The NHS is “sleepwalking” into a nursing crisis with thousands of frontline posts lost and training positions axed

The Royal College of Nursing (RCN) said that despite the Coalition’s promise to protect frontline staff from cuts the NHS workforce has fallen by almost 21,000 since the Coalition Government came to power.The NHS is "sleepwalking" into a nursing crisis with thousands of frontline posts lost and training positions axedThis includes a loss of more than 6,000 qualified nursing posts – from a total of 312,000 nursing posts in the NHS.

The RCN’s report also warns that parts of the health service face the prospect of nursing shortages within three years as thousands of training posts are slashed, meaning trusts will have to recruit from overseas.

Patient safety will be seriously undermined by falling numbers of nurses, with the RCN’s chief executive warning that standards of care “are going to get a lot worse”.

The nursing union has been tracking job cuts since the Coalition came to power in May 2010. It has found that about 1,000 posts are being earmarked as “at risk” by NHS trusts every month as they try to find savings of £20 billion during this parliament.

As well as job losses, the number of new nurses being trained has fallen sharply, by 14 per cent in just two years.

In London, training places for adult nurses have fallen by 21 per cent, which will lead to substantial shortages by 2015 – highlighting failures in long-term workforce planning, warns the RCN. District nursing is heading towards crisis, as numbers of nurses have plummeted by a third since 2001 to 8,000.

The RCN questions how the NHS can re-focus care from hospitals to the community – essential for improving patient outcomes and saving money – if the cull of district nurses continues.

Nurse leaders warn that the Government will soon be stranded in a “perfect storm” of an ageing population with increasing numbers of long-term conditions without enough nurses safely to care for patients.

Peter Carter, the RCN’s chief executive, said: “London is facing a workforce crisis within three years. The remedy will be to go overseas to countries like the Philippines to raid their workforce again, and an over-reliance on agency and temporary staff – in order to bail out the Government’s poor workforce planning.” He added: “The standards of care are under huge strain across England and if this trajectory continues unchecked then things are going to get a lot worse. There is no rogue information in our data. This is not the worst-case scenario: it is the declared scenario from trusts.”

The pledge to protect frontline staff was a key Coalition promise even as it announced the need to save £20bn to cope with increasing healthcare demands as budgets flatline after years of record investment.

But official figures reveal that there were almost 6,150 fewer full-time equivalent qualified nurses in July this year compared with May 2010 despite Coalition promises to protect frontline staff. In total, there are 20,790 fewer NHS staff, but the number of doctors has increased by 7,000, according to the NHS Information Centre.

The long-awaited report into the Mid Staffordshire hospital scandal is expected to recommend minimum nursing levels to improve patient safety in hospitals. On average there is one qualified nurse to every four paediatric patients, but only one for every nine elderly patients.

Yet there is compelling evidence from King’s College London that patient outcomes improve when science is applied to nurse-patient ratios – in short, making sure there are enough nurses safely to care for patients in different settings.


Nurses look after 15 patients at a time

NHS nurses are having to look after up to 15 patients at a time, a major study has found.Nurses look after 15 patients at a timeThe study of 46 NHS hospitals, also found that at one in six trusts, unqualified healthcare assistants now outnumber nurses on the wards.

The findings show a sharp rise in their workload to levels which patients’ groups said compromised safety and left little time for compassion.

It follows growing public concern that hospital patients, especially the elderly, are being denied basic dignity and left thirsty and hungry.

A public inquiry into the Stafford Hospital scandal – where hundreds died amid “appalling” failings in care – is preparing to recommend changes to improve the quality of nursing.

Both the Stafford inquiry and a review of nursing ordered by the Prime Minister are considering whether healthcare assistants should be subject to regulation, and whether rules should be set to guarantee nursing levels.

These could set out either a maximum number of patients per nurse, or a ceiling for the proportion of assistants to qualified nurses on any shift.

The NHS has never set rules on nurse number, but in parts of the US and Australia, mandatory levels have been imposed – typically at around six patients per nurse.

Among the findings of the research were:

* On average, nurses were allocated 11 patients at night and eight by day;
* At some trusts, nurses were asked to care for 15 patients at night;
* Across the country, the proportion of qualified nurses to unqualified staff has fallen below safe thresholds outlined by England’s most senior nurse last year;
* Five years ago, on average there were two nurses for each assistant; now the ratio is closer to 1:1;
* Of 3,000 nurses who took part in the research, two-thirds said they ran out of time to offer “comfort” to patients and relatives;
* More than one-third said they ran out of time to safely supervise their patients.

The statistics disclose a sharp increase in nurses’ workloads. Five years ago, they were allocated an average of seven patients on day shifts and nine at night, previous research shows.

