Two years ago we called for reform in care homes. We're still waiting - Paul Burstow

A supply of reliable, good quality care is urgently needed to meet the needs of our ageing population. More needs to be done to provide leadership and invest in staff

Last year, Jeremy Hunt told a local government audience that families should take more responsibility for the care of their loved ones. It was a statement that offended many and the recent Carers UK State of Caring report makes plain why: the price paid, physically, psychologically and financially is huge.

There are many of course who don’t have a family – findings from the Beth Johnson Foundation and Ageing Without Children highlighted that as many asone in five people aged 50 and over have not had children. The question must then turn to formal care services. Will there be enough good quality care to support those without families in their old age? Will it meet their needs and lifestyles?

There is undoubtedly a growing fear in the care home sector that a major provider will collapse. Certainly the news has been bleak – Moody’s has downgraded its ratings on bonds issued by both Four Seasons, the UK’s largest care home provider, and Care UK. According to research by Opus Business Services for BBC Radio 4s You and Yours Programme, one in four care homes – that’s around 5,600 – could go bust within three years.

Earlier this month, care home leaders lobbied the Department of Health about the continued squeeze on fees and warned that the national living wage would lead to many care businesses struggling with cashflow and facing bankruptcy.

Meanwhile, the Treasury thinks it’s fixed – or at least eased – social care funding, with the introduction of the adult social care precept. The trouble is that the precept yields its best returns in the areas where the care home market is more buoyant because of the higher rates of occupancy by self-funders. Those areas most dependent on the precept will raise the least and still be dependent on state funding.

Of course there must be questions about the opaque and complicated financing arrangements of some care home operators. Two years ago I worked with a group of industry experts to conduct a major review of the future of residential care. We raised concerns that the care home market was dividing in two, one for the self-payers and one for the rest. We warned of the dangers of this bifurcation for quality and stability.

The report recommended a wide range of actions. We argued that the question of what care you need should be separate from the choice of where you live, and so should the regulation.

Registered managers were highlighted as being worth their weight in gold. We called for more to be done to connect registered managers with one another to offer mutual support. Programmes like the City University based MyHomeLife is a good example of this.

The Heights in Buckinghamshire was named an outstanding care home after its unannounced Care Quality Commission inspection in January. Its registered manager, Blesson Thomas, had worked at the home for six years. He had qualified as a nurse in India but started at the care home as a cleaner, before rising through the ranks to become registered manager in April 2014.

The Heights has not always been rated outstanding. When Thomas took on the manager’s job, the home was found to be “non-compliant” with a number of the essential standards. According to Thomas, the root of this was very low staff morale.

Part of the plan for the sector has to be to unleash the potential in the care workforce

On taking on the role, he worked hard to win the confidence of the staff and residents by talking to them, learning from them and planning with them. He implemented a career progression plan for every member of staff, the opportunity to showcase talents to their peers, and the chance to become research assistants. Subsequently, staff retention and sickness absence have all improved, and the home does not use any agency staff.

I tell this story because it is a sign of hope. It demonstrates the difference a registered manager can make and what person-centred practice is all about – good relationships. Part of the plan for the sector has to be to unleash the potential in the care workforce. To nurture and support more registered managers like Blesson Thomas.

Analysis Paul Burstow's Key to Care report on homecare: the sector responds

What we had in mind in our investigation into the future of residential care was the implementation of a new strategy for the industry. We called on the government to provide leadership, rather than simply firefighting.

Since the report was published, many of the issues have not gone away and indeed the financial pressures have worsened. Still there is no sign that the government realises the need for a plan. In effect, we have an industry that urgently needs to restructure to make it fit for the 21st century.

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