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How upskilling nurses can solve the care home crisis

Call for specialist gerontological training and new online learning networks

reform is urgently needed in the way older people are cared for
Image: iStock

Care homes strive to provide good quality long-term care in the face of mounting pressures.

The population of those in the 85 and over age group is set to double by 2041, and increased life expectancy will lead to substantial increases in care needs. Predictions suggest that another 71,125 care home places will be needed in the UK by 2025.

Although there is acknowledgement from all quarters that we face a crisis – and that reform is urgently needed in the way older people are cared for – there remains little clarity on what care home reforms will be put in place.

There are numerous workforce issues in social care, but two are key. The first concerns the future role of the nurse in nursing homes as part of integrated health and care systems. The second identifies the need for professionalisation and upskilling of the large number of social care workers in residential care homes. Both remain to be discussed.

‘Staff have met clinical challenges way above their normal work efforts, demonstrating that it is possible to reimagine long-term care’

During the COVID-19 pandemic, meaningful and supportive relationships have developed between NHS staff and both types of care homes. Staff have met clinical challenges way above their normal work efforts, demonstrating that it is possible to reimagine long-term care. However, challenges to achieving a sustainable change in any future relationship between care homes and the NHS are inevitable.

A wide range of care providers exist, including nursing homes, residential homes and dual registered care homes, amidst a mix of private, not-for-profit, voluntary and charitable ownerships. Meanwhile, social care workers, who represent 70 per cent of the workforce, are among the lowest paid, professionally underdeveloped and under-supported workers.

Health Education England (HEE) has been commissioned by government to review long-term strategic trends for the health and social care workforce.

Nursing home registered nurses have been barely visible in the national debate
Picture: Charles Milligan

As key caregivers and delegators of nursing care in the social care sector, registered nurses employed in the UK’s 5,040 nursing homes will be well placed to contribute to the soon-to-be issued call for evidence from HEE on the topic.

Nursing home registered nurses could help identify the factors that may have the greatest impact on the health and social care sector over the next 15 years. To date, such nurses have been barely visible in the national debate about the best way to reform health and social care.

Hopefully, the recent appointment of the first-ever adviser for care home nursing in England will offer a channel for these nurses’ voices, experiences and ideas. Healthcare assistants in nursing homes have been able to access full membership with the RCN since 2011 and the college has clarified their roles, responsibilities, training needs and working relationships with nurses.

‘There should be an increased focus on education for gerontological nursing and specialist training to promote the role of future strategic leaders, educators and agents of change in nursing homes’

Not so the social care workforce, which remains without a strong representative voice to champion its professional growth, which includes the practice of some nursing skills.

The spotlight on adult social care has so far concentrated on how long-term care can be funded, but it must move to how high quality care can be ensured for an increasingly fragile older population. As part of this shift, there should be an increased focus on education for gerontological nursing and specialist training to promote the role of future strategic leaders, educators and agents of change in nursing homes.

A culture of learning for all staff in a nursing home

This focus should create a culture of learning for all staff in a nursing home so it can act as a beacon for others to follow. To this end, a crucial part of the role of specialist gerontological nurse could be to develop a local online care home learning network with links to a nearby university.

These networks should operate according to a national learning framework, and could offer social care staff apprenticeships. This would help raise the standards of care in all homes, irrespective of whether the home is registered as a residential or nursing home.

The aim would be to produce a new national cadre of specialist nurses and specialist care assistants – a challenge for the RCN and others.


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