Health, social care and housing need to be higher up on the political agenda. Existing systems do not support what needs to happen on the ground to meet the changing needs of older people.
The population is rapidly ageing and older people are going into care homes later, sicker and more frail, but not enough is being done to address their growing healthcare needs.
More nurses are needed in care homes, social care staff must be trained in health-related skills and NHS staff should learn to work in partnership with care homes.
Yet care homes are often seen as the Cinderella service and blamed for matters beyond their control.
“Yet care homes are often seen as the Cinderella service and blamed for matters beyond their control”
Care homes collectively have more than three times the number of beds in the whole of the NHS. They provide care to some of the most vulnerable and sick members of our society. Yet only 4,400 of the 19,884 UK care homes are registered to provide nursing care and most do not have registered nurses working in them.
We need a minister for older people to help those with power and influence understand the complexity of an ageing population, and break down the silo mentality and address the funding crisis in social care. The government needs to take a longer-term, whole-system perspective.
Furthermore, there is a nursing crisis in care homes: many nurses are leaving the sector for the NHS, and better pay and conditions. This is hardly surprising: there is a £6,000 difference in average salaries.
“[Nurse] numbers are decreasing at a time when demands for nurses in adult social care is set to rise”
Numbers are decreasing at a time when demands for nurses in adult social care is set to rise, as the population ages and long-term conditions become more prevalent. Among the issues that need to be addressed are problems of recruitment and retention, an ageing and retiring workforce not being replaced by newly qualified nurses, over-use of bank staff, lack of career development, feelings of isolation and stress, transcultural nursing issues, and the negative image of the sector in the media.
These problems will directly impact on the NHS, increase accident and emergency waiting times and delay transfers of care - most importantly the quality of care for older people.
These issues must be recognised to address the nursing shortages that plague the sector.
Some of the problems are compounded by government - for example, 28% of nurses are non-EEA (European Economic Area) and changes to immigration laws from April 2016 will only allow skilled workers indefinite leave to remain if they have an annual income of £35,000 (rising to £35,800 in 2018). The mean annual rate for nurses working in adult social care is £24,350, so these non-EEA nurses will be forced to return to their country of origin.
“Non-EEA nurses will be forced to return to their country of origin”
Having trained and worked as a nurse myself for many years, I’m aware of the challenges and changes that face social care staff every day. I see it most days too when we train new nurses at City University London.
Since July 2013 I have been part of the Commission of Residential Care, which was created to change the way people think about residential care. Our report in September 2014 made 38 recommendations in areas from commissioning and workforce to planning and regulation.
There is only one recommendation related to nursing: to create a vocational nursing role that allows nurses to be trained while working in care settings. This is definitely needed, but so much needs to change before this is possible.
We will be debating all this and more at City University London on 2 March, when we launch the commission’s “blueprint for action”. To register, go to bit.ly/residential-care-symposium. Please come and share your thoughts with me.
Julienne Meyer is professor of nursing care for older people at City University London