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

DECEMBER 2023

www.caremanagementmatters.co.uk

NAVIGATING CHANGE CQC’s New Single Assessment Framework

Playing the long game

Government support for social care

View from the street Care market review

A brighter future

Changing public perception

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In this issue 05

Inside CQC In view of a new year approaching, Mary Cridge, Director of Adult Social Care at the CQC, shares details of new projects from the regulator and highlights best practice.

CMM News

Into Perspective This month, our experts discuss how care providers can work with people drawing on care to design and deliver meaningful activities.

Celebrating Excellence CMM is thrilled to share the stories of two more outstanding winners. Emma Kiss, Wellbeing Co-ordinator at Foxburrow Grange, explains how she supports people to live well with dementia and we also hear from The End of Life Partnership.

Event Review CMM INSIGHT hosted the Yorkshire and The Humber Care Alliance Conference (YHCAA) in Doncaster on 18th October. CMM shares some highlights from the event.

What’s On?

Straight Talk End of life charity Marie Curie is calling for more investment in end of life care research. Briony Hudson, Associate Director for Internal Research Development at Marie Curie, explains how the charity is supporting projects.

REGULARS

Social Care Insights Simon Bottery explores how best to keep social care on the agenda in the coming election campaign.

FEATURES

Navigating change: What does the CQC’s new single assessment framework mean for providers? CQC’s long-awaited Single Assessment Framework (SAF) is slowly being shared. Philippa Doyle, Partner at Hempsons, a national health and social care law firm, shares her analysis of the new process.

Playing the long game: How much political progress has been made for social care reform in 2023? What can we learn from the Government’s actions in 2023 and what can we expect from political party manifestos? David Brindle shares his analysis of the Government’s support for the sector.

A brighter future: How can we change the perception of social care? Neil Crowther, Co-convener of #SocialCareFuture, shares the story of the #SocialCareFuture movement and offers five tips on what everyone can do to change the perception of social care.

View from the street: The UK Healthcare Market in review Christie & Co has launched its 2023 Care Market Review report. In this article, Rob Kinsman, Regional Director for Healthcare, shares the key trends and his tips for navigating the market next year.

Creative health: Reviewing the benefits of creative approaches and activities in care services In 2022, NCCH and the All-Party Parliamentary Group on Arts, Health and Wellbeing launched a Creative Health Review . The Rt Hon. Lord Howarth of Newport, Chair of the NCCH and Co-Chair of the All-Party Parliamentary Group on Arts, Health and Wellbeing, explains its importance.

CMM December 2023

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CMM December 2023

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SOCIAL CARE INSIGHTS From Simon Bottery Simon Bottery explores how best to keep social care on the agenda in the coming election campaign. Whether or not it is on your Christmas list, Santa is almost certain to deliver us a general election in 2024, perhaps as early as May. The campaign should, in theory, be a time for wide, informed political debate about the future of social care, to a public that – the evidence shows – is unhappy with the current state of social care and wants to see real reform. Yet in recent years, the relationship between social care and election campaigns has been problematic, to say the least. Election firestorms about the ‘death tax’ (2010) and the ‘dementia tax’ (2017) have cemented a reputation for being the ‘third rail’ of politics – one that burns anyone who touches it. That’s a real problem: social care is one policy area that cries out for a broad, public conversation. Without it, reform is harder to achieve. Plus, pragmatically, if parties shy away from social care and don’t include reform in their manifestos, it is much less likely to happen when they are in Government. Everyone in the sector bears some responsibility for keeping social care on the political agenda. How we choose to engage with the political parties, their policy proposals and the wider election debate can and does affect the extent to which social care will be raised, now and in future campaigns. So, it is perhaps time to make some New Year’s resolutions about how we’ll engage with the election campaign. Here's my personal

checklist of things to do/not do to make social care a topic with which the parties are more willing to engage. You can think of it as an ’asset-based’ approach to social care electioneering. • Forget perfection. There is so much about social care that needs changing but it’s not going to happen overnight. No party is going to come forward with plans to tackle all the issues in adult social care at the same time. Accept that and work with what’s on offer. • Similarly, accept the lack of detail. No party is going to be presenting fully worked-up, fully costed plans for social care, especially not in a manifesto aimed at the public rather than the policy specialist. Fine – this is the time to applaud the direction of travel rather than wanting GPS-precise details about the destination. • Keep it as simple as possible. Social care IS complicated but fight the tendency to describe (and argue) every last nuance of it. The social care sector has an unfortunate (and deserved) reputation for this. Accept a degree of imprecision in language, accuracy etc. and focus on the bigger picture. • Accept that you’ll sometimes have to discuss social care through an NHS lens. It may rankle to be asked, yet again, to discuss hospital discharge but use it as an

opportunity to make a few broader points about social care rather than moan that it’s always seen that way. • Avoid getting sucked into debates about how reform will be funded. It is this funding issue which has tended to trip up parties during campaigns. The potential benefits of social care reform – the additional people who will get care, the lives that will be improved etc. – in fact have wide public support. Talk about these. • Finally, talk about problems in the sector but also benefits and solutions. Use the word ‘crisis’ sparingly (though don’t shirk from it when it’s appropriate) but temper that with examples of where change has happened. Talk about other countries that have introduced reforms. Make reform seem possible, achievable – because it is. Of course, none of this absolves us of the responsibility to call out the daft and dodgy ideas that may surface. Or to hold this and previous governments to account for delays and failures. But we don’t have to spend all of our time there. Is this a sensible approach? I think so. Will I stick to it? Perhaps. It’ll require more discipline than I typically possess. And of course, New Year’s resolutions were made to be broken. Happy Christmas and New Year.

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

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INSIDE CQC Mary Cridge

As 2023 draws to a close, Mary Cridge, Director of Adult Social Care at the Care Quality Commission, shares details of new projects from the regulator and highlights good practice taking place in the sector. It’s natural at this time of year to reflect on all that’s happened over the last 12 months, as well as anticipating the new year and all that brings. On top of our inspection and regulation work, our ongoing transformation has been a focus of our last year. One key aspect of this is having taken on new responsibilities under the Health and Care Act 2022 to assess local authorities and integrated care systems.

Learning by doing I spent several weeks over the summer getting involved in our local authority pilot assessments. It’s been a joy for me to be out on site with the assessment team, working with them as we learn together how to do this really well. We’re grateful to the pilot sites – Birmingham City Council, Lincolnshire County Council, North Lincolnshire Council, Nottingham City Council, and Suffolk County Council – for stepping forward, and to all the people, including local authority teams, that we met along the way. There’s the excitement of being involved in something new, of course. But we’re also beginning to see just how much we’ve been missing by not looking at commissioning and systems alongside providers. The systems and local authority work we’re doing brings an additional dimension. Taken together with provider regulation, it will give us fuller oversight to help drive change for people using services and their loved ones. It helps us to identify and articulate the challenges faced across the sector. It can support and strengthen the understanding that adult social care – in all its forms – has a voice at the table, is respected, and is understood for all the benefits it can bring. Also new is the assessment framework that all registered providers will be working on. It’s not change for change’s sake – the new framework allows us to be more responsive and agile in assessing health

and care provision in England. It embeds people’s experience firmly at the centre of our regulation activity. The regulations remain the same. What would have been assessed as Good under the old framework will still be seen as Good under the new. Of course, it’s going to take some getting used to – change always does. But at its heart, it’s a framework based on people's experience. It’s built on ‘I’ and ‘We’ statements. We’ve been testing the new framework and a subset of the quality statements in our local authority work for a year now. Do they work? Yes, they do in that environment, but as we roll out there’ll be more evidence about what works and what might need tweaking. We remain open to making sure that it all works well. Please keep speaking to us and sharing your feedback on the new approach.

Sharing improvement One of our key strategic aims is to accelerate improvement. One of the ways we do this is to highlight and showcase good practice when we see it through our regulatory activities. Earlier this year we inspected at Loveday Kensington, a residential care home providing nursing and personal care for up to 40 people. The people living there included older people, people with physical health conditions, and those living with dementia. Our Deputy Director of Operations in London, Turon Karim, described the outstanding provision at the service and said, ‘People we spoke to were overwhelmingly positive about the exceptional levels of care and support they got from staff and managers. It was lovely to see such an excellent variety of activities, events and trips out that were organised by the home ensuring people led meaningful, interesting lives, something that others may take for granted. ‘People using the service and their relatives were positive about food choices available. We saw people had the option to choose what they wanted and had a good range of healthy and nutritious choices. It was also really encouraging to see Loveday support people’s relatives to join them, putting a real emphasis on the importance of mealtimes.’ The experience of the people using the service is central to staff members’ activities. They have a real commitment to offering people choice and control over their lives. That’s the heart of good adult social care, and we look forward to seeing more evidence of that in our new framework.

Mary Cridge is the Director of Adult Social Care at the Care Quality Commission. Email: providerengagement@cqc.org.uk X: @CQCProf CMM December 2023

NEWS

APPOINTMENTS DHSC

CQC publishes its State of Care report According to the regulator, this year has been a turbulent one for health and social care. In addition to the ongoing problem of ‘gridlocked’ care highlighted in last year’s State of Care, this year's report has found that the cost-of-living crisis is biting harder for the public, staff, and providers – and workforce pressures have escalated. This combination risks leading to unfair care, the CQC has stated – where those who can afford to pay for treatment do so and those who can’t face longer waits and reduced access. In addition, the report has highlighted that local authority budgets have failed to keep pace with rising costs and the increase in the number of people needing care. As local authority funded adult social care places are often less profitable, there is the risk that people who live in more deprived areas and are more likely to receive local authority funded care, may not be able to get the care they need, the report has summarised. Some people who pay for their own care at home have had to cut back on visits to support their basic needs. According to the regulator,

access to and quality of mental health care also remains a key area of concern. Finally, the report has identified that recruitment and retention of staff remains one of the biggest challenges for the mental health sector, with the use of bank and agency staff remaining high and almost one in five mental health nursing posts vacant. The CQC has raised concerns that staffing issues in mental health services are leading to the overuse of restrictive practices, including restraint, seclusion, and segregation, and has called on providers to recognise and take steps to address this. Vic Rayner, National Care Forum's Chief Executive Officer, said, '[The] CQC report lays bare the reality that the notion of a "care market" was flawed from the outset. The outcome of systematically underfunding local authorities, who in turn have not paid the actual cost of delivering care, has brought us to a place where profound health inequalities for individuals and communities are now compounded by profound care inequalities.’ Visit the CQC website to read the report.

Care sector reacts to King’s Speech The King gave his first address in Parliament in November, but any mention of social care and the Mental Health Bill was noticeably absent amongst the 21 proposed legislations. This marks the first blueprint plan from Rishi Sunak’s Government and is likely to be the final one before the upcoming UK general election, meaning the Mental Health Bill will not be addressed until at least next year.

"Three Prime Ministers later, that promise sits broken." The only law surrounding health outlined in his speech was the Tobacco and Vapes Bill which will see tobacco and vape products banned for those under 14, implementing a phased ban. Professor Martin Green OBE, Chief Executive of Care England, reflected on the King’s Speech and said, ‘When Boris Johnson was first elected as Prime Minister, he stood on the steps of 10 Downing Street and promised to fix social care. Three Prime Ministers later, that promise sits broken. With

silence on social care in the King's Speech, the pressure is now on the Chancellor, Jeremy Hunt, to outline how the Government can make true on its promise. Whilst last year's Autumn Statement saw an unprecedented investment into the sector, the dial has not tangibly shifted.’ The Association of Mental Health Providers agreed, ‘We are deeply disappointed and concerned that the #KingsSpeech did not include a Mental Health Bill, which would include a reform of the outdated #MentalHealthAct. ‘Despite manifesto commitments, an independent review of the Mental Health Act, a White Paper, and a parliamentary joint committee report, there was no mention of the Bill.’ The Department of Health and Social Care published a White Paper in January 2021 on reforming the Mental Health Act 1983. The document outlined the Government’s plans to revise mental health legislation in response to a 2018 review. The White Paper served as both the Government’s reaction to the findings and its strategy to enhance and reform mental health policy.

On 13th November, the Department of Health and Social Care (DHSC) announced that Victoria Atkins MP will replace Steve Barclay MP as Health and Social Care Secretary. Victoria Atkins MP previously held the role of Financial Secretary to the Treasury. Will Quince MP has stepped down from his role as Minister of State for Health and Secondary Care. The changes are part of the Prime Minister's Cabinet reshuffle.

