Care Quality Commission is seeking more transparency in care services ownership

In the light of the recent BBC Panorama Report on the so-called Paradise Papers that raised concern about tax avoidance through offshore accounts of large companies, seems to have alerted the Care Quality Commission.

An investigation by the Financial Mail has found that some firms involved in the care industry – many of which receive public money directly from local authorities to pay for residents’ care – have links to offshore tax-haven territories including the Cayman Islands, Luxembourg, Gibraltar and the Channel Islands.

The revelations coincide with a battle for control of the country’s second biggest care home provider, Four Seasons, controlled by Guernsey-based tycoon Guy Hands.

The company has until December 15 to satisfy a £26 million interest payment on its enormous debts.

The Care Quality Commission are to clampdown on large companies and in future Britain’s care home providers will be forced to declare their links to offshore tax havens. The clampdown comes amid growing concerns over the future of Four Seasons, one of the biggest operators in the market.

The CQC have said that from April it will ask firms to lift the lid on what are in some cases highly complex ownership structures – and to reveal the identities of the moneymen behind them.

A spokeswoman for the Care Quality Commission said the care market is ‘much more global than it was ten years ago and we need to be more transparent. We need to develop regulatory policies and want to get a better oversight of providers.’

She added that the CQC wanted to know who are the ultimate owners, and ‘who has influence and control. We need a better understanding of the ownership, of the investors and directors, and to make that public.’

The ownership of some groups passes through multiple layers of bizarrely named companies before ending up with a business or trust in a tax haven.

Among the so-called Big Five, Barchester is owned by a Jersey-based company. Four Seasons is owned by Hands’ Terra Firma, with an office in Guernsey. HC-One has links to the Cayman Isles. Its chairman Dr Chai Patel is director of a Cayman-domiciled FC Skyfall Topco Ltd.

In addition, second-tier groups, including Akari and Orchard Care, which own more than 100 homes between them, operate through a labyrinth of companies. Akari’s ownership funnels through a dizzying array of firms before resting with Caymans-based Csp Iv LP.

Orchard is controlled by a Guernsey-registered outfit along with ASO LUX 3 S.A.R.L, a mysterious Luxembourg-based enterprise.

And some care homes under the Bondcare and Care Worldwide brands are controlled by Gibraltar-based trustees.

Is the CQC right to be concerned about care home ownership?

Currently the Care Quality Commission as part of the registration and inspection process requires providers to have in place, a business plan and evidence on how the service is to be funded. This is to ensure that the service has enough capital to run the business for a considerable time, and to protect the wellbeing of residents from risk should the company become bankrupt. In which case, they will have to move.

The problem with larger companies is much more serious. It is obviously more difficult to establish the financial credibility of some larger providers. Otherwise we are left to conclude they would have done something about it by now. What is even more concerning is given the state of the care industry at this point in time, it would be extremely difficult to relocate such large numbers of residents, and the resulting upheaval to people’s lives

Moral issues

I work from the standpoint that most management and staff in the care sector give their best to residents, and do not receive financial rewards that equate with their level of commitment and effort.

It is morally indefensible for larger companies to take advantage of the offshore tax system when the care industry is suffering as a result of underfunding.

Summary

BBC Panorama Report on the so-called Paradise Papers and the Daily Mail Report on some larger home owners who use offshore accounts has raised the alarm bell with the care Quality Commission.

CQC has a right to be concerned. It is very much a safeguarding and risk issue. Given the overall position and reducing profitability of the care home industry. It may be difficult to relocate large numbers of residents, should any of the bigger companies go bust. It is imperative that the CQC establishes the financial credibility of these larger companies who use offshore accounts.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Tackling the problem of loneliness in care homes

Loneliness is a problem which spans the generations, its impact on us is as bad for our health as smoking 15 cigarettes a day according to recent research. But the elderly are particularly affected.

Figures from Age UK show that 200,000 older people have not had a conversation with friends or family for a month, and for 3.9 million older people the TV is their main company.

A shocking 60 percent of people in care homes get no visitors. This was a big driver for Louise Goulden, who says care home residents are just like anyone else.

“They were in their local community, they were working, they were raising families, and now because they’ve reached a certain physical or mental state they’re shut off in this kind of secretive world.”

It’s not just about tackling older people’s loneliness, says Goulden, young people are “really missing out on not having older people in their lives: the wisdom, the life experience, just a fresh perspective”.

Louise Goulden decided to do something about it. Babies crawl around on mats, playing with colourful plastic toys. Toddlers and parents sit on the floor chatting. A bag of instruments – triangles, shakers and drums – is waiting to be fought over.

It looks like any other parent baby class, but this one has a difference. Sitting around the cluster of children are 20 residents of the Ross Wyld Care home in Walthamstow, ranging in age from 93 to 56. This is their lounge.

