BUILDING STRONG LEADERS

Resources for registered managers

Enhanced care workers

Resource Finder

Financial health of care homes

Evaluating this emerging role

Property professionals

Can profitability return?

JULY 2016 £4.00 www.caremanagementmatters.co.uk

CMM

July 2016

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CMM July 2016 3

In this issue

REG

ULA

RS

FE

ATU

RES

05

07

09

28

31

48

49

50

From the Editor

Is it just me…? Editor in Chief, Robert Chamberlain,

reflects on a new report that questions whether personalised care can be achieved

amid local authority spending cuts.

CMM News

Business Clinic Our panel examines the Teaching Care

Homes pilot and its role in raising the status of nursing in social care.

A View from the Top Paula Keys, Managing Director of HC-One,

is the subject of this month’s interview.

Event preview CMM previews the forthcoming Berkshire

Care Conference.

What’s On?

Straight Talk Diane Lightfoot explores the Care Crisis

Manifesto which raises concerns over funding in the learning disability sector.

20

25

32

37

41

37

25 20

Evaluating the role of enhanced care workers George Holley-Moore evaluates the emerging role of enhanced care workers, lessons learned in its implemention and how the role can benefit the sector.

Squaring the unprofitability circle What is the current financial state of social care? Nick Hood shares the results of his research.

Supporting registered managers Georgina Turner looks at support and tools available to help registered managers deliver great care.

All About Me – the benefits of life story documents Mark Howard, Angie Williams, Andrea Bentley and Dawn Elmore detail the benefits of life story documents.

Resource Finder CMM brings you a selection of specialist property professionals to meet your specific business needs.32

4 CMM July 2016

EDITORIALeditor@caremanagementmatters.co.ukEditor in Chief: Robert ChamberlainEditor: Emma Morriss News Editor: Des KellyContent Editor: Emma Cooper

PRODUCTION Lead Designer: Holly Cornell Director of Creative Operations: Lisa Werthmann Studio Manager: Jamie Harvey

ADVERTISINGsales@caremanagementmatters.co.uk 01223 207770 Advertising Manager: Daniel Carpenter daniel.carpenter@carechoices.co.uk Director of Sales: David Werthmanndavid.werthmann@carechoices.co.ukNational Sales Manager: Paul Leahy paul.leahy@carechoices.co.uk

SUBSCRIPTIONSNon-care and support providers may be required to pay £50 per year. info@caremanagementmatters.co.uk 01223 207770www.caremanagementmatters.co.uk

Care Management Matters is published by Care Choices Ltd who cannot be held responsible for views expressed by contributors. Care Management Matters © Care Choices Ltd 2016ISBN: 978-1-911437-04-8CCL REF NO: CMM 13.5

CMM magazine is officially part of the membership entitlement of:

ABC certified (Jan 2015-Dec 2015) Total average net circulation per issue 16,095

CONTRIBUTORS

George Holley-MooreResearch and Policy Manager, International Longevity Centre – UK

@ILCUK

@SkillsforCare

@OSJCT

@DebbieSorkin2

@ProfMartinGreen

@HC_One

@OSJCT

@OSJCT

@DianeLightfoot

Sharon Blackburn CBE RGN RMNPolicy and Communications Director, National Care Forum

Debbie SorkinNational Director of Systems Leadership, The Leadership Centre

@OSJCT

Angie WilliamsSt John Admiral Nurse, The Orders of St John Care Trust

Professor Martin Green OBEChief Executive, Care England

Georgina TurnerProgramme Head – Employer Engagement, Skills for Care

Dawn ElmoreCare Performance Analyst, The Orders of St John Care Trust

Paula KeysManaging Director, HC-One

Andrea BentleySt John Admiral Nurse, The Orders of St John Care Trust

Mark HowardSt John Admiral Nurse, The Orders of St John Care Trust

Diane LightfootCo-Chair, Learning Disability Voices

@NCFSharon@NickHood5

Nick HoodBusiness Risk Adviser, Opus Business Services

CMM July 2016 5

From the EditorEmma Morriss explores some of the recent

initiatives which are helping to drive the sector forward and raise its status.

Welcome to my final column before our summer break. As CMM will be missing from your desk next month, I wanted to reflect on what we are covering this month and what it means for the future.

There has been a lot of focus in recent months on the future financial health of the sector. With mounting pressures unsettling the sector, there is a risk that another large provider may fail. In his article on page 25, Nick Hood of Opus Business Services delves into the research he conducted for BBC Radio 4’s You and Yours programme, to give his view of the financial stability of care homes.

It is often said that hard times drive creativity and the need to look at new ways of working, adapting operations for the benefit of the clients, the staff, the business and the sector. As such, this issue we are also exploring two innovative approaches in the sector, to see if

they have the potential to make a difference.

On page 20, George Holley-Moore of the International Longevity Centre – UK has shared his organisation’s evaluation of the enhanced care worker role. Sometimes known as senior care leads or care practitioners, the individuals in this role work closely with nursing staff to take on, or support certain clinical tasks. It’s apparent that integrating the role has its issues, however George’s article gives some interesting recommendations on lessons learned during the first ever evaluation of this role; lessons that providers can consider if implementing the role into their settings.

Although further evaluation of the role is needed, it appears that it has the potential to help alleviate the pressure on registered nurses.

Given the sector is facing a

nursing crisis, another pilot has been launched recently to raise the status of nursing in adult social care. Explored within our Business Clinic on page 28, and discussed by our industry experts, the Teaching Care Homes pilot aims to actively encourage undergraduates to work in long-term care settings. It wants to create centres of excellence in practice development and learning for nursing students, medical students and therapists. Do you think this can help to raise the statue of nursing in long-term care? Let us know via the comments

section the CMM website.Finally, I’d just like to remind

you that nominations are now open for the 3rd Sector Care Awards 2016. Categories and how to enter are online at www.3rdsectorcareawards.co.uk The event is a fantastic opportunity for third sector organisations to achieve recognition, so please take the time to enter. We want to hear about the fantastic work you do.

That’s it from me for a few weeks. We’ll be back with the September issue, enjoy your summer.

Email: editor@caremanagementmatters.co.uk Twitter: @CMM_Magazine Web: www.caremanagementmatters.co.uk

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CMM July 2016 7

Is it just me...?Editor in Chief, Robert Chamberlain, reflects

on a new report that questions whether personalised care can be achieved amid local

authority spending cuts.

Published on 6th June, a new report from the Public Accounts Committee expresses concerns regarding local authorities’ abilities to provide ‘truly’ personalised care while seeking to make savings in adult social care budgets.

Chair of the Public Accounts Committee, Meg Hillier MP commented, ‘The need for adult social care is increasing but in recent years the amount spent on such care by English local authorities has fallen in real terms.

‘Against this backdrop, there are clearly risks in pursuing new approaches to providing care.

‘Personal budgets have great potential, but the interests of users are paramount and must be protected.

‘It is vital people receiving care do so through the form of personal budget that best suits their circumstances. They should also be supported to make best use of it.

‘In this time of real funding

pressures, central government must work with local authorities to safeguard the market for social care, including assessing the impact of the National Living Wage and other factors on provision.

‘The Department of Health and its partners must also show they are learning from available evidence and data so that care users can be confident of getting best value from the resources available.’

According to the report, Personal budgets in social care, the Department of Health, ‘does not believe that everyone counted by local authorities as having a personal budget does actually have genuine choice and control over the services they receive’.

The Public Accounts Committee states that there is a need for greater clarity on how local authorities can implement personal budgets to maximise benefits to users.

THE PLIGHT OF PROVIDERS

Reassuringly, the Committee recognises the ‘real threat’ to care providers’ survival in the context of the current and future market. The Report’s summary states that, ‘Local authorities face a substantial challenge supporting sustainable local care markets which offer the diverse range of provision needed for users to personalise their care, while care providers are struggling to recruit and retain appropriately qualified staff as financial pressures increase’.

The Public Accounts Committee calls for the Department of Health to provide guidance for local authorities and care providers to determine what high-quality care with proportionate support looks like and the real costs of delivery. It recognises that the social care market is fragile and calls for the use of analytical tools to safeguard

both the interests of service users and care providers alike.

IS IT JUST ME?

I welcome this report and the issues it raises. There is a clear need for commissioners and providers to work together and co-create models of care that are affordable, sustainable and, most importantly, better meet the needs of service users.

There are obvious instances where cost driven decisions currently disadvantage those in need of care. For example, the move to provide more domiciliary care as an alternative to that in a residential setting sounds like a welcoming proposition. Yet, in reality, this often results in a vulnerable adult receiving just 15-minute home care visits rather than appropriate support when needed.

To me, the elephant in the room is the dynamic in the relationships between local authorities and care organisations.

Too often, the buyer power of councils is used to bludgeon providers to drive down costs. Their use of external consultants to engage with the market to drive down care fees, in return for a commission, is a perfect example of strong hand tactics.

In addition to the recommendations, I would call for action to be taken to address this prevalent culture. There are excellent examples of how some councils have worked with care providers, especially in learning disability supported living, but unfortunately, this is far from the norm. Procurement practices need to become more about partnership than dictatorship to benefit service users and stabilise the market.

Do you agree with Robert? Join the debate. Twitter: @CMM_Magazine Web: www.caremanagementmatters.co.uk

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CMM July 2016 9

Concerns over personal budgets in social careThe Public Accounts Committee has warned that stronger measures are needed to safeguard the interests of adults receiving personal budgets for social care.

The Committee’s report, Personal Budgets in Social Care says, ‘We are not assured that local authorities can fully personalise care while seeking to save money, and are concerned that users’ outcomes will be adversely affected.’

From April 2015, the Care Act requires that all users receive personal budgets, but the Committee is concerned some people with personal budgets ‘may not be receiving care that is genuinely personalised’.

The report states the Department of Health ‘does not

believe that everyone counted by local authorities as having a personal budget does actually have genuine choice and control over the services they receive’.

The Public Accounts Committee warns that while some groups of users are more capable of trying new approaches to care, others are likely to need greater support – for example ‘older adults, those in residential care, those with learning disabilities and those who lack mental capacity’.

It finds that adults who receive social care paid for by their local authority ‘are not yet getting the support they need consistently in order to get the most out of personalising their care’.

The Committee calls for greater clarity on how local authorities

can implement personal budgets to maximise benefits to users and shares local authorities’ concerns that funding cuts and wage pressures ‘will make it hard to fulfil their Care Act obligations’.

Among its other findings, the Committee highlights the fragile nature of the social care market in many areas, warning of ‘a real threat’ that many care providers will not survive.

The Committee calls on the Department of Health to set out clearly to local authorities and providers ‘what high-quality and proportionate support looks like’ and how much it costs, and recommends a range of analytical and other measures to safeguard users’ interests and the social care market.

CQC publishes new five-year strategy

New nursing support role

Sir Stephen Bubb

CQC has published its strategy for 2016 to 2021. Shaping the Future sets out an ambitious vision for a more targeted, responsive and collaborative approach to regulation, so more people get high-quality care.

It was developed following a year-long consultation period when thousands of people, providers, staff and partners shared their views about the future of regulation. CQC says that the new strategy will help encourage services to innovate and collaborate to drive improvement, and ensure people receive good, safe care.

CQC will build on its current approach to use intelligence from a range of sources better, to focus inspections more to where people may be at risk of poor care.

Within the strategy, CQC set out its commitment to continue to inspect and rate all adult social care services, asking whether the current rating is still accurate, so people using services can be confident that its judgements remain timely and appropriate.

The length of time between inspections will be determined by the rating of the service and the

likelihood of quality having changed. CQC will inspect all newly-registered locations within 12 months to award its baseline rating. Services rated as ‘Inadequate’ will be inspected every six months, and those rated as ‘Requires Improvement’ every year.

Over the course of the strategy, CQC will move to longer intervals between inspections for services rated ‘Good’ and ‘Outstanding’ as it has access to better information, and in 2016/17, it will start to work with its partners and people who use services to agree appropriate timescales.

A new role that will sit alongside existing nursing care support workers and fully-qualified registered nurses to deliver hands-on care has moved a step closer as Health Education England (HEE) published the response to its recent consultation on the Nursing Associate role.

The consultation attracted more than 1,000 responses from individuals including patients, members of the public and a wide range of organisations, including professional bodies, trade unions, health care and social care providers and commissioners of healthcare.

The role will be given the title Nursing Associate. In order to get the implementation of the Nursing Associate role right, HEE intends to appoint ‘test sites’.

Sir Stephen Bubb has announced he will be stepping down as Chief Executive of Acevo (Association of Chief Executives of Voluntary Organisations) after 15 years.

He will leave in June to head up the Charity Futures Programme (CFP) – a project that will research and develop new ways of securing strong governance and leadership in the sector.

Berkshire Care Conference Reading, 20th October 2016SAVE THE DATE

10 CMM July 2016

NEWS

The Centre for Ageing Better has found that more than a quarter (27%) of people aged over 50 say that they have a hard time making it through the stressful events that happen to people in later life.

Many changes occur in later life, including retirement, moving home, bereavement, poor health, becoming a carer and entering the care system.

In its major Later Life study, the Centre found that while some people manage these well, many feel lonely or socially isolated or experience a loss of meaning and purpose.

It found that people’s attitudes and outlook were a major factor in whether they were able to manage these changes.

The Centre for Ageing Better has announced a new partnership with the Calouste Gulbenkian Foundation’s Transitions in Later Life programme to develop and

test ways to help people improve the way they manage major life changes, to help them experience longer and happier lives.

The programme also aims to influence employers to understand the importance of providing pre-retirement support to their employees, which includes helping them to prepare emotionally for changes in later life.

The partnership will explore strategies that can help people deal successfully with major life changes. It will test the effectiveness of well-known therapeutic approaches, such as mindfulness and cognitive behavioural therapy, with people preparing for retirement, as well as developing and trialling new methods of support.

It will also work with employers and business groups to share and scale the ideas that work, to try to reach more people who may be affected.

Managing major changes in later life

A new report provides an overview of the number of people with learning disabilities and/or autism receiving inpatient care in hospital.

The Learning Disabilities Statistics Annual Overview is the first annual report of its kind from the Health and Social Care Information Centre.

It brings together various sources of statistics to produce robust data on the number of people with learning disabilities or autistic spectrum disorder.

Analysis focuses on the Assuring Transformation collection and provides counts of inpatients with learning disabilities and/or autism who are: admitted or transferred to

hospital; discharged or transferred from hospital; receiving inpatient care, and receiving long-term inpatient care (over five years).

The report also includes information about the number of inpatients aged under 18 years old with learning disabilities or autism admitted to hospital, including length of stay and age at admission.

Data is collected from the Assuring Transformation Learning Disability Census; Hospital Episode Statistics; the Quality Outcomes Framework; the Mental Health and Learning Disabilities Data Set and the Mental Health Services Data Set, all published by the Health and Social Care Information Centre.

Hospital or home? A new report on learning disability inpatients

JRF and JRHT Julia Unwin CBE, the Chief Executive of the Joseph Rowntree Foundation (JRF) and the Joseph

Rowntree Housing Trust (JRHT), is stepping down from her role at the end of 2016.

