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Exclusive: Best and worst hospital trusts for nursing


In-depth analysis of the latest national survey data has revealed the best and worst trusts for overall nursing care and nurse staffing levels, based on the views of hospital patients.

The investigation, by Nursing Times, was based on results from the 2014 national inpatient survey, published last month by the Care Quality Commission.

Our analysis reveals the top 10 trusts and worst 10 for nursing performance and also for having sufficient nurses on duty (see tables). 

The investigation found hospital trusts with “enough nurses” were more likely to do well on overall nursing performance.

Nursing Times looked at variations in scores between individual trusts on four key questions relating to nursing in the survey (see below). We added the scores for the four questions together to give an overall average score out of 10 for nursing care.


The four key questions on nursing asked by the national inpatient survey:

  1. When you had important questions to ask a nurse, did you get answers that you could understand?
  2. Did you have confidence and trust in the nurses treating you?
  3. Did nurses talk in front of you as if you weren’t there?
  4. In your opinion, were there enough nurses on duty to care for you in hospital?


The overall nursing score for the vast majority of trusts – more than 91% – remained about the same as last year’s survey. Just 13 trusts – just over 8% – had scored higher than the previous year while six trusts – just under 4% – did worse.

The four questions about nursing care cover staffing levels, patients’ confidence and trust in nurses and questions touching on nurses’ communication and respect for patients.

“We have worked hard over the last year to improve recruitment and are reducing agency nurses to appoint substantive staff”

Wendy Matthews

Out of the four, trusts generally scored lower for the question on whether patients felt there were “enough” nurses on duty. Scores for individual hospitals ranged from 6.2 out of ten to 9.5 out of 10.

Nursing Times’ analysis suggests those trusts scoring highly when it came to patients’ perceptions of staffing were more likely to achieve the highest overall scores for nursing care, while those with low staffing scores were more likely to do less well overall.

Five out of the bottom 10 trusts for nurse staffing also featured in the bottom 10 for overall nursing performance. However, Medway Foundation Trust, which was in the bottom three for staffing levels was just nudged out of the bottom 10 overall.

Meanwhile, seven out of the top 10 trusts for staffing were also in the top 10 for overall nursing performance.


Best overall score for staffing question

Queen Victoria Hospital FT (Best) 9.46
Royal National Hospital for Rheumatic Diseases9.11
Liverpool Heart and Chest Hospital FT  9.03
Papworth Hospital FT 8.93
The Royal Marsden FT8.75
Birmingham Women’s FT8.74
Royal Brompton and Harefield FT8.72
Liverpool Women’s FT8.57
Royal National Orthopaedic Hospital Trust 8.54
Frimley Health FT  8.39


Worst overall score for staffing question  

North Bristol Trust 6.21
Barking, Havering and Redbridge University Hospitals Trust 6.22
Medway FT 6.48
Hull and East Yorkshire Hospitals Trust   6.49
North Middlesex University Hospital Trust  6.5
Norfolk and Norwich University Hospitals FT   6.56
Plymouth Hospitals Trust  6.57
Croydon Health Services Trust  6.58
Tameside Hospital FT6.6
Ealing Hospital Trust (Worst)  6.61


The trust with the lowest score for patients’ perceptions of staffing levels was North Bristol Trust, closely followed by Barking, Havering and Redbridge University Hospitals Trust and then Medway.

The poor result for Bristol appears to reveal how patients’ views on staffing are skewed by ward size.

The survey was carried out a few weeks after the trust opened the new Brunel building at Southmead Hospital, in which three-quarters of beds are in single rooms. It replaced “nightingale” wards and other more open ward areas.

Sue Jones, director of nursing and quality at the trust, said: “We have not reduced the numbers of nurses on our wards at the new hospital but we are working hard to make sure our nurses are as visible as possible in our single room environment.”

Barking, Havering and Redbridge said it was taking action to boost nursing staff in response to patient feedback.

“We have worked hard over the last year to improve recruitment and are reducing agency nurses to appoint substantive staff,” said interim chief nurse Wendy Matthews. “During 2015-16 we will invest £5.9m to improve nursing care including over 80 additional nurses.”

A spokesman for Medway said the trust was currently reviewing its nursing establishment and had processes in place to move nursing staff to areas where they were needed.

