At Penrose Care we have long been concerned that poor conditions for home care support workers are in large part responsible for driving down standards of care for some of the most vulnerable members of our society. It is for this reason that we have actively worked with Citizens UK and the Living Wage Foundation in raising standards and were one of the first care companies in the UK to adopt the London Living Wage.
A recent article on the BBC News website(^1) aptly describes the current crisis. The Equality and Human Rights Commission in its detailed home care report ‘Close to Home’ concludes that the way in which care is commissioned by local authorities may increase the risk of older people suffering human rights abuses(^2).

We believe that the work of home care workers (Support Workers) is complex, requiring patience, compassion and technical skills. At Penrose Care we are committed to creating the best working environment to support our staff in caring for those in need- we constantly strive to deliver home care with a human touch.

The following quote from the Cavendish review describes the challenges faced by care workers in the community:

“The phrase “basic care” dramatically understates the work of this group. Helping an elderly person to eat and swallow, bathing someone with dignity and without hurting them, communicating with someone with early onset dementia; doing these things with intelligent kindness, dignity, care and respect requires skill. Doing so alone in the home of a stranger, when the district nurse has left no notes, and you are only being paid to be there for 30 minutes, requires considerable maturity and resilience.”(^3)

The Commissions report in particular criticises the practices of short visits and not paying staff for commuting time between client homes (which reduces the actual hourly rate of pay by some 19%(^4), and often takes it below the National Minimum Wage).

Penrose Care provides Home Care in London and surrounding areas, and is based in Hampstead, North London. We have what we believe is a simple strategy for delivering high quality care- a strategy we have been successfully executing since our foundation in 2012:

• Select staff both on their technical abilities and their human qualities. At Penrose Care we only take on staff that we are truly happy with, which means we are willing to temporarily fore-go growth for the sake of maintaining the excellence of our staff and services. We only take on clients when we have appropriate staffing levels
• We pay staff a fair wage- we set our minimum pay as the London Living Wage. At Penrose Care we believe that our staff deserve to be paid a living wage to help them feel more secure and confident so they in turn are better able to help our client feel secure
• We pay staff for things a decent company would pay but which is not common in the social care sector such as travel time between client homes, training time, and staff meetings. The majority of home care workers in the independent sector are only paid for direct care time(^5), as in not paid for their travel time. This unjust practice has come under heavy criticism from the Equality and Human Rights Commission, the UK Home Care Association and Citizens UK. We pay our staff from the beginning of the working day until the end of their shifts.
• We invest in training staff properly and maintaing their levels of knowledge. Penrose Care has one of the longest induction training programs in the sector – 12 days. We have regular educational updates for our staff and aim that all staff will fulfill sufficient continuing professional development education per year.
• At Penrose Care we do not do ‘short’ visits for purposes of personal care (washing, bathing, feeding). Our minimum visit length is 1 hour for visits involving personal care (we will do shorter drop in visits for security purposes during the day as part of a care package). We believe that both those we care for and our Support Workers (Home Care Workers) benefit from having a longer minimum visit time. Human interaction is a vital, yet unmeasurable, part of care. We structure our care plans to ensure that care does not need to be rushed or hurried through.

The results of our ethical practices speak for themselves: we have had only excellent client feedback, we’ve had no voluntary staff leavers since our inception, the Care Quality Commission found us to be compliant with all care standards, and our staff is made up of substantially high calibre personnel than is typical in England’s social care sector.

References

(1) “Concern over home care worker ‘poor’ conditions”: 08 Oct 2013 (BBC News, 2013), available here.

(2) Close to home recommendations review (Equality and Human Rights Commission, 2013), available here.

(3) The Cavendish Review (HM Government, July 2013), pg 7, available here.

(4) An overview of the UK domiciliary care sector (UK Home Care Association, Feb 2013), pg 8, available here.

(5) Time to care (Unison, 2012), pg 21, available here.

Dr. Knight trained as a doctor at the Royal Free Hospital School of Medicine, Hampstead and University College London (UCL). He then undertook his postgraduate training in Internal Medicine, based in north west London, and is currently working full time as a Registrar in Respiratory Medicine, at the Barnet General Hospital. His main interests are Asthma and allergy and he is currently studying part time for a Masters degree in Allergy, at Imperial College London. Dr. Matthew Knight is the co-founder and non-executive director of Hampstead-based Penrose Care, a provider of home care services in London to the elderly – including to persons with dementia – and to non-elderly adults with physical and/or learning disabilities.

