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The Voice of Excellence in Social Care
Let's talk
social care!
Issue 26
October 2013
£2.50
Focus on
end of life care
l
PLUS: Up Close and Personal with Paul Woodward
Whose death is it anyway?
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CONTENTS
Contributors
Thank you to everyone who has contributed to this
magazine. Do keep your articles, news and views coming.
Jennifer Bernard
Consulting director
Social Care Institute
for Excellence
Jan Sheldon
Consultant
Plum Moment Ltd
People (NAPA)
Laura Boyd
Communications
officer
Think Local Act
Personal Partnership
Debbie Sorkin
Chief executive
National Skills
Academy for Social
Care
Andy Callow
Director of supported
living services
Spirit Care Limited
Professor Keri
Thomas
National clinical lead
GSF Centre for End
of Life Care
Janet Crampton
Consultant
2020 commissioning
Robert Tranter
Solicitor
Lupton Fawcett Lee &
Priestley
Inside Issue 26
11
21
News
05 Caught on camera
06 Whose death is it anyway?
08 Newsround
10 CSMA Club opens its doors to 11
12
13
14
15
social workers
Hospice Care Week
Reducing hospital deaths
Improving end of life care
Keeping information safe
From the G8 Dementia Summit to Norfolk and Suffolk
16 Senior health officials on the
Jonathan Ellis
Director of policy &
advocacy
Help the Hospices
Tracy Wharvell
Consultant
Plum Moment Ltd
Dr Rhidian Hughes
Head of social care
Centre for Workforce
Intelligence
Jenny Wilde
Solicitor
Ridouts LLP
Des Kelly OBE
Executive director
National Care Forum
Paul Woodward
Chief executive
Sue Ryder
frontline
Opinion
17 The demise of the LCP
18 Art for wellbeing and art as training
Good Care Week
19 Get ready for Good Care Week 2014
20 Ben Markham – Good Care Champion
Stories
21 Man’s best friend offers dementia
support
22 Catwalk to compost
23 Having cancer inspired me to care
Debra Palmer
Managing director
Compare All Care
Chat
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Email: [email protected]
24 Voice over:What does a ‘good
death’ mean to you?
25 360° opinion: Moving into
residential care
26 Mrs MacBlog
27 This is your life
27 Planet Janet
28 Up close and personal
Showcase
33
Celebrate
30 2013 Regional Great British Care
Awards
31 And the winner is...
Learn
31 The Registered Managers
Programme
32 @rhidianhughes on #socialcare
33 How to be a good care trainer
34 Transforming an underperforming
service
35 Putting jargon-free information at the heart of personalised care
36 Care workers and employers sign up as ambassadors
Special
37 Music therapy
37 Telecare services
38 Scottish caterer takes good care of his people
41 Work hard and be nice to people
41 Championing change
42 Innovative apetito hospital and care home meals shortlisted for national awards
43 Great assessors are flexible
44 Royal British Legion
45 Time to care
Business
47 Burning cost
48 Business round-up
50 LOROS hospice profile
51 CQC and end of life care
52 Challenging fees
53Property
Fun stuff
54 Short story
55 Care creatures
29 Care Talk on the road
Care Talk is a trading name
of Care Comm LLP.
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Care Talk contacts
Editorial: Lisa Carr [email protected]
Advertising: Rebbecca Harrison [email protected]
Graphic Designer: Tanya Goldthorpe
General: [email protected]
Journalists: Vicky Burman, Julie Griffiths, Debra Mehta
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Care-Talk
www.caretalk.co.uk I 03
than X Factor’s fab four. For some regions
there’s still time to get in those last minute
nominations, so do visit the website (www.
care-awards.co.uk) for details.
Editor’s Note
Hospice Care Week begins on 7 October.
This aims to highlight the growing need
for hospice care as demand continues
to rise rapidly over the coming decades.
Rather fitting therefore that the focus for
this month’s issue is end of life care. Our
lead story on page 6, Whose death is it
anyway?, examines what we really mean
by choice when it comes to the end of
someone’s life and the role of the care
worker in a ‘good death’.
Welcome to the October issue of Care Talk.
As the nights draw in, much of the nation
will be glued to the television for the latest
instalment of this year’s X Factor. And as the
new format, new talent and Simon Cowell’s
ever-inflated ego miraculously inflate the
viewing figures, I am delighted to say that
talent for this season’s Great British Care
Awards is looking better than ever.
Our feature on page 36, Transforming an
underperforming service, will resonate with
many registered managers. Four years
ago, Amy Cole took on a service that was
not performing well, but through hard work,
determination and communication has now
successfully converted a failing care service
into a thriving home for adults with learning
disabilities.
With the 2013 regional awards now in full
swing, our very own stars of social care will
soon be revealed. The judging days are now
upon us and finalists face an interview with
a panel of judges – slightly less intimidating
Finally, don’t miss our story on page 23, which
features a remarkable care worker. Kevin
Husband was inspired to become a care
worker following the care he received when
he had a life-threatening illness as a teenager
and twice came close to death. Despite
the possibility of the cancer returning Kevin
remains positive and committed to providing
quality care.
We do hope you enjoy this issue of Care Talk.
Please do keep your news and views coming
in – we love to hear from you!
Lisa
Circulation list
Has this month’s Care Talk been read by all your staff?
Use our easy circulation list to be sure!
Job
Chief executive
Managing director
Registered manager
Supervisor
Care staff
Ancillary staff
Service users
Families
Read?
CAUGHT ON CAMERA
Sink or Swim,
Channel 4,
12 August
CAUGHT ON
CAMERA
stroke”, and Ellie rings Cassia to get help. We
hear but don’t see paramedics arriving, and
the final scene is of Ellie going to the swimming
baths, the irony being that she can’t actually swim
herself and Cassia is teaching her.
Cynthia is adamant that neither of them is “going
in a home” and instead we see Ellie packing
clothes and the many photos and posters
hanging on the walls of the flat, an insight into
Cynthia’s exploits as a synchronised swimmer in
her youth.
One of the Coming Up series of original short
dramas made for Channel 4 as part of its talent
scheme to encourage new writers and directors,
Sink or Swim tells the story of teenager Ellie, who
is determined that her beloved grandmother
Cynthia, played by Una Stubbs, should not go
into residential care.
This is a sweet little film where more is implied
than shown and we don’t know what’s happened
previously – for instance, why does Ellie seem
to be her nan’s only carer and where are her
parents? – or what happens next. We don’t know
whether Cynthia ends up in a care home or even
if she lives or dies.
Ellie’s friend Cassia turns up with a ‘borrowed’
wheelchair to help in the escape plan – “It’s
another adventure,” says Cynthia at one point,
but then she becomes confused, and the only
way the girls can get her up and dressed (with
full make-up and a fur coat) is by telling her she’s
coming to watch them in a swimming gala.
We see Ellie acting as her nan’s carer, doing the
shopping, making sure she takes her medication
and helping with her exercises. Initially Cynthia
appears to be bedridden but still lively and bright,
not in pain but feeling the cold and needing her
‘nap’.
What Sink or Swim does perhaps reflect is the
fear that older people and their families can feel
about going into residential care, or even letting
social services and other support into their lives.
People who just want to help may be seen as an
intrusion and a threat, particularly to a close-knit
relationship like the one Ellie and her nan share.
Cassia has found them an empty flat to hide out
in, which Ellie brightens up with candles and fairy
lights, and makes plans to fetch her nan’s comfy
chair and proper lamp from their old place; she’s
distraught when Cassia tells her the flat’s only
unoccupied for two weeks.
But something is clearly afoot – Ellie finds a card
left by social services, who called on a prearranged visit while she was out shopping, and
her nan reports that ‘shouty Susan’ the social
worker kept knocking and ringing the bell.
Susan comes back but Ellie and Cynthia keep
quiet and won’t answer the door, and she calls
through the letterbox that she’ll need to report
Ellie missing and get the police involved.
But Ellie and Cynthia still have a lovely evening
together, reminiscing about her swimming career
– until Cynthia suddenly collapses with “another
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www.caretalk.co.uk
I 05
NEWS - LEAD STORY
Whose death is it anyway?
There is nothing more personal
than death – and probably no
more important time to ensure that
someone’s personal wishes are met
than at the end of their life.
Two new reports from specialist care charity
Sue Ryder – Ways and means and A time
and a place – focus on how the health
and care sector could offer everyone truly
personalised support and the same amount
of choice about not just where they spend
their final days, but how.
But what do we really mean by choice when
it comes to the end of someone’s life? And
what role can you, as a carer close to people
who may be reaching that stage, do to help
them (and their families) make decisions so
they can have what they personally see as a
‘good death’?
As the Macmillan patient information booklet
Your life and your choices: Plan ahead points
out: “Only you are the expert on you. If you
plan your care in advance you’ll know that
your care will be right for you. It can also help
you to feel more in control of your life.”
What, not where
The focus of Ways and means is on the
‘end of life journey’; inevitably this can vary
enormously from person to person, both
in length and complexity, but the report
highlights certain factors that contribute to
a particularly poor end of life experience by
causing unnecessary disruption and delays in
providing the care people want, including lack
of choice.
But all too often choice seems to equate to
where someone would prefer to spend their
last days. As Claudia Wood, deputy director
of think tank Demos, which carried out the
research for the two Sue Ryder reports,
says: “For years health professionals and the
Government have been striving to make sure
people die in their preferred place – often at
home.
“But a blinkered focus on dying at home
has meant other settings, such as hospitals,
haven’t improved what they offer people at
the end of life. It also leads us to an uncritical
view of dying at home, when we know this
can be difficult and traumatic.”
For instance, one woman who took part in
the research said her husband – who had
been in a hospice – wanted to die at home.
The things she remembered most about
the experience were being surrounded by
medical equipment, having to arrange for
06 I www.caretalk.co.uk
nurses to sit with her husband so she could
sleep and waiting six harrowing hours for
the doctor and undertaker to arrive after her
husband passed away during the night.
at home’, which provides specialist medical
care to manage pain as well as emotional
support in the comfort of a person’s home,
both for the individual and their families.
These practical details – which, the report
points out, would be dealt with swiftly, with
support on hand, in any other location –
become highly traumatic when unfolding in
one’s own home and can affect the people
left behind. This may contribute to an
individual’s desire not to die at home, for fear
of being a burden to the family or leaving
difficult memories.
Explain the options
The prospect of dying without support can
prompt people to opt out of home care at
the last minute, as Adrienne Betteley from
Macmillan says: “People are consistent in
their wishes, but they do panic – and family
members especially.”
Decisions on where someone wants to die
are also often based on misconceptions,
assumptions and previous experiences,
good and bad. Hospitals can be daunting
for some, but someone with a long-term
condition requiring frequent admissions may
feel very at home in a hospital environment
and with healthcare professionals they’ve got
to know.
Sue Ryder’s head of clinical quality and
nurse lead Sue Hogston told researchers
that: “There is still a perception that hospices
are places where people go to die. Better
understanding and communication regarding
the role of hospices in enabling choices –
in what are often emotionally challenging
circumstances – is crucial.”
It’s important not to make assumptions about
people’s awareness of what care is possible
in different surroundings. A time and a place
aims to differentiate between the what and
the where, pointing out that people tend to
associate end of life care outcomes such
as being pain-free or surrounded by loved
ones with certain places, particularly in the
absence of a real understanding of what
support is available.
The report concludes: “Rather than making
positive choices about end of life care,
people would make unacceptable trade-offs
between dying in the place of their choosing
or receiving the care that they want.”
Based on its findings, Sue Ryder calls for
reforms to ensure everyone’s wishes for care
are met at their end of life, recommending
that all care settings be more flexible and
offer more varied support for people and their
families, including services such as ‘hospice
In an ideal scenario, people will be
encouraged to start ‘what if?’ planning early
on, thinking about various contingencies
and making decisions based on personal
preferences and a full understanding and
awareness of how their needs could be met.
Diagnosis should be the trigger for proactive
advance planning, points out Ways and
means, with referral to specialist palliative
care social workers and good communication
across services so that individual wishes are
recorded and shared with the people who
can make them a reality, if at all possible.
There are inevitably some additional
challenges in helping people to communicate,
and record, their wishes – Ways and means
highlights people with learning disabilities or
dementia, among others, as more likely to
have difficulty making choices and voicing
their preferences.
And difficult and emotional circumstances
surrounding end of life are not exactly
conducive to making rational, well-considered
decisions about future care.
As A time and a place points out: “People
seemingly have a clear idea of what is
important to them as they are dying, but
the reality of dying with a terminal illness
does not always allow for the same level of
reflection and detachment.”
The report found that: “Aside from medicines
being administered, people’s top priorities for
the end of life included very little involvement
from medical or care professionals – only
24% of people selected having trained carers
nearby as something that would be important
to them, and only 16% selected professional
medical support on standby for emergencies.
People clearly want as ‘un-medicalised’ a
death as possible – but they still want to be
free from pain.”
Talk about it
The only way to really know what someone
wants to happen at the end of their life
is to talk about it with them – and their
families – but Ways and means suggests
that even health professionals like GPs are
ill equipped for such discussions. And as A
time and a place points out, older people in
particular may simply expect health and care
professionals to make decisions on their
NEWS - LEAD STORY
behalf, assuming these to be in their best
interests.
younger children to see them if they’re in pain
or hooked up to equipment?
Sue Ryder would like to see all health and
care staff getting end of life training to make
it less daunting to start such conversations
about advance care planning and to provide
better access to information about options
available.
Maybe this is a chance to settle things that
have been worrying them, like quarrels they
don’t want to leave unresolved. The idea of a
‘bucket list’ of things they want to do, or keep
on doing as long as possible, can be a way of
exploring what’s most important in their final
days. Even things like ensuring that, as far
as possible, they are offered their favourite
food, can make the end of their life more
comfortable.
Demos deputy director and co-author of the
report Claudia Wood says: “Too often the
opportunity for patients to have their say is
taken away due to a lack of professional
confidence.”
Among the advice given by Macmillan in Your
life and your choices: Plan ahead and other
resources is to keep encouraging people
to say more. “Don’t fill silences – gaps in
conversation can give them the opportunity to
bring up subjects that are important to them.”
Listen properly
And it’s worth reminding people it’s all about
them and how they feel. A certain amount of
‘trade-off’ is likely to be necessary – will being
on medication that means they are pain-free
result in an impaired ability to communicate
with and recognise loved ones, for instance?
Does wanting to have family around mean
that quiet surroundings are less important to
them?
There are tools available to help people think
about and set down what’s important to them,
but really listening and encouraging them to
voice their thoughts and concerns is crucial
to reach the point where they are sure what
they want.
Understanding what people really mean
is important. A focus group of bereaved
relatives held as part of the research found
that they talked about the need to be
‘comfortable’ rather than using clinical terms
like ‘pain-free’.
Care workers are in a good position to talk
people through what they wish to happen at
the end of their life, not least having probably
already built up a relationship of trust as well
as familiarity with someone’s background,
family circumstances, likes and dislikes.
Be flexible
The priorities Sue Ryder and Demos
suggested to people in their research are
a good starting point, but only by delving
deeper can you get a clear picture of what’s
truly important to the individual.
For instance, if they say they want to be
surrounded by loved ones, who exactly do
they mean? Is there a relative they’d rather
not see, for some reason? Do they want
One of the conclusions of Ways and means
is that an end of life journey needs to be
flexible and responsive. Individual journeys
will have different starting points, including
the person’s acceptance that they are dying
and how they already use health and care
services.
You need to keep talking and listening –
people’s preferences are likely to change
at different stages. The thinking behind the
research for A time and a place is that: “To
state that most people ‘want to die at home’
is an unhelpful generalisation, as it prevents
us from identifying ‘when’ people want these
things. At the moment of death, perhaps
people do want to be at home. But what
about the days, weeks or years that precede
it? People’s preferences appear to change
very significantly over this longer time period.
“True personalisation is being able to
select a package of care that achieves the
outcomes most valuable to you and your
family. Ensuring all end of life settings are
able to be flexible enough to achieve – as
far as possible – good quality care across
all four domains (personal, environmental,
medical and practical) according to people’s
preferences must be the priority for end of life
care reform.”
Vicky Burman
For more discussion on this issue, see our
interview with Sue Ryder chief executive Paul
Woodward on page 30 and read individual
carers’ views on a ‘good death’ on page 24.
What matters most?
People surveyed for the report A time and
a place were asked what would be most
important to them in their final days if they
had a terminal illness from the following:
• Being pain-free/having condition
managed with medication
• Surrounded by loved ones
• Privacy and dignity
• Familiar surroundings
• Calm and peaceful atmosphere
• Surrounded by personal things and/or
your pets
• Trained carers nearby
• Feeling in control of environment and
support
• Professional medical support on standby
for emergencies
• Access to professionals regarding family
or legal affairs
• Having religious, cultural or spiritual
needs met
• Having other people around who are
going through the same thing.
www.caretalk.co.uk I 07
NEWSROUND
Survey shows
personalised social
services being offered
to more users
An Association of Directors of Adult Social Services
(ADASS) survey shows that in 2012-13 local
authorities have continued to move forward apace
with personalising their services and support for
individuals “despite facing significant financial
pressures”, according to ADASS president Sandie
Keene.
“One of the biggest challenges still facing the
continued expansion of personalisation is the
development of a suitably diverse market to
meet individual preferences,” she says. Only
70% of councils surveyed say there is a diverse
and culturally sensitive market available to meet
individual choices and needs.
For more information visit http://www.adass.org.
uk/index.php?option=com_content&view=article
&id=931&Itemid=489
SECTOR
Tony Hunter appointed as
SCIE chief executive
Tony Hunter, chief executive of North East Lincolnshire
Council and senior vice president of the Society of Local
authority chief executives (SOLACE), has been appointed
as chief executive of the Social Care Institute for Excellence
(SCIE).
Tony will join SCIE in January 2014 following the departure of
Andrea Sutcliffe, who becomes the chief inspector of adult
social care for the Care Quality Commission from 7 October.
For more information visit http://www.scie.org.uk/news/
mediareleases/2013/200913.asp
Public oblivious to price of
care, says report (Source:
Anchor)
The British public are oblivious to the realities of the adult
social care system and their own likelihood of developing
care needs, according to a report released by the Strategic
Society Centre and older people’s not-for-profit care provider
Anchor.
Entitled Right Care, Right Price, the report explores the way
in which the price of care is determined. It reveals that nearly
half (48%) of adults have not given any thought at all as to
how they will pay for their own care. This concerning finding
could explain why 50% of people have no idea how much
a week in a care home costs. On average, those who could
give an estimate put the cost at £397 per week – around £140
a week (or more than £7,000 a year) less than the average
care home fees across the UK.
For more information and to read the report in full
visit http://www.strategicsociety.org.uk/wp-content/
uploads/2013/09/MEDIA-COPY-Right-Care-Right-Pricecopy.pdf
08 I www.caretalk.co.uk
Launch of code to drive up quality (Source:
Centre for Welfare Reform)
The Driving Up Quality Code has been officially launched by Minister for Care and Support Norman
Lamb. This is a code for providers and commissioners. Signing up is a commitment to driving up quality
in services for people with learning disabilities.
The code states: “Everyone was shocked about the abuse of people with learning disabilities at
Winterbourne View. The Government and many other organisations that support people with learning
disabilities are taking action to make sure that this never happens again.”
Alicia Wood, chief executive of Housing & Support Alliance (HSA), says: “I have spent the best part
of a year working on a code for providers of learning disability services to sign up to as part of the
Government’s programme to transform support in the wake of Winterbourne View. The Driving Up Quality
Code commits providers to addressing fundamental cultural issues in their organisations and being
honest and transparent about how well they are supporting people.”
For more information on the code visit http://www.drivingupquality.org.uk/home
No excuses for breaking the law on minimum
wage
Directors of adult social services have joined other bodies in condemning the practice of paying any
care worker less than the statutory minimum wage.
According to the Association of Directors of Adult Social Services (ADASS) president Sandie Keene:
“We all of us fully understand the serious financial pressures facing the private home care sector. They
are no less than those faced by the economy as a whole. But that cannot be used in any way as a
justification for breaking the law.”
ADASS was responding to a report published by the Resolution Foundation suggesting that up to one
in 10 care workers is paid less than the current national minimum wage of £6.19 per hour.
ADASS is joining with partners in Think Local Act Personal and the Department of Health to
commission work on excellence in commissioning for outcomes. This work will enable consideration of
key current issues, including best procurement practice for home care.
Sandie Keene adds: “Well-supported staff have greater job satisfaction and overall wellbeing. Care
providers must take this into account when establishing the pay and general employment conditions of
their staff, as we must take it into account when letting contracts for the care of our citizens.”
For more information visit http://www.thinklocalactpersonal.org.uk/News/PersonalisationNewsIt
em/?cid=9625
NEWSROUND
SECTOR
New ADASS vice president elected
David Pearson has been elected vice president of the Association of Directors of
Adult Social Services (ADASS) – a move that will see him becoming president at the
association’s annual general meeting in April 2014.
