More nurses per hospital bed: what's the catch?

"There's been a two per cent decline in the number of nurses - yes - but an increase in the nurse-to-bed ratio." Health Secretary Jeremy Hunt, House of Commons debate, November 27, 2012

Updated on December 5, 2012

Since the Care Quality Commission warned that 16 per cent of hospitals in England are not meeting the CQC standard for adequate staffing levels, hospital staff numbers are once again a focus of debate in the House of Commons.  

When confronted at his departmental question session in the Commons yesterday, Jeremy Hunt admitted that there has been a "2% decline in the number of nurses". He added that this decline is mitigated by an "increase in the nurse-to-bed ratio" - in other words, the number of nurses per hospital bed.

But does this simply mean there's been an even greater decline in the number of hospital beds? In fact, for the ratio to increase, it can only mean both numer have declined. Let's find out. 

We'll begin by looking at nursing staff numbers.

Last week, the NHS's Health and Social Care Information Centre released it's monthly workforce figures which revealed that nurse numbers have indeed declined by 2% since May 2010.  

The graph belows tracks nurse numbers over the past three years, since before the coalition took power.  

The map above isn't especially useful. But if we zoom in, we're able to look at each month in more detail. Just over three years ago, in September 2009, there were 307,749 nurses. When the coalition won the election in May 2010 there were 310,793 nurses. At the last count in August 2012, the NHS recorded 304,566: this is precisely a two per cent decrease. 

The numbers below represent a snapshot extracted by the NHS Information Centre on September the 30th of each year, beginning with 2001.

We can see that the number of nurses had been growing steadily since 2001, with growth stalling in 2010, although as the other graphs show this trend was far from linear. 

One reader got in touch to point out that the decline in the number of nurses is even more evident if we look at the nurse-to-patient ratio. A study conducted by Kings College found that the overall average across all the hospitals surveyed by Registered Nurse Forecasting (RN4Cast) was 1 nurse for every 8 patients in the daytime, and 1 for every 10.8 patients at nightime. 

Bed numbers and the nurse-to-bed ratio 

Given that we know that nurse staffing levels have declined by 2%, for what Jeremy Hunt said to be true- that the nurse-to-bed ratio has increased, that could only mean the number of hospital beds is also declining. 

Because data on nurse-to-bed ratios isn't publicly available, although there are rumours that it soon will be, we calculated our own ratio based on the number of day beds available. (Source: Department of Health) We chose not to calculate a separate ratio for overnight hospital beds  - though the Department of Health publishes that data  - because there isn't an equivalent national figure. 

Methodology

We divided the number of day beds from Q2 of 2010/11 - which would have been collected at the end of the second quarter in September 2010 - by  the number of nurses (Full Time Equivalent) in September 30 2010, and compared that ratio with the same figures from 2011 and 2012. 

Conclusion

We can draw two main conclusions from this exercise:

First, Jeremy Hunt is right to say the nurse-to-bed ratio has increased. In 2010 we had 2.18 nurse for every day-only hospital bed. In 2012, the ratio grew to 2.24 nurses for every bed. 

Second and final point: the number of hospital beds has declined quite dramatically, from 141,477 in 2010 to, as of August 2012, 135,602 beds.  

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Flickr image courtesy of Palmerston North City Library