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Nightingale Hammerson is a charitywhich provides residential, nursingand dementia care to the Jewish
community in Greater London.The organisation came into being in 2012,
when Nightingale House care home inClapham which provides care for about 170residents, merged with Hammerson House,another large care home in Hampstead,now undergoing a major redevelopment.
Sharing the knowledge
Nightingale Hammerson chief executive
HELEN SIMMONS tells Caring Times
editor Geoff Hodgson about about how
an on-site nursery is bringing benefits to
both children and residents.
PHOTO: Yakir Zur
When the work is completed in about twoyears’ time, Hammerson House will be a116-bed nursing home, able to provide allcare types, with the whole home will bedementia-friendly.
Nightingale House also provides nursing,residential and dementia care, butNightingale Hammerson’s chief executiveHelen Simmons points out that these kinds ofcare are provided across different floorswhich are at different levels of investment.
“We have some floors which wouldn’t besuitable for nursing because the rooms arenot large enough, so we still have to investfurther in this site,” said Helen.
“Every few years we invest in anotherfloor, and we make the rooms larger. And wemake them more dementia-friendly becausethe trend across the country is that people arenot choosing to go into care homes until theyhave quite high levels of need, and they arevery frail so they are more likely to havedementia and nursing needs.
“The plan at the moment is to concentrateon Nightingale and Hammerson House – it’sthe higher dependency end of the marketthat we serve within the Jewish communityand I think we do that really well.
“We are about 40% local authority funded.A lot of private care homes are choosing tofocus on private-pay and they are focusingon people who are do not have quite suchhigh dependency levels. We, as a charity, arefocusing on where the need is, which is fornursing, dementia and end of life care,however that’s funded.”
Last year, Nightingale House achieved an‘Outstanding’ rating from CQC for the firsttime, which Helen says was thoroughlydeserved by all the people who had workedvery hard to achieve it.
“In nursing home terms, and consideringthe number of residents that we have, it isthat much harder to achieve an ‘Outstanding’rating so it means a lot to us. We also attainedPlatinum status under the Gold StandardFramework for end of life care last year, so itwas a bumper year for us.”
Apples and Honey
Nightingale House has become a leader inintergenerational engagement, opening theApples and Honey children’s nursery on sitein September 2017.
“This gets us most excited on a dailybasis,” said Helen.
“Children from the nursery can often beseen at Nightingale House taking part inactivities with older people such as bakingand singing. It is receiving so much attention,not just from the media, but from internationalgroups, universities, local authorities. Theinterest is such that we have to group thevisits and the waiting list is packed.”
The nursery has Jewish values but itaccepts all children. Clapham is not a Jewisharea and most of the children are not Jewish.
“They’re having a whale of a time,” saidHelen. “The engagement is intergenerationaland also intercultural. We are seeing thechildren acting very responsibly – being verycareful around the residents, and theircommunication is really developing. With theresidents we are seeing a sense of purpose,which is important to wellbeing, we are seeingjoy and we are starting to see a link withfighting depression, which is very exciting.
“We are starting to get a bit more technicalabout the intergenerational work, and tryingto put out the learning and sharing. We aretrying to develop activity programmes whichdeliver the greatest benefit both generationsand, having a permanent nursery on site, weare a little bit ahead of the game. Peoplereally want to ‘get’ this and we want to shareour knowledge and experience, we wantpeople to copy what we are doing.”
Excelcare is still a family business after30 years. Starting with the 24-bedBowood Nursing Home in Catford, the
company now operates 33 care homesaround London and East Anglia.
“Whenever we interview new staff wealways stress that it’s important not to forgetthat we are a family business, but withcorporate disciplines,” said companychairman Ozzie Ertosun.
Hard work and family values
In 1989, OSMAN ‘OZZIE’ ERTOSUN,
chairman of Excelcare Holdings, opened
his first care home in Catford, South
London. Ozzie tells Caring Times
editor Geoff Hodgson his story of
three decades in the care sector.
“Because of our responsibilities in terms ofregulation, local authorities, safeguarding andso on, disciplines have to be followed, but welike people to know, whether they are relatives,family, friends or staff is that they can call atany time and have an open and frankconversation – that is really, really important.”
Excelcare’s portfolio is mixed; somenursing, some purely residential and manyregistered as specialist dementia. Thecompany also operates a homecare business.
In 1988, when he was just 19, Ozzie didsome work experience at a care home calledNora’s Lodge in Sydenham.
“It was a small residential home belongingto a family friend. I worked there for sixmonths, realised that it was an industry Iwanted to be in, and I felt I could do it betterthan it was being done in those days, in anicer building.
“Our family had a background inconstruction so we built our first home,Bowood Nursing Home, a 24-bed facility inCatford in 1989. I built that with my fatherand some tradesmen – we physically builtthe home over two years.”
“You have really set a standard here,” alady who was the main inspector for theLewisham area told Ozzie. “But you have thedisadvantage that you are very young;people may not have the confidence to placeyour parents with you.”
“She was right,” Ozzie remembers. “Fornine months I didn’t have a single admission!But I soon learnt: I got a nice, maturemanager who worked for me for 28 yearsbefore retiring.”
Then, beginning in Lambeth, Ozzie beganto take on ex-local authority homes.
“I didn’t have a financial background and Iasked my father, ‘How do I grow thiscompany? It’s working; I’m enjoying it and it
seems to be popular with the localauthorities.’ He said I needed to learn how toborrow money in a bigger way – ouraccountant helped me to organise bank loansand we bought people on board who hadworked for local authorities. They steered metowards block contracts, and this became ourtarget market. We won a 15-year contract withLambeth, taking over three of their homes,refurbishing them and building a new one.Then we tendered for a contract in Cambridgeand that began our activity in East Anglia.
