Nine out of 10 nursing leaders in the NHS say they are worried abour their ability to recruit nurses, according to a survey by the Royal College of Nursing. The RCN has also said it believes there are 40,000 nursing vacancies in the service.

The union has also revealed evidence that qualified nursing staff are being substituted for non-registered care staff despite research showing this increases risks to patient care.

For the first time the union is also calling for legislation to require NHS trusts to have safe staffing on wards with the RCN report warning: “It is the lack of NHS funding that has led to efficiency pressures in the system and despite the findings of the Mid Staffordshire Public Inquiry, lessons have not truly been learned.

“Over the last decade efficiency savings and finance have been consistently prioritised over safe and effective staffing. Short-sighted cost-saving measures implemented in the absence of proper engagement with the profession or risk assessment have resulted in a shortage of nurses.”

The union surveyed 90 NHS nursing directors and deputy nursing directors which revealed 76 per cent were concerned about ensuring safe staffing levels while 90 per cent said they were worried about being able to recruit nurses with 84 per cent highlighting fears over retention of existing staff.

The RCN study called “Safe and Effective Staffing: the Real Picture” said: “The time has come for legislation in each country in the UK to ensure that patients always receive the safe care they deserve through genuinely enforceable safe nurse staffing levels.

”This report shows that the skill mix is being diluted and substitution is occurring. Vacancy rates have increased across the UK, but doubled in England in the last three years.”

The RCN highlighted workforce data showing the numbers of qualified nursing, midwifery and health visitor staff had increased by just under 6,000, or 2 per cent since 2010 while unregistered care staff had seen an 11,000 or eight per cent rise prompting fears of what the union said was “nursing on the cheap.”

Using a Freedom of Information Act request the union obtained vacancy data for nurse staffing with a response rate from 76 per cent of NHS trusts in England.

Two thirds of trusts who responded confirmed fears of substitution of nursing staff with two thirds, 65 per cent, employing a higher proportion of care staff than registered nurses in 2016 compared with the previous year.

A total of 16 per cent of trusts said they had decreased their registered nurse numbers while increasing their unregistered support workforce.

The RCN said this was not in line with evidence adding: “We support the development of health care support workers but it must not be allowed to substitute registered nurses with less experienced staff because they are cheaper or more readily available.”

Analysis of the FOI results suggested the number of nursing vacancies has doubled in the last three years from 20,000 to 40,000 in England.

The report said nearly a quarter of NHS trusts reported a registered nurse vacancy rate of over 15 per cent with the highest being 37 per cent.

The union also pointed to the decision to suspend work on safe staffing by the National Institute for Health and Care Excellence in 2015 saying: “The work was handed to NHS Improvement, who are currently in the process of developing safe and sustainable staffing improvement resources across different clinical settings. We are deeply concerned that this approach lacks enforceability.”

RCN chief executive Janet Davies, who will speak at the RCN’s annual congress in Liverpool today, said a “lethal cocktail” of factors was putting patient care at risk.

She said: “Ministers must draw a line under this false economy and address safe staffing levels in new legislation. Nursing directors should not have to fight for the funding.”