Care Management Matters (CMM) Magazine April 2022 by Care Choices Ltd

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DARTING AHEAD Future care home demand

2030 Social care’s Achilles heel The recruitment crisis

Tax relief

Maximising the benefits

Retirement living Setting the standard

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In this issue 05

Inside CQC Kate Terroni updates on the CQC’s regulatory activity, including new priorities and what the current workforce data is telling us.

CMM News

Into Perspective This month, our experts look at the mandatory vaccination policy and the Government’s decision to revoke it.

Celebrating Excellence The 2022 Markel 3rd Sector Care Awards took place on Friday 4th March. Team CMM shares its highlights from the successful awards ceremony.

Event Review CMM reviews a webinar hosted by the Women's Budget Group and New Economics Foundation on the cost of reforming the social care sector.

Straight Talk We asked Andrew Spernick at Choice Support to share his thoughts on what easing COVID-19 restrictions will mean for the learning disability community.

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FEATURES

REGULARS

Social Care Insights Simon Bottery outlines the four key documents driving social care policy and offers his 'Netflix-style' review ratings to describe them.

Social care’s Achilles heel: Recruitment crisis Recruitment specialist Neil Eastwood explains why providers must address often overlooked weaknesses in the sector if we are to build a resilient workforce.

Darting through the decades: Future demand for older people’s care homes With providers facing rising costs, how equipped will the sector be to meet future demand? Julian Evans from the Healthcare team at Knight Frank tells us more.

Maximising the benefits of tax relief Due to increased funding for the sector and new rules, providers could reap tax rewards. Stuart Brodie, Director of Markel Tax, explains how to navigate the potential changes.

Setting the standard in retirement living Integrated Retirement Communities (IRCs) are building momentum on the political agenda. Annie Waddington-Feather, from Standards Wise International, shares the importance of defining a set of standards.

Resource Finder CMM brings you information on some of the leading organisations working in the accountancy sector. CMM April 2022

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

CONTRIBUTORS

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

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

Kate Terroni Chief Inspector of Adult Social Care, Care Quality Commission

Neil Eastwood Founder and CEO, Care Friends

Julian Evans Head of Healthcare, Knight Frank

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Nadra Ahmed OBE Chairman, National Care Association

Charles Armitage CEO, Florence

Stuart Brodie Director, Markel Tax

Annie WaddingtonFeather Consultant, Standards Wise International (SWI)

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 2022 CCL REF NO: CMM 19.2

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SOCIAL CARE

INSIGHTS From Simon Bottery

Simon Bottery outlines the four key documents driving Government policy on adult social care and, with Netflix-style ratings, sorts the ‘Visionary’ from the ‘Scary’. Were it not for the trauma of a global pandemic and, now, a European land war, the last 12 months might have been remembered for the sheer volume of white papers and policy documents affecting adult social care. There have been four main ones and, combined, they will bring in major changes to the sector. But how to keep track of them all? One way is to borrow a trick from Netflix, which has taken to providing you with a handful of adjectives to describe its shows. Bridgerton, for example, is ‘Witty’, ‘Emotional’ and ‘Romantic’. Star Trek is ‘Suspenseful’ and ‘Exciting’. Texas Chainsaw Massacre? ‘Ominous’ and ‘Scary’. You get the picture. So, what adjectives should

we apply, Netflix-style, to the four? The first of them, ‘Integration and Innovation: Working together to improve health and social care’, was published in February 2021 and set out plans for joining up health and care systems through the formal establishment of Integrated Care Systems. There were also a couple of social care specific measures, added because of the Government’s experience in the first stages of COVID-19: a power for the CQC to oversee care commissioning by local authorities and plans to greatly improve data collection in adult social care. In Netflix terms, I’d describe it as ‘Important’ (because it’s laying out the landscape for the NHS and social care in the future); ‘Centralising’

(because it’s bringing back a degree of central oversight of local authority functions); maybe even ‘Visionary’ for that stuff about data. The second, ‘Build Back Better’, set out plans for the Government’s funding reforms. These make the means test more generous and introduce an £86k cap on a person’s lifetime care costs. This all sounded fairly promising at the time but the Government has since rowed back on the cap, changing the small print so that people with limited assets will gain very little from it. In Netflix terms, then, our adjectives would be ‘Promising’ and ‘Disappointing’, in that order. ‘People at the Heart of Care’ was the full adult social care white paper after the ‘Build Back Better’

trailer. It gave us more details on the cap and floor reforms and, in a subsequent impact assessment, details about ambitious plans to introduce a ‘fair cost for care’, whereby self-funders would pay the same amount for their care as local authority-funded clients. This latter measure has gotten a lot of worried attention from providers and local authorities, with more detail on how it will work coming soon. However, there were few other major measures to address problems like unmet need or the social care workforce. So, you might say ‘Eye-catching’ and even ‘Scary’ for that fair cost measure and ‘Underwhelming’ for much of the rest. Finally, the ‘Integration’ white paper, which emerged in February 2022. This one mainly clarified and built on the previous one. It said sensible things about integration, talked about shared health and care outcomes at ‘place’ level (typically a local authority area) and outlined some progressive social care ambitions – such as digitising records. The Local Government Association welcomed it. In Netflix terms, we’d go with ‘Sensible’ and ‘Evolutionary’. Together, these four set the policy framework for health and social care for the foreseeable future. You won’t see a movie about them on Netflix any time soon but they are worth getting to grips with if you want to understand what will shape the social care sector in the coming months.

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

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All of us working in adult social care feel passionately about celebrating great care. I know how important it is to providers and staff working in the sector that you are able to share and demonstrate where you’ve made improvements that could lead to a new rating. I’m pleased that we’ve been able to complete 2,674 inspections in adult social care services from 1st December 2021 to the end of February 2022. Of those inspections, 1,933 have also had an infection, prevention and control (IPC) review. These reviews show that the majority of services have good IPC assurance across our eight questions and prompts, though we do also see that some improvements are needed in keeping up-to-date policies. From March onwards, as we emerge from the pandemic, our inspection emphasis will be on risk and re-rating. We will need to continue to assess IPC and ask questions to understand any impact workforce challenges may be having on continuity and quality of care, but our main focus will be re-rating services wherever we can. I’m pleased that this work will enable us to recognise improvements, share best practice in inspection reports and make sure that our published ratings reflect the quality you provide. In February, we updated our Board with the latest data we have on workforce. Information you’ve shared with us through our Provider Information Return showed care home staff vacancy rates had steadily increased throughout 2021 in England. The rate nearly doubled from 6% at the end of April 2021, to 11.4% at the end of January 2022. Your latest data shows that rates are still high but have not increased in the last month. We know that recruitment and retention is having an impact on your ability to deliver good-quality care. So, I welcome the Government’s recent decision to add social care to the Shortage Occupation List. This is the right step in recognising the impact and value of care workers to the quality of care available for people. You’ll also be aware of our upcoming role in assuring local authorities and Integrated Care Systems. As we continue to develop our thinking in these areas, we’ll be looking at how local authorities support people working in care settings and unpaid carers – as well as how systems implement place-based workforce plans that support

Inside CQC K

A T

Kate Terroni, Chief Inspector of Adult Social Care, updates on CQC’s regulatory activity, including its new priorities, and explains what the current workforce data is telling us and how CQC’s future work will support this area.

all health and social care workers. You can find out more about our work in this area in our latest briefing.

“Freedom to Speak Up Guardians will provide a vital route for staff working in adult social care to raise concerns and escalate issues around their wellbeing and quality of care.” Finally, we know that having a happy and supported workforce is a driver of quality, and this includes people being able to speak

up when they have a concern. I’m pleased to welcome Dr Jayne Chidgey-Clark as the new National Guardian for the National Guardian’s Office (NGO). The NGO team works with a network of Freedom to Speak Up Guardians that are integrated into NHS organisations to support people to speak up about a range of issues. In the recent social care reform paper, ‘People at the Heart of Care’, the Government announced that it will introduce a pilot to explore how Freedom to Speak up Guardians can be introduced in the social care sector. This will provide a vital route for staff working in adult social care to raise concerns and escalate issues around their wellbeing and quality of care, and support providers with their employees’ concerns. I’m looking forward to working with Dr Chidgey-Clark to find the most effective ways that speak-up culture and Freedom to Speak Up Guardians can be embedded in our sector.

