Christine Asbury

Chief Executive Christine Asbury joined WCS Care seven years ago with the aim of making every day well lived for residents. As we start a new decade, CHP found out how its approach to care, technology, innovation and creativity helps WCS Care achieve this.

Anyone who has listened to Christine speak at a public event or toured the WCS Innovation Hub at Castle Brook care home in Kenilworth, Warwickshire, with her will recognise the passion and focus she brings to her role. Christine is confident that’s replicated by staff at every level across WCS Care’s portfolio of 13 homes.

“That’s what makes us an extraordinary provider,” she told CHP.

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Having worked in the not-for-profit sector throughout her career, particularly organisations that support people with physical and learning disability, or autism, as well as older people, Christine’s most recent role before becoming the chief executive of WCS Care in 2012 was with a start-up incubator for assistive technology.

“It’s what sharpened my interest in doing things differently and looking at a more innovative, creative approach,” Christine told CHP.

“WCS Care was a smallish not-for-profit provider when I joined and I knew it was different. It already provided high quality care with a family feel, something I very much related to, but I could see the potential to be much more ambitious.”

Set up in 1992 as a charity, WCS Care now runs eleven homes for older people and people with dementia, plus two homes for younger adults with physical disabilities or long-term conditions, across Warwickshire.

WCS Care puts its values and culture at the heart of everything it does, according to Christine, but it wasn’t a strategic direction she had planned.

“It happened organically because of the group of people who were at WCS Care – from the Board to our teams in the homes, everyone really,” Christine said.

“Our approach has taken off in more recent years because we’ve become very good at articulating what we’re about which has helped us with our messaging and communications.

“I think it’s important that we all have a shared set of values and understand what we’re doing. I’m also aware of not using bureaucratic and complex language – the term person-centred care, for example, doesn’t tell anyone anything and when you start to use that type of jargon, you’re hiding behind it, rather than it actually enabling you.”

It was at a National Care Forum (NCF) conference that Christine discovered what she thought best described WCS Care’s values and culture.

“I heard a talk by the then chief executive at Cornwall Care, invited myself along to see what they did and picked up the work they did around the values of play, make someone’s day, be there, and choose your attitude,” Christine explained.

“I brought it back, tried it with a group of senior managers and a group of home managers, and discovered it worked – because it described what we were doing already, in language everyone understands, rather than trying to get people to think differently. People related easily to those four values.”

There was more work to do to develop ‘every day well lived’ and another mantra the organisation lives by.

Christine explained: “ ‘The standard you walk past is the standard you accept’ just happened because someone talked to me about a You Tube film by an army general in Australia where he used those words.

“I watched it, thought it was powerful and that it would work really well with people. Again, I showed it to managers, one of whom went away afterwards and stuck a notice with those words above her desk – so I knew it was the right thing.”

However, verbalising WCS Care’s values in this way was met with some scepticism when they were
first introduced.

“The Board initially felt these were a bit superficial or informal and wondered if the words were professional enough, particularly telling people to play at work, which they thought counter-intuitive,” Christine explained.

“But the moment we got team members to talk to them about the values, they just bought into it because they could see how much of a fit it was with how we do things. Now, everybody just lives and breathes ‘every day well lived’ – it was just a period of adjusting to something that wasn’t jargon and wasn’t bound in inaccessible language.”

And for Christine, ensuring the values were instilled within staff practice was a personal mission.

“I made sure I led the first few years of our values training,” she added.

“I went around and worked with a key group of staff at every home to deliver training and then I carried on delivering that training myself – and still do. It was partly about making sure those values and what they meant were communicated well and consistently to people. A lot of it was about creative leadership and that you’ve got to model it – and that was being led and modelled by the executive team and home managers.

“We worked closely with Ladder to the Moon to explore creative leadership in more detail and we realised it was something we were naturally doing. Ladder to the Moon helped us build a language and confidence to embed this.

“Every single person that comes into our home, whether they’re a delivery driver, a resident, a relative or health professional, can relate to our values, so it’s how universal it is that’s important.”

Christine told CHP that a values-led culture was really important to achieving outstanding care but it depended on who was defining what outstanding is.

“We want to define outstanding care ourselves and to us, our values are absolutely central and critical to that,” Christine explained.

“Outstanding care isn’t a tick-box exercise and, although they’re important, it’s not just about systems and processes – it’s the lived experience of someone every single day. You’ll often hear me say you’re only as good as your last act of care but if every act of care, the atmosphere and the experience of residents is based on a very clear set of values that people are signed up to and are living and breathing, then I’m confident we are providing the best experience.

