Care Management Matters (CMM) Magazine December/January 2024
WHAT'S NEXT FOR THE REGULATOR?
Forging an improved path
Getting up to speed
The Employment Rights Bill
AI-generated avatars
Supporting dementia care
Improving sector unity
Educating student nurses
Optimised system to drive laundry cost savings, delivering up to 20% reduction of your laundry operational costs.
• Designed for low temperature wash
• Optimised system for care homes • Reduces pre-wash & re-wash
Social Care Insights
Richard Humphries argues that Government’s adult social care position is starting to resemble an advent calendar, with each window revealing a new disappointment.
Inside CQC
Mary Cridge reveals the Care Quality Commission’s plans for the work it needs to do to get back on track in 2025.
Homecare Headlines
Raina Summerson states how providers will be reeling from the recent Autumn Budget that placed additional financial pressures on employers.
CMM News
Into Perspective
CMM invites two industry leaders to reflect on how the Better Care Fund can be re-focused to promote prevention, following the publication of the ADASS 2024 Autumn Survey
Celebrating Excellence
Vanessa Marr and Katy Styles explain how their Markel 3rd Sector Care Award-winning collaboration brought carers’ voices to the heart of Welsh Parliament.
Event Preview
DP Business Events, organisers of the Care Industry Forum 2024, will once again host one of the largest annual gatherings of care sector executives.
What’s On?
Straight Talk
Lee Gilbert highlights the importance of focusing on quality of life in adult social care and offers best-practice guidelines.
What's next for the regulator? Forging an improved path
Nadra Ahmed CBE delves into the findings of recent reports into the Care Quality Commission and outlines what the regulator's priorities should be moving forwards.
Getting up to speed: The Employment Rights Bill
James Sage examines exactly what the recently announced Employment Rights Bill means for care providers.
AI and dementia: An emerging pattern of care potential
David Grey explores the history of AI-generated avatars and analyses their emergence as a helpful tool to support people living with dementia.
Improving sector unity: How registered managers are contributing to nursing education
Cathy Rant discusses a recent project utilising non-nurse registered managers as practice supervisors for student nurses, taking advantage of newly expanded guidance.
Completing the care picture: What providers may miss when residents are alone
In care homes, where safety, dignity and emotional wellbeing are of paramount importance, the challenge of isolation is becoming increasingly clear, reports Thomas Tredinnick.
Cridge Director of Adult Social Care, Care Quality Commission (CQC)
Humphries Senior Policy Advisor, Health Foundation Karolina Gerlich Chief Executive Officer, Care Workers’ Charity @CareWorkersFund James Sage Head of Health and Social Care, RWK Goodman
Cathy Rant Clinical Practice Lead, University of Exeter’s Academy of Nursing @UniofExeter Lee Gilbert Chief Marketing Officer, Nourish Care
Dr Clenton Farquharson CBE Associate Director, Think Local Act
With Christmas approaching, Richard Humphries, Senior Policy Advisor to the Health Foundation, argues that our new Government’s position on adult social care is starting to resemble an advent calendar, in which each window is opened to reveal not a treat but one disappointment after another.
First the funding reforms were scrapped. Then the training and development fund was scaled back. Although the Budget announced an extra £600m for social care from next year, commissioners and providers are united in questioning whether this will cover the extra costs the Chancellor has piled on to providers and councils through the National Minimum Wage and higher National Insurance costs, especially in relation to part-time workers.
The local government financial settlement expected before the end of the year will set out the important detail, such as how much of that £600m is for adult rather than children’s social care and what councils will be allowed to raise through the council tax precept. But as things stand, it seems highly likely that the impact of the Budget will be to leave adult social care in an even worse position than it was before.
The resulting prospects for people who need care and support remain grim. The CQC has highlighted the ‘precarious’ state of social care in its recent annual assessment of the state of health and care. The autumn survey of council directors of adult social care describes the system as being at ‘breaking point’ – a record
81% are over-spending their budgets and over a third are expected to make further savings despite escalating costs and needs.
A comparison with how the NHS is faring is instructive. A high-profile programme of public engagement has been established to deliver a 10-year plan for investment and reform. It got a whopping £22bn in the Budget and although in historical terms this only restores past average increases, social care’s allocation seems crumbs from the table.
So what can be done? First, the Government has some convincing to do that social care reform is still a key priority and to correct the mismatch between words and deeds. There seems to be a vacuum at the heart of detailed policy thinking about adult social care, compared to the clear and well-articulated vision for the direction of NHS reform.
Organisations involved in social care, and the people who draw on it, remain very committed to working with the Government. Before disillusionment spreads, the Government should move quickly to bring forward work to develop a proper long-term plan. This should begin to put
some flesh on the bones of what a National Care Service would mean in practice and how it would address the longstanding and well-documented challenges.
Second, everyone involved in social care, especially those campaigning and lobbying for reform, need to reflect on why it is that this Government, like most of its predecessors, always prioritises the NHS over social care? A blunt truth is that one reason they do so is because the public prioritises the NHS. Despite its current travails, it retains overwhelming public support as a universal service used by large sections of the population.
In contrast, social care is little known and poorly understood. Scattered across 153 local authorities and 19,000 independent providers, it lacks a single, strong and distinctive national brand. In poll after poll, social care barely registers as an issue of concern to the public, whereas the NHS is usually at or near the top of the list. It is hard to avoid the conclusion that campaigners need to spend more time making the case for reform in the court of public opinion and not just in the corridors of Whitehall.
As we approach the end of 2024, Mary Cridge, Director of Adult Social Care at the Care Quality Commission, reveals the regulator’s plans for the work it needs to do to get back on track and rebuild public trust.
It has certainly been a challenging year. Reports into our operational effectiveness from Dr Penny Dash and the implementation of our single assessment framework by Professor Sir Mike Richards have both made recommendations for immediate improvements in our work. Alongside the work we are doing to create a clear and robust plan for improvement, we have been working at pace across several areas to make urgent changes.
Our new Chief Executive, Sir Julian Hartley, has been appointed, and we are in the process of recruiting four permanent Chief Inspectors. They will lead on the regulation and improvement of adult social care services and integrated care; mental health services; hospitals; and primary care. These appointments collectively will strengthen our leadership across the health and social care sectors we regulate.
We know that developing our improvements in partnership with people who use services, health and social care providers and stakeholders is key to our ability to deliver effective regulation. We are working with these groups to review where we need to make changes to our methodology. Early examples of these decisions include reviewing the use of existing ratings to produce scores, stopping scoring at evidence category level and considering the number of quality statements we must review per assessment.
You may have already contributed your own thoughts through the surveys we and the Care Provider Alliance have been running this autumn. We have found your contributions on developing a provider handbook and producing clear ratings characteristics so helpful. Your feedback is essential, and we are listening to what is important to you and the people you care for.
One of the issues mentioned most frequently is the loss of a
INSIDE CQC
Mary Cridge
clear relationship between you as providers and us at CQC. Earlier in the autumn, we started piloting approaches to improve the way we manage our relationships with providers across all sectors. We will be evaluating this work in early 2025 to decide how to apply the most effective approach.
We also know that some providers have had a poor experience of using our new provider portal. To enable us to properly address the issues, we are no longer accepting any type of registration application from the provider portal, other than cancellations. I know that there are concerns about the backlog of applications, but we are making good progress in reducing both the number of applications still to process and the average time they have been with us.
Despite the issues we have faced in the implementation of our new regulatory approach and the associated technologies, our strategic objective to encourage and share improvement where we see it remains a key focus. We know that by spotlighting and sharing improvement and innovation, more improvement and innovation can happen. Seeing improvement in action is always welcome, and I was pleased to read about how we were able to upgrade the rating of The Firs Residential Care Home in Cambridgeshire from ‘Inadequate’ to ‘Good’, taking it out of special measures.
We followed up on improvements we had told leaders to make previously. People using the service and their relatives told our inspection team that they had noticed improvements since the last inspection, with people now supported with person-centred care by a consistent staff team that knew them well. The improvement of any service or organisation requires effort and energy from all involved. But the benefits improvement brings make it worth the effort.
Mary Cridge is Director of Adult Social Care at the
Again we find the headline debates about social care reduced to debates about money. Time and time again, it is made clear that money and funding is critically important for social care, and for the people who draw on it and work in it.
Whether social care providers are for profit, not-for profit or charitable, all need more income than outgoings to pay and develop teams, to invest in existing and new services and to fulfil governance and fiduciary duties. Call it profit or surplus, the numbers simply must stack up in any organisation for it to survive and grow.
In my 36 years of working in various spaces across social care, there have been many years where challenges have presented that seem insurmountable. Time and time again, we all think that the latest ‘crisis’ simply cannot fail to capture public support or political action. Sadly, we are yet to see meaningful public support or political action.
The Employers Rights Bill 2024 had already concerned employers, including those in social care, not because of the spirit of it, but the known reality of implementing it. Providers now face critical times with increased tax costs announced in the Autumn Budget, which add
HOMECARE HEADLINES
to existing cost pressures.
Many services, most notably homecare, live-in care and supported living (all services already not understood by Government), will simply not withstand such a huge increase in wage costs, mainly caused by the lowering of the National Insurance threshold, not the National Minimum Wage uplift.
Those that do will face withdrawing from many low margin public contracts and find the already difficult position of team retention risked further. Already degraded pay differentials between experienced workers and new entrants will be even more unaffordable, and why should people stay where they do not feel recognised and appreciated for their experience and skills?
Where providers, like Agincare, mainly deliver care under public contracts, it has already been said that there is no provision for local authorities to provide the extra funding needed to uplift the price of care to cover any extra costs. The NHS, for all the public rhetoric of recognising and needing social care, continues to be an unreliable commissioner with a woeful lack of fee uplifts applied to the increasingly complex work they ask social care to undertake.
More money for the NHS being a headline rationale for much of these employer tax rises makes this feel even more insulting to social care. £21bn for the NHS and £600m for social care. This money makes headlines but sadly does not touch the sides of the ongoing deficit in local authorities, let alone cover these new costs. Political and public drive exists to 'save our NHS' yet continues to ignore social care's £68bn contribution to the economy and its 1.8 million adult social care workers.
As reinforced in Social Care Future’s lobbying, this should not all be about more money to do the same things, in the same way. We should be asking how we can spend our money better in social care, into strengthening communities, into changing the system to make it better and stronger and people more independent.
Work in some areas, like Sussex Integrated Care Board, shows how better integrated working has radically altered services in localities, not by spending more money but by spending the money differently. What if we actually did have enough funds across health and social care and we just need to allocate and manage them differently? What a game changer that would be for society.
Raina Summerson
Labour’s Autumn Budget delivered
Chancellor Rachel Reeves has delivered Labour's 2024 Autumn Budget.
Some of the measures announced impacting social care include:
• A rise in employers’ National Insurance contributions by 1.2 percentage points to 15% alongside a cut to the earnings threshold at which employers start paying these contributions from £9,100 to £5,000.
• New local government grant funding of £600m for social care, alongside an £86m increase to the Disabled Facilities Grant.
• A 6.7% increase to the National Living Wage, taking it to £12.21 for those aged over 21 and £10 for those aged over 18.
Commenting on the announcements, Professor Martin Green OBE, Chief Executive at Care England, said, ‘The Government’s £600m commitment to be shared between adult social care and children’s services is, unfortunately, a drop in the ocean compared to the staggering £2.4bn in rising costs associated with wage increases and employer national insurance contributions. […] It’s disheartening that social care once again receives only a fraction of the
CQC’s
support it needs, despite its critical role in easing NHS pressures.’
Professor Vic Rayner OBE, Chief Executive Officer at the National Care Forum (NCF), said, ‘Far from heralding a new dawn for social care, this historic budget appears to do little to recognise the vital role that social care plays in the lives of millions of people up and down the country.
‘Adult social care providers will be hit particularly hard by the Government’s planned changes to employers’ National Insurance contributions. Unless fully funded, these increases alongside the welcome raising of the National Living Wage will combine to apply an enormous financial strain and also undermine their ability to focus on the real need to improve care workers’ pay, terms and conditions.’
Caroline Abrahams, Charity Director at Age UK, said, ‘The […] limited extra money for social care will, we hope, help keep fragile provision from completely falling over, but we note it is split between adults’ and children’s social care so it will not go very far. This means that the seemingly endless wait for the far-reaching, fundamental reform and refinancing of social care that is so badly needed goes on.’
State of Care 2023/24
The Care Quality Commission’s (CQC’s) annual assessment of the state of health care and adult social care in England has been published. The State of Care report looks at the trends, shares examples of good and outstanding care and highlights where care needs to improve.
