Speaker1: [00:00:00] Hello, I'm Suhail Mirza, and welcome to this episode in season three of Voices of Care. My guest today is Andrea Kinkade, CEO of Lifeways Group.

Speaker2: [00:00:09] Voices of Care. The healthcare podcast.

Speaker1: [00:00:13] Andrea, thank you very much for coming to join us on Voices of Care. It's a pleasure to have you here.

Speaker3: [00:00:17] Thank you for inviting me.

Speaker1: [00:00:19] It's such a topical issue at the moment. If you look at the press with new government social care. Well, certainly in the election it was quite prominent. I mean, since then. We'll come on to that, I think perhaps less prominent. But can we, with your help, unpack that a little bit? Because social care, normally when people think about it, they associate it with elderly care. Now, Lifeways Group, 30 years I think next year, establishment. Give us a bit of a scope around what Lifeways does because it's a very specialist part of social care.

Speaker3: [00:00:49] Yeah, it is. And I think it's really important to segment it because otherwise we're not personalising the delivery of care that we offer. So Lifeways started in 1995. We have three divisions. We have supported living where people live in their own homes with their own front door keys. We have a mixture of services that provide care and support across England, Scotland, and Wales. So it might be a combination of their own flats or flat schemes or their own homes. We have the residential division, we have about 53 homes across the UK.

Speaker1: [00:01:33] And that's led by Karen Jones, who I think was involved in the All Wales strategy. So huge, huge initiative there.

Speaker3: [00:01:39] She absolutely was. And she was also involved in transferring a lot of the people that we still support into Lifeways from that. So she's on our senior leadership team now. so she has a wealth of experience. And then we have our mental health division, which supports about 500 people as well. So that's that specialist complex mental health. Overall, we provide care and support to about 4500 people, and we're employing about 9500 people. So yeah, quite, quite broad. But it's really important to understand the differences because when we talk about health and social care, obviously by far a lot of that is NHS. But social care actually employs more people than the NHS. You know, we employ 1.6 million people in the sector. And within that framework we've got elderly care, which is entirely different provision than working-age adults.

Speaker1: [00:02:49] And the people that you're supporting are people, as you say, working adults with a range of complex needs. I think that's the key is it's learning disabilities. Autism.

Speaker3: [00:02:59] Yep. Other neurodiversities. And complex physical circumstances as well. So it's a very, very broad range of people. And there's a very great mix of what we're doing to try and support people. So some people, we want to help them achieve greater independence so that they can move on. And at some point in their lives, they won't need support from a social care provider. But given the complexity of people we support, there are also lots of people who will always need some degree of support. So it's about how do we enable them to have the most independence and the most choice and the most opportunities, given their unique circumstances. And I think the uniqueness is the key, we have to be able to personalise and treat people differently. So even within Lifeways, when I came in, we had one chief operating officer who looked after, essentially was responsible for the care delivery of everyone that we support.

Speaker1: [00:03:57] Over 1500 sites or the whole gamut.

Speaker3: [00:04:00] Yeah, exactly. And actually, when you look at the mental health provision, that's really a re-enablement service, you know, supported living and residential are more closely aligned. But they have their differences. So we wrap around the support functions, the governance, all of the business function if you like, to make sure that each of those divisions have what they need. But actually then what each of the MDs do is refine what they're delivering within the subset within the business. And so if you take that as a principle, that's why I believe we really need to segment the sector. There's lots of things we can do together. There's lots of parity. There's lots of opportunities to collaborate. But we do need to understand that social care is not everybody with everybody's needs.

Speaker1: [00:04:50] No. And as you said, you pointed out, I think LaingBuisson, who produced great insight into the sector. I think characterised the area that you're working in as the specialist. Specialist care. I think 3 billion plus. The market size of supported living. Complex home care, etc.. And in the residential, just very briefly, you've got a range of people that you support and sometimes needing 24 care.

