Analysis

Social care staff maintaining quality in 'toughest climate', says CQC

Latest Care Quality Commission report reveals pressure on the care home sector is at an unprecedented level.

Latest Care Quality Commission report reveals pressure on the care home sector is at an unprecedented level.

DroversHouse
Drovers House was rated outstanding by the CQC. Pictured are residents Peter (left) and Muriel Farley (right) with home manager Louise Goode

The Care Quality Commission (CQC) has published its latest report on the state of health and adult social care in England, with an analysis based on rated inspections covering almost 29,000 services.

The State of Care report reveals there are still 1.2 million older people with unmet care needs, up a significant 1 million from last year, and 90,000 staff vacancies across adult social care. Registered nurse vacancies in this sector have risen from 4.1% in 2012-13 to 9% in 2016-17.

More than three quarters of adult social care services are rated as ‘good’. However, 19% are rated as ‘requires improvement’ and 1%, covering 303 locations, are rated as ‘inadequate’.

Nursing homes are cited as a concern, with 28% rated as ‘requires improvement’ and 3% as ‘inadequate’.

The report highlights that the nursing homes rated as inadequate could affect as many as 6,300 people.

Unprecedented pressure

The increasing number of older people who are frail, and who have dementia and long-term complex conditions, is placing unprecedented pressure on the health and social care system, the regulator warns.

In the acute sector, more people are waiting for longer than four hours in emergency departments, higher numbers of planned operations are being cancelled and there are longer waits for treatment.

Acute hospital bed occupancy had its highest ever rates from January to March this year.

1.2 million

older people with unmet care needs across England

(Source: Care Quality Commission)

The number of beds in nursing homes has decreased across most of England and domiciliary care contracts are being handed back to councils because providers say the funding is insufficient to meet people’s needs.

CQC chief executive David Behan praised the efforts of front-line staff, managers and leaders who have maintained quality of care in a ‘tough climate’. He added, however: ‘As people’s health and care needs change and become more complex, a model of care designed for the 20thcentury is at full stretch and struggling to cope with 21stcentury problems.’

Strategic approach

In the March budget, chancellor Philip Hammond announced additional funding of £2 billion for social care in England over the next three years, with £1 billion available in 2017-18.

He added that the long-term challenges of sustainably funding care in older age requires a strategic approach and the government would ‘set out its thinking on the options in a green paper later this year’.

The government has not yet published the green paper, and this is causing concern among experts in the health, social care and voluntary sectors.

90,000

staff vacancies across adult social care

(Source: Care Quality Commission)

Chief executive of charity Independent Age, Janet Morrison, said: ‘The green paper promised at the budget in March has yet to materialise, but the clock is ticking and the government seems no closer to producing a long-term solution for social care for our ageing population.’

She said that although the CQC State of Care report acknowledges improvements in some areas: ‘Others have seen a deterioration of care services, which is likely to lead to more unmet care needs among older people and families facing an unenviable choice of poor quality services.

‘It is also worrying that the number of nursing home beds is shrinking.’

Regional variation

There were almost 4,000 fewer beds in nursing homes in March 2017 than there were in March 2015, according to the report.

There is also a wide variation regionally with the number of nursing home beds falling by 20% in some places and increasing in others.

RCN professional lead for older people and dementia Dawne Garrett says: ‘We should not lose sight of the fact that there is some really good care being delivered in really difficult circumstances. Nurses and our members should know we acknowledge their hard work and effort.’

28%

of nursing homes require improvement and 3% are inadequate

(Source: Care Quality Commission)

However, she continues: ‘All nurses recognise there is an unmet care need for older people in this country. It is two-fold: the financial availability to fund care and staff availability to deliver care.

‘We are seeing increasingly complex needs being met by unregistered staff, along with real concerns about nursing post-Brexit, and we know there is a retention issue in the care home sector, and for nursing and adult social care.

‘The government needs to take concrete action immediately.’

Prioritising debate

Cliff Kilgore, nurse consultant intermediate care and older people and chair of the British Geriatrics Society nurses and allied health professionals council, said it is disappointing that ‘a debate on society’s most vulnerable people has not been prioritised by the government.’

He added: ‘These people need a level of care that requires the knowledge and skills of all our health and social care staff, but they also need time from staff so that care is tailored to their needs.

‘Sir David Behan commented that maintaining quality care in the toughest climate that most can remember is testament to the efforts of front-line staff. My concern is our front-line staff being able to continue to maintain this level of care if the “tough climate” continues.’

Martin Green, chief executive of Care England, the largest representative body for independent providers of adult social care, warned that parliament can ‘ill afford to ignore the warnings from the CQC’.

He said: ‘There is an urgent need for a long-term funding settlement that will reach the front line and support sustainable quality services.

‘The State of Care report clearly shows there is a serious problem in recruiting and retaining nurses and this is leading to nursing home closures. The government must act decisively to secure more nurses to independent care services.’

Strong leadership in high-performing services in adult social care

According to the report, strong leadership is characterised by managers who take an innovative approach, are open to feedback and actively seek out best practice to steer improvement, for example by involving people who use services in training.

Managers are visible in the service, known to staff, people using the service, carers and families. They also genuinely appreciate equality and diversity, and seek ways to meet people’s human rights.

The report states: ‘Good leadership that generates a positive and inclusive culture leads to genuinely person-centred care.

‘In high-quality services, staff really get to know people as people, understanding their interests, likes and dislikes. This supports relationships where staff and people who use services work together to set and achieve meaningful and realistic goals.’

(Source: Care Quality Commission)

Innovative use of new technology in adult social care

Some care providers are successfully using technology to improve care for people. In agreement with individuals, some care homes use a new system called acoustic monitoring.

At Drovers House in Rugby, inspectors reported that its acoustic monitoring system enables staff to respond more promptly and appropriately to people’s needs during the night.

Drovers House, which has been rated outstanding overall by CQC and outstanding for its responsiveness, is a purpose-built specialist care home for up to 75 older people with Alzheimer’s disease and other forms of dementia.

Inspectors said the system has a listening device that is switched on at night and ‘pre-set to ignore the individual’s normal noise level, but to trigger an alarm for unusual noise’.

The provider consulted with people and their relatives to explain the benefits of the system.

People can have undisturbed sleep because staff no longer need to check them at night by opening their bedroom doors.

The night staff take turns to monitor the system. This means the remaining night staff can run a ‘wide-awake club’ for people who do not sleep well.

Inspectors said Drovers House employees are enthusiastic about the benefits of the listening system.

Staff had identified some previously ‘unpredictable’ falls and people had a better quality of life and more one-to-one time at night.

(Source: Care Quality Commission)

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