On adult social care, the CQC has reported that it is continuing to see a need for social care, including when people are discharged from hospital, which cannot always be met as supply has not always kept pace. For example, the report has found that waits for care home beds and home-based care accounted for 45% of delays in discharging people from acute hospital stays for 14 days or more, with nearly 4,000 people delayed a day on average.
In addition, staff vacancies in care homes at the end of 2023/24 were at their lowest rate for the last three years. Increases in international recruitment showed signs of levelling off and there has been
published
a steep fall in the number of overseas workers applying for health and care worker visas.
Commenting on the report’s findings, Kathryn Smith, Chief Executive of the Social Care Institute for Excellence (SCIE), said, ‘This report further evidences the need for a more sustainable, effective, and responsive social care system – one capable of quickly meeting the needs of the vulnerable children and adults who rely on it.
‘We know that the supply of social care staff is not enough to meet the current demand for care and support services and that this demand will continue increasing with our ageing population and the increasing prevalence of chronic, long-term health and mental health conditions. Immediate and comprehensive reform is needed to improve the pay and working conditions of those working in care and the support available to unpaid carers.’
To read the State of Care 2023/24 in full, visit the CQC website
Milewood
Milewood, an established provider of living services for adults with disabilities in England, has appointed Danielle Thurman as its registered manager for Oakwood House, Cedar Lodge and Beechwood House, three residential care properties in Chesterfield. Danielle’s career began as a care assistant, progressing within specialist care settings in the East Midlands over 18 years. Most recently, Danielle undertook consultancy work in turnaround management, reinforcing her strong foundation in governance and operational oversight.
Anthony Collins
Social purpose law firm, Anthony Collins, has announced the appointment of a new Legal Director, Joe Mulrenan from HCR Law, as part of the expansion of its corporate team. Joe has over 10 years’ experience in supporting dealmaking activity, advising organisations such as specialist care, supported living and children’s care. As well as advising specialist care providers, Joe has supported financial institutions and entrepreneurs through complex mergers and acquisitions transactions.
Hamberley Care Homes
Leading dementia expert David Moore has joined Hamberley Care Homes as the company’s new Head of Dementia. David, who has written 10 books on dementia, has held multiple leadership roles in the field of dementia care and dementia education. His 27-year career has been dedicated to collaborating with people living with dementia, challenging misguided and outdated ideas about dementia, and advocating for the rights of individuals and their families.
ADASS 2024Autumn Survey published
The 2024 Autumn Survey has highlighted the growing and urgent challenges facing councils as they work to enable people to have access to vital care and support for people with disabilities, long-term health conditions and their carers amidst unprecedented financial pressures.
The annual survey is conducted by the Association of Directors of Adult Social Services (ADASS) and is sent to every Director of Adult Social Services in the 153 English councils with social care responsibilities. This year, there was an 86% response rate. It was conducted between 12th September and 9th October.
On budgets, the survey has found that adult social care budgets are under severe strain. Currently, 81% of councils expect to overspend their adult social care budgets this year – up from 72% in 2023/24 – with an estimated total overspend of £564m.
The survey has also indicated that a significant number of councils are being required to make further in-year savings –35%, compared to 19% in 2022. These savings come on top of the highest level of planned reductions in eight years, with a projected
increase to £1.4bn in required savings by 2025/26. This severely constrains councils’ ability to invest in essential areas such as workforce development, preventive services and support for unpaid carers.
According to the survey, Directors have positive evidence of what works in terms of prevention across a range of interventions, including what delivers a positive return on investment. However, the survey has found that current operational priorities and financial pressures prevent them from doing more. ADASS has highlighted that the next policy cycle of the Better Care Fund is an opportunity to reorient the fund toward prevention, enabling health and social care partners to deliver the right care at the right time and place.
In addition, the survey’s findings have reinforced that the social care workforce is fundamental to the success of communitybased health and social care. The findings underscore the importance of investing in the workforce, from local social care professionals to allied health roles such as physiotherapists and occupational therapists, which ADASS has outlined as being essential to easing pressures
on health and care systems.
Finally, access to joined-up health and social care data is transformative in understanding people’s needs and making informed, effective policy decisions, ADASS has reported. While client-level data is making strides, further collaboration is needed to unlock the potential of integrated data across health, housing, welfare and social care.
Commenting on the publication of the survey, Karolina Gerlich, Chief Executive Officer at The Care Workers' Charity, said, ‘Care workers are at the heart of our communities, delivering care with compassion and resilience. Yet, this report makes it clear that without adequate support, we risk overburdening those who are already stretched to their limits. Care work is a vocation, but it is also work that deserves fair pay, consistent support, and the assurance of sustainability in the sector. We call on the Government to prioritise this workforce and ensure long-term funding that acknowledges and respects the vital role care workers play in society.’
To read the 2024 Autumn Survey in full, visit the ADASS website
Providers Unite campaign launched
Providers Unite is launching a grassroots campaign to unite adult care service providers across the country, calling on Chancellor Rachel Reeves for an urgent review of recent Budget measures, namely the National Insurance and National Living Wage increases. The campaign has set out to highlight that without immediate intervention, Britain faces the ‘systematic collapse of community care services,’ putting at risk the wellbeing of over 1.2 million individuals who rely on these essential services.
Providers Unite brings together more than 125 signatories as a network of care providers serving communities nationwide, representing a workforce of 1.59 million people and a sector contributing £68.1bn annually to the national economy. With a funding gap of £8.4bn needed by 2024/25, the community care sector is at a critical juncture. The campaign has urged the Government to take action to secure the future of adult care services for millions who depend on them.
Providers Unite is committed to working with Government leaders and the broader community to ensure that the voices of adult
care providers are heard. Its collective goal is to maintain and strengthen community care services across Britain.
An excerpt from the letter reads, ‘We write as a united voice, urging you to consider the profound impact of the proposed tax increases on all those who depend on us. Like GPs, pharmacies and hospices, we are independent businesses and charities embedded in every corner of our communities, committed to supporting citizens with diverse needs. With the state funding more than 70% of our work, we deliver an essential public service.
‘The current Budget measures risk eroding the foundations of the public services we deliver, which extend far beyond elderly care. They include mental health, domiciliary care, learning disabilities, supported living, and other specialised services. To remain viable, these services require appropriate levels of state funding to meet the varied and growing needs of our communities.
‘Although the increase in the National Living Wage is beneficial for our staff, concurrent Budget changes, specifically the rise in National Insurance contributions and
the lowered thresholds, are set to drive an unsustainable minimum 9.4% increase in employer costs.
‘For those committed to paying the Real Living Wage and expanding employment opportunities to our future workforce under 21, this impact is projected to soar above 12%. This total far exceeds the £600m allocated to local authorities, the primary commissioners of our services, and who must spread this funding across all their responsibilities under the Care Act 2014. These include support for children’s services as well as financial pressures in other areas including special educational need.
‘We urgently call for an immediate review of these measures and for the establishment of exemptions similar to those granted to the NHS. Alternatively, we ask that the Local Government Finance settlement be urgently adjusted to bridge this funding gap. We welcome the opportunity to consult with you to explore the options. The alternative is nothing short of a systematic collapse of community care services across Britain.’
To read the full open letter, visit the Providers Unite website
Mental Health Act reformed
New laws will give patients sectioned under the Mental Health Act more dignity and say over their care, according to the Department of Health and Social Care.
Black people are over three times more likely to be detained under the act, while those with a learning disability and autistic people are also found to be inappropriately sectioned. Patients currently have little say over their care and treatment should they be detained, or over who should be involved in making decisions related to their care, such as family members and carers.
The new Mental Health Bill addresses the significant changes in attitudes towards mental illness since the original act was passed, recognising that outdated laws around the treatment of people in a mental health crisis are no longer tolerable. Modernising the Bill was a Labour manifesto commitment, and it will aim to reform the existing Mental Health Act to make it fit for purpose, improving patients’ experiences of hospital and mental health outcomes, while also introducing stronger protections for
patients, staff and the general public.
This includes making it a legal requirement for each patient to have ‘care and treatment plans’ tailored and shaped by their individual needs that will make clear what is needed to progress them to discharge. The Bill will also give patients the right to elect a person to represent their interests and greater access to advocacy when they are detained. Together, these reforms will make it more likely for patients to stay in contact with health services and continue to engage with treatment.
As well as ensuring patients have a voice in their care, the reforms also recognise the critical role that families and carers can play in keeping patients safe – providing insight and knowledge of a patient’s wishes and preferences and an understanding of what keeps them safe – including when a patient is too unwell to express this themselves. The Bill will strengthen the rights of families and carers through changes to the nominated person role and require clinicians to consult
with others close to the patient as they make decisions around their care where appropriate or where the patient wishes.
Police and prison cells will also no longer be used to place people experiencing a mental health crisis, as well as creating more space for police forces to hold criminal suspects. Instead, patients will be supported to access a suitable healthcare facility that will better support their needs.
Commenting on the Mental Health Act reforms, Dr Sarah Hughes, Chief Executive at Mind, said, ‘The Mental Health Bill brings us a step closer to a more progressive mental health system for the 50,000 people who are sectioned each year – but we still need to look at whether it will fully go the distance for meaningful change. The Bill has the potential to be an historic moment for people with the most serious mental health problems and their loved ones, as well as the clinicians and experts who have fought tirelessly to bring the outdated Mental Health Act 1983 into the 21st century.’
Younger workers could be key to boosting workforce
Young people have the skills and talent needed to work in social care but need more support from providers to stay, shows research published by The King’s Fund. Young people are particularly underrepresented in the workforce. 18-24-year-olds make up only 8% compared to 13% of the retail workforce and 50% of all waiters and waitresses. Additionally, more than half of workers under 20 leave social care within the first year highlighting that younger people are more likely to leave the workforce than their older counterparts.
"Change [...] will require cross-sector leadership to address the broad issues affecting younger people’s recruitment and retention."
series of interviews with current and recent care workers, young people told researchers that care work could be tough yet was highly rewarding. But while some young people were able to thrive, others left jobs quickly or were planning to leave. Young people cited that a key reason they leave the sector was due to the workplace culture – some cited unfavourable treatment or bullying due to their age.
On the work environment, a care home and retirement village worker, aged 23, said, ‘It wasn’t the dementia residents or anything like that, it was more the staff. They were so nasty. They would make me feel like I was really stupid when I suggested things and stuff like that. I was not really being listened to and it was quite cliquey with the people that were there.’ Explaining the lack of support, one home-based care worker, aged 19, said, ‘The two weeks shadowing was less than effective because I think they were short staffed, and I think it often feels like the person is getting in the way more than learning.’
Others said that the physical and emotional demands of the role meant they could not see it as a long-term career option
and would seek a role with a better work-life balance or where they felt more valued. One 23-year-old said, ‘I just cannot imagine being 50 doing this job. As much as I love doing it now, it is too much to do forever. I am trying to think, OK, what can I have lined up for when I’m ready to leave?’
Commenting on the findings, Simon Bottery, report co-author and Senior Fellow at The King’s Fund, said, ‘We spoke to energetic and committed younger workers who have a lot to offer but they were often disillusioned by their experiences and ready to leave the sector.
‘The sector will need to decide whether it really does want to recruit and retain more younger people. If it does, it will have to change. That will require cross-sector leadership to address the broad issues affecting younger people’s recruitment and retention but also individual action by providers to address the toxic culture that some people experience.’
The report’s recommendations include actions for Government and employers and other organisations across the social care sector to engage younger workers. Read the full version on The King’s Fund website.
The findings explore why there are so few young people in social care and why they often do not stay in the sector. Through a
Bluebird Care announces new Approved Supplier
A leading care management software provider has been chosen by Bluebird Care as its trusted Assured Supplier to deliver care across its network. Celebrating its 10th anniversary, everyLIFE Technologies’ flagship platform, PASS, has worked in collaboration with Bluebird Care to enhance the tools and support available to its network, placing the best possible care delivery and outcomes at the heart of its partnership. PASS has been supporting social care since 2014 and Bluebird Care is one of over 1,200 customers using the platform to deliver care to their clients.
Commenting on the announcement, Robin Batchelor, Chairman and Chief Executive Officer at everyLIFE Technologies, said, ‘Being named as an approved supplier reflects our mutual commitment to
excellence and innovation in care. We are proud to be industry pioneers – from developing GP Connect for domiciliary care to the first to achieve all 14 Digital Social Care Records standards. Our goal is always to empower care providers with optimum value, absolute confidence, and an outstanding solution.’
