Quality of residential and nursing care hit by staff shortages

An analysis of 100 inspection reports also found staff are being left unsupported due to poor access to training and supervision

Published in partnership with Unison

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Residential care providers must prioritise support for staff even in the face of budget cuts, the Care Quality Commission has warned.

The care watchdog said homes should not “cut corners” on staff support as a Community Care analysis of findings from 100 inspections of residential and nursing homes in England found staff shortages and poor access to training and supervision was damaging care for residents.

The research, which examined findings from 50 homes short of ‘good’ ratings and 50 homes rated ‘good’, found:

  • 62% of homes that fell short of a ‘good’ rating did not have enough staff on duty, compared to only 2% of homes rated ‘good’.
  • 56% of those homes were not offering staff regular one-to-one supervision and annual appraisals, compared to just 10% of ‘good’ services.
  • 54% were not providing staff with regular training opportunities, whereas all ‘good’ homes had ensured staff were appropriately trained.


Andrea Sutcliffe, the CQC’s chief inspector of social care, said there was “absolutely” a link between staff support and quality of care.

While the watchdog has acknowledged that the introduction of the national living wage, staff shortages, and council fee squeezes have all placed additional financial pressures on providers, Sutcliffe warned that support for staff must be prioritised.

“If a service does not have enough staff to deliver safe and effective care, and doesn’t give staff the time to be caring and treat people with dignity and respect, or to be responsive to the different needs that people have, then that is going to have a huge impact on the quality of life for people using that service. Obviously, this is also going to put pressure on the other members of staff within the service.”

She added: “This is one of my worries around the future sustainability of good care in adult social care – what is it that people try to cut corners on when they are facing difficult financial circumstances? It may well be that these things are seen as ‘nice to do’ not ‘must do’.

“As far as I’m concerned, training, supervision and support for staff is a must do. It is blindingly clear in terms of our expectations of what a good service looks like and the regulations in terms of what providers should be doing under the law – these things are not new, it is very clear what is expected and that is what should be delivered.”

Heather Wakefield, head of local government at Unison, said the findings made it clear that good staff support leads to better quality care. She likened the issues with staffing shortages in residential care to 15 minute calls in the home care sector – a practice government ministers have demanded councils crack down on.

She said: “In effect it’s the same thing, because it’s about the amount of time people have. Staffing levels affect the time spent with residents, which is fundamental to good care.”

‘I leave work in tears’

Interviews with frontline care workers highlighted the difference staff support can make. Kate*, who has worked in a residential care unit for just over a year, felt residents were being neglected as a result of the inadequate staffing levels where she works.

“We’re short staffed every day. We work on the minimum anyway, so when someone’s off sick it’s just a nightmare. I deliver personal care to 12 residents, but I never get to sit and have a conversation with them – most sit in their rooms just staring at the wall.

“I support one lady who is nervous about walking. I don’t have the time to help her walk a short distance to get her confidence back and this has resulted in her developing a pressure sore.

“I feel like I’ve failed this lady because I can’t give her the time she needs.”

Kate described herself as “normally a happy-go-lucky person”, but said the pressures of work were beginning to impact her wellbeing.

“The last few months I’ve felt myself getting more and more down when going to work because I know someone will have called in sick and I’ll be running for most of the day.

“Like last Friday I was alone serving 19 residents in the dining room, some of them have more complex needs and get out of their seats a lot. I asked my manager if I could have some extra help – she told me ‘get your senior to do it seeing as you’re obviously not capable’.

“It [the lack of support] makes me come out of work every night in tears.”

Extremely high standards’

Jennifer*, who has been working at a care home for older people since May, described a completely different experience to Kate and credited the “amazing” support she’d received from her manager.

“She will ask us questions out of the blue to keep us on our toes – and asks us to demonstrate techniques such as hand washing and manual handling.

