Martin Jones is responsible for leading the entire UK operation of Home Instead Senior Care, the world’s largest multinational network of franchises specialising in non-medical in-home care for the elderly. He sat down with Home Care Insight to discuss the challenges of providing personalised home care in a growing market, what it takes to become a successful franchise owner and why renowned franchise businesses from other sectors such as McDonald’s can provide inspiration for his business.
Home Instead Senior Care is the largest provider of in-home care in the UK. Where do you see the company fitting into the wider social care market?
My belief is that people’s homes are going to be the hospital wards of the future. Residential care has its place but more and more people are going to have to be looked after in their own homes and that is something that was talked about recently in the latest long-term vision of Theresa May and Matt Hancock in terms of the 10-year strategy of the NHS. More people will need to be looked after in community-based care. Home Instead Senior Care plays a big part in that in the sense that the client wants to be in their own home, the client’s family wants to them be in their own home and if you look at the care continuum overall from an economics perspective, it is more cost-effective for the client to be in their own home.
The business was founded 25 years ago in the US and is now present in 12 countries around the world. What does the structure of the UK operation look like?
The UK business is 12-years-old and we are a franchise business – we have got 195 franchise offices in the UK and will break through the 200 mark this year. We are the largest provider of home care in the UK – the largest provider of home care globally – with a turnover of $1.6 billion (£1.2 billion) across the globe. Our aim is to become the UK’s most admired care company through changing the face of ageing.
Tell us about the sort of culture that exists within Home Instead Senior Care, particularly as you operate a franchise-led model.
We are a mission-driven business. All our franchise owners come to this business because they want to buy a business to make a difference and I fundamentally believe that is one of the reasons why we are as successful as we are. We have 40- CQC ‘outstanding’ ratings across England at the moment – which is over 20% of our English network – and that compares to an average of 2% within social care. I believe the reason for that is down to the support that we provide here, our model, and our franchise owners. We are the only home care provider to win the Queen’s Award for Innovation (in 2016) and it is fundamentally because we put the clients at the heart of everything that we do. We are relationship-based – not task-driven – and that makes us different from most of our competitors in this sector. That’s where we are trying to make a big difference in terms of the wider social care arena.
How has the business evolved since you joined the company in 2011?
At the time we were a lot smaller – we had around 56 offices and we have now grown to 195 so we have seen quite a transformation of the business. We had 14 people in the national office and now we have 52. We have invested in the infrastructure here, as well as the training and development of our team. We have got our own academy because I firmly believe we need to raise the bar of people joining social care – not just at Home Instead but the wider sector. We need to make working in the social care profession a rewarding career because it is one of the most rewarding things you can do. If you’ve got a choice to become a caregiver or to stack shelves in a supermarket, I want people to think, ‘actually, caregiver is the role I really want to do; I really want to make a difference to someone’s life.’
I understand that kind of thinking was central to you moving into the care sector having previously worked in retail?
My journey to Home Instead Senior Care came because I was a carer for my Dad. I had given up my job and set up my own business so I could look after my Dad because he had prostate cancer. And when he unfortunately passed away in 2011 I wanted to do something different and I wanted to join a business that actually made a difference, I came across Home Instead UK and the rest is history. ‘Changing the face of ageing’, both from a global perspective and a UK perspective, is at the root of what we do and that drives me, it drives the team, it drives our franchise owners and it drives our caregivers as well.
That growth you described, in terms of going from 56 franchises to 195 in the last eight years, is quite an achievement. Do you obsesses about growing that number as a company?
It is not about being the biggest, but if you are going to change the face of ageing across the UK you have to have a voice in terms of volume – we are providing over a quarter of a million hours a care every month now. Having that spread and that mass is really important because you can’t change the face of ageing with one office. However, when you can say that you have 40 CQC ‘Outstandings’ and a Queen’s Award and a Princess Royal Training award as well as over 190 offices, then it is making a difference. And you can start to influence those around you that actually it is about relationship-led care and putting the client first.
Having that number of franchises while trying to foster consistent culture and ethos throughout the business must be difficult. How do you tackle that?
You have to find people with the right culture and values. So right from the onset, from the first moment a prospective franchisee starts to look to buy a franchise, they have to fit in with our culture and they have to fit in with the ‘why?’. We cannot afford to fail as our business is delivering essential services to sometimes very vulnerable people, who put their trust in us. So if a prospect is just looking to make money, they won’t be awarded a franchise. Most of our franchise owners have personal experience of looking after their mum and dad – one of our biggest franchisees in London was a well-respected estate agent but she wanted to use the experience she’d had of poor care with her own parents to make a difference. I could give you loads of other examples of that. Yes, we have got the policies, procedures, academy and structure, but the ultimate aim of changing the face of ageing keeps us all on the same road together.
What does the structure of your largest franchisees typically look like?
Across the UK we have got about 10,500 clients and about 9,500 caregivers, broadly speaking, and every office will be different. But it really does depend on the nature of the beast because if one office has got a lot of companionship work compared to an other office with more live-in care then the mix of that staffing requirement is very, very different.
How do you measure the success of a franchise office?
