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"State of Care" controversy - your choice of managers. Guest blog from Geoff Lane

The State of Care - it's about getting the people right

I hope many of you have taken the time to read the latest report on the state of healthcare and adult social care published by CQC in October. There are some interesting statistics. 82% of Primary Care services inspected achieved a good rating. Well done the GP's. However, only 37% of hospitals were rated as good.


In adult social care 59% of nursing and care homes were rated as good. However, that figure hides a number of big variations. 64% of Care homes achieved a good rating but the figure dropped to 46% in Nursing homes. In addition, small homes scored much better than very large homes. This last point is no surprise to me but it did not explain what is going on in our nursing homes to cause this wide disparity.

If you look at the figures in more detail caring scored very highly (82% across the sector) but the primary issues appeared to be in Safe and Well Led. Whilst I touched on Well Led in our last newsletter, CQC have identified the following common themes:

  • Difficulties in recruiting and retaining managers
  • Lack of capabilities in some managers
  • Poor engagement with staff and people who use the services
  • Poor culture especially around sharing learning and promoting improvement
  • A lack of systems to monitor the quality of care being given to people
  • Managers not promoting staff learning

I suspect I am now going to polarise opinion but in my experience the management issues in Nursing homes are significantly greater than in Care homes. Those of you working in Nursing homes will say that they are caring for people with complex healthcare issues, many of whom are at the end of life and this is the reason why it is more difficult. I would counter that by saying that looking after residents in a Care home many of whom have quite severe dementia is just as challenging and maybe more so. So that's not it.

The fundamental issue is one of team working and a common culture. In my experience of running nursing homes and care homes, it is much easier to create this in a Care Home than it is in a Nursing Home. In Care Homes staff often have a similar background and skill set and many deputy managers and Home managers started on the floor.

In good Care Homes there is very good team working and leadership at all levels with staff respected for their skills and experience. In Nursing Homes it is much more difficult to achieve. Why? I believe it's because there is a uncomfortable division between the nursing staff and the care staff and in many instances this pervades the home with nurses "in charge" and carers there to do all the tasks that nurses don't want to do. Now I am sure there are many excellent Nursing homes up and down the country where through great leadership they have achieved good team working and an open and inclusive culture, however in my experience it is much more difficult.

In my view, the main reason for this is that the vast majority of nurses gained their qualifications and experience in the NHS. Whilst the NHS does many things very well it is a very hierarchical organisation and as CQC has identified, after Safety, Well Led is one of their weakest areas with only 41% of hospitals rated as good; the comparable figures in Social Care are 60%. Many nurses bring this NHS view of how to do things into Nursing homes which can add to the problems of managing these units.

So how do you solve this problem? Well I have been told by many people that Nursing homes must be managed by a manager who is a qualified nurse. My answer to that is "rubbish". A nursing home and a care home are first and foremost about people. Pick the best manager who can demonstrate that they have first class people skills especially around building teams, leadership, motivating and developing people all wrapped around with excellent communication skills. If that person happens to also be a nurse – wonderful, you have hit the jackpot - but think smart, recruit a deputy from a care background and you have the making of a great top team. If they aren't a nurse then recruit them anyway and make sure the deputy is a nurse.

CQC identified the following: "For health and social care services to be able to ensure the quality and safety of the care they provide, they will need strong leadership and resilience. They will need to find ways to encourage innovation and creativity, while keeping the quality of care for people who use services at the centre of their work"

Assuming you have got strong leadership in your Nursing and Care homes, you need to be constantly examining what you are doing, how you are doing this and looking for ways to constantly improve. I know many of you will be saying "what about the money?" In my experience high quality organisations with excellent leadership will always deliver a better quality of care at a lower cost.

They also don't usually have any problem attracting customers. More on this next time.

How are you going to address the leadership and innovation issues in your organisation before it is too late? Many thanks again to IPROS for providing the platform. Any comments or communication most welcome.

By: Geoff Lane

Geoff Lane is an experienced hands-on Executive with a wide experience in executive management, business turnarounds and strategy development in the residential care sector. Most recently as CEO of Regal Care and previously COO at ILG and Finance Director at Capio Group.

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