There was a brief moment earlier in the summer when the news coming out of the Department of Health and Social Care (DHSC) was good. Finally, unions and the DHSC had come to an agreement on a long-awaited pay rise for NHS nurses. This news was followed a few days later by the announcement that non-NHS nurses on the Agenda for Change contract would also be eligible for the uplift.
However, the atmosphere soured with the arrival of July’s payslips and widespread complaints that the pay deal had been mis-sold.
Whatever the result of this debacle, the impact on the social care sector is undeniable. In May, Janet Davies, the Chief Executive of the Royal College of Nursing, wrote in a letter to the then Health and Social Care Secretary that the NHS pay deal risked drawing staff away from the social care sector. This fear is shared by providers across the country.
The recruitment and retention crisis in adult social care significantly predates this summer’s NHS pay deal debate. Currently, 9% of nursing posts within the sector are long-term vacant and 32% of social care nurses leave their roles every year. This is a staggeringly difficult environment for providers to build and train a team for the long term.
As the population ages, there is an inevitable increase of people living in the community with multiple chronic diseases. To prevent an untenable influx of increasingly sick patients to the nation’s A&E departments, it is essential that the social care frontline is adequately resourced and staffed.
So how can care providers ensure that they are not losing their best nursing staff to the NHS? In order to reverse this exodus, it is important to tackle two key questions. What are the salient reasons a nurse might choose a career in the NHS over adult social care and, conversely, why might a nurse choose a career in adult social care over the NHS? Once we understand this, we can begin to think of how providers can push back against negative stereotypes and emphasise the positives to attract more nurses into the sector.
Why work for the NHS?
The NHS has a global reputation for excellence. For many, especially those from overseas, working for the NHS comes with a strong social cachet. The opportunities for learning and professional development are extensive. Within the hospital setting, nurses are a bleep away from any multidisciplinary support that they require.
Contrast this to the preconceptions about jobs in adult social care. A career in social care can be seen as the blunt edge of the wedge; that one’s time is spent de-skilling and away from the action.
Whilst the machination of a large hospital may give nurses the support and learning opportunities that they desire, it comes with its downsides. Frustration at supersize organisations is common. Workers are faced constantly with bureaucracy and inflexible systems. Patient care is often rushed, transactional and performed against a backdrop of management key performance indicators (KPIs). Staff can feel like very small cogs in the machine, unable to share their grievances and powerless to enact change.
Why work in social care?
Those making the choice to work in adult social care may be doing so for many reasons. Staff within a care home can develop long-lasting and deep relationships with the residents they care for. There is more scope for nurses to work in a person-centric model of care.
Irrespective of whether a care home is an independent site or part of a larger company, working within a smaller organisation means that staff’s ideas and concerns can be heard. Organisations can be nimble enough to listen to these ideas and make change quickly.
The demographic of those working in adult social care is different to the NHS. Nurses tend to be older and have different priorities for their work. This represents a challenge in itself, with 30% of the nursing workforce predicted to retire in the next decade. This older demographic comes with different priorities and cite increased flexibility as a key driver for working in the sector. Being a slave to NHS rotas becomes less tenable as personal and family commitments become more rigid.
Challenging the negative stereotypes
Tackling the negative stereotypes around social care nursing must be worked on from the ground up. Having worked as an A&E doctor, I have seen first-hand (and indeed been guilty of) the condemnation of what can be perceived as ‘inappropriate’ midnight admissions from the community.
In the bright lights of A&E and surrounded by limitless potential investigations and interventions, it is easy to deem a late-night admission from the community as unnecessary. It is not until you have seen the realities of nursing within a care home that you realise the challenges of managing an unwell resident with little clinical support and no tangible interventions up your sleeve.
There is an endemic attitude of ‘us and them’ within the NHS which must be tackled if we are to reset the stereotypes that exist. By making community nursing a compulsory part of undergraduate education and encouraging preceptorships within the community, nurses can be better placed to understand the unique challenges faced by those working in social care.
Everywhere, commissioners and legislators are pushing to join together health and social care. Encouraging collaboration and cross-fertilisation of ideas at a grass-roots level will lead to greater synergy between the sectors. Not only will this benefit service users as they transition between hospital and the community, but it will do great things to tackle the incorrectly-held preconceptions about social care.
Emphasising the positives
To begin challenging these stereotypes, we must identify and share the positives of working in social care.
The care sector offers a unique opportunity for learning and professional development. Nurses can follow a resident over months and years and chart the complex interplay of how their life is affected by chronic disease. Nurses are able to provide ongoing, person-centred care on a framework of specialist knowledge in their subject areas.
As the population ages and more people live with complex pathologies in the community, upskilling and training of nurses will no longer be a luxury but a necessity.
Continuous learning should be an ingrained culture within an organisation. Nurses should be encouraged to become clinical specialists and lead the team in providing evidence-based best practice support.
Culture and the workplace environment
Care home managers have the unique opportunity to interact with their staff every day and reinforce the organisation’s cultural values. When making hiring decisions, cultural compatibility should come top of the list.
Whilst the blue lights of the operating room may suit some, there is a distinct pleasure of working alongside a close-knit team in a resident’s home environment. Whilst nursing in a care home is undeniably busy, there is still the opportunity for nurses to lead a team that focuses on the individual and develops deep relationships with those for whom they care.
The greatest advantage that social care providers have over large NHS organisations is their ability to be nimble and enact change. Care providers can talk to their staff and identify their likes and dislikes in the workplace. Enacting positive change may feel difficult in a 100-bed care home, but it is certainly easier than in a 1,000-bed hospital.
There is a perception that nursing in social care comes without a recognised route of progression. This could not be further from the truth, as staff can develop into specialist clinical practitioners, managers or educators.
The potential for progression and the development of new skills outside of the core nursing competencies should be emphasised to nurses thinking of working in the sector. Nurses currently working in adult social care should have clear professional development plans and regular meetings with supervisors to chart progress against their plans.
We are seeing a period of radical change in the population’s working patterns. In many industries, there has been an explosion in the proportion of those demanding flexible working.
Within the care sector, there is a continuous leakage of nurses from full-time employment into the arms of agencies. Whilst the current dogma is that these nurses’ motivations are purely financial, the reality is that the desire for flexibility is a huge driver.
Traditional rotas leave little scope for nurses to visit overseas family members for extended periods of time. Those juggling family commitments (especially around school holidays) can find it difficult to commit to inflexible rostering.
Being able to instigate this kind of change and support modern working practices is an ask too many for most NHS trusts. This is an area where social care providers can have first-mover advantage and use it to attract talent.
Enabling flexible working within a care home comes with its own challenges. It goes without saying that attempts must never lead to unsafe staffing levels or jeopardise continuity of care. Judicious use of technology can help managers enable flexible working within their homes without adding to management burden.
Action is needed
A career in social care is fulfilling and varied. Work must be done to tackle the negative stereotypes that surround the sector whilst the positive aspects of the career should be emphasised.
For those already working in social care, the priority should be on creating a workplace that encourages staff retention. Change may seem painful and, at times, inconvenient. But the headwinds that are impacting the sector are due to strengthen over the coming years. Legislators and providers that don’t take active steps to offset these headwinds risk letting the nursing crisis lead the entire sector into the grave.
Dr Charles Armitage is Managing Director at Florence. Email: email@example.com Twitter: @DrCArmitage
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