Care Management Matters (CMM) November 2023 by Care Choices Ltd

NOVEMBER 2023

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IN THE DRIVING SEAT ADASS updates on CQC assessments

A hopeful step forwards

Delivering the Oliver McGowan Training

Irish insights

Reforming social care in Northern Ireland

Resource Finder Legal

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In this issue 05

Inside CQC James Bullion, Chief Inspector of Adult Social Care and Integrated Care at the CQC, encourages providers to reflect and share evidence of best practice and innovation.

CMM News

Into Perspective This month, our experts respond to the CQC’s planned changes and updates to the assessment process and explain how providers can best prepare.

Celebrating Excellence CMM is thrilled to hear from Alex Roland, Director at Love Community CIC, an organisation representing communitybased initiatives, such as GameChanger, and the latest winners of the Community Engagement award.

Event Preview Don’t miss our next webinar: Planning for 2024 – successful commissioner fee negotiations, which takes place on Thursday 16th November. Find out the key themes.

What’s On?

Straight Talk Trustees' Week is on 6th-10th November 2023, and it is a special opportunity to recognise the valuable work of trustees in our sector. Fiona McAuslan, Communications Director at Getting on Board, offers her advice to social care providers.

FEATURES

REGULARS

Social Care Insights Dr Rhidian Hughes, Chief Executive of the Voluntary Organisations Disability Group (VODG), outlines how the organisation is seeking to help its members address the challenges in social care and suggests what longer-term approaches are needed.

In the driving seat: Supporting councils and providers to drive their own improvement journey Michael Chard, a Senior Officer at Association of Directors of Adult Social Care Services (ADASS), explains how ADASS has been driving for reform and tells us more about the CQC assessment framework.

Rebooting adult social care and support in Northern Ireland: What was proposed and how much progress has been made? In 2017 the Northern Ireland Assembly published Power to People: Proposals to reboot adult care and support in N.I. John Kennedy, a Housing and Social Care Consultant, reflects on the Power to People report’s progress in that time and shares the outcome of the 2022 public consultation.

The Care Innovation Challenge: CMM meets the winner The Care Show took place on 11th-12th October at the NEC in Birmingham and the winner of the 2023 Care Innovation Challenge was crowned! CMM caught up with Tresacare to hear about their big ambitions in the years ahead.

A hopeful step forwards: Delivering the Oliver McGowan Training The Oliver McGowan Programme has co-production at its centre. Sally Dunne, Learning and Development Lead at Choice Support, and Mark Rawlings, Admin Support Assistant at Choice Support, update on how the initial roll-out of the training has gone so far.

Resource Finder: Legal CMM shares a round-up of leading legal organisations to help you prepare for challenges ahead. CMM November 2023

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

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@RhidianHughes

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Dr Rhidian Hughes Chief Executive, Voluntary Organisations Disability Group (VODG)

James Bullion Interim Chief Inspector of Adult Social Care and Integrated Care, CQC

Michael Chard Senior Officer, The Association of Directors of Adult Social Services (ADASS)

John Kennedy Housing and Social Care Consultant

@PhilippaDoyle1

@Choice_Support

@mark_rawlings25

Philippa Doyle Partner and Head of Social Care, Hempsons

Sally Dunne Learning and Development Lead, Choice Support

Mark Rawlings Admin Support Assistant, Choice Support

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Alex Roland Director, Love Community CIC

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SOCIAL CARE INSIGHTS From Dr Rhidian Hughes The gap continues to widen between the true cost of care and fee rates. Dr Rhidian Hughes, Chief Executive of the Voluntary Organisations Disability Group (VODG), outlines how the organisation is seeking to help its members address the challenges and suggests what longer-term approaches are needed. Millions of people draw on care and support and have legal requirements to do so, but the annual squeeze on care provider fees continues to put essential services at risk. As we look to the forthcoming Local Government Finance Settlement for England there are pressing matters for providers to influence and fee uplifts for 2024-25 to negotiate. We know councils are in difficult situations and that funding from central Government is not enough. But the combination of squeezed funding, increasing demand and mounting inflationary costs are already having far-reaching impacts on providers. We continue to see the gap widen between the true costs of providing care and the lag in fee rates. This autumn saw VODG bring in the expertise of crisis negotiators and trained actors who used role-played scenarios to explore influencing strategies with our membership, to help them be best placed to address current challenges. Alongside conversations with commissioners, an important tactic is to also engage political leaders responsible for social care portfolios across local authorities. These leaders have a central responsibility for the care provider ‘market’. VODG intelligence across our membership finds that many of our members would not be able to continue local authority funded services if commissioners

did not match fee rates with rises in the latest uplift to the national living wage. Fundamentally care providers must be engaged early to enable the right strategic conversations to be had between the council and providers – enabling risks, issues and opportunities to be addressed. All too often a pattern repeats which sees little meaningful engagement with providers and rates simply published without sufficient understanding of the impact this will have on outcomes for people using commissioned services. In the worst situations, which are becoming increasingly common, rates are set at a level which compromises the viability of services and can lead to the hand back of contracts. We have therefore written to all council adult and children portfolio holders across England calling on them to directly engage with third sector providers delivering support for and alongside disabled people. VODG is calling on cabinet leaders to: • Convene a meeting with third sector leaders to hear first-hand about delivery issues and ideas for co-produced solutions to the council’s challenges. • Ahead of setting rates for 2024/25, gain assurance that effective engagement with the third sector has taken place, including the identification and escalation of issues that could

compromise commissioned services. • Co-produce with providers a local costing model that ensures the rates for 2024/25 and beyond will enable the council to commission the workforce well above minimum wage rates to effectively mitigate workforce competition from other sectors. • Develop a model for the co-design of services with people who draw on social care, the third sector and commissioners. • Encourage transformative approaches to commissioning that maximise relationship-based partnerships and draw on the vision for how integrated care systems should work. Councils and third sector providers share a common purpose to maximise public benefit, and these actions offer a platform for meaningful and sustainable partnership. Partnership building with the third sector need not necessarily require additional resources, but offers huge potential to maximise the benefit of the resource available. Our experience is that when taken together these efforts can help make a difference to local communities, the wider economy and support progressive approaches that enable people who draw on social care to lead their best lives possible.

Dr Rhidian Hughes is the Chief Executive, VODG. Email: ceo.office@vodg.org.uk X (formerly Twitter): @RhidianHughes @VODGmembership

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INSIDE CQC James Bullion

In his first column for CMM, James Bullion, Interim Chief Inspector of Adult Social Care and Integrated Care at the Care Quality Commission (CQC), updates on the regulator’s new regulatory approach and encourages providers to reflect and share evidence of best practice and innovation. I want to start with a thank you. Thank you to everyone who’s shared their thoughts and experience with us as we continue to move towards our new way of working. We’ve heard that you’re keen to make certain that you understand the guidance we’re producing before we start using our new assessment framework. That’s why we’ve flexed and adapted our roll-out model to ensure that you can get to grips with the changes in the ways we’ll be working together. It’s worth a reminder, of course, that not everything is different. Throughout much of our model, ‘what’ we’re looking at isn’t changing a huge amount. It’s ‘how’ we’ll do it where you’ll see the difference. At the heart of our work, we’re still here to ensure that health and care services provide people with safe, effective, compassionate, high-quality care. We’ll also continue to encourage those services to improve. That hasn't changed.

Opportunity for change Our new regulatory approach will enable us to be more streamlined and effective. We’re moving from “inspection” and its snapshot of care as we cross the threshold, to a much more dynamic and adaptive approach. Our new online systems will provide greater consistency, simpler processes, easier contact methods, more transparency and the ability to change a rating more quickly when you improve. We’re starting to invite providers to sign up to our new portal. Please do make sure that your contact information is correct so that, when it’s your turn to be invited, the right person receives the email. Another of our key new pieces of work this year is our assessment of local authorities and integrated care systems. I am delighted that we have been given the remit under the Health and Care Act 2022 to build these relationships. We have a superb opportunity to look more effectively at how care is provided in a local system and can use our learning to share

insights with national Government about local care. I’ve said before that people are at the heart of all our work. That’s just as true in our systems assessment work as it is when we’re working with individual providers. We have both the opportunity and responsibility to amplify people’s experiences and to share good practice.

Your innovation journey Last month, we published a report into how we as a regulator can support and encourage innovation in care. Our new assessment framework includes a quality statement focusing on quality improvement and innovation. We encourage you to reflect on and share evidence of the innovative ways you’re working to improve people’s lives. You can use our new innovation journey map to explore how you can try something new and read case studies from other providers who’ve improved outcomes in an innovative way. We recently visited Abbey View, a care home in Dorset, and were pleased to be able to raise the home’s rating from Good to Outstanding. The home provides residential personal and nursing care for people, some of whom have life-limiting neurological conditions, such as motor neurone disease. Speaking about the inspection, Roger James, our Deputy Director of Operations in the South, said, ‘We saw that people were encouraged and supported to maximise their independence. For example, the home was using innovative communication methods to support people who were losing their previous communication skills. This helped them to maintain relationships and make choices about their own care. Innovative records, including the 10 most important things to know about a person, provided staff with insight into people.’

Data to improve outcomes We use the huge amount of data and evidence that we gather each year not just to publish inspection ratings for individual providers, but also to reflect on the whole health and care sector in England. In State of Care, published this month, we shine a light on the wellbeing of the workforce and the impact that positive wellbeing and staff enablement can have. The work we’ve done on staff wellbeing with front-line staff over the last year has helped us understand and define what 'good' looks like – something we’ll continue to showcase as our new quality statement on workforce wellbeing and enablement is rolled out in the new assessment framework in the coming months.

James Bullion, Interim Chief Inspector of Adult Social Care and Integrated Care, CQC. Email: providerengagement@cqc.org.uk X (formerly Twitter): @CQCProf CMM November 2023

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NEWS

APPOINTMENTS Ambient Support

Skills for Care to develop workforce strategy Skills for Care has published its annual State of the Adult Social Care Sector and Workforce in England report and announced plans to develop a new and comprehensive workforce strategy for adult social care. The report covers the year from April 2022 to March 2023, which saw some improvements in workforce capacity, largely driven by an increase in international recruitment, including more posts being filled, fewer vacancies and less turnover. The report also highlights ongoing trends for the sector, including 390,000 people leaving their jobs – with around a third of them leaving the sector altogether. This year’s report gives brand new insight into what works when it comes to keeping people working in adult social care. Key findings in the report include: • The workforce grew by 1% between April 2022 and March 2023 after shrinking for the first time on record the previous year. • The vacancy rate fell to 9.9% – around 152,000 vacancies on any given day – from 10.6% the previous year. • The turnover rate across the sector was 28.3%

in 2022/23 – down slightly from 28.9% the previous year. • Adult social care added £55.7bn per annum to the economy in England (up 8.5% from 2021/22) – which is more than the accommodation and food service industries. In response to those trends, Skills for Care will be working with a wide range of organisations and people who have a stake in social care, to develop a workforce strategy. The strategy will identify the social care workforce needed over the next 15 years and set out a plan for ensuring the sector has enough of the right people with the right skills. Oonagh Smyth, Chief Executive of Skills for Care, said, ‘We’ll be using the expertise, data, insights and relationships we have developed over the last 20 years to develop that strategy. Given the rich diversity of the sector, any strategy will only be successful if it's created by the many organisations and people that have a stake in the future of social care, so we'll be working with a wide range of partners who are willing to embrace and drive the changes we need.’

NCF publishes manifesto priorities The National Care Forum (NCF) is calling on all political parties to recognise that social care matters to us all in their manifestos by prioritising adult social care reform. NCF sent out five key must haves for reform and long-lasting financial and environmental sustainability, developed in association with its membership, which includes: • Think social care first – Ensure that people care about social care like they do the NHS and understand its central role in joined-up health and care for people. • Improve the pay, terms and conditions of the workforce – Care work is intrinsically skilled and valuable and must be remunerated to reflect this. • Invest in People, Not Profit – Adult social care should be for people, not profit. • The care economy matters: Create an economic growth strategy for adult social care – Social care is a large employer contributing £51.5bn to the English economy, making it an essential part of the national infrastructure.

It also has a large part to play in the development of a net-zero economy. • Enshrine Rights, Fairness and Choice for people in a National Care Covenant – Co-produce and set out clearly the mutual rights and responsibilities of citizens, families, communities and the state. Speaking ahead of NCF’s fringe events at the Conservative and Labour Party conferences in October and after she had chaired a panel at the Liberal Democrats conference, Chief Executive of The National Care Forum Vic Rayner OBE said, ‘All political parties must have social care at the top of their agenda as we move closer to the next election. Prioritising social care in this way will talk to the eight million unpaid carers, the 1.6 million care workforce, the millions receiving care at home or in a residential setting and the millions more unable to access the care they need when they need it, the families and friends of those needing care and the thousands of employers supporting those with caring responsibilities.

Ambient Support appoints Jane Homer as its new Head of Business Development. Jane has a track record of providing exemplary and innovative levels of service to a broad range of clients in the health and social care sector.

Bearsden Antonine House care home, part of leading care provider Meallmore Ltd, has announced the appointment of new manager, Shelley Watters. The 81-bed luxury facility in Bearsden cares for residents with a range of support needs including dementia and palliative care.

McCarthy Stone The UK’s leading developer and manager of retirement communities, McCarthy Stone has appointed Ciaran Aldridge as its new Managing Director for its Northern division. Ciaran joins from Aldi, the supermarket operator, where he was National Property Director since 2016.

Meallmore Ltd Care provider, Meallmore Ltd, has appointed Gavin Manson and Martyn Everett to its board of directors in non-executive roles. Gavin is currently Non-Executive Director of Unbound Group PLC and until June was Chairman of Hostmore PLC. Martyn is currently Non-Executive Director at Stewart Milne Group, as well as Non-Executive Director and Chairman of the Audit Committee at Interserve Group.

CMM November 2023

NEWS

Homecare provider viability threatened Homecare Association research suggests homecare provider viability is being threatened by late NHS and local authority payments. The research also found a reduction in volume of hours available per provider. The research, based on responses from 225 providers representing just over 23,280 care workers supporting nearly 42,995 older and disabled people, indicates that over eight in ten (80%) of homecare providers that hold contracts with the NHS and local authorities have experienced late payments. Nearly half (47%) of homecare providers say almost all of their invoices are paid late. The definition of prompt payment for a small business supplier, contained in the voluntary Prompt Payment Code, is to pay 95% of invoices within 30 days. The Homecare Association's research found that nearly a

quarter (23%) of respondents said their average payment length was over 90 days from the NHS. 21% of respondents said their average payment length was over 90 days from local authorities. Some small providers are owed as much as £350K and have been waiting for over a year. Larger providers report local authority debts of over £1m. According to the Homecare Association, late payments have a significant impact on businesses, leading to cash flow difficulties, which can affect their ability to pay bills and the business’s own suppliers. Without predictable payment terms, homecare providers find it difficult to remain sustainable, invest and expand, the Homecare Association continues. The survey also found that eight in ten respondents who are being commissioned

by local authorities have experienced a reduction in the number of hours available to them to provide. Nearly half (48%) said they had seen a 25% or above reduction in the number of hours available to them from their local authority. Homecare Association’s Chief Executive Officer, Dr Jane Townson OBE, said, ‘Late payment of invoices by the NHS and local authorities is a serious issue, threatening the financial viability of many homecare providers. Some are having to spend months fighting for thousands of pounds owed for care delivered, being pushed from pillar to post without resolution. Local authority commissioners need to appreciate the importance of the volume of hours available per provider, as the reduction of hours delivered severely impacts on financial sustainability of services.’

DHSC expands its recruitment campaign The next phase of the domestic recruitment campaign from The Department of Health and Social Care has launched to encourage people with the right qualities to begin a career in social care.

"... making the recruitment process easier with free resources to help providers fill their vacancies."

The ‘Made with Care’ campaign is returning for a third year, with advertising promoting the wide range of opportunities available to people across England to build a career in adult social care and help people live happy, healthy, fulfilling lives. Running until the end of March 2024, campaign advertising will appear to millions across video on demand platforms such as ITVX, Sky Go and Channel 4; radio and digital audio channels such as Spotify and social media and digital channels like Facebook and Instagram, to direct job seekers to www.adultsocialcare.co.uk.

While the campaign will look to encourage the public to consider if a career in social care may be suitable for them, the Department of Health and Social Care is also calling for all care providers to list their vacancies on the Department of Work and Pension’s ‘Find a Job’ portal, to ensure job seekers visiting the campaign website (www.adultsocialcare.co.uk) can find roles in their local area. The campaign is designed to encourage applications from the right personnel but also to make the recruitment process easier with free resources to help providers fill their vacancies.

Tender aims to provide cost-saving food solutions Care England has announced a joint tender with Creed Foodservice, one of the UK's fastest-growing food service providers, to leverage the buying power of other care providers and reduce costs. Three years of inflation have meant food and beverage costs have increased across the board for care homes by 35%. Energy and high freight costs have added fuel to the fire for the movement of food and deliveries. There’s not a commodity which hasn’t been affected. Care providers who wish to explore the cost savings that can be made with the support of Creed Foodservice can find out more by 10

CMM November 2023

visiting the Care England website where you can also find out how to participate in the food and beverage tender. Tom Workman, Director of Trading at Creed Foodservice, said, ‘Our most recent Commodity Report shows YOY food inflation at 15% which has been driven by poor weather and farming conditions, lack of access to resources, poor staffing levels and a rise in production costs caused by surging gas and electricity prices.' He added, ‘Over recent years we have seen some extreme commodity increases, particularly after the pandemic and more recently as a result of the invasion of Ukraine.

As the world’s supply chain adjusts, we are seeing a small number of improvements at specific product levels, however, there are no signs of any significant decreases on the horizon that would have a positive impact on the total basket. ‘In light of this, the Trading team at Creed Foodservice work diligently to provide cost savings through alternative products while at the same time not compromising on quality. These alternative products, combined with our competitive Country Range own brand have supported and continue to support our customers throughout these challenging times.’

CMM November 2023

NEWS

A new ‘guidebook’ to end of life care launches New polling has revealed over a third (38%) of adults agree they do not know what end of life support and services are available in the UK. Half (50%) admitted they have given little thought to planning ahead if they were to receive a terminal diagnosis. In response, Marie Curie, has partnered with Rough Guides to create the first ever UK 'guidebook' to end of life. The Rough Guide to the End of Life aims to help people navigate the end of life with guidance and information from Marie Curie. The charity aims to double the number of people it provides direct expert end of life care to by 2028 and highlights its services not only support those with advanced cancer, but any illness they are likely to die from including Alzheimer's (and other

Scan me

CMM November 2023

forms of dementia), heart, liver, kidney and lung disease, motor neurone disease, and Parkinson's. Despite end of life being inevitable for all, 40% said they would not know how to access the information or services required to best support the needs of someone nearing their end of life. Two thirds (64%) stated they would expect the NHS to refer them to all available resources if they were given a terminal diagnosis, however every five minutes someone dies in the UK without the care they need, according to Marie Curie. The Rough Guide to the End of Life intends to help with 'planning ahead', from offering tips on making a will and sharing your preferences for your funeral to what to do with your social media and online accounts.

Leaders of tomorrow report published A new report highlights how a lack of access to professional development could be harming aspiring leaders’ progress. This is following research conducted with over 250 social care leaders. The Leaders of Tomorrow report has been published by everyLIFE Technologies. It explores the opportunities, challenges and issues facing leaders in the care sector and provides insights for aspiring leaders. Professional development is a key area where aspiring leaders feel more can be done to support them on their career journeys. Four in ten (40%) polled in the research said a lack of training and one in three (34%) said a lack of mentorship acts as a barrier to their career progression. The report also found that nearly one in three (31%) aren’t

aware of any formal leadership opportunities in their current place of work. Today’s care leaders are facing challenges with recruiting skilled staff (59%), financial constraints (52%) and low staff morale (37%). While established care leaders are stretched, they recognise the value of professionally developing the next generation. Over half of today’s care leaders polled (58%) agreed that aspiring leaders can best be equipped to manage challenges in the sector by being offered professional development opportunities. Good communication (90%), a positive attitude (82%) and empathy (76%) are identified by established leaders as the top three attributes that future leaders need to ensure their team's success.

NEWS

New data published on disability hate crime charges Charges brought against disability hate crime continue to drop, according to figures obtained by Leonard Cheshire and United Response. Through Freedom of Information (FOI) requests to all police forces in England and Wales, the two charities found that just under 11,000 disability hate crimes were reported between April 2022 and March 2023. The data showed that roughly half of these reports involved violence and over 1,300 occurred online. While disability hate crime reports are down by 3.7% from the record numbers of incidents in 2021/22, they are still higher than pre-pandemic figures. Despite the drop in hate crime reports, just 1.2% (132 reports) resulted in a charge or

Call to increase efforts to tackle loneliness

summons. This is down from 1.9% in 2021/22. Across England and Wales, 36 of the 43 police forces provided figures on disability hate crimes. Around half (23) provided further data about outcomes resulting in no charge. The charities found that ‘evidential difficulties’, ‘victim withdrawing’ and ‘no suspect identified’ were the three most common reasons for victims to go without redress. The charities are calling on Government to reverse its decision to merge an anti-hate crime strategy into a wider plan to tackle general crime. According to the charities, Government must focus on developing and publishing a bespoke hate crime strategy, in close consultation with stakeholders and their families.

Charities including the British Red Cross, Mind and Age UK are calling on Government to increase efforts to tackle loneliness. New guidance has also been designed for the next government. Data from the Office of National Statistics shows 7% of people in the UK say they are often or always lonely. The number of people who are chronically lonely has risen by half a million since 2020. The charities have also highlighted that the impacts of loneliness on the workforce alone cost businesses £2.5bn a year. It also increases pressure on the NHS and social care, according to the charities. Recommendations from the charities include: • Appointment of a dedicated

Minister for Loneliness by the next government, supported by a cross-government team. • A refreshed strategy, with clear objectives and dedicated funding. • Guidance for schools and employers to tackle loneliness. • Reform of social care and support so disabled people, older people, and people with long-term conditions and unpaid carers can build and maintain relationships and connections. The call to action has been signed by 14 leading organisations. To read Call to Action: Tackling Loneliness & Building Community in full, visit the British Red Cross website.

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CMM November 2023

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NEWS NEWS / IN FOCUS

Sector calling for end of life care review The new Coalition of Frontline Care for People Nearing the End of Life, which includes Care England, the British Geriatrics Society (BGS) and the Gold Standards Framework Centre (GSF), is calling for enhanced core training in end of life care (EOLC) for generalist frontline health and social care workers. The coalition also wants to see a step-change in health and care integration from integrated care boards (ICBs) and heightened recognition of EOLC by the Care Quality Commission (CQC). In an open letter to the Secretary of State for Health and Social Care and Social Care Minister, the coalition has said that existing NHS resources could be better used to transform a vital system of care that is failing those most in need. Professor Keri Thomas OBE, founder and Chair of the GSF Centre, the leading training provider in EOLC for front-line health and care staff, said, ‘Most

hands-on care for people in their final year of life is given by the front-line generalist workforce, in both health and social care. Therefore, it makes sense to ensure that those giving most care to most people in their final years, in any setting, are well trained in EOLC. ‘The current system, however, is particularly failing vulnerable older people in their final years and the situation will only worsen as the population ages. Patterns of dying are changing too. Healthcare systems must adapt to the age-related conditions causing deaths and long-term illnesses by equipping front-line teams to provide proactive, personalised, co-ordinated and system-focused care for people in their final years.’ The open letter has been signed by seven health and care organisations which represent those providing front-line care to people in the last years of life.

