Nurses at struggling hospitals trusts are set to face major pressures this year, as managers reveal plans to slash staff numbers and review workforce “skill mix”, an investigation by Nursing Times has revealed.
The growing pressure to meet tight financial targets has sparked warnings that trusts must avoid harming care standards, as occurred at Mid Staffordshire Foundation Trust.
Nursing Times has analysed draft plans from among 19 trusts in England identified by our sister title Health Service Journal as planning the biggest cuts this year.
These organisations have said they need to cut costs by 8% or more in 2011-12. Those with published details of their plans aim to make workforce savings through a combination of post reductions, productivity drives, reductions in patient length of stay, changes to workforce “skill mix”, and closure of wards and beds.
The radical cuts proposed reinforce union claims that frontline staff and services will not be protected from the huge savings drive currently sweeping the NHS, despite government insistence that the health budget has been ringfenced.
The plans include proposals to:
- Cut Agenda for Change clinical staff by 192 whole time equivalent (wte) posts – or 13% – at Princess Alexandra Hospital Trust in Essex this year, and by a total of 251 by March 2014. It also wants to close 42 emergency beds and one elective ward this year;
- Cut 142 posts this year at Whipps Cross University Hospital Trust in London, with only 25 earmarked to come from back office or clinical support staff reductions. This includes plans to save £1m through a nursing skill mix review;
- Cut 50 beds, and reduce one surgical ward from seven to five days at West Middlesex Hospital Trust;
- Slash pay expenditure at Imperial College Healthcare Trust by £44m, or 8%, and cut 150 posts this year.
Many of the trusts analysed by Nursing Times cited pressure from primary care trusts to reduce hospital activity, and the drive to reach foundation trust status, among their reasons for major cost cutting.
The Department of Health wants all trusts to achieve foundation status by 2014. Acute trusts currently without foundation status constituted more than two thirds of the 19 trusts planning savings of 8% or more, and five of the seven aiming to save 10% or more.
NHS Confederation acting chief executive Nigel Edwards warned trusts not to duplicate the failures at Mid Staffordshire, where care failures emerged in the midst of a drive for foundation trust status.
“It was the pursuit of financial targets that seems to have been heavily implicated in the problems at Mid Staffs,” he told Nursing Times. “I’m hoping that’s very much in the minds of the people developing these kinds of cost improvements,” he said.
The full scale of the cuts this year has yet to emerge, with most trusts analysed saying they are yet to identify where they would make all the savings they needed.
Royal College of Nursing head of policy Howard Catton said Nursing Times’ findings supported the union’s own findings.
Its latest Frontline First report, published last month, said 9,650 posts – 54% of them nurses – had so far been identified for the axe across a sample of 21 trusts (news, page 3, 12 April).
Mr Catton said: “For an awful lot of nurses [the scale of productivity targets] simply mean having to look after more patients, and more patients who have a higher level of dependency, because they’re in hospital for less time.
He added: “Nursing staff will feel that the quality component of the care people are trying to deliver is squeezed out completely.”
A spokeswoman for Whipps Cross said: “Our [savings] plans for 2011-12 will focus on improvements such as reductions in length of stay and readmissions, which will benefit patients as well as leading to increased efficiencies.
“Our planning assumption is that any reduction in posts will be achieved through natural turnover and reducing use of agency staff. “
An Imperial Healthcare spokeswoman said: “We intend to achieve these savings by first reducing our substantial bank and agency numbers and by natural turnover and redeployment of staff into areas of growth.
“As outlined in our annual plan, we expect to selectively reduce substantive staff numbers by around 150 over the year.”
Of the 19 trusts identified, Nursing Times reviewed the plans of the 13 with published details of their plans for 2011-12 in recent board papers. Not all of these trusts provided detail on the workforce implications of their plans.