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:
- When you had important questions to ask a nurse, did you get answers that you could understand?
- Did you have confidence and trust in the nurses treating you?
- Did nurses talk in front of you as if you weren’t there?
- 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”
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 Diseases||9.11|
|Liverpool Heart and Chest Hospital FT||9.03|
|Papworth Hospital FT||8.93|
|The Royal Marsden FT||8.75|
|Birmingham Women’s FT||8.74|
|Royal Brompton and Harefield FT||8.72|
|Liverpool Women’s FT||8.57|
|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|
|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 FT||6.6|
|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”
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 Diseases||9.24|
|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”
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”
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”.