Last year, I highlighted some ‘corporate doublespeak’ on the part of a Chief Executive of an NHS Trust to the Health Select Committee of MPs. When asked about nurse numbers, Philippa Slinger, the CEO of Heatherwood and Wexham Trust, told MPs:
I have recruited 350 staff in the last year, including qualified nurses and midwives.
Suspicious that this phrasing might cover a multitude of sins, I submitted a Freedom of Information (FOI) Act request to the hospital asking for details – both of the breakdown of the new recruitments and of unfilled positions at the Trust relative to its ‘funded establishment’ (the total number of positions it should be filling).
The answer showed how misleading the CEO’s statement was:
New nurses recruited (whole-time equivalent of WTE): 90.65
WTE nurse positions not filled: 206.57
Last month, with the aid of a couple of wonderful accomplices, I put in similar FOI requests to every one of the just over 140 acute hospitals in England. So far, just under half – 67 – have provided information (some have refused and a large number have not yet responded).
The response is staggering.
Among 67 hospitals, an incredible 9,283 nursing positions were unfilled at the time of response. There is some argument for concluding that the average among the hospitals that have not yet responded may be even higher, as those hospitals might be slower to admit their shortfalls.
However, even just assuming that the rate among those hospitals that have not responded yet is exactly the same as among those who have, this means that the total of unfilled nurse posts is:
a total that dwarfs the 7,000+ nursing posts eliminated under this government.
What is this telling us?
Not every hospital differentiated in its responses between qualified staff nurses and healthcare assistants (HCAs). However, among those who did, the almost unvarying pattern was of far higher numbers of nurse posts being unfilled than of HCA posts. This suggests that hospitals are retaining (and in many cases probably increasing) the number of unqualified, lower-paid HCAs and choosing not to recruit qualified nurses.
This fits entirely with information that has come to light about hospitals changing the usual 60/40 nurse to HCA ratio to a 40/60 ratio in order to cut costs.
But these new figures indicate that in order to make ends meet hospitals are not only ‘de-skilling’ their staffing mix but choosing not to fill many positions of both types at all.
In his report into care failings at Stafford hospital, Robert Francis emphatically concluded that, in the 3 areas of the hospital where poor care did exist, the overwhelming cause was understaffing. This element of his conclusions has been completely and willfully ignored by Health Secretary Jeremy Hunt.
Now we know why. The pressure that Hunt and his party have applied to funds in hospitals all across England and Wales is leading not only to overt cuts in nurse numbers, but to a massive gulf in numbers that is being kept hidden by NHS Trust executives and the government.
It is common, intuitive sense that cutting nurse numbers must affect the quality of care that hospitals can provide to patients. Since the Francis report was published, this has become even more apparent.
But all we hear from the government is that nurses ‘lack compassion’ and need to be trained how to care about people (as if you can ever ‘train’ compassion), and not a word of admission that Francis was right.
The 3 main causes of poor care in the NHS are understaffing, understaffing and understaffing. That the government is not only ignoring it but forcing hospitals to operate on such drastically inadequate frontline numbers makes one conclusion all but inescapable:
The government is setting hospitals up to fail.
Ask yourself why that might be.