Care Management Matters (CMM) Magazine November 2024
A SHINING LIGHT
Supporting older people to thrive
Royal commission
Promise or procrastination?
Intergenerational living
Lived benefits and lessons learned
Resource Finder
Legal
Social Care Insights
With the annual party conferences now concluded, Richard Humphries asks what we can glean about adult social care’s prospects in the months ahead.
Inside CQC
James Bullion updates on the regulator’s efforts to re-build trust in its regulation.
Homecare Headlines
In CMM’s new dedicated homecare column, Dr Jane Townson OBE argues that the Care Quality Commission (CQC) ‘Requires improvement’ in a new Homecare Association report.
Into Perspective
This issue, CMM invites two industry leaders to reflect on the findings of Lord Darzi’s report which has identified long-standing neglect of social care.
Celebrating Excellence
Everybody deserves to have the best quality of life possible, says Emma Barclay, Head of Clinical Services at St Ann’s Hospice and End of Life Care Award winner at the 2024 Markel 3rd Sector Care Awards.
Event Preview
The National Care Association (NCA) invites you to join the debate at its highly anticipated Winter Conference, discussing the most pressing issues impacting the sector today.
What’s On?
Straight Talk
In a sector that promotes wellbeing amongst staff and people drawing on care and support, suicide rates remain high. What can employers do to overcome this? Kate Golding answers.
A shining light: Six ways care homes are supporting older people to thrive
Unwilling to accept that residential care is not always regarded as somewhere that older people can flourish, Dr Bethany Morgan Brett and Amy Simpkins report on new research championing positive lived experiences.
A royal commission: Is social care in the long grass, again? Kathryn Smith picks up the conversation on a rumoured royal commission on social care, evaluating its merit and outlining the sector’s non-negotiables.
Care Innovation Challenge: CMM meets the winner
Announced at the Care Show in Birmingham, CMM interviews the winner of the 2024 Care Innovation Challenge.
Age is just a number: The impact of intergenerational living
Martin Rix talks about the reasons behind the ‘Nursery in Belong’s’ launch, the lived benefits and lessons being learned by all involved in the development.
Resource Finder: Legal
CMM profiles some of the leading legal firms that specialise in social care to help you find one that works for you.
CMM magazine is officially part of the membership entitlement of:
CONTRIBUTORS
@RichardnotatKF
Richard Humphries Senior Policy Advisor, Health Foundation
Amy Simpkins Communications and Marketing Lead, My Home Life England
@CQCProf
James Bullion Chief Inspector of Adult Social Care and Integrated Care, Care Quality Commission (CQC)
@MyHomeLifeUK @SCIE_socialcare
Kathryn Smith Chief Executive, Social Care Institute for Excellence (SCIE)
@CQCProf
Dr Jane Townson OBE Chief Executive Officer, Homecare Association @homecareassn
@MyHomeLifeUK
Dr Bethany
Morgan Brett Research Fellow, My Home Life England
@TLAP1
Isaac Samuels Co-Production Advisor, Think Local Act Personal (TLAP)
Jim Kane Chief Executive Officer, Community Integrated Care
@BelongVillages
Martin Rix Chief Executive, Belong
Emma Barclay Head of Clinical Services, St Ann’s Hospice @StAnnsHospice
@kgolding73
Kate Golding Instructor, Mental Health First Aid England (MHFA)
SOCIAL CARE INSIGHTS
From Richard Humphries
With the annual party conferences now concluded, Richard Humphries, Senior Policy Advisor to the Health Foundation, asks what we can glean about adult social care’s prospects in the months ahead.
In Brighton, the Liberal Democrats affirmed their commitment to health and social care as their signature policy commitment. Significantly, the election of one of their MPs, Layla Moran, as Health and Social Care Committee Chair, signals a determination to offer robust challenge to Government’s performance.
The Conservatives’ leadership election precluded meaningful social care discussion at their Birmingham conference. We can but hope that the eyebrow-raising comments of one leadership contender, ‘we need to make sure we are thinking about the next generation, not just who's going to wipe bottoms for us today,’ are not representative of the party’s views. For the foreseeable future, it seems that constructive opposition will come from the Liberal Democrats.
Inevitably, Labour’s gathering attracted most attention. Setting aside the controversies about gifts, hospitality and the winter fuel allowance, there were warm words aplenty in Liverpool. The Prime Minister talked about the ‘vital, life-affirming work’ of his sister, a care worker, ‘work that surely we know by now is so important for the future of this country.’ Wouldn’t it be great, he
asked, if ‘she could walk into any room and instantly command the same respect as the Prime Minister?’
I cannot remember any Prime Minister speaking of care in such uplifting terms. It was reiterated by Wes Streeting, as Secretary of State, who pledged to deliver ‘a New Deal for Care Professionals: A Fair Pay Agreement, to improve pay and conditions and give staff the status and respect they deserve – our first step towards building a National Care Service.’
More encouraging still was Wes Streeting’s acknowledgement that he was present as Social Care Secretary as much as Health Secretary. Too often social care has been an after-thought, so parity with the NHS is overdue. But these sentiments alone will not elevate social care in the hierarchy of political and fiscal priorities.
There are three lessons for Government to translate words into action. The first is avoiding viewing social care purely as adjunct to the NHS. It is true that the NHS can’t be fixed without fixing social care. But the wider economic and social benefits of investing in social care should not be under-estimated. A National Care Service must be more ambitious
than a national support service for the NHS.
The second lesson is that whilst improving care workers’ pay and conditions is a good start, the promised 10-year plan needs to tackle all challenges facing social care. This should include action on the state of council finances, otherwise, as the County Councils Network has recently warned, councils will increasingly struggle to meet statutory care duties at the expense of other vital services such as leisure and libraries.
The third lesson is that if Government does proceed with an independent review, such as a royal commission, it must be clear about what it wants to achieve, reflected in a clear terms of reference; a skilled and respected chair; a tight timescale; and a means of involving everyone involved in social care to harness their ideas, knowledge and experience. The review must promote reform, not be an excuse to postpone it.
All eyes now turn to the Chancellor’s first budget on 30th October. Crucially it will determine how to fill the £22bn ‘black hole’ identified by the Treasury and will include the 2024/25 local government finance settlement. The mood music is of hard choices to ‘fix the foundations’ – but no return to austerity.
James Bullion, Chief Inspector of Adult Social Care and Integrated Care at the Care Quality Commission (CQC),
updates on the regulator’s efforts to re-build trust in its regulation.
Responding to the review into our operational effectiveness by Dr Penny Dash, and to what providers and stakeholders have been saying for some time, we have now set out our improvement approach. At the centre is our core purpose – ensuring that health and social care services provide people with safe, effective, compassionate, high-quality care and encouraging services to improve.
How did we get here?
Dr Dash’s review highlighted issues that have been a turning point for CQC. In addition to getting back to our core work, we have been reflecting on what we have learned. We know we were too ambitious, taking on too much in too little time with not enough resources or expertise. We also did not listen enough to people who were flagging concerns. This led us to defend our decisions and maintain our course, even when this was unlikely to have the desired impact.
We have developed an approach to recovery that supports the report’s recommendations. We have held regular conversations with Dr Dash to discuss how our changes align with the final report’s recommendations. These actions will help us deliver a clear and transparent assessment programme; improve how quickly and effectively we can register and assess providers; and publish simpler and clearer reports.
What happens now?
INSIDE CQC
Actions include:
• Changing how we use our technology in the interim and working differently. We will examine how to improve our assessments, factual accuracy checks and report publishing. We will also be making changes to the processes we use for registration. You will have different interactions with us because of these changes. Please keep sharing feedback about your experiences as we make these changes.
• Changing the single assessment framework. We will be scoring at quality statement and rating at key question level. Assessments will still evaluate evidence categories to reach a quality statement score, but we will not score evidence categories. We will apply professional judgement to ensure it is a complete picture and the quality statement scoring is correct. This will allow us to assess and inspect more services while ensuring our ratings are robust. This will also allow us to produce better reports that are clearer about our judgements and ratings.
• Evaluating new approaches to ensure they bring us closer to our core purpose. We will independently evaluate our work and liaise with providers if new approaches are rolled out more widely.
Hearing you
We have asked Professor Vic Rayner OBE as Care Provider Alliance Chair to review the single assessment framework from your perspective. Her review will inform any changes or improvements that can be made. In addition, we are planning a series of roadshows for you to connect with your local CQC teams, learn more about specific aspects of our assessment approach and take part in activities to co-design the improvements we are making. We will share more information on this soon.
Our aim is to rapidly improve our understanding of the quality of care through improved operational performance and re-building provider engagement. Sir Julian Hartley has been appointed as our new Chief Executive and we will be appointing at least three Chief Inspectors to strengthen leadership across the sectors we regulate. In addition, a range of internal improvements will increase our number of monthly assessments. Want to learn more about CQC’s single assessment framework? Listen to or watch the latest episode of CMM’s OFF THE PAGE podcast, coming soon. Catch up on all episodes here
In the meantime, we will continue to engage with you, the public and wider stakeholders through our established channels, online engagement sessions and our online participation platform. Please keep feeding back your views and experiences of our changing assessment processes. We are all trying to do the best for people – together, we can achieve that.
James Bullion is Chief Inspector of Adult Social Care and Integrated Care at the Care Quality Commission. Email: providerengagement@cqc.org.uk : @CQCProf
James Bullion
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Effective regulation is vital to safeguard the wellbeing and rights of those who rely on services and maintain public trust in care. Complexity of need and demand for homecare is increasing. Never has it been more important to ensure effective oversight of quality and safety of care services.
Despite paying substantial regulatory fees, homecare providers feel neglected by the CQC. Their dissatisfaction has grown since the pandemic, when CQC gave low priority to homecare. To explore the issues, we studied CQC data from 2013 to June 2024, including annual reports and accounts, and gathered feedback from homecare providers. Our recent report paints a picture of a regulator struggling to fulfil core responsibilities.
Over the past decade, the social care landscape has transformed dramatically. The number of registered locations has increased almost two-fold to a staggering 12,574 in June 2024. A corresponding increase in CQC resources has not occurred, leading to CQC staff numbers per registered location across all health and social care services nearly halving, causing a significant dilution of regulatory oversight.
Alarmingly, 60% of community care providers had either never been rated by CQC (23%) or had a rating four to eight years old as of June 2024 (37%). For most homecare
HOMECARE HEADLINES
providers, this means CQC ratings are non-existent or woefully out of date.
Providers also complain about long delays in registration; inconsistent and flawed inspection methods; and difficulties communicating with the CQC. Local councils, unable to rely on CQC data for homecare tender processes, face hard choices. Some have resorted to contracting with unassessed and unrated providers. Others are disqualifying providers without ratings or with outdated ratings from bidding for work.
CQC has adopted a risk-based approach to inspection and is focusing on underperforming providers. The proportion of locations rated ‘Requires Improvement’ has surged from 0.5% in 2017 to 26.3% in 2024. Residential care has shown a similar trend, with the proportion of locations rated ‘Requires Improvement’ rising from near 0% in 2017 to about 33% in 2024. Despite this, there are still poorly performing providers operating, and some go undetected because of the CQC's limited capacity for monitoring and inspections.
The CQC's struggles have extensive repercussions. People drawing on services face more risks, and providers are experiencing harm. Delays in registration and ratings are causing severe financial problems for providers. Several underlying issues contribute to the CQC's
problems. Many councils have encouraged the proliferation of small homecare providers. About 87% of homecare providers have fewer than 50 employees, with 53% having fewer than 10. This fragmentation of the sector has compounded the CQC's workload.
Other factors include flaws in the CQC's funding model and fee structure; ineffective IT systems despite significant capital investment; and misalignment between CQC and local authority practices. The pandemic exacerbated these issues but is not their root cause.
To address these challenges, our report made several recommendations. These included commissioning a realistic review of the CQC's resourcing needs; increasing transparency in operational costs and performance; reviewing the funding model, improving IT and data systems; and enhancing engagement with providers. We also called for improvements to CQC’s assessment of local authority commissioning.
Policymakers must recognise the interconnections between regulation, commissioning, funding and quality care provision. The CQC cannot succeed in isolation or without adequate resources. Effective regulation depends on intelligent market shaping, sufficient human resources, robust systems and the flexibility to adapt.
WE’RE WOLF
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We routinely work with healthcare customers to provide laundry solutions and ongoing service support to ensure they achieve the highest standard of laundry hygiene alongside DOH-HTM 01-04 guidelines.
