Directors of nursing have warned of their increasing concerns for patient safety as the winter period approaches, claiming the “pendulum is swinging” towards trust decisions being led by financial considerations due to the escalating NHS deficit.
At Nursing Times’ first ever Directors’ Congress last week nursing directors from across the country said the additional investment and focus placed on safe staffing in the wake of the Francis report was now at risk of being lost.
“We are holding the line on opening extra beds, because we haven’t got the money”
The chief nurses highlighted a recent letter sent to trusts from NHS England and the main regulatory bodies, which stressed the nationally recommended minimum one-to-eight nurse-to-patient ratio for adult hospital wards was just “a guide”.
Some noted that it had been met with apparent delight by their fellow trust executives who were keen to save money.
Meanwhile, they said bed closures by local care homes and mental health providers were already creating extra pressure on acute hospitals, which then became the only option for patients.
This was on top of the national nursing shortage, with some trusts now having hundreds of vacancies, they added.
It was also claimed that some acute providers would this year receive reduced money – up to 50% less than 2014 – from clinical commissioning groups to cope with the usual winter pressures.
“As we go into the winter period this year, where finance is king, a letter like the one last week will not help nurse directors”
However, despite the focus by trusts on saving money, the nursing directors said they would hold off opening extra winter pressure beds, if they did not have the money or staff for it to be safe to do so.
Karen Dawber, director of nursing at Warrington and Halton Hospitals Foundation Trust, said: “CCGs are not funding extra beds like they have done in the past so their view is it’s Payment by Results.
“When you’ve got 100 delayed discharges, the only bit of PBR you’re going to get is an excess bed day,” she said.
Ms Dawber noted that if extra beds had to be opened at short notice, the staff required for them then had to be paid premium rates.
“We are holding the line on opening extra beds, because we haven’t got the money… If you look at the work being done around the country on system resilience, most places are saying they haven’t got the winter funding that they had before,” she told Nursing Times.
Another chief nurse at the event, who was from a large acute trust but asked not to be named, said: “We’ve hit winter already, we’ve found more and more nursing home beds shutting around us, more and more mental health beds being shut and, as a result, we are also starting to fail our emergency target.
“We are struggling. I am getting to the point where I’m really worried about the impact on care. I am holding closed beds where I am not staffed but it is really tough,” she added.
“The NHS is busy but this year prepared for winter earlier than ever, and is performing well”
Sherree Fagge, chief nurse at Brighton and Sussex University Hospitals, told Nursing Times the letter from NHS leadership bodies last week emphasising safe nurse staffing was a guide would make it more difficult to secure nurse posts.
“As we go into the winter period this year, where finance is king, a letter like the one last week will not help nurse directors,” she said. “Research shows the more registered nurses you have, the better the outcomes. Not having a 1:6 or a 1:8 is a false economy.
“I am feeling anxious that the pendulum is swinging towards financially-led decisions instead of being quality-led, which is what we had immediately after Francis,” added Ms Fagge.
Another director of nursing, who asked not to be named, warned delegates to be “careful” of the language being used by NHS bodies and trust executives in general.
“There were some subliminal messages being described [in the letter] and they’re not just coming out through boards, they are coming out through Monitor performance meetings,” she said.
“There is some concerning language around ‘do you work to outstanding?’, ‘could you cope with things if you were just good enough?’.”
The chief nurses said they found themselves “walking on a tight rope” – as one described it – by trying to balance safety with finance concerns. They called for nurse leaders to “be brave” and “speak together with one voice”.
“We need to be brave and start saying no to things and be a professional force to be reckoned with,” said one delegate to a round of applause.
A Department of Health spokesman said: “The NHS is busy but this year prepared for winter earlier than ever, and is performing well.
“The overwhelming majority of patients are treated or admitted to hospital quickly – with 3,000 more people being seen every day within the four-hour target than in 2010,” he said.