Upskilling nursing and care staff and

delivering high quality care

Context

➢ The market is about to shift, with changes to GP

contracts and fewer district nurses and staff available

➢How do we meet the increasing needs of a deteriorating

client group with a diminishing workforce?

CQC State of Care Report 15/10/19

➢ “Our inspectors are seeing too many mental health and

learning disability services with people who lack the

skills, training, experience or clinical support to care for

patients with complex needs”

➢ “Increased demand on services has prompted the

development of new roles and an emphasis on upskilling

existing staff”

➢ “The introduction of the nursing associate role has the

potential to create development opportunities for staff

both in adult social care and health care”

Clients

➢ Care is becoming ever more challenging….

➢Nearly half a million adults, mostly older people, live in

care homes, many with long term, fluctuating

conditions, often with multiple impairments and co-

morbidities affecting their health, intellectual capacity

and psychological well being

➢ The average age of clients is 85 with a life expectancy of

between 12 and 30 months

➢ Care homes are seeing more fast track admissions,

where often the prognosis is under 14 days

The workforce (adult social care)

➢ The number of people working in adult social care was

estimated in 2018 as 1.49 million

➢ The sector is one that is growing by around 1.2% (19,000

jobs) between 2017 and 2018 and overall 22% increase

between 2009 and 2018

➢ Registered nurses were one of the only jobs to see a

significant decrease (down 10,500 or 20% since 2012)

Adult social care jobs

Staffing

➢ The estimated turnover rate of directly employed staff was 30.8%, equivalent to approximately 440,000 leavers over the year

➢ It is estimated that 7.8% of the roles in adult social care are vacant, equal to approx. 122,000 vacancies at any time

➢ Registered Manager vacancies (11.8%) equivalent to around 2,300 at any given point

➢One fifth of registered managers left their role, in the last 12 months (22.0%), which equates to around 4900 leavers in 12 months

➢ 10,000 registered managers are due to retire in the next 10 years

Multi-disciplinary team

➢GP’s are being stretched even further

➢ The NHS in England has 2,500 fewer FTE GPs than it

needs this year (2019), and a projected gap of 7,000 FTE

GPs within five years if current trends hold

➢ The Kings Fund report states:

➢ “shortages of this scale represent a fundamental threat to the

sustainability of primary care”

➢ “the only way forward is to make substantial progress towards

a new model of general practice with an expanded multi-

disciplinary team drawing on the skills of other health care

professionals”

Multi-disciplinary team

➢District Nurses, do not fair much better..

➢A report in May 2019 (RCN & Queens Nursing Institute)

shows the number of District Nurses working in the NHS

has dropped by almost 43 percent in England in the last

10 years

➢As a result, there are only some 4,000 District Nurses

providing care for a population of around 55.8 million in

England, a ratio of only one District Nurse for every

14,000 people

Projections

➢ The 65+ model shows:

➢ For every 7 people aged 65 and over, I adult social care job is

required

➢Based on projected number of people in the population, by

2035 this will increase by 36% (580,000 new jobs)

➢ The 75+ model shows:

➢ For every 3 people aged 75 and over, 1 adult social care job is

required

➢Based on projected number of people in the population, by

2035 this will increase by 50% (800,000 new jobs)

In summary, we have…

➢A client group who have far more complex needs

➢Approximately 122,000 social care vacancies

➢ 10,500 less Registered Nurses

➢ 2,300 Registered Manager vacancies

➢ 2,500 fewer GP’s

➢ 43% decrease in District Nurses

➢Decrease in funding for clients

➢AND…..

➢Higher standards from CQC that we are required to meet

Good or Outstanding

➢How do we achieve either Good or Outstanding care

when we have the dilemmas that we are faced with?

➢ Currently nationally only 3.7% of care homes are rated

as Outstanding , Berkshire has 6.7%

➢ In the last months CQC inspections:

➢34 services were rated as outstanding

➢641 rated as good

➢311 requires improvement

➢82 inadequate

GP services

➢ SCIE research shows that how GP’s and care home staff

work together is essential for clients to receive more

timely care

➢ The health and well being of the older people in care

homes depends on them accessing primary care services

➢ Lack of interest and commitment by some GP’s to older

peoples healthcare, high workloads and an assumption

that resident's in care homes are at lower risk are

among some of the reasons that clients are unable to

access GP services (SCIE)

