University Hospital Southampton Foundation Trust is reporting rising tensions over staffing levels, in spite of attempts to manage demand.

On the trust’s risk register, the only score to have gone up between quarters 2 and 3 this year concerned “safe staffing levels with appropriate skill mix”.

The risk, which carries potentially “catastrophic” consequences, rose from “possible” to “likely”, giving an overall score of 20 out of 25. Clinical governance failures, reduced income and negative publicity could result.

Latest board papers note a second phase of “ward staffing investment” had not been agreed.

The trust’s division A, which includes surgery and cancer care, reported “nursing pressures in surgery and critical care due to agency usage, higher activity than plan, vacancies and higher short term sickness and maternity leave levels”.

The division’s pay bill was falling “due to increased vacancies”, and sickness and maternity absence “being absorbed within the remaining workforce”.

A spokeswoman said that over the past three years the trust had invested in permanent ward staff, a move aimed at “maintaining the high level of patient safety and quality that UHS is committed to delivering”.

A broader problem could be failing demand management in the local health economy. Total income for the final three months of 2011 was £11.3m more than expected at £138.6m. A board report said one reason for the variance was “activity being higher than budget due to little activity management being delivered”. Another reason was additional activity to cut waiting lists.