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NHS hospitals could potentially save £3.7m a year by adopting US nursing quality scheme

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NHS trusts could save at least £3.74m a year if they introduced improvements in line with a US-founded scheme that recognises nursing excellence, new analysis has revealed.

Those behind the work said a “staggering amount of money” could be saved by UK hospitals through improvements to patient outcomes and workforce factors that the scheme could bring.

“There is a staggering amount of money that can be saved if we can just aim to reduce the turnover rates alone”

Alison Alsbury

The findings represent the first time an assessment has been made of the financial benefits that Magnet accreditation – awarded by the American Nurses’ Credentialing Center, an affiliate of the American Nurses Association – could bring to this country.

The savings would be made from avoidance of falls and pressure ulcers, and also reduced staff turnover and agency costs, according to those behind the analysis.

They also noted that the investment needed to run the programme – of around £150,000 to £220,000 a year for the biggest hospitals – was “peanuts” compared to the savings that could be made.

One of the main benefits noted by accredited organisations in other countries is improved nurse recruitment and retention.

The international scheme, which started in the US, has been attracting increasing interest from UK employers in in recent months, though currently no organisation in this country holds the Magnet title.

As previously reported by Nursing Times, both Oxford University Hospitals NHS Foundation Trust and Nottingham University Hospitals NHS Trust have announced they intend to apply for accreditation.

To achieve Magnet status, healthcare organisations must meet a number of standards covering areas including nurse staffing levels, training requirements and clinical outcomes for patients.

For example, an organisation must ensure all of its senior nurses at managerial level hold degrees and it must demonstrate annual increases in the numbers of nurses with certification in areas of clinical specialities.

In addition, it is required to collect around two years’ worth of ward-level data on clinical outcomes from nursing care to meet the Magnet standard that the trust is benchmarked in the top 50% of organisations internationally across all indicators for 18 months.

The new analysis, commissioned by Oxford University Hospitals, was presented at the UK’s first Magnet conference last month and is based on data from the trust and also from Nottingham University Hospitals.

It found that if the trusts saw their average annual turnover rate reduce from 12% to the average 3.45% found at Magnet hospitals, they could each save £2.8m a year by avoiding losing 276 staff.

“Trusts will get an adequate return on investment within three to five years. But it is very important to note the clinical gains as well”

Alison Alsbury

In addition, they would each save around £800,000 a year that would have been spent on agency nurses.

Meanwhile, if the trusts achieved the average 5% reduction in pressure ulcers seen at Magnet organisations, it would mean they avoided at least four ulcers every year, each annualy saving £41,475.

In addition, falls are on average at a 10% lower level in Magnet organisations compared with those similar ones that are not accredited.

Based on this reduction level, the UK trusts could each avoid 61 patient falls per year, leading to a saving of at least £91,500 from avoiding increased length of stays.

However, it was acknowledged that this figure “seriously under-estimates the whole system cost”, due to ongoing costs associated with community and social care following the fall.

Finally, the analysis looked at the savings that could be made from occupational health costs.

Magnet research shows needlestick injuries reduce on average by a third in accredited hospitals. If the same effect occurred at the two NHS trusts, this could result in 44 fewer incidents a year, equal to around £4,400 in savings.

“The cost of delivering Magnet is peanuts compared to the savings you can make…I hope this will change some people’s views”

Dickon Weir-Hughes

In total, the factors described could mean £3.74m savings a year, according to Alison Alsbury, who led NHS England’s workforce modelling for new care models between 2015 and 2017, and who carried out the economic analysis.

But she said this figure was only a conservative estimate and she expected far more savings could be made.

She also noted that organisations could start seeing some of the savings in the first year of preparing their Magnet applications – by introducing initiatives to improve clinical care – while staffing benefits would typically be felt within three years.

“There is a staggering amount of money that can be saved, if we can just aim to reduce the turnover rates alone,” she told Nursing Times.

“Trusts will get an adequate return on investment within three to five years,” she said. “But it is very important to note the clinical – and almost moral – gains as well. For instance, there is quite a lot of research about the quality of life improvements from avoiding pressure ulcers.

Dickon Weir-Hughes

Dickon Weir-Hughes

Dickon Weir-Hughes

“That is a strong argument in itself. By having a professional practice model for nurses, by having improved quality, you can reduce category 3 and 4 pressure ulcers – why wouldn’t any trust in the country choose to do it?, ” she said.

Professor Dickon Weir-Hughes, Magnet programme director at Oxford University Hospitals, said he hoped the results from the analysis would convince other trusts that Magnet was not too costly and to look at the benefits it could bring.

“The cost of delivering Magnet is peanuts compared to the savings you can make…I hope this will change some people’s views,” he said.

“We should be delivering excellent care anyway – if you can provide exceptional care that saves money what is not to like?,” he told Nursing Times.

However, researchers have previously highlighted “conflicting findings” surrounding the actual impact of Magnet accreditation.

French research, published in 2015 in the JBI Database of Systematic Reviews and Implementation Reports, looked at 10 studies focusing on ulcers, falls, failure to rescue and 30-day inpatient mortality, job satisfaction and turnover rates in Magnet and non-Magnet hospitals.

The researchers said they found it was “not possible to conclude that Magnet accreditation has effects on nurse and patient outcomes”.

  • 3 Comments

Readers' comments (3)

  • Isn't this just having a safe number of properly qualified and supported staff on duty and treating them with respect?

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  • Is this the thin edge of privatisation?
    Put a safe number of suitable staff to patients needs see the same outcome

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  • We need to demonstrate that better outcomes for patients flow from investing in appointing the right managers who then promote and support the delivery of evidence-based and effective clinical practice; focussed continuing professional and employee development; and within a framework of fair employment practice.

    If the Magnet Scheme does this... all to the good. Nursing practice though covers more than the prevention, of falls, pressure related skin damage and needle stick injury; as important as those matters are.

    Do Magnet protaganists measure the more nuanced outcomes associated with, for example diagnosed mental illness or multiple burns?

    Is Savings, the right language? I see investment more connected with not what can be saved, financially, but how to know that the required amount of money is being made available for investment into treatment and care that is measurably both efficient and effective; including noting sustainable and increasing longer term benefit to both individual and demographic wellbeing. Wordy...I know... sorry! but, hopefully worthy.

    Regarding the second comment; If Magnet is some sort of prelude to, for example, North American health care companies' delivering the NHS, we'll have to develop outcome frameworks measures and research, which is more sophisticated than looking only at the benefit of ulcer, needlestick injury and falls prevention.

    What does that French research, mentioned in the article, say?

    Anecdotally the French seem to offer excellent hospital based care and treatment to 5he physically ill; which on the face of it, seems affordable and acceptable to the citizens of France; and its health care workforce. Maybe we should see what they do, that we don't....or what we deliver to our citizens in the NHS, that they don't.

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