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Fewer than one in 10 hospitals meet their own nurse staffing targets

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More than nine out of 10 hospitals in England are failing to meet their own targets for the numbers of nurses working on wards, analysis has revealed.

The new figures show a significant decline from earlier this year, indicating a deteriorating picture of nurse staffing levels as the NHS approaches the key winter period.

According to safe staffing data reported by 225 acute hospital sites, 92% did not achieve their planned staffing levels for qualified nurses working during the day.

“The issue for the NHS isn’t about reducing the number of substantive staff to save money, it is about recruiting substantive staff to save money”

Heather Caudle

Meanwhile, the data – published on the NHS Choices website – also revealed 81% failed to have enough registered nurses working at night. In total, 79% missed the target for registered nurse staffing across both day and night.

The data, collected last month, records the average staffing levels across all wards at each hospital site in August. It reveals a gradually worsening position for nurse staffing during 2015. Data in January showed 85% missed their staffing targets for nurse day hours and 87% in April.

Monthly reporting of safe staffing date was made a requirement following the Francis report into care failings at Mid Staffordshire Foundation Trust.

The deterioration in performance may reflect trusts increasing their planned levels for nurses on adult wards in response to last year’s safe staffing guidance from the National Institute for Health and Care Excellence.

As has been widely reported, the NHS is struggling to recruit nurses due to a national shortage, while the sector is also forecasting a national provider deficit of £2bn this year – in part due to the use of expensive agency staff, leading the government to introduce a series of caps on spending.

“One of the biggest issues facing the NHS is how we balance the pressure around finance and the demand around staffing levels”

Chris Hopson

Meanwhile, some NHS trusts fear that increasing their nurse establishments at a time of a recruitment shortage means they run the risk of a high vacancy rate, which could attract criticism from the Care Quality Commission.

The organisation with the smallest percentage of day nurse hours filled was Bradford Teaching Hospitals Foundation Trust with 72% at its St Luke’s site, followed by Ashford and St Peter’s Hospitals Foundation Trust with 75% at its Ashford Hospital site.

Bradford’s deputy chief nurse, Sally Scales, said the trust was continuing to “focus heavily” on nurse staffing levels and actively recruiting both newly-trained nurses and those who wished to return to practice.

“Local open days and recruitment fairs are helping to bolster our staff numbers as we seek to recruit locally, nationally and internationally,” she said.

She added: “Our preference is always to directly employ our nursing staff rather than use agencies as we believe it leads to a better patient experience and helps to maintain a high level and continuity of care.”

The five hospitals struggling most to fill planned nurse hours, August 2015
TrustHospital site% of nurse day hours filled% of nurse night hours filled
Bradford Teaching Hospitals FT St Lukes Hospital 72 98
Ashford And St Peter’s Hospitals FT Ashford Hospital 75 100
Sandwell and West Birmingham Hospitals Trust Rowley Regis Hospital 76 74
Sandwell and West Birmingham Hospitals Trust City Hospital 77 66
The Royal Wolverhampton Trust Cannock Chase Hospital 77 92

Ashford and St Peter’s chief nurse Heather Caudle said the trust had struggled to retain nurses recruited from Portugal, while 60 non-European Union nurses had been left waiting 10 months to gain immigration clearance.

“The nurses we do have are leaving to go into agency work, so I do think the agency cap is a good thing, as we will see good nurses come back into the NHS,” she said. “The issue for the NHS isn’t about reducing the number of substantive staff to save money, it is about recruiting substantive staff to save money.”

“It is a constant daily battle to manage staffing”

Karen Dawber

Sandwell and West Birmingham Hospitals Trust had two hospitals in the bottom five performers for nurse day hours filled – Rowley Regis with 76% and City with 77%.

Trust chief executive Toby Lewis said he believed there were data accuracy issues with the staffing levels, but added: “Our daily data on staffing safety, overseen by the chief nurse’s team, provides a basis for our confidence in the care that we provide.”

Royal Wolverhampton NHS Trust was also in the bottom five with 77% of day nurse hours filled. Cheryl Etches, its chief nurse, said her trust was planning to recruit 200 nurses from overseas in addition to local graduates.

“The position we are in has been triggered by the Francis report, let’s be honest,” she said. “The Francis report absolutely put the nursing role as a central issue and we would be foolish to disinvest in nursing. If you want better quality care, better length of stay, better efficiency, less harm, less complications and errors you don’t want to be reducing your nursing staff.”

Chris Hopson, chief executive of the organisation NHS Providers, which represents trusts, said it was clear the sector was under “significant pressure around the recruitment of permanent staff”.

He added: “One of the biggest issues facing the NHS is how we balance the pressure around finance and the demand around staffing levels.”

Meanwhile, Karen Dawber, director of nursing at Warrington and Halton Hospitals Foundation Trust, said: “It is a constant daily battle to manage staffing. The main areas for me are accident and emergency, acute medicine and intensive care, which has become a problem again in the past 12 months.

“The RCN warned that cutting workforce numbers to fund the NHS reorganisation and to find the efficiency savings was the wrong course to take”

Howard Catton

She said there were fewer resources, including money and staff, than this time last year. Despite her trust investing £870,000 in nursing staff last year, Ms Dawber said it was not keeping pace with patient care demands that increasingly required one-to-one care.

She added: “Long term, it’s absolutely about the number of nurses and we also need to look at doing something different like the band 4 nurse assistant. There is a role for a tier of nursing who are not graduates.”

Howard Catton, head of policy and international at the Royal College of Nursing, warned that cutting workforce numbers to help find efficiency savings ”was the wrong course to take”.

“What is urgently needed is a workable long term plan for the workforce and an increase to the number of nurse training places,” he said.

“In the meantime, nursing needs to stay on the shortage occupation list for a considerable period of time, more effort must be made to retain existing staff and to incentivise and appreciate them as they grapple with increased demand, heavy workloads and extra hours,” he added.

The data analysis forms part of ongoing monitoring of NHS staffing levels by Nursing Times’ sister title Health Service Journal.

Staffing targets line graph

Staffing targets line graph

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