NEWS / POLL

CMM July 2016 11

POLL

Yes 70%No 30%

0 20 40 60 80

New volunteer management toolkit for social care providers

Retirement housing report

Volunteers make a unique contribution to the care and support sector by offering time, expertise and friendship.

To mark this year’s volunteer week, the Voluntary Organisations Disability Group (VODG) and National Care Forum (NCF) have produced a volunteer toolkit to help social care organisations build volunteer capability and capacity in local services. The toolkit supports frontline managers to create volunteer roles which enable people to make a real difference to local social care services.

It also looks at how to take an inclusive approach to volunteering. For example, people who may have experienced fewer life opportunities can be encouraged to volunteer.

Volunteers who use services themselves often have insights which mean they are uniquely placed to support others in similar situations.

The new toolkit provides a straightforward approach to evaluating the impact of volunteer schemes within social care settings.

Care services can use this to assess the contribution of

volunteering to the people supported, the volunteers, the organisation and the wider community.

Impact studies may be used to demonstrate what has changed as a result of the involvement of volunteers and identify next steps for the volunteer scheme within their organisation.

This work was funded through the voluntary sector strategic partner programme which is backed by the Department of Health, NHS England and Public Health England.

UK Retirement Housing – 2016 is a new report from Knight Frank. It examines the demand and supply for purpose-built housing for older people across the UK.

It includes an analysis of

the equity release potential of downsizing, as well as highlighting the planning landscape for the retirement housing sector.

Key facts include: by 2039, one in 12 people will be aged

80 or over; just 3% of new-build units in the pipeline or currently under construction are designated ‘elderly’ or ‘sheltered’ housing; and supply of retirement housing needs to increase five-fold.

You can vote via:www.caremanagementmatters.co.uk

Source: www.caremanagementmatters.co.uk Figures correct at time of print.

June’s results

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Stimulating debate on the distinctive contribution of nurses to adult social care: A discussion and good practice paper is a new publication, produced by the National Care Forum and Skills for Care and supported by the Department of Health.

The publication acknowledges the national shortage of registered nurses and expresses the view that too few make the choice to work in adult social care settings.

There are almost 50,000 nurses in social care. However, the latest data estimates that the turnover rate of directly employed nurses in care home services with nursing was 35.1%. This figure is significantly higher than the turnover rate in NHS nursing which is 14%.

Sharon Blackburn CBE RGN RMN, Policy and Communications Director of the National Care Forum said, ‘Adult Social Care provides numerous opportunities for nurses to work in a relational way to achieve outcomes that are meaningful to people using services.

‘Nurses in adult social care are vital if people are to receive services tailored to their wishes and needs. Their contribution is essential in supporting the NHS to deliver an integrated service.’

This month's Business Clinic on page 28 explores a new pilot that has been launched to establish Teaching Care Homes for training nursing students and to raise the profile of nursing in social care settings.

Published in collaboration with National Voices, and developed through working with diverse LGBT communities, Out Loud: LGBT Voices in Health and Social Care contains a set of narrative statements explaining that lesbian, gay, bisexual and trans people want high-quality health and social care that takes account of their sexual orientation and/or gender identity. It also describes what this might look like.

This document is intended to be used both by those who provide services and those who commission services, to support them to work with LGBT people. The aim is to provide a resource to assist in designing and providing care and support that will be successful in meeting LGBT people’s needs, and inclusive of their sexual orientation and/or gender identity, focusing outcomes on what matters most to LGBT people as service users.

Learning Disability Voices (LD Voices) has launched a Care Crisis Manifesto which calls on the Government to provide more funding for learning disability services.

The Manifesto calls on the Government to:• Play its role in ensuring sufficient

extra money is put into social care, to close the large and growing funding gap.

• Give local authorities the freedom to raise the social care precept above 2%, to enable them to compensate for the shortfall created by the National Living Wage and make a greater contribution towards funding for social care.

• ‘Front-end’ the extra £700m from the Better Care Fund to this year, rather than waiting until 2017, to recognise the additional costs borne by the introduction of the

National Living Wage.• Amend the policy requirements

for the Better Care Fund, so that it can be used by local authorities to support care packages for individuals with learning disabilities, rather than restricting it to efforts to reduce pressures on the NHS.

• Ensure that supported housing remains exempt from the cap on housing benefit to be applied to the social housing sector.

• Urgently look again at the 2015 National Minimum Wage regulations; to make it clear that time spent asleep on an overnight shift is exempt from the National Living Wage rate, as was originally intended.

For more information on the Care Crisis Manifesto, see Straight Talk on page 50.

Contribution of nurses to adult social care

Out Loud: LGBT Voices in Health and Social Care

Care Crisis Manifesto

The taboo of lonelinessThe majority of British people have experienced loneliness at some point in their lives and also know someone who is lonely, according to new research.

In the survey, 84% of British people said they have felt lonely, with 13% feeling lonely ‘all of the time’. The research commissioned by the Campaign to End Loneliness also shows that almost two-thirds of people (64%) know someone who is lonely.

Despite the large numbers of people affected by loneliness, the research suggests that loneliness is a taboo subject: 92% of respondents to the research think that people are scared to admit that they are lonely.

The research also indicates that people who feel lonely will be judged negatively: when asked ‘what do you think people imagine about those who are lonely?’ the most common responses were ‘there is something wrong with them’, ‘they are unfriendly’ and ‘it is their fault they are lonely’.

The organisation has previously found that 10% of those over the age of 65 – over one million people

– feel chronically lonely (that is, all or most of the time).

Marcus Rand, Director of the Campaign to End Loneliness said, ‘The taboo and stigma around loneliness is stopping vulnerable people from opening up about their situation. This in turn makes it very difficult for local authorities and other support organisations to find the missing million older people who need our help.

‘The Campaign to End Loneliness has developed a step-by-step guide to help local authorities and stakeholders identify the hidden lonely.

‘The Missing Million: In Search of the Loneliest in our Communities helps commissioners and service providers to identify older people who are experiencing, or who are at risk of experiencing, loneliness. It will assist frontline workers to better understand and respond to loneliness and to engage with older people who are experiencing loneliness.

‘It is unacceptable that 20% of local authority health and wellbeing boards in England still have no written commitment to

tackle loneliness in older age. We’re calling for all Boards to make a commitment by the end of the year.

‘Every local authority in the country should put in place a clear action plan with measurable targets for reducing loneliness in their local population.

‘If we are to drive lasting change for the better, however, we must make loneliness everyone’s business. We need to create a movement for change that breaks down the stigma of loneliness and addresses it head on, like any other health issue.’

The impact of loneliness on physical and mental health is significant and increasingly well-documented – from high blood pressure and higher use of medication to increased likelihood of developing dementia and depression.

This, in turn, has cost implications for the NHS, social care and the wider economy. Lonely individuals are more likely to visit their GP, undergo early entry into residential or nursing care and be admitted to accident and emergency services.

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14 CMM July 2016

NEWS

NHS England has published indicative figures for how much each part of England could see its NHS budget grow by 2020, and the funding available for transformation. This will help local NHS and care leaders develop their Sustainability and Transformation Plans, showing how the NHS Five Year Forward

View will be implemented locally, using the growing funding envelope available to each area.

NHS England also announced that it would invest around £112m (2016/17) in the vanguard projects, which are leading the way and road-testing new models of care in different parts of the county.

NHS funding growth to 2020

The National Council for Palliative Care (NCPC) has announced its support of the General Medical Council’s calls for better training for doctors in palliative and end of life care. The number of people dying in Britain each year is increasing as the population ages, and many people receiving a terminal diagnosis are going to hear that unwanted news first from a doctor.

It is essential that right from the start of their careers, and whatever their specialism, doctors

are comfortable discussing death with patients, and able to quickly and helpfully offer the support and options people need to receive.

Recent data from the Royal College of Physicians highlighted that training in end of life care is mandatory for doctors in only 22% of trusts. NCPC’s own recent Workforce Report recommended that all staff – not only palliative care specialists – receive regular training to enable them to provide high-quality care to people at the end of their lives.

Belong’s award winning Dementia Care Champion and Operations Director, Tracy Paine, is hoping to bring the best of international care practices for older people back to the UK, after being awarded a grant to travel to Australia and the USA to learn from some of the world’s leading care providers.

Tracy will spend five weeks

visiting aged care facilities in the two continents after being awarded £6,700 by the Winston Churchill Travelling Fellowship.

She was among just 150 people from 1,000 applicants to receive a grant from the Fellowship, which provides funding for UK citizens to carry out research projects in a range of fields around the world.

Better training in palliative care

Belong director wins Churchill grant

New framework for nursing, midwifery and careLeading Change, Adding Value is a new framework for nursing, midwifery and care staff in England, wherever they work and whatever role they might have. It is a framework aligned to the NHS Five Year Forward View that nursing, midwifery and care staff can use to lead on delivering the ‘triple aim’ measures of better outcomes; better experiences for patients and staff; and making better use of resources.

It shows how nursing, midwifery and care staff can help close the three gaps identified in the Five Year Forward View – the health and wellbeing gap, the care and quality gap and the funding and efficiency gap – while retaining the well-recognised ‘6Cs’ as being central to all that they do.

Leading Change, Adding Value also highlights the need to focus on unwarranted variation – variations in health and care outcomes, patients’ experience and use of resources that cannot be justified by reasons of geography, demography, or infrastructure.

Leading Change, Adding Value has been co-developed over the last nine months with input from a wide range of national organisations, practitioners, people being cared for, carers and the public.

The new framework for nursing, midwifery and care staff is available to download from the NHS England website. There is also a document explaining what the new framework for nursing, midwifery and care staff means for social care.

Sanctuary Group and Housing & Care 21Leading housing and care providers, Sanctuary Group and Housing & Care 21 have announced their intention to merge. The merger will see the creation of a new operation within Sanctuary Group, specialising in the provision of housing for older people, to be known as Sanctuary 21.

Sanctuary 21 will manage over 32,000 units of retirement and extra care accommodation for older people, as well as care and telecare services, making it a leader in the provision of housing and care for older people. It will focus on meeting and promoting the needs of older people of modest means, through high-quality, affordable housing and services.

The combination of Housing & Care 21’s specialism, Sanctuary’s infrastructure and the financial strength of both organisations, will mean a wider range of older people’s accommodation can be offered across more locations, more efficiently. It is intended that the efficiency gains and capacity created by bringing the two organisations

together will be used to build at least 800 homes a year for affordable rent for older people of modest means, as well as additional properties for shared ownership and sale.

Sanctuary 21 will be committed to enhancing the quality of housing and care for older people and demonstrating the value of court/scheme manager services, where there is a staff member offering support on-site. It will also modernise existing retirement properties to meet contemporary standards and provide improved energy efficiency.

The merger will enable Housing & Care 21 to take advantage of Sanctuary’s infrastructure, including a leading SAP-based ERP computer system, shared service centre, in-house maintenance operation and 24-hour response centre with assistive telecare services. Sanctuary and Housing & Care 21 will be working together to plan the next steps to achieve a successful merger and ensure that benefits for existing and new residents can be realised as soon as possible.

Adullum Homes in SheffieldAdullam Homes is working in a new partnership with Sheffield City Council to provide Adullam Foundations, a dynamic service for 75 clients with mental health histories.

This new service will create around ten jobs in the city.

Service users will be supported in their own accommodation in a way that meets their individual needs and enables them to live as independently as possible

and engage in their own local communities, while building resilience to manage their mental health issues.

Anyone with a mental health need who has a housing issue, such as being at risk of homelessness, can be referred to the service.

Adullam Homes has significant experience supporting individuals with mental health issues and brings a wealth of experience to Sheffield.

In focus

CQC inspections lead to care home improvements

WHAT’S THE STORY?The Care Quality Commission (CQC) has published analysis of care homes rated as ‘Inadequate’, which have been shown to have improved their overall rating on re-inspection.

WHAT DID CQC FIND?Following re-inspection, nearly three quarters of care homes originally rated ‘Inadequate’ were found to have improved their ratings. Of 372 care homes rated as ‘Inadequate', 273 were found to have improved their overall ratings. 205 care homes have moved from ‘Inadequate’ to ‘Requires Improvement’. However, for 68 care homes (25%), the rating improvement was from ‘Inadequate’ to ‘Good’.

WHAT DOES THIS MEAN?CQC argues that this shows that regulation plays an important part in encouraging providers to improve, but is clear that this is not the only influence. The CQC’s statement acknowledges that sustained improvement does not happen overnight. Influential factors include a commitment from everyone – staff, providers, commissioners, funders and regulators – working together and listening to the voice of the public and people using services to improve adult social care.

HOW CAN PROVIDERS LEARN FROM THIS?Examples of how the re-inspected care homes demonstrated that they had improved the

quality of their care include: investing in staff training to ensure staff understand the needs of their clients as well as safeguarding procedures, making sure homes present a welcoming environment at all times, developing activities that match the interests of residents, involving residents in decisions about their care, and empowering staff to suggest ideas of how to do things differently.

WHAT HAPPENS NEXT?CQC has produced a helpful slide deck on re-inspections from 1st October 2014 to 31st March 2016, on which the analysis is based. It also includes case studies from four different regions.

Launching the analysis, CQC’s Chief Inspector of Adult Social Care, Andrea Sutcliffe, said, ‘While services that have moved to “Requires Improvement” are heading in the right direction, I am clear that this is still not good enough and providers cannot afford to be complacent. Evidence of consistent practice and sustainability is what we are looking for, to ensure people always get the “Good” care they deserve.

‘Ultimately, if services cannot or will not improve for the benefit of people they are paid to support, then quite frankly there is no place for them in the care sector. As the regulator, we will be vigilant and will not hesitate to use our powers to put a stop to poor standards of care being provided if necessary.’

NEWS / IN FOCUS

A new report from Independent Age has revealed details of older pensioners living below the poverty line. Pensioners aged 75 and over are thousands of pounds a year worse off than both younger ‘Baby Boomer’ pensioners and working age adults. Meanwhile, those aged 75 and over are also more likely to live in persistent poverty than younger pensioners.

The report examines the financial circumstances of a cohort of older people who lived through the Second World War, sometimes called the ‘Silent Generation’. It uses UK Government household income data to look at disparities between different groups of pensioners. The report challenges stereotypes of ‘wealthy pensioners’ and shows how inequality persists into retirement.

Older pensioners living below the poverty line

CMM July 2016 15

Avery Homes Group funding Northampton-based Avery Homes Group (AHG) is targeting further expansion following agreement on a new £33m funding package with Yorkshire Bank. AHG is one of the country’s largest operators of elderly care facilities, with more than 3,000 beds across a network of 43 homes in England.

AHG’s homes provide a mixture of nursing, residential, respite and dementia care, as well as assisted living facilities and, via significant capital investment, are focused on quality care provision and creation of a hotel-like atmosphere for residents. The Group’s homes support both private and local authority-funded residents.

The new funding, facilitated by Jamie Stuart and Graham Harper from Yorkshire Bank’s Specialist and Acquisition Finance team, is a mixture of revolving credit facilities

and development finance. It will support the development of a new home at Kingstanding in the West Midlands and a refinancing of four of the Group’s existing facilities at Ashurst Mews, Moulton and Glenmoor House, Corby in Northamptonshire and at the Abbey Court and Alma Court homes in Staffordshire.

