Care Management Matters (CMM) July/August 2023

CELEBRATING 20 YEARS OF CMM

In this issue

Social Care Insights

In celebration of CMM’s 20th Anniversary, Des Kelly OBE looks back at his involvement in CMM and shines a light on front-line managers in social care.

Inside CQC

Mary Cridge, Director of Adult Social Care at CQC, spoke to colleagues about their reflections on the work of the regulator over the last two decades.

Social Care Timeline

CMM shares a timeline of significant social care news and legislation.

Uniting the sector

We hear from leading social care membership associations.

Into Perspective

Our experts share their views on how far social care has come in the past 20 years and what the future of care should look like.

Celebrating Excellence

The Markel 3rd Sector Care Awards has been recognising excellence for 10 years – CMM shares highlights from past Awards.

Your voice matters: CMM readers reflect In view of CMM’s 20th Anniversary issue, we asked our readers how the magazine has helped decision makers working in the sector to run their business.

Straight Talk

How much progress has been made within the housing-with-care sector? Michael Voges, Chief Executive of Associated Retirement Operators (ARCO) tells us how the sector has changed and shares a future vision.

The changing faces of Westminster: Who wasn’t up to the task?

David Brindle casts his mind back to past governments and rates the success of each Secretary of State. What will each leader be remembered for?

Past, present and future: Transformation through the decades

CMM catches up with Sharon Blackburn CBE, Executive Director of BallyCara in Australia, who has worked in the sector for over 40 years. Sharon shares her views on the sector with CMM.

How social care actually is leading the way in digital Social care has wholeheartedly embraced technology. In this article, Nuno Almeida, Chief Executive of Nourish Care, explores how far we’ve come in such little time and writes on the future of tech.

Flying the flag: Meet the care campaigning organisations working hard to protect people’s rights

CMM caught up with the Chief Executives of Care Rights UK, Carers UK and The Care Workers' Charity to find out more about the history of the charities and their ambitions for the future.

An inclusive vision: Reflecting on progress and striving for equality

How can we make fuller and faster progress over the next decade in relation to inclusivity and equality in social care?

Clenton Farquharson CBE, Chair of Think Local Act Personal (TLAP), shares his views on the topic.

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SOCIAL CARE INSIGHTS

From Des Kelly OBE

Des Kelly OBE looks back at his involvement in CMM from the outset and discusses why we must value front-line managers in social care.

Imagine a world without iPads or tablet computers; no YouTube or Netflix; no Snapchat, Instagram or Pinterest; no Uber or Airbnb or Spotify…it’s hard, isn’t it? And yet just 20 years ago none of these brands existed. Neither did the Care Quality Commission or Skills for Care or the Department of Health and Social Care. And we hadn’t heard the term Brexit or experienced the effects of COVID-19.

The 20th anniversary of the publication of Care Management Matters (CMM) is an opportunity to reflect on the last 20 years for the adult social care sector. 2003 was also the year the National Care Forum (NCF) was launched to bring a stronger voice to not-for-profit care providers! CMM put managers in social care front and centre – properly recognising

the professionalism of the role. In 2004, CMM became one of the first sponsors of the annual NCF Managers Conference heralding the formal start of an enduring relationship. CMM has since established a strong working relationship across the sector, particularly through its series of regional care sector conferences.

I am also proud to have been around at the beginning of CMM’s formation of the excellent 3rd Sector Care Awards – another far-sighted commitment by Robert Chamberlain as Chief Executive at the time.

Of course, any 20-year reflection on the adult social care sector in the UK would be likely to reveal some significant changes as it’s the nature of a dynamic, evolving sector. Looking back to the early years

of the 21st century is a reminder too of so many hopes and aspirations. The titles of policy papers highlight the promises made: Putting People First (2007), Caring for our Future: Reforming Care and Support (2012) or more recently, Build Back Better: Our Plan for Health and Social Care (2021). These policy statements introduced the idea of prevention and early intervention, the promotion of wellbeing and independence, and person-centred planning –all laudable. They all promised to transform social care services. Promises that have not been delivered because circumstances changed or commitment didn’t match the rhetoric or simply that insufficient funding was available. It all amounts to lost potential, which has undermined care and support services for all groups of users.

Arguably, there have been improvements in our understanding of the primary importance of keeping people at the heart of care and support services, of the value of selfdirected support and even in the quality of many services. Sadly, this is not yet the universal experience for everyone in need of care and support or their families. Eligibility criteria have changed considerably over the years and many more people now pay the full cost of their own care.

The difficulties of recruitment

and retention, which have long been a challenge in social care, appear to have become even more pressing, to the point that staffing is in crisis in some parts of the social care sector. In some areas, the inability to recruit staff is undermining the provision of services. The current cost of living crisis is part of the wider context which, on the back of Brexit, is leading to evident discontent from workers in many different parts of the economy, including the NHS.

The adult social care sector hasn’t yet recovered from the impact of the COVID-19 pandemic. Occupancy levels in care homes, in particular, remain stubbornly below pre-pandemic levels. Confidence in care services has also suffered and, despite promises by the Government to ‘fix social care’, there is little evidence that future funding for social care will be sufficient to deliver the wide-scale reform deemed necessary for the future.

In my view, CMM was ahead of its time. The magazine has consistently championed the need for professional management in social care services, supporting front-line managers with information, education and development opportunities so vital to good care. That gives me grounds for optimism as a better future will be built from properly valuing front-line managers in social care.

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Despite the landscape of health and social care changing, the fundamentals of regulation remain unchanged; it was, and still is, about the people receiving services. Regulation is there to ensure people have safe, high-quality care. It illustrates what ‘good’ looks like, encouraging care services to improve and holding them to account.

There have been several key moments. Acts of Parliament have been passed, including the Health and Social Care Act 2008, which joined together the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission in 2009 to form the CQC.

I spoke to colleagues about their reflections of the last two decades.

Jane, an inspector of adult social care, said, ‘The regulations have been the backbone of our work, but the real essence is how care is perceived by people. It's about people receiving care and support in a safe situation. It's also about people having the freedom to make choices and decide how they want to receive support. This hasn’t changed in 20 years.’

Jane pointed to the importance of our responsibilities around the overview and assessment of how the Mental Capacity Act is implemented. ‘This gave us a muchneeded power. It helped to make sure that even when people can’t make all decisions for themselves, they are still treated as

Inside CQC

MARY CRIDGE

individuals with pasts and personalities that are unique to them. The monitoring of “best interests decisions” has really helped to make sure decisions truly are made in the person’s best interests. This has given us the legal backing to really promote person-centred care for everyone, regardless of their ability to articulate their wishes.’

Collaborative approach

Understanding and reflecting on people’s experience is central to our work. We’re proud to work alongside our Experts by Experience (ExE) in much of our regulatory activity. The ExE role helps us to hear the voices of people who use services during inspections, Mental Health Act visits and monitoring activity. In the last year (1 April 2022 to 31 March 2023), ExE were involved in 4,141 regulatory activities and talked to approximately 40,520 people. Our ExE provide a valuable lens that enables them to share insight with our teams. This will become even more important as we change our ways of working, in ensuring people’s experience of services remain central to what we do.

Co-production remains embedded in everything we do and involves our colleagues, people who use services, providers and strategic stakeholders. By engaging a range of voices, we ensure we’re accurately representing the needs of people we serve.

New ways of working

We’re always looking forward. We’re in the middle of a significant transformation to deliver our ambitious strategy. We’re making sure we continue to meet the needs of ever-changing sectors, understand the quality of care in a local area or healthcare system to improve it and keep people safe.

Our move from generalist to specialist inspection teams several years ago was a game changer, and we’re preserving and developing that specialist approach within our new Integrated Assessment and Inspection teams. This gives us the best of both worlds, as our adult social care inspectors work alongside colleagues focusing on acute, secondary, community and primary care across a local area.

We continue to actively work to reduce inequalities in health and care. Our new single assessment framework, assessments of local authorities and integrated care systems are built on the same quality statements, embedding the voice and experience of what matters to people and their families, but helps us to better regulate the changes in systems and commissioning of recent years.

I’m confident that dedicated and passionate colleagues will continue to do all they can to raise the profile of health and social care and reiterate its importance to and value in society. And that all of us involved in health and social care in England will continue to work to ensure people are able to live their best lives. That hasn’t and won’t change.

Mary Cridge is Director of Adult Social Care at the Care Quality Commission. Twitter: @CQCProf

There’s no doubt the landscape of health and social care has changed hugely over the last 20 years. The Care Quality Commission (CQC) reflects on some of the significant changes and shares its future ambitions.

Readers can get involved with the CQC's Transformation Engagement steering group. Visit https://cqc.citizenlab.co/en-GB/folders/provider-implementation-steering-group

CMM CELEBRATES 20-YEAR ANNIVERSARY

Welcome to this very special edition of CMM Magazine. As the CMM brand turns 20, we wanted to reflect on where it all began and share the latest updates on our current projects. CMM has always aimed to celebrate and support those who work within the social care sector and encourage best practice, knowledge sharing and innovation and these are the key goals that CMM retains to this day.

CMM is published by Care Choices, which produces a range of independent publications designed to support people looking for care and works with local authorities to deliver the information in a range of accessible formats.

CMM wouldn’t be where it is today without the late Rob Chamberlain’s vision for the brand. His ambition, drive and skill saw him quickly rise through the organisation, and he became Chief Executive in February 2003. It was under Rob’s vision and leadership that Care Management Matters was born, and, later, the CMM Insight events.

CMM became the complete management journal for the UK care sector and has remained so ever since. Our first issue was published in Spring 2003 and included features on venture capital for care homes, marketing fundamentals and the latest Government Budget news – CMM has retained its brand identity to update on the latest policy and to share practical take-home advice to support business growth. In that time, CMM has gone from being a quarterly publication, to a monthly magazine – publishing 10 issues a year. In 2014 the CMM website launched in its current format, to cover daily news stories, knowledge articles and a resource finder to support business needs.

I’m delighted to share that 2024 marks the 10th anniversary of the Markel 3rd Sector Care Awards – an event founded and produced by CMM, in association with the National Care Forum. The Awards set the scene for celebrating the work of not-for-profit providers of care and support who were quietly working away, bringing positivity to people’s lives with innovation, creativity and flair.

It’s been a pleasure to organise and host these Awards since 2014 and we look forward to the next decade of annual celebrations and to meeting yet more innovative and wonderful people working in the third sector. You can read our full write-up on the Awards on page 46.

During the COVID-19 pandemic, CMM launched an online wellbeing hub to support registered care managers, including resources to download on creating a positive workplace culture, dealing with grief and loss, and how managers can take care of themselves. We hope to develop this area in the months ahead.

In 2008 CMM hosted its first face-to-face conference, launching the CMM Insight brand, which has united care providers across the country, providing vital information and support in running their organisations. CMM has, and continues, to relish the opportunity to meet with providers in person and we look forward to attending industry events this summer.

