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Analysis
Blueprint to put humanity back into care homes The ongoing crisis in the sector can only be solved by better pay and conditions for staff, according to the Joseph Rowntree Foundation. Nick Triggle reports OVER THE years there has been a great deal of focus on what is wrong with care homes for older people. Cases of neglect and abuse have hit the headlines, while substandard care is sadly still far too common. The issue has once again been acknowledged in a report by the Joseph Rowntree Foundation, which laments the ‘permanent sense of crisis’ in the sector. Year-long inquiry But what marks out the report, based on a year-long inquiry, is the detailed blueprint it sets out to ‘inject humanity’ back into the sector across the UK. Since it cares for more than 400,000 people and employs one million, the report says the sector should be of ‘national strategic importance’. 8
December 2014 | Volume 26 | Number 10
The report, which drew on evidence from those who work in the sector, those cared for and those whose loved ones receive care, criticises the blame culture and bureaucracy that exists. A major theme is how the system acts as a barrier to nurses, care assistants and managers providing good care. The inquiry took a fresh approach to finding out people’s views by using social media and gathering evidence via blogs, Twitter and Facebook (see panel).
The inquiry identified more than 100 separate items of paperwork that have to be completed on a regular basis
So what does it recommend? Better pay, conditions and support for staff are top of the list. It points out staff in the care sector are some of the worst paid in the country with three quarters of care workers earning around £6.45 per hour – just 14p more than the 2013 national minimum wage for adults. It says ‘kind, confident, compassionate and skilled people’ are essential to providing good quality care, but this is only possible if staff are treated humanely. However, pay and conditions are not the only factors that need to be addressed to enable provision of quality care, the report says. Paperwork needs to be cut so that workers have more time to spend on caring for residents and developing relationships. The inquiry identified more than 100 separate items of paperwork that have to be completed on a regular basis, while some managers reported spending 20% of their free time on paperwork. This, it says, comes at the expense of leadership activities that could improve care. Representation The report says managers would be helped if a professional body to represent them was created to set standards, discipline poor performers and influence national policy. The general system of regulation also needs to change, the report says. It is too focused on inspection and should be altered to look at issues such as pay, staffing levels and financing. Technology should be embraced too, it says, pointing out the opportunities offered by modern digital technologies such as tablets. It says they have the potential to connect residents with the ‘arts, politics and civic society’ as well as providing feedback on the care they receive. Of course, underpinning all this is money. The report is clear there is a funding shortfall, pointing out the care home sector accounts for just 1.8% – down from 2% – of national expenditure compared with more than 15% which is spent on the NHS. Report author John Kennedy, the foundation’s director of care services, says: ‘Real change is needed to end the NURSING OLDER PEOPLE
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Analysis neglect of our care home sector. Currently the system is set up to fail, with the minimum resource, effort and value placed on care homes. ‘The sector needs to be brought in from the cold – valued, supported and fully part of a co-ordinated system.’ RCN professional lead for the care of older people Dawne Garrett says she would like to see nurses providing leadership and supervision to care staff. ‘It is difficult for nurses. They are increasingly finding themselves stretched trying to care for patients. Supervision ‘Over the years the level of acuity is getting higher and, therefore, residents need more and more help. The physical environment of care homes also makes it difficult to supervise other staff and I know with the number of agency staff being used nurses find themselves having to delegate to carers they do not know. ‘But I feel there is more that can be done to share expertise and professional knowledge. When nurses are working in care homes they can provide support by advising other staff about what the latest guidance says or what the best practice is.’
There is a lot more hospitals can do to support care homes, including sending their specialists out to care for residents Independent nurse consultant Deborah Sturdy says the profession needs to place more importance on the sector. ‘Providing nursing in care homes is often seen as less important than hospitals. In reality it’s much more challenging. You are dealing with complicated clinical decisions – people who have dementia and multiple comorbidities – without the support network you have in hospitals. You can’t just call on a doctor who is down the corridor.’ She warns that unless the stigma that is attached to care homes is addressed, problems with recruitment and retention ‘will just get worse’. The scale of the problem has already been highlighted by the Care Quality Commission’s annual report on health and social care in England, which found one in three nursing vacancies left unfilled in some areas.
