Here’s a story that’s close to my heart. Having been a Registered Manager for several years, managed the work of a group of Registered Managers as Responsible Individual, and having gained the qualification as a Registered Manager (RMA NVQ4) I feel my opinion comes from a well informed stand point.
I often say to clients that the Registered Manager accounts for 90-95% of the quality of a home. So it is important to-
1-Make sure the home or service has one.
2-Check on their qualifications and experience.
3-Find out how long they have worked in the home or service.
It’s good to see the issue being debated nationally, the headline story being that a proportion of services providing care do not have a manager registered with CQC.
This despite recent efforts by CQC to improve this figure.
Here is what the piece in the Telegraph of 10th October has to say-
More than 2,000 care homes looking after elderly or disabled adults have no registered manager, according to figures to be published this week.
The results mean that 12 per cent of all care homes in England lack the leadership required to ensure that vulnerable people, including frail pensioners with dementia, are cared for properly, according to a study to be presented at the Liberal Democrat conference on Tuesday.
Paul Burstow, the Lib Dem MP and former health minister who obtained the figures, said the figures showed that “a revolution” in care homes was needed.
There are a number of factors underlying these figures and I would like to unpick them here.
The main one in my experience being turnover of managers. The position has changed over the last decade or so, and the focus of the job is diluted by the various stakeholders that the registered Manager finds themselves pulled between. A clear example is the needs of owners to run a profitable business weighed against the needs for care. On the surface one would expect owners to be in care business out of altruistic motives, indeed this was more the case in the past. However more and more the ‘owners’ are venture capital companies more interested in the bottom line. Care decisions are overidden by financial constraints. This leads to the high turnover of registered Managers in the sector, the majority of whom come from a caring background as opposed to a business background.
Lack of support for registered managers is another factor that influences the lack of candidates for the sector. The old saw ‘it’s lonely at the top’ is never more true than it is now for the Registered Manager. As well as the pressures from divergent stakeholders as outlined above, there is the lack of peer support due to the business model of care provision. How can one go to another registered Manager locally for support when they are in fact business rivals? The same is true of the sharing of good practice in care throughout the sector.
Finally where do these managers come from? The skill set required to be successful in these posts is quite unique. A mix of care professional, business manager, HR professional, diplomat, carer supporter, pharmacist, CQC inspector-I could go on! There is a case for the industry taking along hard look at where it recruits from, what skills and knowledge it’s looking for and how these are developed and accredited. Yes I know Skills for Care do a good job of this, but they do it from outside the industry with one foot in the political camp of the current government regulators. Does anyone tell Costa where to get their manager from and what qualifications they must have? No the market decides that, however in the market of care, the qualities needed to manage aren’t clear.