David has been corporate director adult social care, health, and public protection for
Nottinghamshire County Council since 1985. He has covered the role of director of
resources for the authority and is also the deputy chief executive.
Thanking his colleagues for their support, he says: “Being vice president provides a
fantastic opportunity to work with you as we collectively seek to influence and shape
the future of adult social care and provide support to each other in our roles as
leaders of the sector.
Carers UK calls for action as poll
shows lack of care technology
awareness
Tech-savvy consumers, young and old, are missing out on the help technology
can give when caring for older, ill or disabled loved ones, according to a new
poll. While over seven in 10 UK adults routinely turn to technology for banking,
shopping and communications, the research shows only three in 10 are embracing
health and care technology to help care for older or disabled relatives.
The national YouGov poll, commissioned by charity Carers UK and supported by
Tunstall Healthcare (UK), highlights that all generations are failing to switch on to
care technologies – with young and old, middle-class and wealthier respondents
and social media users all reporting low use of gadgets and online health and care
support.
“For those of you who know me, I hope you recognise the passion and dedication I
have for high-quality, personalised and effective social care services that reflect the
needs and aspirations of service users and carers.”
Carers UK says the poll indicates the barrier to using care technology is often a
lack of knowledge, advice and information rather than a public resistance to health
and care technology. Last month Carers UK set out a vision for widening access to
health and care technologies at a Parliamentary event.
For more information visit http://www.adass.org.uk/index.php?option=com_con
tent&view=article&id=930&Itemid=489
For more information visit http://www.carersuk.org/newsroom
NHS
Board role for dementia
carer
A homecare worker and dementia specialist has been
appointed to the board of the 2gether NHS Trust,
which runs mental and social health care services in
Gloucestershire and Herefordshire.
Jinny Searle, a team leader with Gloucestershirebased homecare provider DoCare, applied for the role
because of the passion she has for dementia care.
Jinny was among the first to be trained as a dementia
link worker in Gloucestershire, gaining QCF levels 1 and
2 in dementia awareness.
As a board member, Jinny will help shape future
trust policy, act as a link between the trust and the
community and help ensure it delivers quality services.
Jinny’s role is voluntary and she will continue to work for
DoCare, supporting clients in the Gloucester and Stroud
area.
DEMENTIA
Healthcare experts launch
new dementia training
programme (Source: Virtual
College)
A number of medical experts and academics in Manchester
have joined forces to produce a new healthcare training
programme for hospital staff dealing with dementia patients.
Teams from Greater Manchester West Mental Health NHS
Foundation Trust and the University of Manchester have
combined with other NHS trusts in Bolton, Salford, and Central
Manchester to launch the Getting to Know Me dementia
initiative, which is designed to address the fact lots of nurses
and hospital employees do not always feel confident when
looking after people with the condition.
For more information visit http://www.virtual-college.
co.uk/news/Healthcare-experts-launch-new-dementiatraining-programme-newsitems-801634657.aspx
MENTAL HEALTH
Protection for vulnerable adults
inadequate, says Law Society
There is a “depressing” lack of awareness about the Mental Capacity Act (MCA)
according to the Law Society of England and Wales. In its submission to a House of
Lords select committee, the Law Society said that frontline professionals who work
with vulnerable adults are frequently unaware of the MCA, or lack the skills to put it into
practice.
Nicola Mackintosh from the Law Society’s Mental Health and Disability Committee says:
“Unfortunately, professional training for key frontline staff has not kept pace with the
increasing complexity of community care. We would like to see more training on the legal
framework and practical application of the MCA.”
The Law Society’s submission calls for a review of deprivation of liberty provisions,
greater resources for the Official Solicitor and the Court of Protection, and for the Hague
Convention on the International Protection of Adults to be ratified for England and Wales.
For more information visit http://www.lawsociety.org.uk/news/press-releases/
protection-for-vulnerable-adults-inadequate-says-law-society/
Growth in Alzheimer’s
may be linked to
better hygiene, say
scientists (Source:
The Guardian)
Researchers have suggested that improvements
in hygiene might partly explain increased rates
of Alzheimer’s disease in many developed
countries. The researchers studied the
prevalence of the neurodegenerative disease
across 192 countries and compared it with the
diversity of microbes in those places.
Whether hygiene causes the pattern is not yet
clear – cleanliness or infectious disease might
be associated with some other factor – but the
team does have a speculative hypothesis for
how the two factors might be linked.
For more information visit http://www.
theguardian.com/
Survey prompts CQC call for
improvements in community mental
health care
A major national survey of people who use community mental health services
in England, published by the Care Quality Commission (CQC), shows
the care people receive in the community needs to improve. Of particular
concern is people’s lack of involvement in their care plans and having their
views taken into account when deciding what medication to take.
The survey asked about the experiences of more than 13,000 community
mental health service users during the past 12 months, and involved 58 trusts
in England that provide mental health services.
People were asked about the care and support they received from mental
health services outside hospital, such as those offered by outpatient clinics,
local teams providing crisis home treatment, assertive outreach, early
intervention for psychosis, and generic community mental health services.
For more information visit http://www.cqc.org.uk/surveys/mentalhealth
www.caretalk.co.uk I 09
ADVERTORIAL
CSMA Club opens its
doors to social workers
CSMA Club is an organisation run by members for the benefit of
members and their families. The collective buying power of 300,000
members ensures individuals can save hundreds of pounds
annually. From insurance to leisure retreats, shopping discounts to
cinema tickets, CSMA Club, established in 1923, has something for
everyone.
CSMA Club saved its members £9m in 2012 alone and over time it
has evolved to remain relevant and deliver value for members. This
evolution has led to the historic decision to open the club up to a
number of carefully selected public sector bodies, including social
workers.
The decision to include social workers is in response to the ongoing
privatisation of a large number of public bodies. This has left many
social workers with reduced employee benefits and uncertain
professional affiliations. CSMA Club is well placed to maintain many
of these benefits.
Isn’t it time someone
took care of
social workers?
Join for just £18 a year
Call 0800 66 99 44 or visit csmaclub.co.uk/socialworkers
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Mark Rothery, chief executive at CSMA Club, comments: “We are
celebrating our 90the anniversary this year and are looking forward
to the next 90 years. While our membership is in rude health, we are
always looking at ways we can grow CSMA Club. The bigger the
membership, the greater our buying power, which means we can
deliver even more for our members. We are therefore very excited
about opening up the club to social workers and welcome them to
CSMA Club.”
By clubbing together, CSMA Club can offer better discounts, create
more special events and provide more rewarding experiences for
members. Being a member is about much more than saving money
on life’s essentials and leisure activities; it is also about giving
members access to exclusive events, holidays and lots more. You
won’t just be better off, you will also feel better off.
The introductory membership fee is just £18 and allows new
members to tap into a host of benefits and offers. To find out more,
go to www.csmaclub.co.uk
After all, you spend your time looking after
other people. CSMA Club gives public
service workers access to hundreds of
pounds of exclusive savings, experiences
and special offers for just £18 a year. Last
year we saved our members over £9 million
with our selected brand partners.
What’s more, with our special introductory
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Life’s richer together
AWARENESS SPECIAL
Hospice Care Week:
Making hospice care
count
Help the Hospices, the UK charity for hospice care,
highlights the growing need for hospice care during its
annual Hospice Care Week.
with terminal illness get the care and support
they need in the future.
recognise the value of hospice care and put
hospice care higher on the political agenda.
The hospice sector cares for around 360,000
people each year, including patients with a
range of illnesses such as cancer, dementia
and other life-limiting conditions.
Help the Hospices is also encouraging
supporters to spread awareness of hospice
care among the wider public by taking the
‘Count me in!’ online pledge. All you need to
do is promise to tell five people about why
hospice care counts.
Hospice care looks after all of a person’s
needs. This includes medical care as well as
support for someone’s emotional, spiritual,
psychological and social needs. It places
strong emphasis on dignity, compassion and
meeting people’s personal preferences.
Hospices are also leading providers of social
care, which is vital for maintaining people’s
quality of life and emotional wellbeing as well
as that of their families and carers.
Demand for hospice care is growing fast and
will continue to rise rapidly over the coming
decades.
From around 2015, mortality rates are set to
increase and there will be a huge increase in
the number of older people in the UK, many
of whom will have complex health and social
care needs.
The number of people aged over 85 alone
is predicted to double in the next 20 years.
Further into the future, the number of people
aged 100 is expected to increase more than
eightfold by 2035.
“This demographic ‘ticking
time bomb’ will have a
considerable impact on
hospice care.”
This demographic ‘ticking time bomb’ will
have a considerable impact on hospice care,
and it is vital that we make sure that people
Nearly two thirds of people prefer to die at
home, yet more than half of us will die in
hospital. Hospice care is not just provided
in a hospice building but is also available
in other settings – including hospitals and
people’s own homes – so hospice care can
help people to be cared for in their preferred
location.
We are facing a time of considerable social
change and it is critical that politicians and
other key health decision-makers recognise
the impact of this early on if people are to be
able to receive the care they need.
As part of Hospice Care Week (7-13 October)
we are encouraging politicians at all levels
from local to national to recognise the value
of hospice care and help make sure that we
can reach even more people in the future.
Locally, people can get involved by
contacting their local health and wellbeing
boards (or the equivalent bodies in Wales,
Scotland and Northern Ireland) and asking
them to make hospice care a local priority.
To raise awareness on a national level, we
are asking people to write to their MP, MSP
or Assembly Member to encourage them to
“Nearly two thirds of people
prefer to die at home, yet
more than half of us will die
in hospital.”
With so much change and uncertainty
over hospice income, and given the tough
economic environment for charities generally,
Hospice Care Week will also highlight the
continued importance of local hospice
funding.
On average, each hospice needs to raise
over £7,680 every day to provide care and
support for people with terminal illness and
life-limiting conditions. Simply making a
regular donation, however small, will help
secure the future of your local hospice.
Finally, we are also asking people to look at
other ways they can support hospice care, for
example, through volunteering. Over 100,000
people currently volunteer in hospices across
the UK, either working directly with families,
in an administrative role or helping to raise
money. The role of volunteers will play an
increasingly important role in hospice care in
the future.
Jonathan Ellis
Director of policy and advocacy
Help the Hospices
To find out how you can get involved with
Hospice Care Week, visit the campaign
website at www.hospicecareweek.org.uk
www.caretalk.co.uk I 11
NEWS - SECTOR
Reducing hospital deaths –
GSF in care homes
Recent events in Mid-Staffs and the review of the Liverpool Care Pathway (LCP) mean
that now, perhaps more than ever, those involved in caring for people nearing the end
of their lives must ensure they have the tools they need to provide the very best care
they can.
As identified in both the Mid-Staffs report
and the LCP review, a lack of good
communication and coordination can
lead to a breakdown in care for people
approaching the end of their lives.
The National Gold Standards Framework
Centre (GSF) is the largest provider of
training to enable frontline health and
social care professionals to provide the
right person with the right care in the right
place at the right time, every time, and
communication and coordination are at
its core. That means that regardless of
the setting, whether in a care home, in
hospital or at home, health and social care
professionals should be in a position to work
together to provide that consistent, joinedup care that people nearing the end of life,
and their families, want, need and deserve.
“Participating homes
reduced the number of
residents dying in hospital
from just over 25% to just
less than 10%.”
So how is it possible to not only prevent
people from falling through the cracks,
but also hugely increase their chances of
being cared for in the way they want, in their
chosen place?
As one GP, recently accredited by GSF,
said: “We all have families and a bad death
impacts on the family forever. The GSF
training has enabled us to provide the
patients with proper continuation of care.
Being on the register, they might not die for
a long time, but will get the best care until
the time comes. From a practice point of
view it means we know what to do and when
to do it, and if they are not sure, then the
information is available or they can speak to
12 I www.caretalk.co.uk
a colleague.”
This view is reflected across the hundreds of
GP practices, 2,300 care homes (including
almost half of all nursing homes), 40 acute
and 42 community hospitals across the
country and the 1,200 domiciliary care
workers that have completed GSF training
programmes. The programmes help
professionals identify those approaching
the end of life, assess their needs and then,
with the individual themselves, plan their
care.
A recent assessment of the effectiveness of
the GSF Care Homes programme showed
that participating homes reduced the
number of residents dying in hospital from
just over 25% to just less than 10%. Crisis
admissions were also cut significantly, down
to less than a third from more than a half.
GSF focuses on optimising communication,
planning ahead, continuity of care,
teamworking, symptom management
and support for carers. Staff in GSFaccredited care homes report enhanced job
satisfaction, clearer management, improved
confidence and morale as well as an
improved culture of open communication.
their choice; otherwise we will do everything
we can to help people spend their last days
in the home. People feel the love as they
come through the door, we help them live
life to the full and care for them right up to
the end. People tell us it’s just like being at
home.”
“Staff in GSF-accredited
care homes report enhanced
job satisfaction, clearer
management, improved
confidence and morale.”
That quote is typical of care homes
across the country. Speak to the matron
or manager of a GSF-accredited home
and the message is consistent: by giving
care workers the tools, resources and
information to identify patients, assess their
needs and plan their care, GSF has helped
instil in them new confidence. It also helps
them work more closely with other health
professionals, cross-boundary, to ensure
the people for whom they are caring do not
slip through the net. This accounts for why
the Care Quality Commission includes GSF
accreditation information in its assessment
process.
All of these factors combine to make the
improvements longlasting and sustainable
– it’s not just about working towards winning
an award. All of the GSF programmes
involve a shift in culture and system. This
is evidenced by the number of care homes
that are now, three years after their initial
accreditation, going through the process
again and, in many cases, demonstrating
even higher standards.
The manager of a south London care
home, recently reaccredited by GSF, said:
“The last time one of our residents died in
hospital was two years ago and that was
Professor Keri Thomas
National clinical lead
GSF Centre for End of Life Care
NEWS - SECTOR
Marie Curie works with GPs to
improve end of life care
As people live longer, increasing
numbers of patients have long-term,
advanced conditions requiring more
complex support towards the final
stages of life. The majority of people
die from non-cancer conditions such
as heart failure, chronic obstructive
pulmonary disease (COPD),
dementia, frailty and multiple comorbidities. Yet these conditions are
not always identified early enough
and their course of decline can be
erratic, unpredictable or protracted,
often requiring complex health and
social care support, which can be
challenging.
We want the best end of life care for
everyone and this means ensuring that
people receive the care and support they
need to help them live as well as they can,
for as long as they can – this also means
working effectively with GPs.
“Many people who die in
hospital have no medical
need to be there and do not
want to be there.”
Almost everybody has a GP, and they play
an essential role in caring for people at the
end of their lives – especially those who
are cared for at home. GPs have a special
relationship with not just their patients but
also with the patients’ carers and the people
close to them.
A recent report from Marie Curie – Death
and Dying: Understanding the Data –
painted a complex picture of end of life
care, with big differences in access,
experiences and outcomes for people who
are terminally ill. It also showed that many
people who die in hospital have no medical
need to be there and do not want to be
there.
We are calling for a well-planned, systemwide programme to shift the focus and
ultimately resources away from acute
hospitals in order to provide greater support
for people in care homes, hospices and
their own homes. And we know that GPs
as well as social care professionals have an
important role to play in improving palliative
and end of life care across these different
settings.
final year, months or weeks of life, and
planning proactive, well-coordinated care
that supports the wishes of patients. This
will include joint working between health
and social care and the need for good
communication.
This is why Marie Curie and the Royal
College of General Practitioners (RCGP)
have joined forces to improve the end of life
care provided to patients by GPs. One of
the first steps in the three-year programme
is the appointments of Dr Peter Nightingale,
a new clinical lead for end of life care, and
Dr Adam Firth, RCGP clinical support fellow
for end of life care, who will work part-time
for the Royal College and Marie Curie, while
continuing their other general practice day
jobs.
“The programme will
improve primary care
provision for patients nearing
the end of their life, including
vulnerable patients such as
those with dementia and
learning disabilities.”
Dr Nightingale will lead a programme of
work that will improve primary care provision
for patients nearing the end of their life,
including vulnerable patients such as those
with dementia and learning disabilities. The
programme will prioritise advanced care
planning, patient choice of place of death,
pain management, health inequalities and
commissioning issues.
This will enable more people to live and die
as and where they choose, and help reduce
emergency hospital admissions. As patient
needs become more complex, GPs and
health and social care professionals will
need to work even closer together to deliver
the best possible support to people with
palliative and end of life needs.
Proposed activities include developing
new clinical guidelines for GPs and primary
care teams, online toolkits and support,
promotion of primary care training in the
area of end of life care and identifying
and promoting best practice, as well
as influencing and supporting clinical
commissioning groups in end of life care
planning.
One of the most exciting things about this
project is that it will cut across several other
major themes that the Royal College already
focuses on, including dementia, cancer,
rare diseases and COPD. This marks the
first time that the RCGP has worked on a
clinical priority across multiple conditions,
rather than focusing on one disease area.
Ensuring better pain control for patients who
are being cared for in their home is likely
to be a high priority, as is identifying those
with a terminal illness earlier and planning
ahead. Planning ahead involves recognising
those who might possibly be nearing the
Imelda Redmond
Director of policy and public affairs
Marie Curie Cancer Care
www.caretalk.co.uk I 13
NEWS - SECTOR
Keeping information safe and secure
q Jennifer Bernard
We know a lot about the people we provide
services for. We have information in our
heads, on record sheets and log books,
in paper files, increasingly on computer
systems. We have to share much of it so that
we can deliver seamless care between staff
members and with other agencies. We may
have to tell others what we know because
we are worried or have to provide key
information to a regulator or commissioner.
“Every service has to
consider what information
security controls they have in
place.”
What we always have is a serious moral
and legal responsibility to be sure this
information is accurate and to keep it safe
and secure. This responsibility may be
enhanced if regulations being consulted on
currently across Europe add a requirement
for each business, even a small one, to have
an accountable designated person for data
security.
For example, Mary Smith is a new resident
of your care home. You have to know a lot
about her to offer her good care that meets
her needs and wishes. She will use other
services, such as a GP or chiropodist.
She has a family, some who live locally
and some who do not. They will want
to know how she is getting on, from you
as well as from her. Mary does not want
14 I www.caretalk.co.uk
all of her family to be given information.
Some of her fees are being paid by her
local authority, which requires contract
information including details of her care.
Mary has an interest in local history and
wants to use her own computer to do some
research with the help of your staff. One of
your staff members lives next door to Mary’s
daughter, they socialise together. Mary was
subject to a violent robbery just before she
came into your home because she was
rumoured to have hidden money, and the
local media are following up her story.
In summary, what every service has to
consider is what information security
controls they have in place, if they are
sufficient to manage the risks of holding
inaccurate or incomplete data and of that
data being accessed when it should not be.
This means having effective policies and
procedures that provide enough guidance
for everyone to practise safely because they
know what they should do and have the
knowledge to do it competently.
“We have a serious moral
and legal responsibility to
be sure this information is
accurate and to keep it safe
and secure.”
Policies will need to include what data is
held, where, how and for what length of
time, who can access it, add to or change
it. This would include content from outside
the organisation that may be professionally
relevant, such as learning materials, but
may be inappropriate, illegal or expose the
organisation to system risks.
Then it is necessary to work out how
information is kept safe physically, whether it
is on paper or held on a computer, how staff
or others who may access it legitimately
are made aware of their responsibilities
and how their actual practice is monitored
so any breaches are swiftly identified. Not
forgetting how staff members are briefed
on keeping confidentiality in conversation
outside work as well as within it. Information
that is sensitive will not only be about
those who use services; it might be about
colleagues, or finances or business critical
if released.
Jennifer Bernard
Consulting director
Social Care Institute for Excellence
This short article can’t cover the detail that
would help you do a thorough review of
your information holdings and how you are
managing them. A new publication from the
British Computer Society (BCS), written for
non-experts, may help. Information Security
Management Principles by Andy Taylor,
David Alexander, Amanda Finch and David
Sutton is available from the BCS or other
book suppliers for £24.99.
NEWS - SECTOR
From the G8 Dementia Summit
to Norfolk and Suffolk
It’s great to see the UK leading the
way when it comes to dementia
care. Delivering excellent care and
support for people with dementia
is not just a UK challenge; globally
there is a new case of dementia
every four seconds, and by 2020
we will see nearly 70m people living
with the condition.
Quality care and support for people
with dementia is inextricably linked with
the quality of the health and social care
workforce. Never before has it been so
important that the workforce is equipped
with the knowledge and skills required to
support the increasing numbers of people
with dementia.
“Norfolk is forecasting a
significantly higher than
average number of older
people and higher than
average numbers of people
with dementia.”
At a national level there have been a
number of government initiatives that
recognise the importance of developing
the health and social care workforce;
these include the Dementia Compact and
the Dementia Pledge. Health Education
England has identified improving the
capability of the “dementia workforce” as
one of its top priorities.
Martin Green,
chief executive
of the English
Community Care
Association,
states that “at a
national level we
are starting to rise
to the challenge
of providing the
best possible
dementia care;
the Dementia
Pledge is a clear example of this; however,
local initiatives supporting frontline care
and support are fundamental to continued
improvement”.
