6 | Nursing in Practice | Summer 2023
COVER STORY
Solving the social care puzzle
Nursing provision in care homes has been hit by funding issues , poor pay and negative perceptions of the sector . But those working in social care are piecing together promising solutions , reports Emily Roberts
As vacancies for registered nurses in adult social care continue to rise , with thousands leaving the profession , there are calls for a complete rebrand of the sector .
Figures from Skills for Care 1 , which represents those in adult social care , show the vacancy rate for registered nurses in adult social care in England is 14.65 % – almost 5,000 unfilled posts .
Its most recent data estimate that two in five registered nurses in social care have left their role within the past year . The number of filled registered nurse posts has also fallen by 5 % from 2020 / 2021 to 32,000 .
Research suggests increasing numbers of care homes in England are having to respond by dropping their nursing provision .
According to latest Sector Pulse Check report 2 , produced jointly by the charities Hft and Care England , one-third of adult social care providers have considered exiting the sector in the past 12 months .
Sector leaders have also expressed frustration and disappointment with government plans that appear to have slashed funding promised for the sector , with only £ 250m set to be invested into the workforce over the next two years – half the £ 500m promised in the social care white paper in December 2021 .
Pandemic impact So what impact is this situation having on the ground , and what is being done to address the sector ’ s current struggles ? Skills for Care CEO Oonagh Smyth says : ‘ The recruitment and retention challenges which the social care sector is facing with nursing mean there has been a decrease in the number of small independent providers able to provide nursing care .’
She believes there are several reasons why the social care sector is struggling .
Perhaps the most obvious is the Covid-19 pandemic , which Ms Smyth says ‘ has had a huge impact on all our care workers , including nurses ’.
She adds : ‘ Since society and industry opened back up , this has been the time for some workers to choose to move on . This has been true across many sectors .’
She also points out that social care is ‘ incredibly sensitive to labour market conditions ’, making it less likely for people to work in social care when other jobs are available .
Liz Jones , from the National Care Forum , says one of the problems is the negative perception of working in social care .
She explains : ‘ The challenge we have is an overall shortage of nurses and that ’ s impacting social care because we are competing with nursing roles across the wider NHS .
‘ There ’ s a perception across the health workforce that being a nurse in social care is not as skilled as in a health setting . Actually , it ’ s totally the opposite because if you are the nurse on duty , you might be the only one and therefore have full responsibility for all of those people and staff . You don ’ t have the backup you would have in a hospital , so you have to be so many things to deliver that role well .’
‘ In the long term , we have to make nursing in social care as attractive as nursing in the NHS ,’ Ms Jones says .
She suggests the sector ’ s profile could be enhanced by more a positive media portrayal . ‘ One of the best things we could do is have a soap opera based in a nursing home . It ’ s people ’ s real lives and real homes and it ’ s never seen as particularly glamorous .’
Ms Smyth agrees , and adds : ‘ The most immediate fixes must be focused on helping social care compete with other sectors . That means reviewing pay and terms and conditions , and talking more about the rewarding career opportunities that nursing in social care offers .’
‘ Misguided perception ’ Caron Sanders-Crook , a professional nurse advocate and operations manager at residential care provider Canford Healthcare , underlines the competition the sector faces with the NHS .
‘ There are lots of nurses who left after the pandemic . There are also geographical shortages . We have lost some overseas nurses who have gone home and chosen not to come back . Some nurses have joined agencies to give flexibility ,’ Ms Sanders-Crook says .
She says it is vital to attract good-quality nurses , explaining : ‘ One of the biggest barriers that care homes need to overcome is the misguided perception of what working in a care home is like . For generations it ’ s been seen as a job on the side , or for someone who has kids and needs a bit of extra money . But there is now a clear career pathway , and the skills they have to offer and bring to the table are amazing . They are making really complex decisions every day in coordinating and managing care .
‘ People think they need to go into the NHS because they will gain more skills but that view is misguided , because you can gain more skills in nursing care .’
Ms Sanders-Crook , who has worked in care homes for 30 years , said it offers a rewarding career .
‘ We all have bad days but when you hear the difference you make to someone ’ s mum or dad , all the horrible stuff just melts away , and I think I couldn ’ t do anything else .’
‘ Long-term investment ’ Thankfully , positive changes are in the pipeline , following the government ’ s appointment in 2020 of Professor Deborah Sturdy as England ’ s first-ever chief nurse for adult social care .
There is now a clear career pathway , and the skills social care nurses have to offer are amazing Carol Sanders-Crook