Care England CEO Martin Green says its time to tackle the crisis in nursing home provision.
In the latest State of Social Care Report, the CQC showed that there was a reduction in the number of nursing home beds. This attrition of nursing home places has been going on for several years and is, I believe, the result of a range of factors.
Firstly, nursing care outside the NHS is a very difficult and complex area and there are ever more rules and regulations within which nursing homes have to operate.
Secondly, the funding for nursing care has never kept pace with the true costs and independent services are expected to deliver the same level of support as the NHS, but with significantly less funding and next to no access to some of the professions that support medicine.
Thirdly, and I think perhaps most significantly, the nursing shortage that is afflicting the NHS is absolutely dire in nursing and social care services.
One of our major challenges is that workforce planning only seems to take account of the needs of the NHS. Despite this, we have seen severe nursing shortages in the NHS, making it impossible for many nursing homes to be viable if they have to compete for staff with NHS providers. Given that the mantra of the government is all about accountability, I am surprised that nobody has been held accountable for this lamentable failure.
The crisis in nursing home provision is upon us now and we need some clear and swift action to make sure that we have enough provision to meet current and future needs. The first thing that I believe needs to happen is that the Government must start planning the workforce right across the system. Politicians are very anxious to talk about the integration of services, but they fail to understand that if you want integrated outcomes and integrated systems, this has to start at the planning stage and cannot be delivered without an integrated and seamless planning process.
There have been some attempts to deal with the nursing shortage by developing new roles, such as the Nurse Associate and I believe that this role could deliver better use of nurses and also improve the career pathways in social care. Nurses are highly trained and highly skilled and it is really important that we use their skills and expertise in the most effective way.
Given that we have this acute shortage of nursing, I think we must also examine whether or not the regulatory system needs to change and to enable nurses to be the clinical lead in more than one nursing home.
If this is going to happen, we will certainly need a coterie of skilled support staff with clear accountability trails, so that everyone knows where the clinical accountability for nursing and support lies. If we do move to a system that uses nursing resource more effectively and across more nursing homes, there is a need for us to embrace technology and to make sure that communications are easy and that there is a really good audit trail, so that people who use the services and their families have confidence that the quality has not been compromised.
The UK’s exit from the EU is going to exacerbate the problems of nursing shortages because we will not have ready access to EU trained nurses. Faced with this reality, I hope that the Government will ask the Migration Advisory Committee (MAC) to ensure that we have enough nurses from overseas jurisdictions that can fill the current skills gaps and that the focus of the criteria is skills shortages and not salary levels.
In the long term, we need much better workforce planning and also need to encourage the many nurses who are no longer practising to return to the profession and for some of those to be encouraged to work in independent care services.
The independent sector cannot offer the same terms and conditions as the NHS because of the low level of funding that is currently paid for independent provision. However, there are many benefits to working in the independent sector and the feeling of autonomy and being able to practice without some of the bureaucratic constraints of the NHS are seen as attractive by many practitioners.
Nursing homes are nurse led units and we need to have a career pathway that encourages people to move in and out of NHS provision and a system that will not penalise people for time spent out of the NHS. Some of the things the Government could do are to enable people to continue to contribute to the NHS pension, even though they are working in the independent sector.
The crisis in nursing home provision is happening now and we will soon find that there is not enough capacity for the needs of today, let alone for the challenges of tomorrow. We need all of the system to recognise the challenge and to work together to deliver a long-term solution.