This year has been a very exciting one for the CMM brand. In March 2023, CMM launched its first podcast channel ‘CMM OFF THE PAGE’. The podcast is hosted by respected leaders in the social care sector, alongside CMM’s editorial team, and is essential listening for all decision-makers working in the sector.

Subscription is FREE and the podcast is available to watch via the CMM Website and to listen to via Spotify and Apple Podcasts. I encourage you to catch up on episodes and subscribe!

Readers can enjoy even more interactive content with the launch of the CMM Insight Webinars. In association with The National Care Forum (NCF), CMM is hosting six unmissable webinars discussing the sector’s most pressing current affairs topics – from recruitment and retention to integrated care systems. Please visit the CMM website to find out more and to catch up.

Everyone at CMM would like to take this opportunity to thank all our readers and supporters for their continued support and involvement over the past 20 years and in the years to come.

- Lisa Werthmann, Director

HITTING THE HEADLINES : A timeline of social care news

There has been a number of significant reports and landmark legislation over the past 20 years. From the CQC’s new grading system for regulation, to the Dilnot Commission's published findings, CMM takes a look back and shares key publication dates and highlights moments of organisational change in the social care sector.

2005 2009 2007

Independence, Wellbeing and Choice: Our Vision for the Future of Social Care for Adults in England

Following the announcement in April 2004 that the Government would develop a new ‘vision’ for adult social care, Government consulted a number of stakeholders from inside and outside Government, including people who use social care services. Those discussions helped to develop this Paper. The overall aim of the Paper was to set the social care agenda for the next 10–15 years. It contains some now-familiar themes of personalisation, prevention and technology but offers no new money.

Putting People First: A shared vision and commitment to the transformation of adult social care landmark protocol, published with cross-sector support

Putting People First was heralded a 'landmark protocol', which aimed to ensure independent living for all adults through a joined-up and collaborative partnership between local and central government, the voluntary sector, providers and the social care regulator. The agreement included the following commitments: encouraging stronger local leadership; agreeing and sharing outcomes on issues such as independent living, personal choice and control and active participation in community life; encouraging the use of joint strategic needs assessments to drive change; offering personal budgets and promoting person-centred planning.

The CQC was established in April 2009 and replaced three former regulatory bodies

The CQC is responsible for the registration, inspection and monitoring of health and adult social care providers, including independent providers, under the Health and Social Care Act 2008. The CQC works to make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve. The first State of Care was presented to Parliament on 9th February 2010.

2010 2011 2010 2011

Building the National Care Service White Paper confirms universal access to free care

The White Paper charts a course for the fundamental reform of the care and support system in England. It commits the Government to building a new National Care Service for all of us, offering high-quality care and support for all – whoever you are, wherever you live in England. This White Paper describes how, even through a period of financial consolidation, the Government promises to move forward with reforms to the care system over the next five years, extending entitlements and improving care. It settles on an approach based on everyone paying in but leaves the mechanism for doing this open, with a commission to advise on this.

New Coalition Government takes office

The new Coalition Government said it ‘understands the urgency of reform’ and committed to an independent commission to review options for social care, including voluntary insurance and partnership model. The Coalition Government establishes a commission on funding of care and support, chaired by Sir Andrew Dilnot. The Coalition promised to break down barriers between health and social care funding to incentivise preventative action. The Government also said it would extend the greater roll-out of personal budgets and use direct payments to carers and better community-based provision to improve access to respite care.

The Dilnot Commission publishes its recommendations

On 4th July, the Commission reported to Government with its findings and recommendations for a new funding system. The report highlighted that the current funding system is in urgent need of reform: it is hard to understand, often unfair and unsustainable. People are left exposed to potentially catastrophic care costs with no way to protect themselves. The Commission’s recommendations included that the individual's lifetime contributions towards their social care costs should be capped. After the cap is reached, individuals would be eligible for full state support. The Commission advised that the cap should be between £25,000 and £50,000.

Winterbourne abuse scandal

On 31st May 2011, a BBC Panorama programme exposed serious failings and abuse of people with learning disabilities and autism at the Winterbourne View care home. The independent report said fundamental changes are needed in how care of vulnerable adults is commissioned and monitored. Owners Castlebeck took ‘financial reward without the responsibility’, the report's author Margaret Flynn said. South Gloucestershire Council said it ‘fully accepted’ the findings. In October 2012, the sentencing of 11 care workers began at Bristol Crown Court as the BBC uncovered allegations of previous abuse at Winterbourne View.

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2012 2013 2012 2012

The Health and Social Care Act established

The Health and Social Care Act 2012 established NHS England, Monitor and the NHS Trust Development Authority. Each is a separate legal body and has their own statutory functions. However, since 2018, they have been working under a single operating model effectively as one organisation. This operating model reflects the wider changes in how the NHS has evolved since 2012, with a greater focus on collaboration and integration. However, there are limits to how closely these bodies can work together while they remain separate legal organisations.

Southern Cross Healthcare collapses

Following rapid expansion financed by the sale of leases of its homes, Southern Cross Healthcare’s shares fell 98% from early 2008 to early 2011, reducing its market value from £1.1bn to around £12m. At Southern Cross, deteriorating standards of care were seeping into local media reports. By 2009, Southern Cross homes were attracting the attention of the Care Quality Commission. In June 2012, the Government published a report seeking to ascertain what lessons can be learnt from the collapse of Southern Cross care homes in order to mitigate potential risks to providing care for some of our most vulnerable residents.

Healthwatch England founded

Healthwatch was established under the Health and Social Care Act 2012 to understand the needs, experiences and concerns of people who use health and social care services and to speak out on their behalf. Healthwatch exists on a national and local level, working towards the same goal of enabling people to have a voice about their health and social care systems. Healthwatch is a statutory committee of the independent regulator the Care Quality Commission (CQC).

CQC introduces a new inspection and grading system

According to The King’s Fund, in 2013, the CQC introduced a new approach to inspecting and rating NHS acute hospitals. The change was triggered by several high-profile failures of care that raised questions about regulators’ ability to identify and act on poor performance. The new approach included in-depth inspections by larger, more expert teams and produced ratings and an inspection report for each provider.

This new approach was extended to other parts of the health and care system in 2015 and continues to evolve. CQC’s revised strategy for 2016–21 set outs their plans to further develop their regulatory model.

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2014 2018 2013 2014

Government u-turns on scrapping 15-minute homecare visits

The Homecare Association told The Guardian at the time that given the row over 15-minute care it was ‘dismayed that Government intends to backtrack on its original plans and will leave council commissioning without any independent scrutiny’.

The Equality and Human Rights Commission also briefed peers over concerns that short visits would imperil the human rights of the vulnerable – and that oversight of local authorities would help ensure that did not happen.

Skills for Care and the National Skills Academy for Social Care merge

The merged organisation combined the expertise of both teams to create an offer for employers in the sector covering the leadership, learning and development needs of the sector’s 1.5 million workers at all levels, from front-line staff to senior leaders. Existing Members of the National Skills Academy retained their membership within the new organisation. The first report using data contributed by the adult social care workforce to Skills for Care, which was then referred to as NMDS-SC and has now developed to be the Adult Social Care Workforce Data Set (ASC-WDS) was published in 2008.

Care Act is established

The Care Act is passed, introducing wide-ranging reform of the way in which social care is organised and delivered. It includes proposals for the introduction of a more generous means test and a cap (set at £72,000 rather than £25,000–£50,000) though these are not due to be implemented until 2016.

The Care Act also introduced new ways of supporting adult social care. A set of ‘National Minimum Eligibility Criteria’ was introduced to make sure that people across the country were receiving the same care for the same needs.

After a cabinet reshuffle, The Department of Health and Social Care (DHSC) is renamed to include social care

At the time of a cabinet reshuffle by Prime Minister Theresa May, the Government changed the name of the Department of Health to the Department of Health and Social Care (DHSC). According to the Health Foundation, the change was ‘intended to elevate the Government's priority issue, integrating health and social care.’ There was no substantive change in responsibilities, but DHSC became solely responsible for the Government’s long-awaited green paper on options for reforming adult social care (first announced in the 2017 Spring Budget). Previously, the work was being carried out in the Cabinet Office.

2019 2021 2018 2021

The final report of the Independent Review of the Mental Health Act is published

In October 2017, Prime Minister Theresa May announced an Independent Review of the Mental Health Act 1983. The Act gave the state powers to detain, assess and treat people with severe mental health problems. May said the review would consider the context of rising rates of people being detained under the Act and its disproportionate use to detain people from black and minority ethnic groups.

The Review was chaired by Professor Sir Simon Wessely, former President of the Royal College of Psychiatrists, and reported on 6th December 2018. The report, Modernising the Mental Health Act, made clear that the Mental Health Act needed significant reform.

Associated Retirement Community Operators (ARCO) publishes its Vision 2030

ARCO announced its vision that 250,000 older people will have the option of living in a Retirement Community by 2030 – up from the 75,000 customers our sector already serves today. ARCO believes that older people ought to: Be treated with respect and dignity; be valued for their contributions to society and to their communities; have what they need to be happy and healthy, including access to good support, care, and health services; be enabled and supported to live independently for as long as possible; be empowered and free to make informed choices.

Care job roles added to the Shortage Occupation List (SOL)

On 4th March the UK Government announced changes to the immigration rules designed to make it easier for overseas health and care staff to be recruited to the UK. A role on the SOL is worth 20 of the 70 points required to obtain a skilled worker visa in the new points-based immigration system. Combined with the mandatory criteria – having an acceptable standard of English, an offer from a licensed sponsor and the required RQF level 3 or above skill level, which are worth 50 points – will ensure people in these roles reach the 70 points.

People at the Heart of Care report is published

The White Paper set out a 10-year vision for care and support in England and is based around three key objectives: people have choice, control and support to live independent lives; people can access outstanding quality and tailored care and support; and people find adult social care fair and accessible.

The key elements of the plan’s social care proposals included: a cap on care costs and more generous financial means test thresholds; the ability for self-funders to ask their council to arrange their care; and moving towards a fair rate of care in respect of councils’ fees to providers. The plan announced the creation of a new Health and Social Care Levy to fund the changes.

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2022 2022 2022 2022

CQC announces single assessment framework

CQC confirmed that its quality ratings and five key questions will stay central to its approach. However, the regulator is replacing its existing key lines of enquiry (KLOEs) and prompts with new ‘quality statements’.

CQC calls the quality statements ‘we statements’ as they’re written from a provider’s perspective to help them understand what the CQC expects of them. They draw on previous work developed with Think Local Act Personal (TLAP), National Voices and the Coalition for Collaborative Care on Making it Real.

Digitalising health and social care records

The Department of Health and Social Care published its ambitions relating to digital care records. The aim is for 80% of Care Quality Commission (CQC) registered providers to have digital social care records by March 2024.

