The Francis Report shone the spotlight on a lot of issues for the nursing profession.
It shook nursing more than various other critical reports and reviews had before. But among all those distressing patient stories and accounts of care failings at Mid Staffordshire, one good thing came out of it – the focus on safe staffing. It gave nursing a moment in time to articulate what it needed to provide safe, high-quality and consistent care. And surely that is what all those people, reliving the painful stories of their relatives who suffered at Mid Staffs wanted. They told their stories to help ensure others did not endure the same fate – because a shortage of nurses was at the heart of many of those experiences.
Now, however, that one positive outcome, known as “the Francis effect” – the rush to recruit more nurses on the wards – has gone through the all-too-predictable boom-and-bust cycle, and we are back to a level where care in hospitals is at “pre-Francis levels” (see “Hospital nursing care now at ’pre Francis’ levels, says regulator”).
The report from new regulator NHS Improvement into clinical staff shortages reveals that England didn’t train enough nurses to meet rising demand. In short, trusts had asked for thousands fewer nurses than they actually needed to provide safe care. So, in the rush to try and fill establishments after publication of the Francis report in February 2013, they were forced to use agency nurses at higher costs than permanent staff. Costs spiralled out of control, exacerbated by agencies’ ability to charge more because the shortage was so dire. And the cost of training fewer nurses saved the government a few quid in the short term but, ultimately, hit providers that had based their forecasts on what they could afford, not what they needed.
Lord Carter, the regulators and NHS England think the shortage can be cured by “being more productive”. However, NHS Improvement’s report acknowledges that, without the productivity initiatives of NHS staff around discharge planning and so on, there would be a far worse problem. So I worry how much we can squeeze the lemon. There really is a limit to how much more you can get with significantly less. I worry that Francis will become a distant memory because we failed to heed its warnings,and yet more trusts could be lurking in the wings to become the focus of the next care scandal story.