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.”