The Government said that digitising separate health and social care records will help create a functionally single, life-long digital health and care record for each person. Digitising and connecting records provide access to the right information at the right time, which can improve the quality, safety and productivity of care.

Oliver McGowan mandatory training launches

The training is named after Oliver McGowan, who died in 2016 after being given antipsychotic medication. Oliver’s mother Paula successfully launched a campaign to make training on caring for people with a learning disability and autistic people mandatory for all health and care staff. The Oliver McGowan Mandatory Training comes in two tiers and is designed so staff receive the right level of mandatory training.

Tier one has been designed for staff who need general awareness of the support autistic people or people with a learning disability may need, while tier two is for people who may need to provide care and support for autistic people or people with a learning disability.

Unpaid carers gain new rights as Health and Care Act is introduced

New NHS Integrated Care Boards are now in force across England (since 1st July) and carry new duties making them responsible for involving carers and those they care for in decision-making. Carers now have to be involved when decisions are made about changing or developing a service and there is an expectation of involvement in relation to the patient’s prevention, treatment, diagnosis and care.

Carers also have important new rights at hospital discharge. NHS hospital trusts in England must ensure that unpaid carers are involved as soon as feasible when plans for a patient’s discharge after treatment are being made.

UNITING THE SECTOR

In celebration of 20 years, CMM reached out to some of the membership organisations who have been supporting providers in the social care sector. Chief executives share how the organisations have developed and grown over the years and also reflect on how the sector has changed over time.

ARC England

In the learning disability and autism sector, the pace of change can appear glacial; it may never be as fast as we would like, but it is happening.

20 years ago, it would have

Association of Mental Health Providers (The Association), formerly known as the Mental Health Providers Forum (MHPF), was established 18 years ago to amplify the voices of the VCSE mental

been barely acknowledged that people with learning disabilities and autistic people experienced domestic abuse. We certainly might have found it hard to believe that our colleague Rod Landman, Us Too Project Lead, would be supporting a team of women with learning disabilities and autistic women to run their own project, capturing learning from their shared experience of domestic abuse and using that learning to inform, educate, and change the way that

criminal justice and support services work.

Everyone who works with people with learning disabilities and autistic people will have their own experiences that put us in awe of what people can achieve when they are given the opportunities, the right support, and when their needs are given priority at the highest levels.

We are grateful to our colleagues at Care Management Matters for shining a light on the experience of people with a learning

disability and autistic people.

As the sector continues to operate under serious financial pressures, ARC England and CMM will work together to ensure that the lives of people with a learning disability and autistic people are accorded the importance they deserve.

Congratulations to CMM on your 20th anniversary and thank you for all that you do.

Clive Parry, Director of ARC England

health service provider sector and influence policy and practice. The Association has grown to a network of over 300 provider organisations, delivering more than 3,000 services locally, regionally, and nationally, supporting over eight million people with poor mental health and illness. Collectively our membership has a total turnover of over £5bn and has a larger mental health workforce than the NHS.

Keeping people and providers

at the heart of everything we do, The Association has engaged its members and the people supported to inform the development of all national mental health and social care policies, from 2011’s No Health without Mental Health through to 2023’s People at the Heart of Care I was able to lead the sector through the pandemic as Chair of the Care Provider Alliance, co-chair of the Mental Health and

Wellbeing Advisory Group for the Social Care COVID-19 Support Taskforce, and Chair of the COVID-19 Mental Health Response Fund Governance Group, ensuring both mental health and social care are firmly on the political and public agenda and the value of the voluntary sector is recognised.

Care England

Queen Elizabeth I had a motto, ‘Semper Eadem’ (always the same), and on the face of it, this could be applied to social care over the past 20 years. However, if we look a little deeper, we can see that despite the enormous

challenges in our sector, there has been great progress, and I hope that Care England can take some credit for supporting our members and enabling the sector to have a higher profile and better understanding from governments and the general public.

Over the past 20 years, we have faced enormous challenges, including a global pandemic and the failure of successive

governments (of all parties) to grasp the need for long-term funding reform. What has made me incredibly proud of our sector is despite the inertia and inactivity at the heart of Government, the sector has crafted its own vision for care and support and has consistently delivered life-changing, high-quality services to the people we support. We are also lucky to have such incredibly professional, skilled, and

Kathy Roberts,

Chief Executive of The Association of Mental Health Providers

dedicated staff within our sector, and they have been beacons of hope for many people, and they are the foundation on which our sector is built. The last 20 years have been difficult, but the resilience and innovation that this sector always shows will ensure that we have a bright and sustainable future.

Professor Martin Green OBE, Chief Executive of Care England

National Care Association (NCA)

Having worked in the sector for over 40 years, when I look back, we have come through some seismic changes in the way social care has evolved. The past few decades have seen the traditional concepts of the role change to a point where it

is now akin to delivering complex health care especially in nursing care settings. The introduction of the Community Act increased the reliance on the independent sector to support clients who would traditionally come under the NHS community or primary care services.

The NCA was founded in 1980 and has continued to develop to meet the needs of our membership. Providers have

former leader Des Kelly OBE. I took over as Chief Executive in 2016 and the intervening years have seen exponential growth in our membership numbers and breadth of providers we support, together with an increase in our global profile.

been on a steep learning curve and our workforce continues to fundamentally move towards more health-based delivery, with the social care components still in place demonstrating its entrepreneurial skills. Providers continue to invest heavily in the workforce. Our recent merger with colleagues from the nursing home sector is another step towards a united voice for the sector at a critical time for

tickets. NCF became founding members of Digital Social Care in 2018 and run the Care Innovation Challenge, which provides a framework for budding innovators to devise solutions for challenges facing the sector.

small providers.

Sadly, despite numerous commissions, successive governments have failed to recognise the role of social care in the health economy. We will continue to raise our voices to support our workforce, our members, and most importantly, those whom we support.

Nadra Ahmed CBE, Executive Co-Chairman of The NCA

Conference – bringing providers and expert speakers to Glasgow for an agenda focused on building a sustainable future for the sector.

National Care Forum (NCF) has been central to the social care sector for well over 20 years, from its origins representing local providers in southern England, to its constitution in 2003 as the National Care Forum under

Together with CMM, NCF created the Markel 3rd Sector Care Awards in 2014 giving national recognition to care workers. Thanks to partners Markel and others, the Awards are free to enter and finalists receive complimentary

providers to represent the interests of the homecare sector. The original aims were to advocate for the sector, develop quality standards and campaign for regulation. Until 2003, the Homecare Association’s (previously UKHCA) Code of Practice was the only quality standard in homecare.

NCF’s policy team collaborates with Government, key thinkers, researchers and academics, amplifies members’ voices at party conference fringe events and consults on NIHR projects.

NCF is co-organising September’s Global Ageing

NCF will chair the Care Provider Alliance (CPA) in 2024. NCF has 170 not-for-profit members delivering more than £2.3bn of support to over 277,000 people, while collectively employing more than 124,000 staff.

Professor Vic Rayner OBE, Chief Executive of The NCF

The Homecare Association is the UK’s only membership body exclusively for homecare providers. It is a not-for-profit organisation founded in 1989 by 75 homecare

Now, 34 years later, the Homecare Association represents and supports over 2,400 members across the UK. Our membership is diverse, including small, medium and large organisations

operating in both the state-funded and private-pay parts of the market. Collectively, members comprise about one-third of regular registered domiciliary care providers, including those delivering live-in care, housing with care and complex care with nursing. Together we ensure that homecare is valued so all of us can live well at home and flourish in our communities.

The homecare sector in the UK has changed significantly over the last 20 years, most notably:

• A shift from public sector to independent providers.

• Introduction of regulation of homecare.

• Growth of the private-pay market.

• Growth in demand with an ageing population.

• Increase in complexity of need.

• Greater workforce diversity.

• Introduction of technology solutions.

The Voluntary Organisations Disability Group (VODG) started as an informal, small grouping of influential disability charity chief executives, recognising that the pressures felt in delivering the very best support for disabled people were most effectively overcome by working together. This ethic remains

as relevant for VODG members today as it did over 30 years ago, with a growing membership and networks providing collaboration and support across all parts of an organisation.

Driven by our vision and values, VODG helps to tackle the big problems of the sector alongside progressive areas of policy.

We are focused on supporting the success of a vibrant and trusted voluntary sector that helps

disabled people to live the lives they choose. This means addressing funding issues; promoting health improvement and tackling health inequalities; getting people out of long stay hospitals; and leading work to prioritise equity, diversity and inclusion, most recently by launching the Commission on COVID-19, Disablism and Systemic Racism.

As people’s expectations for care and support change, and with profound demographic trends

upon us, the models of social care will continue to adapt and naturally so will VODG. Across the sector there needs to be a further strengthening between people who draw on care and support and the shape of provision. To these ends #socialcarefuture provides an important beacon for us to collectively work towards.

Rhidian Hughes, Chief Executive of VODG

Dr Jane Townson, Chief Executive of The Homecare Association

THE CHANG NG FACES OF WESTM NSTER

Who wasn’t up to the task?

David Brindle casts his mind back to past Governments and rates the success of each Secretary of State. What will each leader be remembered for and what key social care policy changes took place during their time in office?

When Care Management Matters (CMM) made its debut in March 2003, the Secretary of State at the then Department of Health was Alan Milburn of the Labour Party. Ten others, four Labour and six Conservative, have since held the role. Strictly from a social care perspective, have any of them stood out?

The long silence I anticipate such a question prompting tells a story of the care sector’s dismay at our political leaders’ consistent failure over the past two decades to get to grips with social care reform in England – a failure which goes back even longer, at least to 1996 when John Major’s outgoing Tory Government published a consultation paper entitled: A

New Partnership for Care in Old Age. It was to become just the first of a stream of proposals left to gather dust on Whitehall shelves.

It would be wrong to pin the blame for this policy dereliction entirely on the shoulders of health (latterly health and social care) secretaries. The fingerprints of HM Treasury are all over the many crime scenes involved and Prime Ministers, too, must take their share of the rap. We shall come to that.

Under review

But let us take a stroll down memory lane and remind ourselves of those 11 individuals who

have presided over the Department responsible for social care policy – and we’ll have no nonsense about that being the case only after its change of name in 2018. We’ll give each a mark out of 10 for their performance on social care and Jeremy Hunt will start with a one-point penalty for pretending it was not in his brief before that name change.