Kate Terroni is the Chief Inspector of Adult Social Care at the Care Quality Commission. Share your thoughts and views on Kate’s column on the CMM website. Visit www.caremanagementmatters.co.uk Twitter: @CQCProf CMM April 2022

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CMM April 2022

NEWS

APPOINTMENTS JEWISH CARE

House of Lords rejects change to social care cap The Government has lost a vote in the House of Lords relating to the proposed amendment to the cap on social care costs. The decisive vote, which took place on 7th March, saw 198 members of the House voting in favour of dropping the Government’s proposed cap and 158 voting against its removal. In September, the Government announced a cap on lifetime social care costs in England that was due to begin in October 2023 and set at a level of £86,000. When the possibility of a cap was first legislated for in the 2014 Care Act, total care costs incurred – including those covered by council funding for those with low assets or income – were to count towards the cap. However, in November

2021, the Government proposed to amend the Care Act so that only the amount someone spends themselves would count towards the cap. This amendment is now being considered by Parliament. A joint Institute for Fiscal Studies (IFS) and Health Foundation report, funded by the Health Foundation, found that the proposed Government amendment would impact most strongly on those older people with modest levels of wealth. Those with wealth, including their home, of around £75,000 to £150,000 would face the biggest loss of protection as a result of the amendment. The result is that someone with around £110,000 in assets could lose 78% of their total wealth even after the cap is in place, while someone with

£500,000 could use up only 17%. Commenting on the vote, Sally Warren, Director of Policy at The King’s Fund, welcomed the news and said, ‘Ministers may now ask MPs to vote again on the change in a bid to overrule the House of Lords. Reinstating this regressive change would run counter to the Government’s ambition to “level up”, as well as the promise that no one would have to sell their home to pay for their care. I encourage members of Parliament to consider whether they want to back a policy that will save the Treasury money, but at the direct expense of poorer people living in the North and Midlands who need social care.’ Visit the Health Foundation website to read the report relating to the social care cap.

DHSC publishes mandatory vaccination consultation The DHSC has published the outcomes of the consultation relating to whether to revoke provisions that require COVID-19 vaccination as a condition of deployment in health and social care settings. The Government’s response confirms that it intends to proceed with bringing forward regulations to revoke vaccination as a condition of deployment. The consultation was available through an online survey hosted on gov.uk from 9th to 16th February 2022, and over 90,000 responses were submitted. The consultation outlined the following points: • 90% of respondents supported revoking the requirement, with 9% opposing this proposal. • Members of the health and

care workforce were highly likely to support revocation (84%). The most supportive workforce groups (with at least 100 consultation responses) were community care workers (90%), dental practitioners (90%), homecare workers (90%), nursing associates (91%), other regulated health or social care professionals (91%) and unpaid carers (90%). • There was overwhelming support for revocation across all demographic groups. The groups most likely to support revocation were 35 to 44 year olds (93%), Black or African or Caribbean or Black British (94%), males (93%) and those in the West Midlands (94%) and South West (93%). The demographic groups (with at least 100 responses) most likely

to oppose revocation were Asian and Asian British (15%) and Hindu respondents (20%). • The majority of respondents thought there were no other steps that the Government and health and social care sectors could take to increase vaccine uptake (70%). Comments often referred to personal autonomy and freedom of choice in relation to vaccination. The regulations will come into force on 15th March in order to provide certainty for employers, their staff, patients and people who receive care or support ahead of 1st April when regulations extending the requirement to health and wider social care were due to come into force.

Jewish Care announces two new Trustees to join the Board. Dr Jonathan Shapiro and Amy Woolf will be joining Jewish Care’s Board of Trustees this month (March). Dr Jonathan Shapiro was recruited via the board level hiring platform Nurole and joins Jewish Care as both a Trustee and as the new Chair of Jewish Care’s Clinical Governance Group.

INSPIRED VILLAGES Inspired Villages has grown its senior team with the hire of Louise Read as Legal Counsel and Tajinder Samra as Head of Tax. The appointments, which are new roles for the company, come at a key time for the business. Last year, Legal & General and NatWest Group Pension Fund committed to investing £500m in Inspired Villages to support its growth to 34 retirement communities.

THE OUTSTANDING SOCIETY A national social care organisation, The Outstanding Society, has reappointed one of its founding members to the Board of Directors. James Rycroft, Managing Director at specialist dementia care provider Vida Healthcare, has been reappointed as a board member following his departure in 2020 to concentrate on the construction of Vida Healthcare’s newest care home, Vida Court. CMM April 2022

NEWS

Wrong policy, wrong time, says NCF The Government’s policy to implement vaccination as a condition of deployment in health and social care has been ‘very damaging’ for the morale of social care staff, the National Care Forum (NCF) has said. Some of the most significant impacts felt by the sector were around workforce recruitment and retention, with the majority of our members outlining that recruitment has been made much

more difficult as a result of the policy. The NCF survey found that: • 94% of members thought VCOD had made recruitment more difficult. • 56% said it had been made much more difficult. Respondents told NCF they had each spent thousands of pounds attempting to implement the policy, which brought an enormous extra workload for

organisations trying to meet the deadlines of the policy go live, with many additional hours of engagement with staff, seeking expert legal advice to make sure the policy was being implemented fairly, regular communications to keep everyone informed, coping with chaotic changes to the policy as it was being rolled out and trying to explain it to residents and their families. The NCF is now asking for an

apology from the Government. Vic Rayner, OBE, CEO of NCF, said, ‘The Government must now accept that the VCOD policy really was the wrong policy at the wrong time; it is simply not acceptable to impose such a significant and controversial policy with absolute disregard for the views and expertise of the sector being forced to implement it, only then to suddenly revoke it with no recognition of the damage it caused.’

Bill amendment safeguards carers’ rights Carers UK has strongly welcomed the news that Peers have successfully won an amendment against the Government’s attempt to revoke the Community Care Act 2003 in the Health and Care Bill during its report stage in the Lords. The Bill, if unamended, would have taken away unpaid carers’ vital rights at the point of

hospital discharge. The vote of 205 to 155 against the Government’s proposals sends a very clear message to Government that it should protect carers’ rights as the Bill progresses. The amendment safeguards carers’ rights by ensuring hospitals consult with unpaid carers at the point of discharge, builds in checks that the carer is willing

and able to care, and would ensure joint working to make sure that the carers are supported. Importantly, the amendment means that the rights would apply to adults providing unpaid care to other adults who are disabled or chronically ill, parent carers of disabled children and young carers who are so often overlooked. Helen Walker, Chief Executive

of Carers UK, said, ‘It is vital to uphold this amendment and ensure that it remains in the Bill. Our evidence shows what a devastating time hospital discharge can be for carers if they are not consulted, involved or given the right information and support to care safely and well. They should not be taken for granted.’

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Housing review launches to assess unmet need ARCO has commissioned Professor Les Mayhew and the International Longevity Centre to lead a housing review into the case for Integrated Retirement Communities (IRCs) and the scale of provision needed from now until 2038. Les Mayhew is Head of Global Research at the International Longevity Centre, UK and Professor of Statistics at Bayes Business

School, City University, London. By 2038 there will be an additional 5.5 million over 65s in the UK and almost three million additional over 75s, both significantly increasing as a proportion of the overall population. Based on the available evidence to date, it is estimated that somewhere between 200,000 and 1,500,000 new units will be

needed over this time. The Mayhew Review will be devising a model and seeking evidence to go much further and to develop the most robust figure possible. ARCO is inviting sector stakeholders, investors, operators, academics and older people themselves to submit evidence to the Mayhew Review to inform this work. ARCO will also be gathering

evidence and holding meetings itself to inform the review’s work. In relation to the housing review, ARCO said fundamental changes are needed to how we provide care to older people and the housing options available and highlighted that care provision needs to focus more on keeping people well, to become more person centred and to be delivered more efficiently.

Call for new legal right to maintain contact A coalition of organisations is calling for a new legal right to be introduced, to ensure people can maintain contact with their families across health and care settings. The joint call for a new right has been sent to the Secretary of State for Health and Social Care. Over 30 organisations, including Mind, Mencap, Healthwatch England and Disability Rights UK, have backed the call and visited Parliament on 9th March. The new right would

give anyone who needs care and support access to a ‘care supporter’ – a relative or friend who can help them wherever they need it, such as in hospitals, care homes or GP surgeries. People who have been affected by separation during the pandemic travelled to Westminster to talk to MPs about their personal experiences and why this new right is needed. Parliamentarians have already

expressed their support for a new right, including Liberal Democrat deputy leader, Daisy Cooper, and Plaid Cymru Westminster Leader Liz Saville Roberts. The crossparty event is being co-chaired by Conservative MP Tracey Crouch and Labour MP Dan Carden. Actress Ruthie Henshall will also be attending. Tracey Crouch MP said that access to a care supporter should become a ‘routine’ and ‘key ingredient’ for good care.

Highlighting pressures faced during the pandemic, Jenny Morrison said, ‘The Government must acknowledge that many vulnerable people have simply given up the will to live during the pandemic, as a result of prolonged periods of isolation and separation. We must guarantee people the right to have at least one family member or friend that is designated as part of their care team and is crucial to their mental health and wellbeing.’

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Dementia breakthroughs discussed at UK's largest conference Top scientists gathered in Brighton this month at the UK’s leading dementia research charity’s annual Research Conference. It was the first time so many dementia experts have come together face to face since 2019. Nearly 600 researchers attended the hybrid event, with the majority of those attending in person at the Brighton Centre over the course of three days.