“Work on the recruitment and retention of staff remains a key priority and a project is currently underway to recruit nursing staff throughout the organisation,” he said.

“We are confident the work being carried out will help the organisation to achieve a stable level of nursing, which will improve patient satisfaction levels and quality of care,” he added.

“We are working hard to make sure our nurses are as visible as possible in our single room environment”

Sue Jones

The results from the inpatient survey are based on replies from more than 59,000 patients who stayed in one of 154 acute or specialist trusts in England for at least one night during June, July or August 2014.

Overall scores for nursing are tightly grouped ranging from high scores around 9.3 to lower scores around the 7.4 mark.

The top trusts for nursing are predominantly specialist organisations.

The trust that achieved the highest overall score for nursing was Queen Victoria Hospital Foundation Trust with just over 9.3 out of 10, closely followed by Liverpool Heart and Chest Foundation Trust with nearly the same score. Both feature in the top three for perceptions of staffing.

All of the top 10 trusts for nursing had improved their nursing scores since the previous year.


Best overall score for nursing questions

Queen Victoria Hospital FT (Best)9.34
Liverpool Heart and Chest Hospital FT    9.28
Papworth Hospital FT    9.24
Royal National Hospital for Rheumatic Diseases9.24
The Royal Marsden FT  9.19
Royal Brompton and Harefield FT            9.01
The Christie FT 9.01
Birmingham Women’s FT             8.95
The Walton Centre FT   8.91
Newcastle upon Tyne Hospitals FT          8.85


The Queen Victoria Hospital, which provides specialist reconstructive surgery, burns care and rehabilitation services, scored significantly better than other trusts on 45 out of the 62 questions in the inpatient survey.

It achieved the top scores in several categories including patients’ overall experience of the hospital, emotional support for patients from hospital staff and whether staff did all they could to control pain.

Chief executive Richard Taylor said these excellent results were down to “the commitment and professionalism of staff”.

Sue Pemberton, director of nursing and quality at Liverpool Heart and Chest, said commitment to working with patients and their families was behind its high scores.

“The survey shows that we are not getting some of the basics right”

Carole Flowers

Innovations include a Care Partner Programme to enable families and carers to actively participate in their relative care if they want to, and open visiting at the hospital.

“We have encouraged patient and family shadowing to enable our staff to see care through a patient’s eyes and we also encourage patients and families to let us know if they have any concerns about their care whilst in our hospital,” said Ms Pemberton.

When it came to trusts that fared less well, Ealing Hospital Trust was ranked the lowest overall for nursing, very closely followed by Croydon Health Services Trust and then North Middlesex University Hospital Trust.

Six out of the 10 lowest scoring trusts had fared worse than the previous year.


Worst overall score for nursing questions

Lancashire Teaching Hospitals FT              7.88
North West London Hospitals Trust        7.88
Barts Health Trust           7.85
West Middlesex University Hospital Trust            7.84
North Bristol Trust          7.73
Barking, Havering and Redbridge University Hospitals Trust         7.7
Lewisham and Greenwich Trust               7.61
North Middlesex University Hospital Trust          7.49
Croydon Health Services Trust 7.43
Ealing Hospital Trust (Worst)7.42


Since the survey was carried out, Ealing has been merged with neighbouring organisations to create London North West Healthcare Trust. Its chief nurse Carole Flowers said the organisation was “very disappointed” with the results of the inpatient survey.

“Providing our patients with the best possible experience of care is at the heart of everything we do and the survey shows that we are not getting some of the basics right,” she said.

“Following our merger last October, a major priority for the trust has been to recruit more permanent staff to the workforce, which will allow us to provide better continuity in our care,” she said.

Paul Reeves, nursing director at North Middlesex University Hospital Trust, said he “disappointed” but also “surprised” that patients perceived that nurse staffing levels were low.

“We have a qualified nurse-patient ratio of 1:6, which is greater than the recommended 1:8,” he said. “We are in the same position as many trusts in trying to recruit and retain nursing staff and we have had a great deal of success with this recently.”

“We are in the same position as many trusts in trying to recruit and retain nursing staff”

Paul Reeves

A spokesman for Croydon Health said it was “unfortunate” that the trust’s scores on the nursing questions were at the “bottom end”.