Alan Milburn (1999-2003) – The consummate Blairite was to resign in June 2003 after a clash with the then chancellor, Gordon Brown, over Milburn’s wish to give hospital trusts more freedoms. His focus was on market reforms in the NHS, doing little about social care. In what has become a pattern of ex-ministers >

> recognising the sector’s importance only after leaving office, he recently told Times Radio that social care was critical to society and that care workers should be paid a social care wage ‘well above current levels’. Rating: 3/10

John Reid (2003-05) – Something of a ‘Mr Fixit’ for Tony Blair, this was the tough-talking Glaswegian’s fourth Government job in 12 months. In 2003, he announced the creation of the role of Director General for social care, but it was not in fact to happen until David Behan’s appointment in 2006. Rating: 5/10

Patricia Hewitt (2005-07) – The last of Blair’s appointees, she published the White Paper Our Heath Our Care Our Say, which proposed closer working of health and social care in the community through local area agreements and which set new standards of person-centred care.

Hewitt resurfaced last year as leader of an early Government review of the new Integrated Care Systems, in which she concluded that social care must become a national priority for investment and workforce development. Rating: 5/10

Footnote to the Blair years: Lord Crisp, who as Nigel Crisp was NHS Chief Executive and permanent secretary at the health department from 2000 to 2006, wrote recently in the British Medical Journal that there had been ‘a failure to pivot away from health services towards health and care’ in that period. ‘Various policy papers were published, but no political will drove this forward…’

Alan Johnson (2007-09) – Prime Minister Brown’s first appointee, he published a consultation paper: Why England Needs a New Care and Support System, which developed the principles of choice and control for care users and was to lead in 2009 to another green paper, Shaping the Future of Care Together, which introduced the concept of a national care service. That idea is still the core of Labour’s policy, though 14 years on it remains only sketchily defined.

Johnson has since spoken of a behind-thescenes debate within the Brown Government about creating a wholly new funding stream for social care – an unrealised vision – and has lamented the fact that the calibre of the national debate has ‘rarely risen above the glib and the facile’. Rating: 6/10

Andy Burnham (2009-2010) – Labour’s last Health Secretary, he presided over the Big Care Debate, a series of events and roadshows involving 68,000 people, leading to a White Paper called Building the National Care Service. Seemingly out of the blue, it introduced a new

policy of free personal care at home. Just a week later, however, Brown called a General Election and was to be defeated.

It emerged during the election campaign that Burnham had been involved in secret cross-party talks to broker a deal on care funding. The Tories claimed he wanted a 10% levy on people’s estates after death and they campaigned effectively against ‘Labour’s death tax’. The mistrust caused by this bedevils any cross-party initiative to this day. Rating: 7/10

Footnote to the Brown years: Ed Balls, who was close to Brown and served as Children and Families’ Secretary, made a two-part BBC2 documentary on social care in 2021 and spoke of his ‘guilt’ that he had not done more to help deliver reform. ‘It was the realisation that I thought I knew what care was, and I didn’t.’

Andrew Lansley (2010-12) – In the coalition Government created after the election, and led by David Cameron, Lansley became Tory Secretary of State with the Liberal Democrats holding the care minister portfolio. It was not a marriage made in heaven. Lansley was preoccupied by a determination to introduce enormous, and ultimately unworkable, NHS structural change.

His time is notable, however, for the Commission of Funding of Care and Support, under economist Andrew Dilnot, which proposed a cap on people’s liability for care costs. Although subsequently legislated for, it has still not been introduced and the chances of it ever being so look fast diminishing. Rating: 5/10

Jeremy Hunt (2012-18) – The longest serving Health Secretary in history, Hunt straddled the coalition and the Tory majority Government after 2015. Given his unparalleled opportunity, Hunt’s record on reform must be judged as disappointing and, moreover, social care suffered greatly from funding cuts under the Tories’ austerity programme. Between 2009-10 and 2014-15, spending by councils on care fell 10% in real terms.

At the 2017 General Election, the Tory manifesto appeared to drop the Dilnot cap and proposed inclusion of the value of any property in the means test for care at home. Prime Minister Theresa May famously insisted that ‘nothing has changed’ but Labour, turning the tables on the Tories for 2010, campaigned against their ‘dementia tax’. The resulting row probably cost the Tories their overall majority, forcing them to do a deal with the Democratic Unionist Party.

Despite continuing to claim that he was not responsible for social care policy until 2018,

when his department was formally renamed the Department of Health and Social Care, Hunt has since regretted not achieving more. He told LBC last year: ‘I wish I had secured a 10-year plan to transform the social care system in the way that I did for the NHS.’ Rating: 4/10

Matt Hancock (2018-21) – A colourful character who will be remembered for many things but probably for only two when it comes to social care: his claim to have thrown a ‘protective ring’ around care homes during COVID-19, which was linked to the deaths of more than 40,000 of their residents and the green care badge initiative which he took over from its promoters and sought to encourage care workers to wear to create an NHS-style consciousness. History and the COVID-19 inquiry will judge. Rating: 2/10

Sajid Javid (2021-22) – The first of a recent succession of short-lived secretaries of state, he has more than most to show for his 13 months in the post. The Dilnot cap was resurrected, to start in 2023 (now 2025) and to be paid for by a rise in National Insurance (NI), and a White Paper, People at the Heart of Care, outlined a 10-year programme for care reform. While the White Paper survived last year’s mayhem in Government, the NI levy did not. Rating: 6/10

Steve Barclay (2022) – His first go, lasting three months. Too little to rate.

Thérèse Coffey (2022) – Held office during the brief and chaotic prime ministerial tenure of Liz Truss. Even less to rate.

Steve Barclay (2022-) – Back for a second time, a steady hand on the Department tiller but little evidence so far of much interest in social care. A claimed ‘record’ funding increase of £7.5bn for the period 2023-25 has been pledged by Hunt, now Chancellor, but some of a separate £1.7bn pot for reform, announced by Javid, has been held back. Rating: 3/10

So, there we have it: 20 years of disappointment for social care and a roll call of 11 health (and care) secretaries who, often by their own admission, have not left much of a mark. But what of the seven Prime Ministers they have reported to? Blair, Brown, Cameron and May have all expressed some regret at not having done more on social care. Their successors? Well, not so much yet.

We await in particular an explanation from Boris Johnson of his hubristic claim as he entered Downing Street in 2019 that ‘we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve’. It may be quite a wait. CMM

Past present future Past, present and Transformation through the decades

Sharon Blackburn CBE, currently Executive Director of BallyCara in Australia, has worked in health and social care for over 40 years. In this interview, CMM catches up with her to unpick her knowledge and understanding of how far we’ve come and what’s needed in the sector moving forwards.

Sharon: Firstly, I want to say a huge congratulations to CMM on its 20-year anniversary. My involvement with CMM/Care Choices spans the 20 years and more! It’s a privilege and a joy to have been part of the journey, which has seen the organisation make such a huge contribution to the sector.

Hi Sharon, it’s so good to catch up! Can you start by telling us what social care in England was like 20 years ago and how it was to work in the sector then?

So much has changed and yet strangely the same issues exist and are talked about. However, there’s now a different depth and breadth to the context of these issues.

20 years ago, health, social care and housing were operating in silos (some would say they still are). Those using and working in social care (including those beyond care providers) were trying hard to get the voice of the person using services front and centre, to help people understand the contribution and value of social care.

The general image of the sector was negative and this was not helped by national or local media. The relationship between

the sector and the media was very different compared to how it is now. Care homes in particular were seen in a poor light and the impact of this was huge in terms of how the public saw the sector. Social care wasn’t understood. In health, outputs and outcomes for people using services were more tangible and evidence based. Social care (in my opinion) could not consistently evidence this. The workforce, their skills and expertise were not valued, even though a lot of the change and innovation we see now was led (out of necessity) by providers themselves. Registered nurses working in social care were often perceived as having a lower skillset than their colleagues in health settings.

When Dilnot’s Fairer Care Funding was published it enabled a different conversation about social care generally. The sector and those outside of it began to articulate the

economic value of informal carers and social care, we started to see a wider understanding develop of the sector’s role and importance.

What do you think the biggest shifts have been since then? What has been the most unexpected change?

The voice of people using/engaging with services as well as their significant others – and what matters to them – has become ever more respected and observed. Seeing their influence and contribution to policy and service development is fantastic – there is still more to do but much has been achieved. From a care home perspective, the Enhanced Health in Care Homes work done by NHS England in collaboration with the sector delivered some tangible outcomes, recognising that people who live in care homes should expect and >

> benefit from the same level of support as if they were living in their own homes.

There have also been significant changes to how the sector is perceived; I have witnessed a positive shift in the way the media engages with and reports on social care. In general terms there appears to be an increased awareness and understanding of the complexities of the system and how it impacts people, and the move away from solely uncovering and reporting on exposés has offered a different balance and perspective for the public and helped positively raise the profile of social care.

The visibility and value of the workforce has improved, too, but the work must continue so they get the recognition that is deserved. Data from Skills for Care actively informs and contributes to the dialogue now, providing opportunity for informed decisions to be made to support this.

The introduction of robust, independent regulation has been so important. Views regarding regulators and how they operate will always vary. However, the role of the regulator, alongside the introduction and use of technology, means that providers are better able to evidence and quantify the quality of life and quality of care they provide.

There’s something in me – ever the optimist and glass-half-full – that would have hoped Government would have got their act together by now as far as social care is concerned. That they haven’t is not an unexpected change, but it is a disappointing one.

During COVID-19, membership associations and providers gave voice to that which Government did not wish to acknowledge regarding social care. Whilst the impact on people needing and using services – and on staff in caring roles – was immense, the opportunity that social care utilised to communicate key messages was evident. Providers were put in an impossible position, but social care leaders and the workforce went above and beyond to do what they could to protect and support people.

Finally, the imperative for integration is not new – it has been talked about for three decades, not just the two we are covering here – making it a reality is long overdue.

How does the current landscape in England compare to what is happening in Australia?

Over the last 20 to 30 years, England has seen around 20 to 30 reports on reform, the state of social care, funding, integration...The list

could go on. I have now lived and worked in Australia for four years and, when I first arrived, the Royal Commission into Aged Care Quality and Safety was taking place. The report was published in March 2021. Both past and present governments responded to this one report and have taken decisive action, recognising that older Australians deserve better from the systems that support them.

The present Government is making a huge investment in the sector; wholescale change is underway, including new legislation and reforms for funding and assessments. I know the pay increase for certain categories of workers has made the headlines in the UK. This will see a 15% uplift in pay for defined roles/ categories of staff, which will be funded by Government. A concern which may not have made the headlines is that it does not cover all staff, so providers need to decide what to do for those who aren’t included. However, it does demonstrate that there is a government that is willing to act and not park the issue in the ‘too difficult’ parking lot!

As in the UK, we are seeing a shift towards submitting more data to enable transparency and accountability. Whilst the sector does not negate the intent, the impact of the administrative burden is huge. It must be remembered that change management needs to be factored in when wholescale change is taking place.

In the last 20 years in England, in my opinion, whilst there may have been good intent, the reality is that successive governments have probably wasted more money than they have saved by not implementing change. The cost to people using services has been immense.

In your opinion, what should social care look like in another 20 years’ time?

