Nearly half of nurses believe their organisation is at risk of becoming the “next Mid Staffs”, or is already heading that way, reveals the latest large-scale survey on NHS staffing levels.
The findings suggest many nursing teams are still operating at danger point, with ongoing shortages damaging patient care, according to Unison. It carried out the poll of nearly 3,000 nursing staff on 4 March to show a typical “day in the life” of the NHS.
The union’s head of nursing, Gail Adams, said: “It is a unique insight through the looking glass into what it’s really like and what they are telling us is that it is bloody tough.”
As part of the survey, staff were asked to evaluate their organisation against the care failings at Mid Staffordshire Foundation Trust.
A worrying 31% said there was a risk of a similar situation developing, with 17% claiming it had already happened in all or parts of their organisation.
Only 7% said they were “very confident” a similar situation would never happen at their organisation, while just over 32% said they were “fairly confident”.
“On occasions, staffing levels are bordering on dangerous,” said one nurse who took part. “We are in a Mid Staffs situation and I don’t believe we are the only ones.”
“What they are telling us is that it is bloody tough”
The results mirror those from a survey carried out by Nursing Times in February to mark one year since the publication of the Francis report.
The Nursing Times survey of around 500 nurses found more than half believed their ward or unit remained dangerously understaffed 12 months after the seminal report into Mid Staffordshire Foundation Trust.
Unison said it had shared its survey findings – published in a report titled Running on Empty – with the Care Quality Commission to help potentially pinpoint individual organisations where staffing levels could be putting patients at risk.
The survey also found 45% of nurses were caring for eight or more patients, which went up to 53% for those working night shifts.
“The majority looking after eight or more were in medicine, surgery and elderly care, so we’re talking about patients that are quite vulnerable and whose dependency can be quite significant,” said Ms Adams.
“Research that’s been around for the last two to three years tells us that if you are looking after eight or more patients then harm is occurring,” she said.
“You’d have hoped that research would have informed practice and workforce planning.”
This is the third time Unison has carried out the survey, and Ms Adams said one of the most frustrating findings was that so little had changed since the previous year – despite a new focus on safe staffing since the Francis report.
When asked if there were enough staff to deliver safe, dignified, compassionate care, 60% of nurses said “no” and 31% said “yes” – mirroring last year’s result.
In addition, 65% of nurses said they did not have enough time with patients with 55% reported care was left undone as a result.
“We are in a Mid Staffs situation and I don’t believe we are the only ones”
This is despite the fact 58% worked through breaks or beyond the end of their shift.
A further 45% said they had worked for up to an hour unpaid, while 10% said they had worked up to two hours past the time they were supposed to finish.
The research also highlighted continuing reliance on bank and agency staff, with 45% reporting they had worked alongside one or more bank or agency workers on the day of the survey.
In addition, 80% said their employer frequently used bank or agency staff, a third of whom said this was because of chronic short staffing problems.
The survey report includes a series of recommendations, including calling for the creation of staffing level standards that would be legally enforced.
Failing that, Unison wants mandatory minimum nurse to patient ratios to be set nationally, which should be somewhere between one-to-four and one-to-six in certain types of wards.
The survey found almost 92% of respondents support minimum staffing levels, with 65% in favour of a legally enforceable minimum.
“We think nurses should be automatically reporting incidents where they are looking after eight or more patients or where they can’t deliver the standard that’s required,” said Ms Adams.
She said another concerning finding from the survey was the fact nurses were still reluctant to raise concerns. Half reported not feeling confident in doing so.
On Friday a joint report by the Nuffield Trust and the Health Foundation noted that nurse levels in Scotland, Wales and Northern Ireland had overtaken England in recent years.
The report said that since a previous study in 2010, which used data up to 2006-07, nursing staff levels have been lower in England than in the other three countries.
Earlier this month, NHS England and the CQC published guidance for trusts on publishing information on staffing levels, which forms part of the government’s response to the Francis report.
By June, trusts will have to display the number of staff on each shift outside each inpatient ward, publish monthly updates on staffing levels and review their establishment every six months.
However, as reported last week by Nursing Times, nurses have questioned how useful the data will be without also including the number of patients on a ward.
The Unison survey results were revealed today at the union’s annual healthcare conference in Brighton.
Tomorrow, union leaders are due to seek an emergency vote at the event, asking for permission to ballot its 450,000 NHS members over potential industrial action.