“Our hard work and family values paid off;local authorities could see we were sincere,that we weren’t here just to make somemoney and get out of the business. Then wegained a 30-year contract in Milton Keynes –we would buy the buildings, rebuild themand provide the care. And then we did thesame thing in Essex. We didn’t really targetthe private market because in those days, thelocal authority rates gave you a reasonablereturn. We have always been open andhonest, and local authorities know we havenothing to hide, and that our profits are at thebottom end of the market.”
Homecare
About 15 years ago, Ozzie launched ahomecare business. I t has been successfuland is still operating but he has recentlyclosed some of its branches.
“We couldn’t find the staff and maintainthe quality,” said Ozzie. “How can you go inand provide 15 minutes of care for people,and at the rates that were being offered? Wecould see what was happening and we didn’twant to be in that market – homecare hasbecome a disaster in some local authorities.On the whole we have a very good reputationwith CQC and with local authorities and Ididn’t want to bring that reputation down.”
And the future? Again, like many otherproviders, Ozzie is beginning to look at theprivate-pay market.
“We are looking to knock down some ofour older buildings and build better homesfor our residents. A lot of this will be ‘caresuites’ – they don’t need to be flats, they canbe something like a studio-type apartmentbut small, so elderly people can easily getaround them. I would want these to be withina care home setting but provide somethingmore than just a room with an en-suite.”
Recruitment
Like many other providers, Ozzie placesrecruitment at the top of his list of concerns.
“Up to two years’ ago I had never usedagency staff in London. But we havestruggled to get nurses and carers. Weincreased pay as much as we could but then itbecame still more difficult when governmenttightened the regulations for recruiting nursesfrom overseas. It now takes about eightmonths to bring a nurse in from abroad and itis so expensive that it is sometimes not cost-effective. I have closed about five homes overthe last five years because the fees would nothave allowed us to care for people properly.
“One thing I would like to see change, isthat the recruitment process be speeded up.At present it can take up three months to sixmonths to replace someone when they leave.We’ve written to all the ministers, all ourMPs, our managers have written as well,asking them to acknowledge that we have aproblem and to make these immigrationpolicies softer and easier for qualified peopleto come here where they are needed. It issuch a long-winded process; people can getjobs elsewhere and be working within aweek, so that puts care providers at a massivedisadvantage.”
One of the most difficult areas of lawin the health and social care sectoris Deprivation of Liberties
Safeguards (DoLs). The current DoLSregime is to be replaced by the LibertyProtection Safeguards, which is outlined inThe Mental Capacity (Amendment) Bill,now due to have its report stage and thirdreading in Parliament.
One of the difficulties in this area of law isdefining what a deprivation of liberty is.
Liberty: riddled with complexity
AMINA UDDIN, a
solicitor with Ridouts
Professional Services,
highlights the difficulty
of defining deprivation
of liberty.
www.ridout-law.com
Whilst the in-depth analysis of this area isbeyond the scope of this article, I would liketo highlight the inherent difficulties ofcreating a clear legal definition of what adeprivation of liberty entails, by providing abrief the history of the development oflegislation in this area.
Introduction of DoLS
DoLS were introduced in response to thejudgment of the European Court of HumanRights (ECHR) in HL v the United Kingdom.In this case, the ECHR found that theinformal admission to a psychiatric hospitalof a compliant but incapacitated adult was inbreach of Article 5 of the ECHR.
It became apparent that the law did notprovide adequate protection to people wholacked mental capacity to consent to care ortreatment and who may need to be deprivedof their liberties to keep them and/or othersfrom harm.
As a result of this, a system for theassessment and authorisation of deprivingpeople who did not have capacity of theirliberties was introduced by the MentalHealth Act 2007 (2007 Act) to address thisgap. The 2007 Act was applicable inpsychiatric hospitals alongside hospitals andcare homes whereby people who lackedcapacity to consent to their living provisions,were being deprived of liberty.
Cheshire West
The Supreme Court judgement in theCheshire West case sought to provide furtherclarity on what constitutes a DoLS andintroduced an “acid test’ to determinewhether a DoLS is in place.
The Supreme Court ruled that a DoLS is
in place where (1) theperson is subject tocontinuous supervision andcontrol and; (2) is not free toleave, and they lack thecapacity to consent to thesearrangements. The focuswas therefore not on theperson’s ability to express adesire to leave, but on whatthose with control over
their care arrangements would do if theysought to leave.
The acid test had therefore lowered thethreshold of DoLS and widened thedefinition, thus opening the floodgates ofDoLS authorisation applications, resulting ina considerable backlog of applications.Effectively this means that people may haveDoLS in place with no formal authorisation.
The current DoLS regime was thereforedeemed as not fit for purpose because, inlight of these new legal safeguards,vulnerable people are still not afforded withadequate protection by the DoLS.
New definition
Under the new Bill, the Government hasproposed a clause, outlining what adeprivation of liberty is not.
The definition has been described as astatutory clarification in that a deprivation ofliberty has the same meaning as article 5(1) ofthe European Convention on Human Rights,in that a person is not deprived of liberty in aparticular place if they are:
(i) Free to leave that place permanently(ii) Not subject to continuous supervision
and free to leave the place temporarily(iii) That a person is free to leave a place
even if he or she is unable to do so, providedthat they expressed a wish to leave
(iv) If the arrangements alleged to give riseto the deprivation of liberty are put in placeto give medical treatment for a physicalillness or injury, and the same (or materiallythe same) arrangements would be put inplace for any person receiving that treatment.
