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Exclusive: 'Francis effect' leads to thousands more nursing posts

Hospitals are trying to increase the number of nurses and healthcare assistants working on their wards in a trend being attributed to a growing focus on patient safety in the wake of the Francis report.

An investigation by Nursing Times found a significant majority of NHS trusts have increased the numbers of nurses and HCAs they are prepared to employ – known as the funded establishment – despite the unprecedented financial strain on the health service.

In total, 102 NHS trusts responded to a freedom of information request asking for information about the funded establishment over recent years.

Of these, 73 had allocated more money to employing nurses in 2012-13 compared with the previous financial year. In addition,

59 hospitals increased the number of healthcare assistants in 2012-13 compared with the previous year.

Across the sample, this resulted in the creation of an extra 4,321 full-time equivalent nurse and 740 HCA roles. This is equivalent to a 2.6% and 1.3% increase in the size of the funded workforce respectively since 2011-12.

The rise in funded establishment posts represents only the financial commitment to employ nurses and HCAs, meaning the true number of staff working on the wards will be lower, depending on each trust’s vacancy level and its ability to recruit nurses.

The fluctuation in funded posts will also be affected by trusts gaining or losing services, and the opening or closing of acute facilities.

Professor Jim Buchan, from the School of Health Sciences at Edinburgh’s Queen Margaret University said: “What we are seeing is the effect of a definite post-Francis factor and trusts recognising issues of safe staffing and patient safety are much higher on the agenda.”

The Francis report into care failings at Mid Staffordshire Foundation Trust found insufficient nurses and a low skill mix were behind much of the poor care received by patients at the West Midlands trust. The trust had cut nurse posts in a bid to meet its financial targets and achieve foundation trust status.

Royal College of Nursing policy director Howard Catton said trusts had been focused on hitting savings targets and reducing staff “for years”

but “the ‘Francis effect’ brought the quality and safety component of doing that into sharp focus”.

He added: “That has not only forced many trusts to row back on those plans but also made some recruit more nurses. But, when they go out to the market, they find there isn’t the pool of nurses they thought.”

In the first part of our special investigation last week, Nursing Times reported one third of hospital trusts in England had already been forced to recruit nurses from abroad to fill vacancies.

John Adler, chief executive of University Hospitals of Leicester Trust, told Nursing Times his trust had 500 vacancies to fill after increasing the nursing budget by £5.3m.

He said: “What Francis has done is make people very aware that you can’t provide high-quality care on wards without a sufficient number of nurses – [but] creating the jobs is one thing, finding the people is another.”

Latest figures from the Health and Social Care Information Centre show the number of FTE nurses actually working in the NHS has fallen by 3,000 since 2010.

Twenty-nine hospitals out of the total of 102 reduced their numbers of nurses and HCAs over the past year (see box). University Hospitals Bristol Foundation Trust had one of the largest falls, as did United Lincolnshire Hospitals Trust.

Helen Morgan, acting chief nurse at University Hospitals Bristol, said the trust had closed just under 70 acute beds since March 2010 and had reviewed its workforce skill mix, shift patterns and ways of working.

She said she was confident the current nursing establishment was appropriate and met the Safe Staffing Alliance minimum of one RN per eight patients.

United Lincolnshire, which has been heavily criticised this year by the Care Quality Commission for its standards of care, has promised to invest £4m in extra nurses; 165 have joined the trust since April and more European recruitment is planned.

Sally Brearley, chair of the Nursing and Care Quality Forum, said the post-Francis focus on staffing levels was positive but warned it did not mean “the staff are actually in post”. She added: “Patient safety is about having enough staff on the front line. The rest is meaningless without that.”

A spokesman for Health Education England said: “HEE is planning commissions that will produce new nurses in 2017. However, there is much that trusts can do now, such as looking at “return to work” courses and focusing on retaining and retraining their current staff.”

Readers' comments (21)

  • Excellent news, and encouraging.

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  • it is good that the Francis now appears to be heeded and hopefully in future when nurses speak out they will be too

    visual image of the situation :-?

    nurses on the wards will soon all be tripping over each others' feet and twiddling their thumbs - there will be so many they and their patients won't know what has hit them

    the mountains of paperwork will melt under the weight

    and all we need now is for managers to bend over backwards to accommodate their ever desire such as adequate resources for them to do their job, listening to them when they give an opinion or get out their whistles and blow on them, (they may need a supply of ear plugs to dampen the noise) and see to it that their working conditions and pay is well provided for.

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  • Hmm. It took patient deaths on a horrific and shameful scale (whilst many nurses stood by and did nothing) and the action of their families and friends to gain public enquiries (whilst many nurses stood by and did nothing).

    What has not changed here is the behaviour of nurses. They still stand by and do nothing. Many wouldn't know what the hell you were talking about if you mentioned the Francis Report. The increase in staffing will be temporary and will be reversed when the cost becomes prohibitive. And nurses will stand by and do nothing. I guarantee it.

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  • michael stone

    Anonymous | 20-Oct-2013 12:39 pm

    'Many [nurses]wouldn't know what the hell you were talking about if you mentioned the Francis Report'

    If that is true, it is shameful [for the nursing profession].

    We must ask how these extra nurses are being funded (is money being used now from the budgets of future years ?) and will this apparent concern about staffing numbers persist once Francis is a less fresh memory ?

