• A third of community hospitals have consistently missed their safe staffing plans for three years
  • NHS Improvement analysis suggests standalone community trusts meet their staffing plans more often than integrated trusts
  • Lord Carter has said that integrated trusts are more efficient

One third of community hospitals missed their safe staffing plans every month for at least three years, HSJ analysis suggests.

Data published by NHS Improvement for 55 trusts with community hospital inpatient wards shows 17 did not meet their planned level of registered nurses for day shifts throughout April 2015 to May 2018.

Meanwhile, analysis by NHSI, included in the data, also suggested combined acute and community trusts were less likely to meet their planned staffing levels than standalone community providers, or combined mental health and community trusts. Standalone community providers had the highest fill rates over the last year (see graph below).

National leaders have previously suggested support for integrated trusts, saying they are more efficient.

Trusts meet their staffing plans for registered nurses if they record a 100 per cent fill rate.

According to the data, Mid Yorkshire Trust consistently missed its plans by more than 10 percentage points over the three years, while Derbyshire Community Health Services Trust met its plans in every month bar one. 

However, trusts set their own plans, so those with easier to meet plans may wrongly appear to have safer staffing levels.

Trusts which have failed to achieve 100 per cent fill rates for three years

Organisation Name Number of months fill rate between 90-99% Number of months fill rate between 80-89%
MID YORKSHIRE HOSPITALS TRUST 2 21
EAST LANCASHIRE HOSPITALS TRUST 0 15
SOMERSET PARTNERSHIP FOUNDATION TRUST 23 10
BUCKINGHAMSHIRE HEALTHCARE TRUST 24 8
DERBY HOSPITALS FOUNDATION TRUST 22 8
SOUTHERN HEALTH FOUNDATION TRUST 32 4
NOTTINGHAMSHIRE HEALTHCARE TRUST 7 18
CENTRAL LONDON COMMUNITY HEALTHCARE TRUST 21 1
STAFFORDSHIRE AND STOKE ON TRENT PARTNERSHIP TRUST 37 0
NORTH EAST LONDON FOUNDATION TRUST 35 0
SOUTH TEES HOSPITALS FOUNDATION TRUST 10 18
NORTHUMBRIA HEALTHCARE FOUNDATION TRUST 13 17
YORK TEACHING HOSPITAL FOUNDATION TRUST 8 11
COUNTESS OF CHESTER HOSPITAL FOUNDATION TRUST 35 0
THE ROYAL WOLVERHAMPTON TRUST 16 14
THE NEWCASTLE UPON TYNE HOSPITALS FOUNDATION TRUST 10 10
UNIVERSITY HOSPITALS BRISTOL FOUNDATION TRUST 8 8
NORTHAMPTONSHIRE HEALTHCARE FOUNDATION TRUST 30 4

HSJ approached the trusts listed for comment and a number highlighted that NHSI’s figures do not account for acuity, dependency or bed occupancy and should not be taken in “isolation”.

The figures showed that where trusts consistently missed their plans for registered nurses they often exceeded plans for unregistered staff, such as healthcare assistants. One in five trusts exceeded their planned levels of unregistered staff from April 2015 to May 2018.

Not all community providers have inpatient wards. There was no data available for a number of trusts which have them.

Matthew Winn, chief executive of Cambridgeshire Community Services Trust and chair of NHS confederation and NHS provider’s Community Network, said safe staffing plans for community inpatient wards should be looked at “through a multi-disciplinary perspective”.

This is because for some types of community ward, it may be more appropriate for patients to have a range of different healthcare workers to meet their needs, he said.

According to NHSI’s data, integrated acute and community providers had significantly lower fill rates for registered nurses during the day, on average, compared to standalone community trusts and integrated mental health and community providers.

Of the trusts that had full data, 11 out of 24 acute and community trusts missed their targets for three years or more, compared to two out of 13 standalone and five out of 18 mental health and community trusts.

Earlier this year, Lord Carter, who conducted a review of efficiency and productivity in community services, said that integrated trusts are more efficient.

Average fill rate for different types of trust

Graph based on data published by NHSI. The sharp dip in fill rates for mental health and community providers in August 2016 is unexplained.

A spokesman from NHSI said community hospitals’ safe staffing levels should be decided by trust clinicians or managers, using their “professional judgement” and safe staffing tools, which means there will be times where trusts missed their own targets.

However, the regulator said it had published guidance which included escalation processes that trusts should follow when they do not meet their target, to assure themselves staffing levels are appropriate for patient acuity and dependency.

He added: “That said, we are aware of the challenge some trusts face to deliver safe staffing levels and are working hard to provide the support trusts need to ensure these standards are met.”

Download NHS Improvement’s data and HSJ’s analysis below. Trusts without full or the majority of monthly data submitted have been removed from HSJ’s analysis.