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Numbers or Skill Mix?
The verdict of the final report of the five year Prevention of Abuse and Neglect in the Institutional Care of Older Adults study (PANICOA) is that 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.
NICE has issued guidance on safe staffing levels in NHS settings following the Francis Report, yet no equivalent focus has been placed on social care provision. The Essential Standards rather cryptically use terms such as ‘sufficient staffing levels’ and ‘the right competencies’ without really defining what these might be. A subjective audit if ever there was one.
What are regulators doing about it?
Back in September 2013, the CQC recommended a thematic probe on adult social care staffing. They had noted evidence that suggested poor care in specialist services for high dependency groups, such as those with dementia, severe learning disability or challenging behaviours and needed to collect more information on these services. Their plan is not to propose safe staffing levels, however; they are examining whether staffing levels contribute to poor care.
So what are the indicators that staffing levels are contributing to reduced care quality? Is it just a case of too few pairs of hands?
Cut the spend but preserve the numbers
In situations where funding is tight, home owners may well look at reducing their most expensive cost to save money. Typically, people account for around 45 to 60% of the operating costs of a care home . One way to reduce staff costs without affecting the numbers on duty is to reduce the skilled to unskilled ratio. This replaces qualified staff with basic, entry level care workers which could jeopardise the development of care skills and stifle workplace learning. This is not to suggest that only qualified people make good carers, rather to say that good carers need good role models and a strong evidence base for their activity, which comes from learning and experience.
You can probably do the math; for every costly qualified practitioner (and factor in their CPD, study leave and additional holiday allowances) you can substitute one and a half lower-paid unskilled workers. Examining our interview candidates of late suggests a growing number of these do not have English as a first language and their only experience of caring is for a child or family member. Nothing wrong with that, until faced with a challenging young adult who cannot make staff understand them. The outcome of compromising staff skill mix is written in recent history; until CQC define standard skill levels we must be sure that we take steps not to risk it.