At Alternative Care Services the health, wellbeing and safety of our clients, staff and partners is our top priority – every single day.

The situation with COVID-19 (Coronavirus) continues to develop, and as of Friday, March 13th, the UK government decided that they are no longer testing for the COVID-19 virus and are asking anyone who has symptoms to self-isolate straight away.

Working with our local health team doctor, we have developed a policy to support our clients, our staff and partners to ensure we are protecting and supporting everyone we work with. Our policy closely follows the NHS and UK Government guidelines set out for care providers.

I would like to remind you that if you believe you may have been exposed to the virus must still notify NHS 111 immediately.
We also ask that you notify us immediately, if you have any symptoms and think you may have the virus.
Again, we’d like to remind you of the symptoms, which may develop in the 14 days after exposure to someone who has COVID-19 infection:

• cough
• difficulty in breathing
• fever

The self-isolation period is 7 days, but the NHS have said that you must have two days without a fever before you are able to leave self-isolation.

If you have the virus, but are not critical the procedure we can still provide you support.
Our staff will wear gloves, aprons, face masks and eye coverings when supporting you.
We can also go shopping for you and bring to your home. However, all waste (yours and our PPE) will have to remain in your home until the self-isolation period is over.

We are available to speak over the phone or via email at any time of the day or night.

If you have symptoms or believe you may have been infected and have any of the pre-existing illnesses:
Respiratory illnesses
Heart disease
Cystic fibrosis
or anyone who is not capable of any self-care or are in a very weakened or critical state we will:

We will call emergency services to be administered into the hospital for urgent medical attention. We will call for an ambulance transfer you to a hospital, and inform the ambulance call handler of the potential links to COVID-19.

Following the patient transfer to hospital, we will leave your home and advise that no visitors go to your home as it should be closed and should not be used until further advice is provided by the local Health Protection Team.

We will also contact:
Our local health protection team
Public Health England

What will happen if our staff become infected:

If a member of staff is concerned they have COVID-19 they will contact 111 immediately and follow the NHS guidance. They will contact us (ACS) immediately, self-isolate immediately and follow the PHE guidance. They will not visit or care for individuals until safe to do so.

We will also alert you immediately if our staff have become effected and you have had any contact with them.

While staff are self-isolating we will provide cover with another member of staff and we may have to use staff from another agency.

Your health and safety is our number one priority, as is the health and safety of our staff. We are available to speak any time you need us and will support you through these uncertain times.

We have been featured in Camden Council Proud Stories!


Alternative Care Services and our Managing Director Ramses, have been featured on the Camden Council Proud Stories series.

Marking the London borough’s vibrant and diverse LGBT+ communities, the local authority is sharing stories from some of the people that help to make Camden a diverse and accepting place to live.

Our MD, Ramses took the time to explain why it’s important to be open and inclusive, and why LGBT support is vital for our community.

You can read more about Camden’s Proud Stories series here:

Safe, caring, responsive, well-led and effective: Alternative Care Services is Good on all fronts!

Following only it’s second ever CQC inspection Alternative Care Services has received a brilliant rating of Good in all sections.

The UK’s first LGBTQI+ focused care agency, was rated by the Care Quality Commission (CQC) the independent regulator of all health and social care services in England, in June 2019.

In the new report Alternative Care Services was found to be safe, caring, responsive, well-led and effective. One relative told a CQC inspector that Alternative Care Services is “inclusive and importantly, understand and look at LGBT issues.”

Having previously been praised by the CQC for having “kind and caring staff” and promoting “an open and honest culture,” Alternative Care Services has received even more brilliant commendations following this second official inspection.

The report states that people and their relatives felt listened to and were involved in decisions about their care. Clients positively reported that the agency is “flexible and tailored approach to meeting their needs.”

Also mentioned in the report, Alternative Care Service clients felt safe using the service and relatives said they felt reassured with the service provided. While a health and social care professional praised Alternative Care Services on how they had responded to an emergency.


The CQC monitors, inspects and regulates hospitals, care homes, care agencies, GP surgeries, dental practices and other care services to make sure they meet fundamental standards of quality and safety and publishes what it finds, including performance ratings from Inadequate, Requires improvement, Good and Outstanding.
This new report bolsters Alternative Care Services’ aim to provide exceptional support to aging and vulnerable members of the community, and to ensure no one ever has to go back into the closet when receiving care.

In fact the report finds that Alternative Care Services is passionate about the rights of people who needed support from the LGBTQI+ community and supported clients to have maximum choice and control of their lives, while staff supported them in the least restrictive way possible and in their best interests.


CQC issue new guideline on dealing with relationships and sexuality in adult social care services

When we registered as a care provider with the Care Quality Commission in 2017, we realised that the independent regulator did not have a category or guidelines for LGBT service users or companies.

