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Trusts told to fill only 'essential' vacancies by regulator


Foundation trusts have been told by regulator Monitor they must ensure vacancies are filled “only where essential” and should review their use of acute inpatient safe staffing guidance, as part of a strategy to tackle financial deficits.

In a letter sent to all 152 foundation trusts yesterday, Monitor chief executive David Bennett said the NHS was facing an “almost unprecedented financial challenge” this year and trusts should leave “no stone unturned” in their attempts to stay within budgets.

He urged chiefs to take a range of actions, including ensuring safe staffing guidance for acute inpatient wards had been adopted in a “proportionate and appropriate way”.

“If staffing levels are decided by accountants rather than clinical staff, patient care will suffer”

Janet Davies

The letter also said rosters should be “rigorously managed” to deploy permanent staff “efficiently” across all shifts including evenings and weekends.

It is understood that a similar letter has also been sent non-foundation trusts by the NHS Trust Development Authority.

In 2014-15, NHS providers reported a total deficit of £822 million across all trusts. Analysis by Nursing Times’ sister title Health Service Journal has estimated deficits for 2015-16 will reach more than £2bn this year.

The letter said that, despite Monitor’s review of those 46 foundation trusts in most financial difficulty, more must be done by them and all other providers – including those expecting to end the year in a surplus – to make their money go further.

Responding to the letter, the Royal College of Nursing’s new chief executive and general secretary Janet Davies said budget pressures should not determine how many staff are required for safe care.

David Bennett

David Bennett

“Staffing levels are either safe or they are not, and this must be decided based on patient need, using safe staffing guidance. If staffing levels are decided by accountants rather than clinical staff, patient care will suffer,” she said.

She warned against the potential removal of “non essential” vacancies and the resulting increased workload for frontline employees.

“It is also unclear what constitutes a non-essential job in an NHS trust,” said Ms Davies. “If you get rid of support staff, their work does not disappear. Instead, it will mean frontline staff picking up extra paperwork and spending less time with patients. This is a false economy.”

She noted that the cost of agency workers was one of the main reasons behind NHS deficits and called or a long term plan in training enough nurses for safe staffing levels.

“What does adopting proportionately and appropriately mean?”

Louise Silverton

The Royal College of Midwives warned trusts to “proceed with extreme caution” when defining which staff are “essential”.

RCM director of midwifery Louise Silverton said: “Guidelines for maternity have been developed using the evidence of what it takes to provide a safe, high quality service. 

“What does adopting proportionately and appropriately mean? The whole point of this guidance is to end ambiguity by helping trusts understand exactly what they need,” she added.

NHS Providers, which represents both foundation trusts and trusts, said “clearer and more consistent messages” were required across the entire NHS system about how to strike the right balance between staffing levels and finances.

“We therefore need to be realistic about how much any in-year action on temporary staffing and in other areas can contribute to redressing the significant projected deficit in the provider sector for this financial year,” said the body in a statement.

“We need to be realistic about how much any in-year action on temporary staffing can contribute to redressing the significant projected deficit in the provider sector”

NHS Providers

It highlighted that demand and service cost was growing by around 4% every year, but annual NHS funding was increasing on average by less than 1%.

The body also noted the letter’s reference to a major efficiency review of hospitals in England being led by Labour peer Lord Carter of Coles, which is due to report in full this autumn.

It pointed to interim findings from the review published last month, which suggested a longer term plan was required to deliver savings by a deadline much further in the future – by 2020.

NHS Providers said that while its members would continue to help deliver savings in the short term, there was widespread recognition that for providers to make “significant” further efficiencies, a different approach was needed and “this will take time and investment to deliver”.


Readers' comments (17)

  • In my last job, a community MH service, we once went for 9 months without a service manager: no-one noticed; patients were still seen; everything went on as normal; a couple of us signed time sheets and expenses claims.

    And yet every time we went for any period of time without a clinician or member of admin staff we and our patients noticed it: not enough clinicians to see patients; prescriptions not written; assessments taking far longer to carry out; longer waits for diagnosis; letters not sent; appointments not arranged; phones not answered.

    Now, can we have a definition of "essential" please?

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  • Oh, and it was the same when we were without a permanent chief exec for a time: no-one below board level noticed.

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  • It is appauling that the Guidlines set by our regulators Monitor to ensure that our patients recieve the safest and the very best quality of nursing care are are now the very people who are adding aditional financial pressures to Trusts who are already financialy stretched to the limit and are trying to acheive the impossible on a continueing diminished budget. Our NHS Needs help and plenty of it!!

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  • Please remember what happened at Mid Staffordshire. Nursing staff took the brunt of criticism at all levels. The blame was soley at executive level, in failing to employ adequate levels of nursing staff, compromising patient care. Retention of nursing staff is the issue, & re-evaluating adequate renumeration in keeping staff in post.

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  • Anybody questioned how much it costs to employ the rafts of accountants who seem to be 'needed' by trusts? Their main role appears to be to close wards and departments. If some of these very expensive personnel were to be 'let go', the saving could be put to very good use.

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  • Anonymous 04 Aug 4.25pm is absolutely right. I work in the community and feel the closest to burnout I have ever felt in my life. What I cannot cope with is the constant change; moving offices, moving desks, re-formulating teams, new IT system, endless team meetings. We are stretched enough as it is without, without the added stress of adapting to these ridiculous changes implemented by managers who have to justify their huge salaries. Please stop, you are adding nothing to the quality of service we offer and making our jobs intolerable. The best cost saving measures you can make are to look at retaining the fantastic staff you already have by offering decent working conditions and fair remuneration.

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  • Presumably the regulator understands that with 'essential' staff quotas comes only 'essential' care? Would he be content to have only absolutely essential care for his loved ones? I doubt it!

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  • Every day I come nearer to making the decision to retire early, my health is suffering physically and mentally. This may well be the straw that breaks the camel's back

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  • We now have to do dependency scoring three times a day for senior managers to look at and decide where to move staff. Only trouble is that we are so busy with nursing care that we can't do this three times a day in addition to all the other reams of admin and paperwork we already have to do. It has got totally out of hand, and we have to start saying a firm NO to some of the ridiculous demands made on us under the guise of improving patient care, because a lot of it doesn't. It just takes us away from the patients we're supposed to be caring for.

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  • yes when a band 8 is employed to monitor "I want great care" questionnaires and a similar grade is monitoring e- rostering , you start to ask yourself where is the logic in all this? Personally I think it's "jobs for the boys !"

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