Trusts under pressure to make greater efforts to reduce deficits have indicated they will not be limiting nurse staffing numbers, despite suggestions of “headcount reduction” by regulators.
A snapshot survey of financially challenged acute and mental health trusts by Nursing Times has found most do not plan to reduce nurse numbers, with some stating they are committed to increasing staffing levels.
“We continue to take very seriously our position on maintaining safe nursing ratios”
Northern Lincolnshire and Goole
A joint letter sent in January by regulators Monitor and the NHS Trust Development Authority warned trusts that “collective urgent action” was required to contain this year’s deficit to £1.8bn. The letter asked providers to consider a range of actions they could take to improve their financial position for 2015-16.
It added that regulators would meet with a number of “challenged” providers to agree a set of actions, including headcount reduction, with the “clear intention of improving the financial position of those individual providers”.
“We are firmly committed to reducing our reliance on costly agency staff”
Nursing Times asked 21 foundation trusts listed by Monitor as having a “significant” or “material” level of financial risk whether they had or intended to meet with the regulator on this issue and if they would implement a strategy of “headcount reduction” for nurses.
Of the 12 that responded, none said they would be reducing nurse headcount at this time. Most said they had not met – or did not expect to meet – with the regulator to discuss reducing nurse staff numbers, with six going on to emphasise their commitment to maintaining or boosting numbers.
Sam Foster, chief nurse at Heart of England Foundation Trust, said the organisation was actively recruiting staff and had employed around 500 nurses and midwives in the past year.
“The trust does not have any plans to reduce the nursing headcount,” she said. “We have a robust schedule of workforce reviews in place to check that we have the right amount of staff in our clinical areas.”
A spokeswoman for East Kent Hospitals University Foundation Trust said it also had no plans to reduce nursing frontline headcount, noting the organisation had spent £3m to meet safe staffing requirements.
Karen Rule, director of nursing at Medway Foundation Trust, said it was due to bring in cohorts of new permanent nursing staff in 2016. But she stressed the trust was “firmly committed” to reducing its use of expensive agency workers.
“Like many other NHS trusts, we are firmly committed to reducing our reliance on costly agency staff,” she said. ”This commitment will be enhanced by the arrival of cohorts of new permanent nursing staff throughout this year.”
Meanwhile, University Hospitals Birmingham Foundation Trust said over the past two years it had increased its numbers of nurses by 25%, to around 2,550 and that it was still recruiting.
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Northern Lincolnshire and Goole Foundation Trust noted that while “tight control” of overall staffing costs was a “very major theme” in its discussions with Monitor, the focus had so far been on agency workers.
“At this point, we do not envisage any reduction in nursing establishment as a result of action from Monitor, and we continue to take very seriously our position as regards maintaining safe and effective nursing ratios,” said a trust spokeswoman.
However, it was “very unlikely” organisations would be able to reduce deficits without taking action on nurse staffing, according to a healthcare policy expert.
Even by reducing spend through the recently introduced caps on hourly rates for agency workers – which the government estimates will save £1bn by 2018 – this will not be enough to significantly reduce the NHS deficit, projected to reach £2.3bn by the end of March, he told Nursing Times.
“In the challenge between money and quality, they are backing quality of care”
Richard Murray, director of policy at the King’s Fund think-tank, suggested trusts may soon be forced into reducing numbers of permanent employees by regulators if they continue to choose safe staffing over controlling their finances.
But when trusts had been made to do this previously – around a decade ago when the health service was last in deficit – it had proven “enormously unpopular”, he warned.
“This survey of trusts suggests organisations will be made to do it [reduce nurse headcount]. They are certainly not going to do that voluntarily. In the challenge between money and quality, they are backing quality of care, at least in terms of safe staffing. So that could be a real tussle,” he said.
Many organisations were also breaching the rules on agency caps, he said, but noted Monitor was yet to take firm action over this.
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“There is a question of nerve here for the government and national bodies. For them, they’d quite like to see organisations sorting out their own finances but if you get a lot acting in the way the ones replying to your survey have there are going to be some hard stares across the table,” he said.
Pressure on trusts to reconsider staffing numbers has been mounting in recent months. In October, NHS bodies including Monitor and the TDA were accused of “watering down” safe nurse staffing requirements in a bid to save money, after they stressed a one to eight nurse-patient ratio was just “a guide” in another letter to trusts.
Afterwards chief nurses raised concerns at Nursing Times’ inaugural Directors’ Congress that trust decisions would be increasingly made based on financial rather than safety considerations.
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Foundation trusts that responded to Nursing Times about reducing nurse headcount:
- Heart of England Foundation NHS Trust
- Birmingham and Solihull Mental Health NHS Foundation Trust
- Medway NHS Foundation Trust
- The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust
- University Hospitals Birmingham NHS Foundation Trust
- Dorset County Hospital NHS Foundation Trust
- South London and Maudsley NHS Foundation Trust
- Northern Lincolnshire and Goole NHS Foundation Trust
- East Kent Hospitals University NHS Foundation Trust
- Barnsley Hospital NHS Foundation Trust
- Basildon and Thurrock Hospitals NHS Foundation Trust
- University College London Hospitals NHS Foundation Trust