One-off payment for local authorities The Department of Health and Social Care (DHSC) has announced it will allocate a £26,730 one-off payment for each local authority in England. The payment sets out to support the process of engaging with the forthcoming Care Quality Commission (CQC) review and assessment. This follows the changes made under the Health and Care Act 2022 which placed a duty on the CQC to review and assess local authorities’ delivery of their functions in relation to adult social care under part 1 of the Care Act 2014 commenced in April 2023. This grant is worth £4.1m. According to the DHSC,

the new CQC assessments will provide greater transparency over how adult social care is delivered at a local level. In addition, the DHSC has outlined that the new CQC assessments will make good practice, positive outcomes and outstanding quality easier to spot and share nationally, while also identifying where improvement and additional support is needed. The non-repeating grant will be provided to local authorities in the 2023 to 2024 financial year. The grant sets out to cover the time and resource required by local authorities to familiarise themselves and effectively engage with their first formal assessment.

IN FOCUS

UK hospices struggling to meet costs WHAT’S THE STORY? England’s adult hospices have had their Government funding cut by £47m in the past two years, according to Hospice UK. The charity has stated that insufficient NHS funding means many hospices are struggling to keep up with inflation and rising costs. Hospice UK has gathered data from Integrated Care Boards (ICBs) across England which shows that there is not a single part of the country where Government funding of local hospice services has not fallen in real terms in the last two years. Hospice UK calculated that for adults’ hospices, this means there is now a £47m gulf between the actual funding received and what the figure would have been had it kept pace with inflation.

WHAT WERE THE FINDINGS? The state funding hospices receive is primarily distributed through regional ICBs who have a statutory requirement to provide funding for palliative and end of life care appropriate to the level of need in their area. ICBs should provide ‘uplifts’ in contracts with organisations like hospices who provide those services, to reflect growing costs – though ICBs themselves ultimately rely on central Government for the funds they have available. Whilst some ICBs provided uplifts above the standard 1.7%, this still falls well below the increase needed to keep pace with inflation and help hospices keep pace with rising costs, Hospice UK has outlined.

Over the past two years: • No ICBs provided uplifts to hospice contracts to match inflation. • 5% gave no uplift at all. • 28% of ICBs offered uplifts below the basic NHS uplift. • Nine ICBs were yet to agree 2023-4 uplifts for hospice contracts by July 2023. Hospices provide care and support to 300,000 people a year across the UK. On average, only one third of adult hospice income comes from the state, leaving hospices to rely on charitable donations to pay for the majority of their vital work. According to Hospice UK, with the cost-ofliving crisis affecting everyone, many hospices are increasingly concerned that their local communities will not be able to continue to give as generously.

WHAT DO THE EXPERTS SAY? Toby Porter, Chief Executive Officer of Hospice UK, said, ‘Hospices are a vital part of our wider healthcare system. It is unfair and unrealistic for the Government to allow their funding to hospices to fall short and expect local communities that support hospices so generously to make up the shortfall. ‘ICBs have a duty to ensure palliative and end of life care in their area is well funded. But our data shows that nowhere is that funding anywhere near keeping pace with inflation. Our data shows that some hospices are still being paid the same in 2023 as they were two years ago to deliver services that now cost significantly more to provide.’ CMM November 2023

NEWS

Survey on support for unpaid carers Almost half of unpaid family carers are not getting the support they need as caring hours increase, a new Carers Trust survey has found. Carers Trust identified that a lack of support is particularly acute for ethnic minority carers, LGBTQ+ carers, older carers, those from poorer backgrounds and women. The main findings include: • Only 55% of all unpaid carers get the support they need to be an unpaid carer. • 41% say caring hours have increased over last year with one-in-eight caring for an extra 50 hours a week or more. • Unpaid carers are exhausted, but more than two thirds (68%) are unable to get a respite break from their caring role when needed. • Unpaid carers from the most

AGE UK analysis of internet use

vulnerable groups – older people, LGBTQ+ carers, those from Black, Asian and minority ethnic and lower socio-economic communities and women carers – receive the least help. Carers Trust’s Chief Executive Officer, Kirsty McHugh, said, ‘Many carers tell us their local carer organisations are a lifeline in these difficult times but these services require more funding and staff to ensure they can continue to provide high-quality support. Meanwhile, many are being pushed into poverty by having to give up paid work due to their caring role, often having to make do with Carer’s Allowance, a benefit which had proved completely inadequate and must urgently be overhauled.’

New analysis has revealed that 46% of over-65s in the UK cannot complete eight key tasks to use the internet safely and successfully. The charity says this shows that ‘digital by default’ is excluding millions of older people from being able to access and use the essential public services they need – including some for which they are the target audience and principal users. Age UK's findings coincided with the launch of its new campaign, #OfflineandOverlooked, designed to persuade Government to ensure that everyone can choose to access and use public services offline – by phone, letter or face to face as appropriate – rather than constantly being forced down a digital route. According to the charity, this

would end the discrimination against millions of older people who are not online or digitally savvy, that means many currently struggle to do routine things like make a medical appointment, order a blue badge for their car or pay to park it. A total of 2.7 million over-65s in the UK do not use the internet at all, equivalent to around one in five (22%) of this age group. This includes almost 500,000 over-65s who had used the internet in the past but don’t do so now. Almost one-in-four (23%) are unable to turn on the device and enter any account login information; almost three-in-ten (28%) are unable to find and open different applications; and one-in-four (25%) are unable to keep their login information and passwords secure.

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NEWS

George’s speedway wish is granted George Reade, an 88-year-old resident at the Albany care home in Headington, Oxford, had a special wish come true thanks to the care team. George's wish to go to the Oxford Speedway for a night of fun was picked from the wish tree at the home and he couldn’t be happier. The wish tree was introduced at the home to allow residents to talk about things they want to do and express their wishes for the future. He used to visit the speedway with his twin brother, Charlie, back when they were young lads. They both loved it, and George has been a fan since 1949 as well as an avid supporter of Oxford United. So, one exciting evening, George, along with senior carer

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Virgil Maciu, and activities co-ordinator Liz Perry, headed off to the Oxford Speedway. It was a night of thrilling motorbike racing, and the Oxford Cheetahs triumphed over the Redcar Bears in the last race of the season. George was overjoyed with the result. George is still talking about that amazing night out and the care home is working hard to grant more wishes in the lead-up to Christmas, making residents' dreams come true. Another resident, Mavis Fry, had a wish to spend a day in Blackpool, the place where she got married. Although a trip to Blackpool from Oxford wasn't possible, the care home made it special by creating a Blackpool-themed day with lights, traditional seaside rock, and ice cream.

Christ Church Apartments – which consists of three buildings totalling 62 self-contained apartments for people over 65 – is being developed by Birchgrove on a former Christ Church URC site. Representatives from Birchgrove, main contractor, Kori Construction, and Christ Church URC parishioners attended a ceremony to find out more about the building. Alison, who used to attend the church, said everyone connected with it had fond memories from the various events that took place there. All apartments are specifically designed for people in later life and include exclusive on-site amenities such as a restaurant, licensed bar, club room, fitness suite, library, landscaped gardens,

and new bowling green. Residents will also benefit from a regular events and activities programme, and for added peace of mind there will be a concierge and 24-hour staff presence. More than 30 new trees and hedgerows are to be planted on the site to screen the apartments from neighbouring properties, ensuring privacy. Northamptonshire-based Kori Construction was appointed as main contractor for the £23m development. Managing Director Jordan Connachie, said, ‘Breaking ground is always an exciting time with any new development and Christ Church Apartments is certainly no exception.’ Work on Christ Church Apartments is expected to be completed by February 2025.

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NEWS FROM ACROSS THE GLOBE WHO launches new Mental Health guidance To coincide with World Mental Health Day (10th October), the World Health Organization (WHO) and the Office of the High Commissioner on Human Rights (OHCHR) jointly launched new guidance, entitled ‘Mental health, human rights and legislation: guidance and practice’, to support countries to reform legislation in order to end human rights abuses and increase access to quality mental

health care. While many countries have sought to reform their laws, policies and services since the adoption of the United Nations Convention on the Rights of Persons with Disabilities in 2006, WHO says too few have adopted or amended the relevant laws and policies on the scale needed to end abuses and promote human rights in mental health care. The guidance

proposes legislative provisions to end coercion in mental health services and enshrine free and informed consent as the basis of all mental healthrelated interventions. It also provides guidance on how more complex and challenging cases can be handled in legislation and policies without recourse to coercive practices. The new guidance also provides a checklist to be used

by countries to assess and evaluate whether mental healthrelated legislation is compliant with international human rights obligations. In addition, the guidance also sets out the importance of consulting persons with lived experience and their representative organisations as a critical part of this process, as well as the importance of public education and awareness on rights-based issues.

Global Ageing Network celebrates older people

10% of Japan’s population aged 80 or older

The Global Ageing Network joined other non-governmental organisations and aged care stakeholders to celebrate the International Day of Older Persons on 1st October. The event put a spotlight on the specificity of older persons around the world, for the enjoyment of their rights and in addressing violations and how the strengthening of solidarity through equity and reciprocity between generations offers sustainable solutions to deliver on the promise of the Sustainable Development Goals.

Figures published by the internal affairs ministry ahead of Respectfor-the-Aged Day in Japan (which was on 18th September) show that those aged 80 and older for the first time represent 10% of the population. An estimated 36.23 million people in Japan were recorded to be aged 65 or older. The percentage of the total population rose to a record 29.1 percent, up 0.1 point from 2022. However, the number fell for the first time since comparable statistics became available in 1950 because the demographic group now reaching the age of 65 is relatively small. An estimated 20.51 million women were aged 65 or older, unchanged from 2022 and accounting for 32.1 percent of the female population. The number of men aged 65 or older fell 10,000 to an estimated 15.72 million, or 26% of the male population. The number of people aged 75 or older increased by 720,000

"We owe it to older persons today and in future years." According to the outcomes of the Fourth Review and Appraisal of the Madrid International Plan of Action on Ageing (MIPAA), age-based discrimination in institutions, 18

CMM November 2023

attitudes and practices continues to be rampant, highlighting deficiencies in the implementation of international and national frameworks for older persons. Systemic and structural barriers often exist for older persons in the context of work, standards of living, learning opportunities and access to services and resources because of ageist attitudes, discriminatory laws and policies, underfunding, and lack of accessibility and affordability, among others. Katie Smith Sloan, Executive Director of the Global Ageing Network said, ‘Global ageing is real – this is not up for debate. We owe it to older persons today and in future years to recognise and respect their right to live with dignity, with access to quality services and supports, and to live with purpose and contribute to their communities. On this day, we must join together to celebrate the gift of ageing.’

from 2022 to an estimated 20.05 million and exceeded the 20 million mark for the first time.

"The number of people aged 80 or older rose by 270,000." The age group includes many of the baby-boomers born in 1947 through 1949. The number of people aged 80 or older rose by 270,000 to an estimated 12.59 million, accounting for 10 percent of the total population. The National Institute of Population and Social Security Research projects that those aged 65 or older will account for 34.8 percent of the total population in 2040, when the so-called second-generation baby boomers born in 1971 through 1974 join the group. Social security spending, which represents about onethird of the annual Government expenditure, is growing at pace as Japanese society ages.

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CMM November 2023

IN THE DRIVING SEAT Supporting councils and providers to drive their own improvement journey In view of updates relating to the assessment framework, Michael Chard, a Senior Officer at Association of Directors of Adult Social Care Services (ADASS) explains how ADASS has been an active part of the discussions and development of the assurance process.

CMM November 2023

and published an independent report, Time to Act: A Roadmap for Reforming Care and Support in England. This report draws together the thinking that’s been done on the future path we could take for social care and develops a roadmap to get us there. Our point is that without adult social care reform, CQC assessment will become an expensive way of reinforcing what numerous reports have been telling us for a number of years. Namely, that despite the best efforts, social care is struggling to fully meet its legal duties which has a direct impact on the ability of people being able to live the lives they want to lead.