Speaker3: [00:05:14] Absolutely, yes. Extremely complex. And I think when I first came to work in social care, since then, the complexity of the care needs we do meet well has really increased. And I think that's a really good thing, because that's how we take people from institutionalised settings or being stuck in inappropriate placements or in hospitals. So I think it's right that providers do that. I think providers need the recognition for doing that and how that can unburden other parts of the system, which leads us onto all sorts of other things around funding.

Speaker1: [00:05:53] Which we are absolutely going to cover. And just very briefly, I think August '22, you joined Lifeways if I've got that correct. But you've had many, many years of domiciliary care, learning disabilities. Bit of a destiny with the sector, I think, from your perspective.

Speaker3: [00:06:09] Yes. I mean, like lots of people, I kind of fell into it by accident. And I think I'm unique there. I worked, I've worked, I set my own business up at 23 years old. I've worked in retail, education, women's health. And then I went to work for a company where they really wanted somebody with external experience into their business. And actually, I was kind of a little bit like, well, you know, I mean, give me the business plan, but, you know, actually, I'm a bit of a softie at heart, don't like seeing people hurt or unwell and things like that. And I also didn't have the knowledge or understanding of what being inside a care home looked like. You know, I didn't have that understanding. And you don't get that picture from how the sector is represented in the media. And so I did go and work there. And on day one I actually went as a mystery shopper, and on day one I literally fell in love with it. And I just thought, if only people knew the good things that go on, the things I saw, the good induction, the kindness, the good care, happy people, you'd be able to take a lot more of the fear out of the sector.

Speaker3: [00:07:19] So I was kind of hooked. Since then I have run specialist services always, mostly adults with learning disability, but I've also run children's services. The only area I haven't ventured into is more elderly care. And not because there's anything wrong with elderly care, because it's absolutely intrinsic to, you know, our meeting, our societal needs. Um, but I'm a very kind of up-forward. What can we do? And I think there are other people better at delivering elderly care than me, because I find it a little bit sad. I think it's just, it's a different focus and it's a really important focus. But I kind of really believe, you know, people are much more capable of doing more than they ever realise. And I think the thing I love about working-age adults and children is what can we do despite the challenges you've got, despite the challenges we have in the workforce, in the sector, because of all of the stresses and strains that we know about, but what can we do rather than what can't we do.

Speaker1: [00:08:30] In a personalised way that allows people to have the independence and dignity of living the way that they want to.

Speaker3: [00:08:35] Absolutely. 

Speaker1: [00:08:36] Just panning the camera back a little before we go into some of the detail is that obviously we're in a new era. There's a new government. I just wanted to get your sense check at a very high level around the sector. As I've said, that the conversation seems to have gone a bit quiet around social care. It's a really important time in terms of the watershed, to understand the role that social care plays in the whole ecosystem, specialist and the more traditional home care and residential care.

Speaker3: [00:09:09] Well, I mean, I think, you know, we kind of welcome change. I think we'd just like to know what that change is. And at the moment, I think what we're going to be met with, what we are to expect is a bit slow in coming. So I'd like to see that speed up a little bit because, you know, we have to continue planning. We have to continue business as usual. And we know that the public purse is going to be squeezed. And, you know, we know that providers inadvertently are, you know, subsidising if you like, the sector because we've had, you know, we're not getting inflationary level, fee increases and things like that. So we need to find other ways of making the care pound go further.

Speaker1: [00:09:59] And that's an imperative. I mean, you've got a very, if not unique, a really quite distinctive vantage point, because I think if my memory is right, work across 165 local authorities, 40, 45 plus trusts, something like this, it gives you quite a unique view around what's needed. And I wanted to spend some time thinking around with your experience, Lifeways' speciality. And you wrote a letter to the new government in July highlighting a few key areas that actually you felt could turn the dial to allow providers to flourish and prosper. One of the first ones was hospital discharge. It's a specialist area and maybe mainstream people don't understand, but I think you said that this could or should be the first parliament in which we see the end of long-term stays in hospital. That's quite important because it clogs the system, but it requires recognition of the sector's role.

