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London hospitals told they could slash nursing bill by £421m


London hospitals have been advised by management consultants they could save £421m over the next three years through a major shake-up of nurse productivity, Nursing Times has learnt.

A report commissioned by strategic health authority NHS London identifies ways 18 hospital trusts in the capital could make savings worth £1.27bn, with nearly a third of the total coming from changes to nursing.

The report, written by consultants McKinsey and released after the Freedom of Information Act, claimed increasing nurse numbers was no guarantee of raising care quality and instead advocates increased efficiency and productivity.

It said: “There is no clear evidence that investment in simply increasing the number of nurses as the mechanism to increase the quality of nursing care is a guarantee of good patient care – many of the best health organisations in the world combine high productivity and excellent quality.

“This suggests that other factors, such as ways of working, may be more important than resourcing levels.”

The report said savings could come from “optimising skill mix, reducing agency use, increasing share of patient-facing time and aligning staffing levels with clinical need”.

The consultants based their findings on a comparison of the 18 non-foundation trusts against similar organisations elsewhere in the country.

It added that some clinical specialisms will “undoubtedly” need more staff and resources, but said “efficiency improvements will enable others to deliver improved quality with fewer staff”.

The report’s findings appear to fly in the face of analysis by Nursing Times showing the more registered nurses that a trust employed per bed the fewer of its patients were likely to die or experience long hospital stays.

A major US study, published last year by the New England Journal of Medicine, also found mortality rates were significantly affected by the number of nurses on a ward.  


Readers' comments (31)

  • carol hannah

    Whilst I appreciate that there may be inefficient nurses on some wards, in some hospitals, this is not the case everywhere.

    I work in Mental Health in East London and working with only four staff for twenty (often +) patients is no mean feat, believe me.

    These management consultants ought to come and work on our wards for a week, be part of the numbers and see how difficult and stressful the job can be for our nurses. They ought to try spending shift after shift with distressed, disorientated, confused, angry, disturbed, sometimes violent, aggressive or dangerous patients who, due to their mental illness, want their needs met immediately.

    Fortunately,we are lucky to have the support of our management and our Duty Senior Nurses when our wards are busy or at risk. I love my job as does everyone one else on our ward and we all work really hard so to hear yet another report about making savings to the detriment of nursing - again - is depressing, to say the least.

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  • I despair! What nonsense is this. How can a business consultant organisation evaluate the quality and outcomes of nursing care?

    presumably this report is akin to a time and motion study which just addresses the overt physical needs of patients but without addressing psychological needs and the importance of more covert interpersonal and therapeutic relationships in which nurses are highly skilled (and dare I add is also a high motivator for many in their job).

    It is well recognised in nursing that physical and psychological needs are interdependent and both must be met for healing to take place.

    It is easy for such a firm to stand on the outside and measure the physical tasks carried out by nurses but without having the slightest idea about the rest, and a large and important part, of their work of employing their observational and interpersonal skills as well as offering their patients ample psychosocial attention and tlc.

    Lying in a hospital bed can be a highly stressful and worrying and socially isolating experience and if social and mental needs are not being met this will delay healing, can lead to complications which may affect the auto immune system, and include symptoms such as depression and even the loss of the will to fight illness or to live which may in part be responsible for some of the deaths in hospital.

    The highest and most efficient physical task orientated nursing with a minimum of staff will not make up for these deficits. Nurses know this and report constantly about the shortages and their lack of ability to deliver the quality of care they expect for the well being and positive health outcomes of their patients. Psychological support and health education for patients and their relatives require a lot of time in addition to all the more visible physical tasks and much of which its importance cannot be measured by outside observers.

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  • Such reports are good news for McKinsey but not for anyone else. If it is like their methodology on other projects it will be simplistic in the extreme

    They also helped design the current chaos Lansley is trying to implement. Not much of a CV.

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  • Do we know how much the Consultancy firm charged for this piece of work???

