We have come to understand that the Care Inspectorate do not have prescribed staffing ratios when it comes to care homes for the elderly. As part of an individual care home’s ’Conditions of Registration’ the Care Inspectorate may set minimum standard levels which appears to be the case for Struan Lodge. We are unaware what they are exactly but we have made some assumptions based on the staffing figures as discussed below
All care homes must be registered with the Care Inspectorate and they are required to meet the prescribed National Care Standards.
These ‘Standards’ describe the minimum expectations residents should have of their nominated care home; and they define the ‘Rights’ of residents in the level of care they are entitled to expect.
In relation to Struan Lodge, there are certain parts of the National Care Standards which may be particularly relevant at the moment.
National Care Standards
In relation to Struan Lodge part of the ‘Conditions of Registration’ states that it must ‘comply with the current staffing schedule dated 4/11/05.
This is explained in the National Care Standards, which say:
‘The Care Commission now intend to adopt a consistent approach at first registration which will set out the minimum staffing requirement in relation to the maximum numbers of service users as stated on the certificate of registration.
‘This provides the maximum degree of flexibility to providers whilst minimising the need for frequent changes of certificate and the costs associated with this.
‘This means that Providers may reduce staffing numbers if service user numbers fall below maximum capacity. Any such reduction however, should not only be calculated on a proportional basis, but must always take into account factors such as the design of the building, general dependency levels, individual needs and choices etc of the remaining service users’.
The staffing levels for Struan Lodge would appear to indicate that as part of their ‘Conditions of Registration’, the Care Inspectorate have recommended that there must be 3 x members of care staff on during the day [1 x senior plus 2 x care workers/assistants] and 2 x members of care staff on night duty [1 x senior plus 1 x care worker].
Although it has a relatively small numbers of beds, these levels don’t appear unreasonable – especially if they have residents with high care needs.
Savings by negotiation with Care Inspectorate
If the Council were looking to reduce staffing costs at Struan Lodge , they might be in a position to ask the Care Inspectorate for a variation to the ‘Conditions of Registration’ with a view to altering the staffing ratios for staff on day duty .
This would, however, need to be very carefully thought through, as they would need to ensure that any new clients admitted not only met their criteria for residential care but also had relatively lower care needs than some of the resident they may currently accept. They would be unable to take clients with dementia for example.
It may be that the Care Inspectorate would only consider agreeing a reduction in staffing levels when the manager was on duty or if it was clearly stipulated that the care home would only accept potential residents who require a certain level and type of care; or if available bed numbers were to be reduced from the current 12 to say 9 or 10.
If they were to consider this – and it was agreed with the Care Inspectorate – they would be able to reduce care staff costs by approximately £35,000 to £110,000 per annum.
We know that our external industry expert’s information and assumptions have produced cost figures for Struan Lodge which are in the right zone.
As mentioned above, it may be that even the most expensive of our four costing models could not stretch to the total staffing cost figure given by council officers – £724,306, because of the need to include the costs for supplementary staff (usually bank staff) required to cover holidays and sickness at Struan Lodge – because it is running on the Care Inspectorate’s recommended staffing level.
The deployment of supplementary staff for such purposes must then be a normal and standard operational requirement. It is therefore strange that this was not detailed in the minutes of the last full council meeting from which we got the staffing establishment details for Struan Lodge. Cover for in-service training should easily be covered by the existing staffing numbers and wouldn’t require the use of ‘bank’ staff.
One is entitled to expect a paper accounting for the cost of the operation of Struan Lodge to include reference to a staffing cost element like this, which, in the amount to be made up to reach the declared total, may be substantial.
Outside cover for staff holidays and sickness could possibly answer the discrepancy in the overall staffing costs – but since we cannot be certain of the specific staffing grades involved, we are not in a position to give a definitive answer on this.
We would have expected those costs to have been clearly identified in the staffing levels figures publicly given
They may, of course, have been an unspecified inclusion in the ‘support services’ costs which, at £105,174, we have already said we considered to be very high; or they may be included in the overall staffing figures – but we wouldn’t expect them to appear in both.
If this is the case, it would suggest that the staffing costs we have calculated in Model 2 [our best guess at the grades applying, costed on a 35 hour week] are on the money. With the addition of most of the figure of £105,174, given by council officers for ‘support services’ [i.e. supplementary staffing], our Model 2 costs would then show the accuracy of the overall figure officers gave of £724,306 an accurate one.
The insights from our consultant on practical operational matters which can be used to scrutinise the Struan Lodge scenario are interesting and usefully informative.