Penrose Care is proud to be only one of three Accredited Living Wage Employers in the London home care sector out of c 925 agencies. Penrose Care provides short care at home visits, day sitting, night services including sleepovers, and live-in care services.

The UK is not alone in experiencing the challenges of providing for an increasingly aged population. In 2012 the Office for National Statistics report on Pension Trends and a changing population^1 sharply drew our attention to the demographic challenges of the next 50 years.

In 2010 17% of the UK population was aged over 65, by 2051 this is projected to be greater than 24% (and the percentage over 85 years of age will increase from 2% in 2010 to over 7% in 2051). In 2010 there were 3.2 15-64 year olds for every 65 year old and above. In 2051, if projections are correct, there will only be 2.0- in other words the number of working people supporting 1 pensioner will fall from 3.2 to 2.0. Furthermore life expectancy continues to rise and birthrates continue to fall. The UK has been in state of sub-replacement fertility since 1973- that is that the birthrate is not sufficient to maintain long term population stability^2 resulting in an increasingly elderly population and a reducing ‘economically productive’ population.

This realisation led to substantial reform of the pension system in the United Kingdom, and around other European countries^3. In particular in the UK an increase in the age of retirement and a significant reduction in the benefits received by people in public sector pension schemes.

Whilst projected spending on pensions, health and social care is increasing under the terms of the current spending review (spending on pensions will from 11.7% of total government spending in 2004 to 14% in 2017 and NHS spending from 17.9 to 19.4% of total government spending^4 it is unlikely that the rate will increase sufficiently to provide for all the ongoing needs of an ageing population. A recent report to the Scottish Assembly indicates that the cost of providing elderly care has escalated by over 150% in the last 7 years^5 and health minister, Norman Lamb MP is engaged with talks with care providers around the UK to ensure a ‘crisis’ in home care similar to crises in nursing homes and Mid Staffordshire hospitals, do not occur in the home care sector^6.

At Penrose Care we believe that to ensure good quality and high standards of care starts with recruiting and retaining high quality staff, based on their compassion and dedication to care. This can only be done if staff are trained, paid and treated properly. This however requires significant investment in Elderly care service. During a time of economic crisis, where this money comes from- the State, the individual or a mixture of both- is an ongoing and highly charged debate. Yet a solution needs to be rapidly found as the future of care for our elderly is at stake.

In this Quality in Elderly Care series we will be posting short articles discussing issues in elderly care, drawing on examples from around the world. We hope you find this series interesting- and we welcome feedback or contributions- enquiries@penrosecare.co.uk

References

^1 Pension Trends (ONS, 2012), available online here.

^2 Smallwood, Steve and Jessica Chamberlain, “Replacement fertility, what has it been and what does it mean” (Population Trends, 2005, v119), p. 16, available online here.

^3 The single-tier pension: a simple foundation for saving (DWP, 2013), available online here.

^4 Crawford, Rowena, “Spending through the decades”: 25 June 2013 (BBC News, 2013), available online here.

^5 “Personal care costs rise by 150% in seven years”: 28 Aug 2012 (BBC News, 2012), available online here.

^6 “Disabled and elderly home care: Crisis talks being held”: 13 Jun 2013 (BBC News, 2013), available online here.

Dr. Knight trained as a doctor at the Royal Free Hospital School of Medicine, Hampstead and University College London (UCL). He then undertook his postgraduate training in Internal Medicine, based in north west London, and is currently working full time as a Registrar in Respiratory Medicine, at the Royal Brompton Hospital. His main interests are Asthma and allergy and he is currently studying part time for a Masters degree in Allergy, at Imperial College London. Dr. Matthew Knight is the co-founder and non-executive director of Hampstead-based Penrose Care, a provider of home care services in London to the elderly – including to persons with dementia – and to non-elderly adults with physical and/or learning disabilities.

Penrose Care is proud to be only one of three Accredited Living Wage Employers in the London home care sector out of c 925 agencies. Penrose Care provides short care at home visits, day sitting, night services including sleepovers, and live-in care services.

Yesterday, 31 Jan 2013, the NHS Health and Social Care Information Centre (HSCIC) published the fiscal year 2011-12 (fiscal year ending March 31, 2012) data on England’s expenditure and unit costs in providing personal social care services and it reveals a social care sector in north west London which is in a far more severe funding crisis than we at Penrose Care initially anticipated.

When reading the below data keep in mind that according to data from ONS (2012), the 65+ population in Camden is projected to increase by 2,566 to 26,735 in mid-2021 from 24,169 in mid-2011. The 65+ population in Westminster is projected to increase by 6,178 to 30,801 in mid-2021 from 24,623 in mid-2011.