Jonathan Gardner, Chief Executive Officer at Bluebird Care, said, ‘We have had a longstanding relationship with PASS utilising their care planning software for many years. Through the development of the system with our franchise partners, they have now added a rostering solution which means we are delighted to see them as one of our two approved IT suppliers. We look forward to working collaboratively to deliver even more high-quality care to our customers in the future.’
Film premiere for health and care workers
A new training film jointly commissioned by the University of Gloucestershire and NHS Gloucestershire Integrated Care Board (ICB) providing insight around approaches and provoking discussion between health and social care professionals and patients, has premiered in Gloucester.
Risking Happiness 2 features contributions from NHS staff and social care providers working on the frontline across a range of disciplines, generously sharing their experiences and approaches to making potentially life-saving decisions within high-pressure environments in a person-centred way.
The film will be used in student and staff training and education programmes, as well as workshops across health, social care and voluntary and
IN FOCUS
Annual State of the Nation report published
WHAT’S THE STORY?
Access Social Care’s annual State of the Nation report has revealed a significant increase in the number of requests for social care advice across nine major advice and helpline organisations. The report has painted a desperate picture of the current social care system, with the rise in demand for advice far outstripping the available resources.
The report has also revealed:
• 96% more advocacy queries.
• 204% more unpaid carers' queries.
• Seven times as many mental capacity queries.
WHAT DO THE EXPERTS SAY?
community organisations across Gloucestershire, taking new approaches to delivering better health outcomes.
It premiered at the Sherbourne Cinema in Gloucester to an audience of health, education, and voluntary and community sector leaders as part of the University’s collaborative partnership with NHS Gloucestershire ICB.
Commenting on the launch, Amabel Mortimer, University of Gloucestershire’s Strategic Lead and Programme Director for Arts, Health and Wellbeing, said, ‘Risking Happiness 2 supports the vital work of our current and future health and social care professionals, providing them with renewed confidence and reassurance to carry out their roles within a supportive and proactive culture.’
The fourth annual State of the Nation report is a data collaboration project bringing together anonymised data from Royal Mencap Society, Age UK, Carers UK, Independent Age, RNIB, Ealing Advice Service, Citizens Advice Bureau and Scope. The resulting report draws together over 364,000 separate data points and outlines the key challenges facing people who need social care.
WHAT WERE THE FINDINGS?
The nationwide data in this year's report has shown a 222% increase in the number of enquiries about social care needs assessments compared to pre-pandemic, as well as a 206% increase in enquiries that required specialist social care legal advice. The report has compared data across three timeframes: pre-pandemic 2019-2020; the pandemic year 2021-2022; and finally, the post-pandemic year 2023-2024.
According to Access Social Care, the report's findings are clear – vast numbers of people continue to struggle with accessing social care support.
Kari Gerstheimer, Chief Executive Officer at Access Social Care, said, ‘The last administration asserted they were adequately funding adult social care, whilst civil society estimates there is an annual funding gap of at least £8.4bn per year. With such a reality gap, data collaboration projects like this are vitally important because they allow us to see the real issues experienced by people who need social care across a range of organisations. Year after year this report highlights serious problems experienced by social care advice seekers, and our 2024 report is no exception.
‘In July 2024, the country voted in a new administration. The new Labour Government say they want change, so do we. There is a real opportunity to make sure people can live their best lives by ensuring they can access the support they need when they need it. We hope this report can serve as a springboard to support positive change. We are calling for parties across the political spectrum to act now to understand the scale of social care need and to take decisive and immediate action to solve short-term and long-term pressures on the social care system.’
To read the full report, visit the Access Social Care website
Care England and the Cyber Centre of Excellence (CCoE) partner
Care England and the CCoE have partnered to offer a tailored solution to cyber security in the care sector, launching a new White Paper marking the culmination of a year-long research project with the joint aim of offering affordable protection and reassurance to all care providers.
The year-long research project found personal data from social care providers along with email addresses and passwords on the dark web, likely from multiple sources including ransomware attacks and breaches in third-party systems. Social care providers, particularly smaller organisations and some charities, have limited cybersecurity budgets and outdated technology, leading to weak data protection practices.
Outdated legacy IT systems and vulnerabilities within supply chains, or third-party systems across the care sector are often not updated regularly, and even large corporate organisations that believed they had adequate protection were proven to have vulnerabilities.
Given these findings, Care England worked with the CCoE to develop Care
Protect, which offers a package of cyber security specifically for the care sector and was designed with the ever-growing threat of cyber-attacks against care providers in mind. The package, which can be deployed to fit an organisation of any size, was also crafted to be able to be built around differing scales of available budget. This is to ensure that no organisation is left without some form of essential cyber security.
Care Protect combines state of the art software, in the form of AppGuard, and dedicated online time with a specialist virtual Chief Information Security Officer (vCISO) to ensure that all devices across an organisation are secure from external threats, over and above solutions care providers are currently relying upon.
For larger organisations, or those who have already achieved a level of cyber proficiency, there is an option to go further with a National Security Council-assured Cyber Board course and vulnerability scanning.
Commenting on the new partnership, Professor Martin Green OBE, Chief Executive at Care England, said, ‘In the last year we
have seen a huge increase in cyber-attacks on health and social care organisations. Social care has so far avoided further major attacks, but we have seen the NHS badly hit – and we must therefore be proactive given the digital transformation our sector is experiencing.
‘Whilst care providers are becoming more aware of the risk, there is still some way to go in raising awareness and implementing effective cyber security measures, and we are incredibly proud to have worked with the CCoE to develop, trial, and test these solutions ourselves and with our membership.’
Kurtis Toy, vCISO, and Chief Executive of the CcoE, said, ‘The importance of the release of the Care Protect package cannot be understated. While the care sector may not seem to be the most obvious target for cyber criminals, the stark reality is that more and more care providers are facing very real, very malicious, cyber security challenges.’
To read the full version of the new Care England and CCoE White Paper, Protecting care providers from cyber-attack, visit the Care England website
Call to support working-age adults and disabled people
Councils have called for the needs of hundreds of thousands of working-age adults and life-long disabled people requiring social care not to be overlooked in Government plans for a National Care Service.
It comes as major new analysis by County Councils Network (CCN) and Newton, launched at the CCN’s Annual Conference 2024, has revealed that the costs of providing care for these individuals is now far outpacing social care to the over 65s, with two-thirds of adult social care commissioning budgets dedicated to working-age and lifelong disabled adults.
The report has warned that increased complexity of individual needs, a substantial rise in placement costs and ‘inappropriate and insufficient’ housing options could mean councils’ care and support spending for these individuals could top £17bn by 2030 – a 50% increase compared to 2024.
In addition, the report has revealed that:
• The costs of providing care and support for working-age adults and those with a lifelong disabled condition is now the largest area of adult social care expenditure in England. In 2023/24, 63% of all adult social care commissioned
support, such as residential and homebased care, was on working-age adults, despite these individuals making up just 40% of all adult social care service users.
• Councils have witnessed a dramatic rise in the costs of these services over the past five years, up by a third. Councils commissioned expenditure on care and support for working-age and lifelong disabled adults has increased from £8.3bn in 2019 to £10.9bn in 2024, a rise of 32%.
• Increased spending is driven by the complexity and type of care individuals are receiving, rather than increased numbers of people requiring support. The average level of weekly expenditure per individual has increased by 31% for working-age and lifelong disabled adults between 2019 and 2024, from £565 to £735.
• Care packages for working-age adults with the most complex learning disabilities have witnessed the most acute rise in placements costs. Individuals in this cohort typically receive a care package with an average weekly cost
of £3,316 per person. This has increased by an average £1,299 in the last year. Support for working-age adults with a learning disability is the single biggest element of council commissioning, representing 37% – £6.4bn – of all care and support costs and more than the total amount spent on over 65s.
Commenting on the research findings, Cllr David Fothergill, Chairman of the Local Government Association’s Community Wellbeing Board, said, ‘Adult social care is often seen primarily as a service for older people, but many who access it are younger, working-age adults with disabilities. While their aspirations – such as independence, relationships and hobbies – may align with those of older generations, supporting them effectively requires a distinct approach. This report highlights the urgent need for focused attention on this group as we address funding and reform. Without immediate investment and a long-term funding strategy, the situation will only deteriorate.’
To read the report, The Forgotten Story of Social Care, visit the CCN website
New project promotes voices of disabled older workers
The Centre for Ageing Better has launched a new project designed to develop new policy and practice to improve support for disabled people and people with long-term health conditions in their 50s and 60s to find and stay in work.
The Supporting Disabled Older Workers (SDOW) project sets out to put disabled older workers at the heart of the issue, bringing their voices and experiences into the policy debate on how to raise employment rates and standards for the cohort.
The research project will be guided by a 10-person Experts by Experience Steering Group (EESG), who will shape the direction of the project and have decision-making capacity. The panel is made up of nine individuals with a mix of gender, ethnicity, geography, employment status and age but who are all disabled and/or have a work-limiting long-term health condition.
The project will also explore the differing experiences of people who have acquired a disability earlier or later in life and whether the two groups require different interventions or levels of support.
The Policy Institute at King’s College
London has been appointed as research partner on the project and will work to explore the experiences of disabled older workers to help shape practical recommendations to improve policy and practice.
Commenting on the launch of the new project, Lucy Kenny, Work Project Manager at the Centre for Ageing Better, said, ‘We know that currently older disabled people and older people with long-term health conditions are much less likely to be in work than their peers without a disability or health condition.
‘Narrowing this gap is not only crucial to ensuring the financial security and wellbeing of disabled people as they get older. It is also key to the Government meeting its growth mission and its ambitious targets for raising employment rates and addressing the country’s productivity challenge.
‘Too often the voices of older people and disabled people are sidelined, marginalised or not included. In this project, they will be front and centre of our research as the project makes every effort to ensure that the voices of disabled older people are
heard loud and clear.’
Suzanne Hall, Director of Engagement at the Policy Institute at King’s College London and the project’s Lead Researcher, said, ‘We are particularly excited to partner with nine disabled people who will play a central role in guiding the research.
‘These Experts by Experience will be instrumental in shaping the study design, analysing our findings, and formulating practical recommendations, rooted in people's realities, which improve policy and practice.’
The research project has been funded by the Columbia Threadneedle Foundation, the charity of leading global asset manager Columbia Threadneedle Investments.
Laura Cook, Chair of the Columbia Threadneedle Foundation, said, ‘We are very pleased to be funding this vital research, which contributes to the Foundation’s ambition to address critical social issues, including inclusion and employment, to transform individual lives while also driving fundamental social change.’
To keep up with the work of the project, visit the Centre for Ageing Better website.
Campaign launches to build digital confidence
Skills for Care has launched its latest campaign intended to help build digital confidence in the social care workforce. The campaign, titled Building digital confidence, will aim to help people gain a better understanding of how improved digital skills can facilitate higher quality care and support.
In July 2024, the Workforce Strategy for Adult Social Care launched. The Strategy will aim to ensure the sector has enough of the right people with the right skills to provide the best possible care, including digital skills. This latest campaign will aim to help realise many of the Strategy’s digital objectives.
Skills for Care is also looking to make digital less daunting to people in all roles across social care and highlight the benefits of using digital technology in
adult social care, including better quality of life for people being supported and more efficient care services. You can follow the campaign and join in on discussions on social media using #BuildingDigitalConfidence.
Commenting on the launch of the campaign, Jane Brightman, Director of Workforce Strategy at Skills for Care, said, ‘We hope this campaign boosts your digital confidence, whether it is through learning new skills, mentoring others, exploring a new piece of technology, or experimenting with artificial intelligence.
‘Remember, you do not need to be an expert to take advantage of digital opportunities – and do not worry, you will not break anything by pressing the wrong button!’
Find out more by visiting the Skills for Care website
Elysium Healthcare acquires Vivre Care
A leading mental health service provider, Elysium Healthcare, has expanded its provision of specialist eating disorder services with the acquisition of residential care provider, Vivre Care. Established in 2007, Vivre Care provides specialist support for people with severe eating disorders. Its services align with the NHS strategy of prioritising community-based treatment. Vivre Care also complements the existing specialist eating disorder pathways within the Elysium group for adults and young people across England and Wales.
Commenting on the acquisition of Vivre Care by Elysium Healthcare, Joy Chamberlain, Chief Executive Officer at Elysium Healthcare, said, ‘I am delighted that Asha Mootoosamy and Vivre Care will be joining the Elysium
Healthcare family. I have been impressed by the quality of care and the delivery of successful outcomes enabling people to access the right care, in the right place at the right time.’
