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

DECEMBER 2021

www.caremanagementmatters.co.uk

CARE MARKET ANALYSIS

Reflection and forecasts

Medication delivery

Finding new ways to improve approach

Riding the storm The challenges facing the sector

Food for thought

Nutritional best practice for care homes

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Discover more about our digital care management system and Relatives Gateway portal Call 01483 357657 hello@personcentredsoftware.com www.personcentredsoftware.com

In this issue 05

Inside CQC Debbie Ivanova explains the importance of reviewing your model of care to ensure it meets the needs of people with learning disabilities and autism.

CMM News

Into Perspective Our experts comment on the Social Care Levy and discuss whether the pledge goes far enough to address the funding issues facing the sector.

Celebrating Excellence Martin House Children’s Hospice and Intergenerational Music Making (IMM) won the End of Life Care Award and Campaigning for Change Award at the Markel 3rd Sector Care Awards. This issue shares exciting plans for the 2022 Markel 3rd Sector Care Awards.

Event Review A review of the Associated Retirement Community Operators’ (ARCO) fifth annual conference, What Next? 2021, main conference day.

Straight Talk Karolina Gerlich takes the opportunity to thank care workers for all their hard work and outlines how The Care Workers’ Charity has supported the workforce.

FEATURES

REGULARS

Social Care Insights Simon Bottery, of The King’s Fund, imagines what would happen if the BBC programme The Repair Shop took on the task of fixing adult social care.

Care market analysis: Reflection and 2022 forecasts Mike Hodges, Managing Director of Healthcare Consultancy at Christie & Co, reviews the development and investment activity taking place in the sector and shares what providers need to be aware of in the year ahead.

Medication delivery: Finding new ways to improve medicine administration in care homes How could minor changes improve the way medicines are delivered? Caroline Maries-Tillott, Quality Improvement Lead at West Midlands Academic Health Science Network (WMAHSN), shares insights into a pilot project.

Riding the storm: Challenges facing the social care sector There have been so many policy announcements from the Government, but how transformative are they really? Liz Jones, Policy Director at The National Care Forum (NCF), reviews the political pledges and flags the gaps.

Meaningful movement: Practical solutions for physical activity Virtual exercise is here to stay. Jack McKechnie, Regional Wellbeing Coordinator at Oomph!, shares the benefits of on-demand training and offers some take-home session planning ideas on a variety of disciplines.

Food for thought: Nutritional best practice for older people in care Sophie Murray of the National Association of Care Catering (NACC) and Dove Yu of the British Dietetic Association (BDA) summarise the latest research and innovation taking place in nutrition and explain the importance of a nutrient-dense diet for older people in care. CMM December 2021

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

CONTRIBUTORS

PRODUCTION Lead Designer: Ruth Keating Director of Creative Operations: Lisa Werthmann Studio Manager: Jamie Harvey

ADVERTISING sales@caremanagementmatters.co.uk 01223 207770 Advertising Manager: Daniel Carpenter daniel.carpenter@carechoices.co.uk Assistant Advertising Manager: Aaron Barber aaron.barber@carechoices.co.uk Director of Sales: David Werthmann david.werthmann@carechoices.co.uk

@blimeysimon

@CQCprof

@ChristieCo

@wmahsn

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

Debbie Ivanova Deputy Chief Inspector for people with learning disabilities and autistic people, Care Quality Commission

Mike Hodges Managing Director of Healthcare Consultancy, Christie & Co

Caroline Maries-Tillott Quality Improvement Lead, West Midlands Academic Health Science Network

@CharlesTTHF

@DJAFothergill

@LizatMHA

@OomphWellness

Charles Tallack Assistant Director for the REAL Centre, The Health Foundation

Cllr David Fothergill Chairman, LGA Community Wellbeing Board

Liz Jones Policy Director, National Care Forum

Jack McKechnie Regional Wellbeing Coordinator, Oomph! Wellness

@NACCCaterCare

@doveyu_RD

@KGerlich777

Sophie Murray Head of Nutrition and Hydration, Sunrise Senior Living

Dove Yu PR Officer of BDA Older People Specialist Group and Senior Specialist Dietitian

Karolina Gerlich CEO of The Care Workers’ Charity

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 18.9

CMM magazine is officially part of the membership entitlement of:

CMM December 2021

SOCIAL CARE

INSIGHTS From Simon Bottery

In a tongue-in-cheek seasonal special, Simon Bottery imagines what would happen if the BBC programme The Repair Shop took on the task of fixing adult social care.

Presenter: ‘Today on The Repair Shop we’re taking on an unusual challenge. Our team of expert craftspeople has been asked to “fix” adult social care. We’re joined by a member of the public to tell us a little about adult social care and why it means so much to them.’ Member of public: ‘Well, I’d like to say it’s a cherished family heirloom but, to be honest, we’ve not really paid it much attention until now. We got it around 1948, the same time as the NHS, but not as many people used it and it’s not really had the attention it

should have had. It started to get really run down around 2010 and during the pandemic we really started to notice how badly it was doing. We’d like it to be much more widely used by more people, to really add to the quality of their lives, you know? But we’re worried that there’s some quite basic things wrong with it – its condition seems to get worse every year. We think it’ll need some real money spent on it.’ Presenter: ‘Great, well the team working on the project will be the Government. What's your first impression, Government?’

Government: ‘Well, we can see it’s in need of real work and this Government, unlike all previous ones, is going to really fix it. It’s a once-in-a-generation opportunity and we can promise you some historic reforms to social care.’ Cut. Presenter: ‘So you’re back – how did you get on?’ Government: ‘Well we’ve come up with some changes that we think people will like. We’ve not really done much about the underlying deterioration – we think it’ll take quite a lot more attention and we doubt the

budget would stretch that far. But we’ve added something we’re calling a “cap” and we've also added a small extension at the bottom so that more people will be able to use it. Plus we’ve added a few little touches to make it look better. So we’re thinking “job done”, really.’ Member of the public: ‘That’s not really what I was expecting. I mean, I can see the value of the cap but I don’t think it’s going to help that many people. And it's a real mistake not to do anything about the general deterioration – we worry the whole thing is going to fall over at any moment. So I don’t think you’ve fixed this at all.’ Government: ‘Well obviously that’s disappointing but perhaps you need to wait until you see the full details of our restoration in a white paper before the end of the year.’ Presenter: ‘Well there you have it. Join us next week for another edition of The Repair Shop where we’ll be taking on labour market productivity. Merry Christmas everyone.’ Note: A very similar version of The Repair Shop was broadcast in 2014 and 1999.

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

Defending & Protecting

your business

CQC Appeals to the Tribunal CQC Notices and Investigations CQC Inspection Reports robustly challenged Contract and Fee Disputes successfully resolved Coroners’ Court Inquests

Errol Archer

Regulatory Solicitor

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I want to start by saying thank you to our social care colleagues who have worked tirelessly throughout the pandemic amidst the challenges within our sector. The work that I’m leading to improve regulation of services for people with a learning disability and autistic people has shown me how important it is to have people with the right values and approach leading and working in our services. I know from experience that working in social care provides an exciting and rewarding career. From my first job working with children with learning disabilities, I knew I wanted this career with its variety, the ability to make a difference and the fantastic people you can support to lead lives of their choosing. It’s so important that everyone across the system supports people to have good careers in social care. I’m enjoying taking part in the Oliver McGowan training being piloted by BILD and funded by Health Education England. Oliver’s story shows us the importance of people having the right training and skills to deliver good-quality care for the people they support. This training makes sure we all understand the specific needs of people with a learning disability and autistic people, which should result in better services and improved outcomes for people across health and social care. It also involves learning from people with lived experience, which has been extremely powerful to listen to and learn from. We recently published our annual State of Care report, which is our assessment of health and social care in England. We highlighted challenges in social care to reflect what we’ve heard from colleagues working on the front line of care services and the organisations that support them, including the need for increased funding support, improved infrastructure across the sector and improved professional support that reflects the range of skills and capabilities care staff gain throughout their careers. Essential to delivering good care and high-quality support is recognising that different skills are sometimes needed to meet the needs of different groups of people. I welcome Department of Health and Social Care’s recruitment campaign Made with Care – its emphasis is on how a career in social care has such an impact on the people you’re supporting, as well as the emotional rewards. I encourage recruiting managers and leaders

Inside CQC D E B B I E

I V A N O V A

Debbie Ivanova, Deputy Chief Inspector for people with learning disabilities and autistic people at the CQC, explains the importance of reviewing your model of care to ensure it meets the needs of people with learning disabilities and autism.

to engage with the campaign to help grow your workforces. Recently, I’ve seen cases of providers starting to take on care for people with learning disabilities; while it’s fantastic that more providers want to offer this service, it isn’t something you can just do overnight.

learning disability and autistic people, please contact us. People with a learning disability and autistic people have the right to high-quality care that meets their needs and supports their ambitions, and that enables them to live the life they choose in the setting of their choice. The model of care needs to be

“We need to change the way people think about working in care and get people to think about it as a career with a range of opportunities and fields to specialise in.” Firstly, you need to measure up your service against Right Support, Right Care, Right Culture and, secondly, you need to make sure you have the right workforce to deliver personalised and specialised care that matches the needs of people with a learning disability and autistic people. In our guidance on service user bands, we explain why it’s important to think about the specific needs of the people you are supporting. If you’re thinking of extending your service to provide care or support to people with a

right and people can’t just fit into any existing service. You will need to recruit staff with the right skills, values and experience, offering the training, development and support to retain those skills. We need to change the way people think about working in care and get people to think about it as a career with a range of opportunities and fields to specialise in, as you learn more about how to support people based on their individual needs, background and experiences in or between settings.

Debbie Ivanova is the Deputy Chief Inspector for people with learning disabilities and autistic people at the CQC. Share your thoughts and views on Debbie’s column on the CMM website. Visit www.caremanagementmatters.co.uk CMM December 2021

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NEWS

APPOINTMENTS THE HOMECARE ASSOCIATION

DHSC outlines mandatory vaccination policy Health and social care providers in England will be required to ensure workers are fully vaccinated against COVID-19, unless they are exempt, under plans announced by the Health and Social Care Secretary. All care home staff had to receive both doses by 11th November 2021. The Government has published the response to its consultation on extending vaccination as a condition of deployment across the CQC regulated sector. Despite 65% of respondents being opposed to mandatory vaccination, the Government is pressing forward and has issued draft legislation that is likely to come into force on 1st April 2022. The National Care Forum (NCF) conducted a survey with its members operating care homes and

findings revealed that care providers fear they will lose around 8% of their care home staff as a direct result of this policy. Vic Rayner OBE, CEO of the National Care Forum, said, ‘Since the introduction of this policy we have been vocal about the unnecessary high cost – in terms of human costs, financial costs and the loss in trust and goodwill amongst care staff and their employers as a direct result of this policy. Care homes have been the unwitting guinea pigs through the implementation of this policy, and the impact on people must not be swept under the carpet. It is vital that the Government learns from this experience and makes changes for the wider roll out of this policy.’ The law will apply in respect to providers of CQC regulated activities and will be in respect of any person

they ‘employ or otherwise engage’ who has direct interactions with patients and service users ‘for the purposes of the provision of' the regulated activity. The consultation says the rules include 'those non-clinical ancillary workers who may have direct, face-to-face contact with patients but are not directly involved in patient care’. The social care not-for-profit charity Dimensions said the Government's decision threatens safe care for disabled people right across the country and it undermines the choice and control people have over who supports them. It will also put the viability of many providers at risk. Visit www. caremanagementmatters.co.uk ‘News’ to read more comment.

