Cheap assistants replacing nurses

NATIONAL HEALTH Service trusts are cutting back on experienced nurses and replacing them with half-price healthcare assistants to save money, the Royal College of Nursing (RCN) said yesterday.

The trend to "de-skilling" on hospital wards was putting patients at risk and was a "short-sighted, false economy", Christine Hancock, general secretary of the college, said.

Speaking on the eve of the RCN's annual congress in Harrogate, North Yorkshire, which is expected to draw 2,500 nurses over the week, Ms Hancock said there was evidence that skilled staff nurses earning an average of pounds 20,000 a year were being exchanged for healthcare assistants paid about pounds 9,500 a year. "Hospitals providing a low ratio of registered nurses are not providing patients with adequate care," she said.

Last week, Mid-Staffordshire Hospitals Trust announced that it was considering a proposal to remove all S-grade posts for skilled staff nurses on surgical wards and increase healthcare assistants to help to save pounds 200,000 on the nursing budget.

The Princess Margaret Hospital in Swindon, Wiltshire, which is seeking cuts of pounds 900,000 in its nursing budget, had planned to replace 44 senior staff nurses with healthcare assistants and newly qualified nurses but now aims to make the savings in "a more piecemeal fashion", according to the RCN.

Ms Hancock said that patients ran a higher risk of complications when the number of skilled nurses on a ward was cut. Studies from the United States showed that one extra hour of skilled nursing a day above the average cut the incidence of urinary infections, pneumonia and other complications by up to 10 per cent.

The trend to cut back on skilled staff began among community and school nurses but had now spread to hospital staff. Healthcare assistants could provide comfort but could not bring the understanding to the task necessary to detect when things were going wrong, she said. "Healthcare assistants can be extremely kindly and helpful to people who are very sick. But qualified nurses know what makes them sick and what makes them better and understand the changes that may make them acutely ill."

Estimates of the overall shortage of nurses in the NHS range from 8,500 by the Department of Health to 13,000 by the RCN. A pounds 5m advertising campaign launched last month to encourage qualified nurses among the 140,000 who are not working to return to the NHS has triggered 40,000 requests for information but it is understood few of these have resulted in actual applications.

Yesterday, Frank Dobson, the Secretary of State for Health, announced an extra pounds 5m to help trusts to provide retraining and extra facilities such as creches to attract nurses back to the wards.

A Health Department spokesman said: "Healthcare assistants are a valuable resource and are a flexible way of supporting nurses but they are not there to replace them."

t The future of the St John Ambulance service is under threat after a collapse in the number of people volunteering to work with the organisation.

The first aid charity has lost one-quarter of its adult membership in the past decade, and is launching a recruitment campaign today to reverse the decline after a 7 per cent fall in 1997 to 22,000, the last year for which figures are available.