Transforming Care, NHS and austerity measures in local authorities

18th August 2015 1 Comments

I visited 15 services this week and was really pleased to see a significant number of our staff who have been promoted internally. I am very keen that people join CMG not just for a job but to make a career with us and a number of people have progressed from being support workers to managing residential homes and supported living services. The majority of Regional Directors have also been promoted internally. We are hoping to develop a ‘Next Steps’ programme in a few months to give a more structured development path for people with potential who want to be promoted and develop their career with us.

I have talked before in my blog about the Winterbourne View programme, now called ‘Transforming Care’. I have two frustrations: the lack of progress since the awful abuse at Winterbourne View took place about four years ago and the lack of involvement of community based providers who have the expertise in how to support people with complex and challenging behaviour in the community. I am pleased to say that following a discussion with NHS England’s Director of Transformation, she has agreed that it will be helpful if the provider sector in England could come up with a proposal as to how we could provide greater leadership and input into the process of designing new services as a replacement for assessment and treatment units. A workshop will be taking place in early September, attended by representatives of all the major provider representative bodies in the sector following which there will be a report which will be considered at the Transforming Care Provider Forum which I will be going to for the first time at the end of September.

Michael Fullerton, our Clinical Director and I, also had a meeting with a specialist NHS Trust last week to discuss the idea of setting up a community based crisis team. I think it is essential that we have effective crisis services in place otherwise people will continue to be inappropriately admitted to assessment and treatment units and we won’t see the number of in-patient beds reduced to the level required. Following that discussion, we are now proposing to establish a national pilot site in London for Transforming Care. If this gets off the ground, it will provide us with an opportunity to explore new service models that more effectively support people in the community and prevent inappropriate hospital admissions. There are several other pilot sites in the country but surprisingly given its particular population and characteristics, not one in London at the moment. I am very keen for CMG and other competent social care providers to be involved in looking at how we can re-shape our services so that we aren’t overly reliant on institutional hospital settings.

On a final note, we had a very clear reminder last week that austerity is still very much here. A Local Authority contacted us to say they had reviewed the fees for two of the people we support and that they both need to be reduced by over 40%. I know both individuals concerned and that is complete nonsense. It is disappointing that the Local Authority didn’t have the courtesy of looking at the individual’s needs with us as the provider who knows them best. We will be doing our own assessment using the ‘care funding calculator’ which is a recognised tool for identifying how much money should be spent on an individual and we will be responding robustly. The last time a Local Authority told me our fees should be cut by 40% it was for a group of people with profound and multiple learning disabilities. I said to the Local Authority that the only way the fees could be cut to that extent was by stopping all meaningful activities, not taking people out, leaving them in their chair and just providing basic personal care and that if that was what they wanted, they should find a different provider. Interestingly, nearly two years later, those two service users are still with us on the same fees. Whilst it is really important that we work in partnership with our Local Authority partners, there are occasions where we need to stand up for vulnerable people we support and we will not accept fee cuts that are detrimental to them.

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CQC ratings, Deer Lodge and new development

11th August 2015  Add comments

Congratulations to Kim Long and her staff team at Masons Hill’s supported living service in Bromley which received an extremely good CQC report last week. Her service was judged as ‘outstanding’ for ‘well-led’ and ‘good’ on all four other areas. We believe that one of the other four areas should also be an outstanding and are putting together a factual accuracy challenge. If we are successful, this would make this our third outstanding rated service. We have checked the list of 27 current outstanding services across England and we are the only learning disability provider in the country to have two services meeting the outstanding service. This is something we are very proud of, but we are not complacent and are hoping to get several more.

Just on CQC, generally I think the new rating service works very well and is much better than the previous arrangement of having either compliant or non-compliant services which didn’t motivate managers and staff to continuously improve. My one criticism is that the ‘good’ category seems too broad. I think we have now got 18 services rated as good since the new system came in. At the bottom end, we have had a couple of services that have scraped over the threshold, but a lot of our services which are extremely good, have had fantastic reports which must be close to an outstanding. I have suggested to CQC that they consider adding an additional category of ‘very good’ for those services which are doing really well but don’t quite meet the criteria of good.

