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Carehome Staffing

20 November 2017

“Will we be able to staff our new care home, and at what cost?” 

Ben Hartley 
Co-founder and director of Carterwood

"A decade ago, the question of staffing was an important but secondary consideration to revenue drivers. However, today we are seeing a very different story, with staffing increasingly at the forefront of operators’ minds. As some operators attempt to reduce agency costs and job vacancy rates, some are even choosing to move away from providing registered nursing care altogether. Not surprisingly, one of the key questions operators are asking us is “will we be able to staff our new care home, and at what cost?”

The answer lies in potential staff availability
Now, more than ever, determining potential staff availability for a development site is so important when planning a new care home. In particular, information about the availability of registered nurses and care workers can help determine the category of care to provide. Focusing on personal care, for example, in an area where the ratio of nurses to care home beds is low may be a viable alternative to nursing care. By the same token, an operator may strategically review an operational home’s category of care, depending on staff availability. 

The launch of Carterwood’s new staffing analysis report means that, for the first time, we are able to collect, analyse and provide detailed information about the available workforce surrounding a new or existing care home site. Going further than highlighting a national staffing challenge, our areas of analysis include competition for staff in the local area, rates of pay, vacancies, transportation links, major hospitals and the key areas in which potential staff may reside, amongst other things.

Determining the ratio of registered nurses to existing nursing provision
One area of our analysis uses Royal College of Nursing data to determine the number of nurses living in each area, and compares this against the number of nursing home beds. This forms our ratio of registered nurses to existing nursing provision. 

While each of our staffing analysis reports is unique, we now know that on average, there are 2.5 registered nurses per nursing home bed in Great Britain. However, wide regional variations are evident, with just 1.68 registered nurses per nursing home bed in Surrey, and 3.68 registered nurses per nursing home bed in London. Logically, these variations point to regional challenges. We expect recruitment and retention to be most difficult in areas where the registered nurse ratio is low. This, however, is not always the case, and a number of other key drivers influence staff recruitment at the local level.

This map shows the number of registered nurses available per nursing home bed by county. Counties with the lowest registered nurse ratio include Herefordshire, West Sussex, Somerset, East Sussex and Surrey. In comparison, counties with the highest registered nurse ratio include Bedfordshire, London, Leicestershire, Essex and Greater Manchester. 

Using travel distance analysis, we can also determine where nursing staff are likely to come from, and how many nurses live within a specified catchment. Our empirical evidence tells us that registered nurses tend to live close to where they work. Bearing in mind an average travel distance to work of just 2.7 miles, we can calculate the number of nurses in a care home catchment area. 

London, for example, has a lot of hospitals and not many care homes. This means the ratio of nurses to care homes is excellent, and recruitment and retention should be easier than in most areas. In comparison, in a rural location such as Herefordshire, where there aren’t many hospitals, there are also fewer nurses. This can make recruitment particularly challenging.

Overcoming an uphill challenge
The most telling statistic of all is that just 7.6% of registered nurses work in care homes. Part of the challenge for care home operators, therefore, is enticing them away from the NHS and other career paths.

Those providers that understand the local staffing landscape will be able to plan their development, financial and recruitment strategies. They will know how hard they will have to work to recruit the right staff, and they will be better able to set competitive rates of pay. 

The location of a new development in relation to transport facilities, such as bus stops and train stations, can also help determine how difficult it will be to attract staff. It may be that other tactics will be vital, such as laying on transport or considering an alternative, more accessible site in the area.

Given the staffing challenges that are so rife, it’s far too risky to simply assume you will be able to staff your next care development. Site-specific data on the proposed staff catchment area is now an essential prerequisite for planning and due diligence.
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