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  • michael stone | 20-Oct-2013 12:53 pm

    there are quite a number out there who aren't overly bright or worldly wise! some seem to live in their own little virtual worlds.

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  • Barts Health is proposing the opposite with a reduction in headcount and skill mix and yet are going ahead anyway. It makes me laugh how these 'chief nurses' get rolled out to justify the Trusts positions. I'm not sure who these corporate nurses are meant to represent but it sure isn't nursing, patients or carers.

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  • I don't know where you all work, but there's certainly no extra qualified staff on the cards where I work, indeed, the opposite is true.

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  • I think most nurses, and other health professionals, and the public are aware of the Francis Report. The increase in staff is more than welcome, but as a cynic, I suspect once a position is vacated, it won't be replaced and we will be back at square one.

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  • Anonymous | 20-Oct-2013 11:52 pm

    "I think most nurses, and other health professionals, and the public are aware of the Francis Report."

    Really? I did a crude poll at work the other day. Out of 21 nurses asked, 4 knew about the Francis Report. The rest hadn't a clue. Someone thought it was to do with missing children!

    I don't know about AHPs or the public, but the next day as I was chatting to some two of my neighbours, I did ask them if they knew what the Francis Report was. They didn't. Explanation from me didn't cause any bells to ring.

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  • And who will take the credit for the extra staffing?

    I can hear it now. " We have more nurses in the NHS than under previous government, that demonstrates our commitment to providing a first class NHS"

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  • michael stone

    Anonymous | 21-Oct-2013 8:26 am

    I only really 'knew about/was interested in' the Francis report from my lay position, because of my end-of-life engagement: otherwise, I think I would have briefly been aware of it when the media covered its publication, but that would have been all.

    From memory (I think I'm right about this, but it can't be guaranteed with my memory), the Neuberger Review of the Liverpool Care Pathway received more personal submissions from laymen than from HCPs, which does make you think.

    People only really pay attention to what they do themselves: so the people most aware of Francis will be the folk who are obliged to 'respond' to it (CCG Boards, hospital executives, etc); the people who were awar eof the LCP would be those staff who routinely used it; etc. Beyond this 'personal interest through involvement', people tend towards ignorance of things.

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  • On a lighter note:

    a boss said to a new employee
    'you are far too slow, you work too slowly, you move too slowly and you think too slowly. Is there anything you do fast?' - 'Yes I get tired very quickly'!

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  • Bart's Health are not thinking about safety of patients but how to SAVE MONEY!.
    It is another investigation waiting to go ahead in later years......
    Critical care patients who needs one to one care can not have one to one due to staff shortage.
    De-banding instead of promoting band 6s to band 7s.
    All they care there is "HOW TO SAVE MONEY" No one is Listening now but when the complains & enquiries start emerging from law suits then they the CQC & other bodies will start to listen but then it will be late for some....

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  • michael stone | 21-Oct-2013 11:51 am

    The events at Stafford Hospital and the subsequent inquiries, culminating in the latest Francis Report should interest every single nurse working anywhere in the UK.

    The collective wilful blindness of the Nursing profession is no longer explanable and certainly not acceptable.

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  • We have had more sisters added to our list.
    The staff nurse numbers remains the same. I wish it was the other way, as all the sisters are doing is delegating work to the staff nurses. They go on these courses to learn how to be assertive and delegate work.
    I am really fed up with the new way of leading, it is just cracking the whip, not leading by example.
    The patients are still being cared for by overworked nurses, while the sisters are not helping, except to make a bed or two with a health care assistant for show.

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  • I would dearly love to join in with this discussion . But after my 12.5 hr shift where there was not enough staff to take care of our elderly patients, I now have to go to bed, because I am so dog- tired and wait for it to all start again tomorrow, and hope that the right skill-mix of staff turn up for duty. Good night.

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  • " “What Francis has done is make people very aware that you can’t provide high-quality care on wards without a sufficient number of nurses" Did the NHS really need Francis and Mid Staffs to tell management this?

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  • michael stone

    patrick newman | 22-Oct-2013 12:44 pm

    Sadly, yes !

    What is blindingly obvious, definitely doesn't count in the NHS - before anything will change, you either need a 'formal investigation/report/piece of research' or else you need a prosection of some sort.

    'This cannot be right - even a 10-year old, would see something isn't right here !' unfortunately does not often lead to change of a fundamental nature.

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  • Even with the Francis Report, as has been pointed out by others, NOTHING has changed. Any impression that it has is merely cosmetic and will be temporary.

    Change will never happen within the NHS as a result of a report. The day that the healthcare professionals, in huge numbers and with one voice, say, "enough is enough" will be the day things change. Not before.

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  • I haven't met a nurse yet who hasn't heard of the Francis Report. But then I don't work on a ward any more, and generally work on an individual basis as a senior practitioner so don't rub shoulders as much as I used to.

    I feel that most nurses are so tired and overworked in understaffed areas that on first mentioning of "Francis" they are too distracted by work to think; but with a reminder will remember why they are feeling so unappreciated and devalued, and remember the disparaging remarks by this Government about nurses in the light of the (mis-quoted by Cameron) report.

    Its good that at last its recognised that lack of staff leads to lack of care. But most recruitment is for very low grade posts, and many of these are coming from overseas. Nursing students must be worrying if there will be any vacancies for them when they graduate. And whether they will ever be able to progress to a half decent salary that they rightly deserve.

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