As a registered care home manager, “the buck stops with you”, says Sarah Carter. “You’re responsible for managing that service. You can’t be everywhere all the time; you have to trust your team. So, the job comes with quite a lot of responsibility.”

Sarah, an MiP National Committee member and former NHS manager, runs a 50-bed care home in the East of England. Registered with the CQC for both residential and nursing care, the home welcomes adults of any age, including those with learning disabilities and complex dementia needs.

Sarah began her career with the London Ambulance Service, where she immediately joined UNISON, transferring to MiP when she reached Band 8. “Managers need a different type of protection, and there are different reasons why you might need support and advice,” she says. A National Committee rep since 2024, she hopes to give social care managers and those working in the private sector a stronger voice on the union’s governing body.

“Different and challenging”

Before taking voluntary redundancy from the NHS, Sarah worked as an urgent and emergency care manager for Norfolk and Waveney ICB. When managing patient discharge she often felt frustrated seeing ambulances still queuing outside hospitals because of a lack of available beds. “The decisions or actions you took never seemed to show up as a tangible difference at the front door or in the headlines,” she says.

As a care home manager, every day is “different and challenging”, she says, “but you can see how people’s lives are affected positively by the work we do. When a resident wants a cup of tea and you give them a slice of cake too, it completely brightens their day and you know you’ve made a difference. You really see the richness you bring to people’s lives.”

Working for a small, family-owned business also means “you’re close to the decision maker because there isn’t a massive hierarchy”, Sarah says. “If I need something, I can talk to the finance director, say why I need it, how much it costs, these are the risks and benefits, and he can say yes or no. So in theory you can implement things really quickly.”

While Sarah found her skills were readily transferable to social care, moving sectors wasn’t completely straightforward. Care home managers must be registered with the Care Quality Commission (CQC), a process that involves submitting a full career history and references for verification, an enhanced DBS check (as well as additional checks by the CQC for staff who aren’t clinically registered) and a ‘fit and proper person’ interview. All this takes a minimum of 16 weeks.

“They check everything; they want to get a whole picture of you,” she explains. “At the interview they ask about your experience, your knowledge of the regulations, and what it’s like running the service. At the end, you get a lovely certificate from the CQC.”

While it could be difficult to implement a similar scheme in the NHS, there are some advantages for managers, she says. “In social care registered managers are in a respected position, because there are a number of hoops that you have to jump through to prove you are a fit and proper person.”

Keeping the home properly staffed is one of the biggest challenges Sarah faces in her new career. Many staff are on the minimum wage and small care businesses can’t offer the same career opportunities as larger organisations, she explains.

“Finding people and keeping them is a challenge across all of social care,” she says. “We’ve got rolling recruitment going all the time. I’ve been in my current role for nine months and I feel like I’ve interviewed somebody every week.”

While better career progression might help, many of her team are “dedicated and passionate carers” and may not be interested in management roles, she says. “They’re really happy caring for people and that’s where they get their joy from.”

At the same time, care homes struggle to increase salaries because of funding constraints. “The margins are very slim on local authority funded residents,” she says. “The standard rate is £850 per week and if you look at somebody who needs washing and dressing, and maybe two people to assist them with everything, and you’re laying on food, lighting and heating — that’s a lot of cost.”

With April’s national insurance rise adding to rising costs, many care homes will be forced to balance the books by taking more privately-funded residents — “a huge challenge,” Sarah says, because “you want to deliver high quality person-centred care for every single resident based on their needs, not on how much they pay for their beds.” //