State of the Adult Social Care Sector and Workforce in England
The latest State of the Adult Social Care Sector and Workforce in England shows that the workforce grew, and vacancies fell for a second year. 1.71 million posts were filled, and vacancies fell to 131,000 on any given day. In addition, 24.2% of people working in care left their jobs in 2023/24. Among independent and local authority employers – for whom records go back the furthest – the turnover rate fell to below one in four (24.8%) for the first time since 2014/15, down from 29.1% the previous year.
The number of men working in the female-dominated sector reached a record high, with men accounting for 21% of the workforce. It is the first time that men have represented more than a fifth of the workforce since records began – the proportion had been static at 18% from 2012/13 until 2022/23, when it rose for the first time, to 19%.
"Over the two years since March 2022, 185,000 international recruits joined, and the number of British workers fell by 70,000."
However, Skills for Care's research has found that these positive statistics are mainly due to the record level of international recruitment in 2023/24, and the sector is still struggling with domestic recruitment and retention. The year saw 105,000 international recruits starting direct care-providing roles in the independent sector and the number of people in the workforce with a British nationality shrinking by 30,000. Over the two years since March 2022, 185,000 international recruits joined, and the number of British workers fell by 70,000.
According to Skills for Care, it is clear from the data that this is not a case of international recruits taking jobs from British people, as the number of vacancies across the sector remains high. While the turnover rate for internationally recruited staff in the frontline ‘care worker’ role was 30%, the turnover rate for domestic recruits into care worker roles was 41.1%. 29% of international recruits were male, but men only accounted for 15% of newly recruited British care workers.
These differences are significant because the supply of international workers is declining. According to Skills for Care’s latest tracking data,
an estimated 8,000 new international recruits started between April and June 2024, compared with an average of 26,000 per quarter in the year to March – a decrease of over two thirds.
Even with the record level of international recruitment in 2023/24, the sector’s vacancy rate of 8.3% was still around three times that of the wider economy. Skills for Care estimates that, in addition to filling vacancies, the sector will need another 540,000 posts by 2040 if the workforce is to grow in proportion to the number of people aged over 65 in the population.
Skills for Care has led the development of a new Workforce Strategy for adult social care, which was published in July 2024. The strategy, which has the backing of a wide range of organisations from across social care, health and education, aims to improve the quality of social care roles, ensuring that the sector can attract and keep enough people with the right skills and values to provide the best possible care and support for the people who draw on it.
Commenting on the publication of the latest State of the Adult Social Care Sector and Workforce in England, Professor Oonagh Smyth, Chief Executive Officer at Skills for Care, said, 'It’s clear from our data that international recruitment has been vital in helping the social care workforce grow, but we can’t count on this continuing as we’re starting to see less of it – and the global job market is a competitive one. So, we need to stem the tide of British care workers who are leaving their jobs, and we can only do that by improving the quality of care roles so the sector can be more competitive in local job markets.
'The launch of the Workforce Strategy for adult social care in July was a big step forward. We know what needs to be done, so now all of us with the power to implement the strategy’s recommendations just need to make it happen.
'Not only is the social care workforce vital for our society and a meaningful and fulfilling career for so many people, but it will also be central to the success of the new Government’s missions to build an NHS fit for the future, kick-start the economy and break down barriers to opportunity. Its importance cannot and must not be overlooked.’
To read the latest State of the Adult Social Care Sector and Workforce in England, visit the Skills for Care website or click here
CoolCare
Iain Corrigan has been CoolCare’s Acting Commercial Director since last summer and now formally steps into the role. With extensive experience in the sector, Iain has been instrumental in driving the company’s commercial strategy during this interim period. Meanwhile, Fiona Allen has been appointed as Operations Director, reflective of her wealth of experience and proven track record in operations management. Fiona has been a crucial part of CoolCare's leadership team for two years.
Ambient Support
Claudette Marcano has been appointed as Ambient Support’s new Chief Finance Officer. From one of the UK’s largest residential property developers to accommodation providers supporting some of London’s most vulnerable people, Claudette has gained extensive business and finance experience in both private and public sectors. Claudette is a CIMA qualified accountant, holds the ACT Certificate in Treasury and has keenly demonstrated a strategic and commercial focus throughout her professional roles.
Mencap
Chris Chalkley has been appointed to the role of Executive Director, Personal Support Services (England), Laura Rees will take up the Executive Director of People role and Mary Mawhinney joins as Executive Director of Governance and Company Secretary. Under the leadership of Jon Sparkes OBE, who became Chief Executive in June 2024, these additions to Mencap’s leadership team reflect the organisation’s ambitions for the next phase of its strategic direction.
Two million living with unmet need
New analysis from Age UK has found that two million older people in England are living with some unmet need for social care.
This finding is one of many in a major new Age UK report, The State of Health and Care of Older People in England 2024. The report concludes that England’s health and care services continue to be under enormous pressure so that, despite the best efforts of many dedicated staff, they are currently unable to meet the needs of all the older people presenting who require treatment, care and support.
According to Age UK, long-standing problems were greatly exacerbated during the pandemic years and despite some recovery since then in some areas, in others it has not yet proved possible to prevent a decline in capacity, service availability and performance, with, in the charity's view, worrying implications for older people and their families and unpaid carers.
"The charity has called for services to work together better in ways that enable older people in declining health to be identified, assessed and supported proactively."
In addition, the report has suggested that many emergency hospital admissions could be avoided if the right kind of help was provided earlier on, before relatively minor health problems develop into full scale crises. The inability of services to intervene quickly or effectively enough to support older people at home leads to many waiting for long periods in A&E and becoming stuck in a hospital bed because of a lack of community-based care.
Age UK's report has found that in particular, people aged over 80 are often not getting the NHS treatment, care and support they need. More than one in four (28%) are living with some unmet need for social care, and people in this age group are also the most likely to experience long waits in A&E, having arrived there by ambulance.
Many have complex health and care needs and currently, the system is often insufficiently geared up to meeting them, though there are some isolated, excellent examples of good practice. The report has argued that this needs to be scaled up and that the forthcoming NHS Ten Year Plan is well-placed to accommodate this.
The report's data has found that of older people aged 65:
• 10% (1.1 million) of older people have difficulty dressing.
• 5% (500,000) of older people have difficulty walking across a room.
• 6% (640,000) of older people have difficulty bathing.
• 1% (140,000) of older people have difficulty eating.
• 6% (600,000) of older people have difficulty getting in and out of bed.
• 4% (440,000) of older people have difficulty going to the toilet.
Other key findings include:
• The number of people over 75 has grown by 18% since 2017.
• Fewer older people are receiving local authority long-term care (542,420 in 2022/23 compared to 565,240 in 2017/18).
• A growth in the number of GPs is not keeping pace with the population growth of older people aged 75+.
• The risk of needing to attend A&E increases as we get older: per 100,000 population, there are 49,917 attendances for the 75-79 age group, rising to 93,931 for those aged over 90.
• The social care sector is struggling to fill vacancies in almost every key adult social care role.
• The numbers of district nurses reduced by 17.5% between 2014 and 2023.
Lastly, the report has found that primary (GP), community health and social care services are either inadequate in terms of availability or are insufficiently joined up and planned. The charity has called for services to work together better in ways that enable older people in declining health to be identified, assessed and supported proactively.
Commenting on the findings of the report, Caroline Abrahams, Charity Director at Age UK, said, 'It’s deeply worrying that the numbers of older people living with some unmet need for social care have now reached two million, out of a total older population in England of about 11 million. Some of these older people may be just about managing, but others will undoubtedly be struggling badly
with everyday tasks like getting out of bed and washing, increasing their risk of problems like falls which could cause them serious injury, or worse.
'The Government has not yet said what it intends to do in terms of reforming and refinancing social care, though it has made it clear that it sees social care playing a crucial role in the more joined-up, community-based health and care approach it wants to see supporting older people to stay fit and well at home.
'We completely agree with Ministers and with Lord Darzi that this is the right direction of travel, but the question we would ask is whether it will prove possible to achieve this without the comprehensive social care reform which Ministers suggest it will be impossible to achieve during this Parliament.
'Our fear is that unless this Government grasps the nettle of social care reform firmly and quickly, they will find it impossible to stabilise and strengthen the NHS either, to the enormous detriment of all of us but of older people, its principal client group, most of all. These older people do not have time on their side and it is above all for their sake that we would urge the Government to work with the NHS, local government and charities like Age UK too, to chart a path to a better future for health and equally for social care.'
In light of its findings, Age UK's report puts forward several recommendations for policymakers:
• Stabilise the social care sector and act quickly to consult on putting funding on a sustainable footing.
• Within 18 months, publish a comprehensive plan to reform social care and commit to implementing it during this Parliament.
• Fund an immediate pay rise for care professionals, and within two years publish a comprehensive social care workforce plan, joined up with the NHS Workforce Plan.
• Introduce a right to at least five days of paid Carer’s Leave, plus a longer period of unpaid leave.
• Significantly increase access to respite services and practical support for carers that recognises the specific needs of older carers.
Click here to read The State of Health and Care of Older People in England 2024
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Alzheimer’s Society ‘Behind Closed Doors’ campaign launched
Alzheimer’s Society has launched a new campaign to shed light on the hidden reality of dementia and the impact of a lack of support, creating a case for dementia to be made a political, health and care priority.
"Dementia is the biggest health and social care issue of our time."
With around one million people living with dementia in the UK and numbers set to rise to 1.4 million by 2040, the charity’s latest campaign aims to bring out from behind closed doors the hidden reality of the UK’s leading cause of death. It comes in response to new research that has revealed how thousands of families are left to
cope alone with the impact of dementia, feeling overwhelmed, unsupported and isolated as they pick up the pieces where health and social care services are not keeping up with demand.
TV presenter and journalist Anna Richardson, whose dad is living with vascular dementia, launched the ‘Behind Closed Doors’ installation from London’s Southbank. The installation will encourage people to see, hear and share real-life experiences of dementia, from people from all walks of life.
Alzheimer’s Society has called on people across the UK to share their own stories of dementia to help bring about change and make dementia a national conversation, via a dedicated stories hub on its website, here. The charity will take the stories it collects to those who need to hear them
the most, holding decisionmakers and governments across the UK to account to face up to the UK’s biggest killer, realise the magnitude of the issue and address the challenges it poses.
Research commissioned by Alzheimer’s Society and carried out by Walnut Unlimited has revealed just three in 10 agreed that healthcare support or social support for dementia is easy to access, while less than 40% of family carers were satisfied with the support available for people living with dementia. As a result, over half (51%) of family carers have had their own mental or physical health impacted by caring for someone with dementia and over a quarter of family carers say they feel more isolated. This follows previous insight which found that despite dementia being the UK’s biggest killer, just 10% of people believe this to be true.
Commenting on the launch of the new campaign, Kate Lee, Chief Executive Officer at Alzheimer’s Society, said, ‘Dementia is the biggest health and social care issue of our time. Its devastation reaches families in every corner of the UK and yet it isn’t the priority it needs to be. At least a third of people living with dementia don’t have a diagnosis and are therefore unable to access the vital care, support and treatments they desperately need.
‘Dementia is a forgotten crisis that can’t be ignored any longer. That’s why we’re asking people to share their dementia stories and bring this reality out from behind closed doors. We want to get people talking about dementia and join us in pushing governments across the UK again, and again, and again to make dementia the priority it needs to be.’
Ombudsman complaints figures published
The Local Government and Social Care Ombudsman (LGSCO) has published its latest complaints figures for 2023-24 and has reiterated its call for care providers to be required to tell people about its service, after highlighting the relatively small number of cases it deals with about the independent sector.
In its Annual Review of Adult Social Care Complaints 2023-24, the number of complaints about privately funded and arranged care has dropped by 15%, following a continued trend over the past few years. This number, the Ombudsman says, is far lower than it would expect given the sector’s proportion of the care market. Over the past year, the Ombudsman received 2,982 complaints about adult care, with just 333 of those being from people who fund their own care.
To bridge the gap between the number of people in receipt of care in the independent sector, and the low volume of complaints, the Ombudsman has called for signposting to its services to be made mandatory at the end of every provider’s complaint process.
In 2023-24 the Ombudsman upheld 80% of all adult social care (including council delivered care) cases it investigated in detail, with 99% of organisations complying with the remedies the Ombudsman recommended to put things right.