However, he added that it was “heartening” to note that for three of the four questions the trust managed an average score of 7 out of 10 or more.

“We recognise that we have some work to go to push our scores up to being fully in line with the current national standard and we already have plans in place to increase our number of full-time nurses and improve the experience of care that our patients receive from them,” he said.

The overall results for nursing do not necessarily tally with Care Quality Commission inspection results, although there are more trusts with poor CQC judgements with lower nursing scores. Eight out of the 10 trusts with the lowest nursing scores have been told to improve by the CQC.

Six are rated “requires improvement” while the other two – Barts Health Trust and Barking, Havering and Redbridge – are rated “inadequate” with the latter placed in special measures.

However, trusts judged “inadequate” and “requires improvement” are scattered across the overall nursing rankings with many hospitals with poor CQC judgements doing pretty much the same or better on nursing performance than those rated “good”.


Readers' comments (6)

  • I was disappointed to see that Barking, Havering and Redbridge Trust did not score well as this was not reflective of the experience I observed recently at Queens Hospital. My mother was admitted to Queens Hospital on Saturday 16th May and was subsequently cared for on Sunrise B Ward until she died on Monday 25th May.

    Throughout the time my mum was in Queens, the care she received from both the nursing and medical staff was excellent. Mum was treated with dignity and respect. The communication by the medical staff to myself was without fault. They were open and honest at all times and kept the best interest of mum first in all the decisions made. I felt that the family were part of those decisions and everything was discussed fully with us.
    The nurses looking after mum were kind and showed care and compassion. Every time I asked for something for mum they responded immediately. Mum was cared for exceptionally well.

    My mother died with dignity and was kept comfortable and pain free.

    Considering all the bad press with the Mid Staff inquiry and the subsequent Francis Report, it was a refreshing change to witness care that can only be described as faultless. The Trust Board should be proud to know that staff in their hospital are professional and caring and made the whole family feel that nothing was too much trouble.
    I would say the experience I observed scored highly in all categories.

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  • When the public voice their opinion, it is not easy for them to appraise nursing beyond how they are made to feel by staff, unless their is an obvious deterioration in the patient's health. When my Gran was in hospital, she deteriorated rapidly, and the attitude seemed to be that she was elderly, had dementia, and this was part of her journey towards the end. It was only because my Mother was a nurse that she looked up the drugs, and noticed that one had recently been changed, and the symptoms my Gran was experiencing were the same as the side-effects of the new drug. She was then able to talk to the consultant who seemed to have no idea of the deterioration and was quite annoyed about this on behalf of the patient. The drug was changed back, and my Gran began eating again, became stronger, and could then go home. We lived at a distance, so it could have gone the other way. My Granddad was like a strong man reduced to a crumpled soul.

    What if the changes had been more subtle? You can be pleased with the basic care, yet be unaware of the higher knowledge not expended on your loved one.

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  • It is very apparent when patients or their love ones comment about their care, they express professionalism in terms of kindness, care and compassion and quick or immediate response for something asked for.
    Lets now put this group (A) staff in another setting where there is short staffing and poor management and put another group (B), which was not deemed professional by the public because they did not have the staffing level to do what is asked for immediately and the best they can do is to prioritise so something non life threatening goes right down the list, even though a patient could see this as important.
    Put group B staff in that good environment where there is good management and the area well staffed. Group B will soon be seen by the public as professional and Group A will be seen as lacking. It is not MAGIC.
    It is down to good management and good staffing levels.

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  • Now that the CQC has stopped covering up in faults of the Trusts we are now seeing all the problems which the Public have been showing us for decades and now we cannot ignore the problems which we have been doing for decades.
    Nurses and Doctors have been whistleblowing for years and have suffered for it, now support the CQC and let them sort it out, that is their job after all.

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  • It's nice that we're assessing how well nurses are performing by using woolly questions on opinion. Heaven forbid we tried to do it on something quantifiable.

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  • The top hospitals all appear to be specialist hospitals which may not have the pressures of and A and E dept . This can and does make a big difference to the stress within an organisation on beds which are a direct result of the a and E targets .I completely understand that they will have their own presures but hospitals need to be compared like for like to get a true perspective on a working environment.

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