Vivre Care Director, Asha Mootoosamy, said, ‘Elysium Healthcare are synonymous with specialist eating disorder care and I am confident that they will support the services to go from strength to strength. I am also delighted to be joining the Elysium Healthcare team to further develop the model of care.’
Elysium Healthcare operates over 95 sites across England and Wales. It offers services for learning disabilities, neurological care and specialist mental health support, including secure services, CAMHS, rehabilitation, acute care and psychiatric intensive care.
NEWS FROM ACROSS THE GLOBE
Non-profits welcome Bermuda’s social care ambitions
Charities have welcomed pledges in a recent speech from Bermuda’s Governor, Rena Lalgie, aimed at addressing social issues across the island. The speech, called A Fairer Bermuda for All, focused on issues such as domestic violence, health, housing, social care and substance abuse among young people. It also outlined help for high-risk families and measures to tackle unaddressed, multigenerational trauma.
"To truly support high-risk families, we must ensure barrier-free access to holistic, trauma-informed care."
In response to the speech, the Non-profit Alliance of Bermuda (NAB) and Family Centre said that addressing the island’s social issues was crucial. Dr Nicola Paugh, NAB’s Executive Director, said she welcomed ‘continued emphasis on education reform, as well as development of trade skills, addressing violence and antisocial behaviour through early intervention and prevention’.
She also welcomed commitments to ‘addressing substance abuse through the reintroduction of the Bermuda Youth Counselling Services and encouraging greater preventive health visits through changes to Future Care and the Health Insurance Plan’.
Dr Paugh highlighted the Government’s plans to work with non-profits to tackle various issues. However, she emphasised, ‘We continue to encourage the Government to
ensure their commitment to this includes funding for third-sector organisations, who have frontline roles implementing these priorities.’
She also mentioned the Government’s proposal to use revenue from the corporate income tax to reduce the island’s cost of living and form a sovereign wealth fund for strategic investment, ‘The economic benefits of debt reduction and long-term revenue generation will have profound impacts on community issues, if invested in a socially wise manner. We as a sector look forward to working with the Government to bring these goals to fruition and build a better Bermuda,’ Dr Paugh said.
Sandy De Silva, Family Centre’s Executive Director, said she supported the Government’s focus on a cross-ministry approach to assist
high-risk families, ‘This kind of collaborative effort is essential. It recognises the complex and multifaceted needs that families in crisis often face.
‘At Family Centre, we see first-hand how issues such as unstable housing, food insecurity and limited access to healthcare compound the emotional and psychological stress that children and parents endure. To truly support high-risk families, we must ensure barrier-free access to holistic, trauma-informed care.’
According to Dr De Silva, collaboration was also essential, ‘To have a lasting impact, there must be strong partnerships between governmental ministries, social service organisations and community stakeholders. Only then can we provide a seamless continuum of care that truly meets the diverse needs of high-risk families.’
Second snapshot report into Scottish care workforce
The Scottish Social Services Council (SSSC) has published its second Register snapshot report which gives a unique insight into the social work, social care and children and young people workforce. This second report on the Register highlights the data held about the registered workforce in the SSSC’s role as regulator.
The report, which examines data from 1st April 2023 to 31st March 2024, shows there were 176,781 people on the SSSC Register in March this year,
which is an increase of 8,549 or 5.1% on April 2023.
The registered workforce represents 83% of the total social service workforce of more than 212,000 in Scotland. It is important to understand more about this workforce to help identify trends, opportunities and challenges for workforce planning, which SSSC’s data can also influence and support.
Commenting on the report’s launch, SSSC Chief Executive, Maree Allison, said, ‘I’m pleased to publish this second Register
snapshot report, sharing the unique data we hold.
‘The data provides valuable information for workforce planning and policy makers. Over time our snapshot reports will build a picture of the registered workforce to help them make decisions on how to provide high-quality care in the face of changing demand due to factors including an ageing population, more people receiving care at home and increased early learning and childcare provision.
‘All parts of the Register grew from 2023 to 2024 apart from social work students, which fell for the second year in a row, which is a trend that we’ll continue to monitor.
Read alongside our annual workforce data reports, our snapshot reports help us understand Scotland’s workforce better so we can support a thriving social work, social care and children and young people workforce.’
Read the full report on the SSSC website
WHAT'S NEXT FOR THE REGULATOR?
FORGING AN IMPROVED PATH
Nadra Ahmed CBE, Executive Co-Chairman at the National Care Association (NCA), delves into the findings of recent reports into the Care Quality Commission (CQC) and, drawing on NCA members’ experiences, outlines what the regulator's priorities should be to improve its effectiveness.
It has been a tumultuous year for the regulator; the landscape of CQC changes almost daily as it actions its ‘recovery plan’. The regulator’s challenges have grown increasingly worse over time, as have providers’ frustrations. The CQC’s services have declined to the point where it is not only negative but, in many cases, destructive. For providers, who are not only major funders of CQC through its registration process but are also at the receiving end of its approach to inspections, the organisation’s
position feels untenable. If we consider the views of Dr Penny Dash and Professor Sir Mike Richards, by their own standards, CQC’s operations would fare not only as ‘Inadequate’, but the service would be under pressure to cease trading.
False promises
For some time now, we have heard unreserved apologies and promises of improvement, but there have been no tangible signs in reality.
CQC’s way of working has been in decline for providers as inspections became ever more remote and increasingly data reliant. We are now being told this will change, and inspectors will return to a more visible methodology. This is where we must be – inspections must be carried out by people who understand the parameters of the service they are inspecting.
In January, we wrote to CQC having received an inordinate number of comments from NCA members who were deeply concerned about the regulator’s direction of travel. There were
cases of unnecessary pressure and in others, a complete lack of empathy from inspection teams. It was clear, if providers had the option, they would switch regulators, but despite funding its very existence, the provider has no control over this critical service.
Wellbeing at risk
We received evidence from registered managers, who decided to leave the sector post-inspection because of the lack of respect
for them as professionals by the inspector, who had little or no understanding of the specialist services they provided. The inspections appeared to be creating an atmosphere of pressure and staff were often left demoralised, disenfranchised and deflated.
We became increasingly concerned about the impact of a poor inspection on the mental health of our workforce and in some cases, the lack of respect for the professionals who were delivering the service. In our letter to the CQC, we challenged
behaviours to prevent a culture akin to that uncovered at Ofsted, which tragically resulted in a headteacher taking her own life. The purpose of our unprecedented intervention was to prevent an escalation of the new methodology, under the ‘new ways of working’ being rolled out by the management of CQC without due consideration to the impact on those on the receiving end. This was a system which was flawed from the outset and remained inconsistent and subjective.
Change of direction
Our letter resonated with providers and other representative bodies, and we saw a steady trickle of similar correspondence from across the sector, which eventually led to CQC’s admission that there needed to be a review of their systems, which included the disastrous introduction of a portal and growing confusion over the single assessment framework (SAF). Both of these created further frustrations for providers. Despite assurances and apologies, it was becoming obvious that something had to change, and that change started with the resignation of the Chief Executive Officer.
“Acknowledging failures is only the first step, the action taken to remedy them is what will demonstrate if the recovery plan has been well thought through.”
Thus followed the announcements of the ‘Dash Review’, which was to consider the CQC’s effectiveness, closely followed by the ‘Richards Review’, which was to focus on the SAF. By this time, providers were struggling with their regulatory responsibility to upload information to a portal which was not fit for purpose and engaging with CQC was nigh on impossible for providers. All queries went through a single email address, so responses were variable, to be generous.
Failings exposed
Having worked in the sector for over 40 years, I have always advocated for an independent inspectorate and firmly believe it is in the public interest. What we saw unfolding from 2023, with the introduction of the SAF, was a system which was chaotic, obscure and totally unpredictable for providers. We also started to sense a frustration from CQC inspectors who were also being put under pressure by systems that did not do what was promised.
The Dash Review exposed major inadequacies in the way that CQC had
been operating. This led to an unreserved apology from the Interim Chief Executive Officer, with the promise of change and improvement. The mantra from CQC was that it was working hard to get it right, but it did not feel like it on the ground from what NCA members were reporting.
It was becoming increasingly obvious that the recovery plan was not working. The validity of inspections was under direct scrutiny, especially for those who had not received responses to their factually accuracy or had not had an inspection for some time. We had member with new builds waiting for registrations to operate for months whilst admissions waiting lists grew.
What is baffling is that despite clear messages from both the Dash Review and the Richards Review, I have no real understanding as to how this was being allowed to happen. These decisions were taken at the highest level of the management at CQC, and it was also ratified by its Board. How can that same Board be trusted to deliver a recovery plan?
Road to recovery
The recovery plan is aspirational but not visionary. When failure is so deep set and driven by a model which was not fully thought through, but funded without limits, one wonders how that transition will happen and when? What are the time scales for the organisation’s stability? Providers are reliant on CQC for external accreditation which will impact on their ability to borrow, innovate or enter local authority contracts.
What we need is a carefully thought-out plan which will enable providers to start rebuilding public trust in CQC ratings. Providers pride themselves in the services they deliver, and they need a regulator that will ensure its assessments are fair, accurate and measure improvements in a timely fashion.
In addition, we must ensure that the findings from both reviews are used to create timelines for improvement, which include the simplification of the SAF to reflect the sector it is being used for. We must move away from generic statements and actions, as we all work differently in every part of the sector. As such, our varying outcomes must be measured accordingly to provide accurate public information.
It is inconceivable that inspections have
not been scheduled in a way that ensures there is updated information available on each service in the public domain. This would provide a reliable benchmarking function which could drive up standards and support providers to have improvement plans recognised. Moreover, we must see reports issued within a time-period which will mitigate staff anxiety, which is heightened pre- and post-inspection. CQC must abide by the same deadlines it places on providers.
Re-building relationships
I believe that if the SAF remains, it must be simplified, and the quality statements reviewed to prevent duplication. Furthermore, there must be clarity on how the quality statements are answered and clear guidance on what a ‘Good’ service looks like. This will aid the inconsistencies that subjectivity brings. Subjectivity needs to be replaced with objective and impartial thinking which reflects not only ‘what we see on the day’ but acknowledges the quality of the service overall, based on feedback for those who work with and are recipients of care and support.
Relationship management with every registered service provider is also key to the CQC’s recovery. Providers must have the opportunity to mitigate against incorrect assumptions, enabling sensible conversation which would negate the need for expensive legal interventions on both sides. As a simple example, specialist services deserve specialists to inspect them, not generalists. Without this, assumptions can be made by inspection teams which can cause unnecessary challenges. It is imperative that the incoming Chief Executive Officer creates a methodology to re-build relationships with providers and those who rely on the CQC to credibly analyse the services it inspects.
A strong, fair inspectorate is what we need and deserve. Acknowledging failures is only the first step, the action taken to remedy them is what will demonstrate if the recovery plan has been well thought through. Good practice within CQC must be built upon and poor practice must be called out. The regulator cannot ignore the root causes of its failures as that will mean all the pain providers have experienced will have been in vain. After all, that is what the CQC expects from providers, so it must do the same. CMM
Ahmed CBE is Executive Co-Chairman at the National Care Association (NCA). Email: info@nationalcareassociation.org.uk : @NationalCareAsc
What lessons can the CQC learn from the Dash Review and Richards Review? Visit www.caremanagementmatters.co.uk and leave a comment on this feature or join the conversation to share your thoughts.
Nadra
GETTING UP TO SPEED:... The Employment Rights Bill
James Sage, HR and Employment Partner and Head of the Health and Social Care team at RWK Goodman, outlines what the recently announced Employment Rights Bill means for care providers.
The new Employment Rights Bill (‘Bill’), published on 10th October 2024, was introduced as part of the Government’s effort to improve workers’ rights and tackle inequality in the labour market. The Bill contains measures that will transform the employment rights of employees working in the care sector.
Fair Pay Agreement for social care
A Fair Pay Agreement for care workers was a Labour manifesto promise. The Bill seeks to implement this through the creation of a central body with responsibility for setting remuneration, terms and conditions, and ‘any other specified matters’ relating to the employment of social care workers. This reform aims to address the pervasive issue of low wages for the demanding and critical work care workers do, which has led to workforce shortages and high turnover rates.
The central body will be made up of trade unions and care provider representatives who will be tasked with agreeing and recommending a Fair Pay Agreement for care workers. The Secretary of State may then either accept the recommendation or refer it back to the central body for reconsideration, based on factors such as funding. >
The expectation is that this will create a new minimum rate above the National Minimum/Living Wage for care providers. Trade Unions have already indicated they want a minimum pay rate of £15 per hour. Privately funded providers will likely need to pass the additional costs on to clients, but for local authority funded providers it is essential that any Fair Pay Agreement is properly funded as there are not sufficient margins within current fee rates for providers to absorb the additional costs.
