‘Introduce legislation to ensure safe staffing in NHS’, says Sefton Central MP

Sefton Central MP Bill Esterson has challenged the health secretary Jeremy Hunt about the chronic shortage of nurses in the NHS and has called for legislation to be introduced to ensure safe staffing across the health service.

The MP raised the issue of falling nurse numbers at Health Questions in the House of Commons (October 10) and accused the Minister of failing patients and failing the NHS.

Mr Esterson has backed a Royal College of Nursing (RCN) campaign for legislation to be introduced to ensure safe nurse staffing levels, saying the Government must commit to giving hospitals more funding when it is needed to guarantee safe care for patients.

Mr Esterson said: "Increasing the number of care staff to make up for a lack of registered nurses is an unacceptable response to the staffing crisis in the NHS."

The RCN’s report, titled “Safe and Effective Staffing: Nursing Against The Odds”, showed that the proportion of registered nurses on adult general wards had fallen since 2010 while the number of unregistered nurses (care staff) had increased. Registered nurse vacancy rates in England have doubled in the last three years, and more RNs are leaving than joining the profession, a trend which is being seen in the NHS for the first time.

Mr Esterson said: “These figures show that because of the massive real-terms cuts the Conservative Government has imposed on the NHS, registered nursing staffing levels have dropped to an unsustainable level across the country. More and more unregistered nurses are being used in place of highly qualified registered nursing staff due to sickness levels and an inability to recruit.

“The Government is trying to run the NHS on a shoestring and it is failing patients and failing staff.”

The report was based on a survey asking nurses about the last shift they’d worked. Janet Davies, RCN Chief Executive & General Secretary, wrote: “These are personal experiences – too often desperately sad – and their truth will have its own power in driving the debate forward.

“Over half (of nurses) told us that their shift was not staffed to the level planned and that care was compromised. One-third report having to leave elements of patient care undone due to a lack of time, while two-thirds are working extra time – on average another hour per shift, for which they are hardly ever paid.”

The report ‘s Executive Summary stated: “Having more support staff does not safely or adequately compensate for having too few nurses in terms of quality, outcomes or mortality rates.

“Our findings show that the majority of shifts reported were short of staff and, more often than not, nursing staff stated that care was compromised.

“In some circumstances, poor staffing levels meant that staff had to leave necessary care undone. The vast majority of shifts (96%) captured in this survey were worked during May 2017. This suggests that the pressures we have come to expect in winter are now experienced in most health and care services throughout the year.”

The survey found that

• 55% of respondents reported a shortfall in planned staffing of one or more registered nurses on their last shift

• 41% of all shifts were short of one or more health care support workers

• 20% of the registered nurses across the 30,000 shifts were temporary staff. 28% of health care support workers were temporary staff

• the skill mix of the nursing workforce (proportion of registered to non-registered nurses) in acute settings has been diluted over the past seven years

• 36% of all respondents said that due to a lack of time they had to leave necessary patient care undone

• over half (53%) said care was compromised on their last shift

• 53% felt “upset/sad” that they could not provide the level of care they wanted

• 44% said no action was taken when they raised concerns about staffing levels

• 65% of all respondents said they worked additional time, on average almost one hour extra (53 minutes)

• 93% of nursing staff who worked extra unplanned time for NHS providers were not paid for this. For non-NHS providers, the figure is 76%

• additional unpaid time worked by registered nurses in the NHS across the UK equates to £396 million annually.

The report continued: “Nursing voices are united in saying that too often poor staffing levels are preventing nursing staff from doing the work they joined the profession to do. Patients and nursing staff are suffering the consequences of a lack of clarity about accountability for workforce planning – politically, nationally and locally.

“The boards of all health and social care providers have a duty to ensure patient safety and should provide assurance to the public that services are safe. Governments must respond when health and care workers say that patients are being let down and that they are at risk of harm – the time has come for nurse staffing law.”

Mr Esterson added: “I asked our local NHS Trusts, Southport & Ormskirk and Aintree, to reassure me that their staffing levels are adequate. Both Trusts assure me that their staffing levels comply with national guidance.

“However, digging down into the figures shows that nursing shortages are causing an issue and Aintree’s own Safe Staffing Report from September this year laid out exactly how critical this situation is despite good work by the Trust to recruit and retain nurses.”

