Since joining Greensleeves Care six years ago, CEO, Paul Newman, has led the care home specialist through a period of healthy and stable growth. CHP caught up with Paul at Greensleeves’ Aldgate HQ in London to find out more about the Greensleeves business model
Having previously pursued a successful career with the Royal institute of British Architects and the Royal College of GPs, Paul got his first taste of social care after he was charged with putting together the strategy and vision of the care home arm of a Benevolent Fund looking after people within the
After pursuing a successful restructuring programme, Paul was approached by a headhunter about leading Greensleeves.
“They hooked me in,” Paul told CHP. “I really liked what the organisation stood for. I liked the Board. They were keen to grow and that had been my background with RIBA and the Royal College of GPs. My original background was in marketing at university so I have always been on the business development side of things.”
During the intervening six years, Paul has led Greensleeves through a period of stable financial and operational growth.
“When I arrived turnover was £18m and we helped just over 500 older people across 17 services,” Paul noted.
“We now have 25 services. Turnover hit £40m in the last financial year and will exceed £50m this financial year as we add new homes and help over 1,000 people.”
The Greensleeves geographical footprint reaches to Pelsall in the north, the Isle of Wight in the south, Wiltshire in the west and Suffolk in the east.
The majority of the provider’s homes are in the south, south east and east of England, however.
In terms of new development, the charity’s next new home will launch in Ely, Cambridgeshire. The home was completed in July and will admit residents from September.
“Our logic is not to go outside our current footprint,” Paul said.
“We don’t want to dilute our operations more than they are already.
“A lot of not for profit providers are based in one area because they were once the local services’ care homes before they got spun out. We were part of the WRVS and most of their homes were donated to them.”
Growth has been delivered through a three-pronged strategy, entailing investing in the maintenance and future proofing of its existing estate, acquisitions and new developments.
“Having a blended approach and investing in existing stock and buying good operating homes and also opening brand new homes future proofs you in the long run,” Paul noted.
The combined acquisition and development approach means Greensleeves is able to offer residents a choice of purpose-built, modern or older, converted properties.
“I have lunch with our residents who are living in our older stock who say they don’t want to see out the rest of their life in a white box,” Paul said.
“Some of our homes have real character. At the end of the day, whatever the building looks like, it’s the care that is the most important thing. For us, trying to achieve personalised, high quality care where you have motivated and compassionate carers, led by an inspiring home manager, is what we sell rather than a building.”
Having assessed the financial means to fund its growth, the provider became the first care home provider to launch a retail charity bond in 2017 (see Greensleeves launches charity bond).
In terms of its reinvestment strategy, Greensleeves Care currently has three homes undergoing major redevelopment. This includes the reopening of a mothballed, 57-bed residential and dementia home in Tunbridge Wells in 2020.
Greensleeves Care is also building a 40-bed dementia annexe at its care home in Croxley Green, Hertfordshire.
“The residential wing will drop to around 24 beds and we will have the specialist dementia unit as well,” Paul said. “It’s a constant challenge to keep homes up to date.”
In terms of acquisitional growth, the not for profit added three nursing homes to its portfolio in 2010, 2015 and 2016.
“Our nursing homes are doing very well and are rated ‘good’ in all categories but increasingly dementia care has become our bread and butter alongside respite and end of life care,” Paul noted.
Several of the provider’s homes are registered to provide Gold Standards end of life care.
When looking at acquisitions, Paul stressed the long-term viability of the existing building was of intrinsic importance.
“Any existing buildings are bought in the knowledge that they are fit for purpose or adaptable to the future,” he stressed.
The CEO said Greensleeves Care would also consider turnaround opportunities.
“A couple of homes we have acquired have been where the previous owner has run out of cash and didn’t have the right business model and didn’t undertake the necessary investment,” Paul said.
“We have had to fund that and play catch up. Fundamentally they are good businesses and are popular in the local market.
“We have bought care homes in the past that were requires improvement and turned them around.”
Due diligence is carried out in each home before acquisition as well as a full condition survey and full quality and HR audit.
“It’s certainly time well spent knowing what you are getting yourself in for,” Paul stressed.
The provider is committed to at least matching the existing terms and conditions of staff at acquired homes.
“We don’t go in and change people’s contracts from day one,” Paul said.
“There’s very little for them to push back against. Some of the homes we buy might be standalone homes. They welcome the fact we are a professional care organisation that speaks their language and understands what they are talking about. They are able to share ideas and challenges with new colleagues who understand where they are coming from. All our staff are paid over and above the Living Wage.