Statutory Sick Pay
Further increasing the costs borne by providers are proposed changes to Statutory Sick Pay (SSP), which will be available from the first day of sickness rather than the fourth. The lower earnings limit of £123 a week will also be removed but a lower rate of SSP will be available for those on lower weekly earnings.
Restrictions on zero-hours contracts
Zero-hours contracts have long been used in the care sector due to the fluctuating demand for homecare services and typically as cover, in the form of casual bank staff, in residential care. These contracts provide flexibility but leave care workers without guaranteed income or stable working hours, which is of concern to the Government.
“A distinction between zero-hours employees (who are entitled to the new rights) and zero-hours casual workers (who are not) would make more practical sense in the care sector.”
The Deputy Prime Minister, Angela Rayner, has been reported in The Times as saying, ‘This is personal to me. I started my working life as a carer on causal terms, not knowing if there’d be a pay cheque next month. That fear stuck with me.’
Whilst the Bill falls significantly short of banning the use of zero-hours contracts, it does seek to re-balance the rights of workers and employers.
The Bill proposes:
• Guaranteed minimum hours after working for what is expected to be 12 weeks on a zero-hours contract.
• Prescribed notice of shifts, expected to be double the length of the shift (e.g. two days’ notice for a one-day shift).
• Compensation if shifts are cancelled at short notice.
Our experience is that zero-hours workers in residential care work on this basis out of choice, enjoying the flexibility it offers, and are reluctant to move to guaranteed hours contracts. In homecare, zero-hours contracts are more commonly a requirement by providers to meet fluctuating demand and poor commissioning practices by local authorities, so we may see greater demand for guaranteed hours in this part of the sector.
The requirement to give notice could be problematic where bank workers are engaged to cover absences at short notice, but hopefully this will be considered as part of the consultation process. A distinction between zero-hours employees (who are entitled to the new rights) and zero-hours casual workers (who are not) would make more practical sense in the care sector.
Unfair dismissal from day one
The Bill proposes that employees will have unfair dismissal rights from day one of employment, rather than after two years’ service. The Government plans (subject to further consultation) to introduce a statutory nine-month probationary period during which employers will be required to follow a lighter touch dismissal process or face the risk of an unfair dismissal claim. After the probationary period, the usual unfair dismissal rules, and required processes, will apply. This will increase the need for more robust HR processes and introduces greater legal risks for providers.
Flexible working
Currently employees only have the right to request flexible working. The Bill proposes creating a right to flexible working. Employers will only be able to refuse a request if one of the existing specified grounds for refusal applies and it is reasonable to refuse the request on those grounds. The new requirement for the employer’s decision to be reasonable is new and creates a higher bar to reject flexible working requests.
Expanded family-friendly policies
The Bill makes paternity leave and unpaid parental leave day-one rights. Unpaid bereavement leave will also become a day-one right and the right to leave will be widened to cover a broader group of people.
The Bill also extends protections for employees returning from maternity leave to the first six months after returning to work so that they can only be dismissed in limited circumstances.
Duty to prevent sexual harassment
From 26th October 2024, employers are subject to a new duty to take reasonable steps to prevent sexual harassment in the workplace. The Bill changes the duty to a requirement to take ‘all’ reasonable steps to prevent sexual harassment thereby increasing the compliance threshold. The duty also covers sexual harassment by third parties such as clients, visitors or contractors.
“Providers need to start developing a strategy for how they will implement these reforms, engage with their workforce and manage requests for union recognition.”
Failing to comply with the duty could lead to enforcement action by the European Human Rights Commission and a 25% uplift in compensation awarded by an Employment Tribunal in a sexual harassment claim.
Providers must take proactive steps to prevent sexual harassment including, assessing the risks of sexual harassment in their organisation, implementing an action plan to reduce identified risks, surveying employees to get feedback, training managers and employees and implementing policies on preventing and report sexual harassment.
New liability for third-party harassment
Employers are not currently liable for harassment of their workers by third parties (such as clients, visitors or contractors) related to a protected characteristic. However, the Bill proposes an amendment to the Equality Act to make employers liable for such harassment unless they have taken all reasonable steps to prevent it.
Increased rights for trade unions
Unsurprisingly the Government envisages a greater role for trade unions in the workplace and the Bill proposes:
• A new requirement for providers to give workers a written statement informing them of the right to join a trade union.
• Increased rights for trade unions to access the workplace and for union representatives to access facilities.
• Lowering the thresholds for unions to gain formal recognition.
• New rights for employees who participate in strike action.
Currently union recognition is not widespread in the care sector and tends to be limited to the largest national care providers or smaller charity or not-for-profit providers. In light of these reforms and the unions’ role in negotiating sector pay agreements, it is likely the unions will be seeking to increase membership and secure recognition from a wider section of the sector. Providers need to start developing a strategy for how they will implement these reforms, engage with their workforce and manage requests for union recognition.
Fire and re-hire
The Government’s manifesto promised to abolish fire and re-hire practices, which involves the dismissal of employees who will not agree to less favourable contract terms and offering new contracts on the less favourable terms. The Bill falls well short of this but does higher the legal bar for firing and re-hiring. Instead of the current requirement that the employer has a sound business reason for firing and re-hiring, the Bill provides that employers mitigate the financial reasons for the change to terms and conditions and show that in all the circumstances it could not reasonably have avoided the need to make the changes. Whether a dismissal is fair will require consideration of a number of factors, including the degree of consultation with employees and representatives.
What next?
The Government now plans to consult on the proposed changes in the Bill and it is worth providers engaging in the consultation process to ensure the Government understands the nuances of the care sector. The majority of the changes will not be introduced until 2026, so there is time for providers to prepare and plan for their implementation. CMM
James Sage is a HR and Employment Partner and Head of the Health and Social Care team at RWK Goodman. Email: james.sage@rwkgoodman.com : @RWKGoodman
What was your response to the Employment Rights Bill and how do you plan to implement it in your setting? Visit www.caremanagementmatters.co.uk and leave a comment on this feature or join the conversation to share your thoughts.
INTO PERSPECTIVE
How
can
the Better Care Fund (BCF)
be re-focused to
promote prevention?
In this issue, Into Perspective invites two sector leaders to pick apart the findings of the Association of Directors of Adult Social Services (ADASS) 2024 Autumn Survey. In particular, the BCF’s role in promoting prevention.
The BCF is a programme designed to help integrate the NHS and social care. It is a delivered collaboratively by the Department of Health and Social Care, Ministry of Housing, Communities and Local Government, NHS England and the Local Government Association. These organisations have been tasked with using the BCF to plan and execute integrated health and social care services in local areas across England.
The BCF was set up in 2015 and was composed of an allocation from integrated care systems, the Disabled Facilities Grant,
social care funding and winter pressures grant funding. The purpose of combining funds from these areas was to remove the barriers often encountered with separate funding streams.
The BCF team was set up to manage its delivery and had five objectives:
1. Ensure plans are implemented by offering support to local systems/areas.
2. Accelerate integration to deliver person-centred care and better outcomes.
3. Support and assure BCF plans.
4. Record and share insight on how plan implementation is and moving towards the BCF’s wider ambitions is progressing.
5. Develop and agree policy framework for current and future BCF endeavours and identify ways to dissolve barriers limiting service integration.
Whilst the integration of the NHS and social care was and still is undeniably necessary, the BCF has not succeeded in its goals, according to the ADASS 2024 Autumn Survey. In its publication, ADASS argues that the
BCF, ‘serves as a prime example of a policy originally designed to promote prevention and early intervention, which has since been redirected toward the short-term alleviation of hospital capacity’.
In ADASS’ 2024 Spring Survey, 46% of directors reported an increase in the investment of BCF resources in Discharge to Assess. Comparatively, only 21% reported a rise in prevention and early intervention investment, 35% in intermediate care investment and 14% in crisis resolution investment. One respondent commented, ‘the BCF framework and monitoring is focused predominantly on discharge/post discharge pathways’.
Presented with a range of suggestions for the next cycle, with the current BCF framework ending in 2025, 62% of ADASS 2024 Autumn Survey respondents agreed that ‘more significant pooled budget structures, bringing together a requirement for joint financial planning across NHS community services, social care, continuing healthcare and related activity, would improve the next BCF iteration.
Whilst many in the sector have criticised how the BCF is being delivered, findings from the ADASS 2024 Autumn Survey have highlighted how important its protection is, with 98% respondents agreeing that ‘significant BCF funding underpins essential social service delivery’. Upcoming reviews of the BCF, ADASS has suggested, should be more ambitious and consider how it can be refocussed to support prevention.
Other recurring suggestions from respondents to the ADASS 2024 Autumn Survey included:
• Make responsibilities clear and highlight the need for a unified approach by integrated care boards and councils to financial planning and allocation.
• Put trust in the local systems by reducing monitoring, reporting and required planning permission.
• Increase flexibility in what funds can be used for, enable innovative spending; particularly in preventative and community-based services.
• Strengthen the partnership between health and social care with joint decision-making and a greater integration of services.
• Create a meaningful framework that suits local demands, council timelines, and capacity planning.
ADASS and its survey respondents have stressed the importance of collaboration and integration between the NHS, social care and local authorities as the focus of the new BCF framework to achieve the goal of prevention.
Technology must play its part
Dr Clenton Farquharson CBE, Associate Director, Think Local Act Personal (TLAP) : Search ‘Dr Clenton Farquharson CBE’
Email: clenton.farquharson@tlap.org.uk
At Think Local Act Personal, we believe everyone should have the care and support they need to be able to live their lives their way. For us, promoting prevention is bound up within promoting wellbeing. The Better Care Fund (BCF) can be re-focused on prevention by embedding the principles of wellbeing and personalisation, maximising everyone’s ability to draw on care and support to live life their way.
"Wellbeing, and by extension prevention, starts in a safe supportive environment."
Such an approach supports people who draw on care and support and carers to live healthy lives, where wellbeing and resilience are prioritised. It reflects our shared aspiration to live in a place we call home, within communities where we belong, sharing power as equals.
Technology will be key if we use it to serve people who draw on care and support. It is an enabler, not a driver. Think of it as an operating system to our lives, something quiet, in the
background, helping things run smoothly, so you can get on with the important things: working, socialising, studying and living a full life.
Technology must uphold our rights and choices and reaffirm our existence and identity. It must respect our homes and relationships and connect us to our communities. It should offer convenience and empower us to control our lives, and it must be available to everyone.
Wellbeing, and by extension prevention, starts in safe supportive environments. For many, this will be a place we call home. We have a Making It Real statement that says, ‘I live in a home which is accessible and designed so that I can be as independent as possible.’ The BCF, especially if designed with prevention in mind and making use of new and emerging technology like AI and the Internet of Things, can achieve this.
Belonging, equitable and reciprocal relationships, smart homes, early risk detection, better connectivity to the people and places we love? Imagine if the Better Care Fund became a catalyst for these changes and the impact that would have on our health and wellbeing?
Care work is inherently preventative
Karolina Gerlich, Chief Executive Officer, The Care Workers’ Charity : @CareWorkersFund
Email: info@thecwc.org.uk
The Better Care Fund (BCF) has immense potential to promote prevention within health and social care. However, this will only be achievable if we address a fundamental and often overlooked issue – the workforce. Care work is inherently preventative, and care workers play a crucial role in reducing hospital admissions and enabling individuals to thrive at home.
During a recent roundtable we held examining the formation of a National Care Service, care workers shared how, through consistent, compassionate support, they help people make lifestyle changes that directly impact their long-term health. For example, care workers shared how they had supported individuals in reducing or eliminating harmful habits, such as smoking or excessive drinking.
Prevention relies on proactive, person-centred interventions, whether that is identifying early signs of ill health, supporting people to remain independent at home or addressing social determinants of health. These interventions require a skilled, motivated and stable workforce. Yet, the current landscape makes this challenging to achieve. Low pay, insecure contracts and poor working conditions are driving
high turnover rates and chronic staff shortages, undermining the continuity and quality of care.
To truly refocus the BCF on prevention, we must ensure the workforce is properly valued and supported. This starts with improving pay to reflect the skill and responsibility required in care roles, ensuring parity with equivalent roles in the NHS and other sectors. It also means addressing working conditions, such as reducing zero-hour contracts and providing opportunities for training and career progression.
