It’s been a busy first year for CEO Tom Brookes leading the radical transformation of Orchard’s operational and structural business. CHP caught up with Tom at Orchard Care Homes’ support centre in Harrogate to find out more.
Tom Brookes has hit the ground running since his appointment as Orchard Care Homes’ CEO a year ago, following Paul Mancey’s stepping down from the company.
“The standing joke is I am now four and a half years into a three-month interim contract,” Tom told CHP.
Tom was running his consultancy company when he was first called in to work with Orchard. He had been supporting a number of different care and private equity companies for a number of years.
“I was asked by the then CEO to support the transition of some ex-Southern Cross homes at the back end of 2013,” he said.
Tom began his career with Orchard as managing director of its Larchwood portfolio of homes. He then worked his way through a number of new senior leadership roles, including purchasing and estates director, head of the provider’s Lifestyle portfolio and COO, before being asked to take on the CEO role in June 2017.
In his previous career, Tom was a director of a number of healthcare companies, following earlier postings at pharmaceutical heavyweights, Glaxo Smith Kline and Johnson & Johnson.
Since taking the helm at Orchard, Tom has led a radical transformation programme, which has carried on the restructuring initiated following its takeover by private equity investor Alchemy in 2015.
“The transformation programme is first and foremost about organisational and developmental culture,” Tom said.
This involves devolving power from the centre of the business to home level.
“We are giving the managers the tools they need to do the job,” Tom said.
This has included investing in technology solutions. Orchard is currently rolling out Medicare’s Electronic Medication system, eMAR, and Person Centred Software’s (PCS) digital care planning systems across all its homes.
“I believe we will be the first mid-sized corporate to have eMAR and ecare rolled out right across our estate,” Tom observed.
“eMAR has been very good at improving our adherence and visibility of reporting.
“It’s not a silver bullet, however, and has to be a string in the bow of an overall meds management strategy.”
Having successfully completed two pilots in 2017, Orchard opted for PCS’s mobile care monitoring system at the end of the year.
The move has been instrumental in moving a number of Orchard homes from Requires Improvement to Good this year.
“It’s capturing 40-60 notes per resident per day in greater detail, whereas previously we were at 10-15 handwritten notes,” Tom said.
“The fantastic thing about it is it gives objective evidence of the touch points we are having with our residents and it allows our care staff to have more direct time with residents for their personal care.”
In a bold move towards greater transparency, Orchard is also piloting Care Protect’s CCTV in two of its homes.
Tom said the systems had been instrumental in bringing two homes out of embargo and had been key to evidencing allegations of poor practice in homes that are no longer part of the group.
“We were able to evidence base that there was good practice going on and if there were any allegations we could go back and examine them,” Tom observed.
The CEO said that while staff had been initially suspicious of being under surveillance, they were now fully on board with the system.
“You can’t do it in isolation, it has to be a multi-agency decision involving the CQC, local authority, residents and their families,” he noted.
The system, which was previously piloted in Lifestyle homes, is being trialled in additional homes with a focus on compliance issues as well as falls monitoring.
“It’s a tool in the tool box for turning our challenged homes around,” Tom noted.
Cameras are deployed in communal areas and in the rooms of residents who have provided consent with the system able to be adapted to each individual.
Orchard is also piloting activities’ specialist Oomph!’s Out & About and wellbeing programmes.
“Our ethos and vision is about being at the heart of the community,” Tom said.
The provider is also partnering with local schools to bring children into its homes, as well as providing mother and toddler groups.
The transformation programme also entails promoting staff engagement through Orchard’s Heart Awards, which celebrate best practice, its Heroes and SuperHeroes, a monthly CEO briefing and a Talk to Tom initiative, which enables staff, residents, relatives, local authorities and partners to share ideas and concerns, and acknowledge good practice with Tom.
“It’s proved incredibly helpful,” Tom noted. “A lot of our transformation ideas have been informed by people at ground level sharing what we should do.”
Orchard also holds biannual quality workshops, staff surveys and has just launched its online awards engagement programme, Perkbox.
“We want to make Orchard a great place to come and work,” Tom told CHP.
Where other providers are scaling down or exiting altogether from nursing care, Orchard has been raising its presence in the area.
“We are absolutely committed to nursing,” Tom said.
“We could make life easier on ourselves by just running residential homes because they are better rated by CQC and generally operate with better profit margins, however, we want to be able to offer a range of services and provide solutions and support for other public bodies.
“People are living longer with more acute conditions and, as a result, we will need to be more nimble and agile in the services we operate which will be a specialist, niche care pathway and having a holistic approach to the services we offer rather than traditional residential/nursing.
“If you are a values-based organisation, you have good engagement and give people the opportunity to be fairly rewarded and remunerated and give the people the opportunity for development and feel like they are part of a team, then ultimately you are going to be the first stop on the bus.”
Through its new workforce and OD strategy, Orchard has cut its agency usage by 40% to 5% of working hours since the start of the year.
