There is no doubt that a ship without a Captain is going to go aground at some time in its journey. This applies across the whole range of industry and commercial enterprise and is not in dispute. The BBC Radio 4 You and Yours programme (5 Nov 14) brought this thought to mind when it focused on the shortage of registered care managers in social care, why this is the case and what could be done about it. Andrea Sutcliffe, Chief Inspector for Social Care at the Care Quality Commission (CQC), Professor Martin Green, Chief Executive of Care England and Paul Burstow MP responded to questions from Winnifred Robinson.
A short clip was played about a care manager who, despite it taking 6 months for her registration application to be approved by CQC and working as a manager for over a year, who absolutely reinforced the overall necessity for a ship to have a captain on board. Discussions then revolved around the current shortage of about 1600 registered care managers out of a total of some 17,000 posts, roughly 10%. Andrea was keen to say that the application process was being streamlined and an online version is now available; applications should normally take between 8 and 10 weeks. Under the revised inspection framework, Andrea explained that CQC will be asking the question of whether a care business is well led with the significant emphasis on the availability of a registered manager. The Skills for Care assessment of the shortage is that the vacancy rate is about 2% or 340 rather than the 1600 quoted in the programme.
Paul Burstow felt that the issue is indicative of a more complex problem, where registered managers are generally mistrusted by other professionals in the health and social care system, and there seemed to be something of a general lack of support for them by Local Authorities. The status of registered managers also needs to be improved.
Professor Green agreed that the post of managers should have registered status and that the presence of a registered manager is an essential ingredient in delivering good care, slow registration processes do not help, but there is a general lack of applicants for registered posts partly due to the decreasing availability of nurses for nursing homes and partly because of the lack of people ‘wanting’ to do the job and all that it entails. The responsibilities are profound and the Care Act is putting in place the facility for direct prosecution where services do not meet the fundamental standards, which can be seen as a disincentive to potential applicants.
There was not really enough time in the programme for the interviewer to dig deeper but some of the messages that came through need much stronger attention if the sector is to maintain or improve the quality of care delivery. Neither is there enough space in the briefing to go into any great depth but the headlines seem to revolve around the following issues:
- Professionalising the post of registered manager. Interestingly, this aspect has been moved to the top of the National Skills Academy agenda for care manager development, which is why we placed it at the top of this list.
- Availability of nurses for recruitment. This is well documented in the CQC Annual report at the LINK. 29% of nurses will retire over the next 10 years but there is no evidence that sufficient nurses will be trained and sufficiently experienced for the role of registered manager in time to meet demand. The current turnover of nurses (32%) in the social care sector is also a major concern. Clearly this warrants concentrated attention at national level to resolve the problem.
- Why don’t potential managers want to be registered managers? The overall view is that the job is too big and carries too much responsibility for the salaries offered so there is a serious disincentive developing in managers ‘wanting’ to be registered. We are already seeing inflation in salaries but Local Authority funding for care is not keeping pace with costs. This also warrants a high level of attention.
The whole emphasis of the Care Act 2104 is to move towards keeping people at home for longer, to reduce hospital admissions and to reduce residential care so let us hope that these issues are receiving sufficient attention and are being taken up to the very highest level so that sufficient resources can be put in place to meet the changing demand.