Patients being put at risk as NHS substitute nurses for care staff with only a few weeks of training

Patient safety in the NHS could be at risk as nurses are replaced by low-paid staff who start work on hospital wards after just weeks of basic training, experts have warned.

A major new report by the Health Foundation has revealed what it called a “hollowing out” of the NHS workforce with thousands more unregulated and less well-trained care staff being recruited by the NHS, compared to traditional registered nurses.

This is at a time when the NHS is seeing more patients who are increasingly older with complex conditions meaning their care needs require more clinical expertise.

Between March 2018 and March 2019, the NHS saw the biggest annual increase in its overall workforce since 2010.

But while the number of full-time equivalent nurses grew by just 1.5 per cent (4,500 nurses), the number of care support staff, such as healthcare assistants, jumped by 6,500 – a 2.6 per cent rise. The number of doctors increased 2.5 per cent.

Anita Charlesworth, director of research and economics at the Health Foundation, told The Independent the data showed a continuation of a trend seen in recent years.

She said: “If you are going to try a skill mix change of this order of magnitude then you need to run that very carefully if it is not to put quality and safety at risk.

“This is a piecemeal skill mix change which creates undue risk in our system and it needs to be addressed.”

Healthcare assistants can start work in the NHS after initial training of around two weeks and while many go on to develop their skills they are not educated to the same level as nurses who undertake a three year degree.

The report said there were equal numbers of nurses and support staff in 2009-10 but that the mix had now increased by around 10 per cent.

The report said most changes to the skill mix – meaning the ratio of fully qualified to less qualified staff – are implemented well and led by evidence, but added: “It is important that quality and safety are at the forefront of any skill mix change.”

The Health Foundation’s latest study of the NHS workforce also showed hospitals were being forced to recruit staff from across the globe after a fall in recruits from the EU. Increasingly it is looking to non-EU countries such as India and the Philippines.

In 2018-19 there were 1,791 nurses recruited from India and 3,118 from the Philippines.

Dame Donna Kinnair, chief executive of the Royal College of Nursing, said: “The danger to patients is not from the increase in support workers, but the absence of nurses.

“It is unfair on healthcare assistants to ask them to take on work they aren’t trained or paid for in a desperate bid to plug gaps.

“The evidence demonstrates that where more registered nurses are on shift, patient outcomes improve – it is essential that employers use vital support staff to supplement the work of nurses, not replace them.

A 2016 study from the University of Southampton warned that, for every 25 patients, substituting just one qualified nurse for a lower-qualified member of staff was associated with a 21 per cent increase in the odds of dying.

There are around 44,000 nursing vacancies across the NHS and this could reach 100,000 within a decade.

The Tories have promised 50,000 more nurses, with 18,500 of these coming from existing nurses, 12,500 from overseas, 5,000 via nursing apprenticeships and 14,000 through training.

Labour has said it will employ 24,000 more nurses and pledged to introduce safe staffing legislation for the health service.