The Government has stated that the above isnot a definition but a statutory clarification
due to the evolving nature of case law, whichmade it difficult to draft a definition thatwould remain appropriately precise.
Some have argued that this new definitionnarrows case law in this area and riskspeople not being captured within thedefinition outlined above. One of the otherconcerns is that the above definition impliesthat a person is not deprived of their liberty ifnot subject to continuous supervision andfree to leave the place where they are livingtemporarily, with or without supervision.However, in the Cheshire West case, thepeople that were involved were able to leavethe places where they lived temporarily, yetthey were all considered to be deprived oftheir liberty by the Supreme Court.
This was further clarified by theGovernment in that a person could only beexcluded from being deprived of liberty ifthey were free to leave temporarily and notunder continuous supervision. The definitionwill be accompanied by a detailed statutoryguidance which will include case studies todemonstrate how the exceptions will applyin various settings and scenarios.
The Bill has been heavily debated, whichdemonstrates the difficulty in gettinglegislation in this area right. However, can aclear definition of a deprivation of liberty beproduced without being overly prescriptiveor yet on the other end of the spectrum,excessively vague? I believe the Governmentis partly right in terms of providing astatutory clarification with detailed statutoryguidance. This way, practitioners will be ableto determine examples where a deprivationof liberty may arise and use that guidance toafford protection to the people who areunder their care.
Blackpool Borough Council wererecently recommended to pay £5,500and ordered to apologise to a
vulnerable woman who suffered severeburns to her thigh after being left on acommode too close to a hot radiator. Thewoman (‘Ms Y’) was left screaming in painfor nearly three hours while homecareagency workers failed to seek urgent medicalattention, the Local Government and SocialCare Ombudsman found.
Ms Y had limited feeling down her right sideand difficulty communicating after suffering astroke in 2016. Consequently, Ms Y required
Burns case highlights therole of quality monitoring
help with personal care, the use of a frame forwalking and use of a wheeled commode. Ms Yhad already undergone a long recovery inhospital and rehabilitation to enable her toreturn home and regain some of herindependence, something which Ms Y valued.
However following the incident, Ms Y wasleft with serious burns described as “seven totwelve centimetres in length, and one to twocentimetres in width”. These burns becameseptic, resulting in a hospital admission andthe need for Ms Y to return to residential care.
The Ombudsman’s report outlines seriousfailings by the homecare agency, which actedon behalf of the Council. Under Regulation12 of The Health and Social Care Act 2008(Regulated Activities) Regulations 2014 (‘the2014 Regulations’) care providers are under aduty to provide safe care, includingundertaking risk assessments and takingreasonable measures to mitigate these risks.As such, the homecare agency failed toidentify the “obvious environmental risk” ofthe wheeled commode being placed in closeproximity to a hot radiator and failed toprovide a care plan to mitigate these risks.
The report notes that these risks wereparticularly important given Ms Y’svulnerabilities, including her communicationdifficulties which made it difficult to identifythe source of her pain. The Ombudsmanfound that the carers failed to seek timelymedical attention due to the confusion over the
source of Ms Y’s pain. This resulted inavoidable suffering caused by the delay in MsY receiving pain relief – the appropriateresponse would have been to take immediateaction to mitigate Ms Y’s suffering, irrespectiveof the source and cause of Ms Y’s pain.
Under the Duty of Candour, care providersare required to be open and transparentfollowing a safety incident and to keep anaccurate account of what happened. TheOmbudsman found that there wereinconsistencies in the carers’ account of whatwas known about the injury and when.Furthermore, the Ombudsman consideredthe complaint response, which was producedby the Council, contained misleadinginformation designed to absolve the carers ofresponsibility. This amounted to a breach ofDuty of Candour so the Ombudsman foundfault on the part of the Council.
Safeguarding investigation
Under the Care Act 2014, a local authorityhas a duty to make whatever enquires itthinks necessary to decide whether anyaction should be taken to protect the adult.This includes a timely safeguardinginvestigation and considering all relevantevidence. The officers conducting thesafeguarding investigation in this case failedto follow up on concerns that carers delayedseeking prompt medical advice, and failed toexamine the original carer reports which
highlight the inconsistencies. Furthermore,the Council delayed completing thesafeguarding investigation, which againresulted in fault on the part of the Council.
The Ombudsman’s role is to investigatecomplaints which would otherwise not beremedied through use of the courts. It wasthe Ombudsman’s decision that Ms Y’s caserequired investigating to ascertain why theburns were not dealt with as a matter ofurgency and to review the response andtimescale of the safeguarding investigation.In this respect, the Ombudsmanrecommended that the Council:
i. Apologise in writing for not following uprelevant evidence that could have added tothe safeguarding investigation;
ii. Make payments to Ms Y and herdaughter to reflect their distress;
iii. Ensure its contractors completeadequate risk assessments; and
iv. Conduct regular quality monitoring ofthe homecare agency, focusing on whether itis implementing effective risk assessments.
In usual circumstances the Ombudsman’sRemedy Guidance suggests payments forharm and distress of up to £1,500. However,the Ombudsman considered that Ms Y’s casewas exceptional due to the significant harmover a prolonged period. It therefore decidedto recommend a payment of £5,000 to Ms Y,and £500 to Ms Y’s daughter, who was thecomplainant on behalf of her mother.
The Gables care home is an autism andlearning disabilities specialist based inAlford, Lincolnshire, established by
Mrs Dominique and Dr Brian Pennington in2000, alongside their two sons Jean-Pierreand Michael.