Camden Council’s expenditure on home care fell a whopping 20.7% year-on-year in FY2011-12

Within Camden, Penrose Care’s home council area, FY2011-12 gross council expenditure on adult residential and nursing care and home help/care declined 10.7% year-on-year (“yoy”) to £51.4mn from £57.6mn and the number of weeks of adult residential and nursing care and home care provided fell 3.7% yoy to 81,104 in FY2011-12 from 84,756 weeks in FY2010-11.

Camden’s expenditure on home care specifically fell a whopping 20.7% yoy in FY2011-12 to £10.7mn from £13.5mn in FY2010-11. The average unit price paid by Camden Council paid to independent home care providers fell 6.7% to £19.61/hour.

The pain has been felt in both residential and nursing care as well as home care. The total number of weeks of older people supported in council-funded residential and nursing care in Camden fell by 11.4% yoy and the number of council-funded home care “contact hours” fell by a staggering 15.0% to 545,426 hours in FY2011-12.

On a positive note, 95 more adults in Camden received direct payments at the end of FY2011-12 bringing the total to 535 from 440 at the end of FY2010-11. However, total funding for direct payments only increased £969,000 vs the decline of £6,153,000 in gross expenditure on residential and nursing care and home help/care for all adult client groups in FY2011-12 vs FY2010-11. The average gross weekly expenditure on direct payments per adult receiving direct payments at 31 March 2012 was £192.74/week, a slight increase from £192.00/week in FY2010-11.

Westminster Council’s expenditure on home care fell a horrendous 30.6% year-on-year in FY2011-12

In Westminster, the council area where St John’s Wood and Maida Vale are located, FY2011-12 gross council expenditure on adult residential and nursing care and home help/care declined 18.8% year-on-year (“yoy”) to £54.5mn from £67.1mn achieved by gutting payment rates as the number of weeks of adult residential and nursing care and home care provided actually increased quite dramatically by 10.2% to 97,522 in FY2011-12 from 88,457 in FY2010-11.

Westminster Council’s expenditure on home care fell a horrendous 30.6% yoy in FY2011-12 to £13.3mn from £19.1mn in FY2010-11. The average unit price paid by Westminster Council to independent home care providers fell 19.5% to £17.07/hour.

Despite the increase in the number of weeks adults received some sort of council-funded care in Westminster in FY2011-12, the provision of care to elderly in residential and nursing care and adults receiving home care both declined in FY2011-12 vs FY2010-11. The total number of weeks of older people supported in council-funded residential and nursing care in Westminster fell by 6.0% yoy and the number of council-funded home care “contact hours” fell 13.7% to 775,253 hours in FY2011-12.

The number of direct payments recipients in Westminster declined by 110 people to 395 in FY2011-12. As a result, spending on direct payments declined by 8.1% yoy to £5.6mn despite a 17.3% yoy increase in the average direct payment to £272.18/week from £231.95/week.

Conclusion

This newly released data demonstrates the necessity of what we are committed to doing at Penrose Care – providing excellent care with compassion – and highlights the need for the independent sector to improve the lives of numerous individuals who have or are going to be negatively adversely impacted by the ongoing public social care austerity measures in Camden and Westminster.

In our commitment to excellence in care, we are proud to remain north London’s only home care provider to be an Accredited Living Wage Employer (according to the Living Wage Foundation’s most recent accreditation list published 24 Dec 2012) – as we recognise that care professionals must themselves be well treated and feel secure to help ensure they treat our loved ones well and help provide them with a sense of security.

References

Accredited Living Wage Employers: 24 Dec 2012 (Living Wage Foundation, 2012), available online here.

Personal Social Services: Expenditure and Unit Costs, England 2010-11: 29 Mar 2012 (NHS Information Centre, 2012), available online here.

Personal Social Services: Expenditure and Unit Costs, England 2011-12: 31 Jan 2013 (NHS Information Centre, 2013), available online here.

Subnational population projections for England, Interim 2011-based: 28 Sep 2012 (ONS, 2012), available online here.

Robert Stephenson-Padron is Penrose Care’s managing director. Prior to founding Penrose Care in 2012 with Dr. Matthew Knight, Mr. Stephenson-Padron was a healthcare equity research analyst at Merrill Lynch in London. Prior to joining Merrill Lynch in in 2010, Mr. Stephenson-Padron was a healthcare equity research analyst at Barclays Capital, also based in London. From 2003-2008, Mr. Stephenson-Padron was a research assistant to epidemiologist Prof. Alison Galvani of Yale University.