A complex task

I was on holiday recently and relied heavily on websites that rated restaurants and activities to inform my choices about where to go and what to do. It’s natural that people, their families and carers should be able to access information about the performance of their public services, after all it’s their money that pays for them. So why should adult social care be any different? As a former overview and scrutiny officer in a couple of councils, I’m a big advocate of transparency and accountability. This is no different at the Association of Directors of Adult Social Services (ADASS). We’ve been committed to the principle of transparency for a long time, and by proxy the implementation of the assurance and assessment of adult social care. However, as we set out in our response to the Health and Social Care White Paper, we are of the opinion that assurance should have followed long-term investment and reform of adult social care. We have since commissioned

I’ve led on the ADASS Spring Survey for several years and it’s clear from the insight collected that directors’ confidence in meeting their legal responsibilities is dwindling, which has a detrimental effect on those of us that need adult social care. This year, 86% of directors indicated that they are either partially confident or have no confidence that their budgets will be sufficient to fully meet their statutory duties in 2023/24; this has increased from 69% in 2017/18. We also know that over 400,000 people are waiting for an assessment, care or direct payments to begin or for a review of their care plan, which means too many people aren’t getting the care and support they need and too often, it's unpaid family carers being left to pick up the pieces. Aside from what social care is struggling to do, it’s also important to remember that adult social care touches on a broad cross-section of people’s lives across our communities. As well as care homes and homecare, it covers vital areas such as probation, carers, domestic abuse, mental health and homelessness, to name a few. This is one reason why we’ve not been supportive of the use of single-word ratings, because they can’t possibly reflect the complexity and reach of adult social care or show the public how good different parts of adult social care are. We have also seen the experience of Ofsted’s inspections

CMM November 2023

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IN THE DRIVING SEAT: SUPPORTING COUNCILS AND PROVIDERS TO DRIVE THEIR OWN IMPROVEMENT JOURNEY

of children’s social care, which has also shown the damaging impact a negative single judgement can have on retaining vital staff. There are already 152,000 adult social care vacancies; as such it’s vital for councils and providers that we don’t make the significant recruitment and retention challenges worse. Good data and insight are also areas where more work is required to ensure that assurance and CQC assessment of local authorities can better reflect the outcomes, views and aspirations of people who access care and support. In an ideal world, the data that feeds into the CQC assessment process would have been reformed by The Department of Health and Social Care (DHSC) prior to the formal ‘go live’ of assurance. DHSC has acknowledged, through the publication of Care Data Matters, its roadmap for achieving data transformation across adult social care. Most importantly, there is a commitment to update the user and carer surveys which are the primary means of gathering the opinions of people who access care and support at a national level. As work undertaken by Ipsos in 2021 found, the current surveys are not fully representative of the range of people who access care and support, including people with memory and cognition support needs, mental health as their primary support reason and the youngest and the oldest people from all ethnic minority groups. I’m hopeful that CQC assessment will offer the opportunity to ensure that those people who are under-represented in these surveys will have an opportunity to have their say. Providers will also have a role to play in local authority assessment. The CQC local authority assessment framework includes care providers and local provider forums as key partners from whom feedback will be sought, including through surveys. CQC also has a swathe of knowledge from its provider assessment work which will also be used to feed into the process.

Shaping the framework Although we may not agree about the use of single word ratings, ADASS has been an active part of the discussions and development of

the assurance process with the Department of Health and Social Care, CQC and the Local Government Association. For me personally this process has been one of the most open and transparent that I can remember since the development of the Care Act guidance. During the development of CQC's assessment local authority framework, real positives emerged, such as the use of Think Local Act Personal’s I and We statements to help shape the content, to ensure that what good looks like from an individual perspective is at its heart. We know that good-quality adult social care helps thousands of people to stay well and live the life they want every day. However, we are realistic that there may be instances where services and support could be better, which led to the development and publication of the operational framework for adult social care intervention in local authorities. The framework clearly sets out what will happen if improvements are needed and acknowledges that councils should be given the opportunity to drive their own improvement journey. On the latter, I know that a significant amount of work has gone in across councils, with support from their ADASS and Partners in Care and Health at a national level to prepare for the assurance. From our regular discussions with the directors of the five pilot areas, it’s clear that the process has been challenging, but also worthwhile. Staff have positively embraced the opportunity to share the good work that they and their teams are doing with CQC assessors. You can read about the experiences of one of the pilot areas, Lincolnshire, on the ADASS website. You will see from Glen Garrod, Lincolnshire’s Executive Director of Adult Care and Community Wellbeing, the type of process that councils can expect from the CQC’s local authority assessment process. The process is much more than CQC assessors visiting a council and holding interviews (which is an intensive period in itself), it starts weeks in advance with evidence gathering and the collation of key documents. There is also a range of follow-up activity from CQC, with the need for clarifications and further evidence requests.

Continuous improvement It’s an ongoing process, which is important as the learning from the evaluation of the five local authority assessment pilots will shortly be discussed by all the groups involved with assurance, prior to the CQC starting the formal baseline assessments later this year. This will guide decisions on whether the documentation that underpins assurance and CQC’s assessment framework for local authority assurance support CQC to refine the assessment process such as information requests to councils. It's also important to remember that Integrated Care Systems (ICSs) will be subject to a separate CQC assessment, with Birmingham and Solihull ICS and Dorset ICS acting as the pilots for this approach. CQC will need to ensure that learning from these pilots, including the evidence gathering process, is used to refine their approach for both ICS and local authority assessment so that they are as efficient as possible to minimise burden on councils and their staff. Interestingly CQC has recently announced that these pilots, unlike CQC local authority assessment pilots, will not be subject to ratings.

An opportunity to celebrate One thing that struck me when looking at websites that rated restaurants and activities when I was on holiday was the importance of the detail that exists beneath the star rating. It’s only when you read this and look at the pictures that have been posted that you begin to get a real sense of what a place is really like. Although not directly comparable, the same will hold true for single word ratings from CQC. It’s only when you take the time to read the narrative, that you’ll be able to get a sense of the real value of what social care teams are doing. Beyond the judgements, my hope is that assurance will offer an opportunity to highlight and celebrate the good that adult social care does each and every day. CMM

Michael Chard is a Senior Officer at ADASS. Email: michael.chard1@adass.org.uk X (formerly Twitter): @1adass Do you agree with the comments made in this article relating to the assurance framework? Visit www.caremanagementmatters.co.uk and share your feedback on the article. CMM November 2023

N A E R A C L A I C O S T L U AD G N I T O O D N REB A L E R I RN E H T R O N N I T R O P P SU

What was propo sed and how much progress h as been made?

Des Kelly OBE and John Kennedy advised the Government on how to reform adult care and support in Northern Ireland and shared the initial proposals with CMM in 2018. In this article, John Kennedy, a Housing and Social Care Consultant, reflects on the Power to People report’s progress in that time and shares the outcome of the 2022 public consultation.

CMM November 2023

Now I know very little about music, but I do love a good analogy. But since I make them up sometimes, they don’t work! The reform of social care is always playing in the background. It’s always part of the background music but never the headline act. In music terminology there is the term ‘Ostinato’ or ‘stubborn’ in Italian. It describes a piece of music where a phrase or rhythm is repeated throughout; think Ravel’s Bolero. Never quite building, never reaching a crescendo. Rolling back on itself over and over again. Just like the debate on the reform of social care. How many reports? How many White papers? How many Green papers? How much bluster, how many times must we hear: ‘We’re going to "fix" social care’?! Reform of social care is evidently ‘Ostinato’.

Irish insights In 2017 the Northern Ireland Assembly published Power to People: Proposals to reboot adult care and support in N.I. Des Kelly OBE and I were privileged to have been asked, by the then Health Minister Michelle O’Neil, to write the report following months of touring the province, talking to all manner of folk and seeing many excellent examples of forward-thinking enterprises and innovation. We were encouraged to be ‘radical’ in our proposals from almost everyone we met. The report defined the need for change as ‘a good system of social care can transform lives – it’s that simple. Not just for those who receive social care services but their families, friends and communities too’. The aim of the panel’s report was ‘to challenge the current

approaches, attitudes and established ways of delivering adult care and support to embolden a genuine public movement for change and transformation.’ In the final report we tried to look above the detail of the current and instead to look at the principles and values that a good social care system would value. We marshalled our proposals into seven main themes, as follows.

The value of social care The nature and importance of adult care and support and the contribution it makes to personal wellbeing, health services, society and the economy. Social care needs to be elevated to a far higher status in Government priorities as well as in the minds of citizens, families and communities.

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REBOOTING ADULT SOCIAL CARE AND SUPPORT IN NORTHERN IRELAND: WHAT WAS PROPOSED AND HOW MUCH PROGRESS HAS BEEN MADE?

The citizen at the heart

Putting people, rather than structures and systems, at the centre of all. How do we challenge the power relationships in social care and ensure a far greater degree of Consumer Sovereignty?

Family carers – vital partners for social care The bedrock of social care, as their contribution is the principal way that most people experience care. It is vital that they are treated as partners.

Building resilient communities People live in homes and communities, not in social care systems. How an asset-based community approach could be fundamental in underpinning the structure of a transformed approach to care and support with a crucial role for social workers.

The professional workforce in social care The people who care for us may be doing it for a living, but they are people too. They need to be valued, not exploited.

The ‘market’ for care and support The market doesn’t function in the way we need it to do. What might be done so that an effective and responsive market can be sustained and thrive?

System alignment – making integration meaningful The need for the various systems relevant to adult care and support to be properly aligned.

Towards a new concordat A new settlement between individuals and the State with a recognition that rights are balanced by risks and responsibilities on both sides. Alas despite a broadly positive critical response and several lively radio phone ins, no fundamental change has yet resulted. However, there are some unique reasons why this has occurred. The NI Assembly has only been in session for 13 months of the 58 months since the report was published. There

is only so much a civil service can do about fundamental reform. There has been, however, some clear evidence of a level of Ostinato: stubbornness in the form of tenacity. When the assembly reconvened in January 2020 it was preceded by the publication of A New Decade, New Approach: Priorities of the restored Executive. Up there in the top three is Power to People. On the first page of the report, it details that ‘the parties have agreed that the immediate priorities for the Restored Executive should be: Transforming our health service with a long-term funding strategy.’ The Executive will: • Immediately settle the ongoing pay dispute. • Introduce a new action plan on waiting times. • Deliver reforms on health and social care as set out in the Bengoa, Delivering Together and Power to People reports. Despite political difference of a significant nature all parties could agree on the urgent need to reform social care. So, the dust was blown off and in January 2022 a public consultation on the reform of social care was launched. The consultation ran to July 2022. Summary and evaluation of responses was published in May this year. The consultation was detailed and extensive and I’m not going to bore you with following every point (admittedly you may already be!). But you may be curious to see how much of the key recommendations in Power to People made it through to the consultation and how they were received. The fundamental message from Power to People was to shift the power from the ‘system’ to people and families. The proposals within tried to set out the levers of control and to move them into different hands. Distilled down to the paraphrased basics, Power to People proposed: • Make the use of direct payments the norm. Put the purchasing power in the hands of the consumer. Allow consumers to shape the market. Shape the market through consumer sovereignty and not commissioner sovereignty. • Elevate the status of informal care. After all it’s the majority of social care by far. • Radicalise communities to discover their assets and catalyse neighbourhoods. • Respect and value the social care workforce. How can we expect them to care for us if

we don’t care for them? • Enable a mixed economy of care to energise innovation and create the space for new ideas and ways of doing things. • Regulate the profit motive. There is plenty of room for ‘profit with purpose’ in social care but no room for ‘profit maximisers’. Level the market conditions to ensure fair play.

Level of engagement The consultation was detailed, and the evaluation summary report has a lot to read through. However, there is lots to be encouraged by. Some headline picks: The Department proposes increasing Direct Payment rates to broadly match the cost of equivalent directly commissioned services. The Department proposes the introduction of increased powers of inspection and regulation in relation to overheads and management costs and levels of profit. The Department proposes to improve the pay, terms and conditions of the lowest paid in the social care workforce. The Department proposes strengthening the capacity of the social work profession to support community-focused practice. The Department proposes the introduction of an independent Carers’ Champion role. Carers will be supported in their caring duties and entitled to support in their own right. The consultation period was extended due to the level of engagement. The evaluation summary cites high levels of support for the direction of travel of the proposals. The majority of respondents (70%) agreed or mostly agreed to the proposals. So, room for optimism?