Orchard aims to be an upper-quartile provider of pay and benefits and is planning to launch its Orchard Leadership Academy in 2018. It has also introduced a Nurse of the Year award as one category of the newly launched Orchard Heart Awards.
“It will be always be difficult to compete with the NHS on areas such as pensions so we are having to think differently by looking at bursaries and nursing associate programmes,” Tom said.
Staff turnover is down to 32% from 44% at the beginning of the year and Tom said he wanted to bring that down further to 25% by the end of the year.
The care provider has recently appointed a new head of nursing to drive its nursing initiatives forward and look at recruitment and retention of nursing staff across its estate.
Orchard has also bolstered its leadership team with the appointment of former HC-One and Barchester employee Jacqueline Rodgers, who has come in as director of people talent and OD, and Dan Ryan as COO who Tom has worked with at Board level in a number of different organisations over the past ten years.
Tom has also reset Orchard’s business objectives with a newly published three-year plan, which sets the goal of being an upper quartile care provider, being an employer of choice, being best in class in processes and efficiencies, and being a values led organisation.
“The final and, perhaps most important, thing is that we live and breathe our vision of being at the heart of the community as a values based organisation,” Tom said.
“We have a very engaged investor in Alchemy and they are supportive with our direction of travel.”
The transformation programme and Tom’s focus on driving up quality have begun to bear fruit.
Orchard is up by 10 percentage points in terms of services rated Good this year, with four homes moving from Requires Improvement to Good in the past two months.
The provider made the key decision 12 months ago to split its operations team into ‘business as usual’ and ‘improvement’ functions to help raise quality levels.
The improvement team has been tasked with moving Requires Improvement homes into Good and then from Good into Outstanding. It is also used as a supplementary resource for homes facing challenges.
A clinical governance team, which reports into an integrated governance assurance board, captures best practice and shares it across the organisation.
On the flip side, Orchard also employs root cause analysis to make sure bad practice does not reoccur.
Tom’s full in-tray has also included reshaping the structural side of the business with the acquisition of four leaseholds and ensuring leaseholds are sustainable.
New leaseholds agreements have been struck with three of Orchard’s four landlords over the past 11 months, however, a failure to secure a rent reduction with Holly Blue Healthcare in May, resulted in four homes leaving the group’s portfolio as revealed by CHP last month (see EXCLUSIVE: Former Orchard care home go into administration).
The provider’s 42 homes are now split 70:30 between freehold and leasehold.
“Orchard has been on quite a journey over the past five or six years,” Tom said.
“There’s not been many groups that have gone from 30 homes to 170 homes and down to 42 homes again.
“We have developed a reputation for managing homes on behalf of other people and picking up some of the challenges in the industry.”
Following the Alchemy acquisition, Orchard’s focus has shifted to owning and operating its freeholds in order to gain more control of its services.
“The majority of our landlords are long-term partners,” Tom said. “We have great relationships with them and we are now structured so that we can continue those relationships in a sustainable and profitable fashion.”
Orchard announced two care home closures in Kent in September 2017 in order to consolidate its geographic focus on the north and the Midlands.
“Historically, we have managed up to 70 homes in the south but with the sale of our Larchwood and Lifestyle portfolios in recent years, we were left with just two homes in the south so to continue operating them made no sense,” Tom said.
The provider currently maintains a bias towards the local authority market, with its residents split 70:30 between LA and private payer, but as with other leading corporates, Tom said Orchard was aiming to shift more towards the private market.
“I would like more private payers but as a Midlands and northern focused provider, we will never
have the same levels of private payers as those in the south east,” he said. A key Orchard strategic objective is to be a premier provider of publically funded services and Tom said he was confident that there was a sustainable future for the publically funded model.
“There are still too many areas where we receive less than £4 per hour but first and foremost we will always be a predominantly publically funded service,” he stressed.
Over the past six months, Orchard has created a cost of care tool where it can provide evidence to local authorities of the true cost of care of each resident.
“It’s a difficult discussion to have but we are not going to be in a race to the bottom,” he said.
“We are going to operate services where I am convinced they can be Good or Outstanding.”
Tom stressed he was more focused with achieving higher average weekly fees and the operational ways of achieving that, representing the true cost of care, including going into more acute areas of care provision in partnership with the NHS.
“I am a big believer in partnership working and I think we are developing long-term relationships with Trusts, CCGs and local authorities,” Tom said.
“We have got some great care models with our Dementia+ and intermediate services and are looking at pinch points in our partners’ systems so that we can become a valued member of the local health economy.”
With its transformation on track, Tom said the pieces were in place for future growth of the business through freehold acquisition and sustainable leaseholds.
He said future acquisitions would be based in Orchard’s heartlands in the north and middle of the country.
“I think somewhere between 50 and 70 homes is the right size for a group of our infrastructure over the next few years,” Tom noted. “I would prefer quality over quantity.”