We must commission for quality to avoid ‘sleepwalking into disaster’
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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 Care Forum Wales chairman Mario Kreft.
One of the major causes of the problem, says Mr Kreft, is the flawed way in which social care is commissioned.
“The commissioning process should be about quality and securing value for money and not about paying the lowest possible price,” said Mr Kreft, speaking after it was announced that 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”.
Mr Kreft said the closures were symptomatic of the problems affecting care homes across Wales.
“We know there are major issues affecting the care sector in Wales, particularly in care homes registered for nursing,” he said. “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 more than 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 underpin 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.”
Mr Kreft said Care Forum Wales had been very clear that three aspects were working against the independent sector, and therefore undermining the NHS.
“One is the huge massively significant growth of the need, the growth of the people needing services,” he said. “At the same time we have this very real reduction in resources, which we all understand, and we also have major workforce issues.
“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.”