Saturday 17 November 2018
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Valuing the role of nurses in adult social care

NCF Blog by Tracy Paine - Chair of the NCF Practice Forum

Tracy Paine, Operations Director at Belong, reflects on the impact of the shortage of nurses within adult social care

The serious issue of the supply of nurses working in adult social care seems finally to be recognised.  CQC published their State of Care 2013/14 report which said “We are particularly concerned about the current shortage of nurses within social care services. In 2013/14 we found that many nursing homes did not have sufficient staff on duty to ensure residents receive good, safe care”. This confirms what we as providers have been experiencing for several years.

There are currently around 670,000 nurses registered with the Nursing and Midwifery Council, just over 310,000 of who are working in the NHS and 51,400 are working as nurses in the adult social care sector. It is thought that nurses leave the NHS and move to the adult social care sector hoping for additional flexibility, part time working patterns, and a reduction in stress. We have been keen to build on this by offering flexible hours, competitive pay, supportive practice and career development. But this still does not seem to be enough of a pull to fill the 7% vacant posts.

As a provider of nursing care we made the decision to challenge some of the myths several years ago by recruiting managers on the basis of skills and values that aligned with those of our organisation which sadly often eliminated nurses. We developed a model of care that put the customer first, and respected the importance of living at home (albeit a registered care home). We also took the approach to ‘free up’ the nurse from the shackles of the medication trolley and encouraged nurses to work as professional practitioners within our village community offering advice, support and direction to our highly trained and compassionate support teams who actually provide the 24 hour care. Having a few early challenges from our regulator did not impede our progress and were pleased to demonstrate the advantages through outcomes.

At a recent DH symposium there was recognition that a shortage of nurses in social care isn’t just a matter that impacts on the care sector- it is potentially a whole system issue because lack of provision in nursing homes means there isn’t the capacity to enable the speedy discharge of patients from hospitals. If the demand for nurses in social care is expected to continue to increase should we be thinking outside the box?  Should we really be sitting waiting for the next tranche of students to leave university to bail us out, or keep our fingers crossed that the early retirees will do a couple of shifts for a bit of extra cash for their holidays? Is this meeting the needs of our customers and our committed staff teams?

What will attract nurses into this sector? One where the media and regulator continue to portray an image that all care homes are bad and all staff working within them are abusers. Perhaps the new world of revalidation and the revised code will reassure nurses that they won’t lose their PIN by working in adult social care. It also struck me that the answer is not about where ‘nursing care’ is provided but how. In the early 1990s many of the old geriatric hospitals closed and ‘patients’ became ‘residents’ in shiny new care homes. But the practice remained the same. And to some extent the ‘commissioning’ of nursing in care homes has not changed. The ‘commissioners’ still expect to see a medical model of care- but in a person’s home.

The recommendations by the Commission on Residential Care administered by Demos suggest that we replace the term ‘care home’ with ‘housing with care’. So why not use this opportunity to change the way nursing care is provided too? It seems to me that perhaps the best solution to the problem is to invest more resources for the District Nursing team with nurses who are already skilled in complex care and support for their patients and families but within the home.

Earlier this week the RCN published The Fragile Frontline and called on the next government to ensure that sufficient numbers of appropriately skilled nurses are trained and in place in the community to deliver new models of care and to increase resources for the workforce within a ‘range of community settings’. However I fear that they have not taken into account the needs of care homes and support services within the social care sector. With a loss of over 2,000 District Nurses there will be an inevitable knock-on effect on the resources available to support older people living in care homes. In addition there remains a need to add the adult social care requirements to the RCN request to increase student commissions to satisfy the needs of the nursing workforce to be able to safely care for the 1.8 million over 85 year olds living in the community in 3 years’ time.

Viv Bennett, Director of Nursing DH/PHE said: “In order to meet the needs of our ageing population we have to change the way we work and provide more care in the community. People are living longer and we need services that support people to be as well and as independent as they can for as long as possible. District nurses have the professional expertise and knowledge to lead and provide these services.”

How can the social care sector take up the challenge? It will take a brave provider and CCG to commission nursing care in very different ways, but something has to change … and soon!

Tracy Paine
Operations Director

Member of the National Care Forum |Chair of the NCF Practice Forum