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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”

Alison Leary

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.

Alison Leary

Alison Leary

“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.

Gail Adams

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”

Howard Catton

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.

Elaine Inglesby-Burke

Elaine Inglesby-Burke

“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.


What do you think?

We’re going to be discussing this story and its implications on twitter at 1pm Wednesday 11 June.

To join in, search for #NTtwitchat and use this hashtag in all your tweets.


Readers' comments (39)

  • michael stone

    'Specialist nurses are being made to abandon their caseloads to work on wards to bulk up staffing numbers, Nursing Times has been told.'

    Does anyone else, keep seeing this 'domino effect' whereby 'solving one problem is the [inevitable] cause of the next problem down the line' all over the place, is it just me ?

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  • michael stone

    very similar trolling style to IgonikonJack!

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  • Pointing out the impact of one decision on another sphere of activity is not trolling.

    Posting unsubstantiated stuff about trolling stye however is trolling.

    Oh no.... I just fed the troll!!!

    Or did I?

    On another note, there must be a cost/benefit analysis carried out alongside a risk assessment of such a process. Anyone who doesn't do that shouldn't be in a management role.

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  • Anonymous | 11-Jun-2014 11:50 am

    it was a general message for the attention of MS and applies across all of its comments and not particularly this one.

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  • Using specialist nurses in ward areas will enhance the numbers but what about the skill mix?
    As a specialist nurse myself I would say my skills have become quite specific; there are many competancies required on a general ward that I now longer am up to date with.
    It is a knee kerk instant 'fix' reaction with little consideration for other important factors.

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  • Tinkerbell

    fire fighting, robbing peter to pay paul, are these the only strategies on offer by managers on the titanic. Incompetent managers have got us in this complete mess by allowing the whole profession to become a pushmepull me profession, jack of all trades and master of none. Shame on them! Shame on us for putting up with it!

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  • Nothing new here then. When wards are short staffed i.e. winter pressures - specialist nurses have always been called upon to do shifts to cover. What exactly did Jeremy Hunt/government expect Trusts to do - they have no money! The NHS is required to save up to £20 billion by 2015, an average of 5% per year, the biggest efficiency challenge it has faced. Will this data show the skill mix of staff? I suspect there will be an increase in the HCA ratio to RN's. Whilst this would provide more 'hands on deck' you still need a certain 'number' of RN's on duty for the safety of patients. After all, HCA work is delegated from the RN who ultimately is responsible for the level of care given.

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  • about time specialist nurses see how hard ward based nurses work..... we dont get the recognition as much with the patients as we dont have time to sit and talk

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  • I agree with my learned colleagues. This is a 'sticky - plaster' situation that just patches over the underlying problem without solving or healing what is underneath.
    This is not new and has been going on for years!
    As for the culture of blame.
    I feel that there are very few managers that have voices that are heard these days and that they are terrified of loosing their own jobs. Lets 'not rock the boat' syndrome is a song that is long on-going!
    Nurses are historically, 'wingers' , so lets wake up everyone and stand up for what we believe in; 'better staffing levels to provide better quality and compassionate care and time for nursing staff to be objective and pro-active about what they are doing'!

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  • what do they mean by 'specialist' nurses, is it clinical nurse specialists or those who teach and don't work in clinical areas any more?

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