Construction work on the new Kingstanding home will begin in August 2016 and is scheduled to take around 18 months to complete.

Founded in 2005, AHG employs approximately 3,500 staff and has grown rapidly through acquisition and a successful strategy of developing and selling smaller care homes and then re-investing in new developments. The majority of the Group’s properties are owned by Welltower Inc, the US healthcare real estate investment trust.

Dementia Equity and RightsFailing to develop a rights-based approach to dementia risks leaving large swathes of the population without appropriate support, according to a new report.

Dementia Equity and Rights, produced by members of the Voluntary Sector Strategic Partnership Programme, highlights the fact that over 1 million people will have dementia by 2025, but the condition is rarely considered in relation to equity and rights. The publication is unique in its focus on dementia support in the context

of the ‘protected characteristics’ defined under the Equality Act 2010.

The report includes several innovative approaches to dementia care and recommendations for commissioners, providers, educators, service users and carers. It uses a series of case studies to illustrate the points made. The report presents 10 overarching themes in relation to equity issues in dementia. These will be useful for people who use services, their carers, commissioners and service providers.

16 CMM July 2016

NEWS

Target Healthcare REIT fund raise and acquisition

Delphine Court

Building Carer Friendly Communities

Target Healthcare REIT has announced a successful £84m fund raise. It has also completed the acquisition of a modern, purpose-built care home in Warrenpoint, Northern Ireland, for approximately £5.75m including acquisition costs. This transaction is in accordance with the Group’s investment policy.

The home, Carlingford Lodge, was opened in 2011 and comprises of 74 single bedrooms with full en-suite bathrooms. It also benefits

from a number of large resident lounges and dining rooms as well as a hairdressing and beauty salon and enclosed garden.

The home will continue to be operated by the incumbent operator, a subsidiary of the Priory Group. The existing lease is for a 30-year term with circa 25 years remaining. The rent payable under the lease is subject to annual uplifts of up to 3%. The purchase price represents an initial yield in excess of 7%.

DC Care has completed the lease of Delphine Court, a former residential care home in County Durham.

The property had been a residential care home run by a charity for a number of years, before being bought by Mr G Shaw. Mr Shaw completed a substantial

refurbishment of the building and contacted DC Care to find a new operator to lease the property to. DC Care found a specialist operator looking to establish a service in the area, for clients with a range of learning disabilities, in a supported living environment.

The life chances of many of the 6.5 million people in the UK who care, unpaid, for a disabled, older or ill family member or friend, are being damaged by inadequate support from local services, according to new research launched for Carers Week 2016. The research report, Building Carer Friendly Communities, is based on responses from 6,149 carers who completed Carers UK’s annual State of Caring survey online between March and April 2016.

What’s more, Building Carer Friendly Communities found that when carers face a lack of understanding about their caring role from the overall community, the negative impact on their health, wellbeing, relationships and finances is exacerbated.

Three-quarters of carers (74%) with some of the most intensive caring responsibilities say their

community does not understand or value their caring role, resulting in high numbers of carers struggling to balance other areas of their lives alongside caring.

Mixed support from local services means that the majority of carers are facing barriers to maintaining their health, balancing work and care, and balancing education and care, which is having a markedly negative impact on their life chances:• Over half of carers (51%) have let

a health problem go untreated:• Half of carers (50%) have seen

their mental health get worse.• Two thirds of carers (66%) have

given up work or reduced their hours to care.

• Almost half of carers (47%) have struggled financially.

• Almost one third of carers (31%) only get help when it is an emergency.

NEWS

CMM July 2016 17

Carterwood sells land for Minton GroupCarterwood has sold a piece of land with planning permission for a retirement scheme in Titchfield, Hampshire on behalf of the Minton Group. The Minton Group first approached Carterwood to provide a headline market analysis of the site in late 2013. Subsequent valuation advice was then provided to support the acquisition of the site, and Carterwood was able to assist in

the planning process by providing a planning needs assessment report in June 2014. The scheme was granted full planning permission in June 2015 and marketed for sale by Carterwood.

The land and its associated planning permission, 58 apartments and 28 bungalows, has been purchased by Oak Retirement, who will develop and operate the scheme.

New north east support provider

Stop over-medicationNew guidance has been launched to support prescribing healthcare professionals to review inappropriate prescriptions for people under their care who have a learning disability and/or autism. The Stopping Over Medication of People with Learning Disabilities toolkit comes as NHS England and Rt Hon Alistair Burt MP, Minister of State for Community and Social Care, joined forces with five professional bodies and the Challenging Behaviour Foundation (CBF) to pledge sustained action to tackle the over-prescribing of psychotropic drugs to people whose behaviour is challenging.

Multiple psychotropic drug use often starts at a specialist level, which is then passed onto primary

care for long-term management. Research published last year found that, in too many cases, these prescriptions are repeated without adequate review.

An estimated 35,000 adults with a learning disability are being prescribed an antipsychotic, an antidepressant or both without appropriate clinical justification. Long-term use of these drugs can lead to significant weight gain, organ failure and, in some cases, death.

The Stopping Over Medication of People with a Learning Disability (STOMPLD) pledge has been signed by the Royal Colleges of Nursing, Psychiatrists and GPs, as well as the Royal Pharmaceutical Society, the British Psychological Society and NHS England.

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Hightrees Residential Care Home - EnfieldEdwina House Nursing Home - Palmers Green

Trish Devlin has been appointed in-house interior design manager by Newcastle-based Malhotra Group,

having worked for the organisation on a freelance basis for the past nine years.

Malhotra Group

A north east woman has launched an innovative care provision service after experiencing first-hand the necessity for support personalised to the needs of each recipient. HMS will deliver tailored care for adults with learning disabilities, mental health issues, complex needs and challenging behaviour, focusing on choice, community inclusion,

independence and quality of life.Sam Hackett, from Newcastle,

set up HMS after being approached by Kelly Legg and Nikki Smith. After the appointment of Kelly and Nikki as Registered Manager and Social Care Manager respectively, HMS has recently received its Care Quality Commission certification and has begun to provide care.

18 CMM July 2016

NEWS

NorthStar in SuffolkWorking with local clinical commissioners, GPs, NHS representatives, and other community, sporting and healthcare groups in the Suffolk town of Halesworth, NorthStar has designed a care centre on behalf of its client, Castlemeadow Care.

The care centre will incorporate a community hub building, containing NHS outreach services, day surgery, physiotherapy, rehabilitation and general health promotion facilities, 68 nursing, dementia, respite, and day care beds, 42 extra care apartments, and a further development of 44 extra care bungalows as a second phase, together with an information and advice centre for people with life limiting conditions.

The HHC complex would be the focus for developing a model of care that actively promotes health, rather than just dealing with sickness.

The masterplan includes proposals for a new sports hall to be developed and operated by a separate entity but which will be available to residents of the new health and care village as well as the wider population of Halesworth town and beyond.

Highest ever delayed transfer of care figuresNew figures have delivered the most damning evidence, to date, of the continued and unrelenting pressure on social care, and the impact it has on people in hospital and needing care. The data, from NHS England, shows the highest ever delayed transfer of care figures.

The statistics in Delayed Transfers of Care Data 2015-16 show that more people remained in hospital beds in March, despite being medically fit enough to leave, than at any other time since figures started being compiled this way in April 2011. There were 169,928 individual delayed days; 32.2% were due solely to unprecedented pressures on the adult social care system, with the main reason being people awaiting

care packages in their own home. The previous highest figure was October 2015 with 160,094.

Over the last three years (March 2013 to March 2016), the total number of individual delayed days attributable to social care has risen from 31,980 to 54,763. This represents a 71% increase.

President of the Association of Directors of Adult Social Services, Harold Bodmer, said, ‘People deserve to receive the care and support they need in the right place and at the right time. Sometimes that will be in hospital, but when people are well enough to leave, we need to have good care available to get people home safely.

‘More people are now living

longer, with increasingly complex needs, while adult social care budgets have been cut by 31% in the last parliament.

‘The Government has promised more money but it is too little and too late, with the March budget a missed opportunity to bring forward desperately needed funding currently planned for the end of the decade.

‘Unless the Government addresses the chronic underfunding of adult social care – and quickly – many services will be at significant risk over the next couple of years, with worrying consequences not only for the NHS, but most of all for older and disabled people, their families and carers.’

New research has declared that the long-awaited Care Act failed in its first year. The research from national disabled people’s charity, Revitalise found that over half (55%) of England’s local authorities had spent less overall on services for disabled people and carers since the Care Act came into being than in the year before – to the tune of an incredible £397m – and 42% had reduced their spending on respite provision by an average of nearly £900,000 each.

A central pillar of the Care Act was the legal entitlement of all disabled people and carers to an assessment of their support needs. However, the Revitalise study, based on Freedom of Information (FOI) requests, found that local authorities gave fewer needs assessments for disabled people during the first year of the Care Act than in the year before, and half (48%) had carried out an average of 22% fewer carer assessments during the same period.

A parallel survey of disabled people and carers mirrored the FOI findings. Over half (53%) of the disabled people and carers surveyed by Revitalise said the funding they received had been reduced or not kept pace with inflation over the past year. As a

consequence, two thirds (66%) said they felt more isolated and had been forced to reduce their time spent taking valuable respite, and 44% said they were now struggling to make ends meet.

Despite prominent support from central Government, the failure of the Care Act was demonstrated by Revitalise’s research. Seven out of 10 (69%) disabled people and carers told the charity they were unaware of any changes to their entitlements as a result of the Care Act and half (49%) said the services they received had got worse since the Act’s introduction.

Revitalise’s study, based on FOI requests and its own research, looked at the impact of the first year of the Care Act compared with the preceding year. In light of the study’s findings, Revitalise is calling for an overhaul of the Care Act to ensure that all the disabled people and carers within local authority jurisdictions are approached and offered carer or needs assessments, and more funding from central Government to enable local authorities to fulfil all the pledges contained within the Act. The charity is also reiterating its call for sufficient funding for respite breaks to be a fundamental element of all social care provision.

Charities should be deeply involved at every level of the health and care system, according to a report backed by the Department of Health, NHS England and Public Health England. The report, Joint review of partnerships and investment in voluntary, community and social enterprise organisations in the health and care sector, is based on the largest ever review of the voluntary sector’s involvement in statutory health and social care. It urges local hospitals, clinical commissioning groups and councils to do more to involve expert charities in the design and delivery of services of all kinds.

While there are many good examples of local partnerships, overly complex commissioning processes mean that the expertise of many charities is excluded from design and delivery of health services. The report recommends a ‘simplest by default’ approach to procurement practice, in an attempt to put an end to unduly complex and cumbersome contracting arrangements, which are barriers to the involvement of smaller charities and social enterprises, in particular.

The report argues that the future of the health and care system in England requires a greater focus on promoting wellbeing and helping people live well at home. To do this, the NHS and local authorities need to harness the contributions of families and communities and work more closely with charities and social enterprises rooted within them.

Analysis of more than 300 responses to a written consultation, along with face-to-face and online consultation events showed that, despite this potential, many charities and social enterprises experienced barriers to working with the NHS and councils. These included limited opportunities for engagement, declining funding for some community groups, and complex contractual arrangements to deliver services.

Care Act ‘failed in its first year’

Involve charities in statutory services

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20 CMM July 2016

HEADER

20 CMM July 2016

There are lots of new roles developing in social care at the moment. What is the emerging role of enhanced care worker and what role will they play?

George Holley-Moore, Research and Policy Manager, International Longevity Centre – UK

The challenges facing the adult social care sector are well known. Chronic long-term underfunding, challenges around staff recruitment and retention as well as an ageing population, often with high support needs, mean that the sector needs to innovate to survive.

The International Longevity Centre – UK (ILC-UK), a think-tank addressing the challenges of demographic change and population ageing, were commissioned by the Department of Health to scope an emerging role in the social care sector where a care worker is upskilled to provide enhanced clinical support to registered nurses.

The new report, Innovate to

Q

A

EVALUATING THE ofENHANCEDROLECARE WORKERS

CMM July 2016 21

Alleviate: Exploring how the role of an enhanced care worker could address skills shortages in the social care sector, provides, for the first time, an analysis of the emerging role of the enhanced care worker, with a focus on the characteristics of the job, any challenges faced, and what lessons can be learned if providers were to implement the enhanced care worker role. We found that the new role has been given different titles in different care homes, including senior care lead and care practitioner; for clarity we reference all these roles as an enhanced care worker, as they all share certain characteristics.

The report was informed by a series of interviews with care home managers, nurses and enhanced care workers from a range of different care homes.

THE CHARACTERISTICS OF THIS EMERGING ROLE

While the role is not homogeneous across the sector, the research found that there are certain similarities that run across the job description.

Enhanced clinical supportEnhanced care workers undertake a variety of clinical tasks, either independently or in assisting the nurse, including the administration of medication and simple wound care. Other clinical tasks cited as part of the job description included: ensuring care profiles are up to date; assisting in developing care plans; taking blood pressure; helping with nutrition plans; managing vital signs; and conducting blood sugar analysis.

Softer skills As well as qualifications such as NVQs and training in clinical skills, all interviewees noted that staff members for the enhanced care worker role needed ‘softer’ skills, such as learning quickly, a desire

to advance their career and a willingness to ‘go the extra mile’.

Leadership and managementLeadership and management skills were another defining element of the emerging role. Enhanced care workers need the ability to cope well with stress, natural leadership skills, an ability to cope well under pressure, and a willingness to take the initiative – all important characteristics to look out for.

IMPLEMENTING THE ROLE

As well as gaining an understanding of how the enhanced care worker role is developing across the sector, in compiling the report we also identified some key themes associated with the role in practice.

These themes offer insights into the current feeling of how the role is working in individual care homes, incorporating the views of managers, nurses and care workers. They also provide an understanding of what is working in the role, whether there have been any challenges in implementing the role and how these barriers were addressed and overcome.

Training and qualificationsThere is training and a need to develop qualifications and skills for enhanced care workers that are specific to working in a care home setting. The research found that crucial to the new role was the need to acknowledge that nursing in a care setting can often require a different skill set to nursing in a hospital setting. In gathering evidence for the evaluation of the role, it was emphasised that there is a need for enhanced care workers to be personally motivated and able to emotionally connect with the role, as well as the people they are caring for. This is crucial to the success of the role and integration of the

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22 CMM July 2016 22 CMM July 2016

EVALUATING THE ROLE OF ENHANCED CARE WORKERS

enhanced care worker within a care home setting.

Relationship with registered nurseA strong working relationship between the registered nurse and the enhanced care worker is vital in ensuring that the new role is a success. Many of the interviewees highlighted that there were initial tensions between the two roles; this is understandable as the registered nurses may feel threatened.

However, these tensions almost always eased over time. Reasons for this included regular meetings between registered nurses and enhanced care workers to voice any concerns, as well as registered nurses seeing, over time, the benefit of the support provided by the new enhanced care worker role.