The Gables is a very small care home,caring for nine adults who are supported byeight full-time members of staff. Our Guidingprinciple is to offer value for money to ourservice users and for the taxpayer; as qualitynot size matters in the care industry.
Despite our successes it has not been aneasy road for smaller care homes in thedistrict; without some 'Dunkirk spirit' it mayhave been impossible to survive.
It was a trip to the imperial war museum inLondon with the boys that gave me theinspiration we sorely needed in 2010; the yearmarked the 70th anniversary of the evacuationof more than 300,000 Allied soldiers from thebeaches of Dunkirk, France between May 26thand June 4th 1940, during World War II.Nearly all the escape routes to the EnglishChannel had been cut off and a terribledisaster had appeared inevitable. At the timePrime Minister Winston Churchill called it “amiracle of deliverance”. Our little care homeneeded a miracle at this point to see uscompete against such overwhelming odds.
The evacuation of Dunkirk was by nomeans straightforward and neither was ourstruggle to be noticed by the local authorityin a market dominated by large incumbentsuppliers, somewhat like the lumberingdestroyers sent to rescue the troops.
But the larger ships could not reach thesoldiers as the water was too shallow and itwas the little ships that saved the day as theywhere able to reach closer to the shore line.
We had not had a placement in two yearsand I was questioning myself as to what todo? Our fee had been set by the localauthority at the minimum rate, operatingcosts were mounting and I often dipped intopersonal savings to supplement thebusiness – something had to give.
A small sailing vessel named the Tazmine,
Smaller care homes havethe Dunkirk spirit
Specialist care provider
Dr BRIAN PENNINGTON talks
about how his family weathered
the lean times when other small
homes in his area were closing.
18ft from stem to stern and built of spruce,unexpectedly held the key to unlocking aformula for future success. The boys wereamazed at how such a small boat could haveplayed a part in the Dunkirk rescue or evenmake it across the notoriously choppyEnglish channel, but it did. I also knew then,we could make it through the rough time. Iused my background in computer sciencesand my sons’ knowledge of finance todevelop micro economic models andalgorithms and began streamlining thebusiness. On visits to the larger care homes inthe area, I noticed they had “many managersmanaging managers” and some care homeseven operated car racing teams.
By sacrificing personal extravagance webecame much like the Tazmine , simplyfunctional and fit for purpose. Our smallsize made it possible to offer a morepersonalised level of care that was reallyappreciated by the residents and theirfamilies – we became the 'little ship' thatcould get closer to the shore.
During the past few years, through aprocess of increasing efficiency and reducingwaste a sort of 'make do and mend' approach
we were able to turn a moderate fee into avirtue. Fixing the tariff which providers willreceive means that competition should bebased on quality rather than cost. In theory,therefore, the value achieved for a fixed costshould increase over time, assuming the tariffis set at the appropriate level..
When operating at full capacity The Gablesoffers value for money and benefits fromeconomies of scale. Whilst carrying out myinvestigations and researching the otherbusinesses during the period 2012-2014; Iapplied to the local authority for 'freedom ofinformation' to see our market positionwithin the East Lindsey district. It wasevident that, at our minimum fee, The Gables
could offer a value for moneysaving of £248,480 over a 15 yearperiod complex placement withno less quality than that offeredby local larger provider.
During the period 2015-16,some of our friends locally hadcapitulated and sadly closedtheir small care homes; wewitnessed four closures withinour area and some were takenover immediately by larger
providers. By banding together as a family,we had survived the lean period and almostinsurmountable odds.
The efforts of 700 small ships, someoperated by civilians had crossed the EnglishChannel and saved 338,000 soldiers in 1940 –in 2018 The Gables was cited as an exampleof 'Best Practice' in Care. Although small;stand alone care homes can still be those'little ships' for service users infused with alittle 'Dunkirk spirit'.
Great Oaks, an 80-bed care home withnursing in Bournemouth, hasappointed a soft food diet specialist to
allow for a wide range of diet requirements tobe catered for at the care home.
Patrick Fensterseifer, head chef at GreatOaks, specialises in the production ofdysphagia meals which means he is able tocook dishes for residents who havedifficulties with swallowing. Patrick ispassionate about preparing meals that areflavoursome, nutritious, well-presented andmeet the specific dietary requirements ofevery resident.
As a Dorset Healthcare NHS dysphagiapractitioner, Patrick has a wealth ofknowledge which has enabled him to leadthe rest of catering team confidently and helpexpand their skills and understanding of thedisorder. Patrick has more than 18 years’experience as a head chef and hasdemonstrated to the rest of the team that it isstill possible to be creative when catering fora resident who requires a soft food diet.
“We are so passionate about going theextra mile to put a smile on our residents’faces,” said Patrick.
“Meal times are treated with greatimportance, everyone has individual needsand we take the time to get to know whateach resident likes and doesn’t like to eat.
“Every meal is prepared using fresh,locally-sourced ingredients to ensure ourdishes are as nutrition-rich as possible. Whenwe create meals for our residents withdysphasia, we like to challenge ourselves toserve soft diet food, which still look like theirsolid counterparts.
“We use a range of mould and pipingtechniques that allow us to create a variety ofappetising courses which contain the vitalingredients that boost our residents’ health.”
With two other care homes in Dorset andHampshire, Great Oaks is the latest addition ofan established family of care homes managedby Encore Care Homes. Great Oaks also worksclosely with Dining with Dignity, a specialisttraining provider, to help meet the nutritionalneeds of residents who have dysphagia.
