London's nursing crisis revealed

The full extent of London's nursing crisis is laid bare today.

An investigation by the Evening Standard has revealed that 10.5 per cent of qualified nursing posts in the capital remain unfilled - almost double the official government figure.

In some hospitals, nearly 20 per cent of posts are empty - putting an unbearable strain on ward managers.

Only one hospital in London boasts a full complement of qualified nursing staff. The rest are forced to rely on temporary - but expensive - agency nurses, less qualified care assistants or even students to plug the gaps.

Today nursing unions urged health chiefs to redouble efforts to make the profession more attractive - warning that the shortfall of skilled staff could have devastating consequences.

Tom Sandford, of the Royal College of Nursing, said: "Hospitals are being forced to rely on agency staff who may have all the qualifications of full-time nurses but who are unfamiliar with the working environment and provide no continuity of care for patients.

"If hospitals can't get agency staff, they close beds. The situation is unsustainable."

The scale of the problem was exposed after the Evening Standard asked all 30 NHS Trusts in London for the percentage of full-time posts for qualified nurses they had vacant.

Qualified nurses, also known as registered nurses, are defined as Grade D and above, and include midwives and health visitors. These are the frontline nurses of the NHS.

According to the Department of Health's most recent figures, the average nurse vacancy rate in the capital is 6.1 per cent - almost double the figure for the rest of the country. But the Standard's investigation suggests that the true figure is far higher - with one trust, Newham Healthcare NHS Trust, with a vacancy rate of 19.7 per cent.

Guy's and St Thomas' - regarded as one of the country's top hospitals and expected to be one of the first to be awarded foundation hospital status - has more than 600 full-time qualified nursing posts vacant, a rate of 18 per cent.

In many cases, the vacancy rate does not reflect a drop in the actual number of nurses, but the creation of dozens of new posts which cannot be filled.

The shortfall has serious implications for patients, since doctors rely on qualified nurses to monitor patients' overall condition and raise the alarm if it deteriorates. Most hospitals fill the gap by employing freelance nurses from agencies.

Mr Sandford said: "Agency nurses are extremely expensive and are often unfamiliar with the working environment. Ward managers have to check their work more, which takes time and is bad for team work. It is also bad for the patient, who is seeing a different nurse every day."

Health Secretary Alan Milburn has ploughed millions of pounds into nurse recruitment, attracting more than 20,000 extra full-time recruits, and about 30,000 part time recruits, since 1997.

While the majority of Trusts have made progress, a quarter of London hospitals have more vacancies now than they did 12 months ago - raising questions about the effectiveness of government efforts to attract more nurses to the capital. Critics say many potential recruits are deterred by the cost of housing and say London weighting, currently £3,228, has failed to keep pace with inflation.

This suggests that while record investment means hospitals can afford to employ more nurses in theory, in practice there are not enough people willing or able to do the job.

Liberal Democrat MP Paul Burstow, the party's London health spokesman, said: "The Government claims to be winning the battle on nurse recruitment. But in senior grades, and particularly in London, there are still huge shortages.

"The high cost of living in London is pricing nurses out of the capital. So patients suffer and nurses are overworked and in danger of burnout."

Evening Standard's findings fit in with a survey carried out by the Royal College of Nursing earlier this year. It looked at 70 hospitals across the UK and found an average vacancy rate of over 8 per cent.

Last month, the union also revealed that almost half of London's trainee nurses have been left to look after patients on their own because of the shortage of qualified staff.

A spokeswoman for the Department of Health said: "Qualified nursing vacancy rates for London are dropping. Many NHS staff are concerned about the high cost of accommodation in London. The NHS Plan has a target of 2,000 additional units of af fordable accommodation in London by July 2003.

"We have also introduced more flexible working to encourage staff to return to work."

James Strachan, chairman of the Audit Commission, said ministers were moving "from one extreme to the other far too quickly and too indiscriminately". He called for an independent review to ensure managers could cope.