“I think most people have no appreciation whatsoever of actually how complex it is to support somebody with multiple conditions and dementia in a safe and kind way,” says John Kennedy, director of care services at the Joseph Rowntree Foundation.
Kennedy is responding to the latest research on the role of registered care home managers, which has highlighted the extent of knowledge gaps around the skills, experience and practice of this section of the workforce.
The research was undertaken by the National Institute for Health Research’s School for Social Care Research (SSCR) and reviewed 10 existing UK studies on the role of registered managers. It identified an appetite among managers to gain access to better support, training and professional recognition.
However, the fact there is no mandatory requirement for continuing professional development for the role raises questions over whether this appetite is being met.
Kennedy, who spent 15 years as a general manager before joining the Joseph Rowntree Foundation, says the lack of awareness about the skills required to do the job is a key factor in the public’s perception of registered managers.
“Not only do managers have to be assertive and organised to manage staff, they also have to be empathic and be able to deal with people experiencing strong emotions around them,” he says.
“It is a really high-skill job and managers are absolutely key within an organisation, but actually they rarely get anything but criticism.”
The poor reputation surrounding the care home sector is an ongoing challenge for managers and this was highlighted in the SSCR study, which made reference to several high profile failings, including the Orchid View care home scandal in 2013.
“The general consensus is that dreadful things are happening in care homes because that is what we are ramming down people’s throats,” says Christine Devlin, home manager at Connors House in Canterbury.
“It would help all managers if the government and the media would not always just report on the negative things that happen but equally report on the good things.”
Negative media coverage has also been linked to staff morale and in a survey undertaken by the National Skills Academy for Social Care (NSA) in 2012, a quarter of the 2,886 managers polled reported feeling isolated.
“You’re very much in a heated environment where if anything goes wrong then it is pounced upon with great venom,” says Kennedy.
“In other professions, people get support because it is recognised that there is a psychological pressure that goes with that line of work,” he adds. “There is also that pressure in care management.”
Need for support
The need for external supervision support for registered managers has been recognised by the NSA. The organisation set up a programme in 2013 to facilitate networking and help managers share their knowledge and experiences.
“The registered managers programme was developed in response to the importance placed in the Cavendish Review to the role that registered managers play in the provision of excellence in adult social care services,” says Andy Tilden, Skills for Care’s director of sector development.
“There are now 60 local networks and more than 2000 managers have access to helplines for HR and legal support and peer support from experienced registered managers.”
Skills and experience
Under the Care Standards Act 2000, registered managers are required to undertake the QCF (level 5) diploma in health and social care, with a management of adult services or adult residential services pathway.
But there is no other formal qualification for care home management and according to the SSCR research, little is known about the significance of a manager holding a clinical, or other professional qualification, such as nursing.
For Tracy Paine, operations director at Belong Villages care service, a health or social care qualification is what she’s looking for when recruiting new managers.
“Ideally we want a qualified nurse, occupational therapist or someone with a social care background,” she says.
“I think this is more important now because the service that care homes are providing is much more specialist than it was years ago – we are looking after people who have previously been in hospital and have increasingly complex care needs.”
But Kennedy takes a different view. “It depends what learning is in the qualification,” he says. “A nursing qualification is to be a nurse, not a care home manager.”
“What’s more difficult is finding people with the interpersonal skills, resilience and emotional intelligence needed to do the job right.”
In order to raise the status of care home managers, there is now growing momentum in the sector for the introduction of a formal registration body.
This is taking shape under proposals from the Health and Care Professions Council (HCPC), which has recommended a ‘suitability register’ (formally known as a ‘negative register’) to the government.
“We believe the three elements of our proposed system – a statutory code, an adjudication process that can hold individuals to account and public access to a register of those not fit to work as carers – are vital for public protection,” says Michael Guthrie, director of policy and standards at the HCPC.
The scheme also recommends that CQC registered managers in adult social care in England should be statutory regulated, which Guthrie says would recognise the pivotal role that these managers play in influencing the standards, culture and behaviour of their employees.
As Paine concludes: “Managers need to be supported to keep abreast with the constant changes to the social care landscape and meet the increasingly complex needs of people with long-term conditions like dementia.”
“We need to standardise the people that are responsible for care provision because they are the absolute key person in that organisation – we have to get them right.”