Exclusive: Specialists called onto wards as pressure mounts for safe staffing
Specialist nurses are being made to abandon their caseloads to work on wards to bulk up staffing numbers, Nursing Times has been told.
The revelation comes amid intense pressure on trusts to publish “safe staffing” data to the public, as part of the government’s response to the Mid Staffordshire Foundation Trust public inquiry.
“About a third of people in a room of 70 said they had been asked to work on wards and that meant abandoning their caseloads”
Last year, health secretary Jeremy Hunt said all NHS hospitals would have to display the planned and actual number of nurses on each shift on each ward by the end of June at the latest. This data would then be collected by NHS England and published on the NHS Choices website.
Trusts were given until 10 June to submit information on nurse staffing on their wards during May to NHS England.
Many organisations are reported to have worked “flat out” to meet the deadlines, with a national shortage of nurses adding to their difficulties in filling shifts. Nursing Times has learned the pressure on trusts has led some to ask specialist nurses to work on the wards.
Alison Leary, an independent healthcare consultant who has researched specialist nursing, said she was getting “four to five emails a day” from specialist nurses concerned about being deployed to hospital wards to make up the numbers.
“At a recent conference on long-term conditions, I did a straw poll and about a third of people in a room of 70 said they had been asked to work on wards and that meant abandoning their caseloads,” she told Nursing Times.
While this has been an ongoing problem, Ms Leary said she had seen a sharp increase in complaints over the past six months as the deadline to publish staffing information approached. This was fuelling concern trusts might be tempted to “game the system” to look good to patients and commissioners, she said.
Unison’s head of nursing, Gail Adams, confirmed members and branches had reported “specialist nurses being told they had got to be on a ward on a certain day”. “It’s robbing Peter to pay Paul,” she added.
The data on nurse staffing is due to go live on the NHS Choices website on 24 June. While there is widespread support for increased transparency on staffing levels, there has been growing concern about how this data will be used at a national level to make comparisons between organisations.
NHS England originally told trusts that when the information was put on the site they would receive a red, amber or green rating for safe staffing, based on the fill rate of shifts over a month.
However, Nursing Times has learnt that trusts will not now be rated in this way when the data is first published.
“If it’s not a true reflection of the number needed, then it could give the public a false sense of security”
The drive to make every NHS provider publish ward-level staffing data was inspired by work at Salford Royal Foundation Trust.
Chief nurse Elaine Inglesby-Burke said uploading the data to NHS Choices was “absolutely the right thing to do”.
However, she warned organisations that set a high staffing standard but didn’t always achieve it could end up looking worse than those that had set lower standards.
“Unless we identify a national standard, I don’t know how you can compare across organisations,” she said.
Royal College of Nursing director of policy Howard Catton stressed the publication of staffing data was “a good first step” but added there were potential “weaknesses”.
“We’ll get to see planned versus actual numbers so the supposition is the planned number is the right number,” he said. “But if it’s not a true reflection of the number needed, then it could give the public a false sense of security.”
However, former nursing director Elaine Maxwell, a non-executive director at Basildon and Thurrock University Hospitals Foundation Trust, said trusts were more than capable of dealing with potential negatives.
“If you have an establishment with a very rich number and skill mix and then are not able to achieve it and you are rated amber or red then it’s up to you to communicate to the local community why that is. We saw with mortality rates that trust with high rates were able to explain those and it did not stop people from coming,” she said.
“Publishing the data might help improve staffing levels in the same way that publishing mortality rates for surgeons led to improved outcomes”
Anne Marie Rafferty
Anne Marie Rafferty, professor of nursing policy at King’s College London, described the initiative as “a huge experiment”.
While a single figure could not reflect the complexity and variables involved in ensuring safe staffing, she said publishing the data might help improve staffing levels in the same way that publishing mortality rates for surgeons led to improved outcomes.
Anne Marie Rafferty
“Identifying variations between similar units is a starting point for asking questions,” she said.
A spokesman for NHS England said work was continuing to refine how the data would be presented on 24 June to ensure it was “easy to understand and meaningful” for the public.
He said if a specialist nurse was vital to the needs of patients on a ward, they should be part of the complement of that ward’s staff.
“This is not about ‘gaming the system’. It is about ensuring openness and transparency of data to give the public confidence in hospital services,” he said.
NHS England said staffing should be determined using an evidence-based approach and should be reviewed regularly.
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