Adult social care winter plan announced The Government has published its latest policy paper, the Adult Social Care COVID-19 Winter Plan for 2021 to 2022, setting out the following commitments for adult social care: • Provide £388.3m in further funding to support Integrated Personal Commissioning (IPC), testing and vaccination uptake in adult social care settings. • Provide eligible front-line social care workers and carers with free flu vaccination, ensuring that pharmacists are able to vaccinate staff and recipients of care in care homes, and that front-line social care workers can continue booking their first and second dose of the COVID-19

vaccine through the National Booking Service. • Continue to provide free PPE for COVID-19 needs to the adult social care sector until the end of March 2022, with sufficient stock to cope throughout winter. Regular asymptomatic COVID-19 testing will be maintained, with availability of more intense testing regimes for higher-risk settings. • Continue to support care providers to use technology to support remote monitoring, enable secure online communications and enable people within care homes to remain connected with friends and families.

In addition to this, the Government's COVID-19 winter plan has pledged to provide workforce recruitment and retention funding to support local authorities and providers to recruit and retain sufficient staff over winter. In response to the Government's COVID-19 winter plan for adult social care, Karolina Gerlich, CEO of The Care Workers' Charity, said, ‘The Care Workers’ Charity is sadly largely unsurprised by the contents of the adult social care winter plan, which is wholly inadequate and unrepresentative of the challenges faced by the sector and its workforce.’

Five new non-executive directors have been elected by members to the Board of the Homecare Association, representing a diverse range of providers and geographies across the home care sector. The new representatives bring the association’s board to its full strength of 14 elected non-executive directors and two executive directors.

ANCHOR

Suki Jandu has joined Anchor as Executive Director – housing services. He is responsible for Anchor’s rented and homeownership housing services, including extra care. He also oversees the customer contact centre and the services provided by Anchor on call.

ND CARE AND SUPPORT

Two new registered managers have been appointed at ND Care & Support as demand for its services across South Wales continues to grow. ND Care & Support provides specialist care to individuals in the comfort of their own homes and communities through a range of bespoke domiciliary care services for children, young adults and older people throughout Wales.

CARE UK

Care UK has announced the appointment of Martin Friend to the newly created role of chief operating officer. Martin will join the Care UK’s executive team in January 2022. CMM December 2021

NEWS

Health Secretary urges vulnerable to get COVID-19 boosters Health and Social Care Secretary Sajid Javid has called for the UK to come together to help vaccinate those most vulnerable to COVID-19 with booster jabs. He called on families and friends to support elderly loved ones and those most at risk of the virus to get their vaccines urgently to ensure they are protected over the winter

months. The call comes as almost 10 million people in the UK have received their top-up jabs, with seven in 10 over-80s and three in five over-50s in England already boosted. More than 13 million invites, including texts, letters and emails, have already been sent to eligible people in England so far, asking them to book their booster online

through the National Booking Service. The latest evidence from SAGE shows that protection against symptomatic disease falls from 65% up to three months after the second dose to 45% six months after the second dose for the Oxford/AstraZeneca vaccine, and from 90% to 65% for the Pfizer/BioNTech vaccine.

Protection against hospitalisation falls from 95% to 75% for Oxford/ AstraZeneca and 99% to 90% for Pfizer/BioNTech. COVID-19 booster vaccines have been delivered or booked in at every older adult care home in England where safe to do so, with almost nine in 10 care homes already visited.

CQC publishes state of care report The Care Quality Commission (CQC) has published its State of Care 2020/21 report. State of Care examines the sector's trends, shines a spotlight on examples of good and outstanding care, and focuses on actions contributing towards high-quality care. The report also highlights potential areas of improvement in the sector and makes suggestions for how these can be achieved. This year, State of Care

comprises four themes, summarising key issues faced by the sector in the last 12 months – namely, people's experiences of care, ongoing quality concerns, flexibility to respond to the pandemic and challenges for systems. The report carries additional weight as the first of its kind to cover a whole year of the pandemic. It reflects on the sector's collaborative response to COVID-19 and the impact on people who use

care services. Responding to State of Care 2020/21, Cathie Williams, Chief Executive of Association of Directors of Adult Social Services (ADASS), said, ‘CQC’s State of Care report always provides an important overview of health and social care in England. This year, the dreadful impact of the pandemic is highlighted, not least in the stark effect it had in exposing and exacerbating inequalities,

inequalities that resulted in the deaths of so many people.’ Julie Bass, Chief Executive at Turning Point, said, ‘The state of care for people with a learning disability, as highlighted in the report, has faced challenges throughout the year and the impact of COVID has been stark. The inequalities that persisted before have only worsened; everyone with a learning disability deserves to have appropriate care at all times.’

Care Levy could bring to support wide-ranging and ambitious reform if fairly shared between social care and health.’ Professor Martin Green OBE, Chief Executive of Care England, said, ‘Unfortunately, there will be serious and far-reaching consequences. Care England has offered a plethora of constructive solutions as to how the Government could alleviate this crisis situation but we have been left out in the cold; winter is going to be very, very tough without a

robust social care sector to support the NHS.’ Tim Cooper, Chief Executive of learning disability charity United Response, said, ‘Rishi Sunak may have rolled out the barrel for the hospitality industry, but the many thousands of people reliant on good social care are again scraping the bottom of the barrel. This Budget failed to address the urgent requirements for significant emergency investment to respond to the unprecedented pressures faced by thousands of care settings.’

Sector responds to Budget An additional £4.8bn of grant funding will be made available over the next three years for local Government; however, leaders have argued that the settlement does not go far enough to address the sector's long-term financial requirements. This comes in addition to the previously announced £5.4bn for adult social care, to be raised by an increase in national insurance contributions, as well as an immediate £162.5m fund to help the sector recruit and retain staff.

The National Care Forum (NCF) said the money falls short of what local Government was asking for and none of it is ringfenced for social care. Liz Jones, Policy Director of the NCF, said, ‘This Budget is a missed opportunity to recognise social care as a growing sector which already contributes £50.3bn per annum to the economy in England and the 1.5 million strong workforce making this happen. It also fails to build on the opportunities the Health and

Housing with care announces new identity The UK’s housing with care sector has adopted a new term to describe its service-led operational model. ARCO has called on the sector and Government to use a single term, ‘Integrated Retirement Community’, to describe the new form of specialist housing that its members provide for over 78,000 older people across the UK and plan to provide to a quarter of a million 10

CMM December 2021

people over the coming years. Research was conducted with 600 55-75+ year olds across England. Findings showed existing terms to be confusing and, at times, off-putting, leaving people unclear and uninspired when considering an ever-growing number of new living options now available. The representing body will be working with members and

the wider sector to support the adoption of the new term for the housing with care sector, including providing a clear toolkit and guide to language as well as infographics to describe the differences. ARCO Executive Director Michael Voges said, ‘Our research shows that eight out of ten older people are interested in housing and care options

which will help them to retain their independence, enjoying a fulfilling lifestyle as part of a wider community. People want facilities such as cafés and restaurants, optional activities and social links, with care available if they need it. Integrated Retirement Communities provide this choice at a range of price points, but awareness remains low.’

CMM December 2021

NEWS

New host and venue for Markel 3rd Sector Care Awards Care Management Matters is thrilled to announce a new host and venue for the upcoming Markel 3rd Sector Care Awards. The awards will be hosted by TV and radio presenter Len Goodman. Also taking place at a new venue for 2021, The Grand Hotel in Birmingham, the ceremony promises to continue

to celebrate outstanding achievements in the not-for-profit care and support sector. Following a successful career as a professional dancer, Len Goodman became head judge on Strictly Come Dancing in 2004 and joined the show’s American counterpart, Dancing with the Stars, as head judge in 2005.

Len loves dance, music, history, architecture and cricket and has been thrilled to be part of various documentary series based on these subjects. The ceremony will be held on Friday 11th February 2022 from 10.30am to 4.00pm and includes a drinks reception, threecourse meal and entertainment.

Nominations for the awards have now closed but ticket purchasing options are available to view on the CMM website. As the ceremony is planned to be a face-to-face event, CMM will be following Government guidance and working with the venue to ensure all COVID-19 guidelines are met.

New infection prevention network for social care A new network of adult social care infection prevention and control champions will be launched on 30th November, to help maintain and continuously improve standards across the care sector. Run by the Queen’s Nursing Institute, the scheme will be supported by the Chief Nurse for Adult Social Care, Deborah Sturdy OBE, and backed by a £35,000 grant from the Department of Health and

CMM December 2021

Social Care (DHSC). Chief Nurse for Adult Social Care Deborah Sturdy OBE has taken on the role permanently following an initial six-month appointment. The Government said lessons learned from the pandemic will be rolled out through the network to help minimise the future spread of infections, including COVID-19 and flu, to protect people living in care homes and receiving home care. The champions will share

best practice through a series of virtual meetings, a newsletter and discussion forum. The IPC Champions’ Network will be made up of front-line social care staff from settings around England, who are responsible for infection prevention and control in their specific areas or homes. Membership of the new infection prevention network is free and is not limited to registered nurses. Membership

is open to all of those who manage and deliver care in social care settings. This may include domiciliary as well as residential care. Charlotte Fry QN, Expert Nursing Lead, IPC Champions’ Network, said, ‘I am looking forward to developing the network to enable a platform to support staff to learn and share from experiences, bringing together and sharing good practice across our sector.’

NEWS

The Care Workers’ Charity writing competition returns The Care Workers’ Charity writing competition returned in November, which aims to give the social care workforce the opportunity to share their experiences from the past year. As 2021 starts to draw to a close, The Care Workers’ Charity wants to say a huge thank you to everyone who works in social care, who gives their all to positively shape people’s lives. The theme of this year’s writing

competition is ‘Community’. Throughout the pandemic, the strong bonds of communities have been highlighted, as people shared their kindness and supported one another. The Care Workers’ Charity wishes to hear stories, poems and day-in-the-life commentary that reflects ‘Community’. The theme could cover anything and everything from the care

community you belong to with social care colleagues, to the social care community at large and the community of your local area. Karolina Gerlich, CEO of The Care Workers’ Charity, said, ‘The Care Workers’ Charity is thrilled to have the support of The Care Umbrella, which is donating the prize money which will go the winners of 1st, 2nd and 3rd place in

the competition. Staedtler has also kindly donated some stationery kits. We would like to thank both organisations and our brilliant Charity Ambassadors for their kindness in supporting the event.’ This year’s competition opened on 1st November 2021, with entries closing on 30th November 2021. For further details, visit The Care Workers’ Charity website.

DHSC announces new recruitment campaign People across England will be encouraged to pursue a rewarding career in adult social care following the launch of a new recruitment campaign by the Department of Health and Social Care (DHSC). The Made with Care recruitment campaign will run across broadcast and social media for five months, encouraging people with the values that embody carers to join a workforce dedicated to helping others and build a career that helps

people to live happy, healthy lives. With almost half a million extra job opportunities in adult social care expected by 2035, and more than 105,000 vacancies needing to be filled, the Made with Care campaign aims to encourage people to apply for exciting and rewarding roles across the country. Gracewell and Sunrise currently have over 350 vacancies across their homes, including in management positions. They are using the

campaign to predominantly hire care assistants and nurses. However, they are also on the lookout for non-care roles such as laundry assistants, chefs, housekeepers and receptionists. Helen Shocker, Recruitment Business Partner at Sunrise Senior Living UK & Gracewell Healthcare, said, ‘We welcome the Government’s efforts to address the shortage of workers in the health and social care sector and

we will be doing everything in our power to drive the campaign and bolster our own internal recruitment. As well as advertising our vacancies through the Skills For Care campaign, we will be posting our openings directly.’ There are more than 112,000 vacancies in care and the Government itself predicts the loss of 40,000 to 70,000 workers because of its ‘no jab, no job’ care homes policy.

