Almost three-quarters of adult social care is now rated good or outstanding, and the regional director reading me that line still winced.
She looks after a group of care homes, and she'd had the Care Quality Commission's latest State of Care report open on her laptop since it came out on 23rd October. The headline figure had pleased her board. But she kept going back to a sentence further down the page.
It said leadership is the area most in need of improvement. Two of her homes had no manager in post at that moment, which she mentioned twice in ten minutes. And a third had a resignation letter sitting on her desk, still in its envelope because she wasn't ready to open it.
The coffee had gone cold by then.
Why is leadership the weakest area when most care is rated well?
Leadership holds a service together between inspections, so it shows strain first when a home is stretched. The CQC's report, as Care Management Matters reports, names it as the area needing the most improvement, with almost three-quarters of the sector rated good or outstanding. Inspections also find that well-led services deliver safer, more person-centred care. Yet a good-rated home can still run on a thin management layer.
That gap is the bit worth sitting with.
A rating is a snapshot, and a manager is the reason it looks that way on the other three hundred and sixty-odd days. When the person leaves, nothing changes overnight. The rota still gets filled and the medication round still happens. And everything looks fine from the corridor.
But supervision slips by a week, then two. And the small corrections nobody noticed anyone making stop getting made.
What does a bigger, more consolidated market mean for the people running homes?
It means the job is getting larger and the pool of people who can do it is not. The report describes more care home beds sitting in large homes, with institutional investors buying more of them, while homecare breaks into a growing number of small providers. Each shift needs capable managers, and they need different kinds. And nobody has worked out where the next generation of them is coming from.
A large home needs someone who can run a leadership team. But a small homecare branch needs someone who can do the compliance, the rota and the difficult family phone call in the same afternoon.
Chris Badger, the CQC's chief inspector of adult social care, said investment in leadership capability is needed alongside all of this. I'd put it more bluntly from where I sit. Capability is only half of it, because you also have to be able to find and keep the people who have it. And that is the half most groups are quietly struggling with.
The CQC reports that vacancy and turnover rates have eased slightly across the sector, which is welcome, but concerns remain about the drop in international recruitment. But easing is not the same as solved.
What happens to a home when its manager leaves?
The first few weeks are usually survivable, and the damage tends to arrive after that. A deputy steps up to cover, which pulls them away from their own role. Any new manager then has to go through CQC registration before they are properly in post.
In the gap, oversight gets thinner and governance work gets postponed because there are shifts to cover. Registered manager turnover never appears as a line on a CQC rating, but the rating feels it a few months later. Most of the managers I speak to would say the pressure has moved rather than gone. Or at least they only say it out loud after the second glass of wine.
I wrote about the other side of this not long ago, in a piece on what a settled registered manager is worth to a care home. The short version is that the homes with a steady manager tend to have steadier everything else.
One thing surprises owners every time.
The cost of an empty manager's chair is rarely the agency cover or the recruitment fee. In my experience it is the six months afterwards, when a home that was ticking along starts making small mistakes and nobody has the time to catch them. I've sat in that meeting more than once, and the mood is always the same. Quiet, a bit sheepish, and very focused on dates.
Where do the strong leadership teams actually come from?
Mostly from decisions made a long time before anyone resigns. The groups that cope best with a departure already have a deputy who wants the top job and has been given a proper route to it. They also tend to know, roughly, who they would call if the chair emptied tomorrow.
A few habits separate the steady groups from the rest.
They talk to deputies about ambition before the deputy has to raise it. And they budget for a handover overlap, even a short one, so the outgoing manager's knowledge doesn't walk out of the door with them.
Then there is timing. Steady groups start looking for a replacement the day notice is handed in, not the day the leaving date arrives, because a good registered manager is rarely sitting unemployed. They have a notice period of their own to serve, often a long one. Miss that, and a three-week gap turns into a four-month one.
None of it is complicated. Hardly any of it gets done, because there is always a shift to fill first.
The regional director I started with has since stopped treating the good rating as the finish line. She reads the leadership finding the way she'd read a surveyor's note on a roof, as something to deal with before the weather turns. Her board still likes the three-quarters figure, and she doesn't argue with them about it.
With every group chasing the same few leaders, our health and social care recruitment team can tell you straight who is realistically available for an empty manager's chair.
