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NHS England to develop new indicator for nurse staffing levels

Nearly one in 10 hospitals in England had a fill rate for nursing shifts of less than 90% during May, according to data published for the first time yesterday.

The data on actual versus planned staffing levels was published on a new section of the NHS Choices website, along with other information on the number of safety incidents reported by trusts. The staffing data comes from more than 20,000 shifts across 6,700 wards.

As well as submitting monthly data to NHS Choices, trusts must also begin displaying individual ward staffing levels on boards outside all adult inpatient wards.

Both form part of the government’s new Sign up to Safety campaign, which was also launched last week. All trusts are invited to join the campaign to halve avoidable harm over the next three years.

The staffing measures were announced by the government in 2013, following recommendations made by the Francis report into care failings at Mid Staffordshire Foundation Trust. Greater transparency around nurse staffing data was central to the government’s response to the report.

The data on hospital staffing has been reported as a percentage of planned nursing hours that were filled during the month. Just 8% had fill rates of less than 90%, while 46% of trusts had either fill rates of 90-100% or more than 100%.

However, the data is an aggregate of all registered nurse and healthcare assistant hours over the month, so may mask situations where a shortage of registered nurses has meant more healthcare assistants have been used or wards with regular understaffing. 

Fill rates of more than 100% are likely to have been driven by increases in patient acuity, which meant more staff were required than originally planned, such as one-to-one “specialling” of particularly vulnerable patients.

Staffing graph

Graph showing shift fill based on new staffing data

The NHS Choices website does not currently rate hospitals on the data they have submitted on staffing levels. As a result, valid comparisons are difficult to make between organisations at present without a national standard.

This compares to other indicators included on the new website, such as infection control and incident reporting standards, where hospitals have been rated either “good”, “bad” or “okay”.

NHS England chief nursing officer Jane Cummings said it was too soon to say from the data which organisations had concerning levels of staffing and the most valuable aspect of the information at the moment was the ward level data that trusts were required to publish on their own websites.

Asked about plans to rate trusts on their staffing levels in future, she said a composite indicator would be developed over the next six months, which would also look at factors such as sickness absence rates and use of temporary staffing.

Ms Cummings said the idea would be to start with an indicator for acute trusts and move into other sectors once the National Institute for Health and Care Excellence had developed safe staffing guidance for them.

Draft guidance on staffing adult inpatient wards was published for consultation in May by NICE.

The drive on staffing transparency has largely been welcomed as a step in the right direction, but there has been some criticism of how useful the data will be in its present form without the inclusion of patient numbers.

Only two trusts failed to submit their May data by the deadline: North Bristol Trust because staff and services were moving into a new hospital during the month, and Guy’s and St Thomas’ Foundation Trust because they had been recording the data in a different format.

Readers' comments (2)

  • "However, the data is an aggregate of all registered nurse and healthcare assistant hours over the month, so may mask situations where a shortage of registered nurses has meant more healthcare assistants have been used or wards with regular understaffing."

    Until all data about staffing levels is broken down by band it can be manipulated this way and is in essence meaningless.

    C- Must try harder.

    See also figures about numbers of "nurses" employed, which frequently do NOT separate qualified nurses from HCAs...

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  • Unfortunately these figures are drawn from figures of nursing teams who have already been stripped of substantive roles to save money and new staffing numbers do not meet the needs of the patients we are currently seeing. Cut staffing teams will reduce the overall numbers required to fill vacancies and therefore give skewed data. What are the real figures dependant on patient/staff ratio be I wonder?

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