The conference also saw Alzheimer’s Research UK Ambassador Scott Mitchell – husband of the late Dame Barbara Windsor – address delegates, talking about the importance of their research for all those affected by dementia. The Alzheimer’s Research UK Research Conference gives experts the chance to share the latest findings on all forms of

dementia. One in three people born today will develop the condition in their lifetime unless researchers find new treatments or preventions. There are already nearly one million people living with the condition in the whole of the UK. It's the first time a large-scale dementia research conference has gone ahead since the European Medicines Agency rejected the

potential Alzheimer’s disease drug, Aduhelm, for use. Researchers had the chance to share the latest alternative treatment options being studied and their progress on projects. Talks covered the latest developments in diagnosis techniques – blood tests, brain scans and wearable technology – as well as the latest in preventative research.

New guidance on home adaptations launched Too many tenants are facing delay and frustration according to a new report that examines the workings of adaptations for social housing tenants. The ‘Housing Associations and Home Adaptations: Finding ways to say yes’ report provides recommendations for housing associations, local authorities, central Government and the Housing Regulator to sort out the confusion about funding and improve the speed and effectiveness of home adaptations delivery. It provides practical solutions

to put disabled and older tenants at the heart of decision making, an inclusive approach to services, and for home adaptations to be part of the new customer-focused inspection regime. The research identifies: • Issues in funding and delivery, including splits in legal responsibility, a confusing pattern of funding, a post code lottery in the type of services provided, complex customer journeys and frustration for staff in local authorities and associations. • Rather than saying ‘yes’ to adaptations, barriers are

often placed in the way and adaptations may be refused, especially in general needs properties. They may also be removed unnecessarily when tenancies change. • Not enough accessible homes are being built and adapted homes are not recycled effectively. Asset management databases are sometimes incomplete; there are few accessible housing registers, void times are too short, and there is not enough support to match people to properties or provide help with moving. • Home adaptations lack

importance – although disabled tenants form a substantial part of housing association populations, most associations see adapting homes as a minor operational issue. It is not part of a strategic plan to make the stock work for everyone. • A lack of disabled people working in the sector – a National Housing Federation Survey in 2021 showed that disabled people are under-represented as staff members, not visible as leaders in the sector and only 4.8% of board members are identified as disabled.

geriatrician per 12,561 people over the age of 65, but figures across all regions are stark, with the most well-resourced area, Central and North East London, having one full-time geriatrician per 3,254 people aged over 65. Andrew Goddard, President of the Royal College of Physicians, said, ‘The workforce crisis we’re facing is largely down to an

astonishing lack of planning. All successful organisations rely on long-term workforce planning to meet demand and it’s absurd that we don’t do this for the NHS and social care system. ‘The Government needs to accept the amendment put forward by Baroness Cumberlege and make workforce planning a priority.’

Physicians warn of a crisis in care The Royal College of Physicians (RCP) is warning that a combination of a rapidly ageing population and a lack of workforce planning means we are sleepwalking into an avoidable crisis of care for older people. New analysis by the RCP shows there is the equivalent of just one full-time geriatrician per 8,031 people over the age of 65 in

England. The RCP’s data, pooled from its own census of physicians alongside population data from the Office for National Statistics (ONS), shows the NHS is ‘woefully underprepared’ to cope with an ageing population. The extent of workforce shortages ranges across the country. The East Midlands fares the worst, with one full-time

End of life care to become legal right in UK The UK Government has announced that providing end of life care will, for the first time, be an explicit legal requirement for health commissioners throughout England. The news comes following months of campaigning work from end of life care 12

CMM April 2022

charities, calling for changes to be made to the Health and Care Bill to ensure palliative care is properly recognised and commissioned by Integrated Care Boards. End of life charities have welcomed the news, saying it is a key milestone in end of life care.

One of the charities, Marie Curie, has released new data alongside the announcement showing that around 215,000 people a year currently miss out on end of life care and without intervention this could rise to 300,000 in under 20 years. Hospice UK said that

one in four people who could benefit from end of life care is still missing out on high-quality care as they die, warning that people from minority groups, LGBT+ communities and those from lower socioeconomic backgrounds are disproportionately affected.

CMM April 2022

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NEWS NEWS / IN FOCUS

Growing concern for underfunded reforms Councils could face a budget black hole amid growing concern for underfunded social care reforms, says the Local Government Association (LGA). As councils plan budgets for next year, the LGA's concerns are growing that the Government’s reforms to adult social care are underfunded and risk their implementation, as well as exacerbating existing pressures. Of the £36bn the new UK-wide health and social levy will raise over the next three years, only £5.4bn is to be ringfenced for social care in England. As councils plan their service budgets from April, the LGA said many are increasingly concerned that the funding allocated for reform falls far short of the likely costs involved. The introduction of a ‘fair rate of care’ that councils will pay

providers and tackling the issue of self-funders paying more for their care than those who access support at the council rate will be particular issues going forward, according to the LGA. Without adequate funding to deliver these proposals, the LGA said some councils will face a battle to balance budgets, worsening existing pressures and running the serious risk of impacts on the ability to deliver timely and quality care to those who draw on it. Alongside adequate funding to meet the ambitions in the reforms, councils also need urgent clarity on detail. The LGA is calling for Government to work closely with councils on detailed costings and publish at the earliest opportunity its consultation on the associated guidance.

Universal care service report A new Women’s Budget Group (WBG) and New Economics Foundation (NEF) report is calling for the creation of a universal care service. Creating a universal care service could enable over 1.9 million extra people to access publicly funded care services and create almost a million new jobs, according to report authors. For the first time, this report calculates the costs of all the reforms needed to create a high-quality, universal care service with well-paid care workers, and shows that the Government’s new health and social care levy would only raise 6% of the funds needed to create such a service. Currently, many are unable to access essential care and support services and at least 1.8 million people in England have unmet care needs. The report argues that a combination of means testing, underfunding and competition between private companies to keep costs down has resulted in a failing social care system, in which quality is often poor and gaps in provision are met by increasing

numbers of friends and family providing unpaid care. The report concludes that the economic recovery from the pandemic is a unique opportunity to establish a universal care service that meets everyone’s needs and stimulate the economy with new funding. Dr Mary-Ann Stephenson, Director of the Women’s Budget Group, said, ‘A properly funded universal care service would deliver quality care to users and provide decent wages to carers, helping to boost the economy. Solving social care can’t just be about investing in the current broken system. Any long-term solution must be rooted in a broader definition of social care. It is about more than just providing personal care. Social care should support people to stay rooted in their communities and live their lives with autonomy and dignity. That’s something we would all wish for, but it requires vision and investment.’ Visit either the WBG or NEF website to read the Universal Quality Social Care report in full.

IN FOCUS

The King’s Fund publishes Social Care 360 WHAT’S THE STORY? The King's Fund has published its latest Social Care 360 report this week, which finds that COVID-19 had a significant impact on older people approaching local authorities for social care support. This year’s social care 360 includes data from 1st April 2020 to 31st March 2021, encompassing both the first and second waves of the COVID-19 pandemic.

WHAT WERE THE FINDINGS? New findings in the social care 360 report reveal that 32,000 fewer new requests for support from older people were made during 2020/21 as they avoided contact with social care services during the pandemic. However, more working-age adults made requests during the year, continuing a trend that has seen an increase of 15% in the number of working-age adults requesting support since figures were first collected in 2015/16. Overall, there was a small, 3,000 increase in the number of people receiving long-term care in 2020/21, though there was a larger 12,000 fall in the number receiving short-term ‘reablement’ type care intended to help people regain their independence. The pandemic also led to a sharp rise in local authority spending on social care to help keep the sector afloat, but the report’s authors show that – while welcome – the Government funding for this was short term and time limited. Overall, the annual assessment shows that the sector remains under immense pressure, with a number of worrying long-term trends: • Social care staff vacancies fell

early on in the pandemic but have now begun to rise and in January 2022 nearly one in every 10 roles was vacant. • Care worker pay has increased but it continues to fare badly compared to other roles such as cleaners and catering assistants. • Fewer older people are now receiving publicly funded long-term care, down 6% (36,000) since 2015/16. When population size is taken into account, there has been a large fall in older people receiving long-term care and a small fall in working-age adults.

WHAT DID THE EXPERTS SAY? Simon Bottery, Senior Fellow at The King’s Fund, said, ‘Overall, the report paints a picture of a social care sector still struggling to tackle not just the pandemic but the years of neglect that preceded it. The Government’s recent white paper is a step in the right direction, but it does little to deal with some of the most immediate problems like unmet need, underfunding and workforce. These remain in urgent need of attention.’ Bottery added, ‘The introduction of changes to the means test and a cap on lifetime care costs are just one part of the reform that social care desperately needs. Even here, it is deeply disappointing that the Government wants to introduce changes that will leave people with low levels of wealth exposed to very high care costs and, in many cases, still needing to sell their home to pay for their care. We hope this change is rejected as the legislation makes its way through the House of Lords.’ CMM April 2022

NEWS

New CQC Chair appointed The Health and Social Care Committee has approved the former NHS Resolution head to be appointed as the new Chair of the Care Quality Commission (CQC). MPs confirmed that Ian Dilks has been appointed as the new CQC Chair following a pre-appointment hearing on 22nd February. Mr Dilks – who was the Government’s preferred candidate for the role – previously chaired NHS Resolution,

the arms-length Department of Health & Social Care (DHSC) body managing compensation claims for NHS England. He chaired the body for six years until December 2020, during which time he introduced a greater focus on patient safety. The Committee, led by former Health Secretary Jeremy Hunt, said this experience was ‘valuable’ and indicated a ‘strong track record in making important and

lasting change'. However, the Committee held some concerns around Mr Dilks’ lack of experience in the social care sector: a ‘vital’ area of the CQC’s work. On the appointment, Mr Hunt said, ‘Ian Dilks brings valuable experience to the role of CQC Chair from his prior work in the NHS. However, he was honest about not having knowledge of the social care

sector, a vital element of the CQC’s work. As a result, the endorsement of his appointment was not the unanimous view of the Health and Social Care Committee. ‘We have registered our concerns about the lack of the diversity of candidates progressing through the appointments process and have urged the Department for Health and Social Care to redouble its efforts in this area.’