A really good starting point is Social Care Futures’ vision – ‘We all want to live in the place we call home, with the people and things we love, in communities where we look out for one another, doing what matters to us’.

People should have choice and control over how their care is planned and co-ordinated. A strengths-based approach will help them to live their best lives and deliver the outcomes they want. Living with purpose on purpose. Health, social care, and housing should help people achieve that. Let’s use technology for what it can be used for but never forget that we work with people, and relationships are important. If integration happens, then utilising

the resources we have (including people) appropriately must be a priority. Wellness, prevention, public health must be more prominent so that care stays closer to home. I want to see support to improve health literacy, to enable not disable, to empower not control.

People who use services expect services and systems to talk to each other and we should make that a reality. We need more partnership if we are to improve integration. Working together can ensure that outcomes for people happen and greater effectiveness and efficiencies can be achieved – where there is a will, there is a way!

Lastly, Government should utilise the umpteen reports and the skills and knowledge available to it to make reform a reality. We don’t need to keep reinventing the wheel.

What should we focus on in order to see transformational change happen in social care?

We need leadership at Government level who are bold, informed, courageous, and accountable and know how to make decisions. Government already has the evidence it needs to implement changes but continues to avoid doing so. Social care must be seen as an equal partner with health. Reform is long overdue. Get it right and it will benefit people using services, the workforce, society, the economy now and in the years to come, and ensure a secure future for health, social care and housing. I can dream!

We also need to make integration a reality. Systems change, people move within the system; the intent is good but so often people who are using services do not see or experience tangible outcomes for themselves and for what matters to them. This needs to be our focus and priority when designing for the future. And we need to invest in change management, processes and systems that are sustainable and scalable – otherwise there will be causalities.

I do reflect and wonder what future generations will make of our progress or lack of it.

Finally, providers, in my view, have always and will continue to lead the way. I may be biased but that is where I have experienced transformational change and innovation that makes a difference to the lives of people. Ultimately, social care isn’t about ‘them’; this is about all of us. With the right people doing the right thing in the right way we can achieve the right outcomes for everyone. CMM

In your opinion, what should social care look like in 20 years’ time? Visit

Sharon Blackburn CBE is Executive Director of BallyCara. Email: sblackburn@ballycara.com Twitter: @stb1106

Into Perspective How far has social care come in 20 years?

Our three industry leaders reflect and share their views

The sector and its amazing workforce remain woefully underfunded

Mike Padgham, Chair, Independent Care Group @Mike_Padgham

How far has social care come since 2003?

The answer, in short, is probably not very far.

We’ve heard how reform for social care has indeed stalled over the years and we continue to hear about the disparity between the NHS and social care, but how has the sector moved forwards, evolved, and progressed to support people? Has legislation gone far enough to protect the rights of people in care? Are more people now living in a place of their choice? CMM hears from three experts who have worked in social care for a number of years, and they share their reflections and hopes for the future.

Over those two decades, successive governments have promised to ‘fix social care’ and then failed to deliver. In 2005, in its document Independence, Well-being and Choice, the then Labour Government set out its vision of social care. It talked about independence and choice, about putting service users and their families at the centre, improving access, shifting the focus to a preventative model and empowering the workforce.

Sound familiar? Hand on heart, could we really say that is what, as a society, we have done since that document came out? Numerous other documents have all followed, from governments of all political colour, all promising similar reform of social care.

If we were to write the same vision today, the same desires would feature.

Instead, here we are in 2023, some 1.6 million people can’t get the care they need and we have 165,000 staff vacancies. We have endured a heart-breaking pandemic the sector was ill-equipped to withstand and a subsequent cost-of-living crisis.

We now have social care provision on a knife edge, with all corners of the sector struggling and our ability to care for our most vulnerable compromised.

The sector and its amazing workforce remain woefully underfunded, is not given the respect or regard it deserves and struggles to recruit.

If we have a shred of hope, it is that the pandemic opened people’s eyes to the amazing work social care does and the vital role it plays, alongside the NHS, in the country’s healthcare. Maybe, just maybe, that has edged us closer to getting reform.

Because, despite all the above, the sector does move forward, innovating and adapting to meet changing needs, harnessing new technology to free up staff and, above all, delivering great, life-enhancing care to many hundreds of thousands of grateful recipients on a day-to-day basis.

The tragedy is that if we’d used these wasted two decades for reform, we could be delivering good and outstanding care to many hundreds of thousands more.

I pray that we aren’t writing the same thing in 2043.

If I think back over the past decade, we have made great strides in the way we support people who use human services. We have seen some great pieces of legislation that have helped us focus on rights and see people as unique individuals rather than defined by their need.

In my view the greatest Act in this period was the implementation of the Care Act 2014. For the first time an individual’s wellbeing was legislated to be at the centre of all that we do.

The Act has created a huge opportunity and challenge to service providers to reshape their offer and listen more closely to the voices of the people we support and their families.

It is with sadness and trepidation that I say that this

rights-based legislation is not as solid as I would have hoped. We have seen recent attempts to weaken the Human Rights Act with reforms aimed at removing these hard fought for rights.

Thirteen years of austerity is taking its toll on cash-strapped commissioners. Post pandemic we have a workforce that gave us so much and yet is still paid so little.

There is a fragility to our gains made in the last 20 years meaning we must double down and collaborate in new way.

Never has the quote, ‘If you always do what you’ve always done, you’ll always get what you’ve always got’, been more apt.

Now is the time to be brave and bold and build a co-produced future that is robust to weather the next 20 years.

Raina Summerson, Group Chief Executive, Agincare @Agincare

Writing this reminds me of just how long I have been working in social care, as 2003 doesn’t seem that long ago in my social care career! That was the last year of my career in public sector services before joining the independent sector.

Much of the time, it can feel like we’ve not come very far. Cyclical discussions about the need to address issues relating to funding, health and social care integration, workforce, accessibility, inclusivity and stronger communities all remain. Lobbying by many organisations to improve social care for those drawing on it or working in it can seem ineffective in any real outcomes and negative headlines highlight ‘unmet needs’, a ‘crisis’ in care and fragmentation of essential community support structures.

On reflection though, we have seen change. We’ve seen the polarisation between public commissioners, third sector and independent providers diminish, with more common messaging and calls for action.

We’ve seen thousands of adults living in institutions now living in their own homes, and stronger demands for choice and personcentred support. We’ve seen a shift to home-based care now being recognised as critical, ‘new’ models of live-in care, extra care and retirement living adapt and a huge reduction in the number of care homes along with dramatic changes in how they are used – all leading to people living at home for far longer. And we’ve seen the regulation of services adapt, as well as continued moves to integrate health and social care services: not just together; but with housing and community groups and, most importantly, with people drawing on care.

All of these moves are by no means complete, far from perfect and with still much progress to be made. In the absence of solutions, and with increased expectations and ideas, people are taking control and, with movements like Social Care Future (www. socialcarefuture.org.uk), further positive change is being driven and new ways of working explored.

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Rights-based legislation is not as solid as I would have hoped

We’ve seen a shift to home-based care now being recognised as critical

Sarah Maguire, Chief Executive, Choice Support @sarahmaguire30

"There is a fragility to our gains made in the last 20 years meaning we must double down and collaborate in new way."

HOW SOCIAL CARE ACTUALLY IS LEADING THE WAY IN DIGITAL

From fax machines, bleepers and paper-based care plans, to NHSmail and full digital solutions, the way in which social care operates day-to-day is unrecognisable from 20 years ago. Here, Nuno Almeida asks how we’ve come so far in such little time.

Big transformational changes in social care tend to occur over many decades. After all, this is a sector that constantly faces the choice of either allocating resources to improving itself or focusing on providing support to those in need.

However, the pace at which the sector has embraced digital transformation is truly astounding. Over the past five years alone, and looking solely at care planning software, more than 50% of the 39,000 registered care locations in the UK have adopted digital solutions, despite facing staff shortages and a global pandemic. Comparatively, the digitisation of approximately 9,000 GPs took

over a decade. Care homes and homecare agencies adopted digital care planning in over 19,000 locations within half the time.

From being considered a digital laggard, social care has wholeheartedly embraced technology. The rapid adoption of digital tools and solutions has had a profound impact on the sector, revolutionising the way care is delivered and improving the lives of both care providers and people they support.

The picture back then

In the late 2000s, I spent some time with care providers and founders of companies developing

technology for the sector. I remember finding a wide chasm – technologies that had been designed for other sectors were being shoehorned into the way care teams worked. And care teams were too busy delivering care to sit through days of classroom training to learn how to use desktop applications which all seemed to have been designed for accountants.

From social care there was a sense that there were no good technologies for us; in the technology world there was a sense that care teams ‘didn’t get I.T’.

At a recent conference of a large domiciliary care provider, someone asked a room full of registered

managers if anyone had heard of ChatGPT. Half the people in the room raised their hands – and when asked whether they had tried using it for work, about one in five were already exploring using it for creating care plans.

So, what changed? What made social care adopt digital technology at such a fast pace?

The not so lean start-up

In 2011, Eric Rees published The Lean Start-up, seen by many as the bible of distilled knowledge of how to efficiently launch a digital business. The entrenched beliefs of engineer entrepreneurs were that successful product businesses

were built by understanding who the buyer is, what their problems are, and giving the buyer a product that presents a solution.

But in care, the buyer and the user are not the same. So companies developed with a simplistic engineering mindset continuously failed to understand that in order to have an impact on care teams, a product designer would have to get under the skin of how a care team works, of what makes for a good day in the life of each person who draws on care and support, how teams are managed and co-ordinated, who the people who deliver care are, and how care is managed and paid for.

Social care is very complex; understanding the dynamics of care teams, care services, commissioners, how the sector evolved and how it’s woven into healthcare and the role of regulators is not top of mind for entrepreneurs trying to develop the smallest product possible that will get care providers to part with their money.

This challenge is similar in healthcare, but healthcare technology is able to attract much larger budgets and healthcare organisations developed procurement organisations, which have shaped solutions. If a procurement framework classes 100 items of functionality as mandatory, but fails to establish how easy to use the solution is for a nurse on a hospital ward or walking out of an operating theatre, or how committed a supplier is to improving patient outcomes, then as a health system you will get what the product vendors see as the shortest path to sell into procurement.

In social care this was never going to work – there simply isn’t enough money. But a new generation of products in social care succeeded for

taking a much longer road. Most products that succeeded over the last 20 years are deeply focused on the person receiving care, their life story, their wants, what makes a good day for them, what areas of their lives they need a hand with and what risks are involved.

These products are very well received by care teams, who immediately perceive the benefit.

The design of these products, and how care teams embraced them, is ultimately what led to the accelerated digital transformation of the sector.

Where in 2012 registered managers would resist the drive from owners to digitise, now we see registered managers demanding from owners that the right type of digital transformation takes place.

