The RCN has launched a report which reveals there are nearly 20,000 nursing vacancies currently unfilled in England; a ‘hidden workforce crisis’ that could have serious consequences for the NHS.
Figures from Running the Red Light show the scale of the problem of understaffing is far larger than the official numbers – which show the NHS in England has lost only 3,859 full-time nurses, midwives and health visitors since May 2010.
Calling for the report to be a ‘wake-up call’ to the scale of nursing understaffing in the NHS, Dr Peter Carter, Chief Executive & General Secretary of the RCN says: ‘We sit on the verge of a hidden workforce crisis that desperately needs addressing to ensure the NHS runs properly and patients get the care they deserve.’
The report also highlights a 15 per cent cut in the number of nursing student places commissioned since 2010-11, and forecasts a shortage of 47,000 registered nurses by 2016.
The RCN has outlined a list of urgent priorities for achieving safe staffing in NHS services today, and long-term planning to secure a workforce fit for the needs of tomorrow, including mandatory workforce planning and robust systems of review.
Dr Peter Carter, added: ‘Unsafe staffing levels have been implicated in a number of high profile investigations into patient safety – we call on employers in the NHS to put an end to boom and bust workforce planning and develop clear standards to ensure safe staffing levels are met, supported by robust inspection based on reliable data.’
The RCN launched its Frontline First campaign in July of 2010 to monitor the impact of £20 billion of efficiency savings on clinical staff and clinical services.
At the time, the Government claimed that it would be possible to make efficiency savings without cutting frontline staff.
However, the RCN campaign identified NHS trusts earmarking nursing posts to be lost and deliberately holding posts vacant as a fundamental part of the strategy to make these financial savings.
In many trusts the nursing workforce has been cut to the bone.
The Francis Report and subsequent high profile reports including those produced by Professor Don Berwick and Professor Sir Bruce Keogh, have clearly linked nurse staffing levels to patient safety and quality of care.
Concerns about the safety of staffing levels are widespread among the nursing profession, with a majority fearing similar issues of poor care occurring in their own workplace.
Research also suggests that 43 per cent of hospital wards are regularly operating on more than eight patients per nurse, a level which the Safe Staffing Alliance has determined to be definitely unsafe.
Following the publication of these reports and the clear focus on the evidence between patient safety and nurse staffing levels, there are now indications to show trusts are attempting to unfreeze vacancies, increase their nursing establishment and recruit actively, including going overseas.
However, with evidence of England heading towards a serious nursing shortage, trusts are now encountering serious difficulties recruiting to these vacancies.
Official statistics identify 3,859 full time equivalent nursing, midwifery and health visiting posts have been lost since May 2010, an equivalent of 6,468 individuals.
The RCN does not believe this is actually the true extent of the current shortage once other factors are taken in to account.
Vacancy rates are a key indicator that show the distance between the number of staff actually in post and the number needed to ensure patient safety and quality of care.
The Government stopped collecting data on vacancies in 2011 and prior to this, the last available data suggested that the vacancies for nursing posts were 2.5 per cent.
New research from the RCN into this issue, through a freedom of information request of NHS trusts, showed an average six per cent (ranging up to 16 per cent) vacancy rate in nursing posts. Replicated across the NHS this would amount to nearly 20,000 full time equivalent nursing, midwifery and health visiting nursing vacancies, or up to 34,000 individuals.
We also know that a nursing shortage is creating serious difficulties in recruiting to these vacancies.
Evidence gathered by the RCN shows that 22 per cent of trusts are having to recruit from abroad and a further nine per cent are actively considering the possibility of doing so to plug these gaps over the coming year.
Government-commissioned work suggests that the impending crisis in the supply of registered nurses will result in a likely shortage of 47,545 registered nurses by 2016.
The situation as a whole has been compounded by an almost 15 per cent cut in the number of nursing student places commissioned since 2009/2010.
Despite numerous calls to action, there has been little progress so far on the scale required to stem the impending shortage.
With rising demand for health care services, workforce shortages will have serious implications for staffing levels and the ability for providers to deliver safe, good quality care for patients.
Achieving safe nurse staffing levels in NHS services is already a significant challenge for many providers in England, and as the full effects of a crisis in workforce supply begin to be felt, the situation has the potential to deteriorate rapidly.
Urgent action must be taken now to ensure NHS services have the right tools and resources in place to determine safe levels of nursing staff, within a robust national framework that ensures providers meet their obligation to care for patients in a safe environment.
Ensuring the nation has enough nurses to meet these requirements in the future will require serious investment, not only in a new generation of nursing students, but also in those staff already in the service, who will continue to form the bulk of the workforce for many years to come.
Over the last year, the Francis, Keogh and Berwick reports have all made a number of practical recommendations on safe staffing levels.
The RCN is now calling for action to match the rhetoric, with five urgent priorities for achieving safe staffing in NHS services today, and long-term planning to secure a workforce fit for the needs of tomorrow:
1. A mandatory legislated requirement for safe staffing
There should be a mandatory legislated requirement for health care providers and commissioners to ensure staffing levels and skill mix never fall below levels determined to be safe.
Determining safe staffing must take place within national frameworks of evidence based, best practice standards and guidance, developed in conjunction with leading nurses, academics and institutions.
This must include flexibility that enables nurses to exercise professional judgement in adjusting local staffing in response to changing patient needs.
This should be inspected against by national health care regulators.
2. The mandatory use of validated workforce planning tools
Safe staffing should be determined through the mandatory use of evidence-based, nationally-validated workforce planning tools.
Tools should be developed and validated through extensive consultation, co-ordinated by an organisation such as the National Institute for Health and Care.
3. Robust systems of review, supported by reliable workforce data
Safe staffing levels should be supported by workforce reviews and robust inspection regimes with the findings presented at board level on a monthly basis.
This should be based on reliable, relevant, transparent and publicly available workforce and care quality data.
Provider boards must be responsible and accountable for assuring the safety of staffing levels through the monitoring of a range of indicators.
4. An end to boom and bust nursing workforce planning
There must be national, long-term and consistent co-ordination of workforce planning that is closely aligned to service planning and balanced with the needs of regional and local providers.
Health Education England (HEE) must take urgent action to address an impending nursing shortage and ensure that the necessary investment in the nursing workforce takes place in order to secure the right number of nurses with the right skills to meet current and future health care demands.
5. Investment in the current nursing workforce
The Government and employers must ensure that the necessary investment in the education and working conditions of the current nursing workforce takes place, both to ensure the skills of all nurses reflect the changing health care environment, and ensure the health service retains the staff it urgently needs to meet coming health care challenges.