I had a constructive discussion with our CQC provider Relationship Manager on Friday and he gave me the following up to date statistics on the numbers of services inspected in England so far in the different categories:

Outstanding 27
Good 3,651
Requires improvement 2,147
Inadequate 455

I would like to say a big well done to Leigh Iliffe, Karla AlHassan and all the team at our Deer Lodge resource centre in Brighton. They arranged a fantastic opening ceremony for Deer Lodge which was recently built on Dyke Road in Brighton with a fully re-furbished hydro therapy pool next door. It was a super event and it was great to see families attending. They put on some lovely food and there was a marvellous dance routine by people we support who live in our Brighton services. I would also like to say a big thank you to the worshipful Lady Mayor of Brighton who took the time to come and officially open the service. We want to get the best use out of our hydrotherapy pool and are marketing it to members of the public, as well as people with disabilities.

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I’ll end this blog with another piece of positive news from Brighton. For a number of months now, we have been chasing a planning application with Brighton and Hove City Council to purpose build two eight-bed residential homes on the site of our former Brelade Centre just off the A23. The reason for this, is that we accommodate a number of people with learning disabilities in services in the city, whose needs are changing as they get older with some people finding it difficult to get up and down the stairs. We heard this week that our planning application was successful which means that in the next year, we can build two new services to the highest possible standard which will be fully wheelchair accessible and much better quality accommodation for the people concerned. It also means that we will provide valuable infrastructure for Brighton and Hove to use in the long term as they struggle to find appropriate accommodation for people with learning disabilities. Apparently it was a lively debate at the planning committee and we won by seven votes to five.

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The potential benefit of having ‘mature conversations’ with Local Authorities

4th August 2015 3 Comments

I attended a meeting with Skills for Care last week where we had a discussion about the importance of having ‘mature conversations’ with Local Authorities. This means having sensible conversations with people at a senior level in the Local Authority about the real issues providers face, but also what we can do to help Local Authorities struggling with financial pressures. I strongly advocate ‘mature conversations’, but rarely see them happening in practice. To give one example, I am aware of a Local Authority in huge financial difficulty that has a large in-house service for people with learning disabilities. If that service was outsourced, it would require political support from councillors and would involve the transfer of current staff on their existing terms and conditions. However, given that I believe some of the accommodation is sub-standard, it would be perfectly possible to put together a plan that would enable people living in those services to be re-located to new accommodation designed specifically around their needs with support provided by a high quality provider like CMG or one of our competitors that would enable significant cost savings to be made. The chance of me having that ‘mature conversation’ is virtually zero.

Just to give one other example, I attended a provider forum a few months ago with a Local Authority that has to make £6million of cuts in its learning disability provision. The purpose of the session was to ask providers for their view as to how the money could be saved. I was on a table with some very nice representatives of small not-for-profit organisations. They came up with the idea of supporting service users to go on a camping trip in the summer which would enable the day centre to close and save some money. Whilst this was a great idea, it would clearly go nowhere near saving the £6million required. The commissioner from the Local Authority was involved in that discussion and during the coffee break, I had a chat with him about other ways in which he could save the necessary amount. Having been a commissioner myself in the past, I knew the areas to look at where sizeable savings can be made, including outsourcing in-house services and bringing people back to borough who are in very expensive poor quality placements. I offered to look at his Authority’s expenditure on out of area placements to see the potential for saving money as I’ve got a pretty good idea what fee levels represent value for money. Effectively I was offering him free consultancy. He thanked me and told me my ideas were very interesting and went back to discussing the camping trip.