Great Oaks care home welcomessoft food diet specialist
Nearly half of staff say their carehome doesn’t have the right re-sources and equipment to care for
residents over 25 stone.A survey of 2,803 care home owners, man-
agers and staff, carried out by care home re-view website carehome.co.uk, found only41% of care home staff say they have thebariatric facilities to look after obese resi-dents, with one in 10 care home staff (12%)having to turn them away due to lack of re-sources and equipment.
“The number of obese, older people hasbeen rising in the UK for the last couple ofdecades and care homes need to ensurethey are inclusive and that residents whoare severely overweight are treated withdignity,” said carehome.co.uk editor SueLearner. “Some care homes have builtbariatric rooms, but over half are unpreparedand have no specialist facilities. This inabil-ity to provide care for obese people whooften have associated medical needs meansthey are left stranded at hospital or at home.
“The Government needs to be aware thatcare homes face higher costs if they care forbariatric residents, due to installing specialequipment and needing specialist careworkers who are trained in moving andhandling obese people. It is much more ex-pensive caring for morbidly obese peopleand care homes should receive more fund-ing from the local authority for residentsover a certain weight.”
Mike Vaughan, owner of Red Rocks Nurs-ing Home in Wirral, Merseyside agreed thereshould be extra funding for providing care toobese patients.
“This currently requires specialist and ex-pensive equipment or adaptions, withoutwhich we would be unable to provide care tothis sector,” said Mr Vaughan.
“However, it is also vitally important thatwe do not institutionalise our equipmentand functions to suit this care category alone,
A weighty problemCare homes are reluctant totake on obese elderly people
which might then make clients who do notrequire these extra services feel as thoughthey have to put up with a more institutionalfeel to their care than is absolutely necessary.I am aware this may lead to a two tier systemwith all that comes with this.”
Tracy Paine, deputy chief executive of Be-long, which has nine care villages in theNorth West, said the organisation did sup-port people needing bariatric care.
“In each situation, an assessment is madeof a person’s individual care requirements,”said Ms Paine.
“We work with residents, their familiesand health and social care commissioners todetermine how we can best provide for theperson’s needs and what special provisionswill be necessary. Previously, this has led toinvestment in specialist equipment, includ-ing larger beds and aids to assist people toremain as independent as possible.
“Practice development facilitators at eachBelong village make sure staff have the skillsand knowledge to provide bariatric care, in-cluding how to help with aspects of personalcare and specialist moving and handlingtechniques. Staff also have an understandingof medical conditions associated with obe-sity, such as sleep apnoea and hypertension."
A care home manager speaking anony-mously on Mumsnet explained why carehomes often don’t want to take morbidlyobese people.
“It sounds morally wrong but I think themajority of people don't understand what
the care of an obese person entails,” she said.“If someone is morbidly obese and can just
about transfer to the toilet and can do mostthings with the aid of a carer I can assure youit won't be long before they are immobile.
“Because of the politics of fat, care homesare not given more money for very largepeople, despite the fact that it is so expensiveto take care of them. There would be an up-
roar if people who needed care wereclassified as too fat to take up a 'normal'place in care. It would be deemed dis-criminatory, I feel.
“Unfortunately care homes are pri-vate businesses and unless they are fi-nancially compensated for their timethen they lose money. Obese peoplegenerally cost much more money thanaverage sized people.
“Nursing/care staff struggle to movethe bodies of obese people. It is incrediblyhard to clean them (think two staff manu-ally lifting their abdomen up to exposetheir private area and another staff memberto clean it).
“Staff regularly feel the physical strain ontheir bodies after a shift moving an obesepeople. Trying to push a wheelchair of anobese person (even with a power pack on theback) leaves staff with pain in their shoul-ders. This is despite the best and latestbariatric equipment.
“When I assess a person to see if they aresuitable for my home I would pass on a mor-bidly obese person. If I accepted them Iwould lose money and my door would be re-volving with staff complaining about theirconcerns about their physical health. My di-rectors would want to know why I put theirhome at risk from financial loss and at risklitigation from staff.”
The Call for Presentations is now on our website careinfo.org/events
Deadline for proposals: midnight 28 April 2019
We invite proposals for presentations and posters on any aspect of support, care and treatment for people with dementiaand their families, in any service setting. In addition, this year we would particularly welcome proposals on (but not limited
to): technology, dementia care and living well; innovative projects and service developments; dementia care in acutehospital settings; end of life care for people with dementia; housing & home support for people living with dementia. As in previous years, a strong theme running through the Congress will be the experience of people with dementia, and
involvement of them and their families in services at every level. As appropriate, proposals should show that this importantaspect has been addressed in their project or service. As always, we welcome proposals on a broad range of topics.
Half of all care home residents are prescribed at least one antibioticover a 12 month period, according to UK-wide research, led byBoots UK, which highlights potential areas where community
pharmacists and their teams can support both residents and carers in carehomes in the appropriate and effective use of antibiotics.
Antimicrobial resistance (AMR) is a major global public health problemwhich could prevent the effective treatment of common bacterial infectionsand in 2016, the UK government set a target to reduce inappropriateprescribing of antibiotics by 50%, with the aim of being a world leader inreducing prescribing by 2020.
Inappropriate use of antibiotics includes prescribing an antibiotic in theabsence of evidence or clear rationale of a bacterial infection, and
Using fewerantibiotics
Research identifies opportunities for
community pharmacy to support
antimicrobial stewardship in care homes
continuation of course beyond recommendedguidelines. Previous research published byPublic Health England shows the level ofinappropriate prescribing in primary care inEngland as 20%, suggesting that levels ofprescribing should be reduced by 10% tomeet the Government target.
