We must integrate health and social care: Registration of care staff is a step on that road

7th May 2021 about a 7 minute read

Irene Gray is a Future Care Capital trustee and non-executive director of Forest Healthcare. She also runs and manages her own business as Executive Coach to staff in both the NHS and Social Care.

Here she reflects on how care homes have dealt with a hugely challenging year and she looks back on a nursing career dedicated to elderly care

"If it takes establishing a regulation system for staff who are not registered nurses, then let’s take steps to introduce it. Let’s imagine together and create an integrated health and social care system"

The roller coaster journey that the care home sector has been on over the past 12 months has raised many questions and highlighted many challenges – not simply for the social care sector itself, but by exposing the disconnect between health and social care and the differing views held.

The numerous policies generated on simple visiting arrangements have now culminated in a relaxation in rules which I know is welcomed by the sector, not least by the residents, the families and their loved ones.

There has been much discussion about the human rights of those living in care homes and how the rights of the most vulnerable have been, or may have been, breached. Whilst many restrictions also applied to those in hospital care, there was little thought given in either setting when it came to the psychological impact of those restrictions.

Individuals and families denied visits have felt bereft and there were heart-rending tales of those denied the opportunity to spend final hours at the end of life with a loved one.

We have all worked through unprecedented times with only the interpretation of the science of an unseen predator to direct us in our actions. I hope we will all look back and learn and not simply leave that process to review bodies. There is indeed much to learn!

As I reflect on this difficult period there are several memories that remain with me, not least the constant changing of policies and guidelines. It was back in March 2020 when the Prime Minister delivered a statement on coronavirus above the strapline ‘Protect the NHS’.

It was many weeks later that there was a first reference to the care home sector, and only then because of the rising number of deaths being recorded.

This was rapidly followed on or around June 8th with an announcement that the NHS would provide social care with infection control training, a clear and grossly misguided assumption that the sector didn’t have the infection control skills already in place.

This was followed by comments that social care staff were untrained. This false view was broadcast at a national level and generated unnecessary anxiety for families and those who were living in care homes.

It was a monumental insult to hard-working staff who had received significant training to provide care. It also failed to recognise that many of those staff are registered nurses. This mindset is sadly reflective of my personal experiences of specialising in the care of the older person and it was one of the drivers for me to become involved with Future Care Capital (FCC) over four years ago.

The vision of our Chairman, Andrew Whelan, who I had previously met during my executive role in the care home sector, resonated so very strongly with the beliefs and passions that I held then, and still hold today.

I believe that FCC has the ability to influence the changes so urgently needed to improve the care of those who are most vulnerable in our society. Whilst I have been involved in many charities in the past, and sat on numerous charity boards as a Trustee, I see FCC acting as a catalyst for change across health and social care. It is an organisation that has far-reaching potential.

I began my career 49 years ago, training as a Registered General Nurse at Withington Hospital in South Manchester. The curriculum involved selecting specialities where we would work for three months. Like many of my colleagues, I avoided the care of the elderly module and plumped for the psychiatric module.

Indeed, a recent research article published in Nursing Management identified that only a minority of undergraduate students would consider a career working with older people and most, actively avoided it. So, 49 years on, nothing has changed!

My desire was to work in either A&E or ITU post-qualification. I registered for ITU training and had a two month wait before I started. The hospital was short of staff in the ‘Geriatric’ unit and so I volunteered to work there to fill in a gap in my development.

I ended up staying in the unit for 11 years. I witnessed first-hand the challenges and the opportunities, the passions of both the nursing and medical staff who were so deeply committed to improving the lives of their patients.

I look back on my time in this unit with warmth. But I recall a dear friend and colleague asking me ‘wouldn’t you rather be a ‘proper’ nurse’. I fear that this remains the view of many today, both in and outside of the profession.

This ‘Geriatric Unit’ had 320 beds, which is bigger than some small district hospitals today. It included three acute wards, six rehabilitation wards and six long-stay wards. Care homes were only just beginning to appear in the system and so sadly those who needed long term care remained in hospital.

Twelve of the wards were across the road from the main hospital with no access to basic resus equipment and no system for accessing a medical resus team. My colleagues and I fought this and succeeded in getting the system changed. I have been a passionate campaigner for improved elderly care ever since.

It remains frustrating in the extreme that this fight has to continue at the risk of those who we care for. The pandemic has demonstrated significant misunderstanding of the sector and what it can achieve.

At the outset of the pandemic the transfer of elderly patients back to, or into, the care home environment without testing cost many lives. How many lives we will never know.

Age discrimination permeates society today, and this is translated into discrimination in the care system. Having spent one of the most enjoyable 18 months of my later career as Director of Care (after 28 years as an executive in the NHS) I was horrified to be treated with contempt by junior local authority staff who assumed I and my colleagues knew nothing.

It was during this time in 2010/11 and with my significant breadth of experience that I recognised an opportunity to build closer relationships with the NHS to expedite discharge from hospital. This would then release pressure on beds and move vulnerable people to a more relevant environment for their recovery before returning home.

I subsequently designed four pathways of care and set about talking to NHS colleagues about my ideas. Sadly they were rejected and there seemed to be a complete inability to see the opportunity that existed.

Care homes are now recovering from the distressing events of the last year and deaths are now minimal, if not zero. The transmission of infection in care homes is now minimal, though we are aware from publications that nosocomial transmission in the hospital environment remains a challenge.

As we move forward it is important to recognise that both health and social care working together creates a force to be reckoned with. We must rid ourselves of the attitude of  ‘NHS good, private bad’ and acknowledge that the care home sector developed to fill a void in the system, not to create a two-tier system.

The NHS and Social Care system must be integrated. Social care has been promised a national review at Government level for years but it always ends up in the “too difficult” box. Nobody has been bold enough to address it.

This is something that Future Care Capital is trying to change. Imagine if there was truly a national IT system that bridged health and social care so information could be shared – then and only then will we be on the road to improving things.

Further, if it takes establishing a regulation system for staff who are not registered nurses, then let’s take steps to introduce it. Let’s imagine together and create an integrated health and social care system, without barriers and without prejudice. One day, each and every one of us will be grateful for it.

As someone who has had both personal and professional experience of the care home system I will continue to press for change. Working with FCC is the strongest opportunity for achieving change that I have been presented with thus far in my professional career.



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