Across the UK some areas have a higher
than average ageing population. Norfolk
is one of those areas forecasting a
significantly higher than average number
of older people and higher than average
numbers of people with dementia. This
challenge has led to some groundbreaking
initiatives and partnerships across Norfolk
County Council, health and the independent
sector to tackle some of the challenges
throughout Norfolk and Suffolk.
In East Anglia the Norfolk & Suffolk
Dementia Alliance (NSDA) is launching the
Dementia Care Coach Programme. The aim
of the programme is to make sure that care
providers have access to dementia mentors
to enhance practice and deliver excellence.
This innovative programme will identify the
specific competencies required for those
caring for people living with dementia
across the care pathway, from healthcare
professionals to unpaid carers. It will also
develop an integrated network of dementia
coaches, mentors and role models across
Norfolk and Suffolk.
The programme will use both experiential
and situational learning, ensuring a blend
of different learning and development
methods, experiences and activities are
used to maximise effective learning and
development.
The first
cohorts of the
programme
will
commence in
early October.
Almost
400 places
have been
allocated
for this year;
however,
the level
of interest
from health and social care providers has
exceeded expectations and demand for
places has outstripped capacity.
The programme, funded by Health
Education East of England, Norfolk County
Council, Suffolk County Council and the
Dementia Alliance partners, has been jointly
co-produced by education and service
providers with carer and service user input.
“The aim of the programme
is to make sure that care
providers have access
to dementia mentors to
enhance practice and
deliver excellence.”
Willie Cruickshank, director of NSDA,
says: “Norfolk and Suffolk are proud to
be taking the regional lead on dementia
workforce development and, by focusing
on experiential learning and a small number
of core competencies, I am confident that
we will be able to bring about essential
improvements in the way care is delivered in
practice across health and social care.”
The Dementia Care Coach Programme is
the latest example of the commitment of the
people across Norfolk and Suffolk to work
together, drive
change and
deliver real
improvements
in the quality
of care and
support being
provided to
the growing
number of
people living
with dementia.
Tracy Wharvell (left) and
Jan Sheldon (above)
Plum Moment Ltd social care consultancy
www.caretalk.co.uk I 15
NEWS - SECTOR
Senior health officials on the frontline with
Sue Ryder to see compassionate care in action
Following publication of the Francis report
on the failings of NHS hospitals, in particular
the poor care at Mid Staffordshire Hospital,
the national Sue Ryder care charity has
been working closely with the Department
of Health to promote compassionate care.
From 14-16 August, five senior Department
of Health civil servants visited four of Sue
Ryder’s hospices to shadow staff and see
at first hand excellent standards of care for
people living with terminal illnesses and
their families.
The visits were part of the Government’s
‘connecting’ initiative designed to help
Department of Health staff become more
connected to the real experiences of people
in need of, and receiving, care. The initiative
is in response to the Francis report, which
highlighted the importance of making sure
government policies and the work they
direct are grounded in the reality of people’s
experiences. Sue Ryder is one of the first
charities and the first hospice provider
to be involved in the initiative and offer
placements of this kind.
Feedback from the civil servants that took
part included comments such as: “The
degree of compassion and consideration
shown was exceptional”; “I was struck
by the depth of knowledge about each
individual”; “It was a really uplifting and
positive environment” and “The culture of
the hospice is lived and breathed by all the
16 I www.caretalk.co.uk
staff”.
A senior civil servant who visited Sue
Ryder’s Manorlands Hospice in West
Yorkshire said: “There can be few
people who would not be both moved
and impressed at your collective and
absolute focus on providing appropriate
compassionate care for individuals at their
time of need. Your cheerful courage and
energy in the face of adversity is a tribute to
you all. Manorlands showed itself to me as
an open and welcoming place for patients,
relatives, friends and visitors – a fantastic
asset to have in any community.”
Another senior civil servant said he couldn’t
remember when he had learnt so much
in a single day, and that he was struck
by how the hospice was so integrated
into the community and impressed by the
active and vital role fundraising staff and
volunteers play in supporting frontline care
staff.
Sue Ryder is also working in partnership
with the Department of Health to support
charities to respond effectively to the
Francis report.
Paul Woodward, chief executive at Sue
Ryder, says: “We were delighted to invite
Department of Health staff to undertake
placements at our hospices over a number
of days to learn more about how we provide
round-the-clock compassionate care
tailored to individual needs and wishes.
“The glowing feedback from the civil
servants who took part is testament to
the hard work and commitment of our
healthcare teams in providing the highest
standards of personalised care. We will
continue to offer placements of this type,
extending this to our neurological centre,
and are delighted that the Department of
Health has offered return placements for our
staff to understand more about the work the
department undertakes.
“We hope that learning from the
Government’s connecting initiative will be
used to ensure that care improves across
the NHS. We will continue to work with
the Department of Health on developing
guidelines for charities on how they can
best use the Francis report to improve
standards of care.”
While the Francis report focused on
hospitals, Sue Ryder believes quality of care
is everybody’s responsibility, and the charity
has used the report as an opportunity to
review and enhance its own practices,
where needed, to ensure it provides the
highest possible standards of care. For
more information on how Sue Ryder is using
recommendations in the Francis report to
review and further improve its standards of
care, visit www.sueryder.org.
The demise of the
LCP... will this mean
the demise of quality
end of life care or the
beginning of it?
The Liverpool Care Pathway for the Dying
Patient (LCP) was developed in the 1990s to
transfer the hospice model of care into other
care settings.
The Marie Curie Palliative Care Institute
Liverpool (MCPCIL) and Marie Curie Cancer
Care led the way in transforming end of life
care across all settings, meaning that any
dying patient, whether they were in a care
home, a hospital or in their own home would
have access to the same high standards
of care available to those who ended their
lives in a hospice. This was in response to
allegations that the standards of care were
poor, particularly in acute hospital settings,
which meant that some patients had a less
than dignified death.
“Concerns had been raised
by families that the LCP
had been used without
their permission and had
allegedly hastened the death
of their loved ones.”
The LCP very quickly gained credence
as best practice with regard to care of the
dying, enabling patients to die a dignified
death, with support provided to their family
and carers.
the King’s Fund health think tank, led a
government-commissioned review into the
use of the LCP in the UK. The results led
to the Department of Health releasing a
statement stating that the LCP was to be
phased out in the next 6-12 months.
The rationale for this was based on Lady
Neuberger’s findings that, despite the tool
itself being a useful document, staff were
wrongly interpreting its guidance, leading
to some patients being denied fluids and
in some cases inappropriately ‘drugged’
in their last weeks of life. She also found
that doctors were being expected to make
very significant decisions without the
right support, and that staff were lacking
in compassion to both patients and their
families at this critical time.
The LCP had become a ‘tickbox
exercise’ and needed to be replaced with
individualised, personalised care plans
that take into account the patient’s specific
needs and those of the family, with a named
senior clinician in charge of the patient’s
care.
Lady Neuberger concluded that: “Ultimately
it is the way the LCP has been misused and
misunderstood that has led to such great
problems.”
OPINION
p Debra Palmer, managing
director, Compare All Care
heard – or worse, avoided – demonstrates
a clear lack of compassion and empathy,
which is the very thing they look to us to
give.
“I have had the privilege
of meeting the most
wonderful people at the
end of their lives; some,
had we met under different
circumstances, would have
become friends.”
No matter how ‘good an innings’ someone
has had, or how much of a relief a passing
can be, this is the most painful time for any
family and for them to feel let down at this
time is a bitter pill to swallow. Any staff who
choose to behave in that way, at this time,
are, in my opinion, guilty of misconduct.
I have had the privilege of meeting the
most wonderful people at the end of their
lives; some, had we met under different
circumstances, would have become friends.
My colleagues and I worked tirelessly to
ensure that ‘a good death’ was achieved,
not only for the patient but for the family too.
While the initial reception for the LCP was
very positive, it was heavily criticised in the
media in 2009, and then more recently in
2012. Concerns had been raised by families
that the LCP had been used without their
permission and had allegedly hastened the
death of their loved ones. This led to audits
of end of life care across trusts in the UK.
Fundamentally it would appear that the LCP
was not in itself damaging, but rather the
lack of education and training available to
staff, which allowed them to misinterpret
the prompts as ‘instruction’. Some of the
stories presented to the review panel make
for difficult reading, as if their descriptions
are accurate then the care was not as it
should be and did not reduce the pain and
suffering that we as health professionals
aim to alleviate.
Dame Cicely Saunders, founder of the
modern hospice movement, was quoted as
saying that “how people die lives on in the
memory of others”. We have one chance to
get it right; we need to ensure that we get it
right each and every time for those we care
for and those left behind with the legacy of
that experience. Let’s make sure it is always
a good one.
As questions were raised, Lady Julia
Neuberger, former chief executive of
We know that communication is key, and to
find that patients and their families were not
Managing director
Debra Palmer
Compare All Care
www.caretalk.co.uk I 17
OPINION
Art for wellbeing
and art as training
“It was wonderful to
witness first-hand the
wide array of activities
and arts routinely
taking place in the best
care homes.”
“The arts are contributing
to improving integration
and interdisciplinary
working as well as
shaping training for
nurses and care workers.”
I know I have written before about
the power of the arts and benefit
of creativity as we age but having
witnessed some inspirational
activity over the summer I make
no apology for returning to this
theme again.
On 21 June, the first National Care Home
Open Day was held, with more than 2,500
care homes across the country collectively
opening their doors to the public. What a
great achievement, and I’d like to publicly
thank residents and relatives, staff and
volunteers of all the homes that participated
– you are an inspiration!
The purpose of the National Care Home
Open Day was to demonstrate the
connections that care homes have with their
local communities in order to challenge
the misconceptions about residential
care and show local people the excellent
services that are at the heart of their
communities. The open day was a great
success and allowed people to see the
level of care available. It also provided
a great opportunity to invite members of
local communities to consider becoming
a volunteer in their local care home. It was
wonderful to witness first-hand the wide
array of activities and arts routinely taking
place in the best care homes.
Baroness Joan Bakewell acted as
ambassador for the open day, encouraging
18 I www.caretalk.co.uk
p Des Kelly, executive director,
National Care Forum
MPs to visit care homes in their
constituencies. Dozens of MPs did so,
including prominent frontbenchers such as
Michael Gove and Douglas Alexander, and
this undoubtedly contributed to the open
day’s success. Plans are well under way for
next year’s event on Friday 20 June 2014,
with an ‘Around the World’ theme. So the
chance for care homes to be involved in a
truly global event next year!
Classical guitar, theatre, storytelling,
puppetry, dance and the visual arts are
sadly not often associated with care and
support for older people. While lots of artsbased activity is becoming evident in the
best care settings it is still far from being the
norm.
I was pleased to have been able to visit
services in Helsinki for two days in August,
at the invitation of The Baring Foundation,
and to join Janet Morrison (chair of The
Baring Foundation Arts Committee), David
Cutler (director) and Martin Green, chief
executive of the English Community Care
Association, for a seminar organised by
the Osaattori arts project. We visited two
impressive local authority ‘comprehensive
service centres’ in Helsinki and met city
officials, policymakers, academics, artists
and managers of care facilities involved in
the Osaattori project.
The aim of this European Social Fundbacked project is to bring arts and culture
to older people while improving employment
prospects for artists. It was an inspiring and
stimulating two days and it was evident that
Finland is leading the debate on the ways in
which the full range of arts and culture can
play a vital part in enhancing wellbeing and
quality of life for older people, both in the
community and in care settings. The arts
are contributing to improving integration and
interdisciplinary working as well as shaping
training for nurses and care workers.
We concluded that there are more
similarities than differences between
Finland and the UK. Their policy for older
people to ‘age in place’ by remaining in their
own homes as long as possible is the same
as our recent White Paper aspirations. The
use of the arts to support care workers and
nurses to relate to residents emotionally
and sensitively was very strongly conveyed.
A common aspect of training, for all staff,
is that the arts are especially powerful at
acknowledging and engaging with the
emotional aspect of working closely with
older people.
So, art is good for wellbeing and art has an
important role in training care staff. It would
be great to build on the foundations of the
first Care Home Open Day by bringing
these aspects together in an artistic
celebration of the best care homes can
offer. Are you up for it?
Des Kelly
Executive director
National Care Forum
GOOD CARE WEEK
21 April 2014
Supported by
Sector support
Get ready for Good
Care Week 2014!
Good Care Week, in association with Care Talk
magazine, is a UK-wide annual awareness
campaign that sees local initiatives come together
to create a national movement, celebrating and
promoting excellence in social care.
Jane MacDonald
Our aim
To raise the profile of social care professionals,
challenge negative stereotypes and champion the
many thousands of heroes who provide good care
across the UK every day.
Fiona Phillips
Political support:
Liz Kendall MP, shadow minister for care
and older people
Get involved
•
Following on from the success of this year’s very first
Good Care Week, get on board for 2014. Help us raise
awareness of social care and ensure that this sector gets
the respect and appreciation it merits.
•
Get your colleagues involved; care workers, managers
and providers. What could you do collectively to raise
the profile of social care in your local community?
Open days, encouraging volunteers and visits from
local schoolchildren are just some simple yet effective
initiatives.
•
Get your service users and their families involved. Ask
them to support the campaign by providing testimonials
about their care provision.
u
•
Register to become a Good Care Champion and equip
yourself to promote excellence in social care locally.
By becoming a Good Care Champion you will also be
signing up to our pledge to challenge negativity towards
our sector.
•
Write to your local MP about Good Care Week. Ask
them to help you raise the status of social care in your
community and formally support the campaign.
•
Share your ideas with us for raising the profile of social
care locally so that colleagues throughout the sector can
emulate this in their own communities. We will feature
your examples, stories, comments and suggestions on
the Good Care Week website and in Care Talk magazine.
Sign our pledge to be a Good Care Champion at www.goodcareweek.co.uk
www.caretalk.co.uk I 19
GOOD CARE WEEK
Ben Markham – Good Care Champion
Are champions born or made?
Simple question: Are Good Care
Champions born or made? In all likelihood,
it’s a bit of both, but whenever I interview an
exemplary care worker, I’m impressed by
not only their unflagging capacity to give,
but their commitment to the sector.
Where does it come from? Often, but not
always, a family member has worked in
care, or needed it, and 29-year-old Ben
Markham, winner of the Great North West
Region Frontline Leaders Award, is no
exception.
Ben’s mother has always worked in care, so
perhaps it’s little surprise that from an early
age he volunteered in a Mencap centre and
then gained experience working with people
with Down’s syndrome and challenging
behaviour. So, when he heard of the newly
developed Buckshaw Retirement Village,
it was an obvious move to join as a care
support worker.
“Ben’s mother has always
worked in care, so perhaps
it’s little surprise that from an
early age he volunteered in a
Mencap centre.”
“Buckshaw had an entirely new approach
to previous places I’d worked at; it was
less nursing orientated and more personcentred,” Ben explains. “It’s about how the
residents are on the day and going with how
they’re feeling.”
Without the constraints of prescriptive care,
Ben grew the role from helping residents
with day-to-day tasks and promoting
independence where possible to throwing
himself into involving them with activities
and coming up with ideas of his own. An
example is News of the Day, where he would
search out funny articles in newspapers with
the benefit of orienting residents to times
and dates and places in terms of world
events.
our village.”
A favourite with residents and managers
alike, Ben’s natural passion for the job was
quickly nurtured, and despite difficulties
with dyslexia he became a senior worker,
which, though initially a challenge, enabled
him to overcome his problems, and in 2011
he progressed to senior leader.
But a Good Care Champion doesn’t
disappear behind a desk. Ben changed his
own job description so that only two days a
week would be office work. The rest of the
time he works shifts with the residents and
models his own approach to care with the
staff team.
“My approach has always been one of
common sense,” he says. “I always treat
people with dignity and respect and never
look at the person’s illness or disability; it’s
the person themselves and how they feel.
It’s about striking up a friendship with them.
I’m here to help if they need support and I
just like to have a go at things.”
In other words, Ben likes to make a
difference. And he does.
Believing in the vital importance of not only
joined-up care for every resident, but the
quality of that care, Ben has established
a link with a GP surgery and the district
nursing department, and there’s now
regular contact and updating of each other
regarding residents and problems.
“The service they provide and what we
can give them back is brilliant,” Ben says.
“We now have a clinic here on Monday and
Friday when the GP comes for the whole of
“A Good Care Champion
doesn’t disappear behind a
desk.”
And yet Ben knows there always
improvements to be made. From experience
with residents after hospital visits,
he’s especially keen to see ‘dementia
champions’ established in situ, and when
pressed as to his future, admits to loving the
idea of becoming a dementia adviser.
But for now, Ben is more than happy where
he is, working his magic every day – and
that’s so important. As he says to his staff:
“If you aren’t happy in the job you’re doing,
then please leave – because if you’re not
happy, the residents aren’t going to be. It’s
so important for the environment to have
a positive atmosphere, then care can be
delivered excellently.”
Which, born or made, is exactly what a
Good Care Champion does every day –
deliver excellent care.
Debra Mehta
Sign our pledge to be a Good Care Champion at www.goodcareweek.co.uk
20 I www.caretalk.co.uk
STORIES
Man’s best friend offers dementia support
Dogs have been trained to do many different
things, from sniffing out drugs and explosives to
guiding blind people. Now they’re learning to help
people live well with dementia.
A pilot scheme has demonstrated that dogs can
offer practical help so people with dementia can
carry on with their day-to-day routines. Canine
companionship boosts people’s confidence,
keeps them active and engaged with the local
community and offers reassurance when facing
new or unfamiliar situations.
The Dementia Dog project secured funding
through the Living Well with Dementia Challenge.
It is a collaboration between Alzheimer Scotland,
The Glasgow School of Art, Dogs for the
Disabled and Guide Dogs UK, bringing together
different expertise in dementia care and dog
training.
adapted to suit specific needs, such as knowing
to tug at their owner’s duvet.
The dogs can underpin daily living routines (such
as waking, eating, getting exercise and going to
the toilet), provide reminders (such as prompts
to take medicine or drink fluids), or offer more
general support through companionship and
acting as an icebreaker in social situations.
Although the pilot, which began last spring, is
running for one full year, the placements are
expected to continue for the dogs’ full working
life.
The two couples were chosen to take part
because their close relationships were being
damaged by the dementia. Kaspa has already
made an amazing difference not just to Ken’s life
but hers, says wife Glenys. “Kaspa has given us
our life back.”
“These are the first official
dementia assistance dogs
working in the UK, possibly
the world.”
Simply by Kaspa greeting Ken in the morning
means Ken starts out happy, whereas before she
never knew what mood he’d be in, says Glenys. “I
have noticed if Ken is agitated or unsettled Kaspa
gives him a nudge so Ken talks to the dog or
goes out in to the back garden and forgets what
had bothered him.
Following successful completion of the research
stage, and having secured additional funding,
Dementia Dog has embarked on a pilot scheme,
based at the Guide Dogs for the Blind training
facility in Forfar, Scotland.
“Kaspa has removed my fear that Ken had gone,
life is so much better for both of us now. Ken is
happy and it has taken so much stress away from
me as well. Every day we wake up knowing it’s
going to be a good day thanks to Kaspa.”
The first two dementia ‘assistance dogs’,
Labrador Kaspa and golden retriever Oscar,
have completed their 18-month specialist training
programme to qualify for placements with local
people in the early stages of dementia – both
diagnosed three years ago – and their full-time
carers, backed up by more training, support and
evaluation to contribute to ongoing research.
These are the first official dementia assistance
dogs working in the UK, possibly the world.
Another two are currently in training.
Assistance dogs provide at least three assistive
tasks to their ‘partner’ – the person who has
dementia. They learn general tasks in training,
like responding to an alarm, which can be
“Kaspa has removed my fear
that Ken had gone, life is so
much better for both of us
now.”
Kaspa also nudges Ken when the alarm goes to
remind him to go and read any message Glenys
has left, telling him to switch off the cooker, for
instance. She is confident in the ‘anchoring’ the
dog provides to reassure Ken and discourage him
from wandering. “Kaspa went to Ken’s club and
he stayed for two hours, and I am happy to leave
them together in the supermarket while I do the
shopping.”
Maureen and her husband Frank have also
experienced immediate benefits from having
Oscar in their lives. Maureen had become
withdrawn and started to avoid people as
she lost her ability to find the right words to
communicate. “This is a wonderful project,” says
Frank. “Maureen just loves the dog, and her
conversation skills have improved already.”
What Frank finds particularly useful is that Oscar
knows to fetch the medicine bag twice a day to
remind him to give Maureen her pills.
In another pilot, the Dementia Dog team is
training ‘intervention dogs’, in response to
feedback from the families of people with
dementia. The role of these dogs would be to
work with the individual’s support team, such
as occupational therapists and care workers,
focusing on helping reintroduce tasks that
someone has lost the confidence or ability to do
unassisted. This might involve accompanying
the person to social activities or trips to the
hairdresser, for instance, or improving their
physical as well as emotional being as part of
regular outdoor exercise.
