The senior nurses who monitor quality and safety of hospital care have seen huge upheaval since the government announced its NHS reforms, an investigation reveals.
Analysis shows the news of the reorganisation sparked a tripling in turnover among the senior nurses, doctors and managers who oversee care quality for primary care trusts.
The massive upheaval has fuelled concern about the potential for the NHS to miss serious quality and safety failures while the changes take place.
In July 2010 the government announced PCTs would be abolished. Most of their work will be taken over by GP-led clinical commissioning groups and the national NHS Commissioning Board in April next year.
The size of the upheaval so far – revealed by an investigation by Nursing Times sister title Health Service Journal – has also sparked calls for senior nurses who currently oversee quality for PCTs to be found roles in the new bodies in their area.
The findings also resonate with Robert Francis’s public inquiry into the Mid Staffordshire Foundation Trust scandal, which has heard how a previous NHS reorganisation in 2006 was partly to blame for the trust’s failures going unchecked.
The analysis looked at how often there was a change in PCT directors responsible for overseeing the quality of care delivered by their local providers. Information covering about two thirds of non-specialist trusts revealed there were more than triple the number of changes in the 16 months following the July 2010 announcement than in the previous 16 months. There were 19 changes in the first period, and 65 in the second period.
For each hospital trust, the analysis also looked at the number of changes in the PCT staff member who chaired their regular contractual quality review meeting.
The total number of changes among the chairs was 18 in the 16 months before July 2010 and 56 in the 16 months after – more than triple.
The analysis showed director or chair roles were held by nurses – often nursing directors or deputies – in about two thirds of cases.
Sheffield University Hospitals Foundation Trust chief nurse and quality board member Hilary Chapman called for those developing the system to try to retain senior commissioning quality staff. Professor Chapman said CCGs should only be given permission to take over if they prove they can monitor quality, and they should not “make the mistake” of appointing insufficiently experienced nurses.
Another former PCT nurse director told Nursing Times there was concern about the problem getting worse as senior nurses leave PCTs and are split between jobs at the national board, CCGs, and new “commissioning support services” which are being set up to help CCGs.
19%: Non-specialist hospital trusts that saw one or more change in the PCT director responsible for monitoring their services’ quality in the 16 months before the white paper
61%: Hospital trusts that saw one or more change in the PCT director responsible for monitoring their services’ quality in the 16 months after the white paper
15%: Hospital trusts that saw one or more change in the chair of their PCT’s regular quality review meeting in the 16 months before the white paper
49%: Hospital trusts that saw one or more change in the chair of their PCT’s regular quality review meeting in the 16 months after the white paper