Evidence gathered from social media ‘Time is not there to listen and reassure and be in three places at once’ (Lea via Facebook). ‘If they are over-stretched because their employer has cut down on staff, if they are working for less than the living wage and have a zero hours contract, if they are given a series of tasks to complete rather than encouraged to work on their own personal initiative, then you will not have a working environment that generates kindness’ (Unison retired member via Facebook). ‘Staff and managers feel tied by red tape and procedure which disempowers them from really doing the job they’re there to do and that they really want to do, which is to care!’ (Malcolm via blog). NURSING OLDER PEOPLE
‘Bad management creates anger, bitterness and resentment – causing staff to carry out their duties when they are stressed and feeling undervalued. Good staff leave. Good management means staff feel comfortable communicating issues with their management and know that, when something needs to be done, it will be done’ (Paige via Facebook). ‘If a provider is short-staffed, then the care workers on shift simply don’t have time to sit and talk to residents, and owners put pressure on staff and management to be “busy” – doing physical tasks like laundry or cleaning, not “sitting around chatting”’ (Alice via blog).
Overall, one in five care homes inspected in 2013/14 did not have enough staff on duty to ensure residents received good, safe care. Ms Sturdy says: ‘I would like to see nursing posts in care homes given much more recognition through the creation of nurse practitioner or nurse consultant roles. ‘We also need to see more student placements in care homes.’ But she believes the whole NHS system, including GPs and hospitals, needs to ‘rethink its approach’ as well. ‘There is a lot more hospitals can do to support care homes, including sending their specialists out to care for residents and building relationships that involve teaching and shared learning. ‘GPs have to get more involved too. There are care homes that have to pay supplements to get GPs out. It’s wrong that people are marginalised in this way.’ Good practice Care England chair Jane Ashcroft says providers would welcome that approach. ‘We know the challenges we face. Dementia is a growing problem and as diagnosis rates increase we need to ensure we have properly trained staff.’ But she says it should be recognised that there are still many examples of good practice. ‘I have been into care homes where GP and nursing play an active part, where staff have the right training and residents are treated with dignity and respect. It’s just that it is patchy. ‘The market is still dependent on self-funders making up for the low local authority rates that are paid. It means there is real polarisation between areas with high numbers of self-funders and areas with low numbers.’ Nick Triggle is a freelance writer
References Care Quality Commission (2014) The State of Health Care and Adult Social Care in England 2013/14. www.cqc.org.uk/sites/ default/files/state-of-care-201314-full-report-1.1.pdf (Last accessed: November 5 2014.) Joseph Rowntree Foundation (2014) John Kennedy’s Care Home Inquiry. www.jrf.org.uk/sites/files/jrf/ Care_home_inquiry_FULL_0.pdf (Last accessed: November 5 2014.)
December 2014 | Volume 26 | Number 10
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Analysis
Blueprint to put humanity back into care homes The ongoing crisis in the sector can only be solved by better pay and conditions for staff, according to the Joseph Rowntree Foundation. Nick Triggle reports OVER THE years there has been a great deal of focus on what is wrong with care homes for older people. Cases of neglect and abuse have hit the headlines, while substandard care is sadly still far too common. The issue has once again been acknowledged in a report by the Joseph Rowntree Foundation, which laments the ‘permanent sense of crisis’ in the sector. Year-long inquiry But what marks out the report, based on a year-long inquiry, is the detailed blueprint it sets out to ‘inject humanity’ back into the sector across the UK. Since it cares for more than 400,000 people and employs one million, the report says the sector should be of ‘national strategic importance’. 8
December 2014 | Volume 26 | Number 10
The report, which drew on evidence from those who work in the sector, those cared for and those whose loved ones receive care, criticises the blame culture and bureaucracy that exists. A major theme is how the system acts as a barrier to nurses, care assistants and managers providing good care. The inquiry took a fresh approach to finding out people’s views by using social media and gathering evidence via blogs, Twitter and Facebook (see panel).
The inquiry identified more than 100 separate items of paperwork that have to be completed on a regular basis
So what does it recommend? Better pay, conditions and support for staff are top of the list. It points out staff in the care sector are some of the worst paid in the country with three quarters of care workers earning around £6.45 per hour – just 14p more than the 2013 national minimum wage for adults. It says ‘kind, confident, compassionate and skilled people’ are essential to providing good quality care, but this is only possible if staff are treated humanely. However, pay and conditions are not the only factors that need to be addressed to enable provision of quality care, the report says. Paperwork needs to be cut so that workers have more time to spend on caring for residents and developing relationships. The inquiry identified more than 100 separate items of paperwork that have to be completed on a regular basis, while some managers reported spending 20% of their free time on paperwork. This, it says, comes at the expense of leadership activities that could improve care. Representation The report says managers would be helped if a professional body to represent them was created to set standards, discipline poor performers and influence national policy. The general system of regulation also needs to change, the report says. It is too focused on inspection and should be altered to look at issues such as pay, staffing levels and financing. Technology should be embraced too, it says, pointing out the opportunities offered by modern digital technologies such as tablets. It says they have the potential to connect residents with the ‘arts, politics and civic society’ as well as providing feedback on the care they receive. Of course, underpinning all this is money. The report is clear there is a funding shortfall, pointing out the care home sector accounts for just 1.8% – down from 2% – of national expenditure compared with more than 15% which is spent on the NHS. Report author John Kennedy, the foundation’s director of care services, says: ‘Real change is needed to end the NURSING OLDER PEOPLE
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 25, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Analysis neglect of our care home sector. Currently the system is set up to fail, with the minimum resource, effort and value placed on care homes. ‘The sector needs to be brought in from the cold – valued, supported and fully part of a co-ordinated system.’ RCN professional lead for the care of older people Dawne Garrett says she would like to see nurses providing leadership and supervision to care staff. ‘It is difficult for nurses. They are increasingly finding themselves stretched trying to care for patients. Supervision ‘Over the years the level of acuity is getting higher and, therefore, residents need more and more help. The physical environment of care homes also makes it difficult to supervise other staff and I know with the number of agency staff being used nurses find themselves having to delegate to carers they do not know. ‘But I feel there is more that can be done to share expertise and professional knowledge. When nurses are working in care homes they can provide support by advising other staff about what the latest guidance says or what the best practice is.’