There’s also been interest from care homes
across the UK in the development of ‘facility
dogs’, with the potential to become a valuable
resource as a recreational service for residents.
The project is attracting lots of attention already.
It was a finalist in the One to Watch category at
the 2013 Scottish Social Service Council Care
Accolades, and trainee intervention dogs Rolf
and Evie joined the Dementia Dog team for a
workshop at the Alzheimer Scotland Dementia
Connections Conference in June.
And four of the dogs were the stars of the show
when the team was invited to exhibit at the
National Health Exposition in London in March.
To find out more visit www.dementiadog.org
Vicky Burman
www.caretalk.co.uk I 21
STORIES
Catwalk to compost . . . digging for funds the Mencap way
Conundrum: What links a boutique owner
in Fulham, a garden project in Streatham
providing new skills and experience for
people with learning disabilities, and a
ladies’ lunch in Central London?
Not so obvious? Well, it’s Mencap, or more
especially, their Special Events Committee.
Made up of a team of volunteers, women
like Catherine Rice give their time and
experience to come up with popular
fundraising events, helping to secure
sponsorship, advertising, celebrity speakers
and auction and raffle prizes.
“The Special Events
Committee … volunteers
… give their time and
experience to come up with
popular fundraising events.”
With an invitation to their most recent
fundraiser – The Ladies’ Fashion Lunch at
the Mandarin Oriental Hotel, Hyde Park – I
met up with uber-organiser Catherine Rice
and asked about her involvement.
“I had the privilege of volunteering at a
special needs primary school before being
enticed onto Mencap’s Special Events
Committee,” she says. “The children
became very dear to me and I worried
about their physical care and wellbeing,
and I was particularly concerned about
their welfare as they became adults when
perhaps their parents were no longer able to
care for them.”
Of course, it’s one thing to be touched
enough by people’s lives to put money in an
22 I www.caretalk.co.uk
envelope, but it’s quite another to actively
deploy your own skills and networks to help
raise funds. Catherine has been doing just
that – often on a grand scale – for over six
years. And you don’t get much grander
than the Mandarin Oriental.
After canapés and a wander around stalls
selling clothes and jewellery, ladies from
across the UK sat beneath dazzling crystal
chandeliers for an outstanding two-course
lunch with wine, and coffee with petit fours.
And though you might consider the £80
ticket price a bit steep, consider the
fact that the Streatham Garden Project
costs £10,000 per annum to run. Having
committed to support the project for three
years, Catherine and the team know how
vital it is to raise as much as possible. So,
with a huge push on prizes, the raffle raised
over £3,000, and an auction, presided over
by Nick Bonham of Bonhams Auctioneers,
made £4,450. Meanwhile, boutique owner
Claudia Sebire continued her longstanding
tradition of showing the collections she likes
to champion. All of which gave the event a
kind of elegance rarely seen these days and
that might go some way to explaining the
annual event’s ongoing popularity.
The following day, Catherine visited the
Streatham Project and met several of the
people directly benefitting from the Special
Events Committee’s work, including Joe and
Donald.
Head gardener Donald, 70, has a real
passion for the project and has learned
skills including seed sowing, potting on, and
planting out. Catherine also met Joe, who,
before coming to the UK, had worked in
Caribbean plantations and now enjoys the
physical tasks of digging and composting.
Catherine and the team make things
happen, and make things better –
measurably – for very many people like Joe
and Donald. The drive and commitment of
these volunteers helps to fund invaluable
projects promoting inclusion and equality for
people with a learning disability.
“This project has helped a number of
people with a learning disability find
work,” Catherine explains. “It’s a fantastic
achievement as only 7% of people with a
learning disability have a job among the
65% that want one.”
“The project has helped a
number of people with a
learning disability find work.”
It’s no walk in the park organising these
large-scale events, but Catherine is quick
to recommend what she does. “I love being
involved with Mencap and I hope that
anyone reading this will derive an equal
amount of fulfilment and purpose by getting
involved.”
By the end of the fashion lunch, I realised
there’s less of a distance between Hyde
Park and Streatham than I at first thought.
Debra Mehta
If you want to find out more about Mencap,
or how to volunteer, please contact Yasmin.
[email protected]
STORIES
Having cancer
inspired me to
care
“Cancer has
indisputably affected
the way Kevin
approaches his work.”
The care he received when he had a lifethreatening illness as a teenager prompted
Kevin Husband to pursue a career in the
care sector. Aged 13, Kevin was diagnosed
with leukaemia and twice came close to
death.
On one occasion he had to be resuscitated
and brought back to life by medics. Even
now, aged 29, he still takes medication and
has yearly checks to ensure that the cancer
has not returned.
Cancer has indisputably affected the way
Kevin approaches his work. He says that
because so many people cared for him, he
feels the need to give that care to others.
“If people had edged away from me when
I was ill then I wouldn’t be here. So I don’t
shy away from a challenge. I do everything
I can for people,” says Kevin, a care home
manager at Woodside, which is a residential
home for older people with a specialist unit
for those with dementia.
The illness came about suddenly after a
period of feeling tired. Numerous visits to
the doctor resulted in Kevin being treated
for a viral infection. But, after being sick and
looking white, his mum requested a home
visit from the GP. As soon as the GP set
eyes on Kevin, an ambulance was called
and he was rushed to hospital. And so
began his long journey through cancer.
Kevin began treatment in September 1997.
He had blood transfusions and began
chemotherapy. But within three months he
was five days away from death unless a
bone marrow donor was found. He began
planning his own funeral but, happily, his
nine-year-old brother was a match and
Kevin had a bone marrow transfusion.
Following the transfusion, Kevin was
required to spend six months in an isolation
unit to minimise the risk of infection. He says
it was a lonely and difficult time.
“I was in a small box room with only a few
centimetres around the bed. Nobody could
come into the room except Mum and Dad
and they had to wear white suits and masks.
“Everyone else had to speak to me via an
intercom. I was very very low. I knew I had
to do it to get better but I didn’t know how
long it would be and it felt like it wasn’t worth
it because I had no life at all,” says Kevin.
After four months of isolation, Kevin nearly
died again after contracting septicaemia
after a build-up of drugs in his body. He
required resuscitation.
But two months later, he was able to go
home, although still needed to be isolated
for much of the time to avoid infection. For
“After four months of
isolation, Kevin nearly died
again after contracting
septicaemia.”
two days a week for three years he went to
hospital to receive treatment. At 16 years
old, he was given the all-clear and told he
was in remission.
At 17, he began doing voluntary work at a
local care home, eventually getting a parttime job there. College followed and he then
began working in the care sector full time.
“This is not just a job to me. I strive for the
best every day. It is so rewarding and I love
knowing that I have helped someone.”
Kevin has been told that the cancer may
or may not return and the uncertainty
surrounding his health has become part
of his life. He says that his employers St
Martin’s Care have been amazing; as well as
being a great support they have recognised
his potential and encouraged him to go for
promotion.
He says there is no doubt that his cancer
experience has affected how he looks at life.
“I’m a sitting on a time bomb. I don’t know
when the volcano will erupt or even if it will
erupt. It might return, it might not. It means
that I always go the extra mile for staff and
clients because none of know what life will
throw at us,” says Kevin.
Julie Griffiths
www.caretalk.co.uk I 23
CHAT - VOICE OVER
What does a ‘good death’ mean to you?
End of life care, or palliative care as it is sometimes known, is one of the
most important roles that care workers undertake. Training in this area is
essential for care workers to deliver quality care for those individuals who
have a life-limiting illness. Good training will equip the care worker with
confidence and understanding of this specialist area of care, providing
dignity, comfort and empathy to the individuals and their families. We asked
six care professionals, ‘What does ‘a good death’ mean to you?’
Julie Latch
Mobile Care
Services Ltd
It’s all about fulfilling
their last wishes and
making sure they
receive everything
they want to receive.
We assess on an
individual basis and do a personalised care
plan and that tells us what they’re looking
for from the service. We provide support
to the relatives and our lines are open 24
hours a day for that. It’s a delicate and
sensitive situation and you need to work
with the family, too.
Safina Matovu
Sevacare
You need to be very
sensitive and calming.
If there’s a family
member there it’s
important to talk to
them and offer them
whatever you have
in terms of support. I
always ensure they can have a 24-hour
care package so that someone is there
with them. We will also organise to send
nurses every day, and the GP, to make
sure the person is safe and comfortable.
It’s important to die in a peaceful way, with
people around them.
Michaela
Heaton
Belong, CLS
Services
We keep people
independent in
their own homes for
longer, so we tend
not to be part of the end of life process.
My role is to keep people within the daily
living skills, but I think a good death is
about the quality and support given to both
the person and the family. Feedback and
communication is key, also in terms of level
of support given.
Victoria
Hutchings
Westminster
Homecare
A ‘good death’ means
making someone feel
as comfortable as
possible in the later
stages of life and to
accommodate where you can, and help
the family in bereavement. We’ve had a
few of those experiences recently and I
think some agencies might just look at the
price rather than the person. But we are
very lucky because we have very attentive
carers.
Toni Spiers,
Gateshead Council
It means giving people their dignity and allowing them what they want
to do in their final choices. It’s ensuring they have everything they want
and that they’re comfortable. We work closely with the relatives and
build a bond with them so they can trust us to fulfil their final days. We
also support the families.
Laura Hosking
Nurse Plus UK
Ltd
It would be taking into
consideration how that
person would like to die.
You need to be open
about it if possible, and
take into account their
needs and decisions
and, if possible, enable them to stay at
home if that’s what’s wanted. We support
the families and clients and also from the
office we support the carers to enable that to
happen. To die how someone would like, you
do need to know their preferences. Once
they are known, you work with them and the
carers to make sure that’s how it happens, if
possible.
Top tips
•
•
•
•
•
Dignity, respect and
understanding for the
individual and their family
Good communication
skills; get to know the
family as well as the
individual
Patience, compassion and
honesty with the individual
Fulfilling last wishes
End of life care can be
distressing; training will
help you deal with this
Help raise the profile of social care and become a Good Care Champion – see page 19 for more details.
28 I www.caretalk.co.uk
24
CHAT - 360
How do you encourage people
to make a positive choice to
move into residential care?
Moving into residential doesn’t have to be the ‘last resort’. With the focus on
quality, maintaining independence and person-centred care at the forefront of
care provision, more and more people are making a positive choice to move into
residential care. We asked a group of social care stakeholders, ‘How do you
encourage people to make a positive choice to move into residential care?’
The care provider
Mark Greaves, managing director, Ideal Care Homes
For residential care to be a positive choice we have to firstly dispel and destigmatise
the outdated image that the sector endures by providing positive images and
stories of how many people’s lives have been vastly improved by choosing to live
in a residential setting. How people have made new friendships, become part of a
community again and achieved ambitions that they believed had passed them by is a
great story and achievement but not one that ever garners much attention.
We also need to ensure that the choice is out there, with
a range of homes available to meet people’s needs,
expectations and aspirations and that are fit for
the future. For this to happen there needs to be
more intelligent commissioning and fee structures
that recognise and reward quality and promote
investment.
The property developer
Paul Teverson, head of public affairs and public
relations, McCarthy & Stone
Extra Care Assisted Living developments introduce many of
our residents to the benefits of extra personal care and support
for the first time, but in the comfort of their own apartment.
Demonstrating that support packages are totally flexible and
can be tailored to meet residents’ preferences and individual
needs will give them confidence to be able to remain in control
and continue to live independently, but with the
reassurance of extra help available as and when
they need it. The services that we provide,
for example, also enable couples to remain
together where one is the carer for the
other.
The charity
Sylvie Silver, director, National
Association for Providers of
Activities
The care worker
I would advise older people to go and
visit a care home that is very active
and engaged in the local community.
Choose one that gets articles into the
local press. Older people can get a very
one-sided view of care from national press
features. Most care homes in the modern
age offer lots of choice about every aspect
of life. Try and visit with an open mind and
a clear idea of what you would want your
life to be like if you lived there.
Peter Norman, lead senior
support worker, Belong
Crewe
When someone is making the decision
to move into residential care it’s usually
because they are having some difficulties
with everyday life. It’s really important to
understand that making this decision is not giving
up; it is giving them the choice to live a better quality of life
with the support that can be provided. I see moving into a
care setting as empowering individuals to make decisions
that best suit them, while enabling them to continue to live
to the routines that they have adopted. If they like to go to
bed at midnight and rise at 10am then they can do; if their
daughter washes their clothes every Friday then there’s no
reason for that to stop.
The family member
Peter Moxon, son of Belong resident
You’ve no frame of reference as to what’s normal when you
find yourself seeking permanent care for an elderly relative.
It can be a traumatic time for everyone involved, so planning
ahead before the decision becomes an inevitable crisis really
helps to smooth the journey. My advice is to start looking for
the right home well before you feel the time is nearing, so that
you have the benefit of choice. Look for somewhere where
you will get lots of support and advice yourself, not only
about the care of your loved one, but also the very daunting
financial aspects of the whole process.
Conclusion
•
•
•
•
Visit care homes that are active in the community
A greater focus on intelligent commissioning that
recognises and rewards quality
Focus on retaining independence and choice
Planning ahead for both the service user and the
family
www.caretalk.co.uk I 25
CHAT - MRS MACBLOG
Mrs
G
O
L
C
A
M
Do you remember me telling you about my
keys, and how my daughter found a novel way
of preventing me from losing them? She tied a
floating cork ball to it so that it wasn’t heavy but it
was too big to slip down the side of a cushion or
get left somewhere.
Well, just recently she’d been to an exhibition that
was full of ‘telecare’ things. I thought she was
talking about caring for my telly, but that’s not it.
It’s when you can use sensors and alarms to help
keep people safe and independent.
The long and the short of it is, I’ve now got some!
She has put a thing in the socket that comes
on if I get out of bed and gives me some light.
I did have a little fall recently reaching for the
light switch when I needed to get up to go to
the bathroom. This little thing apparently senses
when I’m moving about and switches itself on.
When I get back into bed and settle down, after
a little while it switches itself off again. Now I call
that clever!
The other thing she got was some plastic aprons
so that when I’m eating I don’t get food down
my front. Mmmm … not very sure about that – it
doesn’t feel very dignified but, as she says, it’s
not very dignified to have a stained jumper either
– AND it isn’t me who has to do the washing!
There’s a fine line really between what is
helpful and what makes you feel useless and a
nuisance. I like the idea of the light switch very
much but I’m not so sure about the pinny. She
might as well get me a bib! Oh well, I suppose
it’s a good idea really. After all, there was a time
when I would have put the pinny on when I was
preparing my meal, so now I just have it on to
eat it!
g
Mrs MacBlo
Verona MacIntosh is 91 years old and has
lived in extra-care accommodation for over
five years after she had a stroke, and gets
four calls a day. She’s been widowed for
11 years.
rs – discuss
Challenge for care worke
the following issues.
1.
2.
3.
are? Can you see these
What do you think about telec
e?
plac
sorts of devices have their
did fall in the night?
What would you do if someone
’s observation that
What do you think of Mrs Mac
a bit undignified? Is
feels
n
apro
tic
plas
a
ring
wea
her keep her clothes
there a way you could help
she needs the
like
ng
feeli
it
out
with
red
cove
n?
ectio
prot
28 I www.caretalk.co.uk
26
Austerity,
Demographics &
Health & Social
Care Reforms
14th Annual Healthcare Conference
A One-Day Conference, Monday 21st October 2013
One Birdcage Walk, Westminster, London, SW1H 9JJ
Organised by LCS International, in partnership with The Sunday Times, this
conference is being held this year against the background of the new Health
and Social Care legislation, the Care and Support Bill before Parliament and
implementation of Dilnot. We anticipate discussions on the day around:
funding issues; quality regulation and workforce challenges; new approaches
to services more in line with the way we work and live; proposals to enhance
Social Care commissioning; and new models of integrated care.
Participants include:
Lord Norman Warner, fmr Minister of State, DoH
Dr Daniel Poulter MP, Minister of State, DoH
Rt Hon Paul Burstow, fmr Minister of State, DoH
Sir Cyril Chantler, Chair, UCL Partners
Dr Charles Alessi, Chair, NAPC
Ian Smith, Chair, Four Seasons Healthcare
Julia Manning, CEO, 2020 Health
Dr Phillip Lee, MP
Steve Gay, Director, Association of British Insurers
Anita Charlesworth, Chief Economist Nuffield Trust
Stephen Collier, CEO, General Healthcare Group
Mike Farrar CBE, CEO, NHS Confederation
Sir Stephen Bubb, CEO, ACEVO
Sebastian Habibi, Director, DoH
Baroness Martha Lane-Fox of Soho CBE,
Chair, Government Digital Service Advisory Board
Delegate Price : £450 + VAT (£225 + VAT for Public and Voluntary sectors)
To book please visit our website at www.lcsic.com or call 0207 387 6828
or email : [email protected] *10% discount if you book before 1st October 2013*
CMM
CAREMANAGEMENTMATTERS
CHAT - THIS IS YOUR LIFE / PLANET JANET
This is Your Life
Finding the right care –
the journey of a relative
provides ‘My Time’, which is a fantastic, flexible
approach to respite care. It is flexible in that I could
leave Mum there for anything from two hours to 24
hours according to our needs.
As part of an ongoing project, Avante Care and
Support are carrying out family focus groups to
have a better understanding of the journey facing
families when deciding on a care home for a loved
one. During this process Mrs Fletcher, who uses
the My Time care package, was interviewed and
gave this very frank and open insight into the
challenges she faced and her journey, which led
her to Bridge Haven care home in Bridge, near
Canterbury, Kent.
“The activities that Bridge Haven provides are
extensive. During one of Mum’s visits she got her
hair and nails done, another day she received
reflexology and hand massages, as well as lots
of trips out, which she really loved. The staff were
incredibly welcoming and supportive, both to
me and to mum. They showed her great respect
and patience, good humour and cheerfulness,
something that I sometimes found hard to maintain
because of the pressures of caring for her full time.
“I became a full time carer for my 83-year-old
mum with dementia. Although it was a privilege to
spend time with such a lovely lady, it was incredibly
draining due to her condition. I initially found
respite at the local day centre where I was able
to take mum for a few hours most days. The staff
were very caring but sadly, due to Mum’s dementia,
she was unable to interact with the other visitors. I
decided she needed somewhere to go where she
could receive more dementia-focused attention,
and I found this at Bridge Haven. Bridge Haven
“After a few months of Mum attending on a day
basis I had to return to work, which meant that
Mum’s stay at Bridge Haven extended to weekly
stays while I worked. Mum came home when I
didn’t work. The fact that Mum had had such a
positive experience during her stay previously
meant that her transition to longer stays was much
easier for her and a lifeline for me. Bridge Haven’s
flexible approach to respite care made it possible
for me to consider returning to work, happy in the
knowledge that Mum was receiving really good
care and stimulation, which is so important for her
wellbeing.
“I am so grateful to all the staff at Bridge Haven for
their kindness and support, giving both me and
mum a better quality of life.”
Sue Keiper, home manager at Bridge Haven,
says: “Holding family focus groups has been an
important part of developing our services and
care home to ensure that not only the residents’
needs are catered for but we also have a better
understanding of how to support the families too.”
We want to hear from service users and their families. What are your thoughts on social
care? Do you have any stories, news or views you would like to share with our readers?
Among all the articles and news items about the
state of the NHS, finally there came a glimmer of
light from the Secretary of State in September,
when he announced with great portent something
that we’ve all known for ages … that GPs need to
take more responsibility for older people’s care,
especially in the last stages of their lives.
Too many people spend their last days in the
relative anonymity of a hospital ward when they
would rather be at home. Their families, too, often
want to be with their frail and elderly relatives as
much as possible towards the end. This can be
arranged – there are many residential care homes
and many homecare services that offer intensive
care in the familiar surroundings of ‘home’.
Recently there has been much publicity too about
the suspension of the Liverpool Care Pathway.
This was a system devised by clinicians and
practitioners to gradually reduce support to
someone in the last days of their lives through the
humane withdrawal of essential fluids and nutrition.
Many years ago I sat on a group that was
reviewing the effectiveness of the Liverpool
Care Pathway (LCP) and the Gold Standards
Framework. I remember sitting in meetings
hugely impressed with the complete dedication
of professionals to offer the most compassionate
and caring response to the care of someone in
their last days and hours. In every discussion an
image was conjured up of the timeless caring
that perhaps one might normally associate with
hospices. The intention was that this approach
would be available in hospitals and registered care
homes. In those days, it was too early to discuss
extending the approach to care-at-home services,
though later those discussions did happen.
What no one anticipated, of course, was that hardpressed, cash-strapped, highly pressured services
would turn the LCP into a formulaic and somewhat
de-personalised system of active suspension of
life by the withdrawal of essential fluids. None
of the people practising it meant ever to be
cruel – human kindness was at the root of every
case, I’m sure – but the result sometimes meant
a distressing end to someone’s life witnessed by
families rendered powerless because their relative
was ‘on the pathway’.
