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Falling hospital nurse numbers could signal peak of 'Francis effect'


Nurse staffing levels in NHS hospitals have fallen for the second consecutive month, sparking warnings that recent recruitment drives could have peaked following the Francis report.

Latest official figures show that the nursing workforce in the acute, elderly and general sector shrank by almost 500 nurses from June to July, bringing its size down to 174,545 posts.

Combined with losses from the month before, there has been a reduction of 690 whole-time equivalent posts since May, when numbers reached an all-time high of 175,235.

“It may be that the post Francis staffing growth has peaked, reflecting tightening budgets”

James Buchan

The figures could represent bad news with winter just around the corner and renewed focus on finances – the health service is currently heading for £1bn deficit by the end of 2014-15.    

While overall nurse numbers have climbed by 6,000 over the past 12 months, many wards around the country remain short-staffed after deep cuts made in recent years due to financial pressures.

The acute sector data comes against a recent backdrop of falling numbers of whole-time equivalent registered nurses and midwives more generally in the NHS.

Robert Francis QC

Robert Francis QC

Provisional workforce figures for July – the most up to date information currently available – were published last week by the Health and Social Care Information Centre.

The data shows there has been a decline in the overall number of NHS nurses for four consecutive months, which has seen a combined loss of 1,929 workers since March.

In July, the health service’s qualified nurse workforce stood at 312,873.

The apparent return to decline follows a period of intense recruitment in the acute sector by hospital managers in response to last year’s Francis report into care failures at Mid Staffordshire Foundation Trust.

“There are 6,000 more nurses, midwives and health visitors than this time last year”

Department of Health

The upward trend – dubbed the “Francis effect” by some – was further cemented by new guidelines on safe staffing by the National Institute for Health and Care Excellence in July this year and new rules in June from NHS England requiring the publication of details of ward staffing levels.

However, the latest workforce figures suggest the Francis effect may have reached its limit, according to Professor James Buchan, a workforce expert from the School of Health at Edinburgh’s Queen Margaret University.

Queen Margaret University

Jim Buchan

He said: “It’s too early to say for certain, but it may be that the post Francis staffing growth has peaked, reflecting tightening budgets.”

The Royal College of Nursing said it too was concerned that the Francis effect could be coming to a premature end.

RCN policy advisor Stuart Abrahams said: “We are concerned that the Francis effect may be stalling. We want to see improvements in recruitment and to ensure that there are the right and safe number of staffing on wards to ensure safe patient care.”

He cited a number of possible reasons behind the decline reflected in the figures, such as trusts struggling to recruit due to the current national shortage of nurses and vacancy freezes. He added that the RCN hoped trusts would be focussing on filling these vacancies over the coming months.

A Department of Health spokesman said: “There is always a dip in numbers of nurses in the summer because of the way the training cycle works, but then numbers normally increase again in September. There are 6,000 more nurses, midwives and health visitors than this time last year.”

Meanwhile, a “challenging winter” has been forecast for the NHS in England by a leading health think-tank, which also warned of “worrying” declines in levels of morale among staff.

A severe winter is being predicted

In its latest quarterly report, the King’s Fund described widespread gloom about budgets workforce issues among NHS finance directors.  It said “increasing workloads and a downward pressure on budgets” were contributing to a decline in morale.

Last month at a Nursing Times conference for deputy nursing directors, a panel of senior nurses was asked whether, during the current financial pressures facing trusts, they believed the NHS would “hold its nerve” on maintain the extra nursing posts created in response to the Francis report.

Janice Sigsworth, director of nursing at Imperial College Healthcare Trust, said she thought trusts had no choice than to maintain the focus on improving nurse staffing levels in the wake of Francis, adding that it was the role of nurse executives and other board members to “hold our nerve and make the right decision”.

Elaine Inglesby-Burke, executive nurse director and deputy chief executive of the Salford Royal Foundation Trust, agreed that it was the responsibility of nurse leaders to “make sure that the investment that has gone in is used to deliver great care and also improve efficiency”.

Nursing Times Deputies' Congress

Janice Sigsworth and Elaine Inglesby-Burke take part in panel discussion


Readers' comments (15)

  • michael stone

    Well, 'Out of sight, out of ..' is perhaps what is happening here.

    It has never been clear, where the money for [needed] extra staff was coming from, in NHS [increasingly squeezed] budgets.

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  • Because of the high pressure on the wards more and more nurses are leaving NHS. Sometimes I am thinking it is only about documentation and fear of complaints instead of taking care of patients and maintaining high morale for staff. And is sad.

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  • I am not sure more nurses are leaving the profession but 'moving' from organisation to organisation within the umbrella of the NHS service delivery. This means that this leaves wards understaffed, staff that are leaving are not motivated because they are leaving, and often experience is lost and replaced with newly qualified staff. This is turn creates the start of the cycle as newly qualified feel it would be better elsewhere, and so the cycle continues. However, making current posts attractive and supportive, having training and days to reflect and work inter-professionally, making the new staff feel welcomed so they stay I feel is key in stabilising numbers within the clinical areas.

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  • Due to Erostering and forcing Nurses to work shifts without decent recuperation breaks between shifts and no support from managers we have lost 15 to 20 staff this year!! Not including the numerous nurses on years maternity now running short staffed on Bank shifts...Its Hell.....Nursing is not what i will be recommending as a career!!

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  • Perhaps if out dated terms like 'matron' and 'sister' were deleted from the profession, nursing would be more attactive to males also, this is an untapped resource that has proven to increase the potential of professionals in the market. Nursing should be treated as a 'professional career' not a 'trained body'. Stop 'training' nurses and start educating them!

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  • Why the surprise? No nurse/patient minimum ratio's, no recommended 1% increase (they can afford tax cuts for their pals!); nurses constantly take the blame for the lack of funding to the health service; constantly blamed by patients who do not get the outcome they want/for having to wait/for not getting what is convenient for them; the ludicrously huge rise in contributions to the NMC gestapo that we have no choice over; the total erosion of any type of life outside work due to the arduous, heavy, mentally draining workload that is foisted upon us; no funds for training so those entering on a band 5 are likely to stay there for the foreseeable future with little chance of promotion; coupled with the ever increase in compulsory updates that have to be taken in our own time...........the list goes on and on.

    I would never recommend any young person to take up nursing unless they are intending to work in the USA/Australia etc. Accounting, Law, Media, Marketing, Management and Politics are all better options for any bright young thing with a much better future. At least when politicians get blamed in the media they are rewarded adequately fiscally.

    I now feel so battered by the media that I never admit to what I am and always change at work so as not to wear the uniform. This is what I feel they have brought us to.

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  • photo is a very poor advert. don't they launder and iron the sheets anymore?

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  • Five empty beds on one ward....that photo has been rehashed from the 70's surely? Bed manager's everywhere will be on the phone as we speak trying to fill them ;)

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  • I walked out after 40 years of nursing. Best decision I ever made. Bullying managers, no staff, getting all the crap shifts if you're not the manager's bezzie mate, paying £100 a year to work, drop in real term wages. No thanks - I'll save that £100 a year ransom demanded by the NMC just to get treated like a recalcitrant school kid because I question why we need 6 more managers than we did 6 years ago. That makes me 'not a team player' apparently.

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  • what is a "team player" - really!!!!!!!!

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