Where have all the nurses gone?

Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission.

I’m writing a new verse for the 1960s anthem “Where have all the flowers gone?” for the adult social care sector — here it is:

Where have all the nurses gone, long time passing?
Where have all the nurses gone, long time ago?
Where have all the nurses gone?
Gone to hospitals, every one
Oh, when will we ever learn?
Oh, when will we ever learn?

Quality of care

Okay, so not all nurses have gone to work in hospitals but not enough are working (or working long enough) in our care homes leading to high vacancies and rapid turnover. This is impacting on the quality of care. We reported on this worrying trend in the State of Care report last year.

Now nearly a quarter of the way through our new inspection regime, we are seeing a similar pattern. Granted we are inspecting some services in response to concerns raised but we are definitely seeing a continuation of the trend that nursing homes are performing less well than residential care or domiciliary care and are much more likely to be requiring improvement or be rated as inadequate

Welcome focus

This was an issue that had a very welcome focus at the King’s Fund conference about enhanced health in care homes with a session led by Sharon Blackburn, Karen Spilsbury, Alison Davey and Jan Hughes. Sharon emphasised the important role of nursing in adult social care while Alison and Jan presented a case study of Jan’s role as a community nurse supporting care homes in Torbay and Southern Devon Health and Care NHS Trust.

I was particularly interested in Karen’s presentation of her work funded by the RCN Foundation looking at the development needs of nurses in care homes. It is a very good analysis and you can see Karen’s slides on the King’s Fund website or read the full report here.

Three steps to take

So what can we do about it? From my point of view there are three steps we need to take.

One: understand

Recognise the impact. In debates about nursing vacancies, much attention is understandably paid to the impact on acute care and sometimes the discussion even (and quite rightly) stretches to mental health and community services. But we ignore the needs of adult social care at our peril. If we don’t meet those needs, we will not sustain and develop the services we need for increasing numbers of older people with complex needs. We need to make sure the planning for nursing numbers and training addresses this demand. This is an issue I have raised with the Department of Health and Health Education England.

Two: attract

Then deliver a strategy to attract nurses to adult social care. This starts with training — encouraging students to see nursing homes as a desirable career option through varied placements which can reveal the tremendously fulfilling roles on offer. Let’s value these important roles and get rid of the stigma that is sometimes attached to working in a nursing home. We should also celebrate the great role models we have. I meet so many nurses in social care who say they love their job and wouldn’t want to do anything else. It would be great for those voices to be heard more loudly.

Three: sustain

And finally, develop a strategy to sustain the nursing workforce in adult social care and strengthen the capability of the nurses we do have. The needs of people living in nursing homes are growing ever more complex and challenging — I am sure the patients cared for on the NHS continuing care wards I managed 20 years ago would all now be in nursing homes. We need great nursing staff to ensure great care — not least because they don’t have the wrap-around support of a busy hospital with other professionals quickly on hand.

Training and development are vital. Employers in social care have an important role to play in making opportunities available for their nursing staff and some are proactive in doing this but it is clear that more needs to be done. That is why Karen Spilsbury’s work is so important. It would also be great to see the examples of collaboration and support from the NHS spread more broadly from isolated pockets in places like Torbay and Southern Devon. Hopefully the new vanguard models of enhanced health in care homes will help but only if the adult social care sector is fully involved and engaged in their development.

A sustainable strategy also needs a shift in culture to one that values and cherishes the good nursing staff we have, uses their skills to best effect and ensures that there are career opportunities for people to pursue.

When will we ever learn?

So the answer to the refrain “when will we ever learn?” is — when we understand that nurses are not just for hospitals but have a vital, valued role in adult social care too.

Originally published at www.cqc.org.uk.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

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