One of the challenges working with Local Authorities is being able to meet people who are sufficiently senior that you can have these types of ‘mature conversations’ with. Sometimes you can talk with commissioners, but quite often they are inexperienced or frightened of saying something that will get them in trouble with their procurement colleagues. Ideally, you want to have this sort of conversation with Directors of Adult Services. In my experience however, that virtually never happens. I can’t remember any occasion in the last 8 years where a Director of Adult Services has asked to have a chat with me about how we can work together to jointly achieve savings whilst improving services.

The Chief Executives who run the major learning disability provider organisations in this country are by in large a very able, experienced group and Directors of Adult Services would find it a pleasant and refreshing experience to speak to them. I think they need to see the CEO’s as their peers and start having these ‘mature conversations’ so that we find our way through the current difficult environment without simply chipping away at services until they become non-viable.

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Service user conference, services requiring improvements and recognising long service

21st July 2015 1 Comments

We had another really successful Service User Conference last Thursday with over 320 staff and people we support in attendance and as usual there was a real buzz in the air. What I particularly love to see is just how much everyone enjoys the day and how much laughter there is. The day comprises of a talent show where individuals we support can get up on stage and sing or dance to a song of their choice. We have an ‘X-Factor’ type judging panel, comprising of two people we support and Rachel Dodgson, our Operations Director for England. We also have an ‘open mic’ session where people we support can go up on stage and offer any comment they like about anything they wish. This is always very popular! This year we also had a performance by ‘Fan Dance’ – a theatre group made up of individuals with PMLD and learning disabilities. Aside from this, we have a cake and art competition, make up and tattoos and other activities for the people we support to participate in.

I do believe that CMG hold some of the best events in the industry and people who attend are always surprised by just how good they are and what a great atmosphere there is. Our next big event is our Athletics Day which will be held in August and I would like to add that families of people who take part are also invited to attend this event.

I managed to visit 14 services this week including two which are rated as ‘requires improvement’ by CQC. I was glad to see progress in both services and hopefully they will be re-inspected soon and can go up to a ‘good’ rating. I am very unhappy when any CMG service falls below a ‘good’ and I hope that all our services will be rated ‘good’ or ‘outstanding’ in England very soon. Congratulations to the team at Honeywood whose inspection report arrived last week and was rated as ‘good’. Congratulations also to the Trebanos House staff in Wales who had a good inspection report from CSSIW.

As I may have mentioned previously in my blog, the inspection system is different in England compared to Wales. In Wales the only way we have of assessing the overall quality of inspection reports, apart from comments made by the Inspector, is to count the number of ‘requirements’ in each report. Currently we have no requirements in any of our welsh services.

We have been reflecting on the feedback from people we support, families, staff and external stakeholders at our recent Driving Up Quality self assessment day. One of themes was around valuing staff who have given long service to CMG. We are giving some thought as to the best way of doing this. One idea which we would like to pilot is establishing an ‘immediate recognition board’ which would involve an area on our intranet and website where we celebrate the achievements of specific staff members who have particular milestones of 5 and 10 years service. We are planning to call this ‘CMG Heroes’. We are also looking at presenting staff who have achieved long service with monetary vouchers. I would appreciate your feedback on both these ideas.

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Visiting services, supporting a family-led organisation and the budget

15th July 2015 1 Comments

I managed to visit 14 services last week including several in Wales. I was particularly impressed when I visited our St Helens supported living service in Newport with the active involvement of people living there in a range of sporting activities. As well as being good for health, sport provides great opportunity for social inclusion. One of the people living there told me very enthusiastically about the range of football tournaments he has participated in recently and another is very excited at the prospect of going on a course with Cardiff City Football Club to become a trained sports coach.

I met with Debs from ‘Bringing Us Together’ last week which is a family-led organisation providing a great deal of support to parents of people with learning disabilities. They do a brilliant job but struggle to get proper funding in the current climate. We would like to develop a long term working relationship with ‘Bringing Us Together’ and as a starting point are hoping to organise a conference for families in the New Year which will give them an opportunity to meet others and receive some important information to help them navigate through what can be a very complicated system to make sure their sons and daughters get the right support. We have a commitment in CMG to be the most family friendly provider in the country. Employing Helen Woods, our Relative Liaison Officer, is an important step in that direction, as is our own annual CMG Family Conference, plus our various other initiatives including our fantastic team of Relative Quality Checkers. We want families to be our partners in making sure their sons and daughters have the best possible quality of life.