Patients’ groups said the study demonstrated that nurses had become dangerously over-stretched, with little heed paid to the lessons of the Stafford Hospital scandal, where standards of care fell dangerously low as nurses were replaced by cheaper staff.

Katherine Murphy, chief executive of the Patients Association said: “The situation has become absolutely disgraceful. One nurse cannot care safely for 15 patients, and identify when their condition is deteriorating, let alone offer comfort or compassion.”

She said it was “appalling” that so many hospitals had increased their reliance on unqualified staff, given the warnings made in the 2009 investigation into Stafford.

Although the health service has been given increases in its budget, just above inflation, it has been told to make £20 billion of efficiency savings by 2015 so services can meet the needs of an ageing population.

The Coalition had pledged to protect frontline jobs from any cuts. Last month, after official figures showed the number of nurses has fallen by 4,500 in two years, Andrew Lansley, the Health Secretary, conceded that the number of posts has fallen. He said decisions were taken by trust boards, not the Government.

Janet Davies, director of nursing from the Royal College of Nursing (RCN), said: “When there aren’t enough nurses, it has a huge impact on the quality of care for patients; they are left unsupervised for too long, and it is harder to provide compassionate care.”

The RCN wants regulation of healthcare assistants – unqualified workers who are only supposed to carry out non-medical tasks such as washing and feeding. It wants a limit set so that they cannot make up more than 35 per cent of nursing staff on any ward.

In evidence to the Stafford public inquiry, which is due to report in the autumn, England’s Chief Nursing Officer, who has just retired, said most wards should not go lower than a 60:40 ratio of registered nurses to unregistered staff.

Dame Christine Beasley said the decision by Mid Staffordshire Foundation trust to reverse that ratio – with six healthcare assistants for every four nurses on some wards, before the scandal was revealed in 2009 – was “unacceptable”.

The research discloses that the average hospital trust now has a balance of 56 per cent qualified nurses to 44 per cent healthcare assistants. In some hospital trusts the proportion of qualified nurses was as low as 43 per cent.

The research, led by the National Nursing Research Unit at Kings College London, found that older patients received the least care and attention. More than three-quarters [76 %] of nurses polled by researchers said there were not enough staff to get the work done.


6,000 patients die a year due to poor staff checks

Six thousand patients are dying every year because hospital staff are not properly monitoring vital signs.6,000 patients die a year due to poor staff checksThe health of patients is deteriorating and going unnoticed because important signs, such as blood oxygen levels which can predict heart and lung problems, are either not being recorded at all or often enough.

Bedside health charts are not designed to pick up subtle physiological changes which together can indicate if a patient’s condition is going downhill, according to the Royal College of Physicians.

Doctors would be able to intervene much more promptly and save thousands of lives every year if hospitals used a more comprehensive chart, the report states.

Hospital staff are also being left confused by the more than 100 different types of chart which are used across the country.

There should be just one system used for all staff who check on patients’ conditions – whether they are in care homes, hospitals or in ambulances, a working group set up by the college said.

It has developed a new chart which it is campaigning to have rolled out across all hospitals in the UK.

The chart is a ‘traffic light’ monitoring system of six vital signs such as pulse, temperature and blood pressure, in which each is given a risk score.

The healthcare worker then adds up the score for each sign to give an indication of the severity of illness and whether the patient needs more urgent care.

Bryan Williams, professor of medicine at University College London, chair of the working party which developed the new chart, said it would have a “major impact”.

“Most improvements we make are incremental, but we see this as transformational. It’s going to make a big difference,” he said. “Subtle changes identified together are often more significant than a single extreme change. That’s why deterioration is often missed.”

“If you go into hospitals, you will find very different systems in place. Sometimes staff are not taking all six measurements, but even where they are, they are not being scored in the same manner – sometimes even between wards.  There is also tremendous variation between hospitals in frequency of monitoring.”

The National Early Warning Score will require nurses and healthcare assistants to monitor temperature, pulse, blood pressure, breathing rate, level of consciousness, and oxygen saturation.

The last is a measure of how much oxygen is in the blood, and has only recently been adopted by hospitals. A low score can indicate heart and lung problems.

The Patients Association welcomed the new chart system, saying it should be implemented “urgently”.

Katherine Murphy, chief executive of the association, said: “The public will be shocked to learn that the NHS has been operating such an ad hoc system of monitoring deterioration in a patient’s condition – with different approaches in each hospital.”

The Royal College of Nursing has been closely involved in the project.