This signified a vital issue to us; that the LGBTQI+ community remains invisible within the care industry, something that we wanted to change.

It was at that time that we contacted the folks at the CQC to see how we could effect change and ensure LGBTQI+ service users are acknowledged and offered a choice.

Two years later we are thrilled to see that the CQC has released new guidelines on the importance of enabling people to manage their sexuality needs.

The report titled “Relationships and sexuality in adult social care services” looks at how providers can help people develop their understanding of sexuality and relationships among many other things.

Being the first company of its kind in the UK, we have come across many aspects of the care industry that we believe could be improved – particularly when it comes to working with the ageing LGBTQI+ community.

So we are thrilled the CQC are now addressing the LGBTQI+ community and their needs when in the care industry.

Our Managing Director Ramses Underhill-Smith’s thoughts on why shame erodes our mental health wellbeing

I was recently at an event where a 6-year-old, in a confused state, asked me if I was a boy or a girl? This was an odd question because I’ve known this child since birth and my gender has never been in question.

The comment its self was not disturbing, but what I understand from this question is, the moral shame of being LGBT+ has been pointed out as a lesson for a six-year-old.

For me, it was a positive question. There was a time when I would have left the event because of the anxiety I would be feeling.

And that got me thinking about the way my own mental health had been affected over the years by very vocal cultural shaming.

So in this post, I want to point out that LGBT+ people from all walks of life are impacted by shaming from the main stream because of their gender or sexuality.

Thankfully, today because of the support I have and the work I do to support my mental health, I can stay at these events, withstanding the stigma of being Transgender out loud.

I think it’s important to be visible and although I’m not always able or willing to take on every battle, I’m thankful that I can at last be myself and be more comfortable.

CQC praises UK’s first LGBTQI domiciliary care company and its ‘kind and caring staff’ after finding the ‘service promoted an open and honest culture’

Alternative Care Services , the UKs first LGBTQI+ focused care service to provide exceptional support to aging and vulnerable members of the community, recently underwent a CQC inspection.
In its report the CQC said the new specialist care provider and its” kind and caring staff promoted an open and honest culture”, bolstering Alternative Care Services’ aim to ensure no one ever has to ‘go back into the closet’ when receiving care.
Clients receiving support from the company told inspectors that the services provided by the company have been “transformative”.
One client to the CQC: “They have an understanding of the LGBT community, they understand us, they respect us. This makes it more comfortable compared to other agencies.”
Another told inspectors: “Having this support has been transformative and very helpful”, “I was specific about what I wanted and they were open and honest with me on whether they could meet our needs, and they have been able to do this”, “Compared to previous agencies, it has been a seamless transition and is working well.”

“The care workers are very competent and know what they are doing. I can see that they have lots of experience.”
While another Alternative Care Service client said: “We need consistency, it is really important and this is what we get. They have been able to accommodate this for us.”
The CQC report said staff told inspectors they were well supported, trained and spoke positively about the values of the provider.
“They are a great agency, they always listen to us” and “I think I’m lucky and feel I’ve hit the jackpot as I know that I have chosen a great company to work for.”
Despite being a small and relatively new company, the CQC report on Alternative Care Services also found that:
• Staff were aware of their safeguarding responsibilities and were confident the registered manager would take the appropriate action if they had any concerns.
• People and their relatives had been actively involved in decisions about their agreed care and support. We received positive comments about the kind and caring nature of care workers and how positive relationships had been developed at the start of the care package.
• People were provided with information on how to make a complaint. Relatives told us they would feel comfortable getting in touch with the provider if they had any concerns.
• The service promoted an open and honest culture. We received positive feedback about the management team and staff felt well supported. Staff were confident they could raise any concerns or issues, knowing they would be listened to and acted upon.
• Staff spoke positively about the values of the provider and the direction the organisation was going in. The registered manager was passionate about the rights of people who needed support from the LGBTQI+ community. He had been involved in campaigning for people’s rights at workshops and national conferences.
• There were arrangements in place to assess and monitor the quality and effectiveness of the service and use these findings to make ongoing improvement.
When reporting his findings on the five questions the CQC asks about care service providers, the inspector had this to say:
Is the service safe?
“There was a safeguarding policy in place and staff were confident any concerns brought up would be acted upon straight away. Staff had received training in safeguarding and knew their responsibilities to report any signs of abuse and protect people from harm.”
Is the service effective?
“Relatives told us that care workers were aware of people’s health and well-being and knew how to respond if their needs changed.
“Care workers completed an induction and training programme to support them to meet people’s needs. There were no formal records of supervision but care workers confirmed they had one to one meetings with the management team.”
Is the service caring?
“We saw that people and their relatives were involved in decisions about the care and support they received, and encouraged to express their views.
“People and their relatives were happy with the care they received. Relatives spoke positively about the caring attitude of the care workers that supported them.
“People were introduced to care workers to help them feel comfortable before the service started. New care workers were developing positive relationships with people they were getting to know and understand and treated them with respect.”
Is the service responsive?
“Care records were discussed to meet people’s individual needs. Staff knew how people liked to be supported. Although people and their relatives had no complaints about the service, they said they would be comfortable in contacting the management team if they had any concerns.”
Is the service well-led?
“Relatives told us that they were happy with how the first few months of the service had been managed. Staff felt supported to carry out their responsibilities and spoke positively about the management team.
“The management team were in regular contact with people using the service and their relatives to monitor the quality of care and support provided.
“The registered manager worked in partnership with a range of organisations in relation to care and support for people in the LGBTQI+ community.”
You can read the full report here:

Dignity in care: we understand more than most why it’s important

Alternative Care Services is a care agency providing support and social care for older LGBT people in their own homes.

Founded by Ramses Underhill-Smith, the company was created after Ramses saw a HIV-positive friend risk his health by rejecting care in his own home, over concern that the care workers might be homophobic.

Some of our staff are trans, gay, bisexual, and from the LGBT community, some aren’t, but all get training in treating patients with dignity.

“If you’ve had surgery and you’ve got scars, you don’t want people looking at them in a certain way. We’re so used to it in the LGBT community – it’s not even the words people say, but the fact that everybody stares. You don’t want to have to explain when you get undressed for personal care.”

Ramses Underhill-Smith: ‘People refuse to accept it when you’re older.’ Photograph: Fabio De Paola for the Guardian

“It’s about knowing that whoever comes to your door is going to understand who you are, that in conversation you’re going to be able to say things openly.” Some frail older people, he points out, barely see anyone but health professionals; if they can’t talk to them honestly, they are completely isolated.”

We are proud that we help provide dignity, support and comfort to our clients and thrilled that our work has been featured in The Guardian.

Alternative Care Services works with CQC to create registration breakthrough

At Alternative Care Services we do things a bit differently, we have to as we are the UK’s first and only LGBTQI+ at-home care provider.

It is our mission to make sure all of our clients are provided the very best, discrimination-free service, as we believe dignity and respect is paramount to providing fantastic care.

LGBT care regualted by the CQC

Being the first company of its kind in the UK, we have come across many aspects of the care industry that we believe could be improved – particularly when it comes to working with the ageing LGBTQI+ community.

When we registered as a care provider with the Care Quality Commission, we realised that the independent regulator did not have a category for LGBT service users or companies.

This signified a vital issue to us; that the LGBTQI+ community remains invisible within the care industry, something that we believe must change.

We therefore contacted the folks at the CQC to see how we could effect change and ensure LGBTQI+ service users are acknowledged and offered a choice.

After months of discussions, the regulator agreed that its registration process needed to change and confirmed to us that it would now redevelop the entire CQC registration process!

We are thrilled to have been a catalyst of change and to have worked directly with the CQC to make sure LGBTQI+ people are no longer invisible when it comes to the industry.

It is worth noting that this is still a work in progress, and there is still much to do to, but with the help of fantastic organisations like the CQC, and its staff, we can improve services for all.

Health & wellbeing: Living well, loving life

As a care provider it is very important to us to provide excellent services to our clients.

It’s also important for us to share our experiences and best practices as care providers to other providers in the UK.

Proudly, as the UK’s first (and only) LGBTQI+ adult care provider we also love to share our innovative thinking and unique approach to care.

So when our Managing Director Ramses Underhill-Smith was asked to join the National Care Forum Managers Conference, he naturally jumped at the chance.

Speaking to leaders and managers from around the country, Ramses eloquently discussed the status of the homecare industry, the challenges facing small businesses and the provision for LGBT+ seniors in the healthcare system.

Ramses’ workshop was extremely well received and enabled managers to gain detailed insight into running an LGBT+ focused organisation, drawing on his expertise and knowledge.

As an organisation we were all thrilled to be a part of the NCF Managers conference, which allowed us to spread a vital message from many who normally do not have a voice.

It’s World Values Day, and these are the core values we hold dear:

We believe that everyone in our care has the fundamental right to:

Be themselves
Be happy
Be regarded as an individual and given individual respect
Be treated equally, and no less favourably than others
Receive respect and understanding regarding their sexual, cultural, religious and spiritual beliefs
Be safe, feel loved and always know that someone cares
Be afforded personal privacy and security
Have the opportunity to think independently, and make their own choices and be listened to
Be free