There is a lot more hospitals can do to support care homes, including sending their specialists out to care for residents Independent nurse consultant Deborah Sturdy says the profession needs to place more importance on the sector. ‘Providing nursing in care homes is often seen as less important than hospitals. In reality it’s much more challenging. You are dealing with complicated clinical decisions – people who have dementia and multiple comorbidities – without the support network you have in hospitals. You can’t just call on a doctor who is down the corridor.’ She warns that unless the stigma that is attached to care homes is addressed, problems with recruitment and retention ‘will just get worse’. The scale of the problem has already been highlighted by the Care Quality Commission’s annual report on health and social care in England, which found one in three nursing vacancies left unfilled in some areas.
Evidence gathered from social media ‘Time is not there to listen and reassure and be in three places at once’ (Lea via Facebook). ‘If they are over-stretched because their employer has cut down on staff, if they are working for less than the living wage and have a zero hours contract, if they are given a series of tasks to complete rather than encouraged to work on their own personal initiative, then you will not have a working environment that generates kindness’ (Unison retired member via Facebook). ‘Staff and managers feel tied by red tape and procedure which disempowers them from really doing the job they’re there to do and that they really want to do, which is to care!’ (Malcolm via blog). NURSING OLDER PEOPLE
‘Bad management creates anger, bitterness and resentment – causing staff to carry out their duties when they are stressed and feeling undervalued. Good staff leave. Good management means staff feel comfortable communicating issues with their management and know that, when something needs to be done, it will be done’ (Paige via Facebook). ‘If a provider is short-staffed, then the care workers on shift simply don’t have time to sit and talk to residents, and owners put pressure on staff and management to be “busy” – doing physical tasks like laundry or cleaning, not “sitting around chatting”’ (Alice via blog).
Overall, one in five care homes inspected in 2013/14 did not have enough staff on duty to ensure residents received good, safe care. Ms Sturdy says: ‘I would like to see nursing posts in care homes given much more recognition through the creation of nurse practitioner or nurse consultant roles. ‘We also need to see more student placements in care homes.’ But she believes the whole NHS system, including GPs and hospitals, needs to ‘rethink its approach’ as well. ‘There is a lot more hospitals can do to support care homes, including sending their specialists out to care for residents and building relationships that involve teaching and shared learning. ‘GPs have to get more involved too. There are care homes that have to pay supplements to get GPs out. It’s wrong that people are marginalised in this way.’ Good practice Care England chair Jane Ashcroft says providers would welcome that approach. ‘We know the challenges we face. Dementia is a growing problem and as diagnosis rates increase we need to ensure we have properly trained staff.’ But she says it should be recognised that there are still many examples of good practice. ‘I have been into care homes where GP and nursing play an active part, where staff have the right training and residents are treated with dignity and respect. It’s just that it is patchy. ‘The market is still dependent on self-funders making up for the low local authority rates that are paid. It means there is real polarisation between areas with high numbers of self-funders and areas with low numbers.’ Nick Triggle is a freelance writer
References Care Quality Commission (2014) The State of Health Care and Adult Social Care in England 2013/14. www.cqc.org.uk/sites/ default/files/state-of-care-201314-full-report-1.1.pdf (Last accessed: November 5 2014.) Joseph Rowntree Foundation (2014) John Kennedy’s Care Home Inquiry. www.jrf.org.uk/sites/files/jrf/ Care_home_inquiry_FULL_0.pdf (Last accessed: November 5 2014.)
December 2014 | Volume 26 | Number 10
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 25, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
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