the ecosystem, and help clarify what our role could be. The commission report presented us with an invitation – a set of recommendations – that, if we were serious about making a meaningful impact on the lives of people living with dementia and their carers, we had an opportunity to run with. And we did just that.

STARTING OUT SMALL We set about building a small but agile team that listened extensively to the sector, began building relationships, and brokered connections between players where they didn’t already exist. Out of these relationships the areas for influencing for change became apparent – awareness and understanding, policy, practice and collaboration. It was at this point that the Music for Dementia campaign came to life. Building momentum and developing a relatable and meaningful narrative were key areas of activity. We appointed Lauren Laverne as our national ambassador, created a hub of information in our website and began bringing people together through the newly created Musical Care Taskforce. Alongside this we continued to seek fund and support organisations across the country delivering a variety of musical services – from playlists to music therapy, live interactive music making sessions, dementia choirs and singing groups, work at the bedside, in hospital and hospices and much more.

RESPONDING TO THE PANDEMIC As we were beginning to find our rhythm, and on the cusp of announcing a Musical Care Pledge for the health and care sectors, the pandemic struck, and we had to pivot significantly. It was clear the priority was keeping people safe and ensuring health needs were prioritised, but the non-medical impacts of the pandemic were rapidly becoming clear. Exhaustion, trauma, bereavement, isolation, anxiety: people were living through daily rollercoasters of emotions, feelings and experiences, and didn’t necessarily have the skills or the support in place to help them manage these. For people living with dementia, their carers and families, they were particularly adversely affected by the pandemic and restrictions resulting in very traumatic experiences at home and in care settings. After the initial rousing choruses of singing from balconies, online concerts and outdoor performances, it became evident that music was playing a critical role in helping communities all over the world manage and deal with the severe impacts of the pandemic. However, for obvious reasons, musicians and music therapists were unable to provide their vital musical services in person and, yet, we knew we needed to help keep the music going in care settings and people’s homes and in doing so could really highlight why music is so important for people with dementia.

CHANGING THE CONVERSATION It was at this point, we decided to launch our

award-winning m4dradio.com, an online radio stream created specifically for people living with dementia and their carers. We went live in June 2020, having worked with people with lived experience to help us develop the content and programming. We knew this was not the answer to musicians and music therapists not being able to go into care settings, or people not being able to attend groups in the community, but it was helping to connect people across physical and emotional divides. As we moved towards the autumn of 2020, we continued to talk with our stakeholders about the urgent and pressing needs that the financial implications of the pandemic were having on charities and not-for-profit organisations. At the same time, a moment of joy was being shared globally with Paul Harvey’s ‘Four Notes’ – an inspirational musical improvisation from a gentleman in his 80s which resonated with so many of us and changed the conversation around music and dementia for the better. We were already in conversation with organisations about the support we could provide but that conversation took a different turn after Sir Tom and Lady Marion Hunter announced on BBC Breakfast that they were donating £1m to Paul and Nick Harvey to donate to their two chosen charities – the Alzheimer’s Society and Music for Dementia – after having followed Paul’s remarkable story and being moved by his beautiful music. This wonderful act of generosity spurred us into action and from donation to dissemination, we were able to distribute £500,000 to 27 organisations across the UK providing a range of musical services for people with dementia. In doing so, we were able to support organisations to continue and for some to increase their offers.

experiences with dementia. Music can help someone to get up, washed and dressed in the morning or to have a meaningful connection in the here and now with a loved one. We need to reimagine dementia care using the power of music and our vision for the future. Reading this today, will you join us to make that happen? The first step you can take in making that happen is signing up to the campaign today – www.musicfordementia.org.uk CMM Grace Meadows is Programme Director at Music for Dementia. Email: grace@musicfordementia.org.uk Twitter: @Grace_Meadows_