Speaker3: [00:10:59] It does, and it requires us to have a voice at the table. And I think, you know, to be fair, I don't think I'd be alone in thinking that, you know, with the ICBs and the ICSs, the social care element was still not represented. So a lot of change that comes out is either for the benefit of the NHS or, you know, or to their advantage. And again, there's nothing wrong with that. But, you know, look out of a different window and you get a different perspective. And we know that, you know, the easy answer is we want more funding, but we have to be realistic. And so I think in terms of getting people out of hospital, there's two elements. One is recognising the expertise of the social care sector that we can deal and support quickly with people with really complex needs. By doing that, we're relieving the pressure on primary care services. You know, we've got hundreds of examples where not only bringing people out of hospital, but also keeping people out of hospital, keeping them well in their own homes, which means they don't have to rely on the ambulance services and A&E and going backwards and forwards and look at the impact that has on people's lives when they've got consistency of care and continuity and they're staying in their own homes. We've got one example of a new service that we opened last year. It's absolutely incredible. It was developed in collaboration with local authority. It was too long in the concept. I mean, ten years so well before my time.

Speaker1: [00:12:33] Patience is a virtue they say.

Speaker3: [00:12:34] It really is. It really is. But that said, it's happened, it's opened and it is really fantastic. So it's five bespoke services bungalows. And I went and visited and I went and spoke to one of the people who had moved in, and I said, you know, how does it feel to have your own home for the first time, having been in hospital and in institutionalised settings for very many years? I think she was about two years in an institutionalised setting. And she said, well, finally, I've got my own voice. And you just think, well, you know, that's what we get up for in the morning, isn't it? But equally, you know, we have another gentleman in the same service. He was 17 years in an institutionalised setting, and therefore he just didn't have the confidence to move on. So the team worked with the local authority. And gradually he developed the confidence to move out. And now he's living there, accessing the community, doing things that he's never been able to do. And, you know, we're talking about personalisation, person-centred care. If there's a better example, I don't know what it is. But equally, actually, if we work in partnership with our funders, with the NHS, actually we can push that cost out elsewhere. So it's not just about where does the funding come from? It's also where can other agencies, if you like, spend their money.

Speaker1: [00:14:06] You get more return.

Speaker3: [00:14:06] Exactly. So, you know, I think there's still just a huge gap between recognising what the social care sector has to offer and how they can truly get the costs down of primary care services.

Speaker1: [00:14:21] And just to touch again on that, because I completely agree, and I think you've highlighted that you mentioned ICBs, ICSs. Now they came into being in a statutory form pretty much around the time you began at Lifeways around that summer of '22. It's two years hence. I mean, it's a bit disappointing. Actually, you're not the only one who said that. Where you've got representation, but the specialist sector, social care. We're still not seeing that as business as usual in terms of representation. Why do you think that is? Is it just embedding? Because it seems like a huge gap.

Speaker3: [00:14:56] I don't know why it is. And I think I believe on one of your previous podcasts, it was actually mentioned as well. I mean, I have we've got to have social care is seen as the third wheel. You know, everyone's a professional, but actually, the way we're regulated and the way we're funded almost feels a little like, well, we're kind of bottom of the chain. And perhaps you may not know as much or have as much experience or whatever it is. I don't know what it is, but I think in the same way that we want parity for support workers working in social care, as with the NHS, we need that for the service managers and leaders in the business as well. There's an entirely different approach. If you go into hospital, you know, it's episodic, it's transactional. When you're in a social care community setting, you're working with people to, you know, on the good days, on the bad days, when it's sad, when it's hard, when they're sick, sadly, when they die. You're asking an awful lot. So the knowledge they have around people individually in the service level is huge, absolutely huge. And so we've got to get to a point where that's understood and respected, so that when we're saying, look, this is how something needs to work, it's understood. If you take Oliver McGowan training as an example, you cannot question the principles of it. Absolutely right. But it came about from a tragedy in hospital, in the NHS. And therefore the design of how we support train people was driven out. We've been doing that kind of work to a professional standard within people's homes for years and years for lots of people. And, you know, so that's a really good example of where had we come together, we could say, okay, well, we're all on the same page. We all want to achieve the right thing, but we all need to do it slightly differently because we're in a slightly different place.