ARCO

ARCO, the national body for operators of Integrated Retirement Communities (IRC) in the UK, has moved to enhance its regulatory oversight role with the appointment of a new, independent Chair for its Standards Committee. Karen McArthur is an experienced Non-Executive Director with several high-profile board appointments and a wider portfolio of standards work with statutory regulators.

Dovehaven Care Homes Dovehaven Care Homes, based in the North West of England, has appointed Emily O’Keefe as its new Group People Director. O’Keefe previously held senior HR roles in organisations such as Certas Energy, Novartis and United Utilities.

Malsis Hall

Sally-Anne Redhead has been appointed as Registered Manager at Malsis Hall with Craig Chatburn joining as the Care Home Manager. Both bring a wealth of experience and expertise to their roles. Malsis Hall, which is based in Glusburn near Keighley, specialises in supporting people with complex mental health conditions along their recovery journey.

CMM December 2023

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NEWS

DHSC launches Accelerating Reform Fund The Department of Health and Social Care (DHSC) launched the Accelerating Reform Fund (ARF), which provides a total of £42.6m in grant funding over 2023 to 2024 (£20m) and 2024 to 2025 (£22.6m), to support innovation in adult social care. Through the ARF, the department wants to support the growth of services that make person-centred care a reality for those who draw on it, support unpaid carers to live healthy and fulfilling lives alongside their caring role and respond to rising demand and the changing needs of local populations. The DHSC says collaboration and communication are vital to embedding and sustaining innovations. The ARF is designed to promote partnership working across local areas, as well as sharing of learning and best

practices nationally. The Minister of State for Care has written to all local authorities to set out the department’s priorities for innovation and scaling. These 12 priorities cover a broad range of areas under the three objectives of its 10-year vision for adult social care reform. The aim of the ARF is to support the adoption or scaling of projects that deliver these priorities. In order to participate, the DHSC is asking local authorities to form consortia with other local authorities in their integrated care system (ICS) geography. Professor Martin Green OBE, Chief Executive Officer of Care England, said, ‘We hope this injection of funding will help provide some much-needed stability to the sector and encourage systematic innovative

thinking which will directly support the delivery of high-quality, person-centred care. It is now incumbent on the Government to ensure the funds reach the front line and do not get caught in the webs of bureaucracy. ‘Innovation plays a crucial role in the social care sector, better enabling us to weather the storm of an ageing population, workforce challenges and ongoing inflationary pressures. This fund, if utilised to the best of its ability, can help foster an environment of transformation, and ensure the care sector remains fit for the future.’ The first payment will be made in March with a further payment to be made in 2024 to 2025. The second tranche of grant payments from 2024 to 2025 will be conditional on the completion of mid-grant reporting.

ADASS publishes Spring Survey 2023 The ADASS Autumn Survey 2023 has been published, outlining how pressures across health and social care can be reduced this winter. This is the first in a series of two reports summarising the data from ADASS’ Autumn Survey 2023 of Directors of Adult Social Services.

"Two in five directors reported that there is limited availability of timely information, advice and support."

Improving care at home, more sheltered, extra care and dementia-focused housing, investment in crisis resolution intermediate care, and better information and advice for older and disabled people would prevent many from needing hospital or residential care, reducing pressures across health and social care every winter, the new ADASS Autumn Survey 2023 from the Association of Directors of Adult Social Services has found. Almost two thirds (63%) of social care leaders said that community-based care and support is not widely available in their local area. Just under half (49%) of adult social care directors indicated that in their area there

is only limited availability of preventative services focused on reducing the number of avoidable admissions to hospital and residential care. This gap in early support is made worse by a lack of information and advice so people can make an informed choice about the care they or family members need. Two in five (39%) social care directors reported that there is limited availability of timely information, advice and support in their local areas. Seven in 10 social care directors said that their staff are increasingly undertaking tasks that were previously delivered by the NHS but without it being funded.

Infection monitoring pilot scheme launches The UK Health Security Agency (UKHSA) has announced a pilot scheme to monitor infections in care homes in England. The new pilot builds on the Vivaldi study during the pandemic, with a wider remit to study other infections. The Vivaldi social care project, commissioned by UKHSA in collaboration with University College London (UCL) and other partners including The Outstanding Society, Care England, and NHS England, is one of several national surveillance studies commissioned by UKHSA to gather evidence on the burden of infections across healthcare and community settings. Researchers looked at the impact of COVID-19 in care homes,

what could be done to prevent the spread of infection and the effectiveness of the COVID-19 vaccination. This new pilot will work with over 500 care homes in England to monitor infections such as COVID-19, flu, norovirus, and urinary tract infections, and analyse the resultant anonymised data in order to help reduce infections in care homes for older adults. The UKHSA has outlined that it remains committed to enhancing surveillance and research capabilities within care homes. According to the agency, the data generated by the Vivaldi social care pilot will play a pivotal role in shaping important policy areas and

priorities as the study progresses. The Vivaldi social care platform has been co-designed with people who live and work in care homes and will connect lists of care home residents with routine data sets already held by the NHS, including hospital admissions, mortality data, immunisations, laboratory test results and prescriptions, all using a common pseudo-identifier based on NHS numbers. This integrated approach will aim to provide a comprehensive view of residents’ health and healthcare interactions. For more information about the Vivaldi study and its results, visit the UCL and GOV.UK websites. CMM December 2023

NEWS

Dementia cases could be higher than predicted A new study predicts dementia cases in England and Wales will double to 1.7 million by 2040, exceeding previous forecasts by over 40%. The research, funded by the UK Economic and Social Research Council and published in The Lancet Public Health, indicates that dementia incidence decreased by 28.8% between 2002 and 2008. However, it increased again by 25.2% between 2008 and 2016. Principal investigator, Professor Eric Brunner (UCL Institute of Epidemiology & Health Care) said researchers don’t know how long this pattern will continue but the UK needs to be prepared. Researchers also found that disparities in the rate of dementia incidence were increasing between education groups. And although an increase

in dementia cases has often been attributed to an ageing population, the researchers also found that the rate of dementia onset within older age groups is also increasing. Hilary Evans, Chief Executive at Alzheimer's Research UK, said, ‘This news highlights the enormous threat dementia poses, for both the public and for our already overstretched health and care workforce. As these figures show, unless urgent action is taken, dementia is set to place a huge and increasing burden on our healthcare system and to blight millions of futures.' She added, ‘These statistics also highlight the important role that social factors play on people’s risk of dementia, meaning some groups in society are being put at a worrying disadvantage.’

NCF launches Environmental Sustainability Network The National Care Forum (NCF) has launched an Environmental Sustainability Network for members. The new member forum was unveiled at NCF’s ‘Growing a Greener Future’ event held at the St Monica Trust’s Chocolate Quarter Retirement Village in Keynsham. As well as supporting member organisations embarking on journeys towards sustainability with resources, peer-learning, and the sharing of data and knowledge during regular forum meetings, NCF will be working to understand how to embed green policies into its own internal strategies and operations. NCF is also advocating for greater support from the Government. Vic Rayner OBE, Chief Executive of The National Care Forum (NCF), said,

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‘Underpinning our mission for a more sustainable future is the commitment to establishing links with wider networks and alliances dedicated to environmental sustainability within adult social care as well as beyond it. Our members are anchor institutions in their communities and have a clear role to play in leading effective change. Our mission is to equip our members with the resources, knowledge and peer support needed to become sector leaders, driving forward environmental sustainability in not-for-profit care.’ Chief Executive of the St Monica Trust, David Williams said, ‘We look forward to sharing our journey towards sustainability with our partner not-for-profit organisations in the care and support sector.’

NEWS

New report on meals on wheels provision

Care leader highlights the impact of carers’ visas

A new report has revealed that only 29% of Meals on Wheels services are still in operation across the UK, and fewer than 18% in England. Meals on Wheels are not statutory for local authorities to provide, so councils can remove the service to save money. The NACC is calling on the Government to: • Ensure councils receive urgent funding to directly support the continuation of existing Meals on Wheels services including direct funding to reinstate Meals on Wheels services lost in recent years. • Consider Meals on Wheels a statutory responsibility to safeguard its future. • Consider other additional alternative support such as VAT relief for service

The National Care Association (NCA) remains deeply concerned about the ‘appalling abuse’ of carers' visas. Speaking on the issue, it noted that the sector is heavily reliant on being able to recruit willing workers in view of the 152,000 vacancies that exist.

providers and help with food and fuel inflation which has impacted on the financial viability of the service. The NACC, along with several other signatories, including Age UK and Care England, has written to MPs to raise its concerns for the future of Meals on Wheels services. NACC chair, Neel Radia, commented, ‘With councils facing a funding gap of some £7bn in adult social care, cutting a service which is relatively low cost in offering multiple lines of support to vulnerable adults is frankly a cheap cut. The benefits of the service far outweigh the costs. Removing a preventative service for the most vulnerable in our communities is short-sighted.’

"78,000 people secured long-term visas to work in the UK social care sector." In light of the report, Nadra Ahmed, Executive Co-Chairman of National Care Association, said, ‘It is extremely frustrating for providers that a pathway which was opened up to tackle the chronic workforce challenges in social care has been allowed to be highjacked

in this way by unscrupulous recruitment agencies. ‘We warned about this early on and offered support to DHSC in relation to the process of ethical recruitment, orientation and pastoral support at a national level, which continues to be rejected. We cannot have a situation where vulnerable people are being recruited to support individuals in need of care and support.’ The news comes after almost 78,000 people secured long-term visas to work in the UK social care sector, following the Government’s easing of immigration rules in the last year. It is believed that this free movement has led to a significant worsening in the workforce situation, since social care workers became eligible for work visas from 15th February 2022.

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CMM December 2023

NEWS

Nursing home opens in Sunderland

Brunelcare launches new service

Exemplar Health Care, a leading provider of nursing care for adults living with complex needs, has marked the official opening of Hylton Grange, its new £5.7m nursing home in Sunderland, Tyne and Wear. Cutting the ribbon to Sunderland’s newest nursing home was the Mayor of the City of Sunderland, Councillor Dorothy Trueman. The Mayor emphasised the significant demand for care services catering to individuals with complex needs. Hylton Grange offers support for adults living with complex mental health needs and neuro-disabilities including Huntington's disease and Parkinson's disease. Without Hylton Grange, residents would otherwise have a prolonged stay in hospital, away from their family and friends.

Brunelcare is excited to announce it has launched a new service at its Little Heath Reablement and Support site in South Gloucestershire. Little Heath is Brunelcare’s newest site, opening in April 2020. The 24-bed site has provided vital care and support to help people return home more quickly after they leave hospital. Over the last three years, the reablement team at Little Heath has supported more than 700 people, receiving amazing feedback from them and their loved ones. With the current contract for reablement services coming to an end, the centre has now been repurposed to focus on providing nursing and care for people who are not living with dementia. This

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CMM December 2023

Split into three, 10-bed communities – as small group living provides a more homely, supportive, and responsive care environment – each of the 30 bedrooms has its own ensuite wet room. Each unit has a communal dining room, lounge, quiet lounge, and a sensory bathroom. In addition, there is an activities hub, an accessible garden, a hair salon, and a therapy room providing a dedicated space for rehabilitation. The home has created 100 new healthcare jobs in the local area, and unlike many local care homes, will feature a multidisciplinary healthcare team. The home has already recruited a mix of care, nursing, and therapeutic practitioners, including healthcare assistants, registered nurses, a physiotherapist, and an occupational therapist.

is in recognition of the fact that there are a number of people who want some level of nursing support, but for whom a dementia-specialist home isn’t the right setting. Brunelcare is also entering into a new partnership with South Gloucestershire Council, to provide four beds to allow admissions from the community into the Little Heath site. These ‘step up’ beds will allow people to access short-term support for up to eight weeks, before returning to live independently in their own homes. Oona Goldsworthy, Brunelcare Chief Executive, said, ‘This will be a new type of service for Brunelcare, and we believe it’s an exciting opportunity to offer support to even more members of our community.’