Key areas of concern over the past year have been delays in the assessment of people’s needs, and a failure to put people at the centre of the care they receive, instead fitting that care in with council and providers’ systems. Poor communication with both clients and their families has also been an area of concern
throughout the process, with particular issues around the information provided to service users, and their families, being unclear or overly complex.
Alongside the annual review, the Ombudsman has also released data for all the organisations, both councils and independent, about whom it has received complaints in the past year, including information about uphold and compliance rates.
Commenting on the findings, Local Government and Social Care Ombudsman, Ms Amerdeep Somal, said, 'People have a right to bring their complaint about adult social care to us, as the independent scrutineer. However, they don’t always know they can do so, and independent care providers should be signposting them to us, just as councils do. Independent care providers will often have both private and
council-funded clients, and there should be the same route to redress however people’s care is funded.
'It is likely that low awareness of our role in privately funded and arranged care plays a part in creating this gap between the expectation and reality of the number of complaints we receive. Independent care providers are not required by law to signpost users to our service, and as it currently stands, we know it happens sporadically.
'If all care providers were required by law to signpost to us it would give confidence that people know where to come with complaints and would support any suggestion that the drop in complaint numbers is caused by something other than a lack of awareness.'
To read the Annual Review of Adult Social Care Complaints 2023-24, click here
Exemplar Health Care celebrates graduates
Senior leaders across Exemplar Health Care recently celebrated graduating as the first cohort of the organisation’s bespoke ‘Leaders 4: Inspire’ training programme. The programme is designed to equip experienced leaders with new and enhanced skills to enable them to drive innovation and inspire their teams. Regional directors and commissioning managers from across the organisation were the first cohort to participate. The programme is part of a wider suite of leadership programmes delivered through the newly formed Exemplar Health Care Academy.
Leaders 4: Inspire commenced in October 2023, and saw the cohort engage in workshops on leadership and communication styles and financial competence, encouraging leaders to make positive shifts in team dynamics and act on business insights. The next stage was a practical workshop on coaching skills, designed to instil valuable mentorship skills and encourage the cohort to inspire the next generation of Exemplar Health Care leaders.
Leaders then progressed to a module on strategic change, using real-world case studies to craft impactful initiatives and exploring how psychological factors can impact people’s reactions to change. The cohort began the final module earlier this year, learning how to transition from working ‘in’ the business to working ‘on’ it, ensuring innovative strategies are effectively delivered and brought to life.
Reflecting on the programme, Mark Rushton, Regional Director of Operations at Exemplar Health Care and Leaders 4: Inspire graduate, said, ‘I am pleased to have completed the Leader 4: Inspire programme and I cannot wait to begin putting everything I have learned into practice.
‘Each module felt incredibly valuable to the entire cohort and
our participation has been a great reminder that learning and development are an essential part of success for everyone in an organisation, no matter their role or experience.’
Exemplar Health Care’s Leadership Pathway programmes are as follows:
• Leaders 1: Aspire – designed for senior healthcare assistants, registered nurses and aspiring managers, this programme focuses on the foundations of leadership.
• Leaders 2: Engage – targeted at unit managers and first line managers, this programme supports new managers through modules around getting the best out of a team.
• Leaders 3: Accelerate – geared towards home managers, deputy managers, clinical nurse managers and senior managers in central services, this programme builds on the skills of senior managers.
• Leaders 4: Inspire – tailored towards leaders of leaders, including regional directors and heads of departments, this programme takes leadership to the next level.
Rob Coxon, Director at the Exemplar Health Care Academy, said, ‘Ten days' off-the-job learning is a big investment, and the programme underpins our partnership with the world-leading Virginia Mason Institute, which aims to build a sector-leading culture of safety and continuous improvement. The ripple effect of their development will reach every corner of Exemplar Health Care, making every day better for both our colleagues and the people we support.’
Housing 21 completes largest ever acquisition
Housing 21 has completed its largest acquisition to date with the transfer of 1,567 properties from Midland Heart. The not-for-profit provider of Extra Care and Retirement Living completed the purchase of 23 schemes from Midland Heart, welcoming over 1,600 residents and 137 employees to Housing 21. As a result of the acquisition, Housing 21 has now achieved the milestone of over 10,000 Extra Care properties, which will be a managed alongside its 14,000-strong Retirement Living portfolio.
"Housing 21 now manages over 650 schemes across England with a total of over 24,000 properties."
Commenting on the acquisition, Tony Tench, Deputy Chief Executive at Housing 21, said, ‘We are absolutely delighted to welcome our new residents and employees to Housing 21 in what represents the biggest acquisition in Housing 21’s 60-year history. Acquisitions are a key part of our growth agenda; in the past 18 months we have purchased over 970 properties from other landlords and are still committed to developing up to 400 new Extra Care and Retirement Living properties every year.
‘As some housing associations are choosing to re-focus on general needs, Housing 21, as a specialist provider of housing for older people, is keen to acquire properties and ensure they remain a positive choice for residents, providing the safe, quality and affordable homes they deserve.’
Following the acquisition, Housing 21 now manages over 650 schemes across England with a total of over 24,000 properties.
Kris Peach, Managing Director of Extra Care at Housing 21, said, ‘To reach 10,000 Extra Care properties is fantastic but to do so in our 60th anniversary year is symbolic as we demonstrate our commitment to providing quality services to more older people.
‘As we increase our presence across England, we are giving more older people more choice and control over their future and will continue to identify opportunities for growth. This acquisition complements our existing portfolio, ensuring we can continue to grow to meet the needs of both new and current residents.’
Care at the transferring schemes is delivered by third party providers and will remain unaffected.
Joe Reeves, Executive Director of Finance and Growth at Midland Heart, said, ‘We’re confident that the transfer of these 23 schemes to a specialist provider will build on the high-quality services we have provided to our residents and offer colleagues more opportunities to develop in their chosen careers. We are sure all residents will continue to enjoy living in their homes, and we wish all colleagues transferring the best with their new employer and in their future careers.
‘This transfer, which is one of the largest to have been undertaken in our sector, will give us valuable additional resource to make our next corporate plan our most ambitious yet. This plan will focus on our core purpose as a landlord of general needs homes. The resources from this transfer will be directed back into the organisation, enabling us to continue to build new, affordable homes that are needed in the Midlands. We will also invest in our existing homes to ensure that over 6,000 homes are fit for modern living with greater levels of energy efficiency, all at an EPC rating of C by 2030.’
UK hospices forced to rely on retail sales
New research from Hospice UK has revealed that for the first time, more money was spent in hospice charity shops than hospices received from central Government, as, in the charity’s view, the sector struggles with the mounting financial pressures of providing end of life care.
While Hospice UK is celebrating the work of retail staff and their customers in supporting the provision of hospice care, the charity has warned that second hand shops and other local fundraising cannot be responsible for plugging the projected £60m funding gap in hospice care this year.
The research has revealed that charity shops would have to sell 5,375 pairs of jeans to fund a palliative care nurse for a year and a further 43,000 blouses to provide a patient with a hospice bed for the same period.
In addition:
• £28 of retail sales would fund a hospice nurse for an hour.
• £207 would fund a hospice nurse for a day.
• £1,034 would fund a hospice nurse for a week.
• £4,479 would fund a hospice nurse for a month.
• £53,750 would fund a hospice nurse for a year.
Commenting on the findings, Sarah West, Director of External Affairs at Hospice UK, said, ‘While it’s incredible to see how much is being raised by hospice charity shops, the astronomical amount of stock that needs to be sold to keep hospices going highlights how unsustainable it is to finance the sector in this way.
‘Hospices are having to make impossible decisions about the services they can afford to provide, including making frontline staff redundant, and closing or reducing some services. This not only puts more strain on the already over-stretched NHS, but also risks leaving many without access to care they so desperately need and deserve. Inaction is not an option.
‘Hospices simply cannot sustain services that cost more and more to run, without meaningful support from government. It’s time for government to urgently address the funding
Study launched to examine software use
A new study has been launched to examine care management software use in community-based based care and support. The survey actively seeks participation from the family members and support networks of people receiving care, including unpaid carers.
The study’s key stakeholders are:
• Brainkind, a leading charity helping people to reach their potential following a brain injury.
• Self-Directed Support (SDS) Network England, providing peer-led problem solving, access to sector specialists, resources and learning opportunities to health and social care commissioners, operational teams and service providers.
• Colligo Labs, a transformation consultant to care businesses.
• Total Care Manager, a complex care management platform.
• National Care Forum, a leading association for not-for-profit social care organisations.
The study aims to reveal obstacles to technology adoption at every level of the sector and identify where the greatest support is needed for digital transformation.
In particular, the organisers are concerned about complex care and people with lifelong support needs. The survey can be completed anonymously and is open to anyone who provides care or support.
Commenting on the launch of the study, Graham Fisher, Digital Director at Brainkind, said, 'It's increasingly recognised that the methods used for reporting and management have a direct impact on the quality and safety of care delivery. That's why at Brainkind we've invested heavily in digital care records for all our services. As a large charity, we were fortunate to have multiple providers competing for our business which helped us find an appropriate solution within our budget.
'Unfortunately, it's a very different picture in the community-based care of people with brain injury or other complex needs. The consequence is that the care of some of society's most highly dependent people is being managed with the most rudimentary systems, often paper and Excel.
'We're pleased to be backing this research because it will help to quantify the scale and extent of this challenge. The hope is that when people leave our services in the near future, the new care setting will be using similarly
model to avoid a devastating future for the sector, and for those who need its vital care.’
Hospice UK has called for emergency support from Government to stem the tide of hospice cutbacks, and for long-term reform of hospice funding so that hospices are fairly funded for the services they provide.
The charity hosted a pop-up charity shop, supported by St Christopher’s Hospice, at Westminster on Thursday 10th October to further highlight the issue and encourage MPs to support the call for vital funding.
Minnie Watts, a hospice care nurse at Royal Trinity Hospice, said, ‘Being able to access hospice care is incredibly important for someone coming to the end of their life or needing respite care, but also for their family and loved ones. No one should be unable to access the care they deserve because of a lack of funding, but that is the heart-breaking reality we are facing.
‘We are so pleased to see the popularity of charity shops across the country continuing to grow and the part they play in funding hospice care, but it is not a substitute for sustainable funding from Government.’
capable software that we're using at Brainkind, giving all relevant stakeholders access to the primary care record, and allowing everyone to collaborate to support the person in living their best lives in the community.'
Antoine Tooley, Chief Executive Officer at Total Care Manager, said, 'Thousands of people in the UK have support needs relating to conditions such brain trauma or learning disability. Whilst these people are relatively few in number compared to those receiving dementia care, they typically receive lifelong care over decades, often in their family homes and supported by specialist case management companies. In some cases, these individuals’ care budgets operate like a business, directly employing teams of over a dozen support professionals and receiving 24-hour, two-to-one care.
'Care management software has proven invaluable in helping to manage this complexity across the adult social care sector and should equally be available in community-based care, so that stakeholders can collaborate towards supported people's desired care outcomes, and help disabled people live their best possible lives.'
Click here to fill out the survey.
Gaps found in Deafblindness provision
Research undertaken by Deafblind UK has found gaps in provision for assessment and care packages for people living with deafblindness. Following feedback that interpretation and compliance of the Care and Support Regulations remains inconsistent, Deafblind UK has explored what the current challenges impacting compliance are and how the charity can help overcome them.
"This research has been extremely useful in helping us to identify the areas where we can offer most support."
As part of this work, Deafblind UK set out to understand more about the needs and challenges that local authorities are experiencing in this area. The charity has found that just half of respondents have a specific identification and referral process for people living with deafblindness in their area.
Local authorities said they would welcome more information and training about issues and available support, particularly for frontline staff who may meet deafblind people. They would also like Deafblind UK to support in educating top-level management and the provision of additional support workers or groups in their area.
The survey found that:
• Only half of respondents have a specific identification and referral process for people living with deafblindness.
• 83% of respondents do not have a senior manager who is the designated strategic lead on deafblindness.
• Only 55% of respondents keep a record of the number of deafblind people living in their area. When asked what the number was, only one respondent answered.
• 33% of respondents stated that they do not have council employed staff who are qualified to assess people with deafblindness for their care needs/planning.
• 28% of respondents stated that they can undertake non-complex assessments and 39% can undertake complex assessments.
Commenting on the research findings, Simone Moore, Director of Operations at Deafblind UK, said, 'We invited all local authorities in England to take part in a survey. The purpose of the survey was to hear their experiences of providing the appropriate support for those living with dual sensory loss in their area, and the challenges in being able to do this alongside their other commitments. We decided to give the respondents anonymity so that answers were as honest as they could be without fear of any negative repercussions.