There will be many people who have experienced
that distress who will have been glad to hear
that the LCP is being reviewed. But the hospice
movement is not among them. For many patients,
the considerate treatment of dedicated workers
in the soothing environment of a local hospice
lived up to the principles and the promise of LCP,
and for the staff and volunteers in those places,
its removal as a resource has been something of
a blow. Let us hope that while the pathway won’t
exist as such, its principles of human kindness and
compassion will endure.
www.caretalk.co.uk I 27
CHAT - UP CLOSE AND PERSONAL
Up close and personal with...
Sue Ryder’s chief executive, Paul Woodward,
talks about why dying isn’t working.
This year is a special one for Sue Ryder; it marks the
charity’s 60th year of providing incredible care. Our vision
is to build on the charity’s legacy and ensure everybody
has access to personalised care when they need it.
skills in having conversations about the end
of life.
“It’s totally unacceptable that
individuals and their families
remain unsupported at the
end of life.”
Over the past six decades we’ve been
expert in providing care for people living
with life-changing illness. As we look to the
future, we’re keen to use our experience as
a provider of specialist end of life care to not
only develop our services to provide more
care but to influence the level of personalised
care that is available to everyone.
It’s totally unacceptable that individuals and
their families remain unsupported at the end
of life. Your diagnosis, where you live or who
your doctor is shouldn’t predetermine whether
or not you have a good death – we want to
change that.
To address this problem, we launched our
campaign, Dying isn’t Working, which is
based on our own experience as a provider of
end of life care and evidence from two reports
we produced with think tank Demos.
The first report, Ways and Means, examines
the barriers that prevent people from getting
the care they want at the end of life. Our
research identified the factors that lead to
inequality in care, which include a person’s
ethnicity, location, their illness and their GP’s
28 I www.caretalk.co.uk
Challenges for the social care sector in
particular that were highlighted included the
fact that people already using social care
when diagnosed with a terminal illness are
more likely not to be referred to much needed
specialist health support, and instead have
continued social care support. Another
challenge is that people with dementia are at
far greater risk of being hospitalised before
death or dying in hospital instead of at home,
as a lack of support in the community leaves
carers unable to cope.
The report also highlighted that specialist
end of life care provided by hospices is more
likely to be accessed by those with a cancer
diagnosis; there is likely to be a more accurate
prognosis, specialist resources and referral
pathways for those with cancer above other
conditions, such as motor neurone disease. In
addition, people who are generally informed
and can draw on social capital are more likely
to access hospice care.
GPs, other health professionals, communitybased organisations and local authorities
have an important role to play in levelling
inequalities in knowledge and informing
all people of what care is available as they
approach making difficult and emotional
decisions at the end of life. More partnership
working across health and social care is also
recommended.
A time and a place is the second report we
published. In the past, government and policy
makers have focused on where, rather than
how, people want to die. We asked 2,038
people which elements of end of life care were
most important to them. 63% of people said
they wanted to die at home and 78% said
pain relief was a top priority for them; only
27% felt that home was a place where they
could be pain-free during their final days. It’s
unacceptable that people should think they
have to accept a painful death in order to die
with their loved ones at home.
We feel strongly that there needs to be better
training for GPs and community practitioners
in administering medication and using
equipment to help people be in comfort and
with good pain relief no matter where they die.
To make this happen there needs to be better
training that is underpinned by end of life care
skills being included in the health education
mandate for workforce development. It is
currently excluded.
“There needs to be better
training for GPs and
community practitioners …
to help people be in comfort
and with good pain relief no
matter where they die.”
A greater expansion of ‘at home’ hospice
care and clinical nursing services (CNS) to
coordinate and advise about care will also
ensure that pain relief and tailored care can
be delivered at home. On a wider scale,
there also needs to be an improvement in the
quality of care given in all settings to meet
people’s needs and desires so that people are
not forced to make compromises about the
end of life care that they want.
In the coming months we will be focusing on
securing government support for our Dying
isn’t Working campaign and implementing our
two reports’ recommendations, following some
very encouraging responses from MPs and
across the sector. For more information visit
www.sueryder.org
SHOWCASE
Care Talk
on the road
Care Talk has a packed agenda of
conferences and seminars ahead. We
are proud to be media partners and
supporters for some fantastic events,
listed below.
Coming up
Improving End of Life Care
- public policy exchange
National Children and Adults
Services Conference
Making health and care services
fit for an ageing population
Central London
Harrogate International
Centre
The Kings Fund, London
16 October 2013
Changing cultures,
working creatively and in
collaboration
BILD Annual Conference,
Birmingham
18 October 2013
16-18 October 2013
LCS and Sunday Times
14th Annual Healthcare
Conference
One Birdcage Walk,
Westminster, London
21 October 2013
22 October 2013
Care co-ordination
The Kings Fund, London
24 October 2013
Safe & Sound, ECCA Conference
Church House, Westminster,
London
NHS Quality of Care
America Square Conference Centre, London
19 November 2013m
NHS Procurement
America Square Conference Centre, London
28 November 2013
IIC Show (Inclusion, Independence, Choice)
Manchester Central (GMEX)
14-15 February 2014
6 November 2013
Media partner
Care co-ordination
Key lessons and practical insight from the front line
24 October 2013, The King’s Fund, London
This conference will share key lessons, from the UK and abroad, and practical insight from the
front line that will help you to understand how to co-ordinate care at a clinical or service level.
The event is an excellent opportunity to learn from areas of the UK that are successfully
co-ordinating care for their population. Sessions include:
> care co-ordination and continuity of care for people with complex needs
> multi-disciplinary working: how to get it right
> lessons on collaborative working from the voluntary sector.
Register online at www.kingsfund.org.uk/events/care-co-ordination
CELEBRATE
2013 Regional Great
British Care Awards
judging days so far....
17th September, Manchester Central Conference Centre
2013
19th September,
Nottingham Forest FC
2013
26th September, Holiday
Inn, Peterborough
2013
See back page for dates and venues of all nine regional awards.
See more highlights of the judging days and the awards in next month’s Care Talk!
To nominate or for table bookings visit www.care-awards.co.uk
30 I www.caretalk.co.uk
CELEBRATE
Susan Bumstead, NorseCare Ltd
Susan Bumstead from NorseCare Ltd was the proud winner of the
Dignity in Care Award at the national finals of the Great British Care
Home Awards.
What the winner said…
What the judges said…
It’s amazing! I’ve always enjoyed working in
care and I’m delighted that I’ve been given
this award in recognition of doing something
that I enjoy.
Susan wants to be hands on and feels
privileged to be. Personal choice is of great
importance and she allows people to say
no. Susan ensures that all the little things
are looked at and makes an obvious
dignity champion. With Susan the
residents are all that matters.
Karen Knight, NorseCare’s managing director,
was equally pleased: “Demonstrating dignity
in everything we do has always been at the
forefront of the care service that we provide,
so to be recognised nationally is a terrific
achievement.”
▲ Host An
ton Du Beke
with winner Su
Bumstead an
san
d sponsor Jayn
e Rawlinson fro
Healthcall Opt
m
ical
LEARN
The Registered Managers Programme
– coming to a network near you
The National Skills Academy
launched its national
programme for registered
managers at the end
of March this year. The
programme looks to support
registered managers in their
pivotal leadership role. So if
you’re a registered manager,
whether you’re working
in residential care, home
care or another setting, this
programme is for you.
There are telephone helplines on HR and legal issues,
peer support on the phone or online from experienced
registered managers, lots of information and guidance,
grouped by subject so that you can find it easily, and
discounts on leadership development programmes
tailored specially for registered managers.
When the programme was launched, Minister for Care
and Support Norman Lamb said: “The programme is
fantastic. It will make a real difference to registered
managers, providing the practical help and support
they need.”
And we know that registered managers agree.
Between April and August, over 1,200 registered
managers joined the programme. We’ll be looking to
have at least 5,000 registered managers on board as
soon as we can.
One of the most practical ways in which we want to
help people is to reduce the isolation that registered
managers can sometimes feel, and to link people up
with each other at local level. So one of the things the
programme offers is funding to set up, and strengthen,
local networks of registered managers.
The first networks are now up and running, and there
will be more opportunities for you to apply for funding –
just go to https://www.nsasocialcare.co.uk/registeredmanagers. We’re aiming to have local networks
across the country. There are already networks
in Staffordshire, Bristol, north and mid-Somerset,
Cambridgeshire and Coventry, and we’re supporting
specialist networks around England for registered
managers working with older people, which will also
look at end of life care. Have a look at the website to
find a network near you.
At the same time, we want to develop leadership
skills and confidence among registered managers,
so we are also working with partners in the North
West, Yorkshire and Humberside, the South West and
Wiltshire and Hampshire to put on free workshops and
events, starting this autumn. There’ll be more events
in more areas coming down the line. Topics include
everything from safeguarding and understanding the
social care market through to using Myers-Briggs and
other psychological approaches to get more out of
your team and building emotional resilience. You can
even work with horses to test your leadership skills with
people!
So do have a look at our website and see what’s on
offer – we really want to support you and develop your
confidence as a social care leader, so that you can
deliver the services you want and drive up the quality
of adult social care across the board.
Debbie Sorkin
Chief executive
National Skills Academy for Social Care
For more information on the Registered Managers
Programme, please contact terri.myers@nsasocialcar.
co.uk or go to www.nsasocialcare.co.uk.
www.caretalk.co.uk I 31
LEARN
@rhidianhughes
#socialcare
#transformation –
taking a looking
back
To fully understand the current state
of social care we need to look back
and understand the past. Residential
Care Transformed: Revisiting ‘The Last
Refuge’ affords us that perspective by
looking at residential care over the last
50 years.
The book revisits the classic 1962 text
by Peter Townsend, The Last Refuge:
A Survey of Residential Institutions and
Homes for the Aged in England and
Wales. Townsend set out to question
the future of residential care through his
comprehensive survey based on visits
to residential providers and residents
during the late 1950s.
“By applying Townsend’s
original measure of quality
alongside modern regulatory
evidence, it is clear that the
quality of care has improved.”
By applying Townsend’s original
measure of quality alongside modern
regulatory evidence it is clear that the
quality of care has improved. However,
only one in four homes survived from
Townsend’s original study. Voluntary
and privately run homes have tended to
survive most over the last 50 years. The
old public institutions and local authorityrun services are least likely to have
survived.
32 I www.caretalk.co.uk
Care homes are much more specialised
than in the past, and residents today
require much more personal and
complex care. For example, in the late
1950s around 82% of residents did
not require help with dressing. The
follow-up study found 33% of residents
required this help.
Just as the demographics of people
using residential care services have
changed over time, so too have daily life
and routines. Today there are activities
to engage residents, whereas the 1950s
saw residents involved in the upkeep of
the homes by undertaking light work,
sometimes paid.
Townsend reports: “Eleven men and
four women help regularly and receive
rewards averaging about 5/-. The duties
include washing up, which is done by
a woman. A man of 66 spends a lot of
time in the dining room in the course of
laying tables etc, another man helps in
the greenhouses, one acts as a stores
porter, one runs messages and one
does dustbins.”
Residential care is also changing for
staff. There are more staff working in
care homes than in the past. Managers
today spend less time providing
frontline care and are more focused on
administration and business activities.
Some workforce trends have remained
constant over time, including low pay
and the shortage of registered nurses
working
in residential care.
“The 1950s saw residents
involved in the upkeep of the
homes by undertaking light
work, sometimes paid.”
Residential Care Transformed illustrates
the big challenges in social care over
the last 50 years and provides important
messages for looking ahead and
developing sustainable care services
for the future. It’s a good, award-winning
read.
Find out more about the book by Julia
Johnson, Sheena Rolph and Randall
Smith at http://new.palgrave.com/
Products/TitlePrint.aspx?PID=287915
Rhidian Hughes
@rhidianhughes
LEARN
How to be a goo d...
care trainer
As a former carer herself, trainer Sangita
Mistry knows how difficult it can be to get
the right training in a way that complements
frontline work.
“Training is important but it can be difficult to
free people up for it when you work in care,”
she says.
So Sangita, a Direct Health branch trainer in
Leicester, has developed training packages
to circumnavigate this problem.
An example is the development of distance
learning workbooks. The workbooks mean
that staff can undertake training and
development over a few weeks in their own
time rather than missing shifts of frontline
care. They then submit the workbook for
marking and, if the work merits it, receive a
certificate.
“It saves time and money and is a much
more productive way of getting people
through development,” says Sangita.
“Specialist training is
important … it helps the
staff member feel confident
that they have the skills and
knowledge to support their
client.”
The development can be specific to the
service users staff members support to make
the training as relevant as possible.
In addition, Sangita has set up specialist
teams so that staff are equipped to deal with
service users with particular conditions. Each
member of the specialist team continues to
support other service users, but has been
trained on how to provide specialist support
to those with specific medical conditions. So
far, there are teams in Parkinson’s, dementia,
stroke and Huntingdon’s disease. There are
plans to add multiple sclerosis to this list of
conditions.
Sangita says that specialist training is
important as detailed knowledge can be
required in the support of someone with a
particular illness. It helps the staff member
feel confident that they have the skills and
knowledge to support their client. And it is of
obvious benefit to the client that their carer
can deal with the intricacies of a condition
that changes and degenerates as time
passes.
“It works really well because someone’s
needs might be quite specific to their illness
and the symptoms and challenges of a
condition like Huntington’s disease are not
well known. Making sure that people know
what changes they need to recognise and
report is important as we know that condition
can change quickly,” explains Sangita.
It also helps business development as Direct
Health can promote their professionalism and
specialist care to social services.
“We can take on more packages and ensure
that care is tailor-made for that service user.
If you don’t have a grounded understanding
of a condition then you can’t deliver personcentred care,” she says.
Sangita is motivated by helping those who
need it most and takes this beyond her dayto-day work. During this year’s Good Care
Week in April, Sangita organised a curry
event for homeless charity Dawn Centre
in Leicester and involved staff and service
users. As well as raising the profile of social
care, she brought together the community to
help the 70 homeless people who turned up
on the day.
All the food used in the curry was donated
by local businesses, with a local bakery
providing naan bread too. In addition to food,
there were donations of clothes, shoes, and
toiletries.
Only starting to organise it four weeks prior
to the event, Sangita says it was a lot of work
but enormously rewarding.
“I was overwhelmed by people’s generosity.
There are so many kind people and they
were dropping off bags of clothes and all
sorts of things to help out,” she says.
And the biggest buzz for her was the
appreciation of homeless people who
Sangita with service user Pravin Patel and
Dawn Centre manager Gary Freestone
benefited from the day, which ran from 8am
to 4pm on a Saturday.
“We opened the doors at 8am and there
were homeless people there already who
had slept rough overnight to make sure they
could get in. People came from right across
the city because we’d notified different
hostels. Some people even travelled from the
surrounding areas to get to us,” she says. “It
was an amazing and humbling experience.”
Julie Griffiths
“During this year’s Good
Care Week in April, Sangita
organised a curry event for a
homeless charity.”
Top tips
•
•
•
•
•
Time for training is an issue – consider
distance learning
Set up specialist teams
Understanding specialist conditions
leads to greater person-centred care
Ensure staff are familiar with potential
changes in a condition
Spread the word about good care by
involving the wider community
www.caretalk.co.uk I 33
LEARN
Transforming an
underperforming
service
Four years ago, Amy Cole took on a service
that was not performing well. The Care
Quality Commission (CQC) report listed
areas for improvement, such as the need for
better risk assessments and health action
plans as well as a review of the system for
checking financial records. Amy needed to
make changes fast.
as comfortable as possible. She offered them
scenarios that happened on a daily basis in
the service and asked them what they would
do in that situation. Then she followed this
up with questions designed to find out more
about the candidate’s personality. These
included, ‘What would you think about that
and what are your feelings about it?’
At the time, Stapleton Drive, which is a care
home for adults with a learning disability,
was going through great change as it moved
from belonging to Solihull Care Trust to being
council-owned. The staff team was well
established and, while this had its benefits, it
also had drawbacks.
“I noticed people would answer in a robotic
or automatic way to the first part of the
questions but then they would say what they
really thought as they went on,” says Amy.
“They needed direction and stability but, at
the same time, they were very resistant to
change,” says Amy.
“The staff needed direction
and stability but, at the same
time, they were very resistant
to change.”
Initially there was a recruitment freeze, but,
when it lifted, Amy decided to ensure that
they found the right people to complement
the existing team. Working within council
procedures, Amy made use of the discretion
afforded to her. She spent a long time
drawing up the questions to ensure that she
could elicit responses that gave an insight
into the interviewee.
“My experience of interviews is that you get
people telling you what they think you want
to hear. I needed to be sure that what people
said in the interview was a reflection of who
they were,” says Amy.
To ensure that happened, she made
the interview informal so that it felt like
a conversation rather than a series of
questions. The aim was to make candidates
34 I www.caretalk.co.uk
Amy was keen to avoid people saying one
thing in an interview and behaving in a
different way in the job, so she used another
council policy to her advantage. A six-month
probation was the norm, but Amy ensured
that the standards to be met were specific to
the service and the role.
To help new recruits to settle in and, at the
same time, avoid possible friction with the
established team, Amy set up a mentoring
system. Each new staff member was
buddied-up with someone of their own
level. It worked well. Amy says that it helped
existing staff take more responsibility for
making the new, larger team a success.
“One mentor said that she felt that if the staff
member she was mentoring was not taken
on after the probation then that would be her
fault. She did everything possible to equip her
staff member for the job and took on more
responsibility to help the new recruit. It was a
shift in thinking,” explains Amy.
The recruitment drive meant that seven new
people were added to the team, which now
comprises 25 members.
“Amy spent a long time
drawing up the questions to
ensure that she could elicit
responses that gave an
insight into the interviewee.”
Amy has also introduced annual staff away
days, which she says help staff to take
ownership and responsibility. It is a time away
from the service where team members can
reflect on the past year and look forward to
the one ahead.
Another initiative that has helped staff engage
with the service has been focus groups. Amy
has set up a number of groups that look at
different aspects of the team’s work, such
as rotas and helping clients to make healthy
eating choices.
“I was thinking about how to help staff feel
involved in the home,” explains Amy.
She believes that the measures are working.
The mix of new and existing staff is positive
and staff have greater engagement with the
service.
“When I started, my management approach
had to be directive. Being collaborative
would have taken too long and we needed
to address the problems immediately. But as
time has gone on, this has changed. Now it
feels like we work as a team,” Amy says.
Julie Griffiths
Top tips
•
•
•
•
•
Reassure staff with a balance of stability
and change
Insightful interview questions designed
to highlight required qualities
Informal interview techniques
Pair up new staff with old staff as
‘mentors’
Staff focus groups
LEARN
Putting jargon-free information
at the heart of personalised care
importantly, some of the frustrations
highlighted by Mark and others.
TLAP is a national, cross-sector
leadership partnership focused
on driving forward work with
personalisation and communitybased social care. We have prioritised
information, advice and brokerage as
one of our key areas of work.
At some point in our lives, we will all be
touched by social care and will want to make
decisions about the services we or our family
members use. Our decisions can only be as
good as the information we have and often
this can be confusing or inaccurate.
Social care jargon can be incredibly
alienating for people who use care and
support services and their carers; as well as
navigating the complex systems involved
with social care they feel they are also
expected to converse in a language they
simply don’t understand.
This fact was highlighted by Mark Neary in
a recent blog for the BBC entitled Viewpoint:
10 jargon phrases used for my autistic son.
Mark, who has an adult son with autism,
wrote: “The language seems to mislead you
right from the start. Processes seem to come
before people.”
“They feel they are also
expected to converse in a
language they simply don’t
understand.”
Mark is not alone, and as a response to such
viewpoints the Think Local Act Personal
(TLAP) Partnership has produced a jargon
buster of the 53 most commonly used social
care words and phrases, a tool it hopes
will save time, befuddlement and, most
Andrea Sutcliffe, chief executive of the
Social Care Institute for Excellence
(SCIE), is an active member of
the TLAP board and chair of the
information and advice workstream.
She says: “We hear far too often
that the information on offer can
be confusing, difficult to find and
unhelpful. I hope the jargon buster
will make a difference to the lives of
people using services and their carers.”
This is not just the responsibility of social
care. With health and social care ‘integration’
the latest buzzword, hot on the heels of
‘personalisation’ and ‘co-production’, the
time is right to ensure that staff across both
sectors understand what is being said.
through the complicated care system and
identifies the ‘pinch points’ where councils
and other organisations need to improve the
information and advice on offer to people
and families.
“People expect to make
decisions for themselves
about health and social care
services … good information
is at the heart of good
decision-making.”
TLAP co-chairs Marjory Broughton and
Clenton Farquharson say: “Good information
and advice provided at the right time helps
people to take control of their lives – it is at
the very heart of personalised care.”
Laura Boyd
Communications officer
Think Local Act Personal Partnership
Still confused? Try our social care
jargon buster quiz
The duty to provide information was updated
under the Care Bill that entered Parliament
this May. It recognises that people expect
to make decisions for themselves about the
health and social care services they use and
that good information is at the heart of good
decision-making.
