Nurses Divided Over Improvements In The NHS

Nurses believe the Government is achieving key health targets in certain priority areas according to a MORI Social Research Institute survey for the Royal College of Nursing (RCN). Most nurses working in cancer care believe that patients are now benefiting from improved treatments, reduced waiting times and more specialist nurses. However, in contrast, the wider nursing population is more divided about whether increased investment has led to significant improvements for most other patients.

The survey, thought to be the largest ever poll of nurses on the effects of investment in the NHS, aimed to find out how far nurses believed that increased investment had translated into tangible benefits for patients, how satisfied they were with the running of the health service and what their investment priorities were.

The Government has stressed the importance of involving frontline clinical staff in decisions about where to target investment to deliver maximum improvements for patients. Despite this pledge, the survey showed that the majority of nurses (80%) have little or no involvement in deciding where new investment was spent. Worryingly, this includes two-thirds of the NHS's most senior nurses [see note 1].

The survey found that most nurses (59%) recognise there has been an increase in investment in the NHS with the majority of cancer nurses (88%) believing that there has been significant overall investment in their area of work. In contrast, less than half (47%) of nurses working with older people have seen increased investment in their clinical area.

When asked about specific areas of investment in their own place of work, less than a third of nurses (30%) say that the number of permanent nursing staff has increased, compared to nearly half (47%) who say spending on agency staff had increased. Three-quarters wanted to see an increase in the number of permanent nursing staff and over a third (39%) saw the need to increase the numbers of permanent medical staff.

Half of all nurses agree that patients' experiences in the NHS have improved over the past four years, with reduced waiting times (41%) cited as the top improvement. But when asked about the NHS in the future, opinion was divided, with a third (35%) saying they believe it will get better and a third (31%) saying they think it will get worse. The survey also highlights a clear link between involving nurses in decision-making and improving patients' experiences. Nearly three-quarters (71%) of nurses who had been involved in deciding where new investment should be spent believed that patients experiences had improved, compared to just over half (55%) who haven't been involved in investment decisions.

Other key findings include:

• Cancer nurses in England report significant progress towards meeting the key targets of the Cancer Plan (2000) with 84% seeing more specialist nurses, 86% decreased waiting times from diagnosis to treatment and 77% seeing improvements in ensuring all patients have the same access to new treatments.
• In mental health, nurses have seen progress towards meeting targets for increasing home treatment (58%) and assertive outreach teams (62%). In contrast, nearly two-thirds (64%) have seen little or no progress towards increasing provision of secure beds and increasing the number of specialist mental health nurses (63%).
• In critical care, half of all nurses say they have not seen an increase [see note 2] in the number of critical care beds, despite the NHS Plan pledge of a 30% increase by 2003. Nearly two-thirds (63%) have also seen no increase in the numbers of specialist critical care nurses.
• Nearly two-thirds (62%) of older people's nurses feel that delayed discharge is a serious problem for their Trust, with a third saying that this often leads to so-called 'bed-blocking' [see note 3], which can result in having to cancel operations for other patients.

Notes

1. Grades G, H and I include senior nurse managers and clinical nurse specialists.
2. 43% said the number had stayed the same and 6% said it had decreased.
3. Please note small base of 84.

Technical details

MORI interviewed a representative sample of 1,014 RCN members for the 'main survey' This was supplemented by four 'sub-samples' of specialist nurses including 100 cancer nurses, 103 working with older people, 100 in critical care and 110 in mental health. Interviews for the 'main survey' were conducted across the UK between 10 and 31 March 2004, while fieldwork for the sub-samples was carried out in England between 10 March and 7 April 2004.

Topline Results

• MORI interviewed a representative sample of 1014 RCN members for the 'main survey' and 4 'sub-samples' of specialist nurses, including 100 cancer nurses, 103 working with older people, 100 in critical care and 110 in mental health.
• The sample for the main survey was drawn from the RCN's database of members, while the interviews with the sub-samples were achieved by approaching nurses via hospital switchboards or Primary Care Trusts.
• Fieldwork for the main survey was conducted in the UK between 10 March - 31 March 2004, while fieldwork for the sub-samples was carried out in England only, between 10 March - 7 April 2004.
• For the main survey, quotas were set on country / region to ensure at least 100 respondents were interviewed in Northern Ireland, Scotland and Wales
• Results from the main survey were weighted by country / region to reflect the known profile of RCN members
• For the sub-samples, quotas were set on region and grade, to reflect the profile of nurses generally. Also, quotas were set on type of Trust. Results from the mental health nurses have been weighted to reflect the known profile of mental health nurses (from the DoH 2002 Workforce Census)
• All questions are based on all respondents unless otherwise stated
• Where percentages do not add up to 100, this may be due to multiple responses, computer rounding or exclusion of 'Don't know/not stated' responses.
• An asterisk (*) denotes a value of less than half a per cent, but greater than zero.

Q1 Overall, how satisfied or dissatisfied are you with the running of the National Health Service / HPSS nowadays? Would you say you are...

Q2 And overall, how satisfied or dissatisfied are you with the running of your local ...(in England, Scotland and Wales: Trust)...(in Northern Ireland: Health Board) nowadays? Would you say you are...

Q3 Thinking about the NHS / HPSS over the next few years, do you expect it to...

Q4 Would you say that the amount of investment in the health service in general over the last four years or so has increased, decreased or stayed the same? Would you say a lot or a little?

Q5 Would you say that the amount of investment in your clinical area in the last four years or so has increased, decreased or stayed the same? Would you say a lot or a little? Base: All in sub-sample survey working in specialist areas

Q6 And would you say that the amount of investment in your clinical areas of nursing in the last four years or so has increased, decreased or stayed the same? Would you say a lot or a little? Base: All in main survey not working in one of the specified areas at Q3

Q7 And now taking some specific areas, would you say that the amount of investment in the following areas in your place of work over the last four years or so has increased, decreased or stayed the same? Would you say a lot or a little? Base: All nurses in main survey

Q8 And now taking some specific areas, would you say that the amount of investment in the following areas in your place of work over the last four years or so has increased, decreased or stayed the same? Would you say a lot or a little? Base: All nurses working in cancer from sub-sample survey

Q9 And now taking some specific areas, would you say that the amount of investment in the following areas in your place of work over the last four years or so has increased, decreased or stayed the same? Would you say a lot or a little Base: All nurses working with older people from sub-sample survey

Q10 And now taking some specific areas, would you say that the amount of investment in the following areas in your place of work over the last four years or so has increased, decreased or stayed the same? Would you say a lot or a little? Base: All nurses working in critical care from sub-sample survey

Q11 And now taking some specific areas, would you say that the amount of investment in the following areas in your place of work over the last four years or so has increased, decreased or stayed the same? Would you say a lot or a little? Base: All nurses working in mental health from sub-sample survey

Q12 And of these areas, where, if at all do you believe investment would be best spent?

* Please note that full listings of others are available for the sub-samples in the tables

Q13 How involved, if at all, have you personally been in making decisions about where increased investment has been spent? Would you say a great deal, a fair amount, not very much or not at all? Base: all who say investment in their clinical areas of nursing has increased*

* Please note small bases of less than 100 for the sub-samples -- data less reliable

Q14 And how involved would you personally have liked to have been? Would you say a great deal, a fair amount, not very much or not at all? Base: all who say investment in their clinical areas of nursing has increased

*Please note small bases of less than 100 for the sub-samples -- data less reliable

Q15 To what extent would you agree or disagree that patients' experiences in the NHS / HPSS over the past four years or so have improved? Would you say you...

Q16 What would you say have been the top three improvements, if any, for patients in the NHS / HPSS over the past four years or so?

Nurses working in cancer care

Q17 As you may know, the Cancer Plan of 2000 set key priorities for investment in cancer services. Thinking about your experience of nursing cancer patients in the last four years or so, how much progress would you say has been made towards meeting the following targets, in your view? Would you say a great deal, a fair amount, not very much or no progress at all? Base: All nurses working in cancer from the sub-samples survey (100)

Nurses working in mental health

Q18 The National Service Framework in 1999 and the NHS Plan in 2000 set priorities for improving and expanding mental health services. Thinking about your experience of nursing patients in mental health in the last four years or so, how much progress would you say has been made towards meeting the following targets, in your view? Would you say a great deal, a fair amount, not very much or no progress at all? Base: All nurses working in mental health from the sub-samples survey (110)

Nurses working in critical care

Q19 The NHS Plan in 2000 promised a 30% increase in critical care beds by 2003. As far as you know, has the number of critical care beds increased, decreased or stayed the same in the last four years or so? Would you say a lot or a little? Base: All working in critical care From sub-sample (100)

Q20 And would you say that the number of critical care nurses has increased, decreased or stayed the same in the last four years or so? Would you say a lot or a little? Base: All working in critical care from sub-sample (100)

Nurses working with older people

Q21 How much of a problem, if at all, is delayed discharge for your Trust? Would you say it is Base: All working with older people from sub-sample (104)

The NHS Plan in 2000 promised an increase of 5,000 extra intermediate care beds for the elderly by 2003, to help alleviate the problems of delayed discharge. In January 2004, the Government introduced a system whereby social services have two days to find a place for older patients ready to be discharged, or face a 163100 fine.

Q22 What impact, if any, does delayed discharge have on your practice? Base: All working with older people who think delayed discharge is a problem from sub-sample (84)