I would like to finish with a comment on George Osborne’s budget. I have always thought that our staff should get a decent level of pay that enables them to have a good quality of life and to be properly rewarded for the excellent work that they do. We have managed to give our staff pay rises in the last 4 years and very few of our competitors have been able to do the same, but our staff are still not up to living wage. On the one hand, I am very pleased that George Osborne will be raising the pay of employees to £9.00 an hour by 2020. On the other hand, I really worry as to how that will be funded in the care industry. I can’t see the government giving Local Authorities more money to pass onto employers and there is a potential risk that care organisations could go out of business threatening both the livelihood of their staff and the wellbeing of the vulnerable people that they support.

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Driving up the road to quality

7th July 2015  Add comments

Last week we held our second Driving Up Quality self assessment day looking at how the organisation is performing in relation to the Driving Up Quality Code. The Code was launched by CMG, the government and other leading care providers in 2013 to ensure the atrocities of Winterbourne View are never repeated again. This Code outlines five standards that ensure high quality learning disability care provision (www.drivingupquality.org.uk).

The day was really successful with over 100 attendees including staff, people we support, relatives and external professionals. In keeping with our event last year, we wanted to gain open and honest feedback in a fun and creative way, so we had a ‘road to quality’. Delegates then split into regional workshop groups and provided feedback via various modes of transport including a tractor, bus and ship (all artwork was created by the people we support with guidance from our Regional Directors).

Sophie Hare, the manager from our Kings Road service also presented, alongside AJ, one of the people she supports, on how her team undertook a Driving Up Quality self assessment in her service and how this contributed to the service recently achieving an outstanding rating from the CQC. Although non-verbal, AJ did a great job of providing information through sign language and diagrams.

The key themes from the feedback we gained from this event will now be incorporated into a comprehensive action plan. We also circulated a report of the actions we had taken from last year’s event and if anyone would like a copy of this report, please contact sue.pym@cmg.co.uk.

We also always ask for evaluation from our events and I’m pleased to say that everyone who completed an evaluation form agreed that the event was ‘useful’, ‘well organised’ and allowed them ‘to give honest feedback in a fun and creative way.’

I am really pleased that we had a commissioner from Newport attend, despite the long drive from Wales to Surrey and I have included his feedback about the event below. It is a little frustrating that more commissioners didn’t attend this event (we do invite them), as I think it would give them a really good insight into the views of those who are connected or concerned with the care of people with learning disabilities, including those with the learning disability themselves.

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As a provider, CMG can never claim to be perfect, but I am really passionate about trying to continually improve our service provision and we can only ever do that by gaining feedback from the people we support and all the stakeholders involved in their care. My thanks to all those who attended.

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Employee of the Month, too weedy and recruitment issues

1st July 2015  Add comments

I visited 18 services last week, one of which was our Carlton Avenue service in Harrow. I was there to present a £100 gift voucher to our Employee of the Month, Cesar Reyes. He is a fantastic member of staff and I have included an extract from the nomination that was sent in about him from his manager:

“Cesar understands the vision of CMG and continually reiterates this to his colleagues and family members. Cesar’s work colleagues respect and trust him and they value his advice. He has positive relationships with all the people he supports and encourages them to learn new skills, fulfil their potential and reach their set goals in life. I believe these characteristics represent all that is good in CMG.”