What is a personal budget?
Key decision factors in care and support
are known to be availability, affordability,
suitability, quality and safety. Councils need
to develop a culture of information-sharing
and an information and advice strategy that
encompasses all of these factors.
How do you find out about social care
services?
To support councils TLAP has produced
Principles for the provision of information and
advice, a short practical framework that sets
out the main issues that councils need to
consider when developing a comprehensive
and coherent local care and support
information and advice strategy.
As well as these principles, TLAP has
launched Advice and information needs in
adult social care, an interactive map that
demonstrates people’s typical journeys
•
•
•
•
•
•
•
Money that is taken from your assets
(e.g. home) to pay for care
Money that is allocated to you by your
local council to pay for care (correct)
An interest-free loan that is allocated to
you to pay for care
My GP would provide me with the
information
The council would provide me with the
information (correct)
I would search on the internet
A private social care organisation would
advise me
What is telecare?
•
•
•
A telephone service that links to social
workers 24 hours a day
Technology that enables you to remain
independent and safe in your own home
(correct)
A medical telephone service
www.caretalk.co.uk I 35
LEARN
Care workers and employers
sign up as ambassadors to
support sector recruitment
The adult social care sector currently
employs approximately 1.5m people
and is driven by significant changes
in demographics and the way services
are being delivered across England. It
is projected that the demand for care
workers could increase by almost 1m by
2025. Finding, retaining and developing
enough workers to meet the current
and future demands of the adult social
care sector continues to be a massive
challenge.
Many people are not aware that there are
a wide range of career opportunities within
social care and the positive impact their role
has on the lives of other people, which is
why Skills for Care is working with employers
and employer partnerships across England
to launch the new ‘I Care…Ambassador’
service to support recruitment and retention
of workers in the adult social care sector.
“I Care...Ambassadors are
enthusiastic people working in
adult social care who are willing
to share their experiences.”
I Care...Ambassadors are enthusiastic
people working in adult social care who are
willing to share their experiences with others
who may not have previously considered a
career in this sector. The aim of the I Care...
Ambassador service is to help people to
gain a better understanding of working in
social care, dispel the negative myths that
are associated with the sector and promote a
wide range of different career opportunities.
For those who are new to social care, the I
Care…Ambassador service promotes a ‘real
life’ view of what it’s like to work in the sector,
providing valuable support for employment
and career advisers delivering informed
advice about working in adult social care and
how people can start a career in social care.
The I Care…Ambassador service responds
to the cry from the sector to build a confident,
capable, skilled workforce that can satisfy the
growing demand for care workers. The sector
is particularly looking to recruit young people
who have the skills and knowledge to meet
future demand.
36 I www.caretalk.co.uk
“The service responds to the
cry from the sector to build
a confident, capable, skilled
workforce that can satisfy
the growing demand for care
workers.”
Skills for Care chief executive Sharon Allen
explains: “There is a worry that people are
not aware of the variety of jobs available
in adult social care. There is a need for
direct care roles for elderly people, yes,
but there are also vacancies in the sector
for specialists, technicians, therapists and
administration roles.
“The I Care…Ambassador service will help
dispel some of these myths about jobs
in the sector and act as an opportunity
for those working in care to provide firsthand knowledge about a sector that offers
opportunities, job security and high job
satisfaction.”
Why should employers get
involved?
Skills for Care is encouraging employers to
register as an I Care…Ambassador service
to help to raise the profile of their own
organisation and inspire people with the right
skills and values to start a career in social
care. Quality employers can help the sector
to attract more knowledgeable and motivated
recruits who are likely to stay in their roles for
longer, helping to reduce recruitment costs.
It is also a chance for staff to talk with pride
about their work, which will help them to build
confidence and develop new skills.
Further information
If your organisation is interested in finding out
more about registering as an
I Care…Ambassador service, or to find out
about joining an employer partnership, visit
www.skillsforcare.org.uk/icareambassadors
or email [email protected].
Music therapy strikes the right note
Music therapy is nothing new. The benefits of music as a
means of encouraging social activity, creativity and selfexpression, and what this can mean for someone’s health,
are long established.
As far back as the 1870s, doctors at Worcester County
Pauper and Lunatic Asylum (which became Powick
Hospital) instituted a series of orchestral concerts there,
as well as Friday night dances for the inmates. Sir Edward
Elgar played in these concerts as a young violinist, later
becoming instructor and conductor of the Asylum Band
(made up of staff) and composing musical works for them.
Music therapy was first used in the UK in the treatment
of people returning from war in the early 20th century,
addressing psychological and rehabilitative aspects of
recovery, and developed more formally in UK health and
education sectors since the 1950s. It achieved state
registration in 1997 and is now a healthcare profession
regulated by the Health and Care Professions Council.
It has a wide range of applications, and research
continues to explore new ways that it can contribute
to people’s physical, mental and emotional health and
wellbeing. On a fairly simple level, for instance, music
therapy sessions in day centres and care homes offer
people the chance to sing, play, perform, listen and move
– all enjoyable activities that engage body and mind and
help individuals maintain and develop skills in a lively
social setting.
On another level, music can reconnect older people with
their emotional past through familiar songs and support
community bonding and family relationships.
Music therapy also offers additional means of assessing
individuals and their particular needs, starting with
looking at the suitability of music therapy for a person
– basically producing a detailed portrait of them using
musical descriptions.
Stuart Wood, head music therapist in a collaboration
between Barchester Healthcare and music therapy
charity Nordoff-Robbins, explains that when used as an
assessment music therapy offers an excellent lens for
understanding general aspects of someone’s condition,
such as the adaptability of a person with autism. This
can often contribute to a more exact diagnosis. It can
also be helpful in a family or caring context, assessing
parenting abilities where a child has a learning disability,
for instance.
Ongoing observation by a therapist can flag up even
slight changes in a person’s physical health and abilities,
such as their grip or strength when using an instrument,
and indicate variations in general attitude and wellbeing
through their responses to music and its effectiveness in
stimulating memory and encouraging participation.
What people respond to varies from moment to moment,
especially if they have a condition like dementia, and
music therapists are trained to be very flexible. These
professionals are able to choose music suited to a
specific individual, or to adapt music so that it is right for
different members of one group, incorporating a variety of
harmonies, rhythms and melodies, explains Stuart.
“The care home environment offers particular advantages
for music therapy,” he says. “We can work on both a
psychosocial and medical model, and at the same time
we can involve staff and families as well as residents.
“Music therapy can bring life to a whole care home or day
centre. And we can also offer training to staff, enabling
them to engage with service users in new ways.”
Helping people to live well with dementia is increasingly
viewed as a major field of work for music therapists.
Music therapy fits the person-centred model of care that
focuses on promoting key areas of psychological need
in dementia – comfort, attachment, inclusion, occupation
and identity – and can help deliver on the key objectives
and recommendations of the National Dementia Strategy,
says Stuart.
TECHNOLOGY
Current dementia care research in music therapy pays
particular attention to various specific effects of dementia,
such as agitation, associated mental health problems like
depression or anxiety, and challenging behaviours, with
a focus on the evident impact of music therapy on those
aspects of the person’s life.
It therefore takes into account the many and various
types of dementia and their likely impact, so what is being
researched in relation to music therapy and vascular
dementia may be very different from research into its
effects on someone with Alzheimer’s, for example.
There is a further, more holistic strand to current music
therapy research regarding how it can generally enhance
the lives of both a person with dementia and those who
care for them.
“There is a lot to be gained from carers observing or
assisting in music therapy where appropriate. Seeing the
person with dementia operating and responding in new
ways offers hope and comfort, and can suggest to a carer
how they might enhance their own approaches,” says
Stuart.
“Joint participation creates an equality; you’re doing
something together, breaking down the basic healthcare
barrier of ‘patients’ and ‘experts’. This can come as an
enormous relief to everyone – it removes the burden of the
carer role, temporarily at least, and equally takes away the
feeling of being a burden that the person being cared for
may have.
“Music transforms the atmosphere and the effects ripple
throughout the care setting.”
Vicky Burman
Advertorial
Telecare services – solution or intrusion?
Focused on the provision of remote care – with
passive sensors usually an integral part of the
package – smart telecare services can act as
discreet safeguards for the activities of people in
retirement villages and care facilities such as rest
homes and dementia units. For more able elderly
people, telecare services can provide the means
for them continuing to live in their own homes.
The growth of telecare services for elderly
people poses interesting discussion around
the fine line between ‘solution’ and ‘intrusion’.
Understandably, it raises questions around the
ethics of monitoring elderly people’s activities
and whether the benefits of telecare outweigh
concerns about intrusion.
John Williams is a director of QVisual NZ Ltd,
which has developed Mimo Care, a telecare
product for the elderly launched in the UK and
New Zealand. This product provides a costefficient monitoring and alerting facility for staff
in care facilities and retirement villages and for
families whose loved ones remain in their own
homes.
John says: “Rather than an intrusion,
sophisticated yet easy-to-install telecare software
such as Mimo Care can be a smart solution for
increasing an elderly person’s safety, comfort,
independence, personal hygiene and health. It is
not so much about monitoring the person – rather,
the environment they live in. Elderly people tend
to follow regular daily routines and the detection
of any deviation from that can result in prompter
responses.”
Central to Mimo Care are a number of discreet
sensors that monitor motion, temperature, light,
pressure pads, and doors/windows.
Positioned in key spots – for example, the
resident’s bed, their favourite chair or a door
– the sensors can recognise activities such as
out-of-bed situations, late-night door openings,
motion detection, whether lights are on or off, and
other unusual events. In a retirement village – or
for people in their own home – staff or a family
member could be alerted to a stove left on or
a fridge left open, and be able to go online to
confirm what is happening. They could also
check online to ensure the stove is switched off in
the evening, or external doors are closed.
When a sensor detects something amiss or a
change in routine – a bed is wet or a dementia
patient is wandering at 2am – a text message
alerts an appointed staff member that the
situation requires immediate attention.
In addition, at any time and from anywhere, staff
can access online data gathered by the sensors
by viewing a rolling minute-by-minute, easy-toread view of the resident’s activities.
John Williams says: “Families, who may live far
away from their loved one, can have greater
peace of mind knowing that when something
shows up as ‘out of routine’ or undesired, it can
be rapidly attended to. That’s about superior
care, not intrusion. No one can actually see the
elderly person or their living space online – that’s
really key in terms of intrusion avoidance. The
system guards against an unexpected fall or
event – and how important is that?”
This article has been contributed by QVisual
NZ Ltd, which developed, and now markets
and installs, the telecare service Mimo Care in
New Zealand and the UK. Further information is
available at www.mimocare.co.nz
NUTRITION
Advertorial
Scottish caterer takes good care of his people
With so many special dietary
requirements to consider, catering for
people in the care sector can be a
challenging undertaking. Yet, for one
chef, meeting these challenges head
on is a task he conducts with relish,
ensuring that it is not just his food that
leaves a lasting impression.
For the past 18 months, John Brereton
has been head chef at Alexandra
Court care home in Glasgow. The
softly spoken Scot makes it his job to
know the exact requirements of the 50
people he cooks for daily, ensuring he
speaks personally to each and every
one, or to their families, about their
individual likes and dislikes, knowing
intrinsically that good food can
enhance their stay.
“Everything we do is geared around
the people who live here,” says John.
“I’ll personally go to visit them in
their rooms to find out their individual
needs. We have two menus, but if
they want something else, they get
something else. It really helps to bring
you closer to them – and for me, it
brings a great deal of satisfaction.”
With a stoic focus on quality, an
insistence on cooking from scratch
and a variety of individual needs,
there is one kitchen ingredient that
John confesses he couldn’t be without
– Pritchitts premium dairy cream
alternative Millac Gold.
“As a chef in the care sector, the
38 I www.caretalk.co.uk
benefits of using Millac Gold are
widespread – firstly, it’s a great
product, really stable and so versatile
you can use it in savoury or sweet
dishes,” he says.
John’s menus regularly contain
a number of soups, quiches and
desserts such as mousses and
cheesecakes – all made with Millac
Gold and all firm favourites. “I’ve
worked out that I get about a 30%
saving using Millac Gold compared
to whipping or double cream. The
versatility really helps me to cater
more effectively for each individual
who lives here at Alexandra Court. As
a pastry chef, I have dessert recipes
that say to use whipping cream,
double cream, you name it – with
Millac Gold you only have to use the
one product and because of this
we get a lot of usage out of it. Also,
because it whips up to three times
its own volume you don’t need to use
as much when you’re adding it into
food – you gain volume and you gain
a saving.”
John has also found that Millac Gold is
perfect for fortifying the food already
on offer.
“In Alexandra Court there are
various dietary requirements and
sometimes food needs to be modified
to produce pureed meals that are
tasty, attractively presented and fully
nutritional, so I use Millac Gold in
potato, porridge and vegetables, for
example. We don’t add water, we
enhance it with Millac Gold. It provides
nourishment and I can’t recommend
it highly enough for giving you that
safety net.”
As John clears down from another
service, he talks candidly about the
activities laid on at Alexandra Court
– dances, afternoon tea with his own
homemade cakes – yet the subject
that gets him most enthusiastic is
when he speaks about the weekly
cookery classes he conducts. “In my
classes we might make some scones,
then after we sit, have a cup of tea,
reminisce, even have a sing-song;
it’s absolutely great for everyone
involved.”
So, does John have advice for other
chefs in the care sector?
“Know your people, know who you’re
cooking for and try to use the best
products you can, alongside brands
you trust. Pritchitts Millac Gold is one
of those products that I can trust and
I would definitely recommend it to
anybody catering for the care sector.”
For more information on Pritchitts and
to find care-specific recipes from John
Brereton, visit the new website at
www.pritchitts.com
FREE
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*Free sample request offer only valid for sample Millac Gold 1ltr
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PRIT6538_FortifyMenuAd_AW.indd 1
10/09/2013 12:57
MEDICAL & CLINICAL
MEDICAL & CLINICAL
Championing change
Attending just one course on continence
has led to huge benefits for residents
and carers at one nursing home.
It began as just a course – when three care assistants at
Hay House Nursing Home, Exeter, were asked by their
manager if they would like to attend a local incontinence
champions’ course. It has gone on to be a major project
for the home.
Natalie Mercer, Daniel Cahil and Karen Rosqueta
attended five separate afternoons of training, looking at
the causes of continence, aspects of personal care and
the characteristics of continence products available. As
the sessions progressed, the group found themselves
discussing incontinence issues and how they could
apply what they had learnt to Hay House, a highdependency unit for people with advanced dementia.
They were so inspired that they thought it would help
other members of the team to also hear about what they
had learned.
“When the course had finished the three of us decided
to have our own regular meetings to apply what we had
learned,” says Natalie. “In the first meeting we took a
good hour to bounce all our ideas around. We listed
what our aims and achievements would be. The only
problem was that the list was much too long!”
Natalie says that instead of being disheartened, they
used this as a list of goals to achieve. They began by
sharing their knowledge with other members of the care
home team.
“We started with the other carers in the home, holding
an in-house incontinence meeting explaining the
basics,” Natalie explains. This included advice on
how to weigh an incontinence pad and a practical
demonstration – with the help of a volunteer carer –of
what it is like to wear a pad. Each carer completed
a three-day diary to help them understand the value
of personal care plans for patients. They received a
certificate at the end.
The project then continued with a series of changes
suggested by the group, all focused on better
communication about individual patients’ needs. All
care plans at the home now include a Bristol stool chart
and position chart. The team now use these without a
second thought, says Natalie. Pad stickers are included
with each patient’s care plan so that the individual gets
the correct pads.
Marked success
Paul Guest, the owner of the home, has been hugely
impressed. He says: “The team have really embraced
the project and have got involved in training others. It’s
become so much more than just a training exercise.”
The result has been improvements to the residents’
lives and also to the home itself, he says. “Things have
improved in the home to the extent that we have recently
spent £10,000 on recarpeting.”
Natalie comments: “I can see that the residents are
more comfortable and that the staff are more positive
as a result of the work we have done. It has been really
rewarding for all those concerned”
The Hay House team has also developed their own
measurement guide and all patients are measured for
their ‘comfort, dignity and choice’. The home has also
added an option of decaffeinated tea and coffee, which,
Natalie says, not only helps with continence, but also
gives the residents more choice.
The three champions say that they are still coming up
with ideas for improving continence care in the home.
“We have decided that we do not wish to be adequate or
good here, but to be excellent! We will strive to get there
and indeed stay there for the benefit and wellbeing of
our residents,” says Natalie.
“It’s person-centred care,” she says. “It’s all about the
person, their diet, medication and dignity: the whole
spectrum.”
* This article was first published in TENA Talk Spring 2013, © Communications
International Group Ltd, London.
SPECIALIST SERVICES
Work hard and be nice to people
I was in a café recently when I read a poster, one of a
common theme these days: Work hard and be nice to
people. My immediate reaction was one of mockery –
‘If only it were that simple; what about safeguarding,
quality standards, frameworks for governance, KPIs,
training and development, recruitment and retention,
health and safety?’ – but as my coffee grew cold, and
my milk began to spoil with my cynicism, I started to see
logic in the message.
“It’s easy to forget about the
cultures and practice that
can render the service user
invisible.”
With this month being the third anniversary of the
Winterbourne scandal, we have seen a recent surge of
interest in specialist provision for people with a learning
disability. The Guardian reported that “the launch of
a quality code (www.drivingupquality.org.uk) means
some good has come out of the scandal”, and we read
of Norman Lamb visiting ex-resident Sam to see how
his new services are supporting him. Yet in the same
week we see an apparent back step by the Care Quality
Commission (CQC), which announces it is set to scrap
its pledge to inspect every individual NHS mental health
service after admitting the target is “virtually impossible”
to deliver.
While the scandal of the abuse will live deeply
embedded in all our memories, and policy shifts slowly
towards specialist community-based provision, it’s easy
to forget about the cultures and practice that can render
the service user invisible in a service they are ‘placed’
in, rather than one designed for and with them.
Before renowned professor of learning disability Jim
Mansell’s untimely death, he spoke at a conference
about providers and commissioners forgetting the main
element of what we do – care. He spoke of the need for
creativity, imagination, competence and commitment to
make community care a reality for people with complex
needs such as challenging behaviour, something I
heard him tell the Government in 1993 and again in
2007. We know that there is a need for a small number
of specialist assessment and treatments services
for use in emergency situations – the Department of
Health’s Winterbourne View Review noted a need for
250-300 places nationally – but that these should be
discharge and enabling-focused, rather than a longer
term solution.
As we all vie to be the most expert, person-centred,
research-led provider, we must not lose the very core
of what we are about. Support and care – being nice
to people – is an absolute non-negotiable for every
professional in the field, whatever grade, discipline or
position they hold in a company.
“We must not lose the very
core of what we are about.”
Probably the most effective way to achieve this is
through ‘positive behaviour support approaches’. It’s
great to see this becoming established as the preferred
approach when working with people with learning
disabilities who exhibit behaviours described as
challenging.
Further
endorsement
from the British
Institute of
Learning Disability
(BILD), the British
Psychological
Society guidelines
and the joint
guidelines of the
Royal College
of Psychiatrists
gives strength to
a growing model
and a framework
for providers to
use, not only in
their daily practice
but also in their
philosophy, recruitment and benchmarking of practice.
BILD tells us that positive behavioural approaches are
fundamentally rooted in person-centred values, aiming
to enhance community presence, increase personal
skills and competence
and place emphasis on
respect for the individual
being supported, or, to put
it another way, working hard
and being nice to people.
Andy Callow
Director of supported living
services
Spirit Care Limited
NUTRITION
Advertorial
Innovative apetito hospital and care home
meals shortlisted for national awards
Leading food company apetito has been
shortlisted for two prestigious Food and
Drink Federation Awards in recognition of
the innovation of two of its healthcare and
care home food ranges.
The Food and Drink Federation, whose
annual awards recognise innovation
and creativity from UK food and drink
manufacturers, has shortlisted apetito’s
CarteChoix range – a ward-level plated meal
range delivered on a warm china plate and
designed for high-turnaround hospital wards
– and its texture-modified range for those
with chewing and swallowing difficulties.
Both ranges have been shortlisted in the
innovation category of the awards, which
recognises significant achievements made
by entrants over the past three years in
leading-edge product development.
The CarteChoix range was developed to
improve the dining experience on acute,
short-stay and out-of-hours wards such as
maternity and oncology, allowing patients to
choose from an à la carte offering at a time
that suits them, reducing food waste by up
to 30% and enhancing recovery.
apetito’s texture-modified range of meals
was created to appeal to and assist those
with chewing and swallowing difficulties
associated with conditions such as
dementia, dysphagia, and neurological
conditions like Parkinson’s, covering texture
categories C-E.
Paul Freeston, chief
executive at apetito,
explains: “As a
company that provides
meals to some of
the country’s most
vulnerable people, we
want to ensure that our
offerings are as tasty
and visually appealing
as they possibly can
be. For example why
should someone who has dementia and
dysphagia be offered a pureed meal that
looks unfamiliar rather than one that has
been designed to look exactly as appealing
as their solid equivalents, or a hospital
patient have to wait for a pre-allocated meal,
which they may not even have chosen?