Janet Davies, director of nursing and service delivery, said: “There is nothing nurses and doctors should prioritise more than patient safety, and this system, if implemented across the board, will be a great leap forward for patient care.”

The Society for Acute Medicine also welcomed it, saying the “lack of consistency” between hospitals “may be a contributory factor in the higher levels of mortality in early August when many junior doctors change jobs”.


Doctors fear catastrophes on hospital wards at weekends

One in eight doctors does not think hospitals provide high quality care at weekends and “catastrophes” are feared on wards because staff cover is so poor.Doctors fear catastrophes on hospital wards at weekendsA survey of senior doctors has found that many are concerned about the care patients receive at weekends, when most hospitals only have a skeleton staff.

One respondent to the Royal College of Physicians poll said: “I often feel relieved on Monday that nothing catastrophic has happened over the weekend.”

Sir Bruce Keogh, medical director of the NHS, has told The Daily Telegraph that hospitals should look no different on a Saturday to the way the look on a Wednesday.

He wants the NHS to offer a full seven day service with routine appointments and operations carried out at weekends instead of emergencies only.

At a meeting at the Royal College, Prof Tim Evans, academic vice-president, reported on progress that the college had made with its Future Hospital Commission, which is investigating how to improve care. He said hospitals were under substantial stress and were providing a disjointed service to patients with a lack of compassion and continuity of care.

The Royal College survey found that hospital doctors were concerned that patients saw a succession of medics and had to repeat their problems each time.

More than one in eight said they rated their hospital’s ability to provide high-quality care seven days a week, as poor or very poor.

Prof Evans said: “I’d rather have a hospital working at 80 per cent of its best seven days a week than one that is 100 per cent five days and only 20 per cent at weekends.” The commission, chaired by Sir Michael Rawlins, aims to come up with ideas to ensure hospitals can cope with the increasing complexity of cases, an ageing population and changes to doctors’ working patterns.

Almost 7,000 doctors responded to the survey. Other studies have disclosed concerns from junior doctors who feel out of their depth at having to look after patients outside their areas of expertise when covering wards at weekends and at night.

The General Medical Council has warned that hospitals may be facing significant problems because juniors were being asked to cope with issues beyond their competence.


NHS facing colossal care bill unless system is overhauled urgently

The Coalition is failing to live up to its pledge to find an urgent solution to the funding crisis over care for the elderly, the leaders of the Royal College of Nursing and Age UK warn.NHS facing colossal care bill unless system is overhauled urgentlyMonths of delays in announcing a white paper to overhaul the care system are fuelling further uncertainty about the future threatening to land the NHS with a “colossal” and unnecessary bill, they say.

In a letter to The Daily Telegraph, Michelle Mitchell, director general of Age UK, and Dr Peter Carter, chief executive of the RCN, accuse the Government of failing to “measure up” on pledges in the Coalition Agreement to find a sustainable solution.

They say that unless “brave and radical decisions” are taken now, the NHS will be flooded with tens of thousands of elderly people who could be cared for elsewhere, costing the taxpayer millions of pounds a year.

Almost a million older people in need of some form of care do not currently receive it because their needs are not considered severe enough need or do not qualify for financial support, it has been estimated.

It is thought that many of those who eventually end up in hospital could have avoided being admitted had they had basic care at home.

At present anyone with assets including their home worth more than £23,500 gets no help with their care, and many people below that level still have to pay much of their costs.

The coalition agreement between the Conservatives and Liberal Democrats in 2010 recognised the “urgency” of reforming the care system and easing the financial burden on families.

A Government-backed commission chaired by the economist Andrew Dilnot last year called for a new system of funding to be agreed, capping the amount anyone had to pay in their lifetime for care at around £35,000.

Dilnot also called for the threshold to be more than tripled to about £100,000.

But a year after they were first published, the Government has yet to make any commitment on the Dilnot proposals, which are the subject of cross-party talks behind closed doors.

The Government is also due to unveil a long-awaited white paper later this month reforming aspects of the care system to integrate it more closely with the NHS.

But it is expected that any major decision on funding will be postponed amid disagreement over the way forward.

The two groups are warning the Government that any further delay in reforming the system could cripple the NHS.

They write: “When the Coalition Government came to power, it said that it recognised the urgency of reforming the social care system.  Ahead of the imminent publication of the Social Care White Paper, just how is the Government measuring up on this issue?

“The answer, sadly, is not well.”

They continue: “[We] fear that unless sustainable funding is established and a fair and decent care system is provided, a colossal and growing slice of the NHS budget will be spent trying to pick up the pieces.

“According to the Department of Health, more than 120,000 days in hospital were lost in just two months last year, because our older people were kept on wards unnecessarily.

