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Residential care in Kent-the challenges of mental health provision

Ever increasing expectations characterising success through the implementation of KLOEs within CQC inspection, means that residential care managers are under increasingly significant psychological pressures.

The value of a committed, well-informed and hard-working manager cannot be underestimated. Facing the prospect of ever increasing challenge as the threshold of difficulty for admission to residential care continually rises, managers are now finding that referrals are often clients who might a decade or more ago have been on long-stay mental health ward.

And, with regard to mental health referrals especially, managers will often find that balancing the books is very challenging. 

Why is this? Well, in contrast to residential care for older and more frail citizens who require lots of ‘hands on’ personal care, the psychosocial support for persons with severe mental illness means that combining too many service users in a shared environment may make an individual’s condition even worse. So, this effectively delimits economies of scale - people with severe and regularly relapsing conditions can, very quickly, be badly impacted by the mental deterioration of individuals in close proximity. 

Additionally, of course, caring for people with such florid conditions does tax the emotional resources of even the most committed residential care worker. And when wage levels are inevitably compressed by the budgetary pressures and industry standard then good leadership and a sense of vocation will have to mean something, otherwise care workers would opt to work in much less psychologically challenging environments.

And then the challenge is even greater when other arms of support from community mental health teams, the out of hours crisis team or the police is so frequently unavailable to managers and staff. Beset with budgetary and staffing problems themselves and faced with ever increasing demands upon their own resources these partners responsible for ensuring that managers and care home staff are properly supported is too often very badly lacking. Professionals working in residential care homes with frequent level of psychiatric relapse do often feel very lonely.

Leadership can have a serious positive impact, however, as such pressing circumstances will often bring talent to the fore.

Recent CQC reporting on improvement in ‘failing’ homes notes that the ‘value of a good leader was found to be a key with a new manager being introduced to deliver improvements in most of the homes. The stability of leadership was also shown to be important with having enough staff to deliver safe services also crucial.

“While establishing a more stable staff foundation was important, tightening recruitment processes helped make sure that new staff coming in were suitable, and improved induction policies led to staff being better prepared,” the report said.’

There was a lack of training and staff appraisals at poor performing providers with improvements in these areas paying dividends.

Andrea Sutcliffe remarks upon the impact a strong manager can have on a poor service stating: “Key lessons we have seen from the case studies include understanding and accepting that problems exist; creating a clear vision to improve and putting that into action; appointing strong leaders who can establish an open and transparent culture where improvement can truly thrive; and focusing on developing a workforce that is valued, well trained and supported to deliver safe, effective person-centred care’’.

“But we’re not saying that improvement is easy. Pressure on resources, increasing demands and workforce shortages mean these are challenging times for adult social care. Providers and their staff have a responsibility to deliver good care – but commissioners, funders and national bodies and the health and care system as a whole has a responsibility to work together to help create the environment that makes this possible’’. (1)

So, residential providers, social care commissioners service users, their families and even the Inspectorate itself, should openly acknowledge the very great skill and effort which goes into producing good or outstanding outcome with these ever increasing challenges. And stakeholders such as community mental health teams and out of hours crisis team management should seriously consider the jeopardy regularly encountered by clients with seriously fluctuation mental wellbeing and the residential care teams left often to carry the burden of supporting alone; this should all be a shared responsibility - ‘don’t duck it’, is the message!

Let us not take for granted managers who lead when others stay well behind the frontline.

1. Driving improvement: Case studies from nine adult social care services CQC 2018.

Thomas Jeffs | Director

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