Nursing Opinion

A new era for nursing in social care

Dr. Dawne Garrett,
Professional Lead Older People and Dementia Care, Royal College of Nursing

As a nurse who works clinically in care homes, the experience Covid exposed so much that was difficult in social care. The available resources, access to training, communication structures across wider health care, difficulties in environments of care and staff not being empowered to make ethical and clinical decisions.

It also exposed the inspiring essential care that colleagues provide every day with their person- centred creative actions. For a while social care, and particularly care home staff, were at the forefront of people’s minds. The dedication and expertise demonstrated by staff was evident and respected, shopping queues parted, celebrities became engaged, and Matt Handcock mentioned social care whenever his green badge was on display. In communities throughout the UK a new and grateful respect was demonstrated.

As we start to emerge from this pandemic we must ensure that this interest and consideration remains firmly in place. Our messages about safe staffing , adequate pay terms and conditions and the importance of social care should be consistent and inclusive. The sector needs to share clear messages with one voice, encouraging ambassadors to engage and explain the value of care provided to the wider community.

Clinically, I would suggest, there must be a place for care home staff to transcend organisational boundaries to regularly share their great practice, engage in research and raise their profile still further.  The advantages gained through increased use of technology have allowed us all to communicate more widely and the opportunities of clinical supervision, expert debriefing and virtual training should be maintained and capitalised upon.

Importantly and essentially, we should have transparent mechanism for setting safe and effective staffing levels, using validated acuity tools, without this bedrock of stability we cannot launch to other things.  The Royal College of Nursing has set out some key principles in its nursing workforce standards[i] which cover all settings and all UK countries. We have seen recruitment to nursing courses increase, the appointment of a Chief Nurse for adult social care and a burgeoning of research in care home practice. There is interest and there is skill, we now need to ensure the enablers and structure are fully in place to maximise our potential, which includes recruitment and retention, career structures and greater intelligence about our activities.  There have been some superb recruitment initiatives throughout the country, providing enhanced placement for nursing students notably those in Yorkshire and the Northeast. The development of an embedded clinical academic career structure to support progression through roles would enhance this further providing the mentors and clinical leaders who can support education and provide role models for the future.

The new configurations of commissioners call for further and consistent engagement. It is not acceptable that models of care are parachuted onto care homes, they should rise from those who deliver care daily. In order to do this care home staff need the space and infrastructure to develop services. Co-production initiatives with commissioners should be garnered and supported by care organisations in order to improve outcomes for residents.

At present we are without an accepted set of validated outcome measures, we are without the ability to readily segment the costs of clinical care and our workforce data is variable, for our good practice to flourish we need all this.  I am a Florence Nightingale Scholar and end with her words  “Were there none who were discontented with what they have, the world would never reach anything better.”



Dr Dawne Garrett


Professional lead older people and dementia care

Royal College of Nursing





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