Government proposals to limit the contribution of individuals to their care costs to £75,000 over a lifetime are promising. More interesting was MP Norman Lamb’s proposal to create a more ‘decent’ society. By this he meant one in which the local community is engaged and supports the elderly living in their own homes. This comes as part of the governments campaign to reduce the number of admissions to elderly care homes and nursing homes.

How can we in our local community help provide a safer place for the elderly? Being aware of your neighbours and being neighbourly is a good start. Yet the hectic nature of people lives in London today mean that often we do not get to see or meet our neighbours from one week to the next.

Recreating the village atmosphere is not something that can be legislated for. However, proposals such as neighbourhood watch extending to neighbours being aware of vulnerable people in their community are promising.

As we age we often become less able to participate in the local community and risk disappearing or becoming invisible, just at the time when perhaps the help and support of the local community is most needed.

Home care and home living support is designed to help support living in the community by making a thorough care assessment of a persons needs, and providing appropriate physical and personal support in their own homes and community, enabling them to live as full a life as possible.

By supporting not just physical needs such as washing and dressing but also by providing the opportunity to socialise and be as active as possible in the local community, quality of life is improved and neighbours are supported in supporting each other. When doing a full physical care assessment, the need to get out of the house and participate in community life must not be overlooked as this is vital to the spiritual and psychological welfare of those who might, without help, be housebound.

We look forward to the upcoming government review and hope to be able to support and implement suggestions for improving the lives of those we care for.

References

Dale, Samuel, “Govt pledges LTC funding reforms ‘before March Budget’”: 24 Jan 2013 (MoneyMarketing, 24 Jan 2013), available online here.

Kirkup, James, “Neglectful Britons blamed for forcing elderly into care homes”: 31 Dec 2012 (The Telegraph, 2012), available online here.

Ross, Tim, “Elderly care reforms will have to wait, warns Chancellor”: 21 Sep 2012 (The Telegraph, 2012), available online here.

Dr. Knight trained as a doctor at the Royal Free Hospital School of Medicine, Hampstead and University College London (UCL). He then undertook his postgraduate training in Internal Medicine, based in north west London, and is currently working full time as a Registrar in Respiratory Medicine, at the Royal Brompton Hospital. His main interests are Asthma and allergy and he is currently studying part time for a Masters degree in Allergy, at Imperial College London.

Note: As part of Penrose Care’s commitment to our local community, Penrose Care screens and trains volunteers to provide occasional companionship to vulnerable individuals residing in north west London. More information can be obtained by visiting our Volunteer Corp page: https://penrosecare.co.uk/volunteer_corp.html

Professor Karol Sikora of the University of Buckingham believes that part of the reason that the elderly receive less treatment is due to generational differences in deference towards professionals. In this short video he advocates one simple method to help improve the quality of care you receive. Ask the specialist seeing you “Why is a more invasive treatment not suitable for me?”.

We believe that attending a medical appointment with a friend, family member or another person who can help to support you as a patient and if necessary act as your advocate is a vital part of achieving better care.

The healthcare professionals looking after you will be working their hardest to provide good quality care, but assumptions about quality of life are often made in the cases of elderly patients, and in the busy and hectic environments of hospitals and clinics, it is vital to communicate your feelings about the type of healthcare that you would want.

References

20 Dec 2012, “Cancer expert admits ageism exists in NHS”: 20 Dec 2012 (The Telegraph, 2012), available online here.

In contrast to the picture seen in developing countries, under-nutrition in the developed world is seen predominantly in the elderly. Up to 10% of residents in nursing homes and 50% of older patients discharged from hospital suffer from frank under-nutrition. (1)

When older people lose weight, they double their risk of death even when they are overweight (2,3). The main causes of weight loss are insufficient intake, cachexia, malabsorption and metabolic problems (eg Thyroid diseases). Weight loss puts the elderly at increased risk of falls and fractures, due to weaker bones and also reduced muscle mass. Drug toxicity increases as body fat composition reduces below safe levels (1)

A recent clinical trial (single blind randomised) by Beck et al (4) demonstrated improved outcome over a 6 month period in elderly patients who received home visits from a dietician following discharge from hospital for an acute event. Patients’ mobility and general functional status were improved significantly in the group that received dietician input, versus controls, and utilisation of ‘meal on wheels’ services were reduced. In this short small trial there was not a statistically significant benefit with regards to reduced hospital admissions, although there was a trend towards this.