The research led by Boots, looked at thelevels of antibiotic use across care homes inthe UK, including multiple courses andvariability in duration of treatment. Half ofcare home residents were prescribed at leastone antibiotic over a 12-month period,suggesting there is an opportunity to optimiseantibiotic use in this vulnerable population tominimise the risk of antimicrobial resistanceand treatment failure.
There are 459,000 residential places in carehomes across England, 16,000 acrossNorthern Ireland, 41,000 across Scotland, and26,000 across Wales. Most residents areelderly and have complex healthcare needsthat are exacerbated by multiple co-morbidities and medicines-related issues.
Community pharmacy teams dispenseacute prescriptions for antibiotics forresidents, and can identify potentialinteractions with current medications, andidentify any known allergies. Researchersbelieve that following the recent focus ofincreasing the clinical role of pharmacistswithin care homes, this is an opportunity toconsider actions to support prudentantibiotic prescribing and improvedantimicrobial stewardship across the UK.
This includes self-care (through homelyremedy policies), helping carers to identifyand deal with early signs of deteriorationand, when antibiotics are prescribed,whether they are appropriate along withadvice to support them being usedeffectively. There is also an opportunity forcommunity pharmacy teams to work moreclosely with carers within care homes,including infection prevention measuressuch as flu vaccinations and encouragingadequate hydration to prevent urinary tractinfections, which are more common in thesevulnerable adults.
Boots UK chief pharmacist Marc Donovansaid that, while nurses and carers providedthe majority of long term care for olderpeople within care homes, pharmacistsacross the UK support residents within thesesettings by dispensing and supplyingmedicines, as well as providing advice andsupport to carers on medicines use, storageand waste.
“As pharmacists, we’re all working topromote integration across healthcare
disciplines and sectors to promote moreefficient and effective care within the NHS,”said Mr Donovan.
“The NHS Long Term Plan recognises thatmany people living in care homes are nothaving their needs assessed and addressed aswell as they could be.
“This research highlights that there is a realopportunity for community pharmacy toplay an even greater role in supporting thesafe and effective use of medicines, andcontinue to support the implementation anddelivery of the Government’s five-year actionplan on antimicrobial resistance.”
� The research paper, titled ‘Antibioticprescribing for residents in long term carefacilities across the United Kingdom’, was co-authored by researchers at Boots UK, PublicHealth England and NHS Improvement.
It has been published in the Journal ofAntimicrobial Chemotherapy (JAC). The fullpaper can be found here:
The Care Workers Charity (CWC) recently hosted its Awards for 2018, an inaugural
ceremony to recognise those who have played a key part in the recent re-emer-
gence of the charity and whose particular contribution merits acknowledgement.
Care home operator Avery won the Best Fundraising Campaign award, with
commercial director Mark Danis receiving the award for Outstanding Contribution
by an Individual.
The CWC Awards were introduced to recognise and reward the exceptional
contributions of the charity’s most dedicated supporters. Appraised by an internal
panel of judges, the CWC recognised 12 outstanding individuals and CWC Part-
ners in seven categories.
“We have been so appreciative of Avery’s support over the last couple of years
and have been most impressed by their commitment to helping us set up an an-
nual event,” said Rebecca Woolley, partnership and events manager at the CWC.
“It was wonderful to see the walks Avery hosted and to see residents enjoying
their mocktails…we can’t wait to see what they have planned next!”
The winners celebrated their accolades at The Ned in Central London in Jan-
uary, enjoying a traditional afternoon tea reception.
Going the extra mile for The CareWorkers Charity
Angus Matthew, senior marketing manager at Avery Healthcare, accepts
Best Fundraising Award for Avery Healthcare from
The Care Workers Charity chief executive Richard Muncaster.
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09.45 - 10.00 Welcome Dr Richard Hawkins, Editor in Chief, Journal of Dementia Care
10.00 – 11.30 PLENARY SESSION
Opening address: We have a dreamPeter Bewert, CEO, Dementia Care Matters
Nothing about us, without us – a message for current andfuture health and social care professionalsWendy Mitchell, Dementia Care Advocate (to be confirmed)
Reflection and learning from our practice through challengingsituationsProfessor Melaine Coward, Head of School of Health Sciences, University of Surrey
Beyond the mirror of dementia careDr David Sheard, Founder, Dementia Care Matters
11.30 – 12.00 Refreshments
12.00 – 13.00 PARALLEL SESSIONSDelegates are invited to attend one of the following concurrent sessions fa-cilitated by Dementia Care Matters team members. The sessions have beendeveloped based on themes from our Observational Audits and most com-monly asked areas of support within our project methodology
1. “I just want to die”Finding a way to be alongside deep emotional pain in dementia careSally Knocker, Senior Consultant Trainer, Dementia Care MattersWhile our increasing focus on living well with dementia is to be welcomed, we still meet people who are in a very desperate and lonelyplace, and may struggle to know how to respond to these often hiddendepths of emotional anguish. This workshop will invite participants to starttalking about ways we can have these difficult conversations withpeople and confront some of our fears around this neglected topic
2. Intimacy and dementia careLuke Tanner, Consultant Trainer, Dementia Care MattersThis session will enable you to understand the balance of safeguarding, deprivation of liberty and the need for intimacy, love and in some casessex. We need to shift our culture and thinking where we label people's emotional and sexual needs as 'problems' rather than embracing this as anessential part of identity and wellbeing
3. Magic momentsNick Andrews, Practice Development Officer, Wales School for Social CareResearch, Swansea UniversityWhile the media often share the bad stories that happen in care homes, thesector is full of good stories. We need to acknowledge and celebrate thesemore. This workshop will provide a summary of the ‘MagicMoments’ work inWales, and introduce participants to simple exercises to support collectivelearning and development using short stories
4. Returning to new culture nursing Mentoring nurses in attached leadershipPeter Bewert RN, CEO, Dementia Care MattersGemma Diss RMN, Consultant Trainer, Dementia Care MattersNursing culture is deeply engrained within the medical model leading to taskorientation. Florence Nightingale first discussed ‘The art of nursing’ but isnursing still an art form? This session will explore the imperatives of Demen-tia Care Matters' new culture in nursing practice. We can enable this throughour care services for older people. It’s time to bring back “the art of nursing”
13.00 – 14.00 Lunch
14.00 – 15.00 REPEAT OF PARALLEL SESSIONS
15.00 – 16.00 From ‘Good’ to ‘Outstanding’ – the Butterfly WayJoin us for an interactive Question and Answer session with homes whohave achieved CQC ratings of Outstanding and maintain a Level One Accreditation status with Dementia Care Matters. You will be enlightened onhow to navigate the pathway of sustainability and what it takes toobtain and sustain ‘Outstanding’ which is a rating awarded to less than 1%of care homes in England. Come and learn from the lived experience of TheButterfly Way and its success on culture change, delivery and sustainabilityfrom an ‘Outstanding’ level by the regulator.