“At apetito we are extremely proud of the
innovations we have made to improve
healthcare, care home and community
meals, innovations that we continually
strive to develop and improve, and we
are very pleased that these have been
acknowledged on this prestigious shortlist.”
The winners of the Food and Drink
Federation Awards will be announced at an
award ceremony at London’s Vinopolis wine
tasting experience visitor attraction on 14
November.
For more information on apetito, please visit
www.apetito.co.uk or call 01225 756071.
My challenge was nutrition
If the CQC inspected us today,
I could tell them the exact
nutritional content of every
single meal we serve
Paul Swithenbank
Founder Chairman and Chief Executive,
The Willows, Blackpool
challenge us
Have you got a nutrition, cost, service or quality challenge?
Get in touch and we’ll help you solve it – GUARANTEED.
www.challengeapetito.co.uk/paul or call the team on 0800 542 2631
Passionate about care home food
Advertorial
TECHNOLOGY
RECRUITMENT & DEVELOPMENT
Great assessors are flexible
At national training provider Intraining we value
our employees’ opinions and we like to know
what makes them tick. We caught up with some
of our health and social care assessors to
find out exactly what they thought of their role,
responsibilities and working at Intraining.
One of the team’s administrators, Kayleigh
Kirkbride, spoke to Denise Carrick, a health and
social care assessor who covers the North East,
about Intraining and life as an assessor.
Q: What do you enjoy most about your role?
A: I like helping people develop in a career that
I enjoyed and was proud to be part of, helping
staff to get the best results and give the best care
possible for vulnerable people.
Q: How did you get into the role/sector?
meeting people in various workplaces.
Q: Can you give some tips on being a great
assessor?
A: To be a great assessor you have to be flexible,
have a sense of humour and be focused and
good at time management.
Q: What does your typical day look like?
A: The best part is that there is no typical day,
every day is different.
We also spoke to Suminder Singh, one of our
health and social care assessors in the Midlands,
to understand what she enjoyed about her role
and what support she has received, being new to
the role.
Q: Why do you enjoy working for Intraining?
Suminder said: “I have vast experience in the
health and social care sector, but coming into
any new job role and learning the process can
be daunting at the best of times. However, I have
found the support and guidance offered to me by
Intraining invaluable.
A: I was a manager and used to be an inhouse assessor and then became a peripatetic
assessor. I enjoy being part of a team and
“I have had support from not only my manager
and colleagues but also the health and social
care sector specialist, who has helped me
A: I worked in the care industry for over 20
years and progressed from a care assistant to a
manager.
improve my assessment practices by the
constructive feedback I have received through IV.
I have also had the support of generic assessors,
who have mentored me and developed my
assessment planning; this has enabled me to
improve on my timely completions.
“Also, the regular standardisation meetings
where all health and social care assessors come
together to review evidence and best practices
are extremely helpful; they have helped me
become more confident in evidence gathering.
The support from head office has also been a
great help, in particular the quality team, who
have helped me with any ‘e-track’ issues.”
“Intraining continues to support and develop
me with regular one-to-one meetings with my
manager where a full caseload review takes
place, as well as team meetings where again I
get to share ideas and work as a team and also
receive regular updates on the company and
business plan.”
Are you looking for a new and exciting career opportunity?
Do you want to develop yourself?
Are you interested in helping others achieve?
If so Intraining could be the place for you!
We currently have many opportunities in the South of
England for you to become an Assessor within the Health
and Social Care sector. We work with many employers on
a local and national level to help up skill their care home
staff.
We are looking for motivated, enthusiastic and driven individuals who
have knowledge within the care home sector and experience of working in an adult care home.
Don’t worry if you aren’t qualified or haven’t assessed previously.
Intraining are a national training provider and learning and development
is what we do best!
We offer a 4 week training academy where you will learn how to
become an Assessor and gain the TAQA qualification. The academy
allows you to develop yourself, pick up the trade and is a warm welcome to Intraining.
We are looking for Assessors in the following areas:
•
•
•
•
•
•
•
Bristol/Gloucestershire
Devon/Cornwall
Somerset/Devon
Luton
Oxford
South London/Croydon
Poole
Starting salary for the role is £19,300 plus a broadband allowance
of £15 per month as all our Assessors are home based. Once you
achieve the TAQA your salary will increase to £22,725 per annum.
Intraining offer 27 days annual leave, company pension scheme and
many more benefits to all our employees.
If you live in or around any of the above areas and are interested in a
career with long term prospects and development opportunities we
would like you to get in touch.
To apply please send your CV and a covering letter to [email protected] and we will consider your
application for one of our assessment days to be held w/c 30 September 2013.
NURSING
Royal British Legion provides
dementia nursing support to veterans
In 2010 The Royal British Legion
commissioned a research study into
the future needs of beneficiaries, which
showed that the number of ageing exService personnel and their dependants is
increasing along with the demands for care.
A significant number of beneficiaries will
develop late onset dementia and much of
the support given to them will continue to be
provided through unpaid care.
In 2012 as part of the Legion’s wider health
and welfare strategy, a new community
dementia nurse service through Admiral
Nurses was launched, in partnership with
Dementia UK.
“The role of the Admiral
Nurse is to establish the
need from the family and,
with agreement, refer into
statutory services.”
The charity currently has two teams of
Admiral Nurses based in Lancashire and the
West Midlands. Admiral Nurses are mental
health nurses specialising in dementia care.
They offer a variety of services, such as
skilled person-centred assessments of the
needs of the carers, families and individuals
with dementia, psychological support to
help deal with emotions and referrals to
treatment and other support services.
Over the last 12 months, the Legion has
helped more than 400 families, including
Evelyn Haslam, whose husband Albert lived
with dementia until he passed away on
Boxing Day 2012 aged 88.
44 I www.caretalk.co.uk
Albert, from Knott End in Lancashire, served
in the Royal Navy on the Arctic Convoy and
supported the Legion as a poppy appeal
organiser for eight years, raising £40,000.
He was diagnosed with dementia in March
2012 and Evelyn was referred to the
Legion’s Admiral Nurse service in July 2012.
The nurses assessed Evelyn and Albert’s
needs and provided support, education and
advice for Evelyn and her granddaughter,
who were Albert’s carers. The Legion
assisted the family by part-funding a riseand-recline chair and a specialist bed to
aid Albert’s mobility issues caused by his
dementia.
our visits. After acknowledging that this is
a problem for the carer and gaining their
agreement, the Admiral Nurse can then help
the carer access the appropriate level of
support and/or treatment. This may include
liaising with primary care services such as
a GP or more specialised health services
when required.”
“Admiral Nurses can help the
carer access the appropriate
level of support and/or
treatment.”
During his care, Evelyn praised staff for
helping her through this difficult time. She
said: “It feels like a weight has been lifted off
my shoulders as I have someone to turn to
as Albert is deteriorating; I don’t feel alone.
Other examples where Admiral Nurses
might refer to health services would be
issues around diagnosis and treatment of
dementia and any other pre-existing mental
health or physical conditions.
“The advice and support that my nurse has
provided to the family has helped me care
for Albert at home, which is something I
wanted to do.”
The service also liaises with non-statutory
services such as Age UK and Alzheimer’s
Society, where educational sessions on
dementia and caring for those with dementia
are delivered along with support at dementia
cafés across the UK.
The service links closely to other health and
social care services. Local authorities are
often the first port of call when families are
considering the need for care at home or a
situation might require access to day care
services. The role of the Admiral Nurse is to
establish the need from the family and, with
agreement, refer into statutory services.
Ben Upton, lead Admiral Nurse in the West
Midlands, said: “Admiral Nurses assist
the carer with addressing their own health
needs; for example, when a carer shows
symptoms of depression identified during
Having an Admiral Nurse as a single point
of contact helps to reduce the carer’s stress
and burden and also helps to evaluate the
effectiveness of what has been provided.
The Legion spends £1.6m a week on
direct welfare support to serving personnel
and veterans and the Admiral Nurse
service demonstrates its commitment to
helping Armed Forces families. For more
information, visit www.britishlegion.org.uk.
TECHNOLOGY
Time to care
CareDocs originally grew out of a need for a
care home manager to keep all the residents’
care plans up to date as well as track an everincreasing number of tasks and responsibilities.
He decided that the most obvious solution would
be to computerise all the records so he could
get on with the important task of caring for his
residents.
Since then, CareDocs has evolved and grown
into one of the leading care home management
systems, used in hundreds of care and nursing
homes throughout the country.
The core function of CareDocs has always been
the production and management of care plans.
CareDocs uses a unique, three-step system to
produce comprehensive, person-centred care
plans.
Step 1 Carers complete a comprehensive
assessment by answering a list of questions
covering all the areas necessary to comply with
current guidelines. The system guides the carer
through the process, and most answers can
be provided with a single click of the mouse.
The intelligent process built into CareDocs
means that, as the carer progresses through the
assessment, only relevant questions are asked,
with unnecessary questions being automatically
omitted. The result is that with all the relevant
information to hand, a full assessment can be
completed quickly and easily.
Step 2 From the information gathered in the
assessment, CareDocs can then automatically
generate a draft care plan, saving many hours of
work. This process usually takes only one or two
minutes.
Step 3 At this stage the care plan is fully
personalised but every section can now be
edited or supplemented with other relevant
information to make it a truly person-centred
document. Every word of every section of every
care plan can be edited so all relevant current
and background information can be included.
There is no limit on the amount of text that can
be entered and users can make sure that all the
information is worded exactly as they would like;
there is no need to accept generic computergenerated text.
There are those carers who claim that
computerised care plans can never be personal
or accurate and the only way to create a care
plan is to sit down and write it out fully from
scratch. The unique method that CareDocs
employs ensures that all information can be
included in the way that the carer wants, and if
anything is missing then that is simply because
it’s not been typed in!
The ongoing maintenance of the care plans is a
simple and straightforward process. All the text
and content can be amended to reflect changes
in circumstances, but all the previous content is
saved for future reference, creating a valuable
record of the care history.
In addition to care plans, CareDocs can store
a great deal of personal and other relevant
information about residents, making it instantly
accessible. Standard reports included in
CareDocs allow a wide variety of details and lists
to be produced quickly and with minimum effort.
CareDocs has many other features that any care
home manager will find invaluable. Staff records
– including training and supervisions – can be
stored, and training reviews and matrices can
be printed in minutes. There is a host of reports
allowing quick analysis of important management
information and automatic reminders ensure that
equipment maintenance and servicing schedules
are not missed.
CareDocs is provided ready to run on dedicated
computers. Unlimited, free technical backup is
provided as part of the package so you don’t
have to worry about hard drive failures or network
issues – CareDocs takes care of it all.
If you would like a free demonstration in your
home, call 0845 500 5115.
When it comes to care planning play a winning hand
For more information visit our website
www.caredocs.co.uk
For care insurance, search ‘Markel’
We see WhaT oThers Miss
Advertorial
BUSINESS
Burning cost -
Gambling on good fortune
What if your customers risked their main
funding asset in a game of chance?
Thousands may unwittingly be doing just
that.
If a sole householder has left their home to stay at your care
residence, they are likely to be affected.
Although the restrictions in cover vary from one policy to another, the
chart below gives the most likely scenarios.
When an individual goes into care, it is in everybody’s interest to
ensure that the chosen solution is affordable for the foreseeable
duration of need. In fact, considerable efforts are made to evidence
the client’s assets prior to acceptance into a residential care home,
often by employing independent consultants to assess and report on
the individual’s ability to fund their care choice.
It may then come as something as a surprise that despite efforts to
guarantee the customer’s ability to pay, a worrying proportion of
self-funders’ financial provisions are at serious risk, relying on good
fortune to see them through.
In many cases, the funding of care is underpinned by the equity held
in the principal residence. When relying on this to ensure the future
of your client at your care home, you would naturally expect the
property to be adequately insured.
Void home insurance policies
Most home insurance policies are set up on the basis that the
insurance company is providing cover for the main residence, which
is being lived in generally on a full-time basis. Usually this will happily
accommodate absences of up to a few weeks at a time without
affecting cover. However, for any prolonged absence, the policy is
likely to be severely restricted.
The typical exclusions are as follows:
•
•
•
•
•
Theft
Malicious damage
Escape of water from fixed installations
Burst pipes
Accidental damage
Furthermore, unless the change in occupancy has been notified
to the insurer and cover agreed, the policy may be automatically
made void by the failure to disclose a change in the information
provided to the insurer at inception of the policy.
If the house is unoccupied
for a longer period,
the insurer may apply
further restrictions or
cancel cover completely.
Is your resident affected?
*Important note
The number of days after which your policy cover is restricted varies
from one policy to another. It is usually either 30 or 60 days. Check
your policy or speak to your insurance provider.
In the first instance, it is always best to approach the existing
household insurer for a cover extension, particularly if the stay in
residential care is likely to be short term. However, their response
should be obtained in writing with confirmation that the cover is not
restricted.
What can we do to assist?
Firstly, if there is an independent financial assessment taking place,
ask for confirmation that the assets they are including in the report
are insured properly and will continue to be so when the property is
empty.
You can download factsheets both for the client and the adviser,
detailing what to look out for and where to turn if the existing insurer
won’t play ball, from www.bickersinsurance.co.uk/carehome. If you
want hard copies of the factsheets, call Bickers Insurance Services
on 01903 791340 and we will be pleased to provide them.
Where can I obtain the cover I need?
Cover for empty properties is available from a small number of
providers, including Bickers Insurance Services. As a specialist in
arranging property insurance for unoccupied homes, our service is
specifically designed to cater for the needs of those entering care.
Cover is available for both buildings and contents of empty houses or
flats.
Colin Bickers
Director
Bickers Insurance Services
www.caretalk.co.uk I 47
BUSINESS ROUND-UP
Business round-up
Care
providers
Barchester to repay
debt obligations in full
following leaseback
agreement
Barchester Healthcare has confirmed
that it has completed the sale and
leaseback of certain Barchester
property assets with Ravenshill
International Ltd. Ravenshill comprises
a group of experienced real estate
investors who are seeking a long term
partnership with Barchester.
Under the terms of the transaction, all
acquired property assets will be leased
back to, and continue to be operated
by, Barchester for a period of 23 years.
The net proceeds of the transaction will
be used by Barchester to pay back all
existing lenders and for the continued
development of the business.
Belong villages launch
Admiral Nurse service
North west care
provider Belong
has launched
an Admiral
Nurse service
to give families
of Belong
customers at
their community
villages access
to specialist
dementia
support and
advice.
Mental health nurse Caroline Clifton
(pictured) has been recruited as
Belong’s first Admiral Nurse, following
a new partnership with Dementia
UK designed to further enhance the
organisation’s expertise and resources
48 I www.caretalk.co.uk
in this area.
Caroline will support the families
and carers of Belong residents and
customers, both in the villages and the
wider community. Caroline will also
provide advice and support to Belong
staff in how best to care for the person
living with dementia.
£6.2m care home opens
in Gloucestershire
One of the UK’s largest not-for-profit
care home providers, the Orders of
St John Care Trust, officially opened
Gloucestershire’s newest care facility
– Windsor Street Care Centre in
Cheltenham – at the beginning of
September. Fra’ Matthew Festing, Grand
Master of the Sovereign Military Order
of Malta, attended the launch event
to tour the new centre and unveil a
commemorative plaque.
Developed as a state-of-the-art care
home for older people, Windsor Street
provides facilities built with residents’
needs in mind. It also offers nursing
care and a specialist dementia unit, in
addition to respite care.
Equipped with 81 beds, the £6.2m
care facility is divided into five separate
household units, each self-contained
and providing all of the personal,
communal and dining space needed to
care for residents.
Windsor Street Care Centre is part of
a £100m project to upgrade or replace
care homes for older people across
the Gloucestershire, Oxfordshire
and Wiltshire. As part of the project,
the Orders of St John Care Trust is
working in partnership with the county
councils and bpha, a leading provider
of affordable homes throughout central,
southern and eastern England.
Guinness Care and
Support acquires care
business
Guinness Care and Support has
acquired the Live Well at Home care
company in Gloucestershire.
Guinness Care and Support is a
member of The Guinness Partnership,
one of the largest housing and care
providers in England, and provides
a range of retirement living options
including sheltered housing, extra care
housing, care at home and residential
care homes. Live Well at Home,
acquired in early September, has an
excellent local reputation for providing
care to people in their own home.
Paul Watson, managing director of
Guinness Care and Support, says: “We
are delighted with this first acquisition,
which adds a well-respected local
company to our existing business
portfolio. We welcome Live Well at
Home staff and customers and look
forward to continuing to deliver a highquality service to customers.”
This acquisition is part of Guinness’s
wider growth plans to increase its
presence in the domiciliary care market,
recognising the importance of being
able to provide more people with care
in their home, so they can remain
independent for longer.
Leicestershire care
provider to create 40
new jobs
A Leicestershire care provider is
opening a new care home in the city
that is expected to create 40 new jobs.
Freedom Care, which currently has
three care homes in Leicestershire and
one in Nottingham, will be opening its
fifth home on Groby Road in the centre
of the city. The home will have the
capacity to offer care for 15 residents
as well as provide a sensory room and
communal room.
Freedom Care is a family-owned
business that specialises in care for
complex and challenging needs for
people with conditions such as autism,
Asperger’s and ADHD. It is managed by
husband and wife team Joe and Katrina
Kinch, who have both had careers in
nursing and caring for people with
Business round-up
learning disabilities.
Renovation work was due to start in
September and is expected to complete
in February 2014.
Care home operator
snaps up firm for £35m
Care homes company Castlebeck has
been acquired out of administration by
rival care operator Danshell in a deal
understood to be worth about £35m.
Castlebeck, the firm at the centre of
abuse allegations at Winterbourne View
care home in Bristol in 2011, provides
specialist care and rehabilitation to
vulnerable people across 22 homes. It
employs 2,000 staff. Danshell, founded
by healthcare veteran Efi Hershkovitz,
operates six care homes in Scotland
that have a total of 400 beds.
Movers and
shakers
Spirit Care appoints new
director of supported
living services
Spirit Care, the national specialist
providers in complex care, has
appointed Andy Callow as new director
of supported living services. Andy
began his career as a support worker
before training as a learning disability
nurse. He brings over 25 years’
experience of working with people
with complex needs and passion and
expertise in developing and delivering
services around the individual,
regardless of challenge.
Andy says: “I am delighted to join
such a well-regarded and respected
company. Spirit’s common goal,
to embrace the principles of
independence, choice and control
initiatives that are underpinned by
government legislation, is one I strongly
support and I am looking forward to
developing our care pathway to meet
individual and commissioner need.”
Homecare company
appoints new area
manager
Homecare
specialists
Home Care
Solutions have
appointed
a new area
manager for
its southern
region. Tracey
Nesbitt (pictured) joins the firm having
previously run a number of successful
branches at Care Mark and Allied
Health Care.
Tracey has more than 25 years’
experience in care working, both on the
frontline and in management positions.
She holds the Level 4 Certificate in
Leadership and Management for Care
Services and is a manual handling
trainer.
Finance
Care business targets
growth with Yorkshire
Bank
A Lancashire domiciliary care agency
is expanding into the residential homes
market with support from Yorkshire
Bank. Seva Line Ltd, which has been
providing home care services in the
Bolton area for 20 years, recently
established a sister company, Seva Line
Care Homes Ltd. The new firm has now
purchased its first property, Hurstead
House Nursing Home in Rochdale, after
receiving a significant funding package
from Yorkshire Bank to assist with the
sale price.
The deal was facilitated by Garry
Birchall, business development
manager with the bank’s Business and
Private Banking Centre in Bolton. Seva
Line Ltd’s management team formed
Seva Line Care Homes to apply their
extensive experience of domiciliary care
services to the care home sector.
With the 30-bedded property enjoying
an occupancy rate of more than 90%,
BUSINESS ROUND-UP
its new owners are already making
plans to extend the home and create
new jobs. The company also aims to
add further care homes to its property
portfolio as opportunities arise.
Property
Jones Melling appointed
to manage £2m
extension of hospice
North west chartered surveyor Jones
Melling has been appointed by Chesterbased Hospice of the Good Shepherd
to oversee the quantity surveying of an
over £2m extension to the centre.
The two-storey construction will provide
day care, offices and further clinical
and outpatient areas, as well as training
facilities for staff. The car park will also
be extended in order to provide further
spaces for patients and visitors.
This is a flagship project for Jones
Melling, which has recently branched
out into the healthcare sector. Work
is set to begin on site in October, with
completion forecast for October 2014.
Suppliers
CACI wins major
software solution
contract
CACI, one of the UK’s leading suppliers
of software solutions for local authority
and independent care providers, has
been awarded a major contract to
install a tailored enterprise resource
management solution for Radian
Support, not-for-profit providers of
high-quality care for adults with learning
disabilities, autism, mental health and
related needs.