    Not cheap I`m sure, and total B******* as usual.

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  • What a load of ****!!
    And what do Consultants know or care??
    There is an abundance of evidence worldwide stating that Patient Ratios SAVES LIVES and decreases the percentage by a huge amount of hospital related Pneumonias/UTIs/Pressure Sores and DEATHS!.
    This article is a disgrace.
    We in Melbourne Australia are fighting the battle of our lives to save our Ratios...and NOTHING will stop us to protect this essential part of our conditions. Safe and Quality CARE.We are in the process of Mass Resignation which is such a hard time for us all...but thats the way it is at the moment here.
    These Consultants are living either in Cuckoo Land or have the $$ sign on top of their heads our Government who do not want to read the evidence! Good Luck UK nurses with your ongoing need truckloads.

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  • I'm not a nurse, but working with clinical staff as I do, I just wish they could be left alone to get on with their job! In my acute trust, everyone (including me at times, because that's part of what I do) just seem to be trying to get more and more out of each nurse.

    There are much better things for me to be doing that would directly or indirectly benefit everyone - staff and patients - but for goodness sake let's leave the nursing staff alone for 5 minutes. We can't all be helping, I know...

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  • tinkerbell

    It added that some clinical specialisms will “undoubtedly” need more staff and resources, but said “efficiency improvements will enable others to deliver improved quality with fewer staff"

    Could you name these specialities - NEED A BIT MORE DETAIL please. Cos it sounds to me as even those that need more staff won't be getting them. They haven't got enough staff as it is. Just let's keep everything woolly and fluffy so no one has a clue what you mean hey, just like this governments reforms.

    "A major US study, published last year by the New England Journal of Medicine, also found mortality rates were significantly affected by the number of nurses on a ward"
    Doesn't need a sherlock Holmes to figure that one out.

    Could you all reveal yourselves and how much you are being paid to come out with this inane garbage?

    When are you sending in the bulldozers to completely scrap OUR NHS?

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  • "A report commissioned by strategic health authority NHS London..."

    this is ambiguous. Are we talking about an anonymous strategic health authority associated with the NHS in London or The Strategic Health Authority NHS London (in which case there is an issue with capitalisation!)

    If it is an authority it should be revealed which one. In either case, the commissioning of such a report from a management consultancy unrelated to the nursing profession is merely an exhibition of obstructive and irresponsible behaviour considering the uselessness of such an exercise and costs that the NHS can at this time ill afford. the money could have been better spent elsewhere on a more constructive project.

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  • Kind of sums up everything when in the first paragraph the term "Nurse productivity" is used....
    Dear management consultants just for your information....I DO NOT work in a factory,performimg a task for product output in a set amount of time.I work with people who need support with their health needs.The key word for you here is PEOPLE,not bits of machinery!!!
    All requiring different levels of support.I can be giving exactly the same treatment to 2 different people and this will take me different amounts of time.
    For the nurses reading this,they will be saying,yes well thats obvious,thats because we know whats required,we know how nursing people works,and quite simply you dont.
    I worked on a service development programme called C-PORT,i took the IT/mangement "consultants" to my work area,they saw how busy we were and thanked me for helping them put things in perspective,they said it helped them understand our requirements more fully and they took more notice of what i said in regard to the project.
    Get out of the office and go do the same,before the NHS becomes terminal!!!!!!!

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  • Actually under-staffing leads to inefficiencies. Use of agency rather than staff who are part of a team and know the area is not efficient. Also trained nurses are an efficient resource if people know what they are doing, how to do it and when to do it they can work efficiently, that seems to have been forgotten or overlooked in recent years.

    We don't get time to work on efficiency we are too busy mopping up.

    Sounds like the outcome of this report was written in advance.

    There are of course huge inefficiencies in management that could save millions - only problem is that it is the managers who decide and they prefer to answer everything with the suggestion that we can work leaner - it is a nightmare with no end in sight.

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