Social care staff not entitled to free testing Health and social care staff will be omitted from free COVID19 testing, according to plans proposed by the Government. Staff have been required to test twice weekly to minimise asymptomatic transmission to vulnerable people. Under the proposed Government plans, it was confirmed that care home residents, hospital patients and other vulnerable groups will

still be entitled to free testing. However, health and social care staff were omitted from this list. The Prime Minister did say, however, that the full details of those who will remain entitled to free tests will be set out in full this month. Social care staff being omitted is likely to be down to the question of who will pay for continued testing, given the Prime Minister’s emphasis on budgetary

constraints. General Secretary and Chief Executive at the Royal College of Nursing, Pat Cullen, said, ‘This move feels unplanned and ill informed. The Prime Minster had the opportunity to reassure health care staff in England they still have access to tests, and they will be alarmed by this omission. ‘Nursing staff remain on the front line of protecting the

most vulnerable in society and extra vigilance is needed for all those working in health and care returning to work after a positive result and a period absent. Nursing staff know the reality of living with COVID-19 and will want to see the evidence for this decision. They need to be assured there are robust plans in place should the number of cases increase again, or a new variant emerges.’

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CMM April 2022

NEWS

Outbreak funding must continue Government must continue to provide outbreak funding for local public health teams to manage COVID-19 locally, councils in England have said. The Local Government Association (LGA) and the Association of Directors of Public Health (ADPH) have warned that, if outbreak funding does not continue, they may be unprepared to tackle new variants and manage

COVID-19 in local schools and care homes due to the loss of staff with relevant expertise. The Government’s Contain Outbreak Management Fund (COMF) is set to end this month (March) and no guarantees have been made about its future. The fund has supported local authorities to upsurge testing for new variants, work with employers and businesses to tackle outbreaks

and ensured schools and care homes could have access to testing, as well as other important steps to tackle COVID-19 in local communities. In the wake of the Government announcing its Living with COVID19 strategy this week, which sets out plans to manage the pandemic moving forwards, councils have said that they will have to stand down important public health services if

they do not receive any further local outbreak management funding. Councils have called on the Government to introduce a long-term strategy on testing and vaccination, including how to protect high-risk settings and vulnerable groups as well as support councils to address workforce gaps brought on by the pandemic, particularly in the care and public health sectors.

of the Omicron variant. In the two weeks ending 29th January 2022, the percentage of people in self-isolation because of COVID-19 increased in three work sectors: teaching and education, social care and health care. The sectors with the highest percentage of the workforce in self-isolation on 29th January 2022 were social care at 4% (95% confidence interval 2.9% to 5.4%) and teaching and

education at 3.9% (95% confidence interval 3% to 5%). The news that the social care sector had the largest percentage of its workforce in self-isolation at the end of January comes as the Prime Minister announced in the latest Prime Minister's Questions that he expects all remaining COVID-19 restrictions to be lifted a month early (currently 24th March), data and case numbers allowing.

Social care in self-isolation The Office for National Statistics (ONS) has confirmed that social care had the highest workforce percentage in self-isolation on 29th January. The ONS publishes regular estimates of the proportion of the UK workforce by work sector and the proportion of the workingage population (regardless of employment status) by country that are self-isolating because of

coronavirus (COVID-19). The latest release uses data from the Coronavirus Infection Survey (CIS) to provide modelled estimates of the proportion of the workforce self-isolating because of COVID-19 by work sector. Estimates are based on data collected between 5th December 2021 and 29th January 2022, during a period of rising infections and changing self-isolation requirements because

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NEWS

Care staff immigration rules relaxed Relaxed immigration rules concerning the ability of care staff to migrate to the UK from overseas have come into force. First announced by the Department of Health and Social Care (DHSC) on Christmas Eve, following a recommendation by the Migration Advisory Committee, care workers have been added to the Shortage Occupation List for 12 months, which will allow migrants to get work visas to address staff shortages in the sector.

Migrant workers will be able to move with dependents, including partners and children, and the visa offers a path to settlement in the UK, the DHSC said. Employers can apply to the Home Office to become sponsors and assign a certificate of sponsorship to a worker they have recruited from overseas, who can then apply to come to the UK under the visa. Despite the relaxed immigration rules for care staff, they will have

to be paid at least £20,480 a year to qualify for the visa. This is considerably higher than the current average for domestic senior care worker jobs, which the Government says is £16,900. In response to the relaxed immigration rules coming into force for care staff, the sector has voiced its concerns that this will provide little relief from staff shortages until the issue of pay is addressed. Mark Adams, Chief Executive

of Community Integrated Care, said, ‘Whilst we’re pleased to see the Government finally concede that care workers play a skilled role in society, the reality is, for most providers, this change will have little or no effect. ‘If the Government truly wants a high-skilled, high-wage economy, then salaries have to reflect the professional standards required to deliver quality care, and local authorities must be funded by central Government to pay for this.’

Workforce planning overhaul rejected Government has rejected the Health and Social Care Committee's recommendation to overhaul workforce planning. In what the Committee's Chair, Rt Hon Jeremy Hunt MP, has described as a 'missed opportunity' to alleviate the workforce crisis in the NHS and social care, the Government has published its response to the Committee's June 2021 report, ‘Workforce Burnout and Resilience in the NHS and

Social Care’, in which it has rejected an overhaul of workforce planning. In its report, the Committee warned that workforce burnout across NHS and care systems had reached emergency levels and was risking the future functioning of services. The inquiry heard that NHS workforce planning was at best opaque and, at worst, responsible for unacceptable pressure on staff. The report concluded that

available funding was the driver behind planning, rather than the level of demand and staffing capacity needed to service it. It further cited the absence of any ‘accurate, public projection’ of workforce requirements in specialisms over the next five to 10 years. Health and Social Care Committee Chair, Rt Hon Jeremy Hunt MP, said, 'Whilst we are pleased that some of our

recommendations to improve workplace culture were well received, this long-awaited response is a missed opportunity to properly address the single biggest driver of workforce burnout: staff shortages. 'We hope the Government will be persuaded by the case for independent workforce planning as the Health and Care Bill progresses through Parliament. Without it, we see little hope that the workforce crisis will be alleviated.'

Social care charity announces pay investment One of the UK’s biggest social care charities, Community Integrated Care, has announced it will pay its frontline Support Workers £10 per hour in England and £11 per hour in Scotland from 1st April 2022. The increase will see the charity pay more than both the Government’s National Living

Wage and the voluntary real Living Wage as recommended by the Living Wage Foundation. The move represents a further £3m investment from the organisation, reflecting the charity’s commitments to frontline recognition under its new Best Lives Possible five-year strategy.

The increase means that a Support Worker in England working 40 hours per week will now receive an annual salary of £20,857 – an additional £625 (gross) per year. There will be equivalent uplifts for the charity’s Advanced Support Worker roles and Nurses. Mark Adams, Chief Executive

Officer at Community Integrated Care, said, ‘As the social care sector continues its battle with low pay and skills shortages, our charity is proud to be in a position where we can go some way in fulfilling our commitment to valuing and rewarding our colleagues fairly for the outstanding work they do.’

New research-based dementia care home Healthcare Management Trust (HMT), the charity which provides health and social care while reinvesting any surplus income back into dementia care research, will be opening a specialist dementia care home in the village of Climping, near the seaside town of Littlehampton, West Sussex. The care home is designed 18

CMM April 2022

to feel less like a care home and more like a familiar home for residents. Designed over two storeys, the home incorporates four separate wings with 16 bedrooms in each wing. The wings are split equally into two distinct households of eight bed ‘homes’, each with their own domestic kitchen, dining and day lounge

spaces. The residents will live in small family ‘homes’ with others at a similar stage of dementia; important for reducing stress and helping in the socialisation for residents. Tony Barrett, Chief Executive at HMT, said, ‘We provide care that gives back. Surplus funds generated through our work are

reinvested in scientific research to serve the ageing population. As a result, HMT offers pioneering, research-led and “family home” focused care to our residents. We are proud to have expanded to a third site and look forward to benefiting local residents through investment, job creation and our residential care offer.’

