Let’s Talk About Care

Our Managing Director, Ramses Underhill-Smith recently spoke to the folks at Let’s Talk About Care podcast.

A media platform that cares about the care sector, the podcast aims to give people hope for the future. It brings funny, heartwarming and inspiring stories about care and hear from experts, policy makers and celebrities as well as those receiving and giving care.

Host Angeline Albert asked Ramses why care homes and home care agencies should champion LGBT+ rights.

Not only does Ramses conclusively answer the question, he shares his personal insight into why it matters.

You can listen to it here:

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Beat the Heat: Coping with heat and COVID-19

Although most of us welcome the summer sun, high temperatures can be harmful to your health. The heat can affect anyone, but some people run a greater risk of serious harm. Many of those who are at risk of harm from heat are also at greater risk of severe illness due to COVID-19 and may need to spend more time at home than they would usually. Others may need to stay at home because they are self-isolating or recovering from the infection.

During the COVID-19 pandemic, its especially important that you know what actions to take to keep yourself and others safe from high temperatures.

This article tells you how to stay safe in hot weather, including how to keep your home cool. In preparation for warmer weather, use our simple checklist to find out if your home is at risk of overheating and find out what you can do if there is a problem. You can download the checklist from the PHE heatwave webpage https://www.gov.uk/government/publications/heatwave-plan-for-england

  • Shade or cover windows exposed to direct sunlight, external shutters or shades are very effective, while internal blinds or curtains are less effective but cheaper.
  • Do not store alcohol hand sanitiser in direct sunlight
  • Metallic blinds and dark curtains can make a room hotter.
  • Open windows when the air feels cooler outside than inside, for example, at night. Try to get air flowing through your home, if possible.
  • Turn off the central heating, and lights and electrical equipment that aren’t in use.
  • Use electric fans if the temperature is below 35°C, but do not aim the fan directly at the body and ensure you stay hydrated with regular drinks.
  • Do not use a fan if anyone in the home is unwell with symptoms of coronavirus (COVID-19).
  • Check that fridges and freezers are working properly.

If you have concerns about an uncomfortably hot home that is affecting your health or someone else’s health, seek medical advice.

You may be able to get help from the environmental health department within your local authority; they can do a home hazard assessment.

Drink plenty of fluids and avoid excess alcohol

Fluid requirements are higher than normal in hot weather and after strenuous activity, to replace fluids lost through sweating

Everyone is at risk of dehydration in hot temperatures, but babies, children and the elderly are particularly vulnerable.

Keeping hydrated will be especially important for people who are unwell with coronavirus (COVID-19) infection and managing their symptoms at home.

Those who have been unwell with coronavirus (COVID-19) and are recovering, particularly those who have been discharged from hospital, are likely to be more vulnerable to risks from heat stress and dehydration due to complications, for example, damage to their kidneys.

Look out for signs of dehydration such as increased thirst, a dry mouth, dark urine, and urinating infrequently or small amounts. Serious dehydration needs urgent medical attention, more information is available at: https://www.nhs.uk/conditions/dehydration.

Drink plenty of fluids: water, lower fat milks and tea and coffee are good options.

Fruit juice, smoothies and soft drinks do count towards your fluid intake, but can be high in sugar. Limit fruit juice or smoothies to a combined total of 150ml a day and swap sugary soft drinks for diet, sugar-free or no added sugar varieties.

Slow down when it is hot

Heavy activity can make you prone to heat related illnesses, even if you are fit and healthy.

What can I do?
Avoid extreme physical exertion. If you can’t avoid strenuous outdoor activity, such as sport, DIY or gardening, keep it for cooler parts of the day – for example, in the early morning or evening.

Children should not take part in vigorous physical activity on very hot days, such as when temperatures are above 30°C.

More of us are walking and cycling to support social distancing measures on the transport system; listen to the forecast and take it easy if the weather is hot, especially if you are travelling in the hottest part of the day.

