The challenges faced by health and social care in the recruitment and retention of staff have never been greater.

Without a whole system recognition and response to the need for a strong and stable social care nursing workforce, the ability to deliver safe and effective care for our vulnerable citizens remains a risk to them and to the ability of the health system to manage the demands for care.

Social care nursing has long been seen as a career dead-end; a place which attracts the less able and less willing. This is not the case. The reality of 21st century care services means that we need to retain and develop the best people to help hold back the tsunami which could hit the NHS if it collapsed.

Care homes are pivotal to supporting effective interfaces with NHS services, expediting discharge and preventing admission through highly-skilled clinical care. The Department of Health, in recognising the need to improve the image and standing of care home nursing, has supported five pilots to develop a model of Teaching Care Homes. The model sets out how care homes are places where learning is woven into daily practice, teams strive to reflect, change and improve practice and outcomes for their residents, supporting learning for undergraduate students, and those working and living there.

The project, led by Care England, was developed with The Foundation of Nursing Studies, Manchester Metropolitan University and the International Longevity Centre UK. The participating homes are: Rose Court, Bury, Chester Court, Bedlington, Millbrook Lodge, Gloucester, Lady Sarah Cohen House, London, and Berwick Grange Harrogate.

From these pilot homes, a learning set has been developed which brought together a rich contribution from home managers, senior clinical nurses and care workers who represented their teams. The participating homes developed a project and disseminated their learning to their wider local community; building relationships and improving their influence. The projects included improving reflective practice, exploring the untapped nursing workforce of care workers who had not attained UK NMC registration and programme development to support them to do so, and improving hospital admission and discharge. The pilot has given participants a confidence about their skills, abilities and recognition that their voice is an important one.

Prior to the pilot, the participants had not had any opportunity to learn in this way or be supported in developing their practice in a structured and supervised framework. This was welcomed by all. The homes also participated in enquiry focus groups, exploring how learning can and best works in the care home, leading to a framework for learning being produced.

There is so much that can and needs to be achieved to create a vibrant and interesting sector which attracts people to work within it. Care homes are places where people live, but where nursing practice is in fact the lead. By changing the narrative and talking about ‘Nurse-Led Services’, we immediately change the perception and dispel the myth of the place where fools rush in. Nurse-led units should draw the best nurses who want to case manage, lead care and utilise their clinical judgement, accountability and professional leadership to the max.

The pilots have started the dialogue and explored the possibility of something new. The influence from this has extended to other key organisations considering their role in supporting care homes more, including the Royal College of Nursing and the Queen’s Nursing Institute. Building momentum for change should be all our responsibilities and, as we face more pressures in the system, the sector must stand tall and make its voice heard; without it the NHS will not cope. Following this, work has started to explore the possibility of a Chair in Care Home Nursing, a UK-first. Establishing a Chair in Care Home Nursing means an academic evidence base can be built and continue to push forward the work of many others. I also would like to see the first Centre for Care Home Nursing Practice, to act as a catalyst for some long overdue recognition and as a solid foundation for the profession in this field to flourish.

The story doesn’t end here, the participants of this pilot should be applauded, as without them we would not have been able to secure funding for a further two cohorts, which will be announced shortly. This will help the sector build a critical mass of beacon homes and contribute to a national network and a brighter future for nurse-led services in long-term care.

Professor Deborah Sturdy OBE is Director, Health and Well-Being at Royal Hospital Chelsea. Email: [email protected] 

More information on the Teaching Care Home Pilot evaluation.

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