care | healthcare summit Healthcare Summit 2022

More than 500 representatives from leading operators, investors, advisors and suppliers gathered to take part in take part in content-led market overviews, thought-provoking panel discussions and tailored round table discussions at the Healthcare Summit 2022 at the Design Business Centre in December. Here’s our round-up of some of the highlights.

Caring Times panel discussion: Care homes approaching ‘tipping point’ as leaders warn of closures

Care home leaders warned the sector is fast-approaching ‘tipping point’ due to soaring operational costs and staffing shortages.

The stark warning came from Nadra Ahmed, executive chairman of the National Care Association and chair of The Care Provider Alliance, who said providers were at their “wits end” and were facing “enormous pressures” with operational costs expected to rise by almost a third in 2023.

The NCA head said that despite the provision of new money by the government in the Autumn Budget, she had been told at a recent council meeting there would be no increase in care home funding.

“The state of the social care sector after years of neglect, glimmers of hope, backed up by lies, has created a really destabilised market,” Ahmed said. “My worry is as a representative of small and medium-sized providers we will see some closures and that will make things worse for the health sector.”

Robert Kilgour, founder and executive chairman of Renaissance Care, said these were “very challenging times” for the sector which was “running on fumes”.

Kilgour said the decision on whether energy bill support would be extended beyond March could be a “tipping point”.

The care home leader said Scottish providers were generally “better off” than those in England, however, thanks to nurse bursaries, a guaranteed nursing rate of £833 a week and the carers’ living wage of £10.50 for anyone over the age of 18.

Group operations director, Martin Murphy, agreed there were regional variations in support in England and

Wales where Hallmark Care Homes operates.

“We find that local authorities recognise the cost of care more in Wales,” Murphy said.

“We have more interaction with our local authorities.”

Despite the sector’s challenges, each panel member stressed there were reasons to be optimistic about the future, however, with the pandemic having accelerated technology take-up and encouraged providers to talk more with each other as well as with the NHS.

Murphy said: “The pandemic taught us how adaptable and agile the care sector is. The next two years are going to be very difficult and not everyone is going to survive and that is going to put a bigger burden on the care sector and the NHS. However, since the pandemic we talk a lot more as care providers and share a lot more. That’s a really positive thing.”

Recruitment and Retention: Top 20 tips from Neil Eastwood Care Friends founder Neil Eastwood offered expert insight on recruitment and retention during the Caring Times presentation stream. Here’s his top 20 tips takeaway.

1. Supporting and valuing staff is more important than pay in retaining people.

2. Improving the provision of childcare or offering care staff free childcare or seriously reduced childcare costs will help.

3. Many of the people we want to reach out to are not active jobseekers.

4. Texting is much more effective than emails in improving candidate response.

5. The biggest group of people who come into care previously did boring administrative roles. This is a big opportunity to sell a role which is emotional and gives people life skills and which helps them develop the relationship experience that can be so useful in many walks of life.

6. Teaching assistants are ripe to come and work in social care.

7. We lose, but also gain, from the hospitality sector.

8. Moving people from benefits into a job in social care doesn’t work.

9. Family carers are far more likely to consider a role in social care if they are approached about it and are far more likely to be high performers.

10. We need to recruit locally in the community and hand-pick people who have the right values.

11. Chip shops are a good place to reach out to candidates with leaflets as they are standing in long queues with nothing to do. Tear off the first few strips of leaflets so that people think everyone else is interested in social care.

12. Job boards only reach a small group of people who are not necessarily suited to the role.

13. Refer a friend has always been the best-quality source of staff. There is the potential for around a quarter of your workforce to come from your own staff recommending people.

14. Providers are trying different social media approaches such as TikTok to reach people.

15. We need to bring people into the sector who have never had a care role before to grow capacity. Only 37% of people who start a direct care role are new.

16. A third of care staff will come back if you ask them to.

17. Do more in the onboarding stage to reduce overall staff turnover.

18. When care workers join, book them in in six months’ time for training to create an emotional commitment to the role.

19. Try and apply for a role in your organisation on your phone to assess the candidate’s experience.

20. Work to be your local employer of choice.

Care home design: Designing for a post-pandemic future

The care home sector needs to use learning from the pandemic to boost the health and wellbeing of residents, Healthcare Summit delegates heard.

During a session on 'Pandemic-proof design for new build,’ Jenny Buterchi, partner at architect firm PRP, said postpandemic design should aim to foster social connections while allowing for social distancing if necessary.

