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NHS reforms spark loss of senior nurses who oversee quality and safety

The senior nurses who monitor quality and safety of hospital care have seen huge upheaval since the government announced its NHS reforms, an investigation reveals.

Analysis shows the news of the reorganisation sparked a tripling in turnover among the senior nurses, doctors and managers who oversee care quality for primary care trusts.

The massive upheaval has fuelled concern about the potential for the NHS to miss serious quality and safety failures while the changes take place.

In July 2010 the government announced PCTs would be abolished. Most of their work will be taken over by GP-led clinical commissioning groups and the national NHS Commissioning Board in April next year.

The size of the upheaval so far – revealed by an investigation by Nursing Times sister title Health Service Journal – has also sparked calls for senior nurses who currently oversee quality for PCTs to be found roles in the new bodies in their area.

The findings also resonate with Robert Francis’s public inquiry into the Mid Staffordshire Foundation Trust scandal, which has heard how a previous NHS reorganisation in 2006 was partly to blame for the trust’s failures going unchecked.

The analysis looked at how often there was a change in PCT directors responsible for overseeing the quality of care delivered by their local providers. Information covering about two thirds of non-specialist trusts revealed there were more than triple the number of changes in the 16 months following the July 2010 announcement than in the previous 16 months. There were 19 changes in the first period, and 65 in the second period.

For each hospital trust, the analysis also looked at the number of changes in the PCT staff member who chaired their regular contractual quality review meeting.

The total number of changes among the chairs was 18 in the 16 months before July 2010 and 56 in the 16 months after – more than triple.

The analysis showed director or chair roles were held by nurses – often nursing directors or deputies – in about two thirds of cases.

Sheffield University Hospitals Foundation Trust chief nurse and quality board member Hilary Chapman called for those developing the system to try to retain senior commissioning quality staff. Professor Chapman said CCGs should only be given permission to take over if they prove they can monitor quality, and they should not “make the mistake” of appointing insufficiently experienced nurses.

Another former PCT nurse director told Nursing Times there was concern about the problem getting worse as senior nurses leave PCTs and are split between jobs at the national board, CCGs, and new “commissioning support services” which are being set up to help CCGs.

19%: Non-specialist hospital trusts that saw one or more change in the PCT director responsible for monitoring their services’ quality in the 16 months before the white paper

61%: Hospital trusts that saw one or more change in the PCT director responsible for monitoring their services’ quality in the 16 months after the white paper

15%: Hospital trusts that saw one or more change in the chair of their PCT’s regular quality review meeting in the 16 months before the white paper

49%: Hospital trusts that saw one or more change in the chair of their PCT’s regular quality review meeting in the 16 months after the white paper

Readers' comments (29)

  • Losing the matrons in our trust which is taking place right now will have grave consequences for us band 7's
    This is not the right way to go about Saving money
    Yet again nurses are hit.

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  • And yet again, nurses will not do anything to prevent this from happening. We really can't go on blaming others for the continued attacks on nursing posts. Unless and until nurses take action to stop this, then it will continue.

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  • One of the great problems in the NHS, (and this problem has existed since administrators were given the role of Chief Executives), is that Managers who grew in this way could only work in a way which was top downwards, they therefore got paid for doing the bidding of the Government. Nurses and Doctors who could think for themselves were laid to one side as they might understand the failings of the system.
    Someone once said that if Florence Nightingale were alive today she would be walking the corridors of the NHS, and she would be demanding to know who is in charge.
    The answer, of course, would be that she would be in charge.

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  • We have just had 4 matrons introduced to our area( we only used to have one, where did they suddenly get the finance from when we are crying out for more nurses), it has caused upset and disruption to services. All they seemed to be worried about is finance, not staffing adequately so that we can give good nursing care, we are constantly pushed to our limit, I have seen young women a third of my age go home crying because of the mental and physical pressure they are put under on a daily basis. I have hearde comments said that at least I still have my registration for another day it should not be like this. There is also another reason why so many senior staff are leaving, myself included, is because A. I do not think I will be fit enough or safe enough to continue working as a physical hands on nurse until I am 66 and B. I was so worried that the government were going to mess with my pension that myself and others have taken early retirement. Surely someone can see what the changes are doing to the health service and the safety of our patients.

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  • I would be really keen to know how "Anonymous 5th June 10.08" thinks that nurses can prevent nursing posts being attacked. This isn't in any way a sarcastic or confrontational message but having spoken out, joined focus groups, liaised with management, waved placards, completed surveys, voted about pensions etc, along with colleagues, so many times, and been unable to stop the roller coaster a lot of us are at our wits end about what to do to stop the dismantling of our profession and our NHS. Concrete suggestions please - what can we do?