NEWS

Legal firm warns of Right to Work scrutiny

Autism Hampshire joins Avenues Group

Care operators are being urged to review their Right to Work processes amid new soaring penalties for businesses that breach the rules. Full-service law firm Thornton's employment and immigration experts have advised that care businesses are more likely to be affected by the new rules following a surge in overseas recruitment. The civil penalty for employers, which was last increased in 2014, will be raised to up to £45,000 per illegal worker for a first breach from £15,000, and up to £60,000 for repeat breaches from £20,000. Details of the fines will be published on the UK Government’s website, creating reputational issues for affected firms. Since Brexit, only British and

Autism Hampshire, a leading charity dedicated to providing support and services to autistic people and their families, is merging with Avenues Group. This development, effective from 1st November 2023, promises ongoing benefits for autistic people in Hampshire and across the country. In recent years, social care charities have faced huge external challenges. These include pressures on funding, the disruption caused by COVID-19, and the cost-of-living crisis. These influences have made it increasingly difficult to continue to provide high-quality services that are sustainable in the long term. To protect the future of its services, Autism Hampshire decided to look for a merger partner that shared its values.

Irish citizens have an automatic right to work in the UK. EU nationals who came to the UK on or after 1st January 2021 no longer automatically qualify. Immigration specialist Jacqueline Moore said, ‘There have been many changes to how Right to Work checks should be conducted in recent years and businesses using out-of-date processes are not protected from penalties. The care sector is likely to be under additional scrutiny and compliance is crucial. Investing in Right to Work should be as much of a priority as health and safety or data protection.’ According to the UK Government, enforcement activity has been stepped up this year with visits at their highest levels since 2019, up 50% on last year.

Avenues Group is a charity specialising in support services for autistic people, people with learning disabilities and complex needs. The charity operates across South East England, London, Hertfordshire, Essex, Suffolk, Cambridgeshire and Shropshire. Allison Henbest, Interim Chief Executive and Operations Director at Autism Hampshire said, ‘Through joining forces with Avenues, we are excited about bringing our strengths together to continue to create a better future for autistic people in Hampshire and beyond. Avenues bring a wealth of expertise that we cannot wait to draw upon, to support the growth of our services, and to continue to fulfil the goals and aspirations of the people we support.’

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CMM December 2023

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NEWS NEWS / IN FOCUS

Annual State of the Nation report published Access Social Care’s annual State of the Nation report has found increased requests for social care advice across nine major organisations. The report paints a picture of the current social care system, with the rise in demand for advice far outstripping the available resources. The nationwide data in this year's report showed a 123% increase in the number of enquiries about social care needs assessments, as well as a 95% increase in enquiries that required specialist legal advice. This data was gathered between 2021-2023 and compared with figures from 2019-2021. Access Social Care is a charity providing free legal advice for people with social care needs. This is the third annual State of the Nation report. The charity has used anonymised data from the Royal Mencap Society, Age UK, Carers UK, Independent Age, RNIB, Ealing Advice Service, Citizens

Advice Bureau, and Scope. The resulting report draws together over 300,000 separate data points and outlines the key challenges facing people who need social care. The report also revealed: • 100% increase in the number of enquiries about accessing social care statutory advocacy. • 80% increase in the number of enquiries relating to being a carer. • 48% increase in the number of enquiries from people seeking general information about social care. • 375% increase in the number of enquiries about mental capacity. Kari Gerstheimer, Founder and Chief Executive Officer of Access Social Care, said, ‘Our country is feeling the effects of years of underfunding of social care, and this is exacerbated by the dire lack of legal support available.’

New language learning programme A new language learning programme is aiming to open up new opportunities for residents in care homes. This new initiative has been developed and operated by Speak Like A Native. Speak Like A Native's Chief Executive Officer, Stuart Rubenstein, said, ‘We’ve been running language courses in nurseries and schools for years but COVID-19 meant we’ve had to wait until now to start in care homes. ‘We create a space where residents can connect the language with memories, which might be food or culture, school experiences, family or holidays. The lessons are very fluid and follow the pace of

those participating.’ Among the early adopters of Speak Like A Native has been Alan Morkhill House in North Kensington, part of the Gold Care Homes group, which now has Spanish for beginners as one of its regular weekly events. Suraiya Islam, Activities Co-ordinator at Alan Morkhill House, said, ‘Language sessions benefit our residents in numerous ways; they help them grow, stimulate their brains, increase their desire to learn and try something new, improve their attention span, slow down cognitive issues, improve memory function, boost their self-esteem and give them a sense of pride.’

IN FOCUS

National Audit Office (NAO) report on Reforming Social Care WHAT’S THE STORY? Two years into its 10-year plan to overhaul adult social care, Government has delayed its plans to cap lifetime care costs that a person pays and scaled back plans for reforming the system it set out in December 2021 and, despite progress in some areas, is behind schedule even on its revised plans. More than a billion pounds of the £1.7bn committed to reforming the adult social care system in December 2021 has been diverted to other care priorities, according to a new NAO report.

WHAT WERE THE FINDINGS? Reforming adult social care in England reveals that only £729m may now be spent between 2022 and 2025 on reforming the adult social care system, representing a 58% fall in the budget. DHSC estimates that in 2023-24, local authorities, in aggregate, intend to spend enough on adult social care to cover cost pressures. However, there is local variation and funding may not be reaching areas that need it most because the Government has not updated the formula used to distribute most local Government funding for adult social care since 2013-14. DHSC estimates that around a quarter of local authorities may not spend enough to keep up with the cost pressures they face this year, while one in six expects demand for adult social care to exceed capacity this winter. While waiting lists have eased slightly, survey data suggests that the number of people waiting more than six months in March

2023 for a care assessment was almost double – at around 82,000 – what it was at the end of 2021. Vacancies in adult social care in England have increased by 173% in the past decade and, despite a recent fall, stand at around 152,000 (a 10% vacancy rate). Around 70,000 staff have been recruited from outside the UK in the past year. The NAO report finds that DHSC has much to do if it is to achieve its 10-year ambition for reforming adult social care and must manage significant risks. However, DHSC has not established an overarching programme to co-ordinate its reforms, making it difficult to know if it is on track to achieve its objectives. DHSC is delivering on two of its eight workforce projects – supporting international recruitment and adult social care volunteering – and the remaining six are in development. Some projects within digital, data and assurance have made better progress.

WHAT DO THE EXPERTS SAY? Gareth Davies, the Head of the NAO, said, ‘If Government is to successfully reform adult social care, it will need to manage some significant risks, including its own capacity and that of local Government to resume charging reform activity alongside system reform. ‘To maximise its chances of succeeding, Government will need to ensure it understands the impact of its ambitions on local authorities and other stakeholders and establish a costed plan which ensures delivery of its long-term goals.’ CMM December 2023

NEWS

NEWS FROM ACROSS THE GLOBE Shortage of Australian aged care workers The Australian Council of Deans of Health Sciences (ACDHS) is raising the alarm over a predicted shortfall in allied health workers in aged care as the Australian population grows and ages. A new model, commissioned by the ACDHS, allows policymakers to see how different policy settings would affect the number of allied health workers needed in Australia over the coming years.

Currently, Australians receiving aged care are on average only receiving eight minutes of allied health care a day. The Final Report of the Royal Commission into Aged Care Quality and Safety recommended that be raised to 22 minutes a day to bring Australia in line with international standards. To achieve 22 minutes a day by 2033, Australia would need to train another 25,000 allied health

professionals. Due to the high demand, obstacles to supply and the overall time required to increase the number of fully qualified allied health professionals, the training would need to start today. Professor Terry Haines, ACDHS Deputy Chair, says that it’s time for a national conversation about the levels of allied health care Australians and their loved ones are going to receive in old age.

‘The amount of allied health care currently received by Australians in aged care compares poorly with the international benchmark cited by the Royal Commission of 22 minutes a day,’ says Professor Haines. The ACDHS is urging the Government to declare whether it is willing to back the Royal Commission recommendation of 22 minutes of allied health care a day.

CommonAge to publish dementia in the Commonwealth report A proposed report on dementia in the Commonwealth has been approved. CommonAge plans for it to be completed by April 2024 and it will be presented at the CHMM 2024 in Geneva in May. The report will also be presented at the Commonwealth People’s Forum

at the Commonwealth Heads of Government Meeting (CHOGM) 2024 in Samoa in October. The Commonwealth comprises 56 member countries and a population of 2.6 billion where the majority are lowerand middle-income countries (LMIC) in Africa, the Caribbean,

and small island states. Mr Andrew Larpent OBE, the Chair of CommonAge — The Commonwealth Association for the Ageing, said, ‘Our efforts join governments, civil society, businesses, and other organisations around the world in the pledge to take

meaningful action to improve the lives of older people, their families and communities. We are passionate advocates for all nations to respect the rights and dignity of older citizens and to join in the call for a UN Convention on the Rights of Older Persons (UNCROP).’

Effective approaches to caregiving training Global Ageing Network members joined together on 25th October 2023, to learn about and discuss effective approaches to caregiving. Speakers from South Africa and India shared the challenges and innovations of their communities in supporting older adults and those who care for them. Elena Moore, a Research Professor from the University of Capetown, provided an overview of the care of older persons in southern Africa. The 60+ population in sub-Subharan Africa is increasing at a more rapid rate than any other region of the world and 52% of older people in South

CMM December 2023

Africa live in households with no one employed, and the older adults in poor health. Further, the number of home-based care workers is limited and the employment position is often ambiguous. There are few community or health-related resources, information, and/or training for family caregivers. Moore outlined a list of recommendations from the Funding Elder Care Provision in South Africa report, which urges financial support at the community level to include more health services to meet the needs of older persons and their caregivers.

Dr Benazir Patil of the Society of Community Health Orientated Operational Links (SCHOOL) in India shared about a successful community programme to support older persons. As a 75-year-old nation, India’s population projections indicate it already has 30 million individuals who are 75 years or older. The programme, called Vriddha Mitra, or Friends of Older People, aims to understand the socio-cultural, economic, and psychological challenges older people face in their day-to-day life. Vriddha Mitra focused on building an age-friendly ecosystem for the elderly

population in India. The programme began with two slums in Pune city in January 2019 – and now reaches over 33,000 elders in 144 slums in Mumbai, Bhopal, and Gwakior districts. Each elder is registered through the mobile app-based format called Saving Life Checklist, which captures demographic information and the WHO Quality of Life 6 domains. Trained youths are placed in the field to deliver services and create awareness in the community. They are continuously mentored and their capacities are strengthened for a clear pathway to growth and development.

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Navigating change:

What does the CQC’s new single assessment framework mean for providers?

The CQC is changing the way it inspects and reports on services but what are the evidence requirements for providers and what areas of the current system will remain the same? Philippa Doyle, Partner at Hempsons, a national health and social care law firm, shares her analysis of the new process.

At the time of writing (October 2023), CQC’s long-awaited Single Assessment Framework (SAF) is slowly being shared. Its implementation has been somewhat delayed, due to IT technicalities and resourcing, but we seem to have a clear(ish) timetable for providers to have access to the new portal in Autumn/Winter 2023, with social care providers in the South ‘going live’ first on 21st November and the rest of the country expected to go live in the new year. Keep watching CQC’s website and sign up for updates to ensure you have the most up-to-date information.

Business as usual? Whilst the SAF is badged as a full-scale change in the inspection process, that change sits with CQC, not with providers. It is CQC that is changing the way it inspects, the questions it asks, how it rates, and how it reports. For providers, it is business as usual. The regulatory framework that underpins the delivery of care has not changed and is not changing. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Fundamental Standards of Care, enshrined in Part Two of those Regulations, are here to stay. All of the good work that you and your teams have done so far and continue to do, and all the excellent policies and procedures you have in place can stay. Keep ensuring your care planning is person-centred. Keep ensuring your staff are up to date with training. Keep ensuring your medicines management is carefully delivered, monitored, and audited.

Inspection insights The SAF is CQC’s new inspection regime. The CQC says it will regulate in a smarter way, adapting and responding to risk, uncertainty, 20

CMM December 2023

and demand. We have seen clear signs of that already. During and post-COVID-19, CQC inspections were led by risk. This meant that there were direct complaints to its helpdesk, whistleblowing allegations, and concerns raised by commissioners, which led to poorly performing services, or those perceived as being poorly performing, being at the front of the queue when it came to re-inspections. Long gone is the inspection programme where a good service would not expect to see CQC again for two years. The four ratings of: Inadequate, Requires Improvement, Good, and Outstanding, remain. The five key questions or domains of safe, effective, caring, responsive and well-led will also remain.

