Almost all hospitals in England have nurse shortages, data reveals

Hospitals are running wards with a dangerously low number of nurses and are using healthcare assistants as 'stand-ins', an investigation suggests.
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Safe staffing

Hospitals are running wards with a dangerously low number of nurses and are using healthcare assistants as 'stand-ins', an investigation suggests

Analysis of two years' worth of official data shows almost every acute hospital in England is failing to meet its own standard on how many nurses it should have on wards.

Safe staffing
Government caps on how much hospitals are allowed to spend on agency staff
appear to have exacerbated the safe staffing problem. Picture: Guzelian

Nurses described 'desperately unsafe' numbers of registered nurses, while others said patients are being put at risk.

The problem appears to have got worse since the government introduced a cap on how much hospitals are allowed to spend on agency staff.

Staffing data

Health secretary Jeremy Hunt ordered NHS trusts to publish monthly data on staffing levels as part of the government response to the care failings at Mid Staffordshire NHS Foundation Trust.

But analysis by the Health Service Journal (HSJ), covering data from 2014-15 to 2016-17, shows 96% of acute hospitals (214) reporting figures failed to meet their own planned level for registered nurses working during the day in October 2016.

Some 85% (190 hospitals) also missed their target for nurses working at night in the same month.

This is the worst performance for both day and night since the HSJ started analysing data in 2014.

Plugging the gaps

Across the two years studied, more than 150 hospitals failed to achieve their planned daytime staffing levels for nurses, while the data suggests gaps in rotas are being plugged with healthcare assistants (HCAs).

Research published in November found that patients are one fifth more likely to die in hospitals where nurses are replaced with less-qualified staff.

University of Southampton chair of health services research Peter Griffiths, an expert on nursing numbers, said the use of HCAs to fill gaps in the long-term could mean trusts 'delude' themselves that they are maintaining safety.

London South Bank University chair of healthcare and workforce modelling Alison Leary said: 'The overall trend shows organisations bolstering nurse gaps with HCAs.

'This might seem like the only practical solution at the time and could be seen as someone being better than no one.

'However, when that becomes the norm, we have to consider the inherent risk, given the evidence that registered nurses have direct benefits for patient safety.'

Ward concerns

As part of the investigation, nurses told the HSJ of widespread problems on wards.

One, working in south west England, said: 'The most patients I have ever had is 16 on a night shift, I know for a fact that I did not do all the observations and can only hope that I did not cause anyone any real harm.'

Another incident report from 2015 showed one nurse was left to care for 24 patients on a medical ward.

Another nurse said: 'Corners are cut and safety is compromised daily, we just do a really good job of covering it up.'

Another said: 'Skill mix was desperately unsafe for a normal shift. I felt sick to my stomach.'

Serious risk

The analysis showed that Princess Alexandra Hospital in Harlow, Essex, has not achieved above 80% of planned nurse staffing since quarter four of 2014-15.

West Cumberland Hospital, part of the North Cumbria University Hospitals NHS Trust, and Princess Anne Hospital, run by University Hospital Southampton NHS Foundation Trust, had less than 90% of planned nurses working at night across the two years.

RCN general secretary Janet Davies said patients were being put at serious risk by low staffing levels.

'While HCAs play a crucial role in the team, research shows that support roles cannot replace registered nurses if patients are to receive safe care,' she said.

Safe staffing work stopped

The National Institute for Health and Care Excellence (NICE) conducted work into safe staffing levels on wards with a view to setting minimum safe numbers.

But this work was stopped by Mr Hunt, who has given the task to NHS Improvement.

NHS Improvement executive director of nursing Ruth May said: 'I've visited numerous hospitals since the New Year and I've seen staff of all disciplines giving everything they've got to provide good care, but there is more we can and should do to help them.

'Right now we need to do more to help get patients back into their homes, supported by social care where necessary.

'We also need to do more to support trusts to recruit and retain more staff.'