Wards in England are still failing to achieve safe staffing levels, new report warns

Workforce study says policies introduced since Mid-Staffs Inquiry have lost momentum

Workforce study says policies introduced since Mid Staffs Inquiry have lost momentum

Picture: Daniel Mitchell

Hospital wards across the NHS in England remain understaffed and are putting patients’ lives at risk, warns a new report – despite policies put in place as a result of the Mid Staffordshire Inquiry.

The 2013 inquiry led by Sir Robert Francis QC – which examined care failings at Mid Staffordshire NHS Foundation Trust from 2005-09 – led to new national policies, including the 2014 National Institute for Health and Care Excellence (NICE) guidelines on safe-staffing for acute hospital wards.

Nurse vacancies

But Jane Ball, research fellow at the University of Southampton, and lead author of the study Implementation, Impact and Costs of Policies for Safe Staffing in Acute NHS Trusts, warns that new workforce guidelines have not led to significant improvements on hospital wards.

According to the study, hospitals are facing major challenges in recruiting and retaining registered nurses, with an average registered nurse vacancy rate reported at 10% across England, with rates as high as 20% in some trusts.

The RCN estimates there is currently a shortfall of 40,000 nurses in England.

Analysis of national workforce data in the study shows that while the total number of nursing staff in acute care has increased since the 2013 inquiry, concurrent growth in patient admissions means there has been no net improvement in registered nurse staffing levels.

The study also highlights an increase in nursing support staff, such as healthcare assistants, that is three times greater than that of registered nurses, causing a dilution of skill levels in NHS acute care.    

Study method

Professor Ball and researchers from the Universities of Southampton and Bangor surveyed directors of nursing in acute NHS trusts, analysed national workforce data, and reviewed case studies and policies from four acute NHS trusts.

The study found that the initial strong policy response to the inquiry - to put patients first and foremost, and avoid a repeat of the failings found in Mid Staffordshire– had become more muted.

‘The ongoing national shortage of registered nurses and failure to increase supply sufficiently has not been addressed,’ Professor Ball said.

‘This failure has prevented safe staffing levels from being achieved. NICE identified a ratio of eight patients per registered nurse as a level that threatens patient safety. But in our survey of directors of nursing, one in four reported wards were routinely running with this high-risk level.'

Legal request

RCN director for England Patricia Marquis called for nursing staffing levels to be enshrined in law, along with a government commitment to staff retention and training.

She said: ‘Rising patient numbers are outstripping small nurse increases.

‘The report is right to raise concerns around the increased numbers of support staff too – these increases must be matched by rises in registered nurses if we’re to keep the full and appropriate mix of skills in care settings.’

Government view

In response to news in February that the RCN was launching a campaign for a safe staffing law in England, a Department of Health and Social Care spokesperson said nurses were a key part of the government’s plans for the future of the NHS.

‘As part of our NHS Long Term Plan, we want the health service to be the safest healthcare system in the world, and our dedicated nurses underpin this ambition,’ they told Nursing Standard.

In other news


This is a free article for registered users

This article is not available as part of an institutional subscription. Why is this? You can register for free access.