Stephen Stewart, HR & Operations Manager of Northern Ireland nursing home developer and operator, Wood Green Healthcare Group, talks to SCP.

SCP: Could you tell us about the history of Wood Green?

SS: At the moment, we have one 81-bed facility catering for both residential care, across two floors, and nursing care on another floor.  Wood Green is a fully registered home providing specialist dementia care to our 81 residents. In terms of where we started, Wood Green is privately owned by a local family whose main priority is providing a high level of care to our residents and enabling them to feel at home at Wood Green. For the first two years, there was a service provider managing Wood Green, until about two-and-a-half years ago, Mark Donnelly, who built the home, decided to oversee its day-to-day management. Since overseeing the day-to-day operations with our own management team, Wood Green has grown to all 81 beds being occupied with a long and active waiting list. So that’s our current home and we’re just in the final stages of launching our second. This will be Willow Tree Lodge which will have 18 beds across three floors. The home will cater to people with acquired brain injuries and mental health and physical disabilities. It will have four self-contained apartment-style rooms with kitchenettes on the ground floor, followed by two floors of
7 large en-suite bedrooms. We’re a successful care home provider in Northern Ireland, and we’re starting to expand and wish to become a leader provider within the healthcare sector.

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SCP: You spoke about your high occupancy. Did this take a knock during COVID?

SS: No. During the first outbreak, we managed to contain the virus and then in January 2021 there was an outbreak and we lost five residents. Since then, thankfully, everyone has been vaccinated and boosted and we’ve not had any residents pass away. So we’ve not had much of a knock-on effect in terms of occupancy. I think it helps that there is a backlog in hospitals and there is a huge need for care homes and providers at the moment. But the demand outweighs the supply.

A dining room at Wood Green care home

SCP: How are your residents funded?

SS: They are mainly funded through NHS Trusts. We have maybe two or three residents who are privately funded, but the majority are Trust-funded with additional top-ups paid by the families on a weekly bases.

SCP: What is the fee range of the home?

SS: It’s around £685 per week for a residential bed, and for our nursing fees its £885 per week. That’s inclusive of our top-up fees.

SCP: What is your view on the current funding system in Northern Ireland?

SS: It’s unlike most private sector businesses where you can push the costs onto your customers. We’re restricted by what we can charge, so this needs to be looked at in greater detail as to how we can cover all our costs because wages are going up and energy bills are going up. Agency staffing is one our major concerns right now. They just pick a fee that they feel they can charge us and we have to keep that cost up. It’s several times the normal salary, so when you have agency staff members working alongside our own members of staff, it creates disparity and envy. There is then a temptation amongst our staff members to think ‘why should I remain a full-time member of staff when I can go and work for an agency?’

SCP: Do you see yourselves moving more towards private pay?

SS: It’s something we may have to look into. But then, at the same time, you have to justify why one resident who is Trust-funded is paying a reduced fee and another that is privately funded is paying more.

SCP: Are Northern Ireland nursing homes largely Trust funded?

SS: Yes, the majority are. We rely heavily on their fees and their guidance and what they charge. We do have our top-ups, which we can set at our own rate, but we have to keep them competitive with other homes. The private side of the market is pretty immature and it’s looking to grow.

SCP: You mentioned staff vaccination. How has that been dealt with in Northern Ireland?

SS: At the moment, it’s not mandatory for staff to be vaccinated. There were concerns with a lot of staff members when we heard the news in England about this, but the majority of our staff have had their vaccines and their boosters. The current guidance in NI is that if you have had two doses of the vaccine and your booster you can return to work after five days of isolation, provided you have had two negative lateral flow tests. However, if you have not had all three vaccinations then you’re required to isolate for the full 10 days.

SCP: How many members of staff do you employ?

SS: We have around 90 staff, including kitchen, domestic laundry and nursing staff. We have our managers on top of that, so probably around 100 staff on site.

SCP: How well were you supported by the regulator, government and healthcare bodies during COVID?

