Agincare, one of the largest independent care providers in the UK, celebrates its 35th anniversary this year.
To mark the occasion, HCI editor Sarah Clarke sat down (virtually, of course) with chief executive Raina Summerson.
The CEO spoke about the evolution of Agincare since its establishment in 1986, her inspiration for joining the company from the CQC in 2004 and her future ambitions for the business.
Summerson also discussed her thoughts on social care reform, including the first things she would do to reform the sector if she were Prime Minister, and the government’s support for home care during the pandemic.
To view a recorded version of this interview, click here.
Could you share a brief history of Agincare and how it first came about?
Agincare was first started in 1986, when Derek Luckhurst, as chairman and founder, opened his first care home in Weymouth. Like a lot of care homes in the 1980s, it was an old Victorian building and he moved in there with his wife and youngest child. They went onto have more children and they continued to live there and manage the home.
Over the following years, he went into partnership with a couple of other people in the locality and opened more homes in Weymouth. Then, come the 90s, and the advent of caring in the community, he saw the opportunity to expand into community services and so developed, first of all, a meals on wheels service. That was a key service at the beginning of Agincare and later developed into home care. Then, as local authorities developed commissioning and outsourcing a little bit more, he became quite active in Dorset and expanded that service.
I joined in 2004 and we had 250 to 300 employees and about eight home care locations. Derek had the three care homes, but with an active intent to expand and develop, which is what we’ve gone on to do, with the launch of live-in services, through to contract wins with local authorities, and we’ve gradually radiated out from Dorset.
For the first few years that I was here, apart from helping to manage Derek’s homes, care homes weren’t a key part of Agincare’s business planning. But after austerity and the impact on the home care sector we turned our sights to care homes and started the care home group. We then developed the group structure that we have now, where we have different service divisions across different holding companies to really ensure
Could you explain what this group structure looks like?
Each division was becoming bigger and more specialist in its own right, so we decided to appoint people who really understand those operations and that led to us having one group company with subsidiary limited companies. Each of them have their own directors and their own specialist operational line management.
Then, when we started focusing on care homes again, we thought, actually, that’s a different skill set and a different operational model, so let’s have a different holding company for that. Similarly, we’ve expanded into complex care and supported living, which we were doing at a minor scale within the other services, but in order to do that in a more focused way and to accommodate growth, we turned it into a specialist group.
We’ve also developed our training – it’s gone from being an internal head office support function to its own trading company, so it’s not just providing training to us, but wider training to other people. Live-in care and home care have also continued to grow and grow.
Government funding for social care has been welcomed and I think the sector would have fared very poorly without it, but it’s a sticking plaster.
What is the biggest growth area in your company right now?
Right now, I think it’s live-in care. This is coming into its own and has been highlighted through the pandemic. I think the one-to-one nature of live-in care has really appealed to people in terms of safety.
Complex care is also a growth area. Again, everyone’s interested in that space and there’s a lot of change going on. There’s a lot of need for innovative services and community-based services so we’re doing some really exciting work there with the team. Home care has been popular as well, in terms of people feeling safer in their own homes with their regular care teams coming in. The care home side is also a growth area despite the difficult circumstances.
We’ve got a five-year plan and all of our organisations play a component part in that. The beauty of having a range of services is that if unforeseen circumstances like COVID hit then we have got that ability to flex and adapt and put more resources into one area.
You worked at the CQC as an inspector for five years before joining Agincare. What inspired you to move to a provider?
I actually started my career in direct care. I worked in hospitals and
care homes and then trained as a social worker. Initially, when I joined the regulator, it was just care home-focused because domiciliary care wasn’t regulated. Then, in the early 2000s, I was part of working groups in the CQC, or the NCSCI at the time, looking into home care regulation. So I saw home care emerging as a regulated service and a service that was going to become more widespread.
I’d inspected Derek’s care homes and he said, like a lot of care providers said, “you should come over to the other side and work for us”. I saw home care as an emerging field in the sector and I thought what Agincare was doing was really interesting.
I just got to one of those life points where I thought “I can stay in what is a relatively safe job with good conditions, and I enjoy it, but we’ve been through a lot of changes”. I went through three iterations of regulatory body and I didn’t really enjoy that experience. So it wasn’t something I wanted to do forever, but I wanted to use my skills and my social work training, so I thought, why not take a chance.
What skills and knowledge did you bring from the CQC into the role of CEO of Agincare, and how have those benefited the business?
It was the knowledge around what it was like to give direct care and to work with families, and also the knowledge of the system. We can all get irritated with the system, whether it’s funding, commissioning or behaviours, but I think it gave me a sense that, actually, you have to understand the system and work within it and understand what people can and can’t do. So I think I brought an awareness of that structure at a time when you needed to understand it to be successful in working with it at scale.
I also brought the policy side. When I joined Agincare there was a very small team with literally a handful of us in one room and we did everything, from policy development to training. So we were at a point, as an organisational start-up, where we were all hands on deck. So I think I brought some structure around policies and procedures.
I also had a confidence in my work. I’ve always loved what I do and I have a passion for it, and I think any entrepreneur or founder wants people in the organisation who’ve got that spirit, but I also had the strength of a professional background to say “this is really what the organisation needs if we’re going to move forward”.
I think the benefit, for me, is that I’ve been able to grow with the organisation and so I understand every component part inside out. I’ve done most jobs that people in the business are doing and although it’s changed with the scale, I’ve got that understanding about what the business needs to do on a daily basis.
I’ve been able to grow with the organisation and so I understand every component part inside out. I’ve done most jobs that people in the business are doing.
Going back to regulation, do you think that there should be an official register for social care staff?
