Public Servant Lifestyle

Nursing ward staff take more sick days than most other public sector workers, according to new figures released in a report by watchdog the Healthcare Commission.

On average, 16.8 days per ward staff member a year are lost to sickness. Across seven other sectors of the public workforce - including police, teachers, social services, civil servants and the prison service - the average is 11.3 days, per employee, a year, substantially lower than that found for the hospital ward workforce.

The figures are based on a major survey covering 135,000 hospital ward staff in 6,000 hospital wards across the UK. The cost of sickness absence nationally for the entire ward staffing workforce is approximately £470 million per year, and if sickness absence could be reduced by 30%, approximately £141 million a year would be saved nationally.

"These high rates of absence among nurses are extremely worrying," says Anna Walker, Chief Executive of the Commission.

Nursing

"Whatever the reasons for them, nurses are far too important for us to ignore this problem. The causes are unclear, but factors such as stress, job satisfaction, workload and the physical nature of the job all may be part of the picture. Nurses are the backbone of the NHS and we need to do more to understand what is happening. We will be pursuing these issues with the Royal College of Nursing and through our assessment processes.”

The report finds, in general, that patients are satisfied with nursing care, though there is markedly higher satisfaction in specialist trusts and lower satisfaction in London trusts. Auditors find that the equipment used by nurses to care for patients is generally clean and in an acceptable condition.

They also find considerable improvement in the amount and quality of data available to measure the quality of care delivered by ward staff, in particular around complaints and outcomes of care. For example, nearly 70% of acute trusts are able to supply data on the incidence of pressure ulcers – up from 35%, in the 2000 review.

“The improvement we have seen in the quality of data is very encouraging and certainly indicates that trusts are both routinely recording and using data on outcomes of care to help understand and improve their own performance. However, trusts, and in particular nurses, should now build on this good work to develop ways of measuring the positive impact of good nursing care,” said Ms Walker.

The data shows, for the first time, a link between patient satisfaction and the use of temporary staff. Patients are less satisfied with the care received, the higher the amount spent on temporary staff. In particular, patients expressed dissatisfaction in the ability of nurses to answer their questions.

Despite high levels of sickness absence, the proportion of budgets spent on bank and agency staff is strongly linked to the level of vacant posts. In 2000, 13.4% of ward staffing expenditure was spent on bank and agency staff, compared to 15% in 2003/2004, and 13.2% for the first quarter 2004/2005. The survey also provides evidence of greater patient satisfaction in trusts employing higher proportions of more skilled and experienced staff, rather than merely employing more staff.

Temporary Staff

“The use of temporary staff across NHS hospital wards remains stubbornly high. Trusts need to focus on recruitment of permanent staff to reduce dependence on temporary staff. While labour market forces are important, we have found considerable variation in vacancy levels between trusts – even those within the same region. Some trusts are better at recruiting and retaining and it is important that good practice in this area is gathered and shared throughout the NHS,” says Ms Walker.

The report is based on information collected directly from 6,000 individual NHS wards during 2004, information from the National In-patient Survey, at the end of 2003, and the NHS staff survey, carried out in 2004. The review of ward staffing was conducted as part of the acute hospital portfolio.The acute hospital portfolio is a collection of reviews of key services, resources or issues that are of national concern and that are important to patients and NHS managers.

The reviews bring together data that is specially collected from trusts and data that is already available to provide a comprehensive picture of performance. Topics reviewed in 2005/2006 are ward staffing, accident and emergency and day surgery.

The Healthcare Commission took over the acute hospital portfolio from the Audit Commission on April 1, 2004 and has continued the programme of work. Trusts have received individual reports from their Audit Commission performance auditors, who continue to deliver the local work on our behalf. The Healthcare Commission does not cover Scotland, as it has its own body, NHS Quality Improvement Scotland. From April 2005, a new body, the HPSS Regulation and Improvement Authority (HPSSRIA), will undertake regular reviews of the quality of services in Northern Ireland.