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London hospitals told they could slash nursing bill by £421m

London hospitals have been advised by management consultants they could save £421m over the next three years through a major shake-up of nurse productivity, Nursing Times has learnt.

A report commissioned by strategic health authority NHS London identifies ways 18 hospital trusts in the capital could make savings worth £1.27bn, with nearly a third of the total coming from changes to nursing.

The report, written by consultants McKinsey and released after the Freedom of Information Act, claimed increasing nurse numbers was no guarantee of raising care quality and instead advocates increased efficiency and productivity.

It said: “There is no clear evidence that investment in simply increasing the number of nurses as the mechanism to increase the quality of nursing care is a guarantee of good patient care – many of the best health organisations in the world combine high productivity and excellent quality.

“This suggests that other factors, such as ways of working, may be more important than resourcing levels.”

The report said savings could come from “optimising skill mix, reducing agency use, increasing share of patient-facing time and aligning staffing levels with clinical need”.

The consultants based their findings on a comparison of the 18 non-foundation trusts against similar organisations elsewhere in the country.

It added that some clinical specialisms will “undoubtedly” need more staff and resources, but said “efficiency improvements will enable others to deliver improved quality with fewer staff”.

The report’s findings appear to fly in the face of analysis by Nursing Times showing the more registered nurses that a trust employed per bed the fewer of its patients were likely to die or experience long hospital stays.

A major US study, published last year by the New England Journal of Medicine, also found mortality rates were significantly affected by the number of nurses on a ward.  

Readers' comments (31)

  • carol hannah

    Whilst I appreciate that there may be inefficient nurses on some wards, in some hospitals, this is not the case everywhere.

    I work in Mental Health in East London and working with only four staff for twenty (often +) patients is no mean feat, believe me.

    These management consultants ought to come and work on our wards for a week, be part of the numbers and see how difficult and stressful the job can be for our nurses. They ought to try spending shift after shift with distressed, disorientated, confused, angry, disturbed, sometimes violent, aggressive or dangerous patients who, due to their mental illness, want their needs met immediately.

    Fortunately,we are lucky to have the support of our management and our Duty Senior Nurses when our wards are busy or at risk. I love my job as does everyone one else on our ward and we all work really hard so to hear yet another report about making savings to the detriment of nursing - again - is depressing, to say the least.

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  • I despair! What nonsense is this. How can a business consultant organisation evaluate the quality and outcomes of nursing care?

    presumably this report is akin to a time and motion study which just addresses the overt physical needs of patients but without addressing psychological needs and the importance of more covert interpersonal and therapeutic relationships in which nurses are highly skilled (and dare I add is also a high motivator for many in their job).

    It is well recognised in nursing that physical and psychological needs are interdependent and both must be met for healing to take place.

    It is easy for such a firm to stand on the outside and measure the physical tasks carried out by nurses but without having the slightest idea about the rest, and a large and important part, of their work of employing their observational and interpersonal skills as well as offering their patients ample psychosocial attention and tlc.

    Lying in a hospital bed can be a highly stressful and worrying and socially isolating experience and if social and mental needs are not being met this will delay healing, can lead to complications which may affect the auto immune system, and include symptoms such as depression and even the loss of the will to fight illness or to live which may in part be responsible for some of the deaths in hospital.

    The highest and most efficient physical task orientated nursing with a minimum of staff will not make up for these deficits. Nurses know this and report constantly about the shortages and their lack of ability to deliver the quality of care they expect for the well being and positive health outcomes of their patients. Psychological support and health education for patients and their relatives require a lot of time in addition to all the more visible physical tasks and much of which its importance cannot be measured by outside observers.

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  • Such reports are good news for McKinsey but not for anyone else. If it is like their methodology on other projects it will be simplistic in the extreme

    They also helped design the current chaos Lansley is trying to implement. Not much of a CV.

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  • Do we know how much the Consultancy firm charged for this piece of work???

    Not cheap I`m sure, and total B******* as usual.