Speaker1: [00:17:07] Well, well you're right. Previous podcasts have highlighted and I'm hoping, I think we all hope that the right people are listening to make sure that representation is effectively a default position. You used the famous F word a number of times with funding. I want to clarify that, and I want to just touch upon that because obviously it underpins commissioning. How important is that? Because it touches upon all aspects. Talk about commissioning because you have the same pressures as all the other providers, because fair funding is vital.

Speaker3: [00:17:43] Yes. And I think it's easy to forget that independent organisations are also being funded from the same pot as not-for-profits. And again, when you're looking at social care as a whole, that's quite often very different from elderly provision. So we're all we're all working in the same field trying to deliver the same thing. And we know that the funding is a struggle, and we understand that local authorities and health have all the same pressures. You know, we understand that. So of course, the easy answer is we need fair uplifts. And I think I think we do. I think we do have to fight for parity for our support workers, because we can't compete forever against Amazon, against the NHS. And when public sector workers are given a 5% pay increase, we're not funded to be able to give that uplift. So when we link that to recruitment pressures in the sector, you know, we need to think about those things. But also we need to look at okay. So again you know if we take a one-team approach how are we going to improve social care and make the resource go further. And I think there were a number of ways that we can do that. So for example, our regulators expect us to have a registration, an office for each registration. But we've all moved on. You know, we're either working from home or we're in services, but we're digitising. You know, we're investing an enormous amount of money in electronic care planning, electronic rotas.

Speaker3: [00:19:27] We've got really detailed technical, digitised governance. So we've got great transparency over services. We don't need all the offices that we've got. And it doesn't help our ESG either you know. So it's just not relevant anymore. So actually providers of our size, for example, could save an awful lot of money that could be reinvested back into the business if we weren't paying for offices that have to have a laptop. I don't want managers sat in offices, I want managers being in services and being hands-on and doing what they need to do. I think another area as well is the perhaps slightly more controversial. I don't know what other people's views are, but the registration of six in, in registered care homes, you know, we're told that demand continues to outstrip supply, but we have vacancies. We have six-bed services that actually are ten beds, but we're registered for six, where at some point can we... if we go back to that kind of respect thing and the trust in, you know, we're all professionals. We all turn up to try and do our best to deliver great care. We don't all have best days, you know, but we try our best. And actually, when we're looking at services that are larger than six, if you look at outstanding outcomes, they're usually of services ten and above. I believe that actually having services larger than six.

Speaker3: [00:21:03] And that's not saying that you couldn't have two-person, four-person, six-person services, but when you've got services larger than six, you've got a larger staff team. You can actually cope with the bumps in the road. Like, you know, people go down with flu or whatever it is, you've got a wider pool to work from. And actually, I think again, are we providing what people want or are we saying what we think people want? And I don't think we should presume. Certainly for a lot of young people transitioning out of schools, they don't want to live on their own. You know, actually having your own front door key can be quite isolating. And, you know, I certainly look at my own grown up sons, for example, they can't afford to have their own front door key. They are absolutely all flat sharing with people because that's the reality of life. So I'm not saying there's a right or a wrong way, but I am saying does it work for that person? And if it does, then let's be a little bit more flexible, you know, and if families are involved in decisions about where their sons and daughters want to live, if people are involved in their decisions about where they want to live, if they go and visit a service that's larger than six and they don't like it, then fair enough. They don't like it.

Speaker1: [00:22:25] Yeah, well, I think that's going to be a question, I think, of policy and regulation, and I just want to touch on the role of regulators, because one of the things that you called for, interestingly, was more resource for regulators. You know, you deal with regulators across the UK. Can you just expand upon that? Because that role is really, really important, particularly from the regularity of assessment.