16.00 Tea and close
When we succeed in dementia care being right, we know that ‘all care’ can be right
Booking opens soon at www.careinfo.org/events/ or contact [email protected] For exhibition opportunities contact Caroline Bowern, [email protected]
Beyond Dementia Care - All Care MattersTRANSFORMATION I FREEDOM I TRUTH I INNOVATIVE I DISRUPTION I HEART
Conference organised by:19 July 2019UNIVERSITY OF SURREY, GUILDFORD
For several years now, Caring Times has been supported by
Barclays, Knight Frank and Pinsent Masons to hold a series of
regional roundtable events, where care providers big and
small discuss the issues of the day. Here we report on the
latest roundtable discussions.
Lucky care home operators were invitedby Barclays, Knight Frank and PinsentMasons to enjoy some clay targetshooting mixed in with some high-leveldiscussion about the sector. Clay targetshooting (formerly known as InanimateBird Shooting) is the art of shooting afirearm at special flying targets known asclay pigeons or clay targets.
Perhaps the sponsors thought it wasimportant that their guests shouldappreciate there were other targets in lifeapart from unfair CQC inspections oranother delayed piece of governmentlegislation or a local authority homepinching their best manager by paying
them way more than the private operatorcould afford.
Buoyed by their success smashing clay topieces, most operators were in surprisinglygood heart about their own businesses. Thisdetermined optimism for their own confirmssimilar results found in the annual surveyconducted by the sponsors in 2018 whichshows that operators are generallypessimistic about the sector but hopefulabout their own businesses.
That said, no one present had a good wordto say for the implications of Brexit forrecruitment and staffing in general.
The survey by contrast revealed that anamazing 12.7 per cent of respondersconsidered recruitment the least of theirworries and a similar number (13.9 per cent)
said that staff costs were of no concern.“Where do they live?” we are forced to ask.
Looking ahead, the feeling wasthat 2019 was looking very uncertain.The outstanding green paper ismaking operators nervous aboutmaking big decisions until they knowwhat it contains.
Combine political and economicuncertainly and people are sitting tightand holding off buying and selling untilthere is more certainty.
The positive is that there was generalacceptance that the healthcare sector ismore defensive than other propertysectors and will hold up better than othersectors should the shooting resume witheven greater ferocity.
By Caring Times editor-in-chief
Dr Richard Hawkins
By Caring Times editor
Geoff Hodgson
Big decisions put on hold amidst the uncertainty
Healthcare Management Solutions chief executive
Tony Stein: ‘too many variables to make a
meaningful assessment’.
How hard can it be to knock down a claytarget? Just aim a little in front, pull thetrigger and have the satisfaction of seeing thetarget blown to smithereens.
Simple enough, so why were we missingso many when we gathered at a shootingschool near Snaith in North East Yorkshiretowards the end of last year?
There were 15 of us, care home providers,bankers, lawyers and healthcare propertyspecialists, spending the morning in theadmittedly atavistic exercise of clay targetshooting before sitting down to discuss thecare sector and, in particular, the 2018 surveyof care home operators conducted by Caring
Times on behalf of Barclays, Knight Frankand Pinsent Masons.
It soon became evident that assessing what
A tale of two sectors
was going to happen in the sector in the nextcouple of years was every bit as difficult ashitting a moving clay target.
“There is so much going on and there aretoo many variables to make a meaningfulassessment,” said Tony Stein of Health CareManagement Solutions.
“Will we ever get the right decisions out ofpoliticians to fix the problems? The NHS is thenation’s sacred cow; it’s worth votes and it’shigh on the political agenda, so it will alwaysattract the money, whereas social care is waydown on the agenda. If you look at the RedBook for the Budget, there are 59 mentions ofthe NHS and 12 mentions of social care, whichgives some idea of the relative importance thatgovernment attaches to each.”
The discussion ranged widely over staffingcosts, recruitment and retention,development finance, the likely impact ofBrexit and the perennial problems of
regulation. It soon became clear, however,that the independent provision of social careservices was now divided into two quiteseparate sectors – the private pay sector andpublic provision, each with their ownconcerns, challenges and opportunities.
“No one is building in Sheffield becausethere isn’t the market for the self-funders,”said Belinda Black, chief executive of Sheffcare,a not-for-profit provider which operates 10residential care homes across Sheffield.
