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”
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.
“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?”
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”
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”.