First and foremost it is about quality. We are a quality-driven business, and the quality of the care that we give to our clients is what comes first. The quality of training that we give to our caregivers is therefore what drives our business. You have got other metrics of course, such as revenue etcetera, but we are a quality-driven business and if you get that right it drives your reputation and your trust – not only within the client’s family and the client themselves but in the wider network in which we operate within the communities that we serve.
Presumably CQC ratings are an important measurement, too?
CQC ratings are important but our own standards are higher than CQCs – we have our own internal audit team that goes out and does supportive audits for our franchise owners and that’s really to ensure they are complying with what Home Instead is all about but more importantly in terms of what the client’s needs and wants are. And don’t forget CQC is only England, you have got the other three countries that we operate in to ensure that the quality is being met, which is why our standards are higher than the regulator’s minimums. It is not a big stick approach, it is a supportive element to ensure everyone really understands why we have got different processes in place. For example, we do introductions between our caregivers and clients – our caregivers are always introduced to a client – and that is not commonplace. We also match our caregivers and clients, which again is not common place.
Your website outlines the different types of care you offer and references the fact that everybody is different – some people need full-on support while others might just require a friendly face popping in to check on them each day. Is it therefore true to say that a tailored approach to care is at the heart of your business model?
Yes, it completely is. The reason why we won the Queen’s Award for Innovation was purely that – nothing to do with technology. It was basically around the way that we put the client at the heart of everything we do with that tailored approach as you put it. We will do a care consultation with a client and find out what their needs and wants are and then we build that package of care. And it might be somebody wanting a bit of companionship for one hour a week or it might be a live-in at the very other end, and then everything else in between.
Is labour as big an issue in the home care sector as we are led to believe it is in many other people-driven industries right now?
Finding great quality caregivers is a challenge – finding great quality people in any industry is a challenge. And I think it will continue to be a challenge. That’s why we started the Home Instead Senior Care Academy a couple of years ago. We need to raise the profile of social care so that people regard it as a chosen profession rather than something they have fallen into. There are a lot of care managers in this sector who have become care managers and they haven’t had the right support, training or development – they have just been the last man standing and been made a manager. We put a lot of infrastructure around people to help and support them. And if we develop people that are so good that they end up leaving and getting another job then actually that’s fine because it still means that we have attracted more great people to the sector and that’s what it has got to be about.
In the time you have been with the business, would you say the market landscape has shifted quite significantly?
I think there is a lot more of the sector now looking towards the private pay segment of the market than there was when I joined seven years ago. And there is also more realisation – even from the government sector – that we need to work more in partnership with both the private sector and the third party sector. I think home care at long last is now being perceived as the way forward and if you look at somewhere like Japan, which is 10 years ahead of the UK in terms of an ageing population, bricks and mortar will not solve the ageing population crisis – and it is going to be a crisis. I am really passionate about the need to think about how we fund social care going forward.
Funding is the million dollar question though, isn’t it?
Yes it is, but I firmly believe there is something along the lines of having some sort of care voucher approach –we have vouchers to look after our young in terms of nursery, why don’t we open it up and have care vouchers for both ends of the spectrum? If we don’t then it comes back to the ageing population and the ageing workforce. There are a lot of people who are unknown carers now, who are having to take time off work to look after mum and dad. That is costing the economy billions. If we had some kind of support in there, then actually you could pay for someone to look after mum or dad so that you could be in work and it becomes self-financing from an employment perspective and a government perspective. I know from speaking to the World Health Organisation that there is a lot of rigour being put into place to make governments around the world really start opening up their eyes to that ageing population by 2025.
That concept of the care voucher scheme is an interesting one. Is that something you have put to ministers?
Not yet. I have been mooting the idea. It was sort of mentioned in the Conservative manifesto. The challenge is what vehicle to put it through. Home Instead Senior Care is apolitical – we are not affiliated to any party – and I think the problem with social care is that it’s a bit like the NHS in that it is used as a political football because governments don’t really look 10 years into the future, they look four years ahead because they are focused on re-election. What we need is a cross-party group to look at how social care and the NHS are funded and where they are going because in 20 years’ time we are going to have a lot of older people. And if we don’t get it right they are just going to bed-block up the NHS. There is no point continuing to just keep putting loads and loads of cash into the NHS because it is not going to make any difference. You could double the budget and still end up in the same place in 10 years’ time because you are not dealing with the issue. The NHS is a sticking plaster – and that’s what it is meant to be, you break your leg, they make you well – it is not about prevention. The care continuum just needs to be joined up better, and that involves pulling in from public, private, charity and cross-party. There is a bit of movement on that.
All your growth in the UK has been organic. Would you ever look at acquiring a company or is that not part of your thinking?
I would never say never, but I think if I was to acquire 20 offices in the south west, just as an example, that would involve a lot of people and it goes back to that earlier point of culture, ethos and values. And with any acquisition like that, it is the culture and values which make or break it.
What kind of partners are central to your business being able to operate efficiently?
