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Community hospital research to reveal impact of nurse staffing levels

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Community hospitals across the country are to be closely scrutinised, as part of a major piece of research into how factors such as staffing ratios and nurse-led wards contribute to efficient services, Nursing Times has learnt.

The research, being led by the University of Leeds and Bradford Teaching Hospitals NHS Foundation Trust, aims for the first time to identify a series of “ideal” community inpatient models and how well all others across the country are performing in comparison.

It will look at the latest NHS data for 180 community hospitals that ranks their performance across a range of different factors such as service models, workforce numbers and mix, waiting times, patient length of stay and finances.

“It is really desirable we are beginning to look intelligently at nursing establishments and working out what’s required because we know the dependency rates have changed a lot”

John Young

The NHS Benchmarking Network data will be analysed to establish what types of community hospital are providing the most financially efficient and quality services. A handful will then be selected for more detailed investigation.

Researchers will then survey all 297 community hospitals across the UK to build up a national picture and find out how close to the “ideal” models their services are and which ones require improvement.

Nursing Times has been told that an online tool will also be developed in the future for clinicians and managers to assess their efficiency.

John Young, professor of elderly care medicine at University of Leeds who is leading the project, said he expected the ratio of registered nurses to support workers to be one of the “critical” factors affecting efficiency.

“It may be in the opposite way people think – it may be that having more trained nurses is a good thing [in terms of efficiency] when you’re looking at inpatient care in community hospitals where you’ve got people with quite complex needs,” he said.

“It may be that having more trained nurses is a good thing [in terms of efficiency] when you’re looking at inpatient care in community hospitals”

John Young

Professor Young stressed that the research – which is using a methodology taken from the utilities industry – would not just be focussing on the cost, but would show how those best performing hospitals were able to provide quality services.

Recent discussion in the NHS has centred on safe staffing levels for nurses and the spiralling cost of temporary workers being used to cover the high number of nurse vacancies at trusts across the country.

Professor Young said he believed his research would make a “contribution” to the debate on safe staffing, but did not expect it to change the “direction of travel that’s being established” by NHS England and the National Institute for Health and Care Excellence.

“From a clinician’s point of view, it is really desirable we are beginning to look intelligently at nursing establishments and working out what’s required because we know the dependency rates have changed a lot in our hospitals over the last ten to 20 years,” he told Nursing Times.

He added: “As more and more patients who are relatively independent and go home very quickly, we are left with hospital wards with older people who are much more dependant. So that has to say something about the nursing establishment that is required.”

“Commissioners are …having to make quite tough decisions about where they put their money so we want to make sure community hospitals are properly considered”

Helen Tucker

The Community Hospitals Association, which is supporting the research, said it hoped the findings would put its members in a stronger negotiating position with commissioners.

Dr Helen Tucker, vice president of the CHA, said community hospitals found it challenging to demonstrate their benefits over other competing services due to  a lack of evidence.

“There is quite a lot of evidence about integrated community teams in the homes… Commissioners are in some areas having to make quite tough decisions about where they put their money, so we want to make sure community hospitals are properly considered,” she said.

However, Professor Young acknowledged the research might also expose some underperforming trusts that would have to “swallow bitter pills” about making improvements.

But he said most hospitals wanted to know this information in order to see where they needed to make changes.

The research is expected to be completed around the end of 2016, with results published shortly after.

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