• North Staffordshire Combined Healthcare Trust reports a spike in nursing shifts being covered by support workers
  • Comes amid a national shortage of mental health nurses
  • Royal College of Nursing calls for increased transparency and data reporting from other trusts

The number of registered nursing shifts being covered by less qualified support workers at an “outstanding” mental health trust has tripled since 2016.

Recent figures published by North Staffordshire Combined Healthcare Trust in its governing board papers showed the average number of times a nurse shift was filled by a healthcare support worker increased from 132 shifts a month in 2016-17 to more than 400 in 2018-2019.

It comes amid a national shortage of mental health nurses, as well as pressures on NHS providers to cut staffing costs.

The trust said it closely monitors and risk assesses situations when the desired skill mix is altered. It added there have been no patient safety incidents relating to staffing levels.

The Royal College of Nursing said it previously would have been “unthinkable” for unregistered staff to fill in for nurses, but said it showed how “endemic the current workforce crisis is.”

It also called for increased transparency and reporting from other trusts on the issue. NHS England and NHS Improvement do not require trusts to collect or publish this specific information.

NSCHT is one of few trusts that routinely publishes specific data on the type of healthcare professional is filling each shift.

A spokeswoman for NSCHT said: “The trust proactively monitors this data internally though we are not required to report externally.

“We always strive to ensure an optimum skill-mix, where skill mix is altered on an ad-hoc basis, this is risk assessed prior to implementation through our safer staffing escalation procedures and patient safety is maintained through prioritisation and allocation of clinical interventions to appropriately trained staff. There have been no patient safety incidents relating to staffing levels.”

Recent data from NHS Digital showed a 10 per cent decline in the number of nurses working in mental health between September 2009 and May 2019, while the levels of healthcare assistants and support workers has almost doubled.

Patricia Marquis, the RCN’s director for England, said: “There would have been a time when it would have been unthinkable for unregistered staff to fill in for nurses, but these figures show the new normal our members describe to us in the current staffing crisis.

“As well as being unfair to patients, it’s unfair to healthcare support workers to expect them to work above their competency and without appropriate support.

“Some studies have shown that, in acute care, substituting even one registered nurse can have a negative impact on patient mortality rates.

We still don’t know what effects long-term substitution could have in other areas of healthcare like mental health. It’s worrying that trusts are being put in this position and it indicates how endemic the current workforce crisis is.

“It’s unclear how far reaching this practice is so it’s important that publicly-funded healthcare organisations produce transparent workforce data so we can observe the true extent of this problem.”

The HSJ Transforming Mental Health Summit, taking place at the Hilton Leeds from 28-29 November, unites 120+ senior figures from across the NHS, local authority and wider mental health service delivery landscape to discuss how to realise the visions of the NHS long-term plan and ensure successful local implementation of national priorities. Held under the Chatham House Rule, attendees will quiz Paul Farmer and other national figures on general policy direction and co-develop solutions to their local challenges with NHS and local government colleagues from across the country. The Summit is free to attend for senior NHS and public sector figures – register your interest here for this free to attend forum on our website: https://mentalhealth.hsj.co.uk/register-2019