Songs & Smiles, a singalong baby and toddler session set in a care home, is the brainchild of Louise Goulden, who came up with the idea while on maternity leave after having her son Heath.

Her sister, who volunteered with elderly people, suggested she take Heath to a care home to brighten up residents’ days.

“It just planted a seed in my head – well, if one child could do that what could a group of children on a regular basis do?” says Goulden.

It inspired her to quit her marketing job and set up The Together Project, a community interest company which aims to tackle loneliness and unite community.

Goulden was aware of plenty of research that intergenerational schemes have benefits, from building self-esteem and improving health and wellbeing, to making people feel more connected to their community.

For many of the parents, it may be the first time they’ve been in a care home. “They feel like very closed off places,” says Goulden. “So, I think for the first-time people come they think it’s quite an unfamiliar environment and [they wonder] ‘how do I speak to someone who’s got dementia, should I try to speak to them or is that going to be awkward for them and for me?”

The point of the singing is to break the ice. In the session I took my kids to, we sang the classics from ‘Wheels on the Bus’ to ‘You Are My Sunshine’, via a resident’s request for an a capella version of ‘Pop Goes the Weasel’.

Many of the residents sang and shook their instruments, with some even dancing in their chairs. Others just looked on, while a handful slept through the noise.

After 20 minutes or so, there was time for mingling, coffee, squash and biscuits. Some of the residents chatted to the children, asking how they were, how their parents were coping and played peekaboo with the babies.

Goulden says that there are benefits even for the least communicative residents. There is one woman with severe dementia, she says, whose husband caught the end of a session. “He just shouted at me rather gruffly ‘excuse me, whose idea was all this’ and I said ‘mine’ and he said ‘thank you, she really enjoys it, it’s really made a difference to her”.

The youngest children at a Songs & Smiles session were eight-week-old twins, who Goulden says were extremely popular with the residents. They also have preschoolers join, who wander around chatting to everybody. “And that’s lovely because kids don’t have that sense of social awkwardness that we do,” says Goulden, “so it’s a good ice breaker.”

In our session, the children range from around four months to three years old. Louisa, there with her two-and-a-half-year-old Gracie, says thinking about her nan was the inspiration for coming.

“My nan went into a care home and she always felt that she was with older people and she wasn’t old, and I just thought it was a really nice way of making people feel young again by being with different generations.”

Goulden also has plans bubbling away to go beyond the singing sessions, and to match older children with isolated elderly people on creative writing and events projects.

For now she is crowdfunding to raise funds to take Songs & Smiles out to 10 to 15 more care homes.

Summary

Louise Goulden and the manager of the Wyld Care home in Walthamstow are to be commended for taking a major step in having a baby and toddler session in a care home to alleviate the loneliness suffered by residents in care homes.

There will be some who will focus on the risks of such a venture, and others who will have concerns about resident’s choice. However, given that these have been addressed and residents and regulators have been consulted, then it is a great idea to open up care homes to the wider community, to the benefit of residents.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Bullying and harassment in the social care workplace

In the past few weeks there are not many of us who have escaped media coverage on sexual harassment and bullying. The Harvey Weinstein affair and the behaviour of members of our political institutions has done much to concentrate the mind. This is not an issue however that is confined to the rich and famous. It does happen in the workplace and no doubt in the social care industry. ACAS are an organisation that I greatly respect for their guidance and expertise, and in this blog I provide a short review on their guidance to managers on bullying and harassment.

What is bullying and harassment

Bullying and harassment means any unwanted behaviour that makes someone feel intimidated, degraded, humiliated or offended. It is not necessarily always obvious or apparent to others, and may happen in the workplace without an employer’s awareness.

Bullying or harassment can be between two individuals or it may involve groups of people. It might be obvious or it might be insidious. It may be persistent or an isolated incident. It can also occur in written communications, by phone or through email, not just face-to-face.

Examples of bullying / harassing behaviour could include:

  • spreading malicious rumours, or insulting someone
  • exclusion or victimisation
  • unfair treatment
  • deliberately undermining a competent worker by constant criticism.

Under the Equality Act 2010, harassment is unwanted conduct which is related to one of the following: age, disability, gender reassignment, race, religion or belief, sex and sexual orientation and is therefore unlawful.

People do not always feel able or confident enough to complain, particularly if the harasser is a manager or senior member of staff. Sometimes they will simply resign. It is therefore very important for managers to ensure that staff are aware of options available to them to deal with potential bullying or harassment, and that these remain confidential.

What can staff about being bullied or harassed?

