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Hospital nurse care now at 'pre Francis' levels, says NHS workforce report


Levels of care provided by nurses in hospitals have only just returned to the same as those last seen at the end of 2011, according to a report by regulators revealing the extent of nurse staff shortages in England.

It suggests the impact of recent national increases in nurse numbers have been dampened by rising demand and other factors such as reliance on temporary staff.

The report, called Evidence from NHS Improvement on clinical staff shortages: A workforce analysis, looked at the causes and extent of present staff shortages among adult nurses and consultants in acute hospitals. 

“[NHS Improvement is] committed to helping providers improve their productivity, which will help curb the rate of increase in their demand for nurses”

NHS Improvement report

It calculated the “intensity of nursing care” currently provided using a new measurement that takes into account admissions and length of stay. The metric is a ratio of number of adult hospital nurses in relation to “patient bed days” – numbers of admissions multiplied by average length of patient stay.

The report said improvements had been largely driven by a rapid growth in the number of permanently employed NHS nurses since 2013, when the publication of the Francis report into care failings at Mid Staffordshire Foundation Trust led to a stronger focus on safe staffing – the so-called “Francis effect”.

Separately, the most recent official statistics from the Health and Social Care Information Centre show that in October there were 179,534 whole-time equivalent acute nurses in the NHS. This is the highest number recorded since data collection began and is around 11,200 more acute nurses than there were in 2011.

However, the report noted levels of nurse care have recovered partly as a result of increasing use of agency staff, indicating the continuing shortage in the supply of qualified staff.

To help tackle the supply problem, trusts have also been using initiatives to “alter the range of work that people in particular roles can take on”, referred to as “role substitution”, the report revealed.

Meanwhile, it identified problems with workforce plans submitted by trusts to education commissioners, which providers said were “often driven by financial controls” and so “might understate true demand”.

In addition, the report’s analysis showed the levels of nurse care that have now been reached are set against a backdrop of rising numbers of admissions, which was not the case in 2011.

“In the past efficiency drives have eclipsed the focus on safe staffing levels but the system will only work at its best when the two go hand in hand”

Donna Kinnair

If providers had not reduced average lengths of stay in the past couple years to help offset this sharp increase in admissions then thousands more nurses would have been required – at the cost of about £250m based on agency rates, it warned.

Other contributing factors to hospital nurse shortages have been the drop in recruitment of nurses from outside the European Economic Area in the past decade, and the length of time it takes to train home-grown nurses, said the report published by NHS Improvement, the new regulatory body due to take over from Monitor and the NHS Trust Development Authority in April.

Recent return-to-practice schemes have also “not had the same level of success” as previous ones. A government-funded scheme between 1999 and 2004 led to 18,500 former nurses and midwives returning to work in the NHS. But the current scheme – introduced by national workforce planning body Health Education England in autumn 2014 – has seen just 1,300 nurses sign up so far, said the report.

NHS Improvement laid out the steps it and other bodies were taking to support providers in the face of these shortages.

It cited the controversial government plans to change student nurse funding – by scrapping bursaries and moving to a loans system – as a way to increase the size of the workforce, as well as its support for keeping nurses on the shortage occupation list and exempt from immigration restrictions.

It said it had “worked closely with partners, including NHS England and HEE, to improve the 2015-16 planning process with, for example, greater coherence between workforce plans and submissions” and also referred to the introduction of caps on agency spend.

In addition, NHS Improvement said it was “committed to helping providers improve their productivity, which will help curb the rate of increase in their demand for nurses and doctors in areas of shortage”.

The recently published Carter Review on improving NHS productivity – which called for a new metric to measure patient care by combining registered nurse and healthcare assistant numbers – would help providers to benchmark their performance against each other, said the report.

The report concluded: “We recognise that workforce challenges cannot be resolved overnight, because it takes time to train new nurses and doctors.

“However, providers can continue to make improvements at a local level,” it said. “Our role is to support local providers in this complicated area and to help resolve some of the difficulties they face at the national level.”

Dame Donna Kinnair, director of nursing, policy and practice at the Royal College of Nursing, said the report indicated the NHS had taken some steps towards safer staffing, but still “has a long way to go”.

Donna Kinnair

Dame Donna Kinnair

Donna Kinnair

She warned that a focus on delivering efficiencies by trusts should not be at the expense of safe care.