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  • Anonymous | 5-Jun-2012 3:14 pm
    from
    Anonymous | 5-Jun-2012 10:08 am

    I completely understand what you are saying, but the solution is very simple. It requires more than you, me and a few hundred others to take action. It requires the hundreds of thousands of nurses in this country to stand together and take concerted and effective action. Concrete suggestions? If everything that you and I are doing, was also being carried out by
    the majority of nurses, then we would be a force that the government could no longer ignore.

    I wish I knew what it would take to get nurses out of their stupor. I wish I knew the tipping point. Only 16% of over 300,000 RCN members bothered to offer an opinion about the changes to their pensions, yet I don't know a single nurse who is happy with the arrangements. Why would anyone sit back and take this? The doctors aren't accepting it? They're p*ssed off and are doing something about it.

    So, I stand by my original post. I will, of course, continue to vote, speak out and protest, and I hope you will too.

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  • Because of the current political trend to hit at nursing every which way but loose. I too will be taking early retirement but I have three years to go, so I will be keeping my head down and hope that I can survive that long.

    The hospital I work for has just organised for another six matrons to come in to post. I wonder the need and the purpose it's more people on the shop floor needed I think.

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  • It's not just the nurses closer to the age of retirement that are being pushed to leave or are "laid-off", but also those in their 40-50s. These nurses have often reached the top of the pay scale, especially if they have advanced degrees. I am one of those nurses. I was told to get my MSN/PhD, when I did, I was told that I was now "too expensive to keep" The institutions, concerned only about the bottom dollar are getting rid of the experienced nurses and hiring those who are cheaper (2-5 years of nursing experience instead of the 17-25+ years most of these nurses have). Nurses are a valuable part of the Health Care System and without us, there would be NO healthcare.

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  • Educatetechsystems | 5-Jun-2012 8:26 pm

    my experience exactly. Was persuaded an MSc would be a good career move up the ladder and guarantee a good job at the end of the 1990s. I had to take a year off work as a carer so started with the certificate part time, as to my surprise I was successful in this, I did a second year to earn my degree, and in my mid-50s ended up in unsuitable short term jobs until I was pushed out of the nursing labour market and unable to find any employer willing to take me on again on the grounds of my age or my qualifications!

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  • I use the old addage too many chiefs not enough indians, loosing experienced staff is to loose quality, who shows the newly qualified what to do ? the NHS is being run down to make way for private healthcare companies to pick its bones , as for Matrons are just another expensive layer of hierarchy , box tickers. The NHS is being pulled like a rug from under our feet , and all we can do is watch, when we had our demonstrations earlier this year the government took no notice and concentrated on the trouble causes so as to dilute any show of strength we may have had, the only way for us to make a stand is to stike and provide emergency / essential cover nationally. In answer why so few replied to RCN pension changes, maybe apathy has got a tight hold on staff being downgraded, payfreezes , membership fees increasing, job insecurity etc etc, but i agree we should not lie down and just take it.

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  • Changes are not in provider roles only - I was a senior nurse in Infection Control in a Commissioning role in a PCT. Since the reforms senior specialist clinical nurses were pushed out ie 'put at risk' and junior staff with Project management but no nursing or specialist qualification put in place (after farsical 'interviews) to monitor standards!!! Patient Safety - dream on! It is about how cheap can we get the service at!! Lansley - you should be ashamed. The NHS needs to change but does not deserve wholesale dismantling and put into the hands of their cronies in private sector. Why dont we start by ensuring the services are only available to UK citizens!

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  • Anonymous | 5-Jun-2012 10:05 pm

    "Why dont we start by ensuring the services are only available to UK citizens!"

    Non-UK citizens are not the problem here! Anyone, regardless of race, creed, colour,etc., gets treated if they come through my doors......because I'm a nurse and, at its most basic level, that is my job. And yours.

    The solutions to our current problems are many and varied and mostly within our reach, if only we bothered to galvanise ourselves. But they certainly should never include withholding health care from anyone.

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  • From what I have experienced as both an in-patient, and out patient, there hasn't been any senior nurses overseeing quality and safety for decades. Which might account for the decline in nursing standards over that period of time.

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  • First, I'm intrigued to know why the majority of people are commenting anomymously here. I'll offer no opinion on it but wait for others to reply.

    Second, all of this paints a rather grim picture for me; I'm a student nurse, in my sign off placement now and will be 41 years old in July. As one of the last of the diploma course students, I will soon be applying for jobs alonside younger nurses who have degrees. Am I to understand that the last three years have effectively been a waste of my time and money and that I will be treated as one of the care assistants before being pushed out of this line of work altogether?

    I agree with Anonymous that we would not be nurses if we were prepared to withhold care from anyone but I also feel, as Anomymous does that we need to find a way to defend our right to be the best nurses we can be without living in constant fear of losing our ability to do so.

