A View from the Top
Tony Stein

Tony Stein, Chief Executive of Healthcare Management Solutions

Reflections on the last decade

How we support our most vulnerable is the most important measure of a civilised society. At HCMS, we’ve spent the last nine years improving care for residents and the working environment for staff and it’s been an honour. It’s enjoyable doing something good and knowing that it’s making a difference to people’s lives. I haven’t had this in other roles.

The last decade has been the most challenging for the sector and local authorities have the most difficult job of all, finding the resources to meet an ever-growing demand whilst trying to balance the books in other areas.

Projections for the next decade

I’m an optimist and I believe we will find a way of fixing the current crisis but, at times, it feels like there’s no joined-up thinking. Politicians make decisions based on political impact and, in everyone’s eagerness to do the right thing, people miss the unintended consequences. For example, in Scotland, the Care Inspectorate has issued new guidance for care home builds. These include new space requirements for room sizes. Whilst we’d all agree that it would be great to give residents more space, at local authority rates, providers can’t afford to build for the public pay market consigning public pay clients to old homes for longer.

A challenge the sector also needs to address is the use of agency staff. One of the hardest things about growing older is the reliance on others for personal care. I always think it must be so much worse when someone who calls for assistance is met by a total stranger. We need to find ways of reducing agency use, protect people’s dignity, improve management and training and reduce cost. The money spent on agency staff premiums could be reinvested in the support and development of permanent staff.

These are big issues that need dealing with, but ones which no-one seems able to address. At the same time, there are some simple ways to reduce pressure on the system.
My mother is getting to an age where she is falling more. She has a panic button which calls the paramedics. They arrive, assess her, and then have to decide whether to leave her where she is, or take her to A&E. Generally, just to be sure, they take her to A&E where she occupies a bed for several hours and where the medical staff pick up a variety of age-related conditions that she’s been happily living with for some time. What she really needed was someone to help her get on her feet, look after her until she’s able to go home again. She would have been better off going to a local care home, freeing up an A&E bed and saving the NHS money.

By contrast, we have Devo Manc (integration of health and social care in Greater Manchester). What it’s trying to achieve is admirable but it’s difficult and complicated, expensive and time-consuming to implement. There’s a real pressure to find solutions but sometimes the simpler solutions are overlooked.


Running a large care group is very different to running a smaller one. It’s too simplistic to assume that the greater scale delivers greater efficiency and often the drawbacks outweigh the benefits. More people are starting to see this.

I am seeing a shift in thinking in this regard. It’s refreshing to hear newer entrants saying that care is central to success and understanding that returns will be lower and longer-term than traditionally expected.


My father taught me that in business you should be true to your word; whether a deal works in your favour or not, your handshake should be your bond. I’ve also worked with some exceptional teams and had some fantastic mentors, especially at Carlsberg Tetley.


Lesson one is that I’m not always right. Secondly, respect the people you work with and surround yourself with the best people you can. I have a great team who are passionate about what we do and committed.

Finally, find time to think about your next move. It can be difficult sometimes, but haste can prove expensive.


In business, always have an open mind and listen to others’ opinions, but ultimately, do what you think is right and don’t be dissuaded by negativity.

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