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Until the social care sector is made more attractive to nurses the most vulnerable adults including those with dementia will continue to face problems accessing the support they need, a regulation chief warned today.
Speaking at the first-ever Nursing Times Patient Flow Forum, Carolyn Jenkinson, head of hospital inspection at the Care Quality Commission and lead for provider collaboration, 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”
Giving an exclusive presentation on the CQC’s latest annual State of Care report for England published today, Ms Jenkinson 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”.
A key concern in regard to the sector that was 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.
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.
When asked by Nursing Times during the session today 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”
She also raised concerns about the high turnover rate in the adult social care workforce, which for registered nurses had increased from 33% in 2014-15 to 34% in 2018-19. For care workers last year the turnover rate was 39%.
“You probably know as well as I do it’s very hard to improve services when turnover rate is so high,” warned Ms Jenkinson.
She said what had “really struck” her in recent months was the affect of the Covid-19 pandemic on the adult social care sector, and how people working in these roles reported feeling “isolated” and “forgotten about”.
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.
Meanwhile, 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.”