Understanding requirements What will change is the introduction of quality statements, which replace the previous 300 or so key lines of enquiry. These quality statements are phrased as questions and providers will be judged against the available evidence to show how those questions are met. Each statement is scored from 1 – 4 based on the quality of the evidence submitted to CQC. At the end of the process, providers will be able to see very clearly exactly where their service is doing well, and where there are gaps that require extra attention. Those providers looking to increase their rating up to the next level will also be able to see how far away from achieving that rating they are and where they need to focus their efforts. CQC has very helpfully shared the different types of evidence that might be required to answer each of the quality statements and this is where the SAF differs for different sector groups. There are eight different sector groups: • Ambulance services. • Care homes and supported living services.

• • • • • •

Community health services and hospices. Homecare and shared lives services. Independent doctors. Mental health services. NHS acute hospital services. Primary health services.

Each sector group will have slightly different evidence requirements, but all the details are available on CQC’s website for a service to map across each quality statement and what evidence they need to put forward. The evidence categories are all very familiar too and are all based on the work CQC currently carries out when it inspects a service. There are six evidence categories: • People's experience of health and care services. • Feedback from staff and leaders. • Feedback from partners. • Observation. • Processes. • Outcomes. Processes is one of the more notable ones for providers to be aware of – this is any series of steps, arrangements or activities which are carried out to enable a provider or organisation to deliver its objectives. CQC assessments will focus on how effective policies and procedures are. To do this, CQC will look at information and data sources that measure the outcome from processes. For example, CQC may consider processes that measure and respond to information from audits, look at learning from incidents and/or notifications and will review people’s care and clinical records. Outcomes is a more NHS-based rather than social care-based evidence category. This will look at outcomes measured in the context of the service and the specifics of the measure. For example, mortality rates, emergency admissions and re-admission rates to hospital, infection control data, and vaccination and prescribing data. This information will be sourced from

> CMM December 2023

DĞĚůŝŶĞ ŽŶƐƵůƚĂŶĐǇ >ŝŵŝƚĞĚ zŽƵƌ ĨƌŝĞŶĚůǇ ŶĂƚŝŽŶǁŝĚĞ ƉƌŽǀŝĚĞƌ ŽĨ dƌĂŝŶŝŶŐ ŝŶĐůƵĚŝŶŐ &ŝƌƐƚ ŝĚ͕ ,ĞĂůƚŚ ĂŶĚ ^ĂĨĞƚǇ͕ &ŽŽĚ ,ǇŐŝĞŶĞ͕ ,ĞĂůƚŚ ĂŶĚ ^ĂĨĞƚǇ͕ DĂŶĚĂƚŽƌǇ dƌĂŝŶŝŶŐ ĂŶĚ ŽŶƚŝŶƵŝŶŐ WƌŽĨĞƐƐŝŽŶĂů ĞǀĞůŽƉŵĞŶƚ ĐŽƵƌƐĞƐ ĂƐ ǁĞůů ĂƐ Ă ŽŶĞ ƐƚŽƉ ƐŚŽƉ ĨŽƌ Ăůů ǇŽƵƌ &ŝƌƐƚ ŝĚ ĂŶĚ DĞĚŝĐĂů ĞƋƵŝƉŵĞŶƚ ŶĞĞĚƐ ƚŽ ƉƌŽǀŝĚĞ ǇŽƵ ǁŝƚŚ ĞǀĞƌǇƚŚŝŶŐ ǇŽƵ ǁŝůů ŶĞĞĚ ŝŶ ĂŶ ĞŵĞƌŐĞŶĐǇ͘ dŽ ǀŝĞǁ ŽƵƌ ƉƌŽĚƵĐƚƐ ƉůĞĂƐĞ ǀŝƐŝƚ ŽƵƌ YZ ĐŽĚĞ Žƌ ƚŽ ƐƉĞĂŬ ƚŽ ŽŶĞ ŽĨ ŽƵƌ ĨƌŝĞŶĚůǇ ƚĞĂŵ ƉůĞĂƐĞ ĐŽŶƚĂĐƚ͗ dĞůĞƉŚŽŶĞ͗ ϬϯϯϬ ϭϭϴ ϬϰϴϬ KƵƚ ŽĨ ,ŽƵƌƐ͗ Ϭϳϳϲϰ ϰϮϰϮϯϳ ŵĂŝů͗ KĨĨŝĐĞΛŵĞĚůŝŶĞͲĐŽŶƐƵůƚĂŶĐǇ͘ĐŽ͘ƵŬ

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NAVIGATING CHANGE: WHAT DOES THE CQC’S NEW SINGLE ASSESSMENT FRAMEWORK MEAN FOR PROVIDERS?

patient-level data sets, national clinical audits and initiatives such as the patient-reported outcome measures (PROMs) programme.

Uncertainty remains What we regrettably can’t say at the current time is how much time CQC will give providers to upload evidence to the portal, how often information will be requested, or the format of the information you will have to upload. None of the requests should involve the need to create any new documents though – anything asked for should already be freely available, in just the same way as it might have been requested during previous inspections. It might be most helpful for providers to look at the quality statements in context. They are expressed as “I” and “we” statements. The “we” statements show what is needed to deliver high-quality and person-centred care and the “I” statements reflect what people have said matters to them.

Using learning culture as an example: The “we” statement reads: We have a proactive and positive culture of safety based on openness and honesty, in which concerns about safety are listened to, safety events are investigated and reported thoroughly and lessons are learned to continually identify and embed good practices. And the “I” statements are: I feel safe and am supported to understand and manage any risks. I can get information and advice about my health, care and support and how I can be as well as possible – physically, mentally and emotionally. The evidence categories CQC will use to judge and score your responses to those statements are as follows: Feedback from partners – • Commissioners and other system partners – how well do you report safeguarding referrals and make notifications to CQC? • Health and care professionals working with the service. Processes – • Duty of Candour records. • Evidence of learning and improvement. • Incident, near misses and events records. The evidence submitted is then scored out of 1 – 4 4 = Exceptional standard. 3 = Good standard. 2 = Shows shortfalls. 1 = Significant shortfalls. For example, if the service scored a 2 in learning culture, this would then feed into the overall scoring in the safe domain. Please see the table opposite for what an example service might look like. This particular service has scored some twos and some threes and when that is converted into a percentage, it has scored 65.6% which puts it squarely into the good rating. The service can see where it needs to do better, for example, infection control. This enables providers to know where to concentrate

their efforts to improve. The theory is that the service will be able to submit evidence to CQC of its improvements and if CQC is satisfied with it, the scoring would be adjusted, which for some services might see an uplift from Requires Improvement to Good. The percentage scores are clearly laid out: • 25 to 38% = Inadequate. • 39 to 62% = Requires Improvement. • 63 to 87% = Good. • Over 87% = Outstanding. So as a service, you can see whether you are “just” missing out on a rating, or if you’ve “just” made it into the next category. Do be mindful that there are some rating limiters: • If the key question score is within good range but with a score of 1 for one or more statements, the rating is limited to Requires Improvement. • If the key question score is within outstanding range but with a score of 1 or 2 for one or more quality statement, the rating is limited to Good.

Transparency is key I am very hopeful that this new way of inspecting, evidence gathering and reporting will provide a far more consistent and transparent approach to regulation. Evidence is key though, even more than it ever has been. Providers will be uploading A LOT of information onto the provider portal before a visit and CQC’s analysis of a service will only be as good as the evidence submitted. It is worth engaging with the different questions, and what evidence CQC is looking for, to ensure that what you provide is specific and relevant. It is no good telling CQC everything you know about a subject – you have to actually answer the exam question. Hempsons has worked with providers for many years supporting them through the CQC process. Our Fundamental Standards of Care training packages for registered managers and front-line staff can help you navigate the regulations, improve the lives of the people you support and tick CQC boxes too. Do get in touch for more information on how we can support you. CMM

Quality Statement

Score

Learning Culture

Safe systems, pathways and transitions

Safeguarding

Involving people to manage risks

Safe environments

Infection prevention and control

Safe and effective staffing

Medicines optimisation

Total score

Maximum score (8 qus x 4)

Percentage for safe

65.6% = Good

Philippa Doyle is a Partner at Hempsons. Email: p.doyle@hempsons.co.uk X: @hempsonslegal Do you feel prepared for the CQC’s forthcoming changes? And what is your view on what’s changing? Visit www.caremanagementmatters.co.uk and share your feedback on the article. CMM December 2023

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How much political progress has been made for social care reform in 2023?

There has been a slow trickle of support for social care from Westminster over the past 12 months and some future roadmaps published – but what can we learn from the Government’s actions in 2023 and what can we expect from political party manifestos? David Brindle tells us more.

Whatever the Government’s wider legacy may turn out to be, an inevitable and unfortunate aspect will be our instinctive suspicion of numbers in Whitehall announcements. Too many headline figures have turned out to be not quite what was purported. When, at the end of October, the Department of Health and Social Care (DHSC) announced details of a £42.6m Accelerating Reform Fund for innovative new projects in social care – and said it also ‘includes our commitment to invest up to an additional £25m to support unpaid carers’ – observers

smelled a rat. They recalled that the initial announcement of the funding, in April, had been of ‘up to £35m’ for innovation alone. Had £35m plus £25m (albeit qualified in the small print as maximums) somehow become not £60m, but £42.6m? Asked if it was short-changing innovators or carers, or both, the DHSC hastily clarified that the single pot included the full £25m for carers and that further sums for innovation would be forthcoming. We shall see. If nothing else, the episode exposed the Government’s wholly self-inflicted wounds

CMM December 2023

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PLAYING THE LONG GAME: HOW MUCH POLITICAL PROGRESS HAS BEEN MADE FOR SOCIAL CARE REFORM IN 2023?

> on social care. Such has been its 13-year record of failure in England to deliver either adequate funding or the reform that everyone accepts is woefully overdue, its capital is all used up. Even when there is some good news, its announcement or re-announcement is greeted with scepticism or, worse, is contemptuously dismissed.

A hopeful start? This year began with hopes higher than for some time. Even the Archbishop of Canterbury, Justin Welby used his New Year message to call for a focus on social care in 2023, declaring: ‘We know our care system is broken. But it doesn’t have to be. We can rise to the challenge of fixing it.’

"Just like the Tories, Labour is playing a long game (and like the Tories, it kept social care largely off the agenda at its party conference)." Welby was speaking shortly ahead of publication later in January of the findings of the Church of England’s commission on ‘reimagining’ care, the first of a fresh slew of reports urging reform, making the case for a new covenant setting out the rights and responsibilities of everyone involved in care. ‘Caring goes to the heart of what it means to be human,’ he said. ‘It’s hard. But it can also be the most beautiful life-giving thing that we ever do.’ There was what some mistook for a following wind: the previous autumn, Chancellor Jeremy Hunt had unveiled a two-year funding boost for social care that he described as ‘the biggest increase in funding under any Government of any colour in history’, amounting to (again) ‘up to’ £7.5bn. There was the familiar element of smoke and mirrors – some of the money was in fact for children’s services, much of it came from deferring again the long-awaited Dilnot reform package, probably shelving it indefinitely, and another big chunk was simply permission for local authorities to raise cash through council tax – but recognition of the sector’s plight was broadly welcomed. Appetites were whetted for a promised further announcement on reform. That update duly arrived in April to, it’s fair to say, widespread dismay. The Next Steps to Put People at the Heart of Care document, supposedly an implementation plan for the 2021 reform white paper, amounted to little more than a holding

statement. Care Minister Helen Whately made the best of it, saying that by 2025 the limited measures in the paper would have ‘shifted the dial’ and ‘achieved real change’, although the overarching vision ‘will not be achieved overnight’. But Sally Warren, Policy Director at The King’s Fund, saw instead ‘a narrow focus on just keeping the current system afloat, with little real ambition or pace for reforms that would make a difference to the hundreds of thousands of people who draw on social care to live their lives’. And there things that have been left, give or take. July brought the now annual funding top-up ahead of winter, £600m over two years this time in the form largely of a workforce fund to boost care capacity, and there has been a series of small announcements stemming from the Next Steps document – for example, a digital skills framework for care workers and the setting up of a taskforce studying older people’s housing needs. But the clear message from Government is that reform is a 10-year project, at least, and we should not expect to hear anything more substantive this side of the forthcoming general election.

