upskilling nursing and care staff and delivering high ... · analyse using restore2 (recognise...
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Upskilling nursing and care staff and
delivering high quality care
Context
➢ The market is about to shift, with changes to GP
contracts and fewer district nurses and staff available
➢How do we meet the increasing needs of a deteriorating
client group with a diminishing workforce?
CQC State of Care Report 15/10/19
➢ “Our inspectors are seeing too many mental health and
learning disability services with people who lack the
skills, training, experience or clinical support to care for
patients with complex needs”
➢ “Increased demand on services has prompted the
development of new roles and an emphasis on upskilling
existing staff”
➢ “The introduction of the nursing associate role has the
potential to create development opportunities for staff
both in adult social care and health care”
Clients
➢ Care is becoming ever more challenging….
➢Nearly half a million adults, mostly older people, live in
care homes, many with long term, fluctuating
conditions, often with multiple impairments and co-
morbidities affecting their health, intellectual capacity
and psychological well being
➢ The average age of clients is 85 with a life expectancy of
between 12 and 30 months
➢ Care homes are seeing more fast track admissions,
where often the prognosis is under 14 days
The workforce (adult social care)
➢ The number of people working in adult social care was
estimated in 2018 as 1.49 million
➢ The sector is one that is growing by around 1.2% (19,000
jobs) between 2017 and 2018 and overall 22% increase
between 2009 and 2018
➢ Registered nurses were one of the only jobs to see a
significant decrease (down 10,500 or 20% since 2012)
Adult social care jobs
Staffing
➢ The estimated turnover rate of directly employed staff was 30.8%, equivalent to approximately 440,000 leavers over the year
➢ It is estimated that 7.8% of the roles in adult social care are vacant, equal to approx. 122,000 vacancies at any time
➢ Registered Manager vacancies (11.8%) equivalent to around 2,300 at any given point
➢One fifth of registered managers left their role, in the last 12 months (22.0%), which equates to around 4900 leavers in 12 months
➢ 10,000 registered managers are due to retire in the next 10 years
Multi-disciplinary team
➢GP’s are being stretched even further
➢ The NHS in England has 2,500 fewer FTE GPs than it
needs this year (2019), and a projected gap of 7,000 FTE
GPs within five years if current trends hold
➢ The Kings Fund report states:
➢ “shortages of this scale represent a fundamental threat to the
sustainability of primary care”
➢ “the only way forward is to make substantial progress towards
a new model of general practice with an expanded multi-
disciplinary team drawing on the skills of other health care
professionals”
Multi-disciplinary team
➢District Nurses, do not fair much better..
➢A report in May 2019 (RCN & Queens Nursing Institute)
shows the number of District Nurses working in the NHS
has dropped by almost 43 percent in England in the last
10 years
➢As a result, there are only some 4,000 District Nurses
providing care for a population of around 55.8 million in
England, a ratio of only one District Nurse for every
14,000 people
Projections
➢ The 65+ model shows:
➢ For every 7 people aged 65 and over, I adult social care job is
required
➢Based on projected number of people in the population, by
2035 this will increase by 36% (580,000 new jobs)
➢ The 75+ model shows:
➢ For every 3 people aged 75 and over, 1 adult social care job is
required
➢Based on projected number of people in the population, by
2035 this will increase by 50% (800,000 new jobs)
In summary, we have…
➢A client group who have far more complex needs
➢Approximately 122,000 social care vacancies
➢ 10,500 less Registered Nurses
➢ 2,300 Registered Manager vacancies
➢ 2,500 fewer GP’s
➢ 43% decrease in District Nurses
➢Decrease in funding for clients
➢AND…..
➢Higher standards from CQC that we are required to meet
Good or Outstanding
➢How do we achieve either Good or Outstanding care
when we have the dilemmas that we are faced with?