Concerns over accountability Often the most significant concern from registered nurses was found to be issues of accountability. To resolve these concerns organisations developed their own strategies and these varied depending on the organisation.

Some organisations stated that enhanced care workers were fully accountable for their actions. Whereas others stated that the line of accountability ultimately lay with the registered nurses. This led to some registered nurses feeling particularly wary about the situation. However, accountability appeared less of an issue where the registered nurse was actively involved in developing the enhanced care worker role.

Making a differenceWhilst the scope of the research did not allow for a full evaluation of the enhanced care worker role, the overwhelming response from staff at all levels was that the enhanced care worker role makes a real difference to their organisation and the people

they support. Not only did it address staffing issues and allow nurses to spend more time providing more complex care, it was also reported that residents were often more comfortable discussing their specific needs with the enhanced care workers who spent more time with the residents on a daily basis.

LESSONS LEARNED

To assist with the potential roll out of the enhanced care worker role, we evaluated the key ‘lessons learned’

by the participating organisations. These are of particular importance to providers who are considering implementing the role. There are a number of experiences that could contribute towards successful implementation.

Clearly define roles and accountabilityIt is important to establish clear communication on the lines of accountability and the delegation of tasks to ensure smoother integration of the role into the organisation. When evaluating the role, it was found that whilst accountability can be troubling to nurses, concerns can be mitigated by clearly establishing accountability lines to give both parties clear definition of responsibilities.

TrainingThe enhanced care worker

needs a full and rigorous training programme to give them the knowledge, understanding and training necessary to work alongside registered nurses. Ideally, the training programme should involve nurses as well. This can foster good working relationships and alleviate nurses’ fears around allowing enhanced care workers to undertake clinical tasks, such as administering medication.

CommunicationAn environment which allows for open communication between all

levels of staff was also found to be beneficial; it was highlighted that this is crucial to create an environment where enhanced care workers can speak up if they are not confident in undertaking a clinical task.

Involvement in planningIt’s important to involve both registered nurses and enhanced care workers in regular planning meetings. Transferring greater responsibilities in terms of care delivery to enhanced care workers should be accompanied by greater involvement of them in planning meetings. This can improve care by giving them a voice on residents’ potential needs, as well as fostering a sense of inclusivity that can strengthen the relationship between the registered nurses and enhanced care workers.

Importance of softer skillsThere needs to be a focus on, or

recognition of, the softer skills mentioned previously. The kind of nursing undertaken in care homes relies on a strong set of softer skills that foster an understanding of residents’ emotional and psycho-social needs. Developing the enhanced care worker role may be boosted by looking beyond clinical training and qualifications to actively recognise the importance of such softer skills.

Growing painsAll organisations should recognise that there will be growing pains in the process. The potential benefits of the enhanced care worker role must be seen in the long-term, and care homes interested in implementing the enhanced care worker role should prepare for some short-term disruptions. While the short-term challenges may be mitigated through proper preparation and clear communication, care homes should nonetheless be aware that the initial phasing in of the role is likely to be something of a bumpy ride.

FURTHER WORK

The analysis of the role and accompanying report makes clear that there is still the need for greater research on the impact of the enhanced care workers. The scope of the research did not allow for a full evaluation. However, this report, the first to provide a scope of this emerging role in the adult social care sector, provides an analysis of how this new role is emerging in care homes, from the point of view of frontline staff and management.

The full report, Innovate to Alleviate: Exploring how the role of an enhanced care worker could address skills shortages in the social care sector is available to download from ILC-UK's website www.ilcuk.org.uk CMM

Would you be interested in introducing the enhanced care worker role into your organisation? Share your thoughts at www.caremanagementmatters.co.uk Subscription required.

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“The overwhelming response from staff at all levels was that the enhanced care worker role makes a real difference to their organisation and the people they support.”

George Holley-Moore is Research and Policy Manager at International Longevity Centre – UK. Email: GeorgeHolley-Moore@ilcuk.org.uk Twitter: @ILCUK

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CMM July 2016 25

Squaring the unprofitability circle

The care sector is in a financial mess. What's the current situation and is it likely to improve? Nick Hood shares his thoughts.

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Four Seasons first deployed Datix patient safety software in 2010 to replace an in-house developed system, today, Four Seasons uses Datix for incident management, feedback and safety alerts to support resident, colleague and visitor safety across the company’s diversified health and social care operations.

According to Haydn Williams, Datix Manager at Four Seasons Health Care, the results of using Datix have been extremely positive, “Our incident reporting has improved dramatically and we now have over 190,000 incidents and 1,400 compliments recorded in Datix. We have developed a more consistent and altogether faster process for managing complaints and feedback using the software. Complaints are acknowledged within two days of receipt and we maintain a target response time of 20 days to resolve any issues. Datix provides an excellent audit trail, enabling us to track both the number of complaints we receive and show regulators evidence of positive feedback.”

Datix is central to our business. It has rapidly become an intrinsic and strategic part of our overall business operationsSue Goldsmith, Governance and Risk Committee, Four Seasons Healthcare

DTX1000154

Datix has been a global pioneer in the field of patient safety over the past three decades and today is the leading supplier of software for patient safety, risk management, and incident reporting for health care. Datix aims to build and promote a culture of safety within healthcare organisations recruiting professionals who are passionate about improving healthcare and championing technological innovation. Datix continually invests in its software and services maintaining a leadership position at the forefront of the worldwide patient safety movement.

DTX1000154 - Care Home Professional Magazine - 210 x 254.indd 1 02/06/2016 13:40

Nearly three years ago, comprehensive research was published by the financial health monitoring specialists, Company Watch, warning that the UK care home sector was facing a financial crisis.

It identified that almost 30% of the companies, which said that they operated care homes of one sort or another were financially vulnerable and at risk of failure. 14% of all care home operators were in the commercial equivalent of negative

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26 CMM July 2016

equity, with liabilities higher than their assets. For the sector as a whole, the level of borrowing was spectacular, a total just short of £4bn, equivalent to 81% of its overall value.

Back then, the squeeze on fees from the Government’s austerity public spending costs had yet to bite into profits; instead the principal concern was about interest rates. With such extraordinary levels of borrowing, pundits asked what would happen when rates began to return to more normal historic levels. Surely, the sector would be devastated?

This was also two years on from the Southern Cross debacle, when the industry’s biggest player had collapsed and been rescued with a great deal of pushing and shoving by central and local government, panicked by the fear that this was a systemic threat akin to the banking crisis at the start of the global financial downfall. Somehow, the financial lessons of this debacle went unlearnt. The problems at Southern Cross were put down to financial engineering, with florid sale and lease back deals being blamed for saddling the sprawling empire with unsustainable rent charges. Property costs for the homes were trimmed and rescuers were found.

FUNDAMENTAL FLAWS

Unfortunately, little attention was paid to the fundamental flaws in the UK’s residential care home business model. These have since been ruthlessly exposed by the savage reductions in fees paid by local authorities for publicly-funded residents and the inexorable increases in costs such as staffing, arising from a scarcity of nurses and rises, first in the National Minimum Wage and, most recently, the new National Living Wage (NLW). At the same time, a string of scandals, such as Winterbourne View served to ratchet up capital investment requirements as the Care Quality Commission has quite rightly imposed ever-higher care quality standards.

The irony of the Southern Cross rescue was that it opened up the UK market to private equity players, both from the UK and the US, with their aggressive funding techniques. Instead of excessive rents, some of the bigger players now have eye watering interest costs to meet before they

SQUARING THE UNPROFITABILITY CIRCLE

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“The financial profile of the industry is parlous. We can only hope that

the Government is listening to the growing calls for help.”

SQUARING THE UNPROFITABILITY CIRCLE

CMM July 2016 27

What are your thoughts on this? Can you see an end to the financial crisis in social care? Visit www.caremanagementmatters.co.uk to comment. Subscription required.

Nick Hood is the Business Risk Adviser for Opus Business Services. Email: nick.hood@opusllp.com Twitter: @NickHood5

can hope to generate any sort of profit. The recent disclosure by Four Seasons Health Care that its debts exceeded £500m and its annual interest bill was over £50m has lifted the lid on the cesspool of toxic debt, which is swilling around at the heart of the financial plumbing system of the industry. No wonder that two of the world’s leading credit rating agencies are questioning the viability of Four Seasons Health Care, while one of them has also raised similar concerns about another major player, Care UK. Another large operator, Cambian has warned of widening losses for 2015, which have put it at risk of breaching its banking covenants.

GRIM REALITIES

Over the past three years, Company Watch has published more data, which, while showing marginal improvement on some financial measures, has only reinforced the grim realities. Earlier this year, Opus Business Services was commissioned by the BBC to carry out research using the Company Watch methodology to update the picture. The research and accompanying commentary was featured in the You and Yours programme on BBC Radio 4 in early May.

The simple truth is that the UK care sector is in a financial and commercial mess, just at the time when demographic trends mean that very significant extra capacity needs to be created to deal with the looming requirements of the legions of ageing Baby Boomers. The Opus research shows that there is still an abnormally high level (28%) of financially vulnerable care home operators, which means that well over 5,500 homes are at risk of going out of business over the next three years. This figure has risen by 17% in the past two years. Technically insolvent ‘zombie’ companies still abound: 761 (13%) of operators have greater liabilities than their assets.

The average level of profit per care home has fallen to £17,600 before tax. These calculations are based on the

latest published accounts for the 5,871 companies which operate the UK’s 20,000 care homes. As such, this is a backward looking measure, which does not yet take any account of the impact of the NLW, since its introduction last month. Overall, the sector’s annual profits shown by the research totalled £352m. Estimates of the impact of NLW vary up to some £900m per annum, but even if the real figure was only half of that, it would make the entire industry unprofitable. Staff costs, on average, represent some 60% of the cost base, so the NLW is a very significant, but unavoidable, hit on profitability.

GOOD NEWS

Almost the only good news is that the level of borrowing relative to business value has fallen since the first research in 2013. The sector still borrows £4bn, but as asset values have risen, this has reduced the level of gearing to 61%. However, this is still worryingly high for an industry which is struggling to make a profit, even if the threat of interest rate rises has receded.

Some parts of the industry are more viable than others. Anecdotally, nursing care earns a higher return for operators, as does specialist care for certain disabilities.

RESIDENTIAL CARE

Residential care however, has become a commodity, and one for which its biggest customer (local government) is both unable and unwilling to pay an economic price. Operators both large and small are queuing up to complain that they lose money on state-funded residents. The clamour has even reached the point where some are threatening to turn them away, on the basis that they would lose less money that way. Posturing or otherwise, this is a further systemic risk for the care system. There is little doubt that self-funded residents are subsidising their state-funded compatriots, and to a very substantial level, given the latest estimate by LaingBuisson that 60% of residents are funded by local authorities.

How long will they and their relatives put up with this, especially as they are the only way that operators can access more revenue?

RELIEVE THE PRESSURE

Are there other ways in which struggling operators can relieve the pressure? Our experience is that existing funding can sometimes be renegotiated to reduce interest costs and capital repayments, or re-financed more cheaply elsewhere. Equally, it is surprising where operational efficiencies and cost savings can be found. It was interesting that one of the factors cited by Cambian for its increased loss was ‘inefficient cost management’. Some operators are proving that care can be profitable. CareTech may have high debts and a large interest burden of £6.7m, but this and investment costs are well covered by operating cash flow of £27m, according to its latest accounts, and most striking of all, its sales and administration costs are 64% lower than Cambian’s.

Nevertheless, the financial profile of the industry is parlous. We can only hope that the Government is listening to the growing calls for help. If it is not prepared to loosen the purse strings of budget-strapped local authorities, we can only hope that it has a Plan B for the increasing numbers of state-funded residents turned away by operators, and an even more cunning plan for the Armageddon scenario of another Southern Cross-like failure of a major operator. The ability of other operators to absorb such a catastrophe is far more limited than in 2011, and attracting new entrants to the market to plug the gap will be much tougher than it was then.

As for the extra capacity needed for all those Baby Boomers, the only good news is the continued interest of US real estate investors and care specialists in the UK care sector, which they see as offering a higher return than they can earn in their home market. Until the unprofitability circle can be squared, it is difficult to see who else will view this as a market with an acceptable investment risk. CMM

28 CMM July 2016

A recent report from Skills for Care on the National Minimum Data Set for Social Care (NMDS-SC) looked at the situation of registered nurses in adult social care. It found that the average age of a registered nurse in adult social care was 47 years old, and almost a third are aged over 55, so may retire within the next 10 years.

In the same report, Skills for Care estimated that 9% of the registered nurse roles in the adult social care sector were vacant – approximately 4,500 vacancies at any one time. It highlighted the significant pressures on the adult social care nursing workforce. Pressures that, it concluded, will continue in the short- to medium-term. This makes it imperative that adult social care can attract and retain nurses with the right skills and values, to raise and deliver quality and standards for people using social care services.

TEACHING CARE HOMES

Given that the pressures on adult social care nursing are unlikely to ease soon, to address these and to advance care home nursing, a ground-breaking new nurse-led pilot has been launched. It aims to improve the learning environment for staff working in homes, undergraduate nurse apprenticeships and all learning placements in care homes.

‘Care home nursing is seen as the last bastion career by many nurses, these much-maligned and out-dated perceptions need to change if we are to make long-term care nursing an attractive option for the nursing workforce of both

today and tomorrow,’ explained Deborah Sturdy, Visiting Professor at Buckinghamshire New University, who is the Programme Lead for the new Teaching Care Home pilot.

The pilot is a partnership between Care England, the International Longevity Centre – UK, Manchester Metropolitan University’s Department of Nursing, Psychology and Social Care and the Foundation of Nursing Studies. Care England was awarded a grant from the Department of Health to set up five pilot Teaching Care Homes for a one-year programme.

Manchester Metropolitan University’s Department of Nursing, Psychology and Social Care will be working with the teams to develop a framework for a Teaching Care Home. The Foundation of Nursing Studies will then lead a bespoke Caring Cultures programme, that all homes involved in the pilot will participate in. It will have both learning sets and workplace development and homes will be supported by an expert executive coach. The executive coach will assist the home leaders to make changes within their environments to support a culture of learning for all.

Finally, the International Longevity Centre – UK will bring together the findings to evaluate the work and write a final report.

ROLE OF CARE HOMES

The homes participating in the pilot are Lady Sarah Cohen House, run by Jewish Care; Millbrook Lodge operated by The Orders of St John Care Trust; MHA’s Berwick Lodge; Chester Court which is operated by

Barchester Healthcare and HC-One’s Rose Court Care. The homes will develop best practice and learning opportunities that can be rolled out to other organisations that deliver long-term care nursing.

Each participating home will undertake a home-based development project. Ideas being explored include: tapping into the hidden workforce talent to aid the development and transition of non-UK registered nurses working in care homes; enhanced nursing roles to enable nurse prescribing and avoidance of admission; and multi-disciplinary team partnerships with the NHS to create shared care and proactive case management.

