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Trusts raise the axe as NHS austerity drive kicks in


Nurses at struggling hospitals trusts are set to face major pressures this year, as managers reveal plans to slash staff numbers and review workforce “skill mix”, an investigation by Nursing Times has revealed.

The growing pressure to meet tight financial targets has sparked warnings that trusts must avoid harming care standards, as occurred at Mid Staffordshire Foundation Trust.

Nursing Times has analysed draft plans from among 19 trusts in England identified by our sister title Health Service Journal as planning the biggest cuts this year.

These organisations have said they need to cut costs by 8% or more in 2011-12. Those with published details of their plans aim to make workforce savings through a combination of post reductions, productivity drives, reductions in patient length of stay, changes to workforce “skill mix”, and closure of wards and beds.

The radical cuts proposed reinforce union claims that frontline staff and services will not be protected from the huge savings drive currently sweeping the NHS, despite government insistence that the health budget has been ringfenced.

The plans include proposals to:

  • Cut Agenda for Change clinical staff by 192 whole time equivalent (wte) posts – or 13% – at Princess Alexandra Hospital Trust in Essex this year, and by a total of 251 by March 2014. It also wants to close 42 emergency beds and one elective ward this year;
  • Cut 142 posts this year at Whipps Cross University Hospital Trust in London, with only 25 earmarked to come from back office or clinical support staff reductions. This includes plans to save £1m through a nursing skill mix review;
  • Cut 50 beds, and reduce one surgical ward from seven to five days at West Middlesex Hospital Trust;
  • Slash pay expenditure at Imperial College Healthcare Trust by £44m, or 8%, and cut 150 posts this year.

Many of the trusts analysed by Nursing Times cited pressure from primary care trusts to reduce hospital activity, and the drive to reach foundation trust status, among their reasons for major cost cutting.

The Department of Health wants all trusts to achieve foundation status by 2014. Acute trusts currently without foundation status constituted more than two thirds of the 19 trusts planning savings of 8% or more, and five of the seven aiming to save 10% or more.

NHS Confederation acting chief executive Nigel Edwards warned trusts not to duplicate the failures at Mid Staffordshire, where care failures emerged in the midst of a drive for foundation trust status.

“It was the pursuit of financial targets that seems to have been heavily implicated in the problems at Mid Staffs,” he told Nursing Times. “I’m hoping that’s very much in the minds of the people developing these kinds of cost improvements,” he said.

The full scale of the cuts this year has yet to emerge, with most trusts analysed saying they are yet to identify where they would make all the savings they needed.

Royal College of Nursing head of policy Howard Catton said Nursing Times’ findings supported the union’s own findings.

Its latest Frontline First report, published last month, said 9,650 posts – 54% of them nurses – had so far been identified for the axe across a sample of 21 trusts (news, page 3, 12 April).

Mr Catton said: “For an awful lot of nurses [the scale of productivity targets] simply mean having to look after more patients, and more patients who have a higher level of dependency, because they’re in hospital for less time.

He added: “Nursing staff will feel that the quality component of the care people are trying to deliver is squeezed out completely.”

A spokeswoman for Whipps Cross said: “Our [savings] plans for 2011-12 will focus on improvements such as reductions in length of stay and readmissions, which will benefit patients as well as leading to increased efficiencies.

“Our planning assumption is that any reduction in posts will be achieved through natural turnover and reducing use of agency staff. “

An Imperial Healthcare spokeswoman said: “We intend to achieve these savings by first reducing our substantial bank and agency numbers and by natural turnover and redeployment of staff into areas of growth.

“As outlined in our annual plan, we expect to selectively reduce substantive staff numbers by around 150 over the year.”

Of the 19 trusts identified, Nursing Times reviewed the plans of the 13 with published details of their plans for 2011-12 in recent board papers. Not all of these trusts provided detail on the workforce implications of their plans.


Readers' comments (10)

  • Close beds= increased waiting times
    reduced staff= more stress= more sickness= more agency/bank staff= more money spend
    Reduce top management pay I say it will help save a substanial amount of money.

