“Serious issues” around low numbers of nursing staff at Aberdeen Royal Infirmary have been revealed as part of report by the healthcare regulation body for Scotland.
In its review of findings, Healthcare Improvement Scotland found a “frequent and unanimous” theme of concern around the use of temporary staffing and that almost 40% of inpatient wards have a ratio of more than seven patients per nurse for every shift.
HIS also found that NHS Grampian – the health board running the hospital – had planned reductions in nurse numbers between 2009 and 2012.
Staffing data provided by NHS Grampian showed that there was an 8% reduction of whole time equivalent nursing staff across the health board’s services from 5,657 to 5,192 between 2009-10 and 2012-13.
“Funding is a challenge, but this is no excuse for the leadership and management failures identified at Aberdeen Royal Infirmary”
The regulator added that, despite the health board’s recent attempt to address the issue, this had still not produced the required levels and mix of staffing.
Aberdeen Royal Infirmary is NHS Grampian’s largest hospital, currently employing around 4,500 staff.
An unannounced inspection at the hospital as part of another HIS report on the care of older people in NHS Grampian acute services further confirmed concerns about nurse staffing.
The regulator added that the continuation of care provision at Aberdeen Royal Infirmary was only possible because of medical and nursing staff commitment, and dedication in “repeatedly covering gaps in the system”.
It has now called for NHS Grampian to develop a robust nursing workforce plan, which should include details on how to ensure all wards are staffed with a sufficient number and skill mix of workers.
“We will bring forward further proposals to recruit and retain both medical and nursing staff”
HIS also said the health board should create a plan to ensure its emergency department was sustainable and able to retain medical workers, while also exploring the “potentially valuable contribution that can be made by non-medical staff, such as advanced nurse practitioners”.
Other problems identified in the report include issues around leadership, accountability and complaints management.
Royal College of Nursing Scotland said the findings exposed that the board was unaware of problems at the infirmary and had made decisions without sufficient evidence or data.
“We know that funding is a challenge, but this is no excuse for the leadership and management failures identified at Aberdeen Royal Infirmary,” said RCN associate director Ellen Hudson.
She added: “It’s clear from the report that up until two years ago there were not enough nursing staff at Aberdeen Royal Infirmary and that the number of nurses had been cut for economic and financial reasons.
“Plans are now in place to address these shortages, but the board is struggling to recruit enough nurses and the vacancy rate is considerably higher than the Scottish average,” she said.
In a statement, NHS Grampian said it had accepted all the recommendations in the HIS report and that the health board was investing in nursing staff.
It said an additional 136 nurses were recruited between March 2013 and June 2014, with an extra 60 nursing posts created more recently – with the latter being almost all across its acute services.
The health board’s interim chief executive Malcolm Wright said the HIS reports did not raise any consistent or widespread concerns about patient safety or quality of care across NHS Grampian.
However, he added: “The report highlights real concerns over staffing levels and we will bring forward further proposals to recruit and retain both medical and nursing staff in what is a challenging labour market environment.
“In 2014-15, more than 200 additional clinical staff were employed at a cost of £9.9m,” he said.