More to come Leading by example, Northern Ireland, along with all the parts of these islands, is struggling to grasp the nettle of reform. Demands, needs and expectations are changing, and the system needs to reform. It is collapsing in slow motion. Will anyone be able to break free of the Ostinato? Break out a riff or maybe we might just have to be content with a Poco a Poco Crescendo! I was over recently and met with a couple of folks who had been involved in the original report. Despite the consultation there is still no political representation, so unfortunately expectations of any imminent move towards implementation of reform are somewhat low. CMM

John Kennedy is a Housing and Social Care Consultant. Email: jpkennedy366@gmail.com X (formerly Twitter): @johnnycosmos What do you think we can learn from Northern Ireland’s approach to reforming social care? Visit www.caremanagementmatters.co.uk and share your feedback and reflections on the article. CMM November 2023

evidence provided in focus groups, interviews and case tracking, the regulator has expressed.

Evidence categories

INTO PERSPECTIVE How can providers prepare for CQC's new assessment framework? The CQC’s new assessment framework aims to be more relevant to the way care is delivered today. With key changes to navigate, CMM finds out what the experts recommend that providers do to prepare for the framework’s roll out. Key questions and quality statements Under the CQC’s new assessment framework, the Key Lines of Enquiry (KLOEs) have been replaced by a set of key questions and subsequent quality statements. The new key questions will be centred around the familiar ‘Safe’, ‘Effective’, ‘Caring’, ‘Responsive’ and ‘Well-led’ criteria, while a host of new quality statements that relate to applicable legislation 28

CMM November 2023

will sit under each key question. According to the CQC, the new quality statements are the commitments that providers should live up to. The CQC will define each quality statement using a ‘We statement’, which summarises for providers what is needed to deliver high-quality, person-centred care.

Informed decision-making The CQC has developed its new quality statements using aspects of the Making It Real framework. This is an initiative that has been co-produced by Think Local Act Personal (TLAP), which worked with a range of partners and people with lived experience of using health and care services. Alongside the aforementioned ‘We statements’, which providers will be encouraged to align their practices with, a series of ‘I statements’ have also been created (and also linked to the new quality statements) as part of the regulator’s commitment to listening to and acting on what matters to the people who are experiencing services. A provider’s compliance with the ‘I statements’ will be measured using

The onus on providers to evidence quality care remains a fundamental aspect of the CQC’s new assessment framework. The regulator has outlined six categories of evidence that will be examined to make judgements and contribute to the determination of providers’ overall ratings. In addition, the CQC has stated that it will inform providers of the particular evidence categories that will be focused on when assessing a particular quality statement, including some examples of the types of evidence in question. The CQC’s new evidence categories are ‘people's experience of health and care services’, ‘feedback from staff and leaders’, ‘feedback from partners’, ‘observation’, ‘processes’ and ‘outcomes’.

Other key differences The regulator has summarised other key differences from its current model of assessment for the benefit of providers. Firstly, the CQC has highlighted how it will place less emphasis on using inspections as the primary way of gathering evidence. Instead, it will collect evidence at different times and through different channels, such as talking to the people who are receiving care services. Secondly, the CQC has revealed that it will no longer use the rating of a service as the main determination of when it next needs to assess. Evidence the CQC collects or information it receives at any time may trigger an assessment. Lastly, the regulator has shared how it will make judgements about quality more regularly, instead of only after an inspection as it does currently. The CQC will use evidence from a variety of sources and look at any number of quality statements to determine this. Its assessments will be more structured and transparent, the regulator continues, using evidence categories and giving a score for what it finds.

Preparation is always key to avoidance of failure

Points mean prizes

Rob Baillie, Founder and Managing Director, Care Quality Solutions Linkedin: robbaillie Email: support@carequalitysolutions.co.uk

Philippa Doyle, Partner and Head of Social Care, Hempsons @PhilippaDoyle1 Email: p.doyle@hempsons.co.uk

As we prepare for the delayed implementation of the CQC’s new assessment framework, some may struggle to see how the jigsaw pieces we are being drip fed will fit together and question whether to wait for the picture to be completed or start preparing now. My advice is preparation is always key to avoidance of failure. In your preparation, it will be vital that you remain up to date with all publications presented by the CQC by subscribing to its newsletters and updates service. Remember that the CQC is the driving force behind all the changes and not the speculators or spectators. The new provider portal is being introduced in stages, with a pilot programme already underway and the rollout will continue until March 2024. You should ensure that the CQC has your up-to-date contact details to ensure receipt of your invitation to use the portal. Be sure to continue improving and maintaining the highest

possible standards of care using the methodology and tools that you already have available to you. Remembering that ‘good’ quality care is just that, irrespective of any changes to evaluation processes and functions. Under the new regulatory approach, the five key lines of enquiry (KLOEs) will remain so, but it will be key to consider the published changes we know to expect, such as the new ‘quality statements’ which are aligned to the KLOEs. Take time now in your preparation to map and gap any potential shortfalls in your governance and audit systems and processes. Identify the areas of change to understand what evidence will fit where and where there may be more focus than previously. Whilst these changes may be overwhelming, taking small steps now to develop your understanding of the revisions to scoring and rating frequency etc. will be key to your ongoing success.

"Take time now in your preparation to map and gap any potential shortfalls in your governance and audit systems and processes."

It’s early October at the time of writing and we’re still not entirely sure on how the new CQC inspection regime is going to work. We’re being drip fed information on timings, quality statements and evidence categories and, whilst it’s helpful to see what sort of information CQC will need to see from providers to measure each quality statement, drilling down into the detail remains a bit challenging. There are six evidence categories: • People's experience of health and care services. • Feedback from staff and leaders. • Feedback from partners. • Observation. • Processes. • Outcomes. Evidence in one or more of these categories might be needed by CQC to answer a quality statement. Added to that, depending on which sector you operate in, slightly different evidence categories might come into play. Take, for example, the care home and supported living services sector. Under the ‘Safe’ domain, there is a quality statement on learning culture. The evidence categories that

come into play here are: 1. Feedback from partners – these being commissioners and other system partners and health and care professionals. 2. Processes – where CQC will review duty of candour records, evidence of learning and improvement, incident, near misses and events records. The provider is then scored on that evidence to answer the quality statement. The points system ranges from one to four (significant shortfalls, some shortfalls, a good standard and an exceptional standard). That score is then added to your scores in all the other quality statements in ‘Safe’, to give you an overall percentage for ‘Safe’, which dictates your rating. • 25 to 38% = inadequate. • 39 to 62% = requires improvement. • 63 to 87% = good. • Over 87% = outstanding. So, each quality statement is answered by way of evidence in different categories, which is scored, and then fed into an overall score. Points mean prizes so get your evidence sorted and you’re half way to a decent rating.

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The Care Innovation Challenge: CMM meets the winner CMM would like to offer its congratulations to all of the finalists of this year's Care Innovation Challenge – the passion, commitment, creativity and team spirit shown by Team Careberry, Team Kit, Team Wellpal, Team Night Safety and Tresacare was so fantastic and really inspiring to see. CMM can’t wait to see how all of the finalists develop their ideas as they aim to support the care sector.

The Care Show took place on 11-12th October at the NEC in Birmingham and on the second day of the show, the winner of the 2023 Care Innovation Challenge was crowned! CMM caught up with Elizabeth Beh, Founder of Tresacare and Sean Davey, Marketing Advisor and Non-Exec Director at Tresacare, to hear their reactions on winning the competition and to find out what’s next for the start-up.

Neil Eastwood, Elizabeth Beh, Sean Davey

Tucked away but by no means out of view – the Care Innovation Challenge Hub was quite literally a hub of activity on the final day of the Care Show. Finalists stood proudly by their informative giant boards, but it was also their giant personalities and smiles that encouraged passers by to listen and to find out more about their ideas. The public vote closed just before lunch and the judges united in the café to debate and discuss each finalist to decide on a winner. It was not an easy decision and judges had to weigh up the evidence and untangle each idea thoroughly and then cast the final vote. The judges chose to name Tresacare the winner of the 2023 Care Innovation Challenge – Tresacare is a social enterprise that elevates care quality by equipping care workers with the tools and skills they need to stay happy and resilient on the job. Neil Eastwood, Founder and Chief Executive of Care Friends and Tresacare mentor, said, ‘Tresacare is deeply committed to improving care worker wellbeing and staff retention within the social care industry. It’s well timed to meet our industry’s needs.’ CMM November 2023

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THE CARE INNOVATION CHALLENGE: CMM MEETS THE WINNER

> CMM: Congratulations to Team Tresacare. How has your Care

Show experience been?

Elizabeth: Regardless of what happened at the final – I have to say that all of the finalists are amazing, and I knew it was going to be really close. The winning wasn’t the main thing for me. Over the last couple of days at the Care Show, I have spoken to care providers and they have taken our flyers and say they really want to work with us. It’s all business development and as mentor Rich Amos was saying, it’s just the beginning! Sean: What’s been great about being at the Care Show is that we have had a lot more conversations with managers, operational directors and people who are responsible for the workforce. We are starting to see how we can develop the product to meet care worker needs. We hope to get care providers and the workforce aligned and to help everyone; that’s the sweet spot really isn’t it. CMM: What updates do you have since we last spoke? Elizabeth: When we went to the Care Innovation Challenge weekend, we were a wellbeing programme and then the feedback we received was that there isn’t budget for wellbeing but there is budget for training. Through the stages of development, I decided to come back to our core mission and focus: to support care workers to stay in the sector and to avoid burnout. We are now a training academy – that’s the pivot. We are a training academy but we are equipping care workers with soft skills around how to avoid burnout and improve the quality of care and that’s combined with a wellbeing gym as well. Sean: At the moment we are in the product market fit stage, where we are talking to lots of customers, trying to co-design as much of the content as possible with care workers, which is its own marketing element. We're using storytelling to share the impact. Care workers often buy into that training so much more if it’s coming from someone with that lived experience. The traditional line of training in the classroom can be quite patronising and not that engaging. We are encouraging care workers to think about their own experience and building that community really. CMM: How do you envisage the delivery of the training? Elizabeth: We are still flexible – the idea is that we have a three-week course or a three-month course and this will be either in person or virtually. Attendees will learn about the vocation of being a care worker, bereavement support, how to build resilience, and stress management. Throughout this programme, care workers will also be able to join a wellbeing gym and they will receive financial rewards for joining the gym. We hope that after doing the programme care workers become ‘re-energised’. I like to explain it by saying that Tresacare’s training will ‘top up’ their cup – we refuel them, so they get the energy to keep going. Tresacare also specialises in offering pastoral and wellbeing support to international care workers who have recently arrived in the UK, generally within the past 12 months. Recognising that these

“I would urge people to come to the Challenge with an open mind – it's not about winning or making lots of money.” care workers often experience loneliness and isolation, we facilitate peer support and mentoring, as well as deliver induction training. Our training encompasses essential aspects such as intercultural understanding, communication skills, housekeeping, food preparation. This holistic approach helps them acclimatise to life in the UK and enhances the quality of care they provide. Additionally, we offer bereavement training to help care workers manage the emotional aspect of working with end-of-life clients, enabling them to gain a constructive perspective on death and grief. CMM: What’s next for 2024 and beyond? Elizabeth: Our goal for next year is to build the online learning management system to scale our impact. So far, we have worked with 40 care workers, and I would love to be able to say next year that we have worked with 1,000 care workers and be able to show the impact that the training has had on care workers and people receiving care. I also need to make sure that I don’t burn out, so I’m applying for financial grants and would love to be able to hire someone to work alongside me on a part-time basis. Sean: We’ve just launched a course online with Lakefield Hospitality College, the course was co-designed by Liz and Lakefield's team. We are going to build more partnerships like that where we work with people who are already providing training, trusted brands, but we inject that care worker wellbeing element to it. We are still seeing where that market area fits, still evolving and will keep looking at the underlining technology element to it. It’s about scaling it, testing it, building that community of care workers so what we are doing is for them, by them. CMM: How would you describe the overall experience? Elizabeth: The experience itself is so worthwhile, especially with the mentoring that you receive and the contacts that you meet. I would urge people to come to the Challenge with an open mind – it’s not about winning or making lots of money. It’s for those people who genuinely want to make a difference in the care sector. It’s good to be curious and go in with the mindset of working with other people and not having a fixed idea. Learn and speak to service users and speak with all of the different mentors. I'm incredibly thankful for Neil Eastwood's generosity and understanding, especially when I experienced a health crisis in the midst of the Challenge. During that difficult time, Neil's support extended

