NHS staff shortages are compromising patient care

New report from the Royal College of Nursing calls for urgent review of Nurse staffing levels to ensure patient safety this winter. 

Image source: http://www.rcn.org.uk

The Royal College of Nursing (RCN) has today published a report, Safe and Effective Staffing: Nursing Against the Odds which shows the results of a recent staff survey. The survey, carried out in May 2017  reveals more than half (55%) say shifts did not have the level of nurses planned, and that shortages were compromising patient care (53% ).

Nursing staff in all four UK countries were asked about staffing levels on their most recent shift and the quality of care provided. More than a third (36%) report having to leave elements of patient care undone due to a lack of time, while two thirds (65%) work an unpaid extra hour on average.

Seven in 10 nurses (71%) in England said their last daytime shift exceeded NICE guidelines, which states that more than eight patients to one nurse should act as a ‘red flag’. A quarter (26%) reported shifts with 14 or more patients per nurse.

The respondents also reported that:

  • patients are no longer afforded enough dignity, even dying alone;
  • colleagues have burned out and have become sick themselves, unable to come to work;
  • staff leave work “sobbing” at the impact of shortages on patient care;
  • many question their future in nursing and contemplate leaving the profession;
  • they struggle to give their children and families enough support after shifts that can exceed 12 hours.

Full report: Safe and Effective Staffing: Nursing Against the Odds

Royal College of Nursing: Urgent action needed to tackle staffing crisis



Number of NHS beds more than halved over the past 30 years

The number of NHS beds has fallen by half in 30 years, and plans for further cutbacks are “unrealistic” | The Kings Fund


A study from The Kings Fund has found that bed numbers – including general and acute, mental illness, learning disability, maternity and day-only beds –  have dropped from 299,000 to 142,000 since 1987.  Hospitals in England now have the least number of beds for their population compared with any other country in the European Union, with just 2.3 per 1,000 people.

The report explains that this decline is in part due to factors such as an increase in care being delivered outside hospitals. It also highlights the impact of medical innovation including an increase in day-case surgery, which has also had an impact by reducing the time that many patients spend in hospital.

The report however warns that there are signs of a growing shortage of beds. In 2016/17, overnight general and acute bed occupancy averaged 90.3 per cent, and regularly exceeded 95 per cent in winter, well above the level many consider safe. The authors state that in this context, proposals put forward in some sustainability and transformation plans to deliver significant reductions in the number of beds are unrealistic.

Full report: NHS hospital bed numbers: past, present, future

A systems approach to health and care design

A more holistic or ‘joined-up’  systems approach to health and social care provision could help  transform the way these essential services are delivered and address the needs of a changing patient population | Royal College of Physicians

The Royal Academy of Engineering, the Academy of Medical Sciences and the Royal College of Physicians have published Engineering better care: a systems approach to health and care design and continuous improvement.

Image source: http://www.raeng.org.uk

This report explores how an engineering approach could be applied in health and social care to develop systems that meet the needs of patients, carers and NHS staff.  It presents a framework to support ongoing work in service design and improvement in health and care.  It found that more widespread application of a rigorous systems approach to health and care improvement, has the potential to have a transformative effect on health and care.

Full document: Engineering better care: a systems approach to health and care design and continuous improvement.


Standards for general practice nurses

General Practice Nurse Standards: voluntary standards for education and practice | The Queen’s Nursing Institute 

The Queen’s Nursing Institute has launched General Practice Nurse Standards: voluntary standards for education and practice.  The standards have been designed to reflect the requirements of this role, working in new models of care and to reflect the rapid changes in the primary care environment.

Download: QNI/QNIS GPN Voluntary Standards Project Information

New care models: harnessing technology

New care models: harnessing technology | NHS Confederation


This report explores how five vanguards are implementing innovative digital technology solutions. It suggests that the starting point for the introduction of any new technology should always be from the perspective of the end user and that end-users should always be involved in the co-production of technological solutions.

Full report: New care models: harnessing technology

Additional link: NHS Confederation press release

STPs and accountable care

Supporting providers: STPs and accountable care | NHS Providers

NHS Providers are working to develop a programme of support that helps provider organisations adapt to the challenges and opportunities presented by the move to accountable care.

The programme, Supporting Providers: STPs and accountable care, will be developed in close collaboration with NHS trusts over the next six weeks. The programme aims to ensure there is the right support and a strong advocate making the case for NHS trusts as they move to accountable care structures that deliver more integrated care for the public.

Elements to support trusts will include:

  • Developing new and effective relationships with local authorities, primary care and commissioners
  • Responding to specific challenges such as moving care closer to home, prioritising mental health, workforce strategy and getting the most out of the NHS estate
  • Exploring new ways to support change, identifying “enablers” including new approaches to contracting, different financial flows, adopting risk stratification and whole population health management approaches, and developing STP level governance arrangements.

More detail at NHS Providers

Person-centred care

This report provides a snapshot of the extent of person-centred care, based on how people report their experience of treatment, care and support.  The report concludes there is a need for person-centred care to be given greater priority and a need for a strategic overhaul of what is measured.

Key findings:

  • Person-centred care is inadequately measured
  • A mixed picture: people’s experiences can be highly variable
  • Some aspects of person-centred care have improved
  • Progress towards involvement in decisions and being in control
  • Steady progress is now deteriorating, both for general practice and inpatient care
  • Little evidence of personalised care and support planning
  • Coordination of care is not measured
  • Family involvement is not central, and most carers need better support

Full report: Person-centred care in 2017: Evidence from service users