Many trusts will need to increase their nurse numbers to comply with new national guidance on setting safe staffing levels in England, Nursing Times has been told. Meanwhile, latest workforce data shows huge variation between hospitals.
Guidance from the chief nursing officer for England and the NHS National Quality Board was announced last week as part of the government’s full response to the Francis report.
It said, from April, all hospitals would have to publish staffing levels on a ward-by-ward basis together with the percentage of shifts meeting safe staffing guidelines. This would be mandatory and done on a monthly basis.
By the end of next year this will be done using models approved independently by the National Institute for Health and Care Excellence, it added.
It is widely expected to lead to trusts identifying shortfalls in their staffing establishments.
There is no official estimate of how many extra nurses might be needed to meet requirements such as cover for unplanned leave among staff.
However, the Royal College of Nursing recently estimated there were at least 20,000 vacancies for registered nurses, while the Centre for Workforce Intelligence has predicted a shortfall of 47,500 nurses by 2016.
Meanwhile, Nursing Times has obtained data suggesting a big variation in nursing ratios between hospitals which gives further indication that the shortfall will be significant.
Data from June, compiled by analytics company Methods and shared with Nursing Times, shows the ratio of available nurse staff days to occupied bed days for every NHS acute hospital.
The ratio among acute trusts varies from 1.33 at Tameside Hospital Foundation Trust to 2.59 at University College London Hospitals Trust. Among trusts that provide both acute and community services, the ratio ranges from 1.52 at Croydon Health Services Trust to 3.34 at Guys and St Thomas’ Foundation Trust.
Even when the varying size of organisations is taken in account, some organisations currently appear to have one and half times more nursing availability than others.
The data must be treated with caution as it includes nurses who are not in patient facing roles and excludes day cases.
Both Croydon and Tameside have been subject to much public scrutiny due to concerns about quality and staffing levels, and are planning to increase their numbers of registered nurses. In total, seven of the 10 acute trusts with the lowest ratios are among those that the CQC has highlighted concerns about.
Ruth May, NHS England’s director of nursing for Midlands and the East, led the development of the new guidance for boards on staffing.
She told Nursing Times the first step for boards was to make sure they knew what their establishment should be.
“To begin with people will be surprised to see they have got a shortfall, but as the weeks and months go on, organisations will get better at aligning their staffing levels,” she said. “It’s likely we will see trusts increasing establishments as well as more focus on rostering correctly to maximise staff they have got.”
Dr May said the idea was for staffing levels to be reported in a similar manner to how wards report how many days they have been free of a pressure ulcer or an MRSA infection.
She stressed the guidance applied to community and mental health providers just as much as acute trusts.
Although additional nursing recruitment is likely to be welcomed by the profession, there is widespread concern among hospital managers about whether it is affordable in the long term. An additional 8,000 band 5 nurses would cost the NHS about £320m.
A Nursing Times investigation earlier this year found 73 acute trusts had increased their nursing establishment in 2012-13 by a total of 4,321. Last week Health Education England revealed trusts are planning to employ an additional 3,700 nurses during the current financial year.
Royal College of Nursing head of policy Howard Catton told Nursing Times it was encouraging that the government seemed to be finally recognizing the existence of a nursing shortage.
“There is a question mark about what the extent of that shortage would be. The work that’s going to flow from this new guidance will put us in a much better place.”
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