'This research has been extremely useful in helping us to identify the areas where we can offer most support. We now plan to develop an annual survey to gather further demographic information and help inform our decision-making process and therefore provide better, specialist support to those who need it.'
As a result of this research, Deafblind UK is planning to establish training provision that will aim to provide a robust programme to meet the needs of local authorities. The charity has also reported that it will connect with key stakeholders at a national level to support a national approach to addressing key issues at local level including awareness, legal compliance, expertise and funding.
To find out more about the work of Deafblind UK, visit the charity's website here.
IN FOCUS
Care workers facing financial inclusion challenges
WHAT’S THE STORY?
A new report, Inclusion at the Crossroads, has highlighted financial inclusion challenges facing care workers. In particular, the report has captured the experiences of women and ethnic minorities, who have been identified as being more likely to grapple with two key predictors of financial exclusion: lower pay and variable income.
For an industry with 131,000 vacancies, furthering inclusivity is vital, the report’s author, Wagestream, has argued. Not only for recruitment, but for retention, engagement and ensuring the sector responds correctly to the needs of an increasingly diverse population.
WHAT WERE THE FINDINGS?
While the report has stressed that employers alone cannot solve these issues, particularly when poor commissioning is at play, it has emphasised the role they can play in alleviating them and makes a series of recommendations to providers:
• Meet the standards for living hours as provided by the Living Wage Foundation.
• Provide support for employees to access state assistance they are entitled to.
• Implement a payroll savings programme, ideally on an opt-out basis, to help employees build savings by default.
• Review workplace policies and benefits through the lens of diversity, equity and inclusion (DE&I) and
prioritise providing financial security benefits that are useful and accessible for the whole workforce.
WHAT DO THE EXPERTS SAY?
Commenting on the publication of the report, Professor Martin Green OBE, Chief Executive Officer at Care England, said, 'For a sector as diverse as social care, inclusion is crucial. This ground-breaking report has highlighted financial exclusion as a challenge for every provider to be aware of. While solving this is not solely an employer’s responsibility, there are clear steps providers can take to support. The commitment made today by some of the biggest players in the sector represents a strong commitment to fostering greater inclusion among this critical workforce.'
Alex Ramamurthy, Head of Health and Social Care at Wagestream, said, 'The findings from Inclusion at the Crossroads demonstrate the urgent need for furthering financial inclusion in the social care workforce. By addressing the financial challenges faced by women, ethnic minorities and part-time workers, employers will not only strengthen their workforce with improved wellbeing, retention and engagement, but also ensure they are delivering the best care possible. At Wagestream, we are committed to working with providers to help them implement a practical solution that makes a real difference. I would encourage all providers to read the report.'
To request a copy of Inclusion at the Crossroads, click here
NEWS FROM ACROSS THE GLOBE
International Day of Older Persons 2024
The United Nations (UN) has issued its annual statement in recognition of the International Day of Older Persons 2024, which took place on 1st October. The 34th commemoration of the event focused on the theme of ‘Ageing with Dignity: The Importance of Strengthening Care and Support Systems for Older Persons Worldwide’.
This year's event bought together experts to discuss policies, legislation and practices that strengthen care and support systems for older persons. It highlighted the urgent need to expand training and educational opportunities in geriatrics and gerontology, address the
global shortage of care workers and recognise the diverse contributions of caregivers.
The commemoration also emphasised the importance of protecting the human rights of both caregivers and care recipients, promoting person-centred approaches to care that respect the dignity, beliefs, needs and privacy of older persons, and for the right to make decisions about their care and quality of their lives.
Commenting on the annual commemoration, UN Secretary-General, António Guterres, said, ‘As populations age, care and support systems are vital for older persons to continue actively engaging and
enriching their communities. Yet too often older persons do not have access to this crucial assistance, deepening inequalities and increasing their vulnerabilities. This disparity falls even heavier on women, including older women, who bear the brunt of providing unpaid care.
‘Recognising the rights of both those who receive care and care givers is essential for more resilient societies. We must work to cultivate people-centred care systems that are sustainable and equitable, and they must amplify the voices of older persons by ensuring their participation in policy making.'
Blooming Health Partners with Western New York Integrated Care Collaborative
Blooming Health, a leading member engagement and service navigation platform for community care hubs and social care networks, has announced a new partnership with the Western New York Integrated Care Collaborative (WNYICC). The collaboration aims to enhance engagement efforts between WNYICC and the populations it serves, promoting health education, screening, service navigation and conducting satisfaction surveys.
WNYICC was established to streamline partnerships between social care providers and healthcare organisations, ensuring
efficient and effective service delivery. By integrating Blooming Health's platform, WNYICC hopes to improve outreach and engagement to increase efficiency in addressing critical health-related needs within its communities.
Commenting on the new partnership, Nima Roohi, Chief Executive Officer at Blooming Health, said, ‘We are thrilled to partner with WNYICC to leverage our platform's capabilities for enhanced community engagement. This collaboration aligns perfectly with our mission to revolutionise how social care providers connect with their members, advance
Milestone reached for new aged care law
The Australian Government has introduced the Aged Care Bill 2024 to Parliament. The Bill is for a new Aged Care Act – the main law that sets out how the aged care system operates. It will deliver major aged care reforms, including:
• Improving the lives of older people accessing aged care services in their homes, community settings and residential aged care homes.
• Encouraging aged care providers to deliver high-quality care.
The proposed rights-based law:
• Addresses around 60 Royal Commission into Aged Care Quality and Safety recommendations.
• Incorporates feedback from several public consultations about the aged care reforms and the new law.
health equity and ensure that everyone stays informed about and has access to the resources they need while creating capacity for the social service provider through the power of automation.’
Nikki Kmicinski, Chief Executive Officer at WNYICC, said, ‘Our goal at WNYICC is to integrate social care services delivered by community-based organisations with clinical care through partnerships. With Blooming Health's platform, we can ensure effective communication with our community members to inform them of services available and to gather their important feedback.’
• Responds to the Aged Care Taskforce about sustainably funding aged care into the future.
The Bill will be referred to the Senate Community Affairs Legislation Committee for inquiry and report. During this time, the department will invite feedback on some of the rules that will sit under the new law. The new Aged Care Act is expected to commence from 1st July 2025.
A SHINING LIGHT
ways care homes are supporting older people to thrive
Despite the sector’s best efforts, residential care is not always regarded as somewhere that older people can flourish. Unwilling to accept this, Dr Bethany Morgan Brett and Amy Simpkins report on new research championing positive lived experiences.
At My Home Life England, we have conducted wide-scale qualitative research exploring residential care experiences, from the perspectives of older people and those who care for them. Through this, we aimed to better understand the challenges and benefits of living in a care home.
We spoke to 125 individuals (older people, care team members and families) in 16 UK care homes. We visited a range of care homes in terms of location, inspection ratings, size and type. We captured the voices of a diverse range of older people, with an average age of 85 and who had been living in a care home for an average of two years.
Our research, Thriving in Residential Care, shines a light on what is working well, and how, when conditions are right, care homes can support older people to really thrive. Here, we share six emerging themes.
Thrive relationally
Company was a lifeline for many older people, who felt lonely and
isolated when living alone. Many had formed friendships with others and relationships with their care team. When asked what the benefit of living in a care home was, 74-year-old Brian replied, ‘Well, being here by having company. The one thing I like is company.’
Moving to residential care also helped restore family relationships. Now that their relative had moved to a care home, families generally felt reassured, welcomed and able to stay actively involved in their relative’s life. Christine told us, ‘They not only care for my mum, and they care for my mum very well, but we’re included in that, you know. It’s given me my mum back for how long or short time I’ve got with her.’
One barrier to building friendships was older people feeling disturbed by those displaying behaviours related to distress in dementia. A perceived lack of shared interests was also a hindrance. However, we saw great efforts from care team members to facilitate connections and help new people settle in, including schemes such as the ambassador’s role to help build friendships.
Thrive actively
When living at home, some older people could no longer do things they enjoyed. Whereas, once living in a care home with the right support, people could adapt their interests to their capabilities. 82-year-old Irene had a long career with a fabric company, which was critical to her identity. She always enjoyed hand-sewing but found it more difficult now, ‘because of my hands’.
She told us, ‘I can’t do my sewing anymore, which was part of my life for 27 years. So, I decided to knit […] I knit scarves for the staff.’ Irene also found renewed purpose through volunteering in her care home, laying tables and attending to others at mealtimes.
We found that well-conceived, person-centred activities and community connections were important for older people's self-expression, confidence and autonomy, also providing opportunities to ‘give back’. This helped older people to find purpose and feel valued and respected.
The challenges identified around activities included people feeling inhibited by health conditions, especially incontinence. Another centred around resourcing, particularly if a home did not have their own transportation. Some older people chose not to engage with communal activities, preferring to pursue personal interests. Having choice about what they wanted to do mattered most.
Thrive inclusively
Inclusivity involves making someone feel welcome, safe, valued and respected, regardless of characteristic or background. We saw wonderful examples of support enabling older people to connect with their identity through embracing faith or culture.
One care team member said, ‘They can have a bit of their community being brought in.’ Our study also included care homes offering specialist provision for specific cultures and faiths, with culturally appropriate activities and foods, language support for those of whom English was not their first language and multi-faith chapels.
We also recognised the importance of fostering an inclusive environment where older people could express their sexual or gender identity. We heard moving stories, including that of 96-year-old Joanie, who identified as gay.
The manager of Joanie’s care home shared, ‘She was 96 and had never held a newborn baby – she thought, because all of her family had told her, her “condition” could be transferred to newborn babies.’ Joanie held the manager’s newborn baby and felt comfortable enough to share that she had a female life partner, reflecting that, ‘We lived as friends’, due to discrimination.
Thrive securely
Older people, families and care teams expressed that safety and security were amongst the greatest benefits of living in residential care. Care homes offered older people reassurance, and also alleviated the strain and worry for families. 94-year-old Harriet, who was becoming increasingly frail, ‘felt really safe’ after moving to her care home, whereas before she was 'getting scared all the time' and had fallen on several occasions.
Before moving into residential care, some of the older people experienced poor housing, insecurity and even violence. 75-year-old Pauline said that, previously, her life was ‘horrible’. She was living with her daughter and her son-in-law, who ‘was a drinker’.
She told us, ‘I didn’t like him. He used to throw bottles, so I was glad that I came out of there and that I’m in here now. Everything’s got better for me.’ Others, like 92-year-old Delith, felt anxious being alone at home, especially at night. But now, ‘When I go to bed at night, I don’t have told worry about whether anybody breaks in. If there’s any fire or anything, I feel safe at night.’
One challenge we recognised was that some care homes may lean towards being overly risk averse for safety reasons, which can stifle meaningful engagement. What we found to be most important was care teams finding creative ways to support people to do the things they enjoyed, even if there were risks involved.
Thrive with dignity
Care home manager Lynette recognised ‘some degree of self-neglect’ in some of the older people who previously lived alone. Many older
people also found it increasingly difficult to keep on top of household chores. They really valued that these things were taken care of in residential care.
Others previously struggled with personal care, but now had support with things like bathing and using the toilet. Having an ensuite bathroom in their care home was very important to some, including 84-year-old Rainee who said that getting to the bathroom by herself supported her independence.
84-year-old Fifi recognised the level of dependence she had on others to manage her incontinence. When asked what good care meant to her, she replied, ‘The carers are a wonderful bunch and you can see how dependent I am on them. Unfortunately, I have to wear pads. So, they’re a big part of me wearing pads, which I didn’t want to wear, so I am very dependent on the carers, who, here, I must say do a wonderful job.’
The greatest challenge to supporting dignity was for staff to remain person-centred working in a busy care home with routines and often depleted resources. Some older people spoke about there not always being enough staff to facilitate the routines they would like. For example, having to get up earlier or not being helped to shower at their preferred time. This was carefully negotiated in care homes as a matter of ‘compromise’.
Thrive healthily
An important benefit of residential care was that older people could be supported to maintain or even improve their health. Care team member Caitlin spoke of a lady who arrived with a ‘grade five pressure sore’. She said, ‘She wasn’t eating. She wasn’t drinking. They expected her to be gone within weeks.’ With the right support, she is now eating well and the pressure sore is healed; ‘She’s amazing, she’s thriving, she’s not going anywhere.’