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The Coronavirus Act 2020 and social care

The Coronavirus Act 2020 (Coronavirus Act) sets out the temporary emergency measures that enable public bodies such as local authorities, NHS and the police to respond to the coronavirus pandemic. The measures are wide-ranging and impact on both existing legislation and regulations.

LGBT care for all
Care for gay seniors

Here is a break down of what the emergency changes mean to adult social care in England, what the temporary suspension of duties are under the Care Act 2014, and regulations and the implications for those individuals who are reliant on care and support provisions from their local authority.

Emergency period

The impact of a severe coronavirus outbreak can result in a significantly reduced workforce due to sickness, imposed isolation, caring responsibilities, and a surge in social care enquires, making it potentially impossible for local authorities to fulfil their statutory duties under the Care Act 2014. In response to the pandemic, several duties under the Care Act 2014 have temporarily been suspended and some modified, to prioritise care and support packages for people with the most urgent and serious social care needs. Government guidance states that such powers should “only be used if demand pressures and workforce illness during the pandemic meant that local authorities were at imminent risk of failing to fulfil their duties and only last during the duration of the emergency”.

Changes to the Care Act 2014

The Care Act 2014 places explicit legal duties on local authorities to provide or arrange services for individuals and their carers with care and support needs in their local area. However, given the emergency period, temporary changes have been made to the Care Act 2014, which mean local authorities do NOT have to comply with the following duties in the normal way:
• Duties to assess the needs of the adult under section 9.
• Duties to assess carers needs under section 10.
• Duties to give written record of adult’s needs and carer’s assessment under section 12.
• Duties to determine eligibility for care and support under section 13.
• Duties to carry out financial assessment under section 17.
• Duties to meets adult’s needs under section 18 and carer’s need for support section 20.
• Duties to prepare care/support plan under sections 24, 25 and 27.
• Duties where an adult expresses a preference for accommodation.
• Duties to assess a child’s needs for care and support under Section 58 and 59.
• Duties where an adult moves from one local authority area to another under section 37 and 38.
• Duties for the transitioning of children to adult care and support.

Human rights
The Coronavirus Act confirms that a local authority must still meet an adult’s needs for care and support under section 18 of the Care Act 2014, where necessary to avoid a breach of the adult’s human rights. Carers’ needs for support under section 20 of the Care Act 2014, must also be met where necessary to avoid a breach of the carer’s human rights. The Government gives examples of which rights could potentially be breached, that is, Article 2 ‘Right to Life’, Article 3 ‘Prohibition of torture’ and Article 8 ‘Right to respect for private and family life’ of the of European Convention on Human Rights (ECHR).

Safeguarding vulnerable adults
It is important to note that the Coronavirus Act does NOT affect the safeguarding protections in the Care Act 2014. This means that local authorities still owe a duty of care, under section 42 of the Care Act 2014, towards an adult who is experiencing or is at risk of abuse or neglect.

Implications and key points
These easements took legal effect on 31 March 2020, but should only be exercised by local authorities where the workforce is significantly depleted, or demand on social care increased, to the extent that it is no longer reasonably practicable for it to comply with its Care Act duties (as they stand prior to amendment by the Coronavirus Act) and where to continue to try to do so is likely to result in urgent or acute needs not being met, potentially risking life.

The emergency measures in the Coronavirus Act are only temporary. They will be reviewed by Parliament every six months, and all assessments and reviews that are delayed or not completed will be followed up and completed in full once the easements are terminated.
Any change resulting from such a decision should be proportionate to the circumstances in a particular local authority. It is clear that they should comply with the pre-amendment Care Act provisions and related Care and Support Statutory Guidance for as long and as far as possible.

Prioritisation decisions made by local authorities must be made consistently and ethically, and by law, they must have regard to the Guidance – Responding to COVID-19: the ethical framework for adult social care issued by the Department of Health and Social Care.

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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.

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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:


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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.


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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.

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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.

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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:

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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.

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