The software solution, OfficeBase,
will effectively manage workflow
across Radian Support’s 500-strong
workforce in Hampshire, Berkshire
and Buckinghamshire, to help improve
the efficiency and quality of its care
services throughout southern England.
www.caretalk.co.uk I 49
BUSINESS - COMPANY PROFILE
LOROS helps fulfil dying wishes
Hospice care is a type and philosophy of
care that focuses on the palliation of a
terminally ill or seriously ill patient’s pain and
symptoms, and attending to their emotional
and spiritual needs. The concept of hospice
has been evolving since the 11th century.
Hospices were places of hospitality for the
sick, wounded, or dying, as well as those for
travellers and pilgrims.
The modern concept of a hospice includes
palliative care for the terminally ill provided
in such organisations as purpose-built
hospices, hospitals or nursing homes, but
also care provided to those who would rather
spend their last months and days of life in
their own homes.
LOROS Hospice, in Leicester, was founded
in 1977 and is a local charity, caring for local
people and dedicated to providing free, highquality, compassionate care and support for
patients, their families and carers.
LOROS provides specialist care at the
hospice on Groby Road in Leicester, in
the patient’s own home, and in partnership
working with local hospitals and GPs, caring
for over 2,500 patients and their families
each year.
“Being at LOROS helped
Linda to achieve her dying
wish of spending her
last few days in peaceful
surroundings with truly
dedicated and caring staff.”
A patient’s story: Linda Davis-Molinari by
Tony Metcalfe-Molinari
dine out with friends and relatives, making us
believe that a recovery was possible.
From the moment my wife Linda walked into
LOROS (the Leicestershire and Rutland
Hospice) for the very first time as a terminally
ill outpatient, she knew it was where she
would like to spend the last days of her
life. She was immediately impressed by the
serenity of the environment and the genuine
warmth with which she was greeted, making
her feel very much at ease and relaxed.
By the middle of July, Linda began to find her
condition more and more difficult and on 3
August she was admitted into LOROS. Such
was the care Linda received that she was
able to rally and within days she was sitting
in a wheelchair at an open-air rock concert,
determined to make every second count.
However, by 23 August she finally conceded
to her Macmillan nurse that she could no
longer endure the ever-increasing pain and
she was readmitted to LOROS.
Linda, aged 57, and I, her husband Tony,
were married in July 2009, next to the
beautiful Lake Orta in Italy. Soon after the
wedding, Linda began a series of operations
that resulted in her losing her job as a
primary school teacher. Undaunted, Linda
persuaded me that we should become foster
carers and in January 2012 we began our
first placement, taking in a young mother and
baby.
After four weeks of fostering, Linda was
diagnosed with thyroid cancer. It was quickly
removed but Linda soon learned that it was
a very particular undifferentiated thyroid
cancer, which was going to be very difficult
to treat and maybe terminal. By April she had
lost the sight in one eye and was preparing
for radiotherapy.
A PET scan soon proved that her sight loss
was due to the spread of cancer and on
15 May Linda was told that her condition
was untreatable and given just weeks to
live. Linda’s determination saw her fight the
condition every inch of the way, amazingly
eating solid food for the first time in weeks,
devouring a three-course meal to celebrate
It was then that Linda’s son Wayne and I
realised that Linda had been hanging on to
please those around her, enduring her pain
and putting on a brave face to keep everyone
else’s hopes alive. She bore her pain with
grace and dignity and inspired all those
around her. I called her the ‘little miracle’
because she had survived against all odds
for so long.
In her last stay in LOROS her nurses called
her ‘the sleeping princess’, such had been
the beauty and warmth of her smile. Linda
died peacefully in her sleep in the presence
of Wayne, me, and my son Paul.
Being at LOROS helped Linda to achieve her
dying wish of spending her last few days in
peaceful surroundings with truly dedicated
and caring staff. Her needs were met with
such professionalism and genuine caring
that it has become easy for me and Linda’s
family to enthusiastically add our support to
LOROS. We are forever grateful to all those
at LOROS.
the Queen’s Jubilee and then continuing to
Linda Davis-Molinari
50 I www.caretalk.co.uk
BUSINESS - LEGAL
Meeting service
users’ needs to
the end – the
CQC’s perspective
“It is their job to maintain the best quality
of life possible for that individual, to ensure
that the service user remains in control and
that any suffering is minimised.”
The Care Quality Commission (CQC) Essential Standards of Quality
and Safety are underpinned by the rationale that a provider of health
and social care services should do everything within their power to
ensure that the care they provide meets the unique needs of every
individual service user.
The dignity and independence of a service user are, quite rightly,
paramount and providers should adopt this ethos from the moment a
service user enters their premises to the moment they reach the end
of their life.
Caring for a person who is nearing death is a challenging task and
requires highly skilled and sensitive staff who are aware that it is their
job to maintain the best quality of life possible for that individual, to
ensure that the service user remains in control and that any suffering
is minimised.
As with all other aspects of care, CQC has included this scenario
in the Essential Standards under Outcome 4 – Care and welfare of
people who use services. The regulation related to this outcome
(Regulation 9 of the Health and Social Care Act 2008 (Regulated
Activities) Regulations 2010) states that providers must take steps
to ensure that all care is provided after the appropriate assessment
of a service user, that care is planned to meet the individual’s needs
and that the welfare and safety of the service user is ensured. These
principles extend to all service users and special application will be
required for service users who are at the end of their lives.
So how will compliance look within this specific service user group?
How can a provider evidence that they have adequately planned this
type of care? As is widely known, CQC will only deem a service to be
compliant with an outcome where evidence has been collected that
proves it.
It is therefore vital that providers carefully record every element of
care. Particular focus should be given to the following points.
“How can a provider evidence that they have
adequately planned this type of care?”
•
How service users are involved in the assessment and planning
for their end of life care and whether they are able to make
choices and decisions about their preferred options, particularly
those relating to pain management.
•
There should be systems in place to ensure further
assessments by specialist palliative care services and other
specialists, where needed.
•
The service user should be provided with information relating to
death and dying available to them, their families or those close
to them.
•
Service users should be able to have those people who are
important to them with them at the end of their life, meaning that
the provider should be aware of who these individuals are and
their contact details.
•
Service users should be ensured a dignified death because
staff are respectful of their needs for privacy, dignity and
comfort. Providers should train staff on how this can be best
achieved.
•
A service user’s care plan should record their wishes with
regards to how their body and possessions are handled
after their death. A person’s religious beliefs should also be
considered.
When a person nears the end of their life it is imperative that they
are fully supported in any decisions relating to their care and
that the care is planned to meet their needs and own wishes.
Consideration of the above points should ensure that the dignity
afforded to a vulnerable person extends through to their last
moments.
Jenny Wilde
Solicitor
Ridouts LLP
www.caretalk.co.uk I 51
BUSINESS AND FINANCE
Challenging fees
In December 2010, the Administrative Court
in Cardiff provided providers with a “legal
sword” for challenging local authority feesetting decisions, ruling that Pembrokeshire
County Council had unlawfully set the fee
level and forcing the council to revise its
decision and subsequently raise its weekly
per resident fee by £58.
Since this time, court judgements have
swung heavily in favour of providers, but
we are starting to see a rebalancing of the
outcomes of cases, meaning providers
should take care in deciding whether or not
to make such a challenge.
“The providers’ issue is
whether the authority has
correctly assessed the usual
cost of care and consulted
correctly with providers in
reaching that decision.”
The legal framework for such issues is set
out in section 21 of the National Assistance
Act 1948, and the relevant local authority
is obliged to make arrangements for
residential accommodation for persons over
18 and in need of care. Under subsequent
legislation, the authority is only required to
make such arrangements for the person
to be accommodated in his/her preferred
care home, if the cost would not require the
authority to pay more than would usually
be expected considering his/her assessed
needs, generally known as the “usual cost”
of care.
The providers’ issue is whether the authority
has correctly assessed the usual cost of
care and consulted correctly with providers
in reaching that decision. The challenge
before the court by way of a judicial review
must be issued within three months of the
council’s decision. This enables a court
to decide whether the authority’s decision
was reached in accordance with procedural
fairness. Rather than set a new fee, the
judge would order the council to reconsider
its decision, in accordance with procedural
fairness.
In October 2011, the Department of
52 I www.caretalk.co.uk
Health issued the Building Capacity and
Partnership in Care agreement between
the statutory and independent social care,
healthcare and housing sectors. This
recognised increasing concern “that some
commissioners have used their dominant
position to drive down or hold down fees to
a level that recognises neither the costs to
the providers nor the inevitable reduction in
the quality of service provision that follows”.
In recent years, many care home providers’
operational costs have increased
disproportionately to inflation. Where a
home has a significant number of residents’
fees paid by a local authority, the provider
can find it increasingly difficult to break
even, let alone make a profit. This is making
the level of fees an increasing bugbear for
providers.
The Department of Health guidance further
states that: “Fee setting must take into
account the legitimate current and future
costs faced by providers as well as the
factors that affect those costs, and the
potential for improved performance and
more cost effective ways of working.”
Local authorities are required to have a
clear consultation process in place when
setting fee levels.
“Some commissioners
have driven down or held
down fees to a level that
recognises neither the costs
to the providers nor the
inevitable reduction in the
quality of service provision
that follows.”
In November 2011, Sefton Care Association
successfully challenged Sefton Council’s
fee levels, arguing those set were not
demonstrably sufficient to deliver assessed
care needs and the required level of care.
The Department of Health guidance and
agreement featured heavily in the court’s
decision, with the council accused of being
driven heavily by budgetary constraints.
Robert Tranter, solicitor at Lupton
Fawcett Lee & Priestley, examines
care home providers’ positions when
challenging local authority fees.
Little or no consultation is a ground that can
be put before the court on its own. However,
one needs to bear in mind the Birmingham
Care Consortium’s unsuccessful claim for
judicial review after the local council had
engaged in a consultation process but
had delayed in making a decision. If an
application is to be made, it is important it
should not be made prematurely.
If the council has consulted sufficiently, then
consideration must be given as to whether
the proposed fee levels are sufficient to
meet the usual cost of care. However,
claimants in this area need to proceed with
caution.
In more recent cases, including R (Redcar
and Cleveland Independent Providers’
Association) v Redcar and Cleveland BC
[2013] EWHC 4 (Admin), we have seen
the tone of judgements shift from strongly
in favour of providers to a more balanced
position, with authorities winning their share
of outcomes, increasing the importance
for providers of carefully considering their
position.
Advertorial
BUSINESS - PROPERTY
New older people’s housing
scheme opens as part of
£50m local regeneration
“This is an important part of the Stanwell
New Start regeneration, which over four
phases will provide a wide range of homes
to meet the needs of the diverse local
community.”
The first residents have moved into a
state-of-the art housing scheme for older
people in Stanwell, Surrey. Chestnut Court,
which provides personal care and social
opportunities for older people as well as
housing, has been built as part of major
regeneration of the area.
Councillor Suzy Webb, planning and housing
portfolio holder for Spelthorne Borough
Council adds: “The council has worked
in partnership with A2Dominion from the
very outset to make sure that the Stanwell
New Start scheme delivers both housing,
community facilities and areas of open space
suitable for the needs and wishes of local
residents.”
Resident Winifred Flitter, aged 92, who has
lived on the estate in Stanwell for 65 years, is
one of the first people to move into Chestnut
Court.
Located in Mulberry Avenue, it has 44
self-contained apartments for residents
aged 55 or over. The scheme is part
of the wider £50m Stanwell New Start,
which is an exciting partnership between
A2Dominion and Spelthorne Borough
Council. The regeneration will provide over
300 new homes, with just under half of these
affordable accommodation.
“The regeneration scheme
replaces temporary housing
put up after the Second
World War.”
The regeneration scheme replaces
temporary housing put up after the Second
World War and some accommodation,
including flats, which were no longer able to
meet modern housing standards.
John Knevett, A2Dominion chief commercial
officer and deputy chief executive, says:
“We’re delighted to open Chestnut
Court, which provides residents with an
environment where they can continue to
retain as much freedom and control of their
lives as possible.
changed
over the
years,
and it’s
now
much
more
built up,”
she says.
“The
Stanwell regeneration is a
good thing for the local area
and the people.”
“The Stanwell regeneration is a good
thing for the local area and the people.
With the old homes having been up for so
long, families need new homes and the
regeneration is definitely needed,” she adds.
At Chestnut Court, A2Dominion’s care and
support team will offer three different levels
of care to residents, depending on individual
needs.
Facilities at the scheme include an on-site
restaurant, a hairdresser’s and beauty room,
IT room, communal lounge and landscaped
gardens.
She says: “It’s lovely to have a new home.
It’s clean and tidy, and nice to have a brand
new place. Although 65 years ago I loved my
home, it was supposed to be a temporary
move for about 10 years.”
Mrs Flitter adds that the opening of Chestnut
Court has meant she can remain in Stanwell.
“I wanted to stay in the area, but didn’t want
another house; it’s too much to look after at
my age. My new home is just right for me.”
A range of activities will also be on offer for
residents, including coffee mornings, music
evenings, seasonal events, singing groups,
bingo and outings. The adjacent community
centre, which has kitchen facilities and a
60-person capacity, will be used for activities
such as exercise classes and job clubs.
Mrs Flitter has witnessed massive changes
in Stanwell over the years, and welcomes the
regeneration. “When I first moved to Stanwell
65 years ago, it was like a village with fields
all around. But then the airport got bigger
and more houses were built. The area has
www.caretalk.co.uk I 53
FUN STUFF - SHORT STORY
The secret life of a service user
Part seven: A bath
and a blade
“Bathing used to be such a great pleasure,”
Alice said, closing her eyes to the dull white
tiles, grips and emergency cords of the
Hollywell bathroom. Surely no one wanted to
live in a world of hypoallergenic body wash
and PH neutral shampoo. “Lavender, mimosa
and geranium were my favourites: heady, rich
and sensual.”
Wearing a plastic apron, Jenny stroked
Alice’s hands before helping her into the
bath. “I like mine hot enough to really steam
the mirror, but I don’t mind what I pour into
it, as long as there’s some froth.” A carer for
many years, Jenny felt she understood her
residents and empathised with their feelings.
But it was only through Alice that she had
felt the great and weighted contradiction of a
truly lived life drawing to its natural end.
“It was only through Alice
that she had felt the great
and weighted contradiction
of a truly lived life drawing to
its natural end.”
“I can well imagine you’ve seen a fair few
lovely bathrooms in your time, Alice –
posh ones with roll-top baths and marble
everywhere.”
Alice stretched her legs forward and leaned
back in the warm water. “Oh, yes. Marble
the colour of tropical sand with views from
French windows across the bay of Naples.
But if I could re-live only one, it would be the
Battersea bedsit bathroom where I fell in
love.”
Cradling Alice’s neck, Jenny poured water
over wisps of hair. “I thought you didn’t
believe in love.”
“Well, I believe we fall in love – and I did.
I just don’t believe it’s the passport to
happiness. If it was, there wouldn’t be so
many endings.”
“Then tell me of Battersea.”
And so, as the blob of shampoo spread over
her scalp, Alice closed her eyes once more.
“When he knew I was lying in his bath, a man
I barely knew called Benoit walked in and
placed a candle by the taps. He was wearing
a white towel tucked neatly about his waist
– his hairless chest and shoulders glowing
in candlelit shafts as he watched parts of me
breaking through the peak of bubbles. His
gaze instantly created a driving physical need
in a way no other man had before. He draped
his hand in the water beside me until a fine
heat began to drive through my body. Candle
striping us a glowing oily-orange, I beckoned
him in. He dropped the towel, kissed my neck
and climbed in by the taps. “Kiss me here,”
he said, pointing to his shoulder. I rose up out
of the water, foam clinging to me like fur and
kissed wherever he continued to point until
I reached his lips with a great want spinning
its way down the length of my spine. Then,
opening the flannel to reveal a razor, he
thrust one hand beneath me and soaped tight
curls in a slow and deliberate motion. Pulling
taut the skin below each hip, he scraped the
blade in short, committed sweeps, pausing
only to dip it beneath the water . . .”
Jenny thought of Dave: the cost of a Gillette
Venus irritated him, and when he once
walked in on her shaving, he grimaced and
told her to lock the door if that stuff was going
on. If Alice’s stories were to be believed, men
must have been very different in the olden
days. They seemed to enjoy women’s bodies
more – not just hanker after the obvious.
“. . . it was as though I controlled the life
of the water with my lungs – rapid, shallow
breaths born of clenched excitement and an
exquisite fear. Trust and pleasure flooded
every muscle like a sugar-rush. And I got
what I wanted: a marriage of want and dread,
together – inseparable.”
“Jenny thought of Dave:
the cost of a Gillette Venus
irritated him.”
“You fell in love with him because he shaved
you?”
“To a degree, yes. With Benoit It was an
elemental connection that I’ve never fully felt
since – perhaps like Cathy and Heathcliff.”
Clean, dry and dressed once more, Jenny
removed the plastic apron.
“I envy your past,” she sighed as she pulled
the plug.
The water began to die quietly away until
the last swirls formed a slim mercury funnel,
revolving and diminishing: the final emptying
heard as a collapse: a death choke.
Alice closed the door on the bath: “My dear, I
envy your future.”
Coming up in the next issue of Care Talk
• Development and training
• Infection control
FUN STUFF - RESIDENT CAT
Care creatures
Thanks to Tomas
Kaluzak, home
manager from
Borovere (part of the
Greensleeves Homes
Trust), for sending
us these lovely pet
pictures.
Jennie enjoys the home’s
cat’s company – his
name is Jack and
he is a proper
‘lap cat’ so
all our
residents
adore
him.
We’ve hatched our own chickens for the
last two years. Here John is holding one of
the newborn chicks.
Tom says: “Animals
play a crucial part in
our residents’ lives,
as they give them
the opportunity to
create and maintain
relationships, bringing
meaning and purpose
back into their lives.”
We’ve had a visit from an owl with a charity
that also gave a talk to our residents about
… yes, you guessed it!
In a competitive market you want to
stand out. Your website, brochures,
policies, newsletters and much more
need to tell people what great care you
offer.
Good written communication:
• Reassures service users, their families and
carers that you offer the best care around
• Gives your staff clear guidance and support to
do their jobs
One of our activities organisers brought
this tiger in and it was a great hit with the
residents, including Gwen. It was later
raffled at one of our coffee mornings.
Tyyne pictured with Tom’s dog Nessie
when she was a puppy. Tyyne would
leave her room only rarely, but did come
out to meet the puppy! Nessie still visits
our residents when she can.
• Shows potential new recruits what a great
career they could have
• Tells commissioners what makes you special
• Demonstrates your high standards to
regulators.
WriteCare can help you send out strong
messages and straightforward information,
demonstrating credibility and professionalism.
WriteCare is cost effective, saving you time but
producing the results you want, offering a fresh
perspective plus practical help with writing,
editing, proofreading and planning.
Why not contact WriteCare for a no-obligation chat about your written
communication needs? Email [email protected], call
Vicky Burman on 01889 590804 or visit www.writecare.co.uk.
nominate
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The Belfry 18th
Hotel,Oct
23rd Nov Nov
20132013
The Lancaster 2nd Nov 2013
18th
Oct 2013 The Lancaster
Nottingham
Nottingham
Newcastle
Newcastle
London
Nottingham
Hotel, London
Newcastle
Hotel,Hotel,
London
Great
South
Great
South
East
Great
Yorkshire
The Great
East
of
Yorkshire
and andand The Great
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Great
South
EastEast
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Great
EastEast
of of The Great
TheThe
Great
Yorkshire
Care
Awards
England
Care
AwardsHumber
Care Care
Awards
Humber
Care
Awards
England
Care Care
Awards
Care Care
Awards
Awards
England
Awards
Humber
Awards
Date
for Nominations: Closing Closing
Date
for Nominations:
Closing Closing
DateClosing
forDate
Nominations:
DateClosing
forDate
Nominations:
for Nominations:
for Nominations:
13th 2013
September
September
13th September
23rd September
2013
13th September
20132013
23rd 23rd
September
20132013
Date
for Nominations:
Closing Closing
DateClosing
forDate
Nominations:
for Nominations:
21st
October
21st October
2013
21st October
20132013
Award
Award
Award
Date:
Award
Venue:
Award
Award
Date:
Award
Venue:
Venue:
Award
Date:
Award
Venue:
Award Award
Venue:
Venue:
Award
Date:Date:
Award
Date:Date:Award Award
Venue:
Award
Date:Date: Award Award
Venue:
Venue:
National
29th
Peterborough
25th
National National
Railway
29th Nov
2013
Peterborough
8th Nov
25th Oct
2013
8thRailway
Nov8th
2013
Hilton,
Railway
29th
Nov Nov
20132013
Peterborough
25th
Oct Oct
20132013
Nov
20132013 The Hilton,
The The
Hilton,
Arena
Arena Arena
Museum,Museum,
YorkMuseum,
York York
Brighton
Brighton
Brighton
Nominations now open for the 2013 Regional awards. For information
about nominations, table bookings or sponsorships please call
0115 959 6133 or visit www.care-awards.co.uk