It is important that we recognise the significant staffing crisis in social care at the moment, which will no doubt be compounded by Brexit when—if—it happens. It says in paragraph 80 of the financial memorandum to the bill:
“this legislation is not intended to address”
the wider recruitment challenges. That does not mean that those are not important but, as Phillip Gillespie said, work is going on elsewhere in relation to the national health and social care workforce plan that seeks to address some of those challenges or mitigate the risks.
For us, the bill will potentially identify the challenge. It will potentially identify a shortage in some areas of the workforce. It might not do that, however. It might identify that there are more effective ways of using the staff that we have at the moment to work to grade or at a different level and deliver good care through different configurations and arrangements.
The committee might be interested in work that we did a couple of years ago with 40 care providers in Scotland, which were struggling to recruit nurses. They were overreliant on agency nurses, which was costing a significant amount of money and not providing good continuity of care. We worked with 40 care homes that were looking to reconfigure their staffing approach by reducing nursing, bringing in peripatetic nursing and nursing assistants, upskilling senior carers, reconfiguring how they provided nursing overnight and examining how community nurses could inreach. That might not necessarily be provided by the care homes themselves. We worked with the care homes and tried to enable innovation, recognising that safety and good quality of care must be maintained. They were able to reconfigure. We required them to have arrangements in place to discuss their proposals with the local commissioners, as well as quality indicators and measures to determine whether or not they were effective.
A year later, we went back to inspect those 40 care homes. The grades of four of them were lower after we inspected, nine of them had improved and 27 remained the same. Four out of any 40 care services’ grades would change over the course of a year—they would deteriorate. However, the care providers were able to look differently at how they configured their existing staff, to be innovative, to bring forward solutions, to engage with partners and to develop an approach that recognised the importance of nursing but acknowledged how scarce that resource was, such that the resource was used only on tasks that needed to be done by a nurse.
Only 40 care homes sought to do that with us. We would like to create the conditions in which all care homes can have a tool that allows them to do that in a more consistent way and deliver outputs relating to the numbers they need, as well as outcomes for ensuring that people are getting good care.