“Health is not just the absence of disease, it’s about social, mental and physical wellbeing,” she said. “We need to think about how we can encourage that through design.”

Incidental spaces within homes can contain seating bays for social interaction, for example, but also act as passing places and reduce bottlenecks. Clusters of bedrooms should have the flexibility to divide into smaller clusters to contain infection. Handwashing stations in corridors can double as hydration stations, to encourage residents to drink water.

Lighting designed to follow the human circadian rhythm, a 24-hour internal clock, is likely to be seen in more care homes in the future, predicted Buterchi.

“We are starting to see circadian lighting put into dementia wings and we believe it will have a large impact on sleep patterns, food intake and depression,” she explained.

Other pandemic-driven developments include staff entrances that open directly into changing areas, and visitor rooms divided by glass screens, to control infection. “If we were doing this in future, I would like to see bifold screens that can be pulled back in the event of a pandemic,” said Buterchi.

Bedroom sizes are increasing, and there are more care suites with living as well as sleeping space, she said. “If you are in your bedroom 24/7 during a pandemic, having a space to sit in a chair and not be in bed all day long is important, as is having a view to the garden spaces and the public realm.”

Natural ventilation and light are important and architects are exploring ways to bring both to care homes while still following regulations. Solutions include louvre windows and sash windows, while access to balconies is increasing. “Obviously that needs to be looked at very carefully from a risk perspective, with higher guarding compared to a normal dwelling, but balconies allow people to be outside and feel part of nature,” Buterchi said.

Pairing bedroom doors, previously seen as a positive, is now a negative. “We thought pairing doors would be lovely because you can meet your neighbours as you are going in and out, but you are increasing the potential for social contact,” she said. There is an argument for including hospital-style windows in bedroom doors. “We haven’t as yet, but that would allow a member of staff to be able to check on someone without actually entering the bedroom, so lessening that contact.”

Post-pandemic design doesn’t have to cost more, concluded Buterchi. “I don’t think there is a huge additional cost, just a slight change of mindset. It is often about rethinking spaces rather than creating new rooms.”

Market research: Market under the microscope

Without reform to the planning system, the care sector will be unable to meet demand, according to research from property advisor Carterwood.

Only 12% of care home planning applications are currently dealt with during the statutory period, down from 22% in 2017, Carterwood’s managing director Tom Hartley told Healthcare Summit delegates.

Carterwood’s analysis shows applications for new-build care homes have remained steady over the past five years, despite Covid. “We are seeing 240 to 250 applications per annum,” said Hartley. “Even in 2020, at the height of the pandemic, we still saw 232 applications.”

While 80% of applications are eventually granted, the time taken to approve them is holding developments back, he said. Three-in-ten planning applications submitted in 2021 are still pending. “Eleven applications are still pending from 2017 – I think that speaks to the speed of decision-making within our planning system,” Hartley told delegates.

The data shows a shortage of around 50,000 good-quality beds. “Not enough of these beds are entering the market,” said Hartley. “Even if all 250 annual applications were registered, that would still only be about 15,000 beds entering the market every year. Those 15,000 beds don’t get developed largely because of the speed of decision-making.”

Currently around 4,000 to 6,000 beds enter the market every year, but about the same number leave, he said. “Until we can find a way to speed up the planning system, we’re going to struggle to see the level of supply we need to make up the shortfall. If we could speed this up, it would make a huge difference.”

Carterwood predicts an increase in care home fees of 10% this year. “This will be necessary to counteract agency costs, the National Living Wage and general nonstaff cost increases such as utilities,” said Carterwood client relationship manager Stacey Jeffries. “We also expect to see mid-year price increases from many more operators.”

Carterwood’s analysis found average care home fees are currently £1,329 a week for nursing care and £983 a week for personal care, with a fee gap opening up between the newest homes and the rest of the market. The Northwest region has seen the biggest increases in nursing fees with a 15.9% rise.

Average occupancy has risen from 75.6% in January 2021 to 82% in September 2022. “There are strong indicators that if growth continues at its current rate, we could hit pre-pandemic occupancy levels of mid to high 80s within 2023,” said Jeffries. Carterwood’s research shows that the larger the home, the lower the occupancy.

“This may relate to the current challenging staff crisis we find ourself in,” said Jeffries. “Staffing is now the blockage of occupancy.”

Care home monthly spend on agency fees has more than doubled from £11,000 in January 2021 to £26,000 in September 2022. Homes rated Inadequate spend an average £48,000 a month on agency fees, compared to an average of £21,000 spent by Outstanding-rated homes.