Analysis

Will staff shortages force care homes to close?

 Skills for Care survey finds one fifth of nurses in the adult social care sector work on zero-hours contracts
Staff_retention

Skills for Care survey finds one fifth of nurses in the adult social care sector work on zero-hours contracts

Recruitment and retention of nurses in adult social care is under significant pressure, and the latest report from Skills for Care on the state of the sector and workforce in England will do little to quell concern.

Nurse turnover rates have been increasing year on year, according to the report, and more than one third of nurses have left their jobs in the sector over the past 12 months. This equates to 14,700 leavers.

Just over one in 10 nurses working in the adult social care sector are employed on bank or pool contracts and almost one fifth are estimated to be working on zero-hours contracts.

...

 Skills for Care survey finds one fifth of nurses in the adult social care sector work on zero-hours contracts

Staff_retention
Care homes need to attract more staff if they are to provide high-quality care. Picture: iStock

Recruitment and retention of nurses in adult social care is under significant pressure, and the latest report from Skills for Care on the state of the sector and workforce in England will do little to quell concern.

Nurse turnover rates have been increasing year on year, according to the report, and more than one third of nurses have left their jobs in the sector over the past 12 months. This equates to 14,700 leavers.

Just over one in 10 nurses working in the adult social care sector are employed on bank or pool contracts and almost one fifth are estimated to be working on zero-hours contracts.

Integration

The report states that integration of health and social care services is one of the main political drivers for future planning and has a direct effect on workforce planning.

It adds that the roles of nurses in the delivery of integrated adult social care services should be considered in policy and planning processes, including the development of sustainability and transformation plans.

47,000

Nurses work in the adult social care sector in England

Skills for Care

Sharon Blackburn, policy and communications director of the National Care Forum, says it is important to acknowledge the complexity of care delivered by care home nurses and district nurses working in residential settings.

‘A person moving into a care home will be aged 85 plus with four or more long-term conditions and potentially a degree of cognitive impairment,’ she says.

Solutions

‘We need to have national and local solutions and use our nurse resources in a better way to ensure people do not go into hospital inappropriately.

‘We need the right interaction between nurses working in care homes, the community and the acute sector to ensure the best outcome for older people using the service.’

14,700

Nurses have left their jobs in the adult social care sector in the last 12 months

Skills for Care

Person-centred care is paramount and often overlooked as a way of attracting nurses into the sector, she explains.

‘People living in care homes need access to nurses who are competent and have a range of skills. The setting can be a wonderful place and allow nurses to provide a holistic approach to care’.

Training

The Department of Health (DH) has funded a project with Care England to improve training and raise the profile of care homes.

Care England nursing adviser Deborah Sturdy has issued a stark warning about the adult social care workforce. 

9%

Estimated nursing vacancy rate at any one time

Skills for Care

She says: ‘If you don’t sort out the workforce, almost everything else becomes irrelevant. If care homes are closing because of a lack of nurses, it affects the rest of the NHS.

‘Residents have to move out, highly complex care has to be picked up by district nurses, and those with high-end needs have to be admitted to hospital.

‘I have heard about one registered nurse looking after 56 people at night in a care home. This is totally outrageous and not safe.

Narrative

‘There needs to be smooth integration between health and social care, we need to trust each other professionally. Workforce solutions are critical or we are heading for deeply troubled waters. 

‘Part of the Care England pilot is trying to raise the profile of care homes. One of the things we need to change is the narrative around care homes.

‘We should describe them as nurse-led care homes because that’s what they are. We need talk them up not down.’

Funding

Emeritus professor and dementia expert June Andrews says: ‘Nursing and care homes are so badly funded that many have not survived as businesses or have been propped up by family top up or charitable income.

‘Last year, the number of care home beds in the UK dropped for the first time in a decade. Nursing shortages, the cost of agency infill, and the funding situation mean that now nursing homes are even more vulnerable and are shutting every week.

85%

Nurses worked in care home services with nursing and were employed almost entirely in the independent sector

Skills for Care

‘NHS nurses in every sector cannot afford to ignore these changes, which increase pressures on community staff and on acute hospital beds.

‘Unless we encourage and develop new nursing roles with different responsibilities, the system will melt down.’

Development

A DH spokesperson said: ‘Nurses do an amazing job in the NHS and social care. To help encourage more nurses into social care, we have invested in a fund for social care employers to support the continuing professional development of staff.

‘We have also funded Care England to launch a ground-breaking, nurse-led pilot to improve undergraduate nurse apprenticeships and all learning placements in care homes.’

A Health Education England spokesperson said the organisation is not currently undertaking any projects on workforce in the adult social care sector.

Nursing associates

Plans to create a new nursing associate role were announced by the government in December 2015 in a bid to bridge the gap between healthcare assistants and nurses.

Universities and employers have been chosen to pilot the new role at 11 test sites from December this year. It is not yet known if the role will be registered.

Frank Ursell, Registered Nursing Home Association chief executive, has doubts about how the role will work in the adult social care sector.

‘If the role is going to sit between the care assistant and nurse, are district nurses for example going to be prepared to take charge and responsibility of a nursing associate in that role?

‘Will the nursing associate be on a register and what is the actual qualification they will need? These are all questions that need answers.’

 

Migration Advisory Committee

The Migration Advisory Committee (MAC) recommended in March this year that nursing should be kept on the government’s shortage occupation list making it easier for the NHS and social care providers to obtain visas for nurses from outside the European Economic Area (EEA).

The RCN welcomed the recommendation, which was accepted by the government, and said that it laid bare the ‘short-term decisions and failure to plan for the long-term’.

The MAC report criticised the decision to cut nursing training places in England by almost a fifth between 2009 and 2013. It estimated 11,000 nurses will be recruited to England from outside the EEA over the next four years.

According to Skills for Care, 83% of the adult social care workforce are British, 7% have an EU nationality and 11% a non-EU nationality.

 


Reference

Skills for Care (2016) The State of the Adult Social Care Sector and Workforce in England, 2016


Petra Kendall-Raynor is a freelance journalist

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