Care homes were shown to provide proactive and pre-emptive medical care, having easier access to other health professionals than if living in the community. As manager Jay shared, ‘In a care home setting, you can be very proactive. You have a lot more time [than in domiciliary care] and you can pre-empt things, plan, be strategic.’
Older people also valued having regular and good-quality meals and drinks. 98-year-old Suzanne shared, ‘When I was at home… [and] feeling really bad, I had to get myself something to eat. It used to take me an hour and a half to get a cup of tea and I lived for a fortnight on brown bread, Marmite and oranges, I was lacking good food.’
Finally, we heard examples of care homes ensuring older people can live their best lives, even in the last chapter of life. It was important to recognise that wellbeing extends through all stages of life and that end of life is no exception.
The best of care
Our research has revealed that, whilst care homes may not be right for everyone, they can be everything for some. It has shown how high-quality, proactive, relationship-centred care, inclusion in a social environment with meaningful activities, nutritious meals and a strong sense of safety and security has, in some cases, been truly transformative and supported many older people to really thrive.
This research was funded by Hallmark Foundation and independently engaged a range of care homes and care home providers. Click here to see the report’s findings in a short animation. CMM
What does good care mean to you? Visit www.caremanagementmatters.co.uk and leave a comment on this article or join the conversation to share your thoughts.
Dr
Simpkins
A ROYAL COMMISSION: IS SOCIAL CARE IN THE LONG GRASS, AGAIN?
While the sector continues to wonder if reform may be achieved under the new Government, Kathryn Smith, Chief Executive at the Social Care Institute for Excellence (SCIE), picks up the conversation on a rumoured royal commission on social care, evaluating its merit and outlining the sector’s non-negotiables.
Given the urgent nature of the issues facing the social care sector, a royal commission must be balanced against immediate action.
Upon winning the election in July, the Secretary of State for Health and Social Care commissioned Lord Darzi to conduct an immediate and independent investigation of the NHS. This aimed to provide an understanding of the current performance of the NHS across England and the challenges facing the healthcare system. We are only a few months on, and the report has already been published, determining that the health service is in ‘critical condition’ whilst outlining a roadmap to recovery.
Understandable apprehension
To date, the social care sector has not been afforded the same opportunity. Instead, there are hints of a royal commission, the approach Labour took in 1997 and largely disregarded. Although a royal commission offers an opportunity to recognise social care as a part of our national infrastructure, not just in transforming individual lives but also in strengthening local communities and the broader social fabric, there is understandable apprehension.
Not least because a royal commission will take years to produce conclusions and recommendations, with no guarantees of implementing the changes. Given the urgent nature of the issues facing the social care sector, a royal commission must be balanced against immediate action.
Many of the issues facing social care are already well understood, and numerous reports and inquiries have already identified areas for improvement. Crucially, the sector has worked hard to come together, with consensus emerging around ideas that will change lives for the better and build strong local communities.
This has been reflected across Time to act: A roadmap for reforming care and support in England from the Association of Directors of Adult Social Services (ADASS), Care and support reimagined: A National Care Covenant for England from the Archbishops of Canterbury and York, Support guaranteed: The roadmap to a National Care Service from the Fabian Society and the adoption of Think Local Act Personal’s (TLAP’s) Making It Real framework within the Care Quality Commission’s (CQC’s) single assessment framework.
Whether a royal commission will go beyond this current consensus, providing a better understanding of the issues and solutions in the sector from where we are today, is a matter to be debated, but what is clear is the amount of energy and optimism in the sector to drive forward change. The Government now needs to capitalise on this goodwill.
There is a recognition that there is no silver bullet and getting this right will take time but, repeating the 1997 commission is not something the sector can afford. Instead, a different approach is needed. The following must serve as the building blocks for the Government’s mooted royal commission.
Creating a shared vision
A royal commission is an opportunity to signal the Government’s intention to stabilise the social care sector once and for all. To do this, there must be agreement as to what the purpose of the social care system is, what the problems and challenges are and what the solutions are. This will include agreement on how care is funded, organised and delivered going forward.
We have our north star with the vision from Social Care Future, but now we need the building blocks to get there. This will include establishing a realistic timeline and actionable steps. Working back from the change we want to see, we need to take into
account the current issues. As is well documented, the sector is under intense financial pressure, due in part to local authority budget cuts, with emerging issues around the quality and availability of care and support, placing more pressure on families and communities to fill gaps.
This is all against a backdrop of demographic and epidemiological transitions which are shifting the demand and profile of care and support, such as our ageing population, rising care needs and the increasing prevalence of chronic health conditions and disabilities among older and working-age adults.
A sensible starting point for the royal commission, which would help realise the vision of Social Care Future, would be to look at how it can fully implement the Care Act 2014. Although we are 10 years on, the Care Act’s ambition has remained unfulfilled because the system is fragmented, services are not personalised and many care and support needs are unmet. Current funding is unfairly and inequitably distributed on closer examination of demographic trends, whilst key issues like wellbeing and co-production require further work to embed these within the system.
Collaboration with the sector
The approach of Government to a royal commission must learn from where previous commissions have failed. Richard Humphries, in his book, Ending the Social Care Crisis, advocated for a movement away from top-down approaches to reform care and instead foster a bottom-up, citizen-led and co-produced approach. Drawing on the knowledge, ideas and experience of people who use social care, their families, carers, health and social care professionals, care providers and commissioners is central to equity and inclusion.
Co-production should not be an afterthought but rather central to policy and practice design. SCIE's Experiences and understandings of co-production in adult social care revealed that only 59% of people with lived experience had previously had opportunities to be involved in co-producing their own care and support. Social care staff reported that time (47%), organisational culture (31%), cost (26%) and communication (25%) were the most significant barriers to implementing co-production. A tide change is required.
Such an approach will also create agreement about the key design principles needed to guide the planning of a social care system fit for the future, one which builds on the consensus and
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partnerships that already exist across the sector. Creating a royal commission, through which power can be shared with the full diversity of the sector, will be a powerful asset for Government.
Investing in solutions that drive change
Scaling innovation and improvement is crucial to helping social care and providing support to carers, including those who are unpaid. To do this, we must facilitate learning, overcome barriers to social innovation and identify and enable those things that support innovation.
A royal commission represents a potentially transformative moment for social care reform.
Given the current pressures on the social care system, it can be hard to imagine a system working well. However, there are examples of good practice and innovation from around the country, and the amazing resilience and contribution of disabled and older people, carers and communities for a royal commission to build on.
For example, SCIE is providing hands-on support for the Government's Accelerating Reform Fund, an initiative to encourage and grow innovation within the social care sector. The programme focuses on scaling and spreading social care innovation in key areas like supporting unpaid carers and delivering new care models.
Examples of projects include Shared Lives, a care and support service that matches people aged 16 and above who want to live independently in their community with Shared Lives carers. Research by SCIE found that Shared Lives can result in an average saving of £8,000 for people with mental health needs and £26,000 for people with learning disabilities.
Sustainability is fundamental
Lord Darzi’s Independent investigation of the NHS in England recognises that health and social
care cannot function effectively in silos; they are interdependent. Both systems aim to enable people of all ages, not just older people, to live independently, manage long-term conditions and relieve the pressure on finite NHS and emergency services.
Without a co-ordinated approach to addressing the issues in the social care sector, as well as the NHS, people will continue to face under-met and unmet care needs, and family carers will remain overstretched. With the Government having launched a mission to fix the NHS by developing a 10-Year NHS Plan, there is a unique moment of opportunity to make the case for sustained investment in the social care system which can deliver change at pace.
The importance and value of investing in early intervention and universal services cannot be understated. By improving upstream support through investment in social care, people will be able to access the care they need, positively impacting their health and those around them. This will include expanding the social care offer through sustained investment in community rehabilitation, reablement and intermediate care, which will prevent the need for long-term care as well as unplanned hospital admissions.
We stand ready
A royal commission represents a potentially transformative moment for social care reform. It presents a unique opportunity to overhaul the current system and establish one that is not only more equitable and sustainable but also more attuned to the needs of those who depend on it.
The extensive work carried out by the sector over the past decade provides a solid foundation. Practitioners, care providers, individuals who draw on care, and organisations, including SCIE, have continued to generate a rich repository of evidence, research, and insights.
The sector requires practical measures that can be implemented immediately, as well as a long-term vision that includes sustainable funding, improved care standards, and a greater focus on person-centred care. SCIE, and the wider social care sector, stand ready to work with the Government to deliver the solutions our sector requires. CMM
How do you think a royal commission could be best used to reform the sector? Visit www.caremanagementmatters.co.uk and leave a comment on this feature or join the conversation to share your thoughts.
Kathryn Smith is Chief Executive at the Social Care Institute for Excellence (SCIE). Email: media@scie.org.uk : @SCIE_socialcare
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INTO PERSPECTIVE
How does Lord Darzi's report influence health and care integration?
This issue, Into Perspective invites two industry leaders to reflect on the findings of a new report commissioned by the Secretary of State for Health and Social Care, which has identified long-standing neglect of social care.
A new report on the state of the NHS, commissioned by the Secretary of State for Health and Social Care and led by Rt Hon Professor Lord Darzi, OM, KBE, has identified several challenges facing the NHS, along with key areas for reform and modernisation. In addition, the report has shed light on the inadequate funding of social care and the lack of value that has historically been placed on the sector.
On this topic, Lord Darzi wrote in his
report, ‘Social care has not been valued or resourced sufficiently, which has both a profound human cost and economic consequences. In my examination of the social care system, the connection between inadequate social care funding and the strain on the NHS is glaringly clear.’
The lack of available social care support is contributing to the patient backlog in the NHS – it can be argued that, with greater integration between social care and health
care, this could be avoided. According to Lord Darzi’s report, a ‘desperate shortage of capital prevents hospitals being productive’, which means patients are not flowing through hospitals as they should be.
With social care being means-tested, rather than funded by taxpayers like the NHS, the gap between those in need of social care and those receiving publicly funded care (those with the greatest need and those who are least able to pay) continues to grow. This in turn places a burden on the NHS, as more people are staying in hospital for longer than they need to be, rather than being discharged to more appropriate facilities.
In fact, 13% of NHS beds house people who are waiting for social care support or more appropriate care in other settings. This has an effect on how productive the workers in the NHS are able to be; the report found that surgical activity for each surgeon has reduced by 12% and each clinician working in emergency medicine has seen their activity fall by 18%. While governments for the last eight years have promised to move care away from hospitals and place it back in the community, in actuality the opposite has happened.
With a social care system unable to prop up the needs of an older, sicker population and different economic models between the NHS and social care, Lord Darzi stated, ‘Too many people end up in hospital, because too little is spent in the community.’
The interim findings of the review of the Care Quality Commission (CQC) by Dr Penny Dash found ‘significant failings in the internal workings of CQC which have led to a substantial loss of credibility within the health and social care sectors, a deterioration in the ability of CQC to identify poor performance and support a drive to improve quality – and a direct impact on the capacity and capability of both the social care and the healthcare sectors to deliver much needed improvements in care’. Lord Darzi agreed with Dr Dash on the failings of the CQC and stated that accountability is important but, with 3,000 people employed by the Department of Health and Social Care in 2024 (an increase of 50% in just 10 years), he highlighted that there are ‘too many people holding people to account, rather than doing the job’. This, he stated, can be counterproductive.
With hospitals being the focus of single-year budgets, rather than primary care, community services or mental health provision, Lord Darzi highlighted ministers ‘throwing more money at hospitals where the pressure is most apparent as waiting areas fill up and ambulances queue outside’. In contrast, ‘publicly funded social care is provided for fewer and fewer people while the demand for it has risen, largely as the result of an ageing population’.
You cannot separate health and care needs
Isaac Samuels, Co-Production Advisor, Think Local Act Personal (TLAP) : @TLAP1
Email: isaacsociety@gmail.com
I have spent years navigating health and social care, so I know the frustration, confusion and heartbreak of these systems not working together. The reality is simple: you cannot separate people’s health and care needs. We do not fit into neat little boxes. We are whole individuals with interconnected needs, and when those systems are not joined up, it is people like me who pay the price.
I have lived through delays, miscommunication and times where I have felt completely invisible – just another number in a system unable to support me as a whole person. The recent report shining a spotlight on the lack of value and resources given to social care hit home hard. It makes it clear that if we are serious about improving lives, health and social care must be fully integrated.
