A group of hospital trusts that are under investigation for higher than expected death rates have fewer nurses on average than hospitals with lower mortality, it has emerged.
In total 14 trusts are facing a government-ordered probe into mortality rates the publication of the Mid Staffordshire Foundation Trust Public Inquiry report last month. The review is being led by the NHS medical director Sir Bruce Keogh.
But an analysis of staffing levels at the 14 trusts and the rest of the NHS has found significant variation between the numbers of nurses and other staffing groups, suggesting a link between workforce levels and death rates.
On average trusts with higher than expected mortality were found to have six fewer nurses per 100 beds than other trusts.
The University of Plymouth study found the average number of registered nurses per 100 beds at the 14 trusts was 136.8, while the average at other trusts was 143.4.
There was also a similar relationship for medical and cleaning staff. For example, trusts facing investigation had an average of 56.1 doctors per 100 beds, compared with 67.5 doctors at other trusts.
The results echo a previous analysis of hospitals with the highest number of excess deaths in the Summary Hospital Mortality Indicator – a mortality index used by the DH. Those with the highest mortality rates had on average 137.3 nurses per 100 beds, compared with 155.9 nurses at those with the lowest number of excess deaths.
Sir David Nicholson, the under-fire NHS chief executive, last week told MPs that hospitals would be expected to identify what level of staffing they needed to maintain safety.
Appearing before the Commons’ health select committee, he said: “As we go through the next two or three years and the financial position gets tighter, we need to ensure the staffing levels on wards are safe, and better than that.
“Every single hospital has to go through a process where they identify ward by ward what their staffing level should be and they should publish it. In my view, as you come into the ward, it should show what the level of staffing should be and what it is,” he said.
Liz Redfern, chief nurse for NHS South of England, appeared before the committee with Sir David. She said trusts would be required to use tools to determine their staffing needs, as set out in the new national nursing strategy Compassion in Practice.
“I have made it clear… that we would expect directors of nursing on a trust board to have a mechanism, for doing this,” she said. “They are both professionally accountable through their registration as well as personally responsible for the quality of patient care through their nurse staffing arrangements.
“We expect them all to have a way of doing it and we expect them all to use one of the tools. If they are not we would expect their trust boards to hold them to account for that,” she added.
The Mid Staffordshire Public Inquiry report recommended that the National Institute for Health and Clinical Excellence should develop minimum nurse staffing levels for all NHS services. The recommendation was backed by both the Royal College of Nursing and Unison.
However, health minister Dan Poulter recently suggested this would not get government support. At a conference last month, he said: “Sometimes when you put in mandatory standards you can have a drive to the bottom… I don’t think staffing ratios is the answer.”
The government’s response to Robert Francis’ 290 recommendations is expected to be revealed at the end of this month.