Speaker3: [00:22:48] Yes. And so we know the challenges that CQC are facing. I'm not saying anything that anyone doesn't know. And actually I don't think you'd find a regulator who doesn't welcome regulation. We all want to raise the standards of care. But again, we have to do it together. You know, if the funding doesn't come or the regulation isn't working, it's very difficult for providers to do that. So we have to do it together. And I for one, when the single assessment framework was announced, I was actually really for it because I thought, oh, you know, this is going to keep us all on our toes. You know, actually, if something goes wrong, it's identified, fix it, evidence it, move on. Not having years of our eyes or negative ratings, which have all sorts of big implications, big implications. But obviously we find ourselves now where it hasn't worked as well as we would have hoped. Of course, you know, I hope that CQC can get their changes through that they want to make. And as a regulator, as a provider of scale, we're absolutely there to support in any way that we can. But we need inspections. We need inspectors. You know, when you're looking at your overall quality metrics, if we've got RIs that haven't been rated for five years, you know, that's not a fair reflection of where the business is at. And I do think that when we're looking at a risk-based approach, we're not looking for and celebrating good, we're not driving standards up.

Speaker3: [00:24:25] If there is risk, of course, that needs addressing. But how do we drive standards forward if we're only focusing on what might be wrong? So I think that, you know, I'm really pleased to hear that CQC are trying to inspect up to 5000 registrations before March. I hope that happens.

Speaker1: [00:24:46] Fingers crossed.

Speaker3: [00:24:47] Fingers crossed. Because I think the actual intention of agile assessment is a really positive one. I was interested to see Ofsted commentary the last couple of days, removing the one-word outcomes and things like that. And I wonder if, if that will impact CQC and their decisions going forwards because I think it is very hard for managers to sit with a requires improvement on them for too long. You know, it's harder and harder to recruit managers. They've got a lot of personal responsibility and liability. And I think we owe it to good managers who have addressed issues and improved services to re-inspect them quickly and put the service back where it is. It has a knock-on effect on families or funders, on recruitment, on retention, you know. So I think that in terms of resource for CQC, we would just like to see a closer working relationship, like the days you could pick up the phone and say, this has happened, what do you think we should do? You know, let's resolve it quickly.

Speaker1: [00:26:06] Well, I think collaboration is something that's a theme that's come out a lot. Hopefully, through the CQC transformation, they'll have a chance to speak with providers. I wanted to touch upon just very briefly, I think you're the largest supported living provider. And obviously we've talked about your other specialisms in mental health and residential, but there's a growing trend for people to use supported living as the environment of choice. That's going to require a workforce that's ready to deal with that. And just very briefly on workforce, the numbers are very clear. We need huge numbers increase, can't rely on international recruitment. So we're going to need to re-envision the way we train and use digital formats to train people to the levels of proficiency.

Speaker3: [00:26:55] I completely agree, and I think this comes back to the professionalisation of the sector and also recognition of the complexities that we're asking people to deal with. They can deal with them, but they need the training and the support. When you look at first-year attrition in terms of recruitment, I think a lot of it comes down to were people confident in the role, you know, and how do we increase that confidence? We've actually done a lot of work this year on changing our induction, changing how we shadow, looking at what additional training we could provide people so that they do feel supported and confident in the service because you know you have a bad day and you're not equipped with the skills. That's likely to drive people out of the sector. And I think it's a shame that we've heard already that the level two certificate is not going to be funded. And I think what it does is actually show that providers, again, need to find solutions with very little in the tank. And we are able to do that. We are innovative. We try different things. We look at different ways. And for us, you know, we're increasing team leader training, coaching programs, area manager support, service manager training. And actually, we've just set up a sort of talent academy for senior leaders as well. So we're really keen on getting that bench strength throughout the business.

Speaker1: [00:28:32] Because leadership is vital in any sector, but particularly in the specialist sector.

Speaker3: [00:28:37] Yeah, absolutely. So I think, you know, we've got to build confidence. I think we've got to invest in training. We've got to recognise why we need the training.

Speaker1: [00:28:48] Absolutely. And one final point I wanted to come on. You've spoken a lot about collaboration, the roles of regulators and governments. And I think one of the key points you called in terms of to the government was the recognition of the role of the independent sector, because you talked around there being divisive rhetoric around for-profit, not-for-profit. Can you expand upon that? Because the for-profit provision has been around for decades, and it seems to be odd that people are still not really accepting of that.