Good nutrition in the post hospital patient leads to improved mobility and quality of life, and is an important need to be addressed. In this trial each patient in the intervention group received 3 visits to their home from a dietician over three months and outcomes assessed at 6 months. Nutrition is one domain that is heavily neglected in many elderly people. Unfortunately at the current time a comprehensive nutritional service is not available via the social healthcare system here in the UK, however this simple intervention has a demonstrable improvement in quality of life.

If you are losing weight then an assessment by your GP is advised and if no obvious cause found a referral to your local dietician is recommended.

References
(1) Morley, JE, Undernutrition in older adults: April 2012 (Fam Pract. 2012), 29 Suppl 1: i89-i93.
(2) Bales CW, Buhr G, Is obesity bad for older persons? A systematic review of the pros and cons of weight reduction in later life: Jun 2008 (J Am Med Dir Assoc, 2008), 9(5):302-12.
(3) Morley JE, Nutrition and the aging male: May 2010 (Clin Geriatr Med, 2010), 26(2):287-99.
(4) Beck AM, Kjær S, Hansen BS, Storm RL, Thal-Jantzen K, Bitz C, Follow-up home visits with registered dietitians have a positive effect on the functional and nutritional status of geriatric medical patients after discharge: a randomized controlled trial: 20 Dec 2012 (Clin Rehabil, 2012), Epub ahead of print.

Dr. Knight trained as a doctor at the Royal Free Hospital School of Medicine, Hampstead and University College London (UCL). He then undertook his postgraduate training in Internal Medicine, based in north west London, and is currently working full time as a Registrar in Respiratory Medicine, at the Royal Brompton Hospital. His main interests are Asthma and allergy and he is currently studying part time for a Masters degree in Allergy, at Imperial College London.

Recent research released by the Nuffield Trust examining the impact of the Marie Curie home nursing service on hospital use and place of death has thrown further light onto the benefits of care at home. In a study of nearly 60,000 patients it found that the Marie Curie nursing service reduced the number of hospital admission to a quarter of the level seen in the control group and more than halved the number of patients who dies in hospital. Interestingly the Marie Curies service reduced the cost of care by more the £1000 as well (1)

Towards the end of life emergency admission to an acute hospital is common and often undesirable. Palliative care at the end of life aims to maximise quality of life and can be provided in a number of environments, of which a patients own home is one. The Marie-Curie home care service provides support to patients and their families at home or in a hospice setting. This study demonstrates improved care and reduced emergency hospitalisation by use of a dedicated and expert home nursing team from the Marie Curie Cancer Care team.

References
(1) The impact of the Marie Curie Nursing Service on place of death and hospital use at the end of life: Nov 2012 (Nuffield Trust, 2012), available online.

Dr. Knight trained as a doctor at the Royal Free Hospital School of Medicine, Hampstead and University College London (UCL). He then undertook his postgraduate training in Internal Medicine, based in north west London, and is currently working full time as a Registrar in Respiratory Medicine, at the Royal Brompton Hospital. His main interests are Asthma and allergy and he is currently studying part time for a Masters degree in Allergy, at Imperial College London.

Putting care into the actual running of a care provider: Concrete practices to implement
When I wrote about Morriss House and CUN, I want to highlight my mention of the “feel” these organisations spin off when you encounter them.

This may seem somewhat unscientific and an aside from the goals of “keeping someone alive” but if you think from a patient or care recipient’s view, a large part of their experience in a health or social care setting will likely be this “feel”. As emotional human beings, this is so important. If a person is in a hospital and can get well in either, but feels genuinely cared for in one but not in the other, where do you think the person would want to stay? This is not rocket science but unfortunately for England’s health and social care sectors, it is often approached as if it is. Looking at the four model organisations in this article series, I hope the solution is obvious by now: the change, the source of providing excellent care with compassion must start with the management of health and social care organisations.

We must instill care and compassion into the way we run our organisations. We must manage with humility and compassion as this helps stimulate an overall culture of compassion from which staff are better able to provide care with excellence and compassion. No matter how many white papers, laws, and regulations are written to promote dignity in care, they will all have been written in vain if the management of health and social care organisations do not themselves expound care and dignity in the way we conduct ourselves. It is simply untenable to ask your staff to be compassionate if you yourself are not treating your staff with compassion.

Model Practices for Care Organisations
Below are some concrete care organisational practices which are exhibited by the model organisations in this article series that your organisation can implement, as they already are at Penrose Care.