“Having the right people in place is incredibly important too – it’s our people who make us who we are. They’ll often tell us that feeling valued, feeling that they contribute and are part of the organisation, knowing they’re doing a good job every day and making a difference to people’s lives, matters more to them than their salary does – although we should never underestimate the importance of pay.

“Certainly, in our experience, other practical things matter to staff too, like rotas you know months in advance so you can plan your life and responsibilities around that, as well as training and development opportunities, which all help keep our staff turnover well below the national average and our agency use averaging 5%.

“We have many people who’ve worked with us for a long time. Many of our home managers started as carers, as did our deputy chief executive, Ed Russell.”

WCS Care’s not-for-profit status has a part to play too, according to Christine.

“There are some very good for-profit organisations out there but there is something special about the not-for-profit sector that has given us the ability to be more creative in our approach and focus more on values,” Christine observed.

“Often, it’s not-for-profits who lead the field with innovative ways of doing things and creativity in care, and I think there’s a reason for that.”

And that was certainly the case when WCS Care became the first care home in the UK to use acoustic monitoring after retro-fitting it at one of its newer homes in Rugby in 2016.

Acoustic monitoring is a non-intrusive system that automatically alerts staff to unusual sounds in residents’ rooms at night, so they can respond quickly when needed.

“After being approached by Dutch company CLB, who were looking to introduce acoustic monitoring to the UK care home market, we were curious about how it would work as it wasn’t something being used here at the time,” Christine said.

“We were initially sceptical about the value of acoustic monitoring, so CLB invited us to the Netherlands to take a night tour of facilities using it. We were blown away by how well night managers monitoring the system knew each resident whilst overseeing hundreds of people at a time.

“Most importantly, we saw how residents weren’t being woken up at night by staff knocking on doors to check they were ok – and it was this that provided the evidence we needed to give it a go. When we switched the system on for the first night, we picked up things we wouldn’t have heard by doing traditional door knocking. I remember we heard a lady crying quietly in her room – we sent a carer in to check that she was ok. She was getting upset after looking through birthday cards from her family, so we were able to comfort her and offer that emotional support; it was an incredibly touching moment.

“Within a year of installing the system, we saw night-time falls at that home reduce by 34% and that was enough for us to realise it worked. We introduced many other innovations such as turning a kitchen storeroom into a working shop for residents; and rolling out Person Centred Software’s mobile electronic care planning system, where carers could log interactions at the touch of a button, meaning they could spend more time with residents instead of on extensive paper recording. It wasn’t long before people started taking notice and asking to visit the home to see how we did things.”

This unexpected interest inspired WCS Care to create an Innovation Hub at its second new build home, Castle Brook in Kenilworth, which provided a unique space full of working mock-ups of the latest technology and concepts they already used or were planning to use.

Christine told CHP: “When we were designing Castle Brook, we had already planned to have a shop, a café, cinema, spa and hair salon in an indoor high street to help create a familiar environment for residents and one of the managers suggested creating a traditional launderette as well.

“And we thought, why not? So, we moved the launderette from a back-of- house position on the second floor, to the ground floor in a very front-of-house location, so it became a central part of the home. It meant that we had freed up space, so we decided to create the Hub and see where things went from there.”

WCS Care worked with existing partners to develop the Innovation Hub but no one predicted its success, according to Christine.

“While we knew there was some appetite for learning from the early interest we had, we didn’t quite expect there to be the interest there has been,” Christine added.

“Since we launched the Hub in 2017, we’ve welcomed almost 1,000 people from around 300 different organisations, including other care home providers, local authorities, NHS trusts, NHS England, the CQC and universities, as well as MPs such as Norman Lamb and Care Minister Caroline Dinenage.”

The Hub gave WCS Care a voice in a sector that was traditionally reluctant to try new technology or share learning more widely.

“We didn’t set out to provide a platform,” said Christine. “It naturally formed itself from the organisation we are and the curious, inquisitive and ambitious approach we take to delivering care, and thinking about how we want to deliver care in the future.

“It’s provided opportunities for us to share our learning through the NCF and specialist groups set up nationally because we’re known for being creative and open to trying new things.

“However, we always say we’re learning all of the time and don’t get things right first time, something that’s important to stress – but what sets us apart is that we’re resilient, we don’t let ourselves get knocked off course by criticism, challenges, ideas or expectations that don’t fit.

“We can collect ourselves to ride out the difficult times without getting big-headed about the good times because we are only ever as good as our last act of care. Our values were the foundation of that platform and a model of care we have developed. One of the things we do whenever we are looking at any change or innovation, and I’m not just talking about technology, is always ask: will this contribute to somebody’s day well lived?”

Christine admits there’s an element of risk in trying new things but it shouldn’t put organisations off from doing things differently.

