Local authority cuts and the National Living Wage are biting into the budgets of most UK care homes. In the face of a recruitment crisis, how can care providers attract the management talent they need?
The quality of leadership in a care home is key to its success, according to the Care Quality Commission (CQC). More than nine out of 10, or 94%, of the care services it rated as good or outstanding also had good or outstanding leadership.
Andrea Sutcliffe, the Care Quality Commission’s chief inspector of adult social care, identifies three key areas: “Our inspections show people can experience good care, with 67% of care homes rated as good so far. But there’s still too much variation. The recurrent themes we reported in the State of Care report last October – including weak leadership, shortages of staff and providers failing to resource and invest in training – are continuing to persist in 2016.”
Neil Garton, head of healthcare at NatWest, says that research carried out by the bank in November 2015 supported the theory that inadequate levels of care can usually be traced back to inadequate leadership. “Our internal research into 135 care homes found to be inadequate or requiring improvement showed that a competent manager was key. The CQC key lines of enquiry finish with ‘Is the home well led?’, as the previous four questions will have told the inspector if the manager is any good. Of the homes we looked at, all were seen as not ‘well led’ and the common themes were poor training and lack of knowledge of the Deprivation of Liberty Safeguards and the Mental Capacity Act (MCA).”
The CQC regulates more than 17,000 nursing and residential care homes in England. The combined market value for residential care for older people, including local authority funded, voluntary and private expenditure, is estimated to be £13.4bn, according to a report released by Age UK in May this year.
The fees for many residents are paid for by local authorities, and in the same report Age UK notes that government funding for care fell by more than 20% from 2010 to 2014. On top of that, the National Living Wage (NLW) came into effect this year, bumping up the cost of wages. The CQC found that, of all work sectors, social care offers the greatest cause for concern as wages start from a low base and productivity improvements can be difficult to realise.
Len Merton, CEO of Advinia Health Care, a group of 16 care homes in England and Scotland, including the award-winning Kingsway care home in Durham, notes: “Many managers have worked themselves up from care. They have big hearts, and passion, but when it comes to leadership, they haven’t been developed or given the opportunity to improve their skill sets, especially around people management and business acumen.”
Merton feels leadership training saves money. “We spend a lot of unproductive time dealing with staffing issues, about 80% of our time. That could be dealt with more effectively with stronger leadership. Investing in that will improve the quality of our services, and reduce the time spent on staffing issues to 20%.”
In 2015, the CQC State of Care report found that adult social care services were struggling to recruit the right staff. Vacancy rates across the sector were 5%, almost twice the national average. The turnover rate for adult social care positions was 25% per annum, compared with a national average of 15%.
Nadra Ahmed OBE is chairperson of the National Care Association, a not-for-profit organisation formed in 1981 to represent small- and medium-sized care providers. She observes that excellent managers make excellent services. “Confident and competent people both motivate and inspire. That sort of person could go into any field at a market rate higher than if they came into the world of social care,” she says.
“You don’t need academic qualifications to run a care home; what you do need is a caring, positive and passionate attitude”
Len Merton, CEO, Advinia Health Care
Care providers can’t compete on salary, and this presents a challenge. Reed.co.uk, one of the UK’s biggest recruitment companies, recently surveyed over 1,000 of its active jobseekers across all sectors. The number one candidate concern when applying for vacancies was salary and benefits. Learning and development, and career progression, came fourth and fifth respectively.
Ahmed advocates looking at developing existing staff into leadership roles. “Our concern is that the appropriate qualifications needed to take staff on that trajectory aren’t quite there yet. We’ve always tinkered around the edges. We’ve created diplomas, and level 4 and 5 NVQs, management levels and so forth. Some of these people are not academic and we need a way to recognise that. It’s doable, but it all rests on the image of the social care sector and the professionalisation of the sector.”
Merton’s approach to this obstacle has been to develop Advinia’s own academy to nurture leadership and business skills. “It’s about recognising that some of my managers have got good skills and strengths but can be developed further to eradicate some of their unskilled areas. You don’t need academic qualifications to run a care home; what you do need is a caring, positive and passionate attitude. Recruitment is all about sourcing the right sort of attitude first. Anyone with an average degree of intelligence can then acquire the people-management and business knowledge needed.”
Ahmed suggests looking to other industries for ideas. “I think we need to cross-fertilise. In one of the best projects I have seen, a care home has teamed up with a local hotel. Staff go to work in the hotel for a day, and the hotel staff work in the care home for a day. That’s good practice.”