WHY IT’S NEEDED

Deborah explained the need for the pilot, ‘We are facing unprecedented difficulties in both recruiting and retaining the workforce. As a result, we need to be actively encouraging undergraduate students to work in long-term care settings. It’s important that we create and support a workforce, who embrace the clinical complexity, diversity of skill and expertise needed to work in a long-term care setting. We need to develop new roles, which support the registered nursing workforce, as well as develop a framework for good undergraduate health learning. By creating a positive, learning, environment for all, we should be able to sustain, retain and develop the current workforce.

‘The sector must demonstrate the potential that long-term nursing has, to be a partner in preparing the future

workforce and build a new narrative, which describes the contribution of this part of the profession. Long-term care nurses have unique skills and knowledge; developing these will help to build a robust foundation for the future.

‘This pilot aims to create real centres of excellence in practice development and learning for nursing students. The Teaching Care Home programme can also provide undergraduate learning for medicine and therapists which is something we will want to explore in the future.’

Care home nursing is not held in the highest regard. However, the role offers a lot of autonomy for a nurse. They lead on their own cases without the distractions that come with acute settings. As such, they offer student nurses and other medical professionals a perfect setting in which to learn, apply their knowledge and take control. This is what the pilot aims to achieve: to create positive learning environments for undergraduate nurses, medical students and therapists to learn, apply that learning and lead with interesting and complex patients. CMM

A new pilot has been launched to set up teaching care homes for training nursing students. It is hoped that it will raise the profile of long-term care nursing and encourage more nurses into the profession. Is it just what is needed to challenge outmoded perceptions?

TEACHING CARE HOMES – RAISING THE STATUS OF NURSING

Will the pilot contribute to raising the profile of long-term care nursing as a proactive career choice? Will it challenge outmoded perceptions? Will it re-energise the workforce and create an environment for learning for all, positive role models and professional sector leaders? What does the panel think?

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CMM July 2016 29

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In its report Managing the supply of NHS clinical staff in England earlier this year, the National Audit Office estimated that there was a shortfall of some 50,000 clinical staff in the NHS. Of this total, the largest shortage – approaching 30,000 – was in nursing staff. So hospitals, community trusts and primary care are all going to be on the look-out to bolster their nursing numbers, especially as patient safety continues to be a key issue.

It follows that anything social care can do to demonstrate its attractiveness as a sector, not only for current nurses, but for those returning to the profession and for people thinking of making it their career, has to be a good thing. And Teaching Care Homes is a very good thing. It’s nurse-led; it’s developmental; and it raises the profile of care homes as an alternative to clinical settings.

Also, we know that wherever

possible, people prefer to be treated in their homes, rather than going into hospital, so this new initiative is very much in-line with the focus on person-centred care at the heart of the Five Year Forward View. Above and beyond the benefits for nursing staff, having this emphasis on learning in care homes can only have a positive impact on care staff, and how they see themselves and their careers.

There are a number of places around the country where lead nurses are funded through the NHS to go into care homes and train staff, so they become more skilled, they can do more for their residents and they start to recognise their own abilities.

Wouldn’t it be great if Teaching Care Homes enabled this to become the norm?

The Teaching Care Homes programme and its pilot certainly have the potential to establish care homes as centres of practice development. The pilots should also showcase care homes as a really worthwhile place to work, for a range of professionals, in both health and social care. Care homes are an essential part of an integrated health and social care system and they have an important role to play in training and developing an integrated workforce.

The biggest challenge to the effectiveness of the project will be a cultural one. Health services have traditionally ignored social careand , worse than that, they have often treated the people who work in social care as second class professionals. This is not helpful given the inter-relating roles of health and social care, and the need to drive integrated ways of working.

Whatever the evidence that comes from the pilots within the

Teaching Care Home Programme, the challenge to its effectiveness will be to make sure it is respected, acknowledged and responded to by the whole system – health and social care.

Care homes and care homes with nursing deal with, and support, people who have very complex needs. This means that in these settings, health and care professionals can have a real opportunity to develop skills and to use their professional judgement to make a difference to people’s lives.

I hope the Teaching Care Homes Programme will graphically show this and herald a new era of mutual respect and truly integrated working. I hope the programme becomes an important part of developing 21st century services that cross the continuum between health and social care.Sharon Blackburn CBE RGN RMN Policy and Communications Director,

National Care Forum Professor Martin Green OBE Chief Executive, Care England

Debbie Sorkin National Director of Systems Leadership, The Leadership Centre

This is an important pilot study. The value and contribution of nurses working in adult social care has long been overlooked and under-estimated.

People residing in care homes live with multiple long-term conditions requiring skill and expertise. Nurses in care homes have to demonstrate a breadth and depth of clinical skills set in the context of relationship-centred care. The person who lives in the care home and their families are central to all that takes place.

These pilots have the potential to contribute to changing the perceptions and image of what happens in a care home. It is a myth that student nurses do not care for older people, as they form the largest group of people needing acute hospital care.

The care home provides an ideal place to gain important skills and knowledge in the care of older people and in long-term conditions.

The care sector has many excellent role models.

This pilot study has the potential to contribute significantly to how nurses working in care homes are perceived. It will also contribute to new ways of working and new roles for nurses.

Nurses working in a care home are part of a nursing and care team providing 24-hour care. They are the lead clinician. They do not have other medical or clinical support immediately to hand. The opportunity to manage and co-ordinate care is immense. The long-term conditions of people living in care settings are not always stable and predictable, meaning that the scope for nurses to learn to manage this complexity is immense and will underpin their future career development.

30 CMM July 2016

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Read about Paula’s typical day on the website www.caremanagementmatters.co.uk Subscription required.A V

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REFLECTIONS ON THE LAST DECADEThe last few years have tested the sector’s resilience and creativity. Austerity, a shortage of nurses, the paucity of skilled managers, a more rigorous regulatory regime and the increased dependency of people using our services have all affected how we operate and deliver kind care.

Our own history sets out the challenges. Born out of the demise of Southern Cross, HC-One’s early years have been shaped by the sector’s challenges. We are a spirited bunch, however, and I’d like to think that we have faced these head on and found new ways of working and creative ways to do what we do best every day.

The challenge of developing a skilled, aligned workforce is not new, but we have had to be ever more innovative. To do this well, it has demanded speed and agility to ensure that developments such as the Care Certificate are incorporated into our learning programme quickly and effectively. As resident needs have increased, alongside workforce challenges, we’ve had to find new ways to measure and manage clinical risk. We’ve developed a set of key clinical indicators to see trends and risks in pressure area management, weight management, infection control and medicines management etc.

It is all too easy to become distracted by challenges and be overwhelmed by the volume and necessity for change. Remembering why I do this job and what

brought me to this sector always focuses me on what I need to do. We work hard at putting the resident at the centre of what we do and living up to our ambition to deliver the kindest care possible.

PROJECTIONS FOR THE NEXT DECADEThe challenges will continue. We’ve only just started to see the impact of the National Living Wage (NLW). This will require a reshape of what we do and how we do it. Our staff deserve to be rewarded appropriately for the valuable role they play and I agree wholeheartedly with the NLW to help us do this. The reality of applying this however, given the continued squeeze on fees, is tough. We need to work harder to highlight to Government these realities, and the consequences if we cannot find a way through the dilemma of a fair fee for care.

That said, there is so much opportunity for us to work in true partnership with health, to create a better way for clients. This is the biggest challenge ahead of us. If we can work through this, we have an opportunity to create a better way to support people when they need it most.

INSIGHTI started working as a retail pharmacist and discovered a passion for customer service that shaped my career. My retail roots taught me the value and importance of an eye for detail and the need for continual focus and follow up. These core

operational skills were drummed into me and I’m grateful for how they’ve served me.

INFLUENCESMy dad once told me to work hard and believe. I’ve been lucky to work with great people. An old boss once taught me the value of staying close to the sharp end of the business. I hold this dear and make sure that I take time to visit homes, talk to residents and meet staff teams. My current boss has been equally influential. He has reminded me about the power of kindness.

LESSONSI am privileged to visit homes, meet teams and residents. I see great homes and, from time to time, homes that need to do more to deliver the kind care we aspire to. The difference is always the manager. A great manager sets the context, leads the way and has a real grip on their business. They know residents, value staff and develop relationships with commissioners. Great managers are busy, organised and focused. But they are never too busy to stop, care and be kind. A great manager makes for a great home and a happy place to live.

ADVICEI have been given some advice that has stood me in good stead. Do what you say you will do. Never over promise and under-deliver. To deliver a great service, be visible, listen hard and act quickly. CMM

P A U L A K E Y SPaula Keys is Managing Director of HC-One.

32 CMM July 2016

SUPPORTING registered managers

CMM July 2016 33

Georgina Turner explores some of the ways that registered managers can access support or contribute to the development of others and looks at some of the tools available to help them manage and deliver great care.

Registered managers in social care frequently describe their role as rewarding and fulfilling; and we know it is a career that people choose because of a strong desire to care for people and improve their lives.

We also know that, just like leaders in any industry, if you’re a registered manager in social care, it’s important that you give yourself time to consider the support you need as an individual, because how you manage yourself shapes how you lead others.

Strong and supported leaders are pivotal to the provision of high-quality services and person-centred care. There are 22,200 registered managers in England and, with approximately 50% of managers reaching retirement age in the next 10 to 15 years, it is vital that we create a supportive environment for people stepping into the post.

There are lots of ways registered managers can get the support they need to take care of their staff and deliver good quality care. There are also many different ways that managers can get involved in supporting their peers – the skills, knowledge and values that make great leaders all exist within the sector.

LOCAL NETWORKS

Registered managers often report feeling isolated – a busy, multifaceted role is exciting and rewarding, but can accentuate this feeling. The role is unique, high pressured and full of responsibility.

For registered managers at any point in their career, joining a network has significant benefits. A recent evaluation of local networks, led by registered managers and supported by Skills for Care, found that attendees reported feeling more supported in their role and that networks allowed them to acquire additional skills and knowledge.

‘The most positive outcome of the networks has been learning from other providers and their experience in things like Care Quality Commission

inspections, what has worked in terms of recruitment and new ideas.’ – Registered manager.

For new managers, networks may provide a safe-space to discuss issues or questions; for experienced managers it might be an opportunity to share knowledge or hear new ideas. No matter how long a registered manager has been in post, speaking to people in the same role is a great way to reflect, challenge themselves and learn.

When we asked registered managers about what they got from their local network, they told us:

‘As a manager of a small, independent home, it is extremely helpful to be part of the network, as I gain invaluable knowledge from other managers and those from organisations who attend to offer information, saving me precious time and resources.’ – Registered manager.

‘It has been an essential support network to me and has been effective in engaging with, and influencing, key stakeholders.’ – Registered manager.

There are over 120 networks in England – these are led by registered managers and supported by Skills for Care. Networks are free to attend and focus on providing topical and useful information, peer support and building links with local stakeholders.

MENTORING

Choosing to become a mentor or a mentee provides a fantastic opportunity to share and learn new key skills, knowledge and experience. It is a partnership between two people and a good mentor will motivate, encourage, support, empower, nurture self-confidence, aid reflection and explore strengths and weaknesses.

Being mentored can boost morale and confidence, and can be of considerable value in supporting continued professional development. Being a mentor can help people to reflect and

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Have you used any of these tools? Share your thoughts at www.caremanagementmatters.co.uk Subscription required.

34 CMM July 2016

SUPPORTING REGISTERED MANAGERS

improve practice and is known to improve job satisfaction; it also provides tangible skills in listening and giving feedback.

Mentoring is built around the mentor supporting their mentee to move forward, by taking ownership of the solution to a specific situation; it is about focused, positive and proactive support – and whilst many people think it is about solving problems, it is also about developing opportunities. The relationship between mentor and mentee is non-judgemental and built on confidentiality, allowing an appreciation of different perspectives.

Registered managers in some organisations may already have access to a mentoring programme or mentoring might be available via a local network.

Alternatively, access to mentoring is a central part of the National Skills Academy (NSA) for Social Care’s registered manager membership package, which includes the sourcing and placement of dedicated mentors. Not only can people find a mentor via membership, but those registered managers interested in supporting others have the opportunity to train as mentors.

EXPLORE MANAGEMENT STYLE

Local networks and mentoring both provide opportunities for reflection. Making time to reflect on their practice, either individually or as part of a support programme, allows registered managers the space and time to think about how they do things, including asking themselves, ‘is the way I work encouraging my staff to perform to the best of their abilities; could I do something differently?’

For registered managers to know where they have strong skills gives them the opportunity to develop the positive aspects of their work. However, it’s also important for them to identify where they might need to improve their approach or strategy. In both cases, having some clear and tangible baselines available can help.

The Leadership Qualities Framework (LQF) is a comprehensive guide, specific to managers and leaders in adult social care, based around the building blocks of leadership; these are referred to as the seven ‘dimensions’ of the LQF.

The LQF gives practical examples of what good leadership looks like against each of these dimensions (with each broken into four bite-size ‘elements’) at leadership levels from frontline worker through to registered manager

or strategic leader. A manager can use the elements relevant

to them to reflect individually on practice, or in discussion with their staff, to gain feedback on their management style. This may also be useful if managers have responsibility for growing new leaders within their organisation.

It is important that all managers make time for reflection – either as a standalone activity or as part of their own supervision or review meetings. Remember, the best leaders reflect on their own needs as well as on those of their staff.

MANAGING AND DELIVERING GREAT CARE

Reflection is only one part of developing a management style and, in turn, improving quality or driving change in an organisation. There are also many different tools available to help you manage and deliver quality care. • Signing-up to the Social Care Commitment

enables employers and employees to choose from a number of tasks designed to help improve services. It’s a great tool for embedding what staff should be doing on an everyday basis and demonstrates commitment to supporting and developing staff.

• The People Performance Management toolkit is a free tool which managers can use to help with the everyday management of their staff. It contains information such as how to discuss a drop in performance with a staff member or how to conduct a formal performance review.

• Knowing what is best practice is vital for registered managers. Skills for Care has published Common Core Principles to support the development of people working in care on a range of topics. These include: Dignity, Equality and diversity, Dementia care and End of Life Care.

• As leaders, registered managers have a key role in setting a service or organisation’s shared values, norms and expectations. The Culture toolkit, developed by Skills for Care, provides activity sheets and good practice examples to embed a positive workplace culture.

NATIONAL SKILLS ACADEMY

As well as ensuring that support is available to all registered managers, it is vital to assert the value of the role; ensuring it has the status and profile it deserves. No other role impacts so fundamentally, both on people in need of care and support, and the way the adult social care sector is regarded by the public.

Skills for Care recommends that all registered managers become members of the National Skills Academy (NSA) for Social Care. Hosted by Skills for Care, it is the membership body for registered managers in England.