Political agendas Social care was conspicuous by its absence from platform speeches at the Tory party conference, with any debate confined to fringe events, and the DHSC continues to rely heavily in its PR on the ‘historic’ 2022 investment commitment, which it now uprates to £8.1bn. Short of any wholly unexpected crisis of conscience on the part of Hunt, who said a lot of supportive things about social care as Chair of the Commons Health and Social Care Select Committee, before he rejoined Government, this appears to be how the Conservatives will go into the election. That slew of new reports on the need for social care reform continued this year with, notably, two ‘roadmaps’ projecting ways forward: one, in April, for the Association of Directors of Adult Social Services (ADASS), setting out 10 key areas of change and stressing that much could be achieved at local level ‘without the need for huge amounts of money’; and the second, in June, for the Labour Party from the Fabian Society, at long last putting some flesh on the bones of the idea of a national care service, first mooted by Labour 13 years ago. Just how keen the Labour leadership is to endorse the Fabian ideas is unclear: at the report’s launch, Shadow Health and Social Care Secretary Wes Streeting seemed as if he couldn’t get out of the room fast enough. Just like the Tories, Labour is playing a long game (and like the Tories, it kept social care largely off the agenda at its party conference). Streeting’s deputy for social care, Andrew Gwynne, appointed

CMM December 2023

PLAYING THE LONG GAME: HOW MUCH POLITICAL PROGRESS HAS BEEN MADE FOR SOCIAL CARE REFORM IN 2023?

> in September in place of the experienced Liz

Kendall, who was moved to social security, has spoken of the need to ‘take time to hear from experts, users and providers’ about how to fashion a national care service. The immediate focus of a Labour Government, he says, would be on a fair pay agreement for care workers – intended to be the first of a series of such agreements across the economy – and on measures via the Care Quality Commission to iron out variations in care standards. Don’t expect to see much else in the Labour manifesto.

The numbers don’t lie Can the sector wait another 10 years, maybe 15, for the next Government of whatever colour to deliver reform? The latest ADASS survey of its members shows that 83% are heading for an overspend in 2023-24, while numbers of people waiting for a care assessment, provision of a care service, allocation of Direct Payment or a care review are climbing again – up 8% between March and August this year to more than 470,000. With 152,000 job vacancies across the sector

"Not for the first time, the overriding impression is of social care having been patched up with a few quid…" in England alone, many observers think the show is being kept on the road only thanks to the recruitment of migrant workers. According to Skills for Care, some 70,000 obtained visas in 2022-23 under the new shortage occupation dispensation introduced in February last year. Numbers have since been running even higher. Everyone knows this is not a sustainable solution. Quite apart from anything else, it is denuding the global south of skilled labour: the leading countries supplying migrant care workers are India, Nigeria and Zimbabwe. Tales are of a legion of exploitation by unscrupulous care agencies and many migrants are simply using the system as a stepping stone to UK residency and work in other sectors. Not for the first time, the overriding impression is of social care having been patched up with a few quid and an expedient labour force plan, in lieu

of proper reform, just to buy a breathing space of another year or two.

Chamber calls for change Who will speak for the sector? Thank goodness for the House of Lords. In October, fully 10 months since its publication, peers met to debate A Gloriously Ordinary Life, the widely praised report of the Lords Adult Social Care Committee. Freed from the shackles of party discipline, they voiced support across the chamber for the report’s recommendations, in particular much greater support for unpaid carers and the appointment of a commissioner for care and support. Strongly endorsing the idea of a commissioner, veteran Labour peer Lord Dubs said, ‘I know the Government doesn’t like it. It may make the job of the Government minister a bit more difficult. But it would be very healthy to have somebody who could pull things together and be an advocate for people in this field, as is the children’s commissioner for children.’

Coming up short The frustration was palpable. ‘We don’t seem to be moving the dial one iota for people,’ said Baroness Fraser, a Tory peer and Chief Executive of the charity Cerebral Palsy Scotland. ‘We won’t enable people to have choice and control unless plans are backed up by funding and action.’ Plans, funding, action. Entering its last 12 months, the present Government is coming up short for social care on all three of those fronts. The worry is that the next Government will offer little more. CMM

David Brindle is former Public Services Editor of the Guardian. He is chair of Ambient Support. Email: dj.brindle@btinternet.com Twitter: @DavidJ_Brindle What would be on your priority list for a political party manifesto? Visit www.caremanagementmatters.co.uk and share your feedback on the article and your political reflections. 28

CMM December 2023

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CMM December 2023

cognitive impairments and limited mobility can participate. In addition, The Access Group reports that residents are more likely to respond positively to freedom of choice – although it is unlikely that you will be able to please everyone. With regulatory inspections in mind, quality providers will manage and routinely review risk assessments to facilitate the safe delivery of successful activities. Skills for Care encourages providers to ensure there is the right mix of skills, competencies, qualifications, experience and knowledge amongst their staff cohort to meet people’s individual needs when delivering successful activities.

Training for success

INTO PERSPECTIVE HOW CAN PROVIDERS USE PEOPLE'S EXPERIENCES AND PREFERENCES TO DELIVER SUCCESSFUL ACTIVITIES? Later in this issue, on page 41, we will hear the true benefit of ‘creative health’ for people in care settings. Activities play a central role in maintaining quality of life in care settings. To round off 2023, CMM’s chosen subject experts delve into what it takes for providers to deliver successful activities. Experiences and preferences Drawing upon the experiences and preferences of people living in a care setting is essential for providers wishing to deliver successful activities. Treating residents as ‘people’ not ‘patients’ by learning about their 30

CMM December 2023

life stories and engaging with their interests should help providers to organise activities that enrich residents’ lives and support physical and mental wellbeing. Individualised care planning and robust communication between staff should help providers to create activities that are an extension of the personalities and identities of the people in their care, fostering unity between residents and delivering person-centred outcomes.

Accessibility and risk management There are, of course, more practical considerations providers must take into account in order to deliver successful activities. Individual experiences and preferences in relation to accessibility and risk are two such examples. The Access Group details the importance of planning activities to ensure that people with

While conversations around activities tend to focus on the outcomes for people receiving them, the staff delivering activities should also be supported to operate effectively in their roles. Staff with the training, knowledge and experience to assess the needs and abilities of residents before planning successful activities should be better placed to deliver them based on the preferences of the people they are caring for. In addition, staff may receive training to tap into the experiences of family members or other significant people in the lives of the people being cared for to help plan and provide successful activities. Friends and relatives can provide invaluable insight for providers that have the capacity to listen and take action. The local community may also wish to support activity provision. This provides the opportunity for residents to remain in touch with life outside of the care setting and calls upon staff to engage with another stakeholder with its own set of experiences that can be utilised to contribute to delivering successful activities.

Listen and learn Engaging with people participating in activities in order to gather their feedback should allow providers to continuously adapt and improve their offerings. Systems in place to provide feedback should be as accessible as possible to people taking part in activities and ideally, in turn, make it easier for providers to plan and resource successful activities on a daily basis. Staff should also be encouraged to make observations, compare notes about what went well and suggest ideas to make activities even more successful next time. Providers face an uphill battle in trying to incorporate the experiences and preferences of multiple stakeholders into the deliverance of successful activities. Now, it’s over to the experts for their input.

Keep channels of communication open

Thriving in residential care – the way forward

Hilary Woodhead, Executive Director, National Activity Providers Association (NAPA) @NAPAlivinglife Email: hilary@napa-activities.co.uk

Geoffrey Cox, Chief Executive Officer, The Eden Alternative UK LinkedIn: the-eden-alternative Email: geoffrey.cox@southernhealthcare.co.uk

There is an art to creating meaningful activities. I believe that this hinges on embracing the unique experiences and preferences of individuals. NAPA champions core strategies providers can employ to harness people's experiences and preferences, turning ordinary routines into extraordinary moments of fulfilment. Delivering meaningful activities begins with understanding individuals. A comprehensive assessment, which explores backgrounds, interests and experiences, lays the foundation for meaningful activities. This is the blueprint for ensuring that every activity is a tailored fit. Open channels of communication and keep them flowing. Regular engagement with individuals and their families ensures that their voices are acted upon. Engaging in ongoing conversations helps us adapt activities to align with evolving preferences and experiences. Preferences are as dynamic as life itself. They shift and evolve over time, and we must adapt. Embracing flexibility ensures that activities remain relevant and meaningful. Collaboration encourages team

members to share their knowledge and experiences and enriches ideas. We create an environment where the exchange of ideas is encouraged, resulting in a broader spectrum of activities that resonate with diverse tastes and backgrounds. We also invest in training our team in meaningful activity provision. By equipping activity and care teams with the skills and mindset needed, we empower them to provide more engaging activities. To ensure our services continuously evolve, we establish feedback mechanisms and regularly assess the impact of our activities. Data-driven decisions enable us to refine our offerings and ensure they meet the changing needs and preferences of individuals. By embracing each person's unique experiences and preferences, we empower them to be active participants. This leads to more enjoyable and fulfilling activities and promotes overall wellbeing and improved quality of life. I promote these principles because I believe that meaningful activities are at the core of delivering compassionate care and support. I encourage all providers to embark on this journey – together, we can make a difference.

We conduct 'activities' and 'meaningful occupation' with the best intentions but what this means can be limited; constrained by task-oriented concepts of what public commissioning of elderly residential care is really about, by limited public budgets and by operating in an impersonal and ageist environment. Predominantly, these things are the failure of political oversight. The dichotomy is that many providers are determined to build people's quality of life with relationship-based care, whilst many local authorities and the NHS are more concerned about coping with growing need on shrinking budgets, predominantly focused on physical function, not wellbeing. Residential care caters to complex health matters but more importantly, builds a life worth living. That takes great skill, but central Government does little to develop this than pay lip service. Modern care homes don't just look at activities as an optional extra, as public commissioners often have, but make quality of life, variety and spontaneity a central theme of what life

is all about. That's not to say some care homes don't still plan activities with limited ambition. Not that long ago, commissioners wouldn't fund these and even now, it's not seen by some as important. Individualised holistic planning is key, including meaningful occupation for supporting people's quality of life. Person-centredness and relating in care settings is vital. Honouring people's rights to determine their own care and fostering partnership working between residents, families, teams and providers are also important. Activities, meaningful occupation and making life worth living reduces loneliness, helplessness and boredom and improves wellbeing. Team and organisation culture to support this is critical. It needs to embrace honest reflection, learning and innovation. Building relationships, emotional intelligence and keeping the focus upon 'life worth living' is achievable, rewarding and sound, business wise. Programmes such as the Eden Alternative, the Butterfly programme and the Chrysalis programme can help to fulfil these aspirations.

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CMM December 2023

A BRIGHTER FUTURE:

How can we change the perception of social care?

The #SocialCareFuture movement celebrated its fifth birthday this year and the movement for change is building momentum. Neil Crowther, Co-convener of #SocialCareFuture, shares the story so far and offers five tips on what everyone can do to change the perception of social care.

Over the past year a succession of high-profile reports about the future of social care, including by the House of Lords Adult Social Care Committee, the Archbishops’ Commission on Reimagining Care and the Association of Directors of Adult Social Services, have recognised the crucial importance of taking action to shift public attitudes towards social care and those of us who draw on it to live our lives. Doing so has been at the heart of the #SocialCareFuture movement since we emerged in 2018. From the very beginning, we recognised that public discourse and attitudes to social care militated against us realising our vision. Born of frustration, but powered by hope, we have charted the development of

CMM December 2023

A BRIGHTER FUTURE: HOW CAN WE CHANGE THE PERCEPTION OF SOCIAL CARE?

our work to change the public narrative on social care on the pages of CMM since.

2. It’s about living good lives Don’t talk about ‘social care’ (few understand the term). Talk about ‘support to live a great life’ (or support to live in the place we call home, with the people and things we love, doing what matters to us).