We have core partners in terms of technology and in terms of how the offices operate. We are using virtual reality for some of our caregiver training. We have core partners in training and to ensure that our caregivers, franchise owners and managers are supported. But we haven’t got the food, we haven’t got the bricks and we haven’t got the furniture. We are going to someone’s home so the infrastructure is all there so there is less of those logistics to look after.
Home Instead Senior Care is the largest home care provider in the UK by some distance. How do you think you’re perceived by the rest of the industry?
That’s an interesting question. I think very well. We have got good relationships with the Care Quality Commission, Skills for Care, UKHA, I am a trustee for the Care Workers charity, I work hand-in-hand with The Silver Line and with Business in The Community so we give a lot back. We share our best practice, we are very collaborative and I think people do see us a benchmark in terms of what ‘good’ looks like. But we are not arrogant enough to think that we know everything, so we do spend a lot of time with other care providers, helping and sharing. In terms of our academy, I do want Home Instead to be the leading light and we do want to drive it forward because if more people come to our sector that can only benefit everyone.
Do you find that the market landscape is more competitive now? If somebody is looking for a home care provider, it feels like they are not going to be short of choice…
There are more players in the sector, but don’t forget the cake is getting bigger, a lot bigger, very quickly. So the opportunity for us all is growing day by day. There a lot of players entering but there are also a lot of players falling out of the sector as well. I would certainly say there are a lot more franchise care businesses entering the sector, too. I think when I joined there was around six, but it’s in the late teens now so it has more than tripled. But we still grew 20% like-for-like last year, we are still opening new offices and we are still finding great franchise owners who want to make a difference.
Do each of your franchises set their own prices and fees, or do they work from a centralised model?
We have a metric in terms of the rationale, but obviously local market places dictate pricing so they have that flexibility and that’s the beauty of franchising. We are not a head office, we are a national office – there is a clear distinction – and I do genuinely believe this is why the model works.
When you talk about franchising, many people would automatically think of companies such as McDonald’s or KFC, who are ultimately selling a low-value, physical commodity. You’re in franchising too, but there is a moral element to the product you sell in the sense that the wellbeing of a human being is at the end of it. What sort of challenges does that bring?
It comes back down to me in terms of the type of franchisee that we attract and the type of franchisee that becomes part of Home Instead Senior Care in the sense that they have got to have passion and they have got to have it in their heart why they are doing this. I had one guy that came to us with a great CV and on paper he should have made a really good franchise owner, but all he talked about was profit and that it was a logistics business. He didn’t mention clients, he didn’t mention caregivers, he didn’t mention quality. I got up and just opened the door and said ‘you’re just not for us’ and he went absolutely ballistic. And that really underlined my reason for making the decision! If you put profit before people in this sector it will never ever work. It has to be about people and quality. You have to put the client first and that quality element first because you are dealing with vulnerable people. And that builds up your trust and your reputation. Profit is a reward for what you do, it is not a reason.
Do you take inspiration from any other global franchise businesses?
In terms of this sector then potentially no. We spend a lot of time within the franchise arena helping and supporting each other. One of my team is out tomorrow with other major franchise brands and if you take somebody like McDonald’s who you just mentioned, they are a great business. They created their own degree for their restaurant managers – I want to emulate that at Home Instead with something along those lines and I have been speaking with them about how you do that. Sometimes social care and the home care sector is insular and a lot of the technology or solutions are in other sectors. The beauty of franchising is that it gives me the opportunity to learn from other brands.
You said earlier that Home Instead Senior Care is likely to surpass 200 franchise offices this year. What can you tell us about your longer-term targets?
The capacity for the UK is around about 285. But obviously within each territory there is no glass ceiling as to the number of possible clients. That is growing all the time. Our market penetration has still got a long way to go in terms of where we could be, so even when we sell all the franchises there is still massive opportunity because our growth is 20% like-for-like. That just shows our momentum and it has been like that now for quite a few years.
And as far as industry challenges go, what keeps you awake at night?
The only thing that keeps me awake at night is the care of our clients. In terms of broader challenges, I think the recruitment of great people is always going to be a challenge, as I said before. You have got to look at where we are going to be in 10 years time – it is the complete coordination and planning and future-proofing for our ageing population. We are driving towards a wall and most people in this sector know we are going to hit the wall but no-one’s willing to have the conversation. The public purse is going to get squeezed and squeezed, so unless we have a government that is going to put 5p on income tax or whatever there is always going to be the challenge of where the money comes from.
Just lastly, The Green Paper for social care keeps getting delayed. What is your view on that?
It is really hard because the fact that it keeps on getting kicked into the long grass kind of speaks volumes to me. But if you were Theresa May, what would you do? Unless you want to leave a legacy about you as a person you aren’t going to do anything about social care. It is not a vote winner, you aren’t going to be there when it comes to fruition – because it is going to be 15 to 20 years hence in terms of what you have done – and it is going to cost a lot of money. So when you are only thinking of the next four to five years, why would you bother, and that is the problem. You kind of need someone who is mission-driven – like Bevan who started the NHS and who wanted to do something not just about the here and now, but for the future of the country from a legacy point of view. The Green Paper is good and it needs to happen. My worry is that even if the Green Paper progresses, all the focus will be on Brexit for quite some time.