While the report highlights the challenges we face, it also presents an incredible opportunity. The way forward is through co-production and co-design, where people like me –those with lived experience – are invited to help shape the services that we use. Too often, decisions about care are made from the
top down.
The vision of a properly integrated health and social care system is not a pipe dream – it is something we can achieve if prioritised. The report points to the need for investment in community-based care, with services designed around people’s lives, not just their illnesses. Imagine a system where your care does not stop at the hospital door, where health and social care professionals work together seamlessly to support you at home and in the community.
But to get there, we need bold action. We need policymakers to take the report’s findings seriously and commit to meaningful health and social care integration. We need investment – not just in hospital infrastructure but in community services that prevent people from needing to go to the hospital in the first place.
We can no longer afford to treat health and social care as separate entities. We must demand a system that sees people as whole, that values their needs and that helps them live healthy, independent and fulfilling lives. Let’s seize this opportunity and make sure that the changes we need are not just talked about, but delivered.
We look forward to seeing strong action from Government
Jim Kane, Chief Executive Officer, Community Integrated Care : Search ‘Jim Kane’
Email: jim.kane@c-i-c.co.uk
Although the care sector was outside the scope of this report, to quote Lord Darzi himself, ‘It is impossible to understand what is happening in the NHS, without understanding what is happening to social care.’ This view is something that we strongly support; these two parallel sectors are fundamentally linked, and only when we finally have a fix for social care, will the cure for the NHS’s challenges be found.
The deterioration of social care, which should be a sector that creates stability and opportunity in our communities, creates a chain of negative impacts that affect people who draw on support, care workers, family carers, public services and our economy.
For many years, the sector has been calling for a more joined-up approach to support a solution for these challenges. In particular, the NHS and social care systems must provide properly integrated care and support when the two systems are dependent upon each other for ensuring better care of people with learning disabilities. This includes better delivery of integrated health and care services in the community,
in turn reducing avoidable admissions into hospital and delayed discharges from hospital into community settings.
Now, with Lord Darzi’s analysis as guidance, we look forward to seeing strong action from Government to improve the health, care and support of people with learning disabilities, to enable them to live their best lives possible.
Beyond that, Government must address the long overdue reform of social care as a whole. As a champion of improved pay for frontline support workers, Community Integrated Care strongly supports the Government’s commitment towards a fair pay agreement for care workers, the development of a National Care Service and the plan for cross-party talks on future funding of the care system.
As a first step, Government should take immediate action to increase the pay of frontline support workers to improve the lives of those receiving and providing care, to increase the productivity of social care and healthcare services and to contribute to economic growth – as called for in our ‘Who Cares Wins Unfair To Care 2024' report.
CARE INNOVATION CHALLENGE
The Care Show took place on 9-10th October at the NEC in Birmingham and on the second day of the show, the winner of the 2024 Care Innovation Challenge was crowned. CMM caught up with Keerthi Busanaboyina and Hemanth Kumar Talupula, Co-Founders of Ellyfe to hear their reactions to winning the competition and to find out what is next for the company.
The 2024 WINNER...
A buzz of creativity and knowledge, the Care Innovation Challenge hub was full of activity and insightful discussions on the final day of the Care Show. The five finalists showcased their ideas and their bright, informative posters were displayed for all attendees to read. Described by many of this year's mentors as one of the most exciting and innovative years of the challenge yet, the finalists were subject to extensive questioning by curious passers by.
The public vote closed just before midday and the judges united to discuss their thoughts on the finalists and carefully weighed up the strengths of each idea to come to a final decision. The judges named Ellyfe as the winner of the 2024 Care Innovation Challenge –the team has developed a wearable device designed to support hydration monitoring for older people in their homes, whilst at hospital or in care homes. Elizabeth Beh, Founder of Tresacare and last year’s Care Innovation Challenge winner, said, 'As their mentor, I've learned valuable lessons too. Encouraging Keerthi to share her personal story behind Ellyfe reminded me of the power of vulnerability in leadership. It has inspired me to embrace my own journey as a Founder, something I've been hesitant to do in the past.'
CMM: Congratulations to Team Ellyfe! What has been your experience of the Care Show?
Hemanth: It’s been my first Care Show and I am so thrilled to be learning, testing our product and engaging with people. It has been an incredibly productive day that I will remember for a long time. The whole show is helpful and fun too. It has been great to interact with the right audience and receive feedback on our testing and learn from others. We have met with the purest souls – the people who are really interested in helping other people. This is a community and we feel we are in safe hands now. I cannot put it into words how much the challenge has supported us.
CMM: How are you feeling after your win?
Hemanth: I am feeling happy and relaxed –mixed emotions because I was questioned a lot while testing. At the end of the day, it paid off not only in terms of our win but also in terms of networking and making connections and a great
deal of happiness when people are sharing their experiences with us and praising our product. Hearing people praising the company and our cause is helpful and gives us a big boost. If someone recognises that hydration is very important, then we are amazed. The show has been a great time to ensure our technical research and cause are understandable and marketable for a wide audience on a very positive note. That is our biggest challenge. We have received some feedback about digestibility in the past but today, we have felt so confident and gained some fantastic results from testing attendees.
CMM: What have you been up to since becoming finalists?
Keerthi: We have been working on testing and improving the product and we bought quite a lot of patches. We also did testing on people we know. It gave us a lot of insight into what we can improve. We wanted customers to be part of the development process because we are making
it for them, so we want them to be included. We have to show our appreciation to the Care Innovation Challenge and the people we met. We are grateful to be in touch with all the other participants here at the Care Innovation Challenge final. We went to Anna Lewkowicz of Team EVA’s care home and tested all the residents and even the higher management team. They gave very good feedback and the residents loved it and the interaction with Hemanth.
Hemanth: The welcome I received from the care home and the residents was unbelievable. The people are so warm and welcoming. We did our research to give the residents the best experience; we made sure the patches were skin-friendly and non-irritable and received some good feedback from the carers and residents. When I spoke with the carers, they felt positive about a result-oriented device which gives immediate results on their hydration levels which helps carers focus on these people.
CMM: What is your background in care and your connection to the people this is going to help?
Hemanth: I have a technical background in electronics and data science. I have worked in the sector where I was able to understand what exactly health meant for people to gauge their comfort, their level of treatment and how technology can support them. I also worked closely with a healthcare team where I built foundational knowledge of how health systems can run and I was able to bring in my technology expertise in terms of saving lives in a well-balanced way.
Keerthi: For me, a few years ago, we lost our grandfather as a result of dehydration. We did not want what happened to my grandfather to happen to anyone else so that is where we got this inspiration from. We wanted to understand marketability, so we worked with the care sector to understand people. This is not just a problem of my grandfather's. There are a lot of people suffering and we need to do something about it.
CMM: Who were some of the mentors that helped you out during the challenge?
Hemanth: Elizabeth Beh, Founder of Tresacare and last year’s Care Innovation Challenge winner, brought a lot of things to us. She transformed our pitching in a very positive way including aiding us with how to be candid with people and smiling.
Keerthi: She does a lot for us and she wanted us to be there as fighting spirits. Even after our win, she gave us feedback explaining what we could improve on. Elizabeth, Ala Szczepura, Liam Palmer, Alex Nash and Toshio Nomura have all been great mentors and offered us guidance. Paula Sardinha has also been one of the backbones for us.
CMM: What does 2025 look like for Ellyfe?
Keerthi: While Hemanth is working on the development process, we also want to continue testing so that we can gather more feedback. It also helps us going forward if we can get some more paid testing which can generate some revenue which we can put back into the product. By July 2025, we want our product to be on the market.
Hemanth: 2025 will be the launching stage. We have conducted trials, concept analysis, concept evaluation, testing and have spoken with people but we want to utilise all these things for the launch. Also in 2025, we want to reach different market analyses and distributions. We are planning to get some user analysis, performance feedback and information about our competitors. This can help us understand what people are loving and what the limitations are from person to person. This can help us to go into 2026 with bigger plans. We have big plans but before that, we want 2025 to be our main learning year.
CMM: What do care managers such as our readers have to look forward to from Ellyfe?
Keerthi: Dehydration is a problem which can lead to many other problems like UTIs and kidney issues. Hydration is important for everyone but older people over 65 have reduced thirst sensation
which can lead to these problems. If we can prevent dehydration, it will prevent lots of other problems in the future. This will contribute to better care for care home residents. I am sure it will be helpful in improving the quality of care and lifespan.
Professor Vic Rayner OBE, Chief Executive of the National Care Forum (NCF), said, ‘The ideas, the energy and the expertise in the room is incredible. The judges are all blown away by how much these teams have managed to do in the intervening months. The challenge is a hugely collaborative experience and everybody is insistent on getting it right for care.
‘On behalf of the whole Care Innovation Challenge and NCF team I warmly congratulate our winners, Ellyfe, who have a concept that could be so valuable for so many people in the sector and therefore they are the ones who we think can make a real difference. They have worked so hard; they have kept coming back and have shown enormous perseverance. They have been out and testing across the care sector learning and developing their product so it is as good as it can be. They are committed to making it a reality and are so committed to social care.
‘It has been a fantastic competition. If this has piqued your interest and you have a great idea, we are coming back next year with another challenge. There are so many things we can do in care to make the sector better and it's only with your excitement, enthusiasm and support we can make that happen.’
CMM
CMM would like to congratulate this year’s Care Innovation Challenge finalists – the passion, commitment, creativity and team spirit shown by
Total Care Manager, Team EVA, Team Carpe and Team Care Coach was exceptional. CMM cannot wait to see how all the finalists develop their ideas as they aim to support the sector. Applications are now open for the 2025 Challenge! Visit the Care Innovation Hub website for more information.
Team Ellyfe, Team
AGE IS JUST A
The impact of intergenerational living number
A year on from the opening of an intergenerational care village in Chester featuring a fully integrated children’s day nursery, Belong’s Chief Executive, Martin Rix, talks about the reasons behind the ‘Nursery in Belong’s’ launch, the lived benefits and lessons being learned by all involved in the development.
To step inside Belong Chester is to arrive in a caring community with a palpable atmosphere of fun, curiosity and, at the same time, respect. In most cases, it will not be long before visitors come across nursery children, who are regularly seen dining with Belong residents in the Bistro. They love to listen to their stories and astound everyone with their empathy – and table manners. They will ask about ‘grandfriends’ who are absent, and it is rare to hear a cry or raised voice.
It is fair to say that the Nursery in Belong has surprised even the staunchest advocates of the idea with just how naturally the relationships between young and old have flourished, bringing joy and a sense of purpose to senior members of the community and remarkable developments in young learners.
Belong Chester is the first care village in the UK to incorporate a fully integrated nursery, where children and residents come together daily to have fun learning and playing together. Since opening, it has shown clear benefits of intergenerational living both for older residents and nursery children, as well as learnings for anyone looking to replicate these advantages.
Partnership working
The Nursery in Belong is the culmination of five years of collaborative planning with our partners, Ready Generations,
the award-winning intergenerational charity which operates the nursery.
A Belong intergenerational practice lead works alongside village and nursery teams to plan, co-ordinate and evaluate a rich curriculum for both children and older adults, called The Mirrored Care and Learning Framework. This allows older people to learn alongside children whilst also becoming mentors and educators, sharing their wisdom and knowledge whilst building meaningful relationships and connections.
There are plenty of opportunities for informal interaction around the village, or older people may choose to join some of the planned intergenerational experiences, which range from weekly multi-generational choir sessions to storytelling, and from ‘dough discos’ (exercise sessions involving play doh) to ‘prambles’ (a walk involving prams).
Weekly ‘Repair Shop’ sessions involve residents helping children to upcycle household items, teaching an important lesson about sustainability and a ‘make do and mend’ mentality – as well as practical skills, such as how to use power tools.
Hub of the community
Activities are supplemented by projects facilitated by partnerships with external groups, including schools, theatres and libraries, as well as the local Grosvenor Museum, which supported a Living Lives Together project running over several weeks and involved role play and dressing up as well as children and older people painting portraits of each other. This led to an art exhibition with portraits and associated photographs displayed around the village.
One factor behind the successful integration of the nursery has been the way in which the village model lends itself to these kinds of intergenerational opportunities. With a village centre including an entertainment venue, creative studio, library, garden room and bistro, there are a range of spaces available to host intergenerational sessions, while also leaving other spaces for those who choose not to participate.
Intelligent design
Intergenerational design features have been incorporated throughout these spaces, with high-quality seating for people of all ages and free-flow access to the secure nursery and
residents’ gardens to allow for spontaneous experiences, such as planting, weeding and just enjoying the sunshine together.