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  • What a load of ****!!
    And what do Consultants know or care??
    There is an abundance of evidence worldwide stating that Patient Ratios SAVES LIVES and decreases the percentage by a huge amount of hospital related conditions...ie Pneumonias/UTIs/Pressure Sores and DEATHS!.
    This article is a disgrace.
    We in Melbourne Australia are fighting the battle of our lives to save our Ratios...and NOTHING will stop us to protect this essential part of our conditions. Safe and Quality CARE.We are in the process of Mass Resignation which is such a hard time for us all...but thats the way it is at the moment here.
    These Consultants are living either in Cuckoo Land or have the $$ sign on top of their heads ....like our Government who do not want to read the evidence! Good Luck UK nurses with your ongoing battle...you need truckloads.

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  • I'm not a nurse, but working with clinical staff as I do, I just wish they could be left alone to get on with their job! In my acute trust, everyone (including me at times, because that's part of what I do) just seem to be trying to get more and more out of each nurse.

    There are much better things for me to be doing that would directly or indirectly benefit everyone - staff and patients - but for goodness sake let's leave the nursing staff alone for 5 minutes. We can't all be helping, I know...

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  • tinkerbell

    It added that some clinical specialisms will “undoubtedly” need more staff and resources, but said “efficiency improvements will enable others to deliver improved quality with fewer staff"

    Could you name these specialities - NEED A BIT MORE DETAIL please. Cos it sounds to me as even those that need more staff won't be getting them. They haven't got enough staff as it is. Just let's keep everything woolly and fluffy so no one has a clue what you mean hey, just like this governments reforms.

    "A major US study, published last year by the New England Journal of Medicine, also found mortality rates were significantly affected by the number of nurses on a ward"
    Doesn't need a sherlock Holmes to figure that one out.

    Could you all reveal yourselves and how much you are being paid to come out with this inane garbage?

    When are you sending in the bulldozers to completely scrap OUR NHS?

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  • "A report commissioned by strategic health authority NHS London..."

    this is ambiguous. Are we talking about an anonymous strategic health authority associated with the NHS in London or The Strategic Health Authority NHS London (in which case there is an issue with capitalisation!)

    If it is an authority it should be revealed which one. In either case, the commissioning of such a report from a management consultancy unrelated to the nursing profession is merely an exhibition of obstructive and irresponsible behaviour considering the uselessness of such an exercise and costs that the NHS can at this time ill afford. the money could have been better spent elsewhere on a more constructive project.

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  • Kind of sums up everything when in the first paragraph the term "Nurse productivity" is used....
    Dear management consultants just for your information....I DO NOT work in a factory,performimg a task for product output in a set amount of time.I work with people who need support with their health needs.The key word for you here is PEOPLE,not bits of machinery!!!
    All requiring different levels of support.I can be giving exactly the same treatment to 2 different people and this will take me different amounts of time.
    For the nurses reading this,they will be saying,yes well thats obvious,thats because we know whats required,we know how nursing people works,and quite simply you dont.
    I worked on a service development programme called C-PORT,i took the IT/mangement "consultants" to my work area,they saw how busy we were and thanked me for helping them put things in perspective,they said it helped them understand our requirements more fully and they took more notice of what i said in regard to the project.
    Get out of the office and go do the same,before the NHS becomes terminal!!!!!!!

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  • Actually under-staffing leads to inefficiencies. Use of agency rather than staff who are part of a team and know the area is not efficient. Also trained nurses are an efficient resource if people know what they are doing, how to do it and when to do it they can work efficiently, that seems to have been forgotten or overlooked in recent years.

    We don't get time to work on efficiency we are too busy mopping up.

    Sounds like the outcome of this report was written in advance.

    There are of course huge inefficiencies in management that could save millions - only problem is that it is the managers who decide and they prefer to answer everything with the suggestion that we can work leaner - it is a nightmare with no end in sight.

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  • working leaner is a great idea towards cutting costs but the only problem is that managers seem to understand working leaner means cutting down on front line staff rather than management staff!