CMM November 2023

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THE CARE INNOVATION CHALLENGE: CMM MEETS THE WINNER

> beyond business concerns; he cared about my wellbeing as an

individual. As a transparent founder, I can attest that the journey is far from easy. However, my own health challenges have actually fueled Tresacare's mission to support care workers. I have spoken with the Care Workers Charity, and we have an active partnership with National Association of Care and Support Workers (NACAS). I think the NCF should definitely continue with the Challenge – I think it’s great because it provides a platform. I would never have been able to afford to come to the Care Show, so having that opportunity for innovation is fantastic. There is always going to be a need to innovate. Sean: I met Liz through the Year Here programme (a full-time postgraduate course and incubator in London designed to cultivate innovative approaches to entrenched social problems) and we both came from corporate backgrounds and felt disillusioned and spent a year volunteering, looking at our own values, our own wellbeing. I think Liz is really far on in her journey; she’s really found her mission with supporting care workers. For me, I’m still working out where I want to have the most impact but being able to support her and be part of the Care Show is amazing. It’s such a tangible way to help people. CMM: Are you excited by other innovations in the care sector? Elizabeth: I think there is a huge need for what Wellpal is doing –

Rahim is so passionate – intergenerational support is so important. I have also heard about ME Passport – they are planning to build a passport for care workers that includes DBS, care certificate and so on, so when they move from one organisation to the next, they don’t need to re-do their forms etc and help to prevent a delay during the onboarding process. Professor Vic Rayner OBE, Chief Executive of the National Care Forum, said, ‘Each year of the Care Innovation Challenge our mentors and judges hope the new cohort of entrants will follow in the footsteps of previous innovators and bring some great, fresh new ideas to help tackle some of the biggest challenges we face as a sector. We were certainly not disappointed by the entries we received, and the projects put through to the final at the Care Show represented the best of the best from a very strong field indeed! On behalf of the whole Care Innovation Challenge and NCF team I warmly congratulate our winners, Tresacare, whose training, wellbeing programmes and HR consultancy offering addresses some of the key issues around workforce. We’re welcoming entries to the 2024 Care Innovation Challenge and encourage any budding innovators, who think they have a great idea that could turn into a solution to a key challenge within social care, to enter and hopefully be selected to come and join the Challenge Weekend next July.’ CMM

For more information about the Care Innovation Challenge, visit https://careinnovationhub.org.uk/challenge/ X: @CareInnovHub CMM interviewed all of the finalists for the Care Innovation Challenge. Visit the CMM website and search ‘Care Innovation Challenge’ to read the features. CMM November 2023

A hopeful step forward Delivering the Oliver McGowan Mandatory Training

CMM November 2023

The Oliver McGowan Mandatory Training on Learning Disability and Autism is named after Oliver McGowan, whose death shone a light on the need for health and social care staff to have better training. Sally Dunne, Learning and Development Lead at Choice Support, and Mark Rawlings, Admin Support Assistant at Choice Support, share insights into the training.

Choice Support is a charitable Community Benefit Society working across much of England to provide the best possible support to autistic people, people with learning disabilities and/or mental health needs. As the Learning and Development Lead at Choice Support, I was sceptical about the need for the Oliver McGowan Mandatory Training in social care settings. Like many other large providers, I had the belief that what we were providing already met our needs. However, from the moment I attended the lead trainer course run by Mencap and the National Autistic Society I began to think differently.

Understanding the need We began our roll out of Tier Two in April 2023. The Oliver McGowan Programme has co-production at its centre. Through working with co-trainers with lived experience, I have had to challenge my previous views and review my approach to the learning and development of social care staff. With 25 years’ experience in the social care sector, and as a carer for autistic relatives, I believed I was somewhat knowledgeable in this area. However, it has been my privilege to train and work alongside some exceptional autistic co-trainers and co-trainers with learning disabilities who have challenged my way of thinking. I would say there are barriers to overcome; in a sector already struggling to recruit and retain staff, an additional training requirement with no extra funds is a challenge. Although if our current approaches were enough, then the average life expectancy of people with learning disabilities and those who are autistic would be the same as the general population. Research1 has shown that people with learning disabilities and those who are

autistic do not receive the same quality of care as those without a learning disability or people who are not autistic. During training sessions at Choice Support, the co-trainers have sadly shared experiences that highlight how society remains inaccessible. However, people with learning disabilities and those who are autistic know which simple reasonable adjustment would have the most positive impact for them. We just need to listen to them! So far, all co-trainers I have worked with highlighted the need for similar training for education, police and retail staff. Therefore, training for health and social care staff should just be the beginning.

Time for action I know many health and social care providers are waiting for the Code of Practice to be finalised. This suggests that they will not implement the training unless mandated. However, the Oliver McGowan Programme is a co-produced, tested, evaluated programme that is available now and can improve the quality of life for everyone. My call to action is that as a sector we should be lobbying the Government for the funds to roll out the Oliver McGowan Mandatory Training Programme rather than debating whether it is needed at all.

Choice Support approach At Choice Support we have trained 11 facilitators and 24 co-trainers with lived experience. We have added the eLearning to our learning management system and assigned this to all staff. We have begun the roll out of the face-to-face Tier Two training across the whole organisation with events scheduled every month at our main offices. We are prioritising new staff and intend to have trained all staff within 18 months. We have assumed that funding will not be made available to us and have therefore budgeted accordingly to enable all our staff to attend training. We have also set aside funds to pay the salaries of co-trainers. The feedback to having co-trainers has been extremely positive, with delegates commenting on the fresh perspective. We intend to extend the use of cotrainers to other courses we deliver.

Overcoming obstacles Having enough co-trainers is the biggest challenge to overcome. Initially I was surprised that we had spaces on our ‘Train the Trainer’ courses. However, fears of how benefits may be impacted has prevented some potential co-trainers coming forward. For example, several of the co-trainers have highlighted

CMM November 2023

A HOPEFUL STEP FORWARD: DELIVERING THE OLIVER MCGOWAN MANDATORY TRAINING

> that they would like to deliver more sessions but the rule around

their benefits and pay prevents this. I have also heard large NHS Trusts plan to recruit full-time co-trainers. This reflects a lack of awareness of the needs of autistic people and those with learning disabilities, including the risk of burnout. At Choice Support we have looked to have several co-trainers in each geographical area. The lack of previous work experience from co-trainers has impacted on the confidence of potential candidates to apply. To overcome this, we have marketed the ‘Train the Trainer’ course as taster sessions with no requirement to take up employment at the end. Even with the taster session approach, we have needed more co-trainers than internal applicants. We have worked with local colleges, autism support groups and family members of our current workforce to find additional candidates. We don’t expect people to come to the taster events for free because three days is a big commitment. Therefore, we offer a voucher for those who complete. This has led to about 80% of attendees choosing to progress to a contract at Choice Support. For those who wish to be employed, another barrier is the need for identification to meet the DBS requirements and proof of right to work in the UK. Many people with learning disabilities or autistic people do not have passports or driving licences. Furthermore, some have appointees so do not have letters addressed to themselves.

Reasonable adjustments A main feature of the course is understanding what reasonable adjustments are needed and ensuring these happen in healthcare settings. It is essential that we demonstrate this good practice and meet the needs of our co-trainers and our delegates. This includes having fidget toys available, being able to reduce the sensory stimulation such as turning lights off and having spaces for people to go to if they become overwhelmed. Another reasonable adjustment is the need for some co-trainers to have support to travel to the training. All co-trainers train with a facilitator; however, some co-trainers need additional support from their regular support team. These all come at an additional cost so need to be factored into a roll-out plan.

Co-trainer perspectives Mark Rawlings, a co-trainer, shared his perspective on delivering the training. He said, ‘I am an autistic young man. I work as admin support at a Choice Support employment service. My manager put me forward for the co-trainer role. I took part in a three-day Train the Trainer course in April 2023. Since then, I have co-trained eight facilitators and nine co-trainers. Those trainings were a huge success! All of the facilitators expressed that the training was incredibly valuable and how they were

able to gain so much more insight into autism having been trained by an autistic person, as opposed to being trained by someone who does not have autism. All eight facilitators couldn't wait to start training and they all wanted to have me as their autistic co-trainer. 'Another staff member who has worked as a learning disabilities nurse for more than 40 years said, "I have learned more about autism in these three days of training than in the whole of my career" and said how it even helped her to support a family member to support their autistic child. 'The training is incredibly inclusive for everyone; especially for me as an autistic co-trainer, not needing to mask is really important. For example, I bring my own fidget toys and feel comfortable to use them throughout the training. Other co-trainers also don’t feel like they need to apologise for needing reasonable adjustments such as: wearing sunglasses because the lights or the sun is too bright; needing to walk out and have some space, because hearing Oliver's story for the first time can be distressing; and needing to put some headphones in because of feeling overwhelmed. 'I think that an opportunity like this is extremely important; it not only provides training to health and social care professionals but also enables autistic people, of which only 29% are currently in paid employment, the opportunity to make a living. It also enables those with a learning disability, of which only 6% are currently in paid employment, that same opportunity. I would love to see more opportunities like this, because this training will enable health and social care professionals to better understand how to help autistic people and those with a learning disability. To ensure that the professionals on the training learn from the people who experience these conditions on a daily basis, so that they can adapt their practices to ensure that the tragic story of Oliver McGowan is not repeated, rather than just reading from some textbook and not learning how to put that information into practice.’

Achieving good outcomes I strongly encourage social care providers to do their due diligence and investigate how to successfully deliver the Oliver McGowan Mandatory Training in social care settings. Given the great uncertainty on funding from this Government and of the next Government to take office, it is our duty and task as facilitators to take action and call on the Government to ensure the best possible care and outcomes for people with learning disabilities and autism. Visit the NHS England website to stay up to date with the latest development relating to the Oliver McGowan Training. Visit www.hee.nhs.uk/our-work/learning-disability/current-projects/olivermcgowan-mandatory-training-learning-disability-autism CMM

References 1 Learning from Life and Death Reviews of people with a learning disability and autistic people | Local Government Association Sally Dunne is the Learning and Development Lead at Choice Support. Email: sally.dunne@choicesupport.org.uk X (formerly Twitter): @Choice_Support Mark Rawlings is an Admin Support Assistant at Choice Support. Email: mark.rawlings@choicesupport.org.uk X (formerly Twitter): @mark_rawlings25 Have you successfully implemented the Oliver McGowan Mandatory Training in your care setting and are you facing similar challenges? Visit www.caremanagementmatters.co.uk and share your feedback on the article. 38

CMM November 2023

“NCF provided us with ‘fresh eyes,’ giving us the opportunity to identify the areas we needed more specific focus on”

Specialist, expert consultancy support for care providers covering:

Contact Jocelyn Cole: jocelyn.cole@nationalcareforum.org.uk www.nationalcareforum.org.uk/projects/ncf-consult/

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RESOURCE FINDER:

Legal Finding a good solicitor is an essential part of running a business in social care, whether you need legal advice on employment matters or wish to challenge a report for rating from the Care Quality Commission (CQC). Here, we’ve profiled some of the leading legal firms that specialise in social care to help you find one that works for you.

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

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

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

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

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

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

Neil Grant Tel: 07968 861242 Email: neil@gordonsols.co.uk Susan Hunneyball Tel: 01483 451900 Email: susan@gordonsols.co.uk 40

CMM November 2023

RESOURCE FINDER: LEGAL

Hempsons

Scott Moncrieff & Associates Ltd

Tel: 01423 724056 Email: socialcare@hempsons.co.uk Website: www.hempsons.co.uk

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

SERVICES • Charity law. • Commercial property. • Community care law. • Contracts. • Corporate law. • CQC regulatory. • Data protection and security. • Disputes and litigation. • Employment law. • Fundraising. • Health and safety. • Inquests and coroners. • Judicial review. • Mental health law. • Safeguarding. • Tendering.