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CMM December 2021

NEWS / IN FOCUS

Committee calls for greater support for dementia The Health and Social Care Committee has published a report calling for greater funding for dementia from the Health and Social Care Levy. The report summarises that the committee is disappointed by the Government's proposed funding settlement in the form of £5.4bn spent on adult social care over the next three years and that there is little detail about reforms to the care and support available for people living with dementia. The Committee's report urges the Government to provide an increased and immediate funding package for the sector, in line with the Committee's previously recommended £7bn annual increase in funding by 2023-24. The report also calls upon the Government to provide further clarity in the upcoming white paper about how funds raised by the Health and Social Care Levy will

address unmet need for people living with dementia, their families and carers. Cllr David Fothergill, Chairman of the Local Government Association’s Community Wellbeing Board, said, ‘We agree with the Committee about the need for long-term funding to be provided to improve services for people with dementia and unpaid carers.’ Cllr Fothergill added, ‘Social care has been on the front line throughout the pandemic and it is disappointing that no additional funding to address existing pressures on care and support have been provided in the Spending Review. Future demand will also create further pressures, with this report worryingly warning that the number of older people living with dementia in England will increase to around 1.35 million by 2040, and many of these will require care and support from councils.’

Home care funding deficit revealed The Homecare Association has revealed a deficit between the hourly cost of funding home care and the amount local authorities pay providers. Through Freedom of Information requests, the Homecare Association found that, on average, councils in Great Britain and health boards in Northern Ireland pay £18.45 per hour of services provided. In contrast, the Homecare Association calculates the minimum cost is £21.43. The Homecare Association's estimate provides for the cost of minimum wage, travel time, pensions, holidays, training, PPE, office staff and 60p for profit or reinvestment in services per hour. While local authorities argue that they are not receiving enough funding from Government in order to pay providers a higher hourly rate, the funding deficit means that providers are unable to raise wages to remain competitive with other

sectors and retain staff. The Homecare Association is calling on Government to increase its investment in home care to address the funding deficit – namely, raising pay to £11.20 per hour; a ban on purchasing home care by the minute; a professional register for care workers; and adding social care workers to the Shortage Occupation List to make it easier to hire from overseas. Homecare Association CEO Dr Jane Townson said, ‘Zero-hour commissioning of home care at low fee rates leads to zero-hour employment of care workers at low wage rates. It makes little sense to neglect people at home, wait until they reach crisis point, then admit them to the most expensive setting of care in an acute hospital. Here they may lose further function and require even higher levels of support and care when they are discharged back home or to a care home.’

IN FOCUS

NEW ONS FIGURES ON SELF-FUNDED CARE

WHAT’S THE STORY? Data from the Office for National Statistics (ONS) reveals that between 2019 and 2020 there were approximately 143,774 (36.7%) self-funded care home residents. Last year, the Office for Statistics Regulation (OSR) published papers outlining gaps in evidence in social care across the four nations of the UK. The research suggested that not enough is known regarding the volume and value of privately funded provision of adult social care.

WHAT ARE THE FINDINGS? A summary of the key findings (source: ONS): • The south east had the highest proportion of self-funders (45.4%) compared with the north east, which had the lowest (24.6%). • Care homes located in the least deprived areas had a statistically significantly higher proportion of self-funders (53.8%) than care homes in the most deprived areas (21.6%). • Smaller care homes, with one to 19 beds, had the lowest proportion of self-funders (15.1%), which is statistically significantly lower than all other care home sizes. • Care homes providing care for

older people had the highest proportion of self-funders (49.6%); this was statistically significantly higher than care homes providing care for younger adults, which had the lowest proportion of self-funders (4.8%). A previous GMB investigation into social care debt carried out by GMB in 2018 revealed at least 166,000 people were trapped in debt for their social care, with more than 78,000 having debt management procedures started against them and more than 1,000 facing court proceedings.

WHAT DID THE EXPERTS SAY? Pete Davies, GMB Senior Organiser, said, ‘The underfunding and exploitation of our care system has weighed heavy on those who find themselves having to pay for their own care. Many people are paying far above the rate that a local authority would pay for the same service. ‘Care workers can't survive on empty promises by a Government that is turning away from the elderly and most vulnerable in our communities, whilst refusing to recognise the highly skilled workforce.’ GMB is campaigning for at least £15 an hour for care workers. CMM December 2021

NEWS

Marie Curie invests in future of care End of life charity Marie Curie is warning more pressure will be put on primary and social care, as well as community services, this winter as half a million people are expected to need palliative care. This comes following a 40% increase in the number of people dying at home with a terminal condition instead of in hospital – creating more than 70,000 extra home deaths – during the pandemic. With over eight out of 10

people predicted to die from more than one condition by 2040, Marie Curie is committed to investing in palliative and end of life (PEOL) research, which currently sits at just 0.21% of all the money spent on health research in the UK. As such, Marie Curie, which is also the biggest charity funder of PEOL research in the UK, has opened its latest research grants scheme, with researchers able to receive a share of £750,000, providing one or more of the

following is addressed: • To provide high-quality care and support for the mental and physical health and wellbeing of people affected by dying, death and bereavement. • To end financial insecurity at the end of life and ensure that everyone has the support they need to address their practical concerns. • To ensure that everyone affected by death and dying – including the family, friends and carers of

the dying person – are supported through and beyond the end of life (including bereavement). • To end inequity in end of life experience by ensuring access to excellent standards of care and support for all. In addition to the above thematic areas, Marie Curie is also inviting proposals in cross-cutting themes and projects aiming to maximise the impact of existing research and evidence.

Hallmark Foundation publishes Care 2030 report Hallmark Foundation, an independent charity, published Care 2030 this week – a vision paper outlining priorities for care. The six priorities for action focus on choice and control, workforce, integration, housing, technology and family carers – all key issues as the Government prepares its spending review and social care white paper. Recommendations in the

paper include creating an Office for Care and Ageing Well, which would monitor and report unmet care needs in our ageing society and promote sustainable ways to deliver better care and prevention. Other recommendations include a renewed drive to make direct payments work for older and disabled people using care, a focus on personal strengths

and relationships, imaginative approaches to recruiting and developing care workers and future leaders, improvements in developing lifelong homes and supporting family carers, and a smooth transition from children’s care services to adult support. The Hallmark Foundation said the recommendations stem from analysis in the paper of growing unmet demand for care,

an underfunded system that increasingly focuses on crisis care, and a largely poorly trained and paid workforce. The charity also said that setting up an Office for Care and Ageing Well is seen as a key step towards ensuring that the widening care gap is closed. Care 2030 was jointly written by journalist Jonathan Bunn and Stephen Burke, Chief Executive of the Hallmark Foundation.

New digital care home game launches 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. The creator, Christopher Green, is an award-winning writer, experiential theatre maker and performer who is best known for their comedy character ‘Tina C’, who featured on BBC Radio Four for five series. 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. Creator Christopher Green has spent years working with care home residents, whose voices they say are overlooked in the debate about the future. Commenting on the project, Christopher Green said, ‘I spent a year creating a large digital entertainment project to give audiences a way into imagining how they might feel being cared for. It was a collaboration

with Saitama Arts Theatre, their directors, filmmakers and actors. It was a something of a surprise to realise recently that the baseline concern behind all their creative content was about notions of “what does care mean?” All the UK creative content was built around “how is care funded?”. This tension between compassion and capitalism as highlighted by the two countries I think is very revealing.’

Dementia specialist housing in Harrogate Work has completed on Vida Court, the new 100-bed specialist dementia care home in Harrogate which will welcome people living with dementia from across the UK. The home has been built on behalf of specialist dementia care 16

CMM December 2021

provider Vida Healthcare. The multi-million-pound facility on a 3.5-acre site off Beckwith Head Road will be home to 100 residents in eight self-sufficient houses, all with en-suite bedrooms. Communal and social facilities on

offer will include a newsagent, coffee shop, private cinema and sensory gardens. Although the 18-month build experienced challenges due to COVID-19 and social distancing restrictions, the scheme has

progressed. Caddick Senior Contracts Manager Chris Allott said, ‘It has been a very rewarding project to work on knowing we are bringing these much-needed facilities to Harrogate when demand is so high.’

CMM December 2021

NEWS

Meals on Wheels Week recognises contribution Meals on Wheels Week returned on 1st to 5th November 2021, the national awareness event organised by the National Association of Care Catering (NACC). Meals on Wheels Week 2021 saw the return of #mealsonwheelsheroes, the social media initiative that shows gratitude to Meals on Wheels services and their teams as they continue to deliver their lifeenhancing services against the

ongoing challenges of the COVID-19 pandemic. The NACC called on everyone – from its members, industry colleagues, partners, associations and friends to local Government, politicians, celebrities and the general public – to take to social media to publicly declare their support and gratitude for all Meals on Wheels heroes. Supporters were asked to hold a special thank you poster, have

their photograph taken and then share it on their preferred social media platforms using the hashtag #mealsonwheelsheroes. Sue Cawthray, the national chair of the NACC, said, ‘Over the past 18 months, we’ve seen how Meals on Wheels services have reinvented themselves in the face of adversity. The combination of the pandemic and reducing social care budgets has changed the Meals on Wheels

landscape. From this we have seen innovation, creativity and brilliant new ways of working. New partnerships between local authorities, providers, charities and hospitality establishments, for example, have ensured continued support where it’s needed. We all have a responsibility to learn from each other, adapt and ensure the physical and emotional wellbeing of older and vulnerable people in the community is a priority.’

Farleigh Hospice wins national award A Chelmsford-based hospice has been nationally recognised for its response to COVID-19, with its dedicated team stepping up to help local hospitals as they faced a sharp rise in patient numbers. Farleigh Hospice reorganised clinical services so that it could care for more people in their own homes during the pandemic and support the pressures on the NHS. This

meant that people could have their loved ones with them during some of the toughest times of the crisis and have access to high-quality end of life care. Matt Sweeting, Director of Care at Farleigh Hospice, said, ‘When COVID-19 struck, we knew we needed to take swift and radical action to maximise our ability to care for people in the community

and in their own homes. Our aim was to work as one team, with the patient at the centre of what we do. This one-team approach led to the reorganisation of our community services and the creation of our Virtual Ward model. By working in partnership with our NHS domiciliary agencies and care home colleagues, we were able to provide a range of specialist care services.’

Hospice UK CEO Tracey Bleakley said, ‘Whether helping to raise awareness about what end of life care is, making sure everyone in the community can get help they need or supporting families through the loss of a loved one, each of our winners has made a massive difference to the care people with life-limiting conditions and their families receive.’

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CMM December 2021

NEWS

Carers UK publishes state of caring report New research from Carers UK reveals that over one in five unpaid carers (21%) are worried they may not cope financially over the next 12 months. Carers UK carried out an online survey between August and September 2021; a total of 8,676 carers and former carers responded to the survey. Carers who took part are currently caring unpaid for family or friends – the majority of whom provide well over 50 hours of care every week – and reveal the huge personal and financial cost of

caring for a loved one. Nearly one in four carers (23%) do not have enough money to cover their monthly expenses. Many carers are worrying about how they will cope this winter, facing rising energy prices and increases in the cost of living. As well as providing significant levels of care themselves, almost two thirds (63%) of carers are also using their own income or savings to cover the cost of care, equipment or products for the person they care for. On average, carers spend

an estimated £1,370 a year on services or equipment for the person they care for. Helen Walker, Chief Executive of Carers UK, said, ‘For years, carers have been propping up our health and care system at a huge cost to their own personal health, finances and ability to stay in work. ‘They desperately need support to regain quality of life and enable them to continue caring. The Government must recognise the toll being placed on unpaid carers and ensure that social care reform delivers for carers.’

Brunelcare celebrates befriending week Bristol-based charity Brunelcare launched its ‘Friends on the Phone’ initiative at the beginning of the pandemic, in a bid to combat loneliness for Brunelcare residents and tenants. Nicky, an Occupational Therapist/Mental Health

Practitioner who volunteered to be part of the initiative and Mike, who lives at one of Brunelcare’s sheltered housing sites, were randomly partnered up as volunteer befriender and befriendee in April 2020. Nearly two years later, the pair are still in contact

and have become great friends! Emma Gwynne, Volunteers Manager at Brunelcare, said, ‘It’s great that lasting friendships have been made from the initiatives we launched during the pandemic – it’s so lovely to see how volunteering can bring people together.

