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||180||54|
|Barts and the London Trust||140||53|
|Epsom and St Helier University Hospitals Trust||86||37|
|North West London Hospitals Trust||85||36|
|South London Healthcare Trust||114||35|
|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|
|Lewisham Healthcare Trust||59||23|
|Newham University Hospital Trust||42||21|
|Croydon Health Services Trust||63||20|
|Ealing Hospital Trust||34||13|
|West Middlesex University Hospital Trust||38||13|
|Kingston Hospital Trust||40||8|
|North Middlesex University Hospital Trust||36||7|