But the reality is that digital transformation in social care has very little to do with people buying products from a software vendor; digital in social care is less ‘lean start-up’, and more ‘it takes a village’. It’s a collaboration of everyone system-wide coming together to adopt and use systems that genuinely deliver an impact for people.

Impact on people

The impact of digital transformation on care delivery is significant. Care workers can now focus entirely on each person, continuously monitor their needs, and respond promptly to warnings or trends. Care becomes safer, with risk management integrated into the care process through information management, medication management, and improved handover processes. Digital solutions have enabled care providers to radically improve their operations, from handling inquiries and managing applicants for job roles, to engaging and managing care colleagues, creating efficient rosters,

automating payroll and invoicing, and utilising auditing and incident management tools.

The improvements in care quality have caught the attention of regulators, leading to increasingly vocal support for digital transformation. Outdated paper-based systems are now seen as presenting numerous disadvantages, risks, and burdens. Regulators are even considering making digital care planning systems mandatory for care providers, such is the belief that they deliver improved outcomes for people.

To support the adoption of digital solutions, initiatives such as the Digital Social Care Records programme and the Technologyenabled Care programme have been established, funded by the NHS Transformation Directorate. In the absence of an equivalent to NHS Digital for social care, providers have formed services to give care providers support in digital transformation, such as Digital Social Care, to facilitate the sharing of best practice and provide guidance on technology adoption and cybersecurity.

What will the next 20 years bring?

Looking to the future, the anticipation and excitement surrounding the use of artificial intelligence (AI) in social care is palpable. Many care providers are already experimenting with AI-generated care plans. AI has the potential to enhance communication with individuals receiving care, particularly those who are neurodivergent or non-verbal. The combination of AI and voice-activated devices can increase their engagement and independence.

AI holds the promise of further reducing time spent on non-value-added work, allowing more time for meaningful interactions and people looking

out for one another. As an eternal optimist, I believe that AI can make us more human.

But AI isn’t the only new technology that may deliver benefits. Albeit less exciting, widespread implementation of interoperability could enable a cocktail of benefits – both for people and their families, enabling them to self-manage by using a multitude of devices in combination with ondemand care, resulting in the optimisation of health and social care systems. The co-ordination of an empowered social care system that works alongside NHS acute and primary care in the management of long-term conditions in the community to deliver a more holistic version of virtual wards is the best shot we have as a country to provide adequate care for our population as it ages.

Social care has defied its reputation as a slow adopter of technology and achieved remarkable digital transformation in a relatively short period. The sector’s collaboration, focus on personcentred care, and adoption of digital tools across the board have led to significant improvements in safety, care delivery and outcomes.

The future looks promising, with the potential for AI to further enhance communication, accessibility, and personalised care in social care settings. But what’s exciting is that a digitally enabled social care sector is now ready to play a bigger role in the national context. And from my regular interactions with social care providers I get a sense we are ready to stand up, collaborate and help the NHS find the way to sustainability and large-scale delivery of person-centred, integrated care which the sector does so well every day. CMM

FLYING THE LAG

Meet the care campaigning organisations working hard to protect the rights of people

Helen Wildbore, Director, Care Rights UK

My colleagues running our helpline have worked as advisers on social care for almost 20 years and they have never seen the sector in such a poor state. A perfect storm has brewed to create a national crisis. Over three years of COVID-19 restrictions, staffing shortages which have long been a problem but exacerbated by Brexit and the pandemic and the cost of living have converged to stretch the sector to breaking point.

Services are so stretched; we hear serious concerns about people’s safety and dignity. Callers to our helpline tell us the distress, anxiety, frustration and despair this causes. With care provision so sparse, people have little, if any, choice and can feel trapped in a broken system.

It is a system stacked heavily against people living in care and their families. They are in such a vulnerable position and are too easily dismissed as ‘expecting too much’ or ‘problem relatives’. When people can face visiting bans or an eviction notice for raising too many questions or making a complaint, all too often they are afraid to rock the boat. If the care home simply doesn’t have the staff to improve the situation, people can feel there’s no point in damaging relationships, so they put up with poor care.

Too many have faced these challenges without the vital support of their family carers. Over three years of COVID-19 restrictions showed the devastating harm this causes. Being shut off from the person who knows you best, helps you communicate, might be the only person you would tell if you were in pain, would spot problems and be your voice to resolve them. There is a growing recognition in the sector of the crucial role of relatives and close friends as partners in care. Many care organisations are joining with us to call on Government to bring in a legal right to a Care Supporter across health and care settings.

With Government leaving the sector woefully underfunded, families tell us they feel bereft and helpless. It is a system relying on the goodwill and dedication of an underpaid, under-supported, unvalued workforce. It is unfair to expect care staff to deliver quality services without the training, rewards, qualifications and career development of their NHS colleagues. Every day on our helpline we hear, ‘The care workers are great, and trying their best but…’.

Yet many care homes can and do provide good care. They are an example of how this can be done, with well-supported staff, good leadership and responsiveness to feedback. Many care providers share our frustration and also want the investment and change >

There are so many organisations and charities who have been working tirelessly on behalf of people working in care and for people drawing on care services and their families. CMM caught up with three leading charities to find out more about their history and their ambitions for the future.

so desperately needed. We must work together to demand a care system where everyone can access good care. This requires political will and resources but also bold leadership from within the sector to reform services so vital to the country’s wellbeing.

Emily Holzhausen OBE, Director of Policy and Public Affairs, Carers UK

Thinking back 20 years, to 2003, when Care Management Matters started, I realise how far we have come for unpaid carers, and yet what unfinished business still remains two decades on. Including the role and lives of families and close friends who provide unpaid care for their disabled, older or chronically ill people close to them has been important to us and to them. So often, unpaid carers go unrecognised, and yet the value of their support is worth a staggering £162bn a year – or £445 a day – the same as the NHS. Most of us will become unpaid carers at some point in our lives – two in three of us – but many of us are not prepared for that individual journey which can happen at any time, including at very short notice.

In 2003, when CMM first started, the first ever Prime Ministerial National Carers Strategy was already into its fourth year and funding of carers’ breaks and support from central Government to local authorities was around £100m. Today that support through the Better Care Fund is around £327m, but now channelled through Integrated Care Boards and no longer directly to local authorities. Whilst funding might have increased, the backdrop of funding of social care has not risen in line with needs and has experienced real terms cuts for nearly a decade.

It's hardly surprising therefore, that with an ageing population, more complex care delivered in the community and tighter budgets for social care, we have seen a rise in the level of care that families are providing. In 20 years the amount of significant care provided by families, for example, 50 hours plus per week, has risen by about 50% (995,000 in 2001 to 1.4 million in 2021). This is unsustainable and a false economy in the longer term, for many reasons. As well as not giving disabled and older people the choice about how they wish to be cared for, for families having to provide increasing amounts of care can be devastating. An estimated 600 people a day give up work to care. It also has an impact on health, wellbeing, broader finances and relationships. If Government were to invest more in care this would not just be about increasing support

for the social care sector, including the paid workforce, it would be a far bigger investment in families and the economy.

Over the past 20 years, carers’ rights have continued to grow and develop – with the Carers (Equal Opportunities) Act 2004 and then the Care Act 2014 giving parity of esteem with people needing care and support. The legislation over time has learned and developed with carers with increased personalisation, although tight budgets remain a challenge in delivering the range and level of support needed.

In 20 years the idea of unpaid carers juggling work and care has gone from the margins to getting better recognition. Given that around one in three workers in care could be juggling work and unpaid care, this is of fundamental importance. In 2003 unpaid carers' first workplace rights, unpaid time off for dependents for emergencies, had only recently been in force. Two decades later, we are on the cusp of new employment legislation, with the Carer’s Leave Bill sponsored by Wendy Chamberlain MP, which would give up to one week’s unpaid leave in the workplace. We expect two million working carers to gain new employee rights, something which the care sector will need to get ready for in 2024. Part of our future will be to support the best implementation of this new law through our Employers for Carers forum, with 230 employers covering around 2.3 million employees.

I hope that the next 20 years will see a wholesale transformation in awareness and understanding of the role of unpaid carers, an expansion of tech for good that makes their lives easier and gives people needing care more independence, real and concrete support in the workplace and enough funding for social care to really deliver the vision that so many creative and committed people have in the sector.

Karolina Gerlich, Chief Executive, The Care Workers’ Charity

There have been many changes over the last 20 years, which is to be expected. The social care system has undergone a dramatic transformation.

In 2000, the UK Government had just begun to develop the National Care Standards, which aimed to improve the quality and safety of care services. At that time not many care workers routinely completed clinical tasks such as supporting people with catheter care, stoma care or cancer medication. Today it is common practice. In the following years

the Government implemented the Care Act 2014, which improved the rights of care users and introduced more rigorous social care regulations. In addition, the introduction of the Care Quality Commission in 2009 saw an increase in the regulation and inspection of social care services.

Then came many more reforms, most focusing more on the NHS rather than its social care counterparts. This has sadly been repeated with the most recent DHSC Budget update showing that only half of the £500m promised in 2021 towards workforce development and reform will be delivered. When the Government promised ‘at least £500m’ for the social care workforce in 2021, this was nowhere near enough to address the crisis facing the sector in the first place, but it was at least a glimmer of hope and commitment to the workforce.

With the advancement of technology, an ageing population, funding issues, and the rise of companies such as Amazon and Aldi who can offer a more competitive wage, the social care sector has had many obstacles to overcome.

Of course, we can’t give an account of the last 20 years without talking about COVID-19.

If anyone felt the coronavirus’s cold breath on the back of their necks, it was care workers.

No ‘working from home’ options were possible and everything that care workers knew changed. Care workers tearfully spoke on the news, Channel 4 released ‘Help’ which showed some of the horrific circumstances faced by care workers and the public ‘clapped for carers’ (eventually) along with clapping for the NHS.

Whilst the pandemic was a tragedy of global proportions, it also helped to highlight the incredible work that care workers do, day in and day out. The level of resilience and strength we have seen from them, despite all the issues they have faced in the last 20 years, has been astounding. They deserve admiration and support for the skilled and steadfast care that they continue to provide for people who draw on social care.

Care workers have remained the solid foundation of our society. The ones who have during the pandemic spent extra time with those who couldn't be with their own families. In care homes, in the community, day centres, and in people’s own homes, they march on, continuing to do what they do to support others. They do what is one of the most amazing jobs in the world. It is such a shame that the sector is so badly funded by the Government and so poorly recognised by society. CMM

In what ways has your care organisation campaigned on behalf of the care sector? Share your campaigning experiences. What key messages do you think sector leaders should be backing? Visit www.caremanagementmatters.co.uk and share your feedback on the article.

An inclusive vision Reflecting on progress and striving for equality

Like running a marathon, progress is a long road that requires determination, persistence, a clear race plan, and some inevitable wrong steps. Unlike a marathon though, people do not all start from the same place. Here, Clenton Farquharson CBE, Chair of Think Local Act Personal (TLAP), highlights what progress has been made on inclusion and equality in social care and explains what still needs to happen.

