Written evidence submitted by Marion Weatherhead, MSc, Dip Est Man, FRICS, FRSA, Sloan Fellow (London Business School) (RTR0128)

 

Introduction

 

I have been seriously researching the care home sector for the last three years. My experience also comes from varied involvement in care homes as a chartered building surveyor, chair of a housing association and as the daughter of a care home resident.

 

My research is being used to write a book to guide potential care home residents on overcoming the lack of transparency in the sector. It aims to fill the gap identified by Members of Parliament in 2018[1]:

 

“Once it has been established that a person has care needs, there is little help on offer for them or their family in choosing care.”

 

My relevant experience also includes the development of degree and post graduate courses in surveying and advising Romanian universities on how to develop courses to meet market need. I am also the author of ‘Real Estate in Corporate Strategy’ (Macmillan, 1997).

 

 

Evidence

 

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?

 

 

 

My evidence is about the management of care homes for the over 65 year olds, but these ideas would apply generally across the social care sector.  My focus is the changes needed now to build a stronger sector in the medium and long term.

 

 

The existing is insufficient

 

The current DHSC offering for the education of registered care home managers[2] is:

 

“Leadership development and tailored support for registered care managers. This will include funding for accredited Level 5 diplomas for registered managers who do not hold relevant formal qualifications and a bespoke support programme for new registered managers in their first year.”

 

The sector needs to attract would-be registered managers:

 


 


 

The solution is not to appoint people to the post of registered care home manager before they start learning about the new skills they need.

 

The sector faces massive challenges, and the Level 5 qualification does not provide adequate education for the running of large commercial care homes.  Some who manage these care homes have MBAs and other management qualifications that help them undertake the task.  The qualifications offered for people who aspire to such roles needs to include all the key skills and knowledge.

 

The sector needs educational routes that will also support people taking up roles in regional and headquarters of organisations providing care homes.

 

The offer of a Level 5 qualification cannot be attractive to those considering a management career in the sector.

 

Looking at the nursing profession to provide the care home leaders of the future is futile; there is a severe shortage of nurses.  Attractive jobs and post-graduate education are available in the NHS.

 

Further, in July 2021, over 70% of care homes were solely residential without nursing services[5]

 

Almost ten years ago, the CQC reported to Parliament  that:

 

A common problem in social care was the lack of a good manager in place at the service, or even the absence of one altogether.”

 

The current proposals will leave the sector no better than it is at present.  The lack of a manager or poor management is cited in CQC inspection reports as a reason for most ‘Inadequate’ ratings.

 

This is not surprising when there is no route to an education that would produce a steady stream of well-qualified entrants into the sector.

 

Tweaking the training arrangements that have been in place for many years is not going to solve the problem.

 

 

All deserve better

 

My interest and the focus of this submission is care home management.  Providers of all types feature among the care homes rated ‘Inadequate’.  Across the sector there is a need for better management so that more care workers are happy at work and residents have better experiences.

 

Younger workers have been hard to retain[6]:  They may well be keener to stay when there are younger people in middle management and as care home CQC registered managers. Those who take a job in social care to earn whilst waiting to work in another sector may be keener to stay with social care when they can see good career options via a university degree within the sector.

 

Whilst this submission focuses on management if the proposals are followed, it will help with recruitment and retention at all levels.

 

 

Neglect of care home management

 

Many new care homes are the size of a hotel but with more complex issues than those facing a hotel manager.  Degree and post-graduate courses in hotel/hospitality management are readily available.  Why are there no degrees in Care Home Management?  Most of the new care homes are the size of a hotel.  Management of these operations requires sophisticated management skills.

 

 

70% of care homes do not offer nursing services

 

With most care homes not employing nurses, why the focus is on a need for nurses rather than developing a proper career path for care home managers is unfathomable.

 

The lack of inspiration is reflected in the apprenticeships and courses available in adult social care.  The highest level is ‘Leader in Adult Social Care’ at Level 5[7] which is equivalent to a foundation degree. 

 

The content of the Level 5 Diploma in Leadership and Management for Adult Care[8] is adequate for a Level 5 qualification but grossly inadequate for running a large care home, moving into regional and national management, or working within the CQC.

 

There is nothing that would help a person gain knowledge of the complex ownership structures, understand the finances, or be able to finely tune the operation.  They do not study international practices in care home management nor the latest research. People studying a Level 5 course do not encounter the university researchers and create the bonds that will help inform during their careers.  It is a poor qualification for the demands of the job.

 

 

Who would want a Level 5 qualification?

 

Why does the sector expect that nurses who already have a degree (Level 6) will be inspired by a course at Level 5?  Most giving up time to study post-degree undertake Level 7 courses for a Masters or post-graduate diploma. Further, there are many Masters degrees for nurses who want to practice in NHS specialisms[9], so why not for care home management?

 

Neither is a Level 5 course what a school leaver or an older person with ‘A’ level or equivalent qualifications will aspire to achieve.  If they are putting in the time to undertake a course, they will want at least Level 6 which is the normal first-degree level. 

