As Care UK’s most senior nurse, no-one is better qualified than Rachel Gilbert, Director of Care Quality and Governance, to explain how the care home provider continues to excel in nursing care in an increasingly challenging marketplace.
Having qualified as a nurse in 1998, Rachel spent most of her early career working for the NHS and specialising in the care of the older person.
Following a career break, she returned to nursing in a residential care home setting before becoming an operations director.
Having joined Care UK in 2013, Rachel was the operational lead on the provider’s award winning partnership with Suffolk County Council. This involved Care UK taking responsibility for running the council’s 16 outdated care homes – along with around 600 colleagues. Over the course of five years, Care UK replaced the 16 old homes with ten brand new ones – each carefully designed to create an environment that was stimulating and comfortable for residents and efficient and pleasant for the teams that support them. Today, half of these homes are rated Outstanding with the remainder rated Good.
“That was an amazing project and it was good to be recognised for that,” Rachel noted.
As part of her role, Rachel oversees Care UK’s nursing provision which has grown significantly in recent years as the care home provider has led the field in terms of new care home development in an ambitious programme.
With all but 19 of the provider’s homes offering nursing and all eight of its homes in the pipeline providing the service, CHP asked Rachel how Care UK had managed to prosper where many of its competitors had failed.
“We know the population of older people is growing and there is pressure to keep people out of hospitals,” she observed.
“The need for nursing provision in a care home setting is going to grow so we need to think about how we manage our nursing services.”
As part of expanding its nursing offering, Care UK has begun to develop a nurse management role to provide additional responsibilities in terms of complex, clinical care.
This has been facilitated by training carer team leaders to take on medication, observation and simple dressing responsibilities.
“We are trying to alleviate some pressures on the nurses so that it frees up their time to do the more complex clinical tasks and to provide leadership to the team,” Rachel said.
Care UK is also able to offer a competitive employment package for its nurses.
“We have periodic reviews looking at what other providers are offering as a package,” Rachel noted. “We know that we offer as good an offer as anybody else. We recruit on a home by home basis by looking at what is going on in that marketplace and what we need to offer people.
“We also focus very heavily on retention. The culture that we develop is values based. We support our nurses in order to maintain their registration and to grow and develop.”
Career pathways are provided for people through an emerging leaders’ programme and clinical development workshops.
“We have had a number of nurses promoted to a regional clinical role in my team as quality development managers and lead quality development managers,” Rachel highlighted.
“We also have nurses that have become deputy managers, clinical leads and home managers with us.”
In fact four in ten of the care home provider’s home manager vacancies are filled from within.
“Our managers are still predominantly nurses,” Rachel noted. “We look to grow and promote from within although it is always good to have fresh input and insight from outside.”
All home mangers and senior nurses go through a leadership programme on dementia education in partnership with the University of Worcester, which is led by lead quality development manager, Suzanne Mumford. Dementia champions for every home are also being developed through the programme.
Care UK has also partnered with NAMASTE International on adopting its approach to end of life care which integrates compassionate nursing care with individualised activities for people with advanced dementia in a group setting.
The care provider’s supportive and enabling approach has resulted in a 13% drop in turnover of colleagues in the last 12 months.
In terms of recruitment, Care UK has just completed a major two-year, overseas campaign that saw 150 nurses recruited from Dubai, India and Jamaica.
“The support we have in place to get people through that has worked very well and is something we should be very proud of,” Rachel said.
Overseas nurses are supported through their preceptorship and induction programme to gain their NMC qualification.
The successful campaign has already led to some of the new intake being promoted to senior nurse and clinical lead positions.
“Our overseas nurses have spoken very positively about us as an organisation and about the pastoral support we provide, not just the clinical care,” Rachel said.
“We have held their hands every step of the way and that’s really well recognised.”
While significantly growing its overseas nursing recruitment, Rachel said Care UK had not seen any Brexit impact as noted by some other providers.
The care provider boasts a “very strong” carer and nurse in-house bank team.
“It’s a range of people with different backgrounds who don’t want to commit to a 40 hour working week,” Rachel told CHP.
“They might work in the NHS or do some care work in another setting. We have some good stories of people from the NHS using our bank scheme to come across to try out working in social care full time. It gives those who have never worked in social care before the opportunity to test what it’s like before they make the leap.”