Managers in every industry perform to their best when they have the support and assistance they need available to them. The resources in this article should help managers to develop themselves and their staff, and deliver great care. CMM

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Georgina Turner is Programme Head – Employer Engagement at Skills for Care. Email: georgina.turner@skillsforcare.org.uk Twitter: @SkillsforCare

FURTHER RESOURCES Registered Managers Resources – www.skillsforcare.org.uk/registeredmanagers

Registered Manager Networks – www.skillsforcare.org.uk/networks

Registered Managers Membership – www.skillsforcare.org.uk/membership

Management Tools – www.skillsforcare.org.uk/managementtools

The Social Care Commitment – www.thesocialcarecommitment.com

People Performance Management Toolkit – www.skillsforcare.org.uk/Leadership-management/People-Performance-Management/People-Performance-Management-Toolkit.aspx

Core Common Principles – www.skillsforcare.org.uk/Learning-development/Common-core-principles/Common-core-principles.aspx

Culture Toolkit – www.skillsforcare.org.uk/Leadership-management/Registered-managers/Your-management-tools.aspx

National Skills Academy for Social Care – www.skillsforcare.org.uk/membership

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CQC’s new inspection model

Expertise secures first franchise

Care Homes Trading Performance

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End-of-life care delivery could be improved

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Councils advised about care charging

Support grows for care farm

Continued rise DOL applications

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Integration in practice

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A view from the top

30 CMM February 2015

The LNT Group’s Founding Chairman, Lawrence Tomlinson, has been a vocal advocate for the need for sensible financing in business since the credit crunch. As one of two Entrepreneurs in Residence at the Department for Business, Innovation and Skills, he published an independent report in November 2013 which looked into bank lending practices and how certain banks deal with businesses in distress. In April 2013, the Group had negotiated a £100 million refinancing of the business with a collective of banks. With that up for renewal in September 2014, the Group has announced a £51 million debt facility with L&G Capital. As the insurer looks to increase its involvement in the care sector, is this the future of financing?

LNT GROUPThe LNT Group, chaired by British entrepreneur Lawrence Tomlinson, includes a number of different, and far-reaching companies including the care sector focused Ideal Carehomes, LNT Construction and LNT Software, plus LNT Solutions and Ginetta Cars.

Ideal Carehomes is a care home operator, offering high quality services for older people without any third party top ups. Its homes are mainly across the UK and are designed and developed to be future-proof.

LNT Construction designs and builds care homes, not only for Ideal Carehomes but for third parties too including Anchor, Avery, Sanctuary and Nugent Care. Having built 52 care homes since 2009, with 36 being run by Ideal Carehomes, it offers providers turnkey solutions and is currently working on developments in the south and Home Counties.

The third care-focused company in

the Group is LNT Software, an integral care sector software package.

REFINANCINGIn April 2013, the Group finalised a £100 million refinancing, though the process was not straight forward. At the time, Lawrence Tomlinson was quoted as saying the deal had taken two to three years to come together, involved four different banks and had ‘issues’. He named Santander and Yorkshire and Clydesdale Banks in the process, plus it’s reported that RBS and Bank Leumi were also involved. Mr Tomlinson went on to say that the amount of paperwork involved was ‘phenomenal’ and that the whole process was ‘complicated’.

He has, however, given very positive feedback about several of the banking partners involved in the 2013 refinance. He told CMM, ‘Whilst there were complexities in the 2013 refinance which were costly, and at times challenging, it met our finance needs for 2013 to 14. I found Santander and Yorkshire Bank particularly helpful throughout the past year, and Leumi continue to be a key partner in enabling our care home developments.’ After all this, the deal would have needed to have been renegotiated in September 2014.

With renegotiation on the horizon, LNT Group has just announced a £51 million debt refinancing with L&G Capital. L&G Capital is a new business line created by Legal and General to provide five key functions: direct investments; implementing the investment strategy across the balance sheet; managing the Group’s Shareholder Funds investments and managing the Group’s debt and liquidity. One of the drivers behind

the business is the slowdown of bank lending which is leading to a shortage of investment capital. This has led the organisation to focus on replacing bank and Government capital with long-term institutional debt or equity funding, as it has done with LNT.

L&G DEALThe deal between LNT Group and L&G Capital, which was announced in mid-May, is a £51 million debt facility, over ten years, to LNT Group incorporating all its subsidiaries. It is secured against the Group’s portfolio of care homes and will give the company the ability to move forward with building a sustainable and growing build pipeline of new care homes. Mr Tomlinson explained the drivers behind the deal with L&G Capital, ‘Our decision to take a debt facility from Legal and General was largely driven by the offer of long-term finance and their understanding of our business model which we believe paves the way for a fruitful partnership for the future.’

Alex Gipson, Lending Manager at Legal and General, said, ‘Organisations that hold enduring business models and that, therefore, operate and plan over medium- to long-term horizons are clearly better matched to external capital that operates over similar long-term durations. For this reason, the financing needs of LNT’s Ideal Carehome business provides a very natural fit with Legal & General’s long-dated pension and annuity liabilities and we expect increasing opportunities in sectors such as the care home market, supporting organisations committed to delivery of long term solutions to meet increasing demand.’

It’s not L&G’s first investment in the care home sector. It acquired 13 care homes from MHA for just over £70 million in December 2013 and it forward funded and purchased five care homes in Suffolk with Care UK for £31 million. These were funded on behalf of Legal and General Property’s Managed Property Fund.

TARGET HEALTHCARE REITOn the same day as the L&G Capital announcement, Target Healthcare REIT Ltd announced that it had acquired a portfolio of three homes from Ideal Carehomes for approximately £13.9 million. These have been leased back to the operator for 35 years. The announcement comes just a month after Target Healthcare REIT acquired two other Ideal Carehomes, the first for £3.8 million and another, due for completion in summer 2014, for £5.1 million. In 2013, Target Healthcare REIT also acquired homes from Ideal Carehomes in September for £4 million and £18 million for four homes in March. CMM

Does a new 10-year deal between L&G Capital and LNT Group, owner of Ideal Carehomes, signal a change in care sector financing?

LNT’S INSTITUTIONAL INVESTOR - THE FUTURE OF FINANCE?

Given the tough nature of the bank finance market, highlighted by the ‘issues’ faced by LNT in 2013, do these new financing options mark the future for care sector financing? Are more providers going to have to look farther afield than the traditional banks to access finance? Will we see more organisations such as L&G begin to meet the needs of the market, not necessarily being met by the traditional banks? Is this the changing face of care sector finance? What does our panel think?

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Ablution Revolution?

Ablution Revolution?A Comprehensive Research Study into Wetroom Provision in UK Care Homes

It is said that, apart from death and taxes, the only certainty in life is change - a truism, for sure, but one that warrants some reflection when we consider how society thinks about the way we care for our older people, and particularly in relation to residential settings.

Before launching into the research I’d like to draw comparisons with the hotel and guesthouse sector. It’s not that long ago that ensuite bathrooms in hotels and guesthouses were a dream for the future. Today, it’s as standard as the beds in the room.

Residential care for older people though might not be keeping up with the ablution revolution, which was our starting point in deciding that there needed to be some in-depth work to establish the current position.

We embarked upon a thorough and extensive research project, carrying out a comprehensive survey over six months involving more than 6,000 telephone interviews. It reveals a very interesting picture. The research includes data from the whole of the UK and comprises information from private, not-for-profit, local authority and some NHS care homes.

Where we were unable to contact a care home directly, we made a number of assumptions based on data from other sources including the A-Z Care Homes Guide and the Care Quality Commission. The principles of what we did and why are relatively easy to convey. The detail, however, is trickier and, unless you are a stats lover, a little less inspiring.

Definitions

For the purpose of this research, we describe an ensuite bedroom as one where there is at least a WC and wash hand basin. Such a room may also provide, though this is not a requirement for the purposes of our definition, a shower cubicle, bath or wetroom.

By contrast, our definition of a bedroom with an ensuite wetroom is one where there is a full wetroom, i.e. a walk-in shower complete with level access as well as the WC and wash hand basin. In effect, this is a subset of the ensuite bedroom provision – simply characterised by a higher level of facility.

Headline results

We know that care homes aren’t keeping pace with the rate of change witnessed in hotel stock, however, although we knew that provision was more limited, the findings have shown an even bigger gap in provision than anticipated.

Ben Hartley analyses the provision of ensuites and wetrooms in UK care homes and draws some interesting conclusions.

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11.30 - 16.30www.3rdsectorcareawards.co.uk

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Wednesday 9th December 2015

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Book your tickets now!

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CMM July 2016 37

According to the Office for National Statistics, over 290,000 older people in the UK live in care homes – a figure expected to rise as the proportion of the population over 65 continues to grow. Recent studies also show that the number of people living with dementia in the UK will increase from 800,000 to 1.7 million in the next 40 years.

With that in mind, The Orders of St John Care Trust (OSJCT) undertook a project to develop an updated All About Me life story document that would allow care teams across its 68 care homes to deliver a higher level of person-centred care, whilst also contributing to the Trust’s compliance with Regulation 9 of the Health and Social Care Act 2008.

WHAT IS A LIFE STORY DOCUMENT?

According to Dementia UK, a life story document is a comprehensive biography about a person, created following conversations with the individual, their family members and friends. These are used to better understand each person. This, in turn, can enhance communication and the ability for carers to meet individual needs more effectively, as well as help those with dementia reduce stress and anxiety, and maintain a sense of self.

Life story documents come in all shapes and sizes. For instance, OSJCT’s updated All About Me life story document is a detailed scrapbook

>

All About Methe benef its

of life storydocuments

Mark Howard, Angie Williams, Andrea Bentley and Dawn Elmore overview the development of The Orders of St John Care Trust's updated All About Me life story document, its benef its and case studies about how it has been put to use to assist care teams across the organisation.

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ENHANCING CARE IN CARE HOMESSocial care leads new models

National Living Wage

Resource Finder

Revalidation

An opportunity for recruitment

Training providers

Providers’ role in new requirements

Includes Miele Professional 4-page company profile

APRIL 2016 £4.00 www.caremanagementmatters.co.ukHOME NEWS FEATURES EVENTS SUBSCRIBE ABOUT US CONTACT

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FOLLOW USCongratulations @DesKellyOBE @NCFCareForum for your continued support of @skillsforcare as a valuable Board member! Oct 17

BESPOKE EDITORIAL, NEWS, OPINION AND BEST PRACTICE INFORMATION

F i n d i n g y o u t h e s o l u t i o n s s i n c e 2 0 0 3 .

F i n d i n g y o u t h e s o l u t i o n s s i n c e 2 0 0 3 .

News

CQC’s new inspection model

Expertise secures first franchise

Care Homes Trading Performance

SureCare rolls out first micro franchise

End-of-life care delivery could be improved

Craegmoor’s new autism service

Councils advised about care charging

Support grows for care farm

Continued rise DOL applications

Fourth Signature contract for GB Building Solutions

Read more

Read more

Read more

Read more

Read more

Read more

Read more

Read more

Read more

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November 2014 October 2014 September 2014 July 2014 June 2014 May 2014

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FOLLOW USCongratulations @DesKellyOBE @NCFCareForum for your continued support of @skillsforcare as a valuable Board member! Oct 17

BESPOKE EDITORIAL, NEWS, OPINION AND BEST PRACTICE INFORMATION

FEATURES

Ablution Revolution?

Integration in practice

Better domiciliary care Who’s who... recruitment

Right to work

Features

A view from the top

30 CMM February 2015

The LNT Group’s Founding Chairman, Lawrence Tomlinson, has been a vocal advocate for the need for sensible financing in business since the credit crunch. As one of two Entrepreneurs in Residence at the Department for Business, Innovation and Skills, he published an independent report in November 2013 which looked into bank lending practices and how certain banks deal with businesses in distress. In April 2013, the Group had negotiated a £100 million refinancing of the business with a collective of banks. With that up for renewal in September 2014, the Group has announced a £51 million debt facility with L&G Capital. As the insurer looks to increase its involvement in the care sector, is this the future of financing?

LNT GROUPThe LNT Group, chaired by British entrepreneur Lawrence Tomlinson, includes a number of different, and far-reaching companies including the care sector focused Ideal Carehomes, LNT Construction and LNT Software, plus LNT Solutions and Ginetta Cars.

Ideal Carehomes is a care home operator, offering high quality services for older people without any third party top ups. Its homes are mainly across the UK and are designed and developed to be future-proof.

LNT Construction designs and builds care homes, not only for Ideal Carehomes but for third parties too including Anchor, Avery, Sanctuary and Nugent Care. Having built 52 care homes since 2009, with 36 being run by Ideal Carehomes, it offers providers turnkey solutions and is currently working on developments in the south and Home Counties.

The third care-focused company in

the Group is LNT Software, an integral care sector software package.

REFINANCINGIn April 2013, the Group finalised a £100 million refinancing, though the process was not straight forward. At the time, Lawrence Tomlinson was quoted as saying the deal had taken two to three years to come together, involved four different banks and had ‘issues’. He named Santander and Yorkshire and Clydesdale Banks in the process, plus it’s reported that RBS and Bank Leumi were also involved. Mr Tomlinson went on to say that the amount of paperwork involved was ‘phenomenal’ and that the whole process was ‘complicated’.

He has, however, given very positive feedback about several of the banking partners involved in the 2013 refinance. He told CMM, ‘Whilst there were complexities in the 2013 refinance which were costly, and at times challenging, it met our finance needs for 2013 to 14. I found Santander and Yorkshire Bank particularly helpful throughout the past year, and Leumi continue to be a key partner in enabling our care home developments.’ After all this, the deal would have needed to have been renegotiated in September 2014.

With renegotiation on the horizon, LNT Group has just announced a £51 million debt refinancing with L&G Capital. L&G Capital is a new business line created by Legal and General to provide five key functions: direct investments; implementing the investment strategy across the balance sheet; managing the Group’s Shareholder Funds investments and managing the Group’s debt and liquidity. One of the drivers behind

the business is the slowdown of bank lending which is leading to a shortage of investment capital. This has led the organisation to focus on replacing bank and Government capital with long-term institutional debt or equity funding, as it has done with LNT.

L&G DEALThe deal between LNT Group and L&G Capital, which was announced in mid-May, is a £51 million debt facility, over ten years, to LNT Group incorporating all its subsidiaries. It is secured against the Group’s portfolio of care homes and will give the company the ability to move forward with building a sustainable and growing build pipeline of new care homes. Mr Tomlinson explained the drivers behind the deal with L&G Capital, ‘Our decision to take a debt facility from Legal and General was largely driven by the offer of long-term finance and their understanding of our business model which we believe paves the way for a fruitful partnership for the future.’

Alex Gipson, Lending Manager at Legal and General, said, ‘Organisations that hold enduring business models and that, therefore, operate and plan over medium- to long-term horizons are clearly better matched to external capital that operates over similar long-term durations. For this reason, the financing needs of LNT’s Ideal Carehome business provides a very natural fit with Legal & General’s long-dated pension and annuity liabilities and we expect increasing opportunities in sectors such as the care home market, supporting organisations committed to delivery of long term solutions to meet increasing demand.’

It’s not L&G’s first investment in the care home sector. It acquired 13 care homes from MHA for just over £70 million in December 2013 and it forward funded and purchased five care homes in Suffolk with Care UK for £31 million. These were funded on behalf of Legal and General Property’s Managed Property Fund.