 

 

The way ahead

 

There are universities that have the mix of academic departments that could quickly address this issue and develop degree courses in Care Home Management and Nursing Home Management.  Some already have strong social care research departments.   It needs some funding, expert input, and support by CQC registered care home providers.  Government support would be a great help to initiate interest. 

 

As well as a first degree, there should be a Masters degree or post-graduate diploma (Level 7).  At this level, a mixture of modules alongside practical experience could make it possible for people with hospitality, management and other first degrees (non-cognate degree holders) to prepare for careers in the care home sector. Similar has been successful in the prison service[10].

 

There should also be post-graduate courses aimed at nurses that focus on management skills and additional nursing skills such as dementia care leading to an MSc Nursing Home Management. 

 

At post-graduate level Care Home Management and Nursing Home Management could have some modules common to both courses making for a more economic provision. 

 

All university-based courses should include digital skills with options for greater study of information technology and artificial intelligence to ensure leadership from the top in these subjects which are recognised as an important aspect of care home management[11]

 

Whatever is done needs to turn care home and nursing home management into a profession.  The existing Skills for Care Registered Manager Membership[12] group could be an important component of developing a profession with its own Levels 6 and 7 qualifications and varied entry routes governing experience, including for those already in post.  It could become an independent voice of professionalism within the sector.

 

The main aim of these university courses should be to increase the numbers of well-qualified people entering middle management in the care home sector who go on to become registered care home managers.

 

 

Nothing much planned at present 

 

The following taken from the White Paper,People at the Heart of care, will be of little help[13]:

 

In July 2021, we commissioned Health Education England to work with partners and review long-term strategic trends for the health and social care workforce. For the first time ever, the long-term strategic framework will include professionals working in social care, like nurses, social workers and occupational therapists. Once published in spring 2022, the framework will inform long-term workforce planning and ensure we have the right numbers, skills, values and behaviours to deliver world leading clinical services and continued high standards of care.

 

It claims this strategy will include the social care workforce but there is nothing about care home management.  Yet it is to provide the long-term strategy – for what?

 

 

 

 

 


[1] Long-term funding of adult social care, First Joint Report of the Health and Social Care and Housing, Communities and Local Government Committees of Session 2017–19, HC 768, House of Commons, 27 June 2018: https://publications.parliament.uk/pa/cm201719/cmselect/cmcomloc/768/768.pdf

Contains Parliamentary information licensed under the Open Parliament Licence v3.0.

 

[2] Developing the Workforce, Department of Health and Social Care, 12 January 2022

https://engage.dhsc.gov.uk/social-care-reform/developing-the-workforce/

 

[3] Registered managers from link in The state of the adult social care sector and workforce in England, Skills for Care, October 2021: https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/publications/Topics/Registered-managers.aspx

 

[4] The state of the adult social care sector and workforce in England, October 2021, Skills for Care (page 111): https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/publications/national-information/The-state-of-the-adult-social-care-sector-and-workforce-in-England.aspx

 

[5] The state of health care and adult social care in England, 2016/17 (page 77), CQC: https://www.cqc.org.uk/sites/default/files/20171123_stateofcare1617_report.pdf  The CQC provided the data that in July 2021, 10,520 care homes were residential and 4,189 were nursing homes.

 

[6] The state of the adult social care sector and workforce in England, October 2021, Skills for Care (page 124): https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/publications/national-information/The-state-of-the-adult-social-care-sector-and-workforce-in-England.aspx

 

[7] What qualification levels mean, gov.uk: https://www.gov.uk/what-different-qualification-levels-mean (click on see a list of qualification levels)

 

[8] Level 5: Diploma in Leadership and Management for Adult Care by Tina Tllmoth, Hodder Education, 2nd Edition, 2019

 

[9] For example, post graduate study for nurses at:

Birmingham University: https://www.birmingham.ac.uk/schools/nursing/postgraduate/index.aspx

King’s College London:

https://www.kcl.ac.uk/search/courses?level=postgraduate-taught&term=Nursing

 

[10] Unlock programme structure for prison officers:

https://unlockedgrads.org.uk/programme/programme-structure/

 

[11] People at the Heart of Care, Adult Social Care Reform White Paper, CP 560, 1 December 2021, Department of Health & Social Care (Chapter 4 especially pages 40-45): https://www.gov.uk/government/publications/people-at-the-heart-of-care-adult-social-care-reform-white-paper

 

[12] Registered Manager Membership, Skills for Care: https://www.skillsforcare.org.uk/Leadership-management/support-for-registered-managers/membership/membership.aspx

 

[13] People at the Heart of Care, Adult Social Care Reform White Paper, CP 560, 1 December 2021, Department of Health & Social Care (para 6.20, page 71): https://www.gov.uk/government/publications/people-at-the-heart-of-care-adult-social-care-reform-white-paper

Jan 2022