Written evidence submitted by the Mortimer Society (RTR0041)

Introduction

The Mortimer Society is a charity which aims to provide quality and safe care for those with a physical and/or a learning disability and in particular those people living with Huntington's disease and other neurological conditions.

Our aim is to create our care homes as a model of excellence for people with a neurological condition that will lead to the Mortimer Society being recognised as a leading quality provider of residential care across South East England and to grow the Society to serve the community better.

Our mission is to fulfil our charitable purpose of providing care for people with physical and/or psychological issues arising form learning disabilities or neurological disorders, such as Huntington’s Disease. The service aims to provide holistic, high quality and appropriate care that meets individual needs in a homely environment by highly trained staff. Our residents will be empowered as far as possible and also be supported, shown dignity and respect at all times.

We aim to provide a specialist and inclusive service that meets the needs of the individuals in our care. We will enable and encourage each individual in our care to live a rewarding and meaningful life that is unique to them. We will encourage residents to reach their potential and achieve exceptional outcomes. We will provide compassionate, inclusive care and support to any person wishing to use our service irrespective of gender, sexual orientation, age, cultural background or religion providing that we are able to meet their individual needs and wishes.

The Charity is also registered as a charity (Number 287579) and is a Company Limited by Guarantee (Registration number 01741444). The Board of Trustees is the governing body of The Mortimer Society and Board members are both charitable trustees and directors of a company limited by guarantee and their activities are governed by both charity and company law. Trustees are jointly and severally responsible for the overall governance and strategic direction of the charity and must ensure that the charity is solvent, well run and delivers against its charitable objects.

The Society operates two care homes, with a maximum occupancy of 52:

• Frindsbury House with 23 residents in Strood, Rochester, Kent
• Birling House with 29 residents in Snodland, Kent

At present we have a total of 47 residents – as some rooms are closed for refurbishment and the installation of a new lift and there have been 2 recent deaths.

Funding of residents is predominantly by Social Services, from several authorities across southern England, and occasionally Continuing Health Care funding. Only one resident is self -funding.

The residents have many issues:

27   Huntington’s Disease – a hereditary progressive neurological disease which progresses over years after diagnosis usually in the 30s or 40s and leads to severe physical disability and dependency and cognitive change

4 Other progressive neurological disease

5 Brain injury / stroke

11 Learning disability, often with physical disability

(These residents have been at the home for many years, when the emphasis of care had been on the care of learning disability residents, but over the last 10 years the Society has looked at developing the care of complex neurological disease)

Of the residents 40(85%) are under 65 years of age

Many residents have been in the homes for long periods of time

              8% over 20 years

              28% over 10 years

              57% over 5 years

              83% over 1 year

Over the last 2 years the Society has faced increasing financial challenges. The costs have increased – with increased salaries as the Living Wage has increased – increased other costs – including utilities, food.  However, there have been very small, and in some cases, no increases in the funding of residents. It has also proved very difficult to obtain extra funding to manage with increased care needs – residents deteriorate and have increased health conditions but in many cases there has been no increase in fees, requests for reassessment have been met with delays and often no increase.

The issues for Mortimer Society about the workforce within a care home for people with complex and changing needs are:

1.Staffing

Over the last 2 years we have faced increased issues with staffing

                Difficulties in recruitment

              Retention of staff

              Large turnover

These are interconnected with the issues of funding, discussed below but in particular the issues are:

(a)    Status of care workers

Care workers appear to have a low status and often are seen as “just care workers” – with a lack of understanding of the skills they do need to deliver the care, including personal care, of people with severe disabilities.  This was highlighted in the documentary on BBC2 by Ed Balls - Inside the Care Crisis with Ed Balls.

