Hospitals’ cost-cutting workforce plan will remove caring arts from nursing

Calderdale and Huddersfield hospitals Trust’s Workforce plan shows a 479 reduction in Whole Time Equivalent staff over next 10 years – a key part of its drive to make massive spending cuts in line with harsh financial controls imposed through the West Yorkshire and Harrogate Sustainability and Transformation Plan.

One of the ways CHFT is going to make do with 479 less staff than at present is “new professional roles” – like Physician Associates and new less-qualified nursing assistants.

Another is:

job evaluation to ensure clinical staff are practicising to the full extent of their education and training and not doing jobs that could effectively be done by someone else.” (Full Business Case, p 9)

At least 136 Whole Time Equivalent jobs are due to go through Job Evaluation,  although there are likely to be more. The 136 figure comes from the Full Business Case table of “Change in Whole time Equivalent Headcount”, which is for only years 3-10 and does not include figures for Years 1-2.  These were sent separately to NHS Improvement. The Full Business Case notes that WTE job losses in the workforce plan for the first two years are double the number for years 3-10. (Full Business Case, p77)

A Calderdale nurse said,

“It sounds like everyone will be frightened for their job, needing to look important at all times and applying for their own job, if not their own job on a reduced grade.

This is already happening. Often specialist nurses are on band 5& 6 grades. Historically, specialist nurses like Macmillan nurses, pain specialist nurses or diabetic specialist nurses were at least a band 7 – most often band 8 (the old junior/ senior sister level).

These same jobs are now sometimes advertised on a band 5 or a band 6 which is entry level staff nurse or Senior staff nurse level. But these specialist roles involve independent work, advising a range of other professionals, lots of education and big case loads requiring lots of knowledge.

On a band 5 you wouldn’t get interest from more experienced staff for that pay, so inexperienced nurses take the roles.

The palliative care nurse at work seemed worried at our last meeting, she said they were being asked to ensure their duties were appropriate to grade so she had to be doing more education and more delegation. We have been here a few times if you ask around – lots of managers in the community needed to reapply for jobs.

They will chop roles, reinvent a reduced number of new ones so 5 senior positions become 2 or 3 new positions and then they all have to apply for the remaining few jobs. All makes for unhappy staff.”

Downgrading the profession

The entire definition of nursing has been called into question in a recent court case about who should fund the qualified nurses in Care homes and in the continuing care budget; it appears that the “NHS” bean counters disingenuously argued that they don’t need to fund the entire nurse pay if that nurse is doing “personal care.”

This could be incredibly important for nursing and fuel the establishment’s current agenda of downgrading the profession. If they can redefine what is a nursing need, they not only avoid the expense of many nursing home and hospital beds but take away the entire art of care side of nursing, leaving it as a clinical task orientated entity.

Calderdale and Huddersfield NHS Foundation Trust is desperately short of nurses and as a result has a lot of agency staff, which cost  £20m in 2016/17.

Cutting this cost is one of the reasons why the Trust plans to scrap the two District General Hospitals in Halifax and Huddersfield and replace them with one acute and emergency hospital in Halifax and one small planned care clinic with outpatients and urgent care centre in Huddersfield.

The Full Business Case says that without “a major injection of permanent staffing and financial resources beyond that which is known to be available from government,” this is the only way for CHFT to meet national clinical standards for staffing and buildings.

Government must increase number of nurses and bring in safe staffing laws

Janet Davies, Royal College of Nursing Chief Executive, has a better solution. Rather than cutting hospital facilities and NHS services, she recently called on the Government to increase the number of nurses as the shortage of nursing staff is putting patients at risk.

Data analysis by the Royal College of Nursing shows that 90% of England’s largest NHS Hospitals are short of Nursing staff and supplementing them with unregistered staff.

Janet Davies said,

“These startling figures show that, despite the Government’s rhetoric, our largest hospitals still do not have enough nurses and that is putting patients at risk.

“In light of this, the Government must redouble its efforts to train and recruit more qualified nurses and stop haemorrhaging the experienced ones who are fed up, undervalued and burning out fast.”

Janet Davies went on to add it is unreasonable to expect unregistered staff to fill staffing gaps.

“It is unfair on the healthcare assistants too – they should not be left in a situation they have not been trained to handle.
“Nurses have degrees and expert training and, to be blunt, the evidence shows patients stand a better chance of survival and recovery when there are more of them on the ward.”

The Royal College of Nursing has, once again, reiterated the need for safe staffing legislation to be brought into force in England – who have fallen behind both Scotland and Wales.

Recent research has found increased rates of patients deaths in hospital following common surgical procedures, on wards with low numbers of registered nurses – where, as a result there is also a higher incidence of necessary but missed nursing care. A report in the International Journal of Nursing Studies (http://dx.doi.org/10.1016/j.ijnurstu.2017.08.004) concluded that analyses of data from the RN4CAST study (2009–2011) supported the hypothesis that missed nursing care is the reason why there is an increased risk of patient mortality on wards with low numbers of registered nurses.

A key assumption in the CHFT workforce plan (Full Business Case p76) is that all wards will have minimum nurse to patient ratios of 1:8 daytime and 1:10 night, with the exceptions of ITU; Level 2 = 1:2, Level 3 = 1:1 and Paediatric wards 1:4.

However, it does not say if these are all registered nurses or not.

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