Mike Padgham, chair of the Independent Care Group (ICG) and managing director of the Saint Cecilia’s Care Group, says the government’s goal for 2021 should be to “get social care done”.
Having previously worked in the NHS as a hospital manager, Mike began his involvement in social care in the late 1980s.
“My partner was a nurse in the NHS and we had seen a lot of bad press about care and we thought we would like to do a better job,” Mike explained.
Having looked around the country for a business to invest in, Mike finally settled on Scarborough in North Yorkshire.
“We looked at the data in the region and the older population was expected to grow rapidly,” Mike explained.
“People retire to the seaside so we thought it was a good place to base ourselves. We took over a very small business that was called Saint Cecilia’s. We had just eight residents living with dementia.
“We were hospital managers one day and running the care home the next because in those days it was like buying a house. You also inherited the people in the property. It was a fairly simple process, there was no national regulatory body so you had an interview with the local authority to register. Running the home was a baptism of fire. We couldn’t go out together because one of us had to be there. We did night shifts and day shifts. We did the cooking and some of the personal care – we did everything.”
Since those early days, Saint Cecilia’s has grown to operate a nursing home, three care homes and a day care centre. It also ran a homecare operation for a period.
“We’re not the biggest company and nor do we want to be,” Mike told CHP. “But we do want to keep growing as there is an optimum size that we want to operate at efficiently.
“It’s a family run business. My son is now involved. We’re still learning all the time and plan to grow further.”
It was not long after setting up his business that Mike was asked to join the local care association that was then called the North Yorkshire Care Group. Shortly afterwards, Mike was elected chair of the group before it went on to merge with the other care associations in York and North Yorkshire to become the Independent Care Group (ICG).
The ICG is a strong, lobbying body acting on behalf of care providers, both regionally with CCGs and local authorities, and nationally, with government.
“We have had a lot success acting on behalf of our members,” Mike said. “We fight our members’ corner but I think we have a healthy relationships with the local CCGs and local authorities.
“I think they respect us and we respect them. We’ve played our part in hopefully making care better both locally and nationally.”
In highlighting the ICG’s success, Mike referred to gaining leave to proceed to a judicial review with a local authority, which resulted in an agreement to a three yearly cost of care view.
“That doesn’t mean to say we’ve got the fees we want,” Mike observed.
“We negotiate with them after each review and we’re now able to do it without recourse to the law.
“As you know, social care funding has been tainted with the fact that it is being cut back so we get the best we can but short of taking action, there isn’t much room for manoeuvre.
“The cost of social care has been argued over for three decades and I still don’t think we have quite got the resolution we need.
“It’s a thorn in the side of the social care sector generally that the costing elements have never been finalised or worked out because there are so many debates nationally and locally.”
Mike said it was time to establish a national cost of care.
“There must be a better mechanism than 152 local authorities all trying to negotiate with each provider group on what the cost per bed per week is,” he argued.
“I think the whole social care sector needs a big shake up from top to bottom. Fundamental, real big change is what we need. Not to keep tinkering around the edges.”
The ICG has grown to around 200 members of all sizes, from small to corporates, who provide the full range of care services, from domiciliary to residential and nursing.
Looking back on the last 12 months, Mike said it had been the most challenging time he had known in his 30 years in the sector.
“It’s never been easy but it has been especially difficult, particularly in the early days of the pandemic,” Mike said.
Sadly, Saint Cecilia’s has lost a number of clients to the pandemic with Mike believing the group’s initial outbreak to have been caused by a hospital discharge before testing was standardised in February last year.
“We lost some people but managed to contain the outbreak,” he reflected.
“Staff and residents were devastated. We had the typical shortage of PPE and confusion from government over guidance.”
Despite the traumatic impact of COVID on his services, Mike agreed to offer one of his homes to help relieve pressure on hospitals by taking in COVID positive patients during the first wave.
“We got slated quite a bit by some of the red tops,” Mike reflected. “I’ve had sleepless nights over this but people who have had the virus are human beings. They have to be cared for somewhere. If every care home turned them away, where are they going to turn?
“I wanted us to look at the bigger picture and play our part because I think in the future the public sector will remember how useful the independent sector was when it came to an emergency and I think if we help them it does us good overall. If we don’t, I think there will be a much bigger provision of public sector care because I think there will be political pressure to expand it, so I think it was right both morally and in terms of the future.”
While conceding staff, residents and their families were in need of reassurance over the policy, Mike said many had expressed their support.
“You always hear from people who are unhappy rather than happy in this country so it did knock us a bit but we came through it,” he reflected.
“I can understand why some care homes are reticent about taking COVID positive patients. I’m certainly not criticising them. I’m just saying we took a decision based on a balanced view and we did get a lot of people who went back home fully recovered so I think it was the right decision in the end.”
