- Carter to call for new ‘principal’ measure of nursing deployment from April
- ’Care hours per patient day’ derived from nursing and HCA hours per inpatient
- Expected call for national strategy to tackle absenteeism, bullying and turnover
Lord Carter’s review of NHS productivity is to recommend that a new metric – “care hours per patient day” – should become the principal measure of hospitals’ use of nurses and healthcare assistants from April this year, it has been revealed.
The new metric is due to be set out in Lord Carter’s final report on how the NHS could save £2bn through better management of its workforce, which forms part of an overall plan to achieve £5bn in efficiency savings.
“I know other directors of nursing share this view that this appears to have no reference at all to the safe staffing work that is going on”
The Carter report, currently in its draft form, is expected to say that one of the obstacles to eliminating unwarranted variation in nursing and care staff use has been the absence of a common means of recording and reporting deployment.
It argues that conventional measures – such as whole-time equivalents or staff-to-patient ratios – may not reflect varying staff allocation across the day. As a result, it will propose the use of care hours per patient day, calculated by adding the hours of registered nurses to hours of healthcare support workers and dividing the total by every 24 hours of inpatient admissions.
It will suggest that this metric can be broken down initially by registered nurses and support workers, and, over time, by pay bands within those groups, according to Nursing Times’ sister title Health Service Journal.
It is expected to recommend that NHS Improvement begin collecting care hours per patient day on a monthly basis from April 2016, and that it becomes the principal measure of nursing workforce deployment. Similar approaches would be extended to other professional groups the following year.
The final version of the Carter report, which is due to be finalised shortly having originally been expected in the autumn, follows interim findings published in June last year.
- ‘Stronger grip’ on NHS workforce management needed
- Lord Carter to produce ‘clearer guidance’ on nurse staffing levels
- Lord Carter calls for increased reporting of NHS staff data
The care hours recommendation is likely to generate concern among some nursing directors, unless there is explicit acknowledgement that safe staffing work done by the National Institute of Health and Care Excellence – and to be taken on by NHS Improvement – is the primary work trusts should be focused on.
One nursing director with knowledge of the proposals said: “The worry for me, and I know other directors of nursing share this view, is that this appears to have no reference at all to the safe staffing work that is going on.”
The report is expected to recommend that NHS Improvement work with the Royal College of Nursing and others to define staffing ranges for different types of wards as a guide for trusts.
The Carter review is understood to have identified significant variation across hospitals in staff turnover, sickness and reported bullying. It is expected to estimate that the real rate of sickness absence in the NHS is close to 6%, higher than both the private and public sector averages.
As a result, the report is expected to call for the regulatory body NHS Improvement to launch a “national people strategy” to tackle high levels of bullying, absenteeism and staff turnover, which Lord Carter believes will hamper the service’s efforts to improve productivity.
In addition, the people strategy will include an expectation that every trust chief executive leads a campaign against bulling and harassment and that trusts improve data collection for, and management of, sickness absence.