“These people, often confused and alone, rarely have the support available at home, and so stay in hospital without needing to be there. This costs the tax payer millions, not to mention the avoidable discomfort it causes to some of the most vulnerable people in our society.”


Nurses claim govt is cutting numbers by stealth

Savage cuts to nursing are stretching resources “to breaking point”, the largest nursing union says today at it’s conference.Nurses claim govt is cutting numbers by stealthGovernment plans to shift care out of hospital and closer to patients’ homes are being used as a cover for the cuts, the Royal College of Nursing warns. It is also leading to patients being discharged too early, the RCN reports.

Over 26,000 nursing posts have been cut in the last two years and a further 61,000 are at risk, according to the RCN.

The college says that, despite government rhetoric claiming more care is being provided outside hospital, there has been less than a 1 per cent increase in the community nursing workforce in the last decade and community nursing is “stretched to breaking point”.

The figures come as Andrew Lansley, the Health Secretary, prepares to address the RCN congress today. In an interview with The Independent ahead of the speech, Mr Lansley denied there were mass reductions in nurse numbers.

He also said staffing numbers were not the only factor in providing good patient care. “In some hospitals the staffing ratios are exactly what we would expect, but some wards are really excellent and some are really bad. This is about leadership,” he said.

Mr Lansley added that a recent staff survey shows that, across the NHS, only 65 per cent of staff would recommend their hospital to friends or family.

A poll conducted for the college on the eve of its annual congress in Harrogate found 90 per cent of respondents agreed patients were being discharged sooner from hospital and with more complex needs than a year ago.

Dr Peter Carter, chief executive of the RCN, said: “Nurses are stretched too thin and many are approaching breaking point. Inevitably patients are going to suffer.” The RCN supported a shift from hospital to community care but nurses reported patients being discharged from hospital before social-care support was in place.

The Health minister Simon Burns said he did not recognise the RCN’s figures: “There are only 450 fewer qualified nursing staff in England than in 2009 and in 2011-12 we expect to train 2,300 community nurses and health visitors.”


NHS staff are overworked- survey finds

One in three NHS staff say they are not enough people in their department to get their work done, according to the annual health service survey.NHS staff are overworked- survey findsAnd almost half of NHS staff said they do not have time to complete their tasks, it was warned.

Staff cuts and a lack of cover when people are on leave or sick is to blame, a union said.

The 2011 NHS Staff Survey, of more than 135,000 health service workers in England, found some were struggling with heavy workloads.

The official NHS staff survey comes after the Royal College of Nursing warned that one in three nurses working on older people’s wards are too busy to help patients with eating or going to the lavatory.

However when hospital staff were asked if a friend or relative needed treatment in their organisation, they would be happy with the standards of care, the proportion answering ‘yes’ varied from just one in three at Croydon Health Services NHS Trust to 96 per cent at Clatterbridge Centre for Oncology NHS Foundation Trust.

Health Secretary Andrew Lansley said: “This survey shows that NHS staff remain committed to providing the highest quality of care to their patients.

“The number of staff happy with the standard of care remains stable, with some foundation trusts performing to a very high standard. Too many trusts continue to have less favourable levels of recommendation to family and friends.”

“The NHS should use this as a basis for seeing improvement in the services we deliver for patients in the future.”

Christina McAnea, Unison head of health, said: “The staff survey reflects some of the pressures felt by staff, but our own survey painted a much bleaker picture.

“Unison’s survey showed that 85% experienced an increase in workload and 83% suffered an increase in stress over the past year. The increase in workload is not a coincidence, it is down to cuts in staffing and to a lack of cover for staff on sick or on leave.”

The NHS survey also found that a fifth of staff said they cannot do their job to a standard they are personally pleased with and half would not recommend their trust as a good place to work.

Almost nine out of ten staff who deal with patients said they were satisfied with the quality of care they provided.


Low staffing levels harms elderly care nurses warn

The care of the elderly is being compromised in UK hospitals because there are too few nurses, according to the Royal College of Nursing.Low staffing levels harms elderly care nurses warnResearch by the union suggested everything from basic communication to care for the dying was suffering.

And it called for minimum staffing levels to ensure standards improved, arguing one nurse for every seven patients was needed.

The intervention by the Royal College of Nursing (RCN) comes after a series of damning reports about the services the elderly are receiving.

The Patients Association and Care Quality Commission have both recently published studies detailing “shocking” levels of care.

Ministers have promised to give more powers to nurses as well as improving monitoring to drive up standards.

But the union said it was now time to insist on strict staffing levels and stop relying on health care assistants to fill the gaps.

It polled nearly 1,700 nurses – 240 of whom were working on wards with older patients.

