With Shaw healthcare’s business growth model being driven through the acquisition of local authority contracts, managing change is key to deputy CEO Suzanne Hughes’s role. CHP caught up with Suzanne at Shaw’s Maitland Park Care Home in Camden to find out how she does it.
With her background in working with local authorities, Suzanne has been ideally equipped to lead Shaw healthcare’s major council contract acquisitions over the past 15 years.
Having started her career as a care assistant at the tender age of 14 and gone on to qualify as a nurse, Suzanne first came into contact with Shaw while working for Herefordshire Council as a service manager.
“My role was to ensure the smooth transfer of Herefordshire homes to Shaw,” Suzanne said.
“I had already experienced being transferred out in my previous life in care. Having been on the receiving end of it, I felt I was in a good place to support the six Herefordshire homes moving to Shaw in 2004, including the building of new homes.”
Having been the main point of contact for Shaw at the local authority, Suzanne was then asked to join the provider.
She joined Shaw as its West Midlands regional manager. Having then been asked to take on Shaw’s East Midlands homes two and a half years later, Suzanne was in effect managing half its business.
At the same time, Suzanne was also tasked with managing the transfer of management of Northamptonshire local authority homes to Shaw.
“The Herefordshire and Northamptonshire transfers actually took place on the same day, doubling the size of the business,” Suzanne said.
The local authority transfers brought in 12 new services to Shaw over a 12-month period.
“We went through a lot of change for residents and staff,” Suzanne said. “There was a change of environment and policies and procedures.
“The next three years was about changing the approach to work, changing the approach to how we delivered care and changing to brand new buildings.
Shaw has since grown to 63 registered services, partly through the acquisition of further local authority contracts. The provider also runs two contracts with CCGs in Herefordshire (a minor injuries unit) and in Staffordshire.
“The main challenges of taking on local authority homes are generally changing the culture and the way that care is delivered and bringing it up to date,” Suzanne observed.
“Very often we have an opportunity to build on good care and enable those teams to have more ownership and more accountability for the services they’re providing.
“We are also able to offer more flexible and family friendly opportunities for our residents because we centre around the individual and not just around existing practice.
“It’s easier for us to bring best practice into play because the staff have transferred knowing it’s going to be different rather than trying to change a culture within.”
Asking staff who previously worked for the local authority to take on Shaw’s culture is not without its challenges, however. Suzanne admitted that staff receptiveness to Shaw’s values and vision could sometimes be mixed.
“There are those that actually rise to the challenge and really enjoy working in nice environments with clear parameters and there are those who find it more difficult to make the change,” she said.
“Those staff subsequently may leave but we still have some good retention rates of people who stay with us. In a lot of our homes we have a large number of staff who originally transferred with us.”
Avoiding the potential pitfalls of agency reliance is a key priority for Suzanne. Agency workers account for around 14% of staff hours at Shaw currently.
Suzanne said finding staff in specialist care areas, such as minor injuries, was particularly challenging. Agency use is also higher in the provider’s more rural homes, she pointed out.
“Agency doesn’t give you consistency,” Suzanne explained. “There are some very good agency workers but my understanding today is that more agency workers are considering that as being their full time job rather than taking up what would have been a traditional contract.
“We have to look creatively at how we ensure we have the right skills mix within our workforce.”
Shaw provides a comprehensive learning and development department and is looking at new ways of training, including nursing preceptorships, nursing assistants and associates in order to combat staff shortages and continue to provide quality care and offer opportunities to develop its staff.
Suzanne said Shaw had seen more applicants since it updated its adverts and website to demonstrate a career pathway.
The company has also created a nurse educator role to provide support for clinical supervision and for preceptors.
“It’s a lot of responsibility to ensure knowledge is passed on to newly qualified nurses,” Suzanne said.
“Nurses like to feel they are supported in their clinical route so we do a lot of clinical supervision and mentoring and nurse forums.
“Our nurses are not just a nurse they have to manage their unit. They have to manage staff performance and all of the clinical decisions. There’s a lot more autonomy than working in a hospital and so they need to feel supported and I think that’s what we do particularly well.”
Shaw has also introduced a new £1,000 loyalty bonus to its nurses and incentivises staff to make referrals.
The provider also offers a benefits package and free employee assistance service for staff with telephone and face to face support on financial, medical, legal or personal issues.
Staff loyalty is rewarded through long-service rewards. Staff recognition also includes an Employee of the Month programme and an annual awards event.
Because of Shaw’s funding model, Suzanne admitted that offering competitive salaries was more of a challenge.
“We are not able to compete with privately focused providers on salaries but where we gain is through the support we are able to offer our nurses,” Suzanne stressed.
“Everybody you talk to in Shaw will say that they are supported and have access to myself and the executive team 24/7.”
Its employee ownership model is another means by which Shaw incentivises staff and gains buy-in to its values and culture.
“When people grasp that they are an owner of a little segment of the business it gives them a sense of belonging,” Suzanne said.
“We are hopeful that will work with retention and with staff feeling that they have a say. We want our staff to feel valued and part of the team.”
Technology is another area where Shaw is looking to invest to provide greater support for its staff and residents alike.
