Monday 18 December 2017
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Juggling on the back of an elephant?

Des Kelly OBE considers the changing role and the competing demands on the Registered Manager

NCF proudly supported The King’s Fund conference on ‘Enhanced health in care homes’ held on 2 July 2015. Proper consideration of the role of care homes in integrating health and care services was seriously overdue. Over 200 delegates attended the event – a hot topic on a hot day and it was rather encouraging to discover that there was close to a 50/50 split between health and care home delegates.

The morning presentations gave a useful account of the NHS England Vanguard sites with a particular focus on integration with health and those involving care homes. A series of parallel sessions covered re-ablement, clinical reviews in care homes, the role of nurses and housing based models of care. However it was particularly refreshing to see the day end with a presentation on new models from Andrea Sutcliffe, Chief Inspector of CQC, who gave the regulator perspective, followed by three care home managers. Their injection of realism made for a perfect conclusion to an excellent day with important reminders of the view from the frontline.

In essence this is what they said:

    It still feels as though the ‘them and us’ attitude is far too common
    It is demoralising to work in a sector constantly criticised in the media
    Commitment to improving pay and the introduction of the living wage is high amongst home managers but funding is yet to be addressed
    Home managers want staff to have regular learning and development opportunities but backfilling staff absent for training is difficult to achieve consistently
    The idea of care homes as a ‘last resort’ still persists and runs deep.

These Registered Managers did a brilliant job of representing their profession to healthcare colleagues and making clear what integration and enhanced health care to care homes actually means. Their honest, no-frills portrayal of the challenges of recruitment (and retention); the constant pressure for quality standards and improvement to meet the needs of people living in care settings and the expectations of their families; the need to continuously motivate and develop staff; meet regulatory requirements and satisfy commercial demands, represents an astonishing breadth of roles and responsibilities, skills and knowledge utilised every day - and still insufficiently acknowledged or rewarded.

The role of home manager has always required juggling skills but to push a metaphor to the absolute limit I wonder if to be ‘well-led’ as a Registered Manager, you now have to be able to juggle more balls than ever while balancing on the back of an elephant (or maybe a camel) and jumping through flaming hoops … oh, and I nearly forgot, with one hand tied behind your back! It might just about be possible but is it really the best way in which to build a vital and sustainable integrated care home service fit for the future?

Des Kelly OBE
Executive Director
National Care Forum        
 
www.nationalcareforum.org.uk