Overall, there is a recurring theme across the “model organisations” covered in this article series: treat your staff with dignity and respect and they in turn will be more likely to put excellence in their work, including treating others with dignity and respect.

Safeguard your employees from temporary organisational setbacks: in a society used to “cyclical redundancies”, how about just avoiding them? As Victorinox has demonstrated, it is fitting and right for the owners of an organisation to absorb the bulk of the pain of temporary setbacks to the extent possible. By doing this, a large amount of stress from your workforce is removed. As what is worse than to go into work everyday not knowing if you will be there tomorrow? In care, a sense of job security among the workforce is so important as we would expect the workforce to be providing a sense of security to patients and care recipients. Although health and social care is generally considered non-cyclical this is not purely true. A cyclical downturn in public tax revenues could result in pressures on health and social care budgets. A weak jobs market could lead to individuals deferring elective procedures. Periods of poor investment returns could impair abilities to privately-procure health and/or social care. In addition, organisational specific events such as the sudden loss of block or other large contracts could be serious short-term setbacks.

If a total transformation is necessary, ensure your organisation is sufficiently conservatively financed to do so in ways which mitigate the negative impacts on staff: As Coloplast has demonstrated, an organisation should limit its usage of debt to give it sufficient breathing room to adjust to difficulties, particularly should they turn out to be structural vs temporary. With such breathing room, staff reductions can be done in ways that limit negative impacts on those losing their jobs through such measures as early retirement, generous redundancy packages, and/or position transfers within the organisation. This is particularly important given the structural challenges facing England’s health and social care system as it struggles with an ageing population. It is further relevant given the high debt levels of some of the larger care organisations in England.

Management and frontline staff compensation divergence should be within reason: At Victorinox, senior management compensation is capped at 5x the pay of an average worker. This to me sounds incredibly sensible, as it is easy to conceive how the culture of an organisation could be engulfed in animosity if workers in are living in poverty while a manager lives in riches. Such a culture is not conducive to providing excellent care with compassion. Recent data from Skills for Care suggests an average care worker in London is paid c £7.10/hour. With c 57.8% (“Time to Care”, Unison, Oct 2012, p19) not being paid their travel time between care recipients’ homes which is c 19% of an average care worker’s work time (“… UK domiciliary care sector”, UKHCA, Sep 2012, p8), this implies many London care workers are effectively paid £5.75/hour which is below the national minimum wage for those 21 and above. The reality that there are certain care organisations that pay their staff such abusive wages while managers/owners live luxuriously is nothing short of outrageous. Local Authorities that commission care work that is priced in ways that force such abusive workforce practices should be reviewed by the Central Government. Firstly, care staff should be paid a decent wage as a minimum and in my view, this is at least the Living Wage. Secondly, care staff must be paid for their travel time between care recipients’ homes – this is just common decency. Thirdly, sensible management compensation caps such as that in force at Victorinox should be encouraged.

Management should manage with humility: Morriss House’s shift manager doing the dishes underlies this model practice. Humility is essential to instilling compassion in an organisation as it is a concrete expression of a belief that we are all humans, equal in dignity and deserving of respect. Staff that feel they are genuinely respected are more likely to have high morale and be in a disposition conducive to providing excellent care with compassion.

Management should to the extent possible, be willing to and be trained in performing the tasks assigned to frontline staff: this is not possible in all settings. Of course, a hospital manager that is not a heart surgeon should by no means try to perform a heart bypass! But this is not necessary, the manager can work alongside the cafeteria staff one day to help prepare the food and tea. Or how about cleaning the toilets from time to time? Why not? Such practices may seem inane but they again, demonstrate humility which helps cultivate a culture of compassion and dignity in an organisation.

Management must remember that each patient or care recipient is an important individual deserving of respect and should be provided the time necessary to receive care with dignity: this is a practice which is incredibly fundamental at CUN and the benefits are evident – patients receive incredible health care in a warm and secure environment. Within social care, a concrete practice is providing sufficient time to a care worker to perform his/her tasks without rushing. As such, personal care appointments in home care allocated at 15 minutes or less should be done away with. In addition, to the extent possible, a care recipient should have stability in their care worker as a care worker that knows a care recipient well is best able to provide care which is comfortable and best customised to the care recipient’s specific needs. In addition, a care recipient should be familiarised with their “back up” care workers ahead of time to avoid unnerving situations where an unfamiliar person shows up at their home.