They face

• Physical issues – of moving and caring for people with, often, very limited movement of limbs and body, and with Huntington’s Disease poor coordination and uncontrolled movement of limbs and body.  Residents are at high risk of falls and injury to themselves and may need help in any movement, even when sitting in a chair or bed
• Nutritional issues – many residents have reduced swallowing ability and require very careful feeding of foods with the correct consistency – after assessment and advice of a Speech and Language Therapist- or feeding using a feeding tube (PEG)
• Psychological issues – residents may have cognitive change, becoming aggressive and verbally and physically abusive; they may become depressed and anxious
• Social aspects – as Huntington’s Disease is hereditary (with a 50% risk of a child being affected) there may be issues of concern for the family. Often family may not continue to visit and keep contact with them, due to their own concerns and fears
• Spiritual and existential aspect – as they face a deteriorating condition, until death. The prognosis is very individualised but is often in terms of several years of severe disability

All of these issues can only be addressed by staff who have had training and understanding of the issues of care for the residents and are able to provide empathic, individualised care to the residents and families.  Staff also provide social interaction, together with our activities staff, to allow maintenance of quality of life for residents

(b)    Pay

The Society pays the living wage as the minimum for support staff, with increments for experience and responsibility for all staff, including carers.  However, at the entry level for carers this is at a similar level to the retail industries locally, where there is also a less challenging role.

If there was adequate funding for resident placement, with an individualised assessed need and consequent funding, pay levels could be increased and the status and remuneration of carers seen to be improved.

(c)     Conditions

The working conditions for staff are often challenging, coping with people with complex needs.  There are many opportunities for fulfilment as well, in providing good care for residents within a caring team. However, the area can be seen as less attractive than other employers, such as retail, particularly when the skills and challenges they face are not appreciated by society in general.

(d)    Opportunities for advancement

Due to the restrictions on salaries throughout the sector there are limited ways for staff to advance in responsibility / remuneration.  There is no clear pathway – unlike the NHS – and there is a need for social care to be developed and be seen as a career, with a clear structure through which staff may rise, if they wish and are able to do so.

(e)    Opportunities for training

The opportunities for training are limited.  All care staff undertake induction training, leading to the Care Certificate and we encourage staff to undertake further training.  However, there is limited funding for this and without increased funding of residents’ fees there cannot be adequate provision of training for staff at all levels.  Such training – including restraint training and staff undertaking NVQ training and continuing education - would help in retaining staff, motivating them in the roles and improving care for the residents.

(f)     Retention

The retention of staff has become an increasing issue over the last year.  The turnover has increased with some staff only staying for a matter of days or weeks before leaving – due to their concerns about pay and workload (which has increased as staffing levels may be reduced by shortages) as well as unrealistic impressions of the role.  We have changed our recruitment procedures, whilst maintaining good and safe practice, but retention remains a problem.

(g)    COVID 19

There have been specific issues during the pandemic.  Staff have had to cope with residents who were isolated from their families, during lockdown; episodes where the homes had to be locked down with no visiting due to infection amongst the residents; and coping with restricted and different visiting procedures over the last few months. They have also had to cope with using PPE – and this has continued even when they see others in the community have been more relaxed in infection control procedures.

We have only lost one member of staff, who refused to be fully vaccinated and left.  However, the need for vaccination may reduce applications for posts when they become available.

(h)    Staff from overseas

The Society has few staff from overseas but the overall pool of possible staff in the wider community does seem to have been reduced since restrictions on immigration have been in force, and earlier when the changes were planned. This has reduced applications for posts and affected recruitment.  The agencies, which provide staff to cover unexpected sickness or absence, have also reduced numbers of staff available.

2. Funding

Whilst not the main subject in this inquiry, it is impossible to ignore the issue of funding as this impacts on all the other points detailed above, as we shall show in our evidence.

(a)    Increased funding

There is a clear and urgent need for increases in the funding of Adult Social Care to stop the contraction within the sector due to care homes becoming financially unviable.  The Government plans relate more to the care of the elderly (over 65 years old) and those with dementia rather than the younger disabled population with complex needs.

(b)    Complex needs

The Mortimer Society is a highly specialist care provider dealing with an all too often forgotten category of care recipients with challenging, highly complex needs. These residents face completely different care needs when compared to the more usual elderly people of Care Home residents.

(c)     Reassessment of needs

County Councils and CCG’s fund the vast majority of our residents following an initial detailed assessment of their needs and agreement to the initial level of funding they are prepared to pay.  Whilst we are proud that we have many residents who have lived within our care for many years we find it almost impossible to obtain increases in their funding even though their needs have become greater with the passing of time.

