Who Holds Up the People Holding It All Together?
Supporting your senior team in care
By Arlene Bunton | Mac Research and Consultancy Limited | November 2026
Registered managers carry the service, the regulator relationship and the 2am phone call. If nobody is carrying them, they will not stay.
Every care service I walk into has one person everybody leans on. Staff go to them with rota problems. Families go to them with complaints. The inspector asks for them by name. The owner rings them when occupancy dips.
So I ask that person a simple question: who supports you?
Too often the answer is a pause, a tired laugh, and "nobody, really."
That is the quiet risk inside many services across Scotland and England. We put real effort into frontline recruitment, induction and training. We put far less into the small group who hold the whole thing together: the registered manager, the deputy, the clinical lead, the senior on shift. When they break, the service follows.
Why senior teams burn out
Senior roles in care carry an unusual mix of pressure. The registered manager is personally accountable to the regulator, yet often has little control over budgets, staffing levels or the building. They are expected to be on the floor, in the office and on call, all at once.
The pressures I see most often are:
Accountability without authority. The manager answers for the outcome but needs sign-off for every spend, hire or repair.
Isolation. There is one manager per service. Their peers work for other organisations, and their own staff are not the people they can offload to.
Permanent firefighting. Sickness, agency gaps, a safeguarding referral, a family complaint and an audit due, all before lunch.
On-call that never rotates. The manager never truly leaves the building, even on holiday.
Contact that only comes when something is wrong. If the owner only phones about problems, every call starts to feel like a threat.
Deputies in name only. Many deputies are full-time on the rota, so they cannot share the management load at all.
None of this is a character flaw. It is a design problem, and design problems belong to the people who own and direct the service.
The warning signs owners miss
Burnout rarely arrives as a resignation letter. It shows up months earlier, in patterns you can spot if you look for them:
Emails sent at midnight and on days off.
Audits completed on time, but the actions never closed.
Defensiveness in meetings, or silence where there used to be challenge.
Staff bypassing the manager and coming straight to you.
Short-notice absence, or a manager who has not taken a full week off in a year.
Agency use creeping up because the manager no longer has the energy to recruit.
"By the time a good manager tells you they are struggling, they have usually already decided to leave."
What good support actually looks like
Support is not a wellbeing poster in the staff room or a box of chocolates after inspection. It is structural. These are the things I build in with the services we work alongside.
Give the role real authority. Agree in writing what the manager can decide without asking: spend limits, agency use, recruitment, minor repairs. If you want them to carry the accountability, give them the tools that go with it.
Supervise the supervisor. Every carer gets supervision. Many managers do not. Monthly, protected, recorded supervision with the owner, a director or an external mentor should be standard. In England, the Nominated Individual has a natural role here. In Scotland, the SSSC Codes of Practice expect employers to support the learning and development of workers at every level, managers included.
Protect management time. If the manager is counted in the care hours, they are a senior carer who does management in their spare time. Separate the two, and hold that line when the rota gets tight.
Make the deputy a real deputy. Give them protected hours, delegated areas such as medication, training and audits, and a development plan. A strong deputy is the best support a manager can have, and your best succession plan.
Share the on-call. A rota that includes the deputy, the seniors and, yes, the directors means the manager can switch off. Tired managers make poor decisions.
Change how you visit. Turn up to listen, not only to check. A structured monthly governance visit (what is going well, what is worrying you, what do you need from me) builds trust. Visits that only look for faults build fear.
Invest in development. Fund the SCQF Level 10 or Level 5 Diploma, leadership learning and time to network. Registered manager networks run by Skills for Care in England, and the SSSC's leadership resources in Scotland, give managers peers who understand the job.
Keep having honest conversations. Support and accountability are not opposites. A supported manager can take challenge. A manager who is left alone and then criticised will either leave or shut down.
The cost of getting it wrong
Losing a registered manager costs far more than a recruitment fee. There is the gap before a replacement starts, the interim or agency cover, the dip in staff morale, and the risk that standards slip while nobody holds the reins. A change of manager has to be notified to the Care Inspectorate in Scotland. In England, a new manager has to apply to CQC for registration, and that takes time.
Above all, inspectors in both countries look hard at leadership. An exhausted, unsupported manager shows up in the governance, the records and the way staff talk about their work. The well-led question is answered long before the inspector arrives.
Five questions to ask yourself this week
When did I last ask my manager how they are, and wait for a real answer?
Does my manager have regular, recorded supervision, and who gives it?
What can my manager decide without me?
Is my deputy doing a management job, or covering shifts?
If my manager resigned tomorrow, who would hold the service?
If any of those answers made you uncomfortable, that is your starting point.
How Mac Research can help
At Mac Research and Consultancy, our team of former inspectors and sector leaders works alongside owners and senior teams across Scotland and England. We provide interim management when a gap opens, operational oversight for owners who cannot be on site every week, Quality Assurance Reviews that show you what is really happening, and an external Nominated Individual service for CQC-registered care homes. We help you build a senior team that is supported, accountable and here to stay.
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