The 2016 Lancashire Care Conference included two workshops for registered care managers (RCMs) Care homes from Venus, Hospitals from Mars? How to work better together and Registered Care Managers: who’d be one? – Valuing RCMs. The issues raised have been consistent themes running through the local Registered Care Manager Network meetings facilitated by Lancashire Care Association (LCA).
These workshop titles represented enduring and continuing challenges. Challenges that are going to need to be ‘sorted’ if the integration agenda is to be more than words, and the independent care sector can take up its rightful place and work seamlessly with NHS and social services to ensure that care pathways aren’t littered with as many holes, breakdowns and obstructions as our gridlocked roads.
It is increasingly recognised how important RCMs are in the system, yet how undervalued and unregarded they are.
Emerging themes for RCMs
Some years ago, as part of a Safeguarding project, LCA ran focus groups for RCMs. The emerging themes were written up in two discussion papers. The discussion papers’ titles each represented the key point arising from the respective focus groups.
FG1 was entitled Through a glass darkly, highlighting the fact that RCMs often felt they were outside of key dialogues and relationships when working with social services and NHS colleagues. It also highlighted that when things were being planned, the public sector ‘usual suspects’ took the lead and, later down the line, there might be some ‘The decision has been made now, we are “consulting” with you’ consultation; definitely not observing the so-called ‘Gunning Principles’ on consultation (proper engagement at a formative stage in a fair process).
The other theme that emerged in FG2 was discussed in the paper R-E-S-P-E-C-T…all I’m asking for is a little… The points here were that the managers in the groups felt that whatever their level of expertise and qualifications, they were rather looked down on by managers and clinical and professional staff in the local authority and NHS, and whatever they could contribute was disregarded. These echoed findings in the NIHR report, Care Home Managers: a scoping review of evidence, which noted the central importance of RCMs, but also their status as ‘an overlooked group’.
There were two aspects to this latter area of discussion. Firstly, the perception that there was a rather colonial view held by the public sector, that the independent sector (especially the private sector) was a lower order in some way and its representatives of a lesser value than public sector and NHS professionals.
Secondly, they felt that their skills levels and knowledge were disregarded or deprecated and seen as less than their public sector peers. This is a disparity which also arose in relation to the dynamic between managers and Care Quality Commission inspectors when comparing competence and legitimacy. It also featured largely in the dynamic between care home managers and hospital ward staff who often, the charge was put, didn’t recognise care homes as part of the care team.
Managers reported, ‘Hospital staff don’t communicate with the person’s support staff’; ‘They won’t share any clinical information’, (the Data Protection Act being used as a shield to any inquiry). Also, that RCMs weren’t recognised as holding any skills or knowledge in contrast to hospital nursing staff, reporting, ‘There’s a lack of equal professional recognition’ and ‘The staff in the acute wards do not value the expertise of the RCM’.
Another issue, which was equally strongly felt across the original focus groups, and which endured into the recent conference workshops, was the sense of relative isolation of the RCM. There wasn’t the means for a more collegiate approach, where a peer network was facilitated and a learning culture encouraged. It was felt keenly by some that proprietors were not always supportive of peer professional group time, seeing it as ‘time out’ from core business and care requirements. This was set in the context of a threatening environment, where managers felt the system was in place to pounce on failings rather than develop and facilitate success and achievement.
Critical success factors
The workshops identified some critical success factors, approaches and structures that need to be in place for RCMs to take up their leadership role and, therefore, for integration to work more effectively.
It goes without saying that money was regarded as important, but over the course of the discussions on the issues in local RCM Network meetings it was not seen as the main issue. Being valued, appreciated and recognised stood out.
The critical success factors were:
- Support/license: empowerment from the proprietor and the system. Some RCMs complained of directors who are focused on money rather than care. This highlights one of the RCM’s ‘USPs’: their ethical responsibility in their role to address care first and foremost, in a squeezed system under increasing financial pressure, but also the conflict that it can create with a business’ ‘bottom line’ issues. Companies should support their RCMs, not leave them to deal with everything alone and RCMs should be given license and help to build a support and information sharing network. Developing a collegiate and learning culture is an important step towards not being isolated.
- Facilitative structure: RCMs called for more networking opportunities; with networking as a core task not marginal or an add-on. They wanted space and time for more regular meetings, training opportunities for the key management skills needed to do the job and opportunities for relationship building through continuity in networking.
- Open culture: trust, honesty and openness were highlighted in the workshops, drawing a contrast with tribalism and threat, which were felt to be endemic features of the health and social care system. Finding the means to build relationships, trust and understanding in the local context, eg through ‘learning together’ workshops and ‘shadowing’ across organisational boundaries, was also seen as critical to a ‘one workforce’ approach to integration.
- Regard and ‘worth’ issues: the final critical success factor applies as much to RCMs as providers of care, as for the care/service users they are supporting: the importance of being treated with dignity, being valued, and being listened to.
Whatever happens in terms of professional regulation and oversight nationally, our work in Lancashire highlights the importance of nurture and generative approaches to building identity and developing voice.
The lessons we take away are: to build opportunities for ‘learning together’ with RCMs and colleagues from health and social services; to take opportunities to raise the profile of RCMs and to improve their standing in the local care networks; to express the RCM voice strongly so as to obtain a more balanced narrative in the public discourse on care and to develop leaders and leadership processes.
Having a coherent development strategy and facilitation is of central importance in helping RCMs develop into the competent, confident and well-supported professional group society needs them to be.
Are these your experiences of the role of registered managers? Log-in to share your thoughts on this and any challenges you may face. You can also access the papers and references mentioned in the article. Subscription required.