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A day in the life of a CEO in adult social care

Dan Hayes CEO of The Orders of St John Care Trust (OSJCT)

The Orders of St John Care Trust (OSJCT) is one of the UK’s leading not-for-profit care providers. OSJCT provides care, support and housing to residents and tenants across 61 homes and 8 extra care housing schemes throughout Gloucestershire, Lincolnshire, Oxfordshire, Suffolk, West Sussex and Wiltshire. This includes specialised dementia, intermediate, respite, day care and expert nursing, including employing its own specialist dementia nurses, Admiral Nurses. 

OSJCT employs approximately 3,600 permanent staff and 500 bank staff, attracts 500 volunteers and assists more than 3,000 residents and tenants

Their compliance with the regulator, Care Quality Commission, is 89%, placing OSJCT in 5th place out of all larger providers, and approximately 10% above the all England average.

We get a glimpse into a day in the life of Dan Hayes, CEO of OSJCT, as he runs through an average day on the job which includes the balancing act of leading an organisation in a volatile environment, visiting one of their care services and his musings on the future of social care.

My day starts with the first port of call on the organisational dashboard. This is a mixture of data and direct communication with colleagues. Pressure in the sector and therefore the Trust means that reviews of occupancy, agency staff usage, COVID 19 prevalence, and working capital, are daily requirements. Although we are a registered charity, less than 1% of our income comes from legacy or donation. At a time where government funding has been withdrawn except for the provision of PPE, but the impacts of the pandemic are still being widely felt, the financial navigation of the Trust is paramount. We’re strongly supported by our bank and thankfully have little/no borrowing, so we are in a good position to make decisions about what we will and won’t do to support the good health of the Trust. In our case, this has meant that we can maintain our level of investment in transformational initiatives such as E-Care. Because of the volatility we are all experiencing, we have to have a  plan B, and even a plan C of what we might need to do in the next 6 months if there’s continued disruption.

Monitoring of our internal Quality Assurance framework and Early Warning Tool coupled with insights gathered from spending time within our services, allows us to track the progress of our care quality and assess the experience of those that live with us. Pressures in all parts of the system means that a constant focus on standards is required.

Next are occupancy levels and the split of the type of individuals in our care. Running such a large organisation means that people are moving in and out daily. They could be with us for respite stays, or because we are supporting the health sector with discharge or other short-stay rehabilitation. Other people are moving in with us permanently, and then we monitor the split between publicly and privately funded clients. The balance changes constantly and we regularly monitor it to understand what is going on at any given time in the organisation as it is vital for planning, resources, staffing levels, agency needs, risk analysis, reporting to the regulator and so on.

Occupancy has dropped by 6% because of the pandemic and we’ve seen a significant change to our typical resident profile, with more residents staying for a shorter time, or arriving with more complex needs. We’ve had to change our long-term business plans and forecasts as a result to address many of the current challenges we are facing which have now become the norm. In addition, we’ve lost a significant number of our workforce, with a 38% turnover, therefore recruitment and retention is an ever-pressing issue. My permanent colleagues are working harder than ever before in terms of the intensity of their workload. Our agency spend is substantial and has gone from being £200,000-£300,000 per month to well over £1million. This position is unsustainable in the longer term both financially but more fundamentally from the point of view of resident experience. Our substantial efforts to address this challenge include increases in reward, wellbeing support, and a push for overseas colleagues to join us. Progress is being made and we are seeing some improvement week by week.

Regulation is a constant backdrop. We are regulated by the Care Quality Commission and local authorities.

I visit our services regularly to experience what is happening on the ground at the point of delivery. This provides helpful insights and observations that are not possible to ascertain at distance or from data.. Most recently I worked in the kitchen and the housekeeping team at one of our Lincoln homes. I was amazed at the team’s knowledge about each person in their care. It reminded me that although often unrecognised through qualification or reward, social care professionals across the sector possess skills and abilities which are the match of their colleagues across the NHS. In addition, the relationships formed between my colleagues and those in our care play a much bigger part in the person’s wellbeing and sense of belonging, than any course of medication.

This aspect of social care is invisible to most people. Even after 20 years in the care sector, it still impresses me.

I’m delighted that the vast majority of the residents and loved ones we provide services to, do see the wonderful care being delivered, and are quick to praise those involved. This provides energy and motivation whenever it is given.

I don’t think it has ever been more difficult to operate a high quality care service as it is now, but equally I have never been more certain of our importance, more proud of the contribution we make to our communities, nor more optimistic for our future.

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