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London rethinks plans to slash nursing numbers

The NHS is re-examining a controversial review that concluded London’s hospitals could safely slash their nursing workforce through greater productivity.

The report in February identified savings of £421m in the capital’s nursing workforce over the next three years.

But Nursing Times has learnt that senior nurses have been involved in reassessing the conclusions of the “Safe and Financially Effective” review, which was carried out by the strategic health authority NHS London using methodology developed by management consultants.

The review had concluded that London’s non-foundation trusts could safely slash their £1.5bn total nursing spend by nearly a third. Individual reports sent to trusts advised some they could reduce nursing spend by half if they matched the efficiency of similar trusts.

However, an internal document released to Nursing Times under the Freedom of Information Act shows NHS London has had to re-examine the assessment.

The document said: “The SaFE analysis was perceived to be too high level to properly comprehend the nursing productivity challenge. Further analysis of the problem is required.”

Nursing Times understands members of the senior nursing community had raised concerns about the scale of savings being suggested by the analysis and that its methodology was not sophisticated enough.

The review compared the London trusts with other similar sized NHS organisations from around the country and calculated a “productivity opportunity” figure suggesting what they could save if they were as efficient.

Nursing Times understands the second review is almost complete and the revised “productivity opportunity” is a fraction of that identified in the SaFE report at some trusts.

An NHS London spokesman said: “The first programme was a desk top review and the current pilot is a trust based data collection exercise using a remodelled template.

“It takes account of a wider group of measures than the initial desk top review, which was for indicative purposes only. The recent pilot was developed by a group of senior nurses and nurse directors from the trusts.”

Royal College of Nursing head of policy Howard Catton said NHS managers should be wary of “productivity get rich quick schemes”.

He described the original review as a “blunt assessment” that failed to take into account London’s unique workforce and population variables.  

“It’s reassuring clinicians are being asked to look at what the workforce requirements are,” he added. “We’ll see what the next steps are.”

However, Mr Catton noted that nurses had been telling the college for some time that their organisations were already “lean” in terms of productivity and workforce.

Professor Anne Marie Rafferty, dean of the Florence Nightingale School of Nursing and Midwifery at King’s College London, said: “Estimates of productivity gains are as good as the definitions and assumptions on which they are based, and in this instance rely upon what a ‘peer’ trust in another part of the country might be.

“Equally such estimates need to be calibrated against demand, which seems to show no signs of slowing down.”

Readers' comments (17)

  • tinkerbell

    if it wasn't so serious it would be laughable. No wonder the tory spivs didn't want the risk register published and got it buried somewhere where no member of the public could have a look.


    Why don't they just have one big closing down sale of the NHS and have done with it rather than dragging out this misery on the pretence that we will still have an NHS after all this is over.

    For the future we will only be healthy if we are wealthy.

    Nothing is being learned about all these cutbacks because those in power have their own get rick quick agenda whilst pulling the rug out from beneath all working class folk.

    There's loadsa money to be made from other peoples misery.

    Whoever thought it would come to this in our society, money before human lives.

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  • So these money saving schemes are now called "pilots" because they don't work?
    Using management consultants instead of front line clinicians was discredited years ago.
    Unfortunately, this backtracking is too late for some who have been penalised unfairly by this initiative.

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  • What I dont quite understand is the term "desk top review". Does that mean that now the flaws in this have been highlighted by people in the know (commonly known as nurses) that they are admitting that they didnt actually do any research before plucking an idea out of the air with the intent of making the NHS all the more attractive to perspective buyers?

    As Tinkerbell says, it is almost farcical!

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  • Yes But

    'The document said: “The SaFE analysis was perceived to be too high level to properly comprehend the nursing productivity challenge. Further analysis of the problem is required.”'

    The NHS probbaly couldn't investigate whether a brewery contained beer - the number of times you read some very expensive and fancy-looking 'report' and think 'Oh for heavens sake ! Do it again, and right this time, ,please !'

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  • Initiatives and ideas in NHS go in cycles of about 8-10 years. This one is a particularly nasty one, but there will be u-turns eventually

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  • Yes, undoubtedly there will be U-turns - but not before a lot more havoc is wreaked on the NHS.