I’ve got really mixed feelings on this. As a social worker, I’m used to a profession that is registered and I definitely support our social care workforce being viewed as professionals and as the highly skilled people that they are, so that is an absolute given. In terms of professional registration, if that was done in a way that would help with that cause then
I would support it.
My fear is that it could end up being something that is done to the workforce rather than with them. If you are an employer and you’re telling people you have to be registered to work for you, then that doesn’t make them feel more professional and it doesn’t make the public perceive them as more professional – it’s a kind of paper exercise. I also think that you can’t professionalise a workforce where there is such fundamental underfunding and under reward and under recognition for what people do.
Apart from the pandemic, what have been the biggest challenges that you’ve faced during your time at Agincare?
Probably austerity in 2008-2009. We had quite an ambitious growth plan and we were opening quite a lot of speculative locations with home care, but overnight we saw that environment change. We saw the funding really dry up and we saw our home cuisine services almost slashed overnight because people couldn’t afford to buy preventive services anymore. We also had big contracts dry up.
But that also led to innovation in new areas and formed what we are today. It was a tough time though because we had to really re-evaluate the business plan in a very short timescale and ensure the organisation was sustainable and viable for the future. We felt responsible for people’s jobs and livelihoods and we were seeing services to vulnerable people being cut quite radically, so I think that was the biggest challenge that hit every aspect of the business.
The call for social care reform has gone on for decades now. Why do think that challenge has defeated so many governments?
I don’t think defeated is the right word, but they have chosen not to take it on. It’s about political appetite. It’s not necessarily been a vote winner or something that people have lobbied their MPs about. By and large, people have felt that needs have been met to a degree that it hasn’t caused huge waves of disruption.
How does social care become a vote winner?
It will become a vote winner when it becomes an untenable situation for people who need services or who use services to the degree where it causes widespread disruption. There are hugely disruptive elements of a lack of provision of social care and a lack of social care reform that affect people every day across the country, but until that’s more universal, I don’t think it will be a vote winner.
However, I do think, now more than ever, there is public awareness of the importance of social care and public willingness to accept that helping fund a better social care system is needed, not just when we’re in an emergency situation, but for longer term good of the country.
Some industry leaders believe that the experience of COVID-19 will shock politicians into action. What are your thoughts on that?
I think there’s no doubt that something will come out this year in terms of social care reform, but I remain a little worried that it revolves around the concept that “you don’t have to sell your house to pay for care”, which is only one component of it. In terms of a real commitment to funding a
sector that isn’t so short-term in its approach, I’m not so confident
There should be better recognition of the economic worth of social care. It’s just seen as a provision rather than a key economic growth contributor sector that employs a huge amount of people with a huge amount of skills.
What do you make of the support that the government has provided to care providers, and home care in particular, during the pandemic?
It’s obviously been welcomed and I think the sector would have fared very poorly without it, but it’s a sticking plaster. So it’s helped people get through a crisis, but it’s not going to guarantee that when that money stops that people won’t fall over a cliff edge into extreme difficulty, and it’s certainly not helping services to be in a position to really innovate and commit to long-term planning and meeting service needs.
Agincare can feel fairly confident about the future as we’ve been around a long time and we’ve got a long-term sustainable model and we don’t have any debt, but there will be a lot of providers who can’t.
If you were the Prime Minister what are the first things that you would do to reform the social care system?
Well, apart from sacking certain people…I think I’d certainly try and prevent the silos between departments so there is a lot more inter-departmental working. Within all the departments there are some really skilled and intelligent people doing a lot of work across different areas of society for central government, but they are not joined up and they know very little about the other things that are being addressed and that we can see are interrelated. So better linking up would be the first thing.
I think there’d also be better recognition of the economic worth of social care. It gets siloed into the Department of Health and Social Care and is just seen as a provision rather than a key economic growth contributor sector that employs a huge amount of people with a huge amount of skills. Equally, I’d get talking to people who are using and delivering the services. They know exactly what’s wrong with the system and what we need to do. So ask the experts and actually do something with that information.
That’s another exasperation of ours – the government cannot say they don’t know what the issues are in social care and about the impact of underfunding because they have been told a million times by a million different people in a million different ways. So do something with that information.
You said at a recent conference that the government’s understanding of social care has increased since the pandemic because of people like Jeremy Hunt chairing the Health and Social Care Select Committee. Could you tell our readers more about that?
Over the last year, the impact of social care either thriving or not being able to thrive because of underfunding has hit home. I think the Health and Social Care Select Committee has helped with that. It’s brought together a huge variety of people who fed back the same thing from all different angles.
So Jeremy Hunt has been a great advocate for social care, but as everyone says, it’s a shame he wasn’t quite that advocate when he was actually in the post of Health Secretary. But it helps to have someone of influence fighting the corner of social care in its own right, not just an adjunct to the NHS and the survivability of the NHS. I suppose that’s another thing I would do if I were Prime Minister –I’d have someone leading on just social care.
What are your company’s biggest ambitions for home care going forward?
My personal ambition is that whenever I do leave Agincare, I leave it in a strong and sustainable position. Our founder and chairman Derek Luckhurst’s sons are working here so it’s my job to make sure they’ve got a senior management team around them who can take them forward for another 35 years.
Our next target is to get to £100,000 in turnover. It’s heading to £85 million this year. So we have those targets in terms of business planning, but they are just numbers. What’s really important is service development. This year, we’ve done a lot of work on welfare and mental well-being and so my ambition for home care and live-in care would be to address some of the workforce issues in the sector, so making jobs more attractive, and rewarding and recognising staff.
To view a recorded version of this interview, click here.