Oakland Care opens new home Oakland Care has officially opened its latest care home, Elsyng House, in Enfield. The luxury care home provider, which operates six care homes in the South of England, celebrated the opening of Elsyng House at a VIP event hosted on 20th October. This new home will deliver 76 individual, private en-suite rooms and offer residential, nursing, memory and respite care. The provider is also set to open two new care homes in Kent in the coming months: Birchwood Heights in Swanley and Maplewood Court in Maidstone. Feryal Clark MP, the Member of Parliament for Enfield North, said, ‘Providing people with dignity in later life and the care that enables this is vital, and Elsyng House will allow our local community to have that dignity in such a pleasant environment.’

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CARE MARKET ANALYSIS:

REFLECTION AND 2022 FORECASTS

CMM December 2021

THE CARE MARKET IN 2021

What impact has the pandemic had on the care market? Mike Hodges, Managing Director of Healthcare Consultancy at Christie & Co, reflects on 2021 investments and explains what providers should be aware of for the year ahead.

Throughout the pandemic and despite many challenges, the care sector has proven to be exceptionally resilient, with care providers and their staff playing a vital and inspiring role. This has also been seen in the transactional market, with 2021 witnessing a resurgence of previously paused mergers and acquisitions activity at a multitude of levels. The year has comprised a number of landmark deals, including the arrival of European investors such as the French healthcare fund, Pierval Santé, which acquired a group of Care UK investments from Legal and General in a deal brokered by Christie & Co. Separately, the major Belgium fund, Cofinimmo, marked its entry into the British market with the acquisition of three modern care homes let to Country Court Care. On the operational side, 2021 has also seen the arrival of Korian, one of the largest European consolidators, with its acquisition of Berkley Care Group, a high-quality platform operating at the private end of the market. What has also been very encouraging this year is the strength of activity and positive sentiment in all segments of the market, where the main underlying theme is strong demand from well-funded purchasers. This, coupled with a shortage of stock, has ensured that pricing has remained strong, a trend that is illustrated well by reference to Christie & Co’s market activity. Christie & Co is routinely responsible for selling more than 50% of all individually transacted deals in the UK market and, in 2020, Caring Times' deal analysis showed that our business was responsible for 62% of homes transacted. During 2021, we have run several major divestment projects on behalf of a variety of corporate clients whilst being extremely busy in the regional transaction markets. When analysing the deals we concluded year to date, two very interesting statistics jump out. The first is that the average number of offers for transacted assets has increased to 6.2. This is notably ahead of the 4.7 seen last year and is higher than the pre-pandemic position of 5.8 in 2019. The second key statistic, which is an analysis of the agreed sale price relative to the asking price quoted, is that year to date, we have achieved on average 95% of the asking price quoted, further reinforcing the strength of buyer demand.

CMM December 2021

CARE MARKET ANALYSIS: REFLECTION AND 2022 FORECASTS

DEVELOPMENT AND INVESTMENT ACTIVITY

2021 has also been an extremely busy year for our development and investment team. This has been fuelled by operators, investors and developers taking a longer-term view in the knowledge that there are material shortages of future fit market standard beds in many parts of the country, coupled with increasing demand as the number of people requiring care is anticipated to steadily increase over the coming years. Additionally, the pandemic has highlighted the need for greater infection control measures and such design features are now being integrated in new schemes which are shaped by evolving operational requirements. These are much easier to incorporate into new build developments than retrofit into existing converted assets. Some areas of the South East have seen high levels of new build activity and specialist developers are now branching out further into pockets of the North and South West of England. These regions have seen much less development activity in recent years but continue to have strong demand drivers and an undersupply of market standard bed capacity. Land availability in locations with compelling underlying demographics remains scarce and securing planning permission continues to be a highly protracted, costly and uncertain process. Due to these factors, land values for sites with planning permission have continued to increase with recent deals in the strongest locations being upwards of £60k per bed and, in some cases, notably higher. We anticipate demand to remain robust for the foreseeable future. From an investment perspective, the year has seen a broadening array of investors active in the market who are attracted by the long-term needs-driven fundamentals of the sector. The increased demand and lack of alternative opportunities for investors is resulting in yield compression across the spectrum

of covenants and is also creating additional liquidity in the sector, allowing operators to undertake strategic growth plans, particularly through the use of forward funding structures.

OPERATIONAL FACTORS Whilst the positive transactional market environment is extremely encouraging, the sector is not immune to challenges facing many parts of the wider economy. These include labour shortages, global supply chain issues and energy cost increases. Such factors have an impact on existing trading businesses and, also, the development of new care homes where we are seeing a trend of build cost increases and delays due to challenges associated with sourcing skilled labour and building materials. The challenges facing the construction industry have recently resulted in the failure of one major contractor with recent tenders coming in at – or in excess of – circa £130k per bed. It was not long ago when build costs were much nearer to £100k per bed. Operationally, the labour challenges play out with a shortage of care, domestic and nursing staff. There is strong competition for good-quality staff, and, with a significant level of current vacancy rates, we are already seeing upward pressure on staff pay rates leading to higher costs. This will be exacerbated by increases in employers’ national insurance contributions following the Government’s Build Back Better programme as announced in September. Wage inflation, along with other cost increases, will create inevitable pressure on operating margins unless revenue growth is sufficient to offset the extra cost. Positively, operators are now reporting strong levels of enquiries with many advising that these are at – or are close to – pre-pandemic levels. Encouragingly, this appears to be translating into good admission levels, although several operators have referenced a surge in respite

cases as residents and their families seek reassurance via an initial shorter stay ahead of committing on a permanent basis.

WHAT TO LOOK OUT FOR IN 2022? The level of fee rate increases for the year ahead is hard to call. The Government’s announcements around funding reforms are unlikely to have any tangible short-term impact on the social care sector, with a number of operators working on the assumption that local authority fee rate increases are likely to be modest and not at the level required relative to the level of cost inflation anticipated. Private fee rate increases are likely to be more pronounced. We

“One particular feature of 2021 has been the relatively cautious approach of many lenders due to an understandable focus on supporting existing customers rather than actively seeking new business.” are hearing proposals in the range of circa 5% to circa 8%, although much will depend on local market dynamics relative to each care home. These points aside though, with new well-funded participants entering the market coupled with strong activity from a wide range of longstanding operators, investors and developers, we fully expect 2022 to be a busy year transactionally. One particular feature of 2021 has been the relatively cautious approach of many lenders due to an understandable focus on supporting existing customers rather than actively seeking new business. We are already seeing a change in this dynamic although, equally, we also expect to see an increase in the number of consensual exits as part of de-leveraging strategies, particularly as loans reach maturity. CMM

Mike Hodges is the Managing Director of Healthcare Consultancy at Christie & Co, a leading specialist adviser for buying and selling businesses across a range of sectors. Email: michael.hodges@christie.com Twitter: @ChristieCo How has the pandemic impacted on your care market strategy and which points raised in this article would you like to know more about? Share your feedback on the article: visit www.caremanagementmatters.co.uk 22

CMM December 2021

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MEDICATION DELIVERY: Finding new ways to improve medicine administration in care homes

Caroline Maries-Tillott, Quality Improvement Lead at West Midlands Academic Health Science Network (WMAHSN), shares insights into a pilot project on medicines administration and explains what the sector can learn from the project’s findings. IMPROVING SAFETY Patient safety is at the heart of everything we do in the health and social care sector. Safeguarding patients from avoidable harm, particularly those who are considered vulnerable such as care home residents, has become a heightened priority. This is not only because of the challenges brought on by the coronavirus pandemic but also due to the growing number of residents with high support needs. Data1 from recent years show as many as 90% of care home

CMM December 2021

MEDICATION DELIVERY: FINDING NEW WAYS TO IMPROVE MEDICINES ADMINISTRATION IN CARE HOMES

residents have high support needs – requiring additional care to manage dementia, confusion, challenging behaviour, mobility dependence, dual incontinence or severe hearing/visual impairments. Residents with such needs rely heavily on multiple medications being prescribed correctly and efficiently and a robust and clear medicines safety framework being in place to ensure that patients are kept safe when medicated. This is why patient safety and medications management make up an incredibly important aspect in ensuring the safe care and comfort of residents with increasingly complex needs.

A MULTIFACETED PICTURE A report in 20192 noted that, of the estimated 237 million medication errors occurring each year in England, 92 million of these errors took place in care homes. With tailored care comes additional challenges and pressures on staff to get care and treatments right. The NHS is seeking to reduce severe avoidable medication-related harm by 50% by 2024 across the UK and a key element of this work is, rightly so, the safer administration of medicines in care homes. The Care Home Use of Medicines Study (CHUMS report) published in 2009 outlined the prevalence, causes and potential harm of medication errors in 55 care homes for older people. The report revealed an unacceptable level of medication errors relating to older people in care, with as many as seven in ten residents experiencing an error with their medicine. These errors range from doses being missed or given incorrectly, to the wrong drugs being given out. In some cases, these errors have the potential to cause very serious harm. Distractions during medicine rounds are one such potential source of error. To mitigate the risks of harm, we must provide staff with the support and necessary resources to ensure they can better manage and reduce possible interruptions and learn from historical errors to ensure effective, long-term interventions are established to keep patients safe.

REDUCING RISK At the start of the pandemic, the 26

CMM December 2021

WMAHSN began a quality improvement (QI) programme at Marian House, a 42-bed nursing home in Sutton Coldfield. We sought to encourage safer administration of medicines and minimise interruptions to staff during medicine administration. The project formed part of the national Medicines Safety Improvement Programme (MedSIP) and was commissioned by NHS England and Improvement (NHSE/I), and its findings will play a critical role in driving improvements nationally. The West Midlands Patient Safety Collaborative (WMPSC), which is leading this work in the West Midlands region, invited expressions of interest from care homes in the area to take part in this pioneering improvement work. Marian House submitted a request to collaboratively undertake the work to reduce interruptions to medicine rounds and was selected as the successful triallist for this project. While it is important to recognise that not all interruptions are avoidable, particularly if there is a safety situation requiring urgent action, a lot can be done through targeted interventions. The staff and the manager of the care home who we worked with for the trial had highlighted a particular interest in reducing avoidable harm and exploring how they could update processes and ways of working to further improve quality of care. Work quickly commenced to establish a baseline for interruption occurrences during medicine rounds with the time of day, number of interruptions and why the interruption occurred being recorded. After this initial collection of data, the team was soon able to establish that the morning medication round saw the most interruptions – an average of three times (n = 3.45) each day – and this became a particular area of focus for developing the improvement strategy.

NO TIME TO WASTE As soon as a baseline was set, the team agreed to attempt to a reduction in interruptions to rounds by a third in one month. It was critical to work with the staff in all areas and at all levels of the business, from nurses to laundry staff, cleaners to administrators, to collectively explore ways in which to

change culture, practice and procedure. In a team session, we set out ideas to test to try and limit interruptions. Solutions came from across the organisation and highlighted areas in practice, staff culture and protocol, which needed to be addressed or updated to limit interruptions. Collaboratively, a list of interventions was established. This included things such as ensuring all new staff and visitors knew how and when to escalate concerns about residents and that nurses handed over phones to care staff while doing each round. The use of a handover communication book for non-urgent messages was also included on the list of possible interventions. Each of these interventions may sound minor but the results seen collectively during the month of implementation speak for themselves. The reduction seen in the medicine interruptions during the trial month far surpassed what the team had hoped to achieve. In fact, the seven-day rolling averages from implementation and the months that followed showed that interruptions dropped by approximately two thirds to less than one interruption per round (n = 0.87). The project also appeared to have an impact on the safety culture within the home. Staff feedback from safety culture assessment pre and post the interruptions project showed improvement in four out of five safety domains – safety climate, stress recognition, perceptions of management and working conditions.

