NHS staff spending variation

Some hospitals have more nursing staff than others

There are "substantial" variations in the amounts hospital trusts spend on ward staff, an independent watchdog has found.

Even though wards in different hospitals may do virtually the same work, staff costs vary widely according to the Audit Commission.

It also found significant regional variations in its analysis of trusts in England and Wales in 2000.

Many would expect NHS trusts to have similar staffing levels on the wards, but there is actually a good deal of variation

Andrew Foster
Audit Commission

But the commission found no link between spending more on staff and better quality of care for patients.

Trusts in the south west spend more than average on ward staffing, while those in the north and Yorkshire spend less. After adjusting for London weighting, the capital's hospitals spent almost exactly the average.

The commission said factors such as local labour markets and hospital layouts could account for some, but not all, of the difference.

The commission's report said the use of nurses and other ward support staff needed to be managed more effectively and efficiently.

But critics said the report raised more questions than it answered.

Costs

Spending on ward staffing is a trust's largest single budget item.

Trusts that spend more on staffing tend to employ more staff per bed, rather than fewer, more expensive staff.

But, the report said: "Trusts cannot demonstrate a link between the amount spent on ward staffing and the quality of care they deliver.

"Trusts that spend more on ward staffing may deliver better quality care but that cannot be effectively demonstrated within the constraints of the existing data."

The report raises more questions than it answers

Geraldine Cunningham, RCN

Dr Jonathan Boyce, of the Audit Commission, told the BBC: "There is a natural assumption that more staff is better. We looked at some outcomes, such as pressure sores, accident rates and so on, and could find no association between those and the number of staff.

"That doesn't mean to say there is not going to be an association if you had good measures.

"We are looking at it, we can't find good evidence right now, but we hope in the future that can happen."

The commission wants national measures that ward staff performance can be evaluated against.

It says there could also be improvements in the way trusts use existing staff.

More also needs to be known about the impact of specialist nurses employed by trusts who do not work on the wards, the report said.

Andrew Foster, controller of the Audit Commission, said: "It's widely recognised that nurses work hard, but it's only with good management and planning that patients will get the most from their efforts."

'Questions raised'

Alistair Henderson, policy director of the NHS Confederation, told BBC News Online: "The report says there are variations but it doesn't quite say why there are variations [or] what effect those variations might have on quality."

Geraldine Cunningham, co-director of the Royal College of Nursing Leadership Programme, said: "The Audit Commission report raises more questions than it answers.

"What is shown is the lack of measurement and evaluation of patient outcomes in relation to nursing levels.

"We would welcome better evaluation of patient outcomes and skill mix in the interests of quality patient care."

A Department of Health spokesman said: "Differences in ward staffing aren't necessarily a bad thing. There are enormous differences between the needs of patients in different wards.

"Some wards may have people recovering from relatively minor surgery, while other wards may have patients who have greater requirements for nursing care.

"We would expect trusts to match their staffing to patient need."

The government, which has pledged an extra 20,000 nurses and 7,500 consultants by 2004, said staffing levels should be decided locally.