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Care Markets meets Sandie Foxall-Smith


Sandie Foxall-Smith, chief executive of The Regard Group, tells Care Markets what she thinks the key to good leadership is, the difficulties faced by small-scale operators, and why she is not afraid to put on a pair of rubber gloves and get stuck into cleaning a toilet.

How did you come to work in social care?

I’ve worked in health care for 20 years but fell into social care when I was head-hunted for this job by a blue chip company which knew I did a lot of charitable work.

I’ve always done charitable work, both in this sector and with the homeless, and I’m a past ‘Prince of Wales Ambassador’ for the homeless.

Learning disabilities care is fabulous and I love it. Every day is rewarding, and every day is different. We have 1,100 clients to look after, so no two people, personalities or behaviour are the same. Our work is very challenging, but very fulfilling. I am lucky because I have some fantastic staff and we’ve achieved a huge amount in the nearly five years I’ve been at the helm.

What do you think is the biggest challenge facing your business at the moment?

There isn’t enough joined-up writing between health care and social care. We get challenged on our fees like everyone else, and we are not seeing the precept figures coming through to us from the Government even though we tell them our wages, food and utilities bills have all increased.

I can understand why this happens - they need to stretch their budget as far as possible, but any reduction in our income means an economy has to be made somewhere. So that might mean some of the vulnerable people we support can no longer go swimming every week, or we have to withdraw another activity they enjoy - because we have to cut our cloth according to our means.

However these kind of interesting and enjoyable activities add value to their lives, and they so look forward to them. When you start cutting back on the things they enjoy, their behaviour changes and that is not good either.

The biggest struggle is going to be the social care budget. Our homes are just that – homes. They are not big care homes or institutions, and running a home with just five people can be very expensive.

A big challenge for the sector will be that the smaller companies will go out of business, and there will be a reduction in available beds. Then we really are going to be stuck.

The demographics in our business are changing significantly too. It used to be that people came to us for care or they stayed with mum and dad. But mum and dad are ageing, and are less able to care for their adult children as they used to.

And our demographics are changing, too. One of our clients who, sadly, passed away recently was 96 years old. That was almost unheard of in learning disabilities years ago, because people with learning disabilities often had other medical conditions which meant a shorter-than-average life expectancy. But advances in medical care mean that is no longer true.

So now, not only have they got learning disabilities, they are elderly as well.

Last year, you were named Leader of the Year by Investors in People. What is the most important quality to being a good leader?

Yes, winning was a bit of a shock. I wasn’t paying attention when the award was announced and I didn’t even hear my name mentioned. My staff all screamed and had to give me a nudge in the direction of the stage.

In our line of work you have to genuinely care about what you do. You live and breathe the sort of care we deliver. My job isn’t about driving a fancy car or playing golf every week while my staff are left to do all the work. I care passionately about what I do, and I remain hands-on.

So yes, I will spend three hours on the road driving to a care home in the middle of nowhere just to make sure I’m happy with it.

And I strongly believe in leading by example. If your employees see you actively engaged all day, every day, it is amazing how that filters down and what cohesion it inspires among your work-force.

I don’t mind cleaning a toilet. I’ve done it before, and I’ll do it again if I need to. Why wouldn’t you just get a pair of rubber gloves and get on with it if necessary? The staff think that’s wonderful.

You can inspire that level of commitment in your staff and expect them to reciprocate if they know you’re prepared to get stuck in yourself.

The way we deliver care is changing, moving increasingly to delivery in home situations and coaching of vulnerable clients in the life skills they need. That might mean teaching them how to catch a bus into town, or to spend wisely the £5 a day they have to go shopping.

Our aim is to ensure everybody’s life is fulfilled so when, as a boss, you encourage people to pursue that goal, and train them to do it, and bang the drum about it all the time, that helps make you a good leader.

What Makes Regard different to others?

We ensure all our homes are real homes. Everyone has choice and if they want a purple room they can have one because it’s their home. It’s those sorts of things that make a difference.

Regard trains everybody whether they are a carer, cleaner or client. We give them as many skills as possible to enable them to have the best life they can. And that is a culture that IIP (Investors in People) recognises and that we live and breathe by.

I even write birthday cards to all my managers and then everyone sees that’s how it should be. Everybody in the organisation gets a birthday present, and we look after them.

What is The Regard Group’s strategy when it comes to growing its residential care estate?

We agree with supported living and not just residential care. Clients have keys to their own bedrooms and to the front door. They often have tenancy agreements so it feels like their own home.

Can you imagine how satisfying it is for a parent of a less-abled child to see them with a set of keys to their own home? That it is amazing.

What barriers/challenges do specialist care providers, who typically have smaller homes than care home providers for older people, face when it comes to opening new homes?

It is finances again. When buying small homes you are competing with ordinary residential buyers. We can’t afford to buy any more homes in Twickenham, Richmond or Surrey because it is so expensive.

Renovation of re-purposed properties costs a lot too, and I think that will be a barrier moving forward.

I’d expect some small businesses to disappear because of the new living wage which – by the way—I entirely support. If you are not big enough to weather the storm and then suddenly your staffing bill goes up by 8%, that’s a massive pressure.

I also think Brexit will cause problems for the sector. Some areas have virtually no unemployment so if you open a care home there, who will want to work for a living wage?

About 15% of my staff don’t come from the UK, so it also has implications for how the sector will access new staff.

How do you incorporate the preferences of your service users into this process?

We do this in a lot of different ways.

They are heavily involved in their care plan, whether that is going for walks, swimming, making papier-mâché or going on holiday.

There’s menu-choosing, where they voice their preferences about a curry or a tapas night.

If we are interviewing for staff, a lot of the clients become involved in the hiring. If we can involve them, we will.

Everyone has their own personal development plan to illustrate what they might want to be able to do. That could be to go on a bus, a train, go to Paris or Disneyland.

These are their aspirations and we take all this into consideration and plan it with them.

We treat them like one of us. It is sometimes other people who treat those with learning disabilities differently.

After merging with ACH last year, what have been the challenges and benefits of bringing the two organisations together?

We were on the road permanently for a month meeting every single member of staff, because we believe that if you can touch and feel the new company that employs you it makes a massive difference.

We set up focus groups to look at both companies’ care plans and we picked the best from both. We wanted them to get fully involved, and that was really good.

The ACH staff have seen some benefits in their terms and conditions, and now receive bank holiday pay.

They have seen some positives in how we treat the clients, and ACH used to be all residential but now they have also adopted the supported living model.

If you could change one thing in the care sector what would it be?

For people with learning disabilities to be accepted just like everybody else is.

They have just as much right to funding as everybody else and I don’t see why we have to fight so hard to get it. But fight I will - for every penny and every vote they are entitled to. Our specially set-up benefits team achieves great results in this respect.

People with learning disabilities should not be the poor relations. They should have a certain standard of life just like everybody else.

Article first published in Care Markets April 2017