“In the past, efficiency drives have eclipsed the focus on safe staffing levels and patient care but the system will only work at its best when the two go hand in hand,” she said.

“A shortage of full time staff has consequences for patient and hospital alike – fewer full time staff impacts on the patient experience whilst the costs of agency nurses soars. The only long-term solution to dealing with agency costs is by training more full time nurses so that supply can meet demand,” she added.


Readers' comments (8)

  • or maybe paying and valuing nurse bit more would help as well. Long hrs,poor pay and bullying...nurses are looking at the work environment and want and need supportive pro-active bosses

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  • Talking about the " continuing shortage in the supply of qualified staff" how will the introduction of the 'associate nurse' help this? Surely we need to be investing in and employing more qualified nurses and healthcare assistants rather than spending a fortune implementing a new curriculum/qualification for this role, a new register (or part of a new branch of the register) for them, a new KSF for them etc. Why not just use the money that's going to be spent on this new scheme to employ more nurses and healthcare assistants? I can't see any justification for this new role other than healthcare on the cheap.

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  • I completed a Return to Practice course in 2014 and have had my PIN back for just over a year. I do NOT want a full-time job - it is far too stressful - and as I do not have a mortgage anymore, I am not desparate. More and more is being asked of nurses and generally the NHS management does not value them enough as people. They are just seen as workers who are there to 'perform', 'be efficient' etc. As for Assistant Practitioners - the wheel has been re-invented - they are largely a modern version of what SEN's used to do ...

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  • Denise Spiers

    Not in the trust where I work, nursing levels are still dangerously low and dependant on incompetent agency staff, we had a hca on the night who didn't even know how to do obs ! How is that safe !!! And we didn't really have time to show her either so more pressure on the other staff !
    I'm doing my training at present but unless things change drastically in the next year, I doubt I will hang around in the hospital setting for long which is so sad as I love my job !!

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  • NHS Improvement equals Kanban nonsense and it'd will hide h and S issues and blaming nurses in regard to performance rather than external issues so in that way staffing can be cut. NHS Improvement we know your game - this is not an issue of patronising productivity and wasting precious time on it. You wanna cut cost then cut the rubbish bullying management and keep bursaries. I'm hearing nightmare stories of students travelling vast distances at own expenses and staying in hotels for days at personal cost in order to get to placement. You want more staff then stop abusing the one's you got. What we have is mass misconduct and wilful neglect in regard to government and bad management. Nobody is gonna wanna work in that, April is crunch time and this lot of government and bad ceo management will reap a mess it sows.

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  • Unison, Unite & RCN stop blaming your members for inaction, rather understand you have placed too much comfort in familial representatives of a managerial level in care organisations. I understand you fear a government this is coaxing you to react, but that has to end now, the time of good industrial relation has served its purpose and in order to preserve peoples well-being both patient and staff in the long run its time to act. There are some of us who have, are and will stand right up in the face of bad management, arguably criminal ceos and government. Unions you know how many of your reps have been targeted for speaking up and how safeguarding can be used in malign attempts to black ball us for doing so. I hear stories all over the country in regard to this and I worry its a common theme - UNIONS you need to share this info about this on mass nationwide in order to serve your members better. STOP being weak we are facing mass americanisation privatisation and you do nothing, UNIONS YOU WILL PERISH IF YOU CONTINUE. The government has gone too far and NHS Improvement is clearly the enemy to proper safe staffing in terms of wrongful productivity. Act now or lose the NHS forever. I believe many of us will stand if you do.

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  • As a nurse who has recently left my job as a nurse in a hospital I have to say that morale is on an all time low. Nurses are being asked to do more and more, they are overworked, understaffed, undervalued and underpaid. I worked 4 hard years of long hours over time, working through breaks and working with minimal staffing, enough was enough. It has affected me so much that I will never work in a hosptial again. These nurses deserve medals.

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  • On my ward alone in the past 6 months: I carer was told she has heart disease, 1 nurse is now taking medication for high blood pressure, 1 nurse is relapsing into mental stress off and on. My own health is detoriatoring.
    We are working as if we are dealing with emergency throughout the whole shift.
    Nurses pulse rates at rest is the same as when in an emergency.
    The workload is getting bigger and the staffing level is not appropriate on the floor. The workload need attention other wise heart problems in nurses will increase.

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