➢ Currently nationally only 3.7% of care homes are rated
as Outstanding , Berkshire has 6.7%
➢ In the last months CQC inspections:
➢34 services were rated as outstanding
➢641 rated as good
➢311 requires improvement
➢82 inadequate
GP services
➢ SCIE research shows that how GP’s and care home staff
work together is essential for clients to receive more
timely care
➢ The health and well being of the older people in care
homes depends on them accessing primary care services
➢ Lack of interest and commitment by some GP’s to older
peoples healthcare, high workloads and an assumption
that resident's in care homes are at lower risk are
among some of the reasons that clients are unable to
access GP services (SCIE)
GP services
➢ There is huge variation in the level of support that care
homes receive from GP’s
➢ Care home in wealthier areas can often pay for better
primary care
Poor Excellent
➢ Care services will often have the Acute Visiting Services /
Advanced Nurse Practitioner / Paramedic (employed by
the surgery) as opposed to the GP for telephone reviews
or visits
Where do we begin
➢ Staff➢ Recruitment➢ Care Quality Matters state in November 2019 edition,
“Invest in your staff by employing only those who will fit into your organisation”
➢ Establish your values, and ensure that the whole team know and recruit using a values based approach
➢Do NOT take staff to fill the numbers, (it is a short term fix), we can teach the skills but not the values
➢An outstanding service will be selective➢ Consider what you can offer staff (short and long term)➢How can staff be involved in recruitment
Care Friends – An app to gamify employee referrals in care
16
If you look after your
staff, they will look
after your customers.
There is no magic formula for
a great company culture.
The key is just to treat your
staff how you would like to be
treated.
Induction and on-going support
Effective induction
The right training
for the role
Ensuring staff feel valued and appreciated
Supervisions / appraisals
Mentor / buddy system
Skills for Care – Mandatory Training
Annual
➢ Fire Safety
➢ Medication management
➢ Assisting and moving people
➢ Moving and handling objects
➢ Positive behavior support
➢ Safeguarding
3 Yearly
➢ Communication
➢ Dignity
➢ Equality and Diversity
➢ Basic Life Support
➢ Nutrition and Hydration
➢ Food Hygiene
➢ Health and Safety
➢ Infection Control
➢ MCA & DoLS (LPS)
➢ Person centred care
➢ Reporting and Recording
Is that sufficient?
Career progression
Become champions or
leads
Qualifications
Level 2/ 3 certificates
Qualifications
Diplomas / apprenticeships
In H&SC
Job role progression
Management training
Healthcare assistant
practitioner
Nursing associate
Support through Registered
Nurse training
Buddy’s / mentors for
new staff
Upskilling within current role
e.g. observations
Registered Nurses
Competency Assessments
➢ Traditionally this has included medication and clinical
procedures e.g. catheterisation, venepuncture etc
➢ Following a study by Stanyon in 2017, this concluded we
should be looking at 22 competencies, which extends
beyond task orientated aspects of care, e.g. drug
administration
➢ This actually provides an opportunity to revisit the role
of nurses within the care home setting
Clients needs are more complex
Meeting their
needs
1. Detailed
Pre-admission assessment
2. Declining admission if
unable to meet needs
3. Permanent staff
(Trained and competent)
4. In line with the service values
5. In line with National
Frameworks and guidelines
6. With care and
compassion
National Frameworks and Guidelines
➢NICE Guidelines
➢ CQC Guidelines
➢ 4AT Test
➢ Frailty scores
➢NHS England framework for Enhanced Health in Care
Homes ( 7 elements, first 4 being rolled out over the next
couple of years)
➢ RESTORE2 / NEWS 2
Enhanced Health in Care Homes
Care Element Sub Element
Enhanced primary care support
Access to named GP and wider primary care service
Medicines reviews
Hydration and nutrition support
Access to out of hours / urgent care when needed
MDT support Expert advice and care for those with complex needs
Helping professionals, carers and individuals navigate the health and care system
Focus on rehabilitation and re-ablement
Rehabilitation/ re-ablement services
Developing community assets to support independence
High quality end of life care and dementia care
End of life care
Dementia care
Deteriorating client
➢We are also seeing more individuals who are acutely
unwell
➢How do we recognise and manage deteriorating clients
➢ Staff who know the clients and can see when there are changes
➢ Staff who are able to undertake observations
➢ Staff who can interpret the meaning and significance of the
observations
➢ Staff who can support the client whilst waiting for the
emergency services and hand over succinctly
➢ Record on the NEWS2 assessment
Deteriorating Clients
➢ Analyse using RESTORE2 (Recognise Early Soft Signs, Take
Observation, Respond Escalate)
➢ This includes the NEWS2 assessment and promotes a
standardised response to the assessment and management of
unwell clients
➢ Escalate using the SBARD Escalation Tool and Action Tracker
(Situation, Background, Assessment, Recommendation and
Decision)
Watch for a combination of these symptoms and if you are concerned dial 999
250,000 people in the UK are affected by Sepsis each year, of which 52,000 die. We therefore need to ensure that all staff recognise the
signs and take appropriate action
Remember….. whilst we are facing challenging times, we need to look after and support our staff
For further information
➢Contact:
➢Tel: 07889 843352
➢Email: [email protected]
➢www.solicitudetraining.co.uk