EachStep Blackburn is Community Integrated Care’s ‘model’ for people with dementia: built from scratch and run with the intention of being an exemplar for all organisation’s other homes. It cost £5m and is a partnership between Community Integrated Care and Blackburn with Darwen Council. They worked with Helen Sanderson Associates to make the care as person-centred as possible. Based on my short visit, I’d say they have succeeded.

Eight small things I learnt (in no real order)

  1. ‘Toast is portable’. In truth, I already knew you could move toast. But this is really about culture: it’s the short phrase that staff in the home use to remind themselves residents have a choice about where and when they eat. That principle of choice is applied in lots of areas, including no.2…
  2. Bedrooms should have minibars. Why shouldn’t residents have a stash of wine or chocolates? Or a pub for that matter (an underused lounge is currently being converted into just that).
  3. There’s logic in completing care plans only after a resident has been in a home for several weeks. EachStep Blackburn waits for six weeks so staff get the chance to know a resident and his or her family. The benefit is that previous decisions and assumptions at other homes can be considered and, if necessary, changed.
  4. If you build a cinema, they will come. The home had the choice of building a cinema or having two extra bedrooms. It went with the cinema which is now one of the most popular activities at the home. They put on double bills and even have a popcorn machine. It also gets used for big sports events. It’s one of the features that would make me want to live there.
  5. Community engagement matters. One of the home’s better known innovations is a top floor that is women-only, created after in-depth discussion with area’s substantial South Asian community. A shout-out here to One Voice Blackburn, who worked with Community Integrated Care to understand community views. The depth of that engagement really mattered. Often, says manager Phil Benson, it was an aside or a chance comment from a relative that brought the deepest insights.
  6. An overnight family guest room is the sign of a care home that is confident in the care it provides. It’s the ultimate Friends and Families test: allowing people to see the home at any hour of the day or night. How many would do it?
  7. Building from scratch makes a big difference. Of course great care can be provided in any setting, but a purpose-built building gives a real head start. 
  8. Being a good home creates a virtuous circle in which the best staff want to work there. That in turn makes the home even better. The opposite also applies of course: good staff leave poor homes.

And a couple of bigger ones

  1. Really good care isn’t about doing one thing really well but about doing lots of things just a little bit better. It is essentially the theory of ‘marginal gains’, famously applied by Sir Dave Brailsford at British Cycling, which has been widely hailed as being responsible for the amazing success of our cyclists at two Olympic Games. So letting residents choose the taps and toilet flushes in their room doesn’t, in itself, make a great care home. But if you apply that principle of choice and control throughout the home, and back it up with staff that believe in it (recruited on their values as well as their skills) and a culture that supports it, then you’re in business.
  2. And – talking of business – great care doesn’t necessarily need to be expensive. Return on investment does matter at EachStep but it’s in balance with providing the best possible service to residents. That’s an approach that allows a cinema to be built instead of the revenue from two more rooms. But it still means the home’s costs are low enough that it can break even if it has a large majority of council-funded residents. It treats staff well and recruits the best but pays ‘only’ the living wage. And while Blackburn with Darwen may be an enlightened commissioner, and it does pay a quality premium, the council has the same cost pressures as the rest of England’s councils. So the answer to the questions I kept asking myself – ‘why can’t all homes be this good’ – is not simply about money. Indeed, it may not even be mainly about money.

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