“It tends to be more affluent market towns where we struggle most to attract and retain people or where there are a lot of providers who have suddenly moved into a market.
“I have done 40-year length of service presentations. We do well in retaining staff. I would like us to do better. It’s not just down to pay. It’s down to culture and values as well.”
Paul said Greensleeves Care was about to commission a rewards specialist to review its pay and benefits for staff at all levels, as part of its bid to further boost recruitment and retention.
“Because of the challenges some of the more affluent areas present, you need to have a more flexible pay policy to respond to the local market challenges,” Paul commented.
The care home provider is carrying out pilots looking at increased pay at a couple of its services, which, if successful, it plans to review spreading more widely after six months.
The charity’s payscale is graded to recognise people’s qualifications with differentials uplifted between each different job description each year.
A 4.9% wage hike was introduced for staff last year.
“We have two outstanding homes in the Lowestoft area and I am told our pay rates there are head and shoulders above the rest of the local competition,” Paul said.
“They are not excessive by any stretch of the imagination and I would like them to be a lot higher but it’s about making sure you have a balanced approach to your finances and are sustainable in the long run.”
Staff turnover at the not for profit is 21%, or around 10 percentage points below the sector average.
Agency staff account for 8% of working hours.
“Our agency use has come down over the last couple of years,” Paul said.
“We have had to work hard at it but it is still too much as far as I am concerned.
“It’s not because of the cost; it’s because I firmly believe it’s easier to deliver high quality care if you know your staff and train them and they are delivering to the standards you expect. It’s about continuity of care.
“We have worked with an agency across all our homes to make our approach more structured.”
The CEO said a third of the charity’s homes had never used agency with a further third using it occasionally and a final third who he described as “serial users” who operate in a tough local market and have not got on top of recruiting for their vacant hours.
“It isn’t necessarily down to the manager not doing their job,” Paul added. “It’s the tight local conditions. It might be NHS competition. It might be another provider who has moved in and is offering higher rates. We had that with one competitor but within two months staff were coming back because their values did not fit with how they were used to being treated and what their expectations were.”
Paul said there were many variables necessary to achieving high quality care at Greensleeves’ homes, of which low agency usage was one factor.
While noting the provider’s three outstanding homes used no or low agency, he added there were others with no agency that remained challenged.
“It is much easier for a registered manager and provider to achieve outstanding traits if you have a longstanding cohort of staff who have mutual trust, who have worked together and bonded and don’t let each other down and feel part of that team and that community,” Paul added.
Best practice is shared among Greensleeves Care homes through quarterly home manager meetings.
The charity’s internal Centre for Quality also helps to achieve outstanding outcomes by bringing staff together from different parts of the business.
“All of our homes have a quality improvement plan that incorporates both positive and negative feedback and evidences how they are seeking to improve themselves,” Paul said.
“It’s trying to embed a culture of continuous quality improvement and ensuring that every day is better than yesterday. It’s the small steps that get you there. There’s a focus on quality in care as well as all our processes.
“We are constantly challenging what we do and looking at how we can improve it. The Greensleeves Care of today is vastly different to what we looked like and how we operated six years ago when I arrived. It’s about getting everyone prepared to take risks. As long as you assess that risk and you still think it’s safe, then crack on and do it. You might get it wrong but at least you tried.”
The Greensleeves Care boss said there was no single formula for outstanding care but added the role of the registered manager was key.
“A lot of it comes down to the drive and ambition of the local manager,” he noted.
Of its three outstanding homes, one manager has been with the company for 24 years, another 10 years and the other has been poached by a competitor.
“Both of our outstanding managers are keen to look at new ideas and innovation,” Paul said.
“They are constantly rearranging their home, trying out new things. They are always wanting to do better for their residents. It’s about culture and behaviour and the role modelling they give to their wider team and people being made to feel part of a team and the vision for the home. It’s homes with direction and momentum that get there.”
As well as its overall outstanding home, the provider also recognises its homes with one outstanding KLOE to provide a further incentive for them to go one better.
Greeensleeves Care also shares its resident and family feedback with Your Care Rating which helps the provider gauge how it is doing across its portfolio as well as how it performs against its peers.
eLearning enables the provider to help staff at acquired homes hit the ground running by allowing them to begin training before day one.
The provider’s training team provide the biggest input during the onboarding process, spending time going through a full induction looking at values, behaviour and checking their training metrics are up to date and ensuring they are not going to fall foul of CQC.
“People like the fact we are a charity and know that any surplus income we generate goes back into the services,” Paul said.
