Title of 2020 Resolution:

RESEARCH, DEVELOPMENT AND INNOVATION IN THE CARE SECTOR

NCW calls on the government to invest in research, development and innovation in the care sector to build a robust infrastructure for high standards of care. The priority should be to develop a system that provides resident centred care involving relatives and care home staff.

The Covid crisis has disproportionately affected residential care homes and led to a loss of confidence. Initial reports suggest that 40% of people over 65 say they are less likely to seek residential care for themselves and 31% of people are less likely to choose care homes for an elderly relative.

For too long care homes have been seen as a Cinderella service. A complex and stressful environment, the estimated staff turnover of directly employed staff working in the adult care sector 2018-19 was 31%. Better training and development along with enhanced career pathways such as high-quality apprenticeships should be prioritised.

Research into policy and practice attracts less attention than other parts of healthcare but they deserve an urgent national focus.

Proposer:            Dr Yitka Graham, NCW Individual Member          

Seconder:          Jenny Spivey, NCW Darlington & District branch member

Submitted by:    Dr Yitka Graham, NCW Individual Member

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Proposer Speech – Dr Yitka Graham

The impact of the COVID-19 pandemic on the care system has highlighted vulnerabilities within the care home sector (1). The majority of the 400,000 people living in UK care homes are amongst the most frail and aged in society, at the end of their lives, often with multiple and complex morbidities such as dementia, mobility issues, incontinence and pain (2). These factors, individually and collectively, render residents of care homes (and the staff working in homes) vulnerable to infection, as seen in the disproportionate number of deaths from COVID-19 in this environment. It is estimated that staff working in social care in the UK are twice as likely to die compared with the general population (1).

Optimal care for people living in care homes can be achieved through working in collaborative, whole-system  partnerships with care homes across health, social care, voluntary, community and social enterprise (VCSE) sectors, with the NHS England Enhanced Health in Care Homes (EHCH) aiming for proactive, resident-centred care involving relatives and care home staff (3).

The COVID-19 pandemic has impacted not only on the delivery and organisation of care, but affected the mental health of the  care home workforce, as a result of working in a complex and stressful environment, underpinned by the risk of infection to themselves and others (4). Traditionally, the care home workforce has a high turnover, which may be exacerbated by COVID-19. In 2018/19 the estimated turnover rate of directly employed staff working in the adult social care sector was 30.8%, equivalent to approximately 440,000 leavers over the timeframe, with implications for continuity of care and delivery of services. Many who leave remain within the sector, as 66% of recruitment comes from within adult social care (5). There appears to be a loyalty amongst care home workers to remain in the sector, with reasons for leaving employment reported as low rates of pay and lack of career development (5).

Initial reports into reactions to the deaths in care homes as a result of COVID-19 have suggested there is a public crisis in confidence in social care, with 40% of people over 65 reporting being less likely to seek residential care for themselves, and 31% of people less likely to choose care homes for an elderly relative (6).

The practice of research in care home settings may be challenging, with variances in organisations, changing models in the delivery of care,  a lack of understanding of the benefits of research and logistics to carry out research in practice, in addition to barriers to recruitment owing to issues such as capacity to consent (7). However, given the significant proportion of people living in care homes, the workforce issues with staff working in these environments, and the health conditions affecting residents, notwithstanding the impact of COVID-19 on the care home sector, there is a rich research environment that requires investment to build and sustain a robust infrastructure for high standards of care.

Priorities for research include exploring current care home workforce issues to offer insight into how to strengthen and sustain staff to meet future predicted demands on care homes. The current public perceptions of care homes needs to be understood with a view to addressing the negativity as a result of the impact of COVID-19. The delivery of the aims of the NHS Long Term Plan, specifically in implementing the findings from the Enhanced Health in Care Homes Vanguards, to improve NHS services to care home residents and communication/information exchange between the two healthcare settings (8) will require evaluation to ensure that these are being met.

Policy

The UK’s ageing population, with accompanying complex health needs is set to increase over the next 20 years (9), which places further demand on the care system, and the employees working within the sector.  The impact of COVID-19 presents a new point of departure for policy within the care home sector in terms of developing positive perceptions of care homes as places of employment, with clear training, development and career pathways.

As an example of best practice, the Queen’s Nursing Institute has positively promoted nursing careers within care homes, offering career and development advice (10). This model could be replicated and tailored for the other roles within this workforce.

Advocating for policy to recognise  the valuable skills and knowledge of the care home workforce, and encouraging investment and support  as the complexities of COVID-19 and the lasting impact are negotiated should be prioritised to ensure a safe and sustainable care home environment for residents and staff.

References

  1. The Health Foundation. What has been the impact of COVID-19 on care homes and the social care workforce? London: The Health Foundation; 2020 [Available from: https://www.health.org.uk/news-and-comment/charts-and-infographics/what-has-been-the-impact-of-covid-19-on-care-homes-and-social-care-workforce.
  2. Goodman C, Davies SL, Gordon AL DT, GH,  MJ. Optimal NHS service delivery to care homes: a realist evaluation of the features and mechanisms that support effective working for the continuing care of older people in residential settings. Health Serv Deliv Res 2017;5(29).
  3. NHS England and NHS Improvement. The framework for enhanced health in care homes version 2. London: NHS England and NHS Improvement; 2020.
  4. Hayes C, Graham Y. HCA roles in COVID-19: the emotional cost of sacrifice. British Journal of Healthcare Assistants. 2020;14(5):246-9.
  5. Skills for Care. The state of the adult social care sector and workforce in England Leeds: Skills for Care; 2019.
  6. Quilter-Pinner H, Sloggett R. Care after coronavirus: an emerging consensus London: Institute for Public Policy Research; 2020 [
  7. Cyhlarova E, Clark M, M K. Recruiting Participants for Adult Social Care Studies: Challenges and Mitigating Strategies. London: NIHR School for Social Care Research; 2020.
  8. National Health Service. The NHS Long Term Plan. London: National Health Service; 2019.
  9. Kingston A, Comas-Herrera A, Jagger C. Forecasting the care needs of the older population in England over the next 20 years: estimates from the Population Ageing and Care Simulation (PACSim) modelling study. The Lancet Public health. 2018;3(9):e447-e55.
  10. Burger S-A, Hay H, Comabella CCi, Poots A, Perris A. Exploring education and training in relation to older people’s health and social care Oxford: Picker Institute; 2018.