WHAT MORE CAN BE DONE? A year later and so much has happened. Not only as a result of the donation but because we have been able to have different conversations about the power of music. We have joined forces with UK Music, with ministerial support, to undertake a review into what more we can be doing with music to support health and wellbeing in the UK through music; we have continued to influence for system change and turned up the volume on the messaging around the vital need to make music an integral part of dementia care. Awareness, however, is not enough in ensuring that the almost one million people in the UK with dementia have access to music as an integral part of their care. As we start recovering and rehabilitating from the pandemic, now is the time to think about what we can do better, and more of, in a post-COVID world. There are many people, either lifelong musicians or musical novices, who have had transformational

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

EVENT REVIEW

INSTITUTE OF HEALTH & SOCIAL CARE MANAGEMENT WORKFORCE CONFERENCE 15th September 2021 The Institute of Health & Social Care Management’s (IHSCM) virtual Workforce Conference invited expert speakers to share their thoughts on the pressing issues facing the adult social care workforce today. The conference was helpfully organised into a series of main sessions and IHSCM offered delegates the chance to tune in to breakout webinar sessions.

LOOKING AFTER THE WORKFORCE Workforce wellbeing from an adult social care perspective was the theme of the first main session, delivered by Amanda WhittakerBrown, Senior Adviser, Workforce, Care and Health Improvement Programme, at the Local Government Association (LGA). The session identified no sole solution to the sector’s current workforce issues. Instead, a multifaceted approach is required, including promoting wellbeing. The LGA has supported the formation of the National Wellbeing Steering Group, which aims to address four priorities – creating and distributing resources to improve wellbeing, publishing best practice examples and positive experiences of wellbeing management in the workplace, embedding cultures of wellbeing sector-wide through practical webinars and influencing commissioning to allow for greater consideration of workforce wellbeing in planning and service delivery.

ENSURING THE SECTOR’S FUTURE Continuing in the main session agenda,

Samantha Barker, NHS Graduate Scheme Trainee, Maternity/Neonatal Network, South Yorkshire & Bassetlaw Integrated Care System (ICS), discussed her lived experience of graduate schemes and examined how to attract talent to health and social care. The primary takeaway is that those pathways leading to management roles for health and social care, both clinical and non-clinical, are not promoted widely enough amongst the emerging graduate workforce. Nor are they deemed a financially viable career opportunity due to current public perceptions of a lowskilled social care workforce. Furthermore, it was suggested that more attention needs to be paid to apprenticeships and other alternative recruitment opportunities such as internal management training schemes to attract a new talent pool to the sector.

DIVERSITY IS KEY Moving into the conference’s breakout room, Adam Race, Deputy Chief People Officer, Royal Wolverhampton NHS Trust, explained his role in leading a diversified workforce. Organised into a series of themes that have contributed to the Trust’s focus on diversity, the session highlighted that leadership opportunities at all levels are subject to scrutiny from equality and inclusion representatives within the Trust. Diversity mentoring has been a recent and successful addition to the Trust’s workforce agenda. Also known as reverse mentoring, it aims to pair up members of senior management with employees from a range of diverse backgrounds to ensure their voices

are heard and their experiences are taken into account in the planning and delivery of services. This programme has also encouraged senior teams to reflect on how both their dayto-day actions and more significant decisionmaking instances within the organisation can impact on diversity.

PROMOTE FROM WITHIN The conference concluded with its final presentation from David Brewster, Leadership and Organisation Development Manager, St Helens and Knowsley NHS Trust, who encouraged delegates to think about strategies for identifying and promoting workforce talent. Asking a series of insightful questions that served to challenge the norm, the closing session proposed a complete overhaul of current talent-spotting practices, applicable across health and social care. The presentation argued that too many sector organisations are focused on instilling a culture of progression and climbing the ladder, often neglecting those who may, due to circumstance, prefer to be trained and experience success in their current roles. For those who do wish to progress, the session emphasised the importance of developing employees’ authentic selves, to ensure that the right people are nurtured into roles that suit them and ensure robust succession planning for sector organisations. To watch recordings of the conference’s speakers in full, visit the IHSCM YouTube channel: http://www.youtube.com/ playlist?list=PLKW96tAdApjei4TWugCch27Z 7y4RjyFI0

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CMM November 2021

MICHAEL VOGES • EXECUTIVE DIRECTOR • ASSOCIATED RETIREMENT COMMUNITY OPERATORS

Michael Voges, Executive Director of ARCO, calls for the Government to be clear in how the housing with care sector is represented and why a joined-up approach is needed to grow the sector.

Earlier this month, the Government defined its mission at the Conservative Party Conference as ‘getting on with the job’. Whilst this was happening, many of us were wondering when we would get the announcements our sector needs which would let us get on with ours. It was also interesting that, whilst the Housing Secretary strove to define the substance of the newly renamed Department for Levelling Up, in our sector we were faced with the opposite problem – struggling to reach an accepted name for a sector that is already very real and substantial. Housing with care represents the single greatest opportunity for growth and innovation in the social care sector and can make a huge contribution to improving housing provision, regenerating town centres, tackling climate change, combating loneliness and reducing the strain on the NHS. Housing with care developments typically consist of 60-250 dwellings

for older people on a shared site, with high levels of integrated services, facilities, clubs and societies, 24hour staffing, the availability of CQC-registered domiciliary care and meals prepared on site. There are nearly 80,000 people living in such developments in the UK and we believe that, by the end of the decade, there will be more than 250,000. When it comes to terminology, though, we have a problem – Government has never adopted a single consistent name for our sector. Over 14 different terms are used in different Government documents to describe our sector – everything from extra care, retirement villages and retirement communities to retirement living, later living and housing with care. This confusion and the consequent inability to target policies or regulation directly at us is reflected in unco-ordinated and contradictory Government approaches to our sector. As an example, we are frequently told by Directors of Adult Social Care across the country that they want to see more housing with care provision to support people who have moderate or intermittent care needs. They understand that such provision is better for older people, as it keeps them independent for longer. They also know it can save the social care system considerable amounts of time and money by keeping people healthier and out of expensive institutionalised care settings. We hear the same messages from County Council leaders and many civil servants at the Department of Health. Yet recently, The Treasury has declined our sector’s request to be treated the same way as care homes when it comes to the new Residential Property Developer Tax – out of a fear it would distort the market in favour of more care provision – i.e. in the exact way their colleagues elsewhere in Government would want it to develop. Similarly, the recent White Paper from Department of Levelling up and Communities (DLUHC) on planning made not one mention of

our ageing population and the need for more specialist housing for older people – and subsequent answers to parliamentary questions from the Housing Minister imply that the department regards current advice in this area as sufficient, despite the views of local councils that they lack the tools and definitions needed to help secure increases in local provision. At ARCO, we have been pushing for two years for a cross-Government task force on housing with care to bring about the more joined-up approach needed to grow our sector and realise its opportunities. We are hopeful that ministers and civil servants have been listening to calls from the sector and large numbers of older people’s charities, investors and parliamentarians for such a task force – it cannot come a moment too soon as ministers assure us they wish to ‘build back better’ after the pandemic. We are also acutely aware that much of the confusion around issues such as terminology is of our own making and for us to take the lead on resolving. That is why ARCO, our membership and our over 100 partners are getting ready to relaunch our sector with a new name and new identity – bringing an end to the confusion of terms out there and acting as a catalyst for future growth. Older people and their families deserve to be able to make informed choices between clearly different types of provision. There will always be an important role for the great work done by care homes and nursing homes, but it is important for our prospective residents to understand how our more moderate and intermittent form of care provision is different. That’s why our new name and identity is based on extensive and intensive work with older people to find a term that makes sense to them. We believe we have found such a term, which integrates all the different features of our sector and makes these differences clear to consumers. Tune in to our conference to join us for this new dawn.

Michael Voges is Executive Director at the Associated Retirement Community Operators (ARCO). Email: info@arcouk.org Twitter: @ARCOtweets 46

CMM November 2021

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