We must commission for quality to avoid “sleepwalking into disaster” says social care leader

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Mario Kreft
Mario Kreft

A social care leader has called for fundamental changes to tackle a dire shortage of nurses in Wales.

The scarcity of medically trained staff is leading to nursing home closures which will push the NHS beyond breaking point, according to Mario Kreft MBE, the chair of Care Forum Wales.

One of the major causes of the problem, says Mr Kreft, is the flawed way in which social care is commissioned.

He said: “The commissioning process should be about quality and securing value for money and not about paying the lowest possible price.”

Mr Kreft spoke out after it was revealed two homes in the Bridgend area were closing.

HC-One, which owns Abergarw Manor in Brynmenyn and Southmead Grange in South Cornelly, blamed “a national shortage of nursing staff” for the “very difficult decision”.

The closures are symptomatic of the problems affecting care homes across Wales.

Mr Kreft said: “We know  there are major issues affecting the care sector in Wales, particularly in care homes registered for nursing.

“The owners of the two homes in Bridgend have been quite clear that for them the overriding issue was the lack of nurses, the inability to recruit enough nurses of the right calibre.

“That is something that is reflected across Wales It should be recognised that the commissioning arrangements make it very difficult to attract people to work in the sector.

“In Wales we don’t commission for quality  it’s more about price  and we then work backwards from the fee that we’re given by local authorities and local health boards.

“The problems are further compounded because we don’t regulate against the service that is being commissioned so we are regulating for a service that in many ways would be an ideal service with unlimited resources.

“Another important fact is  that the NHS is refusing to pay for 24/7 nursing presence in nursing homes yet the Welsh Government regulations insist on this.

“There are a total of over 20,000 beds in the independent social care sector in Wales and of those 11,500 beds, are for people who need nursing care – and these beds are underpinning the ability of the NHS to function.

“There are simply not enough new homes being built to replace the ones that are being lost and this will affect communities across Wales.

“If  we don’t sort this relatively quickly the closures are going to accelerate much more quickly than new investment is coming in – all at a time of soaring demand in an ageing society and when the NHS is also bursting at the seams.

“If we don’t bring more nurses into the independent sector then we’re going to find that the closures which will inevitably come about will mean that more people will have to reside or find their services in a hospital bed.

“If you’re  assessed as needing nursing care in a care home registered for nursing, the only feasible alternative if that home is to close is that either that you go to a similar establishment or a hospital bed.

“That means we are sleepwalking into a perfect storm of rising need, dwindling resources and a recruitment crisis unless urgent action is taken.

“Care Forum Wales has been very clear that three aspects are working against the independent sector, and therefore undermining the NHS.

“One is the huge massively significant growth of the need, you know the growth of the people needing services.

“At the same time we have this very real reduction in resources, which we all understand, and we also have major workforce issues.

“In this case we are talking about a shortage of qualified nurses but they are supported by social care workers.

“What we are picking up from our members and others is a level of morale and motivation that is probably the lowest that it has been in 30 years.

“We urgently need a whole sector solution, we need more nurses in Wales both in the NHS and in the independent sector.

“Our strategy should be interlinked so that we can work in partnership with our colleagues in health boards, with Welsh Government, to ensure that we’re attracting the right people into social care.

“The commissioning process has to reflect the people that we need to employ and retain.

more nursing homes and it is a fact of life that looking after people in hospital is a lot more expensive that providing care in a nursing home which stops unnecessary routine admissions to hospital.

“Hospitals are already full to overflowing with older people who do not need to be there. If this trend continues how many people will not be able to get the important NHS care because beds are not available for them?

“The independent sector should be better supported to do a great deal more and could be a positive solution to some of these capacity problems in Wales.

“We could be doing a lot more high intensity work, and some more specialist services could be developed which are more akin to community hospitals. We already have the assets in place.

“There are several hundred registered settings  with legally qualified regulated people providing services. Why aren’t we building on those valuable community services at this time of need?

“If we work together there are huge savings to be made while at the time providing more appropriate care.

“But if we’re not going to get the quality of commissioning that recognises the quality of staff that we need – both qualified nurses and qualified social care workers – we will be sleepwalking into a disaster.”          

 

 

 

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