We recently re-launched our Employee of the Month scheme significantly increasing the value of the gift voucher that the winner receives. There are also gift vouchers for the people in second and third place and I am now going to the service where the winner works to give them their voucher in person. It’s all part of our efforts to demonstrate that we value and appreciate staff who do a fantastic job. On that note, one of the things we also try to do is to ensure that, where we take over services from other organisations, we work hard to make the new staff feel part of the CMG family. I was therefore very pleased when I visited 3 supported living services in Basingstoke last week where staff transferred to us from other providers, to hear that they were very happy with the way they had been treated and made to feel welcome by CMG.

When I visited Carlton Avenue I was extremely impressed with the range of activities that the people who live there are supported to participate in by the staff team, particularly given that they have profound and multiple learning disabilities. The service has a fantastic activity folder which contains large quantities of photos of people participating in a wide range of activities in the community and also at home.

On a less positive note, several services I visited are looking rather ‘weedy’ and I did pluck out a weed that was over 2 foot tall at one of our services, which will remain nameless. I know my obsession with weeds is well-known across CMG, but it is really important that services give a very positive first impression. The service that does this really well is Trafalgar House in Bexhill. The front garden always looks immaculate and gives a great first impression. I am including a photograph of it below.

Recruitment continues to be a challenge in certain parts of CMG. New staff are coming through but it is taking a lot of effort, particularly as we are very choosy and only want people with the right values. One of our services is having a pretty serious staffing crisis and we are having to transfer staff from other parts of the country to make sure that people living there are properly supported. Our agency usage is still higher than I would like and has crept above 1% of our total staff expenditure. I would like to get it back below 0.5%.

We received a complaint from a parent towards the end of last week following an incident involving their son. The Regional Director who oversees the service has been very responsive and has arranged an urgent meeting with the family to discuss the issue. However, it transpires that none of that would have been necessary if a member of staff dealing with the situation at the time had communicated more effectively with the parent. This is something we cover in our induction training for staff, but unfortunately is still not always practised.

We held our 2nd Driving Up Quality self assessment day yesterday. I will give more details of this in next week’s blog.

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Qualifications for the people we support and good examples of best practice

23rd June 2015 2 Comments

I’ve got a few developments in CMG I’d like to highlight in my blog this week. We are piloting a new system for monitoring outcomes that we help the people we support to achieve which includes independence, education and employment. We are implementing the ASDAN system which involves a structured way of supporting people to develop a range of independence skills, for example, in relation to cooking. Each person we support obtains a qualification once they have demonstrated evidence that they have completed the necessary stages in a specific task (a little bit like a simplified version of the NVQ). We have piloted ASDAN in 13 of our services and overall it has worked very successfully so we will now be looking to roll it out across CMG.

I would like to take this opportunity to celebrate a couple of really good examples of practice in services I have visited in the last week or so. I managed to visit 16 services last week. I was particularly impressed at 53 Rutland Gardens to hear about a young man with Autism who has particularly complex behaviour and often chooses to isolate himself as he finds it difficult to be around others. The staff team have supported him to go wheelchair ice skating and to the cinema which for him are major achievements. To top it off, he is being supported to attend football matches at Brighton and Hove Albion along with 30,000 other supporters.

A group of older men live at our Shardeloes service in Ashtead and I was very impressed to see the system that the home manager has developed for both ensuring people living there are offered choices around the food they would like to eat, using accessible tools and the way in which that is recorded as evidence for CQC and Local Authorities. I was also impressed to see one of the people living there being supported to make choices about how he spends his day using their very comprehensive activity picture board.

I am planning to introduce a video blog for staff each month so that I can share what is happening in CMG and hopefully continue to improve communication. We filmed the first one today and I am very keen to have feedback from the staff to understand what they think and what they would be most interested to hear about.

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Frustrations with sloppiness in care, key categories of complaints and reducing hospital admissions

16th June 2015 3 Comments

I had a busy first week back from holiday last week including visiting 12 services. I also received two more CQC reports, one for our Birdhouse Rise and one for our Beulah Road services, both in Croydon. These services were rated as ‘good’ in all 5 areas and ‘good’ overall, and the description of services provided was ‘excellent’. Congratulations to the staff team at both services. It just shows how high a bar we now have to reach to gain an ‘outstanding’ rated service.