TEAM ENGAGEMENT The improvements achieved at this care home represent not only a major improvement in patient safety and care quality, but a significant culture shift towards safer and more efficient medicine administration. It’s important to note that, although the implementation of QI methods has long been used within the NHS, use within a care home setting is relatively new. Before we embarked on this medicine safety project, literature on the use of QI methods in care homes was incredibly limited and QI data in relation to medication was rare to non-existent. This project broke new ground, not only demonstrating the impact

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MEDICATION DELIVERY: FINDING NEW WAYS TO IMPROVE MEDICINES ADMINISTRATION IN CARE HOMES

that QI methodology can bring to medicines-related activity in the care home sector but also in laying down the framework for how others may approach the subject. In fact, since our test programme in the West Midlands, the project has evolved to generate automated interruptions dashboards, available to care homes across England that are looking to embark on a similar journey as part of the national MedSIP scope of work. Although improvement tools and techniques should not be taken ‘off-the-shelf’, the dashboards provide a useful starting point for adaptation and the application of local context to each care home. More literature needs to become available on the topic; however, results such as these breed more positive outcomes, enabling other care homes to follow on a similar journey.

COVID-19 IMPACT The way we consider patient safety, particularly that of vulnerable care home residents, has changed forever. Residents have long been a group of patients with complex and evolving needs and establishing best practice

to ensure long-term quality of care has risen as a priority in public opinion in a matter of months. Although there is room for more to be done, it is important to remember the tireless work that staff continue to do to ensure resident welfare. Without the support and ongoing resources that enable staff to focus on continuous QI, services will inevitably crumble under the pressures of keeping patients safe. The pandemic has highlighted the importance of carers and care home staff and their unwavering dedication and passion to look after patients and improve care and safety. However, very few care home teams have had the opportunity to receive any formal QI training and are therefore limited in their knowledge around QI and associated areas of practice such as human factors. By introducing care home teams to the model for improvement and by engaging them to be part of a QI project and equipping them with skills to measure improvement, they are given the opportunity to improve standards of care in their place of work. It also fosters a culture of improvement and helps them to design safer systems of working. Ultimately, these insights will

reduce avoidable interruptions to medicine rounds and support care homes in evidencing their efforts to meet the domains assessed by the CQC (particularly safe, effective, responsive and well led) and NICE recommendations 1.5 and 1.6 (reporting and reviewing medicines-related problems and keeping residents safe). If there was ever a time to increase the support and funds to the sector to support staff in not only keeping patients safe but having the time and capacity to review ways of working, it’s now – and both patients and employees will ultimately benefit. We chose the care occupation because we believe care matters, and the best way for us to continue to inspire and encourage the workforce of the future is to ensure we continue to improve the quality of work and the procedures that ensure the safety of patients and wellbeing of staff. CMM REFERENCES 1. http://www.cpa.org.uk/ information/reviews/ changingroleofcarehomes.pdf 2. https://qualitysafety.bmj.com/ content/30/2/96

Caroline Maries-Tillott is the Quality Improvement Lead at West Midlands Academic Health Science Network (WMAHSN). Email: info@wmahsn.org Twitter: @wmahsn In what ways have you adapted to improve the delivery of medicines administration and how is the workforce shortage crisis and pandemic impacting on your approach? Tell us your thoughts on the CMM website, where you can leave feedback on this article: www.caremanagementmatters.co.uk

CMM December 2021

INTO PERSPECTIVE ARE THE SOCIAL CARE REFORMS ENOUGH TO SUSTAIN THE SECTOR AND THOSE IT SUPPORTS? THE STORY SINCE SEPTEMBER

On 7th September, Government published its policy paper ‘Build Back Better: Our Plan for Health and Social Care’, outlining long-awaited sector reform and how it will be funded. Headlines included the introduction of a lifetime cap on personal care costs, the adjustment of local authority financial assessment thresholds, £5.4bn spending over three years, raised by the Health and Social Care Levy, to deliver Government’s commitments and £500m of this package to develop the sector’s workforce. While the introduction of the reforms goes significantly further than multiple previous Governments have been able to achieve and offers potential for growth, many in the sector have challenged their long-term ability to truly reform adult social care and improve the lives of people relying on services. 30

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Since Government published its policy paper in September, the sector has been subject to the Autumn Budget and Spending Review, which was poised to share further details about how the proposed social care reforms would be funded, particularly from a local authority perspective. The Chancellor’s primary announcement for the sector comprised £1.6bn of new grant funding in each of the next three years for English councils. In advance of this, an additional £162.5m of new funding was announced to help workforce retention and recruitment, available until the end of March 2022. Although seemingly attractive on paper and, at the very least, an acknowledgement from Government that the sector needs additional support to enact its reform agenda, the announcement left most feeling underwhelmed about the prospect of the sector’s long-term sustainability. The greatest cause for concern seemed to be surrounding Government’s decision to not ringfence the new grant funding totalling £4.8bn for adult social care, meaning it is unclear exactly how much the sector will be able to get its hands on – unlike the additional workforce retention and recruitment funding, which aims to ensure there is the right number of staff with the skills to deliver high-quality care to meet increasing demands, but ‘amounts to only £100 per member of the care workforce’, according to Dr Jane Townson, CEO at the Homecare Association. Despite the intention of the

adult social care COVID-19 winter plan for 2021 to 2022 to address the sector’s ongoing response to COVID-19, it was difficult to prevent the conversation from circling back to the need for a long-term reform settlement and how the winter plan fell short of this. In summary, Karolina Gerlich, CEO of the Care Workers’ Charity, argued that ‘the winter plan glosses over and indeed, completely minimises the experiences of those working in social care’. The plan failed to mention any additional financial support for the sector’s workforce that had not already been announced, seen by many as an indication of Government’s short-sighted approach to reform.

WHITE PAPER WISH LIST As well as the now ubiquitous demands for greater financial investment in the sector and increased workforce support, the highly anticipated White Paper for adult social care faces a host of additional expectations that it must satisfy to enact sustainable long-term change for the better. Firstly, the White Paper must develop Government’s pledge to enhance service users’ choice, control, and independence when it comes to determining the best care options based on their needs. Other crucial areas the White Paper must build upon include the development of housing with care, taking advantage of the opportunities provided by technology, supporting unpaid carers and considering how best to join up social care and health services to ensure clear and person-centred care pathways are established across the sector.

Another broken pledge?

Government must set clear expectations

Charles Tallack, Assistant Director for the REAL Centre, The Health Foundation

Cllr David Fothergill, Chairman, LGA Community Wellbeing Board

In September, the Government took a bold step by breaking a key manifesto commitment not to raise taxes with the announcement of the Health and Social Care Levy, funded by raising National Insurance contributions. The levy will go towards supporting the NHS’s post COVID-19 recovery, including clearing the elective care backlog and reforming social care. A lifetime cap on social care costs of £86,000 and more generous means test was announced, supported by £5.4bn funding over the next three years. As welcome as these reforms are, the levy does not help address the funding-related challenges plaguing the existing system: high levels of unmet need, staff shortages and poor workforce pay and conditions, and a fragile provider market. All of this awaited the Spending Review. So, what do we know now? As a result of the local Government settlement, councils’ spending power is expected to increase by around 2% a year. But, with increasing demand on services and care provider prices rising to around 3.5% a year, the settlement is only enough to cover the future demand pressures if unspecified ‘efficiencies’ are made,

or local authorities prioritise social care over other vital services. In fact, 3.5% a year may be on the low side as providers face additional costs from the rise in National Insurance contributions and the National Living Wage. Around 21% of care workers are paid the National Living Wage, so this increase will hit care providers particularly hard. If funding is barely sufficient to meet future demand, it will not begin to tackle the other challenges. Meeting future demand, increasing the prices paid for care so that providers can raise quality and wages and increasing the number of care packages by 10% to make some inroads into unmet need, would require additional funding of around £7.6bn in 2022/23. This would rise to £9.0bn in 2024/25, over and above that provided for in the Spending Review, including by the levy. The cap is undoubtedly a long-overdue reform to the way we pay for social care. But without substantial extra money for the existing system, social care will limp on, failing many of those who need its help. The pledge to fix the crisis in social care once and for all may be another broken one.

Investment in adult social care is an investment in all of us, enabling people to live the life they want to lead, contribute to society and in turn strengthen our local communities. The Government’s social care plan set out initial reforms for the sector and how extra funds will be raised, but the recent Spending Review was disappointing and has left councils concerned about the immediate and medium-term sustainability of care and support. While we are supportive of reforms, including the introduction of a cap on care costs, there are still questions about the adequacy of the announced £5.4bn for social care through the new Health and Social Care Levy. It is troubling that only £200m has been made available in 2022/23 to support reform implementation, particularly if that includes the commitment to move towards councils paying a fair rate of care. The Spending Review did not set out how much of the £5.4bn will be used to pay for other Government reform commitments, such as action to better support unpaid carers, investment in the Disabled Facilities Grant, supported housing, and

improved information and advice. Councils urgently need this information, so they have a better understanding of what is expected of them over the coming months. Since 2010, adult social care has had to manage a £6.1bn funding gap, £4.1bn of which was through savings. Social care’s core cost pressures amount to £1.1bn over each of the next three years and come on top of a pre-existing, annual pressure of £1.5bn to stabilise the care provider market. This is in addition to many other challenges, such as the need for greater investment in prevention and action on care worker pay and conditions. The additional £4.8bn in the Spending Review for local Government overall needs to be seen in this context. The new Levy should be used to support front-line social care, to stave off the worst of the pressures and provide a degree of stability for the short- to medium-term. Without proper long-term investment for adult social care, it is likely that councils will continue to struggle to meet their statutory duties under the Care Act, with real consequences for people.

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RIDING THE STORM: The challenges facing the social care sector What h appens w hen Governme The Nat nt does not ‘Think Social Care First'? Liz Jone ional Ca s, Policy Director at re Forum (NCF ), reviews the recent policy updates for the s ocial care sector and outlines the pressing challenges for the mont hs ahead.

Writing this article on 11th November, the day that all care home staff must be double jabbed to continue to work there, gives cause for reflection on how the social care sector finds itself in such a difficult position, where Government policy has exacted such a heavy price. Let us look back at the last few months of policy announcements – it is clear to see that things could have been so different if real social care reform was at the heart of Government policymaking.

A PROMISING START The Health and Social Care Levy announced in the Plan for Health and Social Care was a bold move – it broke a manifesto commitment and raised taxes to pay for the problems resulting from the pandemic in health and social care. It came with

CMM December 2021

RIDING THE STORM: THE CHALLENGES FACING THE SOCIAL CARE SECTOR

a strong statement about taking the difficult decisions about social care reform that other Governments have dodged. But then, the promise it offered started to tarnish as it became clear that, in fact, the plan was to carry on prioritising the funding of the NHS backlog over social care with only £5.4bn of the estimated £36bn earmarked for social care. To anyone looking at the challenges being faced by social care, it seems really clear that the interdependencies between the two bits of the system are still not fully grasped by policymakers. If the £36bn generated by the Levy was equally shared between health and social care, it would go a fair way towards providing much of the additional £7bn that the Health and Social Care committee concluded social care needs now, just to keep going. While there were some things to welcome in the announcement, such as an increased focus on prevention in health, a White Paper for adult social care to be developed with care users, providers and other key stakeholders and a £500m commitment to help the social care workforce with support in professionalising and developing the workforce, it offered nothing to tackle the immediate workforce crisis in social care (see our recent surveys for November, October, August).