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SOCIAL CARE’S ACHILLES HEEL: How we got into a recruitment crisis

Adult social care workforce pressures are at unprecedented critical or near-critical levels. Although it is easy to blame the combination of Brexit, COVID and a resurgent labour market, Neil Eastwood argues we must also recognise and address the often overlooked systemic weaknesses inherent in our sector in order to build a resilient care workforce for the future. 20

CMM April 2022

Demand for direct care is escalating, with an ageing population, disability, mental health challenges, and potentially the effects of long COVID. Building a stable, compassionate and suitably qualified labour pool to satisfy this demand remains one of the biggest global challenges we face. The pandemic has made this task even harder, and many countries have faced border closures restricting the free movement of immigrant labour for long periods. In the UK, the impact of the pandemic was made significantly worse by the timing of Brexit (some might say an entirely avoidable political decision), and the workforce pressures resulting from COVID itself were further exacerbated in England by the introduction of mandatory vaccinations, a policy journey which reminded many in adult social care of the sector’s second-class status to the NHS. But we need to look beyond individual policies, and even the pandemic, to identify how we can repair and grow a sustainable social care workforce. Our biggest challenge now, I would argue, is not what has happened in the past 12 months, but what has been happening, in many countries, for decades. Recent events have laid bare inequalities and undercurrents that must be tackled to secure a compassionate and adequately resourced workforce in the years ahead. The window of time available to prevent wholesale sector collapse has been shortened by the toll taken on the workforce since 2020. So, to start the conversation, I have highlighted three structural flaws we must tackle head on.

VALUING THE ROLE 1. Societies, governments and sometimes even care providers don’t value the role of a paid care worker enough There has long been a stigma associated with paid caring roles. Public perceptions are not helped by low wages and hard working conditions, but the underlying reasons the role is undervalued are much deeper and more entrenched. Paid care is still stereotyped as ‘women’s work’ of secondary economic value, and ‘unskilled’, especially when compared to the NHS in general and nursing in particular. It has been proven there are both racial and class aspects that go some way to explaining how care workers, despite their clear contribution both to society and to enabling the NHS to function at all, are valued so little. In fact, it is not uncommon for ungracious comments towards care workers to be attributed to our NHS colleagues. It is my view that our society, some sector employers, parts of the NHS and successive governments have long taken for granted, or even exploited, the implicit goodwill

CMM April 2022

SOCIAL CARE’S ACHILLES HEEL: HOW WE GOT INTO A RECRUITMENT CRISIS

and charity of those who naturally have a ‘calling for care’. Care workers also regularly reinforce this image, describing themselves as ‘just a care worker’. Many care workers care for loved ones alongside their paid employment. Consequently, their entire life is characterised by service to others, in many cases without much thought for themselves. Within our sector, there is an opportunity for all providers to become employers of choice, especially since their employees haven’t picked the job based on salary. This means creating a healthy, supportive environment on a daily basis. However, employers often fall short. Little things – kindness, fairness, a smile, recognition, praise, encouragement – should be embedded in the culture of every care provider. It can feel much of the workforce crisis is outside their control, but there are positive changes that all providers can make, and for some, action is required urgently.

THE PAY ISSUE 2. Increasing wages isn’t the panacea many think it is There is little doubt that the underpaid care workforce is heavily subsidising the true cost of social care, often prioritising those in their care over their own needs and working longer hours than they are paid for. Unlike the NHS, the highly fragmented structure of the largely privately owned provider market has resulted in a care workforce without a co-ordinated public voice. This has stymied the workforce’s ability to collectively negotiate for better terms and conditions, although I would question whether they would put their clients at risk to push for better pay or conditions anyway. Those they support are equally lacking a voice – not only the older population, but also those with a long-term disability or mental health condition, who are not in a position to make the case for better wages and conditions for the care and support workers they rely on so much. In addition, with the widely prevailing low rates of pay, the rising cost of living and increasingly unaffordable housing and transport costs, there is a risk that many more care workers will soon be in working poverty conditions and simply won’t be able to afford to do the job, despite their calling for the work. Few would argue that care workers don’t deserve higher wages – or at least parity with the equivalent NHS pay scale – but would this

be the universal solution to the care workforce crisis that many believe it to be? The answer, I believe, is no. Increasing wages for care workers specifically, rather than using the blunt mechanism of lifting the minimum wage floor, putting aside how it would be funded and fairly delivered, is something of a conundrum. Increasing pay significantly would certainly give an important boost to the esteem of the workforce and increase the public’s respect for the role, associating it much more with the skilled profession it is. However, increasing wages is not the panacea it may appear to be. There have been examples around the world, including the UK, where significant pay rises or one-off bonuses have been given to sections, or all, of the workforce, with surprising consequences. Care workers are generally expected to work unsociable hours and there is evidence that, for some, an increase in their hourly rate of pay allows them to hand back weekend and evening shifts to redress this imbalance. This phenomenon was reported after 55,000 care workers in New Zealand received substantial hourly rate increases of between 15 and 50% in 2017. Pay rises also caused tensions with kitchen and cleaning staff who did not receive them, and care workers reported an increased pressure from managers to take on more responsibility. Some said they felt no more appreciated by managers than before – clearly the thing they had craved most – and employers reported no material difference in recruitment, with a general response of, ‘well, it is still a hard job that people don’t necessarily like to do’. Equally, there is evidence from the UK that ad hoc cash bonuses can serve to increase short-term absences for the very same reasons – that extra money provides an opportunity to reprioritise home over work, even for a short period. Despite all this, I believe that increasing pay to reflect care workers’ value to society remains essential, not just from an ethical and moral standpoint, but to give the workforce the choice to address the imbalance in their lives if they choose. We just need to recognise that this may result in a reduction in capacity, which new entrants to the sector or productivity improvements must fill. So, a pay rise, or one-off payments, must go hand in hand with a national workforce strategy that puts those with a calling for care at its centre and can adequately source new workers with the right values and train and develop them.

CHALLENGING ATTITUDES 3. Changing work attitudes must be addressed Employers who have been in business for many years often bemoan the changing work ethic of care staff. It is widely noted that attitudes to work have shifted and employer loyalty has weakened. Younger people are now more focused on transferable skills than careers or long-term commitments with a single employer. Commentators have observed societal shifts, characterised as a loss in what is called ‘social capital’ – the bonds that tie communities together. This is partly driven by the rise in social media and technological advancements, which have replaced physical help in the community with opportunities for ‘low effort’ contributions such as likes and comments supporting online causes. There is little doubt that reinvigorating a sense of real community responsibility would need to begin at school age when core values and beliefs are being formed. I wrote in my 2017 book, ’Saving Social Care’, about the need for a national care service to create an environment in which young people could experience the intrinsic rewards of helping those more vulnerable than themselves. But education policy also needs to move away from a prioritisation of theoretical degree education for all, instead recognising the true value to society of vocational skills-based learning. The perception of social care as a last resort option for pupils of lesser academic ability must also be tackled – often this comes from the attitudes of educational staff. Care providers must also adapt to reflect these changing attitudes to work and the tightening labour market by ensuring they always treat care workers with respect, making them feel appreciated and valued. There is now no option but to be exemplar employers in their local communities, especially considering the huge contribution this values-driven workforce makes to society. The pandemic has finally shone a light on the commitment and contribution of care workers. Now it is time for Government, society, the NHS and our sector to grant them a voice as we work together to build a resilient care workforce for the future. CMM

Neil Eastwood is Founder of Care Friends. Email: neil@carefriends.co.uk Twitter: @stickyneil What do you think are the barriers to finding workforce solutions? Share your thoughts and experiences on the CMM website, where you can also leave feedback on this article, www.caremanagementmatters.co.uk . Look out for Neil’s solutions to the short- and long-term workforce challenges in a future issue of CMM. 22

CMM April 2022

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The care home sector has been in the spotlight like never before over the past two years and it’s become clear that demand for beds is rapidly outstripping the supply coming through. Our research suggests that by 2035 there will be a shortfall of 58,000 beds across the sector, whilst the growth in the UK’s older population is such that by 2050 an additional 350,000 older people will potentially need a care bed, almost doubling the level of bed demand in the next 30 years.

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DARTING THROUGH THE DECADES: FUTURE DEMAND FOR OLDER PEOPLE’S CARE HOMES

With 100,000 beds at risk of closure by 2040, this projected bed capacity hiatus means that existing operators should benefit from an increase in occupancy as demand is set to outpace supply. However, various barriers stand in the way of allowing the sector to truly benefit from the increase in demand, potentially leaving people without the care and support they need. On top of the supply issues, UK care home operators could see their costs rise by up to 30% this year due to macro issues including the increased costs of labour, supply and finance, which have compounded. We are at a crisis point and the future of the sector depends on how we act in the next few years.

looking at ways not only to recruit more care workers, but also to increase the number of registered nurses available to the care sector, with a current shortfall of 40,000. The shortage of nurses is especially concerning, given the demand for specialised care, such as dementia, which has never been greater, and which is set to increase. The Government is moving to remedy these challenges by streamlining and relaxing the checking process, sourcing staff from alternative non-European countries including the Philippines and allowing asylum seekers to apply for healthcare and hospital jobs; however, this is yet to relieve the squeeze that the industry is experiencing.