Matters discussed include the following:
In-service training: ‘Staffing during the day will probably operate as is standard in the sector i.e. an early/late shift pattern. There are numerous variations of staff rotas but when you employ contracted full time staff you are always usually left with one surplus shift per week. There are 14 shifts to be covered per week per grade, each member of staff works 5 shifts per week – therefore 3 x 5 = 15, leaving one surplus per week. This surplus shift is usually used for staff training etc.
‘In the private sector employers will also accumulate them to cover annual leave but this rarely happens in the public sector.’
Surplus staff: ‘As discussed previously, I think the number of care staff in post at this home is about right if they currently accept people with higher level of care needs. The posts of cook and assistant cook are also reasonable. The total hours given may be slightly excessive compared to the private sector but not overly so. It needs to be remembered that they will be preparing at least three meals per day, seven days per week.
‘The number of catering assistant hours does appear slightly high, when you take in to account the relatively low number of residents; but I do not know what tasks they are required to carry out. Taking in to account the number of residents you have given me, if we assume that each meal time, including laying the tables, takes approximately 1.5 hours, then we have – 1.5 hours x 3 meals per day x 7 days per week = 31.5 hours per week. If they also assist with a ‘tea & biscuit’ for the residents in the afternoon you could maybe add an additional 5 to 7 hours per week, totalling at the most 40 hours per week. They appear to be funded and costed for 64.5 hours which does appear a bit high. However, I note that one of the posts is currently vacant.’
Domestic staff: ‘Once again I am unsure of the duties this group of staff undertakes; and I am also unaware of the actual physical size of the home but the hours identified for this staff group do appear quite high, almost double what I would expect. I, personally, do not understand the rationale for having the domestic supervisor post, given the low number of domestic staff. Maintenance can be contracted out and care staff could take the relevant driving skills course to allow them to drive a minibus.’
Potential additional costs for covering staff holidays
With these assumptions:
- that staff cover each other’s absences on holiday on a like for like basis at the same grade etc – excluding the Manager (one of the Seniors would probably cover here)
- and excluding the Handyman/Driver (who doesn’t need to be covered )
we estimate the total annual cost for covering staff leave will be £67,040.
Adding this figure to the total for our Model 1 figures [Ed: in article linked here] shows £67,040 + £660,489 = £727,529. This is close enough to the figure council officers produced for staff costs – £724,306 – for us to feel able assume that this figure of £ 67,040 is indeed included in the overall staff figures already given.
This does leave open the question of what exactly the figure of £105,174 for ;support services is for?
Our conclusion from the best interrogation of the council officers figures is that any discrepancy will have been down to an officer doing ‘a desktop job’ – much as our team has done – rather than looking at the actual accounts.
While the reality might be different from either of theirs and our theoretical calculations, it may possibly not be markedly different. We have, in this article shown two sets of calculations each of which put the staffing costs in an acceptable proximity to the figure given by council officers. If the reality shown in the accounts is in the same frame, this would exonerate officers from any serious suspicion of inflation – and we would be genuinely sorry for having suspected just that.
Our consultant remarked on an interesting issue that appears to be omitted from the council officers’ report to councillors, saying:
‘One final note, the information you supplied did not give any indication of the money the council may receive as ‘income’ from the residents currently in the home.
‘As this could be quite substantial, it would be of interest to establish what this figure actually is.’
This is indeed germane to the overall costs of Struan Lodge.
Another archaeological dig on the council website excavated a figure for ‘income’ from ‘respite and residential charges’ of £62,447 per annum. We cannot know if this is a realistic figure or whether it’s simply what they have received in the past year.
Such income will, however, be both variable and unpredictable. For example, Struan Lodge may have a group of residents at the moment who do not have a lot of savings – where, in six months time, they might have a new group of residents who have substantial savings, which could see this £62,447 figure doubling or even trebling.
If the priority were to try to keep Struan Lodge open during the current financial crisis, if the council were willing to do whatever it takes, and if the Care Inspectorate agreed to change the home’s condition of registration and if staff agreed to take a voluntary pay cut/drop in grade - what cost savings could be made in the short term to make this a viable reality?
We are aware that another desktop exercise on this scenario could show a theoretical potential staff savings of around £250k per annum. In reality it probably wouldn’t necessarily deliver that – but the such an exercise would demonstrate to supporters of Struan Lodge what the potential reality of keeping it open would be for staff currently in post.
It might also demonstrate that council officers have not fully investigated viable alternatives to the current proposals. This may be because they do not see any that might be viable or acceptable but it would have behoved them to put forward the best alternative options they could have come up with – and let others decide.