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Study links higher death rates with increased number of HCAs


There is a link between higher death rates and the number of healthcare assistants employed in NHS hospitals, suggests latest nursing research.

A study by the University of Southampton found trusts with a higher number of unregulated HCAs also had a higher mortality rate.

It used survey data from almost 34,000 nurses, which formed part of the seminal RN4CAST nursing workforce study that was published last July. It also examined details of the workforce, bed occupancy and bed numbers for 137 acute hospital trusts and calculated the mortality rates based on the actual number of deaths, compared to the numbers predicted for each trust.

A higher HCA-to-bed ratio increased the mortality rate up to a maximum of 5.4% more than would be expected, the new study found. Across the trusts in the study, HCA-to-bed ratios ranged from 32 assistants per 100 beds to 109 assistants per 100 beds. The average was 66 HCAs per 100 beds.  

The study also identified a clear link between the number of registered nurses and mortality. It found there were fewer deaths the more nurses were employed. For every 10% increase in the number of registered nurses the odds of patients dying dropped by almost 7%.

Based on hospital admissions in 2010-11, the study found a 10% increase in the number of nurses would result in 2,600 fewer deaths.

The research was presented last week at the Royal College of Nursing’s International Nursing Research Conference in Belfast.

Lead study author Professor Peter Griffiths told Nursing Times the findings on HCAs needed further investigation, but said: “It certainly calls into question a workforce strategy that moves registered nurses further away from the bedside and replaces them with assistants.

“This echoes some of the findings of the [Mid Staffordshire Public Inquiry] report, which expressed concern over the lack of regulation for this workforce.”

Professor Griffiths added: “The fewer registered nurses a hospital has, the more patients die. So the significance of nurse staffing levels seems to be well established both in the research and in the tradition of the profession.”

He added that, while the government appeared “dead set” against introducing mandatory staffing levels, “there is surely a level at which we can be clear it cannot be safe under any circumstances.”

He suggested a ratio of eight patients per nurse, saying in his study 60% of shifts were at this level or better.

“The findings taken as a whole point to the need for more qualified nurses at the bed side,” Professor Griffiths said. “It is hard to conclude from this evidence that the solution lies in downgrading the training of the nursing workforce as a whole and reducing the number of registered nurses.”


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Readers' comments (13)

  • Money talks. And it says it the cost of health and or survival is too great. For all of us and our loved ones dependent upon the NHS. HCAs are cheaper, end of.

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  • Says it all when money comes before lives.

    It's also likely that a ward managed by junior nurses would not be as good as a ward managed by more senior, well trained and qualified nurses.

    Also when junior medics start in August, while consultants + regs are on holiday (family commitments/ school hols), with no senior cover mortality shoots through the roof.

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  • Any nurse could have told you that. It all comes down to money, I don't believe things will get any better.

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  • Not just any nurse, any patient in fact anyone who actually cares about the NHS. The amount of training and experience is vital to mortality, morbidity and satisfaction. Why else would some airports be designated 'captains only'. Good healthcare costs money, farming out to the private sector just means you are paying someone's profits too. You only have to look at the railways for that, the only ones requiring a subsidy are the private sector ones, the East Coast runs at a profit. Beware the 1st April, money will be the only thing that counts soon.

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  • Yet more research on staffing and skill mix to be ignored, I guess. Wish there would be a public outcry, but they seem oblivious to the causes of higher mortality, poorer care, unless it happens to them or their loved ones. Then, it is as individual complaints, not en masse, so they slip into oblivion. Their voice would be so much more powerful than ours. Alas, they are under the illusion that the government is doing something about by blaming the nurses.

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  • This is just the same old story but with a different headline. More trained staff - better outcomes. More HCAs - poorer outcomes.

    Does no-one listen to anything.

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  • Doesn't feel like anyone listens to nurses, whatever the grade. They pay lipsservice and say they've listened, then ignore what they've heard and not act on it.
    More likely to listen to patients, especially those who don't take it lying down, to medics (except in August) as they've got a proper degree, to lawyers as money will be involved and to politicians trying to get headlines and our votes.
    It's less attractive for businesses to take NHS over if they have to cut profit margins, pay for more staff to ensure people get well quicker, more comfortably, and unwell patients generate more money than a healthy population. Dying is also very expensive these days.

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  • So come on you guys- again and again this stuff comes out, again and again you say one listens to us....Why dont we band together and form a task force and decide how to move forward our profession to stand up and fight for these issues. I understand we are all sick and tired of the crap,,, but someone somewhere has to be the first to stand. Then when we come to come agreement, lets recruit our colleagues and push forward together. If we don't take a stand now, nursing is going to get slowly worse, and we will be responsible! Lets put our heads together and make a plan

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  • dont think so we are the eyes and ears for the nurse as they are to bizzy!!!!! anyway nurses are accountable while on duty we have to follow their commands and wishes

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  • A misleading title. It is not the number of HCAs leading to death - it is not enough trained staff that is the problem. More HCAs would enhance standards of care if only the increase did not lead to a reduction in RN staff.....

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