Less than a year into her role as managing director of one of the UK’s biggest care providers, Bluebird Care, Yvonne Hignell has already made huge progress in driving the business forward, repositioning its strategy in line with changing customer requirements and an evolving competitor landscape. In an exclusive interview with Home Care Insight, she talks openly about the challenges of providing quality home care in a growing market, attracting and retaining a talented workforce in a low-paid industry and her concerns over the rise of unregulated care.
Bluebird Care was established 15 years ago by Paul and Lisa Tarsey. What was their motivation back then?
Paul and Lisa had home care experience and I guess they thought they could do something different, something better. So they chucked their lot in, borrowed money and did everything they could to raise the capital to set up their own home care business locally, in Petersfield. Their aspiration was always to franchise, so the idea was that they would set up a great model focused on the customer and on quality, demonstrate that it could deliver and then franchise that concept out to others.
The market was very different then; there were very few competitors of the size and scope that we have now. The market has consolidated over the last 15 years, and we’ve had some international brands come into the UK. So that exponential growth during the first six to eight years was huge – at one point Paul and Lisa were selling one franchise every 14 days. We now have 200 plus businesses in the UK and a further 24 in Southern Ireland.
You joined Bluebird Care as operations director in March 2018 and was promoted to managing director in October. What’s your background?
I have 21 years’ experience in health and social care. When I was younger I wanted to be a social worker, so I completed my A Levels and at the time you had to be 21 to do your qualification in social work, so I went and got some experience. I had a real interest in working with people with mental health issues and learning disabilities, so I started working with these people and was quite quickly promoted to registered manager in residential care in my early 20s.
At 27 I applied for the role as founding CEO of an organisation called Halow in Surrey and grew that organisation from having no operational activity to having a turnover of around £1.5 million six and a half years later. I then went on to work for a much larger organisation as Care and Support Services Director. I had three divisions – older people’s housing, residential nursing care and community-based health and wellbeing – and I was there for three and a half years. After this I really wanted to work for a much larger, well-known brand, so I applied for the role of operations director at Bluebird Care.
I guess my passion is about improvement, transformation, vision, strategy and moving something forward. When I came to Bluebird Care, Paul and Lisa had a very clear model and clear strategy, but time moves on, the operating environment changes, the market changes, customer needs and requirements change and the competitor landscape is completely different to what it had been 15 years previously. So I saw real potential at Bluebird Care to rethink who we are and what we stand for.
How’s the new role going so far?
It’s been really good. It’s a challenge because I’m not your typical MD of a large organisation; I’m under 40, I’m female and when I go to events and I’m asked to take part in panel discussions, there is a real sense that I’m a bit of an anomaly amongst the great and good in care, which is fine and, actually, throughout my career that has kind of followed me through. I am a woman, I am a mother and I challenge through what I do and how I do it the preconceptions about what people have to look like and sound like. So that doesn’t faze me.
In terms of the role here, we’ve been through a real journey of transformation over the last year, so we lost a lot of people around the time that I joined and that gave us the opportunity to bring new people in, but also look at the real talent that was in the business and restructure. So we’ve restructured the whole of the Franchise Support Centre (FSC) and aligned that with our strategy. As a team, we’ve reclaimed our culture and decided how we want to work with each other, how we want to engage with each other and what our values are. We’ve also rebuilt relationships with the network, which weren’t as good or strong as they could be.
So it’s been a really exciting journey. Our investors have been fantastic and they really are invested in Bluebird Care’s success. So it feels as if things are settling now. We have a strategy, we have a plan, we have broad support from the network about the future focus for the organisation, and it’s a great place to work.
What was the reason for the mass exodus last year?
Lots of people had been here a long time and I think that organisations move on and not everybody wants to go in the direction that things are moving in. It happens and you just have to roll with it and see it as an opportunity to create a team that really does believe in where you are trying to go and what you are trying to do, and that’s what we have now.
You mentioned that at one stage that Bluebird Care was opening a franchise every 14 days. What is the level of growth that Bluebird Care is experiencing now?