The Aintree Safe Staffing Report to the Board of Directors in September stated: “There is an overarching Trust-wide risk in relation to the lack of substantive recruitment of registered nurses.”

Southport & Ormskirk NHS Trust’s Monthly Safer Staffing Report, which is available on its website, states that in August this year there were 14 incidences of “insufficient nurses/midwives”.

NHS Trusts report a “fill rate” for staffing levels which shows how many actual hours were worked versus how many were planned. A figure of 90% is considered to be acceptable nationally.

Aintree Hospital reported last month that as little as 66% of planned nursing hours were filled by registered nurses on one ward, whereas the accepted safe figure is 90%. Most wards at the Trust reported fill rates of 80% or more.

Southport and Ormskirk reported an overall fill rate for registered nurses on days of 90.08%, non –registered nurses on days was 112.45%. The fill rate of registered nurses on nights was 89.98%; 103.92% for non-registered nurses on nights.

The Southport & Ormskirk report stated: “Where the overall fill rates for care staff is higher than 100% this can indicate that wards are compensating for a shortfall in the registered nurse headcount on a shift by employing a non-registered nurse when efforts to backfill with a bank and/or agency registered nurse or the permanent registered nurses being offered extra time or overtime have proved unsuccessful.”

Aintree hospital had fill rates as low as 66% for registered nurses on day shifts and as high as 211% for unregistered nurses, suggesting that the Trust is finding it difficult to place the right number of registered nurses on wards and is using more non-registered nurses to compensate.

Southport & Ormskirk reported a staff vacancy rate of 11.36% for registered nurses (98.38 whole time equivalents) and 8.35% for non-registered nurse vacancies (31.34 whole time equivalents) at the end of August 2017.

Aintree NHS Trust, in its safe staffing report to the Board of Directors in September, reported that its number of vacancies for Band 5 registered nurses across all areas of the Trust is 123.25 whole time equivalents (WTEs), although it went on to say that 90 RNs were expected to start work at the Trust between September and November this year.

The report went on: “Data from the Nursing & Midwifery Council (2017) indicates that more RNs (registered nurses) are leaving than joining the profession, a trend which is being seen in the NHS for the first time. The top reason for leaving the profession, excluding retirement, was challenging working conditions, including low staffing levels and high workload.”

In relation to nurses leaving Aintree, work/life balance was often given as a reason for registered nurses quitting, particularly from A&E. The report stated: “Registered Nurse ‘leavers’ are monitored at Nurse Staffing Sub Group, and during 2016-17, the highest turnover rates appeared to be in the Accident & Emergency Dept. and Acute Medical Unit. Work/life balance was cited as a reason for leaving in 77.3% of those RNs who left the A&E Dept., with relocation the main reason for leavers from the AMU (30.9%). Within the Division of Surgery, the reasons for leaving were related to work/life balance, relocation or not specified.”

The report also stated: “The Royal College of Nursing (RCN) has released an evidence-based report entitled ‘Safe and Effective Staffing; the Real Picture’ (2017). The hard hitting narrative paints a picture of the NHS struggling to provide the nursing staff it needs to deliver safe care, and includes research evidencing that 76% of Directors of Nursing are concerned about ensuring safe staffing levels, with 90% concerned about recruiting new staff and 84% concerned about retaining current staff. Additionally, 82% of nurse leaders have indicated that organisations run on the goodwill of their staff to keep services running. The report calls for legislation in relation to ensuring that patients always receive the safe care they deserve through genuinely enforceable safe nurse staffing levels, and includes a commitment to ensure that Nurse Directors are supported in securing appropriate funding when needed. The RCN report describes how RN vacancy rates in England have doubled in the last three years, as well showing that retention is now a significant issue.”

The RCN report “Safe and Effective Staffing; the Real Picture” called for “legislation in relation to ensuring that patients always receive the safe care they deserve through genuinely enforceable safe nurse staffing levels, and includes a commitment to ensure that Nurse Directors are supported in securing appropriate funding when needed”.

A King’s Fund report, NHS Staffing Levels, predicted that by 2020 there could be a shortfall in nursing staff in England of as much as 11.4 per cent.