Care homes need minimum staffing levels to tackle risk of abuse, says Comic Relief-funded study

Care homes should be required to meet standards on minimum staffing levels that would be monitored by regulators to help tackle the risks of abuse and neglect of residents.

That was the verdict from the final report of the five-year Prevention of Abuse and Neglect in the Institutional Care of Older Adults study (Panicoa), which was funded and commissioned by Comic Relief.

Though staff were “typically hardworking and committed to delivering respectful care” that promotes independence, this was often undermined by workload pressures.

Staff facing mistreatment and burnout

Staff were “frequently at risk of verbal and physical mistreatment”, and stress and burnout were “not uncommon”, driven by recruitment and retention problems, “higher-risk” care environments involving residents with increasing levels of need and under-funding of services by commissioners. Many managed these pressures by focusing on “meeting urgent physical needs at the cost of providing more relationship-centred care”, and providing “reactive care”, undertaken as a series of unrelated tasks.

Staff also felt they lacked support from managers, while the “hierarchical” structure of some care providers meant registered care home managers had limited autonomy to run their homes. The report concluded that the “good treatment of staff will be likely to result in the good treatment of those for whom they care”, particularly fair reward systems, a culture of trust and openness and management of workload pressures.

To improve the situation, the report called on UK governments to ensure regulators set and monitor standards for minimum staffing levels that care homes would be required to meet. It also said councils must work with providers to agree practicable staff to resident ratios “sufficient to ensure the safe and respectful care of older people at all times”, and to use this as the basis for a “fair and accurate fee structure”.

Safer staffing guidance for NHS but not social care

Currently, care homes, like other registered health and social care providers in England, must “ensure they have sufficient numbers of suitably qualified staff”, to meet the relevant CQC standards. However, while the government, in response to the Francis report, has asked the National Institute for Health and Care Excellence to produce specific guidance on safe and efficient staffing levels in a wide range of NHS settings, it has not done the same for social care.

The CQC has begun a “thematic probe” into adult social care staffing after receiving evidence that insufficient staffing levels were leading to poor care in some settings, particularly services supporting adults with learning disabilities or dementia. However, chief inspector of adult social care Andrea Sutcliffe has said this would not involve proposing staffing ratios but examining whether staffing levels were contributing to poor care.

The Panicoa report also said senior managers and owners of care homes needed to better recognise the pressures staff were under and protect staff, particularly those from black and minority ethnic backgrounds, from physical or verbal mistreatment.

The report was written by former DH social care research lead Carol Lupton and Panicoa project manager Clare Croft-White, and draws on 11 pieces of research conducted since 2008 on reducing neglect and improving dignity in care. These included interviews with 500 individuals or groups on 32 acute hospital wards and 42 care homes.

Registration of care home manages mooted

Among other recommendations, it said national social care bodies needed to work to raise the professional status of care home managers and examine the feasibility of establishing a professional register of them. This is something that the Health and Care Professions Council has proposed but the DH has not yet decided whether this should proceed.

The Panicoa report also said that regulators should do more to disseminate examples of good practice to registered providers and incentivise them to improve. They should also develop measures to monitor the impact of financial pressures on providers, including by assessing the viability of contracts drawn up by commissioners.

In England, the CQC no longer inspects or assesses councils’ commissioning function – despite strong calls from providers and charities for the government to ensure it does so. From April 2015, under the Care Bill, the CQC will be able to inspect a council, with government approval, when there is evidence of serious failing or where poor commissioning is leading to poor provision.