It’s a privilege to be asked to contribute my views on how far we have come with inclusion and equality over the last 20 years to coincide with CMM’s 20th anniversary. It’s a hard ask to sum up two decades of a large and contested area, so these are my personal reflections, rather than a historical account or survey of the whole equalities landscape.

My focus is on adult social care, particularly the pursuit of personalisation. The shift towards meeting people’s needs on a whole person basis, seeing people in their social context, was reinforced in law with the Care Act, which included the duty to promote wellbeing. This should

provide a strong platform to promote equalities and inclusion, particularly when adding the vital notion that people should have choice and control.

Progressive change

My overarching view is we have made some progress, but there is still a long way to go before we can say that we have a ‘fit for purpose’ approach to social care that serves the needs of everyone in an equal, equitable and inclusive way.

We need to do more to recognise the importance of intersectionality; to recognise the interplay between different aspects of people’s lives

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such as disability, race, and gender, rather than looking through a single lens. As a black disabled man with several long-term conditions and an unpaid carer to my mum, this is crucial to seeing me as a whole person. Intersectionality recognises that individuals may face multiple forms of discrimination and disadvantage based on their intersecting identities, whether that’s because of their gender, race or disability. It is essential to understand and address these intersecting dimensions of inequality to ensure that care and support is inclusive and responsive to the needs of all individuals.

It's not only the Care Act where we have seen progress. The introduction of the Public Sector Equality Duty, created under the Equality Act 2010, placed a duty on public sector organisations to go beyond tackling unlawful discrimination, and instead to actively seek to ‘advance equality of opportunity’ and ‘foster good relations’ between people who share a protected

characteristic and those who do not. This has been a force for good and lever for some progressive change.

However, despite some notable exceptions, too many people are experiencing too little personalisation. This means that addressing discrimination and advancing equalities has also been held back.

Issues are compounded by a complex system which is foggy to navigate, where rights and entitlements are not clear, often leaving people ill-informed, confused and fending for themselves. Imagine what it is like for those for whom English is not a first language or who may have limited or no access to the internet.

Where then should we expend further effort to gain most reward? For me, it is about making sure we are running with others in the right direction on the shortest route possible in pursuing the goal of equity and intersectionality throughout; these should be woven into all that is done to improve social care. Here are some further thoughts on how we can make fuller and faster progress over the next decade:

1. A better, more inclusive vision with a ‘Big conversation’

Reforming social care must be based on a better and more inclusive vision of what social care is and who it is for.

If we start with the future we want to see, such as the Social Care Future vision, and work backwards from there to prioritise actions that will take us there, we stand a real chance at change.

I’m not alone in thinking this. Think Local Act Personal’s own work, not least the landmark I and We Statements of Making it Real, has done much to help us see a better way to do things. A more optimistic and bolder vision is reflected in recent reports on social care (see box). Whilst differing in their detail, all point to the need for us to think differently about the purpose of social care, to be more inclusive and universal rather than seeing it as a safety net for those deemed ‘vulnerable.’

https://committees.parliament. uk/committee/580/adult-socialcare-committee/news/174979/ adult-social-care-committeechallenges-government-to-urgentreforms-in-adult-social-care/

https://www.churchofengland.org/ about/archbishops-commissions/ reimagining-care/final-reportreimagining-care-commission

https://www.adass.org.uk/ media/9685/adass-time-to-actapril-2023.pdf

To raise the bar requires us to have a big conversation about the future of social care, not starting with how it is paid for, but what we expect it to achieve for people. This conversation needs to get closer to the well-known African proverb, ‘It takes a village to raise a child’ and move away from seeing social care as something largely for others and primarily to help the NHS with hospital discharges of older people. Social care is fundamentally a relationship thing – let’s start by understanding our individual and collective responsibility to each other and reach beyond the current limited view of social care.

2. Co-producing a more inclusive future with people and communities

Making the right sort of progress means that in every area, and with all groups, we need to invest time and resources to build an infrastructure capable of sustaining strong, connected communities. There are already areas showing the way, so let’s build on their positive legacy and get more local authorities and other parts of the statutory sector developing a much greater understanding of community assets and needs, at the very local level. We need to start listening to, trusting in, and transferring real power to local people and neighbourhoods. Great examples of this working well are too often found at the margins or seen as an innovation, instead of accepted as the best way we get things done.

"Leaders must be able to challenge themselves and their people to do better. We all have our blind spots, so we need to be self-conscious and intentional if we are to tackle the systemic and structural inequalities that still exist."

3. Inclusive leadership, inspiring the workforce

Leadership at all levels – national and local – must have a key role to play in creating an inclusive culture. Leaders must be able to challenge themselves and their people to do better. We all have our blind spots, so we need to be self-conscious and intentional if we are to tackle the systemic and structural inequalities that still exist. This should include bringing staff together to talk about issues in challenging but safe spaces.

This is helped when leaders themselves reflect the diversity of the community they serve. There are now more women in social care management and leadership positions, and it is worth celebrating the fact we have a Black woman, Beverley Tarka, as this year’s ADASS President.

Change at the top must be mirrored by efforts to improve the conditions of the social care workforce at every level. We need to work extra hard to make sure that equity and equality are at the forefront of drives to improve quality, recruitment and retention. That’s why I back the implementation of initiatives like the Race Equality Workforce Standard.

We need to instil greater confidence and more competent practice across the whole care and support sector; confidence in working with diversity, grounded in human rights, and challenging policies, systems and processes which work against equity of access, experience and outcomes. If there is a waiting list for an assessment or a service, do you know the protected characteristics of those waiting? These things matter if we are serious about finding solutions that count.

4. Commissioning different things, differently

Commissioning needs to transform if we are to shift from one-size-fits-all

services to those which are truly anchored in the lives of people and the places they live. There is a strong equalities dimension to this. During the pandemic, the disproportionate impact on people from Black, Asian and minority ethnic communities soon became clear and TLAP commissioned some specific work as a contribution to addressing this. The aim was to find examples of promising practice that demonstrated what good, personalised, community-based care and support looks like for people in ethnically diverse communities.

We found some notable examples of personalised care and support, although the term ‘personalisation’ was not often used by those clearly working in that way. But we also found that organisations in the study were often operating on the edge or outside of mainstream commissioning and decision making. There is much more that councils can and should do to engage with groups and organisations as part of developing a flourishing and diverse ecosystem of support. The opportunities to enrich learning for everyone if we do are considerable.

5. Data that supports intentional action

At one level it seems to me that we have an abundance of data, more than we know what to do with, whilst paradoxically we also have data deserts, which I know from my membership of the NHS Race and Health Observatory.

The question we should be asking is what data do we need to show us how we are doing in providing more personalised and joined-up care and support that enables people to lead good lives? This must include data which shines a light on fair access, experience, and outcomes, covering protected characteristics, both separately and combined.

We also need data that provides

regular and reliable insights into the make-up of the workforce and ways of measuring progress towards creating a diverse and inclusive workforce with fair opportunity. This may be hard to achieve but it is the right thing to do.

But none of this is of much use unless the collection and analysis of data is coupled with a commitment to understand the story of what the data is telling us and use this to act for improvement.

6. Levers with opportunity

Integrated Care Systems (ICSs) are required to ‘tackle inequalities in outcomes, experience, and access’ as one of their four purposes. ICSs should make good use of this mandate, fully involving local authorities and communities to set clear plans to address systemic and structural problems at all levels of system, place and neighbourhood.

Whilst you cannot regulate your way to equality and inclusion, the introduction of the new Care Quality Commission (CQC) assurance regime does provide some opportunity through the Single Assessment Framework to hold leaders and organisations to account across the system.

Final thoughts

We must avoid a sense of ‘learnt helplessness’ where the pursuit of equality, equity and inclusion is seen as too hard, or someone else’s responsibility. Everyone needs to play their part within whatever setting, organisation or institution they are located.

The investment will create a social care system which is based on trusting and reciprocal relationships where everyone belongs and no one is left behind.

That’s a future all of us should be proudly and tenaciously working towards. CMM

CELEBRATING 10 YEARS OF THE MARKEL 3RD SECTOR CARE AWARDS

This year we celebrate the 10th anniversary of the Markel 3rd Sector Care Awards and look forward to meeting more remarkable individuals in the decade to come.

Back in 2014, the inaugural Markel 3rd Sector Care Awards set the scene for celebrating the work of small, not-for-profit providers of care who were quietly beavering away, bringing positivity to people’s lives with innovation, creativity and flair. Today, the celebration is bigger and better than ever, shining a spotlight on the hard work, dedication and commitment of individuals working in the UK’s third sector. As we look forward to receiving 2024’s nominations, we reflect on the part the Awards have had to play in showcasing wonderful work in the care arena over the last decade.

Celebrating the great work you do

If you’ve had the privilege and pleasure of attending the Awards ceremony at some point in its history, you’ll know how seriously the great work you’re doing on a daily basis is commemorated. Even if you’ve never been nominated – maybe we just don’t know about you yet! – the act of coming together to celebrate these individuals and organisations has a wider purpose that affects you too: it’s shining a spotlight on how many individuals and providers are going the extra mile and

Community Engagement Award winners at the first-ever Awards Ceremony back in 2014.

expanding awareness to the wider community about how important the work you’re doing really is.

The different award categories – from creative arts, community engagement and innovation, to quality improvements, integration, technology and governance – are based on specific strategies from Government and the sector and have evolved over time to maintain relevance in an ever-changing landscape. The Awards celebrate providers who are relevant today, moving with the times and giving the best possible service to everyone who crosses their path.

A success story

Jo Boddington is one such provider, winning the Community Engagement Award at the first-ever Awards Ceremony back in 2014 for the work being done at Bodster Equine Assisted Learning Centre on the Isle Wight, where people develop a range of skills, improving their self-esteem, understanding their own behaviour and increasing their emotional intelligence in a supervised horse environment.

Jo recalls, ‘There were more than 200 finalists, guests and board members of supporting organisations, including the National Care Forum, gathered to celebrate the best of care and support services with an innovative and inspiring awards event. We were presented with our winning trophy for our work in engaging learners of all ages in the community. The highlight of the event, which I remember so clearly, was being presented with the award by Dame Esther Rantzen and we gave her one of our Never Too Old booklets, which is about our project working with older people in the community. I would be interested to know if she read it!’

Since winning the award in 2014, the business has gone from strength to strength and the team works with anyone aged six to 90. Jo continues, ‘Since 2014, we have continued to develop our service and have more and more referrals coming our way for people to come and spend time with our herd of ponies on the ground (no riding involved). Being recognised at the Markel 3rd Sector Care Awards has certainly raised our profile in the local community and has helped people understand a bit more how being with ponies can help your mental health, so we want to really thank the Awards staff for recognising what we do.’