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  • In bygone days, working as a psychiatric nurse in the 1980's, my colleague and I were occasinally left to manage the ward we worked on between us for a full days shift, i.e., from 7am until 20.15hrs.
    7We had 20+ male patients residing in the ward, and were also, 'acting up' for our senior nurse manager, who was responsible for upto 5-6 other wards, in additon to our own work.
    Although it was a long day's work, we supported each other in all aspects of nursing care and expertise, because we enjoyed our chosen career, and new each other's capabilities. Our patients, on the whole, were reasonally well behaved on such occasions, but if we did have any aggressive patients, we were were able to keep disturbances to a minimum.
    Now I would say you couldn't get more efficient than that...but we found through experience, that it was more practical to work in this way rather than ask another nurse, who didn't know our patients, to work extra hour/overtime, because it took more time to induct a strangerfor a shift of work than get on and do it ourselves.
    Did we ever get any thanks, recognition or appreciation from senior nurse managers for using our integrity?..... Not a chance!

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  • tinkerbell

    just finished watching 'confessions of a nurse',again, on More 4, great programme about honest, hard working nurses doing the best they canunder difficult situations and remaining caring and still able to say they love their jobs.

    These muppet consultants in 'efficiency' haven't got a clue what our daily working lives consist of, not a clue. We are so expert in managing 'difficult' it is just part of our every day life at work. If we have a quiet shift without difficult its a luxury.

    You can get 99 things right but they will only notice the 1 thing that you get wrong.

    Stuff em. They will never understand unless they are a nurse.

    As i often say, i love my job, there's just too much of it, but i still love it, and programmes like this, watching other good, hard working nurses just reinforces how much 'heart' there in in OUR NHS. Long may we survive.

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  • what about the money wasted doing this report when nurses have been telling the authorities for years what resources they need? i have never heard anything so stark raving mad as the idea of a consultancy organisation attempting to do a report on nursing!

    McKinsey must have been delighted to get this large contract.


    McKinsey

    http://www.mckinsey.com/About_us

    “About Us
    • Overview
    • Our people
    • History
    • Our values
    McKinsey & Company is a global management consulting firm. We
    are the trusted advisor to the world's leading businesses, governments,
    and institutions.
    We strive for world-shaping client impact
    We work with leading organizations across the private, public and social sectors. Our scale, scope, and knowledge allow us to address problems that no one else can. We have deep functional and industry expertise as well as breadth of geographical reach. We are passionate about taking on immense challenges that matter to our clients and, often, to the world.
    We work with our clients as we do with our colleagues. We build their capabilities and leadership skills at every level and every opportunity. We do this to help build internal support, get to real issues, and reach practical recommendations. We bring out the capabilities of clients to fully participate in the process and lead the ongoing work.”


    http://www.mckinsey.com/Client_Service/Healthcare_Systems_and_Services/About_this_practice

    “Healthcare Systems & Services
    • Overview
    • Expertise
    • Latest thinking
    • People
    • Case studies
    ‹ Back to overview
    About this practice
    Healthcare improvements have dramatically increased life expectancy, and new treatments are increasing the quality of life. Yet this progress has created daunting economic challenges. For decades, healthcare spending has exceeded GDP by two percent per year in most industrialized countries. Healthcare is now the world’s largest industry—with a value and cost three times greater than the banking sector.
    Most governments and healthcare leaders understand that spending increases cannot continue indefinitely and are looking for ways to increase efficiencies. How can organizations care for more people, with better results, at a lower cost?
    What we do
    We work with healthcare leaders to improve world health outcomes. We help:
    • National and regional health services to transform care delivery and make it more sustainable
    • Health insurance companies and other payors to improve the value of healthcare
    • Hospital chains to transform operational performance
    • Academic medical centers to refocus strategy, operations, and governance
    • Integrated care organizations to improve healthcare delivery

    We take a highly collaborative approach, from guiding national governments as they set priorities to working with nurses to improve hospital ward operations”


    http://www.mckinsey.com/Client_Service/Healthcare_Systems_and_Services/Expertise/National_Health_Systems

    “Healthcare Systems & Services
    • Overview
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    • Case studies
    ‹All Expertise
    National Health Systems
    We help national health systems fundamentally improve health outcomes, working with clients to expand access to health services, improve the quality of care, use resources more effectively, and deliver better patient experiences.”


    http://www.mckinsey.com/Client_Service/Healthcare_Systems_and_Services/People/Jean_Drouin

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  • and their is loads more about their work on their websites.

