Care Dichotomy: Gold Standard, Bronze Fee

Frank Ursell, CEO of the Registered Nursing Home Association, discusses the remuneration, skills and workforce development challenges facing his sector…

The whole of the care sector could be considered to be one large dichotomy. On the one hand those commissioning our services demand a gold standard of care, but pay a bronze fee.

Staffing is a perfect example of this dichotomy. I regularly ask if it is government policy that the most vulnerable members of our society are cared for by the least well paid and least well trained staff – because that is the case despite their many statements to the opposite.

Working in a care home is more than just a job. Caring for people, especially older people, or mentally disable people, is more of a vocation and, for this reason, so many care home owners recognise this in their recruitment process. However, the current criminal record check, which is demanded prior to starting work, has had a consequential affect on home owners being able to offer a trial period to new staff. So many people believe that because they have looked after ‘mom’ at home they can work in a care home. The reality of looking after 20, 30, 40 etc ‘moms’ is that it is a very challenging occupation. It is, however, at times very rewarding to see what an impact one can have on a patient’s well being.

The biggest challenge we face, as home owners, is choosing the right staff. If fees were higher we could offer more by way of salary to attract a better quality recruit. As it is, local authority funded care does not allow us to compete with Local Authority staff or NHS staff. Our staff pay is often near the National Minimum Wage whilst the NHS and Local Authorities pay at least £1 – £1.50 per hour more on basic pay rates.

Training is a further challenge, and there does seem to be something not quite right about being able to take on staff who do not have training and for that training to take place whilst they are providing care. Would you want a hairdresser to practice on you whilst they were learning the basics of their job? {mospagebreak}

Whilst I recognise that there have been moves to ensure that staff receive induction training which is aimed at ensuring that there is a minimum level of competence from an early stage, there is resistance to permitting training to take place prior to taking up work, or to creating a suitable care qualification which could be secured prior to work.

Many of our European neighbours have a different approach, France and Germany, for example, do not allow workers to start until they have an appropriate qualification. We would expect a book keeper to have a qualification prior to starting work, why shouldn’t we expect care workers to be qualified? This is an issue which must be introduced carefully, but some movement towards the underlying principle would go a long way to improving the care of older people.

It is difficult to identify what an ideal candidate for work in this sector would require. The starting point must be that we would certainly be looking for somebody with a caring attitude – however that might be defined. Patience is a virtue which is essential in a care worker, coupled with an ability to control personal reactions. Some of the behaviour of some of patients would challenge a saint, but they are ‘somebody’s mom’ and they deserve some recognition that life’s challenges, in health or other ways, have probably brought on the challenging behaviour.

We need people who are quick to learn and quick to respond to the changing needs of our patients. We need people who are attentive to detail and also who are observant of change in a patient.
We need people who are able to meet the high demands of working in a care home, especially within a tight time frame, but who also are able to find time to shuffle with a patient to the toilet, or to listen, for the Nth time, to the story about the grand child.

When one addresses the workforce challenges in the care sector we hear that the biggest problem is the recruitment and retention. However, this is only a problem because it should be qualified by the words “at this pay level” or “with these conditions of employment”. If we could ‘fish’ in the £7.50 per hour pool I believe that we would be able to find a larger pool of potential staff members than when we fish in the NMW pool.{mospagebreak}

Clearly the job is rewarding, because despite the low pay we do succeed in securing large numbers of staff. Just think how much better it could be if we paid a reasonable wage…

The future for the workforce does revolve around how the job is perceived. The Cinderella description so often used is unhelpful. The low pay often means that the workforce is more part time in nature than full time (the weekly wage is insufficient for a full time worker). These two challenges need to be taken head-on if there is to be any significant improvement.

There are around 1 million people thought-out the UK who work in the care sector, caring for both younger adults and older people. This large cohort of workers are, in the main, driven by the vocational reward of helping people who are not in a position to help themselves, or have only a limited ability. This reward is so difficult to value, but every success is worth a hundred failures, every smile a hundred frowns.

The Registered Nursing Home Association is a UK wide organisation whose head office is based in Birmingham. We have branches throughout all four countries and offer support an guidance to nursing home owners. Information is available from our website at www.rnha.co.uk