Re-writing the story The research we conducted helped us to develop our story and the language of the campaign. Our story has been widely adopted by councils, providers, campaigning charities, parliamentary committees, political parties, and by Government. The headline of our story, of a future where everyone is able to ‘live in the place we call home, with the people and things that we love, in communities where we look out for one another’ has become a de facto ‘North Star’ for social care reform. The language we developed, such as the idea of social care being something that we ‘draw upon to live our lives’ has become commonplace. Nevertheless, we continue to feel that public mindsets remain rooted in the outdated and unproductive thinking about social care that we identified back in 2019 and that without change, investment and reform will continue to elude us. That’s why in October 2023 we kickstarted the next phase of our movement for change and marked our fifth birthday with the launch of an animated short film, voiced by the TV star and activist Liz Carr.

It doesn’t have to be this way The film, directed by multi-award-winning creative director Yoav Segal, translates our evidence-based public story of the future of social care into a colourful, upbeat mosaic of sounds and visuals. But it doesn’t shy away from the challenge. In the film, distributed via organic and paid social media, Carr, star of Silent Witness and Marvel’s Loki series, warns, ‘Without big changes to the way we think about social care, we and the people we care about face losing control of our lives and contact with the people and things that make our lives worthwhile’ before adding ‘it doesn’t have to be this way’. The film has already been viewed and shared tens of thousands of times on social media, including X, Facebook, and Instagram. Narrating the film was deeply personal for Carr. As she tweeted after it was launched, ‘worth saying that without social care, I would not be able to do the things I do, everything from being on TV to going for a wee.’ We can add to that list recording the narration of our animation, which is what made Liz’s involvement so perfect.

Liz Carr recording the narration to #SocialCareFuture’s film

Potential for change Social care isn’t just under-resourced, it’s also under-imagined. As Anna Sevewright, one of my co-conveners of #SocialCareFuture, who draws on support from personal assistants to live her life has said, ‘As a movement for change, we believe progress depends on shifting how the public thinks and feels about social care and on building stronger support for investment and reform. Our new film is based on extensive public audience research, which found that after exposure to these messages, the public saw social care as more relevant to themselves and their families, as more valuable to the wider community, felt more optimistic about the potential for change and accorded it greater priority for investment.’ Support for the initiative has come from other influential sources too. Dr Anna Dixon, who chaired the Archbishops Commission on Reimagining Care, said, ‘Our commission concluded that without a shift in public attitudes both to care and to those who draw on care or support to live our lives, then much needed investment and reform will continue to elude us. I’m pleased to see #SocialCareFuture lead the way in striving to positively shift how the wider public imagines and feels about social care and its importance to everyone in society.’ Alongside the animated film, we’ve developed and launched a new brand and movement website, which aims to showcase creative ideas, offer resources, and provide a place for people to share and to connect.

How can everyone help to change the story of social care? 1. It’s about people Don’t talk about the ‘social care sector’ as the focus of investment and instead talk about ‘our wellbeing’ and that of ‘people, families and communities.’ Don’t talk about people drawing on support as a different class. Learn to use ‘we, us, our.’

3. It’s an opportunity Don’t talk about ‘crisis’ and impending doom. Talk about the opportunity to improve the lives of people, families and communities, to create good jobs for the future and the infrastructure we all need to get on with our lives. 4. It’s about growing local ecosystems of support Don’t talk about ‘fixing’ the ‘social care system.’ Talk about growing the local ecosystems of support and relationships that permit us all to stay safe, well and to flourish throughout our lives. 5. It’s of increasing value and importance Don’t talk about social care as an ‘escalating cost’ or emphasise growing numbers seeking support with metaphors such as a ‘demographic timebomb.’ Centre instead on its growing value and importance to us all. Tell stories of people drawing on social care that bring this to life. More money is needed, but it must be recognised as a means to ends we all have reason to value. Money should not be ‘the story’. These five easy reframes will help to positively change the way the public thinks and feels about social care.

It’s in our hands This is the opening salvo in a long-term campaign to build public engagement and support for a brighter social care future. Learning from other movements for change, we’ll continue to try to change the public story of social care, alongside action to grow the power and influence of those of us who draw on support to live our lives, and our allies, and to convene different actors to make change together. Another future is possible for social care. The task of growing it is in our hands. Please join us. For more information, visit socialcarefuture.org.uk/do-your-bit CMM

Neil Crowther is a Co-convener of #SocialCareFuture. Email: crowtherconsulting@gmail.com X: @neilmcrowther 34

CMM December 2023

INTRODUCING A brand new publication for the care sector The informative publication is focused on cost-saving solutions and will be essential reading for operational leaders and purchase decision-makers in the social care sector.

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VIEW FROM THE STREET The UK healthcare market in review

CMM December 2023

Leading specialist adviser for buying and selling businesses, Christie & Co launched its 2023 Care Market Review report in October. Rob Kinsman, Regional Director for Healthcare at Christie & Co, shares the latest findings and offers his advice for providers looking to buy or sell in 2024. Earlier this month, Christie & Co launched our 2023 Care Market Review report which analyses a range of topics relating to the UK healthcare business market, including healthcare capital markets, land and development, the transactional market, operational costs, shifts in local authority fee rates, operator sentiment, and the finance landscape.

Healthcare capital markets The first half of 2022 reflected the peak of the market, with the economy in an optimum low-interest rate environment and average UK Bank of England base rates at 1.7%. UK Government gilt yields were tracking at 2.2%, and super-prime yields within the UK care home sector had compressed to record low levels for best-in-class assets. Entering 2023, the market began to adapt, with buyers returning albeit with yields adjusting to reflect higher costs of capital and the changing market environment. Positively, despite the macro-market challenges, there is good demand for care home opportunities, with investors attracted by the strong needs-driven underpin of the sector coupled with long-term index-linked cashflows.

Land and development The underlying business case for purpose-built care homes remains robust, with a continued need for future-proof market-standard beds in many locations across the UK. Despite operators continuing to face significant headwinds – in particular, construction cost inflation and the cost and availability of capital – the care home development market remains active and continues to transact a high volume of new-to-market beds within the UK. Sentiment remains positive, with more operators prepared to take leases on new build assets as a way of achieving growth, resulting in an upward movement in rental levels over the 12 months to June 2023. We are starting to see more domestic and international capital entering the market, attracted by the defensive characteristics of needs-driven Operational Real Estate and the excellent ESG credentials new care homes offer to investors. This additional liquidity, accompanied by the continued imbalance between demand and supply of marketstandard beds to cater to the rapidly ageing demographic, will support sustainable levels of transactional activity for consented care home development sites in both the short and long term.

Transactional analysis When analysing the UK’s elderly care going concern market between 2019 and H1 2023 (first half of the calendar year), we found: • Instruction volumes had rebounded, sitting 70% ahead of where they were in H2 (second half of the calendar year 2022). • There was a rise in the number of larger care homes (60 beds or more) going up for sale. • Only 3% of our transactions were to first-time buyers; this is around a third of the proportion in 2022. • There was an increasing number of transactions concluded by the larger companies and corporates.

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• Independent buyers remain our most active buyer group, accounting for 34% of Christie & Co healthcare deals in 2022 and 36% in 2023. • In 2022, 13% of the sales we completed were on a closed basis; this increased to 18% in H1 2023. • In H1 2023, 45% of closed care home deals were sold to care providers for ongoing care use and 55% were purchased for residential conversion.

Operational costs Analysis of our consultancy data – which looks at profit and loss accounts from the hundreds of formal valuations conducted by our network of healthcare valuers – shows a large increase in costs for care home providers between 2021 and 2023. This clearly reflects the wider economic challenges with labour supply constraints and rising energy prices, and the care sector has greater exposure to a material shift in these costs. We found that registered managers’ salaries, on average, increased by 13% between 2021 and 2023. There are even greater wage pressures on kitchen staff, with head cook wages increasing by 14%, on average. The situation with maintenance staff is also acute, with wages rising by 18%. An analysis of utility costs shows that heat and light costs have also increased by an average of 19% on a per-occupied bed basis.

Local authority fee rates As for our 2022 report, this year we conducted and analysed a Freedom of Information Act survey covering all local authorities across England, Wales, and Scotland. This revealed: • An average residential fee increase in England of 9.5% compared with 5.4% in 2022/23. • An average nursing fee increase in England of 8.1% compared with 6.8% in 2022/23. • Fee rate levels remain a challenge in some areas, with the increases being insufficient to offset inflationary cost pressures. • The burden on the self-funded client base is likely to rise, with the majority of providers achieving private fee increases of 10% or more.

Operator sentiment We also interviewed a cross-section of local and regional providers in the UK and found that 46% of operators have achieved a reduction in agency usage over the last 12 months, whereas 28% stated agency usage had increased. Private fee rates increased across all country regions, with 43% of operators reporting a 10% or above increase in private fee rates. Only 9% of respondents reported increases of under 5%, compared with 31% with local authority fees. Additionally, 38% of operators said that their occupancy levels have increased, while 70% stated that it has returned to pre-pandemic levels.

The finance landscape Historically, whilst in low-interest rate margins, lenders have applied a higher interest rate or a ‘stressed margin’ to calculate affordability. However, we are now operating in a new stressed rate environment, which has made lenders look in greater detail at a business’s ability to service their current levels of debt, as well as any potential increases. Results of a survey of a section of local and regional providers conducted by Christie Finance in July 2023, found that 38% of

respondents are looking to buy a care business in the next 12 months, 30% of which will seek finance to do so. When asked about the confidence they have in lenders to support their plans, 46% said they are very confident, 18% said not confident, and 36% remained neutral.

Buying and selling in 2024 If you’re considering selling your care business in 2024, here are some things to consider. In an environment of higher interest rates, the ‘stress test’ banks apply in assessing a new lending opportunity comes under greater scrutiny and the provision of regular, up-to-date management information is more important than ever. Purchasers and lending institutions are increasingly requesting quarterly profit and loss accounts, giving them the visibility and confidence to meet sellers’ expectations on price and make a deal happen. It is also beneficial to be able to evidence historic occupancy levels to show how the care home has traded in the past and the ‘story’ of the business leading up to the current day. This will help buyers and their lenders determine the sustainable level of trade under new ownership and the serviceability of the buyers' loan. CQC compliance and the ability to clearly demonstrate this to buyers and their advisers is also crucial. Operators may consider commissioning a mock inspection to be able to evidence ongoing best practices and robust governance policies. An effective ESG (Environmental, Social, and Governance) strategy has become increasingly prevalent in the sector and the CQC is now assessing the environmental impact of the business in its ‘Well Led’ criteria. Operators might consider seeking advice on how to improve the green credentials of their care home(s) as well as their staff policies to ensure a positive contribution to reducing the negative impact on the environment (such as sustainable energy, transport, waste etc.). Lending institutions are also paying greater attention to this fast-moving area. Over the past few years, we have seen a greater level of scrutiny on fire compliance. Sellers need to evidence a current fire assessment with any recommendations actioned. A potential longer-term challenge for operators seeking an exit is assessing their day-to-day involvement in the business. The number of owner-operator providers in the market continues to be relatively low and if an operator is looking to sell their care home and is also the registered manager this might limit the pool of buyers. Clearly, some care homes do not have the size to employ a registered manager, however, when scale allows, owners who are also the registered manager of their service should consider succession planning and how buyers will view the business without their ‘owner-input’. When planning the sale of your care home, there are many aspects to think about and the preparation phase is key. Early engagement with an experienced sell-side team (agent, accountant, and solicitor) will go a long way to ensure you maximise the value of your care home. A key concern for buyers in 2024 remains the uncertainty surrounding inflation, the cost of debt, and bank appetite in the sector. Appointing an experienced finance broker to provide options in an increasingly complex market can often be hugely beneficial. For the full report, which also includes a view of the German care market from Christie & Co’s new Head of Healthcare in German, analysis of the healthcare insurance market from Christie Insurance, Christie & Co’s key market activity, and a feature section on Care Home Open Week 2023, visit: www.christie.com/care-market-review-2023/ CMM

Rob Kinsman is the Regional Director for Healthcare at Christie & Co. Email: rob.kinsman@christie.com X: @ChristieCo What are your observations relating to the property market and your own experiences? Visit www.caremanagementmatters.co.uk and share your feedback on the article. CMM December 2023

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CMM December 2023

Creative health

Reviewing the benefits of creative approaches and activities in care services

The National Cen tre for Creative H ealth (NCCH) has evidence and mak been collating ing recommenda ti on s to the Governm role that ‘creative ent on the health’ plays in su pp orting people. Th Lord Howarth of e Rt Hon. Newport, Chair of th e N C C H and Co-Chair of All-Party Parliam the entary Group on A rt s, H ea lth and Wellbeing, the importance of explains maximising the po tential of creative approaches.