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  • Why don't they just get rid of all the staff that come up with these ideas and sit around a table deciding how to get rid of frontline staff. If they went, money saved, problem solved.

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  • What will the next amazing discovery to be made following months of costly, but effective research by our Accountant led Government appointed NHS Management teams and their Fiscal based Management Consultants?

    The wheel perhaps....

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  • michael stone

    Roger Hodgson | 6-Nov-2012 10:28 pm

    Not sure about the wheel - that could be too much of a challenge: fire for cooking, perhaps ?

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  • Tiger Girl

    Roger Hodgson | 6-Nov-2012 10:28 pm

    DH Agent - as if ! | 7-Nov-2012 10:17 am

    The flint axe ?

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  • another load of waffle talking meangingless old tosh that cost a fortune, when will people learn that this is just a load of old bollo's.

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  • tinkerbell

    London rethinks plans to slash nursing numbers and slashes them anyway but at least it sounded like they had a conscience and then it turned out they didn't.

    Nurses please don't fall for all this tosh and fruitless headlines, they really don't care, when we understand that, THAT REALL DON'T CARE, then we will be mentally armed for the fight that is ahead, or we can just lie down and take one shafting after another because be in no doubt whatsoever the beatings will continue for us long as we are prepared to take them. There is nobody coming to rescue nursing or our NHS in this unelected government, they are the perpetrators. Let's not all be victims of this abuse.

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  • tinkerbell

    should read 'when we understand that THEY REALLY DON'T CARE'

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  • How much for the first 'analysis'? More than for the second?

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  • Okay, the reality is that overall care is good in the UK. Media stories highlight when it goes wrong because those headlines mean readers/money. It makes the NHS spend a fortune in time, money & effort identifying what we do wrong which crushes morale of staff, particularly nurses. Then on top, we have a management and government who believe all this tosh and instead of seeing us as valuable members of the clinical team, see us as an unnecessary expense.

    Result, get rid of nurses, it will save us money. The message is that we are a waste of resource.

    Lets see how much of a waste we were when there are hardly any of us left and no new nurses coming through because of slashed training places too. When the negative media stories are no longer headline grabbing rare events but are true and the norm.

    No disrespect to our HCA colleagues, but there is a reason why we are registered professionals and no amount of wholesale substitition with reduced no's of HCA's can compensate for a well educated, highly skilled and trained professional nurse.

    The real issue here is demand. Tackle health issues and demand and you will find natural, undamaging efficiencies. That said, ageing population, population growth will mean demand will always need managing.

    And while I'm at it, isn't it about time our doctor colleagues started to stand up for us. I for one find it galling to know that as junior Dr's they relied on me to show them/tell them what to do, but as Consultants they refer to us as 'just nurses'. How many of you have been asked by a doctor for advice on treatment, what drug, how much, what do I think is wrong? They are not testing me, they do not know. Who is it that has to do complex calculations to ensure the correct dose is administered, especially where weight is a factor?

    Come on, we are all essenital to safe & effective care and without nurses there is no such thing!!

    Rant over!

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  • The Tory government are cleverly cutting nursing posts (and destroying the NHS covertly) by promoting media hype about poor care that has likely been a result of a sheer LACK OF RESOURCES AND SHORT STAFFING, due to their cuts! They are reducing public support and respect for nurse's through the media so that our professional voice is severely weakened in the public domain. Unfortunately, we live in a society where ignorance dominates and people believe whatever they read in the 'Daily Mail'! God help us! The above is yet another way for this evil government to make more cuts and cause more deaths in the NHS and shift blame on to the nursing profession, AS ALWAYS! AND typically, our profession accepts the blame??! What the hell?! The vast majority of nurses are GOOD NURSES. Stand up for them because nobody else will! Stop your spine-less comments about your colleagues and DO YOUR RESEARCH! In the end, the Tories will win as they will have 'proved' to the public that the NHS has already failed... Bye, bye NHS!

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  • tinkerbell

    Anonymous | 10-Nov-2012 1:10 pm

    EXACTLY! Well said.

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