Downbanded or deleted – how the NHS is shedding its senior nurses

Some of the most experienced nurses have been lost to NHS employers in the past five years, research by Nursing Standard reveals.

Out of 114 trusts in England that responded to Freedom of Information requests about their senior nursing establishment, 30 (26.3%) had cut the number of nurse posts at bands 7 or 8 over the past five years.

In addition, Barts Health NHS Trust in London, which returned three years worth of figures, lost 54.4 nurse posts at those grades between 2013 and 2015.

In total, 540.5 full-time-equivalent senior nurse posts vanished across the 30 organisations.

The bands include roles such as matrons, ward sisters, charge nurses, clinical nurse specialists, community nursing team managers and nurse or midwife consultants. These staff are often called on to make critical clinical decisions.

In his report into the care scandal at Mid Staffordshire NHS Foundation Trust, Sir Robert Francis said ward sister and manager roles were ‘universally recognised as absolutely critical’.

Our survey reveals the trust that cut the highest proportion of senior nurses was Hull and East Yorkshire Hospitals NHS Trust. It cites factors such as ward reconfigurement and ‘service transformation’ among its reasons.

Trust chief nurse Mike Wright says: ‘We are confident we have the appropriate number of senior nursing staff. Our nursing and midwifery establishment is reviewed twice a year to ensure this continues to be the case, and to ensure we have the appropriate skill mix to meet the needs of patients.’

The lost posts point to reduced nursing establishments, downbanding of highly skilled clinicians and the reassignment of nurses’ roles.

Barts Health was criticised in 2015 for downbanding nurses by the Care Quality Commission.

‘The decision in 2013 to remove 220 posts across the trust and downband several hundred more nursing staff has had a significant impact on morale and has stretched staffing levels in many areas,’ a CQC report stated.

Many organisations have seen the benefits of investing in senior nurses.

South Tees Hospitals NHS Foundation Trust increased its band 7 and 8 roles by 5.4% (24 posts).

Director of nursing Gill Hunt explains: ‘We have embraced the advanced nurse practitioner role and have a large number of clinical nurse specialists taking on the traditional junior doctor roles.’

The trust has created extra clinical nurse specialists, going from 173.5 full-time-equivalent posts in 2011 to 205.7 in 2015.

Ms Hunt adds: ‘What we haven’t done is put in layers of management in the nursing hierarchy, it has been much more around front line clinical roles.’

Hampshire Hospitals NHS Foundation Trust associate director of nursing Arlene Wellman says its 86.5% increase, adding 148.5 posts in band 7 and 8 nurses is deliberate.

‘Not only is it important for staff to have visible leadership, but it is good for patients and relatives. Our programme to recruit clinical matrons is part of this. We have several more senior nurses starting shortly in clinical matron roles, and are still recruiting.’

A Barts Health spokesperson says: ‘Barts Health undertook a review to standardise staffing following a merger in 2012.

‘We have always sought to ensure we have the correct staffing levels and skills mix. In 2015, nurse and midwifery staffing increased in line with national guidance.’

North Bristol NHS Trust lost 51.15 full-time-equivalent posts, equating to 11.38% of its senior nursing posts over the past five years.

A trust spokesperson says this was due to a review of maternity services that resulted in downbanding of midwives, a reorganisation of acute services in which the number of band 7 ward sisters was cut, and the transfer of specialist paediatric and adult community nursing teams out of the trust.

The spokesperson adds: ‘There was no overall reduction in the numbers of staff on the unit, however it did mean that 28 band 7 midwives were rebanded to reflect their new roles, with the relevant pay protection.’

Health and Social Care Information Centre figures obtained by the RCN last year show that, between April 2010 and October 2014, there were 2,862 fewer band 7 and 8 nurses in NHS England.

RCN head of policy Howard Catton says Nursing Standard’s figures confirm a worrying trend across the NHS.

‘This is a significant finding and we are concerned there has been a disproportionate loss of senior nursing grades in the NHS,’ he explains.

Total number of full-time-equivalent (FTE) band 7 and 8 roles in 30 NHS trusts

‘It represents a vital loss of skill, experience and expertise that we know is critical to patient safety and care quality, as well as a loss of clinical leadership that can’t be quickly replaced or regrown.’

Mr Catton adds that a dearth of senior nurse roles signals a loss of mentorship and potential development.

‘If those band 7 and 8s aren’t there, it sends a strong message to band 5s and 6s that there is limited career opportunity. This could put people off entering the profession or leaving early.

‘Providers looked at some of these posts and thought they looked like expensive nursing posts. They have been lost in the drive for efficiency.

‘We also know the nurses in these posts have an older age profile and it may be that more of those nurses have retired than been replaced.’

Patients Association chief executive Katherine Murphy has concerns about the effect the reduction in band 7 or 8 nurses has on patient safety.

‘Removing senior nurses from the team might look good as a short-term measure to save money, but, in the long-term, the unintended consequences to patient safety can be huge.

‘We need these skills and expertise in the system and we should be doing everything we can to recruit, train and look after our senior nurses’.

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