Almost every hospital in England has fewer nurses on duty than each believes are needed to guarantee safe patient care, research shows.
Analysis of official data by the Health Service Journal (HSJ) found that 96% of NHS hospital trusts in England had fewer nurses covering day shifts in October than they had planned and 85% did not have the desired number working at night.
The disclosure of such widespread failure to ensure hospitals are properly staffed has prompted fresh concern that a chronic lack of nurses and the NHS’s dire finances are putting patient safety at risk.
Nurse shortages have led to patients having to wait for medication, going unwashed or not having observations done on time, the HSJ said.
Janet Davies, the chief executive of the Royal College of Nursing, said: “This is yet more evidence that there are too few nurses caring for patients, putting people at serious risk. Safe staffing levels aren’t an optional extra. Having the right number of nurses is essential to ensure that patients can recover properly.”
The college estimates there are as many as 24,000 vacancies for nurses across the UK.
Nurses told the HSJ that understaffing meant hospitals were already providing substandard care, leading to patient safety “near misses”.
The figures are the worst hospitals have recorded since they were obliged to start publishing details of staffing levels in 2013, in the wake of a report on the Mid Staffordshire care scandal.
The number of trusts that do not have planned numbers of staff at work has gone up despite the recruitment of record numbers of nurses by acute hospitals. Limits introduced in 2015 on the amount hospitals can pay to hire agency nurses may help explain why staffing levels are dropping in many places.
One nurse said: “Sometimes observations get missed and I can recall many times where the patient is found to be deteriorating when they are eventually done. This gives you immense stress as you are left with the realisation you did not pick up on your patient’s condition early enough to prevent an acute episode.”
Another said: “I have seen patients not have proper care, dressings not changed, [and] not given the choice of shower or a wash as it takes more time that we do not have.”
HSJ reached its conclusions by examining data on nurse staffing levels that trusts release through the NHS Choices website. These include the numbers present in general medical wards, maternity units, surgical wards and intensive care units at 214 acute hospitals.
In hospitals in England, a nurse is meant to look after no more than eight medical patients, and the ratio can be as low as one to one in neonatal and intensive care units.
The figures show that Dewsbury and district hospital in West Yorkshire had 75% of the number of nurses it had planned to have on duty last October, down from the 87% it managed in the first three months of 2015.
Princess Alexandra hospital in Harlow, Essex, which went into special measures that month, covered 77% of shifts, as did Pontefract general infirmary in West Yorkshire.
The HSJ found that some trusts were employing unusually high numbers of healthcare assistants. That may suggest they are replacing nurses with cheaper personnel who have little clinical training.
Prof Peter Griffiths, of Southampton University, a member of NHS Improvement’s safe staffing committee for acute wards, said: “This is clearly not a good place for the NHS to be and it isn’t getting any better.” He said healthcare assistants could help plug gaps but relying on them to deputise for nurses in the long term risked compromising patient safety and involved “the risk of a false reassurance”.
The shadow health secretary, Jonathan Ashworth, said: “Tired, overworked nurses cannot be expected to continue providing the quality of care which patients need. The government needs to do much more to make sure nursing remains an attractive profession and to ensure hospitals can get in place the number of nurses they need to keep patients safe.”
A Department of Health spokesman said: “We expect all parts of the NHS to make sure they have the right staff in the right place at the right time to provide safe care. That’s why there are already almost 26,000 extra clinical staff, including almost 11,400 additional doctors and over 11,200 additional nurses on our wards since May 2010.”