Additionally, the BCF must invest in workforce wellbeing. Care workers face high levels of stress and burnout, yet mental health support is limited. By embedding mental health and wellbeing initiatives into the BCF, we can create a more resilient workforce better equipped to deliver preventative care. Offering training and resources on preventive health and ensuring consistent, fair pay will not only retain experienced staff but also improve care quality. Without these changes, the BCF risks being a missed opportunity. Prevention cannot happen without the people who deliver it, and those people need to be treated with the respect and dignity they deserve.
AI and dementia: An emerging pattern
of care potential
David Grey, Founder of GG Care, explores the history of AI-generated avatars and analyses their emergence as a helpful tool to support people living with dementia.
Laying the groundwork
The concept of avatars, digital representations of individuals, has existed for some time. Still, the development of AI-generated avatars has taken this idea to a new level. The early history of AI-generated avatars can be traced to the 1970s and 1980s, when computer scientists and researchers began experimenting with early computer graphics and artificial intelligence forms.
One of the earliest known examples is 3D Art Graphics, a set of 3D computer graphics effects written by Kazumasa Miyazawa and released in June 1978 for the Apple II. Early attempts at creating virtual characters were rudimentary compared to today's standards, but they laid the groundwork for the future development of AI-generated avatars.
Ahead of its time
As computing power increased and AI algorithms became more sophisticated, the capabilities of AI-generated avatars also expanded. In the late 1990s and early 2000s, we saw the emergence of AI-powered virtual assistants and chatbots, representing an early form of AI-generated avatars. These virtual characters could interact with users in a
limited capacity and perform basic tasks.
Microsoft’s Clippy or Clippit was an early example of these virtual characters. It was an interactive virtual assistant in the form of an animated paperclip designed to help users navigate Microsoft Word. According to Alan Cooper, the ‘Father of Visual Basic’, the concept of Clippit was based on a ‘tragic misunderstanding’ of research conducted at Stanford University, showing that the same part of the brain in use while using a mouse or keyboard was also responsible for emotional reactions while interacting with other human beings, thus is the reason people yell at their computer monitors.
Microsoft concluded that if humans reacted to computers as they responded to other humans, including a human-like face in their software would be beneficial. As people already relate to computers as directly as they do to humans, the added human-like face emerged as an annoying interloper distracting the user from the primary conversation. As an iconic symbol of its decade, Clippy was also famously terrible and may have been a generation or so ahead of its time. Worldwide consensus decided that Clippy was annoying and intrusive. Time Magazine even named it among the 50 worst inventions ever.
Picking up pace
One of the significant milestones in the history of AI-generated avatars was the development of deep learning and neural network technologies. These advancements allowed the generation of more lifelike and realistic avatars that could understand and respond to human speech and gestures.
“One of the most interesting potential uses for AI-generated avatars is in older people's and dementia care.”
People use platforms like Elai and Synthesia for AI-generated avatars in various industries and settings. The possibilities are endless, from virtual influencers and digital celebrities to interactive customer service representatives and AI-powered teachers. As AI technology continues to evolve, we can expect to see even more advanced and realistic AI-generated avatars in the future,
blurring the lines between the virtual and physical worlds. One of the most interesting potential use cases for AI-generated avatars is in older people's and dementia care.
Application to care
According to the Organisation for Economic Co-operation and Development (OECD), dementia is on the rise around the world. In the 38 OECD member states, there were 15.7 cases of dementia per 1,000 inhabitants in 2021 – but by 2050, almost 30 in every 1,000 people are expected to be living with dementia.
NTT Data, a Japanese multinational information technology (IT) service and consulting company headquartered in Tokyo, is testing whether avatars can stimulate dementia patients. In addition, Thomas Nørmark, the Global Head of Innovation at NTT DATA Business Solutions, wrote about the dilemma facing his family when his grandmother, who battled dementia, asked about her deceased husband every morning. These experiences led Thomas to think about how carers can bring back the memory of the deceased.
The Living Memory project, a collaboration between NTT Data and Massachusetts Institute of Technology (MIT), was created to improve the quality of life of dementia patients in their final years and stimulate their memory to slow the progress of their symptoms. This technical breakthrough means people with dementia can communicate with loved ones using a tablet or computer.
For example, the avatar of a deceased loved one knows birthdays, anniversaries, shared vacations, pets and other family members. These facts are implemented in the knowledge base along with their interests, like gardening, hiking and cycling, and this information allows the AI to initiate and hold a conversation. The more information in the knowledge base, the easier it is to train a personality and create a virtual character.
Improving AI’s accessibility
I started GG Care to improve the lives of people with dementia and their carers with readily available smart home technology, after seeing Amazon Alexa's positive effect on my grandmother. GG Care’s Alexa-powered virtual dementia care companion simplifies everyday tasks through Interactive Reminders (IRs). Carers can use GG Care’s web interface and Alexa Skill to provide interactive reminders for their loved ones.
The IRs simplify the complexity of tasks by breaking each task into easily digestible steps with a series of questions, prompts and hints, just like a caregiver would. Many consider an Amazon Echo the speaker-device avatar for Amazon’s Alexa AI software. The care recipient interacts only with their voice; there are no clunky menus or buttons. The wide range of IRs include reminders to eat, stay socially connected, take medication and more.
I received grant funding from Innovate UK to create an avatar, cloning my likeness to produce videos about technology and dementia care. One of the use cases GG Care is exploring is cloning the likeness and/or voice of dementia carers to deliver IRs virtually, increasing a care recipient's adherence to the instructions being asked of them. IRs delivered by an AI-generated avatar could remind the care recipient to complete tasks to remain independent, decrease feelings of isolation by engaging in dialogue and promote Cognitive Rehabilitation Therapy (CRT). There is not much information on the efficacy of avatars in dementia care, but such studies are already underway.
Additional research
According to Kerry Yu Fang, a researcher at Western Sydney University, ‘An initial study is currently underway to test the effectiveness of an avatar-based reminder application to improve adherence and overall satisfaction in users. The application is tested on subjects using supplements as a proof-of-concept study. Results from this study should give an indication of the effectiveness and feasibility of using interactive avatar technologies for improving adherence in patients.’
Secondly, Margherita Rampioni of the National Institute of Health and Science on Aging, has argued that the field of Embodied Conversational Agents (ECAs) is novel and poorly discussed in the scientific community. As such, more sophisticated study designs and proof of the approach's efficacy are required. However, research published by Eduardo Carrasco of Viacomtech found all of his study’s 21 users with mild to moderate Alzheimer’s engaged naturally with an avatar, understood the information conveyed by the avatar and answered successfully using a television remote control.
Possible limitations
Although AI-generated avatars for people living with dementia can offer many benefits,
there are also several potential limitations and challenges to consider:
• Technical issues – like all advanced technology, AI-generated avatars sometimes have glitches, hallucinations or malfunctions, which can disrupt the continuity of care and frustrate care recipients and their caregivers.
• Limited capabilities – although AI avatars have made and continue to make significant progress, their ability to understand and respond to complex emotional cues or nuanced situations still needs to be improved.
• User acceptance – people with dementia and their carers are usually older adults. Older adults have higher negative preconceptions around new and unfamiliar technologies, which can hinder their adoption.
• Privacy and security – AI systems often require access to personal data to function effectively. Ensuring the privacy and security of this data is a significant challenge, especially given the sensitive nature of health information.
Ethics are among the most essential considerations technologists and caregivers face when deploying AI. AI in caregiving might reduce human contact and make the care recipient overly reliant on machines for emotional support. With AI-focused research generating plenty of pause for thought, the Scottish Dementia Working Group (SDWG) met to discuss AI approaches in dementia research and whether they could support the NHS more broadly.
Feedback from SDWG’s members suggests they favour AI taking on more laborious and administrative tasks that can take up considerable time for medics and carers. However, the overwhelming feeling among the group is that AI should never, and could never, replace human-to-human interactions. There was also concern that avatars could symbolise a degree of deception – because they give the impression of a real person being present, complete with a representation of their face, voice, expression and pre-programmed knowledge. Essentially, it may not always be possible for people with dementia to distinguish reality from perception. These limitations must be explored further and overcome before the sector's widespread acceptance of AI. CMM
How would you manage a cyber attack?
New guidance for care providers
Includes downloadable checklists to help admin and care staff spot an attack, and to help data protection leads gather information during an incident.
Reduce the risk and impact
Recognise a cyber attack or incident
Respond immediately
Recover, get support and learn
Report an incident
digitalcarehub.co.uk/cyber-security
Education and training for the social care workforce
If you work in adult social care, Macmillan’s Social care community on the Learning Hub is the go-to place for free education and training on cancer care.
There are over 20 on-demand e-learning courses, bitesize resources and virtual classrooms to develop your knowledge and skills in supporting people affected by cancer.
This community is for all staff working in adult social care who want to improve their understanding of cancer and skills in supporting people affected by cancer. This includes staff working in residential care, nursing homes, home care, sheltered accommodation, assisted living and day centres.
In the community you’ll find the following topics:
• Cancer awareness
• Cancer and other conditions
• Communication skills
• Personalised care
• Palliative and end of life care
Scan the QR code to log in or register for an account, then search ‘Social care community’
Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Also operating in Northern Ireland.
IMPROVING SECTOR UNITY:
HOW REGISTERED MANAGERS ARE CONTRIBUTING TO NURSING EDUCATION
Cathy Rant, Clinical Practice
Lead at the University of Exeter’s Academy of Nursing, discusses a recent project utilising non-nurse registered managers as practice supervisors for student nurses, taking advantage of newly expanded Nursing and Midwifery Council (NMC) guidance.
Running a residential care home is a complicated and specialised occupation – as the COVID-19 pandemic brought to the fore in painful clarity. However, registered managers’ skills have to date been largely unrecognised in what they could contribute to nursing education. In my role as Clinical Practice Lead at the University of Exeter’s Academy of Nursing, I have led on a project to utilise this extraordinary skillset and experience in expanding the educational horizons of students on our pioneering MSci Nursing programme.
Expansion into social care
My own 35-year career working in or with social care included the harrowing experience of managing a care home through the COVID-19 pandemic. This crisis magnified the lack of staff, the chronic funding issues and the lack of regard for social care, and I now want to help make a difference by expanding our student nurse placement opportunities into social care, including domiciliary care, residential care, supported living and nursing homecare. >
There is research on the immense benefits social care holds for our students, including where settings do not have registered nurses to supervise the students. Last year, the Nursing and Midwifery Council (NMC) updated their guidance on students’ supervision during clinical placements to include registered managers of social care settings who are registered with the Care Quality Commission (CQC). This represents an important step in recognising the work and expertise of Registered Managers by the NMC.
Leading the way
At the University of Exeter, we are among the first to work with registered managers in supervising student placements. I believe that starting at the beginning, with our nurse leaders of the future, we have a chance to raise the profile of social care and can play a small part in the larger picture, ensuring a functioning integrated health and social care system. Skills for Care recognises the value of this type of placement experience, stating that this will ensure a future nursing profession that has the skills and experience to work across a system.
We are proud to be leading this innovation at Exeter, where our four-year MSci dual adult/mental health programme was founded in 2019. It is just one of the ways we progress our curriculum foundation based on our seven pillars of nursing. Exeter nursing students have a diverse range of practice experiences, not only within the acute trusts but also with the private voluntary and independent sector. Last year, for the first time, registered managers of care homes became practice supervisors on student placements in residential care home settings where nurses are not employed.
Delivering practical experience
The initial phase involved two second year students undertaking a two-week placement focusing on the link between the GP practice and the social care setting in the same Primary Care Network (PCN). This initial pilot demonstrated sound understanding of the benefits of interprofessional learning, and a clearer comprehension of person-centred care. Indirect supervision was provided by registered nurses from the Academy of Nursing.
In the second phase, five second-year students took up placements in five residential care home settings for two weeks, from a GP practice or hospital setting. The registered manager acted as the students’ practice supervisor. This project aimed to test the learning experiences of the student nurse in a social care setting with no registered nurses, and therefore explore the role of the non-nurse CQC registered manager in the practice supervisor role, and to introduce concepts of interprofessional learning in health and social care.
To evaluate the project, we interviewed students and registered managers, gathered feedback questionnaires and held a registered managers' focus group meeting. Students also kept reflective diaries.
Evaluating findings
We found that students were exposed to and included in many interprofessional activities and practice. They got to explore effective
communication skills with residents and understand the roles and responsibilities of various team members and professionals supporting the service.
The students also got hands-on experience of the vital importance of building therapeutic relationships with people living in social care settings, which was learnt in a professional complex environment. One student told us, ‘It made me realise how people with learning disabilities can have a lot of additional needs that go unmet in hospital settings.’
In addition, the students gained a broader understanding of the healthcare system in a social care context by following residents’ complex health trajectories, appreciating how services outside of the NHS provide care in the community. Lastly, registered managers’ interviews and questionnaires showed the positive influence of supervising the student nurses during their placements.