While stressing his altruistic motives for taking hospital discharges, Mike conceded there had been significant financial pressure on providers to take in COVID patients during the pandemic as they suffered from low occupancy and were offered financial incentives by commissioners.
“The press made a great thing of care homes doing this to keep their business afloat but I don’t think that was the sole issue,” Mike said. “You can wrap it up in different ways but it was also about helping the community.”
At the time of speaking at the beginning of December, Saint Cecilia’s had thankfully not suffered a further COVID outbreak during the second wave of the pandemic and the group again came forward to support NHS services by offering itself as a designated setting for hospital discharges.
As well as the additional infection control measures needed to isolate people with COVID, CHP was interested to learn how Mike had coped with the extra staffing needs required to offer this service.
Mike said he had been “reasonably successful” in recruiting new staff, adding the proviso that high vacancy numbers in the sector made staffing challenging.
Saint Cecilia’s has a history of offering innovative recruitment packages to attract workers. It pioneered a ‘golden hello’ package providing nurses a free holiday in the sun, in 2018.
“It’s something we have to think about all the time because everyone is looking at different ways to attract staff,” Mike reflected.
“We try and keep rates as high as we can but the fundamental issue is what we charge is not sufficient to cover our costs.
“You are starting to see people from different walks of life coming into social care but I wouldn’t say the floodgates have opened.
“This type of work is stressful. It’s unsocial hours and low paid work. We want people to come in because they want to help people’s quality of life not because they’ve lost their job at Debenhams and it’s the only thing left.”
Mike said his staff had “pulled out all the stops during the pandemic”.
“They have isolated themselves from their families and put their residents’ first,” he added. “They’ve worked long shifts and they have gone the extra mile over the last nine months.”
While noting he had managed to keep agency use to a minimum during the crisis, Mike said the government’s new immigration regime would place further pressure on providers by limiting access to EU workers.
“It feels as though we are fighting a battle with both arms tied behind our back sometimes,” the ICG
Mike said filling the 400,000 vacancies required in the next decade or so without immigrant workers would be a tall order.
He stressed that making care work more of a vocation with better terms and conditions and pay would be fundamental to addressing the current 110,000 worker shortfall.
The managing director called for the introduction of state registration for care workers in the same way that a general nurse is registered, as well as higher minimum levels of pay.
Mike said a career structure was also required to attract young people from school and university and make them proud to work in the sector.
“We have got to have fundamental change but it is not going to be easy as we didn’t fix the roof when the sun was shining so it’s going to be a lot more difficult when the country is in deficit,” Mike observed.
At the end of the day, Mike said the argument always came back to inadequate funding. He argued a radical shake-up in which people paid for their care out of taxation or national insurance was necessary to create a care system that was free at the point of need in the same way as the NHS.
He pointed out that the English government was yet to follow the Scottish and Welsh governments in financially rewarding care workers for their efforts during the pandemic.
In terms of his own staff, Mike said Saint Cecilia’s had offered bonuses as well as a pay rise in recognition of their enormous efforts during COVID and had also provided counselling services for the emotional toll of working during the pandemic.
“We’ve tried to be as supportive as we can and recognise the great job they’re doing,” Mike noted.
The managing director also highlighted how the government’s effective ban on staff movement during the pandemic was placing an additional burden on providers.
As well as additional staffing costs as a result of the pandemic, Mike pointed out how the crisis had placed a significant extra financial burden on providers, which has only been partly alleviated by government support.
“The additional funding has not gone far enough, particularly with the challenges posed by resuming visiting,” Mike observed.
“I’m not sure the government has got its head around the fact that social care is an independent sector bigger than the NHS with more staff and more beds.
“Giving money to the sector does a public good. It’s not like giving money to any business. They need us just as we need them and actually making sure that we can operate and survive in the future is critical.”
The ICG head said he would like to see additional Infection Control Funding being allocated to support visiting.
“What we are asking for is an Infection Control Fund ‘3’”, Mike said.
“We need another fund because the second fund was for longer but for less money and a lot of local authorities have stopped supporting providers in the second wave.
“If the cost of care had been right in the first place, then there would have been more slack in the system to cope but because it’s paired to the bone, there’s nowhere to go.
“We know it’s not easy when the government is strapped for cash and supporting a lot of businesses but fundamentally what we’re calling for is parity with the NHS.
“If the NHS gets more funding, why is it that local authorities and social care only get a fraction of what they need?
“It’s politics. The public love the NHS but I’m not sure they are so keen on local authorities or the private sector.”
As we spoke, the number of care home deaths in the second wave, while still significant, remained below the peaks seen in March and April.