CMM December 2023

The Managers Conference 2024 Monday 11 March 18:00 onwards | Tuesday 12 March 09:00 – 16:30 Wyboston Lakes Resort, Bedfordshire Managers are fundamental to the delivery of outstanding care, which is why National Care Forum and Skills for Care, in collaboration with ARC England are hosting The Managers Conference 2024 to champion and support this crucial role. Come and join us to learn, share and find solutions to the challenges you face on a daily basis, and help you and your teams provide the highest quality care. This is the only conference dedicated to managers across adult social care.

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Book now to secure your place Attendee tickets include a networking evening with dinner and accommodation on the night of Monday 11 March 2024, followed by breakfast and entry to the full day conference with lunch and refreshments on Tuesday 12 March 2024.

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CREATIVE HEALTH: REVIEWING THE BENEFITS OF CREATIVE APPROACHES AND ACTIVITIES IN CARE SERVICES

The NCCH aims to advance good practice and research, inform policy, and promote collaboration, to create the right conditions for creative health to be integral to health and social care. Creative health is defined as ‘Creative approaches and activities which have benefits for our health and wellbeing’. Activities can include visual and performing arts, crafts, film, literature, cooking, and creative activities in nature, such as gardening. Approaches may involve creative and innovative ways to approach health and care services, co-production, education, and workforce development.

A creative health strategy In 2022, NCCH and the All-Party Parliamentary Group on Arts, Health, and Wellbeing launched a Creative Health Review, with the aim of making recommendations to the Government and Metro Mayors for a cross-departmental strategy on creative health that will support the practice to flourish. As part of the process, we held a series of themed roundtables and gathered evidence and examples of the benefits of creative health, in relation to key policy areas. Recognising the pressing challenges currently faced by the social care sector, including increasing demand, underfunding, and workforce capacity, we identified social care as a key theme and one where we think creative health can make a real difference. Here we outline the impact creative health can have on social care settings, particularly care homes, and how by further embedding creative health into health and social care systems its benefits could be felt more widely, improving conditions for individuals, carers, the workforce, and, ultimately, systems themselves.

A wealth of benefits Creative health can benefit people of all ages, but creativity can be particularly impactful as we age and provide a source of meaningful engagement and social connection. NICE guidelines recommend that group singing, arts, crafts, and other creative activities are provided for older adults at risk of decline in independence and mental wellbeing. Creative health can also have physical health benefits. We know that dance and movement can provide an enjoyable and accessible way to increase physical activity, improve balance

and reduce frailty, leading to a decrease in the risk of falls. Singing can be used effectively to ease symptoms of respiratory conditions such as COPD, whilst music and movement can support people in their recovery from a brain injury or stroke. Singing for Lung Health interventions, consisting of a 12-week singing programme for people with COPD has been shown to reduce healthcare utilisation, including GP visits and hospitalisation and improve respiratory-related quality of life.

"Creative health moves beyond basic needs, and supports people to engage in creative activity that is meaningful to them thereby improving health and wellbeing." There is strong evidence for the use of creative health approaches in relation to dementia. Research tells us that a range of creative activities, including dance, music, art, and storytelling, as well as cultural engagement can help to prevent cognitive decline in older adults. For people living with dementia, creative activities such as music-making, singing, dance, and visual arts can have benefits for speech, cognition, and memory. Creative health can reduce anxiety, depression, stress, and aggressive behaviours, and can provide social opportunities. When creative activities are delivered with family members or carers, both parties can benefit from the wellbeing impact. In the current context, meeting even basic needs in social care can be a challenge for providers. As a recent House of Lords report by the Select Committee on Adult Social Care, A Gloriously Ordinary Life, finds: ‘Services are effectively considered sufficient if they meet individuals’ basic needs. There is little thought given to exploring, acknowledging, or meeting a person’s ambitions and desires, let alone to helping them find the means to accomplish their goals’. As a holistic and person-centred approach, creative health moves beyond basic needs, and supports people to engage in creative activity that is meaningful to them, thereby improving health and wellbeing.

Creative health in care homes Just as in the community, creative engagement in care homes is beneficial for health and wellbeing. There are fantastic examples of diverse forms of creative activity taking place in care homes including filmmaking, opera, dance and movement, poetry, exploring museum collections, and circus skills. These activities bring joy to residents and staff alike and have been shown to improve health and wellbeing outcomes. For example, participatory arts and crafts can build social relationships and reduce loneliness. Live music performances provide a sense of achievement and empowerment. Care home managers report positive changes in residents, including those with dementia, improvement in interactions with staff, and even a reduced need for medication. Furthermore, these activities have been shown to provide a good social return on investment. Evaluations of creative initiatives have also shown positive impacts on staff wellbeing in job satisfaction and retention. In our Creative Health Review roundtable on social care, we heard from Live Music Now about how its Live Music In Care residency programme works to improve wellbeing across the whole care home, with benefits to residents, carers and managers. The programme works with care homes over several months to embed musical activity, building confidence and skills in staff to be able to lead music activities and to use music in their day-to-day care tool kit. In this way, the programme has long-term sustainable benefits for the whole care home. Care home staff have also reported that the activities can change the environment within the care home, and have observed positive changes in behaviours, reductions in levels of anxiety and distress and improved confidence, even leading to a reduction in the use of medication. One care home reported a 50% decrease in the use of sedatives and a 100% decrease in PNR medicine administered on demand. Staff working in care homes can use music to support residents who are feeling anxious or worried. ‘In the evening, they get very agitated and worried. In their reality, many feel they should be going home, making partners' meals, looking after their houses and families. They think they are being held against their will preventing them from doing this… I can bring the music back into the conversation and it brings back the feeling of peace, calm and joy and gives something in my tool bag and

CMM December 2023

CREATIVE HEALTH: REVIEWING THE BENEFITS OF CREATIVE APPROACHES AND ACTIVITIES IN CARE SERVICES

> breaks that cycle (perhaps stopping me

being hit)’ – Activities Co-ordinator in a care home. Developing the health and care workforce is integral to the Live Music in Care model. Training, co-planning and reflection time are built into the model of delivery led by the musicians and standalone training opportunities are also available for professional development.

Maximising the potential The extent of provision is often dependent on the enthusiasm of the care home manager, and while extremely good examples of best practice exist, a system-wide approach including both the arts and social care sectors, with leadership from the Government is required, to ensure all care home residents can access the benefits.

"A recognition of the value of creative health approaches in CQC regulatory assessment frameworks could act as a strategic driver…"

Preparing for regulation A recognition of the value of creative health approaches in CQC regulatory assessment frameworks could act as a strategic driver for healthcare systems, local authorities and private care providers to prioritise provision within care settings. It will also help to create a sustainable and scalable infrastructure to support creative health practitioners working in this area. During the social care roundtable, Karen Culshaw noted that CQC would welcome any good examples of creative health in social care settings when providers have contact with CQC. In response, people asked how to showcase such examples. Karen suggests, ‘CQC encourages care providers to be open, honest and proud with inspectors during any inspection or requests for information in regard to things which are making a difference to people’s quality of life, including creative activities. Under the new assessment framework, there will be places where this type of evidence could be used. For example, under the new ‘caring’ question there is a lot of focus on people’s emotional wellbeing, connecting

with the community and activities that matter to them, reflecting people's cultural, social, and personal needs and preferences in how care is delivered, etc. Also, there are other areas where creative activities could be used as positive evidence such as workforce wellbeing and enablement to provide personalised care, and a considered person-centred approach to how to meet people’s holistic needs. We are already interested in how providers are delivering person-centred care to people, including the use of creative approaches, but this will be strengthened further in the new way we work.’

A personalised approach In the face of huge challenges, we need to rethink the way we approach social care. Recent policy documents and reports from organisations working in the sector have pointed to a shift towards integrated and personalised approaches. However, in practice, social care services are struggling to meet basic needs. We must address the needs of the whole person in the context of the lives they wish to lead. CMM

The National Activity Providers Association (NAPA), which runs the Arts in Care Homes Programme, suggests that a cultural shift in the understanding of the benefits of creativity in care homes along with specialist training and more widespread partnerships between care homes and community organisations and arts providers could support more widespread availability. A key element of the NAPA Arts in Care Homes programme is the National Day of Arts in Care Homes, an annual event that takes place on 24th September each year. Running throughout the pandemic, the National Day has sparked a change in attitudes towards creativity in care settings.

Rt Hon. Lord Howarth of Newport is Chair of the NCCH and Co-Chair of the All-Party Parliamentary Group on Arts, Health and Wellbeing. Email: info@ncch.org.uk X: @TheNCCH What evidence are you able to share in relation to the successful implementation of creative health in your care setting? Visit www.caremanagementmatters.co.uk and share your feedback. 44

CMM December 2023

Troubled by technology? Dazzled by digital? Get free, expert support from Digital Care Hub – run by social care providers, for social care providers. Digital Care Hub is the new name for Digital Social Care. We provide free advice and support on data protection, cyber security and using technology. www.digitalcarehub.co.uk/contact-us

New eLearning resource for care staff From December, Better Security, Better Care are launching a free data and cyber security e-learning resource for frontline care staff that will satisfy key requirements in the Data Security & Protection Toolkit (DSPT). Return on Investment tool A new Return on Investment (ROI) tool will be available from the end of November to help

care services estimate an indicative return on investment and financial savings from adopting a piece of technology. The tool has been developed in partnership with ARC England and tested with care providers. It’s free to use with a full user guide. You can access the eLearning resource and the ROI tool on the Digital Care Hub website using the QR code above.

Markel 3rd Sector Care Awards

CELEBRATING EXCELLENCE

CMM is thrilled to share the stories of two more outstanding winners. Emma Kiss, Wellbeing Co-ordinator at Outlook Care, explains how she supports people to live well with dementia by focusing on individual needs. We also hear from The End of Life Partnership, which aims to improve the quality of end of life experiences for more than 10,000 people annually. Emma Kiss, Wellbeing Co-ordinator, Outlook Care I am passionate about my role, making our residents feel involved and valued every day. At Foxburrow Grange, we follow the Montessori approach, which focuses on re-discovering and supporting the person behind dementia.

People first The approach can be applied effectively to help reconnect the pathways in the brain with experiences to which they are losing access. These adults need individualised, sensorial experiences in order to thrive. Therefore, it is important to get to know everybody’s individual needs, desires and abilities, focusing on the person, not their dementia. At Foxburrow Grange, we believe that to enhance resident interactions, it’s important to apply all Montessori principles, starting with the simple use of name badges for residents, visitors and staff, and signage to allow residents to navigate their way to their bedrooms or other areas.

Changing attitudes People with dementia are often confronted with what they can no longer do, or with the mistakes they make. Montessori principles are 46

CMM December 2023

designed to focus on what they can still do. This is a person-centred approach focusing on individual capabilities, capturing interest and showing respect. It’s important to focus on building on individual strengths. By following these principles, supported by the teams at Foxburrow Grange, I encourage my residents to do a little more every day. The more you do, the better you get – from ‘cannot do’ to ‘can do’. These are my mottos at the heart of the Montessori approach and I apply these every day, but it’s also the ethos of Foxburrow Grange.

Seeking inspiration Since I started, I noticed that music, singing and dancing were having a huge beneficial impact. I had the privilege of seeing a dementia choir perform in Winchester at an awards ceremony. I was very impressed and I thought immediately that this is something we should have at Foxburrow Grange. On my way back home, I decided that I would set up my own dementia choir. I discussed this with my manager, who supported my idea, and we soon got to work, using contacts from the local community. We have choir practice twice a month, branded t-shirts with the name of the choir and our logo. Using the Montessori approach, we practised hard and performed for the first time to an audience in December.

HEADER

Community strength I started to involve relatives, who are always more than happy to come and sing with us. We have residents’ meetings where we discuss what we have done well and what needs to improve. The feedback from everyone is very positive – our residents are happy; they feel valued and it’s a boost to their self-esteem.