Care staff learnt from the student nurses and registered managers improved their confidence in supervising students. There was an increased shared awareness of the interdependence between social care and nursing and the students found the proficiencies easy to read and identified relevance to the social care setting.
The managers did not feel it was too time consuming, and overall enjoyed the experience, but felt a longer placement would be more beneficial. In the words of one manager, ‘[The student] worked well within the team and we felt she learned from the team. Whether it was the medication round, wound care, catheter care, stoma care, handover meetings, the student nurse was keen and enthusiastic which really supported all our learning.’’
Exeter’s student nurses learnt to analyse complex healthcare situations from different angles, fostering critical thinking and creative problem-solving skills. This comprehensive approach enabled the students to provide better care by addressing the physical, psychological, social and cultural aspects of health and social care.
Further opportunities
The non-nurse registered manager as the practice supervisor demonstrated that this role is within their competence and experience. It also opens opportunities for further utilisations of these skilled social care professionals for placement expansion into this often-misrepresented sector. The students' perception of social care was changed after this placement, and it should help to tackle the stigma around this career pathway across nursing.
This educational project provided sound feedback on how interprofessional learning in nursing education prepares future nurses for effective collaboration, enhances their critical thinking and communication skills and promotes person-centred care. It reinforced the value of social care placements, replicating the feedback from other educational projects and research.
It confirmed that non-nurse registered managers are skilled, experienced and exceptionally valuable contributors to the practice supervisor role. All this makes for a more rounded nurse, more able to meet the needs of modern care across a complex and changing sector. Our next step will be a longer six-week placement into residential social care. To find out more about studying Nursing at Exeter, visit the University of Exeter website CMM
Completing the care picture :
What providers may miss when residents are alone
You may be surprised to learn that care home residents frequently spend a large portion of their day alone in their rooms. Research has found that residents can be isolated for between 50-80% of the day, creating a significant challenge for care providers.
While it is essential to provide residents with autonomy, this isolation can lead to unintended consequences. The longer residents spend alone, the greater the risk of potential emergencies going unnoticed, such as falls, infections and changes in mental or physical health. This is exacerbated if staff have limited face-to-face time with residents, potentially missing subtle changes in a resident's health or wellbeing or residents not reporting minor issues. The result? You can end up with problems only being identified when they become severe.
Limited staff-resident interaction
As residents spend more time alone, care teams are tasked with identifying health issues during limited, sometimes rushed, visits. These brief interactions make it difficult to detect subtle changes, such as reduced mobility, increased fatigue or cognitive decline in a resident's condition.
I know from my own experience with my grandparents that residents do not always report subtle changes in their health or mood during brief check-ins. This is either because they might feel it is not
In care homes, where safety, dignity and emotional wellbeing are of paramount importance, a lesser-known challenge is becoming
increasingly
clear, isolation, reports Thomas Tredinnick , Chief Executive
Officer
and Co-founder of Ally Cares.
important enough to mention, or they may simply be unaware of the significance of their symptoms or worse they don’t want to burden an already overstretched team.
The increasing pressure on care staff means they must identify changes in a resident's condition during limited, often rushed, interactions. As staff are responsible for meeting multiple residents’ needs simultaneously, this can often lead to a fragmented understanding of each person’s wellbeing. Subtle signs like increased fatigue, dehydration or cognitive decline may go unnoticed, resulting in missed opportunities for early intervention or adjustments to care plans.
A new approach
Artificial intelligence (AI) is reshaping the way care is delivered in care homes, addressing many of the challenges posed by resident isolation. AI-powered resident monitoring systems are helping care homes address these challenges by providing continuous, non-intrusive observation of residents, even when staff are not present. These systems combine motion and sound sensors with advanced AI algorithms to track residents' movements, behaviours and overall health trends in real time, offering a more comprehensive picture of their needs. >
AI systems provide invaluable support by collecting continuous data and flagging risks before they escalate. Whether it is a resident’s decreased mobility, changes in sleep patterns or unexplained behaviours, AI monitoring enables care homes to take action earlier, often preventing serious complications.
Robin Hall from Oaklands Care Home shares the benefits of AI monitoring, ‘The digital systems that we use allow our manager to be connected to what is happening at the home. The system alerts us if there is an unusual or an unexpected noise, we can ask our care staff to go at that point. Most importantly our staff and our management team feel more confident that they know what's going on in the home.’
AI monitoring can detect patterns such as decreased movement or restless sleep, both of which may indicate health concerns. By flagging these issues early, care teams can take action before the situation worsens, ensuring residents receive timely care.
The impact on care
AI resident monitoring technology is transforming the way care is delivered in several key areas:
1. Improving sleep quality – with no need for regular hourly night-time room checks, residents enjoy more restful, undisturbed sleep. This not only enhances their wellbeing but also leaves them better prepared to face the day, benefiting from uninterrupted rest. ‘This kind of technology has been marvellous in enabling our residents to live their very best possible life. It is apparent that these kinds of technologies most importantly improve quality of sleep and not only reduce falls but also decrease subsequent hospital visits.’ Melanie Dawson, Home Manager at The Lawns.
2. Enhancing care time – care workers no longer need to check on residents every hour, giving them more time to focus on those who need direct care. This improves the quality of care provided and allows carers to spend more time doing what they do best, caring for others. ‘The staff team reported that the system has given them more time to do the more important things that they need to do on a day-to-day basis, especially during the night shift. So, it's somehow supported them and freed up time from unnecessary checks in the night, so they find it really useful.’ Jay Trondillo, Regional Director at Maria Mallaband Care Group.
3. Reducing unwitnessed falls and infections – fewer undiagnosed infections and unwitnessed falls in care homes deliver a positive impact on the overall care system, reducing GP visits, ambulance callouts and hospital admissions, whilst alleviating the strain on an already stretched NHS. This results in cost savings for both private and public healthcare systems. ‘I worked a night shift and listened to several calls of one of our ladies who had a bad cough through the night, we did a COVID-19 test and it picked up a positive result. We also had somebody else who was poorly in the night, and she had a chest infection. So, if we hadn't listened to the recordings, we wouldn't have picked it up.’ Nicola Ray, Registered Manager at Oaklands Care Home.
4. Supporting higher dependency residents – with the removal of administrative night checks, care homes are now better equipped to take on higher dependency residents, as carers have more time to provide the necessary care.
The use of AI resident monitoring technology also supports proactive care changes using the AI data and insights. Julie Burton, Head of Operations at Azalea Court, recounts a situation where the data from AI monitoring helped secure funding for a resident. ‘AI resident monitoring technology has been a game changer for us. Without the data it provided, we wouldn’t have been able to build a case strong enough to secure the funding we needed to care for this resident. Now, the resident is happy, his family is at peace, and our staff can provide the right care at the right time.’
AI data can provide insights that can guide care decisions, enabling more personalised and efficient care. What AI insights can also reveal is when a resident’s condition improves, allowing for a reassessment of their care needs. At Greensleeves, Susan Graham, Home Manager at Harleston House, experienced the power of AI monitoring when staff struggled to identify why a resident was constantly fatigued.
‘We have discovered things we simply wouldn’t have known. For example, we had a resident who was being woken up by the kitchen fan early each morning, limiting his sleep. We have simply changed our cooking routine, and he is now so much happier. By using this technology we have eliminated so many concerns, it’s amazing to see the impact on the residents.’ In this instance, AI monitoring helped the staff identify an underlying issue that would have been difficult to detect through standard observation alone. The system’s continuous monitoring provided valuable insights that directly improved the resident’s quality of life.
The future of AI in care homes
As AI technology continues to evolve, I believe its potential in reducing resident isolation and improving care will become even more significant. Current systems focus on movement and behaviour tracking. It is likely that future advancements will include predictive capabilities, such as identifying early signs of cognitive decline, mobility issues or even infections before they manifest.
Looking ahead, the role of AI will become more sophisticated and significant especially in anticipating residents' needs. The role of AI will be key in quickly analysing patterns in resident behaviour and using AI algorithms to predict falls, mental health declines or infections days before symptoms become obvious. If this becomes a reality this would enable care teams to intervene much earlier to provide pre-emptive care and aim to reduce the risks associated with isolation.
Embracing AI
In summary, I believe AI resident monitoring is revolutionising care homes by addressing one of the most critical gaps – the time residents spend alone. With AI, care homes can provide continuous, real-time monitoring, ensuring that even when residents are physically alone, they are never truly unmonitored.
By embracing AI, care homes can improve early interventions, reduce hospitalisations, and ensure residents receive the personalised care they need. As the technology continues to advance, it will play an increasingly important role in addressing the challenges of isolation, ensuring that residents receive the care and attention they need, even when they are alone. Plus, it promises to play an even bigger role in safeguarding the wellbeing of care home residents across the UK. CMM
Thomas
is Chief Executive Officer and Co-founder of Ally Cares.
Has your care setting embraced AI? What has been your experience? Do you have alternative methods for monitoring residents’ wellbeing in their rooms? Visit www.caremanagementmatters.co.uk and leave a comment on this feature or join the conversation to share your thoughts.
Tredinnick
Your go-to solution for health and social care recruitment in the West Midlands, Staffordshire, and South West regions.
At Meridale, we understand the importance of having a reliable and dedicated team of nurses, healthcare assistants, support workers, and social workers in the healthcare industry.
That’s why we have made it our mission to provide exceptional recruitment services to ensure that your healthcare facility is staffed with the best talent available.
Our team of experienced recruiters have a keen eye for identifying top talent in the healthcare industry, and we pride ourselves on our ability to match the right candidate with the right position. Whether you’re looking to fill a permanent role or require temporary staff, we can help.
At Meridale, we take the time to understand your needs, and we work with you to find a solution that fits your budget and meets your requirements. We take care of the entire recruitment process from start to finish, so you can focus on what matters most - providing quality care to your patients.
With our extensive network of healthcare professionals, we can quickly and efficiently fill your staffing gaps, ensuring that your facility runs smoothly and that your patients receive the best possible care.
Find healthcare shifts at your fingertips with the Meridale Mobile App
Our staff have the opportunity to manage their work-life through our own user-friendly company app
Choose Meridale Recruiting Solutions for all your health and social care recruitment needs. Contact us today to learn more about our services and how we can help you. 30 Riley Crescent, Penn, Wolverhampton, West Midlands WV3 7DS 01902566650 / 07308515191
CELEBRATING EXCELLENCE IN CREATIVE ARTS
Vanessa Marr, Founder of the Domestic Dusters project, and Katy Styles, Founder of the We Care campaign, explain how their Markel 3rd Sector Care Award-winning collaboration brought carers’ voices to the heart of Welsh Parliament.
It all began with a serendipitous meeting on Instagram, when I (Katy) came across Vanessa's powerful project, Domestic Dusters, a creative and collaborative research initiative that invites women to embroider their experiences of invisible domestic labour onto yellow dusting cloths. As a full-time carer, this resonated deeply.
Carers’ work, much like the household chores that Vanessa highlighted, often goes unnoticed. It is a role dominated by women and is largely invisible to society. I initially reached out to Vanessa to ask if I could create my own craftivism piece with dusters. To my delight, she not only agreed but offered to collaborate. The Caring Craftivists We Care Domestic Dusters collaboration was born.
Craftivism as a voice for carers
The motivation behind this project was simple yet profound: we needed to help carers express their feelings in a way that worked within the constraints of their demanding roles. Many carers cannot attend meetings or join protest marches. Craftivism – craft as activism – was a perfect medium to channel their experiences to decision-makers in an impactful way.
Through an existing partnership with Oxfam GB, we aimed to build a stronger, more visible community of campaigning carers in Wales.
Collectively, we set out to reduce the isolation carers often feel and provide a creative outlet for their voices to be heard.
The heart of this collaboration was to bring the often-invisible stories of carers into the public and political spotlight.
Many carers, especially those with intense or long-term caring responsibilities, are unable to engage with traditional forms of advocacy. They cannot take time away from their care duties to attend protests or policy meetings, and often their voices are lost in the shuffle of larger, louder issues. The Caring Craftivists collaboration enabled them to engage on their terms, creating powerful, visible symbols of their experiences that could not be ignored.
Building a community of craftivists
Oxfam Cymru played a key role by displaying posters about the project in their shop windows across Wales. Volunteers – some of whom discovered they were carers through this project – took it a step further by organising stitching sessions. This connection between crafting and realising their own identities as carers was powerful.
