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”
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”.
Dame 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.