INDIVIDUAL IMPACT The workforce crisis in social care really matters because social care matters to people. It matters to the millions of people who draw upon it every day; it matters to the 1.54 million-strong workforce supporting people every day; it matters to millions of unpaid carers and to the 18,200 organisations providing it. Indeed, it matters to the NHS workforce who are facing

huge pressures because without social care, people are forced to remain in hospital, even though their acute healthcare needs have been met, preventing others from gaining access to vital healthcare. It matters to all the people and their families who are struggling at home and are in need of care and support to help them continue to live safely and well. We looked in hope to the budget and the Comprehensive Spending Review at the end of October. This should have been an opportunity to hear more about how the Government plans to support social care and how the Treasury sees this sector as an important contributor to the economy and growing sector. There were no new announcements for social care, only a confirmation that social care will receive £5.4bn over the next three years from the Health and Care Levy. Again, the budget was silent on immediate support for the social care workforce pressures being experienced right now, affecting people and the NHS every day; silent on how the very welcome increase in the National Living Wage is going to be funded for the social care workforce. The Spending Review was also silent on calls to re-apportion the Health and Care Levy to properly fund social care reform and silent on the economic contribution of the £50.3bn the sector already makes to the economy. It fails to recognise that social care is a large and growing sector, which employs more people now than the NHS and will need to employ 490,000 extra people, on top of the current workforce vacancies (105,000), by 2035. Neither the budget nor the spending review help us explain to our workforce why they are paying for a Health and Care Levy that does not appear to benefit them at a time when the need for investment is greatest.

A MUCH BIGGER PROBLEM And then, in early November, we had the Adult Social Care Winter Plan. At NCF, we have been calling on the Government to use the Winter Plan as the opportunity to take some immediate action to support the social care workforce now. Actions include paying a retention bonus to care staff which is not taxed (and not subject to Universal Credit rules), in line with the other countries in the UK. Once again, the plan made disappointing reading. It largely rehearsed all the things that the Department of Health and Social Care (DHSC) had already done or announced. Repeating small funding packages, such as the Infection Control and Testing Fund and Recruitment and Retention Fund, sadly does not increase them. Again, it didn’t acknowledge the scale of the workforce crisis at all nor did it offer much new in the way of resources and practical support for the winter. The Government’s response is simply not proportionate to the sheer scale of the workforce crisis. And with reference to the policy on vaccination as a condition of deployment, the Winter Plan did not recognise the impact this policy has had and is having. In a recent survey to members operating care homes, our findings show that care providers fear they will lose around 8% of their care home staff as a direct result of this policy. This is a very serious loss of staff and one which, given the enormous workforce pressures now, the care sector can ill afford. The national roll out of the policy has been chaotic. Our survey respondents have been critical – stating that their experience on the ground is one of a policy ‘badly thought through’ and that the timing

of the policy is ‘out of touch’ with the enormous pressures experienced by the care workforce. Neither the Winter Plan nor the Impact Assessment (only published on 9.11.21!) of this policy recognise the unnecessary high cost it has had – in terms of human costs, financial costs and the loss in trust and goodwill amongst care staff and their employers as a direct result of this policy.

A NEW NARRATIVE Let us reimagine what the policy for social care could have looked like over the last few months if the Government did indeed Think Social Care First. It could have seen social care as equal partner to the NHS, an essential part of the health and care system that people rely on. As equal partners it would have been easier for both parts of the health and care system to work together and actively support each other through the current winter pressures, such as shared workforce planning and joined-up recruitment initiatives. It could have given the social care workforce the recognition and reward they deserve. It could have created a different narrative for social care – person-centred and looking towards the future, with innovation and new ways of shaping how we provide social care, supporting us to understand and respond better to what people say they want from social care, both now and in the future. It could see the sector as a key part of the economy, one that needs investment and support to keep helping people to live their best lives every day, making a difference to families and communities across the country. As a society, it is time to reimagine what social care can be. CMM

Liz Jones is the Policy Director of the National Care Forum. Email: liz.jones@nationalcareforum.org.uk Twitter: @NCFCareForum @NCF_Liz Do you agree with the social care narrative suggested by Liz Jones? Visit www.caremanagementmatters.co.uk and share your comments on the points outlined in the feature. 34

CMM December 2021

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: t n e m e v o m l u Meaningf Practical solutions for physical activity

CMM December 2021

During the pandemic, Oomph! Wellness provided a virtual lifeline to care home residents with its movement and activity initiatives. In this article, Jack McKechnie, Regional Wellbeing Coordinator at Oomph!, shares session planning ideas on a variety of disciplines.

THE BIGGER PICTURE With the number of people living with long-term health conditions set to rise to 18 million by 2025, it’s more important than ever that people do whatever they can to get active. That needn’t be strenuous exercise but trying to build small and meaningful activity into each day. It has always been our mission at Oomph! to ensure older adults remain physically active. This mission is more vital now, due to the pandemic and the restrictions that have been imposed on people’s lives. Numerous surveys and studies have shown older people, in particular care home residents, suffering increased levels of loneliness, anxiety and stress during the pandemic, especially during lockdowns. (Examples include research from Stirling University and a study by the charity Age UK). This can have consequences for a person’s health. One study has argued that it is as detrimental to health as smoking 15 cigarettes a day. According to Alzheimer’s Society, exercise can encourage mobility – and therefore independence – for as long as possible for people living with dementia. When we are more physically active, we reap the benefits mentally, physically and emotionally, therefore improving our overall quality of life. This message is at the core of Oomph!’s exercise training and something that we strive to support every client with on a day-to-day basis.

PANDEMIC PROJECTS The COVID-19 pandemic accelerated the need for a world of wellbeing resources in one easy-to-navigate platform. As a result, Oomph! On Demand was launched in October 2020. The

service provides a flexible digital resource, full of activity, exercise and TV content. It provides a wide range of resources to support residents, clients, caregivers and family members to improve meaningful engagement and overall quality of life. Oomph! On Demand content is created by a combination of expert instructors as well as trusted partners, including History Hit, Instructor Live and Arthritis Action to mention just a few. Both live and recorded video content provides a diverse range of sessions for clients to enjoy, including seated exercise, Pilates, ballet and dance which are provided up to five days a week. Oomph! currently offers the On Demand wellbeing platform to over 600 clients including care homes, sheltered housing and domiciliary care. Encouraging someone to exercise is not always easy, especially if they haven’t exercised regularly in the past. We believe that no matter what your ability is, you can remain physically active – it is just a matter of adapting the exercise. Within all forms of adaptation, achievement will lead to motivation! It’s important to start out small so that these can be highlighted, celebrated and praised to help build confidence. When delivering an Oomph! session, we don’t refer to it as exercise, but we do try to create a party atmosphere by using themes and upbeat, meaningful music. We have provided some examples of our sessions below.

SESSION PLANNING Please note, all of the following exercises are cost effective and can be delivered with limited resources and space.

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MEANINGFUL MOVEMENT: PRACTICAL SOLUTIONS FOR PHYSICAL ACTIVITY

Low Impact Exercise – Going to the Beach

Strength Based Exercise – Bopfit Routine

Upper move – throwing the beach ball: Bring both hands in front of your chest and imagine you are throwing a beach ball to a person in front of you. Repeat this movement four times. Why not ask what colour the beach ball is? This will stimulate the mind whilst sparking the imagination. Lower move – kick the sea water: Extend your leg outwards in a kicking motion and imagine you are running your toes through the sea water. Ensure you alternate your movements between each leg. How does that sea water feel running between your toes? Repeat this movement four times for each leg! Upper move – reach for the sun: Starting from the sides of your waist, use both arms to slowly reach up towards the sky. Stretch as far as you can and hold the palm of your hands upwards. Can you feel the warmth of the sun on your hands? Slowly, bring your arms back down to the sides of your waist and repeat the movement four more times. Lower move – shake your sandy toes: Extend your leg outwards and shake the sand off your toes. Ensure you alternate between each leg and repeat the movement four times.

Bopfit has been designed to combat key weaknesses that affect balance and strength as we age. The Bopfit exercise routine has been inspired by boxing and uses its principles to improve people’s core strength: Straight Bop: Start with both hands up at your chin. Lift one arm forward, while the other tucks in by your chest. Repeat this movement eight times, alternating between arms. Cross Bop: Sit upright. Keep one arm tucked in and extend the other arm across your body slightly, rotating the body. Repeat this same movement on the other side. Repeat this movement eight times, alternating between arms. Through Bop: Sitting upright and bracing your stomach. Bend one elbow so that your fist is in front of your chin. With the other arm, bend the elbow and pull your shoulder back. Do the same on the other side and transition between arms. Repeat this movement eight times.

Benefits: • Theming sessions and tailoring them to meet specific interests will help to motivate and engage someone living with dementia in a meaningful way. You could use movements that trigger memories such as conducting an orchestra, completing a housework routine, or visiting a football match. It’s important to use music that is enjoyed and songs that can unlock memories. Delivery considerations: • If delivering to a group, seat people in a circle and use the whole space to ensure inclusivity. • When delivering this session ensure chairs have arms to support balance. • Ensure a CD player or media player is on hand ready to play some meaningful music. • When encouraging movements, keep the patterns simple with lots of repetition. We prefer large whole-body movements. • Factor in rest periods between movements to prevent breathlessness. What people say: ‘It’s the best thing I have ever done coming to this class each week. I am 92 and it keeps me going,’ said participant, Joyce, Oomph!

Benefits: • Good core stability will help improve balance and confidence and, as a result, decrease risk of falls. Delivery considerations: • If a person has low mobility, adapt the exercises to suit what they can do! For example, if a participant has a weaker limb, encourage them to use the strong limb to support movements.

Mindfulness Body Scan Activity Body scanning is a form of meditation that helps you pay attention to all the sensations in your body: • The activity requires a combination of breathing and focused ‘sensing’, ‘tensing’ and ‘relaxing’. This will be implemented over a fourcount inhale and four-count exhale. • Participants will begin by sensing their toes for two breaths. How do they feel? • Next, on the third breath, squeeze and tense your toes. • On the fourth and final breath, relax the toes. • Continue this exercise all the way up the body. Benefits: • Mindfulness will help someone with increased levels of anxiety because it brings you into the present moment and makes you aware of negative thought patterns.

Delivery considerations: • Deliver with a clear and relaxed voice focusing on tone, speed and words. • Use calming, gentle music. What people say: ‘Oomph! Mindfulness has been used with one particular resident, whose family shared how much she benefitted from guided mindfulness, with sessions about the beach a particular favourite,’ said Jayne Hill, Graysford Hall Care Home – Sanders Senior Living.

TEAM ENGAGEMENT Oomph! Sport was the first virtual skills-based workshop we delivered during the pandemic, and it was designed to motivate people to keep moving in a fun and creative way. The concept of Boccia encourages teams to think outside the box and makes all Olympic sports accessible and achievable within a care setting. The workshop looks at the resources teams already have and how they can be used to aid in the creation of the Olympic Games. This supports clients to come up with new and innovative ways to deliver their sport-based games, which then helps with motivation and getting participants to take part. Our clients relished the challenge and we witnessed some fantastic adaptations of sport-based games. We had participants competing in a basketball game by using bins as nets and rolled-up pieces of newspaper as balls, adapted archery using swimming pool noodles and Olympic swimming using paddling pools and water bombs! The benefit of workshops is that they encourage wider team engagement. By looking at the whole home approach, we can transform the way people think about activities and promote the inclusion of everyone in the home. Everyone’s participation is celebrated.

