Clinical Updates
Low pay and zero hours contracts see a third of nurses quit social care roles
There are over 110,000 vacancies throughout the adult social care sector.
Social care spending in England has fallen further behind other UK countries.
A new analysis from the Health Foundation shows estimates a social care funding gap of £4.4bn in England by 2023.
In the absence of an additional funding commitment, the money available for adult social care will rise at an annual average rate of 1.4% a year. This is much lower than the 3.4% a year the government has committed to the NHS and crucially, far below rising demand of 3.6% a year, with increasing numbers of elderly and younger adults needing help with day to day activities such as washing, eating and dressing.
In 2010/11, England spent an average of £345 per person compared to £457 in Scotland (32% more) and £445 Wales (29% more).
‘110,000 vacancies’.
The Health Foundation also points to poor pay and conditions in social care as a major threat to the quality of care and future sustainability of the sector.
Staff turnover has been increasing since 2012/13 and there are over 110,000 vacancies in adult social care. Over 40,000 nurses work in adult social care but almost a third are estimated to have left their role within the past 12 months.
After years of capped pay, NHS salaries are now increasing but social care wages are low and below equivalent salaries in the NHS.
Earlier this month, AgeUK warned that many parts of the country have become ‘care deserts’, where older people are unable to access residential or home care, regardless of whether they can pay for it or not.
‘Two-thirds of staff at the minimum wage’.
Anita Charlesworth, Director of Economics and Research at the Health Foundation said: “Adult social care is one of the victims of the current political impasse but is in urgent need of funding and reform.
“Pressures on the service continue to grow at a much faster rate than funding. More people need care but we also need to ensure that care is high quality. Staffing is a key determinant of both quality and cost. With around two-thirds of staff at the minimum wage and a quarter on zero hours contracts, it is perhaps unsurprising that adult social care providers are struggling to attract and retain workers.
“Planned changes to make international recruitment more difficult also present a major challenge to a sector that is highly reliant on staff recruited from overseas. Rising demand and competition for the same pool of workers from other sectors, including the NHS, will compound these problems.
“Tackling the challenge of social care reform will require decisive political action and an appropriate funding settlement. Successive governments have ducked the challenge and the tragedy is that vulnerable people and their families are suffering as a result. If reform remains unaddressed, social care’s inadequacies will continue to undermine the NHS and people in need of care will continue to fall through the cracks.’
Clinical Care
Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study
Hourly rounding places an emphasis on ‘tick box’ care.
Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.
A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.
The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.
Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.
The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.
The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.
Hourly rounding places an emphasis on ‘tick box’ care.
The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.
The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.
The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.
Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.
“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”
Clinical Updates
Nurses’ ‘worry’ better than most early warning scores, finds study
Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’.
A sense of worry can provide important information for the detection of acute physiological deterioration.
Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.
The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.
Nurses were asked to grade each patient between “no concern” and “extreme concern”.
Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.
The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.
The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.
They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.
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