“All staff have regular appraisals, supervision and ongoing training. The support is great too, we all get along and we deal with grievances in a professional way. Overall it’s a lovely home.”

She said the level of support she received made a “massive difference”.

“I would have left ages ago if it was any different. It’s not an easy place to work – there are extremely high standards, but I love it. Our residents are treated with the greatest respect.

“My only complaint is the pay is rubbish. I’m on minimum wage and for the work carers do, and the emotional rollercoaster we go through, I think we should be paid more.”

‘A nicer place to be’

Holly has worked in a nursing home for the past 18 months. She said she received regular supervision and was also able to attend regular team meetings.

“We have a lovely registered manager, she is really supportive and we have a contact number for her to use anytime we need her. There’s a great atmosphere among the staff as well.

“The support we get makes you actually want to go to work and you look forward to your shifts. Supervision is also a good chance for you and your manager to talk about your progress and see what you can do to better yourself. It makes work a much nicer place to be.”

While acknowledging pay rates for care work were a significant issue, Sutcliffe said creating this kind of positive culture could be key to tackling recruitment and retention issues in the sector.

“We’ve still got an awful lot of services that are paying people similar rates of pay but they are recognising and valuing them for the contribution they make, they are providing them with training and support so they feel confident in their role, and the staff are working in an open and transparent culture where they feel able to give good quality care.

“In ‘good’ and ‘outstanding’ services we see the real positive impact can have on people in terms of saying ‘yep this is the place I want to work in.’”

Download the full report ‘Staff support and the quality of care in children’s and adults’ residential care: A research partnership between Unison and Community Care

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7 Responses to Quality of residential and nursing care hit by staff shortages

  1. Gerald November 9, 2016 at 1:48 pm #

    It is very nice of Unison to tell the Private Sector care Homes the obvious but I think they might spend their time better concentrating on the NHS Trust Sector performance now that the CQC are inspecting Trusts. I think they might find more serious problems in this area which needs urgent attention.
    I wonder if it all a matter of diverting the Public’s attention and smoke screening ?

    • Sandra November 10, 2016 at 9:10 am #

      Health and social care are meant to work together so this needs to be highlighted. We have a shortage of Care Homes and most have a high turn over of staff. Training and the standard of care varies greatly. Carers don’t always get the recognition they deserve and the pay certainly doesn’t reflect the skills and training they have.

  2. Emma Thomas November 10, 2016 at 10:23 am #

    Five years since I left a hospital team, how depressing to read this article. Senior managers in CQC, local authority ssds , etc,etc, all saying services are not good enough! Seems to me they’re more full of hot air than our politicians. All know the need for more financial investment to meet standards, but that’s nothing new from 20 years ago, with the savage cuts in between! My view is that health and social care separately are all vying for “who pays” in order to protect budgets in silos. Until there is a full integration, there will always be competition for funding and even then, theres no guarantee of change.

    • Gerald November 15, 2016 at 11:57 am #

      Dear Sandra,

      Well said, this under funding has been going on since 1993, As long as the Public Sector are empowered to purchase care from the Private Sector they will cut us to the bone and yet at the same time they will throw money at their own provisions . At present CCG pay the trusts something like six times the amount they pay a Care Home with Nursing and yet the CQC have recently shown quite clearly that in numerous Trusts the quality is actually worse than in a Care Home . It all boils down to Politics and hypocrisy and Value for money and quality comparisons do NOT come into it .

  3. Me November 10, 2016 at 12:59 pm #

    Why not just give residents of care homes and staff who work there, surveys, that they can hand in, anonymously. This way, opinions can be kept private. I understand the purpose of meetings, but there are always differing opinions in any and every care home. So why NOT?

  4. Bullied462 November 12, 2016 at 2:23 pm #

    If you pay peanuts you get monkeys, enough said.

  5. Care Focus (South West) CIC November 18, 2016 at 5:07 pm #

    Very informative article and the report provides some useful statistics that we will be using at our next care providers meeting.