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”
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.
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.
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”.