Stressing that every extra death was one too many, Mike cautioned against any complacency, highlighting that the government expected the second wave to be more prolonged with less sharp peaks in death rates than the first wave.
The ICG chair also warned of the real danger of a third wave in the wake of lockdown relaxation for Christmas.
“We are not out of the woods by any means even though we mercifully now have a vaccine,” Mike stressed.
“We just need to keep our fingers on the pulse of the virus and make sure that it doesn’t grow in care homes again. Thankfully, care home residents and staff seem to be at the top of the list rather than the bottom for once.”
With vaccinations being rolled out to staff as we spoke and plans being made for their delivery to care homes, Mike also highlighted that the vaccination of the sector, as well as the resumption of visiting, would require enormous additional resources.
Meeting testing commitments alone is placing enormous additional pressures on providers.
Mike calculated a 50-bed care home with 100 staff required 2,250 tests every four weeks.
“Staff have still got to wear the PPE, visitors have still got to be chaperoned and we still have to make appointments,” he added.
“I still need to appoint someone to look after all this so that we are not taking care staff away from their frontline duties.
“It’s just not workable on its own and I don’t think the government really thought this through.”
Several local authorities had closed down their lateral flow testing programmes as a result of concerns over accuracy at the time of writing but Mike revealed that only a few North Yorkshire providers had joined the programme meaning it was too early to judge its success.
“I think we owe it to families to allow some visiting but it might not be perfect,” the managing director observed.
“We can’t do right or wrong on this. There’s always going to be someone unhappy.
“I think the majority of people want visiting to get underway in a safe way but if it is your home then protecting your residents is critical, so balancing the needs of all the individuals involved becomes very difficult.
“I think the government has escaped responsibility on this by saying all the resources are there for this to happen and leaving us to make the decision.
“They should have not set a deadline and given us adequate time to prepare. We are a resilient sector, however, and we will get through this.”
With hundreds of care home residents still dying each week with COVID symptoms at the time we spoke, Mike said the long-term impacts on providers would be significant with it taking several years for occupancy to return to normal levels as consumer confidence had taken a knock.
With research showing that larger care homes have been the worst affected by the pandemic, Mike said he hoped the crisis would spur a “renaissance” for the small care home, while adding there was room for everyone in the marketplace.
He called on the government to make social care zero-rated for VAT so that providers can reclaim the tax on purchases and to incentivise those providers to grow their services in the wake of the crisis.
He added that extra staffing requirements required for domiciliary care would ensure there was no seismic shift to home care from residential care as a result of the pandemic.
“If someone needs 24-hour care in their own home that’s a lot of staff per person, whereas obviously with care homes you’ve got the people in one place so the numbers of staff that are needed are less,” Mike pointed out.
The ICG chair suggested support from local authorities and government in terms of block contracting may be required to help providers survive.
Mike said government after government had got away with failing to tackle social care and the public had let them, adding the sector had too low a profile and didn’t speak with a loud or unified enough voice.
“Social care needs its Nye Bevan moment, somebody in government to step up and say, ‘I’m going to make a big difference’, grab the sector by the scruff of the neck and totally transform it – making a name for themselves as they do,” he said.
“We need properly-funded social care so that providers can offer a complete, professional service and can give their amazing staff, who have fought side by side with their NHS counterparts during the coronavirus, the same pay and professional recognition. It should no longer be a sector where people are expected to do a high-stress, professional job for little more than the National Living Wage. It must be properly rewarded so that those working in care can enjoy a decent standard of living.
“Everything should be on the table. Should independent care providers be brought into provide public care services under contract, like GPs are?” Mike asked.
“We need to have a country where people receiving publicly funded care can get it in their own home or close to where they live.
“We also have to see dementia treated like other high profile, high priority illnesses, such as cancer and heart disease.”
The ICG leader called for the establishment of a National Care Service that could work alongside the NHS.
“Healthcare needs to be rolled in with social care locally with local authorities, or on a national basis,” Mike argued.
“One body doing health and social care is better than one national body doing health and lots of local bodies doing social care,” the managing director said.
“This has come to a head with the pandemic. The current set-up doesn’t work as there are so many different complicated routes for how things come together.”
The care leader added there was the need for the creation of a unified body to act as a single voice for the sector.
“I might be long gone by then but I do envisage a big single association emerging to represent the sector much in the way that the BMA represents GPs,” he predicted.
When asked if a radical shake-up of the sector was on the immediate horizon, however, Mike remained sceptical.
“I had high hopes of Boris Johnson when he came to No 10 saying he was going to fix social care,” he reflected.
“I know we have had the pandemic and now the government is saying it will happen in 2021. My fear is that it will keep getting kicked into the long grass again.
“That’s why someone needs to be bold. The PM said he wanted to get Brexit done. So, 2021 should be the year when we get social care done.”