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  • Get rid of chief execs that will save £200.000 plus a year.

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  • "the nhs will be protected from the cuts"

    what a load of crap
    this is the tip of the iceberg!
    in a few years this con-dem unelected govt will have had maggies wish to destroy/privatise the nhs

    to all those who work for the nhs and voted in these idiots, i hope you are so proud at what you have done to the nhs

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  • Nurses may start thinking of leaving with all this going on. Save the NHS.

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  • "Get rid of chief execs that will save £200.000 plus a year"

    Get real. That isn't much more than the saving my Trust is going to make in not having water coolers anymore.

    My Trust is having to save around £40m - that £200k isn't going to make much of a dent in that is it?

    I predict that handwringing and finger pointing responses on this topic will outnumber useful and thoughtful responses by around 8 to 1.

    We all see waste around us - whether its poor stock rotation that sees supplies thrown out or the use of agency staff instead of sensible rostering. Put down the flaming torches and pitchforks, and pick up the challenge of doing what we do best - even better.

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  • Sorry, I agree that getting rid of CEO's is not much money saved overall. Get rid of the biggest workforce - nursing and that is where you make savings. Unfortunately, the true problem with less nursing staff will be mistakes and the costs of that will escalate. This coalition (sorry Conservative bully led) Government is hell bent on not taking a U turn despite the problems that those of us working in the health service can see. This truly is the end of most of the NHS as we know it. Modernisation, my foot, cuts and only cuts. Going back to competition within the health service is the repeat of the last Conservative Government in the 1980's and it will not promote sharing good practise it will destroy it just as it did then. The last Labour Government started modernisation and it DID work to improve efficiency but it did not save money. If anything it increased costs as we could do more work!!! I have no problem with making savings and modernising further big and a big BUT it is, PLEASE (note the big please too), make change worthwhile, useful, relevant and planning for the long term not a quick financial fix and for good patient care and outcomes.

    Frankly, if CEO's are good keep them if they are failing get rid of them and get decent ones in post. We probably can't do without them. So far I have seen progressively worse senior management in post over the past 5 years. (Labour are at fault too don't forget and ultimately it is also the fault of us nurses and doctors as we have had our expertise and what little power we had eroded completely away.) No voice - just rhetoric.

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  • Anonymous | 10-May-2011 10:16 am
    'con-dem', what an apt description of the Government.

    I wonder what it costs, in senior NHS management wages, while they are in meetings discussing how to make these cuts. The outcome usually results in short term fixes, only for the whole process to be repeated again and again.

    Whatever happens to EBP when it comes to safe staffing levels to provide best practice for our patients? Ignored it seems. Lets not forget, we too are all potential patients at some time in our lives. It's even more scarey for the 'baby boomers' of which I am one. Is there a plan to bump us off, as there will be not enough frontline staff to provide the care?

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  • my initial understanding of the whole idea of the government scheme was to maintain the quality of care whilst reducing the unneccessary layers of management which are wasting money. if they axe more and more front line staff there will be an even more top heavy layer of management, and what will they be still managing to earn there over inflated salaries and bonuses? How can their jobs still be justified? it seems i must have been dreaming.

    i also thought that everybody was far too impatient and the new government needed to be given a chance and time. after all they could not clear up all the mess left by the previous government overnight. now i see they have been in power for almost one year and apart from serious cutbacks everywhere and causing chaos i really do wonder what they have achieved and whether they have actually done, or plan to do, anything positive.

    so many peoples' lives are being messed up or even ruined recently by all the extreme anxiety causing uncertainty which can have very negative effects on health for which it will become increasingly difficult to get support or care and then they preach to the british about happiness!

    It really does seem that we are returning to life in a very primitive and even barbaric society comparable to that of the developing countries.

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  • Typical knee jerk reaction from bad managers: Cut the nursing positions and that will solve the problem. I say sack the idiots who thought up this "idea".

    I thought they govt had promised not to cut front line staff. Is anyone in the govt actually monitoring what goes on in the NHS?

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  • frontline staff are not important enough we do not get in the money,(!)

    see if the NHS will run without any frontline staff...............

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