When most people think about nurses, it's usually hospitals that spring to mind. Occasionally some people might identify with their local GP practice nurse or district nurse, but suffice to say that nursing is very much seen within the confines of the NHS. Yet what about social care?
Nurses are vital in social care, most notably within care homes. Good nursing in care homes helps people to live well, thrive and avoid hospital admission when episodes of ill-health occur. The alternative is falling into a downward spiral of increasing ill-health, yo-yoing between hospital and care home, and potentially dying a very undignified death where a person's needs at the end of their life are neither understood nor met.
Despite the vital nature of the role nurses play in social care settings, attracting nurses into this area of practice has become so difficult that the majority of social care providers I speak to have long-standing vacancies that they are desperate to fill and can't. A combination of the lucrative packages offered by agencies, and the attractiveness associated with some areas of hospital nursing (like paediatrics, theatre and intensive care) are luring nurses away from becoming employees of social care providers.
I am in no way blaming nurses for this. Nurses train hard to earn their right to practice, and are entitled to work within whatever specialty they feel most suited to, but for social care this chronic shortage is a disaster. It's also bad news for the NHS, because without experienced nurses in care homes more people will be admitted to hospital with illnesses and conditions that could otherwise have been treated in the community if the right care and support had been available.
Solving this issue isn't necessarily about trying to persuade nurses currently working in other specialties to become employees of social care providers, that has already been tried, as has recruiting overseas, which many social care providers have been doing for years in a bid to combat the shortfall. Instead we need a far more forward-thinking strategy.
When nursing students enter their training, we need to show them the value and importance of nursing in social care and the immense contribution it enables a nurse to make in their local community. We also need to create a robust pathway for people currently working in social care who aren't qualified nurses to undertake training that will enable them to achieve a nursing qualification if they wish to.
Numerous care workers have the potential to be excellent nurses and yet many, like this young care worker who contacted me, feel disillusioned with their work and are desperate to develop their career rather than watching it stagnate:
"I'm aware of the dire circumstances social care is in, and because I struggle daily in my workplace with them, I feel almost completely uninspired to remain in the sector. Couple this with the lure of better pay in nearly any other job you or I could mention, why should I?"
That last point really gets to the heart of one of the major issues in social care; pay and conditions. The numbers of nurses and care workers who have left salaried jobs to work for agencies clearly points to the fact that we need to value staff, at all levels, far more than we do now if the recruitment and retention crisis dogging social care is to be alleviated.
From the particular perspective of recruiting care workers the recent Living Wage announcement from the Chancellor is very welcome, but without greater funding for social care, and specifically at the point that local councils commission social care services, implementing a Living Wage in this sector would be impossible for the vast majority of care providers.
Meanwhile, social care still has an image issue which areas of hospital medicine don't, and that urgently needs to change. It is beholden upon social care to promote the positives, and highlight the many examples of social care employees who love their work and would never consider working anywhere else, something that agencies like Skills for Care and the Social Care Institute for Excellence do constantly, but we need even more action.
As the young care worker I quoted above said to me:
"I try to remain informed, competent and passionate towards what I do while trying to improve and progress."
Which really sums up the feelings of many people in social care. We need to attract talented individuals into this sector, develop and value them. In a compassionate society, social care cannot continue to play second fiddle to healthcare - both systems (and ideally as an integrated whole) require sufficient numbers of educated and committed employees to deliver the care and support our most vulnerable citizens need.