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Skill mix reviews risk neglecting quality of care, warns UNISON

Nursing and other skill mix reviews in the NHS are being driven by the need to save money, and may reduce the quality of patient care, says health service union UNISON.

The union, which represents over half of all NHS staff, warns that quality of care is coming a poor second to financial considerations in the skill mix reviews which are taking place in many of Britain’s hospitals. It has issued guidelines intended to advise local union members on how to prevent such exercises harming patient care.

Skill mix reviews are intended to examine the balance between the numbers of qualified and unqualified staff, and between staff in different groups, though the report also cites the definition given by former NHS director of personnel Eric Caines, as a means of ‘redressing the balance between professionally qualified and support staff in favour of the latter’.

UNISON argues that pressure on costs in the internal market is so intense that trusts are looking for any method possible to reduce expenditure.

One trust personnel director is quoted as saying: ‘We won’t flog the pay issue — much more money can be pulled out of skill mix changes.’

The guidelines cite a skill mix review undertaken by North Herts Trust which proposed 58 redundancies among staff caring for the elderly.

As an example of how patient care can be forgotten, the union points to a report by Worthing Priority Care Trust which raises issues of quality only in the last two paragraphs of a 50 page document.

‘If skill mix exercises — which can and should be used only to improve the quality of patient care — are not to degenerate into job cutting and deskilling exercises, staff must be fully involved in negotiating and agreeing schemes,’ said Bob Abberley, UNISON’s head of health.

Skill mix in the health service: UNISON guidelines. UNISON, 1 Mabledon Place, London WC1H 9AJ. 071-388 6609.