Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

EDITOR’S COMMENT

'Will measuring care hours cost us more?'

  • 8 Comments

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.

 

 

  • 8 Comments

Readers' comments (8)

  • It's more than a good thought Jenni, it's the truth and the truth is out there.

    Unsuitable or offensive? Report this comment

  • michael stone

    '... Our version is the cut-price alternative ...'

    Seems to be the theme at the moment - I've just read that the CQC is looking to modify its inspection model, because it is going to have its funding reduced by 25 per cent.

    Dr Mattu worked at my local acute hospital - it does seem to have been a 'very sorry saga', and not one which will encourage clinicians to 'speak up about concerns'.

    I don't think getting nurses to work 'increasingly hard' is a good plan - but I like 'working smarter' as an objective !

    Unsuitable or offensive? Report this comment

  • Why I understand your right to speak I find your comment as insulting Stone, you're obviously no nurse. These are heated times where in this rendition smarter means harder. Nurses work smarter already. In my view Please if you have nothing to add then don't add it. Nurses are being worked to the bone and safety is not about just working smarter it's also about the environment and setting worked in. This government is constantly working at ways to undermine workers, patients and union health and safety rights by lean bull, privitisation, dictatorial approaches to managing staff, victimising and black balling people who speak out, getting rid of bursaries, draconian sickness rules, social media propaganda and installing a union bill that hides health and safety reality. You want smarter Stone then understand this government doesn't understand playing fair. Smarter is non political interference and proper funding.

    Unsuitable or offensive? Report this comment

  • The big question is whether use of any metric is going to have any effect on the number of nurses on duty, be they Registered or associate. I've worked at various times on wards where data submitted to senior nurses to enable staff allocation was ignored and no account was taken of the quality of care that shortage of nurses caused.

    Unsuitable or offensive? Report this comment

  • michael stone

    ANONYMOUS13 FEBRUARY, 2016 3:42 PM

    You might view 'working smarter as equalling working harder' but I certainly do not: my definition of working smarter is exactly the opposite (working smarter means achieving more, with either the same or less effort put in).

    If other people - managers, etc - cannot see the difference, and are claiming that 'working smarter means working harder' I suggest that you correct their flawed understanding.

    And I don't disagree with you about your:

    'Nurses are being worked to the bone and safety is not about just working smarter it's also about the environment and setting worked in. This government is constantly working at ways to undermine workers, patients and union health and safety rights by lean bull, privitisation, dictatorial approaches to managing staff, victimising and black balling people who speak out, getting rid of bursaries, draconian sickness rules, social media propaganda and installing a union bill that hides health and safety reality.'

    But that is much wider issue - I was just pointing out, correctly, that provided 'smarter really means smarter [and there will be arguments about that]' then working smarter is good all-around, but flogging staff to death by working them increasingly harder is very bad !

    I'm not a nurse and have never claimed to be a nurse - I've explained who I am, on BMJ:

    http://www.bmj.com/content/350/bmj.h1846/rr

    Unsuitable or offensive? Report this comment

  • michael stone

    David Smith - I agree with you. But if the metric is right, and it is published along with patient outcome data, then perhaps pressure will be effectively brought to bear if the places with poor staffing ratios also have poor patient outcomes.

    Although, this goverment would probably look for cases where lower staffing ratios did not seem to be matched by worse outcomes, and scream 'everywhere else should be like them !' (probably without much sensible analysis, statistical or otherwise).

    Unsuitable or offensive? Report this comment

  • Stone you are falling for nonsense - quality doesn't always equal time or metrics, or speed or numbers, but should definately be meaningful. All that happens in this kinda approach is peppering overtime and making bigger mistakes for less pay and less rights and its the patient that suffers. Why should false money saved from this go into the pockets of useless senior management, who ignore problems and blame their staff to protect their pretty houses, pensions and fast cars. in my view this is nought but metrics making money from the suffering to fund lavish lifestyles of weak management and ceos. Wake up unions time to act or watch us all leave in droves.

    Unsuitable or offensive? Report this comment

  • michael stone

    ANONYMOUS14 FEBRUARY, 2016 2:53 PM

    I agree that often 'quality' defies any simple - and especially 'describable by a number' - metric. I've said that, more than once.

    It is 'the NHS' that is obsessed with 'only counting as real evidence, things we can 'number crunch' - not me !

    I probably fall for a lot of nonsense - I think that one is a very big club.

    Unsuitable or offensive? Report this comment

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.