Exclusive: Majority of hospital trusts missed their own nurse staffing targets

Of 139 acute trusts that reported staffing data for May 2014 to their boards, a total of 105 failed to meet their own targets for total nursing hours worked during both day and night in at least one hospital site.

More than four out of five providers, 86 per cent, failed to meet their targets for registered nursing hours worked during the day, while 112 trusts, 80 per cent, missed their targets for nursing coverage at night.

Under requirements introduced as part of the government response to the Francis inquiry, NHS trusts must now publish monthly staffing data showing their planned number of nursing hours against the number they managed to fill.

A summary of the staffing data published in June on the NHS Choices website used aggregate figures for registered and non-registered nursing staff, which had the effect of obscuring trusts’ results for registered nurses only.

HSJ’s analysis uses the same staffing data, but unlike the summary figures presented on NHS Choices it looks only at the proportion of nursing hours filled by registered nurses, stripping out the effect of healthcare assistants.

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There is mounting evidence of the importance of registered nurses to the delivery of safe high quality care with research suggesting harm begins to occur at a ratio of one nurse to eight patients.

In some cases trusts falling short of nurses attempted to compensate by increasing their HCA staff above planned levels, which had the effect of increasing their aggregate scores presented on NHS Choices.

The majority of trusts that missed their own registered nursing hours targets did so by less than 5 per cent. However, 50 trusts had sites recording fill rates of lower than 95 per cent both day and night, and 13 had sites recording fill rates of lower than 90 per cent both day and night.

The news of trusts struggling to fill planned nursing hours comes despite a drive to recruit thousands of extra nurses in the wake of the Francis inquiry.

Since August 2013 more than 6,100 full-time equivalent nurses have been recruited to the NHS acute sector, according to data from the Health and Social Care Information Centre.

Elaine Inglesby-Burke, executive nurse director and deputy chief executive at the Salford Royal Foundation Trust, told HSJ she was not surprised some trusts had failed to hit their targets.

She added: “I think some trusts have a long way to go in determining what safe staffing is in their organisation and the standards people are being compared against [are not] comparable until everyone is using an evidence based tool.

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“We have started on the journey and leadership attention is being paid to staffing at the frontline, but we can’t take our foot off the pedal.”

Susan Osborne, a former director of nursing and chair of the Safe Staffing Alliance, agreed the analysis was no surprise. She said: “It could be even worse because some trusts may have planned for what were already suboptimal levels.”

She said the aggregate data published on NHS Choices was confusing. “I think it is misleading and a fudge,” she told HSJ. “It is very difficult for a non-executive director to be able to challenge the NHS Choices data and the public looking at it wouldn’t have a clue whether the hospital up the road was safe or unsafe.”

Many of the trusts that recorded the lowest fill rates against their planned registered nursing hours told HSJ they had invested additional money in nurse staffing in the past year. However, some also pointed to problems with the data, and argued that the ratio should not be used as a sole measure of safety.

The trust with the worst single figure for nursing hours during the day was East Cheshire Trust, which recorded a fill rate of 64 per cent at Congleton War Memorial Hospital, where it has a 29-bed intermediate care unit.

Five trusts with the lowest combined day and night nurse staffing

The trust claimed this was an error and the true figure should be 84 per cent, still 16 per cent short of its target.

A spokesman for York Teaching Hospitals told HSJ the foundation trust had “learned lessons in terms of our data collection techniques” since the first data return in May. He added: “The staffing levels should not be viewed in isolation as a measure of safety, and we meet other staffing measures, for example the Safer Staffing Alliance’s 1:8 ratio.”

Northern Lincolnshire and Goole Foundation Trust chief nurse Karen Dunderdale said its figures had been “skewed” because nursing staff had been redeployed from a ward in response to lower than planned patient numbers, but it was still working with commissioners to agree future bed numbers for the ward.

A spokesman for NHS England said including non-registered nursing staff in the NHS Choices summaries was not misleading, saying: “The publication of this data is an important step, but what it doesn’t do at the moment is tell us whether a ward is understaffed or unsafe. And like any data, if used in isolation it doesn’t reflect the complexities of patient care.”

He added that as the process was improved it could be used “trigger questions” about local health services.

A Department of Health spokeswoman said: “Staffing levels in wards fluctuate on a daily basis because of changes in expected demand and its right that hospitals have the flexibility to move nurses to where they are needed. Sometimes wards will need more staff than planned because they have patients with complex needs who need more care, or they may need fewer staff than planned because they have fewer patients than expected.”

The investigation comes ahead of the National Institute for Health and Care Excellence’s expected publication tomorrow of the results of its consultation on safer staffing guidelines for the NHS.