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What keeps me awake at night…Karen Johnson, Clinical Director, HC-One

Karen Johnson, Clinical Director and Chief Nurse, HC-One

Karen Johnson is Clinical Director and Chief Nurse at HC-One and has spent 25 years working in the care sector. As UK’s leading care provider, HC-One run more than 300 homes across the country, specialising in nursing, dementia and residential care. HC-One is ‘The Kind Care Company’ and has continued to grow and flourish since its inception almost ten years ago.

There is no dearth of challenges for any of the professionals in the care sector to focus on or worry about. From the national funding challenges to a global nursing shortage, and from attracting staff with the right attitude to supporting those already in the sector, there is a range of issues to consider. But it is important to remember that, as the saying goes, necessity is the mother of invention – these challenges give us the opportunity for improvement and innovation in the system.

The World Health Organization (WHO) has designated 2020 as the “Year of the Nurse and Midwife” which presents a great opportunity for the Government to address the concerns in the sector and prioritise investment in the social care nursing workforce. Far too often, as seen in the General Election, politicians talk about Nurses purely in terms of the NHS’s requirements, forgetting that social care has its own growing demands.

But providers can do more as well. We’ve worked with our Nursing teams to understand how they want to be supported to thrive in their role. As a result, we’re introducing eCare and eMeds to all our homes, with both platforms designed by our Nursing colleagues. The result will be less paperwork and more time to spend with Residents and complete nursing tasks. HC-One was also a leader in the development of the Nursing Assistant role, which both supported Nurses and created a career path for Senior Carers. Even without the Government’s attention, there is a lot the sector can do itself to support Nurses in our homes.

However, we must be mindful of changes that are out of our control. When I joined the sector, the role of the Nurse in social care was much different to what we have today. The first care home I worked in did not have a hoist, because none of its Residents’ needs were severe enough to require one. Now, with rising acuity, people are moving into homes with more complex conditions, meaning the level of care that would once have been seen on a long stay ward in a hospital is now seen in a care home.

This is not a bad thing – indeed long lives should be celebrated, and the move towards care in the community is a positive one for the individual and the wider system. However, the sector has been left with the ever-increasing challenge of meeting these rising needs, and I am concerned that the funding model is not sustainable, which can mean that people can’t afford the care they need. With finite resources and an already strained sector, this also has implications for the quality and standard of care that can reasonably be expected.

Once this scale is tipped, and a balance struck with a fair funding settlement for social care, the benefits will be huge for the sector. A much-needed funding boost would provide the opportunity to reward and recognise Nurses for their hard work. Enabling the sector to provide wages and improved conditions for social care Nurses that are as attractive as the NHS would help to keep current staff and attract new ones. In the meantime, I and my colleagues who have made a career in the sector need to do more to convince our nursing peers that working in care has the intellectual stimulation and career development opportunities they want, tackling the sometimes outdated view of care that sadly still pervades.

There are also ample opportunities to provide more support and training to our Nurse graduates so they are well equipped right out of school to ease the strain on the current workforce. The acuity of the health issues that we see in Residents now requires well advanced clinical skills that our newly trained nurses are often not exposed to when training. Finding ways to improve the training that they are given – perhaps through greater partnership working with universities or providing more work experiences placements – would mean existing staff have to provide less support to new graduates.

One final concern is the demand on our colleagues from the ever increasing, often duplicated and sometimes conflicting regulatory requirements from Local Authorities, CCGs and the CQC. While we welcome higher regulatory standards and know they can increase the quality of care, they can also have considerable knock on effects. These include rising costs and workforce skill requirements as well as an increase in the time spent working with the many authorities that may be relevant to any given care home. In a sector already facing challenges of recruitment, retention and funding, any way that we can align the regulatory bodies and their compliance requirements would make a huge difference.

In my role at HC-One I need to work with and be aware of the requirements of a significant number of different Local Authorities, 211 different Clinical Commissioning Groups and three national regulators. Each often has their own way of doing things, their own expectations and idiosyncrasies. For national providers, or even frontline staff in cities where employment options can span Local Authorities and CCGs, greater uniformity is needed in what is legally defined as ‘excellent’ care or best practice.

As we head into 2020, I am excited about what lies ahead. I’m sure there will be challenges to overcome, but there will also be opportunities to make things better. We might also finally get that helping hand from Government which could supercharge the care sector for the benefit of all.


Edel Harris





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