Safe staffing levels have seen no improvement over the past year, despite government claims of increased nursing numbers, according to a survey of more than 5,000 nursing staff from across the UK published today (Tuesday) by UNISON.
The annual UNISON study – which was carried out on Tuesday 10 February – shows a typical day in the NHS. It paints a worrying picture of an overstretched and demoralised workforce, with almost half of those surveyed (45 per cent) revealing inadequate staff numbers to deliver safe, dignified and compassionate care. This is despite 70 per cent working through their breaks on that day to make up for the lack of staff.
Nearly half who responded (49 per cent) thought that staffing levels had got worse since May 2010.
Nearly two-thirds (65 per cent) reported that patients missed out on care due to understaffing, while around half (49 per cent) reported not having enough time with each patient.
Research* has shown that one registered nurse to eight patients, excluding the nurse in charge, is the level at which harm starts to occur to patient care. However, a staggering 42 per cent of nurses responding admitted they were caring for eight or more patients, and this jumped to 55 per cent for those working night shifts.
The survey report, Red Alert – Unsafe Staffing Levels Rising, comes almost a year after guidance from the National Institute of Clinical Excellence (NICE) concerning safe staffing levels in acute settings** in England was announced. The government-commissioned guidance followed recommendations made by the Francis, Keogh and Berwick reports.
More than six in ten (61 per cent) of respondents to the UNISON survey who work on an adult inpatient ward in an acute hospital in England felt that the NICE guidance had not made a noticeable difference, and had not led to improved staff levels in their organisation. Almost a third (31 per cent) described the organisation they were working for on the day of the survey as being at risk of a serious care failing.
UNISON has branded the guidance a missed opportunity, because it stops short of calling for a national mandatory staffing minimum – despite recognising the link between caring for more than eight patients and increased risk to patients.
The survey also reveals that when ‘red-flag’ events are occurring as a result of staff shortages – which should result in extra nurses being made available for that ward – action is not always taken. UNISON is calling for the NICE guidance to be amended so that caring for eight patients or more is automatically classed as a ‘red-flag’ event.
UNISON head of health Christina McAnea said: “UNISON has carried out this survey for the past four years and it is deeply worrying that little has changed. Staff are still not able to see all their patients – despite working through their breaks and doing lots of unpaid overtime.
“Demands on the NHS are at an all-time high, but despite the government’s promise, the NHS is operating in a financial straightjacket. With not enough money to fund adequate staffing levels, nurses and midwives are running themselves into the ground as they struggle to keep the health service going.
“With the NHS possibly the most significant issue as the election approaches, voters should think carefully about what another five years of a Conservative-led government might mean.
“It is clear that nurses and midwives have no confidence in the existing guidance on safe staffing levels. It is failing both patients and staff because it doesn’t meet either of their needs. That is why we desperately need nationally set mandatory minimum nurse-to-patient ratios based on patient needs.
“Nurses and midwives should not have to ration their time and make the difficult choice as to which patients receive care and which ones miss out. It is unfair to put staff in this position and it jeopardises patient safety.”
Key findings of the survey include:
88 per cent support national mandatory minimum nurse-to-patient ratios
45 per cent felt there were not adequate staff numbers to deliver safe and dignified care
70 per cent were unable to take all or some of their breaks that day
49 per cent said staffing levels had got worse since May 2010
65 per cent reported care was left undone due to understaffing
49 per cent reported not having an adequate amount of time with each patient
42 per cent were caring for eight or more patients
55 per cent working on night shift were caring for eight or more patients.
46 per cent said they wanted the next government to prioritise ensuring safe staffing levels
37 per cent worked over their contracted hours
75 per cent worked up to an hour of additional time, but only 8 per cent were paid for working overtime.
Some comments included in the report were:
“The government should put patient care before money. It is as though the system is using a ‘pay day loan’ attitude which is more expensive in the long run.”
“I could not offer adequate food or fluids due to workload. I did not have time to explain what was happening to the patient. I had no time to explain their diagnosis or treatment.”
“I was unable to give pain relief immediately as it is a controlled drug and two nurses are rarely available to check drugs for long periods of time.”
“If just one patient had a crisis of any kind, the other patients would have gone without care.”
“Those in post are stressed and exhausted, there is a high sickness rate and resignations.”
“Staff felt very stressed and many could not take a break. Agency staff have begun to cancel their future shifts as they don’t want to work in such a stressful environment.”
Notes to editors:
The report, Red Alert, is available here
* http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62631-8/abstract
** Acute refers to short-term treatment, usually in a hospital, for patients with an acute illness or recovering from injury.
The survey was carried out on 10 February 2015 and received 5,100 responses from staff performing different roles from across the nursing family. The survey had responses from every UNISON region, and across all shift and workplace types.
The areas of care in which respondents worked on 10 February covered the whole spectrum of healthcare. This included A&E, paediatrics, elderly care, community mental health, critical care, general practice, learning disabilities, medical, mental health (inpatients as well as secure unit) obstetrics and gynaecology, surgical, rehabilitation and theatre.
UNISON has shared this information with the Care Quality Commission. It has also highlighted the organisations that were highlighted as failing in both this year’s and last year’s survey.
UNISON press office contacts: Fatima Ayad M: 07508 080383 E: f.ayad@unison.co.uk
Liz Chinchen M: 07778 158 175 E: l.chinchen@unison.co.uk