Everything you need to stay up to date on patient safety and workforce, plus my take on the most important under-the-radar stories. From patient safety correspondent Shaun Lintern
This week I’m focused on the key issue of workforce levels in the NHS and rumours that the government is about to make its biggest mistake. Contact me in confidence here.
Shaun Lintern, patient safety correspondent
Ministers and NHS leaders just don’t get it
There will be a “re-set on the money” in July, NHS England chief executive Simon Stevens warned at the NHS Confederation conference last week. Hushed whispers among delegates suggested this would focus on reducing costs, particularly workforce numbers. This, it is thought, will be hidden detail beneath headlines of the NHS agreeing to new savings targets for 2016-17. Targets that CIPFA labelled as “unsustainable” this week.
These rumours will be cause for concern for anyone focused on patient safety. It’s hard to imagine anything more short-sighted than cutting NHS staff numbers when demand across the system is going in the opposite direction. According to NHS England statistics there has been a 7 per cent rise in A&E attendances and a 4 per cent rise in emergency admissions between March 2015 and March 2016. Looking at total elective admissions there has been a 25 per cent rise between March 2009 and March 2016. Recent performance figures give little reason to think the service can absorb an abrupt squeeze on staffing without a knock-on impact on waiting times or care quality.
Even NHS Improvement’s own analysis of qualified nurse numbers shows the increase in nurses since the Mid Staffordshire public inquiry has barely kept pace with demand. This helpful graph from NHS Improvement illustrates the point nicely.
After the Francis inquiry the prime minister said never again would finance come before quality; that patient safety would not be an afterthought to central government diktats. We’ve already seen efforts to retreat from safe staffing guidance and to lessen the demand for nurses. It’s difficult to see how any attempt to exert crude downward pressure on staff numbers at this point would be in keeping with the lessons the government said we should take from the Mid Staffordshire scandal.
We know, and evidence shows, there is a clear association between staffing levels and safety. Nine out of 10 hospitals are failing to meet their own nurse staffing targets and medical royal colleges have warned about the problem of rota gaps among doctors.
In this context some in Whitehall and senior echelons of the NHS, it appears, believe the service can and should press down on staff numbers. While the spectre of Mid Staffordshire is invoked too often in the NHS, those who believe care will not suffer in the context of a reduced workforce, rising demand and less resource, are dangerously optimistic if they think what has happened before will not happen again.
This is not a demand for an all you can eat workforce policy. It is of paramount importance that the NHS makes the best use of its staff and we know that it does not. Last week’s report by the Royal College of Radiologists was just one example of how technological and bureaucratic processes waste time and resources. Efforts must continue to remove this kind of barrier. But it is unsafe to believe you can cut workforce numbers in anticipation of improved efficiency rather than in its wake.
- Department of Health and Social Care (DHSC)
- East Midlands
- Francis report - recommendations
- Healthcare Safety Investigation Branch (HSIB)
- Mid Staffs Inquiry
- NHS Improvement
- NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST
- Patient safety
- Quality and performance