TARGET HEALTHCARE REITOn the same day as the L&G Capital announcement, Target Healthcare REIT Ltd announced that it had acquired a portfolio of three homes from Ideal Carehomes for approximately £13.9 million. These have been leased back to the operator for 35 years. The announcement comes just a month after Target Healthcare REIT acquired two other Ideal Carehomes, the first for £3.8 million and another, due for completion in summer 2014, for £5.1 million. In 2013, Target Healthcare REIT also acquired homes from Ideal Carehomes in September for £4 million and £18 million for four homes in March. CMM

Does a new 10-year deal between L&G Capital and LNT Group, owner of Ideal Carehomes, signal a change in care sector financing?

LNT’S INSTITUTIONAL INVESTOR - THE FUTURE OF FINANCE?

Given the tough nature of the bank finance market, highlighted by the ‘issues’ faced by LNT in 2013, do these new financing options mark the future for care sector financing? Are more providers going to have to look farther afield than the traditional banks to access finance? Will we see more organisations such as L&G begin to meet the needs of the market, not necessarily being met by the traditional banks? Is this the changing face of care sector finance? What does our panel think?

OVER TO THE EXPERTS...

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3G 4:08 PM

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Designed by Evan Ho�buhr

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FOLLOW USCongratulations @DesKellyOBE @NCFCareForum for your continued support of @skillsforcare as a valuable Board member! Oct 17

BESPOKE EDITORIAL, NEWS, OPINION AND BEST PRACTICE INFORMATION

FEATURES

Ablution Revolution?

Ablution Revolution?A Comprehensive Research Study into Wetroom Provision in UK Care Homes

It is said that, apart from death and taxes, the only certainty in life is change - a truism, for sure, but one that warrants some reflection when we consider how society thinks about the way we care for our older people, and particularly in relation to residential settings.

Before launching into the research I’d like to draw comparisons with the hotel and guesthouse sector. It’s not that long ago that ensuite bathrooms in hotels and guesthouses were a dream for the future. Today, it’s as standard as the beds in the room.

Residential care for older people though might not be keeping up with the ablution revolution, which was our starting point in deciding that there needed to be some in-depth work to establish the current position.

We embarked upon a thorough and extensive research project, carrying out a comprehensive survey over six months involving more than 6,000 telephone interviews. It reveals a very interesting picture. The research includes data from the whole of the UK and comprises information from private, not-for-profit, local authority and some NHS care homes.

Where we were unable to contact a care home directly, we made a number of assumptions based on data from other sources including the A-Z Care Homes Guide and the Care Quality Commission. The principles of what we did and why are relatively easy to convey. The detail, however, is trickier and, unless you are a stats lover, a little less inspiring.

Definitions

For the purpose of this research, we describe an ensuite bedroom as one where there is at least a WC and wash hand basin. Such a room may also provide, though this is not a requirement for the purposes of our definition, a shower cubicle, bath or wetroom.

By contrast, our definition of a bedroom with an ensuite wetroom is one where there is a full wetroom, i.e. a walk-in shower complete with level access as well as the WC and wash hand basin. In effect, this is a subset of the ensuite bedroom provision – simply characterised by a higher level of facility.

Headline results

We know that care homes aren’t keeping pace with the rate of change witnessed in hotel stock, however, although we knew that provision was more limited, the findings have shown an even bigger gap in provision than anticipated.

Ben Hartley analyses the provision of ensuites and wetrooms in UK care homes and draws some interesting conclusions.

Print this article98 SHARES

Add your comment

JAMES SMITH OCTOBER 20TH 2014 4:55PM

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Maecenas enim tellus, dignissim sed ullamcorper vel, pretium quis nisi. Quisque dolor elit, rutrum eget maximus nec, placerat cursus libero. Phasellus sit amet dui in metus pellentesque mattis. Integer vestibulum urna consequat nulla scelerisque, et porttitor urna suscipit.

HELEN MCKENNA OCTOBER 17TH 2014 2:47PM

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Maecenas enim tellus, dignissim sed ullamcorper vel, pretium quis nisi. Quisque dolor elit, rutrum eget maximus nec, placerat cursus libero. Phasellus sit amet dui in metus pellentesque mattis. Integer vestibulum urna consequat nulla scelerisque, et porttitor urna suscipit.

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Wednesday 9th December 2015

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Wednesday 9th December 2015

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Book your tickets now!

Wednesday 9th December 2015

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Book your tickets now!

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38 CMM July 2016

outlining each resident’s past, including family details, former occupations and hobbies, likes and dislikes, photographs and other personal information. This document acts as the cornerstone of the OSJCT’s resident assessment process and relationship-centred care approach.

DEVELOPING A MORE PERSON-CENTRED DOCUMENT

In 2013, OSJCT’s St John Admiral Nurses were asked to lead a project to review OSJCT’s current use of its life story document, which had been in place for nearly 10 years. Because there was very little commitment or awareness about its benefits, the team was also tasked with developing an updated, user-friendly document, in addition to training carers and management on how it could be used to improve the care of residents.

To gain insight, a series of workshops was held with nearly 80 dementia leads from OSJCT’s care homes. Feedback included condensing the number of sections focused on the past and past events, and utilising a scrapbook layout for the new version, in place of a design that required a signature and date of entry on each page and had no pictures or colour.

Several new sections, focusing on ‘the now’ for residents, were also added to the document. These included pages focusing on how individuals like to spend their time, what makes them happy, how they communicate and the people and things that are important to them, in addition to a page relating to end of life care wishes.

Once completed, OSJCT’s home managers were introduced to the new document through a series of interactive sessions. The finished product was then rolled out across all OSJCT care homes at the end of 2013 and throughout 2014.

BENEFITS OF AN UPDATED LIFE STORY TEMPLATE

The primary benefit of more person-centred life story documents is that they encourage and enable a higher level of person-centred care to be used. For example, OSJCT has found that assisting residents with completing their All About Me scrapbook is a very valuable and meaningful activity for employees, residents and also family members.

The information from life story biographies can also be used to support interventions when the Best Interest Summary document is used. By doing this, care workers can demonstrate that care being provided during times when a person struggles to make simple day-to-day decisions has been based on recorded knowledge of their previous likes and dislikes.

Care providers should use life story documents to shape care plans. In the case of OSJCT, St John Admiral Nurses felt it was important that care colleagues completing the life story document were able to make links to care plans, so included a set of prompts to achieve this. For example, reminders were added to the ‘How I like to spend my time’, ‘Are there things that you particularly enjoy in life that you would hate to lose?’ and ‘What makes me happy’ pages, referencing the relevant care plans that should reflect the information on that particular page.

SUCCESS STORIES

Below are two examples of how this type of document can be updated and

utilised to enhance the level of care residents receive, as provided by one of the OSJCT’s St John Admiral Nurses.

A gentleman living in one of OSJCT’s Wiltshire care homes was finding it very difficult to understand and would resist care staff when they tried to assist him with his personal care. The care team soon learned from his sister that the gentleman’s wife used to lay his clothing out on the bed for him, run the shower and prompt him to get undressed and into the shower each day. The care staff tried this approach and found that the gentleman was able to shower and change independently and without distress – he only needed the correct prompts. As a result, this information was added to his life story document, so all care staff working with him could read, understand and adapt to his behaviour.

A lady living at one of the Trust’s Gloucestershire care facilities would regularly become very unsettled after teatime, walking around, asking for her coat and trying to open outside doors to ‘go to work’. The home’s care team eventually found out that, when she was younger, the woman had worked evenings in a pub for a number of years. Bearing this in mind, the care team began inviting her to help gather the plates and glasses and wash up after tea, a routine that fitted in with what she had done for many years in her previous role. As a result, she became more settled in the evenings, knowing she had completed her job. Her life story document was updated accordingly to reflect this information about her past and her behaviours, to help other members of the home’s care team better understand and work with the resident.

EMBEDDING THE DOCUMENTS

Despite finding that the completion of all-new life story documents was not a major day-to-day priority, over 70% of the Trust’s residents now have their own All About Me scrapbook.

Various strategies have been used to better integrate the new document into each home’s culture and everyday routine, including home manager workshops and an Introduction to the All About Me Life Story leaflet created to raise awareness about the document and inform families and employees about its many benefits.

Further All About Me life story workshops are still being facilitated by the St John Admiral Nurses across OSJCT homes, in addition to many homes holding life story-themed coffee mornings or afternoon tea sessions, where residents can bring their life story with them and add photographs from the recent activities or events that have taken place.

MANY BENEFITS

OSJCT’s development and success with the new All About Me life story document demonstrates that engaging with residents and their families to record memories and past experiences can not only improve the quality of person-centred care that employees provide by offering valuable insight into residents’ behaviours, but can also build and enhance relationships.

With individualised care at the forefront of the industry, life story work provides a valuable template which, when used with other tactics, can truly assist care homes with providing uniquely tailored care and support to each client. CMM

ALL ABOUT ME – THE BENEFITS OF LIFE STORY DOCUMENTS

Do you use life story planning documents? Share your experiences at www.caremanagementmatters.co.uk Subscription required.

Mark Howard, Angie Williams and Andrea Bentley are St John Admiral Nurses at The Orders of St John Care Trust. Dawn Elmore is a Care Performance Analyst at The Orders of St John Care Trust. Emails: m.howard@osjct.co.uk, a.bentley@osjct.co.uk, d.elmore@osjct.co.uk, a.williams@osjct.co.uk Twitter: @OSJCT

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42 CMM July 2016

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Training PackInfection Prevention and Control in the Care Home

© BVS Training Ltd. Permission is given to photocopy for training purposes only when product is purchased. Page 1

Page 1 How to use this Training PackPage 1 Trainer Introduction NotesPages 1-2 Bibliography and WebsitesPage 2 ToolsPage 2 Aims and ObjectivesPage 3 Compatibility with Induction and QCF UnitsPage 3 CPD AccreditationPages 3-8 Lesson PlanPage 8 Training Evaluation

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BibliographyDH (2009) Health and Social Care Act 2008DH (2008) Health Care Act 2006: Code of PracticeDH (2007) Essential Steps to safe, clean careNICE (2003) Infection control: prevention of healthcare-associated infection in primary and community care. Available on line at: http://www.nice.org.uk

Contents

How to use this Training Pack

Trainer Introduction Notes

Bibliography and Websites

Training PackInfection Prevention and Control in the Care Home

©BVS Training Ltd. Permission is given to photocopy for training purposes only when product is purchased.

WASTe MANAGeMeNT - UNDerSTANDiNG SeGreGATiONQUicK reFereNce GUiDe TO cOlOUr cODiNG

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WASTE MANAGEMENTUnderstanding segregation

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Waste requiring disposal by incineration in a suitably licensed facility.

Waste which may be ‘treated’ or ‘rendered’ safe in a suitably licensed facility. May also be disposed of by incineration.

Cytotoxic and cytostatic waste requiring disposal by incineration in a licensed facility.

Offensive hygiene waste requiring disposal to a licensed landfill site.This waste should not be compacted.

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Colour Description

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CMM July 2016 43

Cooper Healthcare LtdTel: 07837 335545Email: samantha@cooper-healthcare.comWebsite: www.cooper-healthcare.com

SECTORS

• Elderly care.• Specialist mental health facilities.• Children’s homes.• Turnkey development

opportunities.• Learning disability homes.• Foster care agencies.

SERVICES

• Acquisition.• Disposal.• Consultancy.• Analysis.

LEAD INDIVIDUALS

Samantha Cooper, Managing Director, has over 25 years’ industry experience as a commercial and residential agent, specialising in the acquisition and disposal of care businesses throughout the UK including elderly care, specialist mental health facilities, children’s homes, turnkey development opportunities, learning disability homes and foster care agencies. With Samantha as your consultant, you have direct access to her knowledge and extensive expertise, and can be completely assured that she will manage the whole sale process from inception to completion.

Samantha is recognised for her passion, energy and knowledge, assisting operators and purchasers throughout all the stages of the transaction.

Ian Catterall recently joined Cooper Healthcare to strengthen

the company’s presence locally and nationally and to assist his sister in growing the family business, boasting over 15 years’ successful industry experience.

Ian specialises in personal account relationships from sole traders to large corporate companies. Previous employment includes a leading group of estate agents, specialising in the disposal of residential properties in the North West where Ian prided himself on giving a personal touch which made him a top achiever in target sales. Ian has exceptional knowledge, expertise and focus for client relations which will greatly benefit Cooper Healthcare as we continue to grow.

COMPANY INFORMATION

Cooper Healthcare is an established, nationwide property consultancy offering a more personalised and consultative approach to the healthcare sector. We pride ourselves on working with operators to achieve the best outcome from their business, providing a personal, discreet and client focussed service.

Our prestigious sales brochure sets ourselves ahead of our competition because of its thorough detail and granular analysis, enabling vendors to promote their home(s) without any disruption to their day to day business. If you are considering selling, now or in the future and would like a discreet, confidential consultation and a free financial analysis of your business, please contact us.

Samantha Cooper Managing Director

Ian Catterall

Tel: 07837 335545

Tel: 07912 696218

Email: samantha@cooper-healthcare.com

Email: ian@cooper-healthcare.com

Bespoke CareTel: 0114 236 9532 Email: enquiries@bespoke-care.com Website: www.bespoke-care.com

SECTORS • Health and social care. • Dementia. • Learning disability.• Autistic spectrum.• Mental health.• Children’s services. • Acquired brain injury.• Drug and alcohol rehabilitation.

• Private hospitals.• Investments.• Sites and new build developments.

SERVICES • Bespoke care business sales.• Specific acquisition remits. • Strategic consultancy.• Site finding.

SECTORS

• Care and nursing homes.• Specialist care facilities. • Independent care.• Private hospitals.

SERVICES

• Acquisitions and disposals.• Valuations.• Rent reviews and lease renewals.• Professional consultancy.• Strategic portfolio advice. • Expert witness.

Bilfinger GVA

Tel: 0207 911 2725Email: richard.oxley@gva.co.ukWebsite: www.gva.co.uk/health

SECTORS

• Care homes.• Care homes with nursing.• Dementia services.• Learning disabilities.• Physical disabilities.• Specialist care.

SERVICES

• Sales.• Acquisitions.• Market appraisal.

Burford Care HomesTel: 07808 764748Email: paul@burfordcarehomes.co.ukWebsite: www.burfordcarehomes.co.uk

44 CMM July 2016

RESOURCE FINDER

JLLTel: 0207 087 5858Email: Carrie.Daniele@eu.jll.comWebsite: www.jll.co.uk/healthcare

Phil Hall Chairman – Healthcare, AlternativesTel: 0207 852 4622Email: phil.hall@eu.jll.com

James Hanson Head of Healthcare Investment, AlternativesTel: 0207 087 5858

Email: james.hanson@eu.jll.com

SECTORS

• Retirement housing and housing with care.

• Care homes.• GP practices and pharmacies.• Day centres and nurseries.• Education.• Dentists.• Hospitals.• Learning disability and mental

health.

SERVICES

• Research.• Transactional.• Funding and financial restructuring.• Valuation.• Operational consultancy.• Strategic planning.

LEAD INDIVIDUALS

Phil Hall is Chairman of JLL’s Healthcare team and has over 25 years’ experience in the sector, advising operators, banks and investors. Given his wide-ranging experience and expertise, his advice is particularly sought on strategic issues including acquisitions of operational businesses, loan restructurings and business reviews. Whilst predominantly UK based, his work extends to include projects in Russia, Italy, Spain, Turkey, China and India. Clients find his insight into international healthcare trends and capital flows particularly relevant in today’s increasingly global market.