No detail in care should be overlooked by a manager: At CUN, one can immediately notice the incredible thought and care that goes into cleaning and interior design. Further, CUN has incredibly amazing food – the best food I have ever had at a healthcare organisation. As such, it is an organisation that strives to address the little details in care to help ensure patients receive excellent care. Care organisations should adopt a similar mindset. For instance, reviewing the ingredients of your food and drink? Are there better quality ingredients or drinks you could procure at the same price or could your organisation afford to spend a bit more on food and drink quality? Is your service setting clean? In the case of home care, is your staff sufficiently trained to help ensure a care recipient’s home is properly cleaned and well maintained? These may seem like little details but as CUN demonstrates, when you imbue the little details with excellence, the end result is an overall service which is imbued with incredibly superior quality.

Together, we can transform health and social care in England
Raising the bar in the health and social care sectors is possible and I hope this article series helps inspire other health and social care managers to instill care in the actual running of their organisations. I am under no illusion that every health and social care organisation will be willing to change the status quo, but this is where governments, regulators, patients and care recipients can also help.

Government institutions such as the NHS and Local Authorities and regulators such as the CQC can help by assisting organisations that put in place concrete practices to promote excellence in care with compassion. Patients and care recipients can help by using care organisations dedicated to being centres of excellence and avoiding those not serious about improving the health and social care sectors.

It will be challenging and may take many, many years, but I am hopeful that by working together, organisations and individuals committed to fundamentally transforming the UK’s health and social care sectors for the better can indeed do so, for the benefits of the millions alive today and our posterity that come after us.

Link to Part 4 of the article series

End of article series, Putting care ino the actual running of a care provider

Robert Stephenson-Padron is Penrose Care’s managing director. Prior to founding Penrose Care in 2012 with Dr. Matthew Knight, Mr. Stephenson-Padron was a healthcare equity research analyst at Merrill Lynch in London. Prior to joining Merrill Lynch in in 2010, Mr. Stephenson-Padron was a healthcare equity research analyst at Barclays Capital, also based in London. From 2003-2008, Mr. Stephenson-Padron was a research assistant to epidemiologist Prof. Alison Galvani of Yale University.

CUN – An organisation imbued with a culture of excellence and compassion
In my experiences with numerous healthcare organisations, I have never encountered one remotely as impressive as the Clínica Universidad de Navarra (“CUN”), the teaching hospital of the Universidad de Navarra in Pamplona, Spain. Similar to Morriss House, it is a centre of healthcare excellence which largely goes unnoticed, at least in the English language world. In its over 50 years of operations, CUN has honed a culture that is imbued with compassion for everyone (patients and staff alike), an incredible dedication to excellence, and humble and able management – it is something you feel almost immediately when you walk into the hospital.

I first encountered CUN as a graduate student at the Universidad de Navarra in 2006. As a visitor, I was awed by CUN’s cleanliness and the serenity that its interiors exhume. The staff generally exhibited a joy that one rarely finds to be so common place in a large organisation.

When I later became a healthcare analyst, I became more aware of what a world class healthcare organisation CUN is. I learned how at CUN, delivering personalised care with dignity and striving for excellence throughout the organisation is fundamental. This is what drives the organisation to, along with providing world class frontline patient care, provide impeccable cleaning of its facilities and incredibly delicious food (how often have we complained about hospital food!). It also has a unique innovation, whereby a person is assigned to a patient/patient’s family to personally facilitate their stay at the hospital to ensure the stay is smooth and very importantly, the patient has stability of relationship even if s/he is transferred to different departments.

At the helm of this organisation is a management team which strives to manage with humility and compassion. In 2012, I had the great privilege to meet the managing director of CUN, a brilliant but humble man – the type of manager I have come to learn are commonly behind excellent health and social care organisations.

As I write today, the CUN remains the most impressive healthcare organisation I have ever encountered with respect to delivering excellent care with compassion. I was therefore not surprised in early 2012 when I learned that CUN was named the best private hospital in Spain by Spanish specialist physicians. It is my hope that CUN becomes more well known in the English-speaking world as I have little doubt that if it did, it would quickly stand alongside the likes of the Mayo Clinic as a model healthcare organisation hospitals around the world strive to learn from in delivering world class healthcare with compassion.

Link to Part 3 of the article series.
Link to Part 5 of the article series.

References
CUN 50th anniversary site (CUN), available online.
The University Hospital of Navarra is the highest rated Spanish private hospital by doctors, according to the overall ranking of the OCU [ES]: 19 April 2012. (Clínica Universidad de Navarra, 2012). Available online.

