Directors of nursing have warned of their increasing concerns for patient safety as winter approaches, claiming the ‘pendulum is swinging’ towards trusts’ workforce decisions being led by financial considerations due to the escalating NHS deficit.

Nursing directors from across the country said at the Nursing Times Directors’ Congress last week that the additional investment and focus placed on safe staffing in the wake of the Francis report was at risk of being lost.

Chief nurses highlighted a recent letter sent to trusts from NHS England and the main regulatory bodies, which stressed the nationally recommended minimum of 1:8 nurse to patient ratio for adult hospital wards was just “a guide”.

Some claimed the letter had been met with approval by other trust executives who were keen to cut costs.

Meanwhile, they said bed closures by local care homes and mental health providers were already putting extra pressures on acute hospitals, which then became the only option for patients.

This was on top of the national nursing shortage, with some trusts now having hundreds of vacancies, they added.

It was also claimed that some acute providers would this year receive up to 50 per cent less money than in 2014 from clinical commissioning groups to cope with winter pressures.

However, despite the focus by trusts on saving money, nursing directors said they would hold off opening extra winter pressure beds if they did not have the money or staff to do it safely.

Karen Dawber, director of nursing at Warrington and Halton Hospitals Foundation Trust, said: “CCGs are not funding extra beds like they have done in the past so their view is it’s payment by results.

“When you’ve got 100 delayed discharges, the only bit of PbR you’re going to get is an excess bed day,” she said.

Ms Dawber said if extra beds had to be opened at short notice, the extra staff required had to be paid premium rates.

“We are holding the line on opening extra beds, because we haven’t got the money… If you look at the work being done around the country on system resilience, most places are saying they haven’t got the winter funding that they had before,” she told HSJ’s sister title Nursing Times.

Another chief nurse from a large acute trust said: “We’ve hit winter already, we’ve found more and more nursing home beds shutting around us, more and more mental health beds being shut and, as a result, we are also starting to fail our emergency target.

“We are struggling. I am getting to the point where I’m really worried about the impact on care. I am holding closed beds where I am not staffed but it is really tough,” she added.

Sherree Fagge, chief nurse at Brighton and Sussex University Hospitals Trust, told Nursing Times the letter from NHS leadership bodies last week emphasising safe nurse staffing was a guide would make it more difficult to secure nurse posts.

“As we go into the winter period this year, where finance is king, a letter like the one [from NHS England] will not help nurse directors,” she said. “Research shows the more registered nurses you have, the better the outcomes. Not having a 1:6 or a 1:8 is a false economy.

“I am feeling anxious that the pendulum is swinging towards financially-led decisions instead of being quality-led, which is what we had immediately after Francis.”

Another director of nursing warned delegates to be “careful” of the language being used by NHS bodies and trust executives.

“There were some subliminal messages being described [in the letter] and they’re not just coming out through boards, they are coming out through Monitor performance meetings,” she said.

“There is some concerning language around ‘do you work to outstanding?’, ‘could you cope with things if you were just good enough?’”

One chief nurse said they found themselves “walking on a tight rope” by trying to balance safety with finance concerns. Others called for nurse leaders to “be brave” and “speak together with one voice”.

A Department of Health spokesman said: “The NHS is busy but this year prepared for winter earlier than ever, and is performing well.

“The overwhelming majority of patients are treated or admitted to hospital quickly – with 3,000 more people being seen every day within the four hour target than in 2010.”