If staff are being bullied or harassed, they should take any action you decide upon as quickly as possible. It is always best to try to resolve this informally in the first instance as sometimes a quick word can be all it takes. However, if this fails there are a number of options for staff to consider:

  • see someone that staff feel comfortable with to discuss the problem, perhaps someone in HR or company counsellor
  • talk to your trade union or staff representative
  • keep a diary of all incidents, record: dates, times, witnesses etc
  • keep any relevant letter, emails, notes etc.

Why a manager should act against bullying or harassment?

Bullying and harassment create an unhappy and unproductive workplace, that has:

  • poor morale and poor employee relations
  • loss of respect for managers or supervisors
  • poor performance / lost productivity
  • absence / resignations
  • tribunal and other court cases and payment of unlimited compensation.

What can be done to prevent bullying or harassment taking place in the service?

There are a number of key considerations that should help to prevent this behaviour:

  • develop and implement a formal policy: this can be kept simple, but you should consider involving staff when writing it
  • set a good example: the behaviour of employers and senior managers is as important as any formal policy
  • maintain fair procedures for dealing promptly with complaints from staff
  • set standards of behaviour with a service statement about the standards of behaviour expected; this could be included in the staff handbook.

Is workplace bulling getting worse?

A study in 2011, by public sector union Unison, reported that six out of 10 public sector workers in the UK had either been bullied themselves or had witnessed bullying in their workplace. The findings also suggested a strong link between the increased incidence of bullying and the economic downturn, with one in four workers believing that staff cutbacks had been a direct cause of workplace bullying.

The majority of those polled in the Unison survey – 53% – said they would be too scared to raise concerns over bullying in the current climate, compared with just 25% two years ago.

Individuals on the receiving end of unwanted behaviour described conduct such as being yelled at, eye-rolling, verbal abuse, being ‘talked down to’ in a humiliating way in front of colleagues, as well as more concerted patterns of ill-treatment such as ostracism (‘being sent to Coventry’).

Issues raised often centred on ill-treatment by direct supervisors, frequently building to the point where individuals dreaded going to work, and where their home and family life had been affected. Many were on leave or had recently taken leave to ‘escape’ the workplace, to allay the work-related stress and anxiety they were experiencing.

Summary

Harassment and bullying in the workplace may not receive the attention it deserves. To those who suffer the consequences, they find so stressful that it leads to them giving up their job. This is not only damaging to the individual, but the service. To prevent it services need to adopt a culture that not only identifies harassment and bullying, but has procedures in place to prevent it and support staff who suffer from it. Managers should refer to the ACAS website for more information on this topic.

Albert Cook – BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

 

Social Care Institute of Excellence Report prejudice and social isolation experienced by LGBTQI+ Disabled People

Until now, not much has been documented about the experiences of using self-directed social care support by LGBTQI (Lesbian, Gay, Bisexual, Transgender, Queer, Questioning and Intersex) + Disabled People. However, a recent report by SCIE found that LGBTQI+ LGBTQI+ say they have experienced prejudice and social isolation. They also say they are worried that if they come out to PAs (Personal Assistants) / support workers or those that assess and review their support, then that support could be compromised.

A new report, along with two films and two at a glance briefings, highlight, for the first time, some of the issues faced by LGBTQI+ Disabled People in England. They say that too often they have to make ‘bad bargains’ with PAs / support workers whereby they have (out of necessity) carried on with PA relationships even when there was an element of self-censorship or discrimination.

Quote from the report

A man who was not out to his family with whom he lived at the time, said that he had built up enough rapport and confidence with one support worker to come out: “…So I thought I would tell him about my sexuality and he went straight downstairs and told my mum. She was crying. She said to me, ‘Is this true?’ So, I had to lie to my mum and say, ‘I’m not gay.’”

LGBTQI (+ Disabled People say there are many benefits to using Self Directed Support, such as having more choice and control over their care. But they say that this can be a challenge for a number of reasons. They fear coming out to PAs / support workers because their care might be jeopardised. They say that when care needs are being assessed and reviewed there is a lack of attention to sexual orientation and gender identity. They also say that they can experience social isolation; they have experienced prejudice; and they often feel isolated from the wider LGBTQI+ community.

The report and films have been produced by the University of Bristol, the Social Care Institute for Excellence, Regard and Stonewall.

The research

In a survey, in-depth interviews and a focus group of LGBTQI+ Disabled People who use self-directed social care support, researchers found:

  • More than half of those surveyed said that they never or only sometimes disclosed their sexual orientation or gender identity to the Personal Assistants who they paid to support             them
  • More than a third of those surveyed said that they had experienced discrimination or received poor treatment from their PAs because of their sexual orientation or gender    identity
  • More than 90% of those surveyed said that their needs as a LGBTQI+ disabled person were either not considered at all or were only given some consideration when their needs were assessed or reviewed.