Robert Stephenson-Padron is Penrose Care’s managing director. Prior to founding Penrose Care in 2012 with Dr. Matthew Knight, Mr. Stephenson-Padron was a healthcare equity research analyst at Merrill Lynch in London. Prior to joining Merrill Lynch in in 2010, Mr. Stephenson-Padron was a healthcare equity research analyst at Barclays Capital, also based in London. From 2003-2008, Mr. Stephenson-Padron was a research assistant to epidemiologist Prof. Alison Galvani of Yale University.

Morriss House – Managing with humility and compassion
It’s my firm belief that a manager should be willing to perform the tasks s/he assigns to his/her staff. This creates a more collegial environment, more able management, and a more reliable organisation (as there is one more hand to do frontline work). To this end, in December 2012, I started a healthcare assistant training placement at a north London residential care home, Morriss House, arranged by Stratford-based trainer, Citygate Training. Due to my general experiences with care homes in the UK and US, I did not have very high expectations of my placement. Little did I know that I was placed in what I soon realised is probably the best care home in England – operating with a spirit extremely similar to that of Penrose Care. Morriss House exemplifies the benefits of a humble and compassionate management which drives an operating culture characterised by compassion, patience, and excellence.

I arrived at Morriss House in the very early morning when the night shift was just ending. I was immediately pleasantly surprised by the jovial and upbeat nature of the night staff and had an inclination that I may actually be in a very special care home. As the day progressed, I became increasingly aware of the uniqueness of the organisation.

As I was taken around for get-up duties, the care worker accompanying me performed her duties with joy, compassion, and an incredible amount of patience. Nothing seemed rushed and I noticed this in pretty much every care tasks I saw throughout the day. As breakfast approached, I began to wonder what was driving the unique excellence of this organisation.

It may sound uneventful, but the light bulb moment came after breakfast, when I found the shift manager doing the dishes. Keep in mind that I was in this care home specifically due to my belief that a manager should be willing to do the tasks he/she assigns. So when I saw this I was fairly awes by the irony of the situation. At Morriss House I found an organisation which shared my views.

Soon after breakfast I had the opportunity to meet and discuss care with the home’s incredible registered manager, who I feel so privileged to have met. Here is a leader who has proved Dr. Knight and my strong held beliefs that if you treat staff well and manage them with humility, they will be more apt to provide excellent care with compassion.

In terms of some specifics of the registered manager’s philosophies, the residents and staff eat and drink the same things and from the same venues, creating a family-like atmosphere compared to for instance, having separate resident and staff coffee machines. Staff are given ample breaks and relaxation time during “down periods”. Humility is imbued in the management, and I believe this is core, and it is in part illustrated by the manager’s office being in the basement rather than a “ivory tower” in the top of the house, which instead is where the staff room is located. Although simple things, I am convinced they and other sensible practices are what drive the incredible warmth that you feel when you are at Morriss House.

Without exaggeration, I can say that my discovery of Morriss House was one of the most moving days of my life. It was the first time I have seen the operating culture myself and Dr. Matthew Knight are instilling in Penrose Care, a home care provider, put into practice in a residential care home setting. The results however are what I expected: excellent care delivered by happy and hardworking staff. And when you encounter this – something I have experienced at CUN in Spain (covered in Part 4 of this article series) and at Penrose Care HQ – there is an incredible warmth you feel in the organisation, a warmth that vitally needs to become common place in England’s social care sector. It also further convinced me of the incredible importance of Penrose Care’s mission.

Before I encountered Morriss House, I had very little confidence in the residential care home sector, but now I am confident care homes can be centres of compassion and excellence – Morriss House serves as a model of how this can be done.

In the next section of this article series, I cover the last model organisation in the series: CUN, a private hospital located in Pamplona, Spain which has successfully imbued excellent care and compassion into the entire organisation, from the smallest details through to its overall atmosphere and operating culture.

Link to Part 2 of the article series.
Link to Part 4 of the article series.

References
Inspection Report – Morriss House: 26 Oct 2012 (CQC, 2012), available online
Morriss House website (Abbeyfield), available online

Robert Stephenson-Padron is Penrose Care’s managing director. Prior to founding Penrose Care in 2012 with Dr. Matthew Knight, Mr. Stephenson-Padron was a healthcare equity research analyst at Merrill Lynch in London. Prior to joining Merrill Lynch in in 2010, Mr. Stephenson-Padron was a healthcare equity research analyst at Barclays Capital, also based in London. From 2003-2008, Mr. Stephenson-Padron was a research assistant to epidemiologist Prof. Alison Galvani of Yale University.