    I disagree that this is "very simple" because as Anonymous pointed out, the media is too easily used to alter the public perspective of any attempt to demonstrate. I'm afraid I don't have the answer either but I am ready to listen to suggestions and get involved in anything I feel might be effective. The idea of the entire body of nurses making a stand together sounds impressive, but to get us all in one place at the same time would mean huge costs for the majority of us and would leave every hospital and community in the country without any staff, clearly an unnacceptable failure in patient safety.

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  • It makes no difference if people sign themselves as 'anonymous' - this is an open forum and people can call themselves what they like. Do you think we sound more credible if we give ourselves a name, even if it is obviously false?

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  • It seems to me that the evidence for poor senior nurse monitoring is already out there in the forms of various serious Reports on the quality (or lack of it) of nursing in the past 15 years.

    I would suggest that all the registered nurses need to take responsibility for monitoring the care they provide more seriously - it is after all in their Code of Conduct.

    I make these comments in the knowledge of lack of staff, massive turnover of patients in hospitals etc... etc...
    It is actually up to the nursing profession to deal with this dreadful situation of being unable to provide adequate nursing care.

    At present when challenged the nursing profession (and I mean RCN and NMC) just say what wonderful care is actually out there and that these reports are a minority situation.
    Rubbish - otherwise why would A Dignified Revolution, Kissing it Better and other organsiations been set up.

    With the appalling inadequacies of the NMC, a hike in fees to do their work - I have little confidence in nursing getting any better - only worse.

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  • First, I'm intrigued to know why the majority of people are commenting anomymously here. I'll offer no opinion on it but wait for others to reply.

    Second, all of this paints a rather grim picture for me; I'm a student nurse, in my sign off placement now and will be 41 years old in July. As one of the last of the diploma course students, I will soon be applying for jobs alonside younger nurses who have degrees. Am I to understand that the last three years have effectively been a waste of my time and money and that I will be treated as one of the care assistants before being pushed out of this line of work altogether?

    I agree with Anonymous that we would not be nurses if we were prepared to withhold care from anyone but I also feel, as Anomymous does that we need to find a way to defend our right to be the best nurses we can be without living in constant fear of losing our ability to do so.

    I disagree that this is "very simple" because as Anonymous pointed out, the media is too easily used to alter the public perspective of any attempt to demonstrate. I'm afraid I don't have the answer either but I am ready to listen to suggestions and get involved in anything I feel might be effective. The idea of the entire body of nurses making a stand together sounds impressive, but to get us all in one place at the same time would mean huge costs for the majority of us and would leave every hospital and community in the country without any staff, clearly an unnacceptable failure in patient safety.

    Unsuitable or offensive?

  • It seems to me that the evidence for poor senior nurse monitoring is already out there in the forms of various serious Reports on the quality (or lack of it) of nursing in the past 15 years.

    I would suggest that all the registered nurses need to take responsibility for monitoring the care they provide more seriously - it is after all in their Code of Conduct.

    I make these comments in the knowledge of lack of staff, massive turnover of patients in hospitals etc... etc...
    It is actually up to the nursing profession to deal with this dreadful situation of being unable to provide adequate nursing care.

    At present when challenged the nursing profession (and I mean RCN and NMC) just say what wonderful care is actually out there and that these reports are a minority situation.
    Rubbish - otherwise why would A Dignified Revolution, Kissing it Better and other organsiations been set up.

    With the appalling inadequacies of the NMC, a hike in fees to do their work - I have little confidence in nursing getting any better - only worse.

    Unsuitable or offensive?

  • First, I'm intrigued to know why the majority of people are commenting anomymously here. I'll offer no opinion on it but wait for others to reply.

    Second, all of this paints a rather grim picture for me; I'm a student nurse, in my sign off placement now and will be 41 years old in July. As one of the last of the diploma course students, I will soon be applying for jobs alonside younger nurses who have degrees. Am I to understand that the last three years have effectively been a waste of my time and money and that I will be treated as one of the care assistants before being pushed out of this line of work altogether?

    I agree with Anonymous that we would not be nurses if we were prepared to withhold care from anyone but I also feel, as Anomymous does that we need to find a way to defend our right to be the best nurses we can be without living in constant fear of losing our ability to do so.

    I disagree that this is "very simple" because as Anonymous pointed out, the media is too easily used to alter the public perspective of any attempt to demonstrate. I'm afraid I don't have the answer either but I am ready to listen to suggestions and get involved in anything I feel might be effective. The idea of the entire body of nurses making a stand together sounds impressive, but to get us all in one place at the same time would mean huge costs for the majority of us and would leave every hospital and community in the country without any staff, clearly an unnacceptable failure in patient safety.

    Unsuitable or offensive?

  • I'd like to apologise for the multiple copies of my post that have appered here - I'm not sure how that happened.

    I'd also like to respond to the anonymous who asked whether I feel that adding an 'obviously false' name to a post makes it seem more credible. No, I don't believe that but for my part, the name that appears is my own. I'm still not offereing an opinion on the subject of anonymous posts but remain intrigued as to the reasons.

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