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Hospital nurses on the rise, but mixed picture elsewhere


There was a dramatic rise in the number of nursing staff employed by hospitals in England in the immediate wake of the report into care failings into Mid Staffordshire Foundation Trust, latest official figures reveal.

Hospitals were employing around 2,400 more acute, elderly and general nurses in October 2013 than they were when the Francis report was published in February.

The period was marked by a widespread focus on safe staffing in hospitals culminating in the government telling hospital trusts to begin publishing daily details on ward staffing levels from April, as part of its response to the Francis report.


Acute, elderly and general nurses


According to the workforce data from the Health and Social Care Information Centre, health service hospitals in England are now employing more nurses than at any point since September 2009.

However, this scramble to recruit has not been matched in other sectors, with reductions during the same period in the numbers of nurses working in the community – especially district nurses – as well as mental health and learning disabilities. There was a tiny increase in school nurses.


Community nurses


District nurses have declined

The figures also show that numbers of nursing assistants and healthcare assistants rose by nearly 2,000, from 104,450 in February to 105,863 in October. But their numbers are down overall by over 2,000 since September 2009 when there were 108,056.

Despite, evidence of an upward trend in the acute sector, unions warned that it must be sustained in the long term and nurses were still under significant pressure after years of workforce erosion driven by trusts attempting to meet national targets to save money.  

The information centre, which publishes monthly workforce data, previously published totals for qualified nursing, midwifery and health visiting staff – with breakdowns only for midwives, health visitors and school nurses.

But this month, for the first time, it has begun publishing unparalleled details of the nursing and midwifery workforce in England, which shows staffing levels in specific specialties and roles.

It provides clear evidence of a so-called “Francis effect” among acute hospitals, with managers reacting to concerns about safe staffing levels.

The data shows that for acute, elderly and general nurses there were 172,300 full time equivalent nurses employed in the NHS in October 2013.

This is an increase of 3.5% since September 2009, when the number working in these areas was at its lowest at 166,443 and the country was in the depths of recession.

Howard Catton, policy director at the Royal College of Nursing, said: “No doubt this shows a very significant and welcome rise in numbers.”

Howard Catton

Mr Catton cautioned it was too early to say whether the increases represented a long-term change in the view of employers. He said: “We will only know the answer to that question when trusts face the bite of efficiency savings without being under the glare of media attention.”

He added: “There are some clinical settings where we have seen a decrease, the increase is not consistent.”

The NHS data shows a decline in overall community nursing since 2009, falling from 48,108 in September 2009 to 45,943 in October 2013, a drop of 4.5%. It should be noted that since 2009 some nurses working in community services have been transferred to private providers that have won NHS contracts.

Crystal Oldman, chief executive of the Queen’s Nursing Institute, said: “The number of qualified district nurses has been falling for some time and these figures show a 9.2% reduction over the year to October 2013.

“This is in part due to the reduced number of nurses undertaking the specialist practice programme of district nursing. There are multiple reasons for this trend,” she said. “However, the QNI believes that this trend is reversing, as a result of our sustained campaign… and we anticipate that an increase in district nurses will be seen in 2014.”

But Ms Oldman added that a fall in the numbers of the most senior community nurses was of “great concern”. “The numbers of managers, modern matrons and nurse consultants have fallen steadily and significantly throughout the year,” she said.

“This is due to service redesign, where the role of the matron and the nurse consultant is being revised and in many cases these nurses are being redeployed at a lower grade.

Crystal Oldman

Crystal Oldman

“The impact of this trend on patients, families and carers is not yet known, but we do know that high quality, complex care is required to be delivered and managed by specialist nurses working at advanced level of practice,” she warned.

Meanwhile, the overall number of registered staff working in maternity services fell from 25,768 in September 2009 to 24,971 in October 2013. Within that sector’s workforce, the number of registered midwives actually rose to 21,476 in October 2013 from a low point of 19,569 in September 2009 – an increase of 9.7%.

Jon Skewes, director for policy, employment relations and communications at the Royal College of Midwives, said, “We’ve got more midwives in the NHS in England, yes, but that number still lags far behind the number we need to cope with the historically high number of births. It’s a case of a lot done, a lot still to do.”

Overall qualified nursing, midwifery and health visiting staff across the NHS went from 306,025 full time equivalent staff in August 2013 to 310,924 in October 2013, a rise of 1.6%. But this is still 863 nurses lower than the highest point of 311,787 in March 2010.


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Readers' comments (6)

  • Meaningless nonsense: the increase in staff equates to 14.5 extra qualified staff per acute Trust in England. That's not even one extra nurse per ward.

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  • michael stone

    '... hospitals in England are now employing more nurses than at any point since September 2009.

    However, this scramble to recruit has not been matched in other sectors, with reductions during the same period in the numbers of nurses working in the community – especially district nurses – as well as mental health and learning disabilities.'

    Yo-Yos at work again: how long before the reduction in community nursing leads to more people being hospitalised, this gets picked up by a 'major report', and the yo-yo swings over to 'so we need more DNs' I wonder ?

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  • Nursing numbers on the rise!! Trumpeted by the media at every turn but this as always only takes into account the hospital nursing staff. What about general practice? Absolutely zero investment in practice nursing and at a time when more workload is being shifted to primary care and an ageing practice nurse force. I despair.

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  • Anonymous | 29-Jan-2014 12:14 pm has a good point. Like care homes, practice nursing is out of sight and out of mind for policy makers.

    My big group GP practice has gone in for skill mix dilution to homoeopathic levels.

    Apart from one NP doing her won separate appointment based surgeries as an alternative to the docs, they're all HCAs. I've no idea if they've had any preparation whatsoever, but they are clearly flummoxed by quite fundamental patient questions and they're working without any visible supervision.

    Me? I'm moving surgeries.

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  • We have one extra deputy sister who has supervisor role. Our senior sister is very busy with paperwork, however the deputy seems to be pushed into a role without knowing what to do. At times when parts of the ward is dangeously busy one can find her doing very little. She is not proactive in understanding and dealing with managing care to even out the work load. Trerefore on paper we have sufficient staff, but due to poor management parts of the ward can still be understaffed.
    Ward sisters must take control of the dynamics of the workload to unsure better care for, not some patients but all patients on the ward.

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  • Every "Trust" which reduced nurse staffing levels did so on the advice of a "Director of Nursing"!

    Why are these fools not facing fitness to practice hearings ?

    These "nurse managers" deliberately put patients at risk in pursuit of their "bonus"

    There needs to be a mass clear out of these so called "nurse leaders"

    If you are working on an understaffed, unsafe ward do take ACTION !

    1. Report your situation to the CQC -------


    2. Refer your local "nurse leader" to the NMC for investigation of malpractice.

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