The beauty of this project was its accessibility. To support participants, we distributed craft packs with all the necessary materials, including instructions in both
Welsh and English. The bilingual element was crucial to ensuring the project reached all corners of the Welsh community. Many rural carers, especially those in Welsh-speaking areas, often feel even more isolated, making this project a lifeline for connection. We wanted to make sure everyone could take part, so we also held a series of online workshops over the summer to guide carers through the process. The inclusive online format allowed carers to feel part of something bigger, even from the comfort of their homes.
Through these online sessions, carers shared not only their crafting skills but also their stories, frustrations and hopes. This fostered a growing sense of community. For many, it was the first time they had connected with other carers facing similar challenges. The simple act of stitching gave them a voice, a sense of belonging and a collective strength. This was embodied within the duster, which as a simple cleaning cloth, shared the invisibility of the tasks they undertook.
The dusters, each stitched by participants with their personal stories, were then displayed at the Senedd (Welsh Parliament) on International Day of Care in October, and presented to MPs, calling for change.
Breaking down barriers and creating change
Through this project, we uncovered the deep sense of isolation many carers felt. The act of stitching their experiences onto dusters gave them a chance to connect with others who truly understood their struggles. The co-creation of the dusters created a sense of community among carers, many of whom had long felt alone in their roles.
The exhibit was much more than just a display of crafting activities; it was a bold,
visual representation of carers’ daily lives and struggles. Each duster told a unique story, stitched in the hands of those who often work behind closed doors, away from public view. This powerful display at the Senedd created a moment where the often-invisible labour of carers could no longer be ignored.
Of course, we faced challenges along the way. Ensuring that everything was bilingual required finding translation services through ‘Hello Blod’, a Welsh Government initiative. We also had to navigate logistical hurdles – like getting needles, thread and washing lines through security at the Senedd! Yet, these challenges did not stop us.
On the day of the installation, we displayed 80 beautifully stitched dusters across the Senedd floor. Initially, we were asked to move them, but we politely stood our ground. The impact was undeniable. Senedd staff and members expressed how the dusters touched them – not only through their words but through the stories they told visually.
The outcome? Just days later, the dusters were mentioned in a debate on carers’ services at the Senedd. This was a powerful validation of our work. We have even created short videos with Oxfam Cymru to document the day, sharing the dusters and their stories with an even wider audience.
What’s next?
Following the success of this collaboration, we secured additional funding from the University of Brighton, where Vanessa is Principal Lecturer. With this support, Vanessa and I have been interviewing many of the carers who participated in the project. These interviews will soon be turned into podcasts, further amplifying their voices.
Looking ahead, we are planning guided online art activities in the new year – a 12-week
project designed to continue addressing the isolation carers experience. These sessions will give carers another chance to come together, share their stories, and contribute to a new collective art piece. This project will highlight the need for systemic change, focusing on the need for better recognition and support for carers in all aspects of their lives.
The project has also sparked discussions about expanding the initiative to other parts of the UK. Vanessa and I are exploring how to bring this project to England, with hopes of exhibiting the dusters in Westminster. With this, we aim to bring the voices of carers to the heart of UK politics, ensuring that their experiences are part of the national conversation about care work.
Starting conversations
Stitching a duster may seem like a small act, but it has opened doors for deeper conversations and greater recognition of carers' experiences. The collaboration between Caring Craftivists and Domestic Dusters has made it clear that carers can no longer be left on the fringes of society, their voices drowned out by the demands of everyday life.
This project has proven that when carers are given the tools and the platform to speak, their voices are powerful enough to influence political debates and inspire change. What began as an Instagram connection has grown into a movement that is changing how we think about care work –one stitch at a time. CMM
Vanessa Marr is the Founder of the Domestic Dusters project. Email: V.Marr@brighton.ac.uk
: @wearecarers
Katy Styles is the Founder of the We Care campaign. Email: wearecarers@gmail.com
: @domesticdusters
Headline sponsor
CARE INDUSTRY FORUM 2024
The Care Industry Forum 2024, delivered in association with Care England, will once again host one of the largest annual gatherings of care sector executives.
Crucial business opportunities
The Care Industry Forum is specifically designed and set up to bring senior decision makers and suppliers together so that opportunities can be developed and discussed, and strong relationships are forged that will set a platform for future working relationships. The Care Industry Forum is a flagship care event, held at the Crowne Plaza Hotel, Stratford-upon-Avon, between 9th-11th December 2024.
The Care Industry Forum has grown into one of the largest annual gatherings of care sector executives and consistently aims to deliver high levels of business results to all who attend.
"The forum will allow buyer delegates to maximise time and purchasing effectiveness by meeting with relevant suppliers in one place at one time."
The Care Industry Forum 2024 is fully complimentary for care operators to attend. Over 200 delegates will attend the forum and take part in focused buyer and supplier one-to-one meetings and networking sessions. The Care Industry Forum 2024 will host over 50 senior purchasing executives from leading care homes for suppliers to meet with; that is 50 potential clients located in one place at one time.
Who will attend?
Amongst those expected to attend the Care Industry Forum 2024 are senior representatives from care and nursing home groups who have the decision-making authority for their companies’ purchasing requirements, including owners, directors, senior purchasing executives and specialist care sector procurement companies.
The Care Industry Forum works with many leading companies, including Advinia Healthcare, ExtraCare Charitable Trust, Serene Care, Holmwood Holdings, Care & Support TM Ltd, Abbeyfield Wessex Society, Dignus Group, Hampton Healthcare, Clifton Buying Group, Brookvale Healthcare and many more.
The whole spectrum of the care sector supply chain will be covered, including medical supplies, medical equipment, food and beverage, catering services and equipment, mobility equipment, hoists and lifting aids, laundry systems, furniture and beds, interior decoration, building and maintenance services, staffing requirements, IT and communication, cleaning and hygiene, energy/utilities, fire and security services, bathroom and washroom products and services, waste management, pest control and many more.
How does it work?
Buyer delegates are afforded the opportunity to spend quality time with key suppliers and discuss supply solutions during one-to-one meetings which are pre-scheduled based on the companies that buyers wish to see.
The forum also provides additional networking opportunities through refreshment breaks, lunches and dinner functions, including the Black-Tie Festive Gala Dinner. The forum will allow buyer delegates to maximise time and purchasing effectiveness by meeting with relevant suppliers in one place at one time.
Looking ahead to 2025
For 2025, the following schedule of forums and events, delivered in partnership with Care England, have already been lined up:
• Healthcare Forum, 7th-8th April 2025, Hinckley Island Hotel, near Leicester.
• Care England Golf Day, 4th July 2025, The Warwickshire Golf Club, Warwickshire.
• Care England Forum, 14th-15th July 2025, Chesford Grange Hotel, Kenilworth.
• Care Industry Forum, 10th-12th December 2025, Whittlebury Hall, Towcester.
If you would like more information about the care forums and how these opportunities can benefit you, call 01455 559248, email info@dpbusinessevents.co.uk or visit www.dpbusinessevents.co.uk
WHAT’S ON?
Event:
Date/Location: Contact:
Event:
Date/Location: Contact:
Event:
Date/Location: Contact:
Event:
Date/Location: Contact:
Event:
Date/Location: Contact:
Event:
Date/Location: Contact:
Event:
Date/Location: Contact:
Event:
Date/Location: Contact:
Driving Change Together: The Commissioners’ Conference 3rd-4th December 2024, Alfreton www.commissionersconference.co.uk
Caldicott Guardian Learning Network 5th December 2024, Online www.digitalcarehub.co.uk/events
Care Industry Forum 2024 9th-11th December 2024, Stratford-upon-Avon www.careengland.org.uk/events
Being prepared for CQC inspection seminar 11th December 2024, Online www.skillsforcare.org.uk/news-and-events
Women in Public Sector Leadership 2024 Conference 12th December 2024, Online https://womenpsleadership.co.uk
Health and Safety at Work Conference 2025 22nd January 2025, Online https://hswconference.co.uk
The National Apprenticeships Conference 2025: New Perspectives, New Opportunities 28th January 2025, Online www.governmentevents.co.uk
Digital Health and Care Conference 18th-19th February 2025, Edinburgh https://events.holyrood.com
CMM EVENTS
Event:
Date/Location: Contact:
Markel 3rd Sector Care Awards 2025 Friday 14th March 2025, Birmingham Lisa Werthmann, Director, 01223 207770 lisa.werthmann@carechoices.co.uk www.caremanagementmatters.co.uk/event/ markel-3rd-sector-care-awards-2025
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 2025.
Lee Gilbert, Chief Marketing Officer at Nourish Care, highlights the importance of focusing on quality of life in adult social care and offers best-practice guidelines.
I recently visited a new care home in Wigan called The Rowans, which did not look like your typical residential care setting. It felt more like a hotel, which was unusual as it is 100% local authority funded. The interior design was incredible and rather than big communal areas, the building was split into smaller, comfortable spaces. I visited the on-site hair salon where you can have everything from a blow dry to a balayage and noticed music in every room from the residents’ eras.
“It's not just about keeping people alive, it's about giving people a reason to be alive.”
home – one man likes to assist with the washing up while another resident helps in the laundry room.
Sarah told me, ‘I wanted to run a place with a homely feeling, somewhere that was more like a hotel than a care home. I’ve succeeded because everyone here feels like part of a family. They all have freedom and a voice to have a say.’
The pay-off for treating residents with respect and dignity, maintaining their freedom and encouraging excitement about life is huge. I met Liz, a social worker whose client had moved to The Rowans. She told me that their mobility had improved, physical wellbeing was more stable and their mental health was better. This should not come as a surprise, because there is plenty of research that shows optimism is good for us.
I was there to film Nourish’s ‘Better Lives’ series of fly-on-the-wall documentaries that take a behind-the-scenes look at the adult care sector and the people who devote their lives to it. It did not take long to conclude that if I ever live in residential care, I would want it to be somewhere like The Rowans.
Nathan, the home’s Customer Experience Leader, told me, ‘It’s not just about keeping people alive, it’s about giving people a reason to be alive.’ Isn’t that what we all want? It should not change at the point where we may have to go into residential care.
It looked like everyone was having a lot of fun at The Rowans. Nathan invites community members to teach activities like crochet, the home runs a pen pal scheme with the local school and Sarah, the Manager, revealed that some residents had recently gone to a Meatloaf tribute concert. There are other freedoms within the
Activities at The Rowans go the extra mile. Nathan puts on a regular karaoke evening, and he likes to help residents tick things off their bucket lists. A lady with Huntington's disease used to be a lollipop lady and wants to do it again. She believed her condition would prevent it, but Nathan is determined to make it happen. ‘These people have met presidents; they’ve sailed around the world and run businesses. Their lives don't have to stop just because they are in a care home,’ he said.
I could not agree more and this is the ethos behind Nourish. Our software was developed to give those receiving care more autonomy, a voice and the best quality of care to ensure improved outcomes. People are like plants – the more love and care you pour into them, the better they flourish.
Following The Rowan's lead is more about mindset than budgets. When wellbeing is a priority and you treat those receiving care the way you would treat your loved ones, you improve people’s lives. Whether it is going to a Meatloaf tribute or ironing a shirt – small, everyday things make a huge difference to people’s lives.
The Managers Conference 2025
Wyboston Lakes, Bedfordshire
Monday 10 March 18:30 onwards - Tuesday 11 March 09:30 - 16:00
Wyboston Lakes Resort, Bedfordshire
Managers are fundamental to the delivery of outstanding care, which is why the National Care Forum and Skills for Care, in collaboration with ARC England, are once again hosting The Managers Conference.
Come and join us to learn, share and find solutions to the challenges you face on a daily basis, and help you and your teams provide the highest quality care.
This is the only conference dedicated to managers across adult social care.
Workshop and panel topics include:
■ New political environment - Fair pay agreements
■ CQC Single Assessment Framework - one year on
■ The benefits and pitfalls of AI
■ The Workforce Strategy - making it happen on the ground
■ Changing landscape of learning and development
■ Learning disability research
■ Moving from an Inadequate to Outstanding CQC rating ...plus much more!
Limited early bird tickets on sale now!
Early bird and full attendee tickets include a networking evening with dinner and accommodation on the night of Monday 10 March, followed by breakfast and entry to the full day conference, with lunch and refreshments on Tuesday 11 March.
Tickets from £299 + VAT
SIGN UP FOR
FREE PROVIDERS
Yes, that’s right. Absolutely free.
CMM digital magazine and more
Gain CPD points
Weekly news and thought-leading blog content
Comment on features and debate important subjects
Receive a digital edition of CMM magazine
First to hear about events, webinars and ‘CMM - OFF THE PAGE’ podcast
Now FREE for anyone working in the social care industry