• 32 per cent of trusts not hitting their own targets for nurses in community hospitals
  • Proportion of trusts failing to hit targets has risen in past two years
  • Trusts find it easier to meet targets for night shifts, data suggests
  • NHS Improvement says safe staffing data does not take in to account acuity and activity in community hospitals
  • Number of trusts exceeding plans for unregistered staff nearly doubled in 2016-17 compared to previous year

Nearly a third of NHS trusts running community hospitals have not met their targets for nurse staffing levels on wards for the past two years, HSJ analysis reveals.

Data published by NHS Improvement shows 22 out of 69 NHS trusts with at least one community hospital ward did not meet their own planned level of registered nurses during the day throughout the 24 months from April 2015 to March 2017.

Nurse with chart

Nurse with chart

Safe staffing data has been made public for community wards for the first time

HSJ’s analysis suggests the situation is also getting worse: 40 per cent of the trusts did not meet their targets in 2015-16, compared with 44 per cent in 2016-17.

However, the data does suggest trusts find it easier to achieve their plans for registered nurses working at night with just four of the 69 trusts consistently failing to hit planned levels across the two years.

The data, published on 6 June, is submitted monthly by trusts to NHSI and shows the percentage of nurses working each month on community inpatient wards compared with the planned level.

It is the first time safe staffing data has been made public for community wards. It follows HSJ’s publication of safe staffing rates for acute hospitals earlier this year, which found 96 per cent of acute hospitals were failing to meet their plans.

The table below shows the trusts that have not hit their target for day nurse shifts in community inpatient wards for the past two years. However, trusts with more ambitious staffing plans may appear to perform worse than those with a lower, easier to reach target.

TrustTotal months fill rate below 100%Total months fill rate at 90-99%Total months fill rate at 80-89%Total months fill rate at 70-79%NHSI staffing rating

BUCKINGHAMSHIRE HEALTHCARE TRUST

24

18

2

0

Amber

EAST LANCASHIRE HOSPITALS TRUST

24

0

3

16

Red/Amber

MID YORKSHIRE HOSPITALS TRUST

24

2

14

5

Red/Amber

SHEFFIELD TEACHING HOSPITALS FT

24

11

9

0

Amber

NEWCASTLE UPON TYNE HOSPITALS FT

24

1

7

7

Red/Amber

THE ROYAL WOLVERHAMPTON TRUST

24

4

7

8

Amber/Green

BARTS HEALTH TRUST

24

6

8

5

Red/Amber

DERBY HOSPITALS FT

24

12

8

0

Amber/Green

WEST HERTFORDSHIRE HOSPITALS TRUST

24

18

2

1

Amber/Green

BRIDGEWATER COMMUNITY HEALTHCARE TRUST

24

22

0

0

Amber/Green

CENTRAL LONDON COMMUNITY HEALTHCARE TRUST

24

22

0

0

Amber/Green

GLOUCESTERSHIRE CARE SERVICES  TRUST

24

18

4

0

Red/Amber

KENT COMMUNITY HEALTH TRUST

24

15

6

0

Amber/Green

LINCOLNSHIRE COMMUNITY HEALTH SERVICES TRUST

24

10

9

0

Red/Amber

STAFFORDSHIRE AND STOKE ON TRENT PARTNERSHIP TRUST

24

24

0

0

Red/Amber

HUMBER FT24

 

2

19

1

Red/Amber

NORTH EAST LONDON FT

24

7

14

1

Amber

NOTTINGHAMSHIRE HEALTHCARE TRUST

24

8

1

0

Red/Amber

OXLEAS FT

24

12

8

1

Red/Amber

SOMERSET PARTNERSHIP FT

24

12

9

2

Red/Amber

SOUTH WEST YORKSHIRE PARTNERSHIP FT

24

4

15

1

Red

SOUTHERN HEALTH FT

24

24

0

0

Green

Community hospitals are typically made up of a small number of wards. Often these wards are used for intermediate or stepdown care, and have patients with a lower level of acuity compared to acute wards.

Central London Community Hospital Trust missed its fill rate for day shifts every month between April 2015 to March 2017.

Chief nurse Charlie Sheldon said: “The safe staffing data only provides an indication as to fill rate and does not take into account the fact that CLCH has set high levels of registered nurse and healthcare support worker to ensure resilience in isolated units. We also have a service which is supported by physio, occupational therapy and rehabilitation assistants, all of which are not captured on this return but pertinent to the rehabilitation setting where patients have less acute nursing requirements.”

At Somerset Partnership Foundation Trust, the day time fill rate went as low as 70-79 per cent twice in the 24 months.

Sue Balcombe, director of nursing and patient safety, said: “In common with many trusts across England, we struggle to recruit enough registered nurses to staff our hospital wards… We know we need to do more to improve staffing levels and we closely monitor the quality and safety of patient care on each of our wards and particularly where we know that we have unfilled shifts. Where we have concerns about the staffing levels on any ward we will take action to protect patients and our staff.

“This includes temporarily closing beds and in some instances taking the difficult decision to temporarily close wards whilst we recruit staff as we recently did with Exmoor Ward at Minehead Hospital.”

Fabian Henderson, NHSI’s head of workforce policy and improvement, said usually trusts set their plans six months in advance, though they can adjust them sooner, so the data should be taken in context of trusts’ activity and acuity of patients in the wards.

The data shows trusts did vary their planned staffing levels each month.

However, Mr Henderson said “the NHS isn’t great about measuring activity in the community” and agreed it needs to support better workforce planning.

“It [the data] is potentially indicative of a national shortage of supply in nursing, which is widely publicised, some of the overfill rates are local responses to make sure those wards are safe, but you can’t shy away from a national shortfall in nursing, which we know is well publicised both in community and acute,” he added.

Crystal Oldman, chief executive of the Queen’s Nursing Institute, said: “[The data] probably reflects the issue of nursing staffing across the whole of the NHS, and across all of health services because we are short of nurses in most areas now. We’ve been warning for a number of years that there is a shortage of staffing in the community and I don’t think there is any reason why that it would be any different in a community hospital.”

She said community hospitals are important for intermediate care and where trusts are understaffed in these wards, this could slow down pathways and reduce flow out of acute wards.

Our analysis also shows the number of trusts that exceeded planned levels of unregistered staff during the day almost doubled in 2016-17 compared to 2015-16.

Mr Henderson said guidance on community safe staffing, to be published by NHSI later this year, will give a “greater nod to the entire workforce” and the use of other roles in the community such as advanced healthcare practitioners, occupational therapists and physiotherapists.