We must have statutory annual reassessments with suitable increases to cover the increasing costs brought about by more complex requirements as their situations deteriorate.  Our residents cannot be considered under one banner.  They all have complex individual needs and requirements and as such require individual care costs to be agreed and reviewed on a regular basis.

(d)    Funding arrangements

Consideration must be given in the way funding is provided for Social care. A system similar to the National Health Service would allow funding to be provided more equitably and adequately across all aspects of Social Care. At present Health and Local Authorities have to balance the funding of Social care with all the other commitments that they face. A “National Care Service” running alongside the National Health Service could ensure there is joined up thinking and close collaboration between the two organisations so that they complement each other and tackle the enormous problems within both sectors.

(e)    Standards of care

The Care Quality Commission have increased the level of standards, which lead to increased costs.  However, the Health and Local Authorities have not increased the fees to compensate for these costs.  One Local Authority claimed that they could place the resident in another care facility which could provide full care – for all tasks of daily living- at reduced costs elsewhere, whereas the Society is unable to meet these costs from the existing fee.

In the meantime, if things continue as they are then the inevitable outcome will be the gradual slide into bankruptcy and closure of many Residential Care Homes including our own two homes!

Specific responses to the questions raised in the Terms of Reference:

• What are the main steps that must be taken to recruit the extra staff that are needed across the health and social care sectors in the short, medium and long-term?
• What is the best way to ensure that current plans for recruitment, training and retention are able to adapt as models for providing future care change?

Improvement in the status of care workers - 1 (a)

Pay – and the funding for this to allow care homes to provide adequate / completive remuneration   - 1 (b)

Funding of resident placements to allow staffing and development – 2 (a)

• What is the correct balance between domestic and international recruitment of health and social care workers in the short, medium and long term?
• What can the Government do to make it easier for staff to be recruited from countries from which it is ethically acceptable to recruit, with trusted training programmes?

Care workers from other countries will be needed in the short / medium term but in the long term if pay / conditions / status can be improved this may be less necessary – 1 (h)

• What changes could be made to the initial and ongoing training of staff in the health and social care sectors in order to help increase the number of staff working in these sectors? In particular:
• To what extent is there an adequate system for determining how many doctors, nurses and allied health professionals should be trained to meet long-term need?
• Do the curriculums for training doctors, nurses, and allied health professionals need updating to ensure that staff have the right mix of skills?
• Could the training period for doctors be reduced?
• Should the cap on the number of medical places offered to international and domestic students be removed?

Social care workers and developing a structure for the future is essential

The time scale is shorter as a care worker may receive training “on the job” and be able to provide care within weeks of starting, although this would improve over months / years with training. – 1 (e)

• What are the principal factors driving staff to leave the health and social care sectors and what could be done to address them?

Pay / conditions / future within care / training / status   - 1 (a), 1 (b), 1 (c), 1 (d), 1 (e), 2 (a), 2 (b) 2 (c)

• Are there specific roles, and/or geographical locations, where recruitment and retention are a particular problem and what could be done to address this?

There are increased issues in areas that have increased cost of living – such as the South-east.  The Living Wage is less able to provide a reasonable living standard and staff may even have to claim allowances to survive – 1 (c), 2 (d)

• What should be in the next iteration of the NHS People Plan, and a people plan for the social care sector, to address the recruitment, training and retention of staff?

Social care staff need to be included in a national plan – 1 (a), 1 (b), 1 (c), 2 (d)

• To what extent are the contractual and employment models used in the health and social care sectors fit for the purpose of attracting, training, and retaining the right numbers of staff with the right skills?

Without adequate funding of resident placements these aspects will be impossible to meet – 2 (a), 2 (b), 2 (c)

• What is the role of integrated care systems in ensuring that local health and care organisations attract and retain staff with the right mix of skills?

There is a need to integrate care and ensure medical care is provided effectively by a wider multidisciplinary team to improve quality of life, reduce hospital admissions and allow residents of care homes to die in their place of care – 2 (d), 2 (e).

January 2022