“Positive risk-taking allows us to think differently,” Christine explained. “It opens our eyes to things. So frequently when I visit other providers’ care homes, they might have beautiful gardens but the door to the outside is locked because they don’t want residents to go out unsupervised.

“Yet, we know we can safely leave our garden doors unlocked in our newer homes with secure gardens, and we’ve seen improvements in people’s health and wellbeing – we’ve had people wear their shoes out because they’re walking so much more.

“Those are very concrete examples of how when you stop thinking in risk-averse terms, you can actually deliver much better wellbeing for people. And we’ve put systems in place to monitor the positive impact spending time outdoors has on residents, while supporting home managers to create environments that encourage people into the fresh air, including side-by-side bikes-for-two and cycle tracks, greenhouses and outdoor gym equipment, for example.”

WCS Care is one of the first residential care homes in the country to install circadian rhythm lighting, which mimics natural summer light in the daytime and creates biological darkness at night, keeping the body in a solid circadian cycle, helping improve sleep and daytime alertness, which has positive impacts on people with dementia.

Christine explained how the results of a trial at one of WCS Care’s Rugby homes influenced its decision to install it at their newest home in Warwick.

“We’d heard about the potential benefits of circadian lighting on sleep and wanted to try it for ourselves, so we retrofitted the system into one of the households at Drovers House, as well as in the communal areas, including reception, to compare against a household without it,” Christine said.

“Within eight weeks of installing the system, we saw a noticeable uplift in people’s wellbeing on the household, using dementia mapping as a measurement – with the vast majority of people moving into content or very happy moods. And that was enough for us to install it throughout our newest home in Warwick.”

Woodside Care Village, which is WCS Care’s 13th home, having opened in autumn 2019, replaced one of the charity’s 1960s-built homes on the same plot of land. It’s home for up to 72 adults, including older people, people living with dementia and people who are deaf, and features smaller, family-sized households for between five and seven people with similar interests and backgrounds.

Christine told CHP why there was a step change in the size of households at Woodside Care Village.

“When we started building new homes, we were later than many other providers to do that – our first opened in 2013,” she explained.

“At the time, the advice we were given was that a household of between 12 and 15 was an optimal size, so that’s what we built with the first two new builds. I went to Germany on a study tour that the NCF had organised and I saw a couple of homes that had much smaller households, and noticed the kitchen table being used as the focus of people’s daily life, even for people living with dementia.

“And following a visit to De Hogeweyk in the Netherlands, several things came together at once, and I started sketching two smaller back-to-back households, instead of one larger one, and it just evolved from there – and that’s where the inspiration for Woodside Care Village came from.”

Domestic-scale was important to WCS Care during the design phase as it was aiming to create an environment that was familiar to people, helping new residents settle in and feel at home.

“Instead of being hotel-like or having a vast space, we wanted to create a comfortable environment that feels more like your own house – you feel that you have permission to change the TV channel, or go into the kitchen to make yourself a drink or snack,” Christine said.

“It means we’re able to give people more independence and choice about the type of lifestyle they want to have and the people they’re living with. A move at that stage of your life is never going to be easy but actually the more familiar and homely the living experience is, the better it is for
a resident.”

Drovers House

While it’s too early to tell whether the approach is successful, interest in the new home has exceeded expectations.

Christine added: “We’re still learning from the opening and operating of Woodside Care Village but the future would be that any new developments we do will be based on the model used there. We know this approach is the right route to take because the new home has already been so popular – there’s obviously a demand for this type of care village around here.

“We had a particularly memorable comment from someone who’d visited Woodside Care Village recently, and whose mother had been at another of our homes 15 years ago, and she thought what we were doing was ‘revolutionary’ and ‘lovely’ – being both those things at the same time is exactly what we are aiming for.”

And WCS Care will continue to learn and develop, according to Christine, while sharing its experiences with the wider sector.

“We’ve shared and directly influenced best practice in the sector – talking about our challenges as much as our successes – and I really think the not-for-profit sector is particularly good at leading the way,” Christine noted. “We’ve seen that with the profile of the NCF over the past few years: leading the care innovation and technology agenda.

“More widely, it’s not just about the social care sector becoming better at sharing best practice. What we need is for the sector as a whole to do things differently and start to think differently. It’s a very conventional sector, quite set in its ways and very risk-averse, seeing little reason to change or finding implementing change too difficult.

“We are starting to see a shift in the regulator’s approach to innovation at a national level and it’s part of the conversation I’m having through being part of CQC’s Technological Innovation External Reference Group. I don’t think you can regulate for innovation. From a regulatory point of view, it doesn’t sit easily with the inspection framework – but we’re not being creative and innovative to impress CQC; it’s  because we believe it contributes to ‘residents’ day well lived’, and that’s why we do what we do.”

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