CONSIDER YOUR OPTIONS One key learning participants have taken away from this workshop is how important it is to look at what you can do, rather than what you can’t. Oomph! has run two successful Olympic Games and it has re-enforced the idea that activity and exercise doesn’t have to be complicated. By exploring a theme and looking at the resources you already have you can bring new, enjoyable activities to life that will excite and energise your community and support a vibrant wellbeing programme of events. CMM

Jack McKechnie is the Regional Wellbeing Coordinator at Oomph! Wellness. Email: jack@oomph-wellness.org Twitter: @OomphWellness Which types of exercise and physical activity do you offer in your care setting? Is there a greater demand for one particular discipline? Visit www.caremanagementmatters.co.uk and share your experiences. CMM December 2021

CMM December 2021

FOOD FOR THOUGHT: Nutritional best practice for older people in care Sophie Murray, on behalf of the National Association of Care Catering (NACC), shares the latest research and innovation taking place in care nutrition. In the second part of this article, Dove Yu, a Senior Specialist Dietitian on behalf of The British Dietetic Association (BDA), outlines nutritional needs for older people. Across the care sector, there are pockets of fantastic practice and award-winning homes. In the changing landscape of inspections, there is more onus on care homes to prove their great results and show awareness of their own status quo and ambition for outstanding ratings. Perhaps the most recent and informed piece of work in the NHS, which can translate back to care homes, is the Hospital Food Review, chaired by Phil Shelley and published in October 2020. This research highlighted eight areas for improvement required to achieve great nutrition and hydration in hospitals and addresses key subjects, including working together and training. This was a long-awaited study with some very translatable ideas that can be achieved in the care sector. Henry Dimbleby’s progressive work through the National Food Strategy continues to illustrate how our food system and ill-health are interconnected and, again, whilst not directed specifically at care homes, it will have an influence on food for the nation in time. Research from 2018 by Bunn, Hooper and Welch is thought-provoking. It suggested that existing knowledge may not translate well into hands-on practice in care homes. Does this mean that all the great research is not landing in practice? Does this mean that toolkits, resources and materials are not suited to practice? It is indeed food for thought when it comes to working with stakeholders, including regulators, commissioners and

educators, to help raise awareness and understanding and improve standards.

IDENTIFYING RISK Screening for malnutrition risk in care settings is essential for enabling early and effective nutritional interventions. The National Institute for Health and Care Excellence (NICE) guidance recommends people in care homes should be screened on admission and when there is clinical concern by staff with appropriate skills and training.1 More than 90% of UK care homes screen for malnutrition at the point of admission and use the Malnutrition Universal Screening Tool (MUST)2. In 2018, further research in this area addressed a gap in the existing screening and embedded another validated tool into MUST (found in the BAPEN subjective MUST section). This uses four simple questions to determine malnutrition risk and assist in the decisions for treatment. This research was a collaboration between Bournemouth University and the Patient Association and can also be used as a stand-alone tool called the Nutrition Checklist. Using this tool may not only help increase the identification of malnutrition but also aid the awareness and successful approaches to help improve and reduce malnutrition. Anecdotally the downside to MUST is that many care home staff find MUST difficult to use, especially comprehending the concept of unintentional percentage weight loss. Error in screening can result in malnutrition remaining unrecognised and, of even more concern,

untreated. The nutrition week survey showed that those identified as ‘malnourished’ were most likely to be underweight on admission to a care home and to lose further weight during their residency; someone at low risk of malnutrition was more likely to gain weight.3 Unfortunately, there is not currently a validated tool for identifying dehydration risk in older adults.4 Dependent older adults are generally considered to be at risk of dehydration, which accounts for most residents living in a care home. Food and fluid record charts can be routinely used by healthcare staff. However, literature indicates that they can be highly inaccurate and should not be standard daily practice.5, 6, 7 Instead when a concern is identified, a three-day food record chart is recommended as it can be useful for identifying patterns and targeting strategies to prevent further deterioration. In specific cases of fluid restriction due to cardiac or renal failure, keeping daily fluid record charts will be essential but this will be for the minority of residents and usually involve medical supervision and oversight. Visit www.caremanagementmatters.co.uk to read more studies related to hydration.

ENVIRONMENTAL IMPACT In a year where sustainability has been propelled into public consciousness, we cannot ignore the relationship between food and environmental impact. Presently, there is a lot of research being undertaken by organisations including the Waste and

CMM December 2021

FOOD FOR THOUGHT: NUTRITIONAL BEST PRACTICE FOR OLDER PEOPLE IN CARE

Resources Action Programme (WRAP) and the Soil Association, with the ambition to help create a more sustainable food system with well-informed research used to advise best practice. This research indicates that carbon emissions are mostly impacting the agricultural production and food processing stages (70-80%), with the remainder found in transport, catering and waste. This can help to focus efforts on quick sustainability wins and in procurement and menu planning. Great initiatives have followed in plant-based menus, or dishes that encourage an increased consumption of plantbased food. Sustainability in the care catering sector will remain a focus over the coming years, especially with the outcomes of COP26 and the global focus on climate change. There is a lot of support available to care homes – for example, there are some fantastic free resources on WRAP’s Guardians of Grub to tackle food waste. The Soil Association’s Food for Life programme and Love British Food are both accessible programmes to help care homes achieve sustainability goals.

SUPPLY CHAIN CHALLENGES Planning is imperative. It is advisable, where possible, to order further ahead than usual to avoid getting caught out by last-minute changes. Looking at storage capacity for frozen and ambient products and building up additional stock, for example, is sensible. Adaptability is vital should some products not be available, or deliveries disrupted. Having alternative menus ready is recommended as this allows for flexibility and ensures the dietary needs of residents are always met. Collaborating with other care homes in your locality could also be beneficial.

PRODUCT INNOVATION Care sector suppliers have continued to investigate and innovate market products and studies have been undertaken in areas such as protein in drinks and improving food choice for those who may benefit from finger foods. Catering for dysphagia will also provide innovation over the coming year, as IDDSI implementation continues and the training of care home chefs to create texture-modified foods correctly and safely remains a priority. Innovation is already being seen around the diagnosis of dysphagia itself, with further studies of swallowing assessments via video links taking place. The EDSCF (Eating Drinking Swallowing

Competency Framework) will continue to assist improving relevant training.

MORE WORK TO BE DONE Whilst available research will continue to be embraced, perhaps we need to focus upon translating messages in practice and ensuring the reach of customers is wide enough to have a meaningful impact. The NACC will be looking to relaunch its training academy and will continue its regional and virtual training seminars to help improve skills in care homes and share best practice. This will also assist with professional development, which in turn will help recruit new talent to the sector.

NUTRITION NEEDS FOR HEALTHY OLDER PEOPLE With regards to guidelines, Dorrington et al. published ‘A Review of Nutritional Requirements of Adults Aged ≥65 Years in the UK’ (Table 1).8 The British Dietetic Association Older People’s Specialist Group is currently designing simple guidance for older adults based on this paper with the aim of supporting them to age well. We aim to focus on six key concepts: 1. A nutrient-dense diet. 2. Adequate hydration. 3. Vitamin D. 4. Physical activity. 5. Weight and BMI. 6. Enjoyment of eating.

FOOD PROVISION Older people in care homes have a range of dietary needs. Thus, a blanket approach should not be adopted to food provision. Individual requirements, preferences and needs must be considered. Not all residents should receive fortified puddings. Similarly, not all residents should receive skimmed milk. Residents who are well and have a good appetite can enjoy a balanced healthy diet whereas residents who are at risk of malnutrition or malnourished can enjoy fortified meals to maximise nutrient density. It is usually combined with a little-andoften strategy i.e., small portions of meals and between-meal snacks. NICE CG32 emphasises that the overall nutrient intake of oral nutrition support should contain a balanced mixture of protein, energy, fibre, electrolytes, vitamins and minerals instead of just calories.1 Therefore, food fortification should use more nutrient-dense ingredients (Table 2) instead of calorie-dense

ingredients such as cream and butter. Instead of biscuits and cakes, snacks should include more nutrient-dense choices (Table 3). Nourishing drinks should be encouraged between meals. Each pint of full fat milk can be fortified by adding four heaped tablespoons of dried, skimmed milk powder. For extra nutrition, care homes could also consider fortified drinks rounds during mid-morning and mid-afternoon following the recipes in Figure 1. Visit www.caremanagementmatters. co.uk/feature/nutritional-best-practice-for-olderpeople-in-care to access the nutritional tables referenced in this article.

DINING EXPERIENCE A pleasant dining environment and social connections play a key role in supporting residents’ nutritional intake. The sight, smell and associated rituals of eating are an important stage in preparing the body to receive food, and opportunities for pre-meal preparation by residents should be optimised. Care staff should support and assist residents so that they are in a safe and comfortable position for eating and drinking. To encourage choice and autonomy, foods can be displayed in a buffet style or options shown on plates. The food should be presentable, attractive and tasty. This is particularly important for modified texture meals. For example, someone requiring IDDSI Level 4 pureed food could have their meals prepared in food moulds so that they look like their original form and look more appealing.9 The eating environment is also important – distraction such as the TV or the hoover should be avoided during meal service. Appropriate music and lighting can enhance the mealtime experience and create a calming environment for eating. The National Association for Care Catering (NACC) has launched a good practice guide on menu planning and dining.10

UNITED APPROACH Dietitians, catering and care staff should work closely to provide nutrient-dense diets for residents. Person-centred care should be offered, and any intervention offered should improve CMM quality of life. All references cited in this article are available online. Visit www.caremanagementmatters.co.uk/ feature/nutritional-best-practice-forolder-people-in-care

Sophie Murray is Head of Nutrition and Hydration for Sunrise Senior Living and past Deputy National Chair of the National Association of Care Catering (NACC). Email: info@thenacc.co.uk Dove Yu is a PR Officer of BDA Older People Specialist Group and Senior Specialist Dietitian (Nutrition Support/ Palliative Care) at South Tees Hospitals NHS Foundation Trust. Email: doveyu30@hotmail.com Twitter: @doveyu_RD For further information on BDA OPSG, please email olderpeople@bda.uk.com or visit www.bda.uk.com/specialist-groups-and-branches/olderpeople-specialist-group.html/ Twitter: @BDA_olderpeople Instagram: @bda_olderpeople 42

CMM December 2021

Thank you for your continued dedication to adult social care, now and all year round. Season’s greetings from all the team at CMM. www.caremanagementmatters.co.uk

@CMM_Magazine #CMMInsight

CMM December 2021

CELEBRATING EXCELLENCE

Markel 3rd Sector Care Awards

IN END OF LIFE CARE AND CAMPAIGNING FOR CHANGE

Martin House Children’s Hospice and Intergenerational Music Making (IMM) won the End of Life Care Award and Campaigning for Change Award respectively at the Markel 3rd Sector Care Awards 2020. Closing the series of features celebrating 2020’s winners, Victoria Greensmith, Director of Clinical Services at Martin House Children’s Hospice and Charlotte Miller, Director and Founder of IMM, reflect on the impact of their services and look forward to ongoing support opportunities. Martin House Children’s Hospice was praised for its inspiring end of life care service that enabled people and their families to make informed decisions about the future. The hospice’s leadership team was highlighted further for its involvement in supporting bereaved families. Family first End of life care has always been a central part of the service Martin House offers to families. Our care is holistic and family-centred, and we work hard to ensure that the care we offer at end of life is flexible and tailored to the needs and wishes of the child and their family, which can encompass parents, siblings and grandparents. Families can bring their child to the hospice for end of life care, or we can support them at home, and we also have cooled bedrooms, where a child or young person can stay for up to five days after death, where their family and friends can come to spend time with them, to say goodbye or make keepsake memory items. Our team can support and guide families in making arrangements and decisions they need to make, while making them feel safe and cared for.

CMM December 2021

Constantly evolving It’s been important to us to innovate and ensure our end of life and bereavement care is responsive and reaches as many families who need this support as possible. In recent years, we have extended our care beyond the children and young people who have life-limiting conditions and have used Martin House during their lives, to accept referrals following any sudden deaths. We’ve also worked with the Yorkshire Organ Donation and Transplantation Service to take referrals of children who have been organ donors, which was a national first. More generally, our clinical nurse specialists work closely with hospitals in our region to enable discharge to the hospice or people’s own homes for end of life care, depending on the families’ wishes. Recognising differences End of life care is bespoke to each family, depending on their needs and wishes – we are always guided by what the family wants, whether that’s to be at home, in hospital or at the hospice. One of the things we champion is the use of advance care plans, which gives families the opportunity to make difficult decisions and record their wishes ahead of time. We offer bereavement counselling to every family, including one-to-one support and group sessions, and our bereavement care encompasses the whole family, recognising the different ways family members can feel grief.

