Nurse shortages ‘at the heart’ of missed patient wait targets

Their caution comes after a parliamentary review found key NHS targets are consistently being missed in England. 

”We simply do not have enough nursing staff for patients to get their treatment within the target times”

Donna Kinnair 

In a new report published today, the Commons Public Accounts Committee branded it “unacceptable” that less than half of trusts were delivering elective treatment within the recommended 18 weeks, and only 38% were meeting the 62-day target from urgent referral for suspected cancer to treatment.

The last time the NHS met the targets was February 2016 for elective – or non-urgent – care, and 2013 for cancer.

The picture could get worse as demand for these services continued to grow, it warned. 

Meg hillier mp

Meg hillier mp

Meg Hillier

Patient referrals for elective care had increased by 17% since 2013-14 and the number of patients referred for suspected cancer had almost doubled since 2010-11, the report found.

The report highlighted a “wide variation” in waiting time performance across local areas and hospitals, with poorer scores relating to “bottlenecks” in capacity, including bed shortages.

Hospitals were now routinely operating with a bed occupancy rate of more than 90% in the wake of bed reductions.

“This can affect elective patient care as patients may have their elective care treatment postponed because the beds are needed for emergency admissions, resulting in delays to treatment,” said the report.

“We are concerned that the number of NHS beds has been reduced over recent years but the NHS does not know what the right level of beds is to meet the growing demand for its services,” it added.

“We are concerned that the number of NHS beds has been reduced over recent years”

Commitee report 

The committee criticised a “lack of curiosity” from national bodies responsible for waiting time targets about the impact for patients of longer waits and how often this led to patient harm.

It called on the Department of Health and Social Care together with NHS England and NHS Improvement to introduce a national data collection system on patient harms related to long waits.

NHS England is currently reviewing waiting time standards for a range of services including cancer and elective care.

The committee said this review – along with the NHS Long Term Plan and associated funding increase – presented an opportunity to turn the situation around.

However, it warned that any changes to targets must be made on the basis of improving patient outcomes and experience and not to “water down” current standards.

Meg Hillier, chair of the committee, said NHS England and DHSC must “regain control” of waiting time performance.

“In a high-pressured healthcare environment in which patient numbers are rising and demand is increasing, we were troubled by the department’s and NHS England’s approach to waiting times which seems to be characterised by gaps in understanding of: patient harm, hospital capacity and what is driving demand,” said Ms Hillier.

RCN chief executive and general secretary

Dame Donna Kinnair

Source: Royal College of Nursing

Donna Kinnair

“It is no surprise then that we see such variation of waiting times across local areas and, therefore, why it has proved impossible for local trusts to properly map services and deliver sufficient provision,” she added.

She called on leaders to “steer waiting times standards back on course”.

The committee told NHS England to set out, by December 2019, how, and by when, it will ensure waiting times standards for elective and cancer care will be delivered again.

Health leaders highlighted how shortages in key staff including nurses needed to be addressed if the targets were to be achieved. 

“This report confirms the bleak reality of what we already knew”

Nick Ville

Reacting to the findings, Dame Donna Kinnair, chief executive of the Royal College of Nursing, said: “At the heart of this failure to meet the targets for elective and cancer care is the fact that we simply do not have enough nursing and other clinical staff for patients to get their treatment within the target times.”

She called on ministers and NHS leaders to “focus urgently” on producing a comprehensive and costed strategy for increasing the nursing workforce.

This should include at least £1bn a year to be invested into nurse higher education in order to boost the number of students taking nursing degrees, said Dame Donna.

Nick Ville, director of policy at the NHS Confederation, said: “This report confirms the bleak reality of what we already knew: that the NHS is taking longer to treat patients.

“The skilled and dedicated staff working in front-line NHS services continue to do all they can for patients, but there is only so far they can stretch,” he added.

The report was further proof that a new workforce strategy to address the NHS staffing crisis would be “crucial” to the long-term sustainability of the health service, warned Mr Ville. 

Nigel Edwards

Nigel Edwards

Nigel Edwards

Nigel Edwards, chief executive of Nuffield Trust, said: “I’m afraid I’m not convinced that just issuing new ultimatums to NHS England will resolve these problems.

“It’s all well and good for different parts of government to demand things of each other, but without enough staff and beds the NHS won’t be meeting the old or new targets any time soon,” he added.