Exclusive: Four out of five hospitals miss own nurse staffing targets

In the latest monthly safe staffing data published by NHS providers, collated by HSJ, 194 acute hospitals out of 229 for which data was available failed to meet their own targets for the numbers of registered nurse hours filled during the day – a total of 85 per cent.

The data used by HSJ was published earlier this month and records trust staffing levels for January 2015.

More than two-thirds of all hospitals failed to meet their own targets for nurse hours filled at night with 154 out of 229 (67 per cent) missing their target.

Seventy-nine hospitals missed their staffing target by 5 per cent or less for nurse hours filled during the day. Forty-five reported that more than 10 per cent of their nursing hours went unfilled.

For night shifts, 96 hospitals missed the target for nurses by 5 per cent or less. Forty-three trusts achieved a fill rate of 90-94 per cent, with 15 trusts below the 90 per cent mark.

In total, 107 out of 139 acute NHS trusts failed to achieve their own nurse staffing targets for both day and nights, which was similar to analysis by HSJ last year that found 105 out of 139 trusts failed to meet staffing targets.

Our latest investigation follows an increased focus on nurse staffing in the NHS in light of guidance by the National Institute for Health and Care Excellence last year, which was developed in response to the Francis report in 2013.

In its first staffing guidance, NICE said hospitals employing staff on ratios of eight or more patients to one registered nurse on a “regular basis” could increase the risk of harm in adult inpatient wards. It suggested a 1:8 ratio should be a “red flag” incident requiring action by trusts.

Many providers have aimed to achieve a ratio of fewer than eight to one, and have recruited thousands of extra nursing staff in recent months.

The data also shows that trusts performed better for healthcare assistant staffing than for nurses, although 105 trusts still failed to achieve their planned staffing levels during the day and 52 trusts missed the target for HCAs working at night.

Thirty-two hospitals failed to achieve their staffing targets for both nurses and HCAs across day and night shifts.

The results indicate the difficulties for acute providers in recruiting sufficient numbers of registered nurses, which has driven increases in overseas recruitment and the use of agency staff.

Nursing workforce expert Jim Buchan, from the school of health sciences at Queen Margaret University in Edinburgh, said: “What we are seeing is that trusts, post-Mid Staffordshire and the NICE recommendations on nurse staffing, are recognising they have to develop more evidenced based workload related staffing plans and that is exposing the fact that there is a shortage between what those plans are indicating and the local available supply of nurses.

“It is evident on the supply/demand equation that factor into these local plans that vacancies are up, use of agency staff is up and international recruitment is up. This shows that the shortfall in nurses is real, is probably getting larger nationally and becoming more pronounced in more trusts.”

The data for 229 acute hospital sites, published on the NHS Choices website, is presented as a site average across all wards, meaning ward level results will vary from the numbers given. The data is based on individual trust’s staffing plans, which could vary in quality as there is not a universal methodology for determining them.

Following the Francis report into failures at Mid Staffordshire Foundation Trust, organisations are required to submit monthly staffing data to NHS England, and to report the results on their website and to the trust board.

The hospital with the worst reported performance against their target for nursing hours during the day was Cannock Chase Hospital, once part of the former Mid Staffordshire trust but now run by Royal Wolverhampton Hospitals Trust. The site recorded a fill rate of 73 per cent across its two wards.

Trust deputy chief nurse Lynne Fieldhouse told HSJ: “The trust does not consider there to be a problem with nurse staffing on our Cannock site. As the figures are average they reflect the planned, reduced staffing levels at weekends when the elective surgery post-operative unit is closed.”

She added that the trust had funded additional nursing posts for the hospital, which would have skewed the baseline.

Howard Catton, director of policy and international affairs for the Royal College of Nursing, said: “We know [that] because of the pressures providers are under, they are recruiting because they need to have safe staffing. It does present a very significant challenge but is based on a much better understanding of needs and demands of patients post-Francis.”

He said the competitive environment for nurse recruitment also meant NHS trusts needed to consider the importance of retaining staff.

This story was updated at 6pm on 20/04/2015 to reflect additional information from NHS England regarding the month the NHS Choices staffing data relates to.