CHALLENGES OF BREXIT AND STAFFING ISSUES

INNOVATION OPPORTUNITIES

As the pandemic starts to loosen its grip on the national and international focus, the challenges of Brexit are showing no similar signs of abating. Knight Frank expects that UK care home operators will see costs rise by £165m this year, with staffing the main area of concern, both in terms of costs and supply. We’ll see inflations in the pay rates, from minimum to living wage; however, without a clear career progression, and with competition from other industries, including the likes of large logistics companies promising ‘golden handshakes’, the care sector is struggling to compete for the limited number of workers available. And that’s having a knock-on effect. Huge swathes of care homes are having to close due to staffing issues whilst regulators force them to have a minimum number of staff to operate. Even the much-needed newly built care homes are resorting to delayed or phased openings as they remain unable to fully deliver the necessary service and customer experience. This means that, despite the growing admissions demand, the sector simply cannot provide what is needed. Whilst this is neither a new challenge for the sector, nor limited to care homes, as retirement living and homecare also face these issues, the reduction in migrant workers as a result of Brexit has undoubtedly exacerbated things. A comprehensive solution is needed to address this. The sector needs to be

Care operators have been tested and appreciated over the last two years like never before, and the pandemic has only underlined the sector’s importance. It has always been indispensable in our society as demand for beds and quality care continues to grow with our population, but with this newfound appreciation in the national dialogue, there has been increasing interest from institutional capital and continued investor appetite. This means that there are opportunities for operators to innovate in order to meet growing and evolving demands. We anticipate that investment into the sector will remain robust, from a broad church of domestic and overseas investors seeking defensive healthcare assets to diversify their portfolios, however it is clear that more inward investment is crucial. My position has always been that, as with any sector, in health and care, primary product will prevail and prosper whilst those facilities that are not up to scratch will inevitably fall away. The good operators – who take the lead and embrace the opportunities to innovate, be nimble, and invest in infrastructures which will deliver the care of the future – will succeed. As such, futureproofing existing facilities is vital for operators. The sort of adaptions which we expect throughout the sector to support the needs of the care home inhabitants of the future include: • A rise in dementia and nursing care specialists.

“The good operators – who take the lead and embrace the opportunities to innovate, be nimble, and invest in infrastructures which will deliver the care of the future – will succeed.”

> CMM April 2022

DARTING THROUGH THE DECADES: FUTURE DEMAND FOR OLDER PEOPLE’S CARE HOMES

• A focus on the importance of clinical outcomes and key performance indicators. • Design adaptation for future COVID-19 events. • Growth in technology and telemedicine. • Larger care home sites to include independent living units.

FOCUS ON ESG AND SUSTAINABILITY The environmental, social and governance (ESG) movement is positively driving institutional capital into social care and senior living, however developers and operators themselves have a long way to go to meet the ever-increasing sustainability standards. The Building Research Establishment’s Environmental Assessment Method (BREEAM) will

soon no longer be a cherry on top but will be imperative to the value of developments. However, the impracticalities of retrofitting buildings which are typically used in the sector, such as old rectories or hotels, has resulted in social care lagging behind on Government targets. Operators and owners need more proactivity in terms of futureproofing and implementing other basic systems.

AN OPTIMISTIC OUTLOOK Despite the clear challenges that remain ahead around increasing costs, staffing and development shortages, there are many opportunities for forward-thinking operators, and the sector remains a strong proposition for investors. In 2021, the UK healthcare property market saw £2.34bn of transactions,

whilst £5.41bn was invested in the European healthcare property market despite the impacts of the pandemic, demonstrating the continuing resilience in the sector. However, care home development must be a priority given that the UK elderly care market is at risk of reaching capacity by the end of the decade. We must ensure that we construct new, high-quality care homes in parallel with guaranteeing the renovation of existing stock to meet the needs of older residents and ensure the residential care system is ready for the future. This represents an excellent opportunity for all stakeholders given the older population projections across the UK, which imply there will be unprecedented demand for residential care in decades to come, creating a huge opportunity for those ready to invest. CMM

Julian Evans is Head of Healthcare at Knight Frank. Email: julian.evans@knightfrank.com Twitter: @JulianMEvans What are your focus areas for ensuring your business keeps up with market trends? Share your insights and feedback on this article on the CMM website, www.caremanagementmatters.co.uk

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CMM April 2022

INTO PERSPECTIVE HOW HAVE GOVERNMENT’S U-TURNS ON MANDATORY VACCINES IMPACTED ON SOCIAL CARE? HOW IT BEGAN

Government has officially announced that legislation allowing care providers to deploy only fully vaccinated staff has been revoked. This is what the sector has been calling for, so where does it leave us and what is the impact of the change of heart?

In April 2021, the Department of Heath and Social Care (DHSC) launched a consultation on making COVID-19 vaccinations a mandatory condition of deployment for staff in older people’s care settings. Despite many in the sector expressing concerns that the proposed legislation changes would exacerbate the workforce crisis, and emphasising the work that providers were already doing to encourage uptake of the vaccination, in June 2021 Government confirmed it would be going ahead with the policy. It was passed into law in July and all care staff working in older adults’ care homes needed to have received both of their COVID-19 jabs by 11th November to continue their work after this date. In September, Government began consulting on whether vaccination as a condition of deployment (VCOD) should be applied more widely to other health and care staff, including NHS staff. These plans were confirmed in November and the sector was generally dismayed, having already seen an exodus of staff who did not want to be forced into getting vaccinated. By January, it was clear that VCOD legislation was forcing people to leave their jobs, causing grave issues for providers who had already been struggling with recruitment. Skilled professionals had had to hand in their notice and staff with years of experience and excellent relationships with clients and residents resigned or were terminated from their roles.

MAKING A U-TURN Pressure from sector leaders and individual providers ensued, almost 30

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all voicing their support for the vaccination programme but equally asking Government to hear them when they said this was creating widespread problems. On 31st January, Government announced it would be consulting on revoking the VCOD legislation, stating that as Omicron was now the dominant variant in the UK, and was generally less severe in terms of its symptoms, the policy was no longer necessary. DHSC formally announced on 1st March that it would be revoking the legislation, with effect from 15th March.

WHERE WE ARE NOW Though the sector is generally glad that the VCOD legislation has been revoked, it remains a difficult situation. Providers are now faced with trying to recruit to fill the gaps of staff who have left or been terminated; some are trying to reach out to skilled leavers who have gone to work in other industries in the hope that they will return. There is a general sense of frustration as care operators have had to spend time and money on plans and solutions for the inevitable fall-out of Government’s actions. In some cases, this time and money has been wasted as Government has backtracked on legislation before it came into force. In terms of the impact of the legislation that was in force, it does seem to have had the desired effect – since April 2021, first dose uptake among care home staff has increased from 80% to 96% and second dose uptake from 77% to 95% since the care home VCOD regulations were made. But does this outweigh the pressures that have been put on providers and staff alike?

A damaging and a pointless exercise Nadra Ahmed OBE, Chairman, National Care Association We know that vaccines have been one of the most effective measures against the impact of COVID-19. The vaccine’s introduction was hailed as an enormous step forward during a devasting time. Within the care home sector, we saw unprecedented loss of life due to a hasty and ill-thought-out Government policy to empty hospitals into care settings. Care providers worked hard to support local acute care settings with assurances, which were not worth the paper they were written on, that it was safe to do so. Nine months on, as the vaccine emerged, care home residents and staff were given priority access and we sensed unease from some of the workforce, but we worked hard to support take up. It was a tough pathway, but we persisted and made progress until the mandatory legislation emerged. A steady stream of staff exits followed, increasing the pressure on providers, already struggling with workforce issues pre-pandemic and post Brexit. Care providers had used all the same mitigations as our

NHS colleagues, but they fell on deaf ears. The sector lost circa 30,000 members, for a policy that lasted less than 10 weeks but has left a devasting impact on the workforce crisis it exacerbated. We lost dedicated people who felt the haste with which they were being compelled to take the vaccine was too uncomfortable; their concerns were being trivialised so soon after a vaccine had been introduced. They felt devalued and invisible in the debate; they felt expendable! To see legislation revoked just 10 weeks after it was implemented is nothing short of a damaging and a pointless exercise. A U-turn in favour of halting an NHS staffing crisis will at least help social care providers to recruit on a more equal footing. However, we cannot plan our strategy until we can be sure there are no caveats introduced for a subliminal introduction of this policy and of course, until we can receive the funding required to create parity of esteem for our teams as they exist in the NHS.