The charity established its Centre for Quality in 2015.
“We have a couple of working programmes where we bring together different staff groups to look at different areas,” Paul added.
“The first one we did looked at activities and community engagement. About 12 of our people got together and developed a manual new activities co-ordinators can be given to kickstart them on their journey.”
Cooks and chefs from each of the services come together for two days each year to share best practice. Greensleeves Care also has a learning stream on end of life care in association with the Royal Trinity Hospice in Clapham.
“We take the time to make sure we make the most of the fact we have become a group of care homes,” Paul added.
During the first six months following acquisition, Paul said it was also important to give homes breathing space to be allowed to embed into the organisation.
“We generally have a policy when we take a home on unless there is anything which needs addressing for safety reasons to leave them alone for six months and let them adapt and get used to us and us get used to them because they might be doing things better than we are and there might be ideas we can adopt and transfer to the other homes,” the CEO said.
“It’s a very devolved organisation, each of our home managers will put together their own annual business plan and we will consolidate it at the centre and make sure it all adds up and we are heading in the right direction. We give great autonomy to the front line and particularly the home managers.”
Managers are welcome to visit each other’s homes and learn from each other.
Staff are also thoroughly trained in the charity’s culture and care values with 19 out of its 24 homes accredited with the Eden Alternative care philosophy.
Nineteen out of Greensleeves’ 24 are currently Eden Alternative accredited.
“We like it because it’s about creating vibrant communities and enabling older people to thrive and fulfil their ambitions,” Paul said.
“We reject the sentiment that older people are on a downwards trajectory when they enter a care home. We have lots of residents doing lots of crazy things such as learning to drive and parachuting in later life. No matter how old or frail you are, there are still things you want to achieve in your life and consider important to you.
“What we do through Eden is try to get that out through people and fulfil those wishes. It’s not just about the residents. The pay-off is also with staff too. Rather than having this task orientated approach to care, the residents are suddenly people who you are chatting to about what they want to do. That’s as much as why our staff turnover is lower because we treat our residents as friends who we want to help. Eden makes a vibrant and lively home in which to live and work.
“80-90% of our residents are female and have spent their entire life looking after other people and all of a sudden they are being looked after and some find that really uncomfortable. We encourage residents to care for each other. We will get people in the kitchen who love cooking and carry on doing the things they used to do. We have a resident who used to work in the hospitality sector who sets up silver service on the tables on a daily basis and that’s their job; it gives them fulfilment and they enjoy doing it for themselves and others.”
The outside community is encouraged to come into the home through toddler, school and community groups.
Community integration is also furthered through the homes’ dementia cafes and a peripatetic Admiral Nurse.
“Most of our existing homes have been around for years because of the WRVS legacy,” said Paul.
“They were run by local committees so they are very much perceived as part of the local community. We still have lots of volunteers involved in all of our homes. We frequently have volunteers who end up being members of staff. Because we have that word of mouth attracting people, recruitment is not as hard as some people make out. There are a lot of people out there who want to know they are making a difference and are part of something bigger.”
In the challenging funding climate, Greensleeves has achieved a sustainable private and local authority balance. Private fee payers account for three quarters of residents with local authority accounting for the remaining quarter.
When asked for his thoughts on the future for social care funding, Paul pointed to the Japanese model that has successfully taken politics out of the equation through establishing an independent insurance system whereby the over 50s contribute to their own care costs.
The insurance fund is managed by apolitical trustees who decide how much contributions need to change to meet future needs.
In terms of technology, Paul said eLearning helped monitor compliance with training requirements.
The not for profit uses the Caresys mobile electronic planning system and has begun trialling acoustic monitoring in two homes.
“We are going to run both at the same time and see which works best for us,” Paul noted.
Greensleeves Care also uses Tovertafel interactive tables in its dementia homes and is installing Wifi in all its properties.
Looking ahead, Paul said Greensleeves Care would continue with its steady growth strategy fuelled by its solid financial footing.
As well as one home opening later this year, the provider has another in 2020 and a further two in 2021. Going forward, Paul said the Greensleeves Care strategy was to acquire an operating home each year along with opening a brand new home every other year.
“Our strategy is about extending our charitable impact and helping as many older people as we can for as long as market conditions allow us to do that,” Paul noted.
The chief executive said Greensleeves Care had no plans to diversify into retirement or assisted living and would stick to care homes because that’s what it knew best and was where its strength lies.
While the challenging operational climate threatens the future of many of its competitors, led by Paul’s prudent management, Greensleeves Care looks set to continue to go from strength to strength.