GP services

➢ There is huge variation in the level of support that care

homes receive from GP’s

➢ Care home in wealthier areas can often pay for better

primary care

Poor Excellent

➢ Care services will often have the Acute Visiting Services /

Advanced Nurse Practitioner / Paramedic (employed by

the surgery) as opposed to the GP for telephone reviews

or visits

Where do we begin

➢ Staff➢ Recruitment➢ Care Quality Matters state in November 2019 edition,

“Invest in your staff by employing only those who will fit into your organisation”

➢ Establish your values, and ensure that the whole team know and recruit using a values based approach

➢Do NOT take staff to fill the numbers, (it is a short term fix), we can teach the skills but not the values

➢An outstanding service will be selective➢ Consider what you can offer staff (short and long term)➢How can staff be involved in recruitment

Care Friends – An app to gamify employee referrals in care

16

If you look after your

staff, they will look

after your customers.

There is no magic formula for

a great company culture.

The key is just to treat your

staff how you would like to be

treated.

Induction and on-going support

Effective induction

The right training

for the role

Ensuring staff feel valued and appreciated

Supervisions / appraisals

Mentor / buddy system

Skills for Care – Mandatory Training

Annual

➢ Fire Safety

➢ Medication management

➢ Assisting and moving people

➢ Moving and handling objects

➢ Positive behavior support

➢ Safeguarding

3 Yearly

➢ Communication

➢ Dignity

➢ Equality and Diversity

➢ Basic Life Support

➢ Nutrition and Hydration

➢ Food Hygiene

➢ Health and Safety

➢ Infection Control

➢ MCA & DoLS (LPS)

➢ Person centred care

➢ Reporting and Recording

Is that sufficient?

Career progression

Become champions or

leads

Qualifications

Level 2/ 3 certificates

Qualifications

Diplomas / apprenticeships

In H&SC

Job role progression

Management training

Healthcare assistant

practitioner

Nursing associate

Support through Registered

Nurse training

Buddy’s / mentors for

new staff

Upskilling within current role

e.g. observations

Registered Nurses

Competency Assessments

➢ Traditionally this has included medication and clinical

procedures e.g. catheterisation, venepuncture etc

➢ Following a study by Stanyon in 2017, this concluded we

should be looking at 22 competencies, which extends

beyond task orientated aspects of care, e.g. drug

administration

➢ This actually provides an opportunity to revisit the role

of nurses within the care home setting

Clients needs are more complex

Meeting their

needs

1. Detailed

Pre-admission assessment

2. Declining admission if

unable to meet needs

3. Permanent staff

(Trained and competent)

4. In line with the service values

5. In line with National

Frameworks and guidelines

6. With care and

compassion

National Frameworks and Guidelines

➢NICE Guidelines

➢ CQC Guidelines

➢ 4AT Test

➢ Frailty scores

➢NHS England framework for Enhanced Health in Care

Homes ( 7 elements, first 4 being rolled out over the next

couple of years)

➢ RESTORE2 / NEWS 2

Enhanced Health in Care Homes

Care Element Sub Element

Enhanced primary care support

Access to named GP and wider primary care service

Medicines reviews

Hydration and nutrition support

Access to out of hours / urgent care when needed

MDT support Expert advice and care for those with complex needs

Helping professionals, carers and individuals navigate the health and care system

Focus on rehabilitation and re-ablement

Rehabilitation/ re-ablement services

Developing community assets to support independence

High quality end of life care and dementia care

End of life care

Dementia care

Deteriorating client

➢We are also seeing more individuals who are acutely

unwell

➢How do we recognise and manage deteriorating clients

➢ Staff who know the clients and can see when there are changes

➢ Staff who are able to undertake observations

➢ Staff who can interpret the meaning and significance of the

observations

➢ Staff who can support the client whilst waiting for the

emergency services and hand over succinctly

➢ Record on the NEWS2 assessment

Deteriorating Clients

➢ Analyse using RESTORE2 (Recognise Early Soft Signs, Take

Observation, Respond Escalate)

➢ This includes the NEWS2 assessment and promotes a

standardised response to the assessment and management of

unwell clients

➢ Escalate using the SBARD Escalation Tool and Action Tracker

(Situation, Background, Assessment, Recommendation and

Decision)

Watch for a combination of these symptoms and if you are concerned dial 999

250,000 people in the UK are affected by Sepsis each year, of which 52,000 die. We therefore need to ensure that all staff recognise the

signs and take appropriate action

Remember….. whilst we are facing challenging times, we need to look after and support our staff

For further information

➢Contact:

➢Tel: 07889 843352

➢Email: info@solicitudetraining.co.uk

➢www.solicitudetraining.co.uk