Growth is no longer being driven by new franchises and new locations. We are number three in terms of market share now. The total value of the network, in terms of annual turnover, is about £200 million, but our business is largely private pay and the other two providers are a mix of state and private funded. So opening new franchises is not where growth will come from for us now; it’s about thinking through our strategy and how we can continue sustainable growth through new channels.
So what’s your strategy?
It’s about going back to basics. For us, it’s about repositioning ourselves in the marketplace as the provider that can be there from those light touch, early door services, before people really think that they need care at home. It’s also about consolidating our place in the market around domiciliary care, but then extending customer length of stay through more complex provision, so bridging the gap between health and social care and really challenging the boundaries of traditional health care that is delivered in communities. But that has to be supported by a great employer brand that really cares about its people. We care for our customers so we have to care for our workforce. We aren’t where we used to be – we don’t choose who works for us, they choose us.
How do you attract potential employees to your company?
What we know from research is that it’s really hard to compete in relation to pay, terms and conditions and all of those types of things because the margins are what the margins are in care, so it’s about the motivational factors. We value our workers as individuals, give them the opportunities to grow and develop and make them feel part of something more than just a care call. That’s why at the back-end of the customer journey there’s more complex services that people can deliver and develop skills to deliver.
You mentioned that it’s difficult to compete in the care industry in relation to pay. How challenging is it to operate in a low paid industry?
I’ve been thinking a lot about this recently. The care industry as we know it, as a competitive, commercial environment, has only been existence for the last 15 to 20 years. The Community Care Act was introduced in 1990 and there was the decentralisation of social care services out of local authority control and into the market. So it’s an incredibly immature market. Also, care is traditionally seen as a female role, unpaid.
The NHS emerged 70 years ago and it was a wonderful thing, but it was very much about maintaining the nations’ physical health. In terms of our social wellbeing, we had national insurance and the idea was if you fell on hard times you could tap into your welfare benefits, but don’t worry, your mum or daughter would look after you. But the world has moved on, women are now working and that availability of informal care isn’t as prevalent as it once was and so the structures around social care haven’t kept up with those changes.
We are now, in a very immature market, trying to professionalise care, but that’s adversely compounded by how the government categorises care – as low skilled manual work.
Will we see changes in earnings as the market matures?
I think we are going through a period of transition, but at the end of the day, there has to be a significant shift in how we see social care and the importance it plays in our society because if all the paid-for carers left their jobs tomorrow, all those people who are contributing to the economy and paying their taxes suddenly won’t be able to do that and they’d be the ones caring for their family members. There are already 7 million unpaid carers in the UK.
So when you think about how integral social care is to the overall success of our economy, suddenly the value of that increases, but the way that we value social care is by the hour, unskilled, manual work predominantly carried out by women. We don’t see it as a system and how that fits into the rest of what goes on in the UK, and until that mind shift happens, it’s very difficult to charge more for private pay or convince local authorities to pay more. It has to come from political will to see it as crucial to the future success of the economy in order for social care to be uplifted and valued as such.
The views around social care and the value it has in society aren’t explored deeply enough, in my opinion, and until we do that, it’s very difficult to move things forward.
Reform, in terms of the publication of the Social Care Green Paper, has been delayed again, due to Brexit negotiations. But can Brexit really be used as an excuse?
Brexit is the beginning and end of everything at the moment and the whole health and social care system is being kicked around like a political hot potato, and has been for years and years. But at some point we’ve all got to face up to the issue that the current system is broken, it’s unsustainable and something fundamental has to change. Or we will just keep treading water and people will die as a result. There are hundreds of thousands of people waiting for social care that can’t get access to it and someone needs to come in and say ‘Stop. This cannot continue”. Putting in a care cap and allowing for tax breaks are just tinkering around the edges. We need a seismic shift.
Moving onto the subject of quality, how do you measure the success of a franchise?
We have gone through a process of fully reviewing our businesses. We segment our businesses in terms of their revenue and growth, and also in terms of their compliance and quality. That then determines how we then engage with those businesses. This is a new way of working and we have new team that looks after the entire franchise owner journey, from attraction and selection to exit and sale. We support those businesses and intervene if required, but we have very clear targets in terms of revenue and also around compliance within the network. It’s an ongoing relationship with the owners to get them to where they want to be and where we want them to be.