In a year when the news anddevelopments in the sector werepredictably downbeat, as has becomeusual at the Roundtable events, I found itreally heartening to hear about theinnovative ways in which the attendeeswere dealing with the issues thrown atthem. It was also great to hear some of thenew younger leaders in the sector talkingvery passionately about the sector andwhat they want to do to shape the market.
As has been the case for the last fewyears, there was significant discussionabout staffing shortages (exacerbated inthe lead up to Brexit, with EU recruitsstaying away until the situation becomesclearer), fee cuts, interaction with local
Good to hear from younger leadersBy Dan Braithwaite,
Senior Associate, Healthcare,
Pinsent Masons
authorities and of course, the CareQuality Commission.
However, on a more positive note, a lotof the discussion was focused on the useof new technologies in the provision ofservices and new and innovative ways ofretaining staff. We heard from severalbusinesses who were making realchanges to ensure that their workforceharboured a positive working cultureand appreciated the greater good/moralpurpose in what they and their teamwere trying to achieve. The good newswas that they were already reaping thebenefits in relation to staff retentionand productivity.
It was also interesting to hear about theincreased use of tablet devices and appsthat support patient care (both in carehomes and in community settings).
self-funders and low staff turnover, but I doworry about the sector as a whole. Too manypeople can’t afford to fund their own careand I think they are left too long at home;there’s a lot of unmet need, a lot of lonelinessand isolation. A person has to have had anumber falls now before they are consideredfrail enough to come into a care home.”
There was a general consensus thatstaffing and recruitment costs remained thebiggest concern for providers. Belinda saidthe 4.9% increase in the National MinimumWage was a concern, especially as thatincrease would have to be done for all staffto maintain the differential.
“We forecast that by 2020 we’ll be out ofbusiness, based on historical fee rates fromSheffield Council,” said Belinda.
“We work very hard at recruitment andretention. We have a turnover of about 12%which is one of the lowest levels in thecountry. We pay as much as we can, we givethe staff a bonus every year. The lighterthings that we do include Christmas presentsand thankyou letters, and we pay for all thetraining. But we have fantastic long-standingmanagers and to me, they are the key. AndSheffcare has a great reputation and is seen asa good place to work.”
Pinsent Masons’ James Long, who chairedthe discussion, asked if banks had any sensethat providers were finding acquisition anddevelopment finance more difficult to raise, aswas suggested by the survey results. Barclayshead of healthcare (north) Jonathan Thompsonsaid he had not seen any evidence of this.
“Talking to people, it seems there are farmore forms of finance available,” he said.
“There was a time when banks were prettymuch the only show in town, but now thereare funds flowing from various sources andin many places, the sector is awash withfunding. Increasingly, people are looking tothe ground rent scheme.
“The biggest challenge from a bankingperspective is that banks have become farmore aware of the cost of keeping capital on
their balance sheets and pricing has becomedifficult. The care sector is a big consumer ofdebt funding so it does have an impact onthe balance sheet but really, we’re lendingmore than we have done previously. Goodoperators with a good business plan and amodel we can work with will find fundingis still available.”
As with similar events held in past years,all providers expressed full confidence intheir own operations but all were morereserved in their assessment of the social caresector as a whole. Anchor’s Mark Greavesput his rating at 3 of a possible 5.
“Brexit is a worrying uncertainty,” he said.“We don’t know whether or not there will besecurity of supply of some consumables.”
James Long agreed: “ I think there’ll be a bigdrop in transactions in the first quarter of2019 owing to uncertainty over Brexit, butI’m cautiously optimistic for the sectorgenerally so 4 and 5. There’s going to be a lotof activity over the next five years, in bothcare homes and retirement villages.”
Knight Frank’s Rick Tarver was alsobullish, despite the uncertainties. “I give aconfidence rating of 5 for healthcaregenerally, because the demand is there and isgrowing,” he said. “Most people consider thevalue of their business to have increased overthe past five years. The sector as a whole isdynamic, it’s fluid, it’s constantly changing.That will continue to bring opportunity,innovation and change.”
For most UK investors 2018 was a tough year. Shopping centrevalues fell by 10.5%, the FTSE 100 fell by 12.5% and the countryremained gripped by Brexit uncertainty. Yet amidst thisturmoil, the amount of capital being spent on care home andsupported living investments (on a net lease basis) increasedby 46% from c £1.375bn 2017 to c £2bn in 2018, a significantuplift by any metric.
What is also interesting is where the money came from.We’ve known for a number of years that UK pension funds andinvestment managers have been increasing their exposure tohealthcare and this continued apace in 2018. But what perhapswas less expected, especially given the uncertainty aroundBrexit and the plethora of articles in the press about thechallenges faced by the sector, was the inflow of capital fromboth the EU and Asia.
Much of this money, however, is long-term capital and whatthey have realised is something that those of us in the markethave known for a long time. Regardless of what happens in thegeopolitical economy, every town and city across the country isgoing to need care homes, medical centres and housing withcare. And crucially, from an investors perspective, this means aneed for buildings that deliver long-term rental income streams.
While of course the funding sources, models for deliveringcare and technology will change, and this in-turn this willshape the property requirements, the fundamental need forthem won’t. The delivery of care ultimately requires people,and those people will need buildings because unlike othersectors, you can’t outsource it; you can’t put it on the internet,and you can’t get a robot to do it.
So while much of the world may be changing and there maybe short-term ups and downs; the long-term fundamentals arestrong and amidst the wider turmoil out there it seems thatsome of the smart investors are beginning to realise it.