Like Jo, many winners have experienced a business boost after being presented with their award. All finalists get the chance to interact with leaders in the sector, including chief executives and directors of national

organisations, who have been known to offer their expertise and advice for future projects after the event, which has been a real boon for some. Usually, small providers don’t have the funds for input from industry leaders, so this can be a golden ticket for those wanting to spread their magic further.

Often, you don’t get to share your achievements – you’re too busy achieving them! – but being part of the Awards gives all our finalists the chance to shout about what makes their offering special and allows all winners to share their stories on stage when being presented with their award. Winners also get to join us here at CMM Magazine, where readers are introduced to each winner in a dedicated feature to inspire future entrants to grow and keep moving forward.

The judging process

Each judge over the years has been a well-renowned expert in social care who is passionate about learning all about the work you do, especially if you think outside the box, display extraordinary amounts of compassion or go above and beyond the call of duty to create a service that transforms lives.

The judging process is meticulously planned and comprises two stages. Firstly, eligible nominations are passed to the judging panel for shortlisting and three finalists are selected. Secondly, those finalists are invited to an online interview, where they meet the panel and discuss their contribution to the sector. Finalists are then invited to the sparkling Awards Ceremony: a three-course lunch extravaganza with entertainment and a presentation by an esteemed host such as Dame Esther Rantzen or Angela Rippon CBE.

A whole crowd of remarkable individuals come together in the same room to celebrate the extraordinary achievements of those working in the sector, from those helping the homeless to realise a better future, to others giving children a safe home to live in, to people working with those who have experienced domestic abuse, to hospices providing dignified end of life care, to care home accountants going the extra mile, to chief executives working for their staff on creating more fulfilling lives – and more. We hear from employees working at all levels; we hear from large organisations and those with only one or two members of staff. A glorious range of caring and compassionate people all working to better the lives of others, all coming together under one roof to celebrate in style.

Looking forward to 2024

Whether you’re supporting children or adults, the Awards reward the true excellence of those of you who are making a positive difference to people’s lives in the not-forprofit third sector. Organised by CMM, developed in conjunction with the National Care Forum and with the help of a raft of fantastic sponsors, the Markel 3rd Sector Care Awards enable everyone who participates to share the incredible work they’ve been doing to support vulnerable people.

It’s been a pleasure to organise and host these Awards since 2014 and we look forward to the next decade of annual celebrations and to meeting yet more innovative and wonderful people working in the third sector. Next year, it could be you. And why not?

If you’re brilliant at what you do, we want to hear from you! To nominate yourself or someone else for the 2024 Awards, head over to www.caremanagementmatters. co.uk/3rd-sector-care-awards CMM

Headline Sponsor

The Markel 3rd Sector Care Awards is run specifically for the voluntary care and support sector. Visit www.3rdsectorcareawards.co.uk to view the 2023 event winners and find out more about next year’s event. Sponsorship opportunities are available.

With thanks to our sponsors: National Care Forum, Learning Disability England, The Care Provider Alliance, Association of Mental Health Providers and VODG.

YOUR VOICE MATTERS CMM READERS REFLECT

In view of CMM’s 20th Anniversary issue, we asked our readers how the magazine has helped decision makers working in the sector to run their business. Thank you to everyone who took the time to share their reflections and comments with us, we really appreciate it. Here are some of the responses from readers and supporters.

Dr Jan Sheldon, Chief Executive at St Martins, said, ‘We have found the news articles on Care Management Matters to be a valuable source of information, statistics and up-to-date research. For St Martins, Care Management Matters is an efficient way for us to keep informed about key issues in the sector and how others in the care sector are responding to issues that we face in our work. We are always advocating for both the social care and homelessness sector to be recognised for the essential and professional services we provide and the articles we find on CMM add weight to our discussions at a national level.’

Kirsty Fishlock, Registered Manager at Astor Care and Nursing Agency, said, ‘Six months ago, I was promoted to the role of Registered Manager for Astor Care and Nursing Agency – the only change of Registered Manager in the last 30 years. My background within the company was previously in finance, and I requested to gain experience in care for my personal development. CMM has proved an invaluable tool for me in understanding the industry in more depth, the pressures faced, outstanding work by others and, most importantly, keeping up to date and understanding current and new legislation. Having this resource provides me with the confidence in continuing and developing in this new role.’

Reflecting on how CMM has helped to enhance knowledge and connect with the sector, Mark Topps, Social Care Leader and Campaigner, said, ‘I do find it a great way to keep up to date with the latest social care news. The magazine gives me good insight into how others think and feel about various subjects relating to social care and I have in the past joined webinars, which are a great way to upskill

knowledge and interact with new people. I will often crop pieces of the magazine or news articles and share this with colleagues to help raise awareness or to generate thoughts and our own internal communications.’

Karolina Gerlich, Chief Executive of The Care Workers’ Charity, told CMM, ‘CMM Magazine has helped us get word of our charity in front of more providers than ever before. For a charity, visibility and awareness is so important for funding, but we also need to be visible for those who need support too. CMM’s support has assisted us to provide grants for 8,700 care workers in crisis with over £5m since 2020.’

Claire Henry MBE, an independent consultant working in Palliative Care and End of Life and a Markel 3rd Sector Care Awards judge, has supported CMM for many years. Reflecting on the Awards and CMM’s content, Claire said, ‘I have been involved and used CMM resources for over 10 years. The Care Choices directories have been an invaluable source of information both locally and nationally and, over the years, CMM has provided easy access to latest news and topics. I have also been most grateful for the articles I have had published, which has helped raise the profile of the important role the care sector plays in end of life care.’

The Prospects Trust, a registered charity, organically certified working farm and social enterprise that provides work, skills and training for adults with learning disabilities and autism has been involved with the Markel 3rd Sector Care Awards. Commenting on the charity’s involvement with CMM, Maz Baker, Executive Director of The Prospects Trust, said, ‘Here at The Prospects Trust, we have been very fortunate to win not one, but two CMM Care Awards: The Community

Engagement Award in 2022 and our Chairman won The Leadership Award in March 2023. This national award event hosted by CMM is a room full of caring, compassionate change makers, a ballroom of inspiration and CMM makes everyone participating matter. All guests feel like winners in a sector that is too often forgotten until vitally needed. For The Prospects Trust, scooping two national awards has been a real boost to our care farm and social enterprise; it made us feel bolder, brighter and better – that inspirational uplift was what anyone in the care sector needs after COVID-19 and day-to-day challenges with funding, resources and demands’.

Maz added, ‘We are certain that from these awards more doors of opportunity have opened to us. As a small and proudly unique care provider, trying to keep up to date with care legislation, reforms or just getting our quiet voice heard is difficult and winning an award from CMM has given us credibility on a wider platform. The Markel 3rd Sector Care Awards is simply the best marketing at a national level. We have hosted more Corporate Volunteer days than ever before; including headline Sponsor Markel, who will be back again at Snakehall Farm to continue with building an accessible path around our Re-Wilding Nature Reserve. We have secured grants and benefited from donations using the phrase ‘multiple awardwinning care charity’ and we have even hosted two ministerial visits in 2023.’

Alex Roland, Director at Love Communities

CIC, also shared his feedback on CMM and said, ‘As a tiny business, knowing we are part of something much larger gives us the confidence and security to move forward with ambitious plans and strategies that we may otherwise not have had the confidence or expertise to undertake on our own.’

MICHAEL VOGES • CHIEF EXECUTIVE • ASSOCIATED RETIREMENT COMMUNITY OPERATORS

Michael Voges, Chief Executive of Associated Retirement Community Operators (ARCO), reviews how much progress has been made within the housing-with-care sector and explains what comes next if we are to meet demand in the years ahead and keep up with global best practice.

When ARCO started, older people’s specialist housing was seen as a niche sub-section of the property market, and one often associated with poor practice.

This has now all changed. Integrated Retirement Communities (IRCs) are widely seen as the go-to model of older people’s housing by policymakers, investors and consumers.

What changed? First, UK developers started to take notice of what was happening overseas, especially in New Zealand (NZ) and Australia, which have demonstrated how popular long-term business models are with consumers, as well as pioneers of housing-with-care in the UK, such as the ExtraCare Charitable Trust.

Secondly, ARCO was formed and set down some red lines in terms of what consumers should expect in relation to transparency and disclosure. The ARCO Consumer Code is now in its eighth year and hundreds of assessments have been undertaken, raising the bar and

building trust.

Thirdly, as the IRC sector grew, so did the evidence of the benefits to older people, the NHS and social care systems. Little by little, people have understood that IRCs really do work. And it is the care element that is crucial. One of the key shortcomings of traditional retirement housing models was the absence of any real thinking about care so that people had to move again. IRCs are designed from the ground up to ensure that people can carry on living behind their own front door – even if they experience substantial care needs.

Fast forward to today and a cross-departmental Government Older People’s Housing Task Force has been set up to look at how to grow the sector under the stewardship of both the Social Care Minister and Housing Minister.

It isn’t just the Government taking notice. A recent report commissioned by the Labour Party from The Fabian Society

think-tank calls for a ‘major expansion of housing-with-care’ noting that, ‘The UK has far less specialist housing for older people than many comparable countries, and what is available often does not provide sufficient support to prevent care home admissions when people’s needs grow more complex.’

So, what comes next? More growth: ARCO members currently operate over 250 Integrated Retirement Communities in the UK, but the pipeline of new schemes is big.

Better regulation: While ARCO members abide by a strict consumer code, the absence of dedicated consumer regulation for older people’s specialist housing is still anachronistic. Change seems inevitable. Take event fees: they are popular with consumers. But they are also complex transactions worth tens of thousands of pounds involving consumers aged around 80. The absence of specific consumer protection

regulation for event fees will surely close before too long.

Public attitudes: As the benefits of IRCs and housing-withcare become better understood, a sea change in public attitudes is coming. In countries such as the US and NZ, IRCs are mainstream and widely understood. Moves into IRCs are planned years ahead. The same will happen in the UK as the sector grows.

The truth is that while the Integrated Retirement Community sector has made huge strides over the last decade, we still lag far behind other countries in terms of provision. What that means is that thousands of older people could be living longer and healthier with lower levels of loneliness and improved wellbeing, if we could grasp the opportunity presented by the sector and grow provision to the level of countries such as New Zealand and Australia. That will be the challenge of the next decade.

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Employee Grant Giving

Work with the CWC to set up a fund for your Team

Since 2020, our grants and mental health support have benefited over 8700 people who work in formal care settings across the UK. This has been done by awarding over £5 million in grants.

Let us help by designing a hardship fund for your employees. We will work with you to ensure that the grants reach those who need them most and tackle the issues which are important to you teams. For example, you could allocate funds for:

Cost of living support

Help with childcare costs

Energy bills scheme

Mental wellbeing and health support

If you would like more information about setting up a support fund for your team, please get in touch:

neil@thecwc.org.uk