On a less positive note, I received complaints about quality of care of one of the people we support, from their family. I went to the family’s home on Friday evening to discuss their concerns which I’m sure we can put right very quickly. One of my frustrations with the care sector is a sloppiness and lack of attention to detail that sometimes creeps in. We put a strong emphasis on attention to detail in our training with staff, but still sometimes, they don’t get things right. The analogy I use is that you wouldn’t send poorly prepared, half cold food out in a restaurant, otherwise you would soon go out of business, so why should it be any different in care?

Because we have an increasing number of active parents involved in the people we support, we created the post of Relative Liaison Officer about a year and half ago to make sure that we had effective communication with them and that any concerns families had are acted on quickly and responsively. I’ve asked our Relative Liaison Officer to be in fortnightly contact with the family I saw on Friday evening to make sure every one of their issues is addressed. Rather depressingly, concerns from families tend to fall into the same half a dozen themes and my meeting on Friday was no different: activities, food, clothing (including lost and damaged in the wash), health or health appointments and always communication. For any CMG staff and managers reading this blog, I would urge you to pay attention to these issues and above all communication, because if that is working well, all the other issues can get addressed quite easily.

I found out last week that there is a working group within the Winterbourne View programme structure, whose remit is to develop new staff service models for community based services that will be an alternative to hospital care. It sounds like a sensible initiative however when I looked at the lengthy list of attendees, I didn’t see any providers with expertise in actually running those types of services. The list was mainly NHS, Local Authority and Department of Health figures. With all respect to them, they don’t run residential and supported living services for people with complex needs and challenging behaviour. Doing that well is a very different ball-game to running hospital services. This is an issue I will be raising with NHS England.

I do think one of the keys to ensuring we stop the continued high level of admissions of people into assessment and treatment units is to provide appropriate community based alternatives, including crisis support. CMG has a very good crisis team and we are offering that service, initially to London Boroughs, to see if we can be of any help in trying to stop inappropriate hospital admissions. I am also very keen to see if we can develop this type of service either working in partnership with other providers or with local specialist learning disability services run by the NHS. Crisis Response Team

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Employee of the month, staff reps and two more good inspections

9th June 2015  Add comments

I’m now back from leave and straight into another busy week.  Whilst I was away,  we announced the winners of our newly re-launched Employee of the Month scheme.  Rachael Dodgson, our Operations Director was one member of the judging panel along with Alex Starley who lives at our Charmandean service.  Rachael tells me that she was really impressed with the nominations and quality of work that our employees are achieving and with over 25 nominations, judging was really hard but I would like to add my own congratulations to the winners and all the nominees.

1st prize went to Support Worker Cesar Reyes who works at our Carlton Avenue service.  I will be presenting him with £100 of vouchers.  Aside from his dedication, passion and commitment to his role, Cesar hasn’t had a day off sick since he joined CMG 4 years ago. In 2nd place, Support Workers Lillian Ward and Cheryl Cootes win £50 for being really creative with re-decorating a sensory area at our Meeson’s Lodge service.  And in 3rd place, Richard Hussey, who managers our payroll at Head Office for his consistent concern about the welfare of our staff.

As I’ve said in previous blogs, valuing our staff and recognising good practice at CMG is of real importance to us.  It was also one of the key subjects raised at last year’s Driving Up Quality self assessment day as well as our recent Family Conference so we have put in place a number of initiatives to ensure that we do this better.

Employee-of-the-MonthAnother one of these initiatives is our staff representatives’ scheme.  We now have a staff representative in each of our services and Sarah Evans, our HR and Learning and Development Manager and I, meet with them every 3 months in each region. I am always impressed by their positive attitude and good ideas and we are currently implementing some of their ideas.

I’d also like to say well done to staff in Beaulah Road and Birdhouse Rise whose CQC inspection reports were issued last week.  Both services achieved ‘good’ in all areas.

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