SS: It has been pretty good and beneficial in terms of the supply of PPE – it’s in abundance at the moment – and vaccinations. NHS Trust staff would come in and administer the vaccines to residents and staff, so it was all pretty effective and slick. When we had an outbreak, the COVID team would come and test all the residents and break the spread as quickly as possible. We would also receive regular updates from the Trust in terms of the guidelines. So, on the whole, it’s been positive.

Wood Green specialises in dementia care

SCP: How have you managed to keep residents in touch with their loved ones?

SS: It’s been tough. In our current home we have an activities coordinator and an activities team so they were largely involved in that process when the families couldn’t come and see their loved ones. So in the first stages of lockdown it was all done via Zoom and then as we moved out of it, we were able to organise socially distant visits. At the moment, we have a booking schedule so family members can come in and visit. We also have the care partner scheme, for residents that need a little bit of extra assistance or support, then a designated family member can come in and have that close contact with them. We are about to move into the third stage of our visiting pathway in Northern Ireland, which will allow more visits and a reduction in control measures. I think the residents have found it tough not being able to have that time where they would see their family members and the only faces they were seeing were the care assistants, so the sooner we get more families back into our home the better.

In terms of infection control, visitors still need to wear masks and regularly sanitize their hands. Our care partners need to do PCR tests every week prior to coming into our home and our visitors are doing lateral flow test twice a week. We do currently have an outbreak at the moment and at our last testing round everyone tested positive on the nursing floor, and we haven’t reached that 10-day marker yet. Our residential floors will be out of the outbreak soon, once the deep clean is done, and our nursing floor will hopefully follow shortly.

SCP: How difficult is the current recruitment climate?

SS: It’s a tricky one. It definitely consumes a lot of my time right now, chasing leads and links and any potential avenue for staff. Staff turnover is pretty consistent at the moment in terms of those leaving. That may be because it’s been a difficult couple of years of working under stress and feeling burnt out. Then we have staff off with COVID and our current team have been amazing to pick up the shortages. So staff might be only contracted to four days but they end up working five or six 12-hour shifts. So, as you can imagine, it’s pretty intense and tiring work. We’re focusing our efforts to generate a bit of awareness out there of who we are and how we can offer benefits like welcome bonuses and retention bonuses. We’ve trained our core staff and that’s kept the residents safe going over the last two years, but recruiting certainly is a struggle right now.

SCP: What is your current level of turnover?

SS: At the start of last year, we had one or two staff members leaving per month and then since September we have seen an increase in turnover. So we’re definitely seeing a trend of staff leaving, whether that’s because they think the grass is greener at another care home or they just want a break from care. We currently have about 18 vacancies across the two homes.

SCP: What percentage of your staff is agency?

SS: We are using more than we’d like at the moment, through no choice of our own. It’s probably about 20% a week. The majority are care assistants but about 10 to 15 shifts are week are done by nurses, which is a pretty high cost.

SCP: Are you recruiting from overseas now that care assistants have been added to the Shortage Occupation List?

SS: We’re doing some overseas recruitment at the moment. In December we recruited two staff members from Nigeria and one from Ghana. We also recruited three nurses who originally came from the Philippines but were working in Dubai. We’ve provided them with sponsorship for three years and they have been a great addition to our team recently. The problem with that though is there is a huge upfront cost for overseas recruitment, but we have to think long term, two or three years down the line.

SCP: What are the main causes of staffing problems?

SS: I would say pay is the main one. Being honest, they are not rewarded enough for the work they do. In an ideal world, we’d offer more in terms of pay, but we are confined to what we can charge our residents, so it’s a bit of a vicious circle. Currently you can move into the retail and hospitality sector and get £11 per hour to stack shelves, but it won’t be as rewarding as working in care. A lot of residents become part of the family here and care staff genuinely build that rapport with them.

A nurse station at Wood Green

SCP: Has Brexit also been a problem for you in terms of recruitment?