Speaker3: [00:29:21] Yeah, I think it is odd. I think, you know, I'm a bit of a change agent. I love a bit of change. But I also think if it's not broken, don't fix it. There is no reason why we can't work collaboratively. I believe that in the specialist market, about 9% are not for profit. So if you're really against not-for-profit, what are you going to do with the other, you know, 80, 89, whatever it is, you know, you can't just suddenly change it. If we look at examples in the NHS, you would not know quite often that you're using a privatised service within the NHS. I've been there, you know, and I think what they do differently is, is efficiency. Your form will be sent to your house before you get there. You'll be fully prepped before you get there. You sign in, you do whatever you need to have whatever procedure you're having, and then you go home again, all under the banner of NHS. But it's not NHS. It might be a private scanner or whatever it is.

Speaker1: [00:30:24] You support 45 NHS trusts.

Speaker3: [00:30:26] Yeah. And particularly diagnostics, you see it going that way, which I think is good. If we can speed up the system, that's what we need. And I think the same applies in social care. You know, for us, we've invested £9 million in improving our buildings. We're investing in digitisation of care plans and rotas. We're investing in training people. So where, you know, I think the only way we can do that is by being cleaner and smarter and agile. And that's not a reflection that NFPs don't do that at all. It's just that we have to look at things slightly differently. But we're all fishing in the same pond in terms of funding. We don't get a pot of money that somebody else hasn't got access to.

Speaker1: [00:31:14] And Mr. Streeting, I think, has been on record as saying that he's encouraging private investment. So maybe there's some hope around the rhetoric changing there.

Speaker3: [00:31:24] I hope so, yeah, absolutely. I don't think there's a need to distinguish. I think it's a red herring.

Speaker1: [00:31:31] And in terms of the future, what gives you the most excitement in terms of Lifeways? Because 30 years, next year you'll be celebrating where are the areas that you're particularly focusing on in terms of the next 12 months?

Speaker3: [00:31:44] So for us, we really have gone through a complete transformation. So, you know, Lifeways is a large organisation. We've gone through a process really of integration. So revamping all of our systems, investing in property, investing in tech. I think we've done a lot of transformation in a very short space of time. We've got a fantastically agile team and a very competent team. There's two things that kind of make me feel happy to get up and go to work. One of them is, given the scale of change that we've put into the business. You know, people quite often are fearful of change. But at Lifeways, I think people have been ready for it. And so, you know, I might go into a service and say, look, I know there's a lot of change and it's not always comfortable for everyone. And people just say to me, no, Andrea, we need it. And we want it. You know, if I'd have known how happy putting electronic rostering into services was, you know. My goodness. Yeah. So I think on the one hand I really, really welcome the approach that everyone in the organisation has taken to the change that we've been putting in and we've done it quickly. And really that transformation programme will essentially be finished at the end of this year, beginning of '25. And then as a team, we've always said and then we want to put the icing on the cake, you know. So we've got a solid clean operating platform. We've got great transparency over governance and performance. We've invested in people. We've done all the things that we should and must do. Actually, I think the following year for us will be. And now what can we do? What can we really do to add value? What can we really do to shake things up and drive up the quality of care that we deliver?

Speaker1: [00:33:43] I'm going to request that you come back and let us know how you have added that icing on the cake.

Speaker3: [00:33:47] I would love to. Thank you.

Speaker1: [00:33:49] In the meantime, thank you, Andrea Kinkade, for sharing your wisdom and your candour. It's been a real pleasure.

Speaker3: [00:33:54] Thank you.

Speaker1: [00:33:55] Thank you. If you've enjoyed this episode of Voices of Care, please like, follow, or subscribe wherever you receive your podcasts. And if you want to learn more about how we're turning the dial on health and social care, please visit newcrosshealthcare.com/voicesofcare. In the meantime, I'm Suhail Mirza. Thank you very much and look forward to seeing you on the next episode.

Speaker2: [00:34:15] Voices of Care, the healthcare podcast.