Social isolation is a big issue. When asked about getting support to do LGBTQI+ ‘things’ (e.g. go to an event/bar, have help to have sex with self or others) 22% said that their PAs did not help them with any of these activities.

Benefits of Self Directed Support

Having control over support arrangements is the most commonly cited reason in the report for preferring Self Directed Support. Interviewees gave many positive examples of the benefits of Self Directed Support. Previous experiences with agency staff who changed has frequently often led people to opt for Self-Directed Support as they want to be in control of who comes into their homes.

‘Bad bargains’

The study demonstrates that the reality of choice and control for LGBTQI+ Disabled People using self-directed social care support varies greatly. In more instances than not, those in the study had reservations about being open with PAs and staff about their sexual orientation or gender identity; they had experienced direct and overt discrimination from some PAs or support workers; they had made ‘bad-bargains’ whereby they (out of necessity) carried on with PA relationships even when there was elements of self-censorship or negative attitudes.

Professor David Abbott, Professor of Social Policy at the School for Policy Studies, University of Bristol, says: Self-directed social care support continues to provide opportunities for LGBTQI+ Disabled People to exercise choice and control over the support that they get. When support from PAs really meets the needs of LGBTQI+ Disabled People, people in our study talked about the positive impact on identity, inclusion and belonging. But our collaborative research also highlights the barriers that people faced and the lack of routine attention being paid to their human and legal rights.

Summary

This report highlights the concern of LGBTQI+ Disabled People in England who receive self-directed social care support. Leading to a loss of confidence in their PA’s and support workers. In the light of the report managers must ensure that support staff are appropriately trained, and aware of their responsibilities with respect to; trust, confidentiality, equality, discrimination and duty of care.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

The 6Cs in social care

This week’s blog draws the reader’s attention to the Skills for Care 6C’s. The 6Cs are the values which need to underpin the culture and practice of social care service who deliver care and support. Skills for Care have a new guide to explain how the 6Cs link to the important values, recruitment, qualifications, and leadership frameworks in social care.

What are the 6Cs?

  1. Care
  2. Compassion
  3. Competence
  4. Communication
  5. Courage
  6. Commitment

They underpin Compassion in Practice, the national strategy for nurses, midwives and care staff. The 6Cs, were developed as a way of articulating the values which need to underpin the culture and practice of social care services who deliver care and support. These are immediately identifiable as values which underpin quality social care provision too. As integration between health and social care continues and increases it is helpful to focus on common values expressed in ways which increase consistency within all aspects of the work we do, the workforce, leadership and organisations.

Compassion in Practice

The 6Cs are defined in Compassion with Practice as:

Care

Care is the core business of social care services and the care delivered helps the individual person and improves the health of the whole community. Caring defines us and what we do. People receiving care expect it to be right for them, consistently, throughout every stage of their life.

Compassion

Compassion is how care is given through relationships based on empathy, respect and dignity – it can also be described as intelligent kindness, and is central to how people perceive their care.

Competence

Competence means all those in caring roles must have the ability to understand an individual’s health and social needs and the expertise, clinical and technical knowledge to deliver effective care and treatments based on research and evidence.

Communication

Relationships are essential to effective team working. Listening is as important as what we say and do and essential for ‘no decision about me without me’. Communication is the key to a good workplace with benefits for those in our care and staff alike.

Courage

Courage enables us to do the right thing for the people we care for, to speak up when we have concerns and to have the personal strength and vision to innovate and to embrace new ways of working.

Commitment

A commitment to our service users and populations is a cornerstone of what we do. Staff need to build on our commitment to improve the care and experience of our service users, to take action to make this vision and strategy a reality for all and meet the health, care and support challenges ahead.

Learning

Skills for Care have mapped the 6Cs at learning outcome level to the Care Certificate and the diploma in health and social care mandatory units at levels two, three and five.

The mapping shows that the 6Cs values are relevant at all levels. It is important that learning providers see their work as an opportunity to embed the 6Cs into social care practice, through the values and behaviours they encourage and through the activities and materials they use.

Leadership

The culture of a social care service is reflective of the values of those leading it. Every social care service and individual in a leadership role should ask whether the 6Cs underpin the leadership and management styles of the service. If they do not then it is unlikely they will be part of the social care service culture or experience of those receiving its services.

Skills for Care, home of the National Skills Academy for Social Care, has published the Leadership Qualities Framework (LQF). It illustrates the attitudes and behaviours needed for high quality leadership at every level of the sector. Those using the framework may find it helpful to use the 6Cs by reflecting on how they demonstrate the 6C values within the domains of the framework.

Summary

Registered managers should ensure that the 6Cs become an inherent part of the culture of their service. It is an essential part of the national strategy Compassion in Practice, and will be part of the new CQC approach to inspection.

Albert Cook, BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy