Staff shortages and high bed occupancy levels are increasing the pressure on services across the NHS to unexpected levels, a Nursing Times investigation has found.
An exclusive survey of more than 1,000 visitors to the Nursing Times website suggests nurses are feeling the strain in acute and primary care settings - even before the onset of cold weather that normally heralds the NHS’s busiest period.
Around three quarters - 72 per cent of hospital nurses and 77 per cent of acute nurses - say the service they work in is under greater pressure than this time last year. Sixty per cent of hospital nurses say this pressure is greater than planned for.
Staff shortages because of recruitment freezes or difficulties are given as the main reason for the additional pressure in both sectors, suggesting straitened economic conditions are already having a tangible effect on the front line.
One respondent from the acute sector said: “Pressure on beds to meet emergency and elective targets seems far worse this year due to community health and social services having reduced capacity.”
“Workload has increased and there is a large amount of pressure from senior managers. Therefore departmental stress is very high at this time,” said another.
More than 60 per cent of community nurses said they did not have sufficient staff in their practice or team to cope with the demands on their services. One described the pressure as “overwhelming”.
Forty five per cent of acute staff said they had been asked to work additional hours this autumn because services are so busy.
One acute nurse said: ”[There is a] shortage of staff due to the ward being overspent on its budget. Some weekends the ward is run on three staff nurses and one HCA to care for 27 acutely unwell patients.”
A community nurse added: “The staffing freeze due to the debt that the PCT has incurred has resulted in dangerously low staffing levels. Management disregard any attempt by the ‘coal face staff’ to alert them to the unsafe situation.”
Additionally, 60 per cent of acute staff report that bed occupancy rates in their ward were higher than usual – with more than one in 10 nurses warning that levels were “unsustainable”.
This hike in bed occupancy appears to be the result of emergency admissions – possibly as a result of efforts to meet the four-hour A&E target – because community nurses said they had not noticed a significant increase in GP referrals.
The survey results also suggest that the high bed occupancy rates are having a knock-on effect on discharge, as hospitals attempt to make space.
More than 40 per cent of community nurses said that in their opinion more patients were being discharged before they were fit to go home – risking readmission. This finding is supported by analysis of separate figures from hospitals by NHS data specialists CHKS.
Some nurses said they feared what would happen over the winter. “I feel the worst is yet to come. Flu numbers are low for us so far – I expect things to worsen,” one said.
“The majority of the year has been one huge pressure – making us dread any extra over the winter,” another said.
Appearing to confirm their fears, national director of NHS flu resilience Ian Dalton warned in a letter to NHS managers last week that worse was to come.
He said: “We are…beginning to see increased pressure within the system, particularly on A&E and ambulance services. We are well placed to manage them due to the plans we have in place, but we are reminded of the need to continue to remain prepared for what will potentially be a tough winter for the NHS.”