A Visit from London South Bank University

July 2017

Jeremy Walford was delighted to welcome a team from London South Bank University, led by Professor Rebecca Malby of the School of Health and Social Care. They are looking at the question,

 “What does it take to care well with and for older people?”

and were advised to come to Middleton Hall, a current example of what ‘Outstanding’ looks like. Below is an account of Professor Malby’s findings, with a link to a further online report giving some additional details.  


1) My learning


It really demonstrated to me what living in a care home environment should be aspiring to.

  • The importance of putting the people first – staff and residents.
  • The importance of working to values and strong leadership that focuses on the right culture and attitude – how to do things rather than what things to do.
  • The importance of really embedding a personalised approach – assuming that all residents can do everything and work from there, rather than listing what they cannot do.

The achievement at Middleton Hall to produce a village that caters for our aging population is pretty staggering and policy makers should take note that spending more money downstream could have significant effect on the need for more expensive health and social care services down the line and therefore should not dismiss Middleton Hall as not being achievable. 

My learning was about the impact of people being as independent as possible in every setting. In the care setting an elderly lady was having oxygen. She had had it at home and ordered the bottles herself, which she continued to do when she moved into the care facility at Middleton Hall. The team recognise how important it is for residents to be as independent as they possibly can be no matter which area of the village they live in. The ‘care’ and ‘residential’ homes are not called that, they are part of the whole village, but the area of the village relates to the type of support people need, from fully independent living in small houses or apartments, to rooms in group homes with support.

At one level letting people be independent requires patience, it feels easier to do it for them (and quicker) but in the long run it creates dependency and in turn this creates more work for the carers, and a poorer life for the resident. I was struck by how well everyone seemed even though some residents had significant care needs. It seems that people ‘live well’ here, and this must be good for everyone. It would be interesting to compare health outcomes and the number of health service interventions required for these residents over traditional care home settings.

It was interesting that people live in groups/ types of accommodation dependent on their needs, and integrate for social and activities. The staff are managed in teams working within these needs-based services, and the preference is to recruit people without formal care qualifications, as the ethos of that training is not conducive to an independence and bespoke focused relationship with residents.

Overall this was a respectful, humane, asset based way of working that worked for residents, staff and the business.

The primary lesson for me was that caring intervention at the right time, in the right way can relieve pressure on health services. 

My concern always is to see and assess the evidence supporting different ways of doing things. This has given me an opportunity to observe what appears to be excellence in practice. It would be nice to be able to put more definite measures on quality and-or cost improvements, and compare with some kind of baseline levels.

I found Middleton Halls approach to personalisation interesting and innovative. 

It was nice to see a “thinking out of the box approach” and challenging conformity.


2) What struck me about service and approach


I loved the focus on people. The people working and the people living at Middleton Hall are clearly the primary focus, finding their passion and then making it happen; and not being afraid to take some risks. Middleton Oaks was an amazing example of this.

The space. Not just the physical amount of space particularly outside areas, but the general feeling of openness that they have managed to create throughout.

I was particularly struck by the ethos of challenging established norms to achieve wonderful outcomes for the residents. And of course, the level of care provided, the attention to detail, the kindness and the professionalism of everyone involved. Many people talk about ‘person-centred’ but it absolutely runs through every aspect of Middleton Hall Retirement Village.

I was rather overwhelmed by the attention to detail in how you and the team at Middleton relate to the folk living there. It’s the detail that shows how important your core values are about people’s independence, and the impact of that not only for residents, but also for how the business works was fascinating and totally contradictory to the dominant care model. 

Everyone’s nails where immaculate, the washing hanging on the line in the small group living for people with dementia was white, and it really felt like a proper home, in fact visiting felt a little intrusive, We where clearly guests and where moved through quickly so that we didn’t disturb or intrude. The  patio doors from the residents rooms out to their own outdoors space was lovely. The GPS tracking for residents that like to get out and about, so that if they go to far they can be found and guided back; the yellow footsteps painted on the path for the active resident who liked to go out but kept forgetting her way back so she could follow the footsteps back to her home, was just lovely to see. There was no sense that people where cared for – they where independent and being supported in that independence. That mindset is a significant shift from the overwhelming dependency we see in the care sector.

It’s the first care home I have visited (not that I have been to many as yet) that I would feel happy taking my 5 and 3yr old children to. Probably because it doesn’t feel like a care home.

The whole feel of the place was more like a holiday resort than care home facility, we never heard any intrusive ringing alarms, all residents were immaculate and at no point was the dignity of the residents compromised

The ethos and culture of Middleton Hall cannot be understated, Jeremy has created a learning organisation that is constantly looking to improve services for its residents. The culture is fundamentally resident centric, they then work out how to apply what needs to happen even if that means challenging the status quo regulation

I was struck by the mixture of people living together with a wide range of care needs, and impressed by the way that the service seems to be able to make this all seem so very natural.

It feels unique, I certainly feel there are lessons to be learnt from the advancements made at Middleton Hall.


3) What it means for my work and how I will use the visit for my work


It has helped shape in my mind that standard – high quality care is not about being rated as Good by a CQC inspector, it’s about aspiring to be outstanding for both residents, their families and staff, and that this will mean different things for each person to live well right until the end. I will apply this when working with others to help determine the actions needed in Leeds to deliver high quality care.

This has two dimensions. First, it was useful to visualise how robotics (particularly physical assistance robots) could fit within an excellent care setting. Second, it confirmed my intuitions that flourishing can occur at very late stages in a person’s life, even after terrible bereavement, and this flourishing not only benefits the individual but also the wider community (socially as well as economically). As you probably know, flourishing is a concept with deep roots in Ancient Greek moral philosophy, particularly Aristotle, and it is fascinating to see its tangible application in a modern setting. I will use specific cases, such as the man who went fishing or took up guitar, as examples to illustrate this in my work.

The achievements at Middleton Hall have been largely without external (health) input which significantly challenges the current thinking about medical input into care homes. 

Jeremy, the CE, implied that MHRV has good data on the use of resources by different sectors within MHRV, and even by different patients I believe. This could be used to build a model of what the costs are to deliver excellence in care, sector by sector.

In addition an effort could be made to assess whether cost within this setting, over time, for individual patients, might even be less where quality of this kind is delivered: through reduced need levels for an individual over the whole period of their stay. This would be in addition to any savings that might arise in other health care sectors e.g. acute care settings.

It was interesting to see what an “outstanding” service looks like.  Some of the methods adapted here are certainly things that can be transferrable to community care.