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Study suggests link between fewer nurses and higher death rates


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.


Readers' comments (21)

  • 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.

    You don't say..........

    When will anyone actually listen??? When will anyone actually care?? Why do we keep insisting that the NHS is so great...when this type of issue continually rears its head? The NHS is a fabulous concept, but the way it is a which ever government which is in power and by managers who have no real hands on experience of patient care, it will continuley decline.

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  • Not superised by this report it shows very clearly what we've always known.not enough nurses on the ward can only lead to poor care and altimately death. I hope the goverment is reading this report.

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  • I am an old cynic, but I reckon the tool for working out required numbers will be one which allows for some areas to actually CUT numbers...
    No way will Trusts publicise at the door that you are being admitted to an area with too few nurses.

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  • I agree with the above comments. I cannot believe that managers/government still do not have the common sense to realise that low nurse staffing levels may lead to poor patient care and may contribute to the death of the patient.
    It is so frustrating for nurses who want to deliver the care they have been trained to do but are unable to due to having too many patients to care for!

    It is about time that nurses are listened to and universal measures put in place for safe staffing levels which would enable us to carry out good patient care.

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  • Well there you have it! No s--t Sherlock! The study is only saying what we all have known for ages. It won't get acted upon though.

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  • Well we must ensure it does get acted on. The tide is turning (I hope) and I hope this means future targets are aimed at things that are the responsibility of managers. For too long vacancies are seen as a money saving - how great if trusts lost money when they don't staff services as they are commissioned.

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  • It seems fairly pointless to properly and safely staff your ward when your staff can be sent to short staffed areas to cover their sickness. This seems to be happening increasingly more in my work place, especially at night time when the site sister can move staff around as she wishes.

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  • The title of this article is misleading - the study actually suggests the opposite - that their is NO statistically significant difference between the numbers of nurses at the two groups of hospitals.

    There is a significant difference between the numbers of doctors, consultants and cleaners, but the difference in nurse numbers is statistically insignificant.

    You can find the details at

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  • anyone else remember the good old days when we closed beds to admissions if we didn't have enough staff? I remember those days back in the 90's, not anymore.

    why do we have to keep going on about staff shortages, inappropriate skill mix, managers sitting in the office all day all resulting in patients suffering - it's clear to anyone who has half a brain cell that you need enough nurses and doctors to look after patients, if you don't have enough then patients suffer and the staff suffer.

    why do we have to keep on repeating ourselves and going round and round in circles.

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  • Isn't this common sense?

    You need the right number and right mix of staff to look after patients

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