How are your businesses split in terms of CQC ratings?
Our latest statistics show that 11% (27) of our businesses in the UK have the highest regulatory rating, which is overall ‘Outstanding’ in England, or ‘Excellent’ in Scotland. We have four businesses in every area that are either rated ‘Outstanding’ or ‘Excellent’, which is phenomenal. About 6% of our businesses have an overall ‘Requires Improvement’ rating and we have one business that’s ‘Inadequate’ at the moment. All the rest are compliant, with no areas of ‘Requires Improvement’. That’s an absolute testament to the network’s focus on quality.
How are you innovating for the benefit of service users?
I think it’s really easy to band around the word innovation. It gets used a lot and sometimes inappropriately. So to innovate means to do something completely different, something that’s never been done before, and there is some of that going on, but I don’t think there will ever be a point where you can take people out of delivering care.
In terms of technology, this can be used for a variety of reasons, including reducing risk, improving operation efficiency, improving outcomes for individuals and proving to the regulator that you’re doing what you should be doing. Bluebird Care has used technology for all and some of those reasons, but one of the big things we are looking at now is how we can communicate directly with the people out in the field, delivering care. So we have a staff app, which was launched a few years ago, and we are augmenting the functionality of that app so all of our team members have access to our policies and procedures, care documents, etc. This can connect to family members as well, so there’s real-time information being shared constantly, such as changes to medicine or a care plan.
We’re also using technology for prevention and improving outcomes for people. So we’re working on a new service, which is still in early adopter phase, and in the live-in care space we are using technology to aid independence and allow carers providing complex care to be a little more hands off, so it’s less intensive for them.
Are there any technologies that have the potential to disrupt the care market?
I think a big disrupter for access to care is this whole ‘tech to connect’ thing, which is the Tinder of care. My generation and the generation before me are all used to accessing goods and services on their mobile phones, wherever they are in the world, so if we don’t get ahead of that, we are behind. So that is a big area of focus for us at the moment – thinking about how we can utilise that technology.
However, this type of technology leads to some concerns for me. One of the drums I am banging at the moment is around the rise of unregulated care. I am absolutely, 100% about consumer choice, so I might want ‘Daisy’, who’s going to charge me £15 an hour to come into my home and I employ her directly, or I might choose to go to a regulated provider. My problem is that I don’t know who Daisy is, where she comes from or what her background is. So we need to review the system in England akin to Scotland, Wales and Northern Ireland, where we have a register of care workers, just like we do with childminders. There’ll always be a black market. I do it myself – I pay someone £10 an hour to look after my kids on a Saturday night – but that’s an informed choice that I make and I know the risks associated with that. But a choice is only valid if it’s informed, and at the moment when you go on some of those platforms, I cannot as a consumer, and potentially a vulnerable person, see the difference between Daisy’s home care (unregulated, no DBS checks, no basic training) and Bluebird Care, which is highly regulated and meets all of the legal requirements and standards.
Why do you think England is falling behind in enforcing the compulsory registration of care workers?
It’s been kicked into the long grass. The CQC was talking about this about five years ago in consultation. The other interesting thing about the devolution to Scotland, Wales and Northern Ireland is that we don’t have devolved Parliament. So issues that are effecting Scotland, Wales and Northern Ireland can be dealt with by the devolved Parliament, but England doesn’t have that.
What direction do you see the business heading in over the next five years? Do you plan to open new franchises?
Over the next five years we have objectives to open another 20 to 25 new locations in the UK. Areas of growth for us are the North of England, Scotland and Wales. As I mentioned previously, our plan is to consolidate our market position and look at expansion through light touch services and also complex service lines and propositions. We want to re-establish ourselves in the market, not just as a provider, but as an employer. So it’s about driving growth through great employment opportunities, caring for and valuing our team members and increasing the customer length of stay.
We often think that Home Instead, for example, is a real competitor in terms of the services it provides, but actually the breadth and depth of service Bluebird Care provides is huge. So it’s about how we can structure that so it makes sense to customers, but also offers employees great options so they can grow and become specialists in certain areas, and even go on to do their nursing qualification.