Trust has been shaken even further Charles Armitage, CEO, Florence

The NHS U-turn brought our already low trust in the Government’s stewardship of the pandemic to the ground. Trust has been shaken even further – if that’s possible – by the additional U-turn on vaccination requirements for care home staff. As a result, care managers are facing a range of direct impacts on their ability to plan staffing safely, and well. Most far-reaching is the significant loss of professionals already from the industry. The Care Workers’ Charity estimates approximately 30,000 workers left the sector as a result of November’s vaccine mandate and, anecdotally, we’re not hearing of people deciding to return. Hospitality, gig work, remote work and other opportunities opened up by the pandemic have claimed essential staff, who have left an industry already suffering from chronic shortages. The damage has been done, and a U-turn will not bring people back to care overnight. On the ground, services are now scrambling to provide safe staffing levels via an even more decimated workforce. Morale is at an all-time low, too. Managers expended a great

deal of time and political capital ensuring vaccine coverage in the run-up to November, with many having to let long-serving staff go. The NHS U-turn looks like a bow to pressure that was ignored in the case of social care – plus, the hard work, heartbreak and energy spent enforcing vaccination has come to nothing. Staff themselves see the U-turn as proof they play second fiddle. Was the vaccine mandate only a failed experiment, using social care workers as test subjects ahead of the NHS? That makes our wonderful staff feel disposable and under-valued. Surely, a U-turn on this policy means next time there’s a Government mandate surrounding vaccination (or wider issues), there will be significantly less buy-in from care leaders and workers alike – making our workforce problems even more entrenched. However, a silver lining may be found. This reversal of vaccine law across the NHS and social care could rebalance the recruitment environment. Care leaders can operate in a more level playing field and draw workers back from the NHS, which could help ease staffing challenges going forward.

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THE BENEFITS OF TAX RELIEF New rules and increased funding in social care could offer care operators the opportunity to benefit from a range of tax benefits and rebates. However, these opportunities will need to be carefully managed and will require a full understanding of how they can best be leveraged. Stuart Brodie, Director of Markel Tax, explains. The funding of long-term care has been a political hot potato that successive governments have been happy to ignore to the point where the current Government has been left with no choice but to create what it sees as a workable solution. This solution has been hailed as a fundamental shift in access to social care. It is a vision for how England will offer social care from October 2023 and how Government can limit the costs to the public. It offers opportunities for care operations to benefit from a range of tax benefits. From premises to staffing, there are taxation issues which cannot only be addressed, but that can also be used to benefit care operators’ bottom lines.

VAT – MITIGATING ITS IMPACT As most care supplies are exempt from VAT, the VAT incurred on expenses is a sticking cost for the majority of suppliers. As such, it is sensible to adopt mitigation strategies where these are available. Such strategies include where property works may benefit from zero or reduced ratings, whether VAT can be eliminated from supplies of agency staff or whether the supplies of the provider can be restructured to make them VATable (thereby allowing recovery of VAT on costs). In relation to new builds, only construction services

CMM April 2022

MAXIMISING THE BENEFITS OF TAX RELIEF

qualify for zero-rating, and professional costs, such as architects' fees, are standard rated. Such costs normally amount to 10-15% of the total spend; however, the tax on this can be avoided by using a design and build contract, which means that the professional fees form part of the overall supply of construction services (and the whole supply is therefore zero-rated). Be aware though that the contractor is likely to seek to make a return on the bought-in services, potentially reducing the value of the benefit. For individual projects, this reduction in the benefit is probably acceptable, but for care providers carrying out multiple projects, it can soon add up. To mitigate this, some care groups have set up an in-house design and build company to retain more of the benefit (and also in some circumstances to allow a little flexibility in funding). If you do choose to do this, note that care needs to be taken to ensure such an in-house entity is not merely a cypher, as HMRC has been known to successfully challenge non-commercial arrangements. Care also should be taken in sale and leaseback type arrangements to ensure that a VAT charge is not inadvertently created. This can arise when the entity to whom the zero-rated supply was made disposes of an interest in the property within 10 years. Although the recent Supreme Court ruling in the Balhousie Care case should give some comfort, the very fact it was fought all the way to the Supreme Court indicates that HMRC will look very closely at any arrangements. It is important therefore that advice is taken before disposing of any interest in a property in order to prevent a costly mistake being made.

TAX CONCESSIONS FOR STAFF TRAINING With staff key to any business, it is important to know that tax concessions can be obtained when training is organised. These concessions go above and beyond simply the costs of the training per se. Companies can apply for tax relief if training is entirely for business purposes, including updates to employees’ existing knowledge or maintaining their membership of a professional body. In addition to the training itself, the associated costs, such as travel, food and accommodation, also fall under tax relief regulations.

TAX RELIEF FOR INNOVATIVE PRACTICES Research and development (R&D) has long been the subject of a wide range of tax relief and if care organisations can show that they are truly looking to innovate, expenditure on R&D can be subject to tax relief via credits. The money received via these credits, however, must be reinvested in the company. To be eligible, companies must explain how a particular project has advanced technology in their field. We frequently see examples of companies that don’t realise they are even eligible for tax concessions. It is

common for us to meet clients who are unknowingly fulfilling all the qualifying criteria for R&D relief. They are continually developing products or processes which meet the demand of an ever-evolving market, or simply responding to a customer request to develop an existing product. The key is ensuring you can evidence that the investment in R&D is delivering innovation. Given the level of new investment going into the care sector, we will undoubtedly see increasing numbers of care organisations looking at ways to innovate, which will in turn lead to more qualifying R&D claims.

OVERSEAS WORKERS There is another tax issue that may leave care operators facing both fines and requests for additional taxation payments if left unaddressed. The ever-increasing staffing crisis in the care sector has not gone unnoticed by the Government, and while decision makers haven’t got everything right (think mandatory vaccines), the changes to the health and care visa system to make it easier for overseas workers to be employed in the UK has been seen as a welcome boost. However, it comes with a cost, as to qualify for a visa and be included on the Shortage Occupation List will require the member of staff to be paid a minimum annual salary of £20,480. With revenue and costs still under intense pressure, care operators have increasingly sought to use contractors as a way of accessing capacity at time when there is higher need, but without the administrative burden that comes with employing a member of staff. However, last year the Government sought to clamp down on the potential abuse of the system via enhancement to the IR35 rules. IR35 governs workers who are off payroll and was designed to ensure that companies avoid tax evasion as, in theory, they could hire employees registered as limited companies who are disguised as contractors. In effect, if care operators are utilising a worker via an intermediary that could be viewed as an employee – if the relationship between the contractor and the care operation is direct – they may be deemed to be just that and the same taxation requirements would need to be applied. Companies can be asked by HMRC to prove their relationship with contractors at any point, which could involve looking at up to six years of contracts. Care operators need to ensure that any relationship with external contractors meets the needs of IR35 and there is clear evidence that the contractor is not a quasi-employee. The changes to the way in which care will be funded will open up new opportunities for operators to recoup investments via tax breaks, but to do so companies and management need to understand both the opportunities and the pitfalls, and what needs to be done to ensure that they remain compliant. CMM

Stuart Brodie is Director of Markel Tax. Email: stuart.brodie@markel.com Twitter: @MarkelTaxUK How do you use tax relief to benefit your bottom line? Share your experiences and give us feedback on this feature at www.caremanagementmatters.co.uk 34

CMM April 2022

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D R A D N A T S E H SETTING T

g n i v i l t n e m e in retir Integrated retirement communities are set to be a big player in adult social care, with investment and attention from Government increasing. Here, Annie Waddington-Feather, Consultant for Standards Wise International (SWI), shares the importance of defining a set of standards for these providers and the benefits this could bring.

With Government releasing several white papers and reports over the past few months, the spotlight is firmly on housing and care. Last year, the UK Government committed £40m to Audley Group to support new retirement living homes and in its ’Levelling Up’ white paper, government announced a new taskforce to look at ways in which better choice, quality and security of housing for older people can be provided,

CMM April 2022

including how to address regional disparities in supply of appropriate and specialised housing. ’People at the Heart of Care’ sets out an ambitious 10-year vision for how it will transform support and care in England and states Government’s aim to put people first, with the initial objective being that ‘people have choice, control, and support to live independent lives’. Meanwhile, recent proposals

for health and care integration, ’Joining Up Care for People, Places and Populations’, identify the crucial role of housing in the health and care system, and reiterate the call for more choice around housing options.

NOTABLE IMPORTANCE The benefits of specialised housing in later life have long been recognised. The King’s Fund

and University of York’s study, ’Evaluating the Care and Support Specialised Housing (CASSH) Programme: Results of a scoping exercise’, noted benefits varied from reduced visits to GPs, to reductions in use of community nursing services, reductions in care and care equipment costs, and a reduced likelihood of entering long-term care. Increased amounts of exercise, better fitness and independence, better perceived health, a reduction in falls and increased life expectancy were also all noted. At a holistic level, there were also lower levels of depression, loneliness, isolation and anxiety and improvements in memory and mental function. Indeed, Associated Retirement Community Operators (ARCO), which has long been calling for a cross-Government taskforce to accelerate the growth of the housing with care sector, calculates retirement living would result in

savings of £5.6bn for the NHS and social care. Furthermore, research into the impact of COVID-19 last year on retirement villages and extra care housing, undertaken by St Monica Trust in partnership with Housing LIN, revealed how the housing with care sector’s response to the coronavirus pandemic benefitted residents. It highlighted that the design and external and internal layout of schemes, plus the self-contained nature of individual apartments, enabled residents to isolate and keep their distance.