The survey showed that while older people’s wards only had one nurse for every nine patients on average, general wards, at 6.7 patients per nurse, and children’s wards, at 4.2, were much better staffed.

Respondents said low staffing meant care suffered in a variety of ways.

Eight in 10 said basic support, such as talking and comforting patients, was compromised, while a third said they did not have time to help people properly with eating and drinking.

Nearly one in five also said care for dying patients was neglected.

The research looked at the use of guaranteed staffing rules in places such as Australia and the US and concluded they were needed in the UK.

It recommended there should be one registered nurse for every five to seven patients in the NHS.

Peter Carter, the RCN’s general secretary, said: “Patients on older people’s wards are being let down by systemic failings in our hospitals.

“Despite working tirelessly to provide patients with high quality care, nurses in these settings have repeatedly told us that they are unable to do this because of pressures caused by short staffing.”

Unions’ strike means thousands of operations to be postponed today

Hospital managers are planning to postpone thousands of non emergency operations today, because of the public sector unions striking over pension changes.Unions' strike means thousands of operations to be postponed todayPatients across the UK have been sent letters warning them of the disruption.

Diagnostic tests and outpatient appointments will also be delayed, but hospitals insist emergency and critical care will not be affected.

Managers say they are preparing as they would for Christmas or bank holidays.

An estimated 400,000 nurses and healthcare assistants, as well as paramedics, physiotherapists, and support staff like cleaners and administrators have said they will join the action on 30 November over changes to public sector pensions.

However, the main medical unions – the Royal College of Nursing, the Royal College of Midwives and the British Medical Association are not taking part.

The Department of Health in England said it was expecting at least 5,500 non-emergency procedures like hip and knee operations to be rearranged.

More than 12,000 patients are likely to have diagnostic tests postponed, and 40,000 outpatient appointments are expected to be rescheduled.

On an average day, 28,000 patients have planned treatments or operations in England and there are 60,000 diagnostic tests.

However, managers say they are putting plans in place to make sure people can still get emergency or urgent care, in the way they do on bank holidays or at Christmas.
999 calls

Patients needing urgent treatment like chemotherapy and kidney dialysis will still be able to get it, and maternity units will remain open.

Calls to 999 will still be answered, but patients are being urged to think hard and only call if it is a genuine emergency.

The Health Secretary, Andrew Lansley, said health service workers should not take action that harms the interests of patients.

“I would ask staff to consider carefully whether going on strike is the right thing to do,” he said.

Three quarters of nurses don’t have time to talk to patients

Three out of four nurses lack the time to talk to patients, a major survey of NHS trusts has revealed.Three quarters of nurses don't have time to talk to patientsThe results of a survey involving almost 3,000 nurses by researchers at King’s College London will prompt further alarm over the standards of care in the NHS.

A quarter admit they are too busy to administer drugs on time and more than 40 per cent said at least one patient under their care had suffered a serious fall in the last month.

The findings were based on unannounced inspections at 100 hospitals to check elderly patients were given enough to eat and drink and were treated with dignity.

In some instances, watchdog’s inspectors saw patients rattling bedrails or banging on water jugs in an effort to attract the attention of nurses.

The report also claimed that some hospitals were “putting paperwork over people” with patients being left for more than ten hours without a drink.

The latest study involving 2,943 nurses looked at 31 NHS trusts across England. Researchers found there was an absence of humanity as without regularly talking to their patients nurses had no way of knowing their needs.

The survey revealed that 76 per cent of nurses did not have enough time to talk to or comfort patients and 40 per cent of staff were too busy to carry out necessary checks such as taking their temperature.

Thirty-nine per cent admitted they did not have enough time to record details about patient care such as whether they had been given anything to eat or drink.

Twenty-six per cent said they were too busy to administer drugs on time and 24 per cent had not been able to check skin for signs of pressure sores.

A further 44 per cent admitted that in the past month at least one patient under their care had suffered a serious fall.

And 26 per cent said that at least one patient in the same period had been given the wrong dose of drugs or developed bed sores.

Professor Peter Griffiths, of the national nursing research unit at King’s College London, told the Daily Mail: “Talking and comforting patients is very important as nurses need to know how they are and how they feel.

“It’s about having humanity, having a relationship with people. It’s important to understand what patients need. Sometimes staff feel that paperwork has to come first.”

The Royal College of Nursing admitted it was “not surprised” that so many nurses lacked the time to talk to patients.

Janet Davies, its executive director of nursing and service delivery, said: “We know many nurses are wilting under the strain of longer working hours, taking on the burden on unfilled vacancies and reduced staffing levels.”