James Hanson is the Head of Healthcare Investment and has over 20 years’ experience. In that time, he has advised Healthcare operators,

social care companies, landlords and investors and has a deep understanding of how private sector businesses can create value and work collaboratively with the public sector. James’ work covers corporate strategy, agency, commercial due diligence, valuation, funding and development. He is a Member of the Royal Institution of Chartered Surveyors and sits on the British Property Federation Healthcare Committee.

COMPANY INFORMATION

JLL is a financial and professional services firm specialising in real estate services and investment management. The JLL Healthcare team is part of our Alternatives division which we launched in 2015 to support our clients with this growing market. 2015 was a record breaking year for Alternatives, with over £15bn transacted, which represented a quarter of the total commercial property market.

Our dedicated Healthcare experts are based out of London, Bristol, Leeds and Edinburgh. Our holistic approach enables us to respond to increasing client demands and makes us unique in the current marketplace for advising clients on Healthcare transactions. 2015 marked another year of success for the JLL team. We advised on over £5bn of Healthcare mandates and transacted on over £160m of Healthcare accommodation and development land.

To see our latest research or to find out more about our team and how we can help you, please visit our website: www.jll.co.uk/healthcare or call Phil and James.

DC Care Tel: 01937 849268Email: sales@dccare.co.ukWebsite: www.dccare.co.uk

Alison Taylor BA (Hons) BIM Regional Director (North)Tel: 07825 353748Email: ataylor@dccare.co.uk

Andrew Sandel Regional Director (South)Tel: 07825 206777

Email: asandel@dccare.co.uk

SECTORS

• Elderly care and nursing homes.• Children’s homes.• Learning disabilities/mental health.• Physical disabilities.• Vacant care homes.• Care home groups.• Care home sites.• Care homes in administration or

receivership.• Charities and not-for-profit.• Local authorities.

SERVICES

• Sales and acquisitions.• Care home appraisals.• Marketing reports.

LEAD INDIVIDUALS

As a member of the Institute of Commercial and Business Agents, Alison Taylor has over a decade of specialist healthcare experience. Alison joined DC Care in 2010 and in that time has concluded sales of a range of businesses, from closed care homes and homes in administration, to well performing larger groups. Her extensive transactional, appraisal and relationship management experience gained in this, and other specialised industries, enables her to quickly grasp the often very individual facets of any sale. Alison provides a number of lenders with marketing reports, enabling decisions to be made on the future of businesses showing early signs of distress and also advises clients and investors on portfolio development matters.

Andrew Sandel has a wealth of

experience in business transfer, having been in the industry since 1998. Prior to this, a background in internal auditing provided the relevant accounting experience required in order to give care home owners an accurate appraisal of their business. Since joining in January 2010, Andrew has built an excellent network of contacts in all aspects of care. A real hands-on and personal approach to the entire selling process has resulted in DC Care significantly increasing its presence in the south, making it one of the most active specialist agents in the sector.

COMPANY INFORMATION

DC Care has concluded over 400 transactions, with a total value of over half a billion pounds. Our goal is to maximise the outcome for every one of our clients. The team is focused on service and acts for either vendors or purchasers in relation to buying and selling companies and operational care businesses, empty units for redevelopment and the sale and acquisition of development sites.

We provide assistance on exit strategy planning, portfolio realignment, targeted acquisitions and administrations, liaising closely with carefully chosen professional partners to build a due diligence team, where appropriate. Each member of the team has hands-on, specialist experience, gained over many years. This expertise, coupled with the wider commercial experience of the principals, means we are able to offer practical, relevant and commercial advice to our clients.

DC Care is the trading name of The Franklyn (Developments) Limited.

www.lancashirecare.org.uk @LancsCareAssoc www.caremanagementmatters.co.uk @CMM_Magazine #CMMInsight

The Lancashire Care Conference Mercure Blackburn Dunkenhalgh 22nd September 2016

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CONFERENCES • EXHIBITIONS

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CQC Regulation Update

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Recruitment and Retention

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RESOURCE FINDER

CMM July 2016 47

SECTORS

• Care home.• Elderly care.• Dementia services.• Learning disabilities.• Physical disabilities.• Acquired brain injury.• Mental health.

• Drug and alcohol dependence.• Care villages.• Health centres/doctors’ surgeries.

SERVICES

• Development opportunities.• Land sourcing.

Swordfish Property Enterprises LtdTel: 0208 455 5929Email: stevenjf@btinternet.comWebsite: www.linkedin.com/pub/steven-feldman/1/413/400

Knight Frank LLPTel: 0207 861 1153Email: city@knightfrank.comWebsite: www.knightfrank.co.uk/healthcare

Christopher Wishart Partner – HealthcareTel: 0207 861 1076 Email: chris.wishart@knightfrank.com

Julian Evans Partner – Head of HealthcareTel: 0207 861 1147

Email: julian.evans@knightfrank.com

SECTORS

• Care homes.• Learning disability and mental

disorder units.• Physical disability and ABI units.• Mental health and secure units.• Day centres and nurseries.• Hospitals and surgeries.• Pharmacies and dental practices.• Assisted living and retirement villages.• Development sites.

SERVICES

• Strategic consultancy.• Development consultancy.• Sales and acquisitions.• Valuation.• Portfolio consultancy.• Research and feasibility studies.• Building consultancy and surveys.• Planning consultancy.• Lease advisory.• Property asset management.

LEAD INDIVIDUALS

Christopher Wishart is a partner in the healthcare department. Overseeing the acquisition and disposal of care facilities throughout the UK, Christopher has over 15 years’ experience advising a broad range of clients as to the most beneficial and appropriate strategy for achieving a successful sale.

Christopher advises clients ranging from owner operators looking to retire, through to banks and corporate advisers who are acting on the disposal of distressed assets. Christopher commented, ‘No two care homes are the same, so getting

under the skin of the business prior to taking it to the market is a key factor, focusing on key transaction points which vendors and purchasers will need to consider. Trust, discretion, market knowledge and taking the time to learn about the objectives of each of my clients are key fundamentals to a successful sale.’

Julian Evans’ experience has primarily concerned acting for corporate and private operators, banks, institutions and funds in the valuation, acquisition and disposal of trading care homes, specialist (acute) care homes, hospitals, day centres, medical surgeries and fixed income throughout the UK and Europe. He is Head of Healthcare.

COMPANY INFORMATION

Knight Frank is the world’s leadingindependent global residential andcommercial property consultancy.Knight Frank advises on the fullspectrum of healthcare property witha dedicated healthcare consultancyteam. Having a strong residential armenables Knight Frank to also recogniseproperties with potentially higheralternative use values and work withlarge residential developers to identifysites which could include healthcare.Understanding the nuances ofhealthcare businesses and recognisingthe future of the industry through theidentification of new sites and land fordevelopment has been highlightedin the Knight Frank Healthcareresearch reports. Released quarterly,these focus on different sections ofthe market and give insight into themarket.

48 CMM July 2016

EVENT PREVIEW

20th October 2016, Reading

BERKSHIRE CARE CONFERENCE 2016

who will be delving into this successful initiative that promotes quality of life and delivers positive change in care homes for older people. There will also be an exploration of technological advances for the sector from eeZee IT.

The event will have a dedicated exhibition of care sector specific products and services including Quality Compliance Systems, Berendsen UK, Bupa Care Homes, LNT Group, Care Management Systems, eeZee IT, My Home Life and Sticky People.

The day will be punctuated by a number of valuable networking opportunities, chances to interact with other delegates and the speakers.

BOOK TODAY

To book, visit www.caremanagementmatters.co.uk/events – CMM website subscribers receive a 10% discount for booking online. Subscription to the website is FREE for care providers. The CMM website will be updated regularly with more information on the agenda and confirmation of speakers.

The Berkshire Care Conference returns to the Hilton in Reading in October. For providers in Berkshire and the surrounding areas, the event offers an opportunity to hear from national level speakers on topics that directly affect the local market.

TAILORED AGENDA

Developed in association with the Berkshire Care Association, the programme has been carefully tailored to meet the needs of local providers. Attendees will have the opportunity hear from Sue Burn, Interim Head of Inspection – South Central at the Care Quality Commission. Sue will look at how providers can tackle the challenges facing the sector in the context of regulation and inspection.

She will be followed by Ed Watkinson, Director of Care Quality at Quality Compliance Systems. Ed will be exploring how delegates can deliver quality in a compliant service. Striving to achieve an ‘Outstanding’ quality rating can take a lot of preparation and dedication. Ed will break down the steps providers can take to increase their chances of achieving ‘Outstanding’ before, during and after inspection.

Delegates will also hear an update on current policy developments and how they will affect business. For those facing recruitment and retention issues, the popular Neil Eastwood, Founder of Sticky People, will share more top tips on the most effective ways to recruit and retain the right staff to help your business thrive.

PRACTICAL WORKSHOPS

There will also be an opportunity to attend a practical workshop – the agenda is still being finalised, however, we have confirmed involvement from Tom Owen, Co-Director and Jess Watson, Social Action Lead at My Home Life

In association with

Organised bySupported byCorporate sponsor

CMM July 2016 49

Event: Date/Location: Contact:

Health+Care 201629th/30th June, LondonCloser Still, Web: www.healthpluscare.co.uk

Event:

Date/Location: Contact:

What next? – Shaping the future of retirement communities in the UK6th July, LondonAssociated Retirement Community Operators, Web: www.arcouk.org/conference

Event:

Date/Location: Contact:

A new future for social care? Good practice approaches to meeting care and support needs 12th July, LondonThe King’s Fund. Tel: 0207 307 2596

Event: Date/Location: Contact:

NAPA London Conference: Activity Providers Toolkit5th October, LondonNational Activity Providers Association, Tel: 0207 078 9375

Event: Date/Location: Contact:

Care and Dementia Show 201611th/12th October, BirminghamThe Care Show, Web: www.careshow.co.uk

Event:

Date/Location: Contact:

NAPA Conference Manchester: Managers and lifestyle leaders working together towards ‘Outstanding’ outcomes 16th November, ManchesterNational Activity Providers Association, Tel: 0207 078 9375

WHAT’S ON?Media Partner

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CMM EVENTS

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Event: Date/Location: Contact:

CMM Insight – The Lancashire Care Conference22nd September, LancashireCare Choices, Tel: 01223 207770

Event: Date/Location: Contact:

CMM Insight – Berkshire Care Conference20th October, BerkshireCare Choices, Tel: 01223 207770

Event: Date/Location: Contact:

The Transition Event East 9th November, PeterboroughCare Choices, Tel: 01223 207770

Event: Date/Location: Contact:

3rd Sector Care Awards 20167th December, LondonCare Choices, Tel: 01223 207770

Event: Date/Location: Contact:

CMM Insight 20172nd March, ManchesterCare Choices, Tel: 01223 207770

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we carry out an essential service, day and night, to people that rely on our support; for many individuals, their lives depend on it. Yet providers operate in an increasingly challenging market; one that is at risk of collapse. The provider sector has faced huge cuts, around 40% since 2010. The situation is exacerbated, potentially to crisis point, by the introduction of the new National Living Wage, with costs set to increase year on year. In a world where local authorities contract out care and support on an hourly rate, it is not difficult to see that when costs go up and funding does not, something has got to give.

We all recognise the budgetary constraints that local authorities are operating under, and we’ve worked together to drive efficiencies and make difficult savings wherever possible. But now, when many authorities are telling us that there will be no increase in fees, despite our increased costs, the situation is getting desperate. With the Government effectively our sole customer, there are little or no genuine self-funders, so, unlike other areas of social care, we are unable to cross-subsidise to generate private fees.

The services we provide to local authorities are directly and hugely impacted by central spending decisions. Whilst we contract locally, the funding that authorities receive in the core revenue support grant from Whitehall has decreased dramatically. Although central Government has ensured that funding can be raised locally through the 2% social care precept, this is nowhere near enough.

The Government also promises support via the centrally-managed Better Care Fund, yet no money will be available until 2017. That could be too late. Many providers have already had to leave the sector; the others that remain are facing an enormous financial challenge to their ability to provide high-quality services.

Alongside this, there has, thankfully, been progress in policies that are designed

to support people with learning disabilities. Since the Winterbourne View scandal in 2011, we have seen initiatives such as Transforming Care that are striving to place community care at the heart of service provision. Yet without proper funding of providers, these initiatives will fail.

As a coalition of providers, we know that we join a chorus of organisations, pressure groups and campaign voices in calling on the Government for more funding in every aspect of public services. However, our Manifesto advances some constructive recommendations about how we can address the growing funding gap.

A starting point would be to use the Better Care Fund more effectively, to shore-up the sector with a £700m cash injection this year, rather than holding it back until 2017. These funds urgently need to be released to local authorities, in order to support learning disability services, as opposed to being used simply as a safety net to reduce pressure on the NHS. In the longer term, local authorities also need to be empowered to raise the precept to a level that ensures that they are better able to fund services.

We also urge Government to address our rising workforce costs. Whilst the National Living Wage is undoubtedly a tremendous step forward in rewarding our staff, we urgently need clarity on what should now be regarded as ‘working time’. Many of our employees work on ‘sleep-in’ shifts, which see them available to provide care, should it be needed, at night. This arrangement has been in place for decades, but classifying these shifts as ‘working time’ for the purposes of the National Living Wage will hit us particularly hard.

We have successfully worked in partnership with our one and only customer, the Government, for decades, and we want to continue doing so. Now, with a looming crisis in the funding of learning disability care, we desperately need it to step in before it is too late. CMM

Diane Lightfoot explores a manifesto for change,

addressing funding challenges in the learning

disability sector.

Last month, I became Co-Chair of a coalition of providers set up to deliver a clear message to the Government: care for people with learning disabilities is in crisis, and we need to safeguard our frontline services. This coincided with the launch of our Care Crisis Manifesto, which makes clear policy recommendations concerning our funding, our workforce and, most importantly, our ability to provide high-quality care.

The coalition, Learning Disability Voices brings together charities, not-for-profit and independent companies that provide services across the UK. Representing 20% of the total learning disability sector, we provide highly-specialist care services to some of the UK’s most vulnerable people.

Supporting people with learning disabilities is one of the most complex and specialist areas of social care. As providers,

D I A N E L I G H T F O O T • C O - C H A I R • L E A R N I N G D I S A B I L I T Y V O I C E S

Share your thoughts on this issue at www.caremanagementmatters.co.uk Subscription required. Twitter: @CMM_Magazine

Diane Lightfoot is Co-Chair of Learning Disability Voices and Director of Policy and Communications at United Response.

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EveryLIFE Advert_210x254 v01.indd 1 05/05/2016 11:48

Delivering great care is a 24-hour job, making managing your CQC Compliance and Quality Assurance just another thing for you to fit in. At QCS we provide the social care sector’s leading compliance toolkits, helping providers to meet care standards with minimal fuss.

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qcs-Care-Management-Matters-201606081030.pdf 1 08/06/2016 10:31