Indoors, colour schemes, furniture fittings and resources have been carefully selected to be accessible and respectful for all age groups. Flooring and lighting in the nursery spaces have been chosen to maintain a calm and peaceful environment for both children and older people.
Diverse community
The village community incorporates people with a range of abilities, from those requiring nursing support in our 24-hour care household settings to more independent customers living in our apartments, as well as day visitors from the wider community who access the village facilities or our day care service.
Around two thirds of Belong residents are living with a dementia diagnosis and one of the remarkable features of the intergenerational environment is the ability for people with dementia to connect with children and young people through play or storytelling. They communicate in a way which may escape them when interacting with peers.
Events are advertised through a bi-monthly ‘What’s on’ programme of events and activities, which helps to bring the wider community into the village, reducing feelings of isolation and offering a sense of belonging and connection.
Renewed purpose
Residents who move into the village, including those living with dementia, are exhibiting improvements in physical and mental wellbeing and reporting how the nursery has enriched their lives and given them new purpose and meaning. Those who initially said the nursery was a lovely idea, but would not get involved personally, are now regular and enthusiastic attendees at intergenerational events.
This manifests in greater motivation to engage in physical activity, including walking longer and further when they go ‘prambling’ and taking part in dance and movement sessions. Colleagues report that being around children is making people living with dementia more relaxed. By supporting the children’s learning through such things as storytelling, reading, sharing memories and teaching simple skills, there is improved cognitive functioning and mental wellbeing.
It also caters for the needs created by
changing family dynamics. Many people living at Belong Chester are a distance away from children and grandchildren, so they welcome the opportunity to interact with the children and their families. Similarly, parents of children attending the nursery have relocated for work opportunities from places such as India, Spain, Nigeria and Ireland and do not have older relatives close by, so they value the sustained friendships with residents.
Measuring the impact
Data since opening has been overwhelmingly positive, including feedback from parents and residents’ families.
Customer surveys show that of the people living independently in an apartment at the village, 82% join in intergenerational experiences, with 36% taking part weekly. Over 80% of apartment residents report that both planned and spontaneous intergenerational interactions are changing their lives for the better, with their families also commenting on the difference children are making to their loved ones’ wellbeing. Reductions in isolation and loneliness have also been significant. Interest in this pioneering work is growing, nationally and internationally. Last year, The Nursery in Belong won the LaingBuisson Award for Innovation in Care, followed by the Development and Innovation Award at the 2024 Markel 3rd Sector Care Awards, alongside other international recognition and media coverage. In turn, this has led to visits from industry professionals, including from the Chief Nurse for Adult Social Care, Deborah Sturdy, with more high-profile visits planned.
Looking ahead
As a research setting, the nursery works alongside several academic partners, including Northumbria University and the new Centre for Ageing and the Life Course at Liverpool University to explore the benefits of the approach for children, residents and their families, as well as early years and care workforces.
The intention is for these partnerships to build on existing work and support the growth and sharing of knowledge, understanding and expertise. Potentially, this may include the rollout of additional nurseries as we look to incorporate intergenerational design more broadly, and assist everyone to live fulfilling lives, no matter their age or health. CMM
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RESOURCE FINDER: LEGAL
Finding a good solicitor is an essential part of running a social care business, whether you need legal advice on employment matters or wish to challenge a report for rating from the Care Quality Commission (CQC). Here, we’ve profiled some of the leading legal firms that specialise in social care to help you find one that works for you.
Gordons
Tel: 01483 451900
Email: neil@gordonsols.co.uk
Website: www.gordonsols.co.uk
SECTORS
• Care homes.
• Domiciliary care.
• Supported living and extra care.
• Learning disability services.
• Independent hospitals.
SERVICES
• Regulatory action.
• Responding to civil and criminal enforcement action, and draft inspection reports.
• Safeguarding enquiries.
• Contract disputes (including fees and embargoes).
• Police investigations and prosecutions.
• Mental health, mental capacity and DoLS.
• Health and safety.
• Inquests.
• Employment law
• Corporate finance and banking.
• Sales and acquisitions.
• Property-related matters.
• Commercial law advice.
• Commercial litigation.
LEAD INDIVIDUALS
Neil Grant heads Gordons’ Health and Social Care Provider Team based in Guildford. Neil is an expert in the regulation and funding of health and social care services. He has a wealth of experience, having acted for inspectorates and other public
Neil Grant, Partner
Tel: 01483 451900
bodies at a senior level. Neil only acts for providers, not regulators or commissioners, thus avoiding conflicts of interest.
Susan Hunneyball works alongside Neil and has significant experience in advising clients in the health and social care sector. She has assisted providers with appeals against CQC decisions and, relevantly during the pandemic, on issues arising from compliance with infection control. She has helped providers obtain good outcomes following CQC urgent action. In addition, a large part of the work she does is advising clients who are involved in inquests or have Fitness to Practice issues, particularly in the pharmacy sector.
COMPANY INFORMATION
Gordons Partnership is a respected law firm and is a recognised leader in the healthcare field. It was formed in 1994 by three lawyers from leading practices who were fed up with the ‘factory’ approach to law. At the time, Gordons’ philosophy was to provide high-quality, practical and affordable advice, in a professional and friendly environment. Throughout the firm’s growth, it has not lost sight of that philosophy.
Hempsons
Tel: 01423 724056
Email: socialcare@hempsons.co.uk
Website: www.hempsons.co.uk
SECTORS
• Care homes/nursing homes.
• Domiciliary care/care agencies.
• Supported living and extra care.
• Learning disability services.
• Independent hospitals.
• Charities and third sector.
SERVICES
• Charity law
• Commercial property.
• Community care law.
• Contracts.
• Corporate law (including sales and acquisitions).
• CQC regulatory.
• Data protection and security.
• Disputes and litigation.
• Employment law
• Fundraising.
• Health and safety.
• Inquests and coroners.
• Judicial review.
• Mental health law.
• Safeguarding.
• Tendering.
LEAD INDIVIDUALS
Philippa leads Hempsons’ social care team, specialises in CQC work and has significant experience of working both for and against, which gives her a unique insight and the ability to offer pragmatic advice. She has over 20 years’ experience in the health and social care sector and with a varied workload including information governance, safeguarding, Court of Protection
and consent. She provides extensive registered manager training to aide compliance with the CQC’s fundamental standards as well as navigating the single assessment framework.
Martin acts for organisations in the full range of claims before employment tribunals. He frequently defends factually complex and legally novel claims, particularly in relation to disability, sexual orientation discrimination and whistle-blowing allegations. His practice includes executive and senior manager terminations, discrimination issues, TUPE, reorganisations, complex disciplinary matters and concerns with doctors (MHPS). Martin provides bespoke training on employment topics, ranging from TUPE and related procurement preparation to equal opportunities and disciplinary investigations and appeals.
COMPANY INFORMATION
As leading health, social care and charity lawyers, Hempsons support providers in delivering quality services. The social care team has won the ‘Legal, professional and business’ category at the Care Sector Supplier Awards for the last three years. Hempsons’ social care advice line offers providers up to 30 minutes of free legal advice. Call 01423 724056
Email: neil@gordonsols.co.uk
Susan Hunneyball, Partner Tel: 01483 451900
Email: susan@gordonsols.co.uk
Philippa Doyle, Partner
Tel: 01423 724028
Email: p.doyle@hempsons.co.uk
Martin Cheyne, Partner Tel: 01423 724121
Email: m.cheyne@hempsons.co.uk
Scott Moncrieff & Associates Ltd
Tel: 020 3972 9011
Email: earcher@scomo.com Website: www.scomo.com
SECTORS
• Care homes.
• Homecare.
• GPs and dental practices.
• Independent hospitals, clinics.
• Supported living and extra care.
• Learning disability
• Mental health.
• Cosmetics and ‘aesthetics’ services.
SERVICES
• CQC appeals to the First-Tier Tribunal.
• CQC registration advice.
• CQC notices to refuse, cancel or vary registration, warning notices and fixed penalty notices.
• Buying and selling.
• Commercial law advice.
• Commercial litigation.
• Commissioner fee and contract disputes.
• Contract drafting.
• Employment.
• GP disputes with integrated care boards (ICBs).
• GP referrals to NHS Resolution.
• Health and safety.
• Inquests and judicial review.
• Mental Capacity Act.
• Safeguarding.
• Police investigations.
• Property development and construction.
LEAD INDIVIDUALS
Errol Archer leads on regulatory work for health and social care providers. His experienced team
works with small and large providers, delivering commercially focused solutions. He brings valuable regulatory and policy insights from many years of advising business owners, regulatory bodies, central Government departments and Government ministers.
As a specialist SolicitorAdvocate, he has represented clients at hundreds of court and tribunal hearings, including the First-Tier Tribunal (Care Standards), the Coroners’ Court and the High Court. Tom Woodward is a specialist Employment Lawyer and provides expert advice to employers via a fast-response, cost-effective service on an ‘as required’ basis.
COMPANY INFORMATION
Scott-Moncrieff is a leading firm, established over 30 years ago and known for its commitment to delivering high-quality legal services at an affordable cost.
The firm provides a national service through recognised leaders in their fields, across all legal areas. It has a national reputation and particular expertise in the health and social care sectors. Its co-founder, Lucy Scott-Moncrieff CBE, describes the firm as user-friendly and approachable and emphasises that every client gets a personal service. The firm is known for standing up for clients when the going gets tough.
Errol Archer, Solicitor-Advocate
Email: earcher@scomo.com
Tom Woodward, Solicitor Tel: 07729 421836
Tel: 07917 835134
Email: twoodward@scomo.com
Weightmans LLP
Tel: 0345 073 9900
Email: mike.clifford@weightmans.com
Website: www.weightmans.com
SECTORS
• Care homes and care homes with nursing.
• Domiciliary/homecare providers.
• Supported/assisted living.
• Extra care and retirement living.
• Independent hospitals and clinics.
• Mental health and learning disability services.
• Children’s homes and foster care/agencies.
SERVICES
• Health and care regulatory.
• Challenging inspection reports.
• Corporate, regulatory and police investigations and prosecutions.
• Inquests and inquiries.
• Safeguarding and Local Authority Designated Officer (LADO) investigations.
• Mental capacity and Liberty Protection Safeguards.
• Employment, pensions and business immigration.
• Mergers and acquisitions and joint ventures.
• Real estate and construction.
• Commercial contracts and procurement.
• Contractual and fee disputes.
• Finance.
• Corporate restructuring and insolvency.
• Complaints, claims and litigation.
LEAD INDIVIDUALS
Weightmans’ national multi-disciplinary health and care team comprises more than 150 specialist lawyers, acting for
private, charitable and public sector health and care providers. The team is led by Andrew Parsons and Mike Clifford.
Andrew specialises in health and care regulatory law, providing advice on care home, mental health and public law. He is a leading practitioner in his field and is also the Honorary Legal Advisor to Care England. Mike specialises in corporate law and acts for providers, owners of, investors in and funders of health and care businesses.
COMPANY INFORMATION
Weightmans is a leading commercial law firm with offices in England, Scotland and Wales. It is recognised by the legal directories for its work in the health and care sector. Weightmans acts for many of the largest care home groups as well as a multitude of smaller and specialist providers.
Weightmans provides its clients with a comprehensive ‘one-stop shop’ of legal services. Its approach is based on offering the very best and well-informed advice combined with a responsive and cost-effective service.
Weightmans understands that problems can arise at any time in a health and care setting, so it operates a 24-hour helpline to provide advice and support to its clients. Its services are complemented by seminars and briefings enabling clients to keep up to date with the latest developments.
Andrew Parsons, Partner
Tel: 07711 799471
Email: andrew.parsons@weightmans.com
Mike Clifford, Partner Tel: 07891 809930
Email: mike.clifford@weightmans.com
CELEBRATING EXCELLENCE IN END OF LIFE CARE
Everybody deserves to have the best quality of life possible. This is what Emma Barclay, Head of Clinical Services at St Ann’s Hospice and End of Life Care Award winner at the 2024 Markel 3rd Sector Care Awards, believes and strives to achieve at the Greater Manchester hospice.
St Ann’s Hospice is a charity and a specialist provider of end of life care with two sites, one in Little Hulton, Salford and the other in Heald Green, Stockport. We provide specialist palliative care for people with cancer and non-cancer life-limiting illnesses, at all stages of their illness.
At St Ann’s we believe in a rehabilitative approach to palliative care. We believe in helping those at the end of their lives to live their lives to the highest quality possible. We are there to help patients with their life goals and we also are there to support their families along the way and through their grieving process, no matter how long that process might take. We aim to meet the unique physical, emotional, social and spiritual needs of those with a life-limiting illness, and to help maintain their dignity with holistic support.
Patients’ wishes and goals
Earlier this year, St Ann’s Hospice won the End of Life Care Award at the Markel 3rd Sector Care Awards. The hospice’s application focused
on St Ann’s success in innovation by delivering a rehabilitative approach to palliative care. This approach focuses on patients’ wishes and goals and focuses on what is important to them as an individual.
These goals are as unique as any individual person. For one patient it might be the want to be able to walk again, a goal that may be difficult to achieve for someone who has been cared for in bed for a number of weeks. For another person, it might be about gaining the ability to walk to their favourite pub to have another taste of their favourite beer. For another, it might be about making it to spend another Christmas with their family. Whatever a patient's goal, St Ann’s, along with the patient and their family, will strive to achieve it.
Last year, a goal of one of our patients was to make memories with her friends, as she knew she had limited time left with them. The whole multidisciplinary team of doctors, nurses and therapists worked with her to plan an evening with her friends that she would remember. They decided to have a girly night in. Her friends came to the hospice, with her
room being adapted into a Saturday night space. A bartender from The Griffin Pub in Heald Green came into the hospice. The bartender held a cocktail-making class and the patient and her friends had a brilliant evening. With everyone working together, we created a night that the person thoroughly enjoyed and achieved her goal of making memories.
What matters most
Goal setting is worked through between clinical staff and individuals to ensure there are steps taken to support what matters most at that point. Because no one goal is the same, the clinical staff spend time to understand specific needs, as these will shape the goals they choose to pursue. St Ann’s Hospice strives to keep this person-centred so that the people we work with are supported to address what is important to them.
Often, individuals can have a goal that seems unrealistic compared to their current situation, and functional skills. Staff members will speak to the person about ‘why’ they want to achieve this goal, to understand the reason behind this. A plan can then be put in place to see how a first step towards this goal can be achieved. In many instances, the goal is adapted to be appropriate to the person’s function at that time and broken down into achievable steps, and/or achieving these steps in a slightly different way.
We listen to our patients and families and are grateful for the feedback we receive through surveys and questionnaires to ensure we are providing holistic support that encompasses everything that is wanted and needed. The Integrated Palliative Care Outcome Scale (IPOS) tool is important for us to follow to ensure we are measuring the symptoms and concerns of our patients, to ensure we are providing the best care we can.
Collaborative efforts
St Ann’s is an integral part of the wider health and care system in Greater Manchester. At St Ann’s, we are proud to be part of the GM Hospice Providers collaborative, which brings together representatives from seven adult hospices across Greater Manchester, East Cheshire Hospice, as well as children’s hospices Francis House and Derian House. The GM Hospices Provider Collaborative is committed to working with partners at all levels of the GM Integrated Care System (ICS) and beyond to deliver high-quality and equitable specialist palliative and end of life care to the people of Greater Manchester, not just for today but also for future generations.
Through our collaborative efforts, we seek to establish and maintain standards of care that reflect the needs and preferences of our patients and families, while also taking into account the latest evidence-based practices and research. If incidents arise, we work with the necessary teams to investigate this and look into what the circumstances around this were, focusing on how to resolve this and minimise the chance of them occurring again. Our focus on equity means that we strive to ensure that all individuals, regardless of their background or circumstances, have access to the care they need to achieve the best possible outcomes.
Innovative approaches
Here at St Ann’s, we focus not just on our patients but recognise that it is also a difficult time for relatives, carers and friends and we provide support for them too. We recognise that providing specialist palliative and end of life care is a complex and challenging task, and we are committed to working together to develop innovative approaches that meet the
evolving needs of our communities.
Our multidisciplinary team is there to support families, friends and carers when their loved one is being cared for by St Ann’s. This is often informal support that can be offered in any way the individual wishes. Our bereavement services are available to families whose loved ones have died, and we are also able to refer people to other services depending on their needs. Our Let’s Talk service allows everyone to talk to a trained team of counsellors and assistant practitioners who are there to support individuals.
We also hold annual Forget Me Not and Light Up a Life appeals that give families the opportunity to celebrate the life of a loved one by making a dedication to them. Families are also invited to attend one of the remembrance services that are held as part of each appeal, giving friends and family a space to reflect and remember their loved ones with others who also have a connection to our hospice. Our Light Up a Life Appeal for 2024 has already been launched. It is an appeal that is centred around the festive period. This year, in the first week of December we are hosting six different services, three in Manchester Cathedral, all dedicated to loved ones who are no longer with us.
By working together, from our rehabilitation team, our nursing team, our volunteers and our fundraisers, right through to our receptionists who are always around for a smile and a chat, we here at St Ann’s can continue to achieve goals that matter to the individual patient and support the families and friends through the difficult times they find themselves in. CMM
Emma Barclay is Head of Clinical Services at St Ann’s Hospice. : @StAnnsHospice Email: enquiries@sah.org.uk
Headline sponsor
NATIONAL CARE ASSOCIATION (NCA) WINTER CONFERENCE
The NCA invites you to join the debate at its highly anticipated Winter Conference, discussing the most pressing issues impacting the sector today.
As we all know, the need for social care, across all ages and conditions, continues to increase, but the sector is engulfed with uncertainty and mixed messages following the election, which saw a change in Government. Veiled promises were made during the election campaign, which have now been rolled back and we appear to be at a watershed as we await the emergence of new policy and legislation.
What to expect
The conference will attempt to unpick key issues by engaging with experts, analysts and providers to open the debate and seek tangible solutions. The turbulence of the past few months has exacerbated the challenges facing the regulator with the Government-led review into its operational effectiveness and the ongoing UK Covid-19 Inquiry.
We know that much more looms on the horizon, so we have devised a conference programme covering the plethora of change which may impact providers and their ability to deliver quality care in the coming months.
We are delighted to already have confirmed speakers from the Department of Health & Social Care, Local Government Association, Skills for Care, The King’s Fund and, UNISON, to name a few. Topics up for debate will include the future of social
care, funding gaps, workforce challenges, the image of care and of course, regulation. Providers can submit questions on the day to ensure their voices are heard throughout the programme of interactive sessions.
Picking up the conversation
Our last conference in Manchester received very positive feedback, with providers telling us they felt engaged and positive that they had been represented. Speakers also reflected that they felt at ease delivering difficult messages. Lastly, sponsors and suppliers at the event talked positively about the level of engagement with delegates.
The aim of this conference is to not only share information with delegates but to also gather evidence and information from people who are delivering care and support at the front line. Delegates have attended previous conferences for learning opportunities, but also to network and take thoughts and ideas back for implementation in their own businesses.
A delegate who attended our last conference in Manchester commented, ‘Thank you very much for organising this interesting and useful conference! It was great to attend a conference focused on social care and hear from the industry leaders, including Minister Whately.
‘Each panel was focused on different areas of the sector, to include workforce, regulation and finishing with Anita Astle MBE and Sanjay Dhrona where they powerfully spoke about their mission to improve the lives of residents was inspiring. I left the conference with an abundance of knowledge and felt positive about the sector’s future.’
Why now and why join?
The timing of this conference is deliberate as we approach the time of year when providers are typically negotiating local authority contract fee rates. We hope that providers will have the opportunity to network and gather and share information from our supply partners, sponsors, speakers and each other to fight for better funding on behalf of people drawing on care and support.
In addition, we know that colleagues in the NHS will face an abundance of challenges as the winter months approach. The latest developments concerning Integrated Care Boards and the wider integration agenda will be discussed by a confirmed conference speaker and delegates will undoubtedly be eager to express how the sector stands ready to support the NHS this winter.
Care providers should not miss out on this insightful learning opportunity. See the following section for all the information you need to secure your place at the NCA Winter Conference.
Book now
The conference will be held on 7th November 2024 at the Hilton Dartford Bridge Hotel, Crossways Business Park, Masthead Close, Dartford DA2 6QF. The ticket price for NCA Members is £50 (second ticket at £35), rising to £75 for non-NCA members. To book, call 01634 716615 or email info@nationalcareassociation.org.uk
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NCA Winter Conference 7th November 2024, Dartford https://nationalcareassociation.org.uk/ news-events
Data Security and Protection Toolkit (DSPT) In-depth: Data Security 19th November 2024, Online www.digitalcarehub.co.uk/events
Housing Quality and People’s Health: Making the case for improving health through housing 20th November 2024, Online https://ageing-better.org.uk/events
Tech + Homecare Conference 2024 21st November 2024, London www.homecareassociation.org.uk/ trainingandevents
NCF CEOs and Directors Conference 2024 25th-26th November 2024, Wyboston www.nationalcareforum.org.uk/events
National Children and Adults Services Conference 2024 27th-29th November 2024, Liverpool www.adass.org.uk/events
Driving Change Together: The Commissioners’ Conference 3rd-4th December 2024, Alfreton www.commissionersconference.co.uk
Care Industry Forum 2024 9th-11th December 2024, Stratford-upon-Avon www.careengland.org.uk/events
CMM EVENTS
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Date/Location: Contact: CMM Insight: East Midlands Care Association Alliance Conference 2024 5th November 2024, Derby www.caremanagementmatters.co.uk/event/ east-midlands-care-association-alliance
Please mention CMM when booking your place. Sign up online to receive discounts to CMM events and for more information on our upcoming events in 2024.
Suicide is preventable through education and intervention. Yet, in a sector that promotes wellbeing amongst staff and people drawing on care and support, rates remain high. What can employers do to overcome this? Kate Golding, a Mental Health First Aid (MHFA) England Instructor, suggests possible solutions.
According to the Zero Suicide Alliance, while females in the sector have a lower rate of suicide (5.6 deaths per 100,000) compared to the national female average (5.3 per 100,000), males in the sector have a higher rate (23 deaths per 100,000) compared to the national male average (16.9 per 100,000). In terms of sector occupation, female and male residential and domiciliary care workers have the highest suicide rates (9.7 and 37.5 deaths per 100,000 respectively).
Why are suicide rates so high?
Suicide is complex. Most of the time there is not one event or factor that leads someone to take their own life. It is usually a variety of different factors interacting with each other to increase risk. A combination of individual, community and societal factors contribute to suicide risk. There are several factors that may contribute to the sector’s suicide rates:
• Internal and external investigations can seem out of people’s control, cause intense feelings of shame and have major mental health implications.
• Health and social care staff are exposed to suicide and other distressing circumstances more frequently than the general population. Constant exposure to death, illness and human suffering can take a toll on mental health.
• Recent bereavement is a known factor in suicide behaviour. Research has found that adults bereaved by suicide were 65% more likely to attempt suicide than those bereaved by sudden natural causes.
• ‘[E]xperiences of bullying and unkindness in the workplace’ have a direct impact on stress levels and mental health at work, according to a Royal College of Nursing (RCN) report, revealing that 69% of the 352 nursing staff who sought support from a counselling
service between February 2022 and February 2024 cited ‘work/academic’ as a reason for seeking help.
How can your organisation help?
An inclusive workplace incorporates all our unique views, experiences and backgrounds to create sustainable and inclusive outcomes. NHS England suggests a holistic workforce suicide prevention programme should include clear policies, procedures and practical guidance to help staff on issues including mental health, long-term physical health issues, domestic violence and financial advice.
A crucial first step is to foster and encourage open conversations about mental health at an organisational level. A simple but effective way of achieving this is for managers, and indeed all staff, to lead by example, and role model healthy behaviour towards each other.
Considering the immediate environment and investing in green spaces which are known to benefit both mental and physical health is another option, especially if staff members are interested in gardening and wildlife. Examples of this could include hanging up bird feeders, making bug hotels, planting window or balcony boxes, flower beds or vertical gardens and displaying house plants.
In addition, noticing if a colleague’s mental health is deteriorating and intervening early, is protective and supportive. By incorporating mental health training into your organisation’s health and wellbeing approach, colleagues can gain the knowledge to spot the signs of someone who may be thinking about suicide and the confidence to intervene and put clear, actionable plans in place.
This year, to mark World Suicide Prevention Day, MHFA England created a new workplace resource, the Five pillars of suicide prevention in the workplace. It advises organisations on the things they need in place to support both people having thoughts of suicide and people impacted by suicide.
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