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Exclusive: Trusts in London told they can slash nurse budgets by up to half


Hospital trusts in London have been advised they can safely slash spending on nursing staff, in some cases by 50%, according to secret reports obtained by Nursing Times.

The documents are at odds with growing evidence that cutting the nursing workforce can negatively impact on the quality of care and patient mortality rates.  

As revealed earlier this year, strategic health authority NHS London believes it can shave hundreds of millions of pounds from its nursing budget by “aligning staffing levels with clinical need” and reducing agency spend.

Nursing Times has now obtained the SHA’s trust-by-trust breakdowns of where it sees the potential for nursing budget reductions, following a freedom of information request.

The assessment looked at the capital’s 18 non-foundation trust hospitals to decide whether they were viable in their present form and how to get them through the application process for achieving foundation status.

The suggested savings range from £7m at North Middlesex University Hospital Trust to £54m at Imperial College Healthcare Trust.

In most cases, they represent a cut of around a third of the current nursing budget. However, the results show the SHA modelling some trusts with 50% reductions, such as at Newham University Hospital Trust and the Whittington Trust (see table).   

The figures are likely to alarm nursing directors across the country, as hospital trusts increasingly look to make significant savings in the run-up to an FT application ahead of the government’s April 2014 deadline.

A report summarising the 18 separate analyses released to Nursing Times claimed there was “no clear evidence” that investment in “simply increasing the number of nurses” would increase the quality of nursing care.

It stated: “Other factors, such as ways of working, may be more important than resourcing levels and, whilst some individual clinical areas will undoubtedly require more resource (including increasing the numbers working in those areas), efficiency improvements will enable others to deliver improved quality with fewer staff.”

But the Royal College of Nursing warned that nursing workforces were not overstaffed in London.

RCN head of policy Howard Catton said: “What directors of nursing have been telling us for some time is that they are already close to what you would need to provide a safe service, before you even get into decisions about providing a high quality service.”

Jill Maben, director of the National Nursing Research Unit at King’s College London, warned against viewing nursing staff as an easy way of improving trust finances as part of attempts to become a foundation trust.

She said: “When a trust is going for FT status one of the most obvious targets is always the nursing budget because it’s the largest. But it’s the largest for a good reason and it seems to be disproportionately targeted.”

Professor Maben said: “You need incredibly strong and knowledgeable nursing directors with all the evidence at their finger-tips to argue the case about quality.”

Unsustainable staffing cuts were widely viewed as the main reason for the care failings that occurred at Mid Staffordshire Foundation Trust, with managers criticised for being too focused on achieving foundation status.

A previous joint analysis by Nursing Times and Dr Foster Intelligence, carried out in 2009, has shown that the more nurses a trust employs per bed, the fewer of its patients were likely to die or experience long hospital stays.

Meanwhile, last week a major European nursing study found higher ratios of nurse per patient were linked with increased patient and staff satisfaction, and “evidence of better quality and safety of care”.

The RN4CAST study, published in the BMJ, also revealed that more than 40% of nurses in England considered themselves “burnt out”.


Trust Current nurse pay bill (£m)Maximum predicted savings from nursing budget (£m)
Imperial College Healthcare Trust     18054
Barts and the London Trust      14053
Epsom and St Helier University Hospitals Trust    8637
North West London Hospitals Trust   8536
South London Healthcare Trust          11435
St George’s Healthcare Trust        134  32
Royal Free Hampstead Trust           95 32
Barnet and Chase Farm Hospitals Trust                  85   29    
Barking, Havering and Redbridge University Hospitals Trust   110 28
Whipps Cross University Hospital Trust   66  28
Whittington Trust   49  24
Lewisham Healthcare Trust 59 23
Newham University Hospital Trust  42  21
Croydon Health Services Trust6320
Ealing Hospital Trust 34 13
West Middlesex University Hospital Trust  3813
Kingston Hospital Trust    40  8
North Middlesex University Hospital Trust  36   7





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Readers' comments (38)

  • For those trusts considering this madness I have one word "Stafford".

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  • Well, the cuts are being made already with almost every post that becomes vacant is not replaced. The impact will take time to become fully evident as there will be more and more sickness as the remaining staff get burnt out and even more tired. There will be an increase of serious untoward incidents and targets will be unachievable. I already do over 10 hours extra per week and sometimes 15 hours extra per week just to keep the cancer nursing service running. Interestingly, I have not noticed any managerial posts going! Of course, this government wants the NHS to fail so they can privatise it as we can all be labelled incompetent. Trouble is we all suffer and most of all sick people on low incomes.

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  • Who are these people at the SHA? Let me guess - not nurses. I wonder how much they get paid and how many of them would have to go to make the same saving...

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  • 'efficiency improvements' - in other words, no breaks, going home late, working non-stop with minimal staff, prioritising care to the detriment of patients, and then, hey presto, individual nurses being blamed when we haven't got the time to sit and help someone eat.

    where I work we don't use agency staff, we do have our own in-house bank but they have cut back dramatically over the past few years and now often have an HCA where really we should ask for a RN, that is if there is anyone available.

    there must be other ways of saving or generating money for the NHS without having to cut nursing posts, it's crazy.

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  • Where are the reoprts about the maximum savings achievable from Medical Staffing budgets? Introducing new ways of working and skill mix changes (such as Physician Assistants and Nurse Practitioners) into medical teams will have a much more significant impact and not harm direct care afforded to our most vulnerable patients. This is not an attack on medical teams but look at the good workforce practice that is happening globally in countries with similar funding issues.

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  • has anyone looked into the costs of agency dr's. the sum is obscene

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  • Tinkerbell

    the cake is fully baked, this is the icing on it, coming to a place near you soon.

    Forget everything you were ever told about the patients coming first. It was all a lie.

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  • I agree Tinkerbell wholeheartedly.

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  • Anonymous 3-Apr-2012 11:32am

    Couldn't agree more same thing going on at my trust. I wouldn't recommend this as a career anymore its slave labour.

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  • NHS? What was the NHS?.....
    No Hope Service.
    Go on NHS Trusts, slash the nurses budgets... and you might as well slash their 'juggulars' whilst you're at it.

    If you really believe we don't need nurses in the NHS why bother training them in the first place?

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