SS: We have about 10 staff with settled status from the EU and we didn’t lose any staff to Brexit, but we have seen a reduction in applications, so quite possibly, yes.

SCP: What recruitment channels do you use?

SS: There is a big range of approaches. We’re in contact with local job centres and job agencies and we advertise online through Indeed. The one thing we’re not heavily focused on is social media. We’re just about to work in partnership with a social media team to work on that. There is an instant engagement with social media. If you’re using older processes, by the time you receive an application that person has already applied to four or five jobs. So we’re trying to cut down that recruitment time so there are quicker interactions between us and the applicant.

SCP: Are you trying to get younger people on board too?

SS: Yes, we can offer younger staff an NVQ Level Two and Level Three in social care and that’s funded by the local government as an incentive to drive the younger population to take up a career in care.

SCP: Do you think there are enough qualifications in social care?

SS: There is a lot of training and development that goes on within our home, whether it’s face to face or module learning. But I think anything that can be added to develop that knowledge and provide staff with the best opportunity to do their job would be welcome. We want staff not to just see care as a job they can do for two to three years, but to develop a career and move through pathways. 

SCP: We also wanted to ask you about your experience with Person Centred Software. What is it that made you shift to digital care planning?

SS: We had a previous provider in place, but the system was a little bit outdated. Person Centred Software was more up-to-date and user friendly. I think the staff would agree that it’s easier to use and saves them a lot of time throughout the day. Rather than completing care tasks and filling out paper work later in the day, they can do it virtually, in an instant. So we’re definitely seeing better records and audits and so forth.

SCP: Have you seen an improvement in compliance since switching to Person Centred Software at the beginning of last year?

SS: Like I said, our records are definitely much more in depth and they’re self-contained into one area, so there are no risks of records not being recorded or going missing. So our regulators would now find that our record keeping is one of our best areas.

SCP: What features of the system are particularly useful?

SS: One of the best ones we benefit from is the Relatives Gateway. That gives us contact with relatives and they’re seeing how care is being provided, so that gives the family member input and assures them that the care we are providing is person-centred. It gives family members that connectivity to their family member, and this was particularly useful during COVID when loved ones felt a bit isolated because they weren’t able to visit.

SCP: How easy was the digital adoption process?

SS: With any sort of change, there’s always a wee bit of misunderstanding or push back, but the training offered through Person Centred Software is pretty in-depth and it’s just a case of making sure our staff are as comfortable as possible with the tools we’re providing and how to use the system. What’s good in terms of Person Centred Software is that they are open to feedback, so if there’s something that we’re struggling with or there’s something that might not necessarily be tailored to our care home, we can go back to them and they will come up with a solution for us, or point us into the direction of how to get the best results out of the system.

SCP: What are your short-term growth plans? You mentioned you have another home opening, when will that be?

SS: The auditors were out this afternoon for their first inspection so I’ll be straight over there later to find out the general feeling and how we’re looking. Providing that all comes back okay, we should have our first resident admitted in a week or two. We have residents lined up, but with the type of conditions our residents have, it takes a little longer to move in. We want to make the transition as smooth and enjoyable as possible. So there’s exciting times ahead. There’s been no expense spared and everything is brand new and high-spec. But the owners are adamant that care is the number one priority and it’s the residents’ home and at the end of the day and we’re here to enhance it for them and make it as comfortable as possible. In terms of our residents, they will be younger than in our first home, so between 18 and 65 years old. The likelihood is that they will be Trust-funded, but their care needs are greater so they will need more specialist care. There is a general lack of that type of care in Northern Ireland so we worked in partnership with Trusts to put together a plan for a home that would best meet their needs.

Wood Green’s reception area

SCP: What are the long-term growth plans for the business?

SS: We’ve had brief discussions about where we’re going and what’s next, so ideally, once we get the second home signed off, we’ll start looking at the next project, whether we start from scratch with a new build or acquire other homes.  

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