A GROWING SECTOR Despite the benefits integrated retirement communities bring, just 0.6% of the UK’s over-65s live in these settings. This is relatively low compared to other countries; in Australia, it’s approximately 5%, in New Zealand, it’s 5.5%, and in the United States, it’s 6%.

The UK is catching up though, with the senior living sector growing steadily over the last decade. The past few years have seen greater investment commitments than ever before from private equity, institutional capital, and independent businesses alike. Living in a retirement setting isn’t for everyone but it is a viable option for many, and the consumer interest is there. National Care Forum (NCF) sought the views of people aged between 50 and 70, living in England to understand the needs of the next generation of customers for the care sector. When presented with 12 different care setting options for later life, and asked whether they would consider each option if care and support was needed at some time in the future, 59% of respondents said they would consider paying someone to provide care in their own home, 58% would consider

CMM April 2022

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SETTING THE STANDARD IN RETIREMENT LIVING

retirement living in their own flat with an aid call system and communal areas, and 58% would consider a village-style setting with accommodation for older people with different care levels.

WHAT ARE THE CHALLENGES? One of the challenges faced by the integrated retirement community sector is supply. As pointed out in the House of Lords Built Environment Committee’s recent report, ’Meeting housing demand’, the population is ageing, and by 2050 one in four people in the UK will be over 65; quite simply, the country needs more specialist and mainstream housing suitable for older people. Local planning departments also need to keep up and approve development plans, but they may find that these don’t fit with the Town and Country Planning (Use Classes) Order 1987. And while the consumer interest is there, there are some perceived barriers. The Winckworth Sherwood and Housing LIN report, Holding Back the Years: the rise of retirement villages, identified a number of these, including: • 35% of respondents wanted to remain in the family home/ protect a current property asset. • 33% had a negative perception of life in retirement villages/only living with older people. • 15% were concerned by the lack of choice of product available. • 9% were worried about cost uncertainty. Furthermore, the report pointed out there is probably a degree of inertia in terms of moving house. So, while the consumer has shown more interest in exploring retirement living options, they are wanting more affordable choice in retirement living lifestyle options, with transparency in fees, and are actively looking for alternatives and wanting protection for their rights.

THE SIGNIFICANCE OF STANDARDS Many sector organisations believe standards in senior living settings need to be urgently addressed, and Standards Wise International (SWI) is one of them. While providers of care homes, care homes with nursing and homecare services are required to meet the standards set by the Care Quality Commission, there are very few national standards specific to providers of housing for those aged over 55, where residents generally live independent lives and, in many cases, require little or no support, but may in the future. These settings, such as integrated retirement communities and Alms houses, are mainly governed by housing provision standards, or by member organisations’ codes of conduct (for instance, ARCO has a consumer code) and standards. Standards allow providers to focus on critical areas, from governance and transparency in fees, to leadership and infection prevention. Providers can pinpoint strengths and weaknesses, identify gaps in systems, identify best practice and, overall, improve the quality of service. Standards establish consistency and uniformity across multiple individuals and organisations, while simultaneously setting expectations. For people using the service, universally assured standards are crucial in understanding the quality of service they should expect from their provider. Everyone deserves to have confidence that the services they receive are reliable, safe and verified. Independent standards will also offer more protection for both the individual and the provider. For operators, a set of standards will demonstrate commitment to the consumer, and contribute to a better experience for all stakeholders. This includes

staff, local authorities, and Government. Crucially, staff will take pride in working for a reputable organisation. Furthermore, a quality stamp of standards approval could give a provider the competitive edge.

DEVELOPING STANDARDS FOR SENIOR LIVING By adopting a positive approach to standards, there is an opportunity for operators of integrated retirement communities to become sector leaders. SWI is committed to improving

the lives of older people, their families and communities, by developing sets of internationally informed standards for senior living and homecare to create better outcomes and exemplar practices and models for living. By creating a ‘community of practice’, we can leave a legacy for our sector. Maintaining standards isn’t just about a tick from regulatory bodies; standards are essential in helping organisations to be innovative, reduce costs, and maintain respect and competitiveness in the marketplace. CMM

INTERGENERATIONAL LIVING AND INCLUSION SWI believes senior living should be intergenerational and inclusive of the wider community, and aspects of senior living should be integrated into community infrastructure and developments. The concept of intergenerational living is not new, and there are several settings where stakeholders have worked on this principle to ensure inclusion.

The villages offer 24-hour support in an extended-family-sized setting, providing dementia and nursing care. Facilities include bistros, hair salons, therapy and function rooms, with all facilities, activities and events programmes open to the public. The organisation is also working with Ready Generations to develop multigenerational living complexes.

• Bournville Trust initiative Lightmoor Village is a modern urban village development in Telford, Shropshire. It is a joint venture between housing association Bournville Village Trust (BVT) and the Homes and Communities Agency (HCA). The village will comprise around 1,000 homes, a primary school, community centre, health centre, nursery and shops; as well as parks and numerous green open spaces. At the heart of this village is Bournville House, providing high-quality retirement/ extra care apartments for rent for people aged 50 and over.

• Inspired Villages Inspired Villages offers independent lifestyles, where people purchase or rent a home, set in secure environments. Residents are active members of the broader local community, facilities are open to the local community, and in some cases, the village hosts essential community services; for instance, the medical centre at Great Alne Park, Alcester, provides health services for both residents and the wider community. Community integration and intergenerational living should not be underestimated; they reaffirm ongoing value and inclusion of older people in society and, in doing so, contribute towards negating negative attitudes to ageing.

• Belong villages Belong is one of the early pioneers of the ‘household’ model for people with dementia.

Annie Waddington-Feather is an Independent Marketing and PR Consultant for Standards Wise International (SWI). Email: annie@wadders.co.uk Twitter: @wadders007 What impact do you think a set of standards would have on the integrated retirement communities sector? Share your views and provide feedback on this feature at www.caremanagementmatters.co.uk CMM April 2022

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Open to everyone working, studying or living in the Midlands. You can apply as a team or as an individual. Teams must be 2-3 people.

is a hackathon-style creative weekend of idea generation and prototype trialling in July 2022.

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CMM April 2022

RESOURCE FINDER: Accountants

Whether you’re looking to audit your finances or for advice on VAT, specialist accountancy services could be a vital support to your business. Here, CMM profiles some of the sectors leading accountancy firms.

Hazlewoods Tel: 01242 237661 Website: www.hazlewoods.co.uk

SECTORS

• Raising finance. • Estate planning.

• Care homes and care homes with nursing for older people. • Learning disability/ challenging behaviour. • Specialist needs education colleges. • Assisted living/close care/ extra care. • Drug, alcohol and eating disorder independent hospitals. • Domiciliary care. • Supported living. • Children’s services. • Secure units. • Foster care agencies. • Primary healthcare.

SERVICES • Accounts preparation and audit. • Business planning and advice. • Corporate finance. • Tax advisory services. • Benchmarking. • Sales and acquisitions. • Preparing the business for sale. • Exit planning. • Valuations. • Assisting in negotiations. • Minimising the effects of income tax, capital taxes, VAT and stamp duty land tax. • Due diligence.

COMPANY INFORMATION Whatever stage of the lifecycle your business is at, it is important to have a clear strategic plan, discussing it regularly with advisers who take the time to understand you and your business. The Hazlewoods Healthcare team has expertise in the industry, developed over 30 years, which can be invaluable for healthcare businesses because it enables us to: • Come up with ideas to challenge thinking and improve your efficiency. • Plan effectively for the future, whatever your goals may be – short, medium and long term. • Make introductions to other experts who can help to grow your business/save you money. In 2021, Hazlewoods was recognised as ‘Advisory Firm of the Year’ at the Business Leader Awards and named the sixth most active adviser in the UK by Experian, with the Hazlewoods Healthcare team having advised on transactions worth £658m.

Rachael Anstee Partner Email: rachael.anstee@hazlewoods.co.uk

John Lucas Partner Email: john.lucas@hazlewoods.co.uk

CMM April 2022

RESOURCE FINDER: ACCOUNTANTS

Kieran Lynch

Morris Lane

Tel: 01142 622127 Email: jock@kieran-lynch.co.uk Website: www.kieran-lynch.co.uk

Tel: 01202 715950 Email: mail@morrislane.co.uk Website: www.morrislane.co.uk

SECTORS • Care homes and care homes with nursing. • Learning disabilities. • Challenging behaviour and special needs. • Domiciliary care agencies.

SERVICES • VAT recovery under VAT Contract Restructuring planning.

example of this is the Kingscrest ruling, which only applied to commercial operators and notfor-profit operators were unable to benefit in the same way, whereas all providers of publicly funded services can benefit from contract restructuring. ‘Retrospective claims may be made for periods of up to four years and VAT recovery is also becoming a real tool in terms of acquisition and disposal.’

LEAD INDIVIDUAL