Delivering Integrated Care for Older People with Frailty

Care Talk, with the Kings Fund are hosting an exciting conference on 15th March looking at innovative ways to provide integrated health and social care to frail older people. This seems to be particularly relevant to the domiciliary care sector as we try to keep people at home and independent as long as possible.

As someone who is trying to coordinate integrated care for an elderly relative with multiple morbidities, I am keenly aware of the tensions between dignity and choice on one hand and keeping someone safe on the other.  I saw good integration in so far as the response in an acute episode was superb; the health care and social care has been excellent. Thereafter I have seen little evidence of integration and several examples of poor communication, one a visit from a social worker who knew nothing of the intervening activity resolving the acute health issue, and another where blood tests commissioned by the district team were not checked by the GP team. No criticism here, both teams have been superb, but clearly a communication and integration issue.

The day looks an exciting opportunity to share good practice and find useful ways to deal with this growing problem. The programme includes a presentation looking at ways in which the NHS are looking at new models of care and service redesign to embrace people with frailty. There is also a presentation around acute care for people with frailty. There will be presentations describing innovative new projects: a frailty pathway and the role of the voluntary sector; followed by an opportunity to work together in breakout streams and a closing panel session. I can't go but I certainly hope that the papers and outcomes from breakout sessions will be published. Innovation is certainly needed.


CSW role in resolving Tendering process issues with Bristol City Council

There was a meeting this week between Bristol County Council Director of Commissioning, Netta Meadows and Care & Support West representing aggrieved local domiciliary care providers in relation to the new contract tendering process to date. The meeting may result in the formation of a  ‘Co-Production Group’ to explore how the next steps of the domiciliary care tender process need to proceed. Current providers are to be assessed to join a secondary provider “framework” to work alongside the already successful Main Zone Provider organisations. This Co-Production Grp will hopefully be a step towards resolving the some of the negative feeling caused by the recent tendering process for the awarding of new contracts.

The tender process was controversial from the start. The limited price per hour framework stipulated caused a number of home care providers to opt out of even submitting at the PQQ stage. To win a bid providers claimed that the price per hour had to be between £12.40 and £14:60, in stark contrast to the £15.74 cited by UKHCA as the minimum that would enable any provider to manage a viable organisation or indeed pay the national minimum wage.

In addition in the new contract world all new packages of care will be offered to the four 4 chosen Zone lead organisations and only passed to providers in the secondary framework if the main provider is unable to take the work on. This represents a serious risk to the viability of many provider businesses and real risk to the continuity of care for hundreds of clients.

The controversy grew when out of the 4 providers who won the main zones bid, only one had delivered care in Bristol before and things came to a head when a “whistler blowing” e-mail suggested that there had been process anomalies because one of the successful bidders had allegedly been given prior knowledge. Although the subsequent process audit and allegation investigation found there was no case to answer, local Domiciliary Care providers, feeling vulnerable and aggrieved turned to Care & Support West for support.

At an initial meeting, a report was commissioned from C&SW. (You can download the report here: BCC notes re Dom Care tender process – 19 06 15 This lists numerous serious concerns and risks as a result of the recent decisions and these were addressed at the meeting on 6th July. The outcome, where the majority of providers have joined C&SW, gives the providers a stronger voice, and the potential agreement to create a Co-Production Group, may help to ensure that relations with BCC do not deteriorate further and that progress can be made in a positive and consultative rather than a combative framework.

Charity duo given award for accessible cycling scheme

Two women who started a cycling scheme for disabled people have had their good work recognised at a prestigious awards ceremony.

Chris Hill and Liz Gray were both awarded at the Care and Support West Awards for starting Warmley Wheelers, an accessible cycle scheme run by local learning disability charity Milestones Trust. The awards promote quality in social care, health and support services in the ex-Avon area.

Chris, a project co-ordinator at Milestones Trust, said: “We were elated to have won as a lot of hard work has been put into the scheme. It is proving to be successful and very popular and we’re proud to be a part of it.”

Liz – whose son is supported by the Trust’s day opportunities service – and Chris were recognised in the Day Services Front Line Worker category, which celebrates the development of community based day services that offer life skill support and promote independence.

The Warmley Wheelers scheme does just that – offering a variety of accessible bikes so that people with various disabilities are able to cycle. Chris said: “It’s wonderful to see the freedom these accessible bikes can bring to our service users.

“We’ve also worked with local school children so we really hope to encourage more people who wouldn’t normally be able to ride a bike due to a disability, to get involved.”

There are wheelchair-adapted bikes, as well as ones designed for two people and others that are ideal for people learning to cycle. The project is based near the Bristol and Bath Railway Path in Warmley, Bristol, allowing cyclists to travel around a safe, circular route.

The scheme was made possible following a successful bid by Chris and Liz last year, which secured funding from the Department of Transport’s Local Sustainable Travel Fund for Communities.