The provider has begun discussions with a provider of a digital care planning system.
“We have looked around for a long time and not felt that there was anything that met our needs,” Suzanne said.
The provider is investing in more IT for staff rostering and web portals to encourage staff to take more ownership of their workloads and uses a LloydsPharmacy emar system.
Shaw is also investing significantly in sensory monitoring equipment to offer more independence for residents. It has also introduced Tovertafel table top technology to enhance its dementia support.
The care provider has also adopted interactive floor level sensory technology at its homes for people with learning disabilities which enables them to carry out virtual activities such as kicking leaves.
Another key challenge of taking on local authority stock is, of course, the deteriorating state of their properties.
“One of the reasons LAs look to transfer out to us is because the stock is outdated and doesn’t meet current standards or expectations,” Suzanne noted.
A core part of taking on local authority homes is negotiating about delivering a new environment, whether that’s homes owned by Shaw or those operated on an existing council contract.
“The cost of care is built in with the fact that we will be providing a new building,” Suzanne said.
Funding is also inevitably a key challenge for Shaw with 50% of its residents supported by the local authority.
Its two services in Camden along with a further home in Poole, which will open next year, are fully local authority contracted.
Shaw’s Northamptonshire contract, on the other hand, has 40 private beds spread across seven services.
Altogether, around 50% of Shaw’s beds are run on local authority contracts, with 25% run on a spot purchase basis, with the remaining 25% run on the private market.
Given the increasing pressures on local authority focused providers, however, is Shaw having to increase its private provision?
“Our model has been a responsive one to what local authorities have asked us for,” Suzanne said.
“Very often so far down the contract life you may find what was initially contracted actually isn’t fit for purpose where, for example, dependency levels have increased.
“We will then work with the local authority to look at what is required and sometimes that has involved us taking on more private beds.
“By having this kind of contract it makes the margins very tight and one thing we are absolutely adamant about is that it has to be quality care so we are more likely to say we can’t do something than provide something that is substandard.
“We have grown our business on the local authority contracts but if the opportunity for further growth presents itself then we will look at it.”
Suzanne said Shaw had the experience to be able to capitalise fully on the current resurgence of local authority tenders.
“We know this is something we do well but if there are other opportunities, we will look at them on an individual basis.”
Shaw’s partnership approach to provision means that local authorities remain very much involved in the running of homes.
“The local authorities are very involved in the homes across all of our contracts,” Suzanne said.
“Some operate in a very specific way with clear KPIs. Others are likely to visit and take in the homes for themselves to see whether they have the right feel. They will check our documentation to ensure we are providing what we say we are doing.”
Having set the care home KPIs for Herefordshire Council, Suzanne now ironically finds herself delivering on them.
“Thankfully I set the bar at a good height and one that I knew would lift the homes but equally so I knew that they were demonstrable,” she said.
“LA involvement in our homes can range from micro management to seeing them once a year. Camden Council held their meetings at our Maitland Park Care Home during its first three years so that they could see what was happening.
“We operate in a very open way and are very transparent. If we have issues we will talk to the local authorities about them so that’s something we can co-operate together on.”
Camden Council played a key role in the continuing role of music at Maitland Park. Shaw has launched a partnership with local business Unforgettable on a music playlist project, which it will be trialling at Maitland Park.
Given the yawning gap between local authority and private fees how does Shaw deal with the accusation that private fee payers are subsidising local authority payers?
“It’s like any business, you have to look at where your income streams are and I feel that ours are appropriate and we don’t differentiate for care,” Suzanne stressed.
“Our care has to be excellent. I think driving that excellence forward has allowed us to set our fees accordingly across the patch.”
Recent Which? analysis of CQC data highlights a growing divergence in care quality between care home providers focused on the private pay market and those offering local authority beds.
Shaw has no Outstanding ratings, though it has several services that have achieved individual category Outstandings. So does Suzanne agree that it is more difficult for more cash constrained, LA focused providers to achieve top quality care?
“The funding constraints can impact on the workforce,” Suzanne admitted.
“Gaining Outstanding is all about very specific interventions and outcomes with people. There is no getting away from the fact that while local authorities provide funding streams there are also constraints.”
Suzanne stressed that funding constraints had not impacted on Shaw’s drive to improve quality which is up by 16% over the last year.
She highlighted moves in Scotland towards taking the method of commissioning into account when rating services, which could raise the intriguing prospect of similar approach being taken in England.
The deputy CEO added that consistency of inspection remained an issue for services.
“Being a national company we see different approaches to inspection,” she added.
Looking ahead, with sustainable funding solutions high on the news agenda, does Suzanne expect much movement from the government?
“I think it’s very evident that health and social care are underfunded,” said Suzanne.
“The thing that’s promised for so many years is that joining up of health and social care and it’s not there. The joined up thinking isn’t happening to provide a pathway for people receiving care in a timely way in the appropriate setting, even if that is in their own home. Until the government looks at that patient journey they will not be able to qualify where that money needs to go.
“Something’s got to change whether it’s taxes for people, whether it’s a different cap or whether it’s looking at people’s property or insurance, the whole system needs proper exploration.”