The End of Life Partnership The End of Life Partnership (EOLP) won the End of Life Care Award at the Markel 3rd Sector Care Awards 2023. CMM caught up with this innovative charity to learn more about its work. EOLP is a North West-based charity, with regional and national reach, providing award-winning training and education for palliative and end of life care professionals, both face to face and virtually, from its specialist End of Life Care Education Hub in Cheshire. Many of the charity’s services are bespoke, in response to the needs of a particular care setting. However, it also delivers award-winning training, some developed with a leading business and coaching psychologist, that aims to grow future leaders in the palliative and end of life care sector.

Confidence to care Alison Clifford is the charity’s Chief Executive Officer. She says, ‘We believe everyone should experience compassionate and personalised end of life care and should spend their final days in a place where they are comfortable, confidently cared for and feel at home. Our aim is to give everyone the confidence to deliver this care, whether it is family and friends, care home workers, volunteers or health care professionals.’ In the five years that EOLP has run this programme, the team has educated more than 100 leaders from care homes, hospices, community and hospital settings around the UK. Lauren McKenny, Sister at St Mary’s Hospice, says, ‘I have learnt so much from this course; it has been so inspiring learning and developing with others from different hospices and sharing experiences with them. I would highly recommend to anyone wanting

We have witnessed several positive outcomes. One of our residents told me the choir practice is her reason to leave her room. She has made friends and loves to listen as well as sing. This for me shows how important music, inclusion and following our values benefits the lives of people in our care. Through the choir, our residents can continue to reconnect with a world they are

losing access to. We can see and feel the power of music, and the benefits of singing and friendship.

to develop their leadership skills to attend this course. You are given so many different techniques and ways of working that there is always something that suits your style.’

Consultancy, addresses the diverse challenges caregivers encounter, offering a dedicated hub for guidance and assistance.

Responsive services Another innovation from EOLP is its Care Home Support Service (CHSS). The service is available to any of the 183 residential, nursing and learning disability care homes of Cheshire East and West. Funded by the NHS, the CHSS provides responsive, dedicated advice, training and education to support carers in meeting the needs of residents, including enabling residents to live well and plan for end of life. Each care home has a named EOLP facilitator working with it to identify areas where support may be required. This ranges from consultancy support around the care of an individual, to staff development through education and training and staff wellbeing, to leadership team development. EOLP has also created Care Home Support Forums and an Activity and Wellbeing Co-ordinators Group, educating and networking groups of local care homes together so they can share best practice and support one another.

Emma Kiss is Wellbeing Co-ordinator at Outlook Care. Email: emma.kiss@outlookcare.org.uk X: @foxburrowgrange

A sense of pride Alison, who has a nursing background, adds, ‘Everything we do is aimed at bringing compassion, respect and dignity to individuals and their families, to ensure their comfort and peace during a difficult time. Winning the Markel End of Life Care Award was recognition of the huge impact our relatively small team has made. It was wonderful to have that acknowledged at a national level and gave us a real boost to carry on educating, innovating and collaborating to achieve the best possible outcomes for end of life care.’ CMM Alison Clifford is The End of Life Partnership (EOLP)’s Chief Executive Officer. Email: info@eolp.org.uk X: @_EOLP

Specialist support Recognising the unparalleled demands of caring for individuals in the advanced stages of dementia, EOLP has developed the pioneering Advanced Dementia Support Team (ADST). Comprising a skilled cohort of seasoned specialists, including two Admiral Nurses, the team has extensive experience in supporting families and professionals caring for someone with advanced dementia. The team provides tailored advice, support and, with a Dementia

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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 December 2023

EVENT REVIEW

THE YORKSHIRE AND THE HUMBER CARE ASSOCIATION CONFERENCE 18th October 2023, The Legacy Centre, Doncaster

The Yorkshire and The Humber Care Association Alliance (YHCAA), in partnership with CMM Insight, hosted a one-day conference in Doncaster on 18th October. The Yorkshire and The Humber Care Association Alliance (YHCAA) includes Barnsley Independent Care Home Providers Association, Bradford Care Association, Hull and East Riding Care Association, The Independent Care Group (North Yorkshire and York), Kirklees Care Association, Leeds Care Association, Sheffield Care Association and Wakefield (Independent Sector Liaison Group). Each represents dozens of individual care providers. Its aim is to provide leadership, help, support and advice to its membership, share best practice and work with care commissioners, including local authorities and NHS bodies and other partners to improve the quality of life of those living with a care need.

National conference on a local stage Conference Chair, Mike Padgham, Chair, Independent Care Group and, Managing Director, St Cecilia’s Care Group, said the sector is facing ‘a perfect storm’ – referring to the cost-of-living crisis, staff shortages, and the volume of providers leaving the sector. Mike Padgham outlined the following five objectives for YHCAA: 1. Ring fence a percentage of GDP to be spent on providing social care to those who already receive it and the 1.6 million people who can’t get it. 2. Create a unified National Care Service, incorporating health and social care. 3. Set a National Minimum Wage per hour for care staff on a par with NHS. 4. Set up an urgent social care task force to oversee reform. 5. Fix ‘fair price for care’ tariffs for things like care beds and homecare visits. He said that pure and simple the social care sector is ‘held together by a lot of goodwill’ and added that we should ‘stop seeing social care reform as an electoral liability, but instead see it as a cornerstone manifesto pledge that defines a political party and its hopes and wishes for its citizens.’ 48

CMM December 2023

Industry-renowned speaker, Professor Vic Rayner OBE, Chief Executive of The National Care Forum (NCF), spoke on the public’s perception of care, and the Government’s current consultations and outlined how each political party cited social care at the political party conferences. Recruitment and retention specialist Neil Eastwood explored the bedrocks of effective care recruitment and how we cannot just recruit but grow our capacity by attracting new entrants into the sector and keeping them. Legal comment was provided by Philippa Doyle, Partner and Head of Social Care, Hempsons informing the conference on what providers need to know regarding the CQC’s New Framework.

A view from Yorkshire The YHCAA Board took to the stage to announce its call to action to delegates – 10 priorities for Immediate action: Co-ordinated campaigning and lobbying; Pay; International recruitment; Recognition; Social care representation; Lobbying ICBs; Commissioning reform; CQC Regulation reform; What’s working well; and Data and Intelligence Centre. The Board is meeting with strategic and operational leads on the development and delivery of ICS joint forward plans and better care funding. On the topic of the workforce, the Board stressed the importance of a national approach to pay parity with the NHS and has called for a pilot programme to develop new roles in the sector and asked for the development of an ethical sustainable model for international recruitment and a workforce plan from Government. Peter Hodkinson, Chair of Leeds Care Association and Managing Director of Westward Care, joined to discuss how we are going to make the 10 priorities happen and Abigail Barron, Assistant Director, North Yorkshire Council, updated us on the new ‘North Yorkshire’ council (eight councils replaced by one unitary in 2023) and shared how the council is proactively supporting an ageing population despite significant pressures.

The council is aiming to ensure isolated members of the community receive the care they need – ‘Inclusion health.’ Abigail explained how the council hopes to reduce the reliance on residential care services and how we need to rediscover prevention and independence.

Sustaining services Richard Ayres, Social Care Adviser at Care England, spoke on ‘sustainable solutions’ in social care. He revealed that there is a £12m gap for residential care in North Yorkshire and that there are more care hours paid in the south of England, saying, ‘Providers in the North of England and the Midlands have to be even more efficient with their staffing and really work that workforce.’ Commenting on the importance of the CMM Insight YHCAA Conference, Richard Ayres told CMM, ‘Large-scale policy changes are generally taken nationally and cascaded locally by the NHS and local authorities. Understanding the local views and impact is among the most important perspective that influences the direction of national policy. I welcomed hearing Conference speaker Melanie Weatherley OBE talk about the importance of actively being part of a local or national association and engaging with it to help influence policy and lobbying.’

Making it all possible CMM would like to thank our headline sponsors, OneTouch and Hempsons and all of our exhibitors for joining us at the Conference. Visit the Care Management Matters website to download and catch up on the presentation slides. www.caremanagementmatters.co.uk/ yorkshire-and-the-humber-care-associationalliance-conference-presentations/ CMM

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

Nursing recruitment and retention toolkit 6th December 2023, Virtual https://events.skillsforcare.org.uk/skillsforcare

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Futureproofing social care 31st January 2024, The BCEC, Birmingham www.laingbuissonevents.com/innovation-in-careconference-2024/

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Supporting unpaid carers in the NHS and Social Care 9th February 2024, London www.eventbrite.co.uk/e/supporting-unpaidcarers-in-the-nhs-and-social-care-tickets704489646497?aff=ebdssbdestsearch&keep_tld=1

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Care England Conference and Exhibition 16th March 2024, London www.careengland.org.uk/members/care-englandconference-exhibition-thursday-16-march-2023/

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NCF Manager’s Conference 11-12th March 2024, Wyboston Lakes, Bedfordshire www.nationalcareforum.org.uk/events/themanagers-conference/

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Annual leadership and workforce summit 2024: The future of work is now – embracing positive disruption to meet future challenges 19th March 2024, The King’s Fund, London www.kingsfund.org.uk/events/annual-leadershipand-workforce-summit

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Event: Date/Location: Contact:

CMM Insight Online: Zero hours contracts in adult social care – what providers need to consider Wednesday 29th 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/

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CMM December 2023

STRAIGHT TALK Briony Hudson, Associate Director for Internal Research Development at Marie Curie, explains how the charity is helping to shape the future of palliative and end of life care research.

Dying, death and bereavement will affect all of us at some point in our lives. But sadly, palliative and end of life care research often receives very little funding in comparison to other non-commercial health-related research projects. A report by end of life charity Marie Curie found that by 2048, there will be more than 730,000 people with palliative care needs in the UK, but data has revealed that this sector received a mere 0.21% of the £2.56bn spent on health research nationwide in 2018.

“The priorities identified have been influential in shaping the research calls of Marie Curie and the National Institute for Health and Care Research, but more has to be done.” The charity predicts that in just 25 years' time, more than one person a minute will have palliative needs when they die – but hundreds of thousands won't get the support they need if the system does not change. As the largest charitable funder of palliative and end of life care research, it is important for Marie Curie to focus the projects that are funded on topics that are most important to people who are directly impacted, as well as

the health and social care professionals who support them. This is why the charity has embarked on a new project with the James Lind Alliance (JLA), calling on healthcare workers, people living with a serious life-limiting illness and their family and friends, to take part in a critical survey to have their say on their top concerns for palliative and end of life care. The project will help establish key concerns for the academic research that we will fund in the future, helping to ensure that future research answers questions that are important to people, and generates evidence with the potential to improve end of life experiences. The project – The Palliative and End of Life Care Research Priorities Project – is a refresh of similar work completed in 2015, which found that understanding how best to support people outside of typical office hours was a top priority for those affected. Since then, Marie Curie has allocated more than £1m to seven projects on this topic and in 2022 we published the Better End of Life report, focusing on out-of-hours care for people with advanced illness. The priorities identified have been influential in shaping the research calls of Marie Curie and the National Institute for Health and Care Research, but more has to be done. Much has changed since our initial project; we have all experienced the pressures of the COVID-19 pandemic and are currently facing a cost-of-living crisis. We want to make sure that we continue to produce and fund research that

is in line with the needs of health and social care professionals, patients and those around them who are affected by dying, death and bereavement, and we feel that the time is right to once again ask people what future palliative care research should focus on. Marie Curie is committed to making sure that people with lived experience are at the heart of what we do and to ensure this, we have also developed a lived experience group of 20 individuals who have been impacted by life-limiting illness themselves, or through caring for someone, as well as people who have faced bereavement, to run alongside and advise us during the project – to make sure it has the biggest possible chance of impact. This ensures that we have the best interests of people directly affected at the core of our values. Following on from the survey, which closes on 31st December 2023, the next part of the project will include a second survey to prioritise the topics mentioned and a workshop will be held with people who are directly affected to agree on the most important priorities. The charity will also work with researchers to develop specific research questions relating to each priority area, so we can plan for adequate future research that matters most to those who will benefit from it. This is our chance to shape the future of palliative and end of life care research and improve end of life experiences for all. To find out more about the project and get involved in the survey, please visit https://palliativecarepsp.wordpress.com/

Dr Briony Hudson is the Associate Director of Internal Research Development at Marie Curie. Email: briony.hudson@mariecurie.org.uk X:@BrionyHudson 50

CMM December 2023

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