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  • tinkerbell

    Anonymous | 8-Feb-2012 4:31 am

    Will try to read and digest some of the above as found their articles page. Sounds like they dominate the world in innovation/change/improved productivity/efficiency all the buzz words. Wonder if stop watches are involved. They can certainly talk the talk...............

    Get back to you on it after i've waded through some of their 'spin' and see what world changing strategies they have employed in saving the world. The NHS should be a walk in the park for them after all they've achieved so far.

    Hmmm! We'll all certainly need to get our skates on to whizz round the ward and get things done in half the time with less staff by the sounds of it. Gladiator you will go on my first whistle!

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  • I must confess, Tinkerbell, that I only skimmed it early this am and picked out what i thought was most relevant to post here. I had never heard of the co. before and was interested to find out who they are and what they actually do and how much they can possibly know about nursing - and my conclusions remain as those in my post above:

    Anonymous | 7-Feb-2012 8:45 am
    and also

    4.55 pm and 7.29 pm

    what I find scary, apart from the large sum of money involved, is that they have contracts with the USA and Arab and other healthcare systems around the world which suggests private and costly and not the British NHS! Maybe they do not understand the differences.



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  • tinkerbell

    Apparently, according to Mckinsey, the answer is 'deleveraging' What does this mean in lay man terms? apparently it means paying off your debts, who'd have thought?

    But they say if you can't pay off your debts then it might be better to scrap the whole project and guess what, hand it over to the private sector. The whole project being i assume in this instance OUR NHS.

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  • Tinkerbell

    From Anonymous | 8-Feb-2012 11:30 am (alias Mu)

    This government is privatisation obsesssed.

    Last night I saw a report on Swiss TV news that they are considering selling the Houses of Parliament and Westminster to a private company.

    can this be true? It made me sit up with a start I almost fell off my perch!

    apparently the buildings are sinking and in need of costly repairs. It really wouldn't do if the cellars got damp and gunpowder could no longer be stored if the need arose! Has McKinsey been sniffing around there as well?

    Imagine a private British Government, private NHS and all that in addition to all the other privatised disasters in Britain (despite personal privacy of individuals being rapidly eroded). How about privatising the civil service and the military services while they are at it then there would be little left to privatise after that and far less for the government to meddle with and mess up any further! They could just rest and grow rich and fat on their pickings.

    I have repeated several times, and will do so again, the entreaty of a Swiss politician not to privatise the national railway here - just look at the disaster and resultant mess in Great Britain said she!

    DT said yesterday that the UK was 50 years behind Europe with its rail network. Unfortunately they left no space for comments!

    However, Switzerland continue to invest in their fantastic system and the customer pays with regular sharp fare increases but it is such an excellent system, which they keep up to date and with stunning projects for the future, who begrudges it? Incidentally a friend told me yesterday that they don't have problems in the freezing weather as they have gas heaters all alone the tracks or overhead cables - just imagine that?
    and they always come around with their trolley serving (naturally with a friendly smile) hot and cold drinks, fresh coffee, small bottles of wine and sandwiches, cakes, etc. - imagine that as well in the UK?

    At least nobody can privatise the Alpine sunshine!

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  • tinkerbell

    tinkerbell | 8-Feb-2012 12:27 pm

    so long as somebodys voice is listened to and hopefully that will be the doctors because they are usually more united and forceful, sorry nurses but that seems to be the case.

    The big question is what kind of society do we want? Do we want a society where my life is more important that yours because i have the means to fund my healthcare and you don't?

    Just cos' other countries don't have an NHS does that mean that we shouldn't either? How about selling one of your kidneys to fund your treatment? Apparently it happens on a daily basis in some countries where it is the norm. Have we been so pampered that we don't know what we've got until we lose it, so much taken for granted.

    Wake up everybody and get real about the changes and how they will effect YOU.

    Love me, hate me but don't remain neutral on this issue. Tme to stand up and be counted and united in our response. Stop moaning and take ACTION! If you've got some help and advice how to do this then offer it. Let's all share with each other how we can go about STOPPING this happening.

    This is life and death we're talking about.

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