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Regulator tells NHS trusts to curb clinical staff growth


Interventions taken by regulators in the coming weeks to regain control of NHS finances could result in some providers having fewer clinical staff, Nursing Times’ sister title HSJ has been told.

Efforts to reduce the provider deficit are set to focus on 30 - 40 trusts where the pay bill either increased substantially last year, or which have planned for growth in 2016-17.

In an exclusive interview, Jim Mackey, chief executive of new regulator NHS Improvement, said trusts exceeding the ratio of one nurse to every eight patients could be told “we can’t afford that”.

Mr Mackey said some of that pay bill growth might have been justified, but his team are in the process of exploring where growth that took place last year can be “corrected”, and planned growth for 2016-17 can be ”mitigated”.

”A lot of providers ended up using bank and agency [staff] to try and get close to the safe staffing recommendations, but some went beyond that 1:8 ratio”

Jim Mackey

He said “it is possible” this will lead to fewer clinical staff on wards, adding: “I can think of a couple of providers that went beyond the safe staffing requirement.

“A lot of providers ended up using bank and agency [staff] to try and get close to the safe staffing recommendations, but I’ve met with some that went even beyond that 1:8 ratio from a nursing point of view.”

Mr Mackey said NHS Improvement would scrutinise pay costs across the entire provider sector, not just acute trusts.

The NHS provider sector reported a deficit of £2.45bn in 2015-16, leaving the Department of Health with a huge financial hole to fill in its year-end accounts, which are due to be published this month.

The sector has planned for a deficit of £550m this year, but regulators expect this to reduce to £250m.

Mr Mackey said it was too early to say how much of the pay growth was unjustified, adding: “We’ll have a better feel at the end of this process. By the end of July we want to be really clear what that means for each provider’s plan, so how much of it can be corrected and what’s the timescale.”

A key principle for NHS Improvement was to bring “more fairness and equity” between providers, Mr Mackey said. “If you’re an organisation that has exercised real restraint, and next door an organisation is performing the same or better and has exercised less restraint, that’s potentially quite toxic”.

”[I’d be] surprised if there was a provider that actually has to have a huge lay off process”

Jim Mackey

The process, he said, is about “just restoring good discipline, good governance, and good processes that have continued to exist in our best providers”. 

He said substantive staff as well as agency workers accounted for the pay growth, but he would be “surprised if there was a provider that actually has to have a huge lay off process”. He suggested numbers could be reduced by voluntary redundancies or leaving roles vacant.

There was expected to be an announcement later this week, dubbed a financial “reset”, which will outline the consequences for providers that fail to improve their financial situation.

Jim Mackey

Jim Mackey

Source: Neil O’Connor

Jim Mackey

HSJ understands the consequences would involve an assessment of board capability and potential changes to senior personnel, with consideration given as to whether the organisation should be merged or taken over by another trust.

Mr Mackey denied that pay cost growth was a legitimate reaction to rising demand. “When everyone says activity went up 2 per cent, therefore cost needs to go up, no it bloody doesn’t.”

He added that some providers were “on the edge of going out of business” and were close to not having enough cash to pay staff.




Readers' comments (17)

  • What is the pay of the regulator can the NHS afford this person?

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  • I dispair. The sad reality is that clinical and corporate staff (the majority) work very hard in impossible conditions. Constantly asked to do more with less, balancing reality with expectation. Its become virtually impossible to raise a concern about quality without fear of being seen as awkward and unhelpful. This statement confirms the real proposition of being got rid of for not towing the party line. Diversity is no longer valued, balancing the financial books while retaining an unrealistic political mantra to the public is order of the day. Clinical and corporate think about your professional code and be very careful about just how much you are willing to compromise your position. We have already seen some heads role for fiddling the figures lets not see the numbers grow.And amidst all of this we are failing to tackle some of the most complex fundamental and costly issues that get in our way. Namely inadequate ICT, hand tying information sharing rules, bureaucracy overdrive and a climate of fear. I could go on!

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  • Anon 6.05 in excess of 200k last I looked. None of which I would begrudge anyone committed , able and brave enough to sort out the real issues. Straight to a misguided lets cut the clinical staff solution without a truthful and transparent hypothesis of the supply demand problems facing the NHS is a tragic response.

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  • The concerns raised about safe staffing levels becoming a ceiling - just enough to avoid disaster but no room to exceed without challenge- are becoming a reality. Brexit means more austerity rather than a boost to NHS spending to meet soaring demand - can we now insist politicians be required to observe a duty of candour?

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  • The amount that is spent on un necessary training is just mad ...... it seems a nurse can't move from one hospital to another without becoming a complete idiot ..... at least that what the hospital acadermy would have you think ...... the lastest I heard is " blood transfusion is not a transferable skill" ......sometimes I wonder what our registration is worth ! Apparently a move between hospitals makes you incompetent ! This drives me crazy.

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  • Anon 8.29 spot on really good example of a problem that has been identified time and time again yet no solution. Defensive practise means that unless your eyeballed by your hosting employer nobody is willing to take a reasonable risk.

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  • I work in a private organisation and they are much more efficient than the NHS. Also I agree with the comments about training. I worked as a bank RMN for NHS (to see what I was missing) and they seemed to have more staff than we do but cope less and the training is ridiculous. They pay for staff expenses and travel and some staff have to travel a long way and it's continuous and interferes with the shift pattern. Totally inefficient.
    However on the plus side, they do care about making their staff knowledgeable and well trained and that's to be praised but they can be wasteful with resources.

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  • Katherine what are your views on the connection between good training , morale and productivity? I think you have a good point re staff expenses, Ive always been a bit baffled by offering lunch money for example when folk have to eat wherever they are! Any other ways in which you have found the private sector being more efficient ? Any training that you think is over done in the NHS? Thank you

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  • Well here we go again. So 1:8 is to much? I would personally like to see 1:4 ratio then we could give first class care that our patients require. I for one and sick and tired of nurses always been the ones to suffer isn't it about time that they had a secretary of state for health who actually knew something about it and a government that sees the NHS as a first class service with first class staff who care about the patient and not the pocket.

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  • michael stone

    Anonymous 13 July, 2016 6:18 pm

    I liked your comment a lot.

    I also liked the comment by Phil Noyes.

    And the comment by Katherine was interesting (exactly how efficient or otherwise the NHS is, and whether private service providers are as strongly motivated to actually help patients as 'the NHS' is, are not things I can properly answer: clearly, they are fundamental questions however).

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