From April this year, the number of “care hours per patient day” delivered by nurses and healthcare assistants should become the principal measure of hospitals’ use of nursing staff.
According to Lord Carter’s review, published last week, which recommends ways for the NHS to save £2bn of its £5bn target for efficiency savings, this measure of staff deployment will cut unwanted variation in productivity.
Of course, this is a headline-grabbing, crowd-pleasing recommendation. All nurses want to spend time with their patients and the public expects to see nurses taking care of those in hospital.
The report recommends that NHS Improvement – the regulator taking over the work of Monitor and the Trust Development Authority from April – will measure this. It seems sensible to produce a metric that says how many care hours a day are required in certain hospital settings to provide safe care.
However, if these care hours are not going to be provided only by registered nurses – as Lord Carter seems to be recommending – I see this as yet another case of putting money before safety. This measurement is a laudable one, but when it’s been used overseas, the initiative has been based on registered nursing hours. Our version is the cut-price alternative, and that will only have a negative impact on care provided, regardless of how many hours you count.
Coming on the back of the proposals for a nursing associate role, it seems RNs are facing a further threat of being substituted by unregulated, less qualified healthcare assistants, if this review is taken at face value. We know what the evidence says about that. This is, after all, the most honest of all the recent reviews into the NHS. The report makes clear it was more about the money.
Lord Carter’s points about the culture of the NHS needing to change were interesting. He is right that thousands could be saved by reducing absenteeism and bullying. But many cases of bullying stem from staff raising concerns about care, and our Speak out Safely campaign was set up to change this. Lord Carter’s comments are ironic, then, coming in the week when Dr Raj Mattu was awarded £1.2m by the NHS after it spent £10m trying to gag him for exposing care failings. Perhaps the biggest savings could be made not in telling nurses to work harder and smarter, but in listening when staff say something is wrong, instead of trying to shut them up and pay them off. Just a thought.