When needing to use agency staff, Care UK also ensures it works with the same agencies and same staff where possible.
“Agency stuff are inducted and attend meetings and training so they become part of the team and that way you don’t get so many concerns around continuity of care,” Rachel noted.
Care UK reaches out to universities to offer student nurse work experience and currently has four people on a nursing associate programme with Buckingham University.
“I think there is more work to be done in terms of attracting nurses and educating them on social care roles,” Rachel said. “It is still very much NHS driven. We are encouraging universities to open up the doors to social care more. It is starting to shift.”
Rachel highlighted Andrea Sutcliffe’s appointment as the Nursing & Midwifery Council’s CEO as a welcome development for social care nursing.
“Andrea talks very passionately about social care and the opportunities for nurses in that field,” she said.
“I am starting to think we will need more publicity about the opportunities social care provides, particularly with challenges in the NHS around staffing shortages and people starting to realise there is a different way of working. The Royal College of Nursing need to promote it more now as well.
“It would be great if we could have a chief nurse for social care. I think that would be a wonderful thing to raise the profile in the future.”
The director also noted recent approaches from the NHS to job share and shadow her staff.
“Some of our London homes are actively looking at joining that programme,” Rachel said.
“It helps nurses in the hospitals understand life in the care home and the different ways of working and vice versa. It helps the nursing profession and obviously it helps resident care.”
Technology has played a vital role in helping Care UK’s nursing and carer teams provide personalised care.
The care home provider was an early adopter of digital care planning, introducing its Caresys system in 2014, and is three quarters of the way through an emeds roll out in partnership with Lloyds Pharmacy and Medicare, which is expected to complete in March.
“Emeds helps free up time in terms of the administration behind medication and reduces any errors to ensure stock is there on time,” Rachel noted.
“Our colleagues are loving it. They do really see the benefits. At any one time I can tap into an emeds system and look at a home report. It gives me and my team greater governance oversight and we can also do with that care planning.”
Emeds data is collated within Care UK’s iperform system that develops monthly reports for home managers on clinical trends, including falls and pressure ulcers.
“That gives us great oversight and helps us an organisation look at what we are doing well and what we might need to focus on,” Rachel said.
“We might notice a certain amount of falls for a particular resident are occurring at tea time so we may need to look at our staffing arrangements around then.”
Rachel noted Care UK was aiming to eventually integrate its emeds and care planning data, as well as introduce a mobile care planning system.
The care provider is also carrying out trials of a new rota tool and uses an automatic tracking system, known as Harbour, for applications.
In terms of other artificially intelligent technology, Care UK has introduced the Amazon Alexa as part of its meaningful lifestyles programme.
The use of Alexa in a care setting has come under the spotlight in recent months with it being found to increase anxiety in some residents.
“We use on it on a case by case basis and I don’t think you can say it is going to cause anxiety in every resident,” Rachel stated.
“It’s left up to the individual homes whether they use it with specific residents.”
Further technology being explored includes circadian lighting and acoustic monitoring systems.
“Technology is great but it should never be a blanket approach,” Rachel said.
“I am a great believer in having a toolkit so you can use the right tool.”
Encouraging a culture of innovation and positive risk taking has been central to Care UK’s success in achieving outstanding care.
The provider’s ‘Good to Great’ programme, which is championed by Rachel, helps targeted homes achieve CQC Outstanding.
Care UK’s market leading position in terms of Outstandings (it had 14 at the end of November) is testament to its success.
As well as encouraging care homes to tell their story and celebrate the things they do consistently well that often go unnoticed, the programme helps encourage innovation and positive risk taking to provide greater freedom and independence to residents and ensure that every day is lived well.
Having visited several of Care UK’s Outstanding homes, CHP can testify to how the provider successfully encourages its care home managers to create a uniquely innovative culture that is catered completely towards the needs and individuality of their residents.
“There’s always room for people to say this works really well in my home and we want to do this,”
“You don’t want people to be tied down. It’s around the benefit and the impact on the team and what the expected outcomes so that we can support that.”
It’s a successful formula that looks set to ensure that Care UK continues to lead the field in an increasingly challenging and competitive marketplace.