Massive, hidden gulf in NHS nurse numbers

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.


  1. This is certainly a problem. But there’s another one – it doesn’t even save money. When will the government get into it’s head that good care is cheap care ie if you drive the NHS on safety and quality not only do you get good care which the public wants and deserves but it’s cheaper in the end. The most efficient way to run a hospital (or any other health care set-up) is to employ sufficient, well trained, suitably graded professional and other staff – and give them the facilities and equipment to do the job. As you say, since there’s very good evidence for this approach, either HMG are corporately thick or …….

    1. I agree. My mother has been in and out of hospital all her life and has been pleased with the service and attention she has received. Last year she had another operation (a hip replacement). She felt as though she was on a conveyor belt and had to complain twice about her treatment. I suspect the reason was due a new target driven system . Even when she was in tears and being sick, she was still expected to complete the next step in her recovery plan.

  2. Reblogged this on Vox Political and commented:
    Long comment from one of my readers follows. It is pertinent to this, though:
    “I used to be a nurse for many years. I trained under the old system before Project 2000. I’ve never worked as hard, been so tired or enjoyed a job more in my life. After training I went on permanent night duty in a busy A&E department in a smallish hospital. It was a great, friendly place to work and because during the night there were always fewer staff on duty we all supported and relied on each other. We would often have crazy busy nights when it got to around 5am before anyone got chance to sit down with a brew. We gave our all for our patients because that was why we were there and this fact alone was for me the reason why I got so much job satisfaction, despite the crap wages.
    “Then along came Thatcher and her divide and rule ‘quasi-market’ ideology for the NHS. Suddenly we were not all one hospital any more but an NHS Trust divided into Directorates. Staffing levels started to drop. We were instructed to order cheaper equipment such as substandard paper gowns with no sleeves in and nothing to tie them together at the back so patients felt exposed and embarrassed wearing them or the cheaper intravenous drip tubes made by some company connected with Tory MP John Gummer that somehow never worked properly…cheaper dressings, cheaper everything.
    “Each Directorate had its own nursing budget and the responsibility for this was devolved down to chief Nursing Officers (NOs). This had some perverse consequences such as the NO of the Medical Directorate who was responsible for the cardiac arrest team telling the NO of the Surgical Directorate she’d reached her monthly quota for call outs of the team so any further use of this service would have to come out of the surgical budget…a huge row broke out. Nurse was set against nurse and morale began to suffer.
    “I have no idea what its like to work in the NHS now but what I do know from recent experience as a patient is that wards are chronically understaffed. Despite this I received excellent care from nurses and doctors alike. They saved my life. This nurse baiting is a typical Tory tactic not unlike their attack on benefit recipients. Its lazy and dishonest politics, its unfair and its ugly.”

    1. Marketisation, general management, directorates, purchasers and providers, Trusts, bidding, “choice” ….. what’s been the point of it all?

  3. Yes well I don’t think we are very amazed by this but it’s nice to see it demonstrated. I would re-iterate my points in the second comment down from the top – but point out that none of the many, many reorganisations, centralisations, reports, quangos etc etc over the last 20 years have ever addressed it (strange when you think of it – what could be simpler or more obvious!)

  4. Could you provide proof of the existence of these reports you’ve received? You do quote them, but all I have to go on is your own written words and not much else.

    1. All of the freedom of information requests are online at whatdotheyknow.com and can be found by searching on the name of any individual English acute trust.

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