Coronavirus (COVID-19): care home outbreaks - root cause analysis

8. Leadership

The leadership role in care homes is complex and, particularly in the current circumstances, highly demanding. This was emphasised to us by all of the care home managers we spoke with. Care home managers, who are registered with SSSC, should be trained to SVQ LEVEL 4 and currently 59% of managers hold the required qualification in Scotland. Over 700 people are currently registered with SSSC as managers of care homes for adults. Homes vary in size and degree of specialisation and the structures around managers vary from single owners, to large corporate organisations. The nature of these structures and the cultures they support, impact directly on the autonomy of managers. In the four care homes we spoke with, we witnessed both positive and negative impacts of the wider organisational structure.

As the visible leaders in their units, care home managers are fundamental to establishing and maintaining standards and to establishing relationships with a range of stakeholders including relatives and families, primary care, Health and Social Care Partnerships, local Health Protection teams, and the Care Inspectorate. In relation to staff management, they could be greatly assisted by the reinforcement of information of the key message that personal behaviours can, and do, influence or bring impact for the professional or work environment. Managers reported an added pressure is the level of vigilance they are required to maintain to ensure that aspects of staffs' personal or social lives do not have an adverse impact for the care home environment, such as car-sharing, socialising with colleagues, holidaying abroad and ensuring appropriate quarantining on return.  

Managers are drawn from a diverse range of professional backgrounds, including administration, hospitality and healthcare.  With 41% of managers still to achieve the required management qualification and with the current intense levels of scrutiny, it is clear that more needs to be done to support, sustain and develop the management cohort in the care home sector. Managers with professional nursing backgrounds are more likely to be registered with the NMC rather than the SSSC; however, the NMC does not mandate any particular qualities related to management, nor does it require any specific qualification beyond maintaining effective professional registration. Irrespective of professional background, managers need to have the skills and abilities necessary to support the workforce in the most challenging of times.  In order to undertake their role successfully they need to be supported by their managing bodies and by the wider care and health network.

Managers and their staff are dealing with bereavement, grief and loss on an unprecedented scale. Managers are often

the focal point for the concerns of relatives and families and may also have to handle additional demands including extra inspections, and in a few cases police investigations. It is hard to overstate the level of pressure care home managers are experiencing, and every element of the care and health system needs to work to support a group of staff who are central to maintaining the provision of care.    

Whilst in the longer term access to; enhanced leadership training, mentoring and local leadership networks would all be of assistance, in the midst of the current circumstances there is a need for managing organisations to support the emotional wellbeing of their managers, as they grapple with resilience in what is a complex and very high risk managerial role, during a prolonged period of intense activity. 

Recommendations:  

• Organisations should take steps to ensure the emotional wellbeing of all staff, with a particular focus on care home managers, through providing access to support and signposting to the range of resources currently available
• Consider access to enhanced leadership training, mentoring and leadership networks 
• A national information campaign should be considered for care home staff to ensure information is well understood in relation to how personal behaviour can impact on their role whilst at work, to include social distancing, cigarette breaks, car sharing, and remaining vigilant to risks at all times