Defying adversity Our biggest challenge has been through the pandemic, which has brought so many extra regulations and restrictions, particularly the need for PPE, which can feel like a barrier when providing care and support to families at what is an emotional and distressing time. We’re very proud of the fact that we continuously remained open to families throughout these last two years, so they always had access to end of life care and care after death at Martin House. Listening and learning Our families tell us our support is invaluable to them, both at the end of their child’s life, and in bereavement support. Losing a child is the most painful experience a family can go through, and we want to make sure families don’t have to experience it alone. We’re continuing to work really hard so we can support more families in the future and provide excellent end of life care and bereavement support where and when they need it. Victoria Greensmith is Director of Clinical Services at Martin House Children’s Hospice. Email: vgreensmith@martinhouse.org.uk Twitter: @martinhousech IMM received recognition for relentlessly pursuing its cause, engaging with both ministers and the wider Government to lobby for change. It’s national response to COVID-19, Care to Create, promoted the use of music and creative arts to bring people together. Keeping people connected When the pandemic started, IMM was unable to offer the artistic, intergenerational services that many of our clients relied on and therefore, we felt it was vital to approach the pandemic imaginatively and creatively. Social isolation and loneliness are nothing new to IMM and, now more than ever, we believe the arts have the transformative power to bring people together in ways no one could have foreseen. The work IMM delivers is built upon values of empowerment, inclusion, creativity, trust and respect – we work to champion and amplify the voices and stories of people across generations and sectors. Over the last two years, IMM has been determined to develop ways in which people could stay connected, access creative resources and develop their practice. Championing inclusivity The first response to the pandemic was Care to Create, an inclusive online platform to stimulate and support people of all ages. The Care to Create hub aimed to support

and nurture clients, their carers, NHS staff, families, children and young people through this challenging and isolated time. The creative content encouraged community connection, intergenerational relationships and positive wellbeing for all. The Care to Create hub launched in June 2020 with a live, free family fun weekend of online creative activities attended by 300 people. Care to Create linked local artists and creative practitioners offering creative, educational or performance-based content with people in the community who might benefit from its impacting on their mental health and wellbeing. Collaborative working Since the outbreak of COVID-19, IMM has been the driving force in the formation and consolidation of successful partnerships. IMM’s work throughout the pandemic was continuously evaluated, which enabled our team to develop and refine their approach based upon service user feedback, engagement levels and digital approaches. The research behind Care to Create offered a new understanding of digital disenfranchisement amongst the older generation, safeguarding digital platforms for schools and care homes and staff capacity. This learning fuelled the development of Together with Music (www.togetherwithmusic. org.uk), a national, intergenerational platform launched in December 2020 in partnership with Care England. Together with Music (TwM) has over 1,200 members and has reached over 60,000 individuals. TwM delivers workshops, training, projects and resources, creating partnerships with a variety of social care, health, education, researchers, council and civil society organisations. The work delivered by IMM during COVID-19 has enabled older and younger people to maintain valued connections and create new ones. Participants have been supported to make contact through a variety of media in ways they felt to be beneficial for their wellbeing. The most successful activities involved active and reciprocal exchanges of stories, music and other content with personal meaning. In addition, those which demonstrated feelings of mutual responsibility and care for others within and beyond their own communities. Gaining momentum Throughout the pandemic, IMM has demonstrated the power that music and creativity have within both our individual and collective wellbeing. Our vision is to create a clear working infrastructure, one that sits at the heart of the community, which will enhance and develop a clear care pathway

between the NHS, care sector, education and community. IMM believes that by placing health and wellbeing as part of our collective vision for prosperity and aligning this with education, skill sharing and development, we will secure better outcomes for people. As we all begin to recover from the pandemic, IMM believes that TwM can act as the mediator between the health, arts, social care and education sectors. It can be at the heart of this new thriving community ecosystem – one that empowers caregivers and communities and champions both young and old voices. TwM can encourage cross-sector working and strong integrated care networks across the UK whilst offering training and employment opportunities to enhance public health and civil society. All built upon the joy of musical connections. CMM Charlotte Miller is the Director and Founder of Intergenerational Music Making. Email: charlotte@imm-music.com Twitter: @IntergenTwM

MARKEL 3RD SECTOR CARE AWARDS

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 December 2021

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MARKEL 3RD SECTOR CARE AWARDS

NEW HOST AND VENUE FOR THE

MARKEL 3RD SECTOR CARE AWARDS Care Management Matters (CMM) is thrilled to announce a new host and venue for the upcoming Markel 3rd Sector Care Awards. The awards will be hosted by TV and radio presenter Len Goodman. Also taking place at a new venue for 2021, The Grand Hotel in Birmingham, the ceremony promises to continue to celebrate outstanding achievements in the not-for-profit care and support sector. CMM and the National Care Forum came together to work on the concept, giving national recognition to the care workforce in a different way. Established in 2014, the awards have gone from strength to strength. CMM is delighted to have the headline sponsorship of Markel and others so it can continue to offer free ceremony tickets to finalists, as well as keeping the awards free to enter. The Markel 3rd Sector Care Awards focus on creative arts, community engagement, innovation, quality improvements, integration, technology and governance. These categories and the entry criteria have

always been based on specific strategies – from Government and the sector – and have evolved over time to maintain relevance in an ever-changing landscape. The ceremony will be held on Friday 11th February 2022 from 10.30am to 4.00pm and includes a drinks reception, three-course meal and entertainment. Nominations for the awards have now closed and the finalists have been selected. Ticket purchasing options are available to view on the CMM website. As the ceremony is planned to be a face-to-face event, CMM will be following Government guidance and working with the venue to ensure all COVID-19 guidelines are met. You can take a look at last year’s winners and finalists to see what truly makes the Markel 3rd Sector Care Awards such a remarkable event or you can catch up on the virtual awards ceremony here. To stay up to date with the Markel 3rd Sector Care Awards 2021, don’t forget to follow CMM on Twitter: @3rdSectorCare and use the hashtag #3rdSectorCareAwards

For more information on the Markel 3rd Sector Care Awards, please contact the Awards team on 01223 207770 or email lisa.werthmann@carechoices.co.uk 46

CMM December 2021

A NOTE FROM MARKEL UK, OUR HEADLINE SPONSOR

Markel UK is proud to be associated with the Markel 3rd Sector Care Awards, a fantastic event, which rewards the hard work, dedication, innovation and excellence of everyone working in the not-for-profit sector. Markel UK has been involved with the awards for the last five years and is delighted to once again be the headline sponsor for 2021. Every year we are in awe of the individuals and charities that put entries forward, all demonstrating the diversity and capabilities of charities up and down the UK, all of which do so much good. We’re sure this year will be no different, with numerous outstanding entries, each worthy of recognition. We know that the care industry has been particularly affected by the pandemic and this is a great opportunity to celebrate the innovation and resilience of those in the sector. Markel has vast experience of the UK’s care sector and supports over 10,000 care customers to protect against the unique risks that care organisations face. We provided extensive support to the sector throughout COVID-19 and while many insurers pulled back, we doubled our efforts to give businesses

confidence and financial certainty when they needed it most. As one of the largest care sector insurers in the UK, we understand the challenges faced by organisations in this industry and have developed a suite of bespoke services to help providers operate in safe and compliant environments. As part of this year’s event, we are pleased to offer each category winner a year’s free access to Markel’s online legal portal, Law Hub. This service provides a wide range of legal self-help guides and template contracts on subjects ranging from health and safety to employment, to help care organisations navigate their day-to-day challenges. Having held the last event virtually, we look forward to returning to a live event in February. If you haven’t booked your tickets yet, we would encourage you to attend so you can share in the celebrations and toast the winners. Past winners have subsequently won a Queen’s Award for Innovation, gained valuable publicity and secured extra funding for their organisation. All that’s left is to wish the best of luck to all the finalists!

Why not join us for this annual celebration at The Grand Hotel Birmingham on 11th February 2022? Find out more and buy your tickets at www.caremanagementmatters.co.uk/event/markel-3rd-sector-care-awards-ceremony-2021/ CMM December 2021

EVENT REVIEW

WHAT NEXT? 2021 – THE ARCO ANNUAL CONFERENCE 3rd November 2021 London’s Institute of Engineering & Technology (IET): Savoy Place hosted the main conference day of The Associated Retirement Community Operators’ (ARCO) fifth annual conference, What Next? 2021. The headline take away from the event saw ARCO launch the new term ‘Integrated Retirement Community (IRC)’ to describe its service-led operational model for the UK’s housing with care sector. Responding to research on the views of older people, expressing that they were ‘fed up’ with outdated terminology, ARCO used its annual conference as an opportunity to lead calls for clearer language and clearer housing choices – in particular, a desire to end the use of terms such as ‘old people’s homes’.

ONCE IN A LIFETIME OPPORTUNITY Speaking of opportunity, this was one buzz word of the conference, encapsulated by Gillian Keegan MP, Minister of State for Care and Mental Health, who delivered a refreshingly honest first speech about her ambitions for the future of the adult social care and housing sectors. The Minister said: 'It’s one minute to midnight for social care. We in Government are committed to increasing the range of options [for older people], including extra care housing, which contributes to levelling up across communities and the whole country.' Naturally, the eagerly anticipated White Paper for adult social care dominated the Q&A session that followed the Minister’s speech. A series of probing questions attempting to uncover greater detail about the White Paper’s

content were responded to in good faith by the Minister, who again, challenged ARCO members to collaborate with Government to deliver its plan for long-term sector reform. The sector continues to wait with bated breath for the publication of the White Paper, expected before the end of the year.

A FRESH PERSPECTIVE The conference’s keynote speakers tackled the plethora of invaluable, policy-driven content on offer to ARCO members from an alternative angle. Baroness Camilla Cavendish, award-winning journalist and broadcaster, and the author of ‘Extra Time: Ten Lessons for an Ageing World’, shared how her book’s key theme, investigating the great potential held by our ageing population to contribute more proactively to society, holds weight in the housing with care sector. Tapping into years of international experience in care settings, the Baroness outlined lessons that the UK can learn to empower older people to lead more active and fulfilled lives. International speaker, writer and changemaker, Mac Macartney, enlightened ARCO members in the second keynote speech. Over a period of 20 years, Mac was mentored by a group of indigenous elders. The speech was heavily influenced by this experience, detailing the ideal attributes of a successful and impactful leader. The speech also encouraged ARCO members to consider the benefits of nature as a tool to foster wellbeing when designing future IRCs, recalling conversations with older people who constituted ‘being outdoors with friends’ as

the most essential part of an enjoyable day.

SETTING STANDARDS FOR IRCS Several other insightful sessions comprised the remainder of the conference’s agenda. The conference was opened by an overview of the last 26 months from Nick Sanderson, CEO at Audley Group and ARCO Chair, and Jane Ashcroft CBE, CEO at Anchor Hanover and ARCO Vice Chair, who reflected on the tumultuous experiences within the sector as a result of the COVID-19 pandemic. The speech provided context for the conference and a platform from which other speakers could put forward their thoughts on how the sector can recover and thrive in the wake of the pandemic. Also contributing to the conference’s informative agenda, Anthony Oldfield, Director – Healthcare Capital Markets at JLL, looked towards the projected future of investing in the housing with care market. In particular, the key data points that operators and investors will need, and what needs to happen to the regulatory environment to facilitate much-needed stability across the sector. In one of the conference’s high-level panel discussions, Phillip Smith, CEO at Augustinian Care and St George’s Park Retirement Village, aptly explained why care is at the heart of everything from an operator’s perspective. This session exemplified the values of housing with care and set a standard for future IRCs to aspire to. To view the conference’s full agenda, including the workshop programme on day two, visit the ARCO website.

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CMM December 2021

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

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