We are all aware of the difficulty in recruiting and retaining nurses with CQC registration in care homes. However, If we are to improve the situation, we must make the sector more attractive to nurses. Carolyn Jenkinson, head of hospital inspection at the Care Quality Commission and lead for provider collaboration speaking at the first-ever Nursing Times Patient Flow Forum, said nurse recruitment for adult social care continued to be a major issue that needed addressing nationally. “It’s to do with recruitment often of nurses, it’s so challenging for the sector”
Carolyn Jenkinson giving an exclusive presentation on the CQC’s latest annual State of Care report for England, said the regulator’s findings from 2019-20 suggested the adult social care sector was “still fragile” and “in need of investment and workforce planning and a long-term funding solution”.
Nursing homes downgrading to residential facilities
A key concern in regard to the sector highlighted in the 2018-19 report was the fact that nursing homes were having to downgrade to residential facilities due to shortages of nurses, as reported by Nursing Times.
While both settings come under the umbrella of a care home, nursing homes are for people with conditions that require the support of a registered nurse, such as a severe learning disability or a complex medical problem, whereas residential homes are there for people who need help with personal care and daily tasks, following the policies and procedures for supported living.
The latest CQC State of Care report highlighted ongoing “difficulties across the country for people who need residential care with nursing – this was linked to workforce challenges, with the recruitment of nurses a particular challenge for the sector”.
This was leading to situation where there was a “lack of suitable provision for people with high support needs, including people living with dementia”, it added.
Investing in adult social care
When asked if more nursing homes were having to downgrade to residential facilities, Ms Jenkinson said “absolutely”.
“It’s to do with recruitment often of nurses, it’s so challenging for the sector,” she added.
“Again it all comes back to investing in adult social care as a sector and creating adult social care as somewhere exciting where there’s a career pathway for nurses.
“Until we do that then we are not going to see that situation improve.”
She said while she was sure there were already care home providers across England offering good career opportunities for nurses, “we need to do a lot more” to encourage people into the sector.
“Hand on heart, how many student nurses if you ask them in their third year of training… would say I want to go and work in adult social care in a nursing home? Probably not that many,” she added. “We’ve got to make it attractive. “We have to work as a health and social care system together”
Impact of the pandemic
The CQC’s report described the impact of the pandemic on the sector as “severe” and said care homes had “borne the brunt of a disease that disproportionately affects older people and those with multiple conditions and care needs”.
As well as dealing with high numbers of deaths, the report noted how challenges around staff absences due to people being off sick or self-isolating meant some providers were unable to accept new admissions, which was “putting the financial viability of some care homes at risk”.
The CQC, through its new report, is calling for a “new deal” for the adult social care workforce.
“One that develops clear career progression, secures the right skills for the sector, better recognises and values staff, invests in their training and supports appropriate professionalisation,” stated the report.
Working together as a health and social care system
Ms Jenkinson also appealed to NHS professionals involved in patient flow to be mindful of the challenges facing the social care sector when making decisions around transferrals, and not to “work in isolation”.
“We have to work as a health and social care system together and understand what happens within our local areas and do it together,” she said.
“Otherwise it will never ever work properly, and it just puts people at more risk.”
The recruitment of nurses has long been a challenge facing care homes. According to Carolyn Jenkinson the social care sector needs to do more to make it attractive to nurses. She suggests
we need more investment in adult social care and creating adult social care as somewhere exciting where there’s a career pathway for nurses. “Until we do that then we are not going to see that situation improve.”
Perhaps we could consider an alternative in the form of the development of a nursing qualification specifically designed for social care along with career progression and financial reward. We should not have to rely on nurses opting for social care in their final year when all the evidence is, they are choosing not to.
Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy