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Keogh review exposes concerns over nurse staffing levels


The NHS has little idea whether nurse staffing levels are safe in England, members of a high profile safety review panel have admitted, after they found hospital data on staffing did not tally with what they found during inspections.

The report by NHS England medical director Sir Bruce Keogh said data for eight of the 14 hospital trusts examined by the review suggested there was no problem with nursing levels on wards.

But when the review teams carried out their inspections they found “frequent examples of inadequate numbers of nursing staff in some ward areas”.

In his report Sir Bruce said: “The reported data did not provide a true picture of the numbers of staff actually working on the wards.”

The review suggests high level data on workforce levels may present an unrealistic impression of staff available on hospital wards on any given shift.

This could lead to NHS trusts drawing false assurances from workforce data while their wards go understaffed.

At several of the trusts examined the review team found staff feeling unable to voice their concerns to senior managers.

Ruth May, NHS England’s regional director of nursing for the Midlands who led some of the review teams, told Nursing Times: “I don’t think we do know that staffing is adequate across the NHS.”

Sir Bruce Keogh, who as sat beside her, agreed with her comments.

Ms May said the “big lesson” for NHS boards nationwide was that they needed to “consistently look at [the] staffing” they had available.

She said: “There are lessons on staffing for the NHS outside these 14 trusts. We need to look at this on a shift by shift basis so that boards and some wards are looking at their staff [number] as a whole.”

The review found that at some of the 14 trusts there was a disconnect between the funded nursing levels and the actual numbers available on each shift. This was exacerbated by an “over-reliance on unregistered and temporary staff”.

The review also found “particular issues with poor staffing levels on night shifts and weekends” and problems linked to extensive use of locum doctors.

All 14 trusts have been given actions to improve workforce issues with all undertaking urgent reviews of safe staffing levels.

Paula Clark, chief executive of the Dudley Group Foundation Trust, said she agreed with Ms May about the reliability of data on staffing levels. She added: “If you take the data from something like the [electronic staff record] you will just get your establishment figures.

“There needs to be a lot more collaboration between those putting the data together and the actual trusts.”


Readers' comments (12)

  • I am not surprised that the figures will not tally, also the crafty ways, managers who never took any patients or actively contributed to patient care, but had their names on the off duty. So in essence it appears that there were enough staff. this was in a private hospital, and when managers were approached about staffing levels, the answer would be "oh if you can't get someone to cover the shift let me know and i will pop my uniform on" Showed there faces for all of ten mins did nothing then hid in their office for the rest of the shift. This seems to be the norm as a old work mate of mine says it is the same where she works too

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  • Time for "nurse managers" to get real!

    These appalling incompetents know staffing is inadequate but refuse to acknowledge or take any action to improve the situation.

    Colleagues, please start referring these people (they are not nurses) to the NMC!

    They must be struck from the register !

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  • This is no surprise, the off duty looks fine but in reality you have a ward manager off the ward all day, a deputy ward manager pretty much off the ward all day or 'supervising' and someone else gets moved to an even worse staffed ward than yours.
    Then you've got two NQs on the same shift, neither of who are drug assessed or IV assessed, so you're left with one experienced rn on the ward.
    On nights we have 1 rn to 15 patients which seems to be common practice.
    Looking at ESR is not an accurate way of seeing how many staff you actually have per shift, it doesn't look at skill level, can't predict sickness or changes in the rota.

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  • who is ultimately responsible for ensuring there are ALWAYS enough staff on each shift?
    The staff nurse reports under-staffing and poor skillmix to her line manager who reports it to their manager and so it goes on but no-one ever seems ultimately responsible or accountable.
    Isn't it the job of the nursing director and the CEO to make sure their hospital is safe?

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  • This is interesting that an audit of staffing actually took place on the actual clinical areas. It is well known that many staff on clinical grades do not do much, if any, clinical work, yet they are counted in the establishment figures. Perhaps they should not be on clinical grades?

    It is important for "managers" to massage the figures so that they look good and appear to be meeting skill mix and ratios of staff to patients.
    All staffing level surveys should be done in the actual clinical areas, with managers required to explain any discrepancies.

    Well done to the Keogh group for doing what appears to be a "proper" evaluation, and not just a paper exercise.

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  • I work in an area where my manager does work on the ward if she is in the numbers.
    I am a sister and I am always in the numbers any managerial or audits i do i have to fit in on my shift.

    As for moving staff we are always being moved to cover other areas which leave us short, if we challenge it the lead nurse just comes down gives you a telling off for challenging it and someone is moved. We used to be able to fill out incident reports on low staffing, but that has since been removed from the list.

    There should be a minimal staff to patient ratio which every trust has to employ too, with the correct skill mix for that area. I know we cant account for people going off sick but at least we would a ratio which cannot be ignored.

    Patient safety and good care should be the priority in any hospital trust but over the years that has been replaced by government targets. I feel i work in a cattle market not a hospital at times with the pressure you are put under, to get patients discharged so that you can have another one from A/E before the 4 hr breach.

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  • Often trusts seem to include staff who would never go near a patient in their clinician numbers. Whilst this might be legitimate if still on the register and providing oversight, it may be misleading NHS England to the true situation. It is also unnerving that self-reporting is still considered credible without frequent and thorough fraud investigation.

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  • Anonymous | 17-Jul-2013 1:59 pm

    "We used to be able to fill out incident reports on low staffing, but that has since been removed from the list."

    Typical "management" skulduggery !

    ("Skulduggery" Noun-- Underhanded or unscrupulous behaviour! )

    Inspired and supported, I have no doubt, by your local "head nurse"

    Have you spoken to Unison or the RCN?

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  • michael stone

    'In his report Sir Bruce said: “The reported data did not provide a true picture of the numbers of staff actually working on the wards.”'

    So, it is pointless to endlessly argue about 'minimum staffing ratios', isn't it, if we cannot even measure how many staff are there ?!

    Why not keep it simple - pay more attention to patients who are saying for some wards 'Nobody ever came when I needed a nurse', on the theory that if there are no nurses, none could come.

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  • michael stone

    This could be measured: give all the nurses generic radio transmitters, so that everywhere in the hospital we can keep track of how many nurses are where at any one time (but not which particular nurse is where), and then we would know how many staff were on wards, no arguments.

    If that was also done for the Hospital Board members, we would also know how often they strayed out of their offices and actually visited the front-line (which might encourage them to visit the 'action' more often !).

    After all, the security services already know where you are, if you carry a mobile phone around with you, don't they ?

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