Since then Warmley Wheelers has been used by almost 100 people, were part of Bristol’s Festival of Nature Carnivelo ride event last weekend and is available for group hire. For more information please visit or call Patrick on 07881 270351.

St Monica Trust participates in successful Care Home Open Day 2015

Care Home Open Day for 2015

This year’s Care Home Open Day event proved even more popular than ever, with more and more care homes signing up to take part across the world and more and more visitors turning up at care homes in their area.

With an extra 834 homes joining in for 2015, and creating a “Twitter Storm” across social media, over 4,000 care homes across the globe collectively opened their doors to welcome in visitors and create long-term connections with their local communities.

This year’s themes of The Arts & Valuing Staff, really engaged local people, residents, their friends and families, as well as many local schools and other organisations, and encouraged them to get involved and come up with some fantastic ways to be creative and showcase their dedicated staff, who provide great care day-in and day-out.

The day reinforces the fantastic work being done in care homes across the UK and helps to highlight that care homes are doing great things every day, not just one day of the year!

Next year’s date has been confirmed as Friday 17th June 2016 and we hope to see even more care homes taking part and more visitors joining in, making lasting connections with their local communities and lasting friendships as well.

Locally, 2015 saw 3 St Monica Trust Care Homes take part in the event for the first time.

Garden House Care Home Manager, Liz Leaman, told us that Bristol Zoo had visited and had given a talk about the history of the zoo and there had been several displays. As the themes for 2015 were ‘The Arts and Older People’ and ‘Valuing Staff’; mounted displays of residents’ art work were set up around the care home. “We publish an annual calendar using residents’ art work as images and our welcome card also features art work by a resident”, Liz told us. “It was great to have these on display”. There was also a mounted display of ‘bubble messages’ showing how and why people value the staff so much. Liz said that this had been a very positive exercise.

Although there had been little publicity, other than the Care Home Open Day website and St Monica Trust website, there had been some interest, with volunteers and students  joining in. The St Monica Trust are looking forward to joining in next year and publicising it further.

Are you ready for a competitive market?

Chris Tarry

Chris Tarry

The adult social care sector has, traditionally, not been marketing led. Owner and operator focus has traditionally been inward, not outward, looking. The provision of care, and the logistical demands it imposes on a business have been the core business driver, rather than a desire to ‘sell’ to the marketplace.

But recent years have seen the market changing. Investment from both within the UK and from overseas has seen a number of high quality new builds, setting new benchmarks for the industry. Existing homes find themselves in a more competitive market. Local authority funding is shrinking, both in terms of the overall sum available, and in real term base fee rates. More than ever owners focus needs to be on how to appeal to the privately funded market; image is becoming more important than it once was.

Understanding the appeal of your home(s) within the local area is important. How does it relate to the competition? Is the fabric of my home up to scratch? Could it be improved? Am I charging competitive fees? Do my facilities compare with other local provision? What do my marketing materials say about my business, and do they compare with those of my competition?

Having worked in the sector for the last five years, it has always amazed me how few owners or operators can answer these basic business questions.

There is little understanding, across the sector generally, as to what can influence placement decision making, and how many different factors combine to give an overall impression to the potential resident or, more likely, their relatives. This view is not a theoretical one. It is based on having mystery shopped and visited over 500 care homes across the country, and having worked on re-positioning homes to better equip them for the emerging market forces.

Of course change is difficult, and often slow to achieve impact, particularly on the bottom line. However we now have an industry where unless there is a radical shift of emphasis by some owners, there will be a rash of business failures over the coming years. The crucial first question that owners should ask themselves is: ‘am I willing to change things?’ If the answer is yes then a starting point may be to ask what areas of my business do I need to look at to make changes. I believe seven initial areas can be considered:

  • Capital expenditure (fabric of building)
  • Competition activity
  • Marketing
  • Pricing
  • Staffing
  • Training
  • The impact of new regulatory inspections

It is worth highlighting the last of these. New CQC inspection and grading regimes will involve a much greater interaction with the public experience. There is clearly a desire to move away from a system with a ‘tick the box’ process driven mentality, towards one that takes into account real experiences, and real views. To that end it will be important for owners to be able to demonstrate awareness of their residents views, and to show responsiveness towards them. One of the key prompts for inspectors will be to ask what arrangements are in place to encourage relatives and friends to provide feedback on the services and care they receive. It will also be important to show responsive to the results. To achieve this, some form of regular satisfaction survey may become increasingly important. It demonstrates commitment to resident and relative concerns, as well being capable of being used as a tool for learning and improvement.

The marketing of a care home business is not simply about a pretty brochure and an accessible website. It is a complex mix of factors that combine together to promote a business to its full potential. The adult social care market has changed and will continue to change as public and regulatory expectation grows. The presentation of your business to the outside world is more important than ever. Those owners who choose to ignore this fact may well face an uncertain future.

If you would like to talk to Chris about improving the presentation of your care business you can contact him on

If you want information on gathering feedback you can contact Barbara on