Fundamental change needed to end ‘permanent sense of crisis’ in UK care homes

26th Oct 2014

A unique inquiry into the state of the care home sector for the Joseph Rowntree Foundation (JRF) today calls for sweeping change to ‘inject humanity’ back into care homes, with personal relationships put at the heart of how they are run and regulated.

With more of us living longer and our care needs changing, care homes should be declared ‘a sector of national strategic importance’ by the country, which cares for 400,000 people and employs over 1 million.

The call comes following a year-long personal inquiry by John Kennedy, Director of Care Services at JRF and care provider the Joseph Rowntree Housing Trust (JRHT), who has 30 years’ experience working in care homes.

The current blame culture, bureaucracy and business model have contributed to the ‘permanent sense of crisis’ the sector finds itself in today and needs to be urgently changed. The inquiry argues human relationships and caring needs to be central to the system and the sector - replacing the impersonal and insecure culture that currently shrouds the whole care environment.

John Kennedy’s care home inquiry took a fresh approach to find out what people really thought of the sector, using social media to broaden the range of views and seek an honest and immediate response from those closest to care homes.

He spoke to people being cared for and people shaping the delivery of services - including relatives, care staff, managers, cleaners and volunteers - as well as regulators, commissioners and the public.

The report recommends:

Care workers need to be rewarded sufficiently for their physically and emotionally demanding work. The care sector is one of the worst paid sectors in in the country: three quarters of care workers earn around £6.45 per hour, 14p higher than the 2013 National Minimum Wage.

Opportunities for training and development are limited for this highly-skilled, high-commitment occupation: empathy, kindness and compassion need to be nurtured, rather than just demanded or trained.

Workers need to have more time to spend on caring for residents and developing relationships. The inquiry identified more than 100 separate items of paperwork that must be completed regularly in care homes. Some care managers reported spending 20% of their time on paperwork, rather than leadership activities that could improve care. Paperwork has its place but it should be coordinated and streamlined to be effective in supporting the mission of care, not get in the way.

The way care is funded has led to minimum staffing levels and appalling pay. The sector accounts for 1.8% of national expenditure (£12 billion), yet is inadequately funded for the vital service it provides. This is contrast to NHS services, which accounted to 15.3% of national expenditure, or £102 billion. The care sectors needs to be properly joined up with the NHS, not act as a poor relation, but requires the resource to do so. In an ageing society, care homes should be an essential partner of the NHS.

Regulation should be more than inspection. Regulation should look at pay and working conditions, staffing levels, mission, commissioning practices and transparency of tariffs, in order to improve the quality of care. To be good, care homes need to work in a functional system.

Managers were identified as focal points in running good care homes and need to be supported in the leadership and development they can offer staff. Managers should be registered and have a licence to practise. The body should set professional standards, have disciplinary powers and provide a voice at a national policy level.

  • Better pay, conditions and support for the million care workers
  • Cutting paperwork
  • Better funding for the sector
  • Extend the remit of regulation
  • Creating a professional body to represent care managers

John Kennedy, who led the personal inquiry, said:

“Real change is needed to end the neglect of our care home sector. Currently the system is set up to fail, with the minimum resource, effort and value placed on care homes. Funding and appetite for wholesale reform is lacking and without fundamental change in the way we approach and deal with the care home sector, we risk condemning ourselves to a miserable future.

“We need a clear vision for our future care, based on the reality of our human condition. Kindness and compassion need to be nurtured, it can’t be just legislated. The care home sector needs to be brought in from the cold: valued, supported and fully part of a co-ordinated system. Care home providers also need to step up and accept their wider social responsibility - if you are in it just for the money, you’re in the wrong business.

“How many more reports of failing care do we need to hear about before we decide to act? We need to make our care homes better now. We need to have a system that maximises the potential of all care homes to be good. The Government, regulators and care home providers need to come together to improve funding and pay, cut bureaucracy and inject humanity back into the system we rely upon to look after our loved ones and ourselves.”