LEAD INDIVIDUALS Philippa Doyle leads the Hempsons social care team and specialises in CQC work and has significant experience of working both for and against, which gives her a unique insight and the ability to offer pragmatic advice. She has over 20 years’ experience in the health and social care sector and with a varied workload including information governance, safeguarding, Court of Protection and consent. She provides extensive registered manager training to aide compliance with the Fundamental Standards. Philippa is the first point of contact on Hempsons’ social care advice line and works regularly with colleagues in employment,

commercial and dispute resolution, to meet the needs of providers. Martin Cheyne acts for health and social care organisations in the full range of claims before employment tribunals. He frequently defends factually complex and also legally novel claims, particularly in relation to disability, sex and sexual orientation discrimination and whistle-blowing allegations. His advice practice includes executive and senior manager terminations, discrimination issues, TUPE (Transfer of undertakings, protection of employment), reorganisations, complex disciplinary matters and concerns with doctors (MHPS). Martin also provides bespoke training on employment topics ranging from TUPE and related procurement preparation, equal opportunities to disciplinary investigations and appeals.

COMPANY INFORMATION Leading health, social care and charity lawyers, Hempsons supports providers in delivering quality services. The team won the Care Sector Supplier Awards: Legal and professional category in 2021 and 2022 and are a finalist again this year. Hempsons’ social care advice line offers providers 20 minutes of free legal advice. Simply call 01423 724056. ‘We have found that all our contacts at Hempsons have been knowledgeable, both about our sector and the legislative process. We have also valued the fact that Hempsons have been flexible, accessible and responsive.’ – The Wilf Ward Family Trust

Philippa Doyle, Partner Tel: 01423 724028 Email: p.doyle@hempsons.co.uk Martin Cheyne, Partner Tel: 01423 724121 Email: m.cheyne@hempsons.co.uk

Tel: 020 3972 9011 Email: earcher@scomo.com Website: www.scomo.com

SECTORS • Care homes, homecare. • GPs and dental practices. • Independent hospitals, clinics. • Supported living and extra care. • Learning disability. • Mental health. • Cosmetics and ‘aesthetics’ services.

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

LEAD INDIVIDUALS Errol Archer leads on regulatory work for health and social care providers. His experienced team works with small and large providers, delivering commercially focused solutions. He brings valuable regulatory and policy

insights from many years of advising business owners, regulatory bodies, central Government departments and Government ministers. As a specialist Solicitor-Advocate, he has represented clients at hundreds of court and tribunal hearings, including the First-Tier Tribunal (Care Standards), the Coroners’ Court and the High Court. We have successfully handled numerous Judicial Review challenges for providers. Tom Woodward is a specialist Employment Lawyer and provides expert advice to employers via a fast-response, cost-effective service on an ‘as required’ basis. Robert Cottingham handles any commercial property matters for clients.

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

Errol Archer Tel: 07729 421836 Email: earcher@scomo.com Tom Woodward Tel: 07917 835134 Email: twoodward@scomo.com CMM November 2023

RESOURCE FINDER: LEGAL

Stephensons Solicitors LLP

Weightmans LLP

Tel: 0333 344 4882 Email: regulatoryenquiries@stephensons.co.uk Website: www.stephensons.co.uk

SECTORS • Residential care homes/ nursing homes. • Homecare agencies. • Supported living services. • Learning disability services. • Independent hospitals. • GP practices. • Substance misuse services.

SERVICES • Challenging draft inspection reports and ratings. • Appeals to the first-tier tribunal (Care Standards Chamber). • Challenging notices to cancel, suspend, impose/vary conditions of registration. • Criminal investigations and prosecutions. • CQC registration advice and challenging refusals of registration. • Challenging Warning Notices. • Complaints. • Inquests. • Safeguarding investigations. • Fitness to practice investigations. • Health and safety prosecutions.

LEAD INDIVIDUALS Laura Hannah leads the health and social care regulation team, which specialises in CQC regulation. Laura has extensive experience of successfully defending health and social care providers, helping them to retain their CQC registration following a proposed cancellation; successfully challenge an inspection report;

avoid a criminal prosecution; and improve the overall ratings of a service. Laura is assisted by a team of experienced lawyers, including Chloe Parish, who also leads the early years, education and children’s social care team which specialises in Ofsted regulation.

COMPANY INFORMATION Stephensons is an awardwinning, highly respected, nationally recognised law firm providing individuals, businesses and Government organisations with a wide range of first-class legal services. It has an excellent reputation of defending professionals and businesses within the health and social care sectors and Stephensons prides itself on achieving the best possible results for its clients. Its team of specialist regulatory lawyers understands the intense pressure on providers to comply with the increasingly complex regulations governing regulated services. Stephensons also understands how a negative inspection report and/or enforcement action can significantly impact on a business and in many cases, unfairly so. The team recognises that this can often be a stressful and frustrating time and its experience enables the team to provide clear and strategic advice in a timely and cost-effective way. Stephensons won the Legal Services Award at the Social Care Premier Supplier Awards in 2022.

Laura Hannah, Partner Tel: 01942 774065 Email: laura.hannah@stephensons.co.uk

Chloe Parish, Senior Associate Tel: 01942 774037 Email: chloe.parish@stephensons.co.uk 42

CMM November 2023

Tel: 0345 073 9900 Email: andrew.parsons@weightmans.com Website: www.weightmans.com

SECTORS • Care homes and care homes with nursing. • Domiciliary/homecare providers. • Supported/assisted living. • Extra care and retirement living. • Independent hospitals and clinics. • Mental health and learning disability services. • Children’s homes and foster care/agencies.

SERVICES • Health and care regulatory. • Challenging inspection reports. • Corporate, regulatory and police investigations and prosecutions. • Inquests and inquiries. • Safeguarding and Local Authority Designated Officer (LADO) investigations. • Mental capacity and Liberty Protection Safeguards. • Employment, pensions and business immigration. • Mergers and acquisitions and joint ventures. • Real estate and construction. • Commercial contracts and procurement. • Contractual and fee disputes. • Finance. • Corporate restructuring and insolvency. • Complaints, claims and litigation.

LEAD INDIVIDUALS Weightmans national multidisciplinary Health and Care team comprises more than 150 specialist lawyers, acting for private, charitable and public sector health and care providers.

The team is led by Andrew Parsons and Mike Clifford. Andrew specialises in health and care regulatory law, providing advice on care home, mental health and public law. He is a leading practitioner in his field and is also the Honorary Legal Advisor to Care England. Mike specialises in corporate law and acts for providers, owners of, investors in and funders of health and care businesses.

COMPANY INFORMATION Weightmans is a leading commercial law firm with offices in England, Scotland and Wales. It is recognised by the legal directories for its work in the health and care sector. Weightmans acts for many of the largest care home groups as well as a multitude of smaller and specialist providers. Weightmans provides its clients with a comprehensive ‘one-stop shop’ of legal services. Its approach is based on offering the very best and well-informed advice combined with a responsive and costeffective service. Weightmans understands that problems can arise at any time in a health and care setting, so it operates a 24-hour helpline to provide advice and support to its clients. Its services are complemented by seminars and briefings enabling clients to keep up to date with the latest developments.

Andrew Parsons, Partner Tel: 07711 799471 Email: andrew.parsons@weightmans.com

Mike Clifford, Partner Tel: 07891 809930 Email: mike.clifford@weightmans.com

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CELEBRATING EXCELLENCE Markel 3rd Sector Care Awards

IN COMMUNITY ENGAGEMENT

Continuing to celebrate 2023’s winners, CMM is thrilled to hear from Alex Roland, Director at Love Community CIC, an organisation representing community-based initiatives, such as GameChanger, and the latest winner of the Community Engagement award. GameChanger is a revolutionary initiative that aims to address the issue of social isolation among neurodivergent individuals, people with learning disabilities, autism, and anyone who wants to connect and engage in a thriving community. Following the impact of the pandemic, many individuals have struggled with feelings of loneliness and disconnect. GameChanger seeks to combat this by providing a safe and inclusive space where people can come together, socialise, relax, and, most importantly, play video games. Our three-hour sessions are held weekly across three venues in Somerset.

Fostering social connections The project was born out of a recognition of the power of video games to create a sense of belonging and foster social connections. The driving factors behind the establishment of GameChanger were the desire to bring people back together after COVID-19 to provide them with a platform to share good times, make new friends, and reunite with old ones. The team behind GameChanger includes dedicated professionals and volunteers who are passionate about creating an inclusive and welcoming environment. We involved the people we support right from the start, recruiting them as helpers and advisers. It’s 44

CMM November 2023

that sense of ownership that people love and drives them to feel that GameChanger is theirs.

Finding solutions Having worked in social care since 2002, I knew the popularity of gaming amongst the people I work with, yet it was never taken seriously as a transferable skill by the organisations I’d worked for. Solution? Go self-employed! With any community-based project one of the big questions is ‘where are you going to be based?’ Somerset (where we are) is a rural and spread-out county, so it’s really important we are 100% transportable, but we also have fairly specific needs – we need accessible central venues with light, space, and lots of electrical sockets. We have been helped by Darren Smart from Somerset Libraries who has offered the facilities at Taunton and Yeovil libraries for GameChanger. We also needed the ability to scale up if necessary. We wanted a warm and welcoming feel for the sessions that was also modern and professional.

Everyday ethos I estimated a good turnout would be 12-15 people, but the reality has been 20-50 per session. One of our ‘sneaky secrets’ is we deliberately never have enough consoles for

HEADER everyone to play on at once, so part of our ethos is to share and take turns. We never set strict times or limits on how long people can play for, rather we ask them to show others how to play – people love to show their friends their skills. It is amazing to us how quickly people bond and form friendships when they are playing games together. Whilst I’m a huge fan of gaming, truth is I’m actually a bit rubbish at them. But luckily, I’m fortunate to work with some incredible autistic people who are experts.

Hidden talents Prior to GameChanger, skills and knowledge around gaming often weren’t taken seriously, but now there is an environment where not only can they be shown off, but peers and friends can provide feedback on them too. Seeing our volunteers’ confidence and skills increase has been amazing. If you’ve ever tried setting up a new console or bit of tech at Christmas with someone who’s desperate to play waiting, you’ll understand the pressure the guys are under. Now multiply that by 10 consoles and you’ll grasp the amazing tech skills our volunteers have. One job coach came along with a person who hardly left the house, only the offer of gaming got them out. At the session, the job coach was blown away seeing the planning, fine motor skills, and teamwork the person demonstrated, all through playing video games. They told me they had no idea of the level of skill the person possessed.

Staying active At GameChanger events, participants have access to the latest and greatest games on state-of-the-art gaming systems, but we also have all the old games and systems from people’s childhoods. What’s important we’ve found is, it’s not what you’ve got, but how you use it. The emphasis is not just on idle sitting and gaming, but on active involvement. The project specialises in games that promote movement and physical activity, such as

Nintendo’s Ring Fit Adventure and dancing games such as Just Dance. By incorporating physical movement into gaming, GameChanger aims to encourage individuals to move and groove while having fun. When people are having fun, they don’t notice the physical exertion so much. That being said, we put no pressure on anyone to do anything, some folk just come to see their pals and sit and chat.

Overcoming challenges Challenges faced by GameChanger have included logistical considerations, such as securing appropriate gaming equipment and ensuring accessibility for all participants. However, these challenges have been overcome through collaboration and resourcefulness. Linkedin has been invaluable in connecting us with people and organisations that could help. The folk at Brain in Hand (www.braininhand.co.uk) offered us 18 monitors from their office refurbishment. People often have old consoles and games in lofts, and these are repurposed and reused.

Outstanding outcomes The team has worked diligently to provide an inclusive and accessible experience for all attendees. We are also having to constantly source funds, which is time-consuming and very hand to mouth. As we are part of Love Community CIC, we have been able to apply and get funds and grants, but our goal is to be self-sustaining. We hope to break into the gaming industry and get them involved in sponsorship too. The outcomes of GameChanger have been heartening. Participants have expressed increased feelings of connection, companionship, and enjoyment. The project has seen individuals form meaningful friendships, boost their confidence, and enhance their wellbeing. We have even seen one of our volunteers enter his first ever romantic relationship having met someone at our sessions.

Nominations are now open for the Markel 3rd Sector Care Awards 2024 CMM is delighted to announce that nominations are now open for the Markel 3rd Sector Care Awards 2024. The ceremony will be held on Friday 15th March 2024 at The Grand Hotel, Birmingham. If you would like to nominate a person or team to be considered for an Award, follow the process on CMM’s dedicated web page. Nominations will close on Friday 27th October 2023. Don't miss your chance to attend the Markel 3rd Sector Care Awards 2024 – early bird tickets are now on sale. You can also stay up to date with the awards on social media. Join the conversation on X (formerly 'Twitter') by following @3rdSectorCare and using the hashtag #3rdSectorCareAwards.

Aiming high The vision for GameChanger is to expand its reach and impact, creating a network of events and communities where individuals from all walks of life can come together, enjoy gaming, and forge lasting connections. By doing so, GameChanger aims to uplift and empower neurodivergent individuals and contribute to a more inclusive society. We’d love to roll the project out nationally, being able to almost ‘franchise’ the GameChanger brand and experience to other care teams and organisations. One of our biggest highlights has been winning the Community Engagement award at the Markel 3rd Sector Care Awards. An awesome day and amazing validation that our vision is on the right track. Passion is central to any project, but the thing about passion is that it is contagious; if you’ve got it, others will catch it too. Do what you love, and you’ll find it amazing how many other people love it too! CMM Alex Roland is a Director at Love Community CIC. Linkedin: https://uk.linkedin.com/ company/love-community-cic

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Key dates for your diary Nominations close: Friday 27th October 2023.

Judging day: Friday 26th January 2024. This will take place online and all finalists must be in attendance.

Awards ceremony: Friday 15th March 2024. CMM November 2023

EVENT PREVIEW

PLANNING FOR 2024 – SUCCESSFUL COMMISSIONER FEE NEGOTIATIONS Thursday 16th November 2023 Join the National Care Forum’s (NCF’s) Chief Executive Officer, Professor Vic Rayner OBE, and Liz Jones, Policy Director, for a discussion with a sector commissioner, a Local Government Association (LGA) Partners in Care and Health (PCH) representative, Anthony Collins Solicitors, ARC England and an NCF member, covering a variety of perspectives on successful commissioner fee negotiations in 2024.

Where do commissioners stand? Challenges facing commissioners will be discussed in depth by the webinar’s expert panel of speakers. The Social Care Institute for Excellence (SCIE) has detailed from previous engagement with the sector that commissioning is no longer fit for purpose. SCIE has argued that commissioning was originally intended to be a strategic process which enabled resources to be directed towards the achievement of outcomes, but now tends to be overly focused on the delivery of outputs, such as the amount of time and task delivered. Primarily through a lack of funding from central Government, the sector has long been aware of the gap between commissioners’ fees and the true cost of providing quality care services.

NCF members’ perspective As providers make their necessary financial preparations for the year ahead, delegates attending this webinar will undoubtedly be familiar with the implications of the recent Fair Cost of Care exercise. In particular, one of its primary outcomes called upon care providers and local authorities to arrive at a shared understanding of the local cost of providing care. Subsequent Government

guidance and funding has been made available to help local authorities navigate their responsibilities to increase fee rates paid to providers. Providers will also be eager to hear more details from Government about how it plans to work with them to monitor changes in the market as the Fair Cost of Care Fund is allocated to local authorities.

View from the LGA The LGA and Association of Directors of Adult Social Services (ADASS) are Partners in Health and Care (PCH). The partnership supports councils to develop across strategic commissioning, market intelligence, co-production and operational market management, so that they can facilitate and shape diverse and sustainable markets for care and support which seek to benefit the whole population. The LGA website hosts a wide range of resources and publications to share the latest information, help councils maintain compliance and provide learning opportunities. Delegates attending this webinar can expect to take away knowledge of local authorities’ priorities for commissioning in the year ahead.

Legal considerations Anthony Collins Solicitors, acting as an expert for many leading adult health and social care service providers, will be providing the webinars delegated with a legal perspective on planning for successful commissioner fee negotiations. Anthony Collins has previously outlined its fundamentals for negotiating reasonable terms in the adult social care sector. These include providers considering their historic relationship with the commissioner, a comprehensive evidence

base to demonstrate what providers’ actual costs are and the resources available to the commissioner and the priority it places on the services in question within its overall budget.

The integrated future of commissioning Analysis from The King’s Fund since The Health and Care Act 2022 became legislation has shed light on how commissioning is shifting towards a more collaborative approach to planning and improving services. Instead of focusing on procurement and contract management, the think tank has explained that the new role of commissioners should be to work with partners across the system (including providers) to understand population needs, determine key priorities and design, plan and resource services to meet these needs.

Don’t miss out! To book your free place on the next CMM Insight webinar, ‘Planning for 2024 – successful commissioner fee negotiations’ in association with the NCF, visit the CMM website. Please note that all details concerning the webinar are subject to change. CMM

Look out for announcements about

CMM Insight events happening in 2023 @CMM_Magazine

CMM November 2023

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www.caremanagementmatters.co.uk

WHAT’S ON? Event: Date/Location: Contact: Event: Date/Location: Contact:

International recruitment webinar series 2nd and 28th November 2023 (Virtual) https://events.skillsforcare.org.uk/ skillsforcare/frontend/reg/thome. csp?pageID=557725&eventID=1748&traceRedir=2

Event:

Inclusive Communication and Support in Care Homes: Implementing the Five Good Communication Standards 6th November 2023 (Virtual) www.socialcareconferences.co.uk/virtual-onlinecourses/inclusive-communication-care-homes

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Swift Management Services Ltd is a Health and Social Care Consultancy. We have a specialist team of consultant working within the Care Home Sector, who can provide immediate support for short term issues or build a long term relationship with homes who choose our retained consultancy service.

Event:

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Event: Crisis Management Policy Review and Bespoke Quality Systems Registered Manager support Interim Management – Registered Managers– Area Managers – Senior Management

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I’m a technophobe, get me out of here – taking the fear out of digital for social care managers (Skills for Care) 8th November 2023 (Virtual) https://events.skillsforcare.org.uk/ skillsforcare/frontend/reg/thome. csp?pageID=552553&eventID=1733&traceRedir=4 The King’s Fund Annual Conference 2023: A health and care service fit for now and in the future 1st - 2nd November 2023, London www.kingsfund.org.uk/events/kings-fund-annualconference

CMM EVENTS Date/Location: Contact:

Mock Inspections Assistance with new Registrations Planning and development of new builds/extensions Strategic Reviews Crisis Management Assistance with Regulatory issues

Making the most of digital for your care business (Care England) 7th November 2023, 2:00 - 3:00pm (Virtual) www.careengland.org.uk/events/making-themost-of-digital-for-your-care-business/

www.swiftmanagement.org.uk info@swiftmanagement.org.uk

Date/Location: Contact:

CMM Insight Online: Planning for 2024 – successful commissioner fee negotiations Thursday 16th November 2023, 12:00noon - 13:30pm www.caremanagementmatters.co.uk/webinar/ Markel 3rd Sector Care Awards Ceremony 2024 15th March 2024, Birmingham Lisa Werthmann, Director 01223 207770 lisa.werthmann@carechoices.co.uk www.caremanagementmatters.co.uk/ 3rd-sector-care-awards/

Please mention CMM when booking your place. Sign up online to receive discounts to CMM events and for more information on our upcoming events in 2023. www.caremanagementmatters.co.uk @CMM_Magazine #CMMInsight

CMM November 2023

STRAIGHT TALK Trustees' Week is on 6th-10th November 2023, and it is a special opportunity to recognise the valuable work of Trustees in our sector and to encourage others to volunteer on boards. Fiona McAuslan, Communications Director at Getting on Board, a trustee recruitment and diversity charity, says when care workers become trustees it’s a win-win for the sector and charities simultaneously.

The adult social care sector has a close relationship with the charity sector. Many charities' mission and purpose is to provide services for the very demographic that those in social care see on a daily basis. By their very nature, care workers are ideally placed to become excellent charity trustees. The two sectors are intertwined and often have an intimate understanding of one another. But what exactly is a charity trustee? In a nutshell, charity trustees are the group of people with overall responsibility for a charity. It is a volunteer role. They are often called the board or governing body. They make key decisions about the direction the charity will take and how its purposes will be carried out. They’re the most senior leaders in the charity sector. Many people don’t realise that anyone can be a trustee. We know the term ‘senior’ puts many prospective trustees off, particularly those who are used to holding a front-line role rather than working at a strategic level. There is a perception that trustees need to be lawyers, accountants, c-suite professionals or someone trained to a high level in their professional life. While those people can all make excellent trustees, charities thrive best when they have a diversity of knowledge, skills and experience on their boards. Leading a charity is not just

the preserve of the great and good. While those very senior individuals bring in knowledge, gravitas and certain skills, they might be lacking in the lived experience that is so crucial to a charity delivering on its mission. Yet the belief that it’s a closed shop persists and it’s certainly off putting for anyone who doesn’t see themselves in that role. At Getting on Board we firmly believe that everyone can be a trustee, and this is a view shared by the Charity Commission for England and Wales who have said that, ‘Trusteeship can open doors for people, and young people, people of colour, women, and those from different educational backgrounds or regions of the country should have access to that opportunity.’1 The benefits that someone who is on the front line of a care home, for example, can bring to the right charity are immense. They might have a keen and practical understanding of the logistics of organising care for a range of different needs, budgeting and the constraints involved, the wellbeing concerns of both staff and patients, the impact of staff shortages and a host of other issues pertinent to the sector, and they will have formed opinions on how to address these. Most importantly they are likely to care, and this passion is the most important attribute of all.

Charity trusteeship may be a voluntary role but it’s not without a host of benefits. Leading a charity is a brilliant opportunity to learn by doing, and to gain the myriad transferable skills and mindsets needed to tackle today’s leadership issues and help people advance in their career. Organisational governance, decision-making, conflict management and negotiation are just some of the skills that trustees can develop and bring to their day job. In short, it’s as useful as doing a CPD with a key added benefit: 84% of trustees Getting on Board asked in our most recent survey said that being a trustee made them happier. Guiding your employees to become a charity trustee is a proven alternative to developing your talent pool with conventional leadership training. It is a cost-effective strategy that offers learning by doing with measurable results that benefits your organisation, your employees and society at large. As a nice side benefit it also can lead to better staff retention and improved staff satisfaction. And who can resist that? Getting on Board’s Festival of Trusteeship runs from 6th-10th November 2023. It’s a week of thought-provoking, insightful and thoroughly entertaining online events to help you consider, become and be brilliant and effective trustees. www.gettingonboard.org

References 1 https://charitycommission.blog.gov.uk/2021/11/01/trustees-week-encouraging-different-perspectives/ Fiona McAuslan is the Communications Director at Getting on Board. Website: www.gettingonboard.org X (formerly Twitter): @FionaMcAuslan How has your care organisation supported employees to embark on a trustee role? And in what ways has becoming a trustee benefited you? Visit www.caremanagementmatters.co.uk and share your feedback on this article. 48

CMM November 2023

StayJoin in control. Care England. Stay informed. Join Care England. Stay in control. Join Care England. Keeping abreast of the key issues in policy and regulation is a challenge for care providers.

Keeping abreast of the key issues in policy and regulation is a challenge for care providers.

At Care England we provide our members with a daily flow of policy news, regulation changes, media updates and more. This gives access to the latest information and advice from one well connected, reliable source. Wouldn’t that save time and At Care England we provide ourworry members with a daily flowcare of policy news, too? regulation changes, media updates in your business

and more. This gives access to the latest information and advice from one well connected, reliable source. Wouldn’t At Care England we provide our members with a daily that time andregulation worry inchanges, your care business flowsave of policy news, media updatestoo? and more. This gives access to the latest information and advice from one well connected, reliable source. Wouldn’t that save time and worry in your care business too?

To find out more about the benefits of membership, visit To find out more about the benefits of membership, visit www.careengland.org.uk, email info@careengland.org.uk To find out more about the benefits of membership, visit www.